Modified Ferreira-Ishida Type B Technique Combined with Polygon Tipplasty and Sliding Alar Cartilage Flaps: A Versatile Solution for Primary Caucasian Rhinoplasty

Kerem M, Tatar BE, Bahadırlı N.

PubMed 40646255 Publisher (DOI)Free full text (PMC)

What this paper says

In 110 narrow-to-medium Caucasian noses treated with a low-strip cartilage push-down plus polygon tip-plasty and sliding alar flaps, mean satisfaction was 4.51 of 5, operating time averaged 107 minutes and 3.6% needed revision.

Overview

The Ferreira-Ishida technique preserves the cartilaginous dorsum while removing the bony cap. The Turkish authors modified it with a low (Cottle) septal strip and combined it with polygon tip-plasty and sliding alar cartilage flaps. They retrospectively reviewed 110 primary rhinoplasties from June 2021 to August 2023 with nasal index 75 or less, excluding augmentation, S-shaped humps, wide dorsums and severe deviations. Satisfaction was measured on a 5-point scale.

Sections of note

Mean age 27.7; 76.4% female; mean operative time 107 minutes (range 75-160).
Mean satisfaction 4.51: 63.6% "very good," 26.4% "good."
Early complication: prolonged bleeding 1.8%.
Late complications 3.6% (dorsal widening, bony cap malposition, nostril asymmetry); revision in 4 patients (3.6%).
Satisfaction did not correlate with age or operative time. Level of Evidence II (as assigned).

What it means for a patient

This is a preservation-based approach for straightforward, narrow Caucasian noses with a clean hump; it explicitly excludes wide, S-shaped or badly deviated noses.
Revision and complication rates were low and satisfaction high in this series.
The strict selection criteria are part of why it worked; the technique is not universal.

Why this paper matters

It shows how dorsal cartilage preservation is being combined with modern tip techniques into a modular operation. Limits: retrospective, single group, unvalidated satisfaction scale, follow-up not stated.

Terms

Ferreira-Ishida technique: a hybrid that removes the bony hump and preserves and pushes down the cartilaginous dorsum.
Cottle low septal strip: removal of cartilage at the base of the septum to let the dorsum drop.
Polygon tip-plasty: Cakir's method of shaping the tip as a set of geometric surfaces.
Sliding alar cartilage flap: folding the upper edge of the tip cartilage inward rather than trimming it.
Nasal index: nose width divided by length, times 100; 75 or less is narrow to medium.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Introduction: Dorsal cartilage preservation techniques have gained significant popularity among rhinoplasty surgeons recently, as they present natural dorsal aesthetic lines, and avoid dorsal reconstruction procedures for the cartilage dorsum. With correct patient selection criteria, cartilage preservation techniques give good results, while on the wrong patients, this may not always be possible. Also, blending these dorsal preservation techniques with different approaches in other subunits of the nose (tip complex and alar cartilages) may offer a variety of options in today's rhinoplasty world. This study presents a modified version of the Ferreira-Ishida cartilage push-down technique combined with polygon tipplasty and sliding alar cartilage flaps.

Methods: A retrospective analysis of 110 patients who underwent primary rhinoplasty (June 2021-August 2023) was conducted. The inclusion criteria were primary rhinoplasty cases with no history of any surgical/non-surgical nose treatments and have a nasal index (NI) of 75 or less (leptorrhine or mesorrhine). Cases requiring augmentation, S-shaped humps, wide dorsum, (NI greater than 75), and severe axis/septum deviations have been excluded from the study. The surgical steps included Cottle low septal strip resection, triangular osteotomies from the dorsal aspect of the nasal bones, push-down, lateral osteotomies, polygon tipplasty, and sliding alar cartilage flaps. Postoperative satisfaction was evaluated using a 5-point Likert scale. Statistical analysis was performed to examine correlations between age, operative time, and satisfaction.

Results: The mean age of the patients was 27.7 years, and 76.4% were female. The mean operative time was 107 minutes (75-160). Patient satisfaction scores were high, with a mean of 4.51 points: 63.6% scored "very good" and 26.4% scored "good." Early complications included prolonged bleeding in 1.8% of the cases. Late complications occurred in 3.6% of patients (dorsal widening, bony cap malposition, and nostril asymmetry), with four patients (3.6%) requiring revision surgery. No significant correlation was found between satisfaction and age or operative time (P > 0.05).

Discussion: The modified technique demonstrated several advantages thanks to the modified Ferreira-Ishida technique, where the dorsal cartilage integrity is preserved. Unlike the original high strip technique, the low strip modification lets us to remove the septal base cartilage where deviations are very common. Also, the stronger septal base cartilage provides a better material to be used as a columellar strut. Combining modified cartilage and bony cap preservation, polygon tipplasty, and sliding alar cartilage flaps improves dorsal and tip stability while preserving external nasal integrity.

Conclusion: This approach offers a fast, effective, and modular solution for primary rhinoplasty, yielding natural results, with high patient satisfaction and low complication rates.

Level Of Evidence Ii: This journal requires that authors assign a level of evidence to each article.

Abstract as indexed by PubMed; the article is open access (PubMed Central).