Studies on the support of the nasal tip.

Anatomical studies on the nasal tip indicate four major areas of tip support: (1) the fibrous connection between upper and lower lateral cartilages; (2) the sesamoid complex extending the support of the lateral crus to the pyriform opening; (3) the ligamentous sling spanning between the paired domes of the lower lateral cartilages; and (4) the attachment of the feet of the medial crura to the posterior caudal septum. Routine rhinoplasty procedures compromise tip support predisposing to postoperative tip sagging (Pollybeak); however, tip rhinoplasty procedures can be modified to maintain tip support and projection by: high transfixion through the caudal cartilaginous septum confirming septal shortening to the anterior caudal septum, embricating the membranous septum over the anterior caudal septum, utilizing a cartilaginous strut, between and below the medial crura, or reestablishing the medial cruraposterior caudal septum anchorage.