A 20-Year Review of the "New Domes" Technique for Refining the Drooping Nasal Tip

OBJECTIVE: To describe in detail a technique to achieve cephalic rotation, projection, and narrowing of the nasal tip, the "new domes" technique. DESIGN: Retrospective analysis of more than 3000 primary rhinoplasties performed during the last 20 years. SETTING: A private facial plastic surgery practice in Bogotá, Colombia. INTERVENTION: Through an endonasal cartilage delivery approach to the nasal tip, we mold and reorient the alar cartilages with transdomal and interdomal sutures. MAIN OUTCOME MEASURES: Photographic analysis with nasal and facial measurements taken directly from the patient that allows precise diagnosis and preoperative surgical planning. RESULTS: The new domes technique creates a more projected, cephalically rotated, narrowed nasal tip. The results are predictable and stable over time, and patient satisfaction is high because of the natural-appearing results. Complications such as asymmetries, pinching, or retraction of the tip are rare. CONCLUSION: The new domes technique is a conservative, predictable, and stable technique especially applicable for patients with drooped and wide nasal tips to achieve a more projected, rotated, narrowed, and natural appearance.