Often unappreciated in rhinoplasty is the alar–columellar complex. Patients may present with a preexisting hanging or retracted columella or abnormal alar rim or columellar shape and configuration. In the patient with a preoperative normal relationship, certain surgical maneuvers, made to…
Older reduction tip rhinoplasty techniques are effective in altering tip contour and definition, yet they depend on aggressive cartilage resection, morselization, and sacrifice of tip supports to achieve these goals. Weakening of the crura in this manner, when subjected to…
The “pinched nasal tip” is a deformity caused primarily by collapse of the lateral crura of the lower lateral cartilages. Such collapse may be congenital due to inherent hypoplasia, weakening, or malposition of the cartilaginous support but is often secondary…
Few concepts in rhinoplasty engender as much discussion and conflict as the use of alloplasts in the nose. Clear divisions within the specialty have developed, with some surgeons using alloplastic implants liberally while others staunchly maintaining that alloplasts should never…
Over the past two decades, great improvements have been made in the design of facial implants. Facial implants are able to enhance facial contour and provide permanent volumetric replacement. Facial implants can be used in many anatomic regions of the…
Calvarial bone grafting is an established method of craniofacial reconstruction in facial plastic surgery. Konig and Muller were the first to describe autogenous calvarial bone grafting in 1890, advocating a combined osteocutaneous flap. Smith, Abramson, and Tessier popularized the technique…
The use of rib grafting in rhinoplasty has revolutionized the ability to treat complex nasal deformities. Its can be helpful for both primary nasal deformities (including posttraumatic, cocaine induced, and others), as well as secondary nasal deformities (including postoperative saddle…
Controlling the shape of the nasal tip can be one of the most challenging problems rhinoplasty surgeons face in practice. Prior to the advent of suture techniques, the cartilages of the nose were largely controlled, by excision, crushing, and scoring.…
One of the most important and difficult aspects of rhinoplasty surgery is creating a nicely shaped, natural-appearing nasal tip. This generally involves altering nasal tip definition, width, projection, and/or rotation. Nasal tip appearance is primarily determined by the shape and…
The importance of the middle third of the nose has been increasingly recognized in recent years. Reductive rhinoplasty techniques performed without regard for the structural integrity of this region can cause structural and functional compromise. In this chapter, the anatomy,…