Algorithm of Surgical Deprojection Techniques
and Introduction of Medial Crural Overlay
Peyman Soliemanzadeh, MD; Russell W. H. Kridel, MD
Objectives: To discuss the evaluation of the overprojected
nasal tip, present an algorithm of various treatments
for deprojection of the nasal tip, and introduce our
experience of greater than 10 years with medial crural
overlay.
Design: Retrospective review of a large sequential series
of patients undergoing rhinoplasty who were treated
with various deprojection techniques by the senior author
(R.W.H.K.) from January 1, 1991, through December
31, 2002. Patients underwent preoperative and postoperative
evaluation during this period on a regular basis
to record the effects of various approaches on nasal projection,
rotation, need for revision, and patient satisfaction.
Medical records and photographic documentation
were reviewed. The occurrence of postoperative complications
and secondary revision procedures were noted.
We used the information obtained to evaluate and expound
on an algorithmic paradigm for treatment of nasal
tip overprojection.
Results: From 1991 to 2002, 130 cases used 1 or more
of the senior author’s preferred methods for deprojection.
Ten patients were excluded owing to the primarily
reconstructive nature of their surgery. Of the remaining
120 patients, 3 (2.5%) underwent minor revision of dorsal
irregularities and another 5 (4.2%) underwent tip revision.
Only 9 patients (7.5%) required concomitant alar
base reduction. One patient had postoperative epistaxis,
and there were no cases of postoperative functional
complaints.
Conclusions: Deprojection of the overprojected nasal
tip can be accomplished successfully with a handful of
properly used techniques. Once proper analysis has been
accomplished, an algorithm can be used to help simplify
the approach to deprojection. These techniques offer
sound functional approaches to effect deprojection
while controlling the level of rotation. The beneficial effects
observed using this algorithm are attested to by the
minimal number of complications, the relatively low number
of patients requiring revision, and the overall longterm
patient satisfaction with their results.
