Endonasal suture techniques in tip rhinoplasty

Suture modification techniques have long served as reliable methods to surgically improve nasal tip contour by allowing control of width, projection, and rotation during rhinoplasty. Tip abnormalities characterized by a wide or broad shape are particularly amenable to such techniques. In the senior author's hands (SWP), the endonasal double-dome tip-sculpting technique has become a workhorse for the correction of the wide tip complex. When combined with additional techniques, the double-dome technique allows for the correction of various abnormalities falling under the umbrella of a broad tip (ie, boxy, bifid, bulbous, trapezoid, amorphous), while still adhering to the tenets of modern rhinoplasty philosophy. The authors present a paradigm for surgical planning, along with a series of case studies highlighting the capabilities of various suture techniques performed with the endonasal approach.