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J. Smythe Rich, MD; William H. Friedman, MD; Steven J. Pearlman, MD

Arch Otolaryngol Head Neck Surg. 1991;117(1):56-59.

Abstract
• Nasal tip projection is an important defining feature of the nasal profile. Loss of projection is often the bane of the rhinoplastic surgeon. While augmentation techniques for maintaining or increasing tip projection are useful in selected patients, the majority of rhinoplasties rely on excision of cartilage, particularly cartilage of the cephalic border of the lower lateral crura, to produce the desired cosmetic result. The purpose of this study was to measure the effects of lower lateral cartilage excision on nasal tip projection resulting from three common forms of nasal tip surgery. These techniques included cephalic border resection without vertical dome division, cephalic border resection with vertical dome division, and cephalic border resection with dome division and suture reapproximation of the mesial crura, the so-called "Goldman tip." Despite the fact that overall excellent results were obtained and loss of projection was rarely a noticeable feature, a measurable loss of projection can be seen in all but one case in this series. Although loss of tip projection is usually acceptable due to the masking effect, the concurrent reduction in dorsal nasal height, loss of projection must be anticipated in excisional techniques of the lower lateral cartilage.

(Arch Otolaryngol Head Neck Surg. 1991;117:56-59)

Author Affiliations
From the Park Central Institute, St Louis, Mo (Drs Rich and Friedman), and Department of Otolaryngology—Head and Neck Surgery, St Luke's/Roosevelt Hospital, New York, NY (Dr Pearlman).

Footnotes
Accepted for publication August 7, 1990.

Presented at the Eastern Section of the American Academy of Facial Plastic and Reconstructive Surgery, New Haven, Conn, January 25, 1990.

Reprint requests to Park Central Institute, 6125 Clayton Ave, Suite 430, St Louis, MO 63139 (Dr Friedman).

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