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PubMed1999

Treatment of alar cartilage malposition using the cartilage disc graft technique.

Patients with a bifid, cephalically rotated, contour-deformed, bulky, overprojected, pinched-tip, alar-dislocated, and/or alar-tethered nose had primary and secondary rhinoplasties using complete lateral alar cartilage mobilization, modification, and repositioning and the cartilage disc tip-graft technique. This technique avoids the pitfalls of classic in situ subtraction rhinoplasty and provides a better way to correct the nasal shape without causing airway obstruction. This technique was performed in 30 patients in the past 6 years who had primary or secondary rhinoplasties, with satisfactory results.

Adult↗

PubMedDate not supplied

[Reconstruction of nasal tip in combined technique of cartilage disc grafts and onlay graft].

Rhinoplasty is often thought of as the most challenging of all aesthetic procedures. Irregularities of nasal tip implicate decreasing of nasal function and are generally regarded as an unattractive facial feature. The combined operative techniques which required extracorporeal septoplasty, incorporation of cartilage disc graft and onlay graft were performed in nineteen patients. Among the nineteen patients, fifteen had procedure of primary rhinoplasty and in four of them secondary or revised rhinoplasty was made. Indications for this operative technique were in patients with boxy nasal tip, bifid nasal tip, lateral alar tethering with extremely fat or thin nose skin. We emphasize that this technique is very successful with an acceptable percentage of postoperative complications. The tecnique is method of choice for reconstruction of extreme nasal tip irregularities where the usual reconstruction technique does not give satisfactory results.

Adult↗

PubMed2004

[Nasal deviation rectification: a report of 11 cases].

OBJECTIVE: To observe septo-rhinoplasty therapeutic effect on nasal deviation and to introduce the methods of the operation. METHOD: Eleven cases of nasal deviation with deviation of nasal septum should receive a septo-rhinoplasty. RESULT: Eleven cases of nasal deviation patients obtained satisfied curative effect. Nasal deviation and deviation of nasal septum need only one rectification, choosing seven cases neither have complication. CONCLUSION: Nasal deviation patients could be completely rectified by only one septo-rhinoplasty operation, what's more, it isn't limited by the age.

Adolescent↗

PubMed2006

Nasal reconstruction using 20 mg/ml cross-linked hyaluronic acid.

According to American Society for Aesthetic Plastic Surgery (ASAPS), 200,924 people had rhinoplasties in 2005. Patients typically have surgical rhinoplasty to correct unsightly noses resulting from trauma, surgery, or heredity. Several alternatives presently exist for patients considering surgical rhinoplasty. These include injections of botulinum toxins to correct the shape of the nasal tip and the use of various fillers to correct contour and profile defects. This article presents a simple and effective alternative using hyaluronic acid for some patients requiring nasal recontouring. The procedure offers patients the opportunity to avoid the risks and expense associated with surgical correction.

Cosmetic Techniques↗

PubMed1991

Nose and paranasal augmentation: autogenous, fascia, and cartilage.

The up-to-date plastic surgeon should consider using augmentation rhinoplasty with relative frequency. In selected cases, for improving the face integrally, it is desirable to augment the paranasal area. In the author's hands, grafts of cartilage and fascia are the preferred tissues, based on the experience of many years. Fascia can be used alone or combined, and in the last few years we have used it alone quite often. A temporoparietal fascia graft has great versatility in the correction of a number of nasal deformities. A depressed nasal dorsum can be augmented by utilizing fascia grafts. A depressed nasal radix can be corrected successfully by utilizing fascia grafts. Submucosal placement of strips of fascia has proved to be an effective method of reconstructing the roof of the middle cartilaginous vault. For augmenting the nasal dorsum when it is a case of primary rhinoplasty, the author prefers the use of fascia alone, but if the patient is having a secondary rhinoplasty, then the graft of fascia and cartilage combined is preferred.

Cartilage↗

PubMed1989

Post-rhinoplastic nasal obstruction.

Successful rhinoplasty achieves both aesthetic and functional goals. This article outlines the pitfalls that cause postoperative obstruction that can occur during the process of cosmetic rhinoplasty. It is my sincere hope that iatrogenic nasal obstruction can be reduced by awareness of these problems and careful attention and planning. The aspects of rhinoplasty that maintain a balance between aesthetics and functional integrity are specifically described. These techniques can be incorporated into the rhinoplastic repertoire of any surgeon and will improve the results dramatically.

Airway Obstruction↗

PubMed1985

[Development of pressure in the middle ear after nasal operations].

The middle ear pressure was determined by tympanometry on 46 patients (92 middle ears) before and after rhinoplasty. Abnormal tympanograms and pathological negative pressure in the middle ear space was found in about a quarter of all cases. In the first two days after the operation a high negative pressure developed in about 70%. The negative pressure was equalized after the packing was removed and 5 days after the rhinoplasty we found normal middle ear pressure in 94% of patients. Reasons for development of negative intratympanic pressure are discussed. The conclusion from our investigation is that tympanoplasty and rhinoplasty surgery should not be performed on the same day.

Acoustic Impedance Tests↗

PubMed1995

Suture tip plasty.

The three main characteristics of the nasal tip are projection, rotation, and contour. During rhinoplasty the surgeon will strive to preserve or change these characteristics in a predictable fashion, avoiding undesirable sequelae, even after long-term follow-up. Conservation, relocation and augmentation rather than reduction are key principles in modern rhinoplasty, i.e. for obtaining gratifying tip surgery. Interdomal suture, transdomal suture, and lateral crural steal follow these modern principles, while having their clear indications for different nasal tip pathology. All three types of techniques involve (semi-)permanent sutures to change the shape of alar cartilages and can be considered complementary. Based on the same surgical philosophy these three techniques can be captured with the term "suture tip plasty". The objective of this paper is to describe, in a retrospective fashion, a series of 112 patients in whom suture tip plasty has been used as part of the rhinoplasty procedure. The technique proved versatile with predictable results and few manageable complications.

Adolescent↗

PubMed1997

[Interventions for improving the facial profile with osteoinductive bone implants].

Osteoinductive bone allografts (autolyzed, antigen-extracted, allogeneic bone; AAA bone) were implanted in 207 cases. The patients had plastic surgery procedures to improve their profiles and were followed up for a maximum of 72 months. Twenty-two patients had an asymmetric mandible corrected with AAA bone chips. In 14 cases AAA bone implants were used for genioplasties. Forehead defects were reconstructed in 20 patients using AAA bone. Hypoplasia of the midface was corrected in 88 cases by augmentations with AAA bone chips or powder. A total of 63 patients underwent rhinoplasties in which AAA bone chips were used to shape or erect the dorsum nasi. Patient follow-up and reoperations to remove the osteosynthesis material revealed that the AAA bone implants were remodeled in the patients' own bone within several months. Less than 3% of the AAA bone implants were lost due to local infections. Except for rhinoplasties, secondary resorption of the bone allografts was extremely low. However, in cases in which strong tension resulted from scar formation or from lack of soft tissue, considerable resorption was observed, especially when AAA bone was implanted in the nose (25% of the rhinoplasties). On the other hand, this biodynamic behavior protected the implants from soft tissue perforation. In summary, AAA bone implants represent a convenient alternative to bone autografts in recipient beds with strong regenerative capacity. Since they are remodeled into the patient's bone none of the late complications found with alloplastic implants need to be expected.

Adolescent↗

PubMed2003

Use of banked tissue in plastic surgery.

The availability of safe and reliable, banked tissues in India has enabled the use of human bone allografts as a viable alternative to autografts in reconstructive surgery. Lyophilised, irradiated bone grafts were used in 2 cases of rhinoplasty, a case of hemifacial atrophy, and as a chin implant.In the patient with revision rhinoplasty the rib graft was resorbed. The patient with hemifacial atrophy developed seroma and infection in the zygomatic and infraorbital area and the rib graft had to be removed. The graft from the same rib that was placed over the mandible was retained well and incorporated completely. The iliac crest cortico-cancellous grafts did well in the second case of augmentation rhinoplasty and in the augmentation of chin.The primary objective of reconstructive surgery in the treatment of burns, non-healing wounds and pressure sores is to remove the dead tissue and restore the continuity of the skin without delay. Lyophilised, irradiated, human amnion is a temporary biological dressing conveniently available off-the-shelf. It was used in twenty four patients with burns, eight patients with bedsores and six patients with non-healing ulcers mainly on the foot. The total surface areas of burns sustained were from 2% to 40%. The burns ranged from second degree to deep third degree burns. Amnion was not used in patients with infected third degree burns.The amnion provided good biological cover in all the patients. It was easy to handle and apply, and provided pain relief. The duration of healing varied depending on the extent and depth of the wound and the amount of exudate. The superficial bedsores healed with a single application of amnion. Reduced exudate, healthy granulation tissue and enhanced epithelisation were observed following application of amnion.

Journal Article↗

PubMed1984

The improvement of the gummy smile using the implant spacer technique.

A simple technique for correction of a gummy smile by partially transecting the levator labii superioris, the major lip elevator, and decreasing its cephalic excursion using an implant spacer is presented. Results are given for 21 patients, and 3 representative patients are discussed, in whom a silicone implant with maxillary augmentation with concomitant rhinoplasty; cartilage from the nasal septum with concomitant rhinoplasty; and a silicone implant independent of rhinoplasty without maxillary augmentation were utilized.

Adult↗

PubMedDate not supplied

Cost outcomes of facial plastic surgery: regional and temporal trends.

OBJECTIVE: To describe the geographic and temporal trends in cosmetic facial plastic surgery procedure costs and frequency during the last decade and to evaluate factors that may influence changes in the demand for cosmetic procedures. METHODS: A survey sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (ie, face-lift, brow lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. RESULTS: The annual frequency of the aging-face procedures (ie, face-lift, brow lift, and blepharoplasty) have increased 41% over the last decade while rhinoplasties have declined slightly (18%). Each of the procedures studied have increased in cost since 1989; however, only face-lifts have increased at a rate greater than inflation during this period (average surgeon's fees, $3154-$4582). Although the average cost of each of these procedures is stable across US geographic areas, there seem to be fewer aging-face procedures being performed in the East (represented largely by New England and the northeastern states) compared with the Midwest, South, and West (P< or = .03), while rhinoplasty frequency across these regions is essentially unchanged. In addition to variables such as age, years in practice, and degree of marketing, the strongest correlates with increased cosmetic procedure frequency were the costs of these procedures (P< or = .008). CONCLUSIONS: Although the cost and frequency of cosmetic facial plastic surgery procedures continues to rise across the United States, there are interesting differences in these trends between different regions and procedure type during the last decade. There also seems to be an association between increased cost and increased frequency of these cosmetic procedures.

Aged↗

PubMed2001

Management of the cleft lip nasal deformity.

Management of the cleft lip nasal deformity offers a unique and ongoing challenge in facial plastic surgery. Although there has been no consensus regarding the optimal timing and technique for surgical repair of this deformity, the authors have found a three-tiered approach to be satisfactory. This approach involves a primary rhinoplasty performed at the time of the initial cleft lip repair to address reconstruction of the nasal floor and sill, columellar lengthening, repositioning of the alar base, and repositioning of the skin and mucosa of the lower lateral cartilage. Following alveolar bone grafting, an intermediate rhinoplasty is often performed at 6 to 10 years of age through an open approach to correct the cartilaginous lower nasal deformity. A delayed rhinoplasty is then performed in the later teenage years to correct the bony dorsal deformity and the various causes of nasal obstruction.

Cleft Lip↗

PubMedDate not supplied

Correction of the soft tissue pollybeak using triamcinolone injection.

OBJECTIVE: To describe the technique for correction of the soft tissue pollybeak deformity using intralesional injection of triamcinolone acetonide. METHODS: We discuss our philosophy, regimen, and technique for treatment of the soft tissue pollybeak using triamcinolone injection. We include results from a series of 173 patients who underwent rhinoplasty performed by one of us (N.J.P.). RESULTS: Triamcinolone was injected at 1 week after surgery in 127 patients (73%). A second injection was performed in 92 (72%) of the 127 patients at 4 weeks after surgery. One hundred eight (85%) of the 127 patients had an acceptable result, as judged by the surgeon, with good supratip definition. Nineteen (15%) of the 127 patients had a less than optimal result, with residual supratip fullness, as judged by the surgeon. There were no complications caused by triamcinolone injection. CONCLUSIONS: Because revision surgery is difficult and may be associated with complications, intralesional triamcinolone injection is the first-line treatment for the soft tissue pollybeak deformities caused by subdermal scarring. Should intralesional steroid injection fail to satisfactorily treat the deformity, revision rhinoplasty can subsequently be performed.

Adolescent↗

PubMedDate not supplied

Bending of the upper lateral cartilages for nasal valve collapse.

BACKGROUND: As a consequence of removal of the nasal hump, the upper lateral cartilages are separated from the septal cartilage in reductive rhinoplasty. A decrease in the nasal airway cross-sectional area and collapse of the internal nasal valve (INV) are inevitable unless additional surgical measures are taken. OBJECTIVE: To determine the efficacy of the horizontal mattress bending suture in treating patients with nasal valve collapse. METHODS: Each upper lateral cartilage was separately bent to a certain degree with a horizontal mattress suture following nasal dorsum reduction in the external septorhinoplasty as a preventive or corrective measure for the INV stenosis. The efficacy of this suture was assessed in 28 patients who presented with tension nose by comparing the INV angles preoperatively and 12 months postoperatively, as determined photographically by means of a rigid nasal endoscope. RESULTS: The mean +/- SD preoperative INV angle was calculated as 9.1 degrees +/- 4.2 degrees (range, 0 degrees -18.3 degrees ). The mean postoperative INV angle was increased to 25.3 degrees +/- 3.8 degrees (range, 18.4 degrees -34.5 degrees ) (P<.001). CONCLUSIONS: This method reconstitutes the normal anatomy of the INV, reestablishes stiffness or resistance of the nasal side walls so that they do not bend inwardly with inspiration, improves the airflow at this area, and avoids postoperative nasal valve stenosis in functional-cosmetic rhinoplasty cases that require considerable nasal hump reduction.

Adolescent↗

PubMedDate not supplied

Cleft lip nasal reconstruction using porous high-density polyethylene.

BACKGROUND: The multitude of factors involved with a unilateral cleft lip nasal defect has spurred various surgical techniques in the past. Recently, synthetic materials have been introduced for use in nasal reconstruction. OBJECTIVE: To report on and illustrate the use of porous high-density polyethylene implants in cleft lip nasal reconstruction. DESIGN: A retrospective review of cleft lip nasal reconstruction using porous high-density polyethylene in patients with a unilateral cleft lip defect from January 1, 1993, through June 30, 2000. SETTING: Facial plastic surgery private practice. PATIENTS: Eighteen patients with a unilateral cleft lip without a history of formal rhinoplasty. INTERVENTIONS: All 18 patients required multiple implants, including a columellar strut, premaxillary and prealveolar plumper grafts, a dorsal tip implant, and a unilateral nasal valve batten, using the open rhinoplasty approach. RESULTS: Favorable aesthetic results, as judged by one of us (T.R.), were achieved in all patients. All implants were well tolerated. Postoperative follow-up ranged from 6 months to 7 years. A complication occurred in 1 patient (6%), which resolved with removal of a single implant and intravenous antibiotic therapy. No other complications, including skin erosion or implant extrusion, have been noted. CONCLUSIONS: Porous high-density polyethylene implants for cleft lip nasal reconstruction are well tolerated and achieve good aesthetic results. Porous high-density polyethylene implants lend stability through fibrovascular ingrowth, with integration of the implants to the surrounding tissue.

Cleft Lip↗

PubMedDate not supplied

Diagnosis and surgical management of the caudal excess nasal deformity.

Surgical correction of the overgrown columella-labial junction remains a controversial and neglected aspect of cosmetic rhinoplasty. Failure to reduce an obtuse nasolabial angle resulting from overgrowth of the septum and/or nasal spine may adversely affect the otherwise satisfactory cosmetic result. I review the historical considerations regarding caudal overgrowth and discuss its relevance to contemporary rhinoplasty. Case studies are presented to illustrate surgical treatment options for various overgrowth deformities.

Adult↗

PubMedDate not supplied

New concepts in nasal tip contouring.

Control of nasal tip contour has always been a key component of a successful rhinoplasty. Typically, this procedure is performed with an emphasis on narrowing the nasal tip structure. Creating a natural-appearing nasal tip contour is a complex task and requires a 3-dimensional approach. In an effort to identify the characteristics that make an ideal nasal tip, I evaluated numerous aesthetically pleasing nasal tips. After extensive study, I created a series of images to demonstrate how specific contours create highlights and shadows that will help guide the surgeon in creating a natural-appearing nasal tip contour. Many commonly used nasal tip techniques can pinch the tip structures if an overemphasis is placed on narrowing. These changes isolate the dome region of the nasal tip and can create an undesirable shadow between the tip lobule and alar lobule. Prior to contouring the nasal tip, the surgeon must stabilize the base of the nose with a columellar strut, suturing the medial crura to a long caudal septum, caudal extension graft, or an extended columellar strut graft. Stabilizing the nasal base will ensure that tip projection is maintained postoperatively. To contour the nasal tip, dome sutures are frequently used to flatten the lateral crura and eliminate tip bulbosity. Placement of dome sutures can deform the lateral crura and displace the caudal margin of the lateral crura well below the cephalic margin. This can result in a pinched nasal tip with the characteristic demarcation between the tip and the alar lobule. Alar rim grafts can be used to support the alar margin and create a defined ridge that extends from the tip lobule to the alar lobule. This form of restructuring can create a natural-appearing nasal tip contour with a horizontal tip orientation continuing out to the alar lobule. When dome sutures alone are inadequate, lateral crural strut grafts are used to eliminate convexity and prevent deformity of the lateral crura. Shield tip grafts can be used in patients with thick skin and an underprojected nasal tip. Whenever a shield tip graft is used, it must be appropriately camouflaged to avoid undesirable visualization of the graft as the postoperative edema subsides. When contouring the nasal tip, the surgeon should focus more on creating favorable shadows and highlights and less on narrowing. Nasal tips contoured in this manner will look more natural and will better withstand the forces of scar contracture that can negatively affect rhinoplasty outcomes.

Cartilage↗