title: Closed rhinoplasty with open approach advantages: extended intranasal incisions and tip rearrangement sutures.
abstract: BACKGROUND
  Two main well-known approaches are used in rhinoplasty: open and closed techniques. This study aimed to define two new tip suture modifications that enhance and stabilize tip shape, projection, and position through an extended infracartilaginous incision with an open rhinoplasty exposure.
  
  
  METHODS
  This study investigated 56 consecutive primary rhinoplasty patients 18-51 years of age (mean age 27.8 years) who underwent surgery between June 2011 and June 2012 and had at least a 1-year postoperative follow-up period. Rhinoplasty was performed through an extended infracartilaginous incision with an open exposure. Transdomal suture modification for columella-lobular angle augmentation and a footplate repositioning suture for tip projection (and position) enhancement also were defined. A postoperative satisfaction survey was applied to all the patients at their 1-year follow-up visit.
  
  
  RESULTS
  The postoperative satisfaction rate was 96 %. The nasal tip positions and projections of the patients were fine and stable in all the patients after a 1-year postoperative period. At this writing, no over- or underprojection, supratip deformity, saddle-nose deformity, or dorsal-surface irregularities have been encountered. Representative cases are displayed.
  
  
  CONCLUSIONS
  This study defined two new tip suture techniques and combined them with an extended infracartilaginous incision. Also, control of the entire nose and nasal valve area was possible through this incision.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey, halonka@yahoo.com.
authors.forename: Haldun Onuralp
authors.initials: HO
authors.lastname: Kamburoğlu
authors.forename: Aycan Uğur
authors.initials: AU
authors.lastname: Kayıkçıoğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery; D017060:Patient Satisfaction; D012225:Rhinoplasty / Q000379:methods*; D013536:Suture Techniques; D055815:Young Adult