A New Technique in Rhinoplasty for Stabilizing the Nasal Tip: Backstay Suture.

[BACKGROUND] Stabilizing the nasal tip is often one of the most challenging aspects of rhinoplasty, and various factors can lead to its deviation. This paper presents a new technique called the backstay suture to improve nasal tip stability.

[METHODS] In this longitudinal case series study (Level III evidence), conducted in accordance with STROBE guidelines, data were collected from all patients treated with the backstay suture from 2017 to 2023. Patients with incomplete information were excluded. Patients were assessed preoperatively and up to twelve months postoperatively. Outcomes included patient-reported satisfaction, the presence of postoperative nasal tip deviation assessed by three facial plastic surgeons, and the need for reoperation or additional procedures recorded as binary outcomes.

[RESULTS] A total of 147 patients met the inclusion criteria. The overall satisfaction rate was 85.7% and was comparable to weighted literature estimates (p = 0.36). The nasal obstruction rate was 12.2% (p = 0.82), and the overall reoperation rate was 12.2% (p = 0.82). Minor revision surgeries accounted for 88.8% of reoperations. Nasal tip deviation requiring correction occurred in four patients (2.7%), which was significantly lower than the weighted average reported in the literature (z = - 2.52, p = 0.0118, 95% CI: 0.1-5.3%). Three of these patients had preoperative deviations, and one presented with weak cartilage support. Multivariate logistic regression analysis did not identify age, sex, or deformity type as statistically significant predictors of dissatisfaction, reoperation, or postoperative nasal tip deviation.

[CONCLUSIONS] The backstay suture technique was associated with a low rate of postoperative nasal tip deviation in this case series and may represent a useful adjunct in selected rhinoplasty cases. Further comparative studies are warranted to better define its role relative to other stabilization techniques.

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