The alar-spanning suture: a useful tool in rhinoplasty to refine the nasal tip

Overview

A wide nasal tip with strong, outward-bowing cartilages is a common shape. The authors present the alar-spanning suture, a stitch passed across both lateral crura, as a way to reposition those cartilages and close the space above the tip. The paper uses operative photographs and an intraoperative video to show the steps.

Sections of note

• Technique description; no series size, follow-up or complication data are stated in the abstract.
• Best indication: wide tip deformities with strong, convex lower lateral cartilages.
• Stated effects: improved lateral crural position and elimination of dead space by refining and narrowing the supratip.
• The suture often avoids extensive dissection or additional strut grafting.
• Demonstrated with operative photographs and video.

What it means for a patient

• A wide tip caused by strong cartilage can sometimes be narrowed with a stitch rather than by cutting cartilage or adding grafts.
• The technique is suited to firm cartilage; weak or thin cartilage is not the described indication.
• The article shows how the stitch is placed but does not report how many patients had it or how they fared.

Why this paper matters

Suture reshaping of the tip replaced cartilage excision over the 1990s and 2000s; this stitch adds a tool for the supratip. Its durability and results compared with other tip sutures are not reported here.

Terms

• Alar-spanning suture: a stitch passed across both lateral crura to pull them toward the midline.
• Lower lateral cartilages: the paired tip cartilages that shape the tip and nostrils.
• Lateral crus: the side arm of the tip cartilage running along the nostril.
• Supratip: the area of the bridge just above the tip.
• Dead space: a gap under the skin that can fill with scar and cause fullness.
• Strut graft: a cartilage rod placed between the tip cartilages to support the tip.