Stabilization of the Bony Pyramid in Rhinoplasty Using Dorsal Aesthetic Lines Bony Sutures.

[INTRODUCTION] Modern rhinoplasty relies on osteotomies that risk destabilizing the nasal pyramid. While suture fixation is standard for cartilage, bony stabilization remains technically challenging. We present a novel piezosurgery-assisted 8-shaped "bridge suture" technique along dorsal aesthetic lines (DAL) to address this gap.

[MATERIALS AND METHODS] From 2021 to 2023, 28 patients underwent structural rhinoplasty with DAL bony sutures. The technique involved: (1) DAL osteotomies via piezotome, (2) two pairs of bilateral 2-3 mm perforations, and (3) 4-0 PDS figure-eight sutures securing lateral bony slopes to the dorsum. Outcomes were assessed using ROE/NOSE questionnaires with 12-18 month follow-up.

[RESULTS] All cases achieved stable dorsal symmetry without hump recurrence. Operative time averaged 189.6 ± 51.92 minutes with no major complications. Three revisions (unrelated to dorsum) were required. Significant improvements were observed in ROE (6.7±2.5 to 21.7±1.5, *p*<0.001) and NOSE scores (24.7±17.4 to 2.7±3.6, *p*<0.001).

[CONCLUSION] This technique simplifies bony stabilization by eliminating transcutaneous steps while preventing over-narrowing. The 8-shaped suture design provides three-dimensional control, yielding predictable aesthetic and functional outcomes.

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