Rhinoplasty Research Papers - Academia.edu (original) (raw)

Rhinoplasty remains one of the most challenging aesthetic procedures to master. Astute surgeons must consider a continually evolving societal perception of beauty with their own sense of aesthetic proportion when planning surgical... more

Rhinoplasty remains one of the most challenging aesthetic procedures to master. Astute surgeons must consider a continually evolving societal perception of beauty with their own sense of aesthetic proportion when planning surgical intervention. Optimal results are achieved when the outcome is anticipated and satisfying to patient and surgeon. This requires a careful, thoughtful, systematic approach to preoperative analysis. Patients should leave with a clear understanding of the surgeon's perspective of their nose, aesthetically and anatomically. Understanding the interplay of surface deformities and their underlying anatomic counterpart is critical, involving a systematic analysis to create a surgical plan that avoids landmines leading to a suboptimal result.

Although many surgical techniques have been introduced, there are few clinical studies investigating postoperative results in crooked nose deformity. The aim of this study is to discuss the surgical choices for specific deformities and to... more

Although many surgical techniques have been introduced, there are few clinical studies investigating postoperative results in crooked nose deformity. The aim of this study is to discuss the surgical choices for specific deformities and to report the long-term quantitative surgical results of our cases. One hundred and twenty cases (38 women, 82 men) with crooked noses (48 I-shaped, 72 C-shaped) operated on by the authors were included in the study. The patients have been followed for 6 to 46 months (mean 19 months) postoperatively. The Scion Image software program was utilized for numerical measurement of the nasal crookedness. In cases with I-shaped and C-shaped crooked nose deformity, preoperative and postoperative angle values were as follows: 6.84 +/- 2.58 degrees, 2.01 +/- 1.53, 152.97 +/- 9.03 degrees and 173.67 +/- 4.55 degrees, respectively. In both groups, postoperative correction rates were statistically significant (p = 0.0001). Despite these results, patients undergoing ...

The authors present a review of biomaterials, substances traditionally derived from human or animal tissue or, more recently, biodegradable synthetics modeled after naturally occurring resources. These constructs differ from purely... more

The authors present a review of biomaterials, substances traditionally derived from human or animal tissue or, more recently, biodegradable synthetics modeled after naturally occurring resources. These constructs differ from purely synthetic materials in that they are degraded or incorporated into a host's tissue. These biomaterials include a diverse array of medical products, such as acellular dermal matrix, bone substitutes, and injectables. In this review, the authors examine various clinical applications, including burn reconstruction and wound healing, breast surgery, complex abdominal wall reconstruction, craniofacial repair, and cosmetic surgery. Biomaterials such as acellular dermal matrix have proven beneficial in difficult-to-treat applications; however, more prospective data are needed to determine their true efficacy and cost-effectiveness.

Reconstruction of nasal defects presents a particularly unique challenge for the surgeon. Complex aesthetic subunits and limited available adjacent mobile skin with varying color, texture, and thickness all contribute to this task. The... more

Reconstruction of nasal defects presents a particularly unique challenge for the surgeon. Complex aesthetic subunits and limited available adjacent mobile skin with varying color, texture, and thickness all contribute to this task. The ideal reconstruction of nasal defects recruits tissue of similar color, texture, and thickness to that of the defect. Two versatile local flaps for nasal reconstruction are the glabellar flap and an extension of the glabellar flap, the dorsal nasal flap. The authors describe the use of these two local flaps for reconstruction of nasal defects and modifications of these procedures for certain indications, as well as their use in medial canthal reconstruction.

Background: Dorsal hump reduction is a critical step in rhinoplasty. Most of the reasons behind revisional procedures are related to incorrect hump reduction.Methods: The authors used a modified dorsal hump reduction method in their... more

Background: Dorsal hump reduction is a critical step in rhinoplasty. Most of the reasons behind revisional procedures are related to incorrect hump reduction.Methods: The authors used a modified dorsal hump reduction method in their primary cases, the steps of which are as follows: 1) dissection of the nasal vault; 2) bilateral submucoperichondrial dissections to free the cartilaginous septum; 3) separation of the upper lateral cartilages from the cartilaginous septum; 4) partial dissection of the upper lateral cartilages from the inner surfaces of the nasal bones bilaterally; 5) separation of the bony septum from the nasal bones bilaterally; 6) reduction of the partially isolated nasal bones; 7) en bloc cartilaginous and bony septum removal. The authors have operated on 68 primary cases over a 2 year period (30 mo).Results: In the great majority of cases, the results were satisfactory. No revisions were performed in this patient group.Conclusions: This method is a good alternative to traditional techniques in noses with a high and narrow roof, thin skin, and weak middle nasal vault. Revision could be performed more easily when required. Initially, wide noses may not seem good candidates for this procedure; however, careful case-based preoperative planning may overcome this difficulty.

This study analyzed the outcomes of nongrowing patients with unilateral mandibular hypoplasia treated according to a specific protocol, which combines distraction osteogenesis, orthodontic treatment, and conventional osteotomies. The... more

This study analyzed the outcomes of nongrowing patients with unilateral mandibular hypoplasia treated according to a specific protocol, which combines distraction osteogenesis, orthodontic treatment, and conventional osteotomies. The patients treated were objectively evaluated. Patient's satisfaction was assessed by questionnaire. Surgical changes were analyzed using cephalometry and three-dimensional facial surface data before surgery (T0) and at long-term (T1) follow-up. Four patients were included in this study. The normalization of facial proportion and a high increase in symmetry were evident. Residual defects were documented in the postoperative symmetry of the chin. In the questionnaire, all patients gave favorable responses to their facial changes; for most of the objective parameters, all patients improved. A multistage treatment protocol for the correction of facial deformities in patients with unilateral mandibular hypoplasia is a valid procedure for skeletal and occl...

Because of physiologic changes with advancing age as well as previously traumatized and then healed tissues, secondary rhinoplasty for a middle-aged patient is a challenging procedure. Depending on both factors, changes in the midvault... more

Because of physiologic changes with advancing age as well as previously traumatized and then healed tissues, secondary rhinoplasty for a middle-aged patient is a challenging procedure. Depending on both factors, changes in the midvault can cause a functional airway disorder, and the nose also may need a complete correction for cosmetic purposes. To achieve aesthetic and functional outcomes, augmentation rhinoplasty using a combination of triple cartilage grafts, namely, spreader, columellar, and dorsal onlays, was performed for 12 patients. Sufficient nasal airways with satisfactory appearance were achieved for 11 of 12 patients. Only one patient had improved but still insufficient nasal function with a good aesthetic result. Augmentation rhinoplasty using a combination of triple cartilage grafts for middle-aged patients could be considered an effective procedure for improving the patient’s nasal airway and appearance.

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of... more

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of this study were to prospectively investigate whether patients with mild to moderate BDD are suitable for rhinoplasty, and to assess BDD severity and patient satisfaction with the surgical outcome 1 year after the intervention. All women (n = 116) seeking rhinoplasty at a university hospital between September 2009 and August 2010 were recruited for the study and assessed for BDD. The final sample consisted of 31 patients aged 32 (standard deviation (SD), 10) years with mild to moderate BDD who underwent rhinoplasty. The participants were assessed preoperatively (baseline) and 1 year postoperatively with the Body Dysmorphic Disorder Examination (BDDE). Most patients (22/31, 71%) were of African descent. Socio-demographic variables and the extent of the ...

Although rhinoplasty and the development of facial aesthetic criteria can be traced to several millennia, contemporary techniques have passed through a rapid evolutionary process in the past century (1) (2). Although understanding human... more

Although rhinoplasty and the development of facial aesthetic criteria can be traced to several millennia, contemporary techniques have passed through a rapid evolutionary process in the past century (1) (2). Although understanding human anatomy and the consequences of surgical excision occupied the minds of the founders of rhinoplasty, the process moved towards preservation of supporting structures, and maintaining the physiological functions of the nose. Initially, this endonasal approach created its own series of problems due to excessive tissue removal. External rhinoplasty provided a new impetus for growth in this field, and since its inception, has swung the pendulum of reconstruction firmly into its own sphere of influence. However, as no rhinoplasty technique holds all the answers, hybrid rhinoplasty seeks to combine the best achievements of 20(th) century rhinoplasty, from all schools of thought, in order to provide a safe, sensible and planned approach to the most demanding...

Purpose: To evaluate the functional , aesthetic outcomes, and complications associated with extracorporeal septoplasty (ECS) while correcting moderate to severely deviated nasal septum in unilateral cleft lip and palate (CLP) patients.... more

Purpose: To evaluate the functional , aesthetic outcomes, and complications associated with extracorporeal septoplasty (ECS) while correcting moderate to severely deviated nasal septum in unilateral cleft lip and palate (CLP) patients. Materials and Method: Fifteen healthy adolescent and adult unilateral cleft lip and palate patients reporting for cleft rhinoplasty procedure to our department and consenting for the research protocol were taken up for study. Result:

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... more

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.

For most surgeons, nasal septal cartilage is the first choice in septoplasty. However, when this source is depleted, an alloplastic implant material might be preferable over other autogenous donor sites in order to avoid additional scars,... more

For most surgeons, nasal septal cartilage is the first choice in septoplasty. However, when this source is depleted, an alloplastic implant material might be preferable over other autogenous donor sites in order to avoid additional scars, morbidity, and lengthened operating time. In the alloplastic spectrum, irradiated costal cartilage (ICC) has certain advantages. Herein, we present our results with ICC in a wide range of septorhinoplasties to show its versatility and reliability. Sixty-five patients were included in the study. There were 42 male and 23 female patients. According to the indications, there were four groups of patients: (I) secondary septorhinoplasty (n = 24), (II) traumatic deformity (n = 21), (III) primary septorhinoplasty (n = 13), (IV) deformity due to previous septal surgery (n = 7). The mean follow-up period was 33 months. No significant resorption was detected in any of the patients. Minor complications developed in four cases (6%), including deformity in the dorsal graft, excessive graft length, and erythematous nasal tips. Aesthetic and functional results were satisfactory in the remaining cases. The low incidence of major complications and the versatility of ICC make it a safe and reliable source of cartilage graft for both primary and secondary septorhinoplasties when autogenous septal cartilage is either insufficient or unsuitable.

Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with... more

Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with fluid cartilage filler gently injected as autologous fluid graft in deep planes of defect of the nose that were close to the bone or the cartilage. A computerized tomographic scan control was performed after 12 months. Pearson's Chi-square test was used to investigate differences in cartilage density between native and newly formed cartilages. The endpoints were the possibility of using fluid cartilage as filler with aesthetic and functional improvement and versatility. Patients were followed up for two years. The constructs of fluid cartilage graft that were injected in the deep plane resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. This report demonstrated that fluid cartilage grafts are useful for cartilage regeneration in patients with outcomes of rhinoplasty, internal nasal valve collapse, and minor congenital nose aesthetics deformity

Rhinoplasty surgery remains one of the most difficult operations of the face. Improving aesthetic appearance and maintaining nasal function are inseparable goals in rhinoplasty surgery, and failure to achieve either of these objectives... more

Rhinoplasty surgery remains one of the most difficult operations of the face. Improving aesthetic appearance and maintaining nasal function are inseparable goals in rhinoplasty surgery, and failure to achieve either of these objectives can be devastating for the patient. After evaluating a variety of rhinoplasty complications, increased attention was devoted to the surgical technique for reconstruction of the dorsal aesthetic lines and nasal tip projection in the patient with a prominent dorsal hump. Based on the modern concept of cartilage conservation, the autospreader flap rotation technique should be considered when dorsal reduction is required. Autospreader flaps are a useful tool in the prevention of postoperative nasal obstruction, segmental (inverted V) appearance, midfacial axial asymmetry and an overdone supratip break. In addition, they assist in preserving ethnicity of the nose when desired. The patient with a long nose, prominent dorsal hump, short nasal bones and low lower lateral cartilages are considered to be an ideal candidate for an autospreader flap.

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... more

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.