We try to create this triangle with a shield graft. I use a shield graft only for overly deformed noses. I think that it has no place in primary rhinoplasty. We described this area with the infralobule polygon and added more details to the nose tip.

When the shield graft is used for increasing projection, the tip becomes pointed. To prevent this, a block cartilage has been used behind it. Toriumi mentions this graft repeatedly. We have described the nasal tip area with two dome triangles and an interdomal triangle.

These are multi-edged flat areas which surround a three-dimensional objects. This is the easiest method for making a sculpture. You can imagine round organic forms consisting of several facets. Their sizes, angles, and the ratios between them are important. Analyzing organic forms with the help of cubic forms is a basic drawing method.

These polygons are mass polygons. They are created from cartilage and bone.

In profile, the nose tip makes two breaking points on the same vertical plane. We call the upper refraction Ts (tip superior) and the lower one Ti (tip inferior) points. Peak points of the dome triangles form the Ts point. Bottom inner edges of the dome triangles form the Ti points.

Pay attention to the polygon drawings. If possible, draw them by yourself. It is easiest to begin the drawing with the interdomal polygon.

These are the triangles formed by the Ti, Ts, and Rm points. There are two dome triangles. Dome polygons should look exactly towards the front.

In 2008, the right dome of one of my patients who had beautiful right dome highlights had a triangular shape. In order to give it a similar shape, I made the left dome triangular. The dome triangle concept emerged with this photo.

The dome is the meeting point of the lateral and medial crus. Lateral and medial crura are not formed by the curve of a plane rectangle cartilage from the middle with one angle. If you force it to curve on one plane with stitches, the domes, lateral and medial crura can be malpositioned. The infralobule polygon expands, the apex of the facet polygon closes and the caudal edges of the lateral crura turn towards the nostril.

The lateral and medial crura meet each other at a 15–20° angle. This angled articulation makes the meeting point triangular. In some patients, you can see this triangle clearly. Generally there are more soft transitions between these triangles.

The patient’s right dome shows the triangle form more clearly. Examine how close the medial crus and lateral crus are to each other on the cephalic edge of the dome. We are trying to copy this form with tip sutures.

However, the left dome of the patient does not show the triangle form. The folding line near to the lateral crus is more bent than the other one. Moreover, the folding line close to the lateral crus is folded more at the cephalic edge of the dome. The common characteristics of the left and right domes are that the medial and lateral crura on the caudal edges of the dome which will form the tip of the facet polygon are far away from each other. Cephalic dome suture generates a form similar to the right dome. Cephalic dome suture does not generate a clear triangle, but this form can be expressed with a triangle polygon. The triangle form can be obtained with two different transdomal sutures that are positioned to each other at a 30–40° angle, but a clear aesthetic achievement cannot be obtained. It lasts longer, is more difficult and harder to achieve symmetry.

Below, you can see the photograph of a patient who has clear dome triangles.

Below are the preoperative photos of one of my patients who had an operation in 2007. I created dome triangles by placing two different horizontal mattress sutures at a 30–40° angle. Clear triangle forms were given to the domes, but planning and performing the surgery was not easy.

I have not used this method since 2008. Although the cephalic dome suture cannot make the domes as triangular as above, it is a more useful technique.

The interdomal triangle is the space between the Ts point and both Ti points. Like the dome polygon, it looks towards the front.

For the purposes of aesthetics, you should not only see mass, but also the spaces in between. The superior angle of the interdomal triangle is 80° in men and 100° in women.

Try to see the borders of the light reflected through the tip of the nose. You will see that it forms a triangle.

Dome triangles only contact each other at the Ts points. There should be space between the Ti points. If you close this space with a suture, tip aesthetics substantially deteriorate. Facet polygons expand horizontally; hence you should consider a rim graft. The incidence of a pinch nose increases as the caudal edges of the lateral crura also become medial.

As a result, never close the interdomal polygon.

The infralobular polygon is the rectangle between the Ti and C points, and it has been named by Rollin Daniel. The infralobular polygon looks downwards at a 45° angle. It is a space polygon. The superficial part of the SMAS fills this space and makes it a facet. The strut graft is also located in this polygon. If the strut graft is close to the caudal edge of the medial crus, the infralobule polygon becomes round. The infralobule polygon is constituted by the weakest part of the lower lateral cartilage, named the middle crus. After dissection this part weakens, and contour grafts will be needed in order to strengthen it. We will describe this topic in the chapter on surgery techniques.

The columellar polygon is a space polygon, between the C points and the footplate polygon. The columellar polygon looks downwards. The space between the caudal edges of the medial crus should be protected. A commonly occurring mistake is the extreme grafting of this region or making the caudal edges too close to each other. Extreme grafting expands the columellar polygon. Suturing the caudal edges narrows the columellar polygon. However, in a normal and beautiful nose, the columellar polygon can be seen clearly. A little groove seems to be natural and will not disturb the patient. The medial crura turn laterally and upwards in order to form the footplates. If the columellar polygon is short, then it is possible to lengthen the columellar polygon by suturing the footplates to each other.

When the tip surgery is finished, the superficial SMAS and perichondrium may cause bulging on the columellar polygon. You can perform resections for the bulging on the columellar polygon or make small flaps and turn them to the space in the infralobular polygon. Below, the bulging on the C point was treated with a perichondrium flap.

These are the planes formed by the footplates. They look at sideway and downwards.

The footplate polygon, columellar polygon and lip may not be separated from each other clearly. As in the examples below, the lip, columella or footplate can be dominant.

It can be plumper in women. In men, it is not uncommon to see it form a sharp angle with the lip. In tension noses, the excess of the caudal posterior part of the septum extends between the footplates and expands this polygon. In patients with short columellar polygons, it is possible to make the columellar polygon longer by suturing the footplates. The footplate polygon may be wide enough to obstruct breathing. In surgery this region should usually be narrowed.

In many of our patients, the footplate polygon projection is excessive. This projection can be decreased via dissection. However, if the footplates are constricted too much, the footplate polygon disappears and the columellar polygon elongates too much. This creates an operated look.

This is the polygon between the Ti, Rm, Rl and C points. It looks downward and lateral 45°. One of my essential objections is this region. This area is not a triangle. There is a 2–3 mm edge between the Ti and Rm points. The facet polygon is not a space that has to be filled. This can be seen clearly in beautiful noses. A thin-skinned nose without the facet polygon significantly shows that it has been operated on. It has an anatomy like a tentformed between the middle and lateral crus.

For a good facet polygon,