Turn-in Folding of the Cephalic Portion of the Lateral Crus to Support the Alar Rim in Rhinoplasty

Backgrounds The hypoplastic, weak lateral crus of the nose may cause concave alar rim deformity, and in severe cases, even alar rim collapse. These deformities may lead to both aesthetic disfigurement and functional impairment of the nose. Methods The cephalic part of the lateral crus was folded and fixed to reinforce the lateral crus. The study included 17 women and 15 men with a median age of 24 years. The average follow-up period was 12 months. For 23 patients, the described technique was used to treat concave alar rim deformity, whereas for 5 patients, who had thick and sebaceous skin, it was used to prevent weakness of the alar rim. The remaining 4 patients underwent surgery for correction of a collapsed alar valve. Results Satisfactory results were achieved without any complications. Conclusions Turn-in folding of the cephalic portion of lateral crus not only functionally supports the lateral crus, but also provides aesthetic improvement of the nasal tip as successfully as cephalic excision of the lateral crura.     

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.     

Secondary Rhinoplasty

Revision rhinoplasty is a complex aesthetic and reconstructive procedure in which both functional and cosmetic principles must be considered in the planning of an appropriate operation. Different techniques must be modified according to the specific defects. The modifications may vary from simple integration of a previous poorly performed surgery to complex grafting of homologous or heterologous material. The authors report their experience with 311 cases of revision rhinoplasty.     

A Surgical Algorithm Using Open Rhinoplasty for Correction of Traumatic Twisted Nose

In this series, the authors present their experience with correction of the traumatic twisted nose in Asians using open rhinoplasty. A standard surgical algorithm was followed to determine treatment strategies for 92 patients with traumatic twisted nose at the Tri-Service General Hospital in Taiwan between 1 August 2001 and 1 June 2004. A retrospective chart review was performed to collect patient data and surgical details. A follow-up self-evaluation survey regarding satisfaction with nasal function and aesthetics was distributed to all the participants. All the patients underwent open rhinoplasties under general anesthesia. The 87 males and 5 females were 15 to 53 years of age (mean, 28 years). Their postoperative periods were uneventful and without complications. Patient self-evaluations were largely positive, reporting improvement in nasal function. The authors propose a simple surgical algorithm using open rhinoplasty for optimal correction of traumatic twisted nose deformities. The algorithm, which is adaptable to a variety of anatomic deformities, guides surgical decision making that yields consistently satisfactory functional and aesthetic results.     

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.     

Open Rhinoplasty Through a Forked Flap Incision

Surgical elongation of the short columella is a challenging problem for the surgeon. Although some flaps from the upper lip are successfully used to correct this deformity on cleft lip patients with a scarred upper lip, these methods cannot be applied to noncleft patients with a smooth upper lip. Distant flaps and composite grafts do not give the best aesthetic results. The use of an external approach for rhinoplasty is preferred by many surgeons, especially for difficult or secondary cases. Most incisions for open rhinoplasty are placed on the columella. This report describes a new incision for open rhinoplasty to be used on patients with a short columella. The incision is a standard forked flap with a columellar base but the legs of the flap extend to the nostril bases instead of to the upper lip. This method was used on eight aesthetic rhinoplasty patients with a short columella between March 1995 and March 1998. The results of the method are discussed.     

Rhinoplasty. The Difficult Nasal Tip: Total Resection of the Alar Cartilages

There are many ways to reconstruct and make nasal tips more attractive. Sometimes we cannot find the best way unless we at least remove all surplus from the tip. This may occur in primary or secondary rhinoplasty. In principle, anything is possible when relocating and reconstructing. However, sometimes we face reality when we uncover the tip: broken or bulging cartilages that are difficult to put right. For this reason, in 1987 we thought of totally resectioning the alar cartilages in a case of secondary rhinoplasty with an unsightly appearance. After a year the result was seen to be correct from an aesthetic and a functional perspective and is still so today. Aesthetically, it kept its shape and did not collapse with nasal respiratory failure. We covered the end of the crus medialis with a small, temporary, one- to two-layered fascia patch. Except in exceptional cases, we now use this procedure: Total sectioning of the alar cartilages including the domes, or maintenance of them by preserving the fibroadipose tip tissue with a suture in the middle of the end of the crus medialis and by covering this with temporary fascia, which usually has two layers depending on the thickness of the skin of the tip. This procedure is indicated mainly in secondary rhinoplasty when the cartilages of the tip are completely destroyed, and in primary rhinoplasty when the tip is excessively wide and bulbous. Our philosophy is, therefore, elegance and beauty of the nasal tip with a solid and equilateral base without prejudices.     

Augmentation Rhinoplasty with a Combination of Triple Cartilage Grafts for Secondary Rhinoplasty in a Middle-Aged Population

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.     

外鼻整形术在鼻翼退缩分型患者中的应用效果

目的 观察外鼻整形术在鼻翼退缩分型患者中的应用效果。方法 选取四川悦好医学美容医院美容 外科2021年1月-2023年1月收治的60例鼻翼退缩分型患者,按照随机数字表法分为对照组和观察组,各 30例。对照组行鼻孔缩小术,观察组行外鼻整形术,比较两组外鼻整形参数、鼻美学指标、临床疗效、鼻 通气功能指标、鼻外形畸形情况、鼻腔通气评分及并发症发生情况。结果 观察组鼻长、理想鼻长、额鼻 角、鼻唇角优于对照组,差异有统计学意义（P＜0.05）;观察组鼻尖突出度高于对照组,鼻孔暴露度低于 对照组,差异有统计学意义（P ＜0.05）;观察组治疗总有效率为96.67%,高于对照组的86.67%,差异有 统计学意义（P ＜0.05）;观察组鼻腔最小截面积、鼻腔容积、鼻腔呼气吸气阻力各项鼻通气功能指标优 于对照组,差异有统计学意义（P ＜0.05）;观察组鼻外形畸形评分、鼻腔通气评分低于对照组,差异有 统计学意义（P ＜0.05）;两组均未见并发症发生。结论 外鼻整形术在鼻孔暴露度鼻翼退缩分型患者中的 应用效果优于鼻孔缩小术,对改善患者鼻孔暴露度、鼻部美观度等具有积极作用,更具临床应用价值。     

Closed Rhinoplasty with Marginal Incision: Our Experience and Results

Supporters of traditional rhinoplasty and promoters of open rhinoplasty have debated their approaches for many years. From among different possible techniques, a surgeon must always choose the approach that provides the best aesthetic result. The surgeon’s experience and artistic sense are essential for the closed technique, whereby most of the corrections are performed without exposing the nasal frame. The open technique allows a greater operating range with a direct view of the nasal structure, resulting in improved precision in modeling the cartilages. However, the absence of intact skin cover exposes the surgeon to a less precise overall aesthetic evaluation. This report highlights the marginal technique, described in 1990 by Guerrerosantos, which uses a two-sided circular incision permitting complete dissection of the alar cartilages and the overhead skin cover of the columella. This approach, together with the extramucous technique, permits complete exposure of the skin and nasal septum without a columella incision. Therefore, the marginal technique is suitable for primary rhinoplasty cases in which complex modeling of the nasal tip and an excellent aesthetic result are required.     

Secondary rhinoplasty via transcolumellar incision

The transcolumellar rhinoplasty was used in 90 patients with severe nasal sequelae caused by one or more previous surgical interventions. In each case the deformity was located mainly on the nasal tip making it extremely difficult to correct with conventional surgical procedures. We chose the transcolumellar rhinoplasty procedure to avoid another failure for these patients who sought complete resolution of their problem. At the same time, the technique provides a more secure surgical field to make a definitive diagnosis and to treat the sequelae properly.Presented at the 10th International Congress of ISAPS, Zurich, Switzerland, 1989, and at the International Symposium of Rhinology, São Paulo, Brazil, 1990     

Functional and Esthetic Rhinoplasty

Rhinoplasty is performed to improve the appearance of the nose. However, conventional procedures may result in impairment of nasal breathing. The purpose of this article is to describe a functional and esthetic rhinoplasty technique designed to avoid adverse effects on venti1ation by preserving the structure of the nasal vault. The main indication for this technique is treatment of cyphotic or tension nose. Since this procedure does not correct nasal obstruction due to septo-turbinal abnormalities and narrow nasal fossa, turbinoplasty must be performed concurrently if necessary. Our series of >1000 cases over a 15-year period demonstrates that this conservative rhinoplasty technique prevents most functional complications associated with conventional procedures and often improves ventilation. Immediate and long-term cosmetic outcome is excellent with a natural-looking appearance and fewer tip revisions.