Improving Projection of the Nasal Tip in Primary Endonasal Rhinoplasty

Gaining, improving, and maintaining nasal tip projection is one of the most essential elements of successful endonasal rhinoplasty. For years the hallmark of inadequate nasal tip projection following rhinoplasty has been the Polly beak deformity. Early rhinoplasty technique consisted of intracartilaginous excision of the cephalic margin of the lower lateral cartilages, cartilage and bony hump reduction, and osteotomies. Some of these simple rhinoplasties still look good decades later, however, many are conspicuous in their lack of nasal tip projection. The reason for this inconsistency in rhinoplasty results was the surgeon's inattention to the structural integrity and anatomical position of the LLC. The senior author uses a combination of suture, strut, and cartilage grafting techniques to achieve ideal projection in a manor tailored to each patient's unique anatomic needs.

Modified perichondrial-periosteal flaps to camouflage nasal dorsum in rhinoplasty

Background The smooth and straight nasal dorsum is a goal after nasal hump reduction as dorsal irregularities are unexpectable and inevitable complications. The aim of this study is to evaluate modified perichondrial-periosteal flaps functionally and aesthetically to camouflage nasal dorsal irregularities. A total of 115 patients with nasal humps were enrolled in the study. The perichondrium over the upper lateral cartilages is divided in the midline and dissected forming two laterally based flaps while the periosteum over the nasal bones is dissected superiorly. After completion of all rhinoplasty steps, the flaps were repositioned and sutured as a separate layer. Follow-up for 2 years with an assessment of irregularities of the nasal dorsum, collapse of the upper lateral cartilage, and nasal breathing. Results Aesthetically, no nasal dorsal irregularities were noticed. Also, no patients complained of nasal obstruction. Conclusion The modified perichondrial-periosteal flap is a successful technique, functionally and aesthetically. It avoids the appearance of dorsal irregularities.

Preservation Rhinoplasty: Evolution and Current State of Practice in the United States

Classic Joseph hump reduction techniques have been a hallmark of current rhinoplasty practice and teaching. Recently, there has been a renewed global interest in preservation rhinoplasty techniques, although these techniques are not new. The work and techniques of innovative surgeons including Goodale, Lothrop, and Cottle describing preservation concepts from the late nineteenth century and early twentieth century were not as prevalently adopted as open structural approaches. As such, there has been a relative paucity in both research and teaching of preservation techniques—particularly in the United States. A survey of members of the American Academy of Facial Plastic and Reconstructive Surgery and The Rhinoplasty Society (145 respondents) demonstrates that while 15 (10%) of surgeons are not at all familiar with dorsal preservation surgery, 130 (90%) were. In the group that was familiar with dorsal preservation, the majority were only somewhat familiar (84, 65%) with these techniques. Only 11 respondents received any formal training in dorsal preservation techniques during residency or fellowship. 61 (42%) had attended a course or conference in which dorsal preservation techniques were discussed. One-hundred twenty-two survey respondents (84.1%) do not currently implement preservation techniques into their rhinoplasty practice. Twelve (8%) respondents implement it in <25% of cases, 5 (3%) in 25 to 50% of cases, and 6 (4%) in >50% of cases. As research and formal training in preservation rhinoplasty grow, familiarity and implementation of these techniques will likely also grow in the United States.

Semi-Let-Down and Semi-Push-Down Preservation Techniques: Maintaining the Intactness of the Distal Region

Background The nose is an important part of the face and plays a significant role in interpersonal communication and self-esteem. Dorsal preservation techniques, such as the push-down and let-down techniques, are used for dorsal hump reductions. Objectives In this study, several approaches are defined in which the let-down and push-down techniques were applied depending on the patients’ needs. Methods The records of 64 patients were assessed retrospectively. The patients who underwent either push-down or let-down techniques for hump reduction and who were eligible for these new approaches were included. In this research, the distal part of the septum remained intact after both the push-down and let-down techniques. Patients were assessed before and one year after surgery using the Rhinoplasty Outcome Evaluation (ROE). Results The follow-up period ranged from 16 to 25 months (median of 19.2 months). The median ROE score before surgery was 61.6 (min: 58- max: 64) and increased to 92.2 (min: 82- max: 96) points twelve months after surgery. This increase in the ROE score was statistically significant (p&lt;0.001). The excellent satisfaction rate was 93.75% according to the ROE scale. Conclusions These approaches for the let-down and push-down techniques will lead to better results and will present different choices to surgeons. The present study is also the first to demonstrate leaving behind an intact area of the distal septum in the push-down and let-down techniques.