Rhinoplasty for the Plunging Nasal Tip: Classification & Correction

Lee, Paik Kwon; Song, Jin Kyung; Rhie, Jong Won; Ahn, Sang Tae; Oh, Young Whan

Abstract

Plunging nasal tip is named on all situations with a long and drooping nose at rest. The severity increases with aging. Morphologically, the nose appears to invade the upper lip, which causes cosmetic problems. In more severe cases, the inspired air flow may be disturbed, leading to functional nasal obstruction. Plunging nasal tip is occasionally termed as smiling tip by some authors. We have classified the plunging nasal tip into 3 categories, based on the McCarthy's classification but with modification, which is more suitable for Asians. The study was undertaken with patients whose nasal tip looks like invade the upper lip, even at rest. In Type I(severe type) the nasal septum is long, invading the lip, and with intact attachment of the alar cartilage to the septal angle. Type II(moderate to mild type) is when the loose attachment of the alar cartilage to the septal angle makes the nasal tip appear drooping, but those less severe than type I. In Type III(pseudo type) the location of the nasal tip is relatively appropriate but, due to maxillary protrusion, the tip looks as if it covers the upper lip. The open rhinoplasty technique was applied regardless of the classified type. Dorsal augmentation, tip plasty, interdomal suture of alar cartilage or detatchment of depressor septi nasi muscle were selectively used when required in all patients. In type I, the removal of caudal septum, cephalic lateral crus resection, anchoring suture of the alar cartilage on the septal angle, and columella strut were concomitantly undertaken. The resection of the cephalic lateral crus, anchoring suture of the alar cartilage on the septal angle and columella strut were applied in type 2. Cephlic lateral crus resection and columella strut were done in type 3. We have made a follow up on 13 patients for up to 6.5 years, who had undergone surgery between March, 1993 to september, 2001. We could get excellent results with no definite re-drooping of nasal tip in all cases.