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PubMed2005

[Observe the dissection of the tunnels of augmentation rhinoplasty under endoscope].

OBJECTIVE: To observe and analyse the dissection of the tunnels in traditional blind operation of augmentation rhinoplasty. METHODS: 11 Cases of augmentation rhinoplasty were collected and be observed by an endoscope as soon as the tunnels were formed during the operations. RESULTS: (1) Some of the tunnels did not go through one layer. (2) The bilateral cartilage separated in the mid-line. (3) There were two blood vessels in the surface of alar cartilage. There were perforating blood vessels in the edge of pyriform aperture. (4) In some cases whose incision were in unilateral alar margin, the tunnel were asymmetric. CONCLUSION: In some cases of traditional blind operation of augmentation rhinoplasty, tunnels were not suitable, they were asymmetric; and there were desmo and septa in the tunnels. Those might be the causes of complications post-op of augmentation rhinoplasty.

Endoscopes↗
PubMed2006

["Mini-rhinoplasty"].

OBJECTIVES: To define the interest of the so called "mini-rhinoplasty" in aesthetic nose surgery and to report the surgical technique. METHOD: The experience of the authors, based on more than 500 mini-rhinoplasty surgical procedures is reported. The surgical procedure such as technical tips are reported. RESULTS: Mini-rhinoplasty procedure is indicated in patients with small deformities, particularly in patients with nasal hump or hyper-projected noses, with no deviation. The nasal tip should be normal or slightly drooping. The surgical technique is safe and reproducible. Surgical aesthetic outcomes are excellent. This technique is also indicated in elderly patients willing a facial rejuvenation. CONCLUSION: Mini-rhinoplasty surgical technique is a minimal invasive procedure with no complication in the postoperative period. The postoperative management of patients undergoing this procedure is of main importance.

Humans↗
PubMed1991

Rhinoplasty and the male patient.

A review of male patients undergoing rhinoplasty indicates a surprising diversity of anatomy and especially skin coverage. When compared with rhinoplasty in the female adolescent, the goal must be more of a "balanced rhinoplasty" rather than a reductive rhinoplasty, and the techniques required are more diverse. Careful screening of patients is essential to eliminate a subgroup of men with severe psychologic obsessions.

Adolescent↗
PubMed1991

Augmentation rhinoplasty: observations on 1200 cases.

Over the past 14 years, from January of 1975 to December of 1988, we have done 1263 aesthetic rhinoplasties using ear cartilage. In the field of augmentation rhinoplasty, many kinds of materials, such as bone, septal cartilage, ear cartilage, and prostheses, were used. In this paper, we limit discussion to our experience with the technique for the augmentation of the nasal dorsum using the ear cartilage and compare this with other materials. Patient ages ranged from 15 to 72 years, with an average of 24 years. Some 95 percent of patients (1199) were female, and only 5 percent (64) were male. Patients were followed for a minimum of 6 months and a maximum of 20 months, with average follow-up only 8 months. Of course, we know that this is a very short follow-up period, but we could not follow patients longer because if they had no complaint about the results at the 6-month visit, they never returned, despite our efforts. Five-hundred and ten of the 1263 patients (40 percent) had been augmented elsewhere, and the silicone prosthesis was already in place. However, 753 patients (60 percent) had no previous operation. For the 510 patients (secondary rhinoplasty patients), too-high or too-large a prosthesis was the largest complaint in number, totaling 378 cases (74 percent), and psychological dissatisfaction, such as pain or an uncomfortable sensation, was the second largest in number, totaling 104 cases (20 percent). For the 753 patients (primary rhinoplasty patients), the main complaint was too-short or too-flat a nose (100 percent).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Open rhinoplasty.

Excellent exposure of the nose is possible using the open rhinoplasty technique. This technique improves surgical control of the maneuvers employed, leading to better surgical results. However, thorough understanding and skill in application of rhinoplasty technique are necessary to acquire these better results. The stigma of the columellar incision is slowly being put to rest, as surgeons, employing the technique relate their satisfaction and their patients' lack of dissatisfaction with the scar. Increasingly, surgeons are utilizing this technique, thereby learning more about rhinoplasty and enhancing the teaching and performance of this art. Acceptance is increasing, even to the point of popularity. Open rhinoplasty has survived its infancy and is enjoying a vigorous growth in North America.

Cicatrix↗
PubMed1987

Postoperative sequelae and complications of rhinoplasty.

This article has overviewed complications of rhinoplasty. Generally, these complications fall into two categories: aesthetic (that is, cosmetic sequelae that may require a revision rhinoplasty) and nonaesthetic. Of the nonaesthetic complications, infection has the widest span of severity. A localized Staphylococcus aureus abscess or Pseudomonas infection of the nose may occur postoperatively. Owing to the proximity of the nose to the cranium, a cavernous sinus thrombosis or basilar meningitis may result. Postoperative toxic-shock syndrome is a rare occurrence that surgeons should be aware of; most cases have occurred with the presence of nasal packing, but a case using only plastic nasal splints has been reported also. Bacteremia seems to be uncommon during rhinoplasty. Infection after rhinoplasty is generally much less frequent than one would expect from an operation in an unsterile field. Antibiotics are frequently utilized electively. Postoperative nasal-periorbital edema and ecchymosis are regarded as unavoidable but may be lessened significantly by postoperative head elevation and cold packs. The possibility of postoperative bleeding must be evaluated by the surgeon preoperatively. This sequela usually occurs either within 72 hours postoperatively or at around 10 days postoperatively. Many different causes exist for chronic postoperative nasal obstruction, from poorly supported nasal valves closing upon inspiration to an enhanced allergic rhinitis leading to chronic nasal mucosal edema. The latter may be treated by injection of steroid into the turbinates. Among aesthetic complications, supratip prominence, saddle deformity, and persistent hump are among the more commonly reported. Supratip prominence--"polly-beak"--can be caused by inadequate reduction of tip cartilaginous or soft-tissue elements, especially in relation to the reduction of the dorsum. An over-reduced dorsum will leave an otherwise normal nasal tip with a relative prominence. An accumulation of blood or a mucous cyst occurring under the skin of the tip will produce a prominence. Poor tip projection, tip ptosis, and alar collapse are the result of overreduction of tip elements. A dislocated alar cartilage can appear as an asymmetric nasal bossa. Saddle-nose deformity occurs after overaggressive bony and/or cartilaginous hump removal. Infractured nasal bones that subsequently drop into the piriform aperture can create a bony saddle. Persistent hump is due to inadequate reduction of a bony or cartilaginous hump. If the septal cartilage reduction is disproportionate to the bony septum reduction, the appearance of either a hump or a saddle is possible.(ABSTRACT TRUNCATED AT 400 WORDS)

Consumer Behavior↗
PubMed1977

Revision rhinoplasty.

Revisionary rhinoplasty is discussed in terms of conceptual organization. Its scope is greater than primary rhinoplasty in that it contains elements of augmentation and reconstruction not seen in the usual primary rhinoplasty. A better general understanding of the relationship of the structural elements to the appearance and the structural elements to the lining is required. Defects encountered in revisionary rhinoplasty reflect the contribution of the three nasal elements, which are the cover, lining, and support. Success depends on accurate evaluation of the distortion produced by each element and their correction. Correction implies maintenance of correct position.

Humans↗
PubMed1996

Rethinking the logic and techniques of primary tip rhinoplasty. A perspective of the evolution of surgery of the nasal tip.

Historically, destructive tip-shaping and positioning techniques, although effective to some degree, have created large numbers of secondary deformities. Tip grafts, necessary in secondary rhinoplasty, have been applied widely in primary rhinoplasty, introducing additional variables and a significant reoperation rate. Nondestructive tip-shaping and positioning techniques offer the surgeon a wider range of alternatives, more control and predictability, and a lower reoperation rate. We are making major changes in the way we think about primary tip rhinoplasty. Most importantly, we are learning (or relearning) that preservation of normal anatomy and structural integrity is a surgical principle epitomized in primary rhinoplasty, and that when we can achieve the desired result using that normal anatomy and preserving its structural integrity, the long-term result is more predictable.

Esthetics↗
PubMed1996

[8-year experience with force vector rhinoplasty by J.B. Tebbetts: comparative results].

The aim of the present work is to make a contribution in resolving the controversy between the traditional and "open" approaches to rhinoseptoplasty. Over these last few years, particularly in the United States, the Rethi technique (1920) has encountered unceasing opposition among those using the "open" approach and those who, on the other hand, assert that they can achieve equivalent results without resorting to the supplementary columellar incision. Since 1989 we have been using the technique proposed by J.B. Tebbetts in 1987 and published in detail in the July, 1994 issue of "Plastic and Reconstructive Surgery". The authors feel that Force Vector Tip Rhinoplasty has been the only true innovation since Joseph (1931). Moreover, because of its content, this technique has exceeded the general term of open rhinoplasty. Indeed, this term is extremely general and simply indicates what surgical route is used. Nevertheless, the access route alone does not justify the choice of technique. On the other hand, what is truly innovative is the particular philosophy and technical aspects of Vector Rhinoplasty. In fact, by adding particular suture points and cartilaginous graft along calculated, extremely precise force lines, it is possible to modify the nasal skeleton. This is achieved with a steady, direct control and without damaging the delicate structures being supported. The term "Optimized Force Vector Tip Rhinoplasty" clearly depicts the concept, not only of a more complex access route; it also underlines the advantages in terms of intraoperative diagnostics, precision in performance and stability in time.

Humans↗
PubMed1998

Steroid use in rhinoplasty: an objective assessment of postoperative edema.

The objective of this study was to measure the effect of a single, preoperative 10 mg dose of dexamethasone on postoperative edema associated with rhinoplasty. This was a randomized, double-blind prospective study conducted in a military academic tertiary referral center. Twenty men, aged 18 to 45 years, were enrolled in the study over 28 months. All 20 men underwent rhinoplasty with osteotomy. Preoperative magnetic resonance imaging scans were obtained on the morning of surgery and postoperative scans were obtained within 48 hours. Postoperative edema was quantified as the difference in soft tissue thickness (mm) between the pre- and postoperative scans. Contrary to our expectations, the rhinoplasty patients who received dexamethasone had increased postoperative edema (p < 0.02) when compared to patients not receiving dexamethasone. This is the first objective, double-blind study that shows an increase in postoperative edema after rhinoplasty with a single preoperative dose of dexamethasone.

Adolescent↗
PubMed1998

Refining osteotomy techniques in rhinoplasty.

OBJECTIVE: This article describes an improved method of osteotomies in rhinoplasty to secure better control of the latitude and depth of the nasofrontal angle and a more natural configuration of the lateral nasal wall with increased stability of the upper lateral cartilages--factors contributing to better function and esthetic results of rhinoplasties. METHOD: This retrospective study was based on over 4000 patients (80% female, 20% male) aged 15 to 72 years, who underwent cosmetic and reconstructive rhinoplasties in a private facial cosmetic surgery centre, in the teaching hospitals of the University of Toronto, and a community hospital in Ontario, Canada. RESULTS: Review of postoperative results took under consideration functional and esthetic outcomes, as recorded in follow-up chart entries, and complete photographic documentation. It reaffirmed that low, curved, lateral osteotomies combined with transverse osteotomies, as presented in this article, increased the control and predictability of functional and esthetic results in rhinoplasty. CONCLUSION: The authors have found this method to be reliable and to reduce the frequency of revisions.

Adolescent↗
PubMed1998

Simultaneous rhinoplasty and maxillomandibular osteotomies: Indications and contraindications.

Functional and esthetic correction of a dentofacial deformity may require not only maxillary or mandibular osteotomies but also a rhinoplasty. Rigid internal fixation makes it possible to perform rhinoplasty and maxillary osteotomies simultaneously. Nevertheless, to plan rhinoplasty correctly it is of paramount importance to predict changes of the nose that will follow osteotomy of the maxilla. The authors present their experience concerning the surgical technique, advantages, and disadvantages of rhinoplasty in combination with orthognathic surgery.

Adult↗
PubMed1998

[External rhinoplasty: a useful approach for a young plastic surgeon].

Among the frequently performed plastic surgery operations, rhinoplasty is the most difficult to obtain consistently good results. It is very challenging for young plastic surgeons to modify the external appearance of the nose and restore or maintain a good airway. The external approach has alleviated some of the problems due to understanding and learning of the rhinoplasty operation. Actually, open rhinoplasty allows better visualization of anatomical deformities and better manipulation of tissues allowing better integration of nasal anatomy and physiology. This paper reviews a personal series of 82 patients operated via an open approach between October 94 and October 97. During the same period, 24 patients were operated via an endonasal or percutaneous approach (osteotomies). Indications, advantages and disadvantages of the open approach are discussed. The various techniques used in this series are described and then critically analyzed. In open rhinoplasty, our present revision rate is 8.5%. In conclusion, the open approach seems to be useful for young rhinoplastic surgeons.

Adolescent↗
PubMedDate not supplied

Nasal tip bossae in rhinoplasty. Etiology, predisposing factors, and management techniques.

OBJECTIVES: To identify preoperative risk factors and surgical techniques that influence the risk of developing postoperative nasal tip bossae in rhinoplasty. A secondary objective was to review the characteristics, management techniques, and outcomes of those study patients with postoperative bossae. DESIGN: Univariate and multivariate analysis carried out in a case series. SETTING: Private facial plastic surgery practice. PATIENTS: All patients who underwent aesthetic nasal surgery that included surgical modification of the nasal tip, and in whom documentation was complete and photographic follow-up was available, were considered eligible. The study group consisted of 875 patients of whom 37 (4.2%) developed bossae postoperatively. MAIN OUTCOME MEASURES: Potential risk factors for postoperative bossae included age, sex, previous nasal surgery, preoperative tip asymmetry, preoperative lobular bifidity, preoperative bossae, skin thickness, surgical tip technique, use of columellar struts, columellar battens, lobular crushed cartilage grafts, and tip shield grafts. RESULTS: In the univariate analysis, females, patients undergoing primary rhinoplasty, younger age groups (12- to 22-year-olds), thin skin, and widened interdomal distance (bifidity) were all noted to have moderate or strong associations with nasal tip bossae. In the multivariate analysis, the younger age group, thin skin, and bifidity were statistically significant and independently associated with nasal tip bossae, independent of the type of tip surgery. In addition, clinically relevant associations were noted in females and patients undergoing primary rhinoplasty. Recognition of risk factors, preventive measures, and treatment methods is recommended.

Adolescent↗
PubMedDate not supplied

The radix graft in cosmetic rhinoplasty.

Experience with rhinoplasty over time has shown that a detailed anatomic analysis of the nose is an essential first step in achieving a successful outcome. Failure to recognize a particular anatomic point preoperatively will often lead to a less than ideal long-term result. Deficiency in the radix is a commonly overlooked abnormality that may be found both in patients undergoing primary rhinoplasty and patients undergoing revision rhinoplasty after an overzealous bony hump removal. Whereas surgeons previously reduced the nasal dorsum down to the level of the radix on a routine basis, recent emphasis on a strong natural profile has focused attention on anatomic deficiency in the radix region. We describe a simple technique for treatment of the deep nasofrontal angle and present patient examples. Autologous cartilage grafts may be fashioned into a "radix graft" and reliably used to augment the region either with a precise pocket approach or without when a precise pocket is not possible, achieving a natural aesthetic result.

Adult↗
PubMedDate not supplied

Quantitative study of nasal tip support and the effect of reconstructive rhinoplasty.

OBJECTIVES: To develop a method to quantify nasal tissue resilience, to establish the normal range for persons without nasal obstruction, and to measure the changes in tissue resilience resulting from standard open rhinoplastic techniques. METHODS: A new device is described that determines nasal tissue resilience. Measurements on the nasal tip were obtained in triplicate at 5 distinct anatomical sites. Normal values (N = 60) were stratified for both sexes into 3 different age groups. Preoperative and postoperative measurements were also obtained in 6 patients who underwent open rhinoplasty for airway obstruction. One patient who underwent intranasal valve repair was included for comparison. All operative patients underwent preoperative and postoperative rhinomanometric measurements. RESULTS: Across all age and sex groups the anterior septal angle is the firmest area of the nasal tip. The mean tissue resilience over the interdomal area and the midcolumella is significantly greater in men than in women. The resilience of the interdomal area exhibits an age effect, with decreasing stiffness over time. The postoperative changes seen correlate well with the placement of structural grafts during rhinoplasty. CONCLUSIONS: Nasal tip support can be quantified. Normative values have been established, which allow one to identify areas of inadequate tip support in persons with nasal obstruction. Alterations in tip support resulting from surgical intervention can be quantified. Open rhinoplasty techniques are an excellent tool to restore deficiencies in nasal tip support.

Adult↗
PubMedDate not supplied

The evolution of open structure rhinoplasty.

Modifications and innovations in open structure rhinoplasty that have occurred as this technique has evolved are discussed. In addition, the philosophy and fundamentals of open structure rhinoplasty are reexamined. A retrospective review of representative patients in a private practice setting was performed. All surgical procedures were conducted in a freestanding private surgery center. The preoperative and long-term results of each patient are compared to demonstrate the effectiveness of the described techniques. The fundamental philosophy of open structure rhinoplasty is the maintenance of the integrity and strength of the nasal skeleton. Modifications of tip grafting techniques, along with additional domal grafting techniques, and a stronger focus on domal suturing techniques result in a softer contour and lack of tip tensions while maintaining structural support.

Cartilage↗
PubMedDate not supplied

The use of preserved autogenous septal cartilage in "touch-up" rhinoplasty.

The management of minor contour irregularities after primary aesthetic rhinoplasty often requires correction of soft tissue defects with autogenous cartilage, allograft materials, xenograft matrix, or alloplasts. Inasmuch as the use of native cartilage requires an additional procedure (and potential donor site morbidity) and alloplast insertion raises the specter of extrusion or cicatrical deformity, the use of preserved autogenous cartilage is an attractive alternative, particularly for minor revision surgery. This study describes the experience and technique of the senior author (P.F.G.) with the use of isopropyl alcohol-preserved autogenous nasal cartilage during revision rhinoplasty in which only minor contour correction is required. When grafts are needed for revision surgery, they are inserted via small intranasal stab incisions into minor irregularities of the tip, alae, and dorsum. This technique eliminates the need for additional surgery to obtain graft material, reduces costs and risks associated with alloplasts, and is particularly useful for minor revision rhinoplasty. Office-based techniques for preserving cartilage are reviewed.

Adolescent↗