Nasal Tip Deprojection- An Incremental Approach (original) (raw)
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Aesthetic Surgery Journal, 2010
Beauty is a characteristic associated with a perceptual experience of pleasure, meaning, and satisfaction. 1 Objectively, it is difficult to define but may be characterized by a combination of factors existing in symmetry with one another. Rhinoplasty surgeons in particular must develop an understanding of the relationships, measurements, and symmetrical proportions that result in an attractive or aesthetically pleasing face; this provides them with the ability to assess facial characteristics that are outside what is considered to be the normal range. Successful rhinoplasty is dependent on a thorough knowledge of facial anatomy, a deep understanding of nasal-facial relationships, and an artistic sense of aesthetic judgment. 2 Attaining consistently superior results in rhinoplasty is challenging due to the complex relationship of nasal anatomic structures and the variety of techniques available to alter them. 3 Effective control and refinement of the nasal tip contour is an integral component of the rhinoplasty operation. One of the most frequent presenting complaints from rhinoplasty patients is an excessively wide or bulbous tip. In other cases, patients may be aware only that disharmony exists within their facial proportions, without being able to effectively articulate exactly what is
Gradual approach to refinement of the nasal tip: surgical results
Brazilian journal of otorhinolaryngology
The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty. To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure. Longitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; (7) replacement of lower lateral cartilages. Group 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occu...
Deprojecting the nasal profile
Otolaryngologic clinics of North America, 1999
The nose is the most prominent aesthetic feature of the facial profile. Nasal length, tip rotation, and tip projection are integral aspects in analysis of the nasal profile. In most rhinoplasties the surgeon has the difficult task of increasing or maintaining tip projection of an underprojected or normally projected nasal tip. Less commonly, the rhinoplastic surgeon is presented with an overprojected nasal tip, and efforts are focused on deprojecting the nasal profile. In this article, the authors present a discussion of the overprojected tip, elucidating strategies of analysis, etiologies, and management of the nasal profile and give clinical examples.
Objective Assessment of Tip Projection and the Nasolabial Angle in Rhinoplasty
Archives of Facial Plastic Surgery, 2004
To provide an objective method to measure the extent of nasal tip projection and the nasolabial angle. Design: We retrospectively studied preoperative and postoperative images using a novel approach. The constant position of the cornea in lateral views and the diameter of the iris in frontal views were used to standardize and compare digitalized images of patients before and after surgery. We tested this objective assessment technique using the digitized slides of patients with saddle nose deformities and measured changes in their nasal tip projection and nasolabial angle. We included 63 patients who had undergone an open rhinoplasty with the I-beam technique by the same surgeon over a 7-year period. We tested the reproducibility of these measurements with 10 independent investigators. We also determined whether the measurements using this objective technique correlated with the surgeon's or patients' subjective assessments of the outcome.
All Around the Nose, 2019
The foundation and support of the nasal tip are based on the shape, strength, and location of the lower lateral cartilages (LLC) as well as their association with the ligaments. In addition, the nasal tip is supported by the upper lateral nostril cartilage, septum, base, and pyriform aperture. Before surgery, an examination may shed light on nasal tip deformities, including primary and/or other imbalances. Iatrogenic injury to the nasal tip may reduce structural support. In addition, cephalic pruning of the LLCs, resection, dorsal reduction, nasal incisions, and/or base resections may contribute to a significant loss in tip protrusion. Open rhinoplasty may also result in tip diminution upon soft tissue disruption. The approach is important to surgically expose the skeletal structures. Open or closed surgical methods are useful for tip rhinoplasty. The selection is strategic and is based on the difficulty and the surgeon’s expertise. Non-delivery or delivery approaches are achieved. ...
Clinical evaluation of safety and complications of the nasal tip defatting in rhinoplasty
2018
Objective: Nasal tip refinement is an important objective in aesthetic rhinoplasty and one of the surgical options for soft tissue management in very thick bulbous skin and subcutaneous noses is tip defatting. The aim of this study was to evaluate the safety and complications of tip defatting in thick skin and bulbous noses. Methods: Among 527 patients that underwent rhinoplasty in Modaress hospital between February 2011 and January 2014, nasal tip defatting were performed in 162 of these patients. Intraoperatively and in follow up examinations, any signs of skin congestion, ischemia, hematoma, and skin quality evaluated. Results: Among 162 patients who had performed tip defatting [39 (24.1%) male patients and 123 (75.9%) female], complications were skin congestion in 6 patients (3.7%), ecchymosis in 10 patient (6.1%). There were no cases of skin necrosis, skin perforations or skin irregularity. Conclusion: Our study and many previous studies show that tip defatting in associatio...
A new approach for the refinement of the very broad nasal tip
British Journal of Plastic Surgery, 1991
Refining the very broad nasal tip has been difficult to achieve with a single technique. Operations described often violate the domes and may result in visible irregularities and collapse of the ala. Adequate narrowing can be obtained by decreasing the angle between mediai and lateral crura of the ala cartilage at the dome and decreasing the overall length of the ala cartilage. This narrowing is achieved predictably by removing a small segment at the lateral most part of the ala cartilage. Scorinu of the dome can also be done. We describe the technique iu a large series of patients, all of whom have retained their results without undesirable problems.
Comparison of Techniques Used to Support the Nasal Tip and Their Long-term Effects on Tip Position
Archives of Facial Plastic Surgery, 2010
To examine the indications for the use of septal extension grafts, columellar struts, and tongueand-groove techniques to provide support and set the tip position during rhinoplasty, and to compare the strength of their support and analyze their long-term effects on tip position. Methods: The medical records and photographs of patients who underwent external septorhinoplasty during a 2-year period were analyzed. Forty patients had photographs from short-term follow-up (Ͻ12 weeks) and were included in the study. The short-term and longterm (Ͼ52 weeks) tip positions were compared to determine the maintenance of tip position with each technique. Each stabilization technique was performed on 5 fresh cadavers, and the resistance to displacement of the tip was measured and compared. Results: Objective measurements in the cadaver analysis show increased resistance to tip displacement with the use of caudal septal extension grafts and tongue-andgroove techniques. There was no difference in the maintenance of tip position between the techniques in analysis of the patients who have undergone rhinoplasty. Conclusions: Many factors influence the maintenance of tip position in patients who have undergone rhinoplasty. One should consider using a stabilization technique to help resist displacement of the nasal tip. Clinical and operative findings, as well as secondary effects, are used to help determine which technique should be used.
Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide
Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery, 2014
Tip rhinoplasty is a key component of aesthetic rhinoplasty. An understanding of the correlation between tip surface aesthetics and the underlying anatomic structures enables proper identification and correction of tip abnormalities. Surface aesthetics of the attractive nose are created by certain lines, shadows, and highlights with specific proportions and breakpoints. In this Featured Operative Technique, the authors describe a stepwise process for tip rhinoplasty that conceptualizes aesthetic subunits as geometric polygons to define the existing deformity, the operative plan, and the aesthetic goals. Tip rhinoplasty is described in detail, from initial markings through incisions and dissection. The autorim graft concept is explained, and lateral crural steal and footplate setback techniques are described for the attainment of symmetric domes with correct lateral crural resting angles. Methods in columellar reconstruction are described, including creating the columella (C') br...