Under-Projected Tip

Achieving and maintaining nasal tip projection and rotation in the under-projected nose is the key to a good aesthetic surgical outcome. Various techniques and devices are available to increase tip projection and/or rotation, including columellar struts, lateral crural steal techniques, a variety of tip onlay grafts, septocolumellar suture, and septocolumellar strut. It is very challenging to increase and maintain nasal tip projection in some noses. This must be explained to the patient preoperatively; the patient’s expectations regarding the extent to which the tip can be defined must be realistic to avoid disappointment. The surgical procedure must be planned only after it is determined that the patient is a good candidate who understands what can be realistically achieved.