Tip Refinement Case Study 2
Video transcript: This is a case study where we are doing a hump reduction and refinement of the nasal tip. In the rhinoplasty pre operative assessment you can see that the tip of the nose is somewhat broad and a little bit square shaped or boxy. The skin over laying the tip is medium in thickness and that is important because some of the manoeuvres we use to narrow the tip are appropriate in thick skin but not in thin skin. In medium skin there are various options for us in terms of narrowing the tip, so my recommendation for her was in addition to the hump reduction was to perform a cephalic trim of her tip cartilages and dome defining stitches and I will show you what that looks like.
On side view we want to take away some of her dorsal hump but otherwise her tip position was good and that is different that defining the tip I think it was rotated away from the lip appropriately so I didn’t really want to change the position but on front view I wanted to narrow it a little bit. In terms of the hump reduction as I have shown you in previous videos we basically took down a little of the bone and cartilage that formed her hump.
On front view this is a diagram sort of illustrating the nasal tip cartilages and where they sit so we want to narrow those and define them and the way I do that in her case is by removing the back hedge of the tip cartilages that is called the cephalic margin so we do what is called a cephalic margin trim. That cartilage is removed to make the cartilages thinner and in addition to that I want to reposition them so they are narrower and they have a more acute apex. So the way we do that is to take the cephalicly trimmed cartilages which are now narrower and reposition them so that they form more of an apex or more of a pyramid and that is done by applying stitches to the apex of the cartilage or the dome area and that’s why we call it a dome defining stitch. It changes her broad cartilages into narrow more defined cartilages.
You will see before and after the position of the under lying cartilages changes from wide to narrow and from splayed open to pinched or a more acute angle and that’s the way the cartilages would look skematically underneath the skin. In the actual result she looks like this she goes from having a fairly boxy nasal tip to a much more narrow and defined tip and you will see that on her other views as well that her tip is no longer sort of boxy and protruding through the skin like that it is much softer and narrower, and then again you can see on her profile view that her bridge has been taken down so overall her nose look a little smaller and more refined.
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