Tailoring Rhinoplasty: Selecting the Ideal Graft and Suture for Each Patient and Each Surgeon

Abstract

Objectives: We reviewed graft and suture options in rhinoplasty operations. We aimed to focus on choosing the right graft and suture for each patient based on the specific needs of their nose. Another key factor is selecting procedures according to the surgeon's skill and experience. It is well known that while some procedures are straightforward and produce perfect results for certain surgeons, others can achieve similar outcomes using different techniques. Methods: The literature was searched from 1932 to 2025 using PubMed, Medline, and Google search engines. A list of search terms related to "rhinoplasty," “endonasal,” “open,” “closed,” “grafts,” and “sutures” was compiled and used to find current and relevant publications. The search results encompass a range of research types, including review articles, meta-analyses, randomized controlled trials, prospective studies, retrospective studies, and online sources. Results: Controlling the shape of the nose mainly involves managing the shape of the cartilages. Most of this control is achieved through excisional and grafting techniques. Graft options in rhinoplasty include Floating graft (Goldman), Shield graft (Sheen), Onlay graft (Peck), Prespinal graft, Dorsal graft, Columellar strut, Lateral crural strut graft, alar rim graft, and Spreader graft. The following sutures and techniques are also used in rhinoplasty: the Hemi-Transdomal Suture, the Lateral Crural Mattress Suture, the Columellar-Septal Suture, and the universal horizontal mattress suture. These sutures aid in septal straightening, correcting the collapsed lateral crus (external valve), and the collapsed upper lateral cartilages (internal valve). Suture and grafting techniques are essential for supporting the internal nasal valve, correcting lateral deviation and contour asymmetry, enhancing tip projection and support, facilitating tip rotation, and refining the tip. Conclusion: Achieving good outcomes relies on skilled hands and, more importantly, sound decision-making throughout the entire process, from preoperative evaluation and counseling to recovery. The importance of identifying suitable surgical candidates, understanding their goals, setting realistic expectations, and supporting them at every stage cannot be overstated.

Keywords

• rhinoplasty
• grafts
• sutures
• appropriate techniques
• columellar strut
• dome suture

References

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