title: Rhinoplasty. The difficult nasal tip: total resection of the alar cartilages.
abstract: There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices.
authors.affiliation: Unidad de Cirugía Plástica y Estética, Hospital Universitario "Casa de Salud", Manuel Candela, 41, 46021, Valencia, Spain, cirugia-plastica@rodriguez-camps.com.
authors.forename: Salvador
authors.initials: S
authors.lastname: Rodriguez-Camps
mesh_terms: D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods*; D018570:Risk Assessment; D016896:Treatment Outcome
references.citation: Aesthetic Plast Surg. 2001 Jul-Aug;25(4):273-7
references.pmid: 11568830
references.citation: Aesthetic Plast Surg. 2009 Jan;33(1):72-80; discussion 81-3
references.pmid: 18797961
references.citation: Ann Plast Surg. 1986 Apr;16(4):322-32
references.pmid: 3273050
references.citation: Aesthetic Plast Surg. 1998 May-Jun;22(3):196-205
references.pmid: 9618186