The shape of the tip of the nose is one of the modifiable areas in rhinoplasty. With the visibility offered with an open technique, the tip cartilages can be resected, sutured and cartilage grafted to achieve a new tip shape.
One of the most common requested tip changes is for increased rotation particularly amongst female patients. By opening up the nasolabial angle the nose looks shorter in length, corrects a sagging tip and often softens the appearance of the face. A variety of well known tip cartilage maneuvers can be used to achieve tip rotation but how to put them all together for the desired result is not always predictable.
In the February 2018 issue of JAMA Facial Plastic Surgery an article was published entitled ‘Association of Nasal Tip Rotation Outcome Estimation With the New Domes Technique in Primary Rhinoplasty’. In addressing the possibility of being able to accurately determine the angle of tip rotation after rhinoplasty, the authors describe their dome technique and then provide a quantitative assessment of its outcome in a large series of patients (over 300) over a five year period.The goal is to improve the estimation of the rotation angle of the nasal tipwith this rhinoplasty technique.
Their domes technique consisted of a limited cephalic resection of the alar cartilage, the placement of transdomal sutures that maintains the natural arch of the cartilage at the level of the new dome, a columellar strut graft and interdomal/intercrural sutures. Lastly a long shield cartilage graft is placed. Measurement of the rotation angle of the nasal tip was done before and 1 week and 6 months after surgery. The measurement of the lateralized nasal domes was the key variable studied.
The mean (SD) preoperative nasolabial angle was around 93° which changed to around 105° at the first postoperative week and settled in at 102° at six postoperative months. The mean increase of the rotation that was achieved per lateralized millimeter was 3.6°. The mean rotation angle at 6 months decreased slightly to 3.4°.
The authors found that their dome rhinoplasty technique produced reliable results despite the variables of postoperative swelling and inflammation. It allowed precise estimation of the long-term outcome of the rotation of the nasal tip, enabling the surgeon to determine from the preoperative plan the definitive rotation angle of the nose.
Dr. Barry Eppley
Indianapolis, Indiana