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At least 19 recordsLinked to original sources
PubMed2006

[Rhinoplasty: morphodynamic anatomy of rhinoplasty. Interest of conservative rhinoplasty].

OBJECTIVES: To highlight the morphodynamic anatomical mechanisms that influence the results of rhinoplasty. To present the technical modalities of nasal dorsum preservation rhinoplasties. To determine the optimized respective surgical indications of the two main techniques of rhinoplasty: interruption rhinoplasty versus conservative rhinoplasty. MATERIALS AND METHODS: Based on anatomical dissections and initial morphodynamic studies carried out on 100 anatomical specimens, a prospective study of a continuous series of 400 patients operated of primary reduction rhinoplasty or septo-rhinoplasty by one of authors (YS) has been undertaken over a period of ten years (1995-2005) in order to optimize the surgical management of the nasal hump. The studied parameters were: (1) surgical safety, (2) quality of early and late aesthetic result, (3) quality of the functional result, (4) ease of the technical realization of a possible secondary rhinoplasty. The other selected criteria were function of the different nasal hump morphotypes and the expressed wishes of the patients. RESULTS: The anatomical and morphodynamic studies made it possible to better understand the role of the "M" double-arch shape of the nose and the role of the cartilaginous buttresses not only as a function but also the anatomy and the aesthetics of the nose. It is necessary to preserve or repair the arche structures of the septo-triangular and alo-columellar sub-units. The conservative technique, whose results appear much more natural aesthetically, functionally satisfactory and durable over the long term, must be favoured in particular in man and in cases presenting a risk of collapse of the nasal valve. CONCLUSION: The rhinoplastician must be able to propose, according to the patient's wishes and in view of the results of the morphological analysis, the most adapted procedure according to his own surgical training but by supporting conservation of the osteo-cartilaginous vault whenever possible.

Cadaver↗
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↗
PubMedDate not supplied

Augmentation rhinoplasty with a combination of triple cartilage grafts for secondary rhinoplasty in a middle-aged population.

Because of physiologic changes with advancing age as well as previously traumatized and then healed tissues, secondary rhinoplasty for a middle-aged patient is a challenging procedure. Depending on both factors, changes in the midvault can cause a functional airway disorder, and the nose also may need a complete correction for cosmetic purposes. To achieve aesthetic and functional outcomes, augmentation rhinoplasty using a combination of triple cartilage grafts, namely, spreader, columellar, and dorsal onlays, was performed for 12 patients. Sufficient nasal airways with satisfactory appearance were achieved for 11 of 12 patients. Only one patient had improved but still insufficient nasal function with a good aesthetic result. Augmentation rhinoplasty using a combination of triple cartilage grafts for middle-aged patients could be considered an effective procedure for improving the patient's nasal airway and appearance.

Age Factors↗
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↗