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An Analysis of 1500 Consecutive Rhinoplasties Using a Closed Tip Eversion Technique
Alan Matarasso, MD, FACS1, Darren M. Smith, MD2.
1Manhattan Eye, Ear and Throat Hospital, New York, NY, USA, 2The Hospital for Sick Children, Toronto, ON, Canada.

Rhinoplasty is considered one of plastic surgery's most difficult procedures to teach, learn, and perform with consistent results. This well-earned reputation stems from several factors. The nose has so many variations that there can be no "standard" rhinoplasty. Countless techniques have evolved to address the many variants of pathological nasal anatomy. The effectiveness of these techniques varies on a case-by-case basis depending on subtleties in individual nasal morphology. Therefore, it is necessary to learn and become comfortable with a number of reliable techniques that can be applied as part of an individualized, problem-based approach to rhinoplasty. Here, we present a technique that has the ability to achieve consistent results, is reproducible, and can be "taught". Nasal tip delivery and modification by the maneuvers described here has yielded consistent, powerful tip refinement and rhinoplasty results via a closed approach and serves as a viable alternative to open methods.
Nasal tip delivery via eversion allows the surgeon to reliably access and modify the tip cartilages with predictable results. Components of tip modification with this technique include (as indicated): a conservative cephalic trim, cartilage shaping sutures (5-0 PDS), columellar strut, cap graft secured with fibrin glue, and lateral crural modification (sutures or grafts). Alar rim grafts and other modifications can be used as indicated. Here, we review a series of 1500 consecutive rhinoplasties over the last 10 years from the senior author's (AM's) practice that incorporate the nasal tip delivery technique. Videos were recorded demonstrating key components of the procedure.
1500 consecutive rhinoplasties incorporating nasal tip delivery were assessed. Follow-up ranged from 1 to 10 years. Critical portions of the procedure were clearly documented with video recording. Patients were very satisfied with the results, and complications were consistent with reports of rhinoplasty by any method and unrelated to the delivery technique. The procedures described proved to produce consistent results.
The nasal tip delivery technique is presented as a reliable closed alternative to open rhinoplasty surgery. Some have referred to this hybrid method as a "closed open" rhinoplasty as it offers the advantages of both techniques. Video is used to illustrate key components of the method. We have found this approach to be reliable after evaluating a large series of patients with long-term follow-up.

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