Rethinking the logic and techniques of primary tip rhinoplasty. A perspective of the evolution of surgery of the nasal tip.

Historically, destructive tip-shaping and positioning techniques, although effective to some degree, have created large numbers of secondary deformities. Tip grafts, necessary in secondary rhinoplasty, have been applied widely in primary rhinoplasty, introducing additional variables and a significant reoperation rate. Nondestructive tip-shaping and positioning techniques offer the surgeon a wider range of alternatives, more control and predictability, and a lower reoperation rate. We are making major changes in the way we think about primary tip rhinoplasty. Most importantly, we are learning (or relearning) that preservation of normal anatomy and structural integrity is a surgical principle epitomized in primary rhinoplasty, and that when we can achieve the desired result using that normal anatomy and preserving its structural integrity, the long-term result is more predictable.