title: Nasal tip refinement: analysis of surgical technique, efficacy, and secondary effect of skin thickness.
abstract: BACKGROUND
  Effective control and refinement of the nasal tip is an integral component of the rhinoplasty operation. A multitude of techniques exist to complement the rhinoplasty surgeon's approach, but attaining consistent and long-lasting results is still challenging due to the complex interplay between nasal anatomy and surgical technique.
  
  
  OBJECTIVE
  The authors sought to determine whether the degree of tip narrowing with rhinoplasty is associated with the narrowing technique selected by the surgeon and whether there is an association between skin thickness and tip narrowing.
  
  
  METHODS
  A retrospective chart review was conducted of all patients undergoing rhinoplasty in a single-surgeon practice between April 2004 and November 2006. Demographic information and specific operative techniques were recorded. Standard basal views of pre- and postoperative photographs were examined by two blinded observers, who measured nasal tip width relative to interpupillary distance with imaging software. Skin thickness was assessed and categorized by a surgical expert according to Fitzpatrick classification.
  
  
  RESULTS
  Forty patients were identified with adequate follow-up and complete data sets. A statistically significant reduction in tip width pre- and postoperatively was seen (P = .041). No significant difference in tip narrowing between various techniques was found (P = .309), and no significant association between tip narrowing and skin thickness was identified (P = .186).
  
  
  CONCLUSIONS
  Although tip-narrowing techniques are effective in rhinoplasty, the specific technique employed may not be clinically relevant. Furthermore, skin thickness may not be as significant a factor in tip narrowing as is commonly believed.
authors.affiliation: Division of Facial, Plastic, and Reconstructive Surgery and the Department of Otolaryngology-Head and Neck Surgery, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada. Nitin.chauhan@utoronto.ca
authors.forename: Nitin
authors.initials: N
authors.lastname: Chauhan
authors.forename: Maya G
authors.initials: MG
authors.lastname: Sardesai
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Burchard
authors.forename: David A F
authors.initials: DA
authors.lastname: Ellis
mesh_terms: D000328:Adult; D001837:Body Weights and Measures / Q000379:methods; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055171:Nasal Cartilages / Q000033:anatomy & histology / Q000601:surgery; D009666:Nose / Q000033:anatomy & histology* / Q000601:surgery*; D015588:Observer Variation; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012867:Skin / Q000033:anatomy & histology; D013536:Suture Techniques; D016896:Treatment Outcome