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Published on: June 20, 2018
Systematic Review and Meta-analysis of Vertical Alar Division and Resection in Tip Rhinoplasty
Rafeef Alhajress1, Naif Fnais1, Hadeel Almajed2
1From the Department of Otolaryngology Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Plastic and Reconstructive Surgery. Global Open
|July 28, 2026
Summary
Vertical dome division (VDD) and vertical alar resection (VAR) are effective rhinoplasty techniques for nasal tip refinement. Both offer good outcomes, but VAR may provide superior long-term projection stability.
Area of Science:
- Plastic Surgery
- Otolaryngology
- Facial Plastic Surgery
Background:
- Vertical dome division (VDD) and vertical alar resection (VAR) are established rhinoplasty techniques.
- These methods aim to enhance nasal tip projection, definition, and stability.
- VDD involves cartilage division, while VAR includes resection and graft reinforcement for sustained support.
Purpose of the Study:
- To systematically review and compare the efficacy of VDD and VAR in rhinoplasty.
- To evaluate outcomes such as nasal tip projection, rotation, revision rates, complications, and patient satisfaction.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Searches were conducted across PubMed, Scopus, and Google Scholar databases.
- Five studies were included, with quality assessed using the Newcastle-Ottawa Scale and GRADE system.
Main Results:
- VDD improved nasal tip projection by 15.8% with over 90% patient satisfaction.
- VAR demonstrated sustained projection stability beyond 7 years, with >85% satisfaction.
- Both techniques had low revision rates (2%-6%) and rare major complications; VAR showed better long-term stability and contour definition.
Conclusions:
- VDD and VAR are valuable rhinoplasty techniques yielding favorable aesthetic results and low complication rates.
- VAR appears to offer superior long-term projection stability, particularly in selected cases.
- Further prospective comparative studies are needed to validate these findings due to existing evidence heterogeneity.