Surgical approaches to the nasal tip are diverse and can be divided into :
- Endo-nasal and
- External approaches through :a trans-columellar incision ,
The external approach permits direct observation of areas that cannot be visualized with other techniques
The trans-columellar permits to produce Symetric cartilaginous structures by measured Resections , by Sutures techniques and by Placement of Grafts. (see Chapt V, VI, VII ) .
The columellar incision is very short no longer than 5- 6 mm on the surface and 1- 2 mm laterally ; in fact , the scar is shorter than the external scars after alar resections , and is located in a zone of shadow comparable to submental area from a face lift , chin augmentation or submental liposuction . the scar is generally not a problem if the patient is satisfied with the result and he generally cannot see it unless the tip of the nose is elevated.