Surgeons must recognize large nostril/small tip disproportion as a distinct challenge in rhinoplasty surgery. The critical first step is to correctly analyze the intrinsic and extrinsic factors that contribute to the deformity. The nostril axis is drawn between the nostril apices and extended in both directions. It is then subdivided into a nostril and intrinsic tip component. The ratio of nostril to tip should be 55:45; a ratio of 60:40 is acceptable. The surgical solution requires both an increase in intrinsic tip projection by lengthening the infralobular segment and a nostril reduction. The anatomical deformity consists of three components: (1) the alar cartilages are highly divergent, (2) the infralobular segment is quite short, and (3) the domal segment is flat and ill defined. The operative technique advocated by the author combines a three-stitch tip procedure, including an interdomal suture over a straight strut, plus nostril sill/alar wedge resections. (Plast. Reconstr. Surg. 107: 1874, 2001.)
From the Division of Plastic Surgery, University of California at Irvine. Received for publication July 25, 2000; revised November 27, 2000.
Accepted for presentation at the American Society of Plastic Surgeons Annual Meeting, Los Angeles, California, October 16, 2000.
Rollin K. Daniel, M.D. 1441 Avocado Avenue Suite 308 Newport Beach, Calif. firstname.lastname@example.org
©2001American Society of Plastic Surgeons