Results after rhinoplasty are said to be variable, unpredictable, and uncontrollable; and the portion of the newly fashioned nose most frequently involved is the nasal tip. Secondary dropping of the nasal tip ruins more results in rhinoplasty than any other feature of the operation. The result of rhinoplasty is usually satisfactory at the end of the operation, but four to six weeks later we unfortunately observe that the tip occasionally droops. The nose becomes longer; the cartilaginous dorsum appears too high, and the component parts of the alar cartilages in the tip change in relation to each other. The result is a rounded, unattractive, and unsatisfactory nose.
The causes of secondary dropping of the nasal tip are said to be (1) scar contractures at the septocolumellar suture line, and (2) weight of the lobule. I have tried to stress a third cause: the pull-down action of the depressor septi nasi
FRED GB. Postoperative Dropping of the Nasal Tip After Rhinoplasty. AMA Arch Otolaryngol. 1958;67(2):177-181. doi:10.1001/archotol.1958.00730010183008