Wednesday, 1 January 2014

The Plunging Tip: Illusion and Reality

Aesthetic Surgery Journal
January 2014 vol. 34 no. 1 45-55
doi: 10.1177/1090820X13515482

Aaron M. Kosins, MD, MBA, Val Lambros, MD, Rollin K. Daniel, MD

Dr Kosins is a Volunteer Clinical Assistant Professor WOS and Dr Daniel is a Clinical Professor, University of California, Irvine Medical Center, 1441 Avocado Dr, Suite 308, Newport Beach, CA 92660, USA
Dr Kosins and Dr Daniel are in private practice in Newport Beach, California
Dr Lambros is a plastic surgeon in private practice in Newport Beach, California


The plunging tip is defined as a nasal deformity where the nasal tip descends or “plunges” during smiling.


The authors prospectively measure a series of 25 patients with a focus on the anatomic changes of the nose before and after the patient smiles.


Twenty-five women who presented for cosmetic primary rhinoplasty and complained of a plunging tip were included in the study. Three angles were measured on lateral view (tip angle, nasolabial angle, and columella inclination angle), along with changes in tip, subnasale, and alar crease. The Simon tip rotation angle (STRA) measured tip position in relation to the static tragus. The alar rim angle measured the angle of the alar rim at the nostril. Changes in static and smiling positions were compared.


Tip, nasolabial, and the columella inclination angles decreased between static and smiling positions by 10.9, 11.8, and 11.9 degrees, respectively. Tip position dropped by 0.9 mm, while the subnasale and alar crease junction elevated by 1.3 and 3.7 mm, respectively. The STRA, an angle independent of alar base movement, decreased by less than 1 degree. The alar rim angle increased by 9.9 degrees.


Our data demonstrate that the nasal tip changes its position less than 1 mm with a full smile. The concept of a “plunging tip” is an optical illusion. In reality, the alar crease and subnasale elevate and the alar rim straightens, while the tip position changes minimally. Objectively, the tip moves less than 1 mm and less than 1 degree using the STRA.

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