Closed Rhinoplasty Tip Delivery with Dome-Binding Sutures Incorporating a Columellar Strut

Introduction: Endonasal or closed rhinoplasty is an alternative to the more commonly used open approach. It requires no skin incisions and yet many, if not all, of the maneuvers traditionally used in the open approach can be executed.1 We present a video clip of closed approach rhinoplasty in which the lower lateral cartilages are delivered, intradomal binding sutures are placed, followed by transdomal binding incorporating a columellar strut. Materials and Methods: Video documentation of a recent endonasal rhinoplasty is presented. A combination of intercartilaginous and marginal incisions were used. Maneuvers employed included tip delivery, demarcation of the tip defining point, intradomal binding sutures, placement of a columellar strut and transdomal (interdomal) binding with incorporation of the columellar strut. Immediate inspection of result is possible by replacement of the tip complex into the soft tissue skin envelope. Results: Dome-binding sutures with incorporation of a columellar strut is an effective method to achieve a variety of positive changes in the nasal tip. It acts to narrow and rotate the tip. It can also act to provide support to weak tip cartilages. This maneuver is often employed by the senior author to treat ptotic nasal tips and is often used in conjunction with other rhinoplasty maneuvers, including dorsal reduction, mid vault grafting, and osteotomies. Conclusions: The endonasal or closed approach represents a powerful approach in tip rhinoplasty. Tip delivery combined with dome-binding sutures incorporating a columellar strut has the ability to narrow, rotate, and stabilize the tip complex. It is an effective maneuver to treat a variety of nasal deformities, including the boxy tip, ptotic tip, and asymmetric tip.2 No competing financial interests exist. Authors' Contributions: Data curation, formal analysis, investigation, methodology, project administration, writing original draft, and writing—review and editing by J.S.G. Supervision, data curation, formal analysis, investigation, methodology, project administration, writing original draft, and writing—review and editing by R.H.D. No funding was received for this article. Runtime of video: 3 mins 10 secs