this panel will consist of tip approaches by various speakers

Increasing the tip projection and rotation in rhinoplasty is a frequently performed and well-known topic. However, when it comes to a high projection and also a bulbous tip structure, it is difficult to correct this pathology and this issue is one of the insufficiently clarified challenges of rhinoplasty. In these kinds of cases, the patient already has a high and wide nasal tip. Since deprojection is a maneuver that widens the nasal tip and base, it becomes difficult to manage the nasal tip, which is already wide at the beginning. Therefore, it is one of the challenges of rhinoplasty. We would like to share with the participants how we manage such noses in the light of our experiences and current literature with case presentations.

Rhinoplasty surgery for Arabic noses showed an increased demand, especially in the Middle East. Most Arabic noses do not need augmentation rhinoplasty as they mostly have good projection.

Most Arabic noses have excellent projection, but when we look at the profile view, some patients have some irregularity in this view, which may be corrected with augmentation rhinoplasty, either complete or segmental augmentation, aiming at improving cosmetic appearance. However, some cases with significant Nasal trauma or post-nasal surgery that resulted in saddle deformity also need correction, varying in size and thickness depending on the type of saddle deformity.

Background Caudal end correction is one of the main challenges during septoplasty that needs extra steps and skills. This

complex area affects the shape of the nose. Moreover, the caudal end represents the medial boundary of the internal nasal

valve. Thus, any deviation may disturb this critical area causing nasal obstruction. This study aimed to evaluate the novel

traction-suture technique to correct septal caudal end deviation and its postoperative impact.

Study design This prospective case-series study.

Settings It was held in a tertiary referral university institute between January 2019 to February 2022.

Methods We included 95 cases who suffered from nasal obstruction and a cosmetic problem because of mild or moderate

caudal end deviation. Under general anesthesia, the caudal end was corrected by the novel traction-suturing technique

(TST). To evaluate the surgical outcomes and patients' related quality of life, we used two validated questionnaires; the Nasal

Obstruction Symptom Evaluation and the Rhinoplasty Outcome Evaluation before the surgery and 1 year after the surgery.

Results NOSE and ROE questionnaires showed statistically significant improvements after the surgery (P value was < 0.001).

Complications occurred in seven patients (7.3%), all of which were minor complications.

Conclusions Traction-suturing technique (TST) improved nasal breathing and patients’ satisfaction with their nasal configuration.

Traction-suturing is a simple short maneuver that junior doctors can easily learn without distinct complications

or recurrence.

Septal extension graft is a workhorse for tip rhinoplasty. It has several functions and may be used with different purposes. Furthermore, the shape and spacial position of the graft may be different and should be chosen according to the specific role of the septal extension graft in the specific clinical case being dealt with.

Alar retraction is a frequent finding in rhinoplasty, both in primary as well as in revision cases, and either unilaterally or bilaterally. An alar retraction, if left unaddressed, may jeopardize an otherwise good surgical outcome. Several surgical options are available to deal with alar retraction, which will be explained and demonstrated.

In an era of dorsal preservation rhinoplasty, the role of spreader grafts may become overlooked. However, spreader grafts have several important aesthetic effects and may be advantagous in many different rhinoplasty scenarios. As so, spreader grafts should certainly be considered in many - if not in most - rhinoplasty cases, both primary and revision.