Articles on Rhinoplasty
Rhinoplasty continues to be one of the most commonly performed aesthetic surgical procedures. Over the past 25 years, the open approach has increased in popularity and is the focus of this article. The principles for successful rhinoplasty include comprehensive clinical analysis and defining rhinoplasty goals, preoperative consultation and planning, precise operative execution, postoperative management, and critical analysis of one’s results. Systematic nasal analysis is critical to establish the goals of surgery. Techniques to address the nasal dorsum, nasal airway, tip complex, alar rims, and bony vault that provide consistent results are discussed.
A Multivariate Analysis of Nasal Tip Deprojection
Projection of the nasal tip is a complex problem that often mandates attention during rhinoplasty. Occasionally, the goal is to decrease tip projection. Most published solutions to this problem involve division or manipulation of the lower lateral cartilages, although objective data on the efficacy of these techniques are limited. This study reviews a series of rhinoplasties and determines which maneuvers had the greatest effect on tip projection.
Alar rim deformities such as retraction, notching, collapse, and asymmetry are common problems in rhinoplasty patients. Although alar rim deformities may be improved through rhinoplasty, this area is prone to late changes because of scarring of the soft triangles and a paucity of native structural support. The purpose of this study was to analyze the effect of alar contour grafts on primary rhinoplasty.
In 1997, we performed an anatomic study to compare lateral nasal osteotomies using the internal continuous technique and the external perforated technique. Since our original study, several authors have refined the endonasal approach in an attempt to decrease the morbidity.
The objective of this study was to evaluate the spectrum of columella deformities and devise a working classification system based on underlying anatomy. A retrospective study was performed of 100 consecutive patients who presented for primary rhinoplasty. The preoperative basal view photographs for each patient were reviewed to determine whether they possessed ideal columellar aesthetics. Patients who had deformity of their columella were further scrutinized to determine the most likely underlying cause of the subsequent abnormality.
An abundance of surgical procedures are in use for the management of inferior turbinate hypertrophy in rhinoplasty patients. An ideal treatment approach is elusive, given the variability of patient presentation regarding obstructive nasal airway, significant complications associated with techniques that cause mucosal trauma, and the high recurrence rates associated with more conservative techniques. In an effort to improve patient safety, the authors describe a conservative technique – the closed microfracture – that provides an effective functional airway improvement and minimal to no complications. The authors propose a treatment approach for enlarged inferior turbinates based on turbinate subtype.
The purpose of this study was to retrospectively analyze a series of 100 consecutive rhinoplasty cases by the senior author with a specific focus directed toward the effect of the columellar strut on final tip position, namely, tip projection and tip rotation. Medical information and digital images were obtained from 100 consecutive primary rhinoplasty patients. Preoperative and postoperative digital images were compared using a software application that quantitatively analyzed various facial anatomical features, including the nasofrontal angle, the nasolabial angle, tip projection, and tip translation.
Rhinoplasty is one of the most complex and challenging operations in plastic surgery. This complexity is increased among male patients, because male patients tend to have relatively nonspecific complaints, are typically more demanding, and are regarded as being much less attentive during consultations. It is critical for the surgeon to verify that the male patient has realistic goals before he undergoes an operation, and the surgeon must confirm that the male patient has heard and understood all of the risks, benefits, and options. It is essential that masculine features be preserved for male rhinoplasty patients. Excessive dorsal reduction or tip refinement produces unsatisfactory results. A comprehensive discussion of proper evaluation of the male nose, surgical planning, intraoperative techniques, and postoperative treatment is presented.
Decreasing nasal tip projection is occasionally required in rhinoplasty and requires a working knowledge of nasal support and function. Equally important is an understanding of the evolution to a more conservative and incremental approach when decreasing nasal tip projection. Such a conservative approach reserves the most aggressive and precarious maneuvers to be used only when absolutely required. Methods: The authors review the history and evolution of techniques regarding decrease in nasal tip projection. Anatomy of the nasal tip with focus on tip support structures is reviewed.
Excess infratip lobule projection is often the result of deformities of the middle crus and lower lateral cartilage. The causes and correction of excess projection have not been well described. The classification of the deformities causing excess infratip lobule projection is defined and a surgical algorithm for addressing the infratip lobule is presented. A retrospective review of primary rhinoplasties was combined with the use of a cadaver model to identify the causes of excess infratip lobule projection and develop an algorithm for its correction. Specific cases are presented to demonstrate the consistency and predictability of these techniques.