"Fix Down Concept" Named Image of the Month and Most Popular Article in PRS Journal

Feb 26, 2020

3 min read

Updated: Sep 18

Key takeaways

Prof. Dr. Suleyman Tas's study The Alignment of the Nose in Rhinoplasty: Fix Down Concept was published in Plastic and Reconstructive Surgery (PRS), the highest-impact plastic surgery journal in the world.
PRS selected it as the February 2020 "Image of the Month" and listed it among its "Most Popular Articles".
The paper introduces a way to align the nose in all three anatomical planes, not only the profile, and reports 102 consecutive patients with no revisions during follow-up.
Seven operative videos and 30 figures accompany the article so that surgeons can learn the technique.

Image of the Month PRS Journal Suleyman TAS

A great honour from the leading journal in plastic surgery

Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons, has the highest impact factor of all scientific plastic surgery journals. When it chose Prof. Dr. Suleyman Tas's latest rhinoplasty study as its Image of the Month and placed it among its Most Popular Articles, he described it simply: "It is really a great honour." The recognition placed a technique developed in Istanbul in front of rhinoplasty surgeons worldwide.

What is the Fix Down Concept?

Most rhinoplasty literature concentrates on the profile, the sagittal plane. But the nose is a three-dimensional structure, and a nose that looks straight from the side can still be crooked from the front or asymmetric from below. The Fix Down Concept is a systematic approach to aligning the nose in all three planes: coronal (front view), sagittal (profile) and axial (base view). It combines the fix down technique itself, a preservation-style lowering and fixing of the nasal dorsum, with a set of adjunct manoeuvres chosen according to each nose's specific asymmetries.

Summary of the study

Background. The author aimed to introduce the fix down concept, comprising the fix down technique and adjunct manoeuvres, to achieve alignment of the nose in three anatomical planes and improve rhinoplasty results in terms of symmetry.

Methods. Between March and December 2017, 102 patients (78 women, 24 men; 89 primary and 13 revision cases) underwent septorhinoplasty with the fix down concept. Noses were evaluated in the coronal, sagittal and axial planes and classified by their deformities.

Results. Functional and aesthetic results were satisfactory for patients, independent examiners and the surgeon, and no revisions were necessary during follow-up. Adjunct manoeuvres used to achieve symmetry in the frontal, base and profile views included ethmoid bone grafting (16 patients), the fix up technique (8), dissection of the levator labii alaeque nasi muscle (14) or its plication (4), superior-based transposition flaps (39), rim grafts (17), mucosa grafts (12), double-layer grafts (9), maxillary deepening (5), maxillary augmentation with cartilage or bone grafts (21) and supratip onlay grafts (7).

Conclusion. The fix down concept helps rhinoplasty surgeons deliver three-dimensionally symmetric noses.

Level of evidence: IV. Keywords: fix down, let down, push down, symmetry, facial asymmetry, conservative, preservation rhinoplasty, function, aesthetics, levator alaeque nasi muscle, maxillary hypoplasia.

Why it matters for patients

Symmetry is what patients notice first in a mirror or a photograph, and it is the hardest quality to achieve, especially in crooked noses and faces with underlying asymmetry of the maxilla. The Fix Down Concept gives a structured way to diagnose which plane is asymmetric and which manoeuvre corrects it. It is one of the foundations of the preservation rhinoplasty and Closed Atraumatic Rhinoplasty performed at Prof. Dr. Suleyman Tas Clinic, and its results can be seen in the rhinoplasty before and after gallery.

Read the article

The full paper, with its seven surgical videos and 30 figures, is available from the journal: The Alignment of the Nose in Rhinoplasty: Fix Down Concept, PRS, February 2020. Prof. Dr. Tas's other peer-reviewed work is listed on the publications page and on his PubMed profile.

Frequently asked questions

What is PRS Journal?

Plastic and Reconstructive Surgery is the official journal of the American Society of Plastic Surgeons and the most cited journal in the specialty.

Is the fix down technique a form of preservation rhinoplasty?

Yes. It lowers the dorsum while preserving its natural lines and adds specific manoeuvres for three-plane symmetry.

Does every patient need all the adjunct manoeuvres?

No. Each manoeuvre is chosen only when a specific asymmetry is present; most patients need a few.

Can I have the fix down technique at Prof. Dr. Suleyman Tas Clinic?

Yes. Prof. Dr. Tas uses the concept routinely and teaches it in his plastic surgery course.

Next step

To discuss whether the fix down concept suits your nose, contact Prof. Dr. Suleyman Tas Clinic for a consultation with Prof. Dr. Suleyman Tas.

About the author

Prof. Dr. Suleyman Tas is a European Board-certified plastic, reconstructive and aesthetic surgeon based in Istanbul with over 20 years of experience, author of Rhinoplasty in Practice (CRC Press) and founder of the Closed Atraumatic Rhinoplasty Course. Read verified patient reviews or book a consultation.

This article is for general information and does not replace an individual medical consultation.