The Interface of Form and Function in Tip Rhinoplasty

Today’s rhinoplasty video blog is about the lateral wall of the nasal tip. That refers to the area just above the nostril. This is an area that is both important for appearance and function of the nose. Rhinoplasty is obviously an operation where we want to preserve function while improving appearance. Nowhere in the nose is this more relevant than on the lateral wall of the tip. This illustration highlights the importance of a soft triangular shape of the nasal tip. You can see at this base view that the tip is relatively narrow and the base is relatively wide. In order to establish this triangularity the side wall has to be straight and supported. This area of the sidewall refers to the lateral wall of the nasal tip. The lateral crural strut graft is a very useful, structural rhinoplasty technique that allows the cartilage that forms the lateral wall of the tip to form a straight orientation. In this patient example, you can see collapsed lateral walls on both sides creating both appearance problems and breathing problems. The lateral crural strut graft was placed to create a more triangular tip so that the contour goes from a curved contour to a straighter contour, allowing the nose to take on a more pleasing triangular shape, a more refined appearance and a better functioning nose.

This additional case presentation is another example. This individual had some collapse more so on one side than the other. This was leading to significant airway obstruction in the right nostril. That collapse corresponds to the pinching on the lateral wall of the tip on this side, leads to this harsh shadow that you can see isolating the tip and making the tip look prominent. This is the before and after surgical photograph from the frontal view. You can see the shadow is gone, the tip is more even, there is a softer more triangular shape which you can really see from this base view. Because the lateral wall has been supported, the tip is able to be strengthened and repositioned. The triangular shape results create significant improvement. During this surgery I also performed maneuvers to shorten the limbs of the cartilages that formed the tip, that allowed me to shorten the tip back towards the face and deproject the nose into a position that created more balanced profile.

The clinical case I reviewed is a great example of where form meets function in rhinoplasty. Ideally, all rhinoplasty should lead to an outcome that looks better but also functions at least as good as it did prior to surgery. In the lateral wall of the tip, the side wall between the tip and the base of the nose, that area represents a significant portion of the nose in which form and function work together. A straight triangular shape, with a good transition between the tip and the base is necessary in order to have a good appearance as well as a functioning nose