Correction of a Pinched Nasal Tip

The pinched tip, commonly called a “clothespin nose,”

arises not only when the tip cartilages were sutured too tightly in a previous surgery but also when contracture develops,

so the cause must be carefully distinguished; and because the tip cartilages tend to be severely deformed, for example crooked or twisted,

correction is not that simple.

In addition, because of its cause, a pinched tip is often accompanied by notching, in which the alae are drawn upward

and the nostrils are exposed. 

Such pinching and notching can be corrected with an lateral crural strut graft, with good results.

Today we will look at a case in which a pinched tip was corrected with an lateral crural strut graft.

History

3 nasal surgeries at other clinics

1st: 10 years ago, silicone + septal cartilage harvest + tip plasty with septal cartilage + osteotomy (closed approach) 

               ▶High glabella and pointed tip

2nd: 8 years ago, silicone + ear cartilage + septum left as it was (open approach)

               ▶The dorsal silicone was too noticeable

3rd: 5 years ago, removal of the silicone only (closed approach)

CC

Cartilage showing through at the tip and a pinched nose (Pinching)

P/E

In the frontal photo, the blue dotted line marks the original position of the tip cartilages.

During tip plasty these cartilages were drawn together and sutured, which pulled the tip cartilages  toward the center,

so the tip lost its soft curve and pinching resembling a groove (light green) appeared.

The view from below shows the tip narrowed as if pinched. 

The photo above shows contracture with an upturned tip,

accompanied by grooving and depression of the alae.

The red line on the left marks the groove,

and the light green in the photo on the right marks the depressed area.

This shows the ear cartilage harvested for the lateral crural strut graft,

and the photo on the right shows the columellar portion of the tip cartilages deformed asymmetrically.

The pinched tip cartilages have all been released and spread out; this is the state just before the lateral crural strut graft.

The pinched tip has opened out naturally.

The tip, which looked small from being drawn in too tightly, now appears fuller and softer.