Systematic approach to correction of the nasal tip in rhinoplasty

Surgical correction of the nasal tip is considered to be the most difficult component of rhinoplasty. We describe a systematic method of analyzing and operating on the tip, and discuss the anatomical factors that contribute to tip support. The "tripod" theory of tip projection, support, and rotation is described and illustrated. Altering tip support and excising portions of the lower lateral cartilages have a decided effect on the tripod and the eventual outcome of the nasal tip. We describe four categories of tip procedures, namely, complete strip, rim strip, lateral crural flap, and dome division. An attempt is made to provide the rhinoplasty surgeon with the different techniques from which to choose for each specific type of nasal tip deformity.