Managing nasal tip support and lateral crura malposition remains a challenge in rhinoplasty.This study aimed to evaluate the effectiveness of a novel suture technique-the Pulley-Stitch-in correcting lateral crura malposition. Primary outcome: Change in lateral crura angle; secondary outcome: Long-term stability.Prospective cohort study (N = 42), reported in-line with STROBE guidelines.Forty-two patients underwent open rhinoplasty. The angle between the caudal margin of the medial crus and the anterior third of the lateral crus was measured from intraoperative images at T0 (prestitch) and T1 (poststitch). Standardized postoperative images were analyzed at 1 month (T2) and 12 months (T3).The angle increased from a mean of 18.2 to 26.9 degrees (p < 0.05), reflecting improved anatomical alignment and external nasal valve patency. Stability was confirmed at 12-month follow-up.The Pulley-Stitch is a safe, effective technique to improve nasal tip structure, cephalic rotation, and ala contour.
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