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Original Investigation |

Objective Comparison of Nasal Tip Contours in the Basal View Between Dome Binding and Hemitransdomal Tip Suture Techniques in Rhinoplasty ONLINE FIRST

Fernando Casanueva, MD1; Deniz Gerecci, MD2
[+] Author Affiliations
1Department of Otolaryngology, San Vicente de Arauco Hospital, Concepción, Chile
2Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University. Portland
JAMA Facial Plast Surg. Published online September 01, 2016. doi:10.1001/jamafacial.2016.1061
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Importance  The dome binding suture (DBS) used for nasal tip refinement creates the unwanted effects of nasal tip pinching owing to shadowing and loss of alar support. The hemitransdomal suture (HTS), however, refines the nasal tip while maintaining a natural contour between the nasal tip and the alar lobule. To our knowledge, no objective comparison between the DBS and HTS techniques has been described in the literature to date.

Objective  To determine whether the DBS or HTS technique results in an objectively satisfactory outcome in nasal tip contouring when assessed from the perspective of the basal view.

Design, Setting, and Participants  Postoperative basal view photographs of cosmetic rhinoplasty procedures performed on 112 Hispanic/Mestizo patients (85 [76%] women, and 27 [24%] men) in a facial plastic surgery practice in Chile, from May 2013 to May 2015 were reviewed. Only patients who underwent either DBS or HTS were included. Follow-up ranged from 6-24 months. Comparison of the nasal contour to the ideal tip-lobule line was performed and classified as satisfactory or unsatisfactory.

Main Outcomes and Measures  Satisfactory or unsatisfactory nasal tip contour in the basal view as analyzed by comparison with the ideal tip-lobule line.

Results  A total of 143 rhinoplasty procedures were performed over a 2-year period (May 2013-May 2015). A total of 112 patients met inclusion criteria. Of the 112 participants, mean (SD) age was 30 (9) years; 22 patients underwent DBS and 90 underwent HTS. Of the patients who underwent DBS, 5 of 22 (22.7%) had satisfactory contours. Of the patients who underwent HTS, 84 of 90 (93.3%) had satisfactory contours.

Conclusions and Relevance  Comparison of nasal contour in the basal view with the ideal tip-lobule line demonstrates a statistically significant improvement in the rate of satisfactory outcomes using the HTS compared with the DBS technique. This study is the first, to our knowledge, to provide objective data to support the use of this technique when performing tip contouring in rhinoplasty.

Level of Evidence  4.

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Figure 1.
Changes in Lateral Crural (LC) Positioning With Use of Hemitransdomal Suture (HTS)

A, Longitudinal axis of the LC. B, Rotational axis of the LC prior to HTS placement. C, Rotational axis of the LC after HTS placement. D, Use of the HTS lowers the cephalic border of the LC, elevates the caudal border, and recreates the dome triangle (white arrowheads.). E, Facet triangle is maintained.

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Figure 2
Comparison of Dome Binding Suture (DBS) and Hemitransdomal Suture (HTS) Outcomes

A, Postoperative result using DBS. Note pinching of the nasal tip. B, Postoperative result using DBS. Tip appears isolated. C, Illustration of lateral crural position. Straight line represents ideal tip-lobule line. Nasal contour is medial to line and considered an unsatisfactory outcome. D, Postoperative result using HTS. Smooth continuity between nasal tip and alar lobule. E, Postoperative result using HTS. Note smooth transition. F, Illustration shows improved rotational angle of lateral crura. Nasal contour falls just along ideal tip-lobule line and is considered a satisfactory outcome.

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Figure 3.
Satisfactory and Unsatisfactory Outcomes Using the Hemitransdomal Suture (HTS) Technique

A and B, Satisfactory outcomes: Triangularity of the nasal contour is evident, without pinching or shadowing between the dome and the alar lobule. C and D, Unsatisfactory outcomes: frontal (C) and basal (D) views. Dome appears isolated from the rest of the nose. Nasal tip has lost the triangular shape owing to alar rim pinching and lack of structural support along the alar margin.

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Figure 4.
Preoperative and Postoperative Photos

Nasal tip accessed via endonasal delivery approach. hemitransdomal suture (HTS) and columellar strut used. Additional septoplasty and hump reduction performed. A, Frontal view, preoperative. B, postoperative view (respectively. C, D, Lateral view, preoperative and postoperative (respectively). E, F, Oblique 3/4 view, preoperative and post operative (respectively). G, H, Basal view, preoperative and postoperative (respectively).

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