Stabilization of the Bony Pyramid in Rhinoplasty Using Dorsal Aesthetic Lines Bony Sutures

Overview

Osteotomies can leave the nasal bones unstable. Suturing cartilage is routine, but suturing bone is difficult. The authors describe piezo-assisted osteotomies along the dorsal aesthetic lines, two pairs of 2-3 mm perforations, and 4-0 PDS figure-of-eight "bridge sutures" that fix the lateral bony walls to the dorsum. Twenty-eight patients treated from 2021 to 2023 were assessed with ROE and NOSE at 12-18 months.

Sections of note

• 28 patients, 2021-2023, 12-18 month follow-up.
• All achieved stable dorsal symmetry with no hump recurrence.
• Mean operative time 189.6 minutes (SD 51.92); no major complications.
• Three revisions, none related to the dorsum.
• ROE improved from 6.7 to 21.7 and NOSE from 24.7 to 2.7 (both p < 0.001). Level of Evidence IV.

What it means for a patient

• The nasal bones can be sutured together after they are cut, in principle reducing the risk of shifting or collapse during healing.
• In this small series the bridge stayed symmetric and breathing scores improved markedly.
• The operation took over three hours on average.

Why this paper matters

It describes a reproducible internal method of bony fixation that avoids sutures passed through the skin. Limits: 28 patients, no comparison group, single centre.

Terms

• Bony pyramid: the paired nasal bones forming the upper third of the nose.
• Osteotomy: a surgical cut of bone to reposition it.
• PDS: polydioxanone, an absorbable suture material.
• Dorsal aesthetic lines: the brow-to-tip highlight lines on the bridge.
• Transcutaneous: passed through the skin.