Sunday, October 10, 2004

Algorithm for Correction of Nasal Tip Ptosis

Ali Sajjadian, MD, Ramtin Kassir, MD, and Siamk Agha Mohammadi, Md, PhD.

Correction of nasal tip ptosis requires accurate diagnosis, and planning specific strategy based on the interplay between various anatomic aspects of the nasal tip.

Pre and postoperative results of 42 patients with nasal tip ptosis that have undergone rhinoplasty were critically evaluated. Mean follow up was 18 months. Using computer imaging methods (University of Pittsburgh Facial Landmark Software), objective assessment of the patients were performed, measuring the pre and post-operative exact position of tip defining points, nasion, anterior nasal septal angle, nasofacial angle, Goode ratio, the degree of nasal tip rotation, and projection. Based on these pre and post-operative data, the degree of correction of nasal tip ptosis was determined. An algorithm is developed and presented to predictably and reliably correct nasal tip ptosis using available surgical techniques. Depending on the anatomy of the lower lateral cartilages, and the degree of rotation and projection, various maneuvers can be utilized to correct the ptosis.

If the nasal length is excessive, either the caudal septum is conservatively resected and/or the medial crus is advanced and sutured to the septum, thereby making the nasal rotation and length more aesthetic.

If the etiology of the nasal tip ptosis is abnormal morphology or orientation of the lower lateral cartilages, correction included reshaping, repositioning and rotating of the alar cartilages in a more cephalic position.

In cases of extrinsic forces causing inferior positioning of the alar cartilages, the exact cause is diagnosed and these inferiorly displacing forces are altered or are eliminated. By creating a tissue void in specific areas of the nose, the tip is allowed to rotate superiorly as the healing process is completed.

If the projection is inadequate lateral crural steel technique or a variety of tip grafts can be used to increase the projection while increasing the tip rotation. However, if the tip is over projected, the lower lateral cartilage is overlapped or the intermediate dome is partially resected and resutured and the scroll is modified to improve the rotation.

The algorithm presented here for correction of nasal tip ptosis using these objective pre-operative parameters and measurements would be an excellent research and clinical tool in precise diagnosis and treatment of nasal tip ptosis.