How is a Tip Deprojected? And What Happens to the Nostrils?

Great question. There are a few ways the nasal tip can be deprojected, and the chosen method will depend on the individual circumstances of the patient. Cartilage does not always have to be removed, but may be repositioned or altered instead.  If the lower lateral cartilages are too long, they may be shortened and this will deproject the nasal tip. In some cases, the ligaments between the nasal septum and tip cartilage may be released to deproject the nose. Another common method is to perform a medial and/or lateral crural overlay. The overlay technique rotates (lifts upward) and deprojects (brings the nose closer to the face) the nose. In the event that the nostrils are receding, a composite graft may be used to bring them down, and an alar base reduction can correct nostrils that are too large. I hope this helps answer your questions, and I wish you the best of luck!

There are different techniques to de-project the tip; full transfixion incision, removal of dorsal septal cartilage, sewing the tip cartilages down, extended spreader grafts, and trimming the posterior portion of the caudal septum.  Depending upon the amount of deprojection and derotation, the nostrils can sometimes flare.  If the flaring is excessive, alarplasty is then performed to bring them into balance.

Tip deprojection can be performed either by removing cartilage or repositioning the entire tip cartilage with sutures. Significant de-projection can result in flaring of the nostrils. This can be remedied with Weir excisions. Determining whether this is necessary would require an in-person consultation. However, none of these maneuvers are unusual and should all be in the armamentarium of an experienced rhinoplasty surgeon. I hope this information is helpful.Stephen Weber MD, FACS