A New Technique in Rhinoplasty for Stabilizing the Nasal Tip: Backstay Suture

Caropreso CA, Hirotani PMM, Dias RPP, Neves JCM, Rodrigues JLT.

PubMed 41917227 Publisher (DOI)Free full text (PMC)

What this paper says

In 147 patients treated with a "backstay suture" to hold the tip on the midline, only 2.7% developed a tip deviation needing correction, significantly below the pooled rate in published series.

Overview

Tip deviation after rhinoplasty is common and hard to prevent. The Brazilian authors report a longitudinal case series (Level III, STROBE-compliant) of every patient treated with their backstay suture from 2017 to 2023, assessed before surgery and up to 12 months after. Outcomes were patient satisfaction, tip deviation judged by three facial plastic surgeons, and reoperation.

Sections of note

147 patients met inclusion criteria.
Satisfaction 85.7%, comparable to weighted literature estimates (p = 0.36).
Nasal obstruction 12.2% and reoperation 12.2%, both comparable to the literature (p = 0.82); 88.8% of reoperations were minor.
Tip deviation requiring correction in 4 patients (2.7%), significantly lower than the literature average (z = -2.52, p = 0.0118; 95% CI 0.1-5.3%).
Three of the four deviations had preoperative deviation; one had weak cartilage. Age, sex and deformity type did not predict outcomes.

What it means for a patient

A suture technique reduced post-surgery tip crookedness in this series without changing overall satisfaction or reoperation rates.
Roughly 1 in 8 patients still had some reoperation, mostly minor, which is in line with rhinoplasty generally.
Patients whose tips were already deviated before surgery remained the most likely to deviate afterwards.

Why this paper matters

It introduces a named tip-stabilisation suture with outcome figures benchmarked against published averages. Limits: no concurrent control group, single centre, 12-month follow-up, comparison relies on literature estimates.

Terms

Backstay suture: the authors' suture that tethers the tip complex to resist sideways drift; the name is borrowed from a ship's rigging.
Tip deviation: the tip pointing off the facial midline.
STROBE: reporting guidelines for observational studies.
Longitudinal case series: a group of patients followed forward in time without a comparison group.

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

Abstract

Background: Stabilizing the nasal tip is often one of the most challenging aspects of rhinoplasty, and various factors can lead to its deviation. This paper presents a new technique called the backstay suture to improve nasal tip stability.

Methods: In this longitudinal case series study (Level III evidence), conducted in accordance with STROBE guidelines, data were collected from all patients treated with the backstay suture from 2017 to 2023. Patients with incomplete information were excluded. Patients were assessed preoperatively and up to twelve months postoperatively. Outcomes included patient-reported satisfaction, the presence of postoperative nasal tip deviation assessed by three facial plastic surgeons, and the need for reoperation or additional procedures recorded as binary outcomes.

Results: A total of 147 patients met the inclusion criteria. The overall satisfaction rate was 85.7% and was comparable to weighted literature estimates (p = 0.36). The nasal obstruction rate was 12.2% (p = 0.82), and the overall reoperation rate was 12.2% (p = 0.82). Minor revision surgeries accounted for 88.8% of reoperations. Nasal tip deviation requiring correction occurred in four patients (2.7%), which was significantly lower than the weighted average reported in the literature (z = - 2.52, p = 0.0118, 95% CI: 0.1-5.3%). Three of these patients had preoperative deviations, and one presented with weak cartilage support. Multivariate logistic regression analysis did not identify age, sex, or deformity type as statistically significant predictors of dissatisfaction, reoperation, or postoperative nasal tip deviation.

Conclusions: The backstay suture technique was associated with a low rate of postoperative nasal tip deviation in this case series and may represent a useful adjunct in selected rhinoplasty cases. Further comparative studies are warranted to better define its role relative to other stabilization techniques.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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