Closed Preservation Rhinoplasty in the Mestizo Patient: Challenges and Techniques for Nasal Tip Support.

[BACKGROUND] Closed preservation rhinoplasty continues to grow in popularity. Nevertheless, many surgeons remain wary of performing closed preservation rhinoplasty in certain patient populations. Mestizo noses have a thick soft-tissue envelope and weak nasal tip support. These inherent characteristics have led many surgeons to favor open structural techniques when addressing the tip in the mestizo patient.

[OBJECTIVES] The aim of this article was to describe a set of techniques that have been successfully utilized by the authors to maximize tip support and definition when performing closed preservation rhinoplasty in a patient population for which structural techniques were once thought to be the only viable option.

[METHODS] A total of 417 primary rhinoplasty cases were studied retrospectively between January 2022 and December 2023. All the cases were performed by a closed approach and with dorsal preservation of the soft-tissue envelope. All patients underwent 1 of 4 types of surgical technique for the tip area: Type I, 105 patients; Type II, 124 patients; Type III, 181 patients; Type IV, 7 patients.

[RESULTS] Of the 417 patients, 331 (79.3%) were female and 86 (20.6%) were male. Patient age ranged from 15 to 66 years, with a median age of 23 years. Patients were followed for a period of 6 months to 1 year postoperatively. Seven patients underwent revision surgery (1.7%).

[CONCLUSIONS] Even with its various potential benefits, there is still apprehension about performing closed preservation rhinoplasty in certain patient populations. The authors present several techniques that have been successfully utilized to maximize tip support and definition when performing closed preservation rhinoplasty in the mestizo patient.