Nasal tip overprojection: algorithm of surgical deprojection techniques and introduction of medial crural overlay.

OBJECTIVES To discuss the evaluation of the overprojected nasal tip, present an algorithm of various treatments for deprojection of the nasal tip, and introduce our experience of greater than 10 years with medial crural overlay. DESIGN Retrospective review of a large sequential series of patients undergoing rhinoplasty who were treated with various deprojection techniques by the senior author (R.W.H.K.) from January 1, 1991, through December 31, 2002. Patients underwent preoperative and postoperative evaluation during this period on a regular basis to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction. Medical records and photographic documentation were reviewed. The occurrence of postoperative complications and secondary revision procedures were noted. We used the information obtained to evaluate and expound on an algorithmic paradigm for treatment of nasal tip overprojection. RESULTS From 1991 to 2002, 130 cases used 1 or more of the senior author's preferred methods for deprojection. Ten patients were excluded owing to the primarily reconstructive nature of their surgery. Of the remaining 120 patients, 3 (2.5%) underwent minor revision of dorsal irregularities and another 5 (4.2%) underwent tip revision. Only 9 patients (7.5%) required concomitant alar base reduction. One patient had postoperative epistaxis, and there were no cases of postoperative functional complaints. CONCLUSIONS Deprojection of the overprojected nasal tip can be accomplished successfully with a handful of properly used techniques. Once proper analysis has been accomplished, an algorithm can be used to help simplify the approach to deprojection. These techniques offer sound functional approaches to effect deprojection while controlling the level of rotation. The beneficial effects observed using this algorithm are attested to by the minimal number of complications, the relatively low number of patients requiring revision, and the overall long-term patient satisfaction with their results.