{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:12:17Z","timestamp":1790712737009,"version":"4.1.0"},"reference-count":16,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2006,5,1]],"date-time":"2006-05-01T00:00:00Z","timestamp":1146441600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Facial Plast Surg"],"published-print":{"date-parts":[[2006,5,1]]},"abstract":"<jats:p>Control of nasal tip contour has always been a key component of a successful rhinoplasty. Typically, this procedure is performed with an emphasis on narrowing the nasal tip structure. Creating a natural-appearing nasal tip contour is a complex task and requires a 3-dimensional approach. In an effort to identify the characteristics that make an ideal nasal tip, I evaluated numerous aesthetically pleasing nasal tips. After extensive study, I created a series of images to demonstrate how specific contours create highlights and shadows that will help guide the surgeon in creating a natural-appearing nasal tip contour. Many commonly used nasal tip techniques can pinch the tip structures if an overemphasis is placed on narrowing. These changes isolate the dome region of the nasal tip and can create an undesirable shadow between the tip lobule and alar lobule. Prior to contouring the nasal tip, the surgeon must stabilize the base of the nose with a columellar strut, suturing the medial crura to a long caudal septum, caudal extension graft, or an extended columellar strut graft. Stabilizing the nasal base will ensure that tip projection is maintained postoperatively. To contour the nasal tip, dome sutures are frequently used to flatten the lateral crura and eliminate tip bulbosity. Placement of dome sutures can deform the lateral crura and displace the caudal margin of the lateral crura well below the cephalic margin. This can result in a pinched nasal tip with the characteristic demarcation between the tip and the alar lobule. Alar rim grafts can be used to support the alar margin and create a defined ridge that extends from the tip lobule to the alar lobule. This form of restructuring can create a natural-appearing nasal tip contour with a horizontal tip orientation continuing out to the alar lobule. When dome sutures alone are inadequate, lateral crural strut grafts are used to eliminate convexity and prevent deformity of the lateral crura. Shield tip grafts can be used in patients with thick skin and an underprojected nasal tip. Whenever a shield tip graft is used, it must be appropriately camouflaged to avoid undesirable visualization of the graft as the postoperative edema subsides. When contouring the nasal tip, the surgeon should focus more on creating favorable shadows and highlights and less on narrowing. Nasal tips contoured in this manner will look more natural and will better withstand the forces of scar contracture that can negatively affect rhinoplasty outcomes.<\/jats:p>","DOI":"10.1001\/archfaci.8.3.156","type":"journal-article","created":{"date-parts":[[2006,5,15]],"date-time":"2006-05-15T16:42:44Z","timestamp":1147711364000},"page":"136-185","source":"Crossref","is-referenced-by-count":311,"title":["New Concepts in Nasal Tip Contouring"],"prefix":"10.1177","volume":"8","author":[{"given":"Dean M.","family":"Toriumi","sequence":"first","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery, University of Illinois at Chicago."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2006,5,1]]},"reference":[{"key":"e_1_3_2_2_2","volume-title":"Rhinoplasty: The Art and the Science","author":"Tardy ME","year":"1996","unstructured":"Tardy ME. Rhinoplasty: The Art and the Science. Philadelphia, Pa: WB Saunders Co; 1996"},{"key":"e_1_3_2_3_2","volume-title":"Aesthetic Rhinoplasty","author":"Sheen JH","year":"1987","unstructured":"Sheen JH, , Sheen AP. Aesthetic Rhinoplasty. 2nd ed. St Louis, Mo: CV Mosby; 1987"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199202000-00002"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.fsc.2004.07.004","article-title":"Structure approach in rhinoplasty","volume":"13","author":"Toriumi DM","year":"2005","unstructured":"Toriumi DM. Structure approach in rhinoplasty. Facial Plast Surg Clin North Am. 2005; 13:93-113. 15519931","journal-title":"Facial Plast Surg Clin North Am"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1097\/00006534-199603000-00026","article-title":"Classification and correction of alar-columellar discrepancies in rhinoplasty","volume":"97","author":"Gunter JP","year":"1996","unstructured":"Gunter JP, , Rohrich RJ, , Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg. 1996; 97:643-648. 8596800","journal-title":"Plast Reconstr Surg"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200003000-00049"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000091424.69765.0C"},{"key":"e_1_3_2_9_2","volume-title":"Open Structure Rhinoplasty","author":"Johnson CMJ","year":"1989","unstructured":"Johnson CMJ, , Toriumi DM. Open Structure Rhinoplasty. Philadelphia, Pa: WB Saunders Co; 1989"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199501000-00006"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1001\/archfaci.1.4.246","article-title":"The tongue-in-groove technique in septorhinoplasty: a 10-year experience","volume":"1","author":"Kridel RWH","year":"1999","unstructured":"Kridel RWH, , Scott BA, , Foda HMT. The tongue-in-groove technique in septorhinoplasty: a 10-year experience. Arch Facial Plast Surg. 1999; 1:246-256. 10937111","journal-title":"Arch Facial Plast Surg"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/S1043-1810(05)80008-9","article-title":"Caudal septal extension graft for correction of the retracted columella","volume":"6","author":"Toriumi DM","year":"1995","unstructured":"Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Op Tech Otolaryngol Head Neck Surg. 1995; 6:311-318","journal-title":"Op Tech Otolaryngol Head Neck Surg"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1053\/otpr.2000.26065","article-title":"Structure concept in nasal tip surgery","volume":"7","author":"Toriumi DM","year":"2000","unstructured":"Toriumi DM. Structure concept in nasal tip surgery. Op Tech Plast Reconstr Surg. 2000; 7:175-186","journal-title":"Op Tech Plast Reconstr Surg"},{"key":"e_1_3_2_14_2","first-page":"223","author":"Toriumi DM","year":"2005","unstructured":"Toriumi DM. Rhinoplasty: Facial Plastic Surgery: The Essential Guide. Stuttgart, Germany: Thieme Medical Publishers Inc; 2005:223-253","journal-title":"Rhinoplasty: Facial Plastic Surgery: The Essential Guide"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199704000-00001"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200206000-00050"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S1064-7406(03)00026-9","article-title":"Nasal analysis for secondary rhinoplasty","volume":"11","author":"Kim DW","year":"2003","unstructured":"Kim DW, , Toriumi DM. Nasal analysis for secondary rhinoplasty. Facial Plast Surg Clin North Am. 2003; 11:399-419. 15062267","journal-title":"Facial Plast Surg Clin North Am"}],"container-title":["Archives of Facial Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1001\/archfaci.8.3.156","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1001\/archfaci.8.3.156","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1001\/archfaci.8.3.156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:26:44Z","timestamp":1774430804000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1001\/archfaci.8.3.156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,5,1]]},"references-count":16,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2006,5,1]]}},"alternative-id":["10.1001\/archfaci.8.3.156"],"URL":"https:\/\/doi.org\/10.1001\/archfaci.8.3.156","relation":{},"ISSN":["1521-2491","1538-3660"],"issn-type":[{"value":"1521-2491","type":"print"},{"value":"1538-3660","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,5,1]]}}}