When considering the effect of surgical techniques on the nose, one may think of the tip as a tripod, with each lateral crus composing one leg of the tripod, and the paired medial crura composing the third leg (1,2). Shortening the two " lateral crural" legs will cause the tripod to fall in that direction, thereby " rotating and deprojecting" the tripod. Weakening these two legs (as with cephalic resection) is also said to have the same effect (although less so), as the healing forces applied to these weakened legs of the tripod will cause the tip to rotate and deproject slightly over time. Similarly, a columellar strut will strengthen the ‘ °medial crural" leg of the tripod. Use of a columellar strut to correct buckled medial or in ­ termediate crura may increase tip projection and rotation. Even though the tripod concept oversimplifies the dynamics of the nasal tip, it provides those with little experience in rhinoplasty with a method of predicting the effects of specific techniques.


  1. Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol Head Neck Surg 1984;110: 349-358.
  2. McCollough EG. Surgery of the nasal tip. Otolaryngol Clin North Ain 1987;20:769-784.