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Increasing nasal tip angle during rhinoplasty can be used to treat plunging tip illusion

By increasing the nasal tip angle, surgeons successfully treated plunging tip illusion in 22 women without the need for cutting columellar base muscles.

The study included 25 female rhinoplasty patients who complained of a nasal tip that plunged while smiling. Preoperative and 1-year postoperative photographs were taken to mark the different nasal angles at rest and while smiling.

An open technique with insertion of a columellar strut was used in 24 of 25 patients. Additionally, 24 of the 25 patients received domal creation sutures. Caudal septal excisions were performed in 23 of the patients, with an average of 4.4 mm. A tip position suture was performed in 14 patients, five patients received a tip graft and one patient underwent a tongue-in-groove maneuver. Two patients were adamant they did not want their tips rotated significantly above 90° and were therefore included as part of the three-patient control group.

Tip angle, nasolabial angle and columellar-inclination angle decreased upon smiling preoperatively by an average of 10.9°, 11.8° and 11.9°, respectively, in 22 of the patients with a plunging tip. Tip position also decreased, negating the illusion of a plunging tip, by an average of 0.9 mm on smiling, according to the researchers.

After the procedure, all patients who were treated for a plunging nasal tip on smiling no longer appeared to plunge while smiling. Two patients who continued to experience a plunging tip requested no change in tip rotation, the researchers reported.

The researchers concluded the illusion of a plunging nasal tip was able to be addressed by increasing the tip angle so the nasal tip lies above the alar crease junction in repose without muscle excision. - by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.