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PubMed1992

External rhinoplasties: indications for use.

The technique, indications and role of external rhinoplasty in nasal surgery are presented. The technique has been utilised in 563 patients with a minimum follow-up of 18 months. The external approach has been especially helpful in the severely twisted nose, secondary rhinoplasty, augmentation rhinoplasty, congenital deformities of the nose, closure of septal perforations and in the teaching and learning of rhinoplasty. In this series there were no reported complications attributable to the external approach.

Adolescent↗
PubMed1995

A retrospective analysis of the results of 218 consecutive rhinoplasties.

In a 7-year period, 218 consecutive rhinoplasties were performed within a joint rhinoplasty service comprising a plastic surgeon and an otorhinolaryngologist. Retrospective analysis of these procedures revealed a minor surgical complication rate of 5%, no major complications and requests for revisional surgery in 10% of patients after primary rhinoplasty by the service. However when patients had not had their first operation by our joint service, the revisional operation rate after our first operation was 19%. These results are discussed in relation to other published series. The data generated should enable more precise preoperative patient counselling and act as a useful baseline for subsequent audit of performance. Specifically, patients should know that after rhinoplasty 1 in 10 patients may request revisional surgery. All trainers and trainees should be aware of such data on their own patients in order that standards be set and enhanced with time.

Adolescent↗
PubMed2004

Computer simulation tool for rhinoplasty planning.

Rhinoplasty is a collection of surgical procedures performed on nose for the purpose of correcting functional and shape deformities. Nose is a facial feature which naturally draws attention during everyday contact. Any operation performed on nose has to blend well with the other facial features of the face. For this reason rhinoplasty is a type of surgery which requires artistic skills from surgeon as well as surgical skills. In this paper we present an artistic simulation tool which manipulates the shape of the nose on the bases of rhinoplasty procedures to be used during the surgery. Unlike other artistic simulation tools which can modify shape with no constraints, this tool simulates the effect of individual operations. Simulation tool can be valuable only if it predicts the outcome of the surgery with accuracy. Ultimately the outcome of the simulation depends largely on the experience of the surgeon. This is also the case with the tool presented in this study, so with experience the tool can be useful for predicting outcome more and more accurately. In this paper, the mechanical model of the nose and tools used for simulation are discussed. The simulation results are compared with actual rhinoplasty results to see the fidelity of the approach. A flowchart of the decision process and how rhinoplastic simulation together with the ideal nose data can be used to aid actual rhinoplastic surgery is given at the end.

Computer Simulation↗
PubMed2004

The evolution of the combined use of endonasal and external columellar approaches to rhinoplasty.

By individualizing rhinoplasty techniques for each patient and incorporating the lessons taught by the long-term follow-up on my rhinoplasty patients over the past 20 years, I have incorporated a blend of the endonasal and external columellar approaches to accomplish the desired aesthetic goals for my patients. By recognizing an increased need of spreader grafts for the midnasal vault, the placement of alar strut grafts to support the lateral crus, the use of alar spanning grafts and more suture grafts in the lobule, and refinement grafts in the nasal lobule, I have increased the use of the external columellar approach to approximately 50% of my rhinoplasties, which involves a significant number of secondary rhinoplasties and primary cases with specific indications. By paying attention to detail and using camouflage cartilage grafting, revision rates in my practice have fallen from approximately 7% to 4%.

Combined Modality Therapy↗
PubMed1989

External rhinoplasty in the tropics.

The thick oily and pigmented skin present in majority of tropical patients makes rhinoplasty challenging surgery. Rhinoplasty by the external approach though gaining increasing acceptance all over the world is yet to gain popularity in this country. Hypertrophied scars are not uncommon in coloured skin and the reluctance to give an external incision for a cosmetic procedure is natural. We started the external rhinoplasty approach with some reservations, however in a series of over seventy cases, no significant problem has been encountered, with the columellar scar. Accurate approximation of the columellar wound is probably a more important factor in wound healing than the skin colour. Our experience of external rhinoplasty is presented.

Adult↗
PubMed1999

The one-stage rhinoplasty septal perforation repair.

A combined septal perforation repair and rhinoplasty was performed in 20 patients (12 males, eight females; age range 16-36, mean age 29.6) presenting with septal perforations (size 1-4 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. The perforation was totally closed in 18 cases (90 per cent) with complete resolution of the pre-operative symptoms occurring in 16 (80 per cent). Cosmetically, 19 cases (95 per cent) were very satisfied with their aesthetic result. The exposure provided by the external approach proved to be very helpful in the process of septal perforation repair. Our results show that septal perforation repair could safely be combined with rhinoplasty and that some of the rhinoplasty manoeuvres used could even facilitate the process of septal perforation repair.

Adolescent↗
PubMed2003

Assessing outcome in aesthetic rhinoplasty.

In the measurement of outcome, rhinoplasty surgery suffers from the lack of easily calculable data such as recurrence rates or survival figures, which are inherent in other branches of the speciality and surgical practice in general. We have reviewed methods utilized for the assessment of outcome following aesthetic rhinoplasty, and have developed an instrument by which a pre- and postoperative assessment of nasal and facial appearance can be made from standard frontal, lateral, basal and oblique photographs, the Rhinoplasty Assessment Scale (Photographic) (RASP). It is our intention that this will act as a template for methodical and standardized photographic assessment of the nose prior to rhinoplasty. This will highlight the changes required and provide a quantitative measure of nasal aesthetics, which will be complimentary to existing measures of subjective patient benefit.

Esthetics↗
PubMed2002

Revision rhinoplasty.

Revision rhinoplasty requires sound judgment by both patient and surgeon. Detailed preoperative assessment facilitates proper patient selection. If the patient is deemed a favorable revision rhinoplasty candidate, both patient and surgeon must agree on the goals for and risks inherent in revision rhinoplasty. Thoughtfulness regarding the degree of aesthetic and functional correction desired by the patient and the corresponding intraoperative techniques required to achieve this correction must be contemplated prior to committing to revision rhinoplasty. Furthermore, the surgeon must feel confident that the surgical demands requested by the patient may be met and satisfaction achieved. A precise preoperative surgical plan minimizes intraoperative misadventures. Options for grafting materials should be discussed and agreed upon by both patient and surgeon preoperatively. Both patient and surgeon commit to long-term postoperative follow-up and the patience necessary for the eventual outcome to be realized.

Biocompatible Materials↗
PubMed2003

Revision rhinoplasty.

Revision rhinoplasty can be one of the most complicated procedures performed by the facial plastic surgeon. As septal cartilage is often not available in revision procedures, grafting material is often needed. This material can come in the form of autogenous bone and cartilage. Allografts also can be used, including mersilene, expanded polytetrafluoroethylene, and porous high-density polyethylene (PHDPE). In this article, emphasis is placed on the senior author's method in evaluating candidates for revision rhinoplasty as well as techniques using PHDPE. In addition, the properties of the more commonly used allografts are described, including the advantages and disadvantages of using each material in revision rhinoplasty procedures. In comparing the various alloplastic materials available, it is shown that PHDPE has properties that make it an excellent implant for revision rhinoplasty.

Biocompatible Materials↗
PubMed2003

Expanded polytetrafluoroethylene implants in rhinoplasty: literature review, operative techniques, and outcome.

Gore-Tex, a form of expanded polytetrafluoroethylene (ePTFE), over the past 30 years has attracted much attention as an alloplast for use in rhinoplasty, both from advocates and opponents of its use. It has many desirable traits as an alloplast implant, but many surgeons harbor hesitation and reluctance for alloplast use in rhinoplasty based on historical data of previous nasal implants. Only when objective data from large series of patients with long-term follow-up become available will such skepticism be resolved. Large series of patients with Gore-Tex implant placement during rhinoplasty are beginning to emerge in the literature. The purpose of this article is twofold. The first is to provide the reader with an up-to-date review of the literature on the host response to polymer implants and, second, of the current indications and operative techniques for use and outcomes of Gore-Tex implants in rhinoplasty.

Biocompatible Materials↗
PubMed2003

Adjustment of subtle postoperative nasal defects: managing the "near-miss" rhinoplasty.

Rhinoplasty entails several steps that affect the appearance and function of the nose in an interrelated way. Occasionally, an excellent result can be marred by a minor imperfection and lead to dissatisfaction of both patient and surgeon. For significant pathology, revision rhinoplasty can be performed safely if the architecture and physiology of the nose are respected. To correct the "near-miss" result, minor corrections can successfully restore the aesthetic result. This can require a different frame of reference and approach and can often be thought of in terms of soft tissue correction. Subcutaneous fibrosis, skin depressions, asymmetries, and deficits can be corrected with minor procedures and techniques not routinely associated with rhinoplasty. We detail several methods that can be used to restore simply and effectively an otherwise excellent rhinoplasty result.

Adult↗
PubMed2005

Rhinoplasty in male patients.

The complexities of rhinoplasty are further emphasized when this operation is undertaken in the male patient, and a growing percentage of the rhinoplasty population comprises men. We review the senior author's approach to rhinoplasty analysis, preoperative consultation, and surgical techniques that have been successfully employed for over 40 years. Specific recommendations and modifications to these techniques are discussed as they relate to the rhinoplasty operation in male patients.

Female↗
PubMed2005

Male revision rhinoplasty: pearls and surgical techniques.

Male revision rhinoplasty surgery is the most difficult and challenging procedure that facial plastic surgeons perform because males usually have thick nasal skin, which is more difficult to re-support and project the nasal tip, and often have high or unrealistic expectations. The primary etiology for the need for male revision rhinoplasty is a primary rhinoplasty with aggressive lower lateral cartilage reduction that causes tip ptosis and loss of projection. The goal to an aesthetically pleasing revision rhinoplasty is to re-create adequate tip projection and an intact strong tripod complex. Following tip reconstruction, the height and width of the dorsum should be set. For male revision nasal surgery, a clear and thorough knowledge of nasal anatomy, function, and surgical techniques is paramount. Having an extensive preoperative discussion including expectations, outcomes, and a detailed list of potential complications with the patient can prevent physician-patient mis-communication. Prior to surgery, review the examination, previous operative summary, photographs, nasal analysis sheet, problem list, and plan and then proceed with the surgical treatment.

Cartilage↗
PubMed2006

Rhinoplasty and concepts of facial beauty.

As American society continues to strive for facial beauty, it is not surprising that cosmetic rhinoplasty ranks among the most commonly performed cosmetic surgical procedures in America. Fueled by a growing acceptance of cosmetic surgery, ever more favorable cosmetic outcomes, and widespread media attention, cosmetic nasal surgery continues to grow in popularity at an unprecedented rate. No longer considered an indulgence reserved for wealthy young women, cosmetic rhinoplasty now transcends all age, gender, socioeconomic, and ethnic classifications. Indeed, cosmetic rhinoplasty is becoming increasingly prevalent worldwide, with growing popularity in Asia, South America, and Europe. As the enthusiasm for rhinoplasty reaches an all-time high, it appears that cosmetic nasal surgery has come of age, and further expansion of its infectious popularity seems inevitable.

Beauty↗
PubMed1995

External rhinoplasty: its role in aesthetic and functional surgery of the nose.

Over the past 25 years external rhinoplasty has become increasingly popular. Some rhinosurgeons recommend its use widely, even in routine cases. In our view, however, the classical endonasal approaches remain the first choice. Open rhinoplasty offers an excellent visualization and therefore facility of precise correction, but causes a larger area of wound and scarring. It should, therefore, be restricted to cases of particular difficulties. In the era of minimal invasive surgery, external rhinoplasty advocated as a standard procedure seems to be a drawback, particularly if the aesthetic problem is the leading one. Every facial plastic surgeon should master closed and external rhinoplasty to be able to decide which approach is the most suitable in each situation from the patient's point of view.

Humans↗
PubMed1987

Psychiatric and psychosocial characteristics of patients accepted for rhinoplasty.

Sixty-four patients undergoing rhinoplasty, consecutively admitted to and operated upon at the Department of Plastic and Reconstructive Surgery, Malmö General Hospital, Sweden, were studied with regard to their medical history, personality, and psychosocial and psychiatric characteristics. Forty patients with a history of nose trauma were compared with 24 patients without such history. The aim of the study was to describe and evaluate background factors, with special regard to psychosocial characteristics that might possibly affect the outcome of rhinoplastic surgery. The trauma patients predominantly described themselves as sthenic, outgoing, self-reliant, insensitive to the opinions of others, and as individuals with a low degree of self-criticism. Their consumption of alcohol was fairly high, and they were often exposed to the risk of accidents with bodily injuries. Their major motive for rhinoplasty was to improve nose breathing. The nontrauma patients were characterized by various symptoms of psychoneurosis and somatic signs of anxiety. Their sensitivity was related to their appearance, and the major motive for rhinoplasty was to become less socially inhibited and to develop their personalities. An inverted factor analysis generally demonstrated that the two groups of patients could be recognized when common response patterns in the preoperative interview formed the basis for the categorization. The psychopathological mechanisms and anticipated adaptation after rhinoplasty are discussed for the two groups of patients.

Adult↗
PubMed1996

Orbital hemorrhage during rhinoplasty.

The most common complication of rhinoplasty is perioperative and postoperative hemorrhage. We present two patients who experienced intraoperative orbital hemorrhage during rhinoplasty. Patients with a history of previous nasal trauma, because of scarring/altered anatomy, may be more prone to this serious complication. A precise and well-placed osteotomy must be done to avoid aberrant anatomy and complications. The proposed mechanism for orbital hemorrhage is shearing or tearing of fibrovascular scar tissue involving the angular vessels during the surgical dissection. Prompt recognition and management of an orbital hemorrhage during or following rhinoplasty is necessary to prevent possible ocular injury and loss of vision. A management algorithm for orbital hemorrhage is presented along with a discussion of surgical techniques to prevent this complication. Surgeons performing rhinoplasty should be cognizant of this type of intraoperative complication along with its medical and surgical management.

Adult↗
PubMed1997

Rhinoplasty as part of gender-confirming surgery in male transsexuals: basic considerations and clinical experience.

Because psychotherapy will not change the profound incongruence between the objective biological sex and subjective gender identity experienced by transsexuals, hormonal and surgical treatment to change the body toward the experienced gender is the only way out of this dilemma. To allow the male-to-female transsexual to pass as a member of this gender in public, rhinoplasty may be as important as genital reassignment surgery. In this paper the surgical considerations on gender-confirming rhinoplasty are presented and discussed. From December 1985 to January 1996, 22 male-to-female transsexuals underwent rhinoplasty at the Department of Plastic and Reconstructive Surgery of the Academisch Ziekenhuis Vrije Universiteit to obtain a less masculine appearance. Although revisional surgery was performed in four patients, all were satisfied with the final result in that they were convinced that their faces had become more feminine. We conclude that in selected patients rhinoplasty may help to create a feminine countenance for male-to-female transsexuals.

Adolescent↗