Arumugam Technique: Lower Lateral Cartilage Liberation for Nasal Tip Refinement in Closed Rhinoplasty

Background: Nasal tip refinement remains one of the most challenging aspects of rhinoplasty. Traditional closed rhinoplasty techniques often limit precise manipulation of the lower lateral cartilages due to restricted visualisation and tissue mobility. The Arumugam Technique addresses these limitations through complete lower lateral cartilage liberation via a closed approach, offering open-rhinoplasty-level control without external incisions. Methods: A retrospective cohort study was conducted at Apollo Hospitals, evaluating 150 patients who underwent primary rhinoplasty with tip correction using the Arumugam Technique between January 2016 and May 2025. The technique involves rim incision, hydrodissection, and complete release of lower lateral cartilages from both vestibular mucosa and dorsal skin attachments, allowing bilateral cartilage externalisation, modification, and repositioning. Patient demographics, surgical procedures, complications, and patient-reported outcomes using the Rhinoplasty Outcome Evaluation (ROE) questionnaire were analysed. Inclusion criteria required patients aged 18–55 years undergoing primary rhinoplasty with tip correction indications and minimal septal work. Follow-up ranged from 6 months to 5 years. Results: The cohort comprised 77 males (51.3%) and 73 females (48.7%) with a mean age of 36.0 ± 11.1 years. The most common indications were cosmetic tip refinement (11.3%), minor dorsal hump with tip deformity (8.0%), and pinched tip (7.3%). The overall complication rate was 8.7% (13/150 patients), with prolonged oedema (5.3%), infection (2.0%), and mucosal perforation (1.3%) being the observed complications. All complications were minor and successfully managed. Mean preoperative ROE score was 32.02% ± 8.23%, improving significantly to 80.98% ± 8.96% postoperatively (mean improvement 48.96 percentage points, P < .001). Patient satisfaction was high, with 88.7% achieving ROE scores ≥70% and 38.7% achieving scores ≥85%. Outcomes were consistent across sex and age groups, with no clinically significant differences in improvement rates. Conclusions: The Arumugam Technique represents a significant advancement in closed rhinoplasty, providing surgeons with open-approach-level visualisation and manipulation of lower lateral cartilages while preserving the benefits of closed rhinoplasty, including no external scarring and faster recovery. The technique demonstrates an excellent safety profile, high patient satisfaction, and consistent outcomes across diverse patient populations. Complete lower lateral cartilage liberation addresses tissue memory and elastic recoil limitations inherent in traditional closed approaches, enabling precise bilateral tip refinement. This technique expands the indications for closed rhinoplasty to include complex tip deformities previously requiring open approaches. Level of Evidence: Level IV, therapeutic study.