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At least 289 records · Page 16Linked to original sources
PubMed1989

Rhinoplasty: a humbling experience.

Rhinoplasty can produce a dramatic improvement in one's appearance, but if not performed properly, a lasting deformity exists. Appearance-related surgery places the surgeon's professional reputation at stake more than with other types of surgery. Artistic skills are needed, along with knowledge of anatomy and physiology of the nose, and recognition of factors that produced the problem. The standards of our society demand consistently good results: a surgeon performing rhinoplasty is considered proficient only after approximately 8 years of experience and continuing education. The unpredictable response of nasal tissues to the surgery can present a humbling experience to the surgeon who critically evaluates his or her results.

Female↗
PubMed2004

Double lateral osteotomy in aesthetic rhinoplasty.

Lateral osteotomy is a very important step in a cosmetic rhinoplasty; it allows the surgeon to narrow the nose, to close the open roof created after hump removal, and to achieve symmetry of an asymmetrical nasal bony framework. In most patients a single lateral osteotomy reaches the expected result, with excellent cosmetic outcome, good stability, and rapid healing. We find that double lateral osteotomy is useful in managing severe asymmetry of nasal walls in patients with too prominent and thick maxillary processes that join asymmetrically together with nasal bones. It is also valuable in correcting very large and wide noses. We review our experience of about 1660 rhinoplasties with more than one year follow-up. Two hundred and ten cases (12.65%) had been treated with monolateral, or bilateral double osteotomy. We evaluate postoperative aesthetic and functional results.

Adolescent↗
PubMed2004

Rhinologic pharmacotherapy in rhinoplasty.

Rhinoplasty surgeons inevitably encounter therapeutic considerations in managing their patients, and a thorough understanding of nasal function, as well as of disorders of the nose and sinuses, is requisite for positive clinical outcomes. Patients suffering from allergic rhinitis are not precluded from undergoing rhinoplasty, whereas other disease processes may warrant an otolaryngologic evaluation before proceeding with surgery. A thorough medical history and examination elucidate sinonasal disease conditions that may not improve after septorhinoplasty but potentially could respond to pharmacologic therapy.

Acute Disease↗
PubMed2004

Considerations against concurrent functional endoscopic sinus surgery and rhinoplasty.

Over the last decade, functional endoscopic sinus surgery (FESS) has become the surgical modality of choice in the treatment of inflammatory sinus disease refractory to medical therapy. During the same interval, interest in cosmetic surgery procedures, including rhinoplasty, has exploded. Some of the published literature endorses the performance of concurrent FESS and rhinoplasty. This article addresses some of the concerns regarding the combined approach and its limitations. It offers the reader a framework for surgical risk assessment when concurrent procedures are considered.

Combined Modality Therapy↗
PubMed2004

Concurrent functional endoscopic sinus surgery and rhinoplasty: pros.

Despite historical concerns about the spread of infection from the sinuses to the nasal tissues,concurrent septorhinoplasty and endoscopic sinus surgery may be performed safely in most patients who meet the criteria for sinus surgery. However, otolaryngologists should use good medical judgment in selecting patients appropriate for the combined procedures.Patients with extensive sinus pathology or systemic illness are not the ideal candidates for concurrent surgery. It is recommended to perform the septal and sinus surgery first, so that the surgeon may postpone the elective rhinoplasty procedure if unfavorable intraoperative circumstances develop. Overall, when performed in carefully selected patients, contemporaneous rhinoplasty and endoscopic sinus surgery is safe and effective and offers many advantages for the patient.

Adult↗
PubMed2006

The management of alar columellar disproportion in revision rhinoplasty.

An otherwise attractive nose can be diminished aesthetically if the relationship of the nostril border and ala to the columella is not refined and proportional. Compared with other aspects of rhinoplasty, there has been little attention devoted to the proper diagnosis and treatment of alar columellar disproportion. This article highlights the relevant anatomic components, defines the proper alar columellar relationship, systematically analyzes the different types of alar columellar dis proportion, and stresses the importance of identifying the causative factors in formulating the optimal treatment plan, with particular emphasis on applications to revision rhinoplasty.

Algorithms↗
PubMed2006

Patient evaluation of outcomes of external rhinoplasty for unilateral cleft lip and palate.

Thirty-five patients (range 16-59 years) with cleft-lip nasal deformity treated by external rhinoplasty were evaluated for satisfaction and perception of outcomes. Treatment involved alar base relocation and augmentation of the asymmetric nasal tip with auricular cartilage grafts. The patients completed a satisfaction survey and interview at the 2-year follow-up visit. A visual analogue scale (VAS) numbered 0-10 was also used by the patients to grade outcome compared to preoperative appearance at 4 anatomic sites. Prior to surgery, the nasal tip was perceived as being most deformed (15/35), followed by alar position (12/35) and nasal apertures (8/35). The site on the nose most improved by surgery was the tip (15), followed by alar position (10), symmetry of nostrils (6) and dorsum (4). The highest VAS score was for the tip (8.32), followed by alar position (7.59), dorsum (7.41) and symmetry of nostrils (6.73). No patients suffered long-term pain for more than 2 months following surgery. All patients were prepared to undergo such procedure for a second time, if necessary. The unilateral cleft-lip nasal deformity can be improved in the eyes of the patient, using the combination of external rhinoplasty with alar base relocation, where necessary, and auricular cartilage augmentation of the nasal tip.

Adolescent↗
PubMed2006

Combined open rhinoplasty with spreader grafts and laser-assisted uvuloplasty for sleep-disordered breathing: long-term subjective outcomes.

PURPOSE: To subjectively assess the long-term outcomes of combined functional open rhinoplasty with spreader grafts and laser-assisted uvuloplasty (LAUP) for polysomnogram (PSG)-confirmed sleep-disordered breathing (SDB). METHODS: Postoperative Epworth Sleepiness Scale (ESS) questionnaires were given to 30 patients and compared with preoperative ESS. Patients were also asked questions concerning postoperative improvement in upper airway breathing, nasal appearance, and snoring. Statistical analysis used 2-tailed parametric and nonparametric tests. RESULTS: Thirty patients (average age 55 years) with an average (+/- standard deviation) preoperative apnea-hypopnea index (AHI) of 37 +/- 27 and mean follow-up times of 21 months were evaluated. A statistically significant 50% (P < .001) postoperative decrease in average ESS was observed. Patients with severe (AHI > 30) and very severe obstructive sleep apnea (OSA) (AHI > 60) also had statistically significant (61% and 66%, respectively, P < .001) postoperative decreases in average ESS. In all patients, subjective upper airway breathing was statistically improved (P < .008), graded as significantly in 47% and moderately in 33% of patients. According to the patient's bed partner, snoring was improved and/or decreased in 76% of patients (P = .008). All patients were satisfied with the postoperative cosmetic appearance of their nose (P < .0001). Finally, 90% of patients stated that they would have the procedure again (P = .009) and 90% stated that they would recommend the procedure to a friend or relative with the same condition (P = .009). CONCLUSION: Subjective assessment at long-term follow-up for combined open rhinoplasty with spreader grafts and LAUP for PSG-confirmed SDB produced a statistically significant decrease in excessive daytime sleepiness, even in patients with very high AHI, with high patient satisfaction.

Adult↗
PubMed2006

Four suture tip rhinoplasty: a powerful tool for controlling tip dynamics.

OBJECTIVE: To evaluate the short-term effectiveness of using a 4-suture technique to control nasal tip dynamics. The 4 sutures include a medial crural suture, bilateral intradomal sutures, and an interdomal suture. STUDY DESIGN AND SETTING: Retrospective photograph analysis of preoperative and postoperative photographs of 77 patients with respect to 7 dynamic variables: supratip break, projection, rotation, tip shape, tip definition, tip symmetry, and the presence of a double columellar break. RESULTS: Seventy-four patients underwent primary rhinoplasty and had an overall average score of 5.2 on a -7 to +7 scale, with a mean follow-up period of 3.8 months. The 3 patients undergoing revision rhinoplasty had an overall average score of 5.0 and a mean follow-up of 8.7 months. CONCLUSION: The 4-suture technique worked best with respect to projection and tip symmetry, although the technique proved to be an effective tool overall in controlling all 7 variables mentioned above. EBM RATING: C-4.

Humans↗
PubMed1983

Intracranial complications of rhinoplasty.

The practicing plastic surgeon acquires a wide experience of the complications of rhinoplasty. These range in severity from minor imperfections of contour to the more dramatic but re complications of haemorrhage and infection. While causing alarm to patient and surgeon alike, they rarely pose a threat to life. We wish to bring to the attention to our colleagues three potentially lethal intracranial complications of rhinoplasty which they may not have previously experienced: cerebrospinal fluid rhinorrhea, meningitis and cavernous sinus thrombosis. These three unusual cases have occurred in the author's practice over a period of 20 years.

Adult↗
PubMed1989

The Facial Appearance Sorting Test (FAST): an aid to the selection of patients for rhinoplasty.

A simple test which requires a few minutes to administer and score is described as an aid to the selection of patients for rhinoplasty. The sorting of cards evaluating appearance is performed consistently over a period of time by individual subjects and by different groups of subjects. A numerical formula is proposed which allows for deviation from the common system of evaluating appearance in measuring support for an application for rhinoplasty.

Body Image↗
PubMed1999

Five-year follow-up of cosmetic rhinoplasty.

The psychological impact of rhinoplasty for aesthetic reasons on psychological well-being is controversial. The aim of the present study is to assess short- and long-term psychological changes in patients who underwent rhinoplasty. Seventy-nine patients, without traumatic lesions, who presented for cosmetic surgery, completed the MPI scales for Neuroticism and Extroversion and the IPAT scale for Anxiety, 3 months before and 6 months and 5 years after surgery. Results showed a significant decrease of anxiety and neuroticism in both postoperative evaluations and an increase on the Extroversion scale only at the 6-month follow-up. Psychological distress persisted in most patients after the operation.

Adaptation, Psychological↗
PubMed1996

Management of the nasal tip by open rhinoplasty.

Open rhinoplasty has acquired widespread recognition in the surgical community in recent years. For many years, traditional closed rhinoplasty was the only possibility for correction of most deformities of the nose. Although it is not the only alternative to difficult nasal problems, the wide exposure achieved with the open technique, the excellent results obtained in the management of the tip and its use as a training procedure for residents, accounts for the new resurgence of the popularity of the technique.

Cartilage↗
PubMed1991

Calvarial bone grafts for augmentation rhinoplasty.

A large variety of graft materials have been used for augmentation rhinoplasty. To date there has been no graft material which can be regarded as completely satisfactory. The modern trend is to prefer autologous material to new biological material. The membranous bones of the calvarium are extremely suitable for augmenting moderate to severe saddle nose deformities. Calvarial bone grafts can be harvested easily, with minimum donor site morbidity and disfigurement. Our experience with calvarial bone grafts for augmentation rhinoplasty is presented.

Bone Transplantation↗
PubMed1996

Paraffinoma revisited: a post-operative condition following rhinoplasty nasal packing.

Paraffin impregnated tulle is frequently used as a post-operative dressing after surgical repair of wounds, on skin-donor sites and in packing of tissue cavities. Historically, paraffin has been injected into various sites of the body and paraffinoma is a well-described complication. Despite this, nasal packing with paraffin gauze is still common after rhinoplasty. We report a case of paraffinoma occurring after rhinoplasty and discuss the avoidance of this rare but serious complication and suggest silicon mesh as an alternative dressing.

Adult↗
PubMed1998

Alterations in nasal sensibility following open rhinoplasty.

Alterations of nasal sensibility following open rhinoplasty were studied both subjectively and objectively. In a prospective study, 25 patients were included. All patients underwent open rhinoplasty using a middle columellar incision. Subjective questioning and objective testing of nasal sensibility using the Semmes-Weinstein monofilaments were obtained preoperatively and both 3 weeks and 1 year after surgery. The match-paired Student's t-test was used for statistical analysis. At 3 weeks after surgery, there was subjective and significant objective alteration of sensibility in the area of skin supplied by the external nasal nerve (nasal tip and adjacent upper columella). This altered sensibility, however, recovered by 1 year after surgery. The recovery was thought to be due either to recovery of the external nasal nerve itself, or to collateral sprouting from the nerves supplying the adjacent areas of nasal skin.

Adult↗
PubMed2003

Non-Caucasian rhinoplasty.

Non-Caucasian patients seeking rhinoplasty often have similar goals as their Caucasian counterparts. However, surgeon sensitivity to ethnic variations and patient desires are crucial to a successful outcome. This article presents some of the commonly encountered issues seen in non-Caucasian rhinoplasty, including minimal modification, augmentation materials, and complications with infected and extruded implants.

Black or African American↗