The Rhinoplasty Tip Refinement & Deprojection Technique
An 11-minute surgical walkthrough of how Dr. Buonassisi addresses tip bulkiness, over-projection, and rotation in a single procedure.
This detailed surgical video covers the full range of tip manoeuvres Dr. Buonassisi uses to address a bulbous, over-projected, or poorly rotated nasal tip. The video covers cephalic trim, transdomal sutures, interdomal sutures, columellar strut placement, and tongue-in-groove deprojection — explaining the rationale for each step and how the decisions are made intraoperatively based on what the cartilage looks like under direct vision.
Tip refinement is not a single technique — it is a sequence of manoeuvres, each addressing a specific aspect of tip shape.
Cephalic trim reduces the cephalic edge of the lower lateral cartilages to decrease tip bulkiness. Restraint is critical — over-resection weakens the alar rim.
Transdomal and interdomal sutures reshape the tip cartilages without removing tissue, producing a more refined dome.
Deprojection reduces how far the tip projects from the face. The tongue-in-groove technique is Dr. Buonassisi's preferred approach for moderate deprojection.
A columellar strut graft is placed between the medial crura to maintain tip support after deprojection.
