Evaluation of Nasal Tip Definition in Rhinoplasty

Background: The appropriateness of closed rhinoplasty has frequently been called into question in an era of superior aesthetic results with open techniques. A pattern a poor tip definition was noted in a series of closed rhinoplasty procedures. It was hypothesized that closed rhinoplasty performed to correct simple dorsal hump abnormalities lead to poor tip definition post-operatively in those that had pre-existing tip abnormalities.

Aim: To evaluate nasal tip definition in a series of closed rhinoplasty patients.

Methods: Thirty patients who underwent primary closed rhinoplasty by a single surgeon were photographed for this study over a 8 year period. Nasal analysis was assessed using four standard anthropometric measurements (nasolabial angle, columellar-lobular angle, tip projection  and supratip break) using post-operative photographs.

Results: Thirty patients who underwent primary closed rhinoplasty by a single surgeon were included in this study. The mean nasolabial angle in this series was 104°. The mean columellar-lobule angle was 29° and the mean tip projection was found to be 0.63. The mean supratip break was 175. Upon analysis of a panel of all the post-operative photographs, It was clear that there was a definite pattern of lack of tip definition.

Conclusion: The panel of photographs which display the aesthestic outcomes in closed rhinoplasty show a clear lack of tip definition. This lack of definition can be largely attributed to the loss of dome of the nose. In a era of rapidly evolving and increasingly specialised rhinoplasty techniques, we must call into question the appropriateness of performing closed rhinoplasty in view of these results. Although it would seem that performing closed rhinoplasty for simple dorsal hump abnormalities is an optimal surgical approach as it is relatively straight forward with short operative times, it may not be suitable if the patient displays any pre-existing tip abnormalities. Therefore we must conclude that indications for closed rhinoplasty are diminishing.