Under Projecting Nasal Tip

An underprojecting nasal tip occurs when the measured tip projection is less than 0.67 X ideal nasal length. As in the over-projecting nasal tip, ideal nasal tip projection is based on a "golden" relation with nasal length which in turn is based on proportions to the chin vertical and mid facial height (see analysis and over-projecting tip).

Inadequate tip projection; weak LLC	Inadequate tip projection; weak LLC

A frequently occurring finding in patients with inadequate tip projection is a dorsal hump. The high bridge or dorsum is misleading both aesthetically and structurally. Reduction of the dorsal hump in these instances will result in widened dorsal aesthetic lines, an elongated appearing nose, and a flattened profile. The nasal tip may loose additional projection with the reduction of the dorsum further compromising the outcome. The cause of these catastrophic events often relates to the unrecognized presence of weak lower lateral cartilages (seen above). The lower lateral cartilages support the nostrils and nasal tip. When weak and the tip underprojecting, it is essential to add structural support to this cartilage complex. My preference is to use cartilage grafts taken from the nasal septum. I fix these grafts using sutures in a manner that allows the lower lateral cartilages to be both stabilized and shaped. When tip projection is restored in this manner, minimal lowering of the apparent hump is required.

Byrd HS, Andochick S, Copit S, Walton G: Septal extension grafts: a method of controlling tip projection, rotation, and shape. Plast Reconstr Surg 1997, in press.

Byrd HS: Morphologically prone nasal tip. Operative Techniques in Plastic and Reconstr Surgery Nov 2000, Vol 7(4) pp 208 212