title: Gradual approach to refinement of the nasal tip: surgical results.
abstract: BACKGROUND
  The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty.
  
  
  OBJECTIVE
  To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure.
  
  
  METHODS
  Longitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; (7) replacement of lower lateral cartilages.
  
  
  RESULTS
  Group 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occurred in 4% of cases.
  
  
  CONCLUSIONS
  The protocol used allowed the implementation of a gradual surgical approach to nasal tip definition with the nasal anatomical characteristics, high rate of patient satisfaction with the surgical outcome, and low rate of revision.
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil. Electronic address: cmf.thiago@gmail.com.
authors.forename: Thiago Bittencourt Ottoni de
authors.initials: TB
authors.lastname: Carvalho
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Emerson
authors.initials: E
authors.lastname: Thomazi
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Rafael Panizza
authors.initials: RP
authors.lastname: Leutz
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Rafael P S F
authors.initials: RP
authors.lastname: Souza
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Fernando Drimel
authors.initials: FD
authors.lastname: Molina
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: Vânia Belintani
authors.initials: VB
authors.lastname: Piatto
authors.affiliation: Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.
authors.forename: José Victor
authors.initials: JV
authors.lastname: Maniglia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016011:Normal Distribution; D009666:Nose / Q000033:anatomy & histology; D017060:Patient Satisfaction; D012225:Rhinoplasty / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cartilagens nasais; Nariz; Nasal cartilages; Nose; Rhinoplasty; Rinoplastia