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>> Dr. Lamperti: This is Seattle facial plastic surgeon, Dr. Thomas Lamperti. Today I'm going
to go through part 2 of my bulbous nasal tip repair series in which I show you how to perform
dome binding sutures. Here I'm starting by grasping the dome area to try to create the
proper level of lower lateral cartilage flattening. Now that I've found the proper dome binding
position I'll go ahead and place the first suture. Now I'll double back and place the
second set of the loop. the key is to not distort the domal area while doing this so
proper symmetric placement is very important. Once I'm happy with the dome binding suture
locations I'll then cinch down the knot. As I do this you can see the lower lateral cartilage
flattens quite nicely. This is a key component to treating tip bulbosity. A pleasing, natural
appearing tip is one in which the lower lateral cartilages have a flat rather than convex
or concave appearance.
I'll now repeat the procedure on the patient's left side. You may be wondering what type
of suture I use for the dome binding. I normally use a nylon suture, which is very thin and
permanent to ensure that the cartilages of the tip maintain their new orientation. The
body handles having this type of suture within the nose quite well. You can see here how
it is important to mirror the dome binding effect that was created on the right side.
This is done in order to create as symmetric a final result as possible. In an upcoming
part 3 bulbous nasal tip video I'll show you how I also performed alar base reduction to
narrow this patient's nostril width.