The asymmetrical nasal tip in primary rhinoplasty

An analysis of nasal tip asymmetry is proposed that focuses on intrinsic deformities of the lower lateral cartilages. Three types of intrinsic deformities of the lower lateral cartilages are recognized that result in asymmetrical domal projection and lateral domal deviation. The most common deformity involves ipsilateral middle crural convexity and contralateral concavity. The second problem is caused by different lengths of paired medial crura. The third form of tip asymmetry is caused by a unilateral splayed lower lateral cartilage that is further from the anatomic midline than the opposite lower lateral cartilage. The use of suturing techniques and occasional grafts to restore nasal tip symmetry is described in each of the three scenarios.