DRAMATIC REFINEMENT OF THE NASAL TIP

Every aspect of nasal anatomy that may influence tip aesthetics must be considered when dramatic refinement of the nasal tip is the goal. The nasal dorsum, ala, columella, supratip, and nasal base have to be evaluated in their relationship to the tip. The most heroic and dramatic efforts in nasal tip surgery occur in secondary rhinoplasty when subtle refinement is frequently the goal and dramatic change unrealistic. The same techniques used in secondary rhinoplasty to effect change also may be necessary in grotesque primary rhinoplasty when dramatic change is warranted. Whether it be gross abnormalities of the tip cartilage, columella, caudal septum, tip skin, or nasal base, it is imperative that the patient have realistic expectations for refinement and not perfection. ANATOMY