Abstract / Summary
This technical report describes a surgical technique developed to manage the dead space between the osteocartilaginous framework and the superficial musculoaponeurotic system (SMAS) during open rhinoplasty.The technique utilizes the superficial orbicularis oris nasalis (SOON) muscle to preserve the superficial layer of the nasal SMAS within the columella, with the aim of maintaining columellar volume and anatomy while minimizing dead space formation.During an open rhinoplasty approach, the SOON muscle is preserved through subperichondrial dissection to create a vascularized flap (SOON flap).The flap is subsequently repositioned and secured using the SOON Flap Stitch, a suture technique developed by the author (IARN) to restore the preserved tissue over the nasal tip framework.The technique was performed in 226 consecutive primary open rhinoplasty procedures, with postoperative follow-up ranging from eight months to three years.The senior author (AB) observed reduced dead space and columellar retraction, as well as improved infratip volume, definition, and double-break contour.The SOON Flap Stitch represents a simple and reproducible technique for preserving and repositioning the superficial nasal SMAS, promoting its redraping and integration over the underlying osteocartilaginous framework while enhancing columellar and infratip contour in open rhinoplasty.