Dome truncation for management of the overprojected nasal tip

The nasal tip highlights the facial profile, and in its most aesthetic configuration subtly projects anterior to the dorsum to create a soft supratip break. Overprojection of the tip in relation to the vertical facial plane and the nasal dorsum represents one variant of nasal-facial disproportion that can adversely affect an otherwise pleasant facial appearance. Several strategies for reducing either the lateral or the medial crus to deproject the tip have been suggested. This article describes a method of direct truncation of the dome using an external rhinoplasty approach that can reliably produce tip retrodisplacement while maintaining, or enhancing, tip rotation. Tip definition and projection are optimized by precise, direct reduction of the overprojected dome region and accurate sculpting and realignment of the remaining crural units. When the tip is retrodisplaced, alar flaring can occur; therefore, alar base reduction can substantially enhance the final outcome.