Oblique Dome Division Technique/ Preservation Rhinoplasty

Abstract

Open rhinoplasty techniques as well endonasal techniques that involve lower lateral cartilage delivery and marginal incisions lead to many unpleasant effects such as alar notching, alar retraction, alar collapse, dropped/pinched tip, Pollybeak, asymmetry, alar collapse, deviation, and dimpling. Both the original Joseph endonasal technique and the later Goldman endonasal tip technique has also resulted in the above issues, while these problems are well documented in the open rhinoplasty approach. To reduce these sequalae, the author has developed a new combination technique. It is based on the Goldman's tip and the I-beam of intermediate crura while avoiding lateral crus marginal incision and delivery (which are the culprits associated with a poor outcome). This results in an intact alar rim reducing healing problems along the alar rim. Furthermore, lateral crus preservation together with a strong tripod of conjoined lateral to medial crura supported by a columellar strut and tip grafts lead to significantly enhanced tip support thus substantially reducing negative sequalae such as asymmetry, alar collapse, dropped tip, pinching, notching and alar retraction while at the same time making the outcome more predictable. The author has been applying this technique since 1999 (Last 23 years). The technique and follow-up will be fully discussed.