The Dorsal Flattening Suture (DFS) in Dorsal Preservation Rhinoplasty.

In dorsal preservation rhinoplasty (DPR), approaching the septum with a subdorsal flap (or Cottle technique) classically requires two pillars. If either of these are compromised, despite release of all blocking points, the dorsal contour may not flatten adequately. The first is the caudal pillar, exemplified by the caudal fixation of the septal flap to a stable underlying structure. The subdorsal flap is sutured to the remnant caudal strut of septal cartilage, which remains attached to the maxillary spine, to secure the dorsum in its new extended and reduced position. However, in cases where the caudal septum must be replaced, tensioning the subdorsal flap on the anterior septal reconstruction (ASR) may introduce undesirable posterior and superior forces on the strut, and in turn lack the stability needed for adequate dorsal reduction. The second is the cephalic pillar, typically a stable PPE beneath the radix osteotomy. In some cases, the PPE may be unintentionally disrupted or the sub-radix PPE may be over-resected, resulting in loss of control at the radix. In this situation, the dorsum may not adequately flatten. The senior author (SPM) has successfully utilized a novel dorsal flattening suture (DFS) in situations where one of these pillars is compromised. The most common example would be the anterior septal reconstruction, a modified extracorporeal septoplasty technique. Using the DFS, a single suture technique tightens and flattens the dorsum independently, freeing an ASR graft from the posterior forces of the subdorsal flap. The senior author has used the DFS successfully to correct deviated noses and caudal septal deviations with DPR.Level of Evidence V 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 .