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Aesthetic Plast Surg 2019 10 25;43(5):1269-1278. Epub 2019 Jul 25.

Department of Otolaryngology, Istanbul Training and Research Hospital, Kasap İlyas Mah., Org. Abdurrahman Nafiz Gürman Cad., Fatih, 34098, Istanbul, Turkey.

Background: The tripod theory explains the dynamics of the nasal tip, where surgery is difficult because of anatomic variations and pathologies and the various surgical possibilities. Abnormalities or weaknesses of the lateral crura can result in concavity in ala or alar collapse and cause aesthetic and functional impairments of the nose. Several tip plasty techniques and lateral crura modifications are used in rhinoplasty. Read More

J Craniofac Surg 2018 Sep;29(6):e585-e588

Luleburgaz State Hospital, Kirklareli, Turkey.

Suture tip plasty is one the most used methods in nasal tip surgery. Transdomal suture (TDS) used for this purpose is utilized for providing the dome symmetry, thinning the nasal tip, and enhancing the nasal tip projection and rotation. However, there are not sufficient visual data on what the dome position should be during TDS. Read More

Aesthetic Plast Surg 2018 Feb 12;42(1):275-287. Epub 2017 Oct 12.

Faculty of Medicine, Bahçelievler Medical Park Hospital, Otorhinolaryngology İstanbul, İstanbul Kemerburgaz University, TR, Istanbul, Turkey.

Introduction: Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. Read More

Braz J Otorhinolaryngol 2015 Jan-Feb;81(1):31-6. Epub 2014 Oct 18.

Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço do Hospital de Base de São José do Rio Preto - Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil.

Introduction: The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty.

Objective: To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure. Read More

Facial Plast Surg 2014 Apr 8;30(2):123-30. Epub 2014 May 8.

Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.

Asian patients present with relatively poorly developed dorsal and tip height and thicker skin, so augmentation rhinoplasty is the most commonly performed rhinoplasty procedure. Tip surgery using autologous cartilage followed by dorsal augmentation using an alloplastic implant material is the most widely performed surgical procedure for augmentation rhinoplasty on Asian patients. Cartilage tip grafting procedures, including shield grafting, multilayer tip grafting, onlay grafting, and modified vertical dome division, are key maneuvers for building up and providing better definition on a relatively poorly developed Asian tip. Read More

Otolaryngol Head Neck Surg 2013 May 4;148(5):758-63. Epub 2013 Mar 4.

Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Objective: To assess quality-of-life outcomes in patients undergoing nasal tip surgery with the vertical dome division technique using validated instruments (Rhinoplasty Outcome Evaluation [ROE] and Nasal Obstruction Symptom Evaluation [NOSE]).

Study Design: Case series with planned data collection.

Setting: Tertiary university center. Read More

Iran J Med Sci 2011 Sep;36(3):196-200

Departments of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The technique of vertical dome division or tip defining, involves incising the lateral crura and vestibular skin at or lateral to the dome or tip defining point. The incision divides the lower lateral cartilage into a lateral segment and a medial segment, which are advanced anteriorly and sutured together to increase tip projection. The present study aimed at assessing a new vertical dome division, which is a modified version of vertical dome technique to decrease nasal tip projection, and increase or decrease nasal tip rotation and other tip deformities. Read More

Facial Plast Surg 2010 May 4;26(2):93-101. Epub 2010 May 4.

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

When compared with Caucasian noses, the typical Asian nose appears to be relatively small and flat and has poor tip definition. Therefore, the main concept of rhinoplasty for Asians is augmentation rather than reduction. In selecting the dorsal implant material, skin thickness should be considered. Read More

Clin Plast Surg 2010 Apr;37(2):265-83

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, 1666 NW 12th Avenue, Suite 314, Miami, FL 33131, USA.

Successful outcomes in rhinoplasty depend more on diagnosis than on approach or technique. When the needs of each patient are assessed on multiple occasions, operative performance improves and revision rates decline. The evolutionary track from an endonasal and excisional operation to the more commonly preferred external and restructuring technique is outlined in this article. Read More

Laryngoscope 2010 Apr;120(4):668-72

Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Objectives/hypothesis: Vertical dome division (VDD) is a useful nasal tip surgery technique. However, it is associated with postoperative complications and has never been studied in Asian patients. This study examined results following application of our modified VDD approach in Asian patients requiring nasal tip surgery. Read More

Arch Facial Plast Surg 2009 Jul-Aug;11(4):221-9

Division of Facial Plastic Surgery, Medical School, Federal University of Uberlandia, Minas Gerais, Brazil.

Objective: To present a graduated approach to refining the nasal lobule (a frequent complaint during consultations for rhinoplasty) based on anatomic features and to discuss the casuistics of this procedure since we began performing it.

Methods: A retrospective evaluation of the medical charts of 1152 patients who underwent rhinoplasty from 2003 to 2006; 641 patients fulfilled the criteria for our study (55.6%). Read More

Arch Facial Plast Surg 2008 Mar-Apr;10(2):88-92

Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, MO 65212, USA.

Objectives: To discuss overprojected and broad nasal tips, to overview treatment options, and to relate our experience with the hockey-stick technique.

Design: A retrospective review (1975-2005) was conducted. Patients were selected from a computerized rhinoplasty database of operative cases. Read More

Arch Facial Plast Surg 2002 Jul-Sep;4(3):198-9

PO Box 50407, Jeddah 21523, Kingdom of Saudi Arabia.

J Otolaryngol 2000 Jun;29(3):162-5

Department of Otolaryngology, Mount Sinai Hospital, University of Toronto, Ontario.

Objective: Vertical dome division is an effective maneuver in nasal tip surgery. Its applications include reduction of the tip projection, increasing tip rotation, narrowing of the domal arch, and correction of lobule asymmetry. Nevertheless, some surgeons avoid this technique, fearing tip deformity and possibly impaired nasal airflow. Read More

Arch Otolaryngol Head Neck Surg 1994 Apr;120(4):373-80

Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario.

Objective: A new modification of vertical dome division (VDD) in rhinoplasty using cartilage overlap and suturing to reestablish the integrity of the alar cartilages is analyzed and compared with the more standard technique of cartilage resection and suturing.

Design: Retrospective before-and-after trial.

Setting: Private patients of one of the authors (P. Read More

Arch Otolaryngol Head Neck Surg 1991 Jan;117(1):56-9

Park Central Institute, St Louis, Mo. 63139.

Nasal tip projection is an important defining feature of the nasal profile. Loss of projection is often the bane of the rhinoplastic surgeon. While augmentation techniques for maintaining or increasing tip projection are useful in selected patients, the majority of rhinoplasties rely on excision of cartilage, particularly cartilage of the cephalic border of the lower lateral crura, to produce the desired cosmetic result. Read More

Otolaryngol Clin North Am 1987 Nov;20(4):785-96

Department of Otolaryngology-Head and Neck Surgery, University of Miami School of Medicine, Florida.

Vertical dome division in nasal tip surgery allows for repositioning of tissue with minimal excision. In difficult situations, these techniques will often enable the surgeon to maintain good tip position and appearance without the use of grafts. It is a technique worth the attention and understanding of the conservative rhinoplasty surgeon. Read More