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PubMed2001

Achieving consistency in the lateral nasal osteotomy during rhinoplasty: an external perforated technique.

The lateral nasal osteotomy is an integral element in rhinoplasty. A reproducible and predictable technique for the lateral nasal osteotomy (when indicated) is a significant contributor to operative success. A variety of methods and instrumentation are used to produce lateral osteotomies; currently, the two different modes used most frequently are the internal continuous and external perforated techniques. A previously published study by the senior author detailed the benefits of the external perforated osteotomy after comparing the two different methods. This article describes the role of the external perforated osteotomy technique in reproducing consistent results in rhinoplasty with minimal postoperative complications.

Adult↗
PubMed1985

Rhinoplasty: clinical categorization as a practical preoperative guide.

As progressively more individuals desire rhinoplasty, facial surgeons are experiencing a wider spectrum of potential patients. The young woman in her late teens and 20s once made up the majority of the rhinoplasty case load. Now, the patients desiring aesthetic and reconstructive nasal surgery represent all stages of life. We have divided the patient population into five categories based principally on the special requirements of inherent chronologic differences. This typing system guides rhinoplastic surgeons in dealing with a variety of age groups of both sexes. These categories are useful in defining differences in technique and as an adjunct to preoperative evaluation.

Adolescent↗
PubMed2005

A novel intranasal stent for functional rhinoplasty and nostril stenosis.

OBJECTIVES/HYPOTHESIS: The surgical correction of nostril stenosis and external nasal valve collapse typically involves the addition of tissue to widen and strengthen these areas. However, over the ensuing months, postoperative scar contracture may act to reverse the surgical modifications. This study aimed to determine the safety and efficacy of the use of nasal stents fashioned from a nasopharyngeal airway tube to prevent postoperative contracture at these sites. STUDY DESIGN: Retrospective review of six patients who underwent functional rhinoplasty with alar batten graft placement for nasal valve collapse and one patient who underwent composite graft repair of unilateral nostril stenosis. METHODS: Patients completed a survey inquiring about the ease of use, discomfort, presence of infection, and ability to breathe with these nasal stents. Patients also completed the NOSE (nasal obstruction symptom evaluation) instrument to compare their overall level of preoperative and postoperative nasal breathing. The functional rhinoplasty patients were examined for degree of dynamic airway nasal wall collapse and position of the lateral nasal wall on intranasal examination. RESULTS: Six of seven patients overall reported no to minimal discomfort, easy application, and no to minimal obstruction of nasal breathing with the use of the stents. One patient reported difficulty with application. Preoperative NOSE scores averaged 67.1 (SD 10.4), 18.6 (SD 14.6) at the time of splint removal, and 21.4 (SD 15.2) at 3 months after stent removal. Paired t test analysis showed significant differences between the NOSE scores preoperatively as compared with the time of splint removal (P = .0002) or 3 months after splint removal (P = .0003). All patients demonstrated a significant reduction of lateral nasal wall collapse with inspiration on physical examination. CONCLUSIONS: The use of nasal stents made from nasopharyngeal airway tubes is a safe, convenient, and economic treatment for the prevention of contracture after surgical correction of nostril stenosis or nasal valve insufficiency.

Constriction, Pathologic↗
PubMed2003

Male rhinoplasty.

Rhinoplasty is one of the most complex and challenging operations in plastic surgery. This complexity is increased among male patients, because male patients tend to have relatively nonspecific complaints, are typically more demanding, and are regarded as being much less attentive during consultations. It is critical for the surgeon to verify that the male patient has realistic goals before he undergoes an operation, and the surgeon must confirm that the male patient has heard and understood all of the risks, benefits, and options. It is essential that masculine features be preserved for male rhinoplasty patients. Excessive dorsal reduction or tip refinement produces unsatisfactory results. A comprehensive discussion of proper evaluation of the male nose, surgical planning, intraoperative techniques, and postoperative treatment is presented. These tools should allow plastic surgeons to produce a balanced harmonious nose in relation to the rest of the face.

Adult↗
PubMed2005

Rhinoplasty and endoscopic surgery for functional and inflammatory nasal/sinus disorders.

The rhinoplastic surgeon when faced with nasal sinusitis has traditionally delayed aesthetic treatment of the nose, referring the patient to the ear, nose, and throat consultant until complete resolution of the inflammatory condition. Often, under such a scenario, the patient found the ear, nose, and throat procedure to be a traumatic experience that discouraged further surgery of an aesthetic nature. The advent of functional endoscopic sinus surgery has significantly modified the management of paranasal sinus disorders. This minimally invasive, sophisticated procedure can easily be combined with rhinoplasty. More recently, an endoscopic approach has been advocated for management of the septum and lower/middle turbinates. The authors call this functional endoscopic nasal surgery. Functional endoscopic nasal surgery allows a clearer view of the operative field (septum and turbinates), a more accurate correction of nasal obstruction, and better control of bleeding. Thus, endoscopic techniques permit the treatment of functional and inflammatory nasal disorders in a single stage, along with aesthetic improvement. Only the patient with severe sinusitis is unsuitable for combined therapy. The authors present their experience based on 72 consecutive cases of combined functional endoscopic sinus surgery/functional endoscopic nasal surgery with aesthetic rhinoplasty. Complications were minimal and functional failures were limited to 4 percent, whereas aesthetic outcomes remained uncompromised.

Adolescent↗
PubMed2005

Computer imaging and surgical reality in aesthetic rhinoplasty.

BACKGROUND: Computer imaging enables a surgeon to simulate the postoperative result in a quite artistic and natural manner. Many plastic surgeons, however, are reluctant to use this sophisticated new tool for various reasons, such as the cost of the equipment, the learning process, the extra time involved, and the potential medicolegal implications. The aim of this study was to add experience to the value of computer imaging for rhinoplasty. METHODS: One hundred twenty patients with corrective rhinoplasty were followed from 1 to 5 years postoperatively. The authors and the patients compared the "virtual" with the surgical results on a scale from 1 to 4, where 1 = identical, 2 = similar, 3 = approximate, and 4 = poor. RESULTS: Approximately 70 percent of the surgical results were rated identical or similar by the authors versus 80 percent by the patients, 25 percent versus 14 percent were rated approximate, and only 5 percent versus 2.5 percent were rated as poor. The outcome of the matches between the simulation and the postoperative results correlates favorably with the authors' experiences during the precomputer era. The patients who were satisfied with the outcome in general were not critical about the accuracy of the match. So far, the authors have not experienced medicolegal problems. CONCLUSIONS: The authors have been using computer imaging for more than 5 years, with growing enthusiasm; it has become a valuable tool with which to communicate potential results to the patient during consultation and planning of the procedure. The extra time necessary is well invested. The available software programs are affordable and easy to handle, even for nonexperts.

Adolescent↗
PubMed2006

Septal cartilage defined: implications for nasal dynamics and rhinoplasty.

BACKGROUND: Although the septal cartilage is integral to structural nasal stability, it is routinely violated during septorhinoplasty. This occurs during dorsal hump reduction, caudal septal reduction, submucoperichondrial resection of a deviated septum, or harvesting of cartilage graft material. Despite such routine alteration and/or use, the characteristics of septal cartilage have not been adequately defined. METHODS: By measuring septal length, height, and cartilage thickness mapped out at 5-mm intervals over the entire nasal septum in 11 fresh cadaver specimens, the characteristics of septal cartilage were determined. RESULTS: Septal thickness measurements demonstrated significant differences along the nasal septum, with the greatest thickness along the septal base (2.7 +/- 0.1 mm), followed by intermediate thickness along the septal dorsum (2.0 +/- 0.2 mm) and the least thickness along the central portion (1.3 +/- 0.2 mm) and at the anterior septal angle (1.2 +/- 0.1 mm) (p < 0.001). CONCLUSIONS: These observations clarify several nuances regarding septal structural stability, septal deformities, and the effects of septal alteration during rhinoplasty. The findings of this study reinforce several principles, including recognition of factors contributing to the high propensity of acquired central septal perforations; preservation of a generous L-strut width, especially at the anterior septal angle, or if planning dorsal hump reduction, prudent allocation of harvested septal cartilage; and clarifying the proclivity for supratip deformity following rhinoplasty.

Aged↗
PubMed2006

Frequently used grafts in rhinoplasty: nomenclature and analysis.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Accurately name the most frequently used grafts in primary and secondary rhinoplasty. 2. Describe the precise anatomical position of each graft. 3. Discuss the clinical indications of each graft. SUMMARY: In this article, the authors present the grafting techniques most commonly used to sculpt the nasal framework in primary and secondary rhinoplasty. The grafts are described in terms of their nomenclature, anatomical location, and clinical indications, presenting a simple and easy-to-reference guide for both beginners and expert surgeons.

Humans↗
PubMed2003

Anatomic basis of notch deformity in open rhinoplasty.

Notch deformity at the columella after the stairstep incision is an unsightly sequel that fuels negativism for open rhinoplasty critics. Obvious causes cited include surgical misadventures involving division of the foot of the medial crus and poor healing. The authors offer yet an additional etiology based on the contraction distortion caused by the depressor septi nasi muscle. The purpose of this study is to investigate the anatomic basis for notch deformity after stairstep technique in open rhinoplasty. For this anatomic study, 10 fresh cadavers were used. Dissections were performed, exposing the columellar components. The macroscopic and microscopic photo documentation gathered supports the authors' theory that depressor septi nasi action causes skin-edge deformation that leads to closure malalignment and notch deformity. Pre-incision landmark defining tattoo or sutures will assure proper alignment at closure.

Cadaver↗
PubMed2003

Augmentation rhinoplasty of the Asian nose with the "bird" silicone implant.

Augmentation rhinoplasty of the Asian nose has a long legacy of safety in the Orient. The silicone implant design that is proposed resembles a bird in configuration and represents an intermediary form between the traditional I- and L-shaped implants. A pronounced lobular component often poses problems in the nasal tip: This implant exhibits a more diminutive proximal tip segment. Therefore, augmentation of the nasal dorsum and tip can be accomplished safely and successfully with the technique described for carving and inserting the implant. If complications should arise (e.g., infection, extrusion, mobility, or displacement), the implant can be removed simply and quickly because of the capsular formation around the implant. Infection occurred in only 3% of patients in this series and was managed easily with implant removal, oral antibiotics, and reinsertion. Displacement can be addressed with implant removal and reinsertion, and was also observed in 3% of patients. Mobility and extrusion have not been encountered. This technique has proved to be a safe, simple, reliable, and reversible technique in 1,079 rhinoplasties performed during a 10-year period.

Asian People↗
PubMed2003

Effect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty.

A double-blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty. Sixty rhinoplasty patients undergoing hump resection and lateral osteotomy were included in the study and were divided into 6 groups: group 1 (n = 10), single dose of 8 mg intravenous (IV) dexamethasone 1 hour before the operation; group 2 (n = 10), single dose of 8 mg IV dexamethasone at the beginning of the operation; group 3 (n = 10), 3 doses of 8 mg IV dexamethasone 1 hour before the operation, and 24 and 48 hours after the operation; group 4 (n = 10), 3 doses of 8 mg IV dexamethasone at the beginning of the operation, and 24 and 48 hour after the operation; group 5 (n = 10), 3 doses of 8 mg IV dexamethasone immediately after the operation, and 24 and 48 hours after the operation; group 6 (n = 10), control, no dexamethasone administration before or after the operation. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and days 2, 5, 7, and 10. For the postoperative evaluation of periorbital ecchymosis and edema, a scale of 0 to 4 points was used. There was no significant difference between groups in terms of bleeding (P > 0.05). In the groups using steroid before osteotomy, edema and ecchymosis were significantly lower during the first 2 days compared with the control group (P < 0.05). No significant difference was seen between groups 1 and 2. When patients were evaluated on day 5, edema and ecchymosis were significantly lower in groups 3 and 4 (P < 0.05) compared with other groups, but there was no difference between them. Group 5 had a significantly higher level of edema and ecchymosis compared with groups 1 through 4 at 24 hours and at days 2, 5, and 7 (P > 0.05). There was no significant difference between groups on day 10. In conclusion, if the first dose is given before osteotomy, triple-dose steroid application is the best bet for decreasing postoperative edema and ecchymosis. None of the patients had any complications related to the use of dexamethasone.

Aged↗
PubMed2005

Silicone augmentation rhinoplasty in an Oriental population.

Aesthetic augmentation rhinoplasty is gaining in popularity among Oriental populations. Despite being widely criticized in the literature, silicone implants remain the most commonly used as a result of their ease of application and lack of donor site morbidity. The authors present 355 consecutive Chinese patients who underwent silicone augmentation rhinoplasty from January 1999 to April 2003. During a mean follow-up period of 160 days, 28 patients (7.9%) developed major complications that required either removal or revision of the implant. The patients who had received the largest volume implants had the highest extrusion and infection rates, indicating that overaugmentation is the main cause. The authors hypothesize that the lower complication rates in Oriental compared with white populations is primarily the result of structural differences in the soft tissue envelope of the nose. In our series of patients, nasal augmentation with silicone implants proved to be effective and safe.

Adolescent↗
PubMed2006

A simple and inexpensive method of preoperative computer imaging for rhinoplasty.

UNLABELLED: GOALS/PURPOSE: Despite concerns of legal liability, preoperative computer imaging has become a popular tool for the plastic surgeon. The ability to project possible surgical outcomes can facilitate communication between the patient and surgeon. It can be an effective tool in the education and training of residents. Unfortunately, these imaging programs are expensive and have a steep learning curve. The purpose of this paper is to present a relatively inexpensive method of preoperative computer imaging with a reasonable learning curve. MATERIALS AND METHODS: The price of currently available imaging programs was acquired through an online search, and inquiries were made to the software distributors. Their prices were compared to Adobe PhotoShop, which has special filters called "liquify" and "photocopy." It was used in the preoperative computer planning of 2 patients who presented for rhinoplasty at our institution. Projected images were created based on harmonious discussions between the patient and physician. Importantly, these images were presented to the patient as potential results, with no guarantees as to actual outcomes. RESULTS: Adobe PhotoShop can be purchased for 900-5800 dollars less than the leading computer imaging software for cosmetic rhinoplasty. Effective projected images were created using the "liquify" and "photocopy" filters in PhotoShop. Both patients had surgical planning and operations based on these images. They were satisfied with the results. CONCLUSIONS: Preoperative computer imaging can be a very effective tool for the plastic surgeon by providing improved physician-patient communication, increased patient confidence, and enhanced surgical planning. Adobe PhotoShop is a relatively inexpensive program that can provide these benefits using only 1 or 2 features.

Adult↗
PubMed1987

Nasal tip numbness following rhinoplasty.

Inquiry into the sensory changes of the nasal tip following rhinoplasty in 75 patients showed that 65.3% experienced some degree of numbness of the nasal tip after operation. This included 29.3% who reported numbness as the only sensory change. The numbness lasted less than 3 months in 68.3% of the latter cases. Rhinoplasty involving tip reduction in particular was likely to result in postoperative numbness.

Humans↗
PubMed2004

Dimensional analysis - its role in our preoperative surgical planning of rhinoplasty.

With the advent of new reconstructive rhinoplasty techniques, we have the opportunity to correct a larger number of nasal deformities. Dimensional analysis using non-nasal references assists in identifying the abnormalities in a deformed nose. Analysis of 98 patients undergoing rhinoplasty plus or minus septal surgery was performed to identify the prevalent abnormalities with the help of the dimensional approach.

Face↗
PubMed2002

Computer imaging and patient satisfaction in rhinoplasty surgery.

The measurement and achievement of improved patient benefit following a particular medical or surgical intervention has become an increasingly relevant part of the provision of effective healthcare. We have retrospectively analysed patient satisfaction in 56 patients following rhinoplasty via the Glasgow Benefit Inventory (GBI), 25 of whom underwent pre-operative computer imaging planning. We have also audited patient reaction to this technique via a concurrent questionnaire in those subjects who underwent imaging, and correlated this with overall patient outcome. Patient satisfaction with cosmetic rhinoplasty following computer imaging was significantly improved compared to those patients who did not receive imaging.

Adult↗
PubMed2003

External rhinoplasty: a critical analysis of 500 cases.

The study presents a comprehensive statistical analysis of a series of 500 consecutive rhinoplasties of which 380 (76 per cent) were primary and 120 (24 per cent) were secondary cases. All cases were operated upon using the external rhinoplasty technique; simultaneous septal surgery was performed in 350 (70 per cent) of the cases. Deformities of the upper two-thirds of the nose that occurred significantly more in the secondary cases included; dorsal saddling, dorsal irregularities, valve collapse, open roof and pollybeak deformities. In the lower third of the nose; secondary cases showed significantly higher incidences of depressed tip, tip over-rotation, tip asymmetry, retracted columella, and alar notching. Suturing techniques were used significantly more in primary cases, while in secondary cases grafting techniques were used significantly more. The complications encountered intra-operatively included; septal flap tears (2.8 per cent) and alar cartilage injury (1.8 per cent), while post-operative complications included; nasal trauma (one per cent), epistaxis (two per cent), infection (2.4 per cent), prolonged oedema (17 per cent), and nasal obstruction (0.8 per cent). The overall patient satisfaction rate was 95.6 per cent and the transcolumellar scar was found to be unacceptable in only 0.8 per cent of the patients.

Female↗
PubMed1985

Nasofrontal abscess following rhinoplasty.

Infections are the most common objective complication following rhinoplasty. They may remain localized, extend intracranially, or result in generalized septicemia. The most common infections involve the skin and subcutaneous tissues of the nose. We report an uncommon case of nasofrontal abscess following a rhinoplasty that required aggressive surgical and medical treatment.

Abscess↗