The nose is made up of a fixed and rigid part that is called nasal pyramid, although it rather has the shape of a tent or roof, and a pliable mobile part which is the nasal tip, the alae and its annexes. The nasal tip and the alae are structured by the so called alar or lower lateral horseshoe shaped cartilages with their lateral and medial crura or crus and accessory cartilages, the domes between lateral and medial cruras, the interdomal fibrofatty pad, the caudal or lower septum and the skin of the alae.
Both halves of the nasal tip join with each other in the center of the tip to form a tripod in which the lateral legs are the lateral cruras of the alar or lower lateral cartilages and the central leg the union of both medial cruras of the alar or lower lateral cartilages.
When the lateral cruras of the alar or lower lateral cartilages are oriented too vertical (instead of their canonically normal wide or even close to 90º square angle with the superior septum or nasal midline), having a too narrow angle with the superior septum or nasal midline above them, severely or mildly (all the possible given combinations might be present) a typical deformity called parenthesis tip is present making the tip is prone to look boxy, there are visible ridges at the cephalic upper edge of the inverted cartilages due to overlapping with the middle vault, the alar support is poor leading to nostril collapse and alar retraction, with frequent association with bulbous tip and bifid tip, being the overall nasal look grotesque and artificial, leading to lack of suitable femininity in women and an unsightly look in men.
Treatment of parenthesis alar or lower lateral cartilages has to be customized to each individual situation, being the main pillar the techniques of alar or lower lateral cartilages grafting and repositioning, combining either alar cartilages batten, strut or replacement grafting, lateral cruras eversion, lateral cruras cross location, bridging, tongue in groove maneuver, plasties, plications (shaping sutures through the cartilages), nasal tip grafting, with or without reinforcement of tip support with columellar strut.
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DR. ALEJANDRO NOGUEIRA'S PARENTHESIS TIP DEFORMITY CASES PHOTO GALLERY
BEFORE & AFTER
INTRAOPERATIVE & TECHNICAL
See more accessing Dr. Alejandro Nogueira's entire Parenthesis tip deformity Before & After gallery of cases.
See more accessing Dr. Alejandro Nogueira's entire Parenthesis tip deformity Intraoperative & Technical gallery of cases.
REVIEWS & RATINGS
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- Every patient's individual satisfaction is somehow unpredictable, since this will depend on multiple particular, frequently unpredictable and sometimes uncontrollable expectation factors of a very much subjective, cultural, psychological and intellectual kind.
- Even when you feel very similar to another patient in their experience, your grade of satisfaction will likely vary significantly, because you are a unique person and every individual has not only a completely unique psyche, but also uniquely individualistic assessment capacities, expectation tendencies and acceptance processes, some of which are unpredictable even in very well mentally balanced patients who reflect adequately and do all the other right and recommended assessments before and after their procedure.
- All images are genuine, trustworthy and real standard views of the "before" situation and the long term settled "after" actual results of Dr. Alejandro Nogueira’s work, as well as true intraoperative surgical views and authentic technical or clinical scenarios depicting real practice hands-on cases belonging to Dr. Alejandro Nogueira's skills and expertise.
- No other professional but Dr. Alejandro Nogueira himself as leading and executing surgeon has carried out the techniques, procedures and surgeries shown in the galleries.
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- The images of results, treatments, techniques and clinical situations are mere guidance examples aiming to help the patients in their decision-making process, providing an average overview of Dr. Alejandro Nogueira's work; no one of them can be considered as an obligation of any particular results nor a commitment for the application of any specific techniques, therefore you should not base your results expectations on them.
- Every patient has to be assessed individually in order to establish a customized prognosis of results and design an individual surgical plan, being somehow unpredictable the real final outcome of any procedure as well the surgical gestures applied during the intervention, since they will depend on multiple particular, frequently unpredictable and sometimes uncontrollable factors.
- Even when you feel that you look very similar to another patient in their images, your results will likely vary significantly, because you are a unique person and every individual has not only a completely unique physique, but also uniquely individualistic body healing capacities, scarring tendencies and recovery processes, some of which are unpredictable even in very-healthy patients who rest adequately and do all the other right and prescribed things before and after their procedure.
- Previous successful results of a physician do not guarantee future successful procedures and patient's satisfaction.
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