See how suture based dome binding sutures can be used to both define the nasal tip and flatten a bulbous nasal tip without removing any tissue.

In a prior post I discussed how we can use lower lateral crural strut grafts to effectively flatten and refine the bulbous nasal tip. There are a few additional ways to refine a nasal tip during rhinoplasty. Today let's review one of these methods: dome binding sutures.

What are the nasal domes?

The nasal domes refer to the tip defining points of the tip cartilages. This schematic shows what makes up the nasal domes:

You can see how the tip cartilages include the medial crura which then transition to the intermediate crura before bending at the domes to then become the lower lateral crura. This profile view gives another view of how the tip cartilages form the domes:

What are dome binding sutures?

Dome binding sutures, like the name suggests, involve placing a suture above and below the actual tip defining point to cinch the cartilage. This leads to a more sharply-defined tip. In some cases (depending on the cartilage strength) this maneuver also pulls the lower lateral cartilages downward to help flatten them. This results in a less bulbous, rounded nasal tip.

This schematic shows where dome binding sutures are placed:

In my next post I'll show you some intra-operative photos showing how dome binding sutures can be used during rhinoplasty.