Concomitant Overlap Steel Tipplasty - COST
COST is a method for resolving the nose tip defects in which Doctor Manafi gives a more aesthetically pleasing shape to the tip of the nose through modifying the lower lateral or tip cartilages, eliminating droopy and flat nose tip, and preventing excessive increase of nose height from the face. Nasal tip has a determining role in the beauty of the nose after rhinoplasty and the character of the nose is defined in fact with nasal tip and nasal dorsum, therefore, it is tried to create a beautiful tip and dorsum which is proportionate and has a reasonable size to provide air passages. It should be noted that beautification of the tip and maintaining a secure airway through COST tipplasty is Doctor Manafi’s innovative method which brilliant outcomes are provided by his colleagues in recent years, especially his former residents and current respectful partners.
A. Schematic animation of nasal tip cartilages in a patient with deviated nasal tip and base.
B. Modification of the tip through the COST method and schematic view of cartilages in a modified position providing a favorable symmetry and beauty.
It is noteworthy that the cartilages are asymmetric in deviation and the length and size of nasal tip cartilages are very large and longer than the other side; modification is possible only through cutting, displacing, and overlapping the tip.
- Since most Iranians have droopy nasal tips, we shorten these cartilages along the upper part (lateral steel) to resolve this problem. In fact, by doing so on both sides, we move the tip a little higher (like raising a horse head by the rider through pulling its snaffle). In fact, a successful surgeon can raise the tip and define a new location for it by shortening the upper part of the cartilage. This has several advantages including:
- Nostrils are more opened and breathing gets better. Try to slightly raise your nose tip with your finger, your breathing will be dramatically easier.
- Ugly form of droopy nasal tip will change to a younger, slightly raised shape without giving a pig nose appearance or making nostrils very visible.
- Shortening the cartilage tip can increase its resistance against deep breath, and in order to effectively increase the airflow from nostrils, we further increase the cartilage consistency with additional methods. This method can also prevent further raising, deformation, and disharmony at the edge of nostrils after rhinoplasty.
- The junction of the lower part of the nose to the top of the upper lip deepens naturally with age, because of jaw shrinkage and reducing of the height of both upper and lower jaws; this results in a drooped nasal tip and increased nasal hunch. COST method can also prevent this problem.
- The lower part of two cartilages meets each other at the tip and extends from tip to the junction of lip; this part is called columella. If the upper part is shortened and the lower part is slightly extended, the length of columalla may be increased and the nostrils may be stretched; this can be prevented by cutting and overlapping the lower part of tip cartilage (medial crurae) resulting in a balanced and proportionated height rather than a swine shape with highly raised tip.
- Finally, by combining these two approaches and using the COST and other effective methods, a beautiful and stable nasal tip can be created.
The following animation shows nasal tip repair through the COST method:
This method has been devised by Doctor Ali Manafi and was published in the American Journal of Cosmetic Surgery (AJCS). You can find this article on the Oxford Articles Website here.
Concomitant Overlap Steal Tip-plasty, Aesthetic Surgery Journal, Oxford University Press