Versatile vertical alar resection technique for positioning of the nasal tip

In rhinoplasty, it is very important to adjust the rotation and projection of the tip together harmoniously with the nasal dorsum and face to achieve pleasing results. In this study, our aim is to describe a new modification of the vertical alar resection technique that can effectively regulate nasal tip projection and rotation. Versatile vertical alar resection (V-VAR) technique was applied to 14 primary and 9 revision rhinoplasty cases with highly projected nasal tip. V-VAR technique consists of three steps. In the first step, the original dome point was marked. In patients with high tip projection and caudal rotation, resection was performed from the lateral crus of the original dome. In patients with high tip projection and cephalic rotation, resection was performed from the medial crus of the original dome. In patients with high nasal tip projection but adequate rotation, an equal amount of resections were performed from both the medial crus and lateral crus of the original dome. The patients were followed in average 18 months (between 12 and 24 months). The desired type of rotation and projection was achieved utilizing V-VAR technique in all patients. All patients had satisfactory esthetic results. In highly projected nasal tips, the height can be reduced using the proposed V-VAR technique. Rotation in the nasal tip region was maintained, increased or decreased in accordance with the esthetic aims. 4.