Concomitant Overlap Steal Tip-plasty: A Versatile Technique to Simultaneously Adjust the Rotation, Definition, Projection, and Symmetry of the Nasal Tip

Background: Tip-plasty is a particularly challenging stage of aesthetic nose surgery. The diversity of nasal tip deformities has necessitated the development of numerous surgical techniques that can be difficult to master and may yield unpredictable surgical results when combined. Objectives: The authors describe how concomitant overlap steal tip-plasty (COST) can enable surgeons to address all of the aesthetic characteristics of the nasal tip simultaneously. COST involves lateral crural steal followed by medial crural overlap. Methods: The medical records of 1617 patients who underwent primary open septorhinoplasty with COST were evaluated in a retrospective study. Pre- and postoperative patient photographs were compared for nasal length, nasolabial angle, tip projection, and deviation of the nasal axis. Results: Pre- and postoperative mean nasal lengths were 5.66 cm and 5.17 cm, respectively (P < .05). The mean nasolabial angle was 86.95 degrees preoperatively and 101.8 degrees postoperatively (P < .05). The projection of the nasal tip was reduced from 3.09 cm to 2.53 cm, and tip symmetry was achieved by decreasing the nasal axis deviation from 7.76 degrees to 1.71 degrees (both P < .05). Conclusions: COST does not obviate all other tip-plasty techniques for specific situations. Once mastered, however, COST can become the only procedure needed to achieve all of the aesthetic goals of the nasal tip in most cases.