title: [Correction of the broad nasal tip].
abstract: OBJECTIVE
  The multiple techniques, the accurate examination and the checking of the various anatomic components (skin, cartilage resistance) could explain the difficulty for the surgeon to choose a main line, achieving the purpose of perfect and permanent results. Facing this complexity, the goal of this study is to plan step by step, using a simple and original technique in order to correct a broad nose.
  
  
  METHODS
  The modification of the nasal tip includes resection techniques, currently the most used, the cartilaginous reshaping with sutures or onlay grafts and more recently the reinforcement structures approach by inlay grafts. Basically, there are 3 important stages in the performing of a new nose tip: projection and rotation control of the tip, nasal base stability and reshaping of the tip. The author reports an original technique for the control of the tip projection and reshaping the middle crus with two cartilaginous grafts disposed on the external side of the medial crus. These two grafts permit both improving naturally the support of the tip and stabilizing the columella, avoiding the classical median columellar strut.
  
  
  RESULTS
  Through a ten-year experience with 203 cases, every patient result was analyzed and criticized. All the cases were reviewed after 2 years at least, and the unwanted effects were noted. Nineteen patients have had a secondary rhinoplasty (11%), 4 for a revision tip surgery (2%). There is no respiratory dysfunction and more than 90% of patients are satisfied for their aesthetic result. We think that the main problems as resection techniques with skin or mucosa retraction, unpredictable long-term effect on the tip, unknown future of the grafts, especially onlay grafts responsible sometimes for unpleasant irregularities, could be minimized with this procedure. The more the nasal tip is stabilized, the more the results are better and longer lasting.
  
  
  CONCLUSIONS
  The surgery of the nose tip is focused not only with shaping procedures of the middle or lateral crus. The technique reported is very simple and safety for the nasal tip surgery through a modification and/or a reinforcement of the initial structure, maximizing the contact between skin and anatomical component and economizing the interposition of a cartilage graft as far as possible. It is a new concept including respect of the anatomy, and stability, which are the best guarantee for a durable result.
authors.affiliation: Immeuble Convergence, 50, rue Berthy-Albrecht, 84000 Avignon, France. Electronic address: yves.jallut@orange.fr.
authors.forename: Y
authors.initials: Y
authors.lastname: Jallut
mesh_terms: D000328:Adult; D002356:Cartilage / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000002:abnormalities*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012225:Rhinoplasty / Q000379:methods*; D013536:Suture Techniques
keywords: Broad tip; Chirurgie de la pointe; Graft; Greffe; Inlay; Onlay; Pointe large; Rhinoplastie; Rhinoplastie de structure; Rhinoplasty; Suture; Tip surgery