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Role of Derotation Suture in Bulbous Tip Correction in Asian Rhinoplasty

Abstract: In bulbous tip correction, consideration should be given to the presence of cephalic malposition of lower lateral cartilage as well as volume reduction. Derotation suture is a suture technique for tip lengthening but may contribute to bulbous tip correction through the caudal reposition of lower lateral cartilage. From 2016 to 2018, a total of 50 Asian patients underwent bulbous tip correction with derotation suture. The derotation suture was performed by suture the most convex part of lower lateral cartilage as a spanning suture to the caudal septum with caudal traction of the lateral crus. The chart and pre and postoperative photographs were analyzed to evaluate the effectiveness and complication of the surgery. In most (96%) patients, there was a significant improvement in tip bulbosity and supratip fullness. Complications included tip drooping (4%), nostril asymmetry (2%), and undercorrection (4%) and no pinching deformity occurred. In correction of bulbous tip of Asians with cephalic malposition of lower lateral cartilage, derotation suture is a useful method to create an ideal shaped nasal tip. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.