title: Functional outcomes of structured nasal tip refinement.
abstract: OBJECTIVE
  To describe a technique to refine the nasal tip and supratip while preserving structure; traditional attempts to reduce nasal tip bulbosity involve maneuvers that may result in loss of support, leading to poor functional and cosmetic outcomes.
  
  
  METHODS
  A prospective study of patients undergoing open structure nasal tip refinement using scroll joint excision with a septal-lateral crural suture to flatten the lateral crus. Outcomes assessed were nasal peak inspiratory flow (NPIF), nasal obstruction scores, 22-item Sinonasal Outcome Test (SNOT-22), 36-item Short-Form questionnaires (SF-36), and anchor scores for breathing and cosmesis.
  
  
  RESULTS
  The mean NPIF improved from 100 L/min to 139 L/min, nasal obstruction improved, and the mean (SD) SNOT-22 scores improved from 1.45 (0.86) to 0.63 (0.65) (P< .01 for all comparisons). All patients had improved cosmesis, and 2.2% had both subjectively and objectively impaired nasal breathing.
  
  
  CONCLUSIONS
  A technique is described allowing refinement of the nasal tip while maintaining or improving the nasal airway and providing a high level of patient satisfaction with the aesthetic outcome. Even in patients seen for cosmetic rhinoplasty, there may be a degree of preoperative nasal obstruction that should be recognized and addressed.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, St Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia. daniel.timperley@gmail.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Timperley
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stow
authors.forename: Aviva
authors.initials: A
authors.lastname: Srubiski
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
authors.forename: George
authors.initials: G
authors.lastname: Marcells
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D055815:Young Adult