Structural Contour in Rhinoplasty: A 4-phase Technique for Progressive Dorsal Definition

Dorsal definition represents a persistent challenge in rhinoplasty, especially at the osteocartilaginous junction. We present the structural contour technique, a progressive 4-phase surgical approach designed to achieve a more defined and stable nasal dorsum through combined bony and cartilaginous maneuvers. The technique includes bony framework modification through targeted ostectomy and remodeling, osteochondral stabilization at the keystone area using cerclage sutures, controlled inferior reinsertion of the upper lateral cartilages, and final dorsal contour refinement with a continuous absorbable suture to achieve a cylindrical configuration while preserving nasal valve function. In a preliminary descriptive experience involving 4 patients, this technical approach allowed tailored dorsal contour refinement according to individual anatomical and aesthetic requirements. The structural contour technique provides a systematic and reproducible framework for dorsal refinement, integrating bone and cartilage in a controlled and harmonious manner.