Four suture tip rhinoplasty: a powerful tool for controlling tip dynamics.

OBJECTIVE: To evaluate the short-term effectiveness of using a 4-suture technique to control nasal tip dynamics. The 4 sutures include a medial crural suture, bilateral intradomal sutures, and an interdomal suture. STUDY DESIGN AND SETTING: Retrospective photograph analysis of preoperative and postoperative photographs of 77 patients with respect to 7 dynamic variables: supratip break, projection, rotation, tip shape, tip definition, tip symmetry, and the presence of a double columellar break. RESULTS: Seventy-four patients underwent primary rhinoplasty and had an overall average score of 5.2 on a -7 to +7 scale, with a mean follow-up period of 3.8 months. The 3 patients undergoing revision rhinoplasty had an overall average score of 5.0 and a mean follow-up of 8.7 months. CONCLUSION: The 4-suture technique worked best with respect to projection and tip symmetry, although the technique proved to be an effective tool overall in controlling all 7 variables mentioned above. EBM rating: C-4.