title: The plunging tip: analysis and surgical treatment.
abstract: BACKGROUND
  The plunging tip refers to a deformity in which the nasal tip plunges on smiling.
  
  
  OBJECTIVE
  To understand the plunging tip, we have updated our series of 25 cosmetic rhinoplasty patients who complained of a plunging tip with a focus on the anatomic changes of the nose on smiling.
  
  
  METHODS
  Twenty-five female cosmetic primary rhinoplasty patients who complained of a nasal tip that plunged on smiling were photographed in static and smiling sequences preoperatively and one year postoperatively. Different nasal angles and landmarks were measured to study changes of the nose.
  
  
  RESULTS
  Pre- and postoperatively, there was no statistically significant difference in the changes in the nasal angles and landmarks on smiling. At one year postoperatively, 2 patients had nasal tips that continued to plunge on smiling; these patients had requested no increase in tip rotation preoperatively. Only 2 patients had columellar base muscles cut for reasons other than treating the plunging tip.
  
  
  CONCLUSIONS
  This is the first prospective, evidence-based study on the plunging tip. Measurements of the nose before and after surgery demonstrate that the nasal tip moves less than 1 mm and 1 degree on smiling. Treatment of the plunging tip illusion was effective by increasing the tip angle in repose. No columellar base muscles were cut to treat the plunging tip, and the nose moved just as much after surgery as before. Cutting or manipulating muscles is not necessary for treatment. To treat the illusion, the surgeon must increase tip rotation.
authors.affiliation: Dr Kosins is a Volunteer Clinical Assistant Professor and Dr Daniel is a Volunteer Clinical Professor, University of California, Irvine Medical Center, Irvine, CA. Dr Lambros is a plastic surgeon in private practice in Newport Beach, CA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kosins
authors.affiliation: Dr Kosins is a Volunteer Clinical Assistant Professor and Dr Daniel is a Volunteer Clinical Professor, University of California, Irvine Medical Center, Irvine, CA. Dr Lambros is a plastic surgeon in private practice in Newport Beach, CA.
authors.forename: Val
authors.initials: V
authors.lastname: Lambros
authors.affiliation: Dr Kosins is a Volunteer Clinical Assistant Professor and Dr Daniel is a Volunteer Clinical Professor, University of California, Irvine Medical Center, Irvine, CA. Dr Lambros is a plastic surgeon in private practice in Newport Beach, CA.
authors.forename: Rollin K
authors.initials: RK
authors.lastname: Daniel
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009666:Nose / Q000033:anatomy & histology / Q000601:surgery*; D009903:Optical Illusions; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012904:Smiling / Q000502:physiology*; D055815:Young Adult