Closed Preservation Rhinoplasty in the Mestizo Patient: Challenges and Techniques for Nasal Tip Support.

Background: Closed preservation rhinoplasty continues to grow in popularity. Nevertheless, many surgeons remain wary of doing closed preservation rhinoplasty in certain patient populations. Mestizo noses have a thick soft-tissue envelope and weak nasal tip support. These inherent characteristics have led many surgeons to favor open structural techniques when addressing the tip in the Mestizo patient.

Objectives: The present article describes a set of techniques that have been successfully employed by the authors for maximizing tip support and definition when doing closed preservation rhinoplasty in a patient population for which structural techniques were once thought as the only viable option.

Methods: A total of 417 primary rhinoplasty cases were studied retrospectively between January 2022 and December 2023. All the cases were performed using a closed approach and dorsal preservation of the soft-tissue envelope. All patients underwent one of the four types of surgical techniques for the tip area (Type I - 105 patients, Type II - 124, Type III - 181, and Type IV - 7).

Results: Of the total patients, 331 (79.3%) were female and 86 (20.6%) were male. Patient age varied from 15 to 66, with a median age of 23. Patients were followed for a period of six months to a year postoperatively. Seven patients underwent revision surgery (1.7%).

Conclusions: Even with its various potential benefits, there is still apprehension about doing closed preservation rhinoplasty in certain patient populations. The authors present several techniques that have been successfully employed to maximize tip support and definition when performing closed preservation rhinoplasty in the Mestizo patient.