title: Primary nasal tip surgery: a conservative approach.
abstract: BACKGROUND
  Rhinoplasty and rhinoseptoplasty are very important and complex surgical procedures because the nose plays a pivotal aesthetic role in the face and an important functional role in breathing. Mild bulbous, plunging, undefined tips are very common, and tip refining and repositioning often are required surgical procedures.
  
  
  METHODS
  For 97 selected patients, the authors performed their personal technique consisting of a transcartilaginous approach, incomplete vertical interruption, and retrograde undermining of the lower lateral cartilages to improve tip projection and definition. The five aspects analyzed were nasal tip symmetry, nostril symmetry, tip projection, tip definition, and appearance of the nasal tip only. Each parameter was assessed using pre- and postoperative quantification according to a visual analog scale. Postoperative evaluation was performed during a mean follow-up period of 1 year.
  
  
  RESULTS
  The results at 1 year showed high rates of improvement in tip definition (mean, 7.9±2.4) and nasal tip only evaluation (mean, 6.5±3.1). The patients reported an improvement in nasal tip symmetry (mean, 4.2±3.2), nostril symmetry (mean, 4.5±4.1), and tip projection (mean, 5.8±2.9).
  
  
  CONCLUSIONS
  This simple, safe, and effective technique is proposed for mild bulbous, plunging, undefined, and hypoprojected tips.
authors.affiliation: U.O. Chirurgia Plastica 2, Dipartimento di Medicina Traslazionale, Università degli Studi di Milano, IRCCS Istituto Clinico Humanitas, Via A. Manzoni 56, 20089, Rozzano, Milano, Italy. marco.klinger@humanitas.it
authors.forename: Marco
authors.initials: M
authors.lastname: Klinger
authors.forename: Fabio
authors.initials: F
authors.lastname: Caviggioli
authors.forename: Davide
authors.initials: D
authors.lastname: Forcellini
authors.forename: Valeria
authors.initials: V
authors.lastname: Bandi
authors.forename: Luca
authors.initials: L
authors.lastname: Maione
authors.forename: Valeriano
authors.initials: V
authors.lastname: Vinci
authors.forename: Angelo Virgilio
authors.initials: AV
authors.lastname: Pagliari
authors.forename: Francesco
authors.initials: F
authors.lastname: Klinger
authors.forename: Riccardo Francesco
authors.initials: RF
authors.lastname: Mazzola
mesh_terms: D005260:Female; D006801:Humans; D055171:Nasal Cartilages / Q000601:surgery*; D012225:Rhinoplasty / Q000379:methods*; D011795:Surveys and Questionnaires; D055815:Young Adult