Alar-spanning suture for tip contouring in closed approach rhinoplasty for African-Caucasian noses

Overview

A wide, rounded tip is common in African-Caucasian noses. The alar-spanning suture pulls the two side cartilages of the tip toward each other. It is usually placed through an open approach, but the author performs it through nostril incisions, which avoids a columellar scar that may darken or thicken in darker skin.

Sections of note

• Technique description; the abstract gives no patient numbers, follow-up or outcome data.
• The suture is described as one of the easiest ways to correct the width of the alar complex.
• It does not weaken the lateral crura and is stated to give predictable long-term results.
• The author cautions against changes so large that the result no longer fits the patient's ethnic heritage.
• Closed placement avoids the risk of hyperpigmentation or hypertrophic scarring at a columellar incision.

What it means for a patient

• A wide tip can be narrowed with a single stitch through hidden incisions, keeping the cartilage strong.
• The goal is refinement in keeping with the patient's ethnic features, not a dramatic change.
• The claim of long-term predictability is not backed by figures in the abstract.

Why this paper matters

Scar visibility in darker skin is a real concern with open rhinoplasty, and this paper offers a closed alternative for a common tip problem in ethnic rhinoplasty. Outcome data would strengthen it.

Terms

• Alar-spanning suture: a stitch passed across both lateral crura to pull them toward the midline.
• Bulbous tip: a rounded, wide nasal tip.
• Lateral crura: the side arms of the tip cartilages that run along the nostrils.
• Closed approach: rhinoplasty through incisions hidden inside the nostrils.
• Hyperpigmentation: darkening of a scar, more common in darker skin.
• Hypertrophic scar: a thick, raised scar.