Reconstruction of Scroll and Pitanguy’s Ligaments in Open Rhinoplasty: A Controlled Randomized Study

Introduction: In the preservation rhinoplasty era, ligament management represents a hot topic. The aim of this study is to analyze the role of ligaments as indispensable elements of support of the nasal tip to have an adequate, safe, and predictable aesthetic and functional result. Material and Methods: Patients meeting the following criteria were included in the study: primary rhinoplasty, minimum 2-year follow-up, proficiency in Italian language, signed consent, and standardized pre- and postoperative photographic documentation. The study was performed with a double-blinded randomized design; both the patients and two of the authors measuring outcomes were blinded to the treatment methods. All patients were asked to answer the FACE-Q satisfaction with the nose postoperative scale. Two plastic surgeons reviewed all postoperative photographs, rating the outcome on a 1–5 VAS scale. Results: One hundred and twelve patients were enrolled, 47 males and 65 females, aged between 20 and 50 years. Patients were randomly divided in three groups: group 1, ligament reconstruction and grafts; group 2, only grafts (shield, single and double onlay, umbrella); and group 3, only ligament reconstruction with columellar strut. All rhinoplasties were performed with an open approach. Both the FACE-Q and VAS scores were in groups 1 and 2, which were also the ones undergoing fewer secondary procedures compared to group 3. Conclusions: The best surgical option appears to be the combination of ligament repair and grafts. It reduces dead space and enables a better redraping of soft tissues, obtaining a better control of tip projection, position, and rotation. Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.