Sir: We thank Dr. Guyuron and appreciate his Discussion of our article entitled “Securing Nasal Tip Rotation through Suspension Suture Technique,” which was published in the May 2006 issue of the Journal (Plast. Reconstr. Surg. 117: 1750; discussion 1756, 2006). We would like to explain some facts which may not have been clear enough in context. First, we are not trying to deny the existence of effective techniques to obtain satisfactory results for tip rotation through the closed method in rhinoplasty. We decided to describe this method because with it we can obtain precise and long-lasting results. Although we are not trying to say that this is the best or only method, it is an alternative technique that can be useful in certain cases, such as long or projecting noses. It is true that we work in the subcutaneous plane; however, in cases where it is necessary to modify the cartilage structure (removal of the cephalic margin of the lower lateral cartilages or application of intradomal sutures), we perform it in a manner similar to that used for the traditional closed method, being careful not to leave irregularities. Although trimming of the cephalic margin of the lower lateral cartilages can deter the suspensory ligament of the tip, our dorsal suture definitely replaces it. In our description, we mention that we make a stab incision in the skin on each side of the nasal dorsum at the level of the osteocartilaginous junction and then pass a no. 21 hypodermic needle. We emphasize that we use a nonabsorbable thread that connects the nasal tip (the medial side of the domes) to the upper part of the cartilaginous dorsum (i.e., the upper part of the upper lateral cartilages or osteocartilaginous junction), trying to keep it near the dorsal line to avoid intranasal exposure of the thread. Although the scar tissue helps maintain the desired shape, the thread itself secures the permanent result. This factor is especially useful in projecting noses in which the tip tends to drop with the passage of time. The distance between the entrance and exit points in the dorsal cartilage is usually similar to or slightly longer than that between the domes. Consequently, it does not affect the interdomal distance or the internal valve function. This technique does not exclude the wide variety of possibilities in rhinoplasty, such as spreader grafts, columellar strut, correction of cartilage tip asymmetries, reduction of excessive caudal septum, and so on. This type of anchor suture does not flatten the columella. That aspect was the main reason for developing this technique. In the majority of cases where we tried to rotate the tip by anchoring it to the caudal border of the septum, the consequence was flattening or distortion of the columella. We think that it is more logical to lift the tip from the distal extreme. This resembles anchoring the tip from the dorsum with a piece of tape on the outer skin. Follow-up ranged from 3 to 24 months. Although these periods were not very long, we think that there was enough time to observe the persistence of the results. We have reached up to 4 years of follow-up in some cases and we still find that the results have remained stable. The lack of more clinical examples in our article was due to the editor’s decision, even though we sent four cases (Fig. 1).Fig. 1.: (Left) Preoperative view of a 28-year-old woman with nasal tip ptosis. We used the closed approach, with dorsal exposure by intercartilaginous incision, minimal dorsal reduction rasp of the hump, cephalic lateral crura resection, and excision to the upper anterior border of the caudal septum. (Right) At 18 months postoperatively, the tip suspension suture technique has proven to be effective.In performing our technique, we recommend using a hook after passing the no. 21 needle, to hold the skin away from the cartilage, and using backward and forward movements with the suture to release it in cases where the dermis could be caught, to avoid dimples in the outer appearance. Finally, we think our technique offers good results in cases where it can be appropriate (in long or projecting noses) and that it can be reproduced by any surgeon, assuring long-lasting, beautiful results. In addition, it is another alternative to solving a difficult problem in rhinoplasty. Juan Carlos Cardenas, M.D. Jenny Carvajal, M.D. Alvaro Ruiz, M.D. SURATEP Medellín, Antioquia, Colombia