Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses

Objective: Rhinoplasty started as a closed technique and then the open technique gained popularity. Open technique gave surgeons the opportunity to visualize and manipulate the cartilaginous skeleton at the tip of the nose precisely. The dissection planes in open rhinoplasty technique may be subcutaneous, submuscular (under the superficial musculoaponeurotic system), or subpericondrial subperiosteal. Each plane has advantages and disadvantages. The aim of this study was to combine planes to get the maximal benefit of each plane. Method: The study was performed on 38 Middle Eastern patients, among whom 23 were females and 15 were males. All patients presented for primary rhinoplasty. They were divided into 5 groups on the basis of their skin thickness. Dissection started subcutaneous at the area of the lower lateral cartilages and then shifted subsuperficial musculoaponeurotic system over the upper lateral cartilages and ended subperiosteal over the bony skeleton. Results: This triple plane of dissection gave acceptable results without any complication. Subcutaneous dissection allowed thinning of the thick sebaceous skin at the tip and alar region, subsuperficial musculoaponeurotic system dissection allowed direct exposure of the upper lateral cartilage without thinning skin at an area where it is thin, and subperiosteal dissection helped masking any bony irregularities resulted from osteotomies. Conclusion: The triple plane dissection in open primary rhinoplasty in Middle Eastern patients maximized the advantages of each plane and minimized the disadvantages and resulted in safe cosmetic results.