Intraoperative Measurement-Based Approach to Supratip Deformity in Open Structural Rhinoplasty

Background: Supratip deformity is one of the most common complications after open rhinoplasty. This study aimed to define a new risk scoring system for supratip deformity and determine the distances that should be left between the tip defining point (TDP) and anterior septal angle (ASA) to prevent it. Methods: Four hundred sixty-nine patients who underwent open rhinoplasty between 2018-2022 were included in this retrospective study. The patients were evaluated according to the risk scoring system consisting of four parameters (skin thickness, lower lateral cartilage anatomy, amount of hump resection, and soft tissue procedures). Because of the presence of supratip deformity at the postoperative 12th month, the patients were divided into two groups: (i) without supratip deformity (n = 418) and (ii) with supratip deformity (n = 51). Statistical inferences were made regarding the development of supratip deformity by evaluating the relationship between the risk scores and the intraoperative TDP-ASA distances. Results: There was a significant difference between the groups in risk scores ( P < 0.05). In cases with high-risk scores, it was calculated that the probability of developing supratip deformity decreased significantly when the TDP-ASA distance was above 7.5 mm and increased significantly when the TDP-ASA distance was below 6.5 mm. In cases with low-risk scores, it was found that the probability of developing supratip deformity was reduced considerably when the TDP-ASA distance was over 6.0 mm. Conclusions: The authors recommend keeping the TDP-ASA distance above 6.0 mm in low-risk patients and 7.5 mm in high-risk patients to avoid supratip deformity.