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PubMedDate not supplied

Autologous cartilage graft rhinoplasties.

BACKGROUND: The authors report their experience with autologous graft rhinoplasties. METHODS: Data were collected retrospectively, with selection of only autologous grafts from 2,000 rhinoplasties performed at the Plastic and Reconstructive Department of the University of Rome Tor Vergata. RESULTS: A total of 62 patients from January 1995 to January 2005 were selected. Most of the patients were treated with the "open tip" technique, whereas 9.7% had a classic endonasal approach. Follow-up evaluation was performed with outpatient visits at 2 and 6 weeks, then at 3, 6, and 12 months. Good aesthetic results were obtained for 93.5% of the patients, and 83.7% had complete satisfaction. CONCLUSION: Autologuos cartilage graft rhinoplasty is an affordable technique easy to learn that widens possibilities of interventions for nasal pyramid reconstruction.

Adult↗
PubMedDate not supplied

Use of aerosolized bovine-prepared fibrin glue for skin fixation after primary open rhinoplasty: a prospective randomized and controlled trial.

BACKGROUND: Fibrin glue has been used in diverse areas of plastic surgery. To the authors' knowledge, no clinical controlled trial studies have reported its use for open rhinoplasty. METHODS: A prospective, randomized, masked clinical trial was designed to demonstrate that aerosolized bovine-prepared fibrin glue used in open rhinoplasty controls skin fixation (flap movement), edema, hematomas, ecchymosis, bleeding, and cosmetic results 1 and 12 months postoperatively. The results were reviewed by two blinded plastic surgeons who assessed postoperative photographs using the Strasser score. Other items such as columella scar, pain, surgery/recovery time, and patient satisfaction also were evaluated. RESULTS: A computer system was used to randomize 22 consecutive open primary rhinoplasties. Cosmetic analysis did not differ significantly between the group redraped with fibrin glue and the control group. Patient satisfaction was the only outcome that significantly favored the active group. None of the other items or adverse events significantly differed between the two groups, including operative time and pain. CONCLUSIONS: Fibrin glue is believed to reduce bleeding and to improve the adherence of tissues. The only statistical difference in this study favored the patient satisfaction cosmetic score of the group that received fibrin glue.

Adult↗
PubMedDate not supplied

Effect of aesthetic rhinoplasty on respiratory functions.

Joseph's rhinoplasty operation, with minor modifications, was performed on 20 patients for aesthetic reasons. Various tests of the patient breathing though the nose were carried out both in the preoperative period and 10, 30, and 90 days after surgery. Respiratory-function test results improved in the majority of patients after rhinoplasty. FVC increased in 65% of the cases at day 10, in 85% at day 30, and in 75% at day 90. FEV1 increased in 65% of the cases at day 10, in 65% at day 30, and in 70% at day 90. FEV1/FVC increased in 60% of the cases at day 10, in 65% at day 30, and in 70% at day 90. The only statistically significant increase when compared with preoperative values was the increase in the values of FEV1/FVC at the 30th postoperative day. Decreases in respiratory function test values were insignificant in most of the patients. FEV1/FVC x 100 decreases of more than 10% were seen in three patients, indicating increased nasal resistance, at the 90th postoperative day. However, the lowest value was 50.4 and none of the patients reported subjective nasal obstruction. In conclusion it was observed in this study that properly executed cosmetic rhinoplasty did not have any significant negative effects on respiratory functions in most patients, and improved respiratory functions in most.

Adult↗
PubMedDate not supplied

Ethnic profile of patients undergoing aesthetic rhinoplasty in Stockholm.

During 1985-1995 we performed 640 rhinoplasties in 578 patients. Five hundred eighteen of them were inhabitants of the Province of Stockholm, with a population of 1,708,502. The patients from the Stockholm area were analyzed and divided into subgroups depending on their ethnic origin. It was found that 272 (52%) of them were of Nordic descent, while 248 (48%) were born in and immigrated from non-Scandinavian countries. Among the latter, the largest group were 166 people of Middle Eastern extraction, who generally strived to reduce the size of their noses to the size similar to the average nose of the native Swedes. Middle Easterners were 17 times more prone to undergo aesthetic rhinoplasty than the ethnic Swedes (p < 0.001), whereas immigrants from the other Scandinavian countries had the same rhinoplasty frequency pattern as the natives. In the Slavic group females outnumbered males by the ratio 17:1. The large prevalence of patients of foreign extraction desiring alteration of their noses may reflect the assimilation difficulties and low tolerance of the society in accepting people with a foreign look or name, both in the private sector and in the job market. Psychological aspects of decision making by patients and medico-ethical aspects of decision making by surgeons are discussed.

Age Distribution↗
PubMedDate not supplied

Are rhinoplasty patients potentially mad?

Rhinoplasty patients have long been considered to be psychologically unstable and therefore a "risky" group upon which to operate. Patients who had rhinoplastic operations more than 5 years ago were contacted by post and their psychological health assessed by the use of psychometric tests. The results show no evidence to support earlier suggestions that requests for rhinoplasty may be early symptoms of severe psychiatric disease. However, several points do emerge. Male patients show more symptoms of anxiety and depression than normal, and female patients who give no history of injury preceding their operation behave in a more extrovert and sociable manner than normal. Furthermore, patients of both sexes who give no history of injury before their operation, even though pleased with the operative results, are more self-conscious of their appearance than those who were injured prior to their rhinoplasty.

Adolescent↗
PubMed1993

Rhinoplasty patients revisited.

National Health Service (NHS) rhinoplasty patients have been shown to differ from normal in their performance on psychological tests. In this study the same psychological parameters of two groups of private rhinoplasty patients are documented and compared to that of NHS patients. The two groups of private patients do not differ from each other either in content or in psychological performance. All three groups show consistent differences from normal in their psychological performance. Patients with no history of injury before their rhinoplasty, especially if treated in the NHS, are found to be more psychologically disturbed than other patients. It appears that the NHS is used particularly for treating those with a history of injury, and those with greatest psychological problems.

Adolescent↗
PubMedDate not supplied

Rhinoplasty for the multiply revised nose.

PURPOSE: To evaluate the problems encountered on revising a multiply operated nose and the methods used in correcting such problems. PATIENTS AND METHODS: The study included 50 cases presenting for revision rhinoplasty after having had 2 or more previous rhinoplasties. An external rhinoplasty approach was used in all cases. Simultaneous septal surgery was done whenever indicated. All cases were followed for a mean period of 32 months (range, 1.5-8 years). Evaluation of the surgical result depended on clinical examination, comparison of pre- and postoperative photographs, and degree of patients' satisfaction with their aesthetic and functional outcome. RESULTS: Functionally, 68% suffered nasal obstruction that was mainly caused by septal deviations and nasal valve problems. Aesthetically, the most common deformities of the upper two thirds of the nose included pollybeak (64%), dorsal irregularities (54%), dorsal saddle (44%), and open roof deformity (42%), whereas the deformities of lower third included depressed tip (68%), tip contour irregularities (60%), and overrotated tip (42%). Nasal grafting was necessary in all cases; usually more than 1 type of graft was used in each case. Postoperatively, 79% of the patients, with preoperative nasal obstruction, reported improved breathing; 84% were satisfied with their aesthetic result; and only 8 cases (16%) requested further revision to correct minor deformities. CONCLUSION: Revision of a multiply operated nose is a complex and technically demanding task, yet, in a good percentage of cases, aesthetic as well as functional improvement are still possible.

Adult↗
PubMed2006

Combined use of triple cartilage grafts in secondary rhinoplasty.

UNLABELLED: Secondary rhinoplasty on a patient with a middle vault deformity is one of the most challenging procedures for a plastic surgeon. In order to achieve proper nasal aesthetics and airway function, a surgeon most commonly chooses to engraft the nose with a spreader, dorsal onlay, or columellar graft. This paper examines the aforementioned techniques in the management of 25 patients who presented with a severe middle nasal vault deformity. METHODS: During the last 5 years, 25 patients received secondary rhinoplasty using triple cartilage grafts to repair severe middle vault deformities. Patients were then questioned at least 3 months postoperatively about both airway problems and cosmetic satisfaction. RESULTS: All the 25 patients indicated cosmetic satisfaction with 23 of the patients also achieving complete nasal airway function. Only two patients persisted to have an insufficient nasal airway. An endonasal examination revealed a slight nasal synechiae in one patient, while no anatomic problem was identified in the second patient. From a cosmetic standpoint, a straight dorsum with improved dorsal aesthetic lines and nasal profile, along with nasal-facial balance were achieved. When indicated, secondary rhinoplasty to repair a middle vault deformity using the combination of spreader, dorsal onlay, and columellar grafts to augment the nose has shown to have both functional and cosmetic benefits.

Adolescent↗
PubMed2004

The assessment and treatment of nasal obstruction after rhinoplasty.

Complaints of nasal obstruction after rhinoplasty and nasal surgery are disheartening for both the patient and the surgeon. When a patient presents with complaints of nasal obstruction after rhinoplasty and nasal surgery, the surgeon must reassess the history of symptoms and physical attributes contributing to nasal airway narrowing. The patient's expectations from surgery must also be discussed. The goal is total management of mucosal and anatomic contributors to nasal obstruction. This article describes various causes of nasal obstruction so as to provide rhinoplasty surgeons with the background needed to enhance their preoperative evaluations and avoid future surgical complications.

Combined Modality Therapy↗
PubMed2006

Nasal grafts and implants in revision rhinoplasty.

Problems associated with primary rhinoplasty are often due to overresection of the nasal skeleton. One of the primary goals in revision rhinoplasty is to restore nasal architecture. To do so, the facial plastic surgeon can choose from numerous grafting materials. A key understanding of the benefits and limitations of each implant or graft and implants commonly used in revision rhinoplasty surgery.

Biocompatible Materials↗
PubMed2006

Tip grafts in revision rhinoplasty.

In the patient who undergoes revision rhinoplasty, tip grafts are used often when overresection has resulted in structural deficit of deformity. As a result, the last 20 years have witnessed a progressive movement toward more conservative handling of the nasal tip. Still, as some surgeons have not adopted that philosophy and because many more surgeons have not adopted that philosophy and because many more surgeons now take on difficult primary tip problems because of the advent of the external approach, major tip problems continue to plague the final result. Despite these potential variables, when used correctly, the tip graft is critical in achieving the successful reconstruction of the nasal tip region. This article reviews the indications and techniques for tip grafts in revision rhinoplasty and explores how these indications and techniques for tip grafts in revision rhinoplasty and explores how these indications could be prevented in the primary setting.

Cartilage↗
PubMed2006

Comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using conchal composite grafts.

INTRODUCTION: Anatomical abnormalities and heterogeneous tissue deficiencies of the bilateral cleft lip nasal deformity challenges the cranio-maxillofacial plastic surgeon to create a functional, yet aesthetically pleasing nose. The authors propose a comprehensive rhinoplasty technique to correct the bilateral cleft lip nasal deformity using composite conchal grafts. PATIENTS: Five children with bilateral cleft lip nasal deformities had nasal reconstruction using conchal composite grafts, averaging 5 years in age at time of surgery. Patient follow-up averaged 21 months. METHODS: An open tip rhinoplasty was performed using a 'V' shaped columellar incision. The conchal composite graft was obtained from the lateral aspect of the ear and was used to reconstruct the lateral alar mucosal defects. Conchal cartilage was used as a columellar strut. The columellar skin was closed in a 'V-Y' fashion, giving greater columellar length. RESULTS: Visual inspection confirmed that the cleft lip nasal deformity was improved in all patients. There were no postoperative complications. All patients had complete composite graft take with minimal donor site morbidity and deformity. CONCLUSIONS: This comprehensive rhinoplasty technique improves the abnormalities found in bilateral cleft lip nasal deformity by using the successful aspects of other methods and introducing the composite conchal graft.

Cartilage↗
PubMed2005

The relationship between patient stress and the blood levels of acute phase proteins in rhinoplasty: the report of a prospective study.

OBJECTIVE: This study aims to interrogate the relationship between patient stress and the levels of acute phase proteins (APP) in rhinoplasty. METHODS: Twenty-six primary rhinoplasty patients were asked about the most stressful step of the rhinoplasty process, which were (1) deciding on the operation, (2) waiting in the preoperative room, (3) the first few postoperative hours, and (4) withdrawing the nasal pack, in order beginning from the most stressful one, preoperatively, and then postoperatively. C-reactive protein (CRP), alfa-1-acide glycoprotein (AAG), ceruloplasmin (CER), haptoglobulin (HPT), and alfa-1-antitrypsin (AT) have been studied in blood to detect a relation between the patient stress and the levels of APP. RESULTS: Preoperatively, the "imagined" most stressful step was Step 4 (61.53%). Postoperatively, the "declared" most stressful step was Step 3 (50%). The blood levels of APP matched with the imagined rather than the declared stress. CONCLUSION: Patient stress could be a preoperative issue, which should be eliminated preoperatively. Detailed description of the surgery and some pharmaceutics can inhibit the negative effects of the stressors and have a contribution to patient comfort.

Acute-Phase Proteins↗
PubMed2006

Reducing complications in rhinoplasty.

The dedicated rhinoplasty surgeon continues to acquire throughout his or her career an increasingly detailed understanding of the anatomy and the problems that occur related to rhinoplasty and a growing armamentarium of techniques to achieve improvement or correction. This article out-lines the authors' approach and discusses selected technical problems and approaches to reducing their occurrence. Focusing on the two essential goals-making the patient happy and making this the patient's only nasal surgery-primary rhinoplasty can be a uniquely rewarding experience for the patient and the surgeon.

Constriction, Pathologic↗
PubMed2002

[Cartilaginous grafts in rhinoplasty].

We present a revision of 38 cases operated on for augmentation rhinoplasty from 1992 to 2001, using a cartilaginous graft. 83% of our patients were men and 17% were female. The mean age was 31 years old. In 33 rhinoplasties, the graft was placed in the nasal dorsum; in 4 cases it was placed at the nasal tip and in one case reconstruction of the dorsum and the tip was performed. The most frequently used graft was septal cartilage, in 28 cases. Conchae cartilages were used in 3 cases, lower lateral cartilage in 5 cases, rib cartilage in one, and in another case, septal and lower lateral cartilage were used in the same patient. We stabilized the graft fixing it to the skin with a suture which is removed after a week. We did a postoperative follow-up on 25 of the patients. In terms of patient satisfaction, 12% of them felt that their nasal appearance had improved, 76% felt that there had been a great improvement, and 12% did not notice any change. Only one patient had to be reoperated on because of an overprojection of the graft in the nasal dorsum. We conclude that the use of autologous cartilaginous grafts offers important advantages in rhinoplasty; they are easy to be obtained, easy to mould and with a low index of resorption.

Adolescent↗
PubMed1980

Augmentation rhinoplasty.

A cosmetic rhinoplasty must correct the intrinsic deformities of the nose and leave the facial features balanced and in harmony. Some caucasian noses which create difficult problems for conventional rhinoplasties can be readily dealt with by introducing additional support into part or all of the nose (or at the most, by a combination of augmentation with limited local reduction). Indications for the principle of augmentation in cosmetic rhinoplasty are illustrated by case reports.

Adult↗
PubMed1993

Current trends in rhinoplasty and the nasal airway.

The current trends in rhinoplasty and the nasal airway are discussed. The rhinoplastic ideal is that which is aesthetically pleasing while maintaining or improving the physiologic functions of the nose. It is important for the primary care physician to understand the different aspects of rhinoplasty so that he or she may determine which patients will have success with this surgery. Furthermore, the primary care physician will have a better understanding of what the surgeon tries to achieve with rhinoplasty surgery.

Esthetics↗
PubMed1999

Illusions in rhinoplasty.

A good rhinoplasty surgeon attempts to enhance nasal performance through airway and appearance improvement. The great rhinoplasty surgeon routinely improves not only nasal performance but endeavors to achieve a higher level of overall facial aesthetic enhancement by manipulating the surgical illusions of the face. This cohesive interplay of science between the eyes, cheeks, nose, lips, and chin is known all to well by the master facial plastic surgeon who defines the art of rhinoplasty.

Blepharoplasty↗