![]() Essentially, it is a perpendicular measurement from the tip defining points to the nasal-alar crease (8). There are several definitions used to describe nasal tip projection. In addition, there are several minor tip-support mechanisms have been described, which include, the dorsal cartilaginous septum, the interdomal ligaments, the membranous septum, the nasal spine, the surrounding skin and soft tissues and the alar side walls (2,6). Generally, major tip support includes 1) the size, shape and resiliency of medial and lateral crura, 2) the attachment of the medial crural footplates to the caudal septum, and 3) soft-tissue attachment of the caudal margin of the upper lateral cartilages to the cephalic margin of the lower lateral cartilages (2,6). ![]() This emphasized the importance of the extensive ligamentous attachments between the crural cartilages (5,6,7). The “tripod concept” was then described, which relates the medial and lateral crura to projection and rotation of the nasal tip (4,5). Major tip-support mechanisms were first described by Janeke and Wright which have been further studied (3). Nasal tip support has been classified into two categories, major and minor groups. These include chin projection, upper lip height, nasolabial angle, dorsal height, nasofrontal angle and other physical characteristics (2). Aside from the nasal anatomy, the perception of nasal tip projection is influenced by many factors. The patient’s aesthetic goal must be carefully balanced with the maintenance of functional support since any procedure that reduces tip projection narrows the nasal valve and reduces air flow. It is important from a cosmetic point for facial harmony but also functionally for adequate air entry. Nasal tip projection is important for both aesthetic and functional reasons. The goal of the nasal aesthetic surgeon is to use his or her judgment to try and achieve the patient’s goals and optimize the aesthetics of the nose. Surgical correction of the nasal tip is most difficult and the least predictable component of rhinoplasty surgery. The overprojected nasal tip, commonly referred to as the “Pinocchio” nose, is a relatively uncommon but challenging deformity (1). Authors Dr Amy Mabini, Dr Richard Rival, Dr Phillip Solomon
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