Nose tip refinement using interdomal suture in caucasian nose

Abstract

Summary Introduction: Refinement of the nose tip can be accomplished by a variety of techniques, but currently, the use of sutures in the nasal tip with conservative resection of the alar cartilage is the most frequently recommended approach. Objective: To classify the nasal tip and to demonstrate the interdomal suture applied to nasal tip refinement in the Caucasian nose, as well as to provide a simple and practical presentation of the surgical steps. Method: Development of surgical algorithm for nasal tip surgery: 1. Interdomal suture (double binding suture), 2. Interdomal suture with alar cartilage weakening (cross-hatching), 3. Interdomal suture with cephalic removal of the alar cartilage (McIndoe technique) based on the nasal tip type classification. This classification assesses the interdomal distance (angle of domal divergence and intercrural distance), domal arch width, cartilage consistency, and skin type. Interdomal suture is performed through endonasal rhinoplasty by basic technique without delivery (Converse-Diamond technique) under local anesthesia. Conclusion: This classification is simple and facilitates the approach of surgical treatment of the nasal tip through interdomal suture, systematizing and standardizing surgical maneuvers for better refinement of the Caucasian nose.

Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique

“…As with every new technique, there is a learning curve, but, as stated previously, the overall features of this technique make it easy to learn and perform, something we observe when teaching it to our residents. The only reference to an endonasal technique that shares some similarities with our suture was published by Pasinato et al 12 They also used a straight needle to carry out their technique, but instead of burying the knot in the inner part of the tip, in the cephalic aspect of the interdomal space as we do, they placed it in the vestibular side of the tip lateral to the alar crura. The significance of this maneuver is that the knot is exposed to the exterior of the nose, increasing the risks of contamination and even infection and posterior loosening of the suture, something we noticed when performing this technique in the past.…”

“…Gruber 10 presented the lateral crura convexity control suture and Guyuron, 11 the medial crura footplate suture refinement. The only reference to a tip suture performed through a nondelivery endonasal approach was in 2012 in an article by Pasinato et al, 12 where they used a straight needle introduced through the vestibular skin in a back-and-forth mattress-like suture that grabbed the domes and narrowed the tip, leaving the knot lateral to the external vestibular aspect of the dome. When performing rhinoplasty, aggressive reduction may set the stage for unpredictable long-term healing and undesirable sequelae.…”

Technical and Clinical Considerations for Facial Feminization Surgery With Rhinoplasty and Related Procedures

“…Tip reshaping is one of the key points in feminization rhinoplasty, and to provide long-term stability, grafts, such as a caudal extension graft in combination with a tongue-in-groove maneuver, shields, or on-lay grafts on top, are essential . Suturing the medial and lateral crura (intradomal sutures and interdomal sutures) is important to create an attractive nose projection, refinement, and rotation …”