Mattress Sutures to Remove Unwanted Convexity and Concavity of the Nasal Tip: 12-Year Follow-Up

Abstract

Nasal tip bulbosity, or convexity, has been one of the most difficult problems to correct during rhinoplasty. Excision of cartilage from the cephalic part of the lateral crus has helped. However, complete correction of the deformity is not always possible with this maneuver alone. Suture techniques have also helped to improve outcomes. Twelve years ago, the lateral crus mattress suture was introduced as a way of converting the lateral crus to a flat, straight segment with resultant correction of the convexity. Since then, this suture technique has been employed in most primary and some secondary rhinoplasties and has stood the test of time. We report our experience with this technique, including a slight modification to facilitate its application when the cartilage is unusually narrow or when the original technique is difficult to complete. In addition, the suture technique for the less concave lateral crura is redescribed. It, too, has withstood the test of time.

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 …”

“…[15][16][17][18] Suturing the medial and lateral crura (intradomal sutures and interdomal sutures) is important to create an attractive nose projection, refinement, and rotation. [19][20][21][22] Feminization of the Profile | Any excess bridge composed of bone and cartilage is removed to lower the profile for an optimal result. If the amount of the hump to be resected is less than 2…”

Rinoplastia abierta estructurada en Cirugía de Feminización Facial. Lecciones aprendidas tras 1422 casos consecutivos.

“… Trabajo de punta: el uso de suturas (intradomales, interdomales, retrodomales y spanning) son esenciales a la hora de crear una nariz con una proyección adecuada, refinada y con la rotación necesaria 10,11 . En los casos en que sea necesario, se pueden añadir injertos tipo onlay para aumentar la proyección y enfatizar el supratip break [12][13][14] .…”

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

“…The suture was originally described by Gruber et al in 2005 and have published their 12-year follow-up in 2014. [33][34][35] For convexity, the suture is epicentered around the area of maximal convexity and is placed 1 mm from the caudal border of the lateral crus and exits $1 mm from the cephalic border. A parallel mattress suture is then placed from the cephalic border to the caudal border where the knot is tied in a more caudal location that is felt to be less visible.…”

“…A parallel mattress suture is then placed from the cephalic border to the caudal border where the knot is tied in a more caudal location that is felt to be less visible. 35 The most powerful straightening of the convexity (or concavity) of the lateral crus, however, will often be achieved with the lateral crural strut graft.…”