Background: In open rhinoplasty technique, the soft tissue and ligaments are vulnerable to injury. Routine reconstruction of the ligaments usually has little attention by the surgeons Purpose: To study the long term results of ligaments preservation together with nasal tip structure in thick skin nose. Methods: Subperichondrial dissection to the nasal tip preserving tip ligaments, Septal extension graft with bilateral dome grafts were used, and reconstruction of bitanguy’s ligament. Study was done on 37 patients underwent open rhinoplasty Results: All patients have better aesthetic and functional outcome with long lasting preservation of tip definition, projection, and rotation as well as the same results in early postoperative period. No patient needed secondary revision surgery due to loss of projection or tip dropping. The objective findings and subjective assessments were satisfying for the patients and surgeons Conclusion: Refinements of nasal surgery have no limits. Study Suggests that nasal ligaments preservation/ reconstruction; Scroll ligament, Septo-columellar ligament and Pitanguy ligament combined with tip grafts could maintain nasal tip projection and rotation for long time in thick skin nose.

Senior Consultant plastic surgeon - Medline Aesthetic Centre
European board of plastic and reconstructive surgery
FRCSI clinical examiner
ISAPS active member
ASPA active member
Member of European society of Rhinoplasty
Operation smile cleft surgeon