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Objectives
The surgical anatomy of the nasal tip is determined by intrinsic factors, such as the nasal tip volume, shape, definition, and symmetry. These factors are intimately related to the morphology of the lower lateral cartilages. Tip sutures reduce the need for grafts and allow the surgeon to manipulate the tip with a high degree of precision...
Contexts in source publication
Context 1
... crural fixation suture ( Fig. 1) 1. Equalizes initial projection of the domes 1. Placing the suture above the point of divergence of the intermediate crura will narrow the angle of divergence 2. Tip projection can be increased as necessary The middle crura suture (Fig. 2) 1. Helps more pronounced reduction of the interdomal ...
Context 2
... crura. In contrast to the medial crural fixation suture, the middle crura suture results in a more pronounced reduction of the interdomal distance and narrows the lobule. The middle crura suture approximates the most anterior por- tion of the medial crura. This suture provides greater strengthening of the tip and some approximation of the domes (Fig. ...
Citations
... Therefore, the methods contributing to the tip support can be added to get more consistent tip structure in the patients above 40 years of age. 20,21 In their study about the aging rhinoplasty, Toriumi et al. emphasized that usage of septal extension graft, bilateral spreader grafts, and lateral crural strut grafts in this population is the main key point to support both the nasal airway and tip projection. 22 Because of the loosening of the intra-and intercartilaginous attachments, the maneuvers targeting these connections will prevent the separation of nasal tip from the middle 1/3 part of the nose substantially. ...
Background: There are several factors affecting the results of rhinoplasty, and the predictability of outcomes still remains insufficient. Objective: To associate the rhinoplasty results with patients' age by anthropometric measurements. Methods: Retrospective chart review of patients undergoing rhinoplasty who were divided into decades of age. Anthropometric measurements were carried out using Rhinobase® Software. Wilcoxon t test was used for the postoperative 3 months and 2 years analysis. p values of <0.05 were considered statistically significant. Results: A total of 243 patients (median age: 37.1; M:F = 68:175) were included in the study: group I (19-29 years) n: 80; group II (30-39 years) n:71; group III (40-49 years) n: 48; and group IV (50-61 years) n: 44. In group IV, the highest value of difference (Δ) was seen in the midfacial height with the number of 5.5 ± 1.1 (mm) (<0.001). The values of nasal length, tip projection, and midfacial height parameters showed significant differences in both group III and group IV. Conclusions: Unfavorable age-related changes in long-term postoperative period following rhinoplasty can occur in patients above 40 years of age.
... Cingi et al. (25) have done a comprehensive study on nasal tip sutures. They have detailed the positive effects of various suture techniques on projection and other structural problems. ...
... They have detailed the positive effects of various suture techniques on projection and other structural problems. In our study, objective results were found to support these analyzes in patients using both strut grafts and suturing techniques (25). In a previous study the use of columellar strut grafts with the correct indication in patients with inadequate projection was emphasized. ...
Introduction:We aimed at comparing nasal tip projection and nasolabial angle changes following primary open rhinoplasty with short-floating columellar strut graft and suture techniques.Methods:Participants were divided into two groups depending on the type of technique employed. In the first group, short-floating columellar strut grafts were employed. The second group involved those who underwent suture techniques only.Results:We included 119 patients who underwent primary rhinoplasty in the study. The mean value of preoperative nasolabial angle measurement was 92.77±8.5 degrees and 92.14±6.7 degrees in groups 1 and 2, respectively. Postoperative nasolabial angle measurement in group 1 was 107.2, 104.3 and 101.3 degrees in the 1st, 3rd, and 5th postoperative year, respectively. Postoperative nasolabial angle measurement in group 2 was 107.4, 104, and 102.2 degrees in the 1st, 3rd, and 5th postoperative year respectively. The mean value of preoperative nasal tip projection was 0.605±0.07 and 0.653±0.08 in groups 1 and 2, respectively. Postoperative nasal tip projection measurement in group 1 was 0.636, 0.632 and 0.627 in the 1st, 3rd, and 5th postoperative year, respectively. Postoperative nasal tip projection measurement in group 2 was 0.656, 0.634 and 0.632 in the 1st, 3rd, and 5th postoperative year, respectively.Conclusion:Suture techniques were efficient than columellar strut grafts in maintaining the nasolabial angle but not the nasal tip projection when.
... [17,18] Tip sutures reduce the need for grafts and allow the surgeon to manipulate the tip with a high degree of precision. [19] The results of our procedure were encouraging in all 18 consecutive patients with no additional morbidity and better appearance of nose correction especially in the adolescent age group, following surgery all of our patients were relieved from nasal congestion and obstructive symptoms. It is a well-known fact "beauty lies in the eyes of the observer," most of our patients were quite satisfied and confident about their appearance and esthetic outcome after surgical correction. ...
Introduction:
The purpose of this study is to highlight the role of cartilage correcting suture in single-stage surgical correction for secondary unilateral cleft lip nose deformity with three-dimensional observations of preoperative and postoperative nasal forms.
Material and methods:
Between July 2017 and June 2019, 18 consecutive patients of unilateral cleft lip nose deformity aged between 16 and 28 years underwent surgical correction. The corrective procedure of nose involved columellar lengthening, medial and lateral nasal osteotomies along with augmentation of premaxilla by bone graft at premaxilla, and alar base wedge resections. Focus was laid to correct nasal cartilaginous framework using tip sutures along with repositioning of lower lateral cartilages, fixation of the alar cartilage complex to the septum, and the upper lateral cartilages. We investigated the following surgical interventions and nasal tip suture techniques, which were transdomal suture, interdomal suture, lateral crural mattress suture, columella septal suture, and intercrural suture.
Results:
We achieved adequate esthetic and functional results in all the patients without any morbidity.
Conclusion:
This concept of simultaneous approach toward complete single-stage correction of secondary cleft lip nasal deformity incorporating various cartilage suture using 5-0 nylon in developing nation like ours, where the patient presents late with complex conditions showed promising esthetic and functional outcome.
... There are several basic suture techniques used in remodeling nasal tip as a part of nondestructive technique that include: Interdomal Suture, Transdomal Suture, Middle Crura Suture, Medial Crura Suture, Lateral Crura Spanning Suture, Tip rotation suture, Lateral crural steal suture, Septocolumellar suture, Lateral crural mattress suture, Medial Footplate Suture and Tongue-in-groove technique [9] . When cartilage is missing or extraordinarily weak, grafting is necessary. ...
... On the contrary, the endonasal approach allows us to avoid graft fixation to the septum, which thus preserves tip natural flexibility. 14 Similarly, most nasal tip sutures (e.g., domal, columellar-septal, intercrural, lateral crural steal, and tongue-in-groove technique) 15 produce an increase of tip projection and, at the same time, an augmentation of tip rotation, which is undesirable in a hyper-rotated tip. On the contrary, our SEG-DCG produced an increase in tip support and projection and a CLA reduction simply by restoring the septal caudal edge, which was hyperresected during the previous surgery. ...
Background:
The septal extension graft (SEG) is widely used in secondary rhinoplasty for correction of a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip secondary to an overresection of the caudal septum. Although SEG precise fixation can be relatively easy in the external approach, the difficulties of SEG placement in "closed" rhinoplasty can be discouraging.
Objective:
To describe an easy surgical technique for SEG placement in endonasal revision rhinoplasty and to analyze the aesthetic results of the procedure.
Methods:
Thirty-eight patients were submitted to an endonasal approach revision rhinoplasty with endonasal placement of SEG for the correction of a short nose with a hypoprojected and hyper-rotated nasal tip. Pre- and postoperative nasal length, tip projection, and tip rotation (nasolabial and lobulocolumellar angles) were measured for each patient.
Results:
An increase (mean ± standard deviation) of nasal length by 15.02 ± 3.91% and an augmentation of tip projection by 11.34 ± 2.26% were noticed after surgery with respect to preoperative conditions. A significant (p < 0.001) decrease in the columellar-labial angle was recorded on postoperative (91.23 ± 3.85°) examination with respect to preoperative (99.81 ± 6.49°) conditions. A decrease (p < 0.001) in the columellar-lobular angle was noted on postoperative assessment (34.02 ± 5.28°) with respect to preoperative examination (50.02 ± 0.36°). No relevant postoperative complication was recorded.
Conclusion:
The "endonasal" approach described for SEG placement was an easy and reliable procedure to treat a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip, especially in revision surgery. The advantages of our technique over previously described approaches were reported.
... In several studies, changes in nasal tip projection were reported after conventional septoplasty maneuvers or the basic stages of open and closed rhinoplasty techniques, such as incision, cephalic trimming, dome suturing, or grafting. 1,[4][5][6][7][8] However, no study has reported the effects on nasal aesthetic character of open-approach extracorpereal septoplasty (OAES) without simultaneous rhinoplasty. The present study focuses on the objective changes to nasal tip projection and rotation after OAES without simultaneous rhinoplasty. ...
... In addition to reporting advances in endoscopic endonasal surgery, the AJRA remains committed to providing the latest studies that evaluated functional and cosmetic nasoseptal deformities. Cingi et al. 18 evaluated rhinoplasty outcomes after common nasal tip suture techniques to clarify the differences among them. They found that sutures play an important role to increase tip projection, rotation, and stabilization. ...
Background
The nasal tip plays a crucial role both esthetically and functionally. The application of nasal tip grafts is an effective method for improving nasal tip form. Ear cartilage is a common choice for nasal tip grafts, but it still presents several challenges in clinical application that need to be addressed. This study aims to address the issues associated with the use of ear cartilage in clinical rhinoplasty applications through the development of a novel septal extension graft using ear cartilage for nasal tip reconstruction.
Methods
From May 2018 to April 2022, a total of 132 cases of nasal tip reconstruction surgeries were performed using a seagull-shaped nasal septum extension graft, constructed with bilateral cavum concha cartilage. Among these cases, 25 patients had previously undergone rhinoplasty using silicone implant, 7 patients had undergone augmentation rhinoplasty using expanded polytetrafluoroethylene, whereas the rest were primary rhinoplasty cases. All patients were followed up for a period ranging from 3 months to 4 years postoperatively, with photographs taken to assess the nasal tip morphology.
Results
In this study, all patients exhibited good healing of the incisions made at the posterior aspect of the auricular concha, with no occurrences of hematoma and inconspicuous scarring. In 116 cases, significant improvement in nasal appearance and a realistic nasal tip form were achieved postoperatively, yielding satisfactory outcomes. Only 16 patients experienced minor issues with nasal tip morphology, which were subsequently improved through further surgical procedures.
Conclusion
This study reports a surgical technique for nasal tip refinement using bilaterally harvested cavum concha cartilage to construct a seagull-shaped nasal septal extension graft. The procedure has achieved satisfactory outcomes, and its application is worth extending to clinical practice.
This chapter focuses on the most commonly performed aesthetic surgeries of the nose and lower face, which include rhinoplasty (nasal augmentation), genioplasty (chin augmentation), and rhytidectomy (facelift). The nonsurgical modalities for these facial regions include nasal augmentation with filler injections, or liquid rhinoplasty, and aesthetic skin treatments (among others) which are discussed in detail within chapter “Non-surgical Facial Aesthetic Procedures”. When nonsurgical treatments are incapable of producing the patient’s desired results, often because of deep rhytids or severe nasal or mental aesthetic deformity, surgical modalities are recommended. It should be noted that rhytidectomy is used to target age-related facial changes in the upper and lower face, both of which is discussed in this chapter.KeywordsAnatomical review of nasal structure and anomaliesIndications for surgical rhinoplasty and techniquesAssessment of nasal aestheticsSurgical cosmetic chin augmentationAesthetic surgeries of the midfacial and lower facial compartmentsAesthetic surgical rhytidectomy (facelift) techniques and indicationsGenioplasty techniques and advancementsComplications of lower facial aesthetic surgery
The secondary cleft nasal deformity presents a challenge for the surgeon devoted to deliver high-level longitudinal cleft care. The underlying complex anatomic deformities combined with scarring from a needed primary rhinoplasty make the secondary cleft rhinoplasty a challenging procedure, with no consensus about a single surgical approach to fully address the multilayered abnormality (skin, cartilage, vestibular lining, and skeletal base platform). This chapter addresses the surgical approach to the secondary cleft nasal deformity after skeletal maturity, highlighting the abnormalities of unilateral and bilateral cleft nasal deformities and its surgical treatment aiming nasal symmetry from the top-down with definition and straightening of the nasal dorsum, adjustment of the nasal tip (rotation, projection, definition, and length), proper alar base repositioning, and improvement of nasal airway functioning. Multiple surgical techniques, that is, component nasal dorsum reduction, nasal dorsum argumentation, septoplasty, spreader flaps, spreader grafts, columellar strut graft, septal extension graft, cephalic trim, nasal tip suturing methods, tip grafts, alar base mobilization, nasal osteotomy, and inferior turbinate reduction, are also reviewed.
