Nasal valve obstruction complicating rhinoplasty: prevention and treatment. Part I.
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Biomedical subjects
Publications and source records attributed to W E Berman.
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Like others in my field, I wasn't happy with sharp edges of tip cartilage or a wider narial base postoperatively. Necessity is the mother of invention, and the techniques described for eliminating those pitfalls are safe and effective. I hope that you have found these segments on nasal tip surgery provocative. At the very least, they have been tried and true for many years. It will be a pleasure to answer your comments and questions.
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Adequate undermining of the SMAS layer, excision of redundant SMAS, and repositioning with permanent sutures to fascia in a more superior area has afforded better results without untoward risks. Plication of the lateral edge of the platysma to the mastoid fascia with the same 3/0 permanent suture is usually sufficient, although strong mid-neck banding must be treated with a submental incision, excision of the medial platysma borders which are then sutured together with the same permanent sutures. My series represents more than fifteen hundred cases performed in this manner. I recently did a secondary facelift sixteen years later and found these sutures still holding very well. In these days of many facelift techniques, it would be interesting to compare your comments and suggestions.
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