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

Abstract 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. 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. 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. 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. Refinements continue to evolve through improved mapping of cartilage responsiveness, integration of regenerative strategies, and advancements in suture-based modulation. This experience-based approach offers reproducible, stable, and naturally refined results in primary rhinoplasty, emphasizing durable tip support and patient-specific aesthetic goals.