The role of internal sutures in stabilization of nasal dorsum in primary rhinoplasty

Background Nasal dorsum anatomy is disrupted in rhinoplasty operations. Nasal dorsum restoration is critical in providing a natural, smooth, and stable nasal dorsum. In this article, a dorsum restoration technique for protecting anatomical structures and 1-year postoperative outcome assessment is presented. Methods A total of 324 patients who all had a dorsal hump > 3 mm and required dorsal hump reduction were included in the study. All patients underwent dorsum restoration using the same technique, which included medial, lateral, and horizontal osteotomies, and nasal dorsal and mucosal approximating by polydioxanone sutures. At 1 year follow-up, dorsal irregularities and symmetry of dorsal aesthetic lines were evaluated by analysis of standard pictures. Evaluations were performed by two other plastic surgeons. Patients also completed a Rhinoplasty Outcome Evaluation (ROE) questionnaire with high scores indicating greater patient satisfaction. Results The average duration of operations was 168 min. At follow-up, dorsal aesthetic lines of 299 patients (92.2%) were symmetrical. Unacceptable dorsum irregularity was detected by palpation in 12 (3.7%) patients and 18 (5.5%) patients underwent revision rhinoplasty. All patients (n = 324) completed ROE questionnaire (score range 0-24) and the mean ROE score was 21.45. The results of the ROE scores show that 65% and 28% of patients gave 4 points and 3 points for ROE questionnaire, respectively, which shows that 93% of points were 3 and higher. Only seven patients scored their appraisal of nasal appearance < 3 while 237 patients reported a maximum score for social admiration. The aesthetic and functional results were satisfactory for patients and the surgeon. Conclusions Reconstruction of disrupted nose dorsum anatomy in rhinoplasty surgery is necessary for successful results. The protective and restorative techniques for nasal dorsum described using this technique provided a stable, permanent, soft, symmetrical, and natural nose dorsum at 1-year follow-up. Level of evidence: Level IV; therapeutic study