**Columella Sliding for Nasal Tip Projection Using Septocolumellar Transmucosal Mattress Sutures**

Nikolay P. Serdev

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/62063

#### **Abstract**

In author's hands, columella sliding is a surgical technique to correct unaesthetic/ unwanted depression or projection of the nasal tip. The tip can be increased or decreased by a simple mini-invasive technique during primary or secondary rhinoplasty as well as by a separate procedure. Main aim of the technique is to obtain the aesthetic 30° angle between dorsum and profile line and correct volume of the nasal tip at the line of the beauty triangle. It is possible to change the projection of the nasal tip using a retrocolu‐ mellar incision, to slide columella against septum upward or downward and fix the new position with 2–3 transmucosal columella-septal sutures. The stitches will be removed af‐ ter 2–3 weeks, which is enough for columella to heal stable initially to septum. Columella sliding is an important technique to obtain a dorsoprofile angle of 30°, which is an aes‐ thetic rule. The technique is atraumatic, mini-invasive, nearly bloodless. The procedure is very well tolerated by patients: there is no need of casts, tampons, and patients return to social life almost immediately.

**Keywords:** Rhinoplasty, columella sliding, retrocolumellar incision, columella-septal inci‐ sion, mattress transmucosal suture, columella sliding upward, columella sliding down‐ ward, no downtime, atraumatic

#### **1. Introduction**

#### **1.1. Surgical procedure**

Nasal tip projection determines how far out from the face the tip protrudes. The author accepts that the correct position of the nasal tip is in close relation to the 300 dorsoprofile or dorsoalar angle [1-5], where the alar line refers to a vertical line drawn through the point where the alar base attaches to the cheek and establishes the straight profile line. A 300 dorsoalar angle is accepted as aesthetic.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

When a retrocolumellar incision is present, 2–3 mattress transmucosal sutures are passed from columella caudal surface to a higher point of caudal septum to give projection to the nasal tip. (Figure 1). Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum. The sutures are removed after 2 weeks. This time is observed to be enough to form a stable fibrosis and give a permanent result. Patients have to prevent the nasal tip from trauma. The depressor septi nasi muscle is responsible for smiling deformity. Excision of the depressor nasi muscle or botox injections could help additionally in this regard. Patients are asked to reduce wide opening of the mouth and too much laughing, in order to prevent from depressing the tip during the early post-op and healing period.

The author has experienced no complication with any of the above-described transcutaneous and transmucosal sutures in more than a thousand operated cases. Sutures can be placed at any time as ambulatory procedures with no downtime.

columella caudal surface to a higher point of caudal septum to give projection to the tip. Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum. 2. Clinical cases **Figure 1. A.** The position of the nasal tip implements the proper formation of the 300 dorsoalar angle, which is respon‐ sible for how far from the face the tip is positioned. **B.** When a retrocolumellar incision is present, 2–3 mattress trans‐ mucosal sutures are passed from columella caudal surface to a higher point of caudal septum to give projection to the tip. Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum.

A. B.

make up, she answered that she feels beautiful.

Figure 2. A. Before. Aquiline long nose. No aesthetic proportions are present. B. After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmentation by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. The skin color tape will be removed on day 3. There is no bruising due to atraumatic technique. On day 1, patients visit the clinic to clean the nose, remove the crust. On the question why she has used

Figure 1. A. The position of the nasal tip implements the proper formation of the 30<sup>0</sup> dorsoalar angle, which is responsible for how far from the face the tip is positioned. B. When a retrocolumellar incision is present, 2–3 mattress transmucosal sutures are passed from

columella caudal surface to a higher point of caudal septum to give projection to the tip. Vice versa, the columella is sutured to lower

#### **2. Clinical cases** points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum.

2. Clinical cases

A. B.

When a retrocolumellar incision is present, 2–3 mattress transmucosal sutures are passed from columella caudal surface to a higher point of caudal septum to give projection to the nasal tip. (Figure 1). Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum. The sutures are removed after 2 weeks. This time is observed to be enough to form a stable fibrosis and give a permanent result. Patients have to prevent the nasal tip from trauma. The depressor septi nasi muscle is responsible for smiling deformity. Excision of the depressor nasi muscle or botox injections could help additionally in this regard. Patients are asked to reduce wide opening of the mouth and too much laughing, in order to prevent from depressing

The author has experienced no complication with any of the above-described transcutaneous and transmucosal sutures in more than a thousand operated cases. Sutures can be placed at

> Figure 1. A. The position of the nasal tip implements the proper formation of the 30<sup>0</sup> dorsoalar angle, which is responsible for how far from the face the tip is positioned. B. When a retrocolumellar incision is present, 2–3 mattress transmucosal sutures are passed from columella caudal surface to a higher point of caudal septum to give projection to the tip. Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after

artistic excision of retrocolumellar mucosa and eventually part of caudally projected septum.

**Figure 1. A.** The position of the nasal tip implements the proper formation of the 300 dorsoalar angle, which is respon‐ sible for how far from the face the tip is positioned. **B.** When a retrocolumellar incision is present, 2–3 mattress trans‐ mucosal sutures are passed from columella caudal surface to a higher point of caudal septum to give projection to the tip. Vice versa, the columella is sutured to lower points of the septum to lower the projection of the tip in selected cases. The suture is used as well in cases of hanging columella after artistic excision of retrocolumellar mucosa and

A. B.

Figure 2. A. Before. Aquiline long nose. No aesthetic proportions are present. B. After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmentation by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. The skin color tape will be removed on day 3. There is no bruising due to atraumatic technique. On day 1, patients visit the clinic to clean the nose, remove the crust. On the question why she has used

the tip during the early post-op and healing period.

22 Miniinvasive Techniques in Rhinoplasty

any time as ambulatory procedures with no downtime.

A. B.

make up, she answered that she feels beautiful.

2. Clinical cases

eventually part of caudally projected septum.

Figure 2. A. Before. Aquiline long nose. No aesthetic proportions are present. B. After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmentation by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. The skin color tape will be removed on day 3. There is no bruising due to atraumatic technique. On day 1, patients visit the clinic to clean the nose, remove the crust. On the question why she has used make up, she answered that she feels beautiful. **Figure 2. A.** Before. Aquiline long nose. No aesthetic proportions are present. **B.** After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmenta‐ tion by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. The skin color tape will be removed on day 3. There is no bruising due to atraumatic technique. On day 1, patients visit the clinic to clean the nose, remove the crust. On the question why she has used make up, she answered that she feels beautiful.

Figure 3. A. Before. Aquiline long nose. No aesthetic proportions are present. B. Day 4 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection. Better self-confidence, still some nearly invisible edema, no bruising. Beautification without additional surgeries due to correct proportions, volumes, and angles. **Figure 3. A.** Before. Aquiline long nose. No aesthetic proportions are present. **B.** Day 4 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection. Better self-confidence, still some nearly invisible edema, no bruising. Beautification without additional surgeries due to correct proportions, volumes, and angles.

A. B.

appearance of the Asian face.

Figure 4. A. Before. Asian patient with a typical, very acute dorsoprofile angle, and low position of the nasal tip. B. After columella sliding for tip projection as a separate procedure. A correct 30<sup>0</sup> dorsoprofile angle is obtained, which changes positively the flat

present.

A. B.

bruising. Beautification without additional surgeries due to correct proportions, volumes, and angles.

Figure 3. A. Before. Aquiline long nose. No aesthetic proportions are present. B. Day 4 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection. Better self-confidence, still some nearly invisible edema, no

Figure 4. A. Before. Asian patient with a typical, very acute dorsoprofile angle, and low position of the nasal tip. B. After columella sliding for tip projection as a separate procedure. A correct 30<sup>0</sup> dorsoprofile angle is obtained, which changes positively the flat appearance of the Asian face. **Figure 4. A.** Before. Asian patient with a typical, very acute dorsoprofile angle, and low position of the nasal tip. **B.** After columella sliding for tip projection as a separate procedure. A correct 300 dorsoprofile angle is obtained, which changes positively the flat appearance of the Asian face.

columella sliding for tip projection, and chin enhancement with Serdev Suture® for straight profile. Correct proportions, volumes, and angles lead to beautification. **Figure 5. A.** Asian patient with an aquiline long nose and retrograde chin. **B.** Immediately after T-excision for nasal tip rotation, columella sliding for tip projection, and chin enhancement with Serdev Suture® for straight profile. Correct proportions, volumes, and angles lead to beautification.

Figure 5. A. Asian patient with an aquiline long nose and retrograde chin. B. Immediately after T-excision for nasal tip rotation,

Figure 6. A. Before. Aging face and aquiline long nose. No aesthetic proportions are present. B. Immediatelly after Serdev Suture® temporal, medial, and lower face and neck lifts, and rhinoplasty: T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for tip projection. C. After 18 months. Correct proportions and dorsoprofile angle. Rejuvenation and beautification are

A. B.

A. B.

**Figure 4. A.** Before. Asian patient with a typical, very acute dorsoprofile angle, and low position of the nasal tip. **B.**

A. B.

**Figure 5. A.** Asian patient with an aquiline long nose and retrograde chin. **B.** Immediately after T-excision for nasal tip rotation, columella sliding for tip projection, and chin enhancement with Serdev Suture® for straight profile. Correct

Figure 5. A. Asian patient with an aquiline long nose and retrograde chin. B. Immediately after T-excision for nasal tip rotation, columella sliding for tip projection, and chin enhancement with Serdev Suture® for straight profile. Correct proportions, volumes, and

Figure 6. A. Before. Aging face and aquiline long nose. No aesthetic proportions are present. B. Immediatelly after Serdev Suture® temporal, medial, and lower face and neck lifts, and rhinoplasty: T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for tip projection. C. After 18 months. Correct proportions and dorsoprofile angle. Rejuvenation and beautification are

appearance of the Asian face.

24 Miniinvasive Techniques in Rhinoplasty

angles lead to beautification.

proportions, volumes, and angles lead to beautification.

present.

changes positively the flat appearance of the Asian face.

After columella sliding for tip projection as a separate procedure. A correct 300

Figure 4. A. Before. Asian patient with a typical, very acute dorsoprofile angle, and low position of the nasal tip. B. After columella sliding for tip projection as a separate procedure. A correct 30<sup>0</sup> dorsoprofile angle is obtained, which changes positively the flat

dorsoprofile angle is obtained, which

bruising. Beautification without additional surgeries due to correct proportions, volumes, and angles.

Figure 3. A. Before. Aquiline long nose. No aesthetic proportions are present. B. Day 4 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection. Better self-confidence, still some nearly invisible edema, no

**Figure 6. A.** Before. Aging face and aquiline long nose. No aesthetic proportions are present. **B.** Immediatelly after Ser‐ dev Suture® temporal, medial, and lower face and neck lifts, and rhinoplasty: T-excision for nasal tip rotation, humpec‐ tomy, digital fracture, and columella sliding for tip projection. **C.** After 18 months. Correct proportions and dorsoprofile angle. Rejuvenation and beautification are present.

humpectomy, digital fracture and columella sliding for correct proportion and angles, along with simultaneous brow lift and chin enhancement using Serdev Suture® techniques. Beautification as a result of correct proportions, volumes, and angles. **Figure 7. A.** Before. Incorrect proportions, Aquiline long nose, low eyebrows, retrograde chin. **B.** After rhinoplasty in‐ cluding T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles, along with simultaneous brow lift and chin enhancement using Serdev Suture® techniques. Beautification as a result of correct proportions, volumes, and angles.

A. B.

Figure 8. A. Before. Incorrect proportions, aquiline long nose. B. After rhinoplasty, including T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles. Beautification as a result of correct proportions, volumes, and angles.

Figure 7. A. Before. Incorrect proportions, Aquiline long nose, low eyebrows, retrograde chin. B. After rhinoplasty including T-excision,

A. B.

Figure 7. A. Before. Incorrect proportions, Aquiline long nose, low eyebrows, retrograde chin. B. After rhinoplasty including T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles, along with simultaneous brow lift and chin enhancement using Serdev Suture® techniques. Beautification as a result of correct proportions, volumes, and angles.

and columella sliding for correct proportion and angles. Beautification as a result of correct proportions, volumes, and angles. **Figure 8. A.** Before. Incorrect proportions, aquiline long nose. **B.** After rhinoplasty, including T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles. Beautification as a result of correct propor‐ tions, volumes, and angles.

Figure 8. A. Before. Incorrect proportions, aquiline long nose. B. After rhinoplasty, including T-excision, humpectomy, digital fracture

nasal tip projection and dorsoprofile angle of 30<sup>0</sup>. **Figure 9. A.** Before. Secondary case with short columella and incorrect acute dorsoprofile angle. **B.** After columella sliding for correct nasal tip projection and dorsoprofile angle of 300 .

A. B.

of Aesthetic Surgery and Aesthetic Medicine, Krulig Clinic, Caracas, Venezuela, Nov. 1999

[5] Serdev NP. Aesthetic surgery methods for face beautification. Int J Cosm Surg 2001; 1(3): 188-256

sedation and analgesia 2005; 23. 02. Available from: http://ijcs.org/courses/2005/90/index.php

[4] Serdev NP. Beautification rhinoplasty. Int J Cosm Surg 2001; 1(3): 257-311

3. Conclusion

immediately.

References

Surgery, Tokyo April 8-10, 2000

China, Oct. 30–Nov. 1, 2000

Figure 10. A. Before. Incorrect proportions, long nose with a bulbous tip and columella hanging. B. After rhinoplasty, including Texcision, humpectomy, digital fracture, and columella sliding downward for correct reduction of the nasal tip projection.

Columella sliding is a very useful mini-invasive technique to control position of the nasal tip as an independent procedure or as a part of primary or secondary rhinoplasties. It is simple, atraumatic, and very well accepted by patients. There are no known complications and the columella is fixed and heals in the new position in 2–3 weeks. There is no bruising, no need of tapes, tampons, or casts. Downtime is minimal and patients can return to social life almost

[1] Serdev NP. Sliding of the Columella by the Serdev Technique. Live Surgery Workshop, The International Academy

[3] Serdev NP. Rhinoplasty for Beautification. Asia Pacific Craniofacial Association. Third Conference, Shanghai, P.R.

[6] Serdev NP. Course: Beautification rhinoplasty, t-zone excision, columella sliding, suture methods, updates in IV

[2] Serdev NP. Principles of Face Beautification. Third World Congress of the International Society of Aesthetic

Figure 9. A. Before. Secondary case with short columella and incorrect acute dorsoprofile angle. B. After columella sliding for correct

26 Miniinvasive Techniques in Rhinoplasty A. B. Figure 9. A. Before. Secondary case with short columella and incorrect acute dorsoprofile angle. B. After columella sliding for correct Columella Sliding for Nasal Tip Projection Using Septocolumellar Transmucosal Mattress Sutures http://dx.doi.org/10.5772/62063 27

Figure 10. A. Before. Incorrect proportions, long nose with a bulbous tip and columella hanging. B. After rhinoplasty, including Texcision, humpectomy, digital fracture, and columella sliding downward for correct reduction of the nasal tip projection. 3. Conclusion **Figure 10. A.** Before. Incorrect proportions, long nose with a bulbous tip and columella hanging.. **B.** After rhinoplasty, including T-excision, humpectomy, digital fracture, and columella sliding downward for correct reduction of the nasal tip projection.

Columella sliding is a very useful mini-invasive technique to control position of the nasal tip as an independent procedure or as a part of primary or secondary rhinoplasties. It is simple, atraumatic, and very well accepted by patients.

#### There are no known complications and the columella is fixed and heals in the new position in 2–3 weeks. There is no bruising, no need of tapes, tampons, or casts. Downtime is minimal and patients can return to social life almost **3. Conclusion**

immediately.

A. B.

A. B.

**Figure 8. A.** Before. Incorrect proportions, aquiline long nose. **B.** After rhinoplasty, including T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles. Beautification as a result of correct propor‐

A. B.

**Figure 9. A.** Before. Secondary case with short columella and incorrect acute dorsoprofile angle. **B.** After columella

A. B.

of Aesthetic Surgery and Aesthetic Medicine, Krulig Clinic, Caracas, Venezuela, Nov. 1999

[5] Serdev NP. Aesthetic surgery methods for face beautification. Int J Cosm Surg 2001; 1(3): 188-256

sedation and analgesia 2005; 23. 02. Available from: http://ijcs.org/courses/2005/90/index.php

[4] Serdev NP. Beautification rhinoplasty. Int J Cosm Surg 2001; 1(3): 257-311

Figure 10. A. Before. Incorrect proportions, long nose with a bulbous tip and columella hanging. B. After rhinoplasty, including Texcision, humpectomy, digital fracture, and columella sliding downward for correct reduction of the nasal tip projection.

Columella sliding is a very useful mini-invasive technique to control position of the nasal tip as an independent procedure or as a part of primary or secondary rhinoplasties. It is simple, atraumatic, and very well accepted by patients. There are no known complications and the columella is fixed and heals in the new position in 2–3 weeks. There is no bruising, no need of tapes, tampons, or casts. Downtime is minimal and patients can return to social life almost

[1] Serdev NP. Sliding of the Columella by the Serdev Technique. Live Surgery Workshop, The International Academy

[3] Serdev NP. Rhinoplasty for Beautification. Asia Pacific Craniofacial Association. Third Conference, Shanghai, P.R.

[6] Serdev NP. Course: Beautification rhinoplasty, t-zone excision, columella sliding, suture methods, updates in IV

[2] Serdev NP. Principles of Face Beautification. Third World Congress of the International Society of Aesthetic

nasal tip projection and dorsoprofile angle of 30<sup>0</sup>.

sliding for correct nasal tip projection and dorsoprofile angle of 300

3. Conclusion

immediately.

References

Surgery, Tokyo April 8-10, 2000

China, Oct. 30–Nov. 1, 2000

Figure 9. A. Before. Secondary case with short columella and incorrect acute dorsoprofile angle. B. After columella sliding for correct

.

tions, volumes, and angles.

Figure 8. A. Before. Incorrect proportions, aquiline long nose. B. After rhinoplasty, including T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles. Beautification as a result of correct proportions, volumes, and angles.

Figure 7. A. Before. Incorrect proportions, Aquiline long nose, low eyebrows, retrograde chin. B. After rhinoplasty including T-excision, humpectomy, digital fracture and columella sliding for correct proportion and angles, along with simultaneous brow lift and chin enhancement using Serdev Suture® techniques. Beautification as a result of correct proportions, volumes, and angles.

> References [1] Serdev NP. Sliding of the Columella by the Serdev Technique. Live Surgery Workshop, The International Academy of Aesthetic Surgery and Aesthetic Medicine, Krulig Clinic, Caracas, Venezuela, Nov. 1999 [2] Serdev NP. Principles of Face Beautification. Third World Congress of the International Society of Aesthetic Surgery, Tokyo April 8-10, 2000 [3] Serdev NP. Rhinoplasty for Beautification. Asia Pacific Craniofacial Association. Third Conference, Shanghai, P.R. Columella sliding is a very useful mini-invasive technique to control position of the nasal tip as an independent procedure or as a part of primary or secondary rhinoplasties. It is simple, atraumatic, and very well accepted by patients. There are no known complications and the columella is fixed and heals in the new position in 2–3 weeks. There is no bruising, no need of tapes, tampons, or casts. Downtime is minimal and patients can return to social life almost immediately.

> > [5] Serdev NP. Aesthetic surgery methods for face beautification. Int J Cosm Surg 2001; 1(3): 188-256

#### [6] Serdev NP. Course: Beautification rhinoplasty, t-zone excision, columella sliding, suture methods, updates in IV sedation and analgesia 2005; 23. 02. Available from: http://ijcs.org/courses/2005/90/index.php **Author details**

Nikolay P. Serdev\*

Address all correspondence to: serdev@gmail.com

China, Oct. 30–Nov. 1, 2000

nasal tip projection and dorsoprofile angle of 30<sup>0</sup>.

New Bulgarian University, Sofia, Medical Centre "Aesthetic Surgery and Aesthetic Medicine," Sofia, Bulgaria

[4] Serdev NP. Beautification rhinoplasty. Int J Cosm Surg 2001; 1(3): 257-311

#### **References**


## **Digital Fracture Versus Lateral Osteotomy**

## Nikolay P. Serdev

[3] Serdev NP. Rhinoplasty for Beautification. Asia Pacific Craniofacial Association.

[5] Serdev NP. Aesthetic surgery methods for face beautification. *Int J Cosm Surg* 2001;

[6] Serdev NP. Serdev techniques in beautification rhinoplasty: T-zone excision, colum‐

[7] Serdev NP. Nasal tip refinement, rotation, projection, alar base narrowing In: Serdev NP, Ed. *Serdev Sutures® Face and Body Lifts and/or Volumising*. Marllor editions, Italy,

[8] Serdev NP. Serdev Sutures® in middle face 4. Beautification rhinoplasty – tip rota‐ tion and refinement, alar base narrowing. In: Serdev NP, Ed. *Miniinvasive Face and Body Lifts – Closed Suture Lifts or Barded Thread Lifts*. Intech, Rijeka, 2013. Available from http://www.intechopen.com/books/miniinvasive-face-and-body-lifts-closed-su‐

[9] Serdev NP. Course: Beautification rhinoplasty, t-zone excision, columella sliding, su‐ ture methods, updates in IV sedation and analgesia 2005; 23. 02. Available from:

Third Conference, Shanghai, P.R. China, Oct. 30–Nov. 1, 2000

ella sliding, Serdev sutures. *Int J Cosm Surg* 2008; 8(1):388-469

ture-lifts-or-barbed-thread-lifts/serdev-sutures-in-middle-face.

http://ijcs.org/courses/2005/90/index.php

1(3): 188-256

28 Miniinvasive Techniques in Rhinoplasty

2013: 75-81

[4] Serdev NP. Beautification rhinoplasty. *Int J Cosm Surg* 2001; 1(3): 257-311

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/62064

#### **Abstract**

The purpose of digital fracture versus lateral osteotomies is to narrow the bony base of the nose after the dorsal correction, by closing the open dorsal roof, avoiding the lateral "rocker" or steplike deformities. The author presents the digital fracture technique, which is simple, safer, closes the open dorsal roof after medial osteotomy much better, and does not provoke bleeding and bruising. It is atraumatic and saves time during the operation and recovery.

**Keywords:** Rhinoplasty, digital fracture, infracture versus lateral osteotomy, dorsal roof closure, mini- invasive, atraumatic, no bleeding, small bruising, no complications

#### **1. Introduction**

Lateral osteotomy, internal or external, or in different levels, has some negatives that can lead to single or multiple reoperations. Its main complications are: unnatural contour of nasal bones; visible and palpable bony step, collapse of the upper lateral cartilages, along with infection, bleeding, massive edema, anosmia, lacrimal duct injury, intracranial injuries, disfigured appearance, narrow airway, and nasal obstruction. It is very difficult to reverse a lateral osteotomy and revision may end up with more of a flat top or square top nose, known as an open roof deformity [1, 2].

Choosing a method for closure of the open dorsal roof after medial osteotomy must be balanced with the other features and characteristics of the nose. In this regard, "digital fracture" has many advantages over lateral osteotomy – it is much more precise in closing the dorsal roof, without danger of bleeding, step formation, collapse of the upper lateral cartilages, and nasal obstruction. It is performed easily in any type of nose. The author has not observed any complications connected to this technique [3, 4].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

#### **2. Surgical technique**

shortened.

and digital fracture.

The author applies the digital fracture technique after medial osteotomy and hump removal, in primary as well as in secondary cases. It is performed by applying lateral pressure on the nasal bone in its dorsocaudal end, using the thumb. The other hand fixes the head with opposite pressure (Figure 1). There is a very small percentage of difficult digital fractures, mostly in men with thick nasal bones. A skin-colored tape is used for 3 days to reduce the swelling – the glue of the tape is hypertensive and partially absorbs the edema (Figure 2).

**Figure 1.** Digital fracture better adapts the nasal bones to close the dorsum and prevents step form deformity, which can often be seen in cases with lateral osteotomies. In all of author's chapters, results after humpectomy show the result of digital fracture as well. Due to the lack of trauma, there is no post-op bruising in 30% of the cases with medial osteotomy

humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmentation by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. Aesthetic proportions, angles, and volumes give aesthetic beautification The skin-colored tape will be removed on day 3. On day 1, as apparent, there is no bruising due to the atraumatic nature of the technique. On the first day, patients visit the clinic to have their nose cleaned and the crust removed. On questioning why she has used make up, she answered that she feels beautiful. **Figure 2. A.** Before. Aquiline long nose. No aesthetic proportions are present. **B.** After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmenta‐ tion by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. Aesthetic proportions, angles, and volumes give aesthetic beautification The skin-colored tape will be removed on day 3. On day 1, as appa‐ rent, there is no bruising due to the atraumatic nature of the technique. On the first day, patients visit the clinic to have their nose cleaned and the crust removed. On questioning why she has used make up, she answered that she feels beautiful.

Figure 2: A. Before. Aquiline long nose. No aesthetic proportions are present. B. After. Day 1 after T-excision for nasal tip rotation,

The technique has been used in all cases of author's rhinoplasties with humpectomy, under local anesthesia, since 1994. It gives a very natural result in all primary cases, as well as in secondary cases. It saves time, there is almost no bleeding and trauma is minimal Thus, downtime is shortened.

#### **3. Clinical cases**

disappears in a week (Figure 3).

**2. Surgical technique**

30 Miniinvasive Techniques in Rhinoplasty

seen in cases with lateral osteotomies.

<H1>CLINICAL CASES

and digital fracture.

shortened.

beautiful.

can often be seen in cases with lateral osteotomies.

why she has used make up, she answered that she feels beautiful.

The author applies the digital fracture technique after medial osteotomy and hump removal, in primary as well as in secondary cases. It is performed by applying lateral pressure on the nasal bone in its dorsocaudal end, using the thumb. The other hand fixes the head with opposite pressure (Figure 1). There is a very small percentage of difficult digital fractures, mostly in men with thick nasal bones. A skin-colored tape is used for 3 days to reduce the swelling – the

Figure 1: Digital fracture better adapts the nasal bones to close the dorsum and prevents step form deformity, which can often be

The technique has been used in all cases of author's rhinoplasties with humpectomy, under local anesthesia, since 1994. It gives a very natural result in all primary cases, as well as in secondary cases. It saves time, there is almost no bleeding and trauma is minimal Thus, downtime is

**Figure 1.** Digital fracture better adapts the nasal bones to close the dorsum and prevents step form deformity, which

Due to the lack of trauma, there is no post-op bruising in 30% of the cases with medial osteotomy

A. B. Figure 2: A. Before. Aquiline long nose. No aesthetic proportions are present. B. After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmentation by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. Aesthetic proportions, angles, and volumes give aesthetic beautification The skin-colored tape will be removed on day 3. On day 1, as apparent, there is no bruising due to the atraumatic nature of the technique. On the first day, patients visit the clinic to have their nose cleaned and the crust removed. On questioning

**Figure 2. A.** Before. Aquiline long nose. No aesthetic proportions are present. **B.** After. Day 1 after T-excision for nasal tip rotation, humpectomy, digital fracture, and columella sliding for exact tip projection; simultaneous chin augmenta‐ tion by Serdev Suture® and lower lip scar excision. Atraumatic surgery, no plaster, no tampons. Aesthetic proportions, angles, and volumes give aesthetic beautification The skin-colored tape will be removed on day 3. On day 1, as appa‐ rent, there is no bruising due to the atraumatic nature of the technique. On the first day, patients visit the clinic to have their nose cleaned and the crust removed. On questioning why she has used make up, she answered that she feels

In all of author's chapters, results after humpectomy show the result of digital fracture as well.

glue of the tape is hypertensive and partially absorbs the edema (Figure 2).

In all of author's chapters, results after humpectomy show the result of digital fracture as well.

Due to the lack of trauma, there is no post-op bruising in 30% of the cases with medial osteotomy and digital fracture.

Bruising is observed in nearly 70% of the cases. It is mostly linear along the tear through and disappears in a week (Figure 3). Bruising is observed in nearly 70% of the cases. It is mostly linear along the tear through and

day after humpectomy and digital fracture of the nasal bones, T-excision and columella sliding. The nasion is marked, the dorsum is slightly concave. Beautification is visible, due to correct aesthetic proportions, nasal angles, and tip volume. On the third day post op, the tape is removed, edema and bruising are minimal. <H1>CONCLUSIONS **Figure 3. A.** Before. A patient with a so-called Greek long nose. Small hump is present with no marked nasion concavi‐ ty. **B**. Third day after humpectomy and digital fracture of the nasal bones, T-excision and columella sliding. The nasion is marked, the dorsum is slightly concave. Beautification is visible, due to correct aesthetic proportions, nasal angles, and tip volume. On the third day post op, the tape is removed, edema and bruising are minimal.

Figure 3: A. Before. A patient with a so-called Greek long nose. Small hump is present with no marked nasion concavity. B. Third

Digital fracture is superior to lateral osteotomy. It is a very simple technique, atraumatic, takes only some minutes to perform, prevents from bleeding and shortens downtime. It prevents surgeons and

[2] Trenité GJ. Surgery of the osseocartilaginous vault. Osteotomies. In: Trenité GJ, Ed. Rhinoplasty: A Practical Guide to Functional and Aesthetic Surgery of the Nose. Kugler

[6] Serdev NP. Aesthetic surgery methods for face beautification. Int J Cosm Surg 2001; 1(3):

#### patients from all possible lateral osteotomy complications and has no known complications itself. **4. Conclusions**

REFERENCES

188-256

[1] Rolling KD. Primary rhinoplasty. Osteotomies. In: Rolling KD, Ed. Rhinoplasty: An Atlas of Surgical Technique. Springer, New York, 1999: 304. Digital fracture is superior to lateral osteotomy. It is a very simple technique, atraumatic, takes only some minutes to perform, prevents from bleeding and shortens downtime. It prevents

[3] Serdev NP. Beautification rhinoplasty. Int J Cosm Surg 2001; 1(3): 257-311

publications, The Hague, 2005: 102.

surgeons and patients from all possible lateral osteotomy complications and has no known complications itself.

#### **Author details**

Nikolay P. Serdev\*

Address all correspondence to: serdev@gmail.com

New Bulgarian University, Sofia, Medical Centre "Aesthetic Surgery and Aesthetic Medicine," Sofia, Bulgaria

#### **References**

