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PubMedDate not supplied

Correction of the bony rings during the aesthetic rhinoplasty: apologia of the transpalpebral osteotomy.

It is observed that in many cases of rhinoplasty, the final aesthetic result on the face of patients was not satisfactory. The reason is the persistence of "rings" making a shadow beside the root of the nose. These "rings" seem to be palpebral but are actually made by the frontal process of the maxilla. Osteotomy in rhinoplasties classically involve the nasal bones. However, the osteotomy in our cases is made on the frontal process of the maxilla. This surgical refinement is detailed with regard to a minute palpebral incision, precisely placing the lateral osteotomy on each frontal process of the maxilla, in-fracture and rasping equally. While the osteotomy procedure is well documented in rhinoplasties, the improvement of the patients' final appearance at the root of the nose after rhinoplasty is less clearly established. This report will detail an innovation based on the author's 15-year surgical experience with primary and secondary rhinoplasty. The improved result is remarkable on the final appearance of the nose. Close-up photography demonstrates the anatomy as well as the technique.

Eyelids↗
PubMedDate not supplied

Surgical anatomy of the nose in the elderly: value of conservative rhinoplasty by transoral route.

Functional or aesthetic rhinoplasty is being done later and later in life. It is essential to know the characteristics of morphological ageing of the nose in order to modify surgical techniques. An anatomical study was carried out on 40 fresh cadavers more than 70 years old. All the subjects studied were measured to define the external morphology of the nose. Amongst these 40 subjects, 20 were dissected plane by plane, 10 were operated on by a new conservative rhinoplasty technique utilizing a strictly transoral route and 10 were operated on by a classical rhinoplasty technique. The anatomy of the nose in the elderly subject is characterized by thinner skin, subcutaneous fat infiltrating in the muscles in 50% of cases and the small muscles of the tip of the nose undergoing complete involution. The technique of rhinoplasty described here shows the value of better respecting lesions at the tip of the nose which is particularly fragile in the aged subject. It may be extended to post-traumatic rhinoplasties or to the nose which has already been operated on.

Aged↗
PubMed1999

[Rhinoplasty].

Rhinoplasty is performed in order to correct aesthetic deformities of the nose or to improve nasal breathing. A detailed knowledge of the complex three-dimensional anatomy, familiarity with the various rhinoplasty techniques and a well-developed aesthetic perception are essential for the success of this procedure. The fundamental requisites for rhinoplasty are outlined, i.e. anatomy of the nose, aesthetic considerations, essentials about patient selection, patient history and clinical examination. The main goal of any rhinoplasty is to achieve a nose that appears natural, functions properly, and is in balance and harmony with the other facial features. The 'operated look' should be avoided by all means. The basic techniques to correct some of the most common deformities are illustrated. A discussion of the post-operative management and complications is completing this comprehensive overview of current rhinoplasty procedures.

Contraindications↗
PubMed2003

Rhinoplasty for the Mediterranean nose.

Homogenization of world culture through communications media, refinements in surgical techniques, and improved rhinoplasty results have resulted in a more extended dissemination of rhinoplasty among non-Caucasians. This request has led to increasingly anatomic, morphologic, and anthropometrical studies of the non-Caucasian nose upon which surgical techniques have been proposed and addressed to create in these patients nasal features typical of a Caucasian-looking nose. There are few reports in medical literature concerning rhinoplasty that specifically address particular Caucasian ethnic groups (Anglo-Saxon, Germanic, Latin, and Slavic). Generally included within the Latin group are subjects presenting both paradigmatic nasal morphologies (typically, the classic "Greek," "Roman," and "French" noses) and important cultural differences that greatly influence the subjective perception of the defect and, therefore, the type of change requested. These challenging conditions require a highly "customized" approach, both in the phase of the preoperative planning and in the choice of surgical options. The authors, by means of a photographic analysis systematically used with all their rhinoplasty patients, have identified some archetypes of nasal pyramid configurations that are typical of the reference population (44% Northern Italy, 15% Central Italy, 41% Southern Italy) and, on the basis of a medium/long-term evaluation of the relationship between adopted surgical techniques and results, propose some surgical options that are specific for every nasal archetype. This categorization helps the surgeon carry out a structured preoperative aesthetical analysis and provides him/her with both an anticipation of what findings to expect and the ability to deal with already diagnosed problems. Every archetype shows strong similarities in terms of preoperative analysis, surgical solutions, and subjective perception of the success of the surgery. The surgical options used proved to be apt to modify some paradigmatic defects in a satisfactorily predictable way. Combining the different tesserae of this puzzle to reach the goal of a satisfied patient (and not necessarily a beautiful nose) makes rhinoplasty a true challenge that requires a special talent from the surgeon: combining analysis capabilities, surgical logic, and manual skills with artistic sensitivity.

Adolescent↗
PubMed2006

Combining rhinoplasty with septal perforation repair.

A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting with septal perforations (size 1 to 5 cm) and external nasal deformities. The external rhinoplasty approach was used for all cases and the perforation was repaired using bilateral intranasal mucosal advancement flaps with a connective tissue interposition graft in between. Complete closure of the perforation was achieved in 90% of perforations of size up to 3.5 cm and in only 70% of perforations that were larger than 3.5 cm. Cosmetically, 95% were very satisfied with their aesthetic result. The external rhinoplasty approach proved to be very helpful in the process of septal perforation repair especially in large and posteriorly located perforations and in cases where the caudal septal cartilage was previously resected. Our results show that septal perforation repair can be safely combined with rhinoplasty and that some of the routine rhinoplasty maneuvers, such as medial osteotomies and dorsal lowering, could even facilitate the process of septal perforation repair.

Adult↗
PubMed2002

Aesthetics and the Hispanic rhinoplasty.

OBJECTIVES/HYPOTHESIS: Current aesthetic standards for rhinoplasty have been formulated for an Anglo-American population. Nevertheless, these standards vary, and it is doubtful that these norms are universally applicable to Anglo populations, much less Hispanic ones. STUDY DESIGN: A retrospective study was carried out to determine how the Western norms apply to rhinoplasty populations of Anglo and Hispanic background. The effectiveness of rhinoplasty techniques used in Hispanic rhinoplasty were assessed. METHODS: The open approach was used frequently to augment the nasal skeleton in this population with thick skin. Techniques were primarily aimed at achieving symmetry, straightening the dorsum, and improving projection, since these Hispanic patients were less interested in tip definition or alar base narrowing. RESULTS: Hispanics were significantly more likely to have dorsal humps, saddle deformities, dependent alae, retracted columellae, and poor tip projection. The nasolabial (columellar-labial) angle method of assessing tip rotation was not accurate in the Hispanic population. Tip definition was better in Anglos, and skin thickness and base width were greater among Hispanics. Rhinoplasty can be effective in achieving aesthetic norms: As a group, the Hispanic profile was brought into greater conformity with the aesthetic norms than their Anglo counterparts who did not have surgery. CONCLUSIONS: Thick nasal skin does not adapt well to a small osteocartilaginous framework, and it is better to augment and strengthen the skeleton with cartilage grafts. Even among Anglos, the Western artistic canons are merely guidelines. Good communication with the patient is more important than adhering to aesthetic norms.

Adolescent↗
PubMed2002

Digital photography for rhinoplasty.

Standardized, high-quality, preoperative photographs of the nose are critical for preoperative rhinoplasty planning, comparative postoperative assessment, and demonstration of surgical results. To produce these high-quality, reproducible photographs, it is essential to standardize lighting, to properly position the patient in standard views, to avoid lens distortion, and to maintain consistent camera-to-subject distances. Traditional photographic standards have been well documented in the literature; however, most do not address digital photography, and none address digital photography for rhinoplasty. Certain variables in digital photography that are not present in 35-mm photography can be critical to the appearance of the final image. Variables such as image color and contrast (which usually vary between digital cameras), focal length differences between 35-mm and most digital cameras, the effect of resolution and compression on image quality, and the effect of the printing method used can affect the appearance of the external anatomy of the nose in the final print or image. Lack of detail in the external nasal anatomy becomes an issue if the surgeon uses the photograph intraoperatively for reference, as the authors do. Initially, the authors experienced difficulties with observing subtleties in the tip-defining points and tip anatomy using digital photography when compared with our traditional methods of 35-mm photography. The lack of detail in the external anatomy was most prevalent in the frontal and basal views. Thus, the authors have since tailored their photographic methods to document the rhinoplasty patient to maximize the visual information of the external nasal anatomy in the photographic and the printed image. This article is intended to review the photographic principles for standardized rhinoplasty photography, address the additional considerations necessary when using digital photography, discuss the printing variables that can affect overall quality of the printed image, and discuss the authors' new method of photographing the rhinoplasty patient.

Humans↗
PubMed2002

Extended incision in open-approach rhinoplasty for asians.

The purpose of this study was to introduce an extended incision in open-approach rhinoplasty for obtaining greater satisfaction in aesthetic rhinoplasty for Asians. This incision is the same as for the usual open rhinoplasty incision, but it is extended along the caudal border of the footplates of the medial crura onto the floor of the nasal vestibule to access the footplates of the medial crura more easily. This simple extended incision enabled the authors to achieve further tip projection because the pressure of the skin flap on the tip was reduced. By approximating the lateral curves of the medial crural footplates, the width and the length of the columella were narrowed and lengthened, respectively. The columella was also advanced caudally; thus, the shape of the nostrils could also be elongated. In addition, a cartilage graft or an implant insertion for alar base augmentation could be performed through this extended incision without an additional incision. Another advantage was that in correction of caudal septal deviation, displaced septal cartilage could be repositioned by suturing to the periosteum or soft tissue around the anterior nasal spine without drilling into it through an intraoral incision. Fifty-one consecutive patients who underwent this extended open-approach rhinoplasty between August of 1999 and September of 2000 were included in this study. A total of 40 patients had an adequate follow-up time of over 6 months. Patient satisfaction and postoperative complications were recorded. The majority of the patients (35 of 40) were satisfied with the results of the procedure. Two patients had complications of nostril-scar contracture requiring close follow-up. There were no cases of implant extrusion, displacement, or infection. No patients experienced transcolumellar or extended-incision scarring. Although further studies and longer follow-up are needed to determine the value of this incision, the authors believe that the addition of the extended incision in open-approach rhinoplasty is safe and reliable for effecting better results for Asians.

Cicatrix↗
PubMed2005

Waste not, want not: the use of AlloDerm in secondary rhinoplasty.

BACKGROUND: This article describes the author's successful experience with AlloDerm onlay grafts for the correction of nasal contour deformities in secondary rhinoplasty. AlloDerm is a cadaver dermal filler graft, an off-the-shelf product that is readily available, pliable, and affordable. It is particularly suited for secondary rhinoplasty patients who are graft-depleted. The maximum dorsal augmentation is less than or equal to 3 mm; it is not a support graft. The major indication in this study was dorsal augmentation in the overresected secondary rhinoplasty patient to create a soft, smooth bridge and pleasing dorsal aesthetic lines. METHODS: Twenty-five secondary rhinoplasty patients underwent multiple nasal corrections and were followed for 2 to 8 years. RESULTS: Analysis demonstrated no contour changes between year 1 and year 2, showing the dermal grafts to be stable after 1 year. Long-term follow-up for 2 years or longer showed good results, although partial graft resorption (defined to be < or = 50 percent) occurred in 45 percent of patients. Resorption was most common over the bony dorsum, with approximately 20 to 30 percent of the graft absorbing; over the tip, approximately 10 to 15 percent of the graft absorbed. CONCLUSION: Absorption did not seem to relate to the number of layers used. AlloDerm does not shift. Overall, the experience for nasal augmentation in secondary rhinoplasty was encouraging. Partial absorption, especially over the bony dorsum in a thin-skinned patient, is a definite disadvantage. Complete absorption was not seen in this study. The author has discovered that it is imperative to overcorrect the defect intraoperatively. Regrafting is possible and sometimes necessary.

Adult↗
PubMed2006

Rhinoplasty model in rabbit.

BACKGROUND: Rhinoplasty has become one of the most frequently requested and performed surgical procedures for both functional and aesthetic purposes. As an attention-attracting prominence, even the slightest disfigurement of the nose causes serious disturbance to the patient before or after the operation. Functional problems also cause discomfort. For these reasons, postrhinoplasty complications are regarded as challenging problems for both for the patient and the surgeon. Some cases necessitate grafts for better aesthetic or functional outcome, but there is still controversy over the preference for autogenous or allogenous grafts, both for primary and secondary cases. Evaluation of autogenous and allogenous grafts implanted in the nose is quite challenging for several reasons, including the possibility of unpredictable complications leading to catastrophic disfigurements, the impossibility of obtaining pathologic specimens, and the need for a long follow-up period for stable results. An experimental model for rhinoplasty, fulfilling the need for precise evaluation, was planned and performed after anatomical observation of the noses of rabbits. METHODS: Fifteen adult New Zealand rabbits were used, five for the anatomical evaluation and 10 for the rhinoplasty model. Computed tomographic images and measurements were obtained before and after the surgical processes. RESULTS AND CONCLUSION: This experimental model for rhinoplasty has not been reported in any previous studies. This study demonstrates the surgical anatomy of the rabbit in detail and constitutes a guide for researchers as a convenient experimental model for rhinoplasty, with all stages similar to those performed on humans.

Animals↗
PubMed1994

[Principles of rhinoplasty. THe "Indian" and "Italian" method].

Enumeration of individual methods of rhinoplasty for total reconstruction of the nose does not lay claim to completeness. It is the sole purpose of this review to show that the development of rhinoplasty received its definitive origins about 600 BC ("Indian" method) and in the 15th century AD ("Italian" method). As a result of the need to reconstruct the external nose after its destruction from infectious diseases, injuries or tumors, various methods of rhinoplasty have evolved. As such, the history of reconstructive rhinoplasty is almost identical with that of plastic surgery. Since their introduction, adjacent flaps (Indian method) and distant flaps (Italian method) are still in use at the present time. Although India should be considered the cradle of rhinoplasty, further refinements must be credited to Italian surgeons who undoubtedly knew about the Indian method for rebuilding the nose.

History, 15th Century↗
PubMedDate not supplied

The utility of concurrent rhinoplasty and sinus surgery: a 2-team approach.

OBJECTIVE: To evaluate the safety and efficiency of and patient satisfaction with a 2-team approach for combined rhinoplasty and sinus surgery. METHODS: We conducted a retrospective medical chart analysis of consecutive patients with sinus disease and functional nasal obstruction. Forty-four patients (29 women and 15 men; age range, 22-75 years) had severe nasal obstruction with chronic sinusitis and were found to have indications for this procedure. All patients were followed up for a minimum of 6 months after surgery. Patients completed a standardized questionnaire at the time of medical chart review, and 36 patients completed a telephone interview. RESULTS: All 44 patients underwent rhinoplasty with an endoscopic sinus procedure. Twenty-seven procedures (61%) were endonasal, whereas 17 (39%) were open rhinoplasty. Patients with internal nasal valve collapse underwent 28 butterfly grafts, 6 spreader grafts, and 8 batten grafts. The endoscopic sinus procedures consisted of maxillary antrostomy (30/44 [68%]) and ethmoidectomy (28/44 [63%]). Overall, 20 (65%) of 31 patients reported a postsurgical nasal airway that was significantly improved. Most sinus symptoms were resolved postoperatively, with 25 (71%) of 35 patients describing their improvement as significant. Thirty-two (92%) of 36 patients stated that they would recommend the concurrent procedure. CONCLUSION: Patients presenting with nasal obstruction and chronic sinusitis tolerated combined rhinoplasty and sinus procedures without added morbidity.

Adult↗
PubMed1988

Revision rhinoplasty. Analysis and treatment.

As rhinoplasty becomes an increasingly popular procedure, the aesthetic expectations of both the facial plastic surgeon and the patient become more discriminating. Thus, the number of revision rhinoplasties increases. Of 697 rhinoplasties performed by the senior author (F.M.K.) during a three-year period, 18% of those procedures were revision surgeries. The senior author was the primary surgeon in 53% of those revision cases. This article presents an analysis of 126 consecutive revision rhinoplasty cases from that period, outlining the major deformities in a clinically meaningful system. Treatment of each problem category is discussed and representative cases are shown. The senior author's own revision rate and observations are discussed and compared with those in the medical literature.

Adolescent↗
PubMed1989

Surgical considerations in the open rhinoplasty approach to closure of septal perforations.

Repair of nasoseptal perforations is a difficult problem for the otolaryngologist. Recently, there has been an increased incidence among patients, particularly with the rise in cocaine abuse and trauma. The variety of proposed methods of repair points to the lack of a definitive solution for successful surgical treatment of nasoseptal perforations. Successful septal perforation repairs using an open rhinoplasty approach with bipedicled mucoperichondrial flaps and temporal fascia grafts were achieved in eight of nine patients in a series. Resident otolaryngologists in training were the primary surgeons in all nine patients. The open rhinoplasty approach affords better exposure to the septal perforation than does a closed technique, and it facilitates the elevation of mucoperichondrial flaps on all sides of the perforation. This method also allows the surgeon access to perform a limited concurrent rhinoplasty when indicated. The open rhinoplasty approach is ideally suited for teaching the technique of large septal perforation closure in surgical training programs. The surgical considerations in using this method are discussed.

Cocaine↗
PubMed1993

Perforating osteotomies in rhinoplasty.

While perforating lateral osteotomies have been previously described by other authors, most of the current literature emphasizes only sliding lateral osteotomies. Therefore, we present our experience with 106 consecutive rhinoplasties performed with perforating lateral osteotomies with a minimum 2-year follow-up. The perforating lateral osteotomy technique used in these rhinoplasties is described in detail and is compared with those techniques previously reported for perforating lateral osteotomies in rhinoplasty. Anatomical considerations are discussed. The results with the perforating lateral osteotomy technique have been excellent and are also presented. We think that perforating lateral osteotomies are an important and useful part of the rhinoplasty armamentarium.

Adult↗
PubMedDate not supplied

An adjunctive technique to rhinoplasty of the aging nose.

This report presents a simple, valuable adjunct to rhinoplasty in the specific case of senile elastosis. This type of skin will not contract as in younger individuals, and tip ptosis is quite often a problem in the senile nose. Described is a semilunar skin excision of the nasal dorsum in a large nose undergoing primary or revisionary rhinoplasty. Correction of tip ptosis occurring many years after rhinoplasty or its prevention in large elderly noses undergoing rhinoplasty is presented.

Aged↗
PubMedDate not supplied

Patient satisfaction following rhinoplasty.

This retrospect study was conducted to evaluate patients satisfaction following rhinoplasty. Of the 1,062 patients who had undergone rhinoplasty and received a questionnaire, there were 468 respondents. They rated satisfaction with aesthetic and functional results of the surgery. Four groups were created: Group I comprised all the respondents: 468 patients of which there were 381 (81.4%) females and 87 (18.6%) males; 6.2% of this group was dissatisfied. Group II [373 patients: 301 (80.7%) female and 72 (19.3%) male] was composed of patients who underwent a primary rhinoplasty by the lead author, with or without revision of which 7.5% was not satisfied. Group III [95 patients: 80 (84.2%) female and 15 (15.8%) male] comprised those who underwent the initial rhinoplasty by another surgeon and the secondary procedure by the lead author. The surgery failed to satisfy only 1.1% of this group. Group IV [86 patients: 78 (90.7%) female and 8 (9.3%) male male] underwent initial surgery by the lead author and then required revision surgery. This group exhibited the highest dissatisfaction level (13.6%). This article analyzes the results of the questionnaire in detail. In summary, the percentage of dissatisfied patients in the total population was higher among male patients (12.8%) than among female patients (4.6%).

Adolescent↗
PubMedDate not supplied

Open rhinoplasty through a forked flap incision.

Surgical elongation of the short columella is a challenging problem for the surgeon. Although some flaps from the upper lip are successfully used to correct this deformity on cleft lip patients with a scarred upper lip, these methods cannot be applied to noncleft patients with a smooth upper lip. Distant flaps and composite grafts do not give the best aesthetic results. The use of an external approach for rhinoplasty is preferred by many surgeons, especially for difficult or secondary cases. Most incisions for open rhinoplasty are placed on the columella. This report describes a new incision for open rhinoplasty to be used on patients with a short columella. The incision is a standard forked flap with a columellar base but the legs of the flap extend to the nostril bases instead of to the upper lip. This method was used on eight aesthetic rhinoplasty patients with a short columella between March 1995 and March 1998. The results of the method are discussed.

Adolescent↗