Tip Extension Suture

BACKGROUND: Recent changes in the release and rebuilding of the tripod structure during Asian rhinoplasty have allowed for additional lengthening and rotation of the nasal tip. To rebuild the nasal tip framework, we used the tip extension suture technique alone or in combination with other procedures. A retrospective, longitudinal study was conducted to evaluate the safety and efficacy of the tip extension suture technique for use in Asian rhinoplasty. METHODS: From May of 2008 to December of 2011, 283 Asian patients underwent the tip extension suture technique and were postoperatively monitored for 6 months or longer. The tip extension suture surgical technique involves advancing the lateral crus, which is fully released from the pyriform margin-supported hinge areas, and fixing it to the caudal septum. The patients' medical charts and serial photographs were analyzed to assess outcome stability, complications (pinched deformity, skin necrosis, airway problems, or nasal valve collapse), patient satisfaction, and the need for revision surgery. RESULTS: This technique allowed most patients to retain an altered nasal tip shape during the follow-up period. The nasal tip was incompletely corrected in 14 patients (4.9 percent), and surgical revision owing to development of pinched deformities was required in eight patients (2.8 percent). Ultimately, 92 percent of the patients were satisfied with their outcomes. Complications, such as circulation or airway problems, did not occur. CONCLUSION: This study describes and recommends a new tip extension suture procedure for rebuilding the released nasal tip framework during Asian rhinoplasty, with fewer aesthetic and functional complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.