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PubMed1983

Mental health correlates of valid perception of nasal deformity in female applicants for aesthetic rhinoplasty.

Thirty-four female applicants for rhinoplasty were assessed prior to undergoing surgery by means of a measuring scale for objective evaluation of the nasal shape. This scale yields an objective nasal deformity score as well as a measure of validity of subjective perception of nasal shape (nose image) and deformity. Subjects were assessed also for identity integration by a short measure of Eriksonian identity, and for psychological well-being and self-acceptance by means of the appropriate California Psychological Inventory (CPI) scales. Degree of nasal objective deformity was found to correlate with various aspects of positive mental health, namely, identity integration, psychological well-being, and self-acceptance. Validity of nose image was also correlated with identity integration. Findings are in accord with former investigations and call attention to the need for careful selection and management of patients for rhinoplasty, especially when deformity is mild.

Adolescent↗
PubMed1986

Tip graft from the cartilaginous dorsum in rhinoplasty.

A cartilage graft from the cartilaginous hump can be used in primary rhinoplasty for nasal tip projection. This technique has now been used for two years without complications in 35 patients with similar nose deformities, which included an inadequately projected tip and a high dorsal line. These grafts have proved to be another easy way to get an adequate tip projection in primary rhinoplasty.

Female↗
PubMedDate not supplied

Lateral crus sculpturing in open rhinoplasty: the Delicate Alar Clamp.

The wide exposition obtained with the open approach in rhinoplasty allows a precise evaluation of size, morphology, thickness, and position of the alar cartilages. This precise intraoperative diagnosis has permitted the development and improvement of surgical techniques in nasal tip sculpturing. At the same time, many surgical instruments have been adapted or created for the external approach. We describe our preferred and most commonly selected sequence in primary rhinoplasty with emphasis on the nasal tip work. A new, personally developed instrument, named the Delicate Alar Clamp, utilized to hold and stabilize the lateral crus during measurement and sculpturing of the cartilage, is presented with the description of its technical characteristics and practical application.

Humans↗
PubMedDate not supplied

Silicone implants in augmentation rhinoplasty.

During the past six years, we have treated 406 patients with classical silicon augmentation rhinoplasty. The types and incidence of complications after subcutaneous or subfascial implantation were examined and discussed. We proposed that most complications are related to the depth of the implant and the character of the tissues. In order to improve our operation and prove our hypothesis, we performed subperiosteal augmentation rhinoplasty in 22 cases with satisfactory results. At the same time, we investigated the biomechanical properties of human nasal periosteum and fascia, including tensile strength, stress-strain relationship and stress relaxation characters under uniaxial tension. Although less elastic, the periosteum has more tensile strength than fascia. So, in the view of biomechanics, the periosteum is thicker, tougher, and stiffer than fascia, thus more suitable for covering silicon implants.

Adolescent↗
PubMedDate not supplied

The spreader-splay graft combination: a treatment approach for the osseocartilaginous vault deformities following rhinoplasty.

Deformities following primary rhinoplasty may be located at different anatomical regions related to the primary operation. Osseocartilaginous vault deformities such as open roof deformity, over-resected bony and cartilaginous dorsum, excessive width of the middle vault, inverted-V deformity and middle vault collapse are the most frequent ones. Stair-step deformity combined with middle vault problems is uncommon. Patients with these deformities not only have poor aesthetic results, but also have moderate or severe respiratory problems due to the severity of the deformity. Spreader grafts, onlay grafts and biomaterials can be used to correct these deformities. We preferred to use the spreader-splay graft combination for severe osseocartilaginous vault deformities. In this paper we present 3 cases. Two cases had severe open roof deformity, middle vault collapse and over resection of the osseocartilaginous hump, along with severe respiratory problems. The Spreader-splay graft combination was used, along with lateral osteotomy and medialization of nasal bones to treat these patients. One patient had a very severe stair-step deformity due to over resection of the hump and excessive infracturing of nasal bones along with severe respiratory problems due to collapse of the middle vault. This deformity was corrected with proper outfracturing along the old osteotomy site and the use of spreader-splay graft combination. All patients had good aesthetic and functional outcome after the surgery. In conclusion, the spreader-splay graft combination provides a good anatomical restoration to obtain a better respiratory function and aesthetic outcome on severe osseocartilaginous vault deformities following rhinoplasty.

Adult↗
PubMed2004

Secondary rhinoplasty of the Asian nose: correction of the contracted nose.

The contracted nose is a unique entity that follows primary rhinoplasty in the Asian patient. The proposed reasons for this complication are capsular contraction from a silicone nasal implant, pressure necrosis of the lower lateral cartilage resulting from the nasal implant, and infection after alloplastic implantation. The two principal anatomic constituents that must be addressed at the time of secondary rhinoplasty are the lower lateral cartilages and the skin envelope. The lower lateral cartilages should be derotated, projected, and transfixed with an extended spreader graft. Additional onlay grafting may be required to provide greater nasal tip derotation and projection. A transcolumellar incision situated at the columellar-labial angle permits undermining of the upper lip skin to release tension on the incision. If the nasal tip retraction is severe, then the skin envelope may be insufficient to provide coverage to the new cartilaginous framework. In this case, a paramedian forehead flap is recommended to provide adequate tissue coverage. Correction of alar-columellar disparity should be undertaken with composite grafting only after 6 months have transpired to gauge the ultimate relation between the alae and columella. Infection that arises after correction of the contracted nose can be devastating. It should be treated aggressively, but tailored to the severity of the infection. Wound tension along the columella may predispose to skin necrosis and consequent cartilage exposure, which should be managed in turn with prostaglandin emollients to accelerate wound healing and to prevent infection.

Adult↗
PubMedDate not supplied

A perichondrial flap for functional purposes in rhinoplasty.

Recent trends in rhinoplasty techniques have focused on anatomic repair as well as respect and preservation of soft tissue integrity. In this article, the authors describe the use of a perichondrial flap, then discuss technical considerations and clinical perspectives of their advantages. A perichondrial flap helps to restore the stability of the upper lateral cartilage, to achieve extra padding, and to secure osteocartilagenous grafts. The method described has been used for 60 consecutive patients. The majority of these patients were satisfied with the results. To obtain detailed information about the perichondrial flap, the authors performed an anatomic study of 13 cadavers. The average thickness of the perichondrium was 186+/-146.1 microm (range, 90--596 microm). On the basis of the results, it was concluded that elevation of the perichondrial flap with loupe magnification could improve the outcome of rhinoplasty.

Follow-Up Studies↗
PubMedDate not supplied

Secondary rhinoplasty.

Revision rhinoplasty is a complex aesthetic and reconstructive procedure in which both functional and cosmetic principles must be considered in the planning of an appropriate operation. Different techniques must be modified according to the specific defects. The modifications may vary from simple integration of a previous poorly performed surgery to complex grafting of homologous or heterologous material. The authors report their experience with 311 cases of revision rhinoplasty.

Adult↗
PubMedDate not supplied

A technical refinement to prevent supratip deformity in aesthetic rhinoplasty: "the trapezoid peak".

BACKGROUND: The relationship between appropriate caudal dorsum resection and supratip deformity or inadequate tip projection currently is clear. Correct quadrangular cartilage management seems to have a basic role in the final tip aspect after aesthetic rhinoplasty. METHODS: Primary aesthetic rhinoplasty was performed for 38 Caucasian patients. A septal refinement was used for patients requiring extra tip support and not requiring grafts. RESULTS: The minimum follow-up period was 1 year. No supratip deformity was noted after surgery. The tip and midvault had adequate projection. CONCLUSIONS: The described maneuver sustains the alar cartilage without sutures, preventing supratip deformity, sustaining soft tissues, and avoiding loss of tip projection.

Follow-Up Studies↗
PubMedDate not supplied

Lambda-shaped implant for augmentation of anterior nasal spine in Asian rhinoplasty as an ancillary procedure.

There is often a preexisting acute columella-labial angle in Asian noses and in most of these cases, the nasal spine is underdeveloped or sometimes even absent. Moreover, nasal tip projection by a tip graft or cephalic rotation of the nasal tip may get worse at the retracted columella-labial junction in the Asian nose with an underdeveloped anterior nasal spine, thus requiring the use of a maxillary spine graft or an implant. In many instances, however, the ideal source of autogenous tissue may not be available or the donor site for these tissues may be objectionable. So I have designed the lambda-shaped silicone implant for augmenting the underdeveloped anterior nasal spine (ANS) to correct the acute columella-labial angle. From March, 1996 until September, 1999, I have done ANS augmentations using the lambda-shaped silicone implant in Asian rhinoplasty on 37 female patients. The correction of an acute columella-labial angle was readily accomplished by application of the lambda-shaped implant using the unilateral intranasal approach. The author suggests that ANS augmentation with the lambda-shaped implant is a simple and effective method as an ancillary procedure in Asian rhinoplasty providing esthetically pleasing results in properly selected Asian patients.

Adult↗
PubMedDate not supplied

Short columella nasolabial complex in aesthetic rhinoplasty.

Many papers describe different approaches for short columella in cleft lip or Negroid noses. Very little has been found in international literature related to these aesthetic rhinoplasties. The scarce skin of the columella, the firm union between the nasal tip and the lip, due to the hypertrophy of the depressor septi nasi muscle, and the low projection of the nasal tip, consequence of the open position of the caudal part of the medial crura, are the cause of this problem. Therefore, the skin, muscle, and cartilage were treated simultaneously. Herein is described a VY composite advanced flap for projecting the tip, suturing both divergent medial crura together and adding the skin and muscle tissues of the lip to the columella. With this flap the tip was projected, the columella was narrowed, the nasolabial angle improved, and the upper lip elongated. Good results could be achieved without using any other cartilage graft or silastic strut. Standard rhinoplasty and septumplasty could be combined with this technique. Inconspicuous scars were observed.

Female↗
PubMedDate not supplied

Extracorporeal septoplasty combined with open rhinoplasty.

Extracorporeal septoplasty is a radical solution for the severely deviated nose. The major problems associated with this procedure are fixation of the septal cartilage graft and dorsal irregularities. Extracorporeal septoplasty was performed in combination with open rhinoplasty in 17 patients with severe nasal deformities. In this technique septum was totally removed through the columellar incision of open rhinoplasty, corrected outside, and replaced as a free "L" shaped cartilage graft. The cartilage graft was fixated to the upper lateral cartilages to restore the natural relations of the anatomical structures. Additional rhinoplastic manipulations were also performed. The follow-up period was up to 18 months. The overall result was successful in all patients. Nasal deviation did not recur and secondary revisions were not needed for any patient during follow-up.

Adult↗
PubMedDate not supplied

Augmentation of the columella-labial angle to prevent the "smiling deformity" in rhinoplasty.

Aesthetic diagnosis of the smiling deformity, which is functional rather than anatomical, is essential to provide the best treatment in rhinoplasty. The nasal tip tends to rotate inferiorly during smiling, and the central upper lip moves superiorly. A posteriorly sloping upper lip with a retrodisplaced columella-labial junction gives an unaesthetic appearance. Downward movement of the tip and a sharper nasolabial angle are usually aesthetically unpleasant. In 28 nasal surgeries, augmentation of the columella-labial angle with cartilage strip grafts has been performed. The augmentation of the angle and additionally cutting of the depressor septi muscle created a wider nasolabial complex, and this angle looks full and more pleasant. This procedure has mainly been used as an additional procedure to standard reduction rhinoplasty in order to improve smiling deformity. Strip cartilage grafts were inserted subcutaneously into the upper lip extending half way to the columella and secured with a transcutaneous suture under the columella-labial angle to prevent misslocation. Augmentation by the cartilage graft together with cutting the depressor septi muscle prevented elevation and shortening of the upper lip, and also drooping of the nasal tip. This procedure provided an aesthetically pleasant appearance both at rest and during smiling.

Adolescent↗
PubMedDate not supplied

Nose surgery (rhinoplasty) without external immobilization and without internal packing: a review of 812 cases.

In a review of 812 cases of rhinoplasty, none of our patients had early bone or septal displacement; swelling, bruising, and pain were almost nonexistent. This confirms that an external splint would not have been of any benefit in these cases. Packing should help prevent epistaxis, synechiae, and early bone and septal displacement. Not using any packing, we have not encountered these complications. Besides, we have not seen a single submucosal hematoma or a septal necrosis. Therefore, we doubt the value of packing in our patients. The inconveniences and complications of external splints and internal packing are described. Early postoperative photographs show the reduced swelling and bruising, and late photographs show the final results. Difficult primary and secondary rhinoplasty cases are demonstrated.

Female↗
PubMedDate not supplied

Motivation for rhinoplasty: changes in 5970 cases, in three groups, 1964 to 1997.

The motivational factors were divided into three categories: (1) independent decision, (2) observation of previous patients, and (3) external influences. The results of the percentage breakdown of the patients in our present study are compared with previous results are presented in 1983 in this journal. Once again, the independent decision of the patient was the most important factor in deciding to have cosmetic rhinoplasty, followed by their observation of results in other patients. These two factors have been the motivation in approximately 80% of all the patients in all three studies. The age breakdown of cosmetic rhinoplasty patients shows that after the age of 21, as patients get older, a smaller and smaller percentage of patients was motivated for surgery by independent decision alone. These older patients need external influences to motivate them to have surgery. In most cases, the desire for surgery had smoldered in them since adolescence, and they needed an external "OK" to have it done.

Adolescent↗
PubMedDate not supplied

Psychosocial impact of cosmetic rhinoplasty.

The psychosocial impact of cosmetic rhinoplasty in Scandinavia is poorly investigated. Therefore a study was undertaken utilizing a mailed audit covering self-percepted experiences before, during, and after surgery. A total of 67 of 80 patients responded to the questionnaire (84%), on average 18 months after surgery. The mean age was 31 years (range, 16-63 years) and the M/F ratio was 20/44 among the 64 patients analyzed, half of whom were of foreign extraction. The self-report disclosed that a majority of the patients had been preoccupied with their noses since puberty and that the mental awareness of nasal stigmatization was given mainly by the mirror (58%), not by others. Despite the early exclusion of patients with possible body dysmorphic disorder, almost one-fourth had a severe complex, and one-third felt socially inhibited by their noses and avoided being looked at from certain angles. Surgery was not a significant problem even though it was performed under local anesthesia and i.v. sedation. The great majority (91%) were satisfied with the result and 89% would recommend the procedure to others. More than 60% felt more self-confident and perceived life as being easier. To conclude, successful rhinoplasty may change preoccupied patients' lives, because the majority simply stopped thinking about their noses.

Adolescent↗
PubMedDate not supplied

A case of human adjuvant disease after augmentation rhinoplasty.

Human adjuvant disease (HAD) is an autoimmune syndrome which is caused by prolonged hypersensitization of injected foreign materials. Usually, this occurs after mammary augmentation with foreign materials. We report a rare case of HAD after rhinoplasty with silicone injection. Thirty years ago, the patient underwent augmentation rhinoplasty with silicone injection. We removed the silicone and grafted the area with fascia lata. After the operation, local and systemic symptoms improved.

Adult↗
PubMed1984

Psychological aspects of cosmetic rhinoplasty.

This paper summarises some of the major findings of a doctoral research entitled "Psychological Aspects of Cosmetic Rhinoplasty" carried out when the author was working in the United Kingdom on a thesis that was accepted for the degree of PhD by the University of London. From the point of view of the clinical psychologist there can be no doubt that cosmetic rhinoplasty does have largely beneficial short- and long-term psychological and behavioural effects on patients who request the operation and several observations and experiments are described to account for the efficacy and therapeutic value of this operation.

Adult↗