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The Boxy Nasal Tip: Classification and Management Based on Alar Cartilage Suturing Techniques

Rohrich, Rod J., M.D.; Adams, William P. Jr., M.D.

Plastic and Reconstructive Surgery: June 2001 - Volume 107 - Issue 7 - p 1849–1863
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The boxy nasal tip is characterized by a broad, rectangular appearance of the tip lobule on basal view. This manifests anatomically as one of three types: type I, which features an increased intercrural angle of divergence (greater than 30 degrees) and normal domal arc (4 mm or less) manifesting as the tip-defining points; type II, which features an increased angulation of the domes of the lower lateral segments of cartilage, creating a widened domal arc (greater than 4 mm) and normal angle of divergence (30 degrees or less); and type III, which features a combination of increased angle of divergence (greater than 30 degrees) and widened crural domal arc (4 mm or greater). In this article, the available techniques for correction of the boxy tip are reviewed and an algorithmic approach for the management of this problem is demonstrated using the open approach to rhinoplasty. Using an individualized algorithmic approach with intraoperative nasal tip analysis and three nasal tip suture reshaping techniques, consistent aesthetic results can be obtained in the correction of the boxy nasal tip. (Plast. Reconstr. Surg. 107: 1849, 2001.)

Dallas, Texas

From the Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center. Received for publication August 29, 2000; revised October 25, 2000.

Rod J. Rohrich, M.D.

Department of Plastic and Reconstructive Surgery

University of Texas Southwestern Medical Center

5323 Harry Hines Boulevard, E7.210

Dallas, Texas 75390-9132

rod.rohrich@utsouthwestern.edu

©2001American Society of Plastic Surgeons