Subdomal Graft Control of Nasal Tip Aesthetics: A Long-term Digital Photographic Evaluation

BACKGROUND: Long-term stability and symmetry of the nasal tip remain challenging in rhinoplasty. Despite meticulous suturing techniques, postoperative deformities such as asymmetry or pinched tip may occur. The subdomal graft has been proposed to reinforce tip support, but its long-term efficacy compared with standard suturing remains unclear. OBJECTIVES: To evaluate whether subdomal grafting improves long-term control of the interdomal angle and domal symmetry compared with standard tip suturing. METHODS: A retrospective comparative study included 379 female patients undergoing primary closed preservation rhinoplasty between January 2022 and December 2023. Group 1 (n = 223) underwent standard tip suturing, whereas Group 2 (n = 156) received subdomal grafting. Standardized photographs were obtained intraoperatively and at 12 months postoperatively. Interdomal angle variation was measured using digital analysis (ImageJ/Fiji), and domal symmetry was independently assessed by 3 blinded plastic surgeons using a 3-point Likert scale. RESULTS: Mean interdomal angle change from intraoperative to 12 months was 12.5° ± 7.5° in Group 1 and 6.3° ± 4.8° in Group 2 (p < 0.05). Mean domal symmetry scores were higher in the graft group (2.7 ± 0.35 vs 2.3 ± 0.41; p < 0.05). Revision surgery was required in two patients in Group 1 (0.9%) and one patient in Group 2 (0.6%). CONCLUSIONS: Subdomal grafting improves long-term control of the interdomal angle and enhances nasal tip symmetry compared with suturing alone, supporting more predictable and stable aesthetic outcomes in primary closed preservation rhinoplasty.