The Problem Work on the nasal tip is done to improve rotation, projection, and definition. This can be done with sutures and or grafts. In this chapter, we will focus on contemporary grafting techniques for the nasal tip. The lower third of the nose is formed by a tripod structure that is composed by both alar cartilages. The conjoined medial crura forms the central portion of…
The Problem Wide, firm, convex lower lateral cartilages. The Background Among all the anatomic nasal aesthetic problems that bring a patient to the plastic surgeon, the boxy tip is very common, especially in the female patient. The firm, abundantly convex lower lateral cartilages with shouldering in the oblique view, a tall vertical dome height, and often a central interdomal depression or cleft gives a distinctly masculine…
The Problem Creating normal structure and shape to the nasal tip. The Background If rhinoplasty is the most difficult procedure in aesthetic plastic surgery, tip plasty is arguably the most difficult procedure in rhinoplasty. In our experience, the most frustrating problems have been a supratip deformity, a bulbous tip, and an ill-defined tip. Secondary surgery has been frustrating because scar tissue has made it difficult to…
The Background A piezotome is an electrically powered ultrasonic tool that delivers rapid and controlled cutting of bone ( Fig. 30.1 ; Video 30.1). It has been available to dentists, maxillofacial surgeons, and neurosurgeons for dental and craniofacial osteotomy, but also more recently to otolaryngologists and plastic surgeons for burring or osteotomy of nasal bones during rhinoplasty. The ultrasonic tool has a variety of cutting tips…
Introduction Lateral osteotomies and transverse osteotomies are typically performed in order to correct deviation of nasal bones, to narrow wide nasal bones, and/or to close an open roof. Lateral osteotomies can be done via many methods. Two common approaches include an internal or an external (percutaneous) method. In this chapter, we will mainly focus on external percutaneous lateral osteotomy. You’re Reading a Preview Become a Clinical…
The Problem The nasal bony pyramid is a complex anatomical structure. Lateral and medial osteotomies are planned and performed to contour and shape the bony vault. This step has a critical role in the function and aesthetic of the nose. The Background Osteotomy is a determinant part of the rhinoplasty. Historically, lateral osteotomy has been aimed to narrow a wide bony pyramid and create a smaller…
The Problem Dorsal nasal augmentation is frequently needed in many secondary and some primary rhinoplasty patients. The Background The autogenous cartilage graft is commonly utilized in augmentation of dorsal nasal deficiencies. Historically there has been an unwritten agreement to count the septal cartilage as the first choice for minimal dorsal augmentation and the costal cartilage as the first option for major dorsal reconstructions. Despite numerous advantages…
The Problem Shallow nasal radix. The Background One of the relatively common anatomical variations is a deficient nasal radix. Radix augmentation is therefore a common procedure in rhinoplasty that has significant effects on patient aesthetics. In 1996, Skoog reported using a resected dorsal hump as an autograft for the correction of an overly resected hump and a shallow radix. The resected hump can be displaced superiorly…
The Problem A low radix creates the illusion of a pseudohump. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
The Background The dorsal hump is an ethnic feature in the Mediterranean White and Middle Eastern populations. The reduction of the dorsal hump has become a crucial rhinoplasty step in this group of patients. Depending on the degree of reduction, the surgery includes the upper lateral cartilage in most of the cases and an osteocartilaginous resection of the hump and septal region. However, the reduction of…
The Problem Dorsal hump resection or reduction is one of the most commonly performed rhinoplasty procedures. Patients often present with concerns regarding a “hump” or over projection of the dorsum of the nasal vault. As such, rhinoplasty surgeons must approach hump reduction surgery with precision and a certain delicate touch to prevent many complications associated with this procedure. The Background The dorsum of the nose begins…
Disclosure Statement Dr. Azizzadeh receives royalties from Wiley, Thieme, Elsevier & Springer. The other author has no financial or conflicts of interest to disclose. No funding was received for this article. The Problem Surgical reduction of the nasal dorsal hump is one of the most common maneuvers performed in rhinoplasty. A dorsal hump creates an aesthetically unpleasant appearance that frequently contributes to decreased self-confidence and negative…
The Problem The dorsal hump is the most common complaint in patients presenting for cosmetic rhinoplasty. Mastering this technique, its pitfalls, and its functional implications is essential for the surgeon wanting to build a successful rhinoplasty practice. The Background The dorsal hump may be osseous, cartilaginous, or osteocartilaginous. It may be associated with a deviation in the dorsum, in which case the nasal bones will be…
The Problem Excessive dorsal nasal convexity (large) The Background One of the most common concerns in cosmetic rhinoplasty is a large dorsal hump. It is the most easily identified by the surgeon, the patient, and the public as an unaesthetic appearance. The hump is defined as the dorsum of the nose from the most superior point of the nasal bones that begin to extend above the…
The Problem A need for autologous cartilage sufficient in strength and in quantity to manage both complex primary and secondary nasal deformities. The Background Cartilage grafting is often necessary to achieve the aesthetic and functional goals in rhinoplasty. Septal cartilage is an ideal material but is often in short supply. Auricular cartilage may be used, but it is relatively weak and irregular in contour. In contradistinction,…
The Problem How to remove temporalis and mastoid fascia simultaneously. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
The Problem Dorsal nasal augmentation as recommended by Jack Sheen is needed in primary operations for patients with a deep nasofrontal angle or in secondary overresected cases. To achieve a balanced nose as described by Sheen, material for augmentation is needed. The most common material used is autologous cartilage block harvested from the septum, ear concha, and rib. Although these materials give a durable and permanent…
The Problem A predictable source of autogenous graft is commonly needed in almost all revision rhinoplasties and many complicated primary nose surgeries. The Background Conchal cartilage is one the oldest known sources of autogenous cartilage graft. It easily provides a considerable amount of cartilage with no considerable change in ear appearance. The harvested auricular graft may be fashioned for different uses in tip plasty with some…
The Problem A predictable source of autogenous graft is commonly needed in almost all revision rhinoplasties and many complicated primary nose surgeries. The Background Autogenous cartilage is currently the gold-standard augmentation material in rhinoplasty. Different sources of autogenous grafts are frequently compared in rhinoplasty literature, and it seems all sources have their own advantages and limitations. Conchal cartilage was originally used for minor deformities. However, many…
The Problem The cornerstone of rhinoplasty is restructuring the nasal framework, and creating a beautiful, stable configuration usually requires cartilage grafting. Nasal septal cartilage is the most commonly used graft source as it is readily available and structurally suitable. Safely harvesting as much septum as possible in one piece maximizes the potential to make the necessary grafts. The Background Whether aesthetic or functional, a rhinoplasty involves…