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Original Investigation
Nov/Dec 2016

Objective Comparison of Nasal Tip Contours in the Basal View Between Dome Binding and Hemitransdomal Tip Suture Techniques in Rhinoplasty

Author Affiliations
  • 1Department of Otolaryngology, San Vicente de Arauco Hospital, Concepción, Chile
  • 2Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University. Portland
JAMA Facial Plast Surg. 2016;18(6):481-487. doi:10.1001/jamafacial.2016.1061
Key Points

Question  Is the hemitransdomal suture (HTS) superior to the dome binding suture (DBS) in creating a satisfactory nasal tip contour?

Findings  In this case series of 112 patients who underwent cosmetic rhinoplasty with tip refinement, those who underwent HTS were significantly more likely to have a satisfactory outcome than those who underwent DBS, as assessed from the basal view.

Meaning  Use of the HTS is superior to the DBS in creating a satisfactory outcome of nasal tip contour, as assessed from the basal view.


Importance  The dome binding suture (DBS) used for nasal tip refinement creates the unwanted effects of nasal tip pinching owing to shadowing and loss of alar support. The hemitransdomal suture (HTS), however, refines the nasal tip while maintaining a natural contour between the nasal tip and the alar lobule. To our knowledge, no objective comparison between the DBS and HTS techniques has been described in the literature to date.

Objective  To determine whether the DBS or HTS technique results in an objectively satisfactory outcome in nasal tip contouring when assessed from the perspective of the basal view.

Design, Setting, and Participants  Postoperative basal view photographs of cosmetic rhinoplasty procedures performed on 112 Hispanic/Mestizo patients (85 [76%] women, and 27 [24%] men) in a facial plastic surgery practice in Chile, from May 2013 to May 2015 were reviewed. Only patients who underwent either DBS or HTS were included. Follow-up ranged from 6-24 months. Comparison of the nasal contour to the ideal tip-lobule line was performed and classified as satisfactory or unsatisfactory.

Main Outcomes and Measures  Satisfactory or unsatisfactory nasal tip contour in the basal view as analyzed by comparison with the ideal tip-lobule line.

Results  A total of 143 rhinoplasty procedures were performed over a 2-year period (May 2013-May 2015). A total of 112 patients met inclusion criteria. Of the 112 participants, mean (SD) age was 30 (9) years; 22 patients underwent DBS and 90 underwent HTS. Of the patients who underwent DBS, 5 of 22 (22.7%) had satisfactory contours. Of the patients who underwent HTS, 84 of 90 (93.3%) had satisfactory contours.

Conclusions and Relevance  Comparison of nasal contour in the basal view with the ideal tip-lobule line demonstrates a statistically significant improvement in the rate of satisfactory outcomes using the HTS compared with the DBS technique. This study is the first, to our knowledge, to provide objective data to support the use of this technique when performing tip contouring in rhinoplasty.

Level of Evidence  4.