Transection of Pitanguy’s Midline Ligament to Avoid Supratip Depression in Closed-Approach, Low-Septal-Resection Dorsal Preservation Rhinoplasty

Abstract

Abstract Background Supratip depression is a common complication after preservation rhinoplasty. Objectives This aim of this paper was to present a simple surgical maneuver to prevent supratip depression. Methods Thirty-six patients who underwent closed-approach, low-septal-resection dorsal preservation rhinoplasty between January and June 2021 were included in this retrospective study. Depending on the operation performed on Pitanguy’s midline ligament, the patients were divided into 2 groups as follows: (1) a group in which Pitanguy’s midline ligament was transected (transection group); and (2) a group in which Pitanguy’s midline ligament was preserved (preservation group). Standardized postoperative 6-month lateral-view photographs were scanned for the presence of supratip depression or pollybeak deformity. The Rhinoplasty Outcome Evaluation (ROE) scale was applied at 6 months. Results Supratip depression was observed in 4 patients in the preservation group (n = 16), but was not observed in any of the patients in the transection group (n = 20; P < 0.05). There was no pollybeak deformity in either group. With respect to the Rhinoplasty Outcome Evaluation scores and number of satisfied patients, no statistically significant difference was found between the transection and preservation groups (P > 0.05). Conclusions Transecting Pitanguy’s midline ligament reduces the likelihood of supratip depression and does not affect the likelihood of pollybeak deformity in closed-approach, low-septal-resection dorsal preservation rhinoplasty. Level of Evidence: 4