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PubMed2006

[Appraisal of augmentation rhinoplasty with 3-dimension CT investigation].

OBJECTIVE: To appraise results of augmentation rhinoplasty with combination of CT and clinical examination. METHODS: 10 female patients (average 29 years old) of augmentation rhinoplasty with longer than 3 months, period of recovery were selected. All of them received cranial CT examination and aesthetic evaluation. RESULT: Although 60% of patients were pleased with their augmentation rhinoplasty, 90% of them existed problems in varied extent, if evaluated by CT-investigation and physical examination. CONCLUSION: modification in prosthesis had a direct effect on postoperative aesthetic effects. In order to improve outcomes and to lower complications, individual prosthesis were required.

Adult↗

PubMed1991

The complications of external rhinoplasty.

An analysis of complications of 867 consecutive external rhinoplasties over a 14-year period is presented. The most common intraoperative complication was excessive bleeding. Transient epiphora, bleeding, excessive and/or prolonged edema, septal dematoma, transient anosmia and various problems with packing were observed in the early postoperative period. Late complications included hypertrophic scar, localized periostitis, skin telangiectasia, etc. The complications of external rhinoplasty are comparable in incidence and severity of standard endonasal rhinoplasty.

Adolescent↗

PubMed1990

[Complications of rhinoplasty].

For an operation as technically demanding as rhinoplasty, surprisingly few studies have examined the results of this procedure. A retrospective study was, therefore, made of 5470 patients who had undergone rhinoplasty, performed by different surgeons, from 1970 to 1989. The patients were followed up for a minimum of one year. As for all forms of surgery, aspecific complications such as infections, hemorrhage and side-effects from anesthesia will occasionally occur but, fortunately, such cases are quite rare. The specific classification included both early and late complications. Post-rhinoplasty failures may be estimated at approximately 28% of all cases; this figure taking into account typical deformities, both minor and severe, as well as functional sequelae and patient dissatisfaction. Approximately 4% have required secondary procedures. Some causes for failure derive from patient characteristics; for example, the importance and complexity of initial deformity are, of course, partly responsible, particularly after trauma. The skin quality (i.e. thickness, or whether it is fatty or loose) also affects the results. Furthermore, uncontrollable factors inherent to healing (i.e. excessive scar contraction in the intranasal area, connective tissue hyperplasia, particularly at the tip, and periosteal proliferation either to the osteotomy site or over the nasal dorsum) can all lead to residual deformities. Nevertheless, most failures can be attributed the operator. The commonest mistakes are linked to cartilaginous dorsum and nasal tip (approx. 22%). There are several polymorphic deformities the main sites of which should be known well in order to prevent, or at least reduce, such risks.

Adolescent↗

PubMed1990

External approach to rhinoplasty.

The external approach to rhinoplasty offers several distinct advantages over the classical endonasal approach for incising, excising, repositioning, and augmenting the framework of the nose for functional and aesthetic improvement. The history of external rhinoplasty, advantages and alleged disadvantages are discussed; personal experience since 1982 is outlined. Various nasal deformities which have been corrected using the external approach are listed and several are discussed and illustrated. This report presents an overview of the technique of external rhinoplasty which will become even more popular as the advantages continue to be recognized by more nasal surgeons.

Female↗

PubMed1989

[Alar and columellar refinement in rhinoplasty].

This paper emphasizes the value of surgical techniques of nasal sculpturing with special attention to the structural details in primary and secondary rhinoplasty to achieve a perfect aesthetic as well as functional result. The marginal resection of the alae and the columella allows the appropriate reduction adapting the nostril contour to the new proportions of the nose at the end of a rhinoplasty or to equalize the height of the alar rim in cases of harelip nose. In order to perfect the nasal contour, we also introduce cartilaginous onlays into the anterior part of the columella emphasizing the lobulo-columellar double-angle in a harmonious profile. In case of moderate fibrocicatricial retraction of the alar border, a vestibular advancement flap is dissected through the inter-cartilaginous incision and a thin cartilage graft fills the loss of tissue as a spacer. It is then held in place using transalar mattress sutures. Important losses of alar tissue necessitating composite graft are not especially considered in the paper which essentially concerns refinement procedures. The finesse of the latter seems to be indispensable to adapt the alar-tip-columellar complex to the bony structures of the nose and to ensure the harmonious equilibrium of the rhinoplasty.

Esthetics↗

PubMed1989

[Postoperative xeroradiography in esthetic rhinoplasty. Comparison of tissue reactions].

The cephaloxerogram has been a very useful exam before rhinoplasty since 1975. The comparison with post-operative cephaloxerograms performed on 72 rhinoplasties between. 10 and 23 months, was performed to investigate the soft-tissue response following rhinoplasty. The soft-tissue response was studied in seven different zones. This study shows how the soft tissue alteration is very different from one zone to one another. It is possible to conclude that the study of the importance of the soft tissue response is difficult; but necessary to obtain the most exact super imposed profile before and after operation. The soft tissue alteration is particularly hypertrophic in relation to the upper cartilage zone and supratic area, where the musculo-aponeurotic system (nasal SMAS) is very important. Preservation of this system, during undermining of the nasal soft tissue, may be an important step to reduce the hypertrophic response at this level.

Connective Tissue↗

PubMed1986

[Open rhinoplasty--indication, technique and results].

Authors in the recent American literature stimulated the discussion of external approaches to rhinoplasty surgery. Occasionally even the experienced surgeon has been confronted with situations where an open approach is advantageous. In the author's series of 410 rhinoplasties in the last two years, the external approach has been used in 7.3% of cases. Two-thirds of open rhinoplasties were revisions. The technique consists of a transverse columella incision that cuts only the skin (Type A) or elevates skin and medial crura as a "composite flap" (Type B). Indications and results of both techniques are demonstrated.

Follow-Up Studies↗

PubMed1985

Augmentation in rhinoplasty--a personal view.

This paper presents a view on the use of various synthetic materials in rhinoplasty and the authors' preference for autologous bone as an augmentation material. The biology of bone transplantation as it applies to rhinoplasty is reviewed. Specific techniques for augmentation of the major saddle deformity are described, emphasizing the use of the external rhinoplasty approach for exposure as well as the authors' view that the dorsal graft should not extend beyond the cephalic border of the lower lateral cartilage. The senior author's experience with autologous bone as an augmentation material in 60 patients with major saddle deformities is reviewed. There were three patients whose grafts totally resorbed, and two cases of late graft fracture and displacement. The remaining patients had resorption graded as minor or insignificant. There were only two donor site complications--both wound seromas. Patients reviewed had been followed from one to 18 years.

Bone Transplantation↗

PubMed1978

Pre- and postoperative management of the rhinoplasty patient.

The role of the otolaryngologist has widened to include facial cosmetic surgery. As such it encompasses all aspects of age-diminishing surgery as well as facial contour augmentation, surgical and traumatic scar camouflage, and otoplasty as well as rhinoplasty. It necessarily follows that the rhinoplasty surgeon must view the total face rather than the nose in isolation. A complete understanding of the indications and contra-indications of rhinoplasty is necessary for adequate pre- and postoperative assessment of the patient. These ideas are developed and the analysis of the nasal pathology is discussed.

Adolescent↗

PubMed1981

Corrective rhinoplasty before puberty: a long-term follow-up.

Our experience with corrective rhinoplasty performed between 8 and 12 years of age in 44 patients is presented. The operation included lateral and central osteotomies as well as adjustments of the alar cartilages and, in a few cases, septoplasty. Thirty-six patients had deformities associated with cleft lip; five had nasal trauma early in life; two had hemangioma; and one had a congenital large nose. The patients have been followed for a minimum of 5 years and a maximum of 8 years, and all were at least 15 years old at the time of evaluation. Photographic and physical anthropometric serial studies were used for assessment. The results of corrective rhinoplasty early in life are comparable in this series with the results of this operation when growth is complete. Nasal and facial growth were not altered when a complete, conservative, aesthetic rhinoplasty was performed before 12 years of age. The evidence from our series shows no contraindication for nasal correction in children when the psychological problems originated by a severe deformity at that difficult age can be prevented or alleviated.

Adolescent↗

PubMed1980

Rhinoplasty in midlife.

Because of altered physical and psychological patterns, patients requesting rhinoplasty in midlife must be managed and treated with specific goals and limitations in mind. Subtle and conservative nasal appearance changes generally suit this category of patient best, avoiding a dramatic metamorphosis. When performed in conjunction with other age diminishing operative procedures, rhinoplasty plays a critical role in overall facial appearance improvement. By keeping in mind the principles and limitations discussed in this article, the surgeon can find exceeding satisfaction in performing conservative rhinoplasty in patients who find themselves in the middle stages of life.

Adult↗

PubMed1994

[Conservative rhinoplasty].

In most reduction rhinoplasties, conservative rhinoplasty of the nasal roof and septum can be performed in the place of traditional rhinoplasty with resection of the hump. An anatomical and functional study of the nose justifies and explains this new surgical technique. However, impaction alone is not always sufficient, but, in some cases, must be combined with support or projection of the nose tip. In the rhinoseptoplasty proposed, the nasal roof phase is performed before the nostril roof phase. The advantages of this technique, particularly indicated in kyphosis, are related to the preservation of the natural appearance of the nose and its persistence over time.

Aging↗

PubMed1977

Current concepts of rhinoplasty.

Like all surgical operation, aesthetic rhinoplasty is a technique that is constantly undergoing change. These changes are brought about by accumulated experience, improved instrumentation, and not the least by the pressure of changing cultural and social requirements. The fine subtleties of rhinoplasty are difficult to learn by the student and difficult to master by the mature surgeon. Technique improves with the accumulation of surgical experience and constant observation and study of one's results. The learning process should never stop. The most significant changes in rhinoplasty technique since the operation was designed are emphasis on attention to detail and less, rather than more, extensive surgery. The removal of less bone, cartilage, and soft tissue is emphasized as well as meticulous attention to details of repositioning and alignment of all structures.

Anesthesia↗

PubMed1996

Use of spreader grafts in the external approach to rhinoplasty.

The challenge for the modern rhinoplasty surgeon is to create a nose that appears natural and balances with the individual's face and ethnicity. The use of spreader grafts in endonasal rhinoplasty as described by Sheen has been expanded by the external approach to (1) straighten and buttress weakened L-struts in a high dorsally deviated septum, (2) recreate dorsal aesthetic lines, (3) reconstruct a narrow middle vault, and (4) restore the internal nasal valve. The advantages of the external approach in the use of septal spreader grafts includes ease of harvest, accurate contouring, and precise placement and suture stabilization to minimize postoperative graft displacement. The versatility of this technique allows the surgeon to attain consistent functional and aesthetic results in the management of dorsal mid-vault problems in primary and secondary rhinoplasty.

Adolescent↗

PubMed1998

Effect of esthetic illusions on rhinoplasty assessment.

OBJECTIVE: Esthetic assessment in rhinoplasty represents a balance between art and science. The result of surgical maneuvres in creating esthetic illusions has been alluded to, but has never been scientifically reported. This project analyzed the effect of optical illusions in esthetic assessment. METHOD: Eight rhinoplasty case studies were designed using computer imaging. Two hundred and ten judges analyzed the apparent differences in one parameter, such as tip projection, tip rotation, dorsal hump, and nasal size, when a different parameter was altered. RESULTS: This study confirms the validity of nasal esthetic illusions. These results indicate how surgical maneuvres that vary one parameter can create the illusion of a variation in tip projection or tip rotation. CONCLUSIONS: The surgeon can exploit esthetic illusions to provide greater control over rhinoplasty dynamics.

Chi-Square Distribution↗

PubMedDate not supplied

Secondary rhinoplasty in nasal deformity associated with the unilateral cleft lip.

The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. The sliding-flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap. We modified this technique by using an open rhinoplasty approach with the laterally based chondrocutaneous sliding flap. Columellar struts and shield grafts were some of the techniques combined with this approach to produce optimal results. In a total of 7 patients, we performed both the original sliding-flap cheilorhinoplasty and the modified open rhinoplasty, which are described and discussed herein. The laterally based sliding-flap cheilorhinoplasty is an effective technique for correcting both the secondary nasal deformity and the lip scar associated with the unilateral cleft lip.

Adolescent↗

PubMedDate not supplied

Endoscopy-assisted rhinoplasty.

In nasal surgery some surgical steps are done without the aid of direct vision. In these situations, surgeons must use their experience and judgment. I have adapted techniques used in endoscopic sinus surgery to perform some of the surgical steps of functional and aesthetic rhinoplasty. Between September 1999 and February 2000, 11 patients underwent endoscopic-assisted septorhinoplasty, and 18 patients underwent traditional closed rhinoplasty. The following parameters were compared: surgical bleeding, postoperative edema and ecchymosis, dorsum irregularity, and operative time for each technique. The following steps were clearly visualized with the endoscope: raising the periosteum from the nasal bone, resecting the nasal hump, and rasping the nasal bones. The use of endoscopic instruments does not change the surgical steps required. Rather, it allows direct vision of steps previously not viewable.

Diagnostic Techniques, Respiratory System↗

PubMedDate not supplied

Surgical treatment of the nasolabial angle in balanced rhinoplasty.

Nasal analysis and surgical planning are crucial for a successful, aesthetically pleasing rhinoplasty. One of the key parameters for evaluation is the nasolabial angle. The nasal spine, caudal septum, and medial crura of the lower lateral cartilages provide the framework for this area. Alteration of these structures, as well as nasal tip rotation and projection, may affect the resultant nasolabial angle, length of the upper lip, and overall harmony of the nose. Fullness at the nasolabial junction caused by a pushing philtrum may also result in an unbalanced appearance. The literature is replete with methods for categorizing the nasal tip and with recommendations for surgical treatment. Treatment of the caudal septum and nasal spine is often an afterthought that is left up to the aesthetic judgment of the surgeon. To make this a more systematic decision, in 1990 we devised a classification for analysis and treatment of this area. This study included the length of the nose, the nasolabial angle, and the presence of a pushing philtrum, with suggested treatment to allow proper tip placement and to provide aesthetic balance to the nose. The only modification was in the order of presentation of nasal types. Since that publication, the senior author has consistently followed these guidelines and has found them to be a reliable tool in creating a harmonious result in rhinoplasty.

Face↗