Role of upper lateral cartilage tension spanning suture in restoring the dorsal aesthetic lines in rhinoplasty

Geissler PJ, Roostaeian J, Lee MR, Unger JJ, Rohrich RJ.

What this paper says

This technique article introduces the upper lateral cartilage tension spanning suture, a single stitch that resets the side cartilages of the bridge into position after component hump reduction, which the authors report consistently restores smooth, symmetric dorsal lines; the abstract gives no patient counts.

Overview

When a hump is removed, the upper lateral cartilages are freed from the septum and can drift inward, distorting the two lines that define the bridge from the front and narrowing the airway. The senior author (R.J.R.) removes the hump in components to keep these cartilages whole, and here describes a suture that pulls them back into anatomic position without spreader grafts.

Sections of note

Technique description; no series size, follow-up or outcome measurements appear in the abstract.
Problem addressed: distortion of the dorsal aesthetic lines and functional deformity after hump reduction if the upper lateral cartilages are not preserved and repositioned.
Prior step: component dorsal hump reduction, which preserves the integrity of the upper lateral cartilages and avoids routine spreader grafts.
The suture is described as efficient and reproducible.
Reported result: consistently smooth and symmetric dorsal contour and pleasing dorsal aesthetic lines.

What it means for a patient

After hump removal, a stitch can restore the width and shape of the middle of the nose using the existing cartilage rather than added grafts.
The technique depends on the hump having been removed in a way that keeps those cartilages intact.
The abstract offers a description, not data; a companion paper from the same group reports the suture used in 65 of 100 patients.

Why this paper matters

The spanning suture is the key maneuver in the Dallas group's argument that spreader grafts are not routinely needed. This article documents how it is placed. Outcome numbers are reported elsewhere, not here.

Terms

Upper lateral cartilages: the paired cartilages forming the sides of the middle third of the nose.
Tension spanning suture: a stitch across both upper lateral cartilages and the septum that resets their position.
Component dorsal hump reduction: removing a hump in stages, cartilage and bone separately, to keep the upper lateral cartilages intact.
Dorsal aesthetic lines: the paired curved highlights along the bridge seen from the front.
Spreader graft: a cartilage strip placed beside the septum to hold the middle vault open.
Reconstitution: restoring structures to their anatomic position after they have been released.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Dorsal hump reduction can lead to significant aesthetic and functional deformities with distortion of the dorsal aesthetic lines without first preserving and subsequently restoring proper position of the upper lateral cartilages. The senior author (R.J.R.) previously described the component dorsal hump reduction to…”

Excerpt; the full abstract is on PubMed.