Open-tip approach: evolutions in rhinoplasty.

Modifications and innovations in open-structure rhinoplasty that have occurred as this technique has evolved are discussed. In addition, the philosophy and fundamentals of open-tip approach in rhinoplasty are reexamined. A retrospective review of representative patients in a hospital practice setting was performed. All surgical procedures were conducted in a department of plastic surgery of the University of Rome Tor Vergata. The preoperative and long-term results of each patient are compared to demonstrate the effectiveness of the described techniques. The fundamental philosophy of open-tip rhinoplasty is the maintenance of the integrity and strength of the nasal skeleton. Modifications of tip grafting techniques, along with additional domal grafting techniques, and a stronger focus on domal suturing techniques result in a softer contour and lack of tip tensions while maintaining structural support.