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Page 2 of 13 Randall et al. Plast Aesthet Res 2024;11:18 https://dx.doi.org/10.20517/2347-9264.2023.115

Differences in the nasal tip, a major subunit of the nose, can result in significant nasal obstruction and
noteworthy undesirable nasal shape and appearance. As such, the intricacies of nasal tip surgery lie in its
dual requirement of fulfilling aesthetic desires while preserving or enhancing nasal function. The delicate
balance between these objectives necessitates a thorough understanding of the underlying anatomical
structures and their interplay. Historically, ablative techniques incorporating reduction or division of the
[2]
osseocartilaginous framework were used . However, in recent years, there has been a shift toward
preserving natural nasal anatomy. This has been achieved through cartilage-sparing techniques and by
augmenting areas that lack volume in order to correct irregularities in shape and provide additional
support . The functional importance and aesthetic prominence of the nasal tip, therefore, warrants
[3]
significant consideration before, during, and following any rhinoplasty. Whether through tip enhancement,
reduction, or simply ensuring that tip support is maintained, every surgical approach to the nose must
address the nasal tip.

Support for the nasal tip consists of the structure, shape, and attachments of the cartilage and soft tissue
structures that are housed therein - namely the bilateral lower and upper lateral cartilages and the nasal
septum. The complexity of the nasal tip support structures is reflected in the challenging, though rewarding,
undertaking of tip reduction, enhancement, or repair. As the approach to the nasal tip is varied and
intricate, nasal tip surgery is fraught with challenges. The pursuit of ideal nasal tip aesthetics can give rise to
postoperative deformities such as nasal tip asymmetries, bossae, and alar retraction. These are all
well-documented complications that can occur as a result of over-resection of the tip cartilages or failure to
support weakened lower lateral cartilages during rhinoplasty. This lack of support can have negative
consequences, both in the appearance of the nose, and the patency of the external and internal nasal valves.
Over the years, many techniques have been refined to address these complex nasal tip complications, each
with its distinctive set of advantages, limitations, and learning curves. This review outlines the most
common causes, prevention strategies, and treatment approaches to these prevalent rhinoplasty nasal tip
complications. By delving into a thorough assessment of academic literature, this review aims to provide a
comprehensive understanding that may steer surgeons toward making informed decisions during surgical
planning and execution, ultimately elevating patient outcomes and satisfaction in nasal tip surgery.

METHODS
A comprehensive literature review was conducted to identify relevant data previously published on the
causes, prevention, and treatment of nasal tip asymmetry, nasal bossae, and alar retraction.
PubMed/MEDLINE database was searched using the following terms in multiple combinations:
Rhinoplasty, asymmetry, rhinoplasty complications, nasal tip, nasal bossae, alar retraction, revision
rhinoplasty, secondary rhinoplasty, and postoperative complications. Results from the past 30 years were
included. This search yielded 194 results. Non-English articles were excluded. Two of the authors separately
reviewed the results of the search for articles that focused on the pertinent nasal tip complications for
inclusion in this review.

RESULTS
A total of 66 articles were identified that offered high-quality data pertaining to the causes, prevention,
and/or treatment of nasal tip asymmetry, nasal bossae, and alar retraction. The potential causes, techniques
for prevention, and strategies for the management of these potential rhinoplasty complications will be
reviewed individually.