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

Year 2025, Volume: 8 Issue: 2, 77 - 84, 31.08.2025

Ahmet Arslanoğlu , Gürcan Sünnetçi , Erdi Özdemir , Nuray Bayar Muluk , Mustafa Yazır , Furkan Kaya , Cemal Cingi , Regan Thomas

https://doi.org/10.65396/ejra.1762285

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

Ethical Statement

Ethics Committee Approval: It was not needed as the study is a review. Informed Consent: It was not needed as the study is a review. Peer review: Externally peer-reviewed. Acknowledgements: N/A Author Contributions: Concept, Literature Search, Design, Materials, Data Collection, Supervision, Analysis and Interpretation, and Writing Manuscript were done by all authors. RT did the final Critical Review. Declaration of Interests: The authors have no conflict of interest to declare. Funding: The authors declare that this study received no financial support.

References

• 1. Scattolin A, D’Ascanio L. Grafts in “closed” rhinoplasty. Acta Otorhinolaryngol Ital. 2013 Jun;33(3):169-176.
• 2. Daniel RK. Mastering rhinoplasty. Berlin, Heidelberg, Germany:Springer Verlag; 2010. Pp25
• 3. Daniel RK. Rhinoplasty: open tip suture techniques: a 25-year experience. Facial Plast Surg 2011;27:213-224.
• 4. Micheli-Pellegrini V. Rinoplastica. Atlante di chirurgia pratica. Firenze: SEE Editor; 2005.
• 5. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984;73:230-239.
• 6. Sheen JH. Tip graft: a 20-year retrospective. Plast Reconstr Surg 1993;91:48-63.
• 7. Bottini DJ, Gentile P, Donfrancesco A, et al. Augmentation rhinoplasty with autologous grafts. Aesthetic Plast Surg 2008;32:136-142.
• 8. Peck GC. The onlay graft for nasal tip projection. Plast Reconstr Surg 1983;71:27-39.
• 9. Eitner E. Kosmetische Operationen. Wien: Springer Editor; 1932.
• 10. Daley J. Retaining a correct septo-labial angle in rhinoplasty. Arch Otolaryng 1944;39:348-352.
• 11. Baum SJ. Nasal projection. Arch Otolaryngol 1977;103:262-277.
• 12. Tebbetts JB. Rethinking the logic and techniques of primary tip rhinoplasty: A perspective of the evolution of surgery of the nasal Tip. Otolaryngol Clin North Am 1999;32:741-754.
• 13. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997;99:943-952.
• 14. Millard DR Jr. Alar margin sculpturing. Plast Reconstr Surg 1967;40:337-742.
• 15. Gruber RP, Chang E, Buchanan E. Suture techniques in rhinoplasty. Clin Plast Surg. 2010 Apr;37(2):231-243.
• 16. Daniel RK. Creating an aesthetic tip. Plast Reconstr Surg 1987;80:775.
• 17. Daniel RK. Rhinoplasty: a simplified three-stitch, open tip suture technique. Part I: primary rhinoplasty. Plast Reconstr Surg 1999;103:491–502.
• 18. Gruber RP, Friedman GD. Suture algorithm for the broad or bulbous nose. Plast Reconstr Surg 2002; 110:1752–1764.
• 19. Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part I experimental results. Plast Reconstr Surg 2005;115: 589–594.
• 20. Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: Part II, clinical results. Plast Reconstr Surg 2005;115:595606.
• 21. Park SS. The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg 1998;101:1120–1122.
• 22. Schlosser RJ, Park SS. Functional nasal surgery. Otolaryngol Clin North Am 1999;32:37–51.
• 23. Ozturan O, Miman MC, Kizilay A. Bending of the upper lateral cartilages for nasal valve collapse. Arch Facial Plast Surg 2002;4:258–261.
• 24. Hohman MH, Fichman M, Piedra Buena IT. Rhinoplasty. [Updated 2024 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558970/
• 25. Ghavami A, Janis JE, Acikel C, Rohrich RJ. Tip shaping in primary rhinoplasty: an algorithmic approach. Plast Reconstr Surg. 2008 Oct;122(4):1229-1241.
• 26. Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg. 1997 Sep;100(4):999-1010.
• 27. Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg. 1999 Oct-Dec;1(4):246-56; discussion 257-258.
• 28. Hohman MH, Teixeira J. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 24, 2023. Transgender Surgery of the Head and Neck.
• 29. Harel M, Leibou L. Interdomal Suture through a Nondelivery Endonasal Approach: A New Technique. Plast Reconstr Surg Glob Open. 2016 Aug;4(8):e1005.
• 30. Goldman IB. The importance of the mesial crura in nasal-tip reconstruction. AMA Arch Otolaryngol. 1957 Feb;65(2):143-147.
• 31. Goin MK, Rees TD. A prospective study of patients’ psychological reactions to rhinoplasty. Ann Plast Surg. 1991 Sep;27(3):210-215.
• 32. Bilgin E, Say MA, Baklacı D. Assessment of Patient Satisfaction With Primary Septorhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire. Cureus. 2020 Nov 29;12(11):e11777.
• 33. Randhawa PS, Watson N, Lechner M, Ritchie L, Choudhury N, Andrews PJ. The outcome of septorhinoplasty surgery on olfactory function. Clin Otolaryngol. 2016 Feb;41(1):15-20.
• 34. Shuaib SW, Undavia S, Lin J, Johnson CM, Stupak HD. Can functional septorhinoplasty independently treat obstructive sleep apnea? Plast Reconstr Surg. 2015 Jun;135(6):1554-1565.
• 35. Yamasaki A, Levesque PA, Lindsay RW. Improvement in Snoring-Related Quality-of-Life Outcomes After Functional Nasal Surgery. Facial Plast Surg Aesthet Med. 2020 Jan/Feb;22(1):25-35.
• 36. Sokoya M, Gonzalez JR, Winkler AA. Effect of allergic rhinitis on nasal obstruction outcomes after functional open septorhinoplasty. Am J Otolaryngol. 2018 May-Jun;39(3):303-306.