Cephalo-crural suture: a new way to deal with supratip fullness

Supratip fullness is a common postoperative problem in rhinoplasty. There are approaches designed to reduce or augment the underlying framework and/or reduce the "dead space" between the skin and the cartilaginous structure, but these fail to create a stable midline framework in the supratip area.

In this report, a technique is described to surgically obtain a clinically desirable supratip breakpoint by creating, in the midline, a stable, symmetric, "stronger," well-shaped cartilaginous framework (flat or concave as needed) in the supratip area, with maximum preservation of the native alar cartilage.

An open approach was used for maximum preservation of the lateral crura by means of sutures and excision of only the overlapping midline lateral crura. A suture was placed between the preserved lateral crus, running caudally to both middle crura and back cephalically to the opposite lateral crus at the same level, and was tightened as needed. By doing this, a flat or concave supradomal structure was created in the midline.

The procedure was performed in 20 primary open rhinoplasty patients with a minimum follow-up of 9 months. A pleasing supratip contour was obtained in all cases. The patients were satisfied and no functional complaints were noted.

The use of the cephalo-crural suture improves the likelihood of obtaining a clinically acceptable supratip breakpoint, with good supratip contour and maximum preservation of nasal anatomy and physiology.