Correction and prevention of tip asymmetries, bossae, and alar retraction

Abstract

Secondary rhinoplasty to address complications from initial surgical intervention is a technically challenging operation. Common aesthetic complications that plague patients after primary rhinoplasty include nasal tip asymmetries, bossae, and alar retraction. These adverse outcomes are usually a result of over-manipulation and/or over-excision of native cartilage and are especially prevalent in patients with thick lower lateral cartilages and thin nasal skin. Techniques to minimize tissue handling, maintain natural nasal anatomic support and structure, and soften sharp edges from cartilage grafts or incisions are all essential in the prevention of nasal tip irregularities. In addition to prevention, there are many operative and procedural interventions to correct tip asymmetries, bossae, and alar retraction. These interventional corrections include varying cartilage and/or fascial grafts, camouflaging of previously performed grafts, and repositioning of the alar cartilage.

Keywords

Secondary rhinoplasty / complications / bossae / nasal tip asymmetry / alar retraction

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