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In the systematic approach to rhinoplasty, the author routinely uses an intercartilaginous columellar incision for dissection and reconstruction of the nasal tip, especially to facilitate separation of the tip cartilages from other tissues in the lower third of the nose. This technique has been used by the author for more than ten years and its advantages are demonstrated.
Augmentation rhinoplasty using soft tissue and cartilage was performed on 120 patients and the results were reexamined. They were found to be satisfactory and without complication. To narrow a round tip, a resection of two-thirds of the lateral crus cephalad portion and a transection of the caudal portion with a strip resection was done. To elevate the tip, septal cartilage was sutured to one-third of the upper part of medial crus to form a columella cartilage strut. To maintain the strut and to prevent pointing, a fibrous muscle tissue stretching from the medial crus to the upper cartilage or a dermis was transplanted into the area surrounding the septal cartilage tip. For a simple elevation of the dorsum, an onlay graft of dermis was applied, but where further elevation was required, further dermis and conchal cartilage was added for suture and attachment to the dermis.
The diversity of ancestry of the present-day Egyptian people has resulted in a mix of physical features, especially with regard to the nose. Both Caucasian and non-Caucasian characteristics are present, sometimes in the same individual. In performing rhinoplasty, particularly in the non-Caucasian nose, either of two procedures may be used, depending on the height and breadth of the bridge of the nose, both with successful consequences.
A new type of cartilage graft that is synthesized from cartilage fragments minced by our instrument and mixed with fibrin glue is described. This new material is useful when particular grafts are required in primary or secondary rhinoplasty.
Rhinoplasty in men has caused more traumatic problems of dissatisfaction, as compared to women, ranging from higher rates of complaints to murder of the surgeon. After an evaluation of the special problems related to change, I chose to reduce the amount of hump resected and to restrict the elevation of the nasal tip-nasolabial angle to a minimum compatible with normal appearance. The purpose is to avoid the tag of "operated nose." Some illustrative cases are shown. The goal is presented as precision, discretion, and satisfaction. Sometimes, doing less is more.
Ear cartilage is an important source of grafts for rhinoplasty. The majority of cartilage grafts is harvested from the concha of the ear. We describe indications in which the tragal cartilage is a more favorable graft source than conchal cartilage. The technique is fast, simple, and does not require special dressings.
The Japanese nose exhibits a combination of leptorrhine and mesorrhine features that mandates an innovative treatment strategy. Unlike elsewhere in Asia, the Japanese nose often has adequate dorsal height, and at times even dorsal convexity, but maintains a more retruded and amorphous tip configuration. The proposed systematic approach to Japanese rhinoplasty is divided into four categories: (1) dorsal augmentation with or without tip augmentation, (2) dorsal reduction with tip augmentation, (3) tip augmentation only, and (4) dorsal reduction only. The use of autologous and alloplastic materials to achieve the desired aesthetic objectives is described herein. A layered auricular graft technique is outlined for tip surgery, and a unique nasal implant design is discussed.
Since 1997, 129 patients have undergone the open approach rhinoplasty procedure. Scar quality with running W incision was compared to the scar with V type incision. According to clinical and statistical evaluations after 6 months, postoperatively the running W incision group showed better scar quality than the V type incision group. The advantages of a running W incision are camouflaging the depressed scar in the incision line and decreasing the angles of the corners of incision lines. Running W type incision is superior to V incision on the columella and may provide less scaring than a single Z, and reverse V incisions according to our long-term clinical results.
BACKGROUND: Management of nasal tip projection and support for positioning of the tip represent an important part of rhinoplasty operations that must be handled properly for a final satisfying result. Manipulation of the nasal tip is complex and variable. Plastic surgeons use many techniques to achieve this goal. METHODS: The authors propose that the caudal septal advancement technique be used to manipulate the positioning of the nasal tip, especially in cases of an underprojected tip and those requiring tip support. The authors prepare a rectangular septal cartilage, which after advancement carries the nasal tip to the desired position. RESULTS: This technique is easy to use, and the results are dependable. All the patients who underwent surgery with this technique were satisfied with the result. CONCLUSION: The caudal septal advancement technique presents another good and reliable alternative for managing nasal tip projection and support.
The authors present an original approach to the problem of the reconstruction of the nasal pyramid after a demolition for neoplasia. Reductive rhinoplasty is done at the same time as demolition, so that the remaining gap in the soft tissues is reduced to the point where it can be repaired with a local flap. The positive aspects of this method are its excellent aesthetic results, comparative ease, and quick execution. The negative aspects are it is limited to defects of less than half of the nasal pyramid and it cannot be used for defects of nostrils; there have also been isolated cases of psychological problems from the sudden physical change.
The current tendency to perform corrective rhinoplasty with the help of computerized images or cephalometric evaluations is justified by the need to adapt the amount of correction to all of the cephalometric relationships and draw on indications on the exact quantity of tissue to add or remove. We propose a very simple standard of surgical planning, which permits obtaining immediate data on the position of the jaw, the maxilla, and the correct nose proportion, and we confront the results of surgical planning with the postoperative.
The author, after a brief review of the main ideal size, proportion, and units of measurement of the nose, describes the historical techniques employed for cosmetic rhinoplasty. Particular attention is given to Sanvenero-Rosselli's cases. A paragraph is reserved for the history regarding the correction of saddle-nose and the main materials employed for the correction (autografts, allografts, xenografts, and implants). For each procedure, they were mentioned the first time they were employed.
Extramucosal approach provides for earlier results, less edema and echymoses. The final inspection using the magnificence of the videoscopic camera makes visible small irregularities at the cut edge of the nasal bones, upper portion of the lateral cartilage, and dorsal aspect of the septal cartilage. The removal of both cartilaginous and bony spicules provides improvements in the quality of the results. Videoscopic assistance in association with extramucosal approach is very helpful to achieve an aesthetic and functional result in rhinoplasty.
Nasal reconstruction presents a significant challenge to the facial plastic surgeon. Reestablishment of the desired aesthetic nasal contour and restoration of respiratory function are the dual goals of this endeavor. While autologous cartilage or bone is considered optimal grafting material, the supply is often limited and harvesting entails additional morbidity. Many synthetic materials have been introduced for use in nasal reconstruction, but high infection and extrusion rates have left most surgeons dissatisfied with conventional implants. Porous polyethylene (Medpor) implants were used for nasal reconstruction in 187 patients; 66 (35.3%) patients underwent primary rhinoplasty, while revision surgery was performed in 121 (64.7%) patients. Most patients required multiple implants, including columella struts, plumper grafts, dorsal tip implants, and nasal valve battens. Postoperative follow-up ranged from 6 months to 3.5 years. Complications occurred in five (2.6%) patients. Three early and two delayed infections necessitated implant removal in five patients, all of whom had compromised skin-soft tissue envelopes secondary to heavy smoking, cocaine abuse, or prior surgery. One case of an overly augmented nasal dorsum and tip required implant removal, reduction, and reinsertion. All implants were easily removed. No other complications including implant extrusion or skin erosion have been noted. Porous polyethylene (Medpor) implants allow for fibrovascular ingrowth, which lends stability to the implant. Porous polyethylene implants are well tolerated and provide an ideal material for nasal reconstruction.
The effect of continued differential growth of the adult male craniofacial skeleton on the nasal profile is examined in the present study. Two groups of individuals (N = 20) were compared, young (ages 16-23) and old (49-64). A three-dimensional CT scan was created for each individual in a standardized view. The change in position of four skeletal reference points with soft tissue correlates was analyzed. Changes were evaluated in both the vertical and the horizontal dimensions relative to the sella-nasion and to a perpendicular from the sella-nasion. Results show that the area of the maxilla at the pyriform remodels posteriorly with age (p = 0. 017), while the position of the other three points does not change in a significant fashion. This suggests that differential growth continues to occur in the aging craniofacial skeleton. Differential growth is further documented by calculating the percentage change in the position of any of the four points: the pyriform changed 80.2% from young to old, while the other points changed only from -9.3 to +22.1%. The craniofacial skeleton is the scaffold for the overlying soft tissues. Because the pyriform aperture represents the skeletal platform for the nasal pyramid, pyriform remodeling in a posterior direction retrudes the nasal profile with age. In addition, loss of pyriform height may distort the normal relationship of the alar base to the columella. These changes require assessment for the optimal result from aesthetic rhinoplasty.
A 7-year-old girl had suffered from progressive swelling of the nasal dorsum over 2 years. Computed tomography and magnetic resonance imaging showed a large soft tissue density in the nasal dorsum. Tc-99m DTPA cisternography and brain SPECT showed a restricted mass in the nasal dorsum without intracranial connection. The mass was resected using an external rhinoplasty approach, and the pathologic diagnosis was of neurofibroma. Furthermore, the nasal dorsum was identified as the origin of the neurofibroma without the stigma of neurofibromatosis. Here, we present this case and discuss the clinical and pathological aspects of neurofibroma arising in the nasal dorsum.
Secondary septorhinoplasty in patients with cleft lip and palate (CLP) is performed to improve nasal form and function. The purpose of this study was to compare the initial findings and the surgical outcome in 30 patients with unilateral CLP. Open rhinoplasty was carried out to correct nasal deformity. Nasal soft tissue analysis was done by measurement of standardized raster photographs of the nose and lateral teleradiography. Deviations from the ideal form regarding nasal symmetry, nasal width, and alar base line were determined. The nasal profile was assessed by measuring the nasofacial and nasolabial angle, the angle between the upper lip and the Frankfurt horizontal plane (FHP), and the angle between the columella and the FHP. Nasal patency was evaluated by rhinomanometry. The overall flow (cm3/s) was determined and the flow of the cleft side and non-cleft side compared. Evaluations were made immediately before and 6 months after surgery. In the frontal plane, nasal symmetry was significantly improved and the alar form adjusted. The deep position of the columella was corrected. The acute nasofacial angle and the drooping ala were not significantly improved. An increase in the overall flow and correction of the quotient cleft/non-cleft side was achieved by the surgical procedure. In this study, aesthetically and functionally relevant findings were objectified and can be used for quality control.
Body image disturbance may be an early sign of schizophrenia. The significance of this and dysmorphophobia with relation to patients seeking cosmetic rhinoplasty is discussed. Results of a follow-up of patients 10 years after cosmetic surgery to see whether they developed schizophrenia or serious psychological disorder are presented. The literature, significance of the findings and the clinical implications are all discussed.