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

Question

How is a tip deprojected? Is there always cartilage removed? What happens to the nostrils- do they always flare? Thank you for your answers.

Paul S. Nassif, MD · Answer

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!

Thomas A. Lamperti, MD · Answer

Cartilage doesn't have to be removed to deproject the tip. There are various techniques to achieve deprojection. Most involve repositioning the tip cartilages rather than excising tissue. With significant deprojection nostril flare may be evident, but this isn't always the case. If flaring occurs a nostril reduction may be indicated to improve this.

William Portuese, MD · Answer

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.

Stephen Weber MD, FACS · Answer

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

Shervin Naderi, MD, FACS · Answer

Hi

	The tip can be deprojected using a complete transfixion incision to detach attachment of tip cartilages to the surrounding cartilages or additional maneuvers may be needed to actually shorten each part of the tip cartilages.  Suture techniques can also be use to suture the tip cartilages in a less projected fashion.  Nostrils can flare depending on degree of deprojection.

Michael L. Schwartz, MD · Answer

Nasal tips are typically deprojected by either releasing their support to the septum, lowering the septal profile or shortening either the medial or lateral crura. As the tip is set back the nostrils do flare out. Depending on where you are starting from this may or may not be desirable and have to be addressed.

Francis R. Palmer, III, MD (retired) · Answer

The projection, of the nasal tip, can be decreased uaing several methods.  Which one is best depends on what else is to be done, to the tip, during the Rhinoplasty.  Yes, in each case, the nasal tip cartilage must be reduced either along the Columella or at the tip cartilage "high ponits" in order to decrease the tip projection.  

	 The nostrils change the least using the Columellar shortening technique while the open Rhinoplasty with tip cartilage reduction allows the ability to change (making more narrow and symmetric) the nostrils to a greater extent.  IMHO, the Columellar shortening works best when minimal tip thinning is desired, while the Open Rhinoplasty and tip reduction works best with a wide/asymmetric or previously operated scenario.  Hope this helps.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	The tip can be thought of as a 3 legged tripod of cartilage. Any one of these legs or a combination of them can be reduced. Also destabilizing the major tip supports can deproject the tip. Flaring can happen but is usually not significant.

	Best,

	Dr.S.

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

Answers (8)

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