Nasal tip support system

Nose is the most prominent portion of face. It is also responsible for the aesthetics of the face. Surgical increase / decrease of projection of nasal tip in relation to face play an important role in the success of rhinoplasty procedures. Anatomically nasal tip area is very complex. Inadvertent damage to the support structure of nasal tip area during surgery will cause disastrous results.

Tripod theory of Anderson: This theory explains the nasal tip supporting mechanisms. Anatomically the two alar cartilages form a functional tripod that supports the nasal tip. The right and left lateral crura comprise the two legs of the tripod, while the two conjoined medial crura forms the third leg. The apex of the tripod is considered to be the tip of the nose. This tripod is supposed to be the major support of nasal tip. Medial crura are shorter than the lateral crura. Tip rotations can take place either due to increase in the length of medial limb or decrease in the height of lateral limbs. These medial crura are further supported by attachments to superior and inferior portions of nasal septum. The nasal tip tripod is considered to be a dynamic unit suspended and supported by surrounding rigid structures. Other major nasal tip supports include:

1. The attachment of medial crural feet to the caudal end of quadrangular cartilage
2. Scroll like attachment of the caudal end of upper lateral cartilage to the cephalic margin of the lateral crura

Tardy’s classification of nasal tip support systems:

According to Tardy there are three major and six minor support mechanisms of nasal tip.

Tardy’s major support mechanisms include:

1. Size, shape, strength and resilience of medial and lateral crura
2. Attachment of medial crural foot plate to the caudal border of quadrangular cartilage
3. Attachment of upper lateral cartilages (caudal border) to alar cartilages (cephalic border).

The six minor support mechanisms are supposed to augment the major support system.

Tardy’s Minor tip support system includes:

1. Ligamentous sling spanning the domes of alar cartilages
2. Dorsal portion of cartilaginous nasal septum
3. Sesamoid complex extending the support of lateral crura to the pyriform aperture
4. Attachment of alar cartilage to the overlying skin and musculature
5. Nasal spine
6. Membranous portion of nasal septum

This classification of support systems of nasal tip is based on clinical experience rather than anatomical models. According to Tardy the tip recoil mechanism can be used to study the contribution made by these different nasal tip support systems.

Janeke and Wright nasal tip support hypothesis:

This hypothesis proposes that fibrous connection between the upper and lower lateral cartilages play a vital role in the nasal tip support mechanism. This is in addition to the support structures suggested by Tardy. According to Wright this fibrous connection between the upper and lower lateral cartilages play a vital role in determining the nasal tip tripod structure.

Figure showing nasal tip support structure

Figure showing nasal tip support from below