The distance from your upper lip and cheek to the tip of your nose is called projection. If the nasal tip sticks out too far, it is called over-projected. Not surprisingly, if it does not stick out far enough, it is called under-projected. There are a number of ways to determine this, including defined measurements and ratios. Many surgeons also just estimate the amount of change needed, which is also fine with an experienced surgeon who has a good “eye” for the procedure. If you picture the tip of the nose has being a three-legged stool made up of the two “lower lateral” cartilages that meet in the center, alterations of the legs of this stool will change the projection. This concept was well demonstrated and taught by some of the giants of rhinoplasty in the ’70’s and ’80’s, Drs. Jack Anderson of New Orleans, Eugene Tardy of Chicago and Richard Webster of Boston. There are a number of techniques used to increase or decrease projection. Moving a tip back (called retro-displacement or de-projection) often involves cutting or trimming the cartilage of the tip. Increasing projection or re-projecting an under projected tip often involves extending the cartilages by cutting then and sewing them in a more projected position or adding cartilage grafts commonly taken from the nasal septum. Some examples of these grafts are called columellar struts (The columella is divider between your nostrils.) tip onlay grafts or shield grafts.