Understanding Double Dome Highlights in Rhinoplasty

One of the major issues with traditional rhinoplasty has been to create an overpinched nasal tip that has been dubbed the “unitip”.  This unitip simply looks unnatural because it is not the natural shape of a nasal tip.  When one looks at a nose, especially a white person’s nose, that has relatively thin skin and pronounced underlying cartilage structure there should be a gentle splaying of the nasal tip with two small white highlights as light strikes it.  The absence of these highlights can create a fake look or at the very least an unnatural look.  These dome highlights are not as evident in thicker-skinned, ethnic noses.  The reason that these domal highlights disappear is due to the over-tightening of the nasal tip in order to reduce the boxiness or bifidity of the nasal tip in an attempt at greater refinement.  The way that I refine the nose without losing the natural appearance to it is to do what is known as a double dome-binding suture.  I first refine each dome and then I bring the two domes together leaving a slight degree of splay to the domes so that the natural and attractive domal highlights are preserved.

Double dome binding suture shown that preserves domal highlights

Samuel M. Lam, MD, FACS is a board certified facial plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s Rhinoplasty procedures please call 972.312.8188 to schedule a consultation. If you would like to ask Dr Lam a question about a nose job please visit our Rhinoplasty forum.