Pulley-Stitch: An Innovative Technique for Optimizing the Lateral Crus in Rhinoplasty

Abstract

Introduction

Managing nasal tip support and lateral crura malposition remains a challenge in rhinoplasty.

Objectives and Hypotheses

This study aimed to evaluate the effectiveness of a novel suture technique—the Pulley-Stitch—in correcting lateral crura malposition. Primary outcome: Change in lateral crura angle; secondary outcome: Long-term stability.

Study Design

Prospective cohort study (N = 42), reported in-line with STROBE guidelines.

Methods

Forty-two patients underwent open rhinoplasty. The angle between the caudal margin of the medial crus and the anterior third of the lateral crus was measured from intraoperative images at T0 (prestitch) and T1 (poststitch). Standardized postoperative images were analyzed at 1 month (T2) and 12 months (T3).

Results

The angle increased from a mean of 18.2 to 26.9 degrees (p < 0.05), reflecting improved anatomical alignment and external nasal valve patency. Stability was confirmed at 12-month follow-up.

Conclusion

The Pulley-Stitch is a safe, effective technique to improve nasal tip structure, cephalic rotation, and ala contour.

Keywords

rhinoplasty - lateral crura - nasal tip support - external nasal valve

Ethical Approval

The study was conducted in compliance with the Declaration of Helsinki and the Guidelines for Good Clinical Practice.

Informed Consent

All patients approved a statement of ethical approval and signed informed consent for publication of photographic material.

Publikationsverlauf

Eingereicht: 21. Mai 2025

Angenommen: 04. September 2025

Accepted Manuscript online:
04. September 2025

Artikel online veröffentlicht:
10. September 2025

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