A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments

A complete subperichondrial and subperiosteal dissection technique during rhinoplasty may minimize soft tissue disruption, resulting in less scar tissue formation and preservation of ligamentous structures.

The authors describe their results with subperichondrial dissection of the nasal framework and manipulation of the preserved nasal ligaments.

The charts of 228 consecutive patients who underwent rhinoplasty with complete subperichondrial dissection via an open or closed approach between May 2008 and April 2011 with the senior author (BÇ) were retrospectively reviewed. Intraoperatively, the scroll ligament and Pitanguy's midline ligament were repaired to stabilize the internal valve and tip position, respectively.

Patients in this series (182 women, 46 men) ranged in age from 18 to 54 years (mean, 24.3 years). A total of 203 procedures were primary rhinoplasties; 14 were secondary, and 11 were revisions. The open approach was used in 92 patients, whereas a closed dome delivery was used in the remaining 136 patients. Follow-up ranged from 9 months to 3 years. A complete subperichondrial dissection technique resulted in relatively limited edema and more rapid patient recovery compared with the authors' previous experience with the sub-superficial musculoaponeurotic system (SMAS) approach. Repeat elevation in the subperichondrial plane was easier and less traumatic in revision cases compared with secondary rhinoplasty cases.

Subperichondrial dissection of the nasal framework allows reshaping and redraping of the nasal tip and controlled manipulation and repair of ligaments without disturbing the overlying soft tissue.