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PubMed1994

Does rhinoplasty make the nose more susceptible to fracture?

This study was conducted to investigate the vulnerability of the nasal bones following rhinoplasty. The incidence of nasal bone fracture in the general population was reviewed from the data available from the National Center for Health Statistics (NCHS). The NCHS report indicates an average of 51,200 nasal bone fractures each year for an average yearly population of 239,328,200 over a 5-year period for the United States, producing an average rate of 0.021 percent per year. The history of 1121 patients who had undergone routine rhinoplasty or septorhinoplasty on an elective basis was then investigated for possible fractures following rhinoplasty. Of this group, 24 patients (16 females and 8 males) sustained a total of 28 nasal bone fractures following rhinoplasty over a mean follow-up period of 4 years. This yields an actual or crude rate of 0.624 percent per year, as compared with the age-standardized rate of 0.485 percent, according to the indirect adjustment method. The time interval between the first nasal procedure and subsequent fracture varied greatly, spanning from 1 month to 6 years. The average time interval between the first nasal procedure and the subsequent fracture for 16 patients was less than 1 year. Over 70 percent of the patient population (n = 17) who sustained post-rhinoplasty fracture were under 30 years old at the time of the fracture. On the basis of the study, it was concluded that the incidence of nasal bone fracture following rhinoplasty (0.624 percent actual and 0.485 percent adjusted) is higher than that of fracture in the general population (0.021 percent) (p < 0.001).

Adolescent↗
PubMed1994

Temporalis fascia grafts in open secondary rhinoplasty.

Parchment thin skin is a common problem associated with secondary rhinoplasty. When such skin is present, the underlying osseocartilaginous skeleton often becomes visible. Although many techniques have been used to treat the condition, we have found that an onlay graft of temporalis fascia is a most satisfactory method to cover the underlying osseocartilaginous framework or cartilage grafts. Temporalis fascia grafts have been advocated for this purpose in closed rhinoplasty; however, precise placement of the graft is difficult because the graft rolls. On the other hand, when used in open rhinoplasty, the graft may be placed accurately and secured under direct vision. This paper presents our experience with temporalis fascia grafts in open secondary rhinoplasties. Six female patients ages 31 to 57 underwent open secondary rhinoplasty. Five patients also had autologous cartilage grafts. Our average follow-up was 24 months; the minimum was 1 year, and the longest 7 years. All patients had excellent dorsal contours and osseocartilaginous irregularities were not observed. One patient developed a culture-proven nasal infection that responded successfully to antibiotics without removal of the fascia or cartilage graft, a result unlikely to occur when alloplastic materials are used. Biopsy of the temporalis fascia and cartilage grafts was obtained in one patient 12 months after placement. Microscopic examination confirms the long term viability of both grafted tissues, inasmuch as the temporalis fascia was vascularized and normal chondrocytes were present in the cartilage grafts. In summary, we have found that temporalis fascia grafts are a very satisfactory method for managing thin skin in open secondary rhinoplasty.

Adult↗
PubMed1999

Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty.

Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. The factors involved in nasal tip support are numerous; however, the role of the anterior septum versus the lower lateral cartilages has been debated in the literature. The purpose of this study was to quantitate, using fresh cadavers, the critical elements for nasal tip support with open versus closed rhinoplasty techniques. Multiple nasal manipulations, including cephalic trim, cephalic trim and interruption of the lower lateral cartilages, dorsal hump resection (1 to 4 mm), submucous resection of the septum, and complete septal removal, were performed using fresh cadaver heads and using both the open and closed rhinoplasty approach. Changes in nasal tip support were recorded. In comparing similar procedures, the mean loss of tip projection for the open approach was 3.43 mm versus 1.98 mm for the closed approach (p < 0.001). There was a significantly larger loss of tip projection in open versus closed procedures for cephalic trim, cephalic trim and interruption of the lower lateral cartilages, and cephalic trim with interruption of the lower lateral cartilages and septum removal (p < 0.001, 0.001, and 0.001, respectively). We attributed the differences between the open and closed approaches to the increases in ligamentous disruption and skin undermining that occur when using the open approach. Septum manipulation in general resulted in larger losses in tip support in both the open and closed approach. We conclude that the open approach for rhinoplasty results in a significantly increased loss of tip projection when compared with the closed technique due to the larger disruption of ligamentous support. Contrary to previous data, septal manipulation resulted in significant losses of tip projection, most likely secondary to lowering the nasal septal angle, and this effect may be more significant in closed rhinoplasty. The apparent clinical implications are that active measures, such as columellar struts and/or suture techniques for adding or maintaining nasal tip support during rhinoplasty, are indicated, especially when using the open approach and when any anterior septal alteration is performed using the open or endonasal approach.

Humans↗
PubMed2006

Alar base flap and suspending suture: a strategy to restore symmetry to the nasal alar contour in primary cleft-lip rhinoplasty.

OBJECTIVE: Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. We describe the mechanism and contribution of different surgical techniques to restore alar symmetry in primary cleft-lip rhinoplasty. STUDY DESIGN: We evaluate surgical results using a retrospective, randomized, blinded surgical grading system. We describe a surgical technique designed to restore nasal symmetry in patients undergoing primary cleft-lip rhinoplasty. Patients were selected retrospectively. METHODS: A series of patients were identified with nasal asymmetry associated with cleft-lip deformity. All patients underwent cleft-lip repair with concurrent primary cleft-lip rhinoplasty. Patients who underwent alar base flap suspending suture (ABF-SS) were grouped and selected consecutively after a modification in the senior author's surgical technique. A control group was matched for age, sex, and cleft characteristics. Primary rhinoplasty was carried out concurrently for both study groups while undergoing unilateral cleft-lip repair. The control group did not undergo the described ABF-SS technique. All patients were operated on by the same surgeon over a period of 5 years. Surgical outcomes were evaluated by a panel including lay people as well as trained health care workers experienced in the critical evaluation of esthetic results after cleft-lip rhinoplasty. RESULTS: Forty-six records were reviewed of patients undergoing complete unilateral cleft-lip repair. After applying strict inclusion/exclusion criteria, nine patients underwent the described ABF-SS technique. All patients in the preoperative group had a clinically and statistically comparable degree of deformity (P > .05). There was a clinical and statistically significant improvement in nostril size, shape, symmetry, alar base symmetry, and nasal tip/dome symmetry for patients undergoing repair with the described technique compared with the control group. No clinical or statistically significant difference was observed in the scarring scores between groups. CONCLUSIONS: Patients presenting with cleft-lip deformity usually present with a characteristic nasal deformity. Execution of the described surgical techniques restores nasal alar symmetry in patients undergoing concurrent primary cleft-lip rhinoplasty.

Cleft Lip↗
PubMed2002

Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation.

The fragile alar rims are complex structures whose specialized and supportive skin ensures the competence of the external valves and the patency of the inlets to the nasal airways. A chart review was performed of 100 consecutive secondary or tertiary rhinoplasty patients in whom the author had placed composite grafts before February 1999. Follow-up continued for at least 12 months. In 94 percent of the patients, composite grafts were harvested from the cymba conchae by removing the cartilage with its adherent anterior skin. In 6 percent of the patients, independently indicated alar wedges supplied the grafts. Six patients required secondary procedures to thin the alar rims, but such revisions have not been necessary since primary contouring of the cartilaginous graft component was instituted. Three auricular donor-site complications (one keloid, two thickened graft contours) were successfully revised through office procedures. Prior cosmetic rhinoplasty in a patient with normal alar cartilage anatomy exceeded all other etiologies as the cause of the deformity for which composite grafts were indicated (50 percent). The second most common etiology was deformity from prior rhinoplasty in a patient with alar cartilage malposition (33 percent of patients). Congenital deformities (7 percent of patients), trauma (6 percent), and prior tumor ablation (4 percent) comprised the remaining etiologies. Composite grafts were used most frequently to correct alar notching or asymmetry in rim height (43 percent of patients) or to provide an increase in apparent or real nasal length (28 percent). External valvular incompetence (14 percent of patients), nostril or vestibular stenosis (11 percent), or combined vestibular stenosis and lateral alar wall collapse (4 percent) were less common indications. Most composite grafts were oriented in the coronal plane (parallel to the alar rims). However, nostril or vestibular stenosis was corrected by sagittally placed composite grafts, and a third orientation (axial plane), to the author's knowledge not described previously, was used in patients with combined nostril stenoses and flattening of the alar walls. In this secondary rhinoplasty series, iatrogenic alar rim deformities or stenoses following cosmetic rhinoplasty dominated other causes requiring composite graft reconstruction (83 percent of patients). Of these 83 patients, 39.7 percent had preexisting alar cartilage malpositions, further supporting the importance of making accurate anatomical diagnosis part of every preoperative rhinoplasty plan.

Adolescent↗
PubMed2003

Hispanic rhinoplasty in the United States, with emphasis on the Mexican American nose.

Because an increasing number of Hispanic patients are seeking nasal surgical treatment, a critical analysis of 25 consecutive Hispanic rhinoplasties was performed. After a review of the patient data and preoperative photographs, a new classification was developed, based on the type of deformity rather than geographical origins (as previously used). A treatment paradigm is offered for each type of deformity. Type I involves a high radix, a high dorsum, and a nearly normal tip and is often referred to as a Castilian nose. Treatment consists of a closed functional reduction rhinoplasty, with dorsal reduction and minor tip changes. Type II involves a low radix, a normal dorsum, and a dependent tip and is a new designation. Treatment consists of a finesse rhinoplasty with a radix graft, minimal dorsal changes, use of a columellar strut for support, and open tip suturing. Type III involves a broad base, thick skin, and a wide tip deformity, with its worst expression in the mestizo nose. Treatment consists of a balanced rhinoplasty with minimal dorsal alteration but maximal lobular reduction and an open-structure tip graft. The following conclusions with respect to Hispanic rhinoplasty in the United States are important: (1) an enormous anatomical diversity of deformities is present, in contrast to Asian and black noses; (2) three distinct types of deformities have been identified, each of which requires a different surgical approach; (3) a wide variety of surgical techniques are necessary, in contrast to other ethnic noses; (4) conservative dorsal reduction is essential for type II and III noses; and (5) limitations imposed by the skin envelope are far less than presupposed, and the results are better than generally recognized. As the Hispanic population grows and becomes more prosperous, plastic surgeons in the United States can expect to encounter an increasing number of Hispanic patients requesting rhinoplasty.

Adult↗
PubMed1995

Fundamental terms, considerations, and approaches in rhinoplasty.

It is essential to appreciate the healing dynamics in rhinoplasty patients that occurs over a period of months. It is for this reason that long-term analysis and follow-up are essential for the surgeon to fully realize and understand the final effects of the effort. Discussion of important patient selection considerations, review of standard terminology, review of incision and approach choices, and brief review of alar cartilage procedures were presented. The importance of performing minimal surgery that would be capable of predictably producing the desired changes is stressed. In the majority of rhinoplasty cases, use of nondelivery or limited-delivery approaches, limited transfixion incisions, and conservative alar rim strip techniques seems to offer maximal predictability. These considerations, however, must be balanced with the improved exposure and teaching opportunity allowed via open rhinoplasty. The decision of which approach to use must be based on a thorough understanding of the problems presented by each case, and the techniques available within a surgeon's armamentarium. Excellent exposure and control of symmetry in the open structure approaches has led many teaching institutions to rely solely on that approach. It is the author's opinion that nasal reconstruction in more complicated secondary rhinoplasty, severely distorted, or congenitally deforms noses, or complex combinations of anatomic structure requiring grafting or lengthening should be performed via open rhinoplasty. It is believed, however, that an effective rhinoplastic surgeon should be able to successfully accomplish most nasal correction via any of the standard approaches discussed. With more conservative nondelivery approaches comes the probability of reduction in surgical trauma, decreased scarring, and increased relative predictability necessary for cosmetic surgical cases. Unfortunately, limitations of exposure and access are often difficult for even very experienced surgeons. It is not acceptable that all patients have to be exposed to only one type of exposure or technique based solely on the individual's original training experience. Rhinoplasty offers an ongoing learning experience, with a variety of elements. It remains perhaps the most challenging and demanding of the procedures in cosmetic and reconstructive surgery.

Cartilage↗
PubMed1996

Assessment of patient's benefit from rhinoplasty.

It is standard practice for most rhinoplasty surgeons to assess what they perceive to be the cosmetic outcome of their surgery. There have, however, been few attempts to gauge the degree of success of rhinoplasty from the patient's perspective. The aim of this study was to measure the benefit of rhinoplasty in an unselected group of patients who had undergone this procedure under the National Health Service (NHS). Two hundred and twenty-four patients who had undergone rhinoplasty or septorhinoplasty in the Department of Otolaryngology at Glasgow Royal Infirmary from 1990 to 1994 were surveyed by post; two questionnaires were administered. The Glasgow Benefit Inventory has four subscales which assess the patient's perception of the success of surgery, and the influence of surgery on the patients physical health, psychosocial function and social interaction. The Nasal Symptom Questionnaire (Fairley et al., 1993)--previously validated as an outcome measure in the context of FESS--was used to assess nasal symptoms. Multivariate and factor analysis was used to analyse the results. Four factors were extracted from the 103 responses to the Glasgow Benefit Inventory. The major factor of the benefit score was perception of surgical success which explained 50% of the variance. Three other factors (improvements in psychosocial functioning, social interaction and physical health after surgery) accounted for 10%, 5%, and 6% of the variance, respectively. Analysis of the Nasal Symptom Questionnaire yielded one predominant factor which was inversely related to perceived benefit. The outcome of rhinoplasty is influenced by the presence of nasal symptoms. Greater attention to nasal function would increase the benefit of rhinoplasty.

Humans↗
PubMedDate not supplied

Interdomal fat pad: an important anatomical structure in rhinoplasty.

OBJECTIVE: To describe the interdomal fat pad, an important anatomical structure that, to our knowledge, has not been reported in the rhinoplasty literature. DESIGN: Anatomical observations were made during a consecutive series of external rhinoplasties, and the existence of the interdomal fat pad was documented in patients with noses of varying nasal skin thicknesses. SETTING: Private facial plastic surgery practice. PATIENTS: One hundred consecutive white patients undergoing external rhinoplasty were analyzed. Thirty-seven patients were undergoing secondary rhinoplasty and were excluded. Sixty-three patients undergoing primary rhinoplasty were enrolled into the study. INTERVENTION: None. MAIN OUTCOME MEASURES: The nasal skin type of each patient was subjectively determined preoperatively to be thin, average, or thick. The presence or absence of a distinct fat pad between the domes of the lower lateral cartilages was observed and recorded in each group of patients. RESULTS: Among the 63 patients studied, 22 had thick skin; 31, average skin; and 10, thin skin. Well-defined interdomal fat pads were noted in 12 patients with thick skin, 13 patients with average skin, and 2 patients with thin skin. CONCLUSIONS: There is a distinct anatomical structure that we refer to as the interdomal fat pad that exists in noses of all skin types. The awareness of this structure should encourage a careful and direct examination of the undersurface of nasal tip skin. An unrecognized, extensive fat pad may interfere with tip narrowing and refinement. It may be the cause of persistent postrhinoplasty supratip fullness and excessive tip width. Arch Facial Plast Surg. 2000;2:260-263

Adipose Tissue↗
PubMedDate not supplied

The ideal nasal profile: rhinoplasty patients vs the general public.

OBJECTIVES: To evaluate whether patients seeking reduction rhinoplasty hold a different concept of the ideal nose than does the general public, and to determine what features characterize the ideal nasal profile. METHODS: Twenty-seven patients seeking reduction rhinoplasty and 15 randomly selected members of the public evaluated a series of computer-manipulated photographic profiles using a pictorial visual analogue scale to rate their preferences for several variables. Center-scale images were created from mesh-warped ("morphed") computer averaging of 12 white women. Differences between the rhinoplasty group and the public group were then compared, as was each group's deviation from the center of the scale. RESULTS: Both groups preferred narrowly distributed differences from the "average" profile to a high degree of significance. No statistically significant difference was found between the ideal nasal profiles selected by the rhinoplasty group and the public group. CONCLUSIONS: Reduction rhinoplasty patients do not appear to have a different concept of the ideal nose than does the public at large. The ideal nose, as it pertains to the ideal white female profile, has characteristics that differ from a mathematically averaged nasal profile.

Adult↗
PubMedDate not supplied

Rhinoplasty perioperative database using a personal digital assistant.

OBJECTIVE: To construct a reliable, accurate, and easy-to-use handheld computer database that facilitates the point-of-care acquisition of perioperative text and image data specific to rhinoplasty. METHODS: A user-modified database (Pendragon Forms [v.3.2]; Pendragon Software Corporation, Libertyville, Ill) and graphic image program (Tealpaint [v.4.87]; Tealpaint Software, San Rafael, Calif) were used to capture text and image data, respectively, on a Palm OS (v.4.11) handheld operating with 8 megabytes of memory. The handheld and desktop databases were maintained secure using PDASecure (v.2.0) and GoldSecure (v.3.0) (Trust Digital LLC, Fairfax, Va). The handheld data were then uploaded to a desktop database of either FileMaker Pro 5.0 (v.1) (FileMaker Inc, Santa Clara, Calif) or Microsoft Access 2000 (Microsoft Corp, Redmond, Wash). DESIGN: Patient data were collected from 15 patients undergoing rhinoplasty in a private practice outpatient ambulatory setting. Data integrity was assessed after 6 months' disk and hard drive storage. RESULTS: The handheld database was able to facilitate data collection and accurately record, transfer, and reliably maintain perioperative rhinoplasty data. Query capability allowed rapid search using a multitude of keyword search terms specific to the operative maneuvers performed in rhinoplasty. CONCLUSIONS: Handheld computer technology provides a method of reliably recording and storing perioperative rhinoplasty information. The handheld computer facilitates the reliable and accurate storage and query of perioperative data, assisting the retrospective review of one's own results and enhancement of surgical skills.

Computers, Handheld↗
PubMed1992

New retractor for open rhinoplasty.

One of the problems often encountered in external rhinoplasty is retraction of the flap. When a wide, double-pronged retractor is used, the tongue of the external rhinoplasty flap falls between the two points, often obscuring the view of the tip-and-dome anatomy. When vein retractor-type instruments are used, they will often slip and do not stay stable. A retractor has been designed for external rhinoplasty that consists of a wide, double-pronged element to elevate the soft tissues of the lower third of the nose above the cartilaginous and bony anatomy, combined with a central, slightly set-back retractor that holds the tongue of the rhinoplasty flap in a secure, retracted position. This has been a significant improvement in retraction for the external rhinoplasty flap.

Humans↗
PubMed1993

Skin excision revision rhinoplasty.

A technique of skin excision revision rhinoplasty is described for application in patients undergoing rhinoplasty. This group of patients includes those with soft-tissue polly beak deformities and a variety of other difficult post-rhinoplasty deformities. Horizontal nasal dorsal skin excision affects tip elevation and eliminates supratip fullness, while vertical midline nasal dorsal skin excision enhances tip definition, decreases dorsal height, and eliminates supratip fullness. We describe several patients who underwent either horizontal or vertical nasal dorsal skin excision for a variety of cosmetic deformities following conventional closed and open rhinoplasty. The techniques presented herein are meant to be added to the list of techniques available to the revision rhinoplasty surgeon rather than to replace existing techniques.

Adult↗
PubMed1994

Vertical dome division in open rhinoplasty. An update on indications, techniques, and results.

OBJECTIVE: A new modification of vertical dome division (VDD) in rhinoplasty using cartilage overlap and suturing to reestablish the integrity of the alar cartilages is analyzed and compared with the more standard technique of cartilage resection and suturing. DESIGN: Retrospective before-and-after trial. SETTING: Private patients of one of the authors (P.A.A.) undergoing surgery in the Department of Otolaryngology of the University of Toronto (Ontario). PATIENTS: A consecutive sample of 116 patients having undergone open rhinoplasty with VDD between 1981 and 1990 were evaluated. Seventy-five had VDD before 1987, when a cartilage resection and suturing technique was used (P.A.A.); 41 had their surgery after 1987, with the cartilage overlap and suturing technique. All patients were available for follow-up. The mean follow-up time was 15.2 months, with a range of 6 to 63 months. INTERVENTION: Indications for VDD were lobule asymmetry (47%), retrodisplacement (24%), wide domal arch (22%), hanging infratip lobule (6%), and rotation (1%). Prior to 1987, VDD was performed by dividing the alar cartilages, resecting certain portions, and then suturing the cartilages together again to recreate the alar margin. After 1987, VDD was revised by overlapping the portions of cartilage that would have been previously resected and suturing the overlapping portions to recreate the alar margin. MAIN OUTCOME MEASURES: Patient satisfaction; physician evaluation; physical examination; blinded comparison of preoperative and postoperative photographs; need for revision surgery. RESULTS: Overall, six (5.0%) of 116 patients required revision surgery or had photographic and/or physical evidence of nasal tip irregularities. Three (4.0%) of 75 patients from the cartilage excision group and one (2.4%) of 41 patients from the overlap group required revision surgery. The other two patients, one in each group, had minor tip irregularities not requiring surgery. The tip irregularities were due to nasal bossae in four patients and lobule asymmetries in two. There was no alar notching or lower nasal third pinching. Tip irregularities were three times as likely to occur in patients presenting for revision rhinoplasty than in those for primary rhinoplasty. CONCLUSIONS: Vertical dome division is a powerful tool in rhinoplasty, allowing for complex manipulations of alar cartilages to selectively enhance projection, rotation, and domal arch width. It also allows for correction of lobule asymmetries and elongation or hanging of the infratip lobule. The cartilage overlap technique reduces the occurrence of several common postoperative tip abnormalities and lowers the need for revision surgery when compared with cartilage resection VDD. The reported results can only be considered trends, as sample sizes in the series were too small to allow for statistical significance.

Adolescent↗
PubMed1995

The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. A 6-year experience.

OBJECTIVE: To determine the safety and efficacy of expanded polytetrafluoroethylene (Gore-Tex soft-tissue patch, W. L. Gore & Assoc Inc, Flagstaff, Ariz) as an implant in rhinoplasty. DESIGN: A retrospective study of 137 patients who underwent rhinoplasty including augmentation with Gore-Tex over a 6-year period. A review of the medical literature concerning the use of Gore-Tex as an implant in the head and neck was also conducted. SETTING: Two major academic medical centers and two private office surgical centers. PARTICIPANTS: One hundred thirty-seven consecutive patients who received Gore-Tex implants in the course of rhinoplasty. INTERVENTION: Sixty-nine patients presented for primary rhinoplasty; the remaining 68 presented for revision surgery. All received Gore-Tex nasal implants to augment the nasal dorsum and/or base. The grafts ranged from 1 to 6 mm in thickness. Follow-up ranged from 6 to 80 months, with an average of 25 months. OUTCOME MEASURES: Clinically noted complications and patient satisfaction. RESULTS: Three (2.2%) of 137 grafts became infected and were removed. One graft was removed 5 months post-operatively because of excessive augmentation. None of the patients who underwent implant removal required subsequent augmentation. All 137 patients are pleased with their results. CONCLUSION: Gore-Tex is a safe and effective implant material to use in primary and revision rhinoplasty when augmentation is needed and autogenous material is not available or desirable.

Adolescent↗
PubMedDate not supplied

Sociological aspects of rhinoplasty.

Although the psychological aspect of the rhinoplasty operation has been a subject of interest for a long time, with the exception of a few studies, sociological factors have been almost totally ignored. In this prospective study the personality characteristics and socioeconomic backgrounds of 216 rhinoplasty patients were evaluated. Between 1994 and 2000, a questionnaire and the Minnesota Multiphasic Personality Inventory (MMPI) were given preoperatively to 157 females and 59 males. The MMPI was also given to age-matched people as a control. Six months after surgery, patients were called on the telephone and asked to rate their satisfaction. According to questionnaire, a great majority of the rhinoplasty patients were young, unmarried women with high education levels. In the rhinoplasty group, one or more scales of the inventory were not in the normal ranges in 45% of the patients, whereas this proportion in the control group was 28% (p < 0.01). When MMPI results are considered, female patients of this study could be described as egocentric, childish, highly active, impulsive, competitive, reactive, perfectionistic about themselves, talkative, and emotionally superficial. Male patients could be described as rigid, stubborn, over-sensitive, suspicious, perfectionistic, pessimistic, over-reactive, and having somatizations. Tension and anxiety with feelings of inferiority were found to be characteristics of the male patients. The satisfaction rate after six months was reported as 72%. There was no significant correlation between MMPI results and demographic variables, nor satisfaction rate. In conclusion, the rhinoplasty patients in our study are young people at the very beginning of their careers. It could be that their personalities and socioeconomic backgrounds combine to make aesthetic surgery rewarding enough, both socially and personally, to encourage them to follow through.

Adolescent↗
PubMed2004

Nasal tip plasty using various techniques in rhinoplasty.

Rhinoplasty is one of the most common aesthetic surgical procedures in Korea today. However, simple augmentation rhinoplasty results often failed to satisfy the high expectations of patients. As a result, many procedures have been developed to improve the appearance of the nasal tip and nasal projection. However, the characteristics of Korean nasal tips including the bulbous appearance (attributable to the thickness of the skin), flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medical crus of the alar cartilage and a short columella have made such procedures difficult. Currently, most plastic surgeons perform rhinoplasty simultaneously with various nasal tip plasty techniques to improve the surgical results. An important part of an aesthetically pleasing result is to ensure an adequate nasal tip positioned slightly higher than the proper dorsum, with the two tip defining points in close proximity to each other, giving the nose a triangular shape from the caudal view. From June 2002 to November 2003, the authors performed rhinoplasty with simultaneous nasal tip plasty using various techniques according to the tip status of 55 patients (25 deviated noses, 9 broad noses, 15 low noses, and 6 secondary cleft lip and nose deformities). The surgery included realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The postoperative results over an average period of 10 months were entirely satisfactory. There were no patient complaints, nor complications resulting from the procedures. Good nasal tip projection, natural columellar appearance, and improvement of the nasolabial angle were achieved for most patients. In conclusion, rhinoplasty with simultaneous nasal tip plasty, achieved by a variety of techniques according to patients' tip status, is an effective method for improving the appearance of the nose and satisfying the desires of the patients.

Adult↗
PubMedDate not supplied

Revision rhinoplasty using porous high-density polyethylene implants to reestablish ethnic identity.

BACKGROUND: This study aimed to evaluate a surgical technique used for patients requiring revision rhinoplasty to reestablish their ethnic identity. METHODS: A retrospective review involved 29 patients who underwent revision rhinoplasty to reestablish their ethnic identity using residual septal cartilage and porous polyethylene implants. The follow-up period ranged from 6 month to 7 years. RESULTS: For all patients undergoing revision rhinoplasty, multiple porous polyethylene implants were used to reestablish ethnic identity and to restore nasal function. Implant extrusion developed in one (3.4%) of the 29 patients. There were no cases of postimplant infection. CONCLUSIONS: In our experience, patients who feel they have lost their ethnic identity after primary rhinoplasty tend to have overresected dorsal cartilage and bone and overresected tip cartilages. The use of multiple porous polyethylene implants in revision rhinoplasty to restore ethnic identity can provide the necessary grafting material needed for reconstruction. Many grafting options are available. According to our experience, porous polyethylene provides safe, effective, and reliable results.

Adult↗