A New Extrasupported Tip Graft in the Treatment of Bulbous Nasal Tip

Treatment of bulbous nasal tip is difficult. In the presence of thick, inelastic skin, cartilaginous framework should be supported in special areas. Many tip grafting techniques have been described but the results usually are not satisfactory. We developed a new tip grafting technique to provide extra support and extra length to the nasal tip. The graft is prepared from the septal cartilage and has an extended ``A' appearance. The tip graft is supported with a columellar strut graft. Both grafts are inserted into small separate pockets through separate incisions. If necessary, the alar base is reduced with a modified Weir technique. Fifty-two patients were treated with this technique over the last 3 years. Results were satisfactory in all patients without any complications such as graft displacement, infection, or resorption. Extrasupported tip graft is an effective method in the treatment of bulbous nasal tip with thick skin.     

Nasal Tip Plasty Using Various Techniques in Rhinoplasty

Rhinoplasty is one of the most common aesthetic surgical procedures in Korea today. However, simple augmentation rhinoplasty results often failed to satisfy the high expectations of patients. As a result, many procedures have been developed to improve the appearance of the nasal tip and nasal projection. However, the characteristics of Korean nasal tips including the bulbous appearance (attributable to the thickness of the skin), flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medical crus of the alar cartilage and a short columella have made such procedures difficult. Currently, most plastic surgeons perform rhinoplasty simultaneously with various nasal tip plasty techniques to improve the surgical results. An important part of an aesthetically pleasing result is to ensure an adequate nasal tip positioned slightly higher than the proper dorsum, with the two tip defining points in close proximity to each other, giving the nose a triangular shape from the caudal view. From June 2002 to November 2003, the authors performed rhinoplasty with simultaneous nasal tip plasty using various techniques according to the tip status of 55 patients (25 deviated noses, 9 broad noses, 15 low noses, and 6 secondary cleft lip and nose deformities). The surgery included realignment of alar cartilage by resection and suture, fibroareolar and subcutaneous tissue resection, tip graft, and columellar strut. The postoperative results over an average period of 10 months were entirely satisfactory. There were no patient complaints, nor complications resulting from the procedures. Good nasal tip projection, natural columellar appearance, and improvement of the nasolabial angle were achieved for most patients. In conclusion, rhinoplasty with simultaneous nasal tip plasty, achieved by a variety of techniques according to patients tip status, is an effective method for improving the appearance of the nose and satisfying the desires of the patients.     

Tip graft from the cartilaginous dorsum in rhinoplasty

A cartilage graft from the cartilaginous hump can be used in primary rhinoplasty for nasal tip projection. This technique has now been used for two years without complications in 35 patients with similar nose deformities, which included an inadequately projected tip and a high dorsal line. These grafts have proved to be another easy way to get an adequate tip projection in primary rhinoplasty.Paper presented at The Annual Meeting of the American Society for Anesthetic Plastic Surgery, in Los Angeles, California, April, 1983     

Effect of Nasal Tip Surgery on Asian Noses Using the Transdomal Suture Technique

The past two decades have ushered in a new era of nasal tip surgery. The new philosophy focuses on preserving and reorienting nasal tip structures. Modern suture techniques can give predictable results because of more precise suture placement. Only a few reports, however, have objectively evaluated the suture techniques for Asians. Accordingly, the authors aimed to assess the efficacy of the tip suture technique through projection and rotation analysis. We focused on transdomal sutures because they involve one of the most popular suture techniques. Preoperative and postoperative photographs of 85 patients who underwent rhinoplasty at Inha University Hospital between June 2002 and June 2004 were analyzed. The patients were categorized into four groups according to the techniques used. Tip projection was measured by the modified Heuzinger’s method and tip rotation by the nasolabial angle. The pre- and postoperative indexes were compared within each group and among the four groups. Paired and unpaired t tests were used for statistical analysis. When the pre- and postoperative indexes were compared within each group, only the combined technique (transdomal suture with onlay graft) showed significant tip projection improvement. All tip surgeries resulted in insignificant tip rotation increase. Comparison among the four groups showed no significant difference based on the type of tip surgery performed. The suture technique has many advantages, although it has some limitations with Asian noses, especially if used alone. Therefore, we recommend using the suture technique in combination with other tip surgical procedures, such as onlay grafts, to achieve significant tip projection.     

A Simplified Use of Septal Extension Graft to Control Nasal Tip Location

Background For defining the shape and projection of the nasal tip, the bilateral and symmetric batten-type septal extension grafts proposed by Byrd and colleagues have drawbacks. The main problems are stiffness of the nasal tip and thickening of the septum in the nasal valve area. Methods Since 1998, unilateral single-batten grafts, and more frequently, bilateral asymmetric batten grafts as compared with Byrd’s bilateral symmetric application, have been used for 72 patients in our facility. Results At the 6-month postoperative follow-up assessment, tip projection was found to be satisfactory in 61 patients. Less than desired projection occurred in three cases and overprojection in two cases. Nasal lobule deviation was evident in one patient. The loss of the columellar break point was evident in five cases. Conclusion Unilateral or asymmetric bilateral batten grafts facilitate adjustment of the nasal tip intraoperatively. This technique results in a more pliable nasal tip in the horizontal plane. Construction of a three-layered cartilage in the nasal valve area is not needed, and the nasal airway is preserved. With this modification, a reliable and predictable nasal tip location is obtained with a minimum of graft usage.     

Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review

Tip surgery, the most important part of the rhinoplasty procedure, has entered a new era in the past few decades. Various treatment protocols have been attempted. To date, however, opinions on the management of the Asian tip have not been solidified. To generalize and provide appropriate guidelines for the treatment of typical Asian tips, an English literature search from 1977 to March 2007 was conducted. Finally, a total of 26 papers were selected for review. The full text of each paper was read carefully, and data were extracted. Then all extracted information was imported into Microsoft Excel. Nine articles treating 11 groups of patients described the suitable techniques for Asian nasal tips, with 81.8% of the groups advocating that the protocol include a grafting technique, 64% reporting use of the grafting technique alone, and 9% applying cartilage reduction and a suturing technique. Of the 11 (18%) groups, 2 attempted more than one technique. Because of the Asian nasal tip's innate qualities, success with nasal tip plasty for Asians depends on the combined application of appropriate suturing, grafting, and defatting, with grafting techniques contributing the most.     

鼻小柱支撑移植物在鼻尖整形中的作用

目的：探讨鼻小柱支撑移植物在鼻尖整形中的分类、材料组成,作用及使用方法。方法：70例鼻尖整形病人中,均使用鼻小柱支撑移植物,其中使用鼻中隔软骨48例,肋软骨19例,耳甲腔软骨3例;使用漂浮/固定型移植58例,固定型移植4例,延伸型移植18例。结果：除1例出现了鼻尖突出度不足,经二次手术纠正外,余69例鼻尖成形良好,病人对手术效果满意。结论：根据不同情况,选择不同种类,不同材料进行鼻小柱支撑移植是鼻尖整形中一项良好的手术技术。     

自体脂肪移植综合技术矫正面部局限性硬皮病

目的 探讨自体脂肪移植综合技术矫正面部局限性硬皮病的临床效果。方法 2009年1月至2015年8月,对12例面部局限性硬皮病患者应用自体脂肪颗粒注射移植,联合局部皮瓣转移和局部黏连组织松解技术,矫正其组织缺损,自体脂肪颗粒注射3~4次,每次注射间隔6个月。结果 患者术后随访8~18个月,脂肪存活良好,面部形态改善良好,病变区皮肤色泽改善。本组患者术后均无血肿、皮下硬结、感染等并发症发生。结论 自体脂肪移植综合技术矫正面部局限性硬皮病安全有效,值得临床推广应用。     

块状肋软骨移植物在隆鼻术中矫正鼻基底凹陷的临床效果

分析块状肋软骨移植物在隆鼻术中对鼻基底凹陷患者的矫正效果。方法 选择2021年 5月-2023年5月于我院行隆鼻术的100例鼻基底凹陷患者为研究对象，采用随机数字表法分为对照组和 观察组，各50例。对照组行颗粒状肋软骨矫正，观察组行块状肋软骨矫正，比较两组鼻部美学角度测 量值、并发症发生情况及满意度。结果 观察组小柱上唇角、小柱小叶角、鼻面角及鼻额角均高于对照 组，差异有统计学意义（P ＜0.05）；观察组并发症发生率为4.00%，低于对照组的20.00%，差异有统计 学意义（P ＜0.05）；观察组满意度为100.00%，高于对照组的80.00%，差异有统计学意义（P ＜0.05）。结 论 块状肋软骨移植物在隆鼻术中矫正鼻基底凹陷的临床效果良好，能够改善患者的凹陷症状，提高鼻部 美学效果，且术后并发症发生几率较低，患者满意度较高。     

植骨在手术治疗跟骨关节内骨折中的作用

目的通过前瞻性随机研究,观察植骨在切开复位内固定治疗关节内跟骨骨折中是否有益。方法2001年1月至2005年12月收治需要手术治疗的闭合性关节内跟骨骨折110例,随机分为植骨组和非植骨组。采用“L”形外侧延长切口,直视下显露整个跟骨外侧壁、距下关节后关节面及跟骰关节,给予跟骨骨折复位。对于植骨组采用自体髂骨植骨填充复位后的骨缺损,而非植骨组则不进行植骨。随后将塑形良好的跟骨解剖重建板放置于跟骨外侧壁以固定跟骨骨折。手术前后摄片测量Bohler角,术后采用美国矫形足踝协会踝后足评分标准进行患者的功能评价。结果手术前后植骨组和非植骨组的Bohler角增加没有统计学差异,术后6个月Bohler角的丢失也没有统计学差异,术后6个月、1年及2年的足功能评价也没有差异。结论在手术治疗关节内跟骨骨折中植骨并不具有优势。     

Compound implant to project the nasal tip

Use of a compound implant to project the nasal tip in cases of thick skin, a depressed or slightly descending tip, and a minimal bony hump is reported. This implant gives shape and projection, is easy to obtain, and is well tolerated by the organism. It is made of a strip of septal cartilage or silastic; the anterior end is covered by a portion of alar cartilage. There is a low percentage of complications with this technique.     

Lateral crural retrodisplacement for superior rotation of the tip in rhinoplasty

Three techniques for producing superior rotation of the nasal tip are presented. One merely retrodisplaces the lateral crura on the upper lateral cartilages, one horizontally shortens the lateral crura by resection of cartilage between their anterior and posterior extremities, and one transects the cartilage in a curved fashion to allow the anterior portions of the lateral crura to be rotated on the posterior portions and upper lateral cartilages. All three techniques allow maintenance of good airways and a strong valve tending to prevent inspiratory collapse and visible external dimpling. The procedures are based on physiologic and anatomic principles. Details of the methods and short-term and long-term results are shown.Presented at the Fourth International Congress of the International Society of Aesthetic Plastic Surgery on April 28, 1977, in Mexico City, Mexico.     

Tricortical Calcaneal Bone Graft and Management of the Donor Site

The clinical outcomes of 19 patients requiring autogenous grafts for foot surgery were followed up until healing at the donor site occurred. In all cases, tricortical bone was extracted from the calcaneus for use at another pedal site. The first cohort of 9 patients had the calcaneal deficit replaced with allogenic cubes. The second cohort received no tissue replacement. Patients were reviewed postoperatively with a questionnaire and clinical examination to evaluate the outcome of the operations. Radiographic outcomes were observed at the donor and recipient sites in both groups until healing was confirmed as bridging trabeculation. Incorporation of the graft at the donor site was also reviewed. Clinical outcomes, namely pain, local sensory function, and return to footwear, were satisfactory in all patients and were not significantly different between groups. One patient from each group sustained a heel fracture. The donated autogenous grafts at the recipient sites were all incorporated uneventfully at 6 months. In the first cohort, allogenic graft incorporation in the calcaneus was complete in only 2 patients at the 12-month stage. The remaining 7 cases showed reduction of the deficit by new bone formation arising from the calcaneus. Donor sites with allogenic bone replacement healed at a median of 18 months (interquartile range, 18-18 months). In the group without replacement, healing occurred at a median of 6 months (interquartile range, 6-12 months), a highly statistically significant difference (P < .001). In the second cohort without allogenic graft replacement, radiographic filling at the donor site was complete within a 12-month period. Tricortical bone can be successfully harvested from the calcaneus, but there may an associated risk of heel fracture. The role of replacement allogenic bone in assisting healing at the donor site is unclear.