Anatomical studies on the nasal tip indicate four major areas of tip support: (1) the fibrous connection between upper and lower lateral cartilages; (2) the sesamoid complex extending the support of the lateral crus to the pyriform opening; (3) the ligamentous sling spanning between the paired domes of the lower lateral cartilages; and (4) the attachment of the feet of the medial crura to the posterior caudal septum. Routine rhinoplasty procedures compromise tip support predisposing to postoperative tip sagging (Pollybeak); however, tip rhinoplasty procedures can be modified to maintain tip support and projection by: high transfixion through the caudal cartilaginous septum confirming septal shortening to the anterior caudal septum, embricating the membranous septum over the anterior caudal septum, utilizing a cartilaginous strut, between and below the medial crura, or reestablishing the medial cruraposterior caudal septum anchorage.
Janeke JB, Wright WK. Studies on the Support of the Nasal Tip. Arch Otolaryngol. 1971;93(5):458–464. doi:10.1001/archotol.1971.00770060704004
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