Systematic Review and Meta-analysis of Vertical Alar Division and Resection in Tip Rhinoplasty

Alhajress R, Fnais N, Almajed H, Alharthi R, Alharbi W.

PubMed 42517059 Publisher (DOI)Free full text (PMC)

What this paper says

Across five studies, vertical dome division increased tip projection by 15.8% with over 90% satisfaction, and vertical alar resection with graft support kept projection stable beyond seven years, both with 2-6% revision rates.

Overview

Vertical dome division (VDD) cuts the tip cartilage at the dome to reshape it; vertical alar resection (VAR) extends this by removing a segment and adding graft reinforcement. The Saudi authors ran a PRISMA-guided review of PubMed, Scopus and Google Scholar, found five qualifying studies, and assessed quality with Newcastle-Ottawa and GRADE.

Sections of note

Five studies met inclusion criteria.
VDD: tip projection increased 15.8%; satisfaction above 90%.
VAR: projection stable beyond 7 years; satisfaction above 85%.
Revision rates 2-6% for both; major complications rare.
VAR judged to have better long-term stability and contour definition because of graft support.

What it means for a patient

Cutting through the dome is an older idea that fell out of favour over fears of pinching and bossae; these pooled data show acceptable results when done with modern reinforcement.
The version that adds a graft held up better over years.
The evidence is retrospective and varied, and only five studies exist.

Why this paper matters

It is the first pooled analysis of dome-division techniques, which some surgeons still avoid. Limits: five heterogeneous retrospective studies, no direct comparison with suture-only techniques.

Terms

Dome: the highest point of each tip cartilage where the medial and lateral crura meet.
Vertical dome division (VDD): cutting the cartilage vertically at the dome to narrow or project the tip.
Vertical alar resection (VAR): removing a vertical strip of cartilage and reinforcing with a graft.
Bossa: a visible knuckle of cartilage that can appear at the tip after healing.
GRADE: a system for rating certainty of evidence.

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

Abstract

Background: Vertical dome division (VDD) and vertical alar resection (VAR) are key rhinoplasty techniques developed to improve nasal tip projection, definition, and stability. Although VDD remodels the dome through controlled division of the lower lateral cartilage, VAR expands this concept by incorporating cartilage resection and graft reinforcement for long-term tip support.

Methods: A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, Scopus, and Google Scholar databases. Five studies met the inclusion criteria and evaluated VDD and VAR techniques in terms of projection, rotation, revision rates, complications, and satisfaction. Study quality was assessed using the Newcastle-Ottawa Scale and the GRADE system.

Results: VDD significantly increased nasal tip projection by 15.8% with more than 90% patient satisfaction. The VAR provided sustained stability of projections beyond 7 years, with satisfaction rates greater than 85%. Revision rates remained low (2%-6%) with both methods, and major complications were rare. VAR demonstrated superior long-term stability and contour definition due to graft-supported reinforcement.

Conclusions: Both VDD and VAR are commonly used techniques for nasal tip refinement and are associated with favorable aesthetic outcomes and low reported complication rates. However, the available evidence is largely retrospective and heterogeneous. Although VAR seems to offer improved long-term projection stability in selected cases, further prospective comparative studies are required to confirm these findings.

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