title: Graduated approach to refinement of the nasal lobule.
abstract: OBJECTIVE
  To present a graduated approach to refining the nasal lobule (a frequent complaint during consultations for rhinoplasty) based on anatomic features and to discuss the casuistics of this procedure since we began performing it.
  
  
  METHODS
  A retrospective evaluation of the medical charts of 1152 patients who underwent rhinoplasty from 2003 to 2006; 641 patients fulfilled the criteria for our study (55.6%). Outcomes were assessed by comparing preoperative and last follow-up photographs and considering the width, symmetry, and contour of the nasal lobule. Cases were allocated into 7 groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; and (7) replacement of lower lateral cartilages.
  
  
  RESULTS
  Of the 641 patients enrolled in the study, 435 were women and 206 were men. Mean follow-up period was 1.5 years. An asymmetric tip was present in 28 patients (4.4%), and a persistent width of interdomal space in 34 (5.3%). None presented overnarrowing of interdomal space. Surgical revision rate to enhance refinement of the lobule was 5.6%.
  
  
  CONCLUSIONS
  Our graduated approach has shown excellent outcomes, a high rate of patient satisfaction, and a low rate of revision.
authors.affiliation: Division of Facial Plastic Surgery, Medical School, Federal University of Uberlandia, Minas Gerais, Brazil. lucaspatrocinio@triang.com.br
authors.forename: Lucas G
authors.initials: LG
authors.lastname: Patrocínio
authors.forename: Tomas G
authors.initials: TG
authors.lastname: Patrocínio
authors.forename: Jose V
authors.initials: JV
authors.lastname: Maniglia
authors.forename: Jose A
authors.initials: JA
authors.lastname: Patrocínio
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery; D009666:Nose / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult