Nasal Tip Suspending Transfixion Suture

Anterior septal height is an important determinant of nasal tip projection. Accordingly, the anterior septal extension technique has proven itself to be a powerful tool for achieving long-lasting nasal tip projection in rhinoplasty. However, anterior septal extension does not protect against postoperative loss of nasal tip rotation unless an additional suspension strategy is used. A tip-suspending transfixion suture is the authors' strategy for supporting nasal tip rotation whenever an anterior septal extension technique is performed. Of 156 rhinoplasties performed by the authors between 2010 and 2012, a cohort of 22 droopy-tip rhinoplasties was extracted in which the described technique was used. The patients in this cohort were included in a retrospective nasal tip projection and rotation analysis. The nasolabial angle (NLA) and Goode ratio measurements were compared between preoperative, 3-week postoperative, and 1-year postoperative profile-view photographs. The NLA and the Goode ratio measurements were significantly higher in the 3-week postoperative group than in the preoperative group, indicating an effective gain in both tip projection and rotation. The NLA and the Goode ratio measurements did not differ statistically between the postoperative 3-week and postoperative 1-year groups, indicating long-term maintenance of nasal tip position. A tip-suspending transfixion suture is an easy method for securing nasal tip rotation when used in conjunction with an anterior septal extension. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.