Modified Ishida-Ferreira Type B Technique Combined with Polygon Tipplasty and Sliding Alar Cartilage Flaps: A Versatile Solution for Primary Caucasian Rhinoplasty.

Introduction: Dorsal cartilage preservation techniques have gained significant popularity among rhinoplasty surgeons recently, as they present natural dorsal aesthetic lines, and avoid dorsal reconstruction procedures for the cartilage dorsum. With correct patient selection criteria, cartilage preservation techniques give good results, while on the wrong patients, this may not always be possible. Also, blending these dorsal preservation techniques with different approaches in other subunits of the nose (tip complex and alar cartilages) may offer a variety of options in today's rhinoplasty world. This study presents a modified version of the Ishida-Ferreira cartilage push-down technique combined with polygon tipplasty and sliding alar cartilage flaps.

Methods: A retrospective analysis of 110 patients who underwent primary rhinoplasty (June 2021-August 2023) was conducted. The inclusion criteria were primary rhinoplasty cases with no history of any surgical/non-surgical nose treatments and have a nasal index (NI) of 75 or less (leptorrhine or mesorrhine). Cases requiring augmentation, S-shaped humps, wide dorsum, (NI greater than 75), and severe axis/septum deviations have been excluded from the study. The surgical steps included Cottle low septal strip resection, triangular osteotomies from the dorsal aspect of the nasal bones, push-down, lateral osteotomies, polygon tipplasty, and sliding alar cartilage flaps. Postoperative satisfaction was evaluated using a 5-point Likert scale. Statistical analysis was performed to examine correlations between age, operative time, and satisfaction.

Results: The mean age of the patients was 27.7 years, and 76.4% were female. The mean operative time was 107 minutes (75-160). Patient satisfaction scores were high, with a mean of 4.51 points: 63.6% scored "very good" and 26.4% scored "good." Early complications included prolonged bleeding in 1.8% of the cases. Late complications occurred in 3.6% of patients (dorsal widening, bony cap malposition, and nostril asymmetry), with four patients (3.6%) requiring revision surgery. No significant correlation was found between satisfaction and age or operative time (P > 0.05).

Discussion: The modified technique demonstrated several advantages thanks to the modified Ishida-Ferreira technique, where the dorsal cartilage integrity is preserved. Unlike the original high strip technique, the low strip modification lets us to remove the septal base cartilage where deviations are very common. Also, the stronger septal base cartilage provides a better material to be used as a columellar strut. Combining modified cartilage and bony cap preservation, polygon tipplasty, and sliding alar cartilage flaps improves dorsal and tip stability while preserving external nasal integrity.

Conclusion: This approach offers a fast, effective, and modular solution for primary rhinoplasty, yielding natural results, with high patient satisfaction and low complication rates.

Level of evidence ii: This journal requires that authors assign a level of evidence to each article.