Incisions are methods of gaining access to the bony and cartilaginous structures of the nose and include trans-cartilaginous, inter-cartilaginous, marginal, and trans-columellar incisions. Approaches provide surgical exposure of the nasal structures including the nasal tip and include cartilage-splitting (trans-cartilaginous incision), retrograde (inter-cartilaginous incision with retrograde dissection), delivery approach (inter-cartilaginous, marginal incisions), and external (trans-columellar and marginal incisions). Based on an analysis of the individual patient’s anatomy, appropriate incisions, approaches, and tip-sculpturing techniques are selected (1) (Appendix E).

In this section, a trans-cartilaginous incision is performed on one side. Then an inter-cartilaginous and marginal incision is made on the other side to deliver that cartilage. Next, proceed with the external rhinoplasty approach. Following these instructions will allow an experience with several incisions and approaches in a single specimen.