Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Algorithm for Analysis and Correction on Nasal Tip Deformities in Revision Rhinoplasty

Authors:Samieh S. Rizk, M.D, FACS¹, David Rosenberg, M.D²

¹Manhattan Eye, Ear & Throat Hospital, Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, NY NY

²Manhattan Eye, Ear & Throat Hospital, Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic & Reconstructive Surgery, NY NY


Consistent correction of tip deformities in revision rhinoplasty requires proper diagnoses and a detailed understanding of preoperative physical findings. This investigation describes a detailed correlation between nasal preoperative physical findings with the surgical plan. An algorithm was developed to correlate various tip maneuvers to specific surgical corrective techniques. Correction of nasal tip deformities in revision rhinoplasty entails correction of lower lateral cartilage asymmetries, caudal septal deflections, excessive membranous septum, camouflaging defects in cartilage and sharp edges in grafts with Alloderm, correcting nasal valve collapse from absent previously excised lower or upper lateral cartilage.

This study retrospectively reviewed 371 patients who underwent revision rhinoplasty over a 5 year period. Of these patients, 287 underwent revision rhinoplasty with the open (external) approach and 84 patients underwent the endonasal rhinoplasty approach. Patients ranged in age from 16-75 years old with an average age of 37. There were 262 females and 109 males. Ethnicity included Caucasians (68%), Hispanic (18%), Asian (10%), and African American (6%).

Physical and surgical deformities in these patients included asymmetric lateral crura remnants, displaced tip grafts, tip ptosis, polybeak deformity, asymmetric domes, hanging columella, dislocated caudal septum, asymmetric bossae, excessive soft tissue/vestibular mucosa or redundant membranous septum, and medial crural flare.

Correct diagnoses of the etiology of nasal tip anomalies sets the stage for an algorithm for surgical repair which best matches the surgical procedure or maneuver needed to properly correct the underlying deformity. Intraoperative surgical findings correlated well with preoperative assessments of deformities based on this algorithm.

Written by Dr. Sam Rizk

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