The classic transdomal (dome-defining) suture successfully reduces tip width but on occasion also causes a pinched tip (concave alar rim) and an inversion of the lateral crus. We present a modification of that suture technique which only reduces the cephalic end of the dome. By suturing only the posterior (deep) part of the cephalic end of the dome, the lateral crus is everted and a pinched tip is minimized. It is referred to as the hemitransdomal suture because it only reduces the cephalic half of the dome. Twelve cases were studied indicating dramatic correction of dome width without unwanted side effects.
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