Nasal Tip Depressor Manipulation through Upper Buccal Sulcus Approach in Selected Open Primary Rhinoplasties

During smiling, the prominent action of nasal tip depressors (NTDs) antagonizes the rhinoplasty nasal tip support maneuvers and favors scarring forces' pulling the nasal tip in a less projecting vector. The NTDs' disinsertion is feasible through the open rhinoplasty approach. Yet, the reliability of the open approach to manipulate all NTD attachments is still questionable. The upper buccal sulcus approach (UBSA) is a reliable approach to manipulate variable anatomy of the NTDs.

Thirty-two patients had primary open rhinoplasty between 2016 and 2020. All patients showed hyperactive NTDs during smile preoperatively. Through UBSA, disruption of NTDs was done. Aesthetic outcome was evaluated by comparing the pre/postoperative nasal tip projection (NTP) and nasolabial angle (NLA) in lateral views.

The sample included 28 women and four men, and the mean age was 30.7 years. The mean follow-up period was 23.8 months. Preoperatively, 53% (n = 17) of patients showed normal NTP measurements; this percentage increased to 87.5% (n = 28) postoperatively. The mean NLA for the 32 patients was 91.0 degrees preoperatively' which was increased to 102.5 degrees postoperatively. These aesthetic results were maintained throughout the follow-up period' with no significant increase in the incidence of complications.

The combination of the UBSA with open rhinoplasty resulted in objective visualization and manipulation of the NTDs. This was proven by the maintained NTP and NLA in aesthetic optimum values throughout the follow-up period. We believe that UBSA can be safely combined with open rhinoplasty as a reliable hidden approach to manipulate hyperactive NTD cases.