Simultaneous Repair of Defects on the Nasal Dorsum and Nasal Tip

Retraction of columella and collapse of nasal tip may be a primary phenomenon or secondary to poor results of rhinoplasty. This may be due to excessive resection of dorsocaudal septum or inappropriate removal of the nasal spine. Reconstruction of the columella is a difficult surgical procedure and many techniques have been described. This report describes a technique of interposition of a composite skin-conchal cartilage graft between the caudal septum and columella. The graft will restore the projection of the nasal tip and correct a retracted columella by increasing its base. The newly positioned columella forms an aesthetically acceptable obtuse angle with the lip and is 2–3 mm lower than the alar rims. The cartilage from the concha of the ear is an excellent grafting material for nasal reconstruction. It has been used for augmentation of the nasal dorsum, tip grafting, and correction of vestibular atresia. The graft is harvested utilizing a technique that allows for minimal postoperative auricular deformity at the donor site. Aesthetic results have been satisfactory, with very low morbidity following this method.

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The Nasal Width and Boxiness Index: Introduction and Pilot Study on Reliability and Validity of Sonographic Morphometry

Facial Plastic Surgery ◽

10.1055/s-0038-1667025 ◽

2018 ◽

Vol 34 (04) ◽

pp. 373-380

Author(s):

Ralph Litschel ◽

Abel-Jan Tasman

Keyword(s):

Pilot Study ◽

Cross Section ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Skin Surface ◽

Likert Scale ◽

Nasal Dorsum ◽

Limits Of Agreement ◽

Nasal Tip ◽

Lay Persons

AbstractBoth intended and unintended surgical modifications of nasal width and shape of the nasal tip continue to be of interest to the rhinoplasty surgeon. As validated instruments for quantifying width and boxiness are lacking, the objective of this study was to introduce a width index and a boxiness index for the nasal dorsum and the nasal tip. A width index and a boxiness index were defined within the methodological limits of noncontact sonography. The reliability of both indices was studied by comparing the measurements of two examiners on the noses of five volunteers. The validity of the indices was studied by correlating the sonographic width and boxiness with the 5-point Likert scale ratings of photographs of 5 noses by 21 lay persons. Nasal width was defined as the diameter at a distance of 5 mm from the skin surface on a sonographic cross-section perpendicular to the skin surface. Boxiness was defined as the quotient of width at a depth of 1 and 5 mm. Bland–Altmann analysis revealed negligible bias between both examiners and 95% of limits of agreement of 13, 7, and 13% for width at 1 mm, width at 5 mm, and boxiness, respectively. Corresponding Pearson's correlation coefficients were r = 0.93, r = 0.93, and r = 0.71. The correlation between the cumulative lay persons' scores and sonographic width and boxiness were r = 0.97, r = 0.66, and r = 0.81 for nasal tip width, dorsal width, and boxiness, respectively. Both the width at a depth of 5 mm as measured with sonography and the boxiness index that is defined as width at a depth of 1 mm divided by the width at a depth of 5 mm may prove to be acceptable surrogate parameters for width and boxiness of the nose in comparative morphometric studies.

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Supracrural Ligament Graft in Rhinoplasty

Facial Plastic Surgery ◽

10.1055/s-0040-1714666 ◽

2020 ◽

Author(s):

Kirkland N. Lozada ◽

Garrett D. Locketz ◽

Daniel G. Becker

Keyword(s):

Potential Risk ◽

Fascia Lata ◽

Nasal Dorsum ◽

Temporalis Fascia ◽

Graft Size ◽

Initial Exposure ◽

Nasal Tip ◽

Primary Rhinoplasty ◽

Thin Skin ◽

Areas Of Concern

AbstractIrregularities of the nasal dorsum or tip are a potential risk after rhinoplasty. Patients with thin skin are considered to be at a higher risk of these irregularities. Different materials and grafts to address areas that may result in a contour irregularity postoperatively include diced or crushed cartilage, temporalis fascia, fascia lata, and AlloDerm. We describe a new graft, the supracrural ligament graft, which can be used to camouflage or add bulk during primary rhinoplasty. The graft is harvested easily during the initial exposure and does not require additional surgical sites or extra dissection. In this research, we described the use of the supracrural ligament graft in 49 patients. We found the average graft size to be 0.6 × 0.4 cm. The graft was used in the following locations: nasal tip (49%), radix (40%), and nasal dorsum (10%). No complications were seen using the graft in any of the 49 patients. In conclusion, the supracrural ligament graft is a safe, simple, and effective camouflage graft for commonly encountered irregularities in rhinoplasty. Common areas of use include the nasal dorsum and nasal tip. Routine harvest of this graft may obviate the need to use either additional grafting material or an additional surgical site to help camouflage areas of concern in thin skin patients.

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Surgical pearl on reconstructing surgical defects of the nasal tip

Dermatology Reports ◽

10.4081/dr.2016.6828 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Artur César ◽

Ana Barros ◽

Paulo Santos ◽

Filomena Azevedo

Keyword(s):

Surgical Technique ◽

Nasal Dorsum ◽

Full Thickness ◽

Nasal Tip ◽

Skin Defects ◽

Full Thickness Skin ◽

One Stage ◽

Thickness Skin ◽

Cutaneous Flap

Repairing surgical defects of the nasal tip is challenging, mainly because of the lack of freely mobile skin available peripherally. The Peng flap is a one-stage cutaneous flap that circumvents this difficulty by recruiting skin from the nasal dorsum and sidewall regions. The design produces a tridimensional shape perfectly adapted to the configuration of the nasal tip and allows for an inconspicuous closure of the defect. We present three examples of full-thickness skin defects involving the nasal tip, reconstructed using a modified version of the Peng flap, and present the experience at our department with this surgical technique.

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Reconstruction of Nasal Defects With Dermal Skin Substitutes—A Retrospective Study of 36 Defects

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419852060 ◽

2019 ◽

Vol 23 (4) ◽

pp. 413-420 ◽

Cited By ~ 3

Author(s):

Katharina Moratin ◽

Philipp-Sebastian Koch ◽

Johannes Benecke ◽

Azadeh Orouji ◽

Corinne Bauer ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Procedures ◽

Nasal Dorsum ◽

Skin Substitutes ◽

Nasal Tip ◽

Nasal Ala ◽

Dermal Regeneration ◽

The Aesthetic ◽

Nasal Defects

Objectives: It is uncertain whether dermal regeneration templates (DRTs) are helpful to reconstruct nasal defects. The aim of this study was to assess whether the aesthetic subunits determine the outcome. Methods: In this unicentric, retrospective study, the surgical procedures and outcomes of patients who received DRTs to reconstruct nasal defects were assessed and compared with the involved aesthetic subunits. Results: DRTs were used for reconstruction of 36 nasal defects in 35 patients with involvement of 76 aesthetic subunits: nasal sidewall (n = 21), nasal ala (n = 13), nasal tip/columella (n = 12, n = 1, respectively), nasal dorsum (n = 12), and extranasal aesthetic areas (n = 17). Fifty-eight nasal and 8 extranasal aesthetic subunits were reconstructed with DRTs, 10 subunits with a flap. Twenty-nine of 36 defects healed without any complications (80.5%). All reconstructed nasal tips/columella and the nasal dorsa healed without any complications. Region-specific complications were retraction of the ala rim (4/12; 33.3% of the patients with involvement of the nasal ala) and the formation of a fistula in the nasal sidewall (1/21; 4.8%). Region-specific complications of extranasal subunits were the development of an ectropium (2/3; 66.7% of the patients with involvement of the lower lid). Conclusions: DRTs can be helpful to reconstruct nasal defects. However, if the defect involves the aesthetic subunits nasal ala or the infraorbital region, different techniques should be preferred.

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Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8050602 ◽

2019 ◽

Vol 8 (5) ◽

pp. 602 ◽

Cited By ~ 5

Author(s):

Hyung Joon Seo ◽

Rafael Denadai ◽

Lun-Jou Lo

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Three Dimensional ◽

Normal Subjects ◽

Width Ratio ◽

Nasal Dorsum ◽

Nasal Tip ◽

Primary Rhinoplasty ◽

Bilateral Cleft Lip

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.

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The Horn Technique for Nasal Tip Support in Rhinoplasty

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1709193 ◽

2020 ◽

Author(s):

Luiz Carlos de Melo Barboza ◽

Maíra Garcia Martins ◽

Carlos Alberto Caropreso ◽

José Luiz Teixeira Rodrigues ◽

André Baraldo Rodrigues

Keyword(s):

Retrospective Review ◽

Aesthetic Surgery ◽

Nasal Dorsum ◽

Effective Technique ◽

Nasal Tip ◽

Small Loss ◽

Tip Projection ◽

Tongue In Groove ◽

Nasal Tip Projection ◽

New Surgery

Abstract Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

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