Dynamic Adjustable Rotational Tip Tensioning Technique

The Problem

A deprojected and superiorly rotated nasal tip complex with nasal valve collapse. The small or overresected nose.

The Background

Arden and Crumley described the history of structural grafting in rhinoplasty. In 1951, Foman et al. described a columellar strut to project the medial crura forward. Sheen popularized spreader grafts as a method of reconstruction of the internal nasal valve and recontouring the aesthetic appearance of the nasal dorsum in rhinoplasty. Byrd et al. described septal extension grafting by utilizing cartilage grafts to extend the tip in a controlled fashion by securing it to the septum and the lower lateral cartilages. Many other versatile and elegant reconstructive techniques have been developed to address reshaping the small or overresected nose. The common triad of a deprojected, superiorly rotated nasal tip complex with nasal valve collapse was typically treated with a variety of separate techniques. Some of these improved the esthetics of the nose but did not address the airway. Some of these improved the airway but did not fully address esthetic correction. The dynamic adjustable rotational tip (DART) technique combines the concepts of utilizing a columellar strut with spreader grafts secured to the septum and lower lateral cartilages to create a controlled projection and derotation of the nasal tip complex while simultaneously improving nasal valve collapse in one technique.

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