PURPOSE: Reshaping the nasal tip is the most difficult part of rhinoplasty, particularly in certain types of nasal tip deformities, such as the recessed, thick-skin, boxy tip, asymmetrical, bifid tip, turned-up tip, and turned-down tip, with flaring nostrils and short columella.
METHODS: Among 3800 rhinoplasties, in the last 14 years, 2200 had tip rhinoplasty for broad nose.
During rhinoplasty, using a vestibular approach, after the dorsal, lateral, and septal work completed;defatting of tip region is performed. Through a 4mm longitudinal incision on the lateral side of columella, a pocket is created inside of crura, from the base to the tip, using blunt tip scissors. In select cases, through an incision from the base of nostrils, the alar base is approximated using subcuticular 3x0 ethilon sutures. Cartilage is diced in pieces of 0.5mm using a # 11 blade, wrapped with Surgicel and then molded into cylindrical form and inserted into the columella and pushed up to the tip region; a strut of cartilage is inserted into the columella below the diced cartilage mass. After that, the tip is externally molded between the fingers to achieve the desired form.
RESULTS: Shaping the tip region with diced cartilage and approximation of alar base improved our result considerably; giving the tip desirable form and eliminating the complications of late show of the strut.
CONCLUSION: In broad tips with thick skin and week cartilage, defatting, remodeling of the tip and utilization of cartilage graft as a support, is necessary to obtain satisfactory results.