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

Overview

Two suture techniques are used to narrow the nasal tip. The dome binding suture cinches the two tip cartilages together and can leave the tip looking pinched. The hemitransdomal suture is intended to refine the tip while keeping a natural line running from the tip out to the nostril rim. The authors compared postoperative photographs taken from below to test which produced a better contour.

Sections of note

• Retrospective review of postoperative basal view photographs from a facial plastic surgery practice in Chile, May 2013 to May 2015.
• 143 rhinoplasties were performed in that period; 112 Hispanic or Mestizo patients met inclusion criteria.
• 85 (76%) were women and 27 (24%) men; mean age 30 years, SD 9.
• 22 patients had the dome binding suture and 90 had the hemitransdomal suture.
• Follow-up ranged from 6 to 24 months.
• Contour was graded satisfactory or unsatisfactory against an ideal tip-lobule line.
• Results: 5 of 22 (22.7%) satisfactory with dome binding, 84 of 90 (93.3%) with hemitransdomal; the difference was statistically significant. Level of evidence 4.

What it means for a patient

• A pinched-looking tip after rhinoplasty can come from the specific stitch used, not just from how much cartilage was removed.
• The two groups were very unequal in size, 22 versus 90, and patients were not randomly assigned.
• The single outcome was a photographic judgment; patient satisfaction and breathing were not measured.
• All patients came from one practice and one ethnic group, so the numbers may not carry to other populations.

Why this paper matters

Tip suture choice is taught largely by preference, and this is presented as the first objective comparison of these two. It gives a measurable reason to favor one stitch. The retrospective design and unequal groups mean the size of the true difference is uncertain.

Terms

• Basal view: The photograph taken looking up at the underside of the nose.
• Dome: The bend at the top of each lower lateral cartilage that forms the point of the tip.
• Dome binding suture: A stitch pulling the two domes together to narrow the tip.
• Hemitransdomal suture: A stitch placed through part of one dome to refine the tip while preserving contour.
• Alar lobule: The rounded outer wall of the nostril.