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Evaluation of Nasal Tip Definition in Closed Rhinoplasty

Buckley, Christina E. MD, MRCSI; McArdle, Adrian MD, MRCSI; McInerney, Niall M. MD, MRCSI; O’Broin, Eoin MD, FRCSI (Plast)

Plastic and Reconstructive Surgery – Global Open: January 2016 - Volume 4 - Issue 1 - p e603
doi: 10.1097/GOX.0000000000000588
Meeting Abstracts

From the Department of Plastic, Reconstructive and Aesthetic Surgery, Cork University Hospital, Wilton, Cork, Ireland.

Presented at the Irish Association of Plastic Surgeons Meeting, May 14-15 2015, Galway, Ireland.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by The Irish Association of Plastic Surgeons.

IAPS: Irish Association of Plastic Surgeons (IAPS) Summer Meeting, in Galway, Ireland, May 14-15, 2015.

Eoin O’Broin, MD FRCSI (Plast), Department of Plastic, Reconstructive and Aesthetic Surgeon, Cork University Hospital, Cork, Ireland, E-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

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Trends in rhinoplasty techniques have seen a significant shift from closed to open over the last decade.1,2 The ideal surgical approach for rhinoplasty continues to be debated amongst aesthetic surgeons. Each technique has its merits. Open rhinoplasty is deemed the procedure of choice in all but the simplest rhinoplasties, reserving the traditional closed approach for hump reduction cases due to reduced operative times and reduced swelling and scarring. However, even in minor “hump reduction” cases, we feel there may be aesthetic shortcomings using a simplistic traditional closed technique. A pattern, a poor tip definition, was noted in a series of closed rhinoplasty procedures. It was hypothesized that closed rhinoplasty performed to correct simple dorsal hump abnormalities leads to poor tip definition postoperatively in those that had preexisting tip abnormalities.

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The aim of this study was to objectively and subjectively analyze the loss of nasal tip definition in a series of patients who underwent a traditional closed rhinoplasty.

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Thirty patients who underwent primary closed rhinoplasty by a single surgeon were photographed over an 8-year period.

All cases were assessed preoperatively and were deemed appropriate for closed rhinoplasty. Nasal analysis was assessed objectively using 4 anthropometric measurements (nasolabial angle, columellar-lobular angle, tip projection, and supratip break) using postoperative photographs. Nasal tip definition was also assessed subjectively using the panel of 30 postoperative photographs.

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Thirty patients who underwent primary closed rhinoplasty by a single surgeon were included in this study. Nasal analysis revealed a wider nasolabial angle (mean, 104°), a narrower columellar-lobule angle (mean, 29°), and a mean tip projection of 0.63, which is considered inadequate. The supratip break was completely neutral, and no concavity was seen in our series of patients. The panel of photographs found a classic rounded tip profile associated with the closed technique. There was a lack of supratip break and the indistinct tip defining points (Fig. 1).

Fig. 1

Fig. 1

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In summary, the traditional closed approach consistently generated a “rounded” underprojected nasal tip. Ultimately, our experience showed that the closed technique resulted in diminished control of the tip, leading to suboptimal aesthetic outcomes. The aesthetic outcomes in closed rhinoplasty show a clear lack of tip definition. Although it would seem that performing closed rhinoplasty for simple dorsal hump abnormalities is an optimal surgical approach, as it is relatively straightforward with short operative times, it may not be suitable if the patient displays any preexisting tip abnormalities. We must conclude that the indications for closed rhinoplasty are diminishing.

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1. Adamson PA, Galli SK. Rhinoplasty approaches: current state of the art. Arch Facial Plast Surg. 2005;7:32–37
2. Sheen JH. Closed versus open rhinoplasty—and the debate goes on. Plast Reconstr Surg. 1997;99:859–862
Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.