Secondary Rhinoplasty of the Asian Nose: Correction of the Contracted Nose

The contracted nose is a unique entity that follows primary rhinoplasty in the Asian patient. The proposed reasons for this complication are capsular contraction from a silicone nasal implant, pressure necrosis of the lower lateral cartilage resulting from the nasal implant, and infection after alloplastic implantation. The two principal anatomic constituents that must be addressed at the time of secondary rhinoplasty are the lower lateral cartilages and the skin envelope. The lower lateral cartilages should be derotated, projected, and transfixed with an extended spreader graft. Additional onlay grafting may be required to provide greater nasal tip derotation and projection. A transcolumellar incision situated at the columellar-labial angle permits undermining of the upper lip skin to release tension on the incision. If the nasal tip retraction is severe, then the skin envelope may be insufficient to provide coverage to the new cartilaginous framework. In this case, a paramedian forehead flap is recommended to provide adequate tissue coverage. Correction of alar–columellar disparity should be undertaken with composite grafting only after 6 months have transpired to gauge the ultimate relation between the alae and columella. Infection that arises after correction of the contracted nose can be devastating. It should be treated aggressively, but tailored to the severity of the infection. Wound tension along the columella may predispose to skin necrosis and consequent cartilage exposure, which should be managed in turn with prostaglandin emollients to accelerate wound healing and to prevent infection.     

Running W Incision in Open Rhinoplasty: Better Scar Quality

Since 1997, 129 patients have undergone the open approach rhinoplasty procedure. Scar quality with running W incision was compared to the scar with V type incision. According to clinical and statistical evaluations after 6 months, postoperatively the running W incision group showed better scar quality than the V type incision group. The advantages of a running W incision are camouflaging the depressed scar in the incision line and decreasing the angles of the corners of incision lines. Running W type incision is superior to V incision on the columella and may provide less scaring than a single Z, and reverse V incisions according to our long-term clinical results.     

A Systematic Approach to Rhinoplasty of the Japanese Nose: A Thirty-Year Experience

The Japanese nose exhibits a combination of leptorrhine and mesorrhine features that mandates an innovative treatment strategy. Unlike elsewhere in Asia, the Japanese nose often has adequate dorsal height, and at times even dorsal convexity, but maintains a more retruded and amorphous tip configuration. The proposed systematic approach to Japanese rhinoplasty is divided into four categories: (1) dorsal augmentation with or without tip augmentation, (2) dorsal reduction with tip augmentation, (3) tip augmentation only, and (4) dorsal reduction only. The use of autologous and alloplastic materials to achieve the desired aesthetic objectives is described herein. A layered auricular graft technique is outlined for tip surgery, and a unique nasal implant design is discussed.     

Rhinometry: An Important Clinical Index for Evaluation of the Nose Before and After Rhinoplasty

Background Preoperative planning and postoperative outcome assessment in rhinoplasty are important. For preoperative planning, some standard relationships are defined and evaluated primarily with standard photographs, but photographs do not necessarily reflect reality. Outcome assessment, on the other hand, is mostly subjective, and again, even photographic analyses may not address real changes after rhinoplasty. Methods “Rhinometry” is introduced as a clinical method for preoperative evaluations and postoperative judgments, and rhinometric parameters are defined. Measurements of these parameters were performed for 300 patients before rhinoplasty and in the follow-up visits 3 months postoperatively. Results Preoperatively, the nasal length and tip projection for most patients were more than ideal. There was moderate reduction in nasal length (mean, 9.21 mm) and a decrease in tip projection (mean, 3.34 mm) for the majority of the patients after rhinoplasty. Reductions in nasal length, tip projection, bony base width, alar base width, and alar base width during a smile were statistically significant. Patients who underwent surgery using the closed approach had significantly more reduction in nasal length and less reduction in tip projection. All the patients were satisfied with these pre- and postoperative data. Rhinometry changed the ideas of the authors about some changes that their operative approaches produce. Conclusions Rhinometry can change the ideas of plastic surgeons about the changes their operative approaches accomplish and can be a very useful guide for patients. It is recommended as a part of the pre- and postoperative physical examination of patients undergoing rhinoplasty.     

Comparative Columellar Scar Analysis Between Transverse and Inverted-V Incision in Open Rhinoplasty

BACKGROUND: Rhinoplasty can be performed using both open and closed approaches. A visible scar on the columella is the major disadvantage of open rhinoplasty. Different columellar incision types have been used in open rhinoplasty. In this retrospective study, we compare transverse and inverted-V columellar incisions with a scar assessment scale. METHODS: In this retrospective study, open rhinoplasty was performed on 84 patients between 2001 and 2006. The transverse incision was used on 39 patients (18 males, 21 females). The inverted-V incision was used on 45 patients (21 males, 24 females). The entire surgical procedure was performed by a single surgeon. The columellar incision was closed using 6-0 interrupted polypropylene sutures. All sutures were removed on the fifth postoperative day. With this assessment scale, we observed satisfactory scar, pigmentation, and notching. RESULTS: We compared both groups and found that the inverted-V incision resulted in better scar formation (p < 0.05) and less notching (p < 0.07). Scar pigmentation was found to be irrelevant to the incision technique employed (p < 0.3). CONCLUSION: As a result of this study we concluded that the inverted-V incision might be a better choice in open rhinoplasty.     

Rhinoplasty and Hemophilia A

Major surgical procedures can be performed safely for hemophiliacs provided the clotting factors are adequate. However, rhinoplasty, an elective facial procedure, has not yet been evaluated in this group of patients. The authors present a hemophilia A patient who underwent rhinoplasty for cosmetic reasons.     

Surgical Correction of the Overgrown Columellar Labial Junction: Complementary Method

The overgrown columellar labial junction remains a controversial and neglected aspect of rhinoplasty. The authors encountered this problem in a large number of their patients and found that routine techniques were not sufficient to correct it. They therefore developed a complementary method in rhinoplasty that is safe and easy to handle, with long-lasting, satisfactory results for both the patient and the surgeon. This method has provided not only better stability on the columellar base, but also good aesthetic results. The study involved 43 rhinoplasty patients with a follow-up period of approximately 1.5 years. This report analyzes the surgical anatomy related to the overgrown columellar labial junction. Pre- and postoperative aspects of cases involving overgrown columellar labial junctions and surgical procedures are discussed.     

The use and abuse of external incisions in rhinoplasties

The author emphasizes his basic opposition to the use of external incisions in surgical rhinoplasty with only a few minor exceptions. External incisions are justifiable in only a limited number of cases, and when they are published these cases should be exceptional indeed and not suggested as an alternative technique or as an innovation to be used on a routine basis. The endonasal approach should be used in the vast majority of aesthetic rhinoplasties with only a few exceptions mentioned here.     

A Perichondrial Flap for Functional Purposes in Rhinoplasty

Recent trends in rhinoplasty techniques have focused on anatomic repair as well as respect and preservation of soft tissue integrity. In this article, the authors describe the use of a perichondrial flap, then discuss technical considerations and clinical perspectives of their advantages. A perichondrial flap helps to restore the stability of the upper lateral cartilage, to achieve extra padding, and to secure osteocartilagenous grafts. The method described has been used for 60 consecutive patients. The majority of these patients were satisfied with the results.To obtain detailed information about the perichondrial flap, the authors performed an anatomic study of 13 cadavers. The average thickness of the perichondrium was 186 ± 146.1 μm (range, 90–596 μm). On the basis of the results, it was concluded that elevation of the perichondrial flap with loupe magnification could improve the outcome of rhinoplasty.     

Rhinoplasty for preventing nasal cartilage growth

The physiologic growth of the nose, which continues, particularly in females, throughout life, prompted us to develop a technique for preventive surgery. The method consists in producing a scar in the cartilaginous portion of the nose to prevent continued growth of that tissue and to preserve the nose without deformities.     

Rhinoplasty in the older patient

Rhinoplasty is often indicated in the older patient, either as an isolated procedure or in continuous or staged combination with other facial rejuvenative operations. The operations must be tempered with conservatism and artistic judgment. The nose of an older person should look natural and inconspicuous and fit the patient's face. Because of possible coronary or hypertensive problems, epinephrine in the local anesthetic solution should be used in lesser concentrations, requiring a longer wait for its full vasoconstrictive effect. Nasal cartilage is tougher, and the nasal bone more brittle in the older patient. In addition to the usual complete rhinoplasty, the partial rhinoplasty is a useful operation for the older individual.     

聚丙烯酰胺水凝胶注射隆鼻术后并发症的处理及临床分析

目的探讨聚丙烯酰胺水凝胶注射隆鼻术后并发症产生的原因及相关的处理。方法通过总结处理52例聚丙烯酰胺水凝胶注射隆鼻术后并发症的经验体会，分析并发症产生的原凶及处理补救措施。结果52例中产生的并发症有感染、肉芽肿、皮肤破溃、外形不良、疼痛和严重的心理压力等。每例有1～4种并发症。根据不同情况采取不同处理方法，并选取适当病例在取出聚丙烯酰胺水凝胶的同期或二期置入硅胶或膨体聚四氟乙烯假体，多数病例能取得较满意的效果，少数病例遗留后遗症和长久的心理压力或鼻部隐痛。结论聚丙烯酰胺水凝胶注射隆鼻术后并发症种类多样，与聚丙烯酰胺水凝胶的同有性质、鼻部软组织解剖特点有关。出现并发症后反复抽吸，会导致聚丙烯酰胺水凝胶分布更加紊乱，损伤加重。只有采取综合的手术方法才能较彻底地清除聚丙烯酰胺水凝皎。     

鼻尖肥大的整形修复

目的　探讨治疗鼻尖肥大的手术方法 ,以获得美观鼻外形。方法　本组 2 8例患者 ,均采用“飞鸟形”切口 ,根据鼻尖形态 ,修剪鼻尖部过多的软组织 ;显露鼻翼软骨外侧脚和穹窿后 ,剪除外侧脚至穹窿处侧鼻软骨侧部分软骨 ,保留鼻翼缘处 0 .2cm宽鼻翼软骨外侧脚 ,缝合穹窿以重塑鼻尖外形。矫正鼻部其他畸形 :10例鼻尖低平者 ,行硅胶假体隆鼻 ;9例鼻翼肥厚者 ,修薄鼻翼缘 ;3例鼻翼基底过宽者 ,经口内入路缝合缩窄鼻翼 ;1例鼻底过宽者 ,凿开上颌骨鼻突 ,挤压缩窄塑形。结果　自 1995年以来 ,用上述方法整复 2 8例患者 ,经 3个月至 2年随访 ,除 3例鼻尖肥大矫正不足外 ,其余 2 5例效果稳定 ,无继发畸形发生。结论　鼻尖肥大需综合整复 ,方能获得良好的效果。