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PubMed2003

Mestizo rhinoplasty.

Cosmetic rhinoplasty is performed by specialists all over the world; increasingly, people of different ethnic groups want their noses reshaped in one way or another. The term mestizo is defined and its general nasal characteristics and anthropometric measurements are presented. Surgery is planned using the patient's specific facial characteristics, with the goal of achieving harmony and balance while preserving ethnical background and complying as much as possible with the patient's desires. All surgeries are performed using the open-rhinoplasty approach. Mestizo patients usually want noses that look finer and thinner but not necessarily bigger. Different surgical options are presented and overall results evaluated, always trying to maintain ethnicity and harmony unless the patient desires otherwise.

Cephalometry↗
PubMed2003

Reduction structured rhinoplasty.

Rhinoplastic surgeons continue to seek technical refinements that will result in a consistently reliable postoperative outcome. Over the past 25 years there has been a steady progression away from the simple Joseph reductive rhinoplasty technique toward the use of various grafts to improve both the functional outcomes and aesthetic end result of this procedure. The original reductive template continues to be a major component of a new conceptual paradigm, which has evolved to incorporate the understanding that structural components must be placed to allow a more precise outcome. Specifically, once the nose is reduced to proportions that correspond to the preoperative analysis, separate grafts and implants are placed to prevent a change in the shape of the nose by the constricting effects of the skin shrink-wrapping around the skeletal framework. This article focuses on the use of implants for structural architecture in the senior author's primary reduction-structured rhinoplasty cases.

Biocompatible Materials↗
PubMed2006

Surgical treatment of the nasolabial angle in balanced rhinoplasty.

Aesthetic rhinoplasty is a complex surgical procedure that contains numerous components; when performed harmoniously, it should yield a successful, balanced result. The process begins with a comprehensive nasal analysis and surgical planning. Many surgeons concentrate on altering the nasal dorsum and nasal tip but may ignore potential contributions to overall appearance from the caudal nasal septum and nasal spine. One of the key parameters for evaluation and aesthetic treatment of the nose is the nasolabial angle. The nasal spine, caudal septum, and the 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 by a pushing philtrum may also result in an unbalanced appearance. The literature is replete with methods for categorizing the nasal tip and recommended surgical treatments. Treatment of the caudal septum and the nasal spine is often an afterthought that is left to the aesthetic judgment of the surgeon. A chart-with recommended treatment for the caudal septum and nasal spine following appropriate profile analysis-is included in the interest of a more systematic process. The chart takes account of the length of the nose, nasolabial angle, and possible presence of a pushing philtrum with suggested treatments to allow for proper tip placement and aesthetic balance to the nose. Adherence to this process provides a valuable tool for assuring a harmonious result in rhinoplasty.

Humans↗
PubMed2006

Nuances in tip modification: specific applications of cartilage splitting in rhinoplasty.

Division of the lower lateral cartilages in rhinoplasty has long been maligned for producing unnatural results. However, recognition of medial, intermediate, or lateral crural discrepancies allows for their division and overlay. By identifying variant nasal anatomy and understanding the anticipated postsurgical dynamics, the rhinoplasty surgeon will be able to produce consistent, natural outcomes.

Humans↗
PubMed2006

Structural approach to endonasal rhinoplasty.

The marriage of endonasal rhinoplasty with structural grafting has resulted in more consistent rhinoplasty results. The nasal base can be stabilized by tongue-in-groove techniques, a columellar strut, or extended columellar strut. The middle vault can be addressed with spreader grafts or butterfly grafts. Lower lateral cartilage weakness can be supported with alar batten grafts or repositioning of the lower lateral cartilages.

Cartilage↗
PubMed2006

The current trend in augmentation rhinoplasty.

Augmentation rhinoplasty is one of the most commonly performed cosmetic surgeries in Asia. Although they are traditionally considered procedures done predominantly in the Far East, these surgeries have gained increasing popularity in America with the great influx of Asian immigration. This article reviews the unique anatomical features in typical Asian noses, various augmentation options, and the most updated techniques of Asian augmentation rhinoplasty currently being used.

Asian People↗
PubMed2006

Rhinoplasty in the aging patient.

Rhinoplasty in the aging patient presents a unique challenge to the facial plastic surgeon. The effects of age on the skin, ligaments, and cartilage of the nose conspire with the relentless pull of gravity to create a ptotic tip and collapsing nasal sidewalls. Combined with the increased incidence of other comorbidities in the aged patient, the resulting functional and cosmetic problems that ensue can be difficult to overcome. The astute plastic surgeon, however, will not vary from a systemic and patient-centered approach to each individual problem. Moreover, armed with common tools such as cartilage grafting, tip-suturing techniques, and meticulous handling of fragile tissues, the surgeon can restore the nose to a more youthful appearance and functional state. Although once taboo, rhinoplasty in the aging patient is increasingly a rewarding procedure for both patient and surgeon alike.

Aged↗
PubMed1995

[Subjective and objective evaluation of the outcome of rhinoplasty. A retrospective study].

Between 1983 and 1988, 206 patients underwent a septorhinoplasty in the ENT Department of the University Hospital Benjamin Franklin in Berlin. The results of the operation were analysed by an "objective" evaluation form including measurements of cephalometric angles and a "subjective" questionnaire reflecting the patient's view. Ninety-nine patients responded to our questionnaire. About one third of our patients were foreigners (mostly Turks). Seventy-five percent of the results were good in objective as well as subjective terms. Comparison of results between the two sexes did not show a significant difference. A relevant discrepancy between the objective and the subjective results was seen in the foreign patients. The low average age and therefore unrealistically high expectations are a possible explanation for this phenomenon. Patients with small preoperative deformities also turned out to be less satisfied with the outcome even though the objective result was better. While obtaining the objective results, we also realized that the nasofrontal angle seems to be of minor importance for the facial profile. The nasofacial and the nasolabial angle actually seem to be more important for the rhinoplasty and reflect the aesthetic correction of the nose better than the nasofrontal angle. It was much more often possible to correct the nasofacial and the nasolabial angle, while the nasofrontal angle remained uncorrected in many cases. Our retrospective study was able to answer the question whether the aesthetic outcome after rhinoplasty can be rated objectively.

Adult↗
PubMed1998

Nasal lining flaps in contemporary reconstructive rhinoplasty.

The advances that have taken place in the last decade in reconstructive rhinoplasty are based in strong major on the development of internal lining mucosal flaps used to resurface the interior of reconstructed full thickness nasal defects. This paper provides an in-depth analysis of these thin well vascularized flaps harvested from the remaining mucosa and vestibular skin of the nasal passage. They provide the foundation which is overlaid with cartilage grafts to replace skeletal support and covering flaps to resurface the grafts. This contemporary concept of layered reconstruction, replacing missing tissue with like tissue has revolutionized the approach to reconstructive rhinoplasty and has raised it to a higher level of sophistication resulting in enhancement in aesthetic and functional results.

Bone Transplantation↗
PubMed1997

Secondary rhinoplasty: analysis of the deformity and guidelines for management.

Secondary rhinoplasty aims at modifying the functional and cosmetic defects caused by an improperly performed a primary procedure. Correction follows a logical sequence from which there is no reason to deviate if one wishes to achieve sure results. The sequence includes analysis of the deformity, accurate photographic documentation, functional and diagnostic examination, consultation with the patient, and precise planning of the different steps of surgery. Deformities are grouped in four different sectors depending on the characteristics of the repair: upper, intermediate, lower, and inner. However, defects may involve more than one sector, making it difficult or impossible to establish a precise boundary between them. The surgical technique requires a wide exposure of the operating field so that the surgeon can clearly evaluate the anatomical deformities and carry out the necessary corrections. For this reason, the open approach is the solution of choice. Two types of grafts are commonly used in revision rhinoplasty, cartilage and bone. They become necessary to reestablish function and to restore volume and/or contour. We strongly believe that only autologous grafts can be used. Grafting materials, their sources, and applications in different clinical cases are described here.

Bone Transplantation↗
PubMed1996

Interrupted and continuous strip technique for tip surgery during traditional rhinoplasty.

The authors report their experience in corrective surgery of the tip during traditional closed rhinoplasty. After a critical revision of the proposed techniques by other authors, the advantages of the "Doberman's ears" and "Butterfly" are given. The choice of the corrective techniques of the tip next to Tardy's algorithm can use a "sequential criterium" after having used a delivery approach. During rhinoplasty it is possible to perform a system of "progression" from one method to another maintaining or interrupting the cartilaginous arch and having as a goal the increasing or the decreasing of the tip.

Female↗
PubMed1995

Illusions in rhinoplasty.

In both primary and secondary rhinoplasty, favorable illusion may be created by cartilage grafting of various nasal anatomic components, as well as rearranging components in relationship to one another. Recognizing which patients will benefit from the procedures described herein can lead the rhinoplasty surgeon to improved long-term outcomes.

Cartilage↗
PubMed2002

Rhinoplasty and nasal function in patients with cleft lips.

The purpose of this study was to find out whether harvesting septal grafts and simultaneously doing a septoplasty improves nasal function in patients with clefts who are having a rhinoplasty to correct the external deformity. We studied 14 patients with a unilateral cleft (UCL(P)) and four with bilateral clefts (BCLP). Nasal airflow resistance was measured with active rhinomanometry preoperatively and postoperatively. In nine of the 14 with UCL(P) and in all those with BCLP nasal resistance was normal or near normal both preoperatively and postoperatively. In five with UCL(P) postoperative nasal resistance was highly increased on the cleft side and in three of these patients nasal resistance decreased significantly but still remained abnormal. Only one patient subjectively complained of poor nasal airflow but all sought improvement of their nasal appearance. Harvesting of the graft and simultaneous straightening of the nasal septum during a rhinoplasty in patients with clefts neither improved, nor had a deleterious effect on, nasal function.

Adolescent↗
PubMedDate not supplied

Biomechanics in augmentation rhinoplasty.

During the past 6 years, we have treated 406 patients with classical silicone augmentation rhinoplasty. The types and incidence of complications after subcutaneous or subfascial implantation were examined. We have 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. In order to determine scientifically which layer the silicone implant should be inserted into, we investigated the biomechanics of human nasal periosteum and fascia, including tensile strength, stress-strain relationship and stress relaxation characters under uniaxial tension. Although having less failure strain, the periosteum has more tensile strength than the fascia. So, in the view of biomechanics, the periosteum is thicker, tougher and stiffer than the fascia, thus is more suitable for covering silicone implants.

Adult↗
PubMed1981

A critical evaluation of 200 rhinoplasties.

Since few comprehensive statistics on results of rhinoplasties have been published since Klabunde and Falces' article [1] in 1964, a retrospective study of 200 consecutive patients was undertaken. These patients underwent rhinoplasty by a single surgeon and were followed for a minimum of six months. A separate reviewer studied patient satisfaction, physician satisfaction, rate of revision, and type of complications, including obstruction of airway, nasal deformity, hematoma, infection, hemorrhage, and psychological reactions. The incidence of infection, hemorrhage, and revisions has lessened in the past fifteen years. Patients not referred by a physician were more than twice as likely to be dissatisfied as those who were physician-referred (p less than 0.005). A higher percentage of female patients was dissatisfied than of male patients (p less than 0.05). The incidence of dissatisfaction increased significantly among patients in their fifth decade as compared with that in younger patients (p less than 0.01). No statistically significant difference was found in the incidence of dissatisfaction among single, married, widowed, or divorced patients.

Adolescent↗
PubMed1984

Anatomy of a rhinoplasty--saw technique.

Great latitude is given the concept of individual variations in part and in the entirety, but generally corrective rhinoplasty requires anatomic alteration in five areas: removal of a dorsal hump (Fig 5-9A), narrowing of the bony nasal arch (Fig 5-9A), lowering and/or shortening of the upper lateral cartilages (Fig 5-9B), narrowing and lowering of the nasal tip (lower lateral cartilage) (Fig 5-9C), and shortening and tilting of the cartilaginous septum (Fig 5-9D). Proper appreciation of the contribution of each of these anatomic parts to the entire unit of nasal form will aid the surgeon in more consistently reaching the desired functional and cosmetic goal in corrective rhinoplasty.

Anesthesia, Local↗
PubMed1984

Rhinoplasty: a graded aesthetic-anatomical approach.

The fundamental rhinoplasty principles established by Joseph and the aesthetic canons of Sheen can be reconciled by selecting the optimal surgical technique based on in-depth anatomical knowledge. Since neither the perfect nose nor the perfect rhinoplasty operation exists, the goal remains to choose those procedures best suited for the individual patient. The greater the surgeon's commitment and repertoire, the higher the chances of success.

Adult↗
PubMed1986

The predictive validity of psychosocial factors for patients' acceptance of rhinoplasty.

Adaptation to rhinoplasty one year postoperatively was studied in 56 patients and the results compared with their preoperative psychosocial profiles. Of the patients, 21 (37%) reported unfavorable experiences with the operation, such as dissatisfaction with the results and/or increased nervous symptoms. Patients dissatisfied with the operational result were more often men who had experienced a nose trauma as an adult. A high consumption of alcohol, poorly established social relations, and an outgoing sthenic attitude were other characteristics. Patients reacting with increased mental symptoms after the operation had expected the operation to result in a substantial change in their general life situation. Their sensitivity regarding the shape of their noses was, in some cases, of a delusional severity. The remaining 35 patients (63%) adapted fairly well to the operation. By a system of different weights given to interview items, it was possible to demonstrate a significant predictive validity of the preoperative psychosocial evaluation with regard to postoperative adaptation. Application of this evaluation technique therefore should increase the possibility of reliably predicting the outcome. Operations on patients not suited to rhinoplasty might be avoided with the application of such a technique.

Adaptation, Psychological↗