Functional Outcomes of Structured Nasal Tip Refinement

Objective: To describe a technique to refine the nasal tip and supratip while preserving structure; traditional attempts to reduce nasal tip bulbosity involve maneuvers that may result in loss of support, leading to poor functional and cosmetic outcomes. Methods: A prospective study of patients undergoing open structure nasal tip refinement using scroll joint excision with a septal-lateral crural suture to flatten the lateral crus. Outcomes assessed were nasal peak inspiratory flow (NPIF), nasal obstruction scores, 22-item Sinonasal Outcome Test (SNOT-22), 36-item Short-Form questionnaires (SF-36), and anchor scores for breathing and cosmesis. Results: The mean NPIF improved from 100 L/min to 139 L/min, nasal obstruction improved, and the mean (SD) SNOT-22 scores improved from 1.45 (0.86) to 0.63 (0.65) (P<.01 for all comparisons). All patients had improved cosmesis, and 2.2% had both subjectively and objectively impaired nasal breathing. Conclusions: A technique is described allowing refinement of the nasal tip while maintaining or improving the nasal airway and providing a high level of patient satisfaction with the aesthetic outcome. Even in patients seen for cosmetic rhinoplasty, there may be a degree of preoperative nasal obstruction that should be recognized and addressed.