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Facial Plast Surg
DOI: 10.1055/a-2764-3319
Original Article

Combining Preservation Concepts and Structural Techniques in Nasal Tip Management: A Practical Approach

Authors

  • Francesco Buttarelli

    1   Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Lombardy, Italy
    2   Department of Plastic and Reconstructive Surgery, Ospedale Sant'Anna, San Fermo della Battaglia, Lombardia, Italy

  • Masoud Saman

    3   Saman Facial Plastic Surgery, Rhinoplasty and Facial Rejuvenation, New York City, New York, United States
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Abstract

Aims and Backgrounds

This article describes the senior author's (M.S.) approach to nasal tip management in primary rhinoplasty, integrating preservation concepts with selective structural reinforcement to enhance long-term stability and refined definition.

Historical Aspects

Over 15 years, the technique transitioned from routine columellar strut grafting, effective early but prone to late ptosis, to a septal-based philosophy centered on the Teostrut and the septal extension graft (SEG), providing more predictable projection control.

Anatomy

Clinical decision-making relies on assessment of skin thickness, lower lateral cartilage strength, and inherent tip support, which together determine the degree of preservation or reinforcement required.

Techniques

The operative approach combines preservation of native support when feasible, controlled strengthening through Teostrut or SEG when indicated, conservative cephalic adjustments, and precise dome–suture modulation. This sequence balances structural stability with aesthetic subtlety while respecting tissue dynamics.

Current and Future Development

Refinements continue to evolve through improved mapping of cartilage responsiveness, integration of regenerative strategies, and advancements in suture-based modulation.

Conclusions and Clinical Relevance

This experience-based approach offers reproducible, stable, and naturally refined results in primary rhinoplasty, emphasizing durable tip support and patient-specific aesthetic goals.

Keywords

preservation rhinoplasty - alar preservation - lower lateral cartilage - structure rhinoplasty

Declaration of GenAI Use

The authors declare the use of generative artificial intelligence (AI) tools during the research and writing process. According to the GAIDeT taxonomy (2025), the following tasks were performed by GAI tools under full human supervision: proofreading and editing, text summarization, and reformatting. GAI tools are not listed as authors and do not bear responsibility for the final content. The authors have reviewed and edited the content and take full responsibility for the final version of the article.




Publication History

Received: 26 November 2025

Accepted: 03 December 2025

Article published online:
18 December 2025

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