The Alignment of the Nose in Rhinoplasty: Fix Down Concept.

[BACKGROUND] The current literature on rhinoplasty focuses mainly on the nasal profile (sagittal plane); however, the nose is a three-dimensional structure, and alignment of the nose in consideration of other aspects is important to achieve an aesthetic result. The author aimed to introduce the fix down concept, which includes fix down technique and the adjunct maneuvers for achieving alignment of the nose in three anatomical planes and improving the results of rhinoplasty in terms of symmetry.

[METHODS] Between March of 2017 and December of 2017, a total of 102 patients (78 women and 24 men), 13 revision and 89 primary cases, underwent septorhinoplasty with the fix down concept. The noses were evaluated in coronal, sagittal, and axial planes and classified according to their deformities.

[RESULTS] The functional and aesthetic results were satisfactory for the patients, examiners, and surgeon. No revisions were necessary during the follow-up period. In addition to the fix down technique, ethmoid bone grafting (16 patients), fix up technique (eight patients), dissection of the levator labii superioris alaeque nasi muscle (14 patients), plication of this muscle (four patients), superior-based transposition flap (39 patients), rim grafts (17 patients), mucosa grafts (12 patients), double-layer grafts (nine patients), maxillary deepening (five patients), maxillary augmentation with cartilage/bone grafts (21 patients), and supratip onlay grafts (seven patients) were used as adjunctive maneuvers to achieve symmetry in the frontal, base, and profile views.

[CONCLUSION] The presented fix down concept will help to provide three-dimensional symmetric noses for rhinosurgeons.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.