Suture techniques in rhinoplasty

Suture techniques are an indispensable means to biologically sculpt the cartilage of the nose. Here the authors review their use in tip-plasty and present a 4-suture algorithm that allows for simple, complete control in sculpting the shape of all nasal tips in primary rhinoplasty. After a standard cephalic trim of the lateral crus leaving it 6 mm wide, one or more of the four suture techniques are applied. One of the newest techniques that has yielded excellent results is the hemi-transdomal suture, a variation of the conventional transdomal suture. This technique narrows the dome but also everts the lateral crus slightly to avoid concavities of the nostril rim. The 4-suture algorithm is useful in both the open and closed approaches. A more general use of sutures is described and referred to as the "universal horizontal mattress suture," which can be applied to remove all unwanted convexities or concavities and can be used not only to straighten the cartilage but also strengthen it. This suture has applications for the crooked septum, the collapsed lateral crus (external valve), and the collapsed internal valve, as well as for converting ear cartilage grafts into straighter, stronger grafts than previously thought possible.