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PubMed2000

Dynamics in rhinoplasty.

Nasal dynamics were studied on 87 patients undergoing rhinoplasty of one zone or two distant nasal zones. Statistical analysis of the results revealed that reduction of the nasion area, besides setting the soft tissue back, gave the appearance of increased intercanthal distance and lengthened the nose. Reduction of the nasal bridge resulted in a wider appearance on frontal view and a cephalically rotated tip on profile. Augmentation of the bridge affected the nose reversely. Tip cephalad rotation was achieved by resecting one of the three areas: the cephalad portion of the lower lateral cartilages (affecting the rims more), the caudal septum (affecting the central portion more), and the caudal portion of the medial crura of the lower lateral cartilages (affecting the central portion only). Resection of the alar base not only narrowed the nostrils but also moved the alar rim caudally. Furthermore, it reduced tip projection when a large alar base reduction was done. Reduction of the nasal spine increased the upper lip length on profile and reduced tip projection when a large reduction took place. Significant reduction in caudal nose projection resulted in widening of the alar base.

Humans↗
PubMed2000

Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose.

To achieve permanent results for the correction of a drooping nasal tip, it is important to understand the mechanism responsible for the caudal rotation of the tip when a person speaks or smiles. This mechanism can be considered to depend on a "functional unity" formed by three components: (1) the cartilaginous framework (alar cartilages and accessories acting as a single structure); (2) muscular motors (m. levator labii superioris alaeque nasi and depressor septi nasi); and (3) gliding areas (apertura piriformis, the valvular mechanism between the upper lateral cartilages and alar cartilages, the lax tissue of the nasal dorsum, and the membranous septum). We describe a new anatomical and functional concept responsible for the plunging of the nasal tip. When a person smiles, the functional unit is activated by a combination of two forces acting simultaneously in opposite directions that rotate the tip caudally and elevate the nasal base. The levator moves the alar base upward and the depressor pulls the tip caudally. To correct the drooping tip, the transcartilaginous incision is extended laterally, and the lateral portion of the alar arch is dissected free from the skin and the mucosa, thus exposing the accessory cartilages. The arch is then severed at the level of the accessories to allow the cephalad rotation of the domes. The muscle insertions are dissected free from the accessories and a section of the muscle and, if necessary, the accessory cartilages, is removed. From January of 1991 onward, 312 patients have had this ancillary procedure performed in addition to the basic rhinoplasty technique.

Cartilage↗
PubMed2001

Rhinoplasty: large nostril/small tip disproportion.

Surgeons must recognize large nostril/small tip disproportion as a distinct challenge in rhinoplasty surgery. The critical first step is to correctly analyze the intrinsic and extrinsic factors that contribute to the deformity. The nostril axis is drawn between the nostril apices and extended in both directions. It is then subdivided into a nostril and intrinsic tip component. The ratio of nostril to tip should be 55:45; a ratio of 60:40 is acceptable. The surgical solution requires both an increase in intrinsic tip projection by lengthening the infralobular segment and a nostril reduction. The anatomical deformity consists of three components: (1) the alar cartilages are highly divergent, (2) the infralobular segment is quite short, and (3) the domal segment is flat and ill defined. The operative technique advocated by the author combines a three-stitch tip procedure, including an interdomal suture over a straight strut, plus nostril sill/alar wedge resections.

Adult↗
PubMed2006

Alloplastic materials in rhinoplasty.

PURPOSE OF REVIEW: This review examines implant materials currently used in rhinoplasty. In revision cases, the most desirable autogenous grafts from the septum are often unavailable in adequate quantities. The 'ideal' implant has strict requirements concerning biocompatibility, plasticity, stability of form, resistance to infection, and removability. RECENT FINDINGS: Silicone implants continue to be used in spite of frequent reports of rejection. In spite of its described absorption, conserved cartilage can help in preserving profiles. Increasingly, good results are being reported with porous polyethylene, although Proplast is sometimes used in its place. Despite the fact that AlloDerm is partially absorbed, it can still be useful. GoreTex is effective for smaller defects. Mersilene mesh is not absorbed and retains its stability of shape. 'Turkish Delight' (diced cartilage with a wrapping) seems to be absorbed when the wrapping is made of Surgicel, but a wrapping of autogenous fascia provides lasting results. SUMMARY: Several alloplastic materials do have a place in nasal surgery. Provided that the correct techniques are employed, side effects from their use are no greater than the complications resulting from the use of autogenous costal cartilage, with the intervention necessary for its harvesting.

Biocompatible Materials↗
PubMed2003

Augmentation rhinoplasty with dermal graft and review of the literature.

Nasal augmentation required following a trauma or a rhinoplasty operation poses a challenging problem to many plastic surgeons. Currently, allografts and autologous tissues are used for nasal augmentation; however, an ideal technique has not yet been described. Although preferred for augmentation of different parts of the body, pure dermal graft use has not been described for nasal augmentation. The authors performed nasal augmentation using a dermal graft in 90 patients in their hospital between 1994 and 2000, and they followed up the patients for 6 months to 8 years. In this article, the early and late results of dermal grafts for nasal augmentation are presented, and their advantages and disadvantages are discussed with a review of the literature. It was concluded that the easily obtained dermal graft could be an appropriate alternative in nasal augmentation, though it has not been used widely for this purpose.

Adolescent↗
PubMed2003

Secondary rhinoplasty using flying-bird and vestibular tornado incisions for unilateral cleft lip patients.

To correct the nasal deformity in cleft lip patients, a new procedure of open rhinoplasty using a "flying-bird" incision in the nostril tip with a vestibule "tornado"-shaped incision in the cleft side is presented. The newly designed vestibular incision produces effective vestibular advancement with the freed lower lateral cartilage. The flying-bird incision makes it possible to produce a suitable nostril tip appearance with symmetrical external nostril vestibules. If the vestibular defect after flap advancement is wide, a full-thickness skin graft is used to give priority for making a good external nostril shape. This procedure is useful for most cleft lip noses, particularly in cases of moderate to severe deformity.

Adolescent↗
PubMed2004

Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty.

Dorsal hump reduction can create both functional and aesthetic problems if performed incorrectly. Component dorsal hump reduction allows a graduated approach to the correction of the nasal dorsum by emphasizing the integrity of the upper lateral cartilages when performing dorsal reduction. Use of this approach can minimize the need for spreader grafts in primary rhinoplasty patients. Possible untoward sequelae of dorsal hump reduction include long-term dorsal irregularities caused by uneven resection or overresection or underresection of the osseocartilaginous hump irregularity; the inverted-V deformity; and excessive narrowing of the midvault. The component dorsal hump reduction technique is a five-step method: (1) separation of the upper lateral cartilages from the septum, (2) incremental reduction of the septum proper, (3) dorsal bony reduction, (4) verification by palpation, and (5) final modifications (spreader grafts, suturing techniques, osteotomies). A graduated approach is described that offers control and precision at each interval. Fundamental to the final outcome is the protection and formation of strong dorsal aesthetic lines that define the appearance of the dorsum on frontal view. Furthermore, preservation of the transverse portions of the upper lateral cartilages is essential to maintain patency of the internal nasal valve, maintain the shape of the dorsal aesthetic lines, and avoid the inverted-V deformity. Finally, if needed, spreader grafts are enormously adaptable and can be customized for any deformity (unilateral or bilateral, visible or invisible) to handle functional or aesthetic problems.

Adult↗
PubMed2004

Rhinoplasty with advancing age.

Rhinoplasty in the aging patient poses a unique set of challenges to the plastic surgeon. Aging patients usually have different expectations and motivations than their younger counterparts; therefore, open communication and frank discussions are paramount to define realistic goals. Anatomically, changes in skin quality, cartilage characteristics, underlying bony framework, and the nasal airways mandate special considerations to optimize the functional and aesthetic results. This review will present a practical approach to the management of the nose in the aging patient.

Aged↗
PubMed2005

The use of alloplastic materials in secondary rhinoplasties: 32 years of clinical experience.

BACKGROUND: A retrospective evaluation of the authors' 32 years of experience in revision rhinoplasty is presented. The authors suggest that iatrogenic nasal deformities are studied under four groups on the basis of their location and the affected structures: lower third, middle third, upper third, and combined deformities. The authors also present the vertical columellar incision for insertion of alloplastic implants and cartilage grafts, a genuine approach avoiding contamination with the nasal flora. METHODS: A total of 182 cases were studied, as follows: lower third (n = 81), middle third (n = 65), upper third (n = 17), and combined (n = 19) deformities. The mean age of the patients was 40 years. RESULTS: Our follow-up was a minimum of 2 years, and some of the cases with Proplast implants have been followed for as long as 21 years. During this rather long follow-up, only two of the Proplast implants had to be removed (one because of an acute infection and the other because of a chronic infection causing extrusion after 5 years). CONCLUSIONS: The authors have always preferred to use autogenous cartilage grafts for tip deformities and Proplast implants for middle and upper third saddle nose deformities whenever necessary. Their long-term results with Proplast for more than 20 years show that alloplastic materials may be as reliable as autogenous implants if the surgical principles are met and the cases are carefully selected.

Adolescent↗
PubMed1996

A prospective study of the psychological effects of rhinoplasty.

Fifty-three consecutive patients referred for rhinoplasty within the National Health Service by their General Practitioner were evaluated prospectively to determine the psychological impact of this procedure. The patients were independently assessed before surgery, and then 1 week and 4 months after the surgery using the Derogatis Stress Profile, a Self-Esteem Inventory, an Introspectiveness Inventory and a range of questions relating to their expectations of the surgery. Photographs were taken at their initial visit and at 4 months after surgery. These were rated at random order by 28 independent lay people. Pre-operatively, the surgeon also documented his objectives and later assessed how well he had achieved them. Surgical intervention had strong effects in improving self-esteem ratings. These effects became more marked from the first post-operative assessment to those at four months making it likely that this is a real effect of surgery.

Adolescent↗
PubMed1996

The combination of morphine with local anaesthetic in rhinoplasty--no evidence of a peripheral morphine effect.

BACKGROUND: The recognition of a peripheral opioid action has prompted a number of clinical reports demonstrating a prolonged analgesic effect of peripheral opiate. As most studies have used a model of intraarticular instillation of narcotic we examined direct morphine infiltration of the surgical site in a unique clinical model. METHODS: Sixty patients undergoing primary rhinoplasty were entered into this prospective, randomized, double-blind study. Patients received a standard protocol of premedication, intravenous sedation, and nasal block. Two 2 ml syringes containing saline or morphine 3 mg in saline were provided for IM injection and for addition to the local anesthetic (IW, intrawound): Group I (control)-saline IW, saline IM; Group II morphine IW, saline IM; Group III-saline IW, morphine IM. Intraoperative assessments included need for further sedation, need for further local anesthetic, and degree of bleeding. Recovery room analgesic requirements, pain scores, and recall of intraoperative pain were recorded prior to discharge. Followup phone calls at 24 hours recorded home pain scores and analgesic use during the first postoperative day. RESULTS: Significantly more patients in Group II (9/20) required supplemental local anesthetic intraoperatively compared to Group I (2/20) and Group III (0/20). Significantly more patients in Group II (6/20) recalled their surgical experience as painful compared to Group I (1/20) and Group III (1/20). Group II patients also evidenced significantly more operative bleeding. There were no differences in postoperative pain scores, but Group I patients required analgesic in the recovery room significantly more than in Groups II and III (85% vs 45% and 50%, respectively). There were no differences between groups in analgesic consumption at home. CONCLUSIONS: The results of this study indicate that the preoperative injection of intrawound morphine in combination with the local anesthetic both promotes bleeding and has an early pain-enhancing effect while providing no late analgesic benefit beyond that of IM morphine.

Adult↗
PubMed1984

Some preliminary psychological observations on narcissism, the cosmetic rhinoplasty patient and the plastic surgeon.

From the point of view of the clinical psychologist, one important dimension of the psychological experience of the typical cosmetic rhinoplasty (CR) patient that has been underemphasized in the psychological and plastic surgery literature is the patient's narcissism. The author's aim is to facilitate the plastic surgeon's understanding and management of these patients by putting the disparate aspects of their behaviour into a unifying theoretical framework. A total of 41 CR patients from the UK, who had been referred through the National Health Service, were interviewed, psychologically tested and clinically assessed at varying times before and after surgery. A control group of patients undergoing wisdom teeth extractions were also interviewed and tested. The CR patient's narcissism was manifest, for example, in their self-absorption, inadequate self-esteem and fantasies of ideal beauty which was observed in his/her pre- and postoperative behaviour. Some suggestions on the management of the CR patient with narcissistic problems are offered to surgeons and hospital staff in order to maximize the clearly beneficial psychological and behavioural effects of CR.

Adult↗
PubMed1986

Aesthetic rhinoplasty in the non-Caucasian.

The aesthetic goals of rhinoplasty in the non-Caucasian nose are similar to those in the Occidental nose. Successful surgery in such noses requires appreciation of nasal aesthetics, knowledge of anatomic differences, thorough preoperative evaluation and planning, and meticulous attention to detail while performing the operation. Reliable and predictable methods for sculpturing the lobule and augmenting the dorsum of the non-Caucasian nose are discussed.

Asian People↗
PubMed2004

Prevention of hanging columella in open rhinoplasty.

In this article we discuss the anatomy of the nasal base and explain the causes of postoperative hanging columella, distinguishing this entity from similar deformities with which it can be confused. We suggest measures that could be helpful in preventing this deformity. We performed external-approach rhinoplasty with the dome suturing method in 82 consecutive patients (64 women and 18 men) from 17 to 44 years of age (mean age, 22 years). Comparative measurements of the alar-columellar complex were made before and after operation. Among the 48 patients with conventional tip suturing (38 women and 10 men), 19 true hanging columellae were detected. In the 34 patients with a modified dome approximation (26 women and 8 men), no more than 5 cases of true deformity were diagnosed.

Adult↗
PubMed1998

External rhinoplasty approach for extirpation and immediate reconstruction of congenital midline nasal dermoids.

Surgical extirpation is the treatment of choice for nasal dermoids in the pediatric population. Approaches include vertical-dorsal rhinotomy, lateral rhinotomy, transverse rhinotomy, and external rhinoplasty. While short-term results suggest that the last approach is cosmetically most acceptable, the required wide undermining of the nasal tip and dorsum may affect subsequent nasal growth. To assess long-term results, we reviewed our experience with 8 cases encountered over the past 10 years. Modifications of the technique to minimize midline dorsal depression are described.

Adolescent↗
PubMedDate not supplied

Nasofrontal angle changes in rhinoplasty.

In emphasizing changes in the nasal tip, the rhinoplastic surgeon often neglects modifications that should be made in other aspects of the profile. Techniques that advance, retrodisplace, and inferiorly or superiorly displace the nasofrontal angle are discussed, calling attention to this part of the profile. Nasofrontal angle modifications can (1) eliminate certain hazards of tip changing along, (2) make possible effects that cannot be achieved with tip positioning alone, and (3) make rhinoplasty more predictable in certain cases.

Cephalometry↗
PubMed1986

The less-than-satisfactory rhinoplasty: comparison of patient and surgeon satisfaction.

An analysis of patient response to less-than-ideal results in rhinoplasty reveals a marked discrepancy between the way patients react and the way in which surgeons think they would react. We feel that, by showing less-than-ideal results to prospective patients, we may be able to develop a method to predict the degree of dissatisfaction that a patient might show to a result that was less than ideal.

Adolescent↗