Ghavami Ashkan, Vranis Neil M
From the Department of Surgery, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
Plast Reconstr Surg. 2025 Apr 1;155(4):619-629. doi: 10.1097/PRS.0000000000011738. Epub 2024 Sep 11.
Creating a stable, long-lasting supratip break continues to be a challenge, particularly in patients with moderate to severe skin thickness. Multiple techniques have been previously described to address this, including Pitanguy ligament preservation, resuturing, and cartilage frame alterations to increase the tip-to-septal angle differential. Each has noteworthy limitations.
The senior author (A.G.) developed a novel technique that uses the native Pitanguy ligament augmented by 2 bilateral, medially based superficial musculoaponeurotic system/soft-tissue flaps. This reduces supratip dead space and prevents tissue glide while controlling supratip/tip shape and position.
Twenty-six primary rhinoplasties in which the supratip and tip skin sleeve was of appropriate thickness were selected and followed up for 1-year postoperatively. The trilaminar neo-Pitanguy ligament technique was used in all patients. Every patient maintained a varied degree of supratip break at an average follow-up time of 14 months (range, 12 to 16 months). There was 1 revision requiring local anesthesia. No patients requested or were indicated for a return to the operating room. No cases of postoperative pollybeak deformity were observed.
The power of this novel supratip control technique is multidimensional. It allows the surgeon to precisely control the location of supratip break, creating a broad based, diamond-shaped supratip depression. Trilamination with 2 superficial musculoaponeurotic system/soft-tissue flaps provides added strength, control, and long-term stability compared with simple suturing. Soft-tissue tensioning above, around, and below the new tip complex prevents dorsal skin tissue glide and further secures the infratip/columella in the appropriate position.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
创造一个稳定、持久的鼻尖上区凹陷仍然是一项挑战，尤其是在中重度皮肤厚度的患者中。以前已经描述了多种技术来解决这个问题，包括保留皮坦盖韧带、重新缝合以及改变软骨框架以增加鼻尖与鼻中隔的角度差异。每种技术都有明显的局限性。
资深作者（A.G.）开发了一种新技术，该技术使用双侧内侧带蒂的表浅肌肉腱膜系统/软组织瓣增强天然皮坦盖韧带。这减少了鼻尖上区的死腔，防止组织滑动，同时控制鼻尖上区/鼻尖的形状和位置。
选择了26例鼻尖和鼻尖皮肤袖厚度合适的初次鼻整形手术患者，并在术后进行了1年的随访。所有患者均采用了三层新皮坦盖韧带技术。每位患者在平均14个月（范围12至16个月）的随访时间内都保持了不同程度的鼻尖上区凹陷。有1例需要局部麻醉的修复手术。没有患者要求或被建议返回手术室。未观察到术后鸟嘴畸形病例。
这种新型鼻尖控制技术的作用是多方面的。它使外科医生能够精确控制鼻尖上区凹陷的位置，形成一个宽阔的、菱形的鼻尖上区凹陷。与简单缝合相比，使用2个表浅肌肉腱膜系统/软组织瓣进行三层缝合可提供更大的强度、控制力和长期稳定性。在新的鼻尖复合体上方、周围和下方进行软组织张紧可防止鼻背皮肤组织滑动，并进一步将鼻尖下/鼻小柱固定在适当位置。
临床问题/证据级别：治疗性，IV级。
