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Combining Preservation Concepts and Structural Techniques in Nasal Tip Management: A Practical Approach.

Francesco Buttarelli1,2, Masoud Saman3

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This study presents a refined rhinoplasty technique for nasal tip management, focusing on preservation and structural reinforcement for stable, natural results. The approach evolved to prioritize septal grafts over older methods, improving long-term tip support and definition.

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Area of Science:

  • Plastic Surgery
  • Otolaryngology
  • Facial Aesthetic Surgery

Background:

  • Nasal tip management in primary rhinoplasty presents challenges in achieving long-term stability and aesthetic refinement.
  • Traditional techniques like columellar strut grafting can lead to late-onset ptosis.
  • A shift towards septal-based techniques offers more predictable projection control.

Purpose of the Study:

  • To describe an evolving, experience-based approach to nasal tip management in primary rhinoplasty.
  • To integrate preservation principles with selective structural reinforcement for enhanced stability and definition.
  • To detail a technique transitioning from columellar struts to septal extension grafts (SEG) and Teostrut.

Main Methods:

  • Clinical decision-making based on skin thickness, lower lateral cartilage strength, and inherent tip support.
  • Operative approach combining preservation of native support with controlled strengthening (Teostrut or SEG).
  • Incorporation of conservative cephalic adjustments and precise dome-suture modulation.

Main Results:

  • The technique evolved over 15 years, moving from routine columellar struts to a septal-based philosophy.
  • The Teostrut and SEG provide more predictable and stable nasal tip projection.
  • The approach yields reproducible, stable, and naturally refined results in primary rhinoplasty.

Conclusions:

  • The described rhinoplasty technique offers durable nasal tip support and achieves patient-specific aesthetic goals.
  • Integration of preservation and reinforcement strategies enhances long-term stability and definition.
  • Ongoing refinements include cartilage responsiveness mapping and regenerative strategies.