Optimising Rhinoplasty Outcomes in Short, Depressed and Thick-skinned Indian Noses: Practical Techniques Without Supratip Skin Thinning

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Background: Rhinoplasty in short, depressed and thick-skinned Indian noses presents unique challenges. The thicker nasal skin acts as a veil, shrouding the distinct features of the underlying skeletal framework and diminishing their visibility. Traditional approaches often focus on thinning the dermis, which can compromise blood supply, lead to skin necrosis, surface irregularities and postoperative fibrosis. Augmenting only the dorsum in these noses often results in an artificial, unnatural and ‘done nose’ appearance. Materials and Methods: Our technique involves an open approach, preserving Pitanguy’s ligament in primary noses. We occasionally remove excess fat from the supratip region and between the domes. A firm cartilaginous framework is created through reinforcing the weak cartilaginous vault and using a differentially carved dorsal strut. In primary noses, Pitanguy’s ligament is restored. In secondary noses or cases where Pitanguy’s ligament was not preserved, supratip subdermal suture is used. This suture obliterates the dead space, adjusts supratip skin thickness internally and prevents supratip bulging. This approach allows for desired tip shape without actual thinning of supratip skin. We emphasise the importance of nasal lengthening, which maintains nasal proportions with the face. Lengthening also helps stretch thick skin, creating a more refined appearance. Results: Patients expressed high satisfaction with the aesthetically pleasing and durable outcomes, which were maintained over a minimum follow-up period of one year. Notably, no supratip deformity was observed postoperatively, and the tip and midvault regions exhibited adequate projection, contributing to a favourable and long-lasting result. Conclusion: Rhinoplasty in short, depressed and thick-skinned Indian noses can be performed safely and effectively without thinning the supratip skin. By tailoring the dorsal strut to skin thickness, obliterating the dead space at supratip and ensuring a firm cartilaginous framework, surgeons can achieve natural-looking results with minimal risk and ensuring adequate tip projection.

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