The infradome graft: a new technique to improve dome reshaping in rhinoplasty

As the open approach rhinoplasty has gained popularity, newer techniques for aggressive reshaping of the alar cartilage have become available. The most effective way to increase alar dome definition is the dome plication technique described by Daniel, which places a horizontal mattress suture, applied with incremental tension, between the medial and lateral crura. The disadvantage of this technique is that it can produce either overtightening or distortion of the cartilage, with excessive pinching of the nasal tip. Also, as it relies on a single nylon suture to fight against the cartilage's shape memory, it has the potential for relapse. The present article describes a new technique to overcome these problems. It consists of placing two parallel strips prepared from the resected alar cartilage excess under the domes. These grafted cartilages block the plication suture, thus avoiding the risk of excessive pinching of the domes and ensuring symmetry and stability. Using this technique, I have consistently obtained a nasal tip that is well defined over the nasal dorsum line in my patients.