The domes crossover: a new method of nasal tip modification.

Objectives: To discuss overprojected nasal tips, to overview treatment options, and to introduce a new method of nasal tip modification.

Patients and methods: A retrospective study was conduced on 29 patients who underwent rhinoplasty where the domes crossover technique was employed. Patients were stratified into 3 groups: 18 patients presented with homogeneous overdevelopment of the LLC (nasal tip over projection type 1), 5 patients with predominant over development of the lobular portion of the LLC (nasal tip overprojection type 2), 6 patients with a true Pinocchio-type nose and a predominant overdevelopment of the columellar portion of the LLC (nasal tip overprojection type 3). Before and after photographs were compared to evaluate nasal tip characteristics. Analysis of results was performed by the use of 3 measurements: Goode's ratio, nasofacial angle and lobule-to-columella ratio.

Results: Final nasal tip projection, rotation, volume and shape were satisfactory in all cases. No complication was observed during the follow-up period.

Conclusion: This new method of nasal tip modification presents the advantage of preserving natural domes, being quick and allowing the achievement of desirable nasal tip projection, rotation, volume and shape. Moreover according to the alar ring concept, the crossover technique preserves the continuity of the inferior cartilaginous arch and gives an excellent support to nasal tip.