Tip support - deprojection

Deprojection refers to decreasing the amount of anterior projection of the nose. Lifting involves changing the angle from the lip to the columella and increases projection. It is possible to do both together by resecting some cartilage. This does not necessarily damage tip support. The procedure can be done but is rarely indicated. Unfortunately, you have not provided photographs.

Best Wishes,

Gary Horndeski, M.D.

In our experience, nasal tip deprojection involves dividing the lower lateral cartilages and by lowering the central post of the tripod. The tripod is the combination of the sutured medial crura, and each lower lateral tip cartilage. Adjusting each limb of the tripod is how we achieve a favorable nasal tip appearance. The addition of a columella shoring strut graft is how we add nasal tip support. Thank you for your interesting question. Sincerely, Dr Joseph

... as long as the surgeon makes sure there's good tip support at the end of the procedure.
Lifting the tip is usually a good idea when deprojecting the nose, because the deprojection usually makes the nose *look* longer, as if the tip had actually dropped. So it's important to lift the tip to correct that impression, and also to do whatever elevation the nose seems to need before it was projected.

The reason most surgeons don't want to deproject a nose is that it's technically difficult, and they don't have the skill to accomplish it with predictability. In fact, in expert hands, deprojecting a nose is one of the most predictable change to make. Even in a revision.


How *much* to elevate a tip, or deproject the nose, or make other changes? We figure that out with morphs, well before surgery. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that you describe -- particularly the deprojection -- require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And it also discusses how to take photos that are best for online evaluations.

It is simple to deproject the tip and you won’t lose support. Some surgeons use grafts for tip “support” with no reason other than that it sounds good but doesn’t really make sense. Hence a lot of unnecessary cartilage grafts which make the tip feel hard

Hello and thank you for your question. In the right hands, nasal tip deprojection can be a powerful and extremely safe procedure. The information you were presented is incorrect. It is very possible to elevate the nasal tip at the same time as tip deprojection. Please see the video attached. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon