Stabilization of the Bony Pyramid in Rhinoplasty Using Dorsal Aesthetic Lines Bony Sutures.

INTRODUCTION

Modern rhinoplasty relies on osteotomies that risk destabilizing the nasal pyramid. While suture fixation is standard for cartilage, bony stabilization remains technically challenging. We present a novel piezosurgery-assisted 8-shaped "bridge suture" technique along dorsal aesthetic lines (DAL) to address this gap.

MATERIALS AND

METHODS

From 2021 to 2023, 28 patients underwent structural rhinoplasty with DAL bony sutures. The technique involved: (1) DAL osteotomies via piezotome, (2) two pairs of bilateral 2-3 mm perforations, and (3) 4-0 PDS figure-eight sutures securing lateral bony slopes to the dorsum. Outcomes were assessed using ROE/NOSE questionnaires with 12-18 month follow-up.

RESULTS

All cases achieved stable dorsal symmetry without hump recurrence. Operative time averaged 189.6 ± 51.92 minutes with no major complications. Three revisions (unrelated to dorsum) were required. Significant improvements were observed in ROE (6.7±2.5 to 21.7±1.5, *p*<0.001) and NOSE scores (24.7±17.4 to 2.7±3.6, *p*<0.001).

CONCLUSION

This technique simplifies bony stabilization by eliminating transcutaneous steps while preventing over-narrowing. The 8-shaped suture design provides three-dimensional control, yielding predictable aesthetic and functional outcomes.

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