SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The result of secondary rhinoplasties in men must be absolutely natural. The dorsum, the tip's elevation, and the diverse angles that the nose forms with the rest of the face--that is, shape, dimension, and proportion--must be correct. Illustrative cases of the most frequent defects are presented along with ways to prevent them.
Nasal dynamics were studied on 87 patients undergoing rhinoplasty of one zone or two distant nasal zones. Statistical analysis of the result 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 front 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.
Reshaping the nasal tip is the most difficult part of a rhinoplasty, particularly in certain types of nasal tip deformities, such as the recessed tip, the thick-skin tip, the boxy tip, the asymmetrical tip, the thin-skin tip, the bifid tip, the turned-up tip, and the turned-down tip. A new approach is introduced regarding the use of Mersilene tip implants. Guidelines for preoperative evaluation and surgical technique are outlined. The so-called "PEPSI" rule (pocket, experience, positioning, shape and size, and incision) is emphasized. The advantages and disadvantages of the Mersilene tip implant are discussed. The Mersilene implant was used in the tip region in a total of 98 patients, and the results are satisfactory.
23 external rhinoplasties were carried out over a 4-year period between 1986 and 1989. In 19 cases, they related to major malformations or traumatic sequelae requiring a spindle or columella bone graft. In 14 out of these 19 cases, an iliac graft was used. This approach requires a specific technique but it allows an accurate dissection of all the nose structures and grafting under excellent conditions.
The authors study some cases of surgical revision in post traumatic or secondary rhinoplasty. Cartilaginous grafts with temporal superficialis fascia are recommended. The removal of ear cartilage is used by a posterior approach for the concha cartilage associated with a septum or an alar cartilage removal. They describe the Delta graft associating a concha cartilage supported by a prop (auricular or septal) to repair a loss of substance from the middle or lower third of the nasal pyramid.
From 1981 to 1986 the author has used osteotomy technique for corrective rhinoplasty in 15 cases. They were localized depression or deviation of the nose. The depression deformity was treated by osteotomy and elevating by making cuts along the midline of the nose and on each lateral cartilage. Then the dorsum of the nose was repositioned. All 15 cases obtained satisfactory cosmetic result without any complication.
We describe our experience with autogenous septal cartilage onlay grafts for augmentation of the nasal dorsum in primary and secondary rhinoplasty cases. After careful nasofacial analysis, the grafts are custom-shaped into inverted-V-frame, A-frame, or inverted-U-frame grafts, depending on the type and degree of augmentation desired. The dorsal elevation is thus tailored to fit the imperfection at hand, resulting in a smooth, natural-looking nasal contour. The indications for each type of graft are reviewed, and the surgical technique of graft harvesting and carving is detailed and illustrated.
Corrective rhinoplasty may be performed in two ways. With the traditional endonasal approach the incisions are made on the inside of the nose. The open technique uses an incision made on the outside of the nose, in the columella. This affords better insight into the surgical anatomy than the endonasal approach. It is concluded from the literature and from experiences in 80 patients that the advantages of the open technique more than compensate for the (avoidable) risks such as impaired wound healing and an ugly scar.
This study emphasizes motivations and psychological consequences of rhinoplasty on a sample of 207 patients operated by the same surgeon. Four dissatisfaction risk factors that are rather independent from personality are defined to help the surgeon on his decision making. Psychiatrist/surgeon joint working is envisaged in a triangular relation with the patient under risk in order to tackle causes of misfit somehow. The main benefit from this working together is at increasing surgeon's protection within his operating act.
Reviewing 45 cases of augmentation rhinoplasties with bone grafting the authors discuss some technical points and the choices of their indications: donor site, incision, patterns of graft implantation depending on clinical examination which selected the cases where exogenous material from the nose is needed for reconstruction. A columellar support seem to them necessary to correct collapsed noses and in these cases a mortise and tenon joint has been employed. When a pure saddle nose deformity exists, a biomaterial can be used reducing morbidity of an iliac bone graft.
We describe a computerised cephalometric method which allows ideal positioning of the tip of the nose and chin (bone and skin) for use when rhinoplasty is planned.
The tip correction phase in reduction rhinoplasty cannot and must not be performed according to the same protocol in all patients. Simple clinical examination can determine the predominant element in projection of the tip: lateral crus, medial crus, the septum, which may participate to varying degrees in this projection. Precise procedures are performed on the basis of the elements observed on clinical examination.
The rhinoplasty in the old age (55 year old patients and more) presents some particular points of indication and surgical procedure whose are discussed by the author. About five personal cases, the results are analysed in the view of the literature.
The authors describe a simple mean to visualize the several profiles which is possible to perform in the patient who is undergoing rhinoplasty or profiloplasty procedure. Failure in giving a clear opportunity of choice of a profile may lead to misunderstanding between surgeon and patient.
Results of the use of grafts in primary and secondary rhinoplasty are reported, the grafts being either of cartilage (concha auriculae, nasal septum, alar cartilage), bone (mastoid, ilium) or connective tissue (temporal aponeurosis). The distinction is made between modelling grafts of softened cartilage, supporting grafts of non-softened cartilage and mastoid bone, of bone reconstruction and of cartilaginous filling grafts.
The authors describe a study of the labio-columellar region and of the alae of the nose in corrective rhinoplasty excluding malformations. Esthetic characteristics and the anatomical structure of this junctional area between the mobile nose and the facial plane are revealed. Surgical problems are analyzed with study in succession of surgical approaches, maxillo-septal angle, the columella, the maxilla, the muscular layer and the alo-jugal junction. Surgical techniques which can be divided into inferior septoplasties, columelloplasty and labio-columelloplasty have precise indications in accordance with the type of formation of the labio-columellar region. A technique of nostril resection with the absence of damage to and shortening plasty of the muscle layer is described.
This article presents the guest editor's views on basic primary rhinoplasty at this time, and explains changes in techniques during the past 30 years of his practice.
Evaluation of preoperative rhinoplasty patients requires a careful study of overall facial proportions (including the profile relationships of the chin). High-quality photographs and computer analysis can assist the surgeon in this analysis.