Write a short note on nasal tip-plasty/ What are different surgical approaches to nasal tip? What are the indications of nasal tip surgery? What are the complications of nasal tip surgery?

Tip-plasty is surgical surgical procedure performed for deformity of tip of nose with intervention on the roof.

The various surgical approaches to the nasal tip includes the following:

1. Cartilage-splitting approach
2. Tip delivery approach
3. Retrograde approach
4. External rhinoplasty

To achieve tip definition and refinement, it is necessary to narrow nasal tip. The various methods include:

1. Removal of cephalic strip of the lower lateral cartilage
2. Vertical division ± strip excision of lower lateral cartilage
3. Tip suturing
4. Tip grafting

• Approximately 10 mm of lower cartilage should be left insitu to avoid buckling of the cartilage with the formation of bossae.
• The lateral part of the lower lateral cartilage is left intact to maintain the integrity of the nasal valve.

INDICATIONS OF TIP-PLASTY:

The following are the indications of tip plasty:

1. Correction of the over projecting tip: Medial and lateral vertical segment excision is done by transfixation incision/ Goldman vertical dome division.
2. Correction of under projecting nasal tip: Goldman tip-plasty/ only graft/ lateral crus steal/shield graft
3. Management of box shaped or broad nasal tip

COMPLICATIONS OF TIP-PLASTY:

The complications of tip plasty includes:

1. Polybeak deformity
2. Retracted ala
3. Alar asymmetry
4. retracted columella
5. Bossae formation