鼻美容整形术的现状与展望

鼻整形手术是最古老的整形外科手术之一,印度人采用额部皮瓣行鼻再造已经有2600余年的历史。16世纪,意大利人首创的前臂带蒂皮瓣鼻再造术是西方最古老的整形外科手术之一。由于鼻在容貌美中占有重要的位置,所以鼻美容整形术很早就受到西方人的重视,另外由于某种“鼻形”是种族(     

鼻美容整形术进展

近20年来，以美容外科为主体的美容医学得到蓬勃发展。而鼻美容整形术是美容外科临床医师实施的常用手术之一，数量仅次于眼部美容手术，在美容医学美学理论的指导下，融于美学理念的设计以及手术方法，理论与技术得到不断的有新的改良和创新。     

额部扩张皮瓣全鼻再造术

修复全鼻缺损的方法很多，且历史悠久，但有一点为众所公认，即额部皮瓣最为理想。主要因其具有再造鼻外形稳定，色泽近似，通气功能良好，且在转移过程中无肢体固定痛苦等优点。但供区遗留的皮片移植凹陷畸形或（和）明显瘢痕却不尽人意。为避免上述不足，我们将扩张器应用于全鼻再造术中，利用扩张的额部皮瓣行全鼻再造，不仅可使供区I期缝合，瘢痕不明显，产生类似延迟的效应，而且效果优于一般延迟术，从而提高皮瓣的成活率，效果满意，现报告如下。     

扩张后额部带蒂皮瓣带游离肋软骨支架一次完成全鼻再造术

目的探讨扩张后额部带蒂皮瓣带自体肋软骨支架一次完成全鼻再造术的方法，方法自1994年以来，应用扩张后额部蒂皮瓣带自体肋软骨支架一次完成全鼻再造术，临床治疗6例，对修复缺损内衬和皮肤的准确设计，皮肤扩张器应用的方法，肋软骨支架的雕刻固定，皮瓣的设计，手术方法和术后鼻塞的应用作了详细的报告和讨论。结果，本组6例患者，肋软骨支架和皮瓣全部成活。结论，应用扩张后额部带蒂皮瓣带自体肋软骨支架行全鼻再造术成为首选治疗方案。     

膨体聚四氟乙烯在鼻整形术中的应用

隆鼻术是整形外科非常常见的美容手术。目前常用的隆鼻假体多为硅橡胶，其次是膨体聚四氟乙烯，除以上2种材料外．还有应用带肋软骨的自体肋骨进行隆鼻。自2005年11月起，本科应用国产膨体聚四氟乙烯（expanded polytetrafluethlene．ePTFE）进行隆鼻手术，手术效果良好。现报道如下。     

扩张的额部复合皮瓣预制法鼻再造术

目的：探讨一种应用扩张的额部复合皮瓣预制进行鼻再造的手术方法。方法：2008年7月～2010年1月,对7例鼻缺损患者分四期行鼻再造术。一期：埋植额部扩张器,同时额部皮下移植自体软骨,额肌深面中厚植皮;二期：取扩张器,行额部扩张复合皮瓣转移鼻再造术;三期断蒂;四期修整。结果：7例患者手术后随访6～12个月,手术均取得较好的效果。结论：扩张的额部复合皮瓣预制法鼻再造术为修复鼻全层缺损提供了一种新的术式选择。     

综合鼻整形术及若干问题分析讨论

目的 探讨利用综合鼻整形术是对鼻部进行整形的外科手术的若干体会.方法 通过综合分析患者鼻部状况,以及个人要求的不同,精准测量患者鼻梁、鼻翼、鼻尖、鼻孔、鼻小柱等相关美学数据,寻找到鼻部高度、长度、宽度弧度以及视觉度的最佳平衡点,对鼻梁、鼻头、鼻翼等进行多部位联合手术.结果 患者一次整形使鼻部形态得以全面综合改善.结论 ...     

应用改进的额部扩张皮瓣行全鼻再造术

目的 探讨应用改进设计的额部扩张皮瓣行全鼻再造术的效果。方法 将前额主要供血支部分结扎阻断，保留选用的轴型血管蒂，强化皮瓣扩张的延迟效应，除设计以额正中皮瓣做全鼻再造外，还选用额上区横向扩张皮瓣，其供区缺损施以同侧或对侧扩张皮瓣推进修复，直接缝合。共已应用11例。结果 11块额部扩张皮瓣转移后完全存活，随访6个月～8年4个月，再造鼻功能形态恢复满意，供区瘢痕不明显。结论 强化额部扩张皮瓣血供或选用额上区横向皮瓣都是鼻再造的有效方法。     

颞浅血管蒂额部岛状皮瓣修复鼻部分缺损

目的　研究颞浅血管蒂额部岛状皮瓣修复鼻部分缺损的方法。方法　自 1992年以来采用颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 17例 ,全层缺损以皮瓣远端折叠法或局部翻转皮瓣法制作衬里。皮瓣最小面积 1.5cm× 3cm ,最大面积 8cm× 10cm。结果　 17例中 ,移植皮瓣完全成活 12例 ,经随访 1～ 11年 ,鼻缺损修复后轮廓形态逼真 ,移植皮瓣颜色和周围肤色差别小 ,外形和功能良好。皮瓣供区痕迹不明显。移植皮瓣回流障碍 3例 ,术后局部遗留色素改变。移植皮瓣部分坏死 2例 ,皮瓣部分坏死后 3周 ,用对侧鼻唇沟带蒂皮瓣移植修复。结论　颞浅血管蒂额部岛状皮瓣修复鼻部分缺损 ,是一种良好的选择。     

通过鼻再造术一次性修复鼻及鼻周缺损

目的：探索一次性修复鼻及鼻周缺损的治疗方法。方法：1995年～2008年,收治34例鼻及鼻周缺损的患者,男21例,女13例;年龄17～70岁。先行额部扩张器置入术。二期手术,利用缺损周围的局部翻转皮瓣形成鼻衬里,将缺损纳入鼻前庭;额部扩张皮瓣移位行鼻再造术。三期断蒂。病程6～26月。结果：34例患者,32例疗效满意。结论：将鼻周的缺损视作术后新鼻部解剖区的一部分,再造全鼻并修复缺损,重建面部美学解剖分区。该方法与传统方法相比,能够获得更为满意的效果。     

Secondary rhinoplasty

During the past 15 years the guest editor has developed new and better procedures for secondary rhinoplasty. These techniques, including ear cartilage grafts, are discussed in this article.     

Open rhinoplasty

Open rhinoplasty provides visualization, which for many is essential for the best sculpturing. The indications for its use include every primary and secondary rhinoplasty candidate unless tip grafts are going to be under tension or if the deformity is minor. The technique of opening the nose has been described. Emphasis is placed on (1) suturing the medial crura together, (2) suturing the medial crura to the septum, (3) resecting a portion of the lateral crus, and (4) leaving as much cartilage in the supratip and cephalic parts of the lateral crus as possible. The result is (1) greater tip projection with fewer tip grafts, (2) improved correction of tip convexity, (3) fewer supratip deformities, and (4) fewer Weir excisions. The columella scar is usually inconspicuous and has not been a significant problem in any case.     

Endoscopy-assisted rhinoplasty

In nasal surgery some surgical steps are done without the aid of direct vision. In these situations, surgeons must use their experience and judgment. I have adapted techniques used in endoscopic sinus surgery to perform some of the surgical steps of functional and aesthetic rhinoplasty. Between September 1999 and February 2000, 11 patients underwent endoscopic-assisted septorhinoplasty, and 18 patients underwent traditional closed rhinoplasty. The following parameters were compared: surgical bleeding, postoperative edema and ecchymosis, dorsum irregularity, and operative time for each technique. The following steps were clearly visualized with the endoscope: raising the periosteum from the nasal bone, resecting the nasal hump, and rasping the nasal bones. The use of endoscopic instruments does not change the surgical steps required. Rather, it allows direct vision of steps previously not viewable.     

Augmentation rhinoplasty

Augmentation rhinoplasty using a silicone implant is the most popular operation in Japan, but is not without several complications such as exposure of the implant and its deviation. We obtained good results in preventing these complications by a fixation at the hollow which is made by chiseling the frontal bone and by fibrous tissue which grows through the small holes of the implant tail.This paper was presented at the 36th Congress of the Japan Society of Aesthetic Plastic Surgery, Yokohama, Japan, May 16, 1987, and at the 9th Congress of the International Society of Aesthetic Plastic Surgery, New York, October 11–14, 1987     

Secondary rhinoplasty

A secondary rhinoplasty can and should be performed when the primary procedure is unsuccessful. There are many reasons for failure of a primary rhinoplasty, some unrelated to the surgeon's skill or the nasal anatomy, such as inflammation or epistaxis. Improper healing of parts of the nose may result in defects, as will improper application of surgical technique. A secondary rhinoplasty should be performed only after a careful examination of the entire nasal area, including a soft-ray radiographic examination of the osteocutaneous profile. We performed this secondary procedure in 70 patients between 1963 and 1978.     

Revision rhinoplasty

Revision rhinoplasty requires sound judgment by both patient and surgeon. Detailed preoperative assessment facilitates proper patient selection. If the patient is deemed a favorable revision rhinoplasty candidate, both patient and surgeon must agree on the goals for and risks inherent in revision rhinoplasty. Thoughtfulness regarding the degree of aesthetic and functional correction desired by the patient and the corresponding intraoperative techniques required to achieve this correction must be contemplated prior to committing to revision rhinoplasty. Furthermore, the surgeon must feel confident that the surgical demands requested by the patient may be met and satisfaction achieved. A precise preoperative surgical plan minimizes intraoperative misadventures. Options for grafting materials should be discussed and agreed upon by both patient and surgeon preoperatively. Both patient and surgeon commit to long-term postoperative follow-up and the patience necessary for the eventual outcome to be realized.