Modification of Push-Down Rhinoplasty with Maxilla-Pyramid Sutures

A key point, that determines the late outcome of push-down procedures, is a stable fixation of the bony pyramid in its new position. Therefore, rhinoplasty surgeons are consistently trying to find the effective technique for fixation of the osseocartilaginous vault that has been investigated. Nonetheless, all described techniques are less or non-effective in cases when simultaneous septoplasty is required. Thus, we have found more relevant a lateral fixation of the bony pyramid. Using a needle piezotome, two holes above and below lateral osteotomy lines should be performed bilaterally. The downward inserted pyramid is fixed with maxilla-pyramid sutures through these holes. 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 www.springer.com/00266 .