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Surgical Technique |

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

Stephen W. Perkins, MD; Ahmed S. Sufyan, MD
Arch Facial Plast Surg. 2011;13(6):421-424. doi:10.1001/archfacial.2011.68.
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The alar-spanning suture is a surgical technique used by an experienced rhinoplastic surgeon to address certain nasal tip deformities. Wide nasal tip deformities with strong, convex lower lateral cartilages are best indicated for treatment with this technique. The alar-spanning suture can improve lateral crural position and eliminate dead space by refining and narrowing the supratip, often without requiring extensive dissection or additional strut grafting. We use operative photographs and an intraoperative video to demonstrate the alar-spanning suture technique, which is a useful addition to the armamentarium of any rhinoplastic surgeon.

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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.

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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.

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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.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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