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

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.