Nasal tip projection: counterpoint.

The achievement of tip projection in rhinoplasty has been overemphasized in recent programs and publications. The normal spring support of the tip by the medial crura will ordinarily give adequate tip projection in a well-executed rhinoplasty. If additional tip projection is required, the simplest procedures are advancement of the columella and tip upward on the end of the septum and similar advancement of the alar cartilages toward the bridge. For additional support, a cartilage strut is inserted between the medial crura. Retrusion of the distal nasal complex requires maxillary advancement or support beneath the base of the alae and columella. If a tip graft is required, one achieves a more natural tip by a posterior conchal graft, utilizing its natural curve, rather than by a building-block support.