Fine-Tuning of the Supratip in Rhinoplasty: An External Approach

Overview

Supratip (pollybeak) deformity is one of the most common reasons for revision, especially in thick skin. The Turkish authors describe an "external supratip suture" (ESS) that tacks the skin down to the framework, following the hemostatic-net principle of Auersvald. Thick-skinned patients having structured primary rhinoplasty were compared with and without the suture; supratip shape was analysed against a tangent from tip to nasion, and two blinded surgeons rated it on a 5-point scale.

Sections of note

• Control: 33 consecutive thick-skinned patients without the suture; study: 31 with the suture; plus 19 moderate-skin patients with the suture.
• The ESS group had significantly better results on both supratip parameters (p < 0.05).
• No ischaemic (skin blood-supply) complications.
• The authors say it lets the surgeon reduce nasal volume in "noncompliant skin" by controlling redraping.
• Level of Evidence IV.

What it means for a patient

• Thick skin tends to fill the area above the tip with scar; a temporary skin suture can hold the skin down while it heals.
• In this comparison the suture improved the supratip break as judged by blinded raters.
• The suture passes through the skin, leaving temporary marks; scarring from the puncture sites is not reported in the abstract.

Why this paper matters

It offers a simple preventive step for the most common revision-generating deformity in thick skin. Limits: non-randomised, single centre, follow-up not stated.

Terms

• Supratip: the area just above the tip on the bridge.
• Pollybeak deformity: fullness above the tip making the profile look like a parrot's beak.
• Supratip break: the slight dip that separates tip from bridge in a refined profile.
• Hemostatic net: a pattern of temporary through-skin sutures that closes dead space and limits bleeding.
• Nasion: the deepest point between the eyes at the root of the nose.