Use of the Goldman technique to correct both the overprojected and the broad nasal tip.

BACKGROUND: Tip surgery probably is the most challenging objective in modern rhinoplasty. The Goldman technique, despite its 50 years of history and its many variations proposed in the past, still remains a powerful tool for the surgeon who has to deal with an overprojected or broad nasal tip.

METHODS: A retrospective review was performed for all the patients who underwent surgery with the Goldman technique by the senior author from 2004 to 2009 for correction of the broad or overprojected nasal tip. The clinical and pathologic findings of these patients were reviewed, and an independent observer evaluated the pre- and postoperative photos of the patients using five parameters: projection, rotation, symmetry, shape, and distance of the tip-defining points. The evaluation was performed using a scale of -1 to +1 for each of the five parameters.

RESULTS: Of the 205 patients who underwent the technique, 115 (56%) were patients with overprojected tips, and 90 (44%) were patients with broad (boxy) tips. A total of 189 cases (92.2%) involved primary rhinoplasties, and 16 cases (7.8%) involved revision. The mean follow-up period was 3 years (range, 1-5 years). During this period, complications were observed in five patients (2.4%), who underwent revision rhinoplasty with a successful result. The average score for the five parameters already mentioned for primary rhinoplasties according to the scale of -5 to +5 (resulting from the summation of all the parameters) showed a significant postoperative improvement (score, +4.3). The revision rhinoplasties showed significant improvement as well (score, +4.5).

CONCLUSION: The Goldman technique is safe when performed by experienced surgeons and according to specific indications. This conclusion is indicated by the low rate of complications in the large series of patients in this study. When performed correctly, the Goldman technique provides a long-term aesthetic, functional, and natural result, which is the goal of modern functional rhinoplasty.