Video 3.14: Spiderweb Network Suture – Fixing the Centred Nasal Framework

What this video shows

Once the nasal structure is centred and the profile is set, the framework has to be stabilised so that the correction does not relapse. Video 3.14 shows the spiderweb network suture that Prof. Dr. Suleyman Tas uses for this purpose, placed with 4/0 polydioxanone. Each bite of the suture enables a counter-clockwise rotation of the profile, decreases tension and prevents recurrence.

The book also explains what to do with a deviated nasal spine at this stage: the deviated part can be reshaped or the septum can be stitched side by side on the opposite side, and for more challenging spine deviations bone grafts from the vomer or maxillary crest are used for stabilisation.

Key points

• Spiderweb network suture with 4/0 polydioxanone.

• Each bite rotates the profile counter-clockwise and reduces tension.

• Prevents recurrence after fix down centring.

In the book: Chapter 3 – Dorsum Surgery, section 3.4.2.2.1 Down Techniques – Fix Down Technique, Step 5 Fixing the Nasal Framework, p. 55 of Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques (CRC Press, 2021). About the book and all companion videos.

Related publication record: The Alignment of the Nose in Rhinoplasty: Fix Down Concept.

Surgeon: Prof. Dr. Suleyman Tas, plastic, reconstructive and aesthetic surgeon, Istanbul. This video is part of the surgeon-training material of the book; patients considering rhinoplasty in Istanbul can use it to understand the techniques used at Prof. Dr. Suleyman Tas Clinic.