In the case of primary rhinoplasty, various deformations occur due to incorrect decisions, inaccurate procedures, misuse of various substitutes, and unexpected inflammation, and follows with the situations requiring secondary tip-plasty.

Various reasons for implementing Secondary Tip-plasty are related to the following.
- Projection – under/over
- Rotation – cephalic/caudal
- Asymmetry and Deviation
- Tip volume – bulbous/pinched
- Demarcation – alloplastic/autologous
- Stiffness or mobility
- Supratip problems
- Infectious problems
- SSTE & scar tissue problems
- Functional problems
- Contracture and contriction

During consultation, it is important to thoroughly check the following matters.
- History taking – prev. procedures and materials
- Anatomical analysis – bone and cartilage
- Anatomical analysis – SSTE (thickness and elasticity)
- Functional analysis (including endoscopy)
- Donor tissue availability
- Facial balance
- Patient’s desire

After establishing a flexible surgical plan according to the intraoperative unpredictable hidden finding, all various available procedures should be used accordingly.

Secondary tip-plasty (Aesthetic rebuilding) is implemented according to the general considerations as follows,
- Wide dissection for redraping newly extended tip
- Autologous tissues only on tip
- Structural tip tripod rebuilding (tip extension and tip expansion concept)
- Natural tip contouring & tip vector and aesthetic nuance control


Most secondary deformations that are not aesthetically natural such as pinched and upturned tip are often caused by the central fixation of all tissues by maximal tip projection using a fixed septal strut. To solve this problem, the expansion of the tip structure and volume is required through the complete release of the alar cartilage.
In order to improve deformation and create a natural nasal tip, the tip extension and tip expansion concept are very important rather than merely raising the hard tip, and volumetric and tip vector & aesthetic nuance control through structural tip rebuilding and nasal tip contouring are required.

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