Tip extension suture: a new tool tailored for Asian rhinoplasty

Overview

Newer Asian rhinoplasty releases the tip framework so it can be lengthened and rotated, then rebuilds it. The authors used the tip extension suture, alone or with other steps, to do that rebuilding. They reviewed their own cases to assess how safe and effective the method was.

Sections of note

• Retrospective longitudinal study of 283 patients operated between May 2008 and December 2011, all monitored six months or longer.
• Technique: the lateral crus is fully released from the pyriform margin supported hinge areas, advanced, and fixed to the caudal septum.
• Charts and serial photographs were reviewed for stability, complications, satisfaction and revision.
• Complications specifically sought were pinched deformity, skin necrosis, airway problems and nasal valve collapse.
• The tip shape was incompletely corrected in 14 patients (4.9 percent).
• Revision for pinched deformity was required in 8 patients (2.8 percent).
• 92 percent of patients were satisfied. No circulation or airway problems occurred. Level of evidence IV.

What it means for a patient

• The technique lengthens and rotates the tip using stitches rather than added grafts, and held its shape over the follow-up period in most patients.
• The most common problem was a pinched look to the nostril, which needed a further operation in about 1 in 36 patients.
• There was no comparison group, so this does not show whether the method beats other tip lengthening techniques.
• Follow-up was at least six months, which is short for late changes in tip position.

Why this paper matters

Releasing the tip framework buys length and rotation but leaves the tip needing a new anchor, and how that anchor is made determines the failure mode. Whether the suture holds beyond the reported period, and how it compares with graft based rebuilding, is unanswered.

Terms

• Tip extension suture: a stitch that advances and fixes the tip cartilage forward.
• Lateral crus: the outer arm of the lower tip cartilage.
• Caudal septum: the front lower edge of the wall dividing the nostrils.
• Pyriform margin: the rim of the bony nasal opening in the skull.
• Pinched deformity: a squeezed, narrowed look to the nostril area.