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PubMed2002

Suture algorithm for the broad or bulbous nasal tip.

The history and current status of suture techniques to correct a broad or bulbous nasal tip are reviewed. General principles for suture techniques to control tip shape are discussed; they include leaving an approximately 6-mm-wide lateral crus. The algorithm presented includes four sutures, all of which are not necessary in every case. These sutures include (1) the transdomal suture (to narrow the individual domes), (2) the interdomal suture (to provide symmetry and tip strength and sometimes to narrow the tip complex), (3) the lateral crural mattress suture (to reduce lateral crural convexity), and (4) the columella-septal suture (to prevent tip drop and adjust tip projection). The lateral crural mattress suture is the newest of these sutures. It specifically controls undesirable convexity of the lateral crus. The four-suture algorithm is principally designed for primary open rhinoplasties. However, it is also recommended for secondary rhinoplasties. A minor modification is suggested for use in closed rhinoplasties. The algorithm is intended to reduce the difficulty of determining which of the currently available rhinoplasty sutures are useful and in what order they should be used. Illustrative cases are provided. The advantages and disadvantages of this particular algorithm, compared with others that have been proposed, are also reviewed.

Algorithms↗
PubMed2003

Nasal augmentation with Surgicel-wrapped diced cartilage: a review of 67 consecutive cases.

Cartilage grafting has been used extensively to correct both the functional and aesthetic aspects of the nasal framework. The technique described by Erol ( 105: 2229, 2000) uses Surgicel-wrapped diced cartilage grafts in rhinoplasties. The advantages include its ease of preparation, the large volume of graft substrate available for use, and the avoidance of contour irregularities in the areas of placement. A retrospective case review of 67 consecutive patients who were treated with a Surgicel-wrapped diced cartilage graft as part of an aesthetic and/or functional rhinoplasty, in a 5-year period between 1995 and 2000, was performed in this study. All cases of congenital nasal deformities or deformities caused by trauma or tumors in which the technique was used were excluded. The charts were reviewed to determine demographic variables, the surgical procedures performed, prior operations, the rhinoplasty approach used, and the graft donor and recipient sites. Preoperative and postoperative photographs were examined, and the results were assessed. Data on the donor and recipient sites, complications, and the necessity for revisionary procedures were tabulated. There were two complications, namely, an infection, which resolved with aspiration and oral antibiotic therapy, and a recurrence of a dorsal depression, which necessitated repeated augmentation within 6 months. The technique of using Surgicel-wrapped diced cartilage proved to be effective for the augmentation of various areas of the nose. The complication and revision rates were acceptable and comparable to those of other techniques. Patient satisfaction with the aesthetic results was rated highly, with no reports of graft extrusion or contour irregularities. This technique is recommended for nasal augmentation and contouring for selected rhinoplasty patients.

Adolescent↗
PubMed2004

Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique.

Do perforating lateral osteotomies cause less ecchymosis and edema compared with the popular continuous method? Many studies have demonstrated that perforated osteotomies cause less trauma and periosteal disruption. Numerous investigators have subjectively perceived less postoperative ecchymosis and edema, but no clinical study has compared the perforated methods versus the continuous technique in the same patient. This prospective, randomized, partially blinded study was designed to test the hypothesis that the perforating method causes less postoperative ecchymosis and edema compared with the continuous lateral osteotomy technique. The questions remain: does the type of perforating osteotomy affect the results? Does a percutaneous approach cause more ecchymosis and edema by the access maneuver of piercing the skin? The two perforating lateral nasal osteotomy techniques require the same 2-mm straight osteotome, so any genuine difference in postoperative ecchymosis or edema could only be attributed to the differing surgical approaches. Accordingly, this study also tests whether the external percutaneous perforating osteotomy causes more ecchymosis and edema than the internal transnasal perforating method. Twenty-five consecutive rhinoplasty patients (group A) requiring bilateral osteotomies (50 total lateral osteotomies) were randomized so that each patient received an internal/transnasal perforating lateral osteotomy (2-mm straight chisel) on one side and an internal/transnasal continuous osteotomy (4-mm curved, guarded osteotome) on the other. The next 25 patients studied (group B) received an external/percutaneous perforating lateral osteotomy (same 2-mm straight chisel as used in group A) on one side and the same internal/transnasal continuous osteotomy on the other. The final 25 consecutive rhinoplasty patients (group C) received an external percutaneous perforating lateral osteotomy on one side and an internal transnasal perforating lateral osteotomy on the other. The entry sites for the perforating osteotomies were either external (groups B and C) with a percutaneous skin puncture or intranasal (groups A and C) at the pyriform aperture. All 75 patients (150 total lateral osteotomies) initialed the surgical plan on the Gunter rhinoplasty worksheet, which has been approved by the Institutional Review Board of Abbott-Northwestern Hospital, Minneapolis, Minnesota (study no. 1341-1 M). All patients were evaluated for ecchymosis and edema on the left versus the right side of the face at 2 to 3, 7, and 21 days after the operation. The clinical evaluation was performed by two blinded examiners (clinic registered nurse and the patient with his or her family) and a partially blinded examiner (the surgeon, who did not refresh his memory about the randomization). To compare the two methods in each study (groups A, B, and C) for the six outcomes (edema and ecchymosis at 2 to 3, 7, and 21 days), the authors used an exact binomial test of the null hypothesis that the treatments do not differ. To compare the two methods in each study (groups A, B, and C) using all six outcomes simultaneously, the authors used a permutation test. By both testing methods, the perforating internal method was superior to the continuous technique (group A; p < 0.01 in both tests). Although the perforating external method gave better results than the continuous technique (group B) and the perforating internal method gave better results than the perforating external method (group C), neither of these differences was significant by either testing method. A lateral osteotomy technique should be precise, reproducible, and safe, and it should minimize ecchymosis and edema. Since edema and ecchymosis are comparable regardless of osteotome size, this prospective randomized study confirms the subjective clinical impression that perforating lateral osteotomies with a 2-mm straight osteotome reduce postoperative ecchymosis and edema in rhinoplasty patients compared with the continuous osteotomy (4-mm curved, guarded osteotome). These findings should encourage te the use of perforating osteotomies rather than continuous osteotomies.

Adolescent↗
PubMed2004

Nose surgery: how to prevent a middle vault collapse--a review of 50 patients 3 to 21 years after surgery.

There is a conception, likely a misconception, that when performing a nasal osteotomy with a concomitant dorsal hump removal, the upper lateral cartilages are detached or damaged and, over the long-term, respiratory difficulties result because of a middle vault collapse or interference with the internal nasal valve. A follow-up of 50 patients between 3 and 21 years postoperatively provides evidence that this can be prevented. The vast majority (82 percent) reported they were breathing very well for an average of 6.5 years postoperatively. Of the authors' own 38 primary rhinoplasty patients, only two patients (5 percent) reported respiratory difficulties. The authors are unable to substantiate that either the osteotomy or the dorsal hump removal was responsible. Of the 12 patients who had their primary rhinoplasty performed elsewhere, six (50 percent) reported respiratory difficulties before the secondary rhinoplasty at this clinic. Furthermore, an appreciable improvement in breathing was reported by 66.7 percent of these patients after the secondary rhinoplasty. The authors conclude that their gentle proper surgical technique, combined with a good understanding of nasal physiology (with respect to the septum, inferior turbinates, and external and internal valves), allows them to perform a concomitant dorsal hump removal and osteotomy without interfering with nasal physiology.

Adolescent↗
PubMed2006

Securing nasal tip rotation through suspension suture technique.

BACKGROUND: Multiple techniques have been described to produce tip rotation in rhinoplasty, including the use of sutures, a technique popularized by several authors and shown to be predictable, controllable, and nondestructive. The authors describe a simple procedure for nasal tip rotation with a suture suspension technique through a closed method that allows the nasal tip to be rotated while maintaining its appropriate position. METHODS: In each case, after the authors performed standard rhinoplasty techniques, the osteocartilaginous junction was used as an anchor for their suture suspension technique. This technique requires the use of a guide that positions the sutures across the medial side of both domes of the alar cartilages and osteocartilaginous junction. RESULTS: Between September of 2002 and September of 2004, this technique was used in 30 patients with nasal tip ptosis who requested improvement of this condition. There were 21 primary rhinoplasty and nine secondary rhinoplasty procedures. The results were satisfactory in all of the patients, but four patients had minimal asymmetries of the tip. In the follow-up of these patients, the projection of the nasal tip was maintained long term. CONCLUSION: With this suspension suture technique, the authors were able to maintain the optimal position of the nasal tip, using the osteocartilaginous junction as a pillar to provide long-term stability of the nasal tip.

Adult↗
PubMed1994

The nasal hinge.

It is generally agreed that rhinoplasty is the most challenging procedure performed by the facial plastic surgeon. Mastery of nasal tip maneuvers to alter tip projection, rotation, and lobule refinement is intrinsic to successful rhinoplasty technique. The nasal hinge region comprises the most lateral aspect of the lower lateral cartilage. Its importance is often overlooked. As the foundation of the nasal base, it plays a key role in tip dynamics and can be sculpted to significantly modify projection, rotation, and lobule refinement. One hundred randomly selected rhinoplasty patients were studied with respect to the indications for hinge maneuvers, techniques applied, and resulting affect on tip aesthetics. Clinical results are shown. The applicability of these hinge techniques is compared with other lateral crural techniques. The importance of the hinge region in rhinoplasty dynamics and the necessity of knowledgeably applying surgical maneuvers in this region are discussed.

Adolescent↗
PubMed2000

Mucous cyst of the nasal dorsum.

The case of a 47-year-old patient with a nasal dorsum cyst excised via external rhinoplasty is described. The lesion was diagnosed as a mucous cyst. Only ten cases of mucous cysts on the nasal dorsum have been published to date, all having developed post rhinoplasty. To our knowledge, ours is the first case that is not associated with rhinoplasty. The external rhinoplasty approach permits better exposure and complete excision of the nasal dorsum masses, and offers good esthetic results.

Cysts↗
PubMedDate not supplied

The tongue-in-groove technique in septorhinoplasty. A 10-year experience.

BACKGROUND: Correction of the lower third of the nose is perhaps the most challenging component of performing a rhinoplasty. The tongue-in-groove (TIG) technique provides a method for correcting excess columellar show and maintaining correction of caudal deviation. It is also indicated for controlling nasal tip rotation and projection while preserving the integrity of the lobular cartilaginous complex and may be combined with either the external or endonasal rhinoplasty. It is typically used in combination with other septorhinoplasty maneuvers. The TIG technique consists of a method by which the medial crura are advanced cephaloposteriorly onto the caudal septum into a surgically created space between them. OBJECTIVE: To determine the effectiveness of the TIG technique to aid in correction of columellar show, a deviated caudal septum, and various tip rotation and projection problems. SETTING: Private practices of 2 authors (R.W.H.K., Houston, Tex, and H.M.T.F., Alexandria, Egypt). PATIENTS: The records of 287 patients who underwent TIG rhinoplasties in one private practice from 1989 through early 1999 (n = 203) and in another practice from 1994 through early 1999 (n = 84) were reviewed. MAIN OUTCOME MEASURES: Physician judgment of outcome was based on reduction of columellar show, change in tip rotation or projection, narrowing of the columella, and straightening of a deviated caudal septum as indicated in preoperative and postoperative photographs taken of all but 4 of the 287 patients. Patient judgment of outcome was measured by patient requests for revision and patient comments made during follow-up visits. RESULTS: Of 287 patients, 278 (97%) had satisfactory to excellent results. Only 9 (3%) required revisions related to the TIG technique. Eight of these 9 did not achieve enough reduction of columellar show or adequate rotation or projection. A repeated TIG technique was used in these 8 patients with satisfactory revision results. One of the 9 was overprojected and required revision. Of the 108 patients who had preoperative caudal septal deviation, none needed further surgery. CONCLUSIONS: The TIG technique provides a direct, effective solution to columellar show and is a reliable, reproducible method for achieving predictable tip rotation and projection. Furthermore, when used in conjunction with septoplasty techniques, it helps maintain the correction of a deviated caudal septum.

Adult↗
PubMedDate not supplied

Measuring cosmetic facial plastic surgery outcomes: a pilot study.

OBJECTIVE: To test 4 previously published outcomes instruments (the Facelift Outcomes Evaluation, the Rhinoplasty Outcomes Evaluation, the Blepharoplasty Outcomes Evaluation, and the Skin Rejuvenation Outcomes Evaluation) in terms of their reliability and validity in assessing patient-related outcomes of surgical intervention. DESIGN: A prospective pilot study of 78 patients in 3 similar private cosmetic surgery centers undergoing a total of 100 face-lift, rhinoplasty, blepharoplasty, and skin rejuvenation procedures. Patients were evaluated at 2 preoperative and 1 postoperative time points and the instruments were analyzed with regard to their test-retest reliability, internal consistency, and responsiveness to change. RESULTS: All 4 outcomes instruments had excellent reliability, consistency, and validity scores. Test-retest reliability was 0.74 to 0.83 (Pearson correlation coefficients), internal consistency scores were.83 to.88 (Cronbach alpha), and responsiveness to change was statistically significant for each instrument tested (P< or =.001). In addition, patients experienced significant quality of life improvement, with overall satisfaction increasing on average from 37% to more than 84% after these procedures. CONCLUSIONS: These 4 instruments are reliable and valid and can be used to accurately assess patient-related satisfaction in studies of face-lift, rhinoplasty, blepharoplasty, and skin resurfacing outcomes. These brief questionnaires provide the cosmetic surgeon with quantitative tools to evaluate otherwise subjective and purely qualitative outcomes and are recommended for use in future prospective studies.

Blepharoplasty↗
PubMedDate not supplied

A novel, conformable, rapidly setting nasal splint material: results of a prospective study.

OBJECTIVE: To determine if a fiberglass splint material (3M Scotchcast, St Paul, Minn; Smith & Nephew, Inc, Charlotte, NC) serves as a better nasal cast than Aquaplast (Smith & Nephew, Inc) based on the criteria of total preparation time, ease of use, conformability, adhesion, and patient acceptability. DESIGN: Prospective randomized comparison study with statistical analysis. SETTING: University-based division of a facial plastic surgery private clinic. PATIENTS: Sixteen consecutive patients desiring a functional and aesthetic improvement underwent open structure rhinoplasty with lateral osteotomies. No patients withdrew because of adverse effects. INTERVENTION: Half of the patients were randomized to the study group (fiberglass splint material) and half to the control group (Aquaplast). Each patient was fitted with the appropriate casting material at the conclusion of the rhinoplasty procedure. Data were collected with respect to total preparation time, ease of use, conformability, and adhesion. Each patient was asked to evaluate the cast for level of comfort after 1 week. RESULTS: There were no significant differences between study groups for adhesion (P =.18) and conformability (P =.35). Patient acceptability was good or excellent in both study groups. The fiberglass splint material was significantly easier to use (P<.001) and required less total preparation time (P<.001). The mean total preparation time for the Aquaplast and fiberglass splint materials were, respectively, 7 minutes 32 seconds and 2 minutes 37 seconds. CONCLUSIONS: Compared with the commonly used nasal splinting material Aquaplast, fiberglass splint material is not significantly more adhesive, conformable, or comfortable for the patient. Fiberglass splint material is significantly easier to use and requires less total preparation time than Aquaplast. These differences may provide advantages in the immediate postoperative period and for the long-term success of rhinoplasty surgery.

Female↗
PubMedDate not supplied

Powered instrumentation for nasal bone reduction: advantages and indications.

OBJECTIVE: To evaluate power-assisted bone removal in cosmetic rhinoplasty. DESIGN: Nonrandomized, nonblinded, retrospective evaluation of consecutive case series. SETTING: Academic facial plastic surgery practice. INTERVENTIONS: Power-assisted bone removal in 105 consecutive rhinoplasties requiring nasal bone reduction. MAIN OUTCOME MEASURES: Subjective evaluation by patient and surgeon. RESULTS: Of the 105 patients undergoing power-assisted bone removal, 102 obtained satisfactory refinement of the nasal dorsum after 1 operation. Three patients required surgical revision of the nasal dorsum following power-assisted bony hump reduction. Of these, 2 required surgical revision for delayed bone regrowth, while the remaining patient required surgical treatment of a persistent bony hump. Ultimately, all 105 patients achieved satisfactory surgical results. No other surgical complications were observed. CONCLUSIONS: Power-assisted bone removal is a useful adjunct for bone removal in cosmetic rhinoplasty. This study confirms the previously reported advantages of powered instrumentation for patients with small bony humps or modest bony asymmetries. Moreover, because powered instrumentation is comparatively atraumatic, it may be preferable for use in nasal bones previously weakened by trauma, aging, or prior nasal surgery. Finally, because the powered nasal rasp permits rounding of the bone edges, the characteristic widening associated with flat hump reduction is reduced, and the need for aggressive sidewall infracture is diminished. Complications associated with power-assisted bone removal were rare.

Adult↗
PubMedDate not supplied

The use of fibrin glue in the correction of pollybeak deformity: a preliminary report.

BACKGROUND: Supratip fullness, also known as pollybeak deformity, is one of the most common postoperative complications of rhinoplasty. The deformity can result from many different causes, some of which are related to the surgical technique and can be prevented. Poor redraping of thick, inelastic skin and thick subcutaneous tissues over the reduced cartilaginous framework may result in the creation of a subcutaneous "dead space," leading to the formation of excessive subcutaneous scar and a soft tissue pollybeak in some cases. OBJECTIVE: To evaluate the effectiveness of a homologous fibrin glue (Tisseel; Baxter AG, Vienna, Austria) in the prevention and correction of the soft tissue pollybeak deformity. DESIGN: Prospective study. PATIENTS AND METHODS: Thirty patients were treated with fibrin glue to achieve better adherence of the skin to the underlying skeletal framework. Ten patients had no previous nasal surgery. The remaining 20 patients presented with the complication of pollybeak deformity. In this group, 14 patients had undergone 1 previous surgical procedure, 3 had undergone 3 previous rhinoplasties, and 3 had undergone 4 or more previous procedures. RESULTS: There were no intraoperative or postoperative complications. Follow-up ranged from 2 to 34 months, with all patients achieving successful aesthetic outcomes. CONCLUSION: Fibrin glue is an excellent adjunct to rhinoplasty procedures because it successfully eliminates the dead space that can cause soft tissue pollybeak deformity.

Adult↗
PubMedDate not supplied

The long-term effects of alar base reduction.

OBJECTIVE: To statistically analyze the long-term results of alar base reduction after rhinoplasty. METHODS: Among a consecutive series of 100 rhinoplasty cases, 19 patients required alar base reduction. The mean (SD) follow-up time was 11 (9) months (range, 2 months to 3 years). Using preoperative and postoperative photographs, comparisons were made of the change in the base width (width of base between left and right alar-facial junctions), flare width (width on base view between points of widest alar flare), base height (distance from base to nasal tip on base view), nostril height (distance from base to anterior edge of nostril), and vertical flare (vertical distance from base to the widest alar flare). Notching at the nasal sill was recorded as none, minimal, mild, moderate, and severe. RESULTS: Changes in vertical flare (P<.05) and nostril height (P<.05) were the only significant differences seen in the patients who required alar reduction. No significant change was seen in base width (P=.92), flare width (P=.41), or base height (P=.22). No notching was noted. CONCLUSIONS: It would have been preferable to study patients undergoing alar reduction without concomitant rhinoplasty procedures, but this approach is not practical. To our knowledge, the present study represents the most extensive attempt in the literature to characterize and quantify the postoperative effects of alar base reduction.

Adult↗
PubMed2006

Total skeletal reconstruction of the nasal dorsum.

OBJECTIVE: To review the outcomes of rhinoplasty in patients who underwent full-length dorsal reconstruction. DESIGN: Retrospective review. SETTING: Private-practice facial plastic surgery clinic. Patients Thirty-seven patients in a consecutive series of 1273 rhinoplasty cases. INTERVENTIONS: In all patients, a single high-density porous polyethylene implant was used to span the full length of the nasal bridge as part of their rhinoplasty reconstruction. MAIN OUTCOME MEASURES: Retrospective review of medical charts and preoperative and postoperative photographs to identify any complications, including infection, extrusion, movement, or displacement, and examination of the aesthetic outcome. A telephone survey was performed to assess patient satisfaction regarding the appearance and sensation of the nose. RESULTS: In all cases, the full-length dorsal implant provided a smooth bridge contour without leaving an inverted V deformity or focal irregularities. There were no cases of infection or extrusion. In 2 cases, revision surgery was required to enhance cosmetic outcome. CONCLUSIONS: The high rate of patient acceptance, safety, and success of full-length dorsal reconstruction in providing a natural frontal contour challenges the minimal indications for using this type of reconstruction as opposed to using smaller grafts. As with all alloplasts, long-term follow-up is required.

Adult↗
PubMedDate not supplied

The new anatomical viewpoint of the nose: the interdomal fat pad.

To the plastic surgeon, the nose is one of the most interesting and challenging facial structures and its anatomy is well defined. From the point of view of aesthetic surgery, the nasal tip area is an especially important structural unit, and the most difficult to address in rhinoplasty. The objective of this study was to demonstrate the existence of the nasal interdomal fat pad as a distinct anatomical structure that occupies the interdomal space and is apart from subcutaneous fat. In our study we proved the existence of the interdomal fat pad by histochemical studies and anatomical observations in 88 patients who underwent primary external rhinoplasty and three fresh cadavers. All specimens were examined by hemotoxylen-eosin, Sudan black, and oil red staining, as well as S100 protein immunoreactivity staining. The mass of the interdomal fat pad was greater in patients with bulbous noses and/or divergent alar cartilage than in patients with thin skin. We speculated that the interdomal fat pad may be the major anatomic structure contributing to unexpected results in difficult cases, such as those involving bulbous noses. According to our study, the existence of the interdomal fat pad should be kept in mind during the preoperative planning of rhinoplasty.

Adipose Tissue↗
PubMed2003

Relationship between tip nasal muscles and the short upper lip.

Since 1993 the authors have been using a new approach to the treatment of the muscles intimately related with the nasal tip and the upper lip, today known as dynamic rhinoplasty. With the idea of improving the dorsum-tip-labial relationship, the dynamic rhinoplasty technique is based on performing an intraoral zetaplasty at the labial frenum, allowing the access to the local musculature, represented by the depressor septi nasi muscle and its three fascicles. Next, we perform a subperiosteal undermining of the medial bundles, releasing them from the lower nasal spine, followed by the treatment of the intermedial bundles (which substitute the former by the special kind of plication at the median line, according to the primary characteristics of the upper lip). Initially, we used the new method only for the treatment of negroid nose or for cases of exuberant droopy nasal tip. Today, with improvements in the surgical technique, it is possible to operate on almost any kind of nasolabial combination, including mouth-breather patients and even cases with long upper lip and upright nose tip. Thus, the authors have established a semiotic classification, discussing both surgical indication and technique, and also showing the importance of combining several surgical stages (septoplasty, dynamic rhinoplasty, rhinosculpture, and turbinectomy) involved in each group.

Facial Muscles↗
PubMedDate not supplied

A new approach to smiling deformity: cutting of the superior part of the orbicularis oris.

A diagnosis of an aesthetic smiling deformity, which is functional rather than anatomic, is essential for provision of the best treatment in rhinoplasty. Smiling deformity consists of three elements: (a) the nasal tip tending to retrodisplace and rotate inferiorly; (b) the lower part of the upper lip moving superiorly; and (c) a horizontal groove occurring in the midphiltral area. An active depressor septi and orbicularis muscle can accentuate a drooping nasal tip and shorten the upper lip during smiling. Downward movement of the nasal tip and a sharper nasolabial angle usually are aesthetically unpleasant. During the study period (January 2000 to January 2004), the authors identified 38 patients with smiling deformities, 16 of whom underwent dissection and transposition of the paired depressor septi during rhinoplasty. The remaining 22 patients experienced hyperactivity of both the depressor septi and orbicularis muscles, as diagnosed by a descending nasal tip and a shortened upper lip at animation. These patients underwent a modification of the depressor septi and orbicularis muscles. No relapse was evident up to 2 years postoperatively. Repositioning of the depressor septi nasi muscle improved only mild cases. However, modification of the orbicularis and depressor septi muscles was a valuable adjunct to rhinoplasty for moderate and severe forms of smiling deformity. The new approach for smiling deformity provided an aesthetically pleasant appearance for the patient both at rest and when smiling.

Adult↗
PubMedDate not supplied

Surgical correction of the overgrown columellar labial junction: complementary method.

The overgrown columellar labial junction remains a controversial and neglected aspect of rhinoplasty. The authors encountered this problem in a large number of their patients and found that routine techniques were not sufficient to correct it. They therefore developed a complementary method in rhinoplasty that is safe and easy to handle, with long-lasting, satisfactory results for both the patient and the surgeon. This method has provided not only better stability on the columellar base, but also good aesthetic results. The study involved 43 rhinoplasty patients with a follow-up period of approximately 1.5 years. This report analyzes the surgical anatomy related to the overgrown columellar labial junction. Pre- and postoperative aspects of cases involving overgrown columellar labial junctions and surgical procedures are discussed.

Adult↗