Facial Plast Surg
DOI: 10.1055/a-2308-3649
Original Research

A Novel Treatment for Convex Lateral Crura: The Inverted Spanning Suture

Carlos Alberto Caropreso
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
José Carlos Neves
2   Department of Facial Plastic Surgery, My Face Clinic, Lisboa, Portugal
,
Gabriela Ichiba
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Paula Hirotani
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Victor Carvalho
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
Maria Carolina Souza
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
,
José Luiz Rodrigues
1   Department of Facial Plastic Surgery, Universidade de São Paulo (USP), São Paulo, SP, Brazil
› Author Affiliations

Abstract

Rhinoplasty is one of the most complex and challenging procedures in plastic surgery, even for experienced surgeons. Among the steps leading to an aesthetic and functional nose, there is the nasal tip improvement. Today's approach to nasal tip is the product of different techniques shifting through time, mainly from a resection tendency, to preservation and suture use to reshape cartilages. Addressing the lateral crura is vital to an aesthetic nasal tip and it is frequently obtained by adequate suture techniques. The alar-spanning suture described by Perkins is one of such. Regardless of its importance, it was not able to improve convex crura in some cases. The inverted alar-spanning suture (ISS) is an adaptation designed to treat those cases with the suture alone. ISS is a novel technique that can lead to better results treating the convex lateral crura by distributing the force vector in a more effective way. New techniques in rhinoplasty have multiplied, bringing this procedure to a new level and keeping up with the updated notion of restoration instead of excision the ISS is a new, precise, approach to an old problem.



Publication History

Accepted Manuscript online:
17 April 2024

Article published online:
11 May 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Daniel RK. Rhinoplasty: creating an aesthetic tip. A preliminary report. Plast Reconstr Surg 1987; 80 (06) 775-783
  • 2 Behmand RA, Ghavami A, Guyuron B. Nasal tip sutures part I: the evolution. Plast Reconstr Surg 2003; 112 (04) 1125-1129 , discussion 1146–1149
  • 3 Baker SR. Suture contouring of the nasal tip. Arch Facial Plast Surg 2000; 2: 34-42
  • 4 Daniel RK. The nasal tip: anatomy and aesthetics. Plast Reconstr Surg 1992; 89 (02) 216-224
  • 5 Hussein WKA, Ismail AS, Ibrahim AA, Omran AA. Modified lateral crural spanning suture of the nasal tip: suspension element. Egyptian J Ear Nose Throat Allied Sci 2017; 18 (01) 5-10 . ISSN 2090–0740
  • 6 Perkins SW, Sufyan AS. The alar-spanning suture: a useful tool in rhinoplasty to refine the nasal tip. Arch Facial Plast Surg 2011; 13 (06) 421-424
  • 7 Bloom JD, Antunes MB, Becker DG. Anatomy, physiology, and general concepts in nasal reconstruction. Facial Plast Surg Clin North Am 2011; 19 (01) 1-11
  • 8 Koppe T, Giotakis EI, Heppt W. Functional anatomy of the nose. Facial Plast Surg 2011; 27 (02) 135-145
  • 9 Pitanguy I. Revisiting the dermocartilaginous ligament. Plast Reconstr Surg 2001; 107 (01) 264-266
  • 10 Cakir B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
  • 11 Daniel RK, Glasz T, Molnar G, Palhazi P, Saban Y, Journel B. The lower nasal base: an anatomical study. [published correction appears in Aesthet Surg J. 2013 May;33(4):619] Aesthet Surg J 2013; 33 (02) 222-232
  • 12 Saban Y, Polselli R. Atlas d'Anatomie Chirurgicale de la Face et du Cou. Firenze SEE Editrice. 2009
  • 13 Saban Y, Polselli R. Anatomie du visage et du cou: en chirurgie et cosmétologie (French Edition). Issy-les-Moulineaux: Elsevier Masson; 2015
  • 14 Rohrich RJ, Hoxworth RE, Thornton JF, Pessa JE. The pyriform ligament. Plast Reconstr Surg 2008; 121 (01) 277-281
  • 15 Griesman BL. Muscles and cartilages of the nose from the standpoint of a typical rhinoplasty. Arch Otolaryngol Head Neck Surg 1944; 39 (04) 334-341
  • 16 Saban Y, Andretto Amodeo C, Hammou JC, Polselli R. An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 2008; 10 (02) 109-115
  • 17 Gassner HG, Sherris DA, Friedman O. Rhinology in rhinoplasty. In: Papel I. editor. Facial Plastic and Reconstructive Surgery. New York: Thieme; 2009: 492
  • 18 Westreich RW, Burstein D, Fraser M. The effect of facial asymmetry on nasal deviation. Facial Plast Surg 2011; 27 (05) 397-412
  • 19 Sowder JC, Thomas AJ, Ward PD. Essential anatomy and evaluation for functional rhinoplasty. Facial Plast Surg Clin North Am 2017; 25 (02) 141-160
  • 20 Toriumi DM. Structure approach in rhinoplasty. Facial Plast Surg Clin North Am 2005; 13 (01) 93-113
  • 21 Toriumi DM, Johnson Jr. CM. Open structure rhinoplasty: featured technical points and long-term follow-up. Facial Plast Surg Clin North Am 1993; 1 (01) 1-22
  • 22 Johnson Jr CM, Godin MS. The tension nose: open structure rhinoplasty approach. Plast Reconstr Surg 1995; 95 (01) 43-51
  • 23 Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1999; 1 (04) 246-256 , discussion 257–258
  • 24 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8 (03) 156-185
  • 25 Çakir B, Doğan T, Öreroğlu AR, Daniel RK. Rhinoplasty: surface aesthetics and surgical techniques. Aesthet Surg J 2013; 33 (03) 363-375