Can a Dome Stitch Done to the Tip of my Nose Be Removed or Loosened?

Question

I had a revision rhinoplasty done about six months ago and my surgeon used a dome stitch to the tip of my nose without my knowledge. I really liked my tip presurgery, and asked specifically not to have any tip work done, now I hate my tip. It looks like a ball that has been pinched at the bottom. My question is can the dome stitch be simply removed or revised to improve this overstuffed ballish look? Thanks for any help.

Thomas Buonassisi, MD · Answer

Dome stitching can be a very usefull technique to narrow the nasal tip. The sutures can be removed and the tip relationships loosened. Depending on how long the sutures have been in place you may need some removal of scar tissue as wll to re-establish a broader looking tip.

Moneer Jaibaji, MD · Answer

Sorry that you are not happy with the nose tip. I think it is too early to judge the shape of the tip since you are only six months out from revision rhinoplasty. Revision cases tend to be more complex and the swelling and scarring takes longer to settle. My best advise to you now is to wait for another six months and then evaluated the tip. If revision is needed then your plastic surgeon can perform that for you.

Mario J. Imola, MD, DDS · Answer

Dome sutures are one of the most common and powerful technique available when attempting to reshape the nasal tip during rhinoplasty.  Several dome sutures have been described over the years, but they can all be classified falling into one of the following groups:

	·         Intradomal - Placed within one of the intermediate crura of the lower lateral cartilages.

	·         Interdomal - Spanning from one lower lateral cartilage to the other.

	When properly selected and executed, domal sutures will refine the shape of the nasal tip.  However, they can also cause undesirable contours if used improperly.  

	Unfortunately, it is hard to determine the exact cause of the untoward outcome in your situation.  In addition, at 6 months there is still a variable degree of remodeling which will occur up to 1 year following surgery.  At that time, it is safe to undertake revision surgery.  I would begin with your plastic surgeon in an attempt to understand what may be underlying the untoward outcome and what the prospects for revision surgery are.

	 

	Mario J. Imola, MD, DDS, FRCSC.

Richard W. Fleming, MD (retired) · Answer

This stitch which is used o narrow, contour, and define the nasal tip can be removed. The tip cartilages may have to be mobilized if there are adhesions between them

Francis R. Palmer, III, MD (retired) · Answer

The suture can be removed but there's no way to know if the tip cartilage was manipulated, trimmed or changes before placing the intra-domal suture. It would require an open Revision Tiplasty however, the shape and exact size of your old nasal tip is most likely gone forever. You can make this tip better, but not have the old tip back.

Can a Dome Stitch Done to the Tip of my Nose Be Removed or Loosened?

Answers (5)