The Alar-Spanning Suture:  A Useful Tool in Rhinoplasty to Refine the Nasal Tip

Figure 1. Operative technique. A, Intraoperative placement of the alar-spanning suture at the cephalic margin of the lateral crus just superior and adjacent to the domes. B, Tightening of the horizontal mattress suture in the lateral crura, with the suture knot tied in the center between the domes. C, Artist's illustration of the placement of the alar-spanning suture that is used after cephalic trim (red), strut graft (green) placement, and single- and double-dome sutures.

Figure 2. Representative patient with cephalic malposition of the alar cartilages and a wide nasal tip. A, Preoperative frontal view. B, Postoperative frontal view. C, Operative schematic of strut grafts and the alar-spanning suture required to correct the nasal tip deformity.

Figure 3. Representative patient with strong convex alar cartilages and thin skin. A and C, Preoperative frontal and oblique views. B and D, Postoperative frontal and oblique views. E, Operative schematic. After placement of alar strut grafts, single- and double-dome sutures were used. The alar-spanning suture was needed to further refine and narrow the nasal tip.