Feasibility and Efficacy of Transdermal Skin Contour Sutures: A Retrospective Propensity Score Matched Study

Achieving optimal contour and projection of the nasal tip is one of the most challenging aspects of rhinoplasty. The skin-soft tissue envelope (STE) plays a pivotal role in determining the final outcome, as its thickness and elasticity significantly impact the predictability of postoperative results. Avoiding dead space in the lower third of the nose is essential to ensure consistent outcomes. Recently, transcutaneous skin contour sutures (TSCS) have been proposed to enhance the precision of tip definition and contouring, particularly in patients with thick STE. To mitigate risks such as skin necrosis or scarring associated with traditional TSCS techniques, we modified the approach by placing the knot of the transdermal contour suture on the internal nasal surface.A retrospective, propensity-score matched analysis was conducted on 159 patients who underwent rhinoplasty. After matching, two cohorts of 120 patients were retained: 60 patients underwent rhinoplasty with TSCS, while the control cohort of 60 patients underwent rhinoplasty without TSCS. Patient-reported outcome measures (PROMs) were utilized to evaluate functional and aesthetic outcomes.Using PROMs, we found significant improvements in mean preoperative scores for all PROMs in both cohorts. Postoperative assessments revealed that while the overall healing trajectories were not significantly different, TSCS offered notable early benefits in nasal contour and patient satisfaction, especially during the first 3 to 6 months postoperatively.The modified TSCS technique shows significant early postoperative benefits, particularly in the first 3 to 6 months. However, the overall healing trajectories over 12 months of follow-up were similar between both groups. This suggests that while TSCS has a short-term impact, the natural healing processes in both groups likely converge over time, leading to a diminishing of observable differences. Future research should focus on identifying patient subgroups that experience the greatest benefits from TSCS. The level of evidence is 3.