Concomitant Overlap Steal Tip-plasty: A Versatile Technique to Simultaneously Adjust the Rotation, Definition, Projection, and Symmetry of the Nasal Tip.
BACKGROUND
Tip-plasty is a particularly challenging stage of aesthetic nose surgery. The diversity of nasal tip deformities has necessitated the development of numerous surgical techniques that can be difficult to master and may yield unpredictable surgical results when combined.


OBJECTIVE
The authors describe how concomitant overlap steal tip-plasty (COST) can enable surgeons to address all of the aesthetic characteristics of the nasal tip simultaneously. COST involves lateral crural steal followed by medial crural overlap.


METHODS
The medical records of 1617 patients who underwent primary open septorhinoplasty with COST were evaluated in a retrospective study. Pre- and postoperative patient photographs were compared for nasal length, nasolabial angle, tip projection, and deviation of the nasal axis.


RESULTS
Pre- and postoperative mean nasal lengths were 5.66 cm and 5.17 cm, respectively (P < .05). The mean nasolabial angle was 86.95° preoperatively and 101.8° postoperatively (P < .05). The projection of the nasal tip was reduced from 3.09 cm to 2.53 cm, and tip symmetry was achieved by decreasing the nasal axis deviation from 7.76° to 1.71° (both P < .05).


CONCLUSIONS
COST does not obviate all other tip-plasty techniques for specific situations. Once mastered, however, COST can become the only procedure needed to achieve all of the aesthetic goals of the nasal tip in most cases. LEVEL OF EVIDENCE 4: Therapeutic.
Dr Ali Manafi is an Associate Professor, Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran. Dr Ahmadreza Rajaee is an Assistant Professor, Department of Otolaryngology, International Branch of Shiraz University of Medical Sciences, Shiraz, Iran. Dr Amir Manafi is a Research Fellow in Digestive Oncology, Tehran University of Medical Sciences, Tehran, Iran.
Ali
A
Manafi
Dr Ali Manafi is an Associate Professor, Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran. Dr Ahmadreza Rajaee is an Assistant Professor, Department of Otolaryngology, International Branch of Shiraz University of Medical Sciences, Shiraz, Iran. Dr Amir Manafi is a Research Fellow in Digestive Oncology, Tehran University of Medical Sciences, Tehran, Iran.
Ahmadreza
A
Rajaee
Dr Ali Manafi is an Associate Professor, Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran. Dr Ahmadreza Rajaee is an Assistant Professor, Department of Otolaryngology, International Branch of Shiraz University of Medical Sciences, Shiraz, Iran. Dr Amir Manafi is a Research Fellow in Digestive Oncology, Tehran University of Medical Sciences, Tehran, Iran.
Amir
A
Manafi
D000293:Adolescent; D000328:Adult; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000002:abnormalities / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000175:diagnosis / Q000601:surgery*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D012399:Rotation; D016896:Treatment Outcome; D055815:Young Adult