The contoured auricular projection graft for nasal tip projection

In all rhinoplasty surgery, the universal need exists to increase, decrease, or preserve existing tip projection. When proper tip projection is lacking, a variety of techniques are useful for improving projection. We describe a valuable technique for tip projection, particularly useful and indicated in the Asian rhinoplasty, African American rhinoplasty, and in certain revision rhinoplasties. In the past 15 years, the senior author (M.E.T.) has used the contoured auricular projection graft in selected patients for achieving satisfactory tip projection in patients with blunted tips. The aesthetic outcomes have been predictable, pleasing, and reliable for the long term. Precision pocket preparation for auricular conchal cartilage graft placement is key to symmetry and projection of the final outcome. The results yielded a rounded nasal tip that may be more natural-appearing in Asians, African Americans, and selected patients with revision rhinoplasty. The contoured auricular projection graft provides a highly useful graft for the nasal tip.     

Rhinoplasty for African American patients: a retrospective review of 75 cases

OBJECTIVE: To determine satisfaction, change in self-esteem, and maintenance of ethnic characteristics in African American patients after rhinoplasty. Patients African American male (n = 21) and female (n = 54) patients aged 14 through 58 years (mean, 33.8 years) who underwent rhinoplasty. METHODS: Open structure rhinoplasty, using the 3-tiered approach, was performed on all 75 patients. An anonymous questionnaire addressed postoperative patient satisfaction, maintenance of ethnic characteristics, self-esteem, and nasofacial harmony. The rate of complications was determined by medical record review. RESULTS: On a scale of 1 to 5 (1, no change; 5, complete change), patients reported a significant degree of preservation of ethnic characteristics (mean, 2.3), high self-esteem (mean, 4.3), and very high satisfaction (mean, 4.6) and facial harmony (mean, 4.3) postoperatively (P < .001 for all). The overall complication rate was 2.7%. CONCLUSION: In African American patients, 3-tiered open structure rhinoplasty yields high patient satisfaction with a minimal rate of major complications.     

Cardiac surgery in African Americans

Retrospective and prospective randomized studies that provide information on the influence of race on the morbidity and mortality of cardiac surgical procedures are reviewed. We intentionally focus our attention on the specific outcomes of these procedures in African Americans because African Americans have a high incidence of all-cause cardiovascular mortality and a high prevalence of a number of risk factors associated with cardiovascular mortality. Furthermore, numerous studies have confirmed that blacks, as a function of race, lack equal access to diagnostic and therapeutic invasive cardiac procedures. Here we use the terms "black" and "African American" interchangeably. In this context we interpret both terms to refer to Americans of African descent. Similarly, we use the term "white" or "Caucasian" interchangeably to refer to Americans of European descent.     

黄种人鼻整形的研究进展

黄种人的鼻整形是在鼻整形领域中的一个扩展性的研究命题。虽然各种鼻整形技术的主要原则同样适用于黄种人．但由于种族因素和解剖学差异,黄种人的鼻整形有其独有的特点。在近些年的研究中,黄种人的鼻部整形呈现一些值得注意的进展。本文就黄种人群鼻整形中鼻背部整形、植入材料、鼻尖成形及隆鼻后并发症处理方面等的最新进展进行综述。     

DRB1*15 allele is a risk factor for PR3-ANCA disease in African Americans

Anti-neutrophil cytoplasmic autoantibody (ANCA) disease rarely occurs in African Americans and risk factors for the disease in this population are unknown. Here, we genotyped MHC class II alleles and found that, among African Americans, those with proteinase 3-ANCA (PR3-ANCA) had 73.3-fold higher odds of having HLA-DRB1*15 alleles than community-based controls (OR 73.3; 95% CI 9.1 to 591). In addition, a disproportionate number of African American patients carried the DRB1*1501 allelic variant of Caucasian descent rather than the DRB1*1503 allelic variant of African descent. Among Caucasians, those with PR3-ANCA had 2.2-fold higher odds of carrying DRB1*1501 than controls (OR 2.2; 95% CI 1.2 to 4.0). A validation study supported by the Vasculitis Clinical Research Consortium confirmed the strong association between the DRB1*15 allele and PR3-ANCA disease, among African Americans. Furthermore, we found that DRB1*1501 protein binds with high affinity to amino acid sequences of sense-PR3, purportedly an antigenic epitope, and to the amino acid sequence complementary to this epitope in vitro. Peptides of sense-PR3 and complementary-PR3 also bound to TNF-α-induced surface expression of DRB1*1501 on peripheral neutrophils. Taken together, these data suggest HLA-DRB1*15 alleles contribute to the pathogenesis of PR3-ANCA disease.     

Rhinoplasty in male patients

The complexities of rhinoplasty are further emphasized when this operation is undertaken in the male patient, and a growing percentage of the rhinoplasty population comprises men. We review the senior author's approach to rhinoplasty analysis, preoperative consultation, and surgical techniques that have been successfully employed for over 40 years. Specific recommendations and modifications to these techniques are discussed as they relate to the rhinoplasty operation in male patients.     

Benign Fibro-Osseous Lesions of the Craniofacial Complex A Review

Benign fibro-osseous lesions of the craniofacial complex are represented by a variety of disease processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes. The definitive diagnosis can rarely be rendered on the basis of histopathologic features alone; rather, procurement of a final diagnosis is usually dependent upon assessment of microscopic, clinical and imaging features together. Fibrous dysplasia and osteitis deformans constitute two dysplastic lesions in which mutations have been uncovered. Other dysplastic bone diseases of the craniofacial complex include florid osseous dysplasia, focal cemento-osseous dysplasia and periapical cemental dysplasia, all showing a predilection for African descent individuals; although no specific genetic alterations in DNA coding have yet to be uncovered and most studies have been derived from predominant high African descent populations. Ossifying fibromas are neoplastic lesions with four subtypes varying with regard to behavior and propensity for recurrence after surgical excision. The clinicopathologic and molecular features of this unique yet heterogeneous group of diseases are reviewed.     

The decision process in choosing costal cartilage for use in revision rhinoplasty

The aims of rhinoplasty reconstruction include maintaining or augmenting long-term tip projection, restoring rigid dorsal stability, and restoring optimum respiratory function. The methods set forth to obtain these objectives are inherently based on the intrinsic nasal principles at the time of the rhinoplasty. Because of the excellent and consistent results autologous costal cartilage grafts provide when faced with problems such as the traumatic saddle deformity, defects after neoplastic resection, congenital nasal deformities, severe tip weakness or underprojection, rhinoplasty in the ethnic patient, and revision rhinoplasty, they are an invaluable resource to the rhinoplasty surgeon. Once the surgeon becomes comfortable and proficient at harvesting this graft, it inevitably will become the graft of choice when substantial amounts of cartilage are required.     

Psychological considerations in the revision rhinoplasty patient

The nose contributes greatly to the facial aesthetic. Derangements in nasal cosmesis, whether from surgery, trauma, or natural causes, have a plethora of implications for the emotional well-being of the individual. Rhinoplasty and revision rhinoplasty are both facial cosmetic operations that have potentially profound cosmetic, and therefore psychological, implications for the patient. Although many revision rhinoplasty patients have hopeful yet realistic surgical expectations, there is a subset of revision rhinoplasty patients having underlying psychological disturbances that may negatively affect the surgical outcome, no matter how favorable the surgical improvement. In this article, the various psychological disorders impacting revision rhinoplasty patients will be discussed. In addition, this article will familiarize the revision rhinoplasty surgeon with many of the hallmark characteristics of psychopathology, as well as the typical emotional presentation of the well-adjusted revision rhinoplasty patient, to facilitate differentiation between these seemingly similar, but distinctly different patient groups.     

Evolutionary Origins of the Differences in Osteoporosis Risk in US Populations

Over the past 50 years, it has been increasingly evident that there are population differences in bone mass and the risk of osteoporosis. In the United States, many studies have reported a lower prevalence of osteoporosis in African Americans compared with people of European descent. If we trace the trajectory of changes in lifeways from the earliest migrations of early Homo out of Africa over the past two million years or so, to include lower vitamin D levels in higher latitudes; more meat in the diet; increasing sedentism; and a longer lifespan/longer postmenopausal period, it is not surprising that osteoporosis occurs more frequently in populations of European descent. While many scholars have explored the apparent “paradox” of higher bone mass, lower vitamin D levels, and higher parathyroid hormone levels among African Americans, this brief review of evolutionary shifts that affected our species may change the approach to understanding the current population differences in the United States.     

External rhinoplasties: indications for use.

The technique, indications and role of external rhinoplasty in nasal surgery are presented. The technique has been utilised in 563 patients with a minimum follow-up of 18 months. The external approach has been especially helpful in the severely twisted nose, secondary rhinoplasty, augmentation rhinoplasty, congenital deformities of the nose, closure of septal perforations and in the teaching and learning of rhinoplasty. In this series there were no reported complications attributable to the external approach.     

Revision of the cleft lip nose

Secondary or revision rhinoplasty for the cleft nasal deformity represents one of the most challenging problems in rhinoplasty surgery. The secondary nasal deformity of the unilateral cleft lip involves a retrodisplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, and other deficiencies. This article discusses techniques to achieve the best possible outcome for patients with cleft nasal deformities. We emphasize the importance of early intervention by way of primary cleft rhinoplasty and highlight the typical challenges presented in delayed (secondary) or revision cleft rhinoplasty. We describe how the sliding flap cheilorhinoplasty effectively corrects these deformities using a laterally based chondrocutaneous flap via an open rhinoplasty approach. Columellar struts and shield grafts are some of the techniques combined with this approach to produce optimal results.     

Complications Associated With Isotretinoin Use After Rhinoplasty

Background This study aimed to evaluate the association between the postoperative use of isotretinoin and the formation of nasal tip deformities after rhinoplasty.Methods A retrospective study investigated a case series of patients who presented with nasal tip deformities subsequent to the use of isotretinoin after rhinoplasty. Patients who had taken isotretinoin after rhinoplasty were identified from a single surgeon’s case log. Clinic charts and operative reports were reviewed. Predisposing factors and time intervals to complications were identified.Results Three patients were found to have undergone isotretinoin therapy after rhinoplasty. Nasal tip deformities included bossa formation, asymmetry, and prominence of a composite graft. All three patients required subsequent procedures to repair soft tissue nasal tip deformities. In all three cases, isotretinoin was started within 2 years of the primary rhinoplasty. The nasal tip deformities were first observed within 6 months after isotretinoin was started.Conclusions Three cases are described in which postoperative use of isotretinoin was associated with nasal tip deformities after rhinoplasty. Further studies are needed to investigate this possible causative relationship and to describe the risks involved.     

Ethnic Profile of Patients Undergoing Aesthetic Rhinoplasty in Stockholm

During 1985–1995 we performed 640 rhinoplasties in 578 patients. Five hundred eighteen of them were inhabitants of the Province of Stockholm, with a population of 1,708,502. The patients from the Stockholm area were analyzed and divided into subgroups depending on their ethnic origin. It was found that 272 (52%) of them were of Nordic descent, while 248 (48%) were born in and immigrated from non-Scandinavian countries. Among the latter, the largest group were 166 people of Middle Eastern extraction, who generally strived to reduce the size of their noses to the size similar to the average nose of the native Swedes. Middle Easterners were 17 times more prone to undergo aesthetic rhinoplasty than the ethnic Swedes (p < 0.001), whereas immigrants from the other Scandinavian countries had the same rhinoplasty frequency pattern as the natives. In the Slavic group females outnumbered males by the ratio 17:1. The large prevalence of patients of foreign extraction desiring alteration of their noses may reflect the assimilation difficulties and low tolerance of the society in accepting people with a foreign look or name, both in the private sector and in the job market. Psychological aspects of decision making by patients and medico-ethical aspects of decision making by surgeons are discussed.     

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 ethnic nose

There are distinctive anatomical differences between the non-Caucasian (platyrrhine, mesorrhine) nose and the Caucasian (leptorrhine) nose. In general, non-Caucasian patients requesting aesthetic rhinoplasty desire improvement and refinement of their noses with preservation of defining ethnic characteristics. Surgeons who perform rhinoplasty in this patient population must be familiar with the variations in nasal anatomy and implement augmentation rather than reduction techniques to achieve the desired aesthetic and functional outcomes. We provide a brief review of recent historical trends in ethnic rhinoplasty, highlight relevant anatomical differences, and describe our strategy for addressing the challenges of ethnic rhinoplasty.     

Mini-forum: rhinoplasty by external approach. External or endonasal approach for rhinoplasty?]

There appears to be a renewed interests in the external approach to rhinoplasty, first described 60 years ago, despite the external columellar incision, due to the excellent exposure of the cartilaginous structures provided by this approach. Progress has been made in rhinoplasty. Cartilage grafts are much more widely used than in the past and surgeons try to reconstruct a normal anatomy of the skeleton, which has become easier with this approach. However, the closed approach has demonstrated its efficacy for a long time and allows correction of a large range of deformities. The open rhinoplasty should not be the standard procedure and its indications should only be based on limitations of the closed approach. The external procedure is particularly indicated in some difficult cases of nasal tip surgery and secondary rhinoplasty.     

The precise role of ethnicity and family history on aggressive prostate cancer: a review analysis

Review analysis of prostate cancer among men of sub-Saharan West African descent in comparison to other ethnicities and men with a family history of prostate cancer.     

Correction of the cleft-lip nasal deformity

Correction of the cleft-lip nasal deformity is a difficult task that requires a clear understanding of the associated complex anatomic abnormalities. These deformities tend to accentuate as nasal growth continues. Primary tip rhinoplasty in the unilateral deformity improves nasal tip symmetry and decreases the need for intermediate surgery. Intermediate rhinoplasty in the bilateral deformity is performed when nasal tip projection is markedly diminished. In both the unilateral and bilateral deformity, definitive rhinoplasty utilizing the open-structure rhinoplasty approach allows maximum exposure for placement of structural grafts to improve tip projection, definition, support, and function. In this article, the pathologic anatomy of the unilateral and bilateral cleft nasal deformity is described. The philosophy and timing of repair are discussed. Finally, the techniques used by the authors to address both the aesthetic and functional problems are outlined.     

Rhinoplasty and the male patient

A review of male patients undergoing rhinoplasty indicates a surprising diversity of anatomy and especially skin coverage. When compared with rhinoplasty in the female adolescent, the goal must be more of a "balanced rhinoplasty" rather than a reductive rhinoplasty, and the techniques required are more diverse. Careful screening of patients is essential to eliminate a subgroup of men with severe psychologic obsessions.