Effect of Depressor Septi Transposition on Preventing Tip Droop During Smiling in Tongue-in-Groove Tip Plasty: A Randomized Controlled Trial.

[BACKGROUND AND AIMS] Plunging tips caused by overactivity of the depressor septi nasi (DSN) muscle present common challenges in rhinoplasty. The tongue-in-groove (TIG) surgical technique has proven effective in correcting static tip drooping.

[OBJECTIVE] This study aims to assess the effect of DSN transposition on preventing tip drooping during smiling in TIG tip plasty.

[METHODS] This clinical trial was conducted at a tertiary academic hospital from April 2022 to July 2024. Fifty patients with plunging tips who were undergoing septorhinoplasty were randomly assigned to two groups: TIG alone (n = 25) and TIG with DSN transposition (n = 25). The primary outcome measured was the percentage change in the tip angle between relaxed and smiling poses, evaluated through preoperative and one-year postoperative assessments. Secondary outcomes included the position of the tip, the position of the alar, tip projection, rotation, and patient satisfaction measured by the Standardized Cosmesis and Health Nasal Outcomes Survey.

[RESULTS] The reduction in tip angle was significantly greater in both groups (TIG alone: from - 9.38 to - 5.80%, p < 0.001; TIG with DSN transposition: from - 11.57 to - 8.65%, p = 0.001). There were no significant differences between the groups in terms of tip angle (p = 0.518), tip position (p = 0.363), alar position (p = 0.239), or nasolabial angle (p = 0.287). Improvements in patient satisfaction scores were also similar between the groups (TIG alone: 15.62 ± 8.44; TIG with DSN transposition: 18.50 ± 8.64, p = 0.286).

[CONCLUSION] Both TIG and TIG combined with DSN transposition effectively reduce dynamic nasal tip drooping during smiling. DSN transposition may not lead to a significant improvement in outcomes compared to TIG alone.

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