Systematic Review and Meta-analysis of Vertical Alar Division and Resection in Tip Rhinoplasty

Vertical dome division (VDD) and vertical alar resection (VAR) are key rhinoplasty techniques developed to improve nasal tip projection, definition, and stability. Although VDD remodels the dome through controlled division of the lower lateral cartilage, VAR expands this concept by incorporating cartilage resection and graft reinforcement for long-term tip support.

A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, Scopus, and Google Scholar databases. Five studies met the inclusion criteria and evaluated VDD and VAR techniques in terms of projection, rotation, revision rates, complications, and satisfaction. Study quality was assessed using the Newcastle-Ottawa Scale and the GRADE system.

VDD significantly increased nasal tip projection by 15.8% with more than 90% patient satisfaction. The VAR provided sustained stability of projections beyond 7 years, with satisfaction rates greater than 85%. Revision rates remained low (2%-6%) with both methods, and major complications were rare. VAR demonstrated superior long-term stability and contour definition due to graft-supported reinforcement.

Both VDD and VAR are commonly used techniques for nasal tip refinement and are associated with favorable aesthetic outcomes and low reported complication rates. However, the available evidence is largely retrospective and heterogeneous. Although VAR seems to offer improved long-term projection stability in selected cases, further prospective comparative studies are required to confirm these findings.