Comparison of techniques used to support the nasal tip and their long-term effects on tip position.

Objectives: To examine the indications for the use of septal extension grafts, columellar struts, and tongue-and-groove techniques to provide support and set the tip position during rhinoplasty, and to compare the strength of their support and analyze their long-term effects on tip position.

Methods: The medical records and photographs of patients who underwent external septorhinoplasty during a 2-year period were analyzed. Forty patients had photographs from short-term follow-up (<12 weeks) and were included in the study. The short-term and long-term (>52 weeks) tip positions were compared to determine the maintenance of tip position with each technique. Each stabilization technique was performed on 5 fresh cadavers, and the resistance to displacement of the tip was measured and compared.

Results: Objective measurements in the cadaver analysis show increased resistance to tip displacement with the use of caudal septal extension grafts and tongue-and-groove techniques. There was no difference in the maintenance of tip position between the techniques in analysis of the patients who have undergone rhinoplasty.

Conclusions: Many factors influence the maintenance of tip position in patients who have undergone rhinoplasty. One should consider using a stabilization technique to help resist displacement of the nasal tip. Clinical and operative findings, as well as secondary effects, are used to help determine which technique should be used.