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Accurate analysis is the foundation for successful rhinoplasty. A general outline for systematic analysis is presented. The importance of accurate recordkeeping and self-analysis is stressed. Examples illustrate the high points of the article.
Vertical dome division in nasal tip surgery allows for repositioning of tissue with minimal excision. In difficult situations, these techniques will often enable the surgeon to maintain good tip position and appearance without the use of grafts. It is a technique worth the attention and understanding of the conservative rhinoplasty surgeon.
In the profile analysis of the rhinoplasty patient, consideration should be given to adjunctive measures that may enhance the overall appearance of the patient. This article discusses augmentation of the chin and cheekbones with particular emphasis on technique. Refinements in surgery for the nasal alae and base of the nose are explained as adjunctive procedures to improve the proportions of the inferior triangle (base) of the nose.
The rhinoplasty surgeon must convert a mental image into a surgical reality through aesthetics, anatomy, and analysis. This article attempts to provide a reasoned solution to the recurrent difficulty of progressing from image to reality.
During the past 15 years the guest editor has developed new and better procedures for secondary rhinoplasty. These techniques, including ear cartilage grafts, are discussed in this article.
There seems to be a great difference of opinion among rhinoplastic surgeons concerning incisions to gain access to the nasal tip. Some state that the method of exposure is of secondary importance. This author firmly believes that many unsatisfactory results could be avoided if adequate surgical exposure were used for nasal tip surgery. Alar cartilage delivery and external approach rhinoplasty are recommended as the only methods for all cases. These methods are described in detail, and in accordance with the author's conviction that all pre- and postoperative photographs should be published to allow proper assessment, these are provided in selected cases.
Profileplasty is an extension of rhinoplasty. It encompasses the minimal correction of the shape of the nose, correction of the upper and lower jaws, remodelling the contour of the neck as well as the reshaping of the entire neuro- and viscerocranium applying the techniques of craniofacial surgery. While the patient sets the indication, the surgeon acts as a consultant. Beside technical skills in performing a profileplasty, a good sense for harmonious proportions is more important than exact measurements. Rhino- and profileplasty come close to one of the essential goals of plastic surgery. Form, function and appearance of a person may be altered to his advantage without visible scars. Better appearance usually initiates a positive development of the personality.
There is a reluctance amongst plastic surgeons to carry out a rhinoplasty in older patients. It is stated that many of these patients tend to be dissatisfied with their results. The noses of older people are characterized by a loss of skin elasticity often combined with a tendency for the nostrils to collapse. An analysis is made of the patients under our care relating to motives for surgery, indications, techniques, and the results are illustrated.
A personal experience of 1199 cases of secondary rhinoplasty with an analysis of possible mistakes is attempted. Avoidable and partly avoidable complications are listed. The surgical and psychological aspects are discussed and the therapeutic consequences outlined. Typical cases to illustrate these principles are presented.
The external (combination) rhinoplasty approach has gradually gained acceptance as an approach to expose the nasal infrastructure. Its wide exposure has sharpened diagnostic skills by correlating pre-operative clinical impressions with specific anatomic deformities found at surgery. Its wide access has greatly increased as well as simplified the range of surgical maneuvers used in reconstruction. Following a review of the external approach, attention is focused on some of the problem nasal deformities where this approach has been helpful in obtaining good results. Nasal valve obstruction, nasal tip problems, nasal pyramid depression, and the crooked nose are discussed in terms of pathological anatomy and techniques of repair.
External rhinoplasty is considered as the approach of choice in correcting nasal deformity following injury, either accidental or surgical. The advantages of a good exposure, lack of injury to the skin, osteotomies under direct vision, and the accurate placing of grafts giving a good anatomical and physiological correction are discussed. Pictorial demonstration of results is accompanied by drawings showing the nasal pathology as seen through the external approach.
The indications for, advantages, and disadvantages of external rhinoplasty are considered from a pragmatic and philosophic point of view. The results in more than 200 patients are analyzed.
Augmentation rhinoplasty has become a popular plastic operation in Asia. In Korea most surgeons prefer using silicone rubber prosthesis instead of autogenous material. The authors have used the standard shaped silicone prosthesis, boat-shaped and also L-shaped prostheses. The standard shape prosthesis has less extrusion and fixation problems. In over 1,500 cases, there were 357 complications (20.8%). All the complications were due to the silicone prosthesis acting as a foreign body or failure in design of implant or unskillful operative technique. In order to minimise complications, care should be taken to use the proper size of prosthesis, the correct shape of implant and to ensure that there is adequate undermining and meticulous closure technique. To minimise the overlying skin tension at the tip and on the dorsum of the nose, the cutting of the depressor septi nasi muscle and transverse part of the nasalis muscle are recommended. In this review, we report the types and incidence of complications by analysing the cases seen during the past 10 years in our Unit and offer a few solutions to overcome these complications.
Killian's submucous resection of the septum and Cottle's septoplasty are still described in textbooks and journals as alternative methods of treatment for septal deformities. It is the aim of this paper to show that Killian's submucous septal resection and Cottle's "maxilla-premaxilla" approach are only mile stones on the road to the modern plastic surgery of the septum. It is recommended that the names of Killian and Cottle should be dropped, and it would be better to use the terms septoplasty or plastic surgery of the septum, if deformities of the septum should be treated. These techniques also changed the methods of rhinoplasty and lead to functional septorhinoplasty.
A histological study is presented on 18 cartilage grafts, conserved in Merthiolat TM, which had been implanted for reconstruction of the caudal border of the nose for time periods of 1 month up to 11 years. These cartilage graft preparations were compared to non graft cartilage from patients died in an age of 37, 51 and 53 years respectively. Our findings show that cartilage grafts are eroded from the edge by resorption granulations of the host. Besides resorption one case showed purulent chondritis and another one osteoneogenesis. The extent of the erosion and the resorption rate seem to depend strongly on the original quality of the cartilage graft. This is possibly due to degenerative focuses which could be found in all of the natural cartilage preparations. After our opinion these focuses regarded like "loci minoris resistentiae". Therefore cartilage material to be used for rhinoplasty ought to be checked for such degenerative focuses.
Based on contemporary social psychological theory and research, the aesthetic appeal of one's physical appearance can have considerable influence on others--on social attraction, attitudes, attributions, and actions, which in turn can affect one's psychosocial experiences and development. From this perspective, the present controlled experiment represents a modified and extended replication of recent research testing the hypothesis that aesthetic surgeries such as rhinoplasty produce improvements in physical attractiveness that foster more favorable personality attributions by others. The hypothesis was largely supported--for male and female perceivers of patients of both sexes and various ages. The implications and limitations of these findings as well as the directions for further fruitful investigation are discussed.
The function of the nasal muscles in rhinoplasty has not been investigated sufficiently. On this reason electromyographical and neuromyographical investigations were done in a group of rhinoplastics before and immediately after surgery but also at least 8 weeks later on. By performing a conservative technique the initial disturbance of the muscles immediately after surgery disappears in a high percentage and voluntarily movements of the nasal muscles can be observed. Different results are discussed.
Submucosal placement of strips of cartilage along the anterior border of the septum--the spreader graft--has proved to be an effective method for reconstructing the roof of the middle vault. It is recommended in all primary rhinoplasty patients in whom resection of the roof of the upper cartilaginous vault is a necessary part of the surgical plan.