A 20-year review of the "new domes" technique for refining the drooping nasal tip.

OBJECTIVE To describe in detail a technique to achieve cephalic rotation, projection, and narrowing of the nasal tip, the "new domes" technique. DESIGN Retrospective analysis of more than 3000 primary rhinoplasties performed during the last 20 years. SETTING A private facial plastic surgery practice in Bogotá, Colombia. INTERVENTION Through an endonasal cartilage delivery approach to the nasal tip, we mold and reorient the alar cartilages with transdomal and interdomal sutures. MAIN OUTCOME MEASURES Photographic analysis with nasal and facial measurements taken directly from the patient that allows precise diagnosis and preoperative surgical planning. RESULTS The new domes technique creates a more projected, cephalically rotated, narrowed nasal tip. The results are predictable and stable over time, and patient satisfaction is high because of the natural-appearing results. Complications such as asymmetries, pinching, or retraction of the tip are rare. CONCLUSION The new domes technique is a conservative, predictable, and stable technique especially applicable for patients with drooped and wide nasal tips to achieve a more projected, rotated, narrowed, and natural appearance.