The Influence of the Pitanguy Ligament on the Supratip Break Point in Open Rhinoplasty

Overview

The supratip break point is the slight dip just above the nasal tip, and fullness there is called pollybeak deformity. The Pitanguy ligament attaches tissue and helps control scarring there. The authors compared three ways of handling it: leaving it untouched, removing it, or suturing it to the front septum, measuring photographs at 3 and 12 months.

Sections of note

• Design: retrospective study, May 2019 to July 2023, 120 patients in three equal groups of 40, 96 women and 24 men. Level of evidence therapeutic III.
• Group 1, no-touch: ligament left untouched. Group 2, excision: ligament removed. Group 3, repair: ligament sutured to the highest point of the caudal septum.
• Supratip depth was measured from photographs at 3 and 12 months.
• Group 2, the excision group, showed statistically significant change between 3 and 12 months, p less than 0.05.
• At 12 months, supratip depth in the repair group significantly exceeded that of the other two groups, p less than 0.05.
• Stated conclusion: repairing the ligament enhances supratip depth and prevents pollybeak deformity.

What it means for a patient

• Fullness just above the tip is one of the most common complaints after rhinoplasty, and how the ligament is handled appears to affect it.
• The group whose ligament was removed changed the most between 3 and 12 months, which suggests scar filled the space over that period.
• Leaving the ligament alone was not equivalent to repairing it, so repositioning it, not merely preserving it, was what mattered.
• Limits: retrospective, groups of 40, one measurement method on photographs, and no patient reported satisfaction data.

Why this paper matters

The debate over nasal ligaments has been argued largely from anatomy, with cadaver studies describing what the ligament does but not what happens to patients. Comparing three handling strategies with a measured outcome at a year is a step past that. Whether the measured depth difference is visible to patients is not established.

Terms

• Supratip break point: the slight dip on the profile just above the nasal tip.
• Pollybeak deformity: fullness above the tip creating a beak like profile.
• Pitanguy ligament: a fibrous band running from the bridge down to the nasal tip.
• Caudal septum: the front lower edge of the wall dividing the two sides of the nose.
• Fibrosis: formation of scar tissue.