Clinical Implications of Pitanguy Ligament Management for Nasal Tip Contouring in Open versus Closed Rhinoplasty

Boynuyogun E, Kilic T, Yildizdal S, Cakaroglu M, Kocer U.

PubMed 41998167 Publisher (DOI)

What this paper says

Across three groups of 40 patients, repairing or preserving the Pitanguy ligament reduced early tip swelling and improved supratip definition, but by 12 months all groups looked the same.

Overview

The Pitanguy ligament runs from the skin of the bridge to the tip cartilages and is cut in most open rhinoplasties. The authors compared open rhinoplasty without ligament repair (Group I), open with repair (Group II) and closed with ligament preservation (Group III), 40 patients each, measuring supratip depth, tip oedema, rotation, projection and ROE satisfaction.

Sections of note

Early follow-up: supratip depth and tip oedema were significantly worse in Group I (no repair) than in Groups II and III (p < 0.001).
Early Goode score and nasolabial angle differed between Groups I and III (p < 0.05).
At 12 months: no significant differences in supratip depth, tip oedema or Goode score among the three groups.
Level of Evidence IV.

What it means for a patient

Keeping or reattaching the ligament gives a faster-settling, better-defined tip in the first months.
By one year the difference had gone in this study, so the benefit is in the recovery period rather than the final result.
The finding applies to both open surgery with repair and closed surgery with preservation.

Why this paper matters

It tests one of the central claims of preservation surgery, that ligament handling matters, and finds a real but temporary effect. Limits: non-randomised, single centre, 12-month endpoint.

Terms

Pitanguy ligament: a soft-tissue band linking the dorsal skin to the tip cartilages.
Supratip: the area just above the tip; a "supratip break" is a subtle dip that defines the tip.
Goode score (ratio): tip projection divided by nasal length.
Nasolabial angle: the angle between upper lip and columella, a measure of tip rotation.
ROE: Rhinoplasty Outcome Evaluation satisfaction questionnaire.

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

From the abstract

“Several modalities have been developed to achieve precise tip contouring and address postsurgical edema. This comparative study aimed to analyze the short- and long-term effects of the Pitanguy ligament management on nasal tip aesthetics and postsurgical edema in open versus closed rhinoplasty. Methods: Patients were…”

Excerpt; the full abstract is on PubMed.