The nose is made up of a fixed and rigid part that is called nasal pyramid, although it rather has the shape of a tent or roof, and a pliable mobile part which is the nasal tip, the alae and its annexes. The nasal tip and the alae are structured by the so called alar or lower lateral horseshoe shaped cartilages with their lateral and medial crura or crus and accessory cartilages, the domes between lateral and medial cruras, the interdomal fibrofatty pad, the caudal or lower septum and the skin of the alae.
Both halves of the nasal tip join with each other in the center of the tip to form a tripod in which the lateral legs are the lateral cruras of the alar or lower lateral cartilages and the central leg the union of both medial cruras of the alar or lower lateral cartilages.
We consider the nasal tip is weak when its support may fail or be insufficient at either the medial or lateral cruras of the alar or lower lateral cartilages, and tip support depends mainly or solely on the cutaneous cover, the alae and eventually the caudal or lower septum, which might be caused by one or more of congenital or ethnically conditioned thin cartilages, surgical trim of the supporting cartilages, excessively heavy tip, short nasal septum, untreated anatomical nasal issues, aging, etc. This leads to a typical flattened nasal tip shape with supratip prominence, poor definition of the tip, broad nasal base, prominent alar flare and eventually nasal valve incompetence.
Treatment of weak nasal tip has to be customized to each individual situation, combining either septal lengthening, alar cartilages batten, strut or replacement grafting, tip grafting, columellar strut, tongue in groove maneuver, etc.