The Multi-Lock System for Rhinoplasty

Overview

Setting the nasal tip and keeping it from rotating too far upward are among the harder parts of rhinoplasty, and existing suture and graft methods can give imprecise results. The author describes a standardised combination of grafts, the Multi-Lock System, and reports the outcome of a consecutive series operated with it.

Sections of note

• 28 operations performed by the author using a standardised technique.
• The technique combined a modified distal onlay dorsal graft, a modified columellar strut, and cartilage sliver grafts on both sides of the caudal septum.
• All patients were followed for at least 365 days. Twelve had follow-up of 456 to 619 days.
• There was no loss of tip projection or rotation at follow-up.
• One patient left the study after a traumatic nasal fracture. Two had alar retraction on one side, which the author attributes to causes other than this technique.
• One patient with thin nasal skin had revision surgery to thin the caudal septal extension grafts and improve airflow. Level of evidence 5.

What it means for a patient

• The stated aim is a tip position that holds rather than drifting downward or rotating upward in the months after surgery.
• Every patient was followed for at least a year, which is long enough for most tip changes to appear.
• One of 28 patients needed a further operation, in that case because the grafts were too bulky for thin skin and affected breathing.
• Twenty-eight patients, one surgeon, no comparison technique and no patient-reported satisfaction scores, so this describes a method rather than proving it superior.

Why this paper matters

Loss of tip projection over the first postoperative year is a recognised cause of dissatisfaction, and structural grafting is the mainstream answer. This series adds a defined combination with at least twelve months of follow-up on every patient. Whether it outperforms simpler fixation, and how it behaves in thick skin, is not addressed.

Terms

• Nasal tip projection: how far the tip stands out from the face.
• Tip rotation: the upward or downward angle of the tip.
• Onlay dorsal graft: cartilage laid on the bridge to smooth or raise its contour.
• Columellar strut: a cartilage support placed between the nostrils to hold the tip.
• Caudal septum: the front lower edge of the nasal partition, near the tip.