• Two reliable methods of reducing nasal tip projection include a direct method, which interrupts continuity of lower lateral cartilage by removal of the dome portion and leaves an intact vestibular skin cuff; continuity and cartilage volume are changed. The second method, indirect, preserves continuity of the inferior margin of the lower lateral cartilage, which is grossly weakened by resection of cartilage in cephalic areas of the lateral crus dome, and adjacent medial crus. Vestibular lining is preserved as a cuff. Volume loss and supportive strength of lower lateral cartilage allow the nasal tip to assume a less projected stance with resulting widening and outward flailing of nostrils, which can be corrected by vestibular wedging. Complete transfixion of the membranous septum and adequate lowering of the cartilaginous septal angle are adjuncts to success with either method.
(Arch Otolaryngol 104:564-569, 1978)
Smith TW. Reliable Methods of Tip Reduction. Arch Otolaryngol. 1978;104(10):564–569. doi:10.1001/archotol.1978.00790100018004
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