Dynamics of the Subdomal Graft.

[BACKGROUND] The authors examined the dynamics of the subdomal graft and its frequency of use in primary and secondary rhinoplasty in detail.

[METHODS] One hundred consecutive primary and 100 consecutive secondary rhinoplasty patients with at least 1 year of follow-up were reviewed retrospectively. The nose sheet containing a detailed intraoperative recording of all rhinoplasty maneuvers was reviewed to analyze the frequency of subdomal graft use. Intraoperative observations of the effects of the subdomal graft on the nasal tip and the surrounding structures were recorded. Data were tabulated in an Excel file and analyzed.

[RESULTS] The subdomal graft was used in 77 percent of 100 primary rhinoplasty patients and 31 percent of 100 secondary rhinoplasty patients. After placement of the subdomal graft, the intraoperative changes included (1) improved dome symmetry in all three dimensions, (2) precise control of interdomal distance, (3) lateral and cephalic rotation of the lateral crura of the lower lateral cartilages, (4) widening of the nostrils secondary to lateral rotation of the lower lateral cartilages, (5) external valve function improvement, (6) prevention of lateral crura concavity by preventing overtightening of the transdomal suture, and (7) prevention of excessive narrowing of the domal arch.

[CONCLUSIONS] The subdomal graft improves domal symmetry, precisely controls the interdomal distance, reorients the domes/lateral crura, widens the nostrils, prevents excessive narrowing of the medial genu angle, and prevents lateral crura concavity from transdomal sutures. The graft should be strongly considered in primary and secondary rhinoplasty patients with (1) pinched tip deformity, (2) excessive narrowing of the interdomal distance, (3) asymmetric domes, (4) caudally positioned lower lateral cartilages, and (5) narrow nostrils with external valve dysfunction.

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