The Asian nose: augmentation rhinoplasty with L-shaped silicone implants

Few procedures in facial plastic surgery elicit the controversy that surrounds augmentation of the Asian nose. Asian surgeons generally advocate augmentation with custom-fabricated silicone prostheses, a technique that Western surgeons, who strongly recommend autogenous material, condemn as inherently dangerous. Analysis of the evidence relating to augmentation with silicone prostheses suggests that there is little factual support for Western dogma and indicates that, when properly executed, augmentation with silicone implants yields reliable and consistently superior aesthetic results. A detailed blueprint for execution of augmentation rhinoplasty with custom- fabricated silicone implants is provided.     

鼻部表浅肌肉筋膜系统与隆鼻术假体层次关系的探讨

目的明确鼻部表浅肌肉筋膜系统及隆鼻术假体置放层次与它们之间的关系.方法运用显微解剖及组织学检查18具成人尸体鼻部.结果鼻部软组织分为皮肤、表浅脂肪、肌肉及其筋膜、深脂肪、骨膜及软骨膜五层,深脂肪层容易剥离形成腔隙.结论隆鼻术硅胶假体置入层次为深脂肪层.鼻部表浅肌肉筋膜系统的解剖特点有助于假体的稳定.     

鼻部表浅肌肉筋膜系统与隆鼻术假体层次关系的探讨

目的　明确鼻部表浅肌肉筋膜系统及隆鼻术假体置放层次与它们之间的关系。方法　运用显微解剖及组织学检查 18具成人尸体鼻部。结果　鼻部软组织分为皮肤、表浅脂肪、肌肉及其筋膜、深脂肪、骨膜及软骨膜五层 ,深脂肪层容易剥离形成腔隙。结论　隆鼻术硅胶假体置入层次为深脂肪层。鼻部表浅肌肉筋膜系统的解剖特点有助于假体的稳定。     

膨体聚四氟乙烯假体修复隆鼻术后外形不佳

目的 探讨应用膨体聚四氟乙烯在隆鼻修复术中的手术技巧及应用价值.方法 选择隆鼻术后效果不佳68例患者,手术取出原有的硅橡胶鼻假体,将膨体聚四氟乙烯加强型补片,根据患者的脸型、鼻型、要求以及医学美学观点,进行雕刻后置入体内.其中24例取自体耳软骨,固定于假体的鼻尖部位,以改观鼻尖效果.结果 本组患者68例,2例术后1个月时,出现鼻根部过宽,触之假体偏硬,其中1例取出假体修剪后,再次置入,效果良好,另外1例3个月后,逐渐变软,未加处理;还有1例鼻尖部发硬,3个月后缓解;其余均取得良好的手术效果.结论 膨体聚四氟乙烯为较理想的隆鼻材料替代品,尤其适合硅橡胶隆鼻术后,外观不佳、鼻尖部张力过大导致鼻尖皮肤变薄的患者;假体复合自体耳软骨能有效延长鼻长度,抬高鼻尖.     

假体外形与隆鼻术后并发症的关系探讨

通过对取出的鼻模假体观察分析，寻找鼻模外形与其术后并发症的关系。将取出的３３只鼻模，根据其外形分为４种类型，分别联系其各自的并发症表现。发现皮肤破溃（９例）与尖梭形鼻模和阔面型鼻模有关，假体漂浮（１４例）与凹模型鼻模有关。修雕的鼻模假体不宜过大、过高、过长，避免凹槽、尖梭、阔面、重叠型的鼻模使用。     

隆鼻术中假体的雕刻与设计

目的：积累总结固体硅胶隆鼻术中，关于硅胶雕刻设计的具体实践经验，以提高固体硅胶隆鼻术的成功率和美观性。方法：回顾分析1286例以固体硅胶为假体的隆鼻术的成败，归纳硅胶的总体设计要点，并列举几种特殊的硅胶雕刻设计。结果：根据临床实际情况，按照文中所述的硅胶雕刻设计的要点，精雕细刻，有效提高了隆鼻术的成功率和美观性。结论：固体硅胶隆鼻的成功以及是否自然美观很大程度上取决于硅胶的雕刻设计，本文所作的经验总结具有临床的借鉴意义。     

Revision rhinoplasty for the Asian nose

Revision rhinoplasty of the Asian nose requires a combination of cultural sensitivity and unique surgical strategies to achieve a successful outcome. Cultural sensitivity means understanding some of the folkloric motivations to undergo rhinoplasty and divergent ethnic standards of beauty. Basic techniques for Asian rhinoplasty are reviewed as a prerequisite knowledge for revision rhinoplasty of the Asian nose, specifically a combination technique of expanded polytetrafluoroethylene for bridge augmentation and autogenous cartilage tip grafting. Revision Asian nose surgery oftentimes involves removal of a previously placed solid silicone implant, which remains the most popular option for augmentation rhinoplasty in Asia. Strategies for revision rhinoplasty in the Asian nose are then reviewed.     

The current trend in augmentation rhinoplasty

Augmentation rhinoplasty is one of the most commonly performed cosmetic surgeries in Asia. Although they are traditionally considered procedures done predominantly in the Far East, these surgeries have gained increasing popularity in America with the great influx of Asian immigration. This article reviews the unique anatomical features in typical Asian noses, various augmentation options, and the most updated techniques of Asian augmentation rhinoplasty currently being used.     

Structure rhinoplasty of the long nose

Rhinoplasty modifies the aesthetic appearance and functional properties of the nose with operative manipulation of the skin, underlying cartilage, bone, and linings. A long nose is an aesthetically undesired feature disturbing the harmony of the face. The underlying pathology of the long nose may be due to either a long septum that invades the lip or dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. The increase in the nasal height due to a dorsal nasal hump may give an illusion of a long nose. An absent or shallow frontonasal angle also gives the illusion of a long nose. With the introduction of the dynamics of the nasal structures and dynamics in rhinoplasty, recreation of a straight nasal dorsum and a normal frontonasal angle dynamically shortens the long nose. This study presents a multicenter experience (three centers) in rhinoplasty of long noses. The study included 138 patients who complained of having a long nose. The study employed the concept of structure rhinoplasty to address the three-dimensional nasal structures contributing directly or indirectly to the appearance of the long nose rather than the traditional excisional techniques. Based on objective and subjective evaluation, shortening of the nose was achieved in 122 patients (88.4%) with better overall nasal aesthetics. The study concluded that structure rhinoplasty, which addresses the three-dimensional nasal anatomy, maximizes the aesthetic and functional outcomes when treating the long-nose deformity.     

The classification of complications after augmentation rhinoplasty

The authors classify the complications resulting from augmentation rhinoplasty into 6 typ3s according to the nasal areas involved, then guide the reader to the corresponding technique of management for each type. Their classification is based on the data of 113 patients whom they treated with a secondary rhinoplasty in their clinic during the past 10 years. In the case of augmented noses, it is especially noted that removal of the implant must precede any further treatment in a secondary rhinoplasty.Presented at the 6th Congress of the International Society of Aesthetic Plastic Surgery, Tokyo, September 28, 1981     

Corrective rhinoplasty for post-traumatic deformity of nose

From 1981 to 1986 the author has used osteotomy technique for corrective rhinoplasty in 15 cases. They were localized depression or deviation of the nose. The depression deformity was treated by osteotomy and elevating by making cuts along the midline of the nose and on each lateral cartilage. Then the dorsum of the nose was repositioned. All 15 cases obtained satisfactory cosmetic result without any complication.     

透明质酸钠凝胶注射隆鼻的临床应用

目的 评价应用透明质酸(HA)注射隆鼻的临床效果.方法 自2009年6月至2012年6月,对35例求美者行HA注射隆鼻术,并观察注射后的临床效果、疗效保持时间、不良反应等.结果 所有求美者注射后即刻均得到改善.注射后3、6、12个月随访,分别有100%、91.43%、65.65%的注射部位维持了改善的效果,求美者对鼻外形及填充高度满意.注射治疗中未出现急慢性过敏反应及感染、肉芽肿、血管栓塞、皮肤坏死等并发症.结论 HA注射隆鼻术安全,方便,有效,维持时间约6～12个月.     

"The open sky rhinoplasty" for correction of secondary cleft lip nose deformity, Technique and recent results

The typical nose deformity after cleft-lip repair still represents great challenge for the plastic surgeon in this field. Many methods have been designed in attempts to correct the deformity, either during primary closure of the lip or as a secondary procedure when growth of the nose is complete. In this paper the author's own technique of secondary rhinoseptoplasty in cleft-lip patients is presented. The different cartilaginous and osseous structures are approached through a transcolumellar incision and the skin of the nose completely reflected upwards. This so-called "open sky view" gives a total perspective on the entire pathology of the cleft-lip nose deformity and makes it possible to correct it accordingly. Emphasis is put on some important surgical manoeuvers. Recent results are presented and the pros and cons of this procedure discussed.     

隆鼻术的广泛应用

报道隆鼻、隆鼻尖的广泛应用，与其他手术联合应用２９例，包括全鼻再造，唇裂后鼻畸形，隐性鼻裂，碟面畸形，先天性鼻下端畸形，烧伤后鼻畸形等的修复，提高了整复效果。     

Corrective rhinoplasty of the congenital deviated nose

From 1981 to 1986, a total of 11 cases of crooked nose were treated. The method include resection of the excessive portion of deviated lateral cartilage, and reduction of significantly dislocated lower part of septum, otherwise correction could not be radical.     

Irradiated homologous costal cartilage for augmentation rhinoplasty

Although the ideal reconstructive material for augmentation rhinoplasty continues to challenge plastic surgeons, there exists no report in the literature that confines the use of irradiated homologous costal cartilage, first reported by Dingman and Grabb in 1961, to dorsal nasal augmentation. The purpose of this paper is to present a retrospective analysis of the author's experience using irradiated homologous costal cartilage in augmentation rhinoplasty. Twenty-seven dorsal nasal augmentations were performed in 24 patients between 16 and 49 years of age with a follow-up ranging from 1 to 27 months. Good-to-excellent results were achieved in 83.3% (20 of 24). Poor results requiring revision were found in 16.7% (4 of 24). Complication rates included 7.4% infection (2 of 27) and 14.8% warping (4 of 27). The resorption rate was zero. These results compare favorably with other forms of nasal augmentation. Advantages and disadvantages of irradiated homologous costal cartilage are discussed.     

High septal osteotomy in rhinoplasty for the deviated nose

When attempting to straighten a patient's healed, deviated bony nasal dorsum, deviation of the central structure (high dorsal septum and medial nasal bones) must be addressed following the completion of medial and lateral osteotomies. When hump resection is not performed, blunt fracture (digitally or with forceps) of the deviated central structure is not a reliable method of mobilization, often leading to postoperative nasal drift. An intranasal osteotomy technique to mobilize the central structure of the nose is described, called "high septal osteotomy." Review of 25 cases suggests high septal osteotomy, supplemented as needed by resection of overlapping septal elements, can be performed safely and efficaciously, permitting stable midline reduction of the nasal pyramid. The technique is not advocated when hump resection is performed, as it is unnecessary and could destabilize the dorsum. Even aggressive maneuvers to mobilize the bony dorsum may fail if not performed properly with meticulous attention to completion of all osteotomies.     

隆鼻硅胶假体雕刻中的四个角度

目的探讨隆鼻硅胶假体雕刻中的四个角度与隆鼻并发症的关系。方法总结了420例硅胶假体隆鼻术患者,分析并发症与假体雕刻的关系,提出假体雕刻要与鼻部解剖形态相吻合的四个角度。结果术后1周,发现3例患者假体鼻根部向一侧轻度偏斜,2例6个月后鼻根部假体固定不良。1例术后主诉头痛,取出假体后症状消失。其余未发生并发症。结论假体雕刻与鼻部解剖形态的四个角度相吻合,可以减少并发症的发生,提高美容效果。     

致密多晶羟基磷灰石微粒人工骨整复鞍鼻

用致密多晶羟基磷灰石微粒人工骨整复鞍鼻６０例，并对手术方法以及并发症的预防和处理进行讨论。方法：采用鼻小柱正中切口，于鼻背筋膜下腔隙注入ＨＡ，手法塑形。效果：对鼻形满意者５６例，不理想者４例。作者认为ＨＡ作为隆鼻的填充物对人体安全有效，且无毒性和炎症反应。该手术进路证明，技术操作容易，损伤极小，并发症少，是目前较为理想的隆鼻材料。