title: Quantifying Changes in Nasal Tip Support.
abstract: OBJECTIVE
  Imparting surgical change to the nasal tip remains one of the most challenging aspects of rhinoplasty. The surgeon must assess the tip preoperatively and execute the necessary maneuvers to impart the desired change.
  
  
  OBJECTIVE
  To assess nasal tip resistance to compression in a cadaveric model before and after specific rhinoplasty maneuvers using a novel method.
  
  
  METHODS
  Open rhinoplasty maneuvers were performed at an academic tertiary care center on 6 fresh-thawed cadaver heads. Assessment of tip support was performed with a motorized, computer-controlled test stand equipped with a digital load cell. Tip support was assessed by compression to a depth of 2.5 mm from contact both preoperatively and after each surgical maneuver. All force data were recorded in pound-force and converted to newtons (N) following analysis.
  
  
  METHODS
  Nasal tip support, measured as resistance to compression, before and after various rhinoplasty maneuvers.
  
  
  RESULTS
  Following the elevation of the skin-soft-tissue envelope with septoplasty, resistance to compression (1.82 N) was not significantly different from the preoperative assessment (1.60 N for all specimens). Tip support following placement of a caudal extension graft was significantly different from all other conditions (3.16 N; P < .01), showing support increased by more than 66% from preoperative assessment. Placement of columellar strut (1.28 N) did not show significant increase in tip support. Tip support was decreased slightly after placement of intradomal sutures, which was significant (1.22 N; P < .01).
  
  
  CONCLUSIONS
  This study demonstrates the use of materials testing equipment to assess and quantify change in tip support after several rhinoplasty maneuvers. Minor supporting maneuvers that rely on healing and scar do not significantly alter tip support in a cadaveric model. Caudal extension graft is an important maneuver imparting significant effect on nasal tip support.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Willson
authors.affiliation: Department of Health Education and Training, Tripler Army Medical Center, Honolulu, Hawaii.
authors.forename: Tyler
authors.initials: T
authors.lastname: Swiss
authors.affiliation: Texas Facial Plastic Surgery and ENT, San Antonio4Uniformed Services University of the Health Sciences, Bethesda, Maryland5University of Texas Health Science Center, San Antonio.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Barrera
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D019245:Compressive Strength; D005240:Feasibility Studies; D006801:Humans; D055171:Nasal Cartilages / Q000502:physiology / Q000601:surgery; D009300:Nasal Septum / Q000502:physiology / Q000601:surgery; D009666:Nose / Q000502:physiology* / Q000601:surgery; D012225:Rhinoplasty / Q000379:methods*; D016474:Weight-Bearing