Algorithm for the Treatment of Tip Malformation Combining a Clinical Qualitative Assessment and Specific Closed-Rhinoplasty Techniques Based on Retrospective Analysis of Pellegrini's Fellows 40 Years' Experience.

BACKGROUND: The aesthetic importance of nasal tip and the complexity of its surgical correction make the surgery of this area one of the most fascinating facial surgical procedures. Despite description of different sculpturing techniques to correct nasal tip defects, this surgery remains one of the most discussed and challenging aesthetic procedures. OBJECTIVES: The objective of this study was to define an algorithm of treatment for nasal tip surgery based on 40-year experience on Caucasian patients evaluated by our proposed clinical qualitative assessment, who were treated by closed rhinoplasty. METHODS: We retrospectively reviewed 19,643 Caucasian patients (15,266 females and 4,377 males) who underwent primary closed rhinoplasty from 1979 to 2019 due to different tip defects. The patients were evaluated by volume projection rotation (VPR) assessment. The surgical indications options, long-term aesthetic results and complications were analysed. RESULTS: 22% patients with minimal nasal defects were treated by non-delivery approach and 78% patients with important tip malformation by delivery approach. In all cases, the surgery was performed to reduce tip volume and modify tip projection and rotation based on the specific nasal defects. 67% patients, who needed important reduction of tip projection, were treated by tip-interrupting techniques. 88.7% patients declared full satisfaction after surgery, and only 12.3% needed a requiring minor revision surgery during the 20 years follow-up. CONCLUSION: The proposed algorithm may be a useful tool to plan surgery. The use of an adequate technique depending on the evaluation of volume, projection and rotation may guarantee higher patients satisfaction and a stable long-term aesthetic result. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Spreader graft in closed rhinoplasty: the "rail spreader".

Spreader grafts (SGs) have been widely used for both aesthetic and functional reasons to prevent middle vault collapse and treat internal nasal valve insufficiency. Although SG precise fixation can be easily achieved in open rhinoplasty, the difficulties of SG placement in closed rhinoplasties can be discouraging. In the present report, we describe a new custom-made SG (called "rail spreader") and the personal easy method of application of such graft in "endonasal" rhinoplasty. The technical details and results are reported along with the advantages of our technique over previously described approaches.