The Boxy Nasal Tip: Classification and Management Based on Alar Cartilage Suturing Techniques

• Published in: Plastic and reconstructive surgery (1963) Vol. 107; no. 7; pp. 1849 - 1863
• Main Authors: Rohrich, Rod J, Adams, William P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Society of Plastic Surgeons 01-06-2001; Lippincott Williams & Wilkins
• Subjects: Adult; Biological and medical sciences; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Medical sciences; Nasal Septum - surgery; Rhinoplasty - methods; Skin plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Suture Techniques; Human; Nose tip; Anatomical variation; Indication; Treatment efficiency; Plastic surgery; Suturation; Algorithm; Aesthetic perception; Cartilage; Morphological classification; Treatment; Surgery; Surgical approach; Ala nasi; Application method; Technique; Rhinoplasty
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/00006534-200106000-00034

The boxy nasal tip is characterized by a broad, rectangular appearance of the tip lobule on basal view. This manifests anatomically as one of three typestype I, which features an increased intercrural angle of divergence (greater than 30 degrees) and normal domal arc (4 mm or less) manifesting as the tip-defining points; type II, which features an increased angulation of the domes of the lower lateral segments of cartilage, creating a widened domal arc (greater than 4 mm) and normal angle of divergence (30 degrees or less); and type III, which features a combination of increased angle of divergence (greater than 30 degrees) and widened crural domal arc (4 mm or greater). In this article, the available techniques for correction of the boxy tip are reviewed and an algorithmic approach for the management of this problem is demonstrated using the open approach to rhinoplasty. Using an individualized algorithmic approach with intraoperative nasal tip analysis and three nasal tip suture reshaping techniques, consistent aesthetic results can be obtained in the correction of the boxy nasal tip. (Plast. Reconstr. Surg. 1071849, 2001.)