See how dome binding sutures can be used to reduce the roundedness and fullness of the nasal tip during open rhinoplasty.
In Part 2 of a Bulbous Nasal Tip Case Study, Thomas Lamperti, MD, uses a novel, high definition point-of-view camera to narrate an intra-operative video that shows how he performs dome binding sutures to improve the appearance of a bulbous nasal tip. You can see Part 1 of the Bulbous nose repair video series here.
"This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going to go through part 2 of my bulbous nasal tip repair series in which I show you how to perform dome binding sutures. Here I'm starting by grasping the dome area to try to create the proper level of lower lateral cartilage flattening. Now that I've found the proper dome binding position I'll go ahead and place the first suture. Now I'll double back and place the second set of the loop. the key is to not distort the domal area while doing this so proper symmetric placement is very important. Once I'm happy with the dome binding suture locations I'll then cinch down the knot. As I do this you can see the lower lateral cartilage flattens quite nicely. This is a key component to treating tip bulbosity. A pleasing, natural appearing tip is one in which the lower lateral cartilages have a flat rather than convex or concave appearance.
I'll now repeat the procedure on the patient's left side. You may be wondering what type of suture I use for the dome binding. I normally use a nylon suture, which is very thin and permanent to ensure that the cartilages of the tip maintain their new orientation. The body handles having this type of suture within the nose quite well. You can see here how it is important to mirror the dome binding effect that was created on the right side. This is done in order to create as symmetric a final result as possible. In an upcoming part 3 bulbous nasal tip video I'll show you how I also performed alar base reduction to narrow this patient's nostril width."