Aesthetic Plastic Surgery

, Volume 42, Issue 1, pp 275–287 | Cite as

Cutting the Holy Dome: The Evolution of Vertical Alar Resection

  • Süreyya Şeneldir
  • Aytuğ Altundağ
  • Denizhan DizdarEmail author
Original Article Rhinoplasty



Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. In this study, we retrospectively analysed our rhinoplasty patients in whom we used vertical alar resection (VAR) to assess the advantages and disadvantages of this technique. To our knowledge, this is one of the most exhaustive studies of VDD, including over 3000 patients.

Materials and Methods

This retrospective case series reviewed the charts of 3965 patients who underwent VAR between 2000 and 2015. All patients were operated on by the senior surgeon. Dome division was used for various reasons, including a deformed tip area in revision rhinoplasties, droopy nose, wide tip, pinched nose, tip asymmetry, and overprojected nasal tip. Patients were excluded if they had septal deviation that enabled tip rotation, or a dorsum problem that caused tip asymmetry.


The study included 3965 patients (3172 women and 793 men) who underwent open rhinoplasty from 2000 to 2015. The mean patient age was 28.3 years (range 18–50 years). The mean clinical follow-up duration was 11.2 years.


In conclusion, this technique is capable of modifying all parameters of the nasal tip (projection, rotation, and volume), as required, at the same time, addressing many tip problems.

Level of Evidence IV

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


Rhinoplasty Dome division Tip Tip plasty 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 7887 kb)

Supplementary material 2 (MP4 26384 kb)

Supplementary material 3 (MP4 49296 kb)


  1. 1.
    Daniel RK (1992) The nasal tip: anatomy and aesthetics. Plast Reconstr Surg 89:216–224CrossRefPubMedGoogle Scholar
  2. 2.
    Kridel RW, Konior RJ (1990) Dome truncation for management of the overprojected nasal tip. Ann Plast Surg 24:385–396CrossRefPubMedGoogle Scholar
  3. 3.
    Simons RL (1987) Vertical dome division in rhinoplasty. Otolaryngol Clin North Am 20:785–796PubMedGoogle Scholar
  4. 4.
    Simons RL, Greene RM (2010) Rhinoplasty pearls: value of the endonasal approach and vertical dome division. Clin Plast Surg 37:265–283CrossRefPubMedGoogle Scholar
  5. 5.
    Adamson PA, McGraw-Wall BL, Morrow TA, Constantinides MS (1994) Vertical dome division in open rhinoplasty, an update on indications, techniques, and results. Arch Otolaryngol Head Neck Surg 120:373–380CrossRefPubMedGoogle Scholar
  6. 6.
    Chang CW, Simons RL (2008) Hockey-stick vertical dome division technique for overprojected and broad nasal tips. Arch Facial Plast Surg 10:88–92PubMedGoogle Scholar
  7. 7.
    Kridel RW, Konior RJ (1991) Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg 117:411–415CrossRefPubMedGoogle Scholar
  8. 8.
    Davis AM, Simons RL, Rhee JS (2004) Evaluation of the Goldman tip procedure in modern-day rhinoplasty. Arch Facial Plast Surg 6:301–307CrossRefPubMedGoogle Scholar
  9. 9.
    McLure TC (1991) A modified Goldman nasal tip procedure for the drooping nasal tip. Plast Reconstr Surg 87:254–260CrossRefPubMedGoogle Scholar
  10. 10.
    Rich JS, Friedman WH, Pearlman SJ (1991) The effects of lower lateral cartilage excision on nasal tip projection. Arch Otolaryngol Head Neck Surg 117(1):56–59CrossRefPubMedGoogle Scholar
  11. 11.
    Tuğrul S, Doğan R, Koçak I, Eren SB, Ozturan O (2015) Split cartilage resection of nasal dome: a solution to ptotic nasal tips. J Craniofac Surg. 26:400–405CrossRefGoogle Scholar
  12. 12.
    Boccieri A, Marianetti TM (2010) Barrel roll technique for the correction of long and concave lateral crura. Arch Facial Plast Surg 12:415–421CrossRefGoogle Scholar
  13. 13.
    Patrocínio LG, Patrocínio TG, Barreto DM, Subhan YS, Patrocínio JA (2014) Evaluation of lateral crural steal in nasal tip surgery. JAMA Facial Plast Surg 16:400–404CrossRefPubMedGoogle Scholar
  14. 14.
    Foda HM, Kridel RW (1999) Lateral crural steal and lateral crural overlay: an objective evaluation. Arch Otolaryngol Head Neck Surg 125:1365–1370CrossRefPubMedGoogle Scholar
  15. 15.
    Tardy ME Jr, Becker D, Weinberger M (1995) Illusions in rhinoplasty. Facial Plast Surg 11:117–137CrossRefPubMedGoogle Scholar
  16. 16.
    Rohrich RJ, Raniere J Jr, Ha RY (2002) The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 109:2495–2508CrossRefPubMedGoogle Scholar
  17. 17.
    Gunter JP, Rohrich RJ (1992) Correction of the pinched nasal tip with alar spreader grafts. Plast Reconstr Surg 90:821–829CrossRefPubMedGoogle Scholar
  18. 18.
    Toriumi DM, Josen J, Weinberger M, Tardy ME Jr (1997) Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol Head Neck Surg 123:802–808CrossRefPubMedGoogle Scholar
  19. 19.
    Kridel RW, Yoon PJ, Koch RJ (2003) Prevention and correction of nasal tip bossae in rhinoplasty. Arch Facial Plast Surg 5:416–422CrossRefPubMedGoogle Scholar
  20. 20.
    Gilman GS, Simons RL, Lee DJ (1999) Nasal tip bossae in rhinoplasty: etiology, predisposing factors, and management techniques. Arch Facial Plast Surg 1:83–89CrossRefGoogle Scholar
  21. 21.
    Simons RL, Gallo JF (1994) Rhinoplasty complications. Facial Plast Surg Clin North Am 2:521–529Google Scholar
  22. 22.
    Goodwin WJ Jr, Schmidt JF (1987) Iatrogenic nasal tip bossae: etiology, prevention, and treatment. Arch Otolaryngol Head Neck Surg 113:737–739CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2017

Authors and Affiliations

  • Süreyya Şeneldir
    • 1
  • Aytuğ Altundağ
    • 2
  • Denizhan Dizdar
    • 3
    Email author
  1. 1.Süreyya Şeneldir ClinicIstanbulTurkey
  2. 2.Private OfficeIstanbulTurkey
  3. 3.Faculty of Medicine, Bahçelievler Medical Park Hospital, Otorhinolaryngology İstanbulİstanbul Kemerburgaz University, TRIstanbulTurkey

Personalised recommendations