Great care is used to place these sutures in a symmetrical fashion. Sutures are carefully tightened to create the new dome. One suture can be left long on each knot so that they can be tied together. Alternatively, an individual interdomal suture may be placed. Sutures are joined to create a double-dome suture.
Care is taken to make sure the domes are at equal levels.
If the suture is not perfect, it is removed and replaced. Division and suturing also may have secondary tip effects in tip projection and rotation. A tip graft may be used in certain situations. Tip grafts can be used to create the illusion of a narrowed tip. Placement in different areas can have different effects.