A couple questions regarding dome binding sutures and a columellar strut...?

I'm wondering if it's always necessary to do a cephalic trim when fixing a bulbous nose. What is the point of this? In my case I feel like there isn't much room for trimming. If I did that, plus the sutures, plus the columellar strut, is my nose at a high risk for pinching in the future? Wouldn't want that, now would we... I assume general is preferred to local anesthesia. What would be a reasonable price to pay for it all, & what's the best way to go about it? Wishing I was a millionaire....

Doctor Answers (6)

Rhinoplasty for bulbous tip and dome binding sutures

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The bulbous tip is best addressed with intra-domal or inter-domal suture techniques to the lower lateral cartilages. In some patients a conservative cartilage( cephalic trim) removal is also performed, but not all patients. Some patients require a columellar strut when there is poor tip support, but in our practice we don't use them very often. All rhinoplasties are performed under general anesthesia for patient safety and comfort. 


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

A couple questions regarding dome binding sutures and a columellar strut...?

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I would not worry about a pinched appearance.  I have not seen one from the hundreds and hundreds of tips I have done.  There are a multitude of techniques beyond those mentioned that can be utilized.

Find a board certified plastic surgeon who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 180 reviews

Tip work

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Tip work will vary from patient to patient.  In many cases a cephalic trim is performed with tip suturing as well. It is always best to be seen in person.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

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Dome binding and columellar struts

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Much of what you ask is technical and may not even apply to the rhinoplasty you need. Future pinching is prevented by leaving adequate support to the tip and airway. Best way to go about things is seeing a board certified plastic surgeon in your area.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 26 reviews

Open Rhinoplasty Questions

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Usually a dome binding suture and a columellar strut are used during an open rhinoplasty procedure. You may also be a candidate for a closed rhinoplasty.

The cephalic trimming gives the nasal tip definition and refinement not pinching.

Without the benefit of pictures or an examination, I am at a disadvantage giving medical advice. A rhinoplasty including a board certified professional fee, a board certified anesthesia fee, and an accredited Medicare approved surgicenter is $4100. Consult with a Board Certified Plastic Surgeon.

Best wishes

George C. Peck, Jr, MD
West Orange Plastic Surgeon
5.0 out of 5 stars 10 reviews

All good questions about Nose Surgery

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You have some very good questions with regard to specific surgical maneuvers that can be done during a tip rhinoplasty. The approach to each nose should be tailored to the individual's concerns and anatomy. In some cases cephalic trims may not be required as you suggest. The "success" of dome shaping sutures can be influenced by a number of different factors including the skill of the plastic surgeon, thickness of the nasal tip skin, and strength of the dome cartilage. I highly recommend searching for a plastic surgeon in your local area to answer your questions. If the surgeon you meet can't answer these questions with clarity, move on and find another one who can. Thank you for sharing your questions. Best wishes.
For additional information about Rhinoplasty:

Gregory Park, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 49 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.