Surgical Techniques to Improve the Soft Tissue Triangle in Rhinoplasty: A Systematic Review

Overview

The soft tissue triangle sits between the tip cartilage and the nostril rim and has no cartilage support. It is a common site of visible notching after rhinoplasty and a frequent reason for revision. This review catalogued what the literature says about it and what outcomes have been measured.

Sections of note

• Systematic literature review from 2002 to 2019 using MEDLINE/PubMed, Embase, Ovid and Cochrane databases.
• Keywords were rhinoplasty combined with soft tissue triangle or facet.
• 26 studies were identified as appropriate for inclusion.
• The vast majority describe the relationship of structure and function in the soft tissue triangle, focusing on notching and retraction.
• The area is described as important yet often neglected in rhinoplasty.
• It is identified as a common source of patient dissatisfaction and of the need for revision rhinoplasty.
• The authors call for formal evaluation of its role in nasal airway patency, using validated measures such as the NOSE score or SCHNOS.

What it means for a patient

• Notching or pulling back at the top of the nostril is a recognized complication with no cartilage support to prevent it.
• The published work describes the problem but does not measure how well any technique fixes it.
• The authors argue the area may affect breathing as well as appearance, which has not been formally studied.
• Limits: this reviews the literature rather than patients, and the 26 studies included are largely descriptive.

Why this paper matters

An area that drives dissatisfaction and revision has attracted 26 papers in 17 years, none using a validated outcome measure. Identifying that gap is the review's substance. Whether any of the described techniques works remains unmeasured.

Terms

• Soft tissue triangle: The small skin-only area between the tip cartilage and the nostril rim.
• Facet: Another name for that same area.
• Notching: A visible V-shaped indentation in the nostril rim.
• Retraction: The nostril rim pulling upward or backward from its normal position.
• Nasal airway patency: How open the nasal passage is to airflow.