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At least 19 recordsLinked to original sources
PubMed2026

Rhinoplasty Difficulty Scale: Development and Psychometric Analysis of a Surgeon's Assessment of Rhinoplasty Technique and Nasal Deformity Correction.

BACKGROUND: Rhinoplasty surgeons lack a universal scale of the relative difficulty of rhinoplasty techniques and rhinoplasty deformities. OBJECTIVE: To compare the expert opinion of the difficulty of rhinoplasty techniques and rhinoplasty deformities among international rhinoplasty surgeons, as measured by a scale of difficulty. METHODS: A cross-sectional survey of rhinoplasty surgeons collected training levels, experience, case volume, and perceived expertise. Rhinoplasty techniques/deformities (n = 64) were rated from 1-10, representing the least to most technically demanding. Rasch analysis was used to examine the fit of the observed data to Rasch model requirements, assess rating scale functioning, and provide estimates of internal consistency. RESULTS: Respondents (n = 63) were in practice (<5 years, 14%; 5-10, 20%; 10-20, 20%; 20-30, 26%; >30, 20%), and rhinoplasty volume ranged from <25 (14%) to >100 cases/year (32%). Self-reported expertise was comfortably novice (32%), intermediate (10%), advanced (28%), and expert (30%). Otolaryngology (42%), facial plastic surgery (30%), and plastic surgery (28%) were represented. Rasch estimates of internal consistency reliability were excellent (0.96 for surgeons and 0.99 for items); the item difficulties were more heterogeneous (mean: 0, SD: 1.23) than the distribution of surgeons (mean: -0.09, SD: 0.58). Survey items were ordered by difficulty, ranging from least difficult (inferior turbinate reduction = 1.01) to most difficult (contracted nose repair post-infection = 8.24). CONCLUSION: The newly developed Rhinoplasty Difficulty Scale provides ratings of common rhinoplasty techniques and deformities with a high correlation among experts using this rating scale.

Humans↗
PubMed2000

Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties.

A retrospective study was conducted of 150 consecutive secondary rhinoplasty patients operated on by the author before February of 1999, to test the hypothesis that four anatomic variants (low radix/low dorsum, narrow middle vault, inadequate tip projection, and alar cartilage malposition) strongly predispose to unfavorable rhinoplasty results. The incidences of each variant were compared with those in 50 consecutive primary rhinoplasty patients. Photographs before any surgery were available in 61 percent of the secondary patients; diagnosis in the remaining individuals was made from operative reports, physical diagnosis, or patient history. Low radix/low dorsum was present in 93 percent of the secondary patients and 32 percent of the primary patients; narrow middle vault was present in 87 percent of the secondary patients and 38 percent of the primary patients; inadequate tip projection was present in 80 percent of the secondary patients and 31 percent of the primary patients; and alar cartilage malposition was present in 42 percent of the secondary patients and 18 percent of the primary patients. In the 150-patient secondary group, the most common combination was the triad of low radix, narrow middle vault, and inadequate tip projection (40 percent of patients). The second largest group (27 percent) had shared all four anatomic points before their primary rhinoplasties. Seventy-eight percent of the secondary patients had three or all four anatomic variants in some combination; each secondary patient had at least one of the four traits; 99 percent had two or more. Seventy-eight percent of the primary patients had at least two variants, and 58 percent had three or more. Twenty-two percent of the primary patients had none of the variants and therefore would presumably not be predisposed to unfavorable results following traditional reduction rhinoplasty. This study supports the contention that four common anatomic variants, if unrecognized, are strongly associated with unfavorable results following primary rhinoplasty. It is important for all surgeons performing rhinoplasty to recognize these anatomic variants to avoid the unsatisfactory functional and aesthetic sequelae that they may produce by making their correction a deliberate part of each preoperative surgical plan.

Adolescent↗
PubMed1992

[Mini-forum: rhinoplasty by external approach. External or endonasal approach for rhinoplasty?].

There appears to be a renewed interests in the external approach to rhinoplasty, first described 60 years ago, despite the external columellar incision, due to the excellent exposure of the cartilaginous structures provided by this approach. Progress has been made in rhinoplasty. Cartilage grafts are much more widely used than in the past and surgeons try to reconstruct a normal anatomy of the skeleton, which has become easier with this approach. However, the closed approach has demonstrated its efficacy for a long time and allows correction of a large range of deformities. The open rhinoplasty should not be the standard procedure and its indications should only be based on limitations of the closed approach. The external procedure is particularly indicated in some difficult cases of nasal tip surgery and secondary rhinoplasty.

Cicatrix↗
PubMed1995

Secondary rhinoplasty following open rhinoplasty.

On the basis of 56 cases of secondary rhinoplasty following an initial open rhinoplasty, I conclude that secondary surgery is safe and effective. Either an open or closed approach can be used in most cases with little risk of skin necrosis or poor scar formation. The decision as to which approach to use depends on numerous factors. In general, a closed technique is favored when augmentation is the solution, while an open technique is favored when structural correction is required. Reopening the nose was done consistently without problems but was avoided in two patients because of severe thinning following previous defatting. However, certain "stigmata" were seen following open primary rhinoplasty and should be avoided: (1) a depressed, visible scar, (2) destruction of the soft-tissue facets and nostril apices, (3) columella deformities with associated nostril asymmetry, and (4) excessive tip or supratip defatting.

Adult↗
PubMed1997

Revision rhinoplasty for monographs in facial plastic surgery contemporary rhinoplasty.

Revision rhinoplasty represents the amalgamation of years of knowledge, judgment, technique, communication, self-critique, and patient selection. The surgeon's ego, economics, or personality should not persuade or dissuade him or her from undertaking revision rhinoplasty. This decision should be made after critical evaluation of his/her skills at technical execution, and communicating with the patient, as well as the patient's perception and expectations. If any concern exists, delay. Re-evaluation and referral become prudent. These patients may already be angry. They are obviously dissatisfied with their results and have frequently had attempts at revision by the previous surgeon. All these factors complicate the psychological aspects of an already difficult task. One other realization is the fact that this now becomes your result if it is the revision of a colleague's surgery. When comfortable with all of these factors, revision rhinoplasty can then be undertaken. The need for revision may be subtle or grotesque and can result from a multitude of factors: unrecognized deformities at the primary surgery; misunderstood consequences of technique; poor technique; unfavorable healing; postsurgical injury; the inevitable need for revision surgery in a difficult nose; and poor aesthetic judgment. Revision of one's own results is emotionally more difficult, but functionally and technically easier. A complete understanding of the primary surgery, access to the initial photographs, and a rapport with a patient who is willing to return are all helpful in achieving a satisfactory result. In approaching the correction of postoperative deformities, it is important to have an understanding of the anatomic abnormality as well as the aesthetic deformity. Recognizing the anatomic cause of the postsurgical deformity is more relevant to their avoidance and to the maturation of the surgeon than to their correction and the desired aesthetic result except when functional abnormalities exist and need correction. Ultimately it is the deformity that needs to be corrected, and this may or may not require the restoration of anatomic normalcy.

Humans↗
PubMed1992

[Miniforum: rhinoplasty by external approach. Technical aspects of rhinoplasty by external approach].

The authors present the principle techniques of external transcolumellar rhinoplasty and stress the excellent exposure it provides, allowing effective treatment under direct vision of the anatomical structures of the nose tip, nasal spine and septum. Based on a series of 186 operated cases with a follow-up of between one and more than six years, the advantages and indications of this technique are briefly defined. The best indications are difficult nose tips, whether rhinoplasty is primary or, more particularly, when it is secondary.

Esthetics↗
PubMed1992

[Mini-forum: rhinoplasty by external approach. Collumello-trans-alar approach of open rhinoplasty: advantages].

For several years, the authors have been using a columellar transalar incision through the medial crus along the nasal septum, reaching the vault and continued laterally by a transalar cartilaginous incision. The nasal tip is thus opened like a car-hood, leaving the alar cartilage attached to the skin and exposing the triangular cartilage and the nasal septum. This approach allows septoplasty to be performed with excellent exposure. The tip is easily revised backwards allowing anomalies to be viewed directly. The advantages of this external approach compared with the classical external Rethi's approach are multiple: simplicity and rapidity of the technique, excellent access to triangular cartilages and the triangular-septum junction; possibility of always going from an endonasal approach to an external one and excellent access to the tip. Moreover, there is no long term swelling of the tip. The indications of this external approach are asymmetry of the tip, excessive tip projection, saddle nose deformities and secondary rhinoplasties. No complication has been observed in a series of 32 patients with a follow-up of 6 to 48 months. There is no disturbance of the tip position and the skin scar is imperceptible.

Bone Transplantation↗
PubMed1999

Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty.

Tip suture techniques offer a reliable and dramatic method of tip modification without needing to interrupt the alar rim strip or add tip grafts. The present simplified three-stitch technique consists of the following: (1) a strut suture to fix the columella strut between the crura, (2) bilateral domal creation sutures to create tip definition, and (3) a domal equalization suture to narrow and align the domes. If required, columella septal sutures can be added; either a dorsal rotational suture or a transfixion projection suture can be used. This simplified method represents a refinement based on more than 13 years of experience with tip suture techniques. It does not require a complex operative sequence or specialized sutures. Primary indications are moderate tip deformities of inadequate definition and excessive width and certain specific tip deformities, including the parenthesis tip and nostril/tip disproportion. The primary contraindications are for patients with minor tip deformities that are best done through a closed approach and those with severe tip deformities requiring an open structure graft. The technique is simple, efficacious, and easily learned.

Adult↗
PubMed1999

Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part II: secondary rhinoplasty.

Tip suture techniques have proven effective in managing many secondary tip deformities. The open approach is used in most cases because it allows analysis and utilization of the alar remnants. If the alar rim strip is intact and not deformed, then a three-stitch technique (strut, domal creation, and domal equalization) is used. If the domes were previously transected, they are repaired and an attempt is made to shape them with sutures. If sutures are ineffective or the domes are deformed, judicious excisions and tip-shaping sutures are employed to achieve an aesthetic "tip shape," as expressed through the overlying skin. Removal of sutures from previously sutured tips has proven effective in the columella and infralobular area, ineffective in the supratip midline, and unpredictable over the domal segment. Overall, tip suture techniques should be considered in secondary tip deformities whenever the alar cartilage remnants permit.

Adult↗
PubMed1993

[Preventive antibiotic administration in rhinoplasty. Tissue level and pharmacokinetics with reference to rhinoplasty techniques].

Prophylactic antibiotics (cefuroxime 1500 mg) were administered during induction of anesthesia to 34 patients undergoing nasal surgery. The infusion ended at the time of mucosa incision (mean infusion time: 22 min). A hemitransfixion incision was followed by elevation of the mucoperichondrium on both sides of the septum. The blood supply of the cartilage was thus diminished essentially. In the septal cartilage, the concentration of cefuroxime 68 min after the administrations of antibiotic was 28.1 micrograms/g; this concentration was 19.8 micrograms/g in the septal bone at 74 min. The mean peak plasma concentration was 158 micrograms/ml and the end half-life elimination time 77 min. High antibiotic concentrations in the cartilage resulted from passive diffusion through the septal mucosa and occurred at a mean time of 22 min. The time between the start of infusion at the induction of anesthesia and interruption of the septal blood supply by separating of the septum from overlying soft tissues was sufficient for developing high antibiotic concentrations. During nasal surgery the routine approach to the septum had no influence on the efficacy of antimicrobial prophylaxis.

Adult↗
PubMedDate not supplied

Rhinoplasty approaches: current state of the art.

OBJECTIVE: To survey rhinoplasty surgeons to determine their current approaches and the reason for their use, how they have acquired their knowledge, and trends in the use of open and closed approaches. DESIGN: A rhinoplasty questionnaire on open and closed rhinoplasty approaches was presented to surgeons attending the annual meetings of the American Academy of Facial Plastic and Reconstructive Surgery and the American Academy of Otolaryngology-Head and Neck Surgery. The 178 questionnaires were reviewed for analysis, and the results were tabulated by a statistician. Raw data were analyzed and cross-tabulations of specific subsets were reviewed. Main outcome measures included proportion of surgeons in various demographic groups using each technique, preferred incision, reasons for using each technique, usage over the past 5 years, and expected trend in the next 5 years. RESULTS: Most of the surgeons were in private practice, and most described their practice as otolaryngology (ear, nose, and throat [ENT]), facial plastic surgery (FPS), or ENT/FPS. Of the 178 responding surgeons, 46% had FPS practices and 27% devoted 90% to 100% of their practice to FPS. Most perform 100 or fewer rhinoplasties annually, and 23% perform open rhinoplasty 90% to 100% of the time. Sixty-three percent of FPS surgeons and 55% of ENT/FPS surgeons perform open septorhinoplasty (OSR) more than 50% of the time. Surgeons learn OSR mostly during residency (56%) and in didactic courses (51%) and learn closed rhinoplasty mostly during residency (75%). The most common indications for open rhinoplasty were difficult tip surgery (74%), revision procedures (73%), and grafting procedures (68%). Simple tip (65%) and simple dorsal (73%) procedures were common indications for closed rhinoplasty. The preferred incision for open rhinoplasty was the inverted "V" transcolumellar gull wing (58%); for closed rhinoplasty, cartilage delivery (48%) and intercartilaginous (28%). Most surgeons performed OSR at the same frequency during the past 5 years and expected to use OSR at the same frequency in the next 5 years. CONCLUSIONS: Overall, 53% of respondents used OSR more than 50% of the time. The movement toward open rhinoplasty seems to be plateauing, with a possible slight upward trend in its use. Over the past 5 years, there was still some trend toward the increasing use of the OSR approach, and most surgeons are performing OSR at the same frequency. Those with more than 5 years' experience believe that they are unlikely to change their approach in the next 5 years. Open septorhinoplasty may be indicated for rhinoplasties by a large proportion of surgeons, especially for rhinoplasties that are "difficult" or revisions or those requiring grafting.

Data Collection↗
PubMed2002

Differing characteristics in 100 consecutive secondary rhinoplasty patients following closed versus open surgical approaches.

Open rhinoplasty has unquestionably become more popular during the past two decades because of the putative diagnostic and technical advantages that direct transcolumellar access offers. To test the hypothesis that patients initially treated by the opened or closed approaches differed in the secondary deformities that developed, a retrospective study was conducted of 100 consecutive secondary rhinoplasty patients (66 women and 34 men) operated on by the author before February of 1998. Sixty-four percent had previously undergone closed rhinoplasties and 36 had undergone open rhinoplasties; the incidence of prior open rhinoplasty had increased steadily over the survey years, from 21 percent in 1996 to more than 50 percent in 1998, 1999, and 2000 (p < 0.05). The data generated indicate the following. First, the open rhinoplasty patients had undergone more operations (3.1 versus 1.2) and had more presenting complaints (5.8 versus 2.6) than the closed rhinoplasty patients. Second, although the most common presenting complaint among prior closed rhinoplasty patients was an overresected dorsum (50 percent) or tip (33 percent) or internal valvular obstruction (42 percent), prior open rhinoplasty patients complained more frequently than the closed rhinoplasty patients of these problems and also external valvular obstruction (50 percent, p < 0.0001), short nose (39 percent, p < 0.001), wide columella (36 percent, p < 0.001), narrow nose (31 percent, p < 0.001), columellar scar (25 percent, p < 0.001), and symptomatic columellar struts (19 percent, p < 0.001). Only excessive nasal length was more prevalent among closed rhinoplasty patients (20 percent, p < 0.01). Third, ranking of deformities differed significantly (p < 0.0001) between the two groups, so that complaints related to the nostrils, nasal tip, nasal length, or columella were more common among the open rhinoplasty patients than among those previously treated endonasally. Fourth, the relative frequencies of surgical complaints also differed: whereas patients previously treated endonasally were 6.7 times more likely to complain of long noses, patients previously treated by open rhinoplasty complained more frequently of the following: excessive columellar width (open approach, 36 percent of patients; closed approach, none), hard columellar struts (open approach, 19 percent of patients; closed approach, none), external valvular obstruction (4.5 times as frequent with the open approach as it was with the closed approach), alar/nostril distortion (four times as frequent), and narrow nose (3.9 times). Although the most common complaints among all postrhinoplasty patients remain the overresected dorsum, tip, or (internal valvular) airway obstruction, the author's data suggest that patients previously treated by the open approach are more likely to have postsurgical deformities and complaints referable to those anatomic structures most easily reached by transcolumellar exposure and to techniques that can be performed more readily or aggressively through that access route.

Adolescent↗
PubMed2003

Cosmetic rhinoplasty in body dysmorphic disorder.

Body dysmorphic disorder (BDD) occurs in about 5% of patients seeking cosmetic surgery. Such patients are often dissatisfied with surgery or their symptoms of BDD are the same or worse after surgery. We report on a study that was designed to determine the frequency of BDD in patients requesting cosmetic rhinoplasty in the UK and to compare them with BDD patients in a psychiatric clinic. In the first stage of the study, we used a screening questionnaire for BDD and found that 20.7% of patients requesting rhinoplasty had a possible diagnosis of BDD. However, we believe that we identified a group of patients with sub-clinical or very mild BDD who are satisfied by cosmetic rhinoplasty. In the second stage of the study, we compared (a) patients without BDD who had a good outcome after cosmetic rhinoplasty with (b) BDD patients seen in a psychiatric clinic (who crave cosmetic rhinoplasty but for a variety of reasons do not obtain it). We found that BDD patients seen in a psychiatric clinic who desire cosmetic rhinoplasty are a quite distinct population from those obtaining routine rhinoplasty without symptoms of BDD. BDD patients are significantly younger, more depressed and anxious than this group, and are more preoccupied by their nose and check their nose more frequently. They are more likely to conduct "D.I.Y" surgery and have multiple concerns about their body. They are more likely to be significantly handicapped in their occupation, social life, and in intimate relationships and to avoid social situations because of their nose. They are therefore more likely to believe that dramatic changes would occur in their life after a rhinoplasty. This study provides some clues for surgeons who wish to identify patients with BDD who might have a poor prognosis in cosmetic rhinoplasty. Further research is required in the development of a screening questionnaire or interview for identifying patients with BDD seeking cosmetic surgery.

Adult↗