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Defining the Infratip Lobule in Rhinoplasty: Anatomy, Pathogenesis of Abnormalities, and Correction Using an Algorithmic Approach

Rohrich, Rod J. M.D.; Liu, Jerome H. M.D., M.S.H.S.

Plastic and Reconstructive Surgery: November 2012 - Volume 130 - Issue 5 - p 1148–1158
doi: 10.1097/PRS.0b013e318267d6ae
Cosmetic: Original Articles

Background: Excess infratip lobule projection is often the result of deformities of the middle crus and lower lateral cartilage. The causes and correction of excess projection have not been well described. The classification of the deformities causing excess infratip lobule projection is defined and a surgical algorithm for addressing the infratip lobule is presented.

Methods: A retrospective review of primary rhinoplasties was combined with the use of a cadaver model to identify the causes of excess infratip lobule projection and develop an algorithm for its correction. Specific cases are presented to demonstrate the consistency and predictability of these techniques.

Results: The classification of excess infratip lobule projection is divided into intrinsic (i.e., long middle crus, wide middle crus, lower lateral malposition, and combination) and extrinsic causes (i.e., prominent septum). After correcting extrinsic causes, the algorithm progresses from medial to lateral, working from the medial crus to the lateral crus. Final refinement using transdomal sutures establishes the endpoint for infratip lobule projection and alar rim position when the cephalic and caudal edges (rotational orientation) of the lower lateral cartilage lie in the same plane.

Conclusions: A simple classification and logical algorithm are established to help rhinoplasty surgeons achieve aesthetic and consistent infratip lobule projection in cosmetic rhinoplasty. Establishing appropriate infratip lobule projection is essential for an aesthetic result in the lower third of the nose. The appearance of this complex area with the tip, columella, ala, and lobule has great importance in the final outcome in rhinoplasty.


Dallas, Texas; and San Jose, Calif.

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and private practice.

Received for publication January 14, 2012; accepted May 18, 2012.

Disclosure: Dr. Rohrich receives book royalties from Quality Medical Publishing and instrument royalties from Micrins Surgical (Lake Forest, Ill.). Dr. Liu has no financial disclosures.

Rod J. Rohrich, M.D.; Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

©2012American Society of Plastic Surgeons