Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review

Size: px
Start display at page:

Download "Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review"

Transcription

1 Aesth Plast Surg (2008) 32: DOI /s REVIEW Aesthetic Rhinoplasty of the Asian Nasal Tip: A Brief Review Guang-Yu Mao Æ Song-Lin Yang Æ Jiang-Hong Zheng Æ Qing-Yang Liu Published online: 24 January 2008 Ó Springer Science+Business Media, LLC 2008 Abstract Tip surgery, the most important part of the rhinoplasty procedure, has entered a new era in the past few decades. Various treatment protocols have been attempted. To date, however, opinions on the management of the Asian tip have not been solidified. To generalize and provide appropriate guidelines for the treatment of typical Asian tips, an English literature search from 1977 to March 2007 was conducted. Finally, a total of 26 papers were selected for review. The full text of each paper was read carefully, and data were extracted. Then all extracted information was imported into Microsoft Excel. Nine articles treating 11 groups of patients described the suitable techniques for Asian nasal tips, with 81.8% of the groups advocating that the protocol include a grafting technique, 64% reporting use of the grafting technique alone, and 9% applying cartilage reduction and a suturing technique. Of the 11 (18%) groups, 2 attempted more than one technique. Because of the Asian nasal tip s innate qualities, success with nasal tip plasty for Asians depends on the combined application of appropriate suturing, grafting, and defatting, with grafting techniques contributing the most. Keywords Asian Grafting Nasal tip plasty Rhinoplasty Suturing often have failed to satisfy the high expectations of patients. Therefore, many procedures have been developed to improve the appearance of the nasal projection and nasal tip. Nasal tip surgery was first introduced at the end of the 19th century by John O. Roe. At that time, aggressive techniques involving alar cartilage resection were used. Recently, more conservative techniques have become increasingly recognized including suture techniques, tip grafting, and subcutaneous tissue resection. However, the characteristics of the Asian nasal tip including the bulbous appearance, flared nostrils, and restriction of the nasal tip attributable to an underdeveloped medial crus of the alar cartilage and a short columella have made such procedures difficult. Metaanalyses are becoming an increasingly accepted means for achieving evidence-based conclusions, helping surgeons to make rational decisions in choosing methods. The lack of adequate trials and publications comparing the efficacy of varied methods for performing Asian nasal tip plasty spurred us to perform an analysis of the literature on this subject. In this evidence-based review, the current literature was examined to determine whether any significant scientific evidence existed to support a standard method for the Asian nasal tip. Currently, rhinoplasty is one of the most popular aesthetic surgical procedures, particularly in China and South Korea. However, the results of simple augmentation rhinoplasty G.-Y. Mao S.-L. Yang (&) J.-H. Zheng Q.-Y. Liu Department of Plastic Surgery, Shanghai No.6 People s Hospital, Shanghai Jiao Tong University, 600 Yi Shan Road, Shanghai , China Materials and Methods Search Criteria A relevant literature search was performed by using Medline (through Pubmed, from 1977 to March 2007). The search strings and the number of hits are given in Table 1. The search was performed with limiting factors of

2 Aesth Plast Surg (2008) 32: Table 1 Search strings and number of hits Search strings Medline Nasal tip and Asian 30 Nasal tip and Oriental 28 Cartilage reduction and nasal tip 41 Cartilage cutting and nasal tip 6 Suturing and nasal tip 30 Cartilage graft and nasal tip 131 restriction of the nasal tip. With the development of the management for the Asian nose since the year 2000, plastic surgeons have paid more attention to the classification of the Asian nose/nasal tip. In this review, all classifications were based on the internal anatomic structures (skin and alar cartilages) or on their external reflections. According to the detailed distinctness, the different treatment programs listed in Table 2, were used. human and English language. Additional articles identified from these references that contained relevant supporting information then were included. Inclusion and Exclusion Criteria After excluding identical papers, we selected peerreviewed articles that met the following criteria: Articles about other fields except for the aesthetic nasal tip plasty were excluded. Literature that focused on the treatment of aesthetic nasal tip plasty was selected regardless of the number of patients. Additional articles identified from the references that contained relevant supporting information then were included. After all the abstracts had been read, 19 papers about the treatment were selected for review. The full text of each paper was read carefully, and data extraction was performed. Finally, all extracted information was imported into Microsoft Excel. Data Extraction The techniques described in the articles were divided into three types: suturing, grafting, and cartilage reduction. The respective number of patients treated using each technique was calculated. Cases with no complications were considered as demonstrating a good result whether the patient was satisfied with the outcome or not. Any treatment that lengthened the columella (e.g., columellar strut use) was considered as a type of grafting. Results Classification According to common knowledge, the typical Asian nose is characterized by its bulbous appearance, flared nostrils, and Management Indication After screening of the abstracts, 9 articles describing treatment for 11 groups of patients were selected for techniques suitable for Asian nasal tips. The detailed data are listed in Table 3. Most clinical studies advocated a multiple choice for the Asian tip. Of the 11 groups, 9 (81.8%) included a grafting technique with the protocol, 7 (64%) reported the use of grafting techniques only, and 1 (9%) respectively underwent cartilage reduction and suturing techniques. Two (18%) of the 11 groups attempted more than one technique (Fig. 1). Discussion Nasal tip procedures have undergone a significant change in the past few years. Previous techniques resected or vertically divided the alar cartilage, resulting in altered structural integrity and stability. In contrast, the new philosophy of tip surgery focuses on preserving and reorienting the nasal tip structures, thus maintaining their integrity instead of destroying it. It is speculated that for Asian noses, sufficient tip projection cannot be attained by either the domal suture technique or onlay grafting alone because of weak alar cartilage, thick skin, and abundant subcutaneous tissue. Therefore, clinicians need to be familiar with suturing and grafting techniques and to combine them properly. Grafting and Implanting Many Asian plastic surgeons believe that an alloplastic implant [1], especially a silicone graft, is the correct material for three reasons. First, for most Asians, harvesting of autologous cartilage or bone may be difficult to accept for traditional or religious reasons. Second, for the Asian nose, a moderate amount of augmentation is indicated for preservation of the racial type. Finally, although many Western supporters of biologic nasal augmentation argue that silicone is a foreign body that is not incorporated into the patient s

3 634 Aesth Plast Surg (2008) 32: Table 2 Classification of Asian nose/tip Author Description Treatment Aung et al. [3] 2000 A. A very prominent alar lobule forming a full and rounded nasal tip No mention B. A less prominent alar lobule forming a more defined nasal tip C. The least prominent alar lobule forming a relatively straight slope from the tip to the base Shirakabe et al. [25] 2003 A. An unprojected dorsum and tip Dorsum augmentation with or without tip augmentation B. Prominent dorsum and diminutive tip Tip augmentation and dorsum reduction C. Adequate dorsum height and diminutive tip Tip augmentation only D. Prominent dorsum and adequate projected tip Dorsum reduction only Ahn [1] 2006 A. Thin skin and strong cartilages Interdomal suturing/columellar strut/shield graft B. Thick skin and strong cartilages Cartilage onlay grafts/alloplastic implants C. Thick skin and weak cartilages B + A/premaxillary grafts Table 3 Publications on the management of the Asian nasal tip Author Tip morphology Technique Suturing Cartilage reduction Grafting Defatting Shin & Lee [24] 1994 Flat nasal tip - - Columella lengthening - Deva et al. [7] 1998 No mention - - Silicon implant - McKinney [20] 2000 Bulbous nose - Resection of the cephalic or - - middle portion of the lateral crura Lam & Kim [16] 2003 No mention - - Bird - Silicon implant Shirakabe et al. [25] 2003 Diminutive tip - - Conchal cartilage - + Silicon Lee et al. [18] 2004 Deviated nose - Alar cartilage resection Columella strut + Broad nose Septal cartilage graft Flat nose Lin et al. [19] 2006 Bulbous nose - - Lateral crura flap - Saddle tip Silastic tip implant Hodgkinson [13] 2007 Flat tip - - Conchal graft - Bone graft Jang et al. [14] 2007 No mention - - Onlay graft Onlay graft - tissue, and thus will become infected or extruded, this may not be completely true because the nasal soft tissue of Asians is thicker and less extensible than that of Caucasians. However, not all Asian noses can be treated adequately using simple implant insertion alone. Wu [27] thinks that for thick bulbous tipped noses, a simple implant placement can produce a trilobed appearance of the tip, which is made up of the implant tip and the displaced domes of the alar cartilages or lower lateral cartilages that lie on either side of the implant tip. In his opinion, the smallest, sharpest tips can be attained only with autogenous materials. Wu prefers to use a silastic implant only for the dorsum, terminating the implant in the supratip region. The tip of the nose then is given more projection by resecting the upper two-thirds of the lower lateral cartilages and using these as supporting grafts for the columella and tip. The availability of increasingly varied alloplastic materials has evolved in response to techniques for nasal augmentation. The best implant for nasal augmentation, however, remains controversial. Three factors must be considered: biocompatibility, the patient s selection, and long-term results.

4 Aesth Plast Surg (2008) 32: Fig. 1 Distribution of patients undergoing different techniques Generally, implants can be divided into biologic and alloplastic types. Biologic materials include cartilage, bone, and fascia [17]. Alloplastic materials comprise silicone, Supramid, Vicryl, Proplast, Mersilene, Medpore, polytetrafluoroethylene, and ivory. Each has its advantages and disadvantages [1, 7]. Alloplastic implants are straight or curved sheets for augmentation of the dorsum, and sometimes for augmentation of the tip as well. They are readily available and easy to fashion and shape, but they may incur some serious complications (e.g., resorption, infection, extrusion, and foreign body reaction), which can be avoided with the application of autogenous implants. Nevertheless, autogenous implants also have some disadvantages such as insufficient supply, longer procedure time, high cost, and donor-site morbidity. Kŏnig [8] was the first to use autogenous cartilaginous grafts for humans. The earliest clinical application of septal grafts in the nose was reported by Metzenbaum [8]. One of the two most commonly used techniques is the shieldshaped (sometimes triangular) graft proposed by Sheen and Sheen [23]. The first technique places the shield graft in the lobule to accentuate the middle crura columella angle and to provide tip projection. The second technique positions the rectangular onlay graft over the domes, as proposed by Peck and Peck [22]. Some widely used biologic grafts are listed in Table 4, and a few donor sites are listed in Table 5. In addition, actual lengthening of the columella would increase nasal tip projection. The medial crura of the alar cartilages are the primary components of the columella and provide tip support. Footplates of the medial crus vary in size, shape, and angulation. To solve this problem, Oguz Cetinkale et al. [5] used cartilage grafts in both the tip and the labiocolumellar junction at the same time, whereas Shin and Lee [24] used V-Y advancement or an earlobe composite graft in the columella base to lengthen the columella. Suturing Rhinoplasty in the 20th century places more emphasis on surgery of the nose for aesthetic reasons than ever before. The period ranging from 1930 to the early 1980s was Table 4 Overview of tip grafts [5, 6, 9 10, 12, 15, 21 23] Description Graft pocket (envelope) Application Anchor graft Shaft is sutured to the caudal margin of the medial crura Improve tip support and/or project and collapse or Transverse components replacing the lateral crura or deform the lateral crura lying over their remnants and sutured to them Cap graft Between the tip-defining points and the middle crura Refine, soften, and fill in clefts of the nasal tip in patients with thin skin to enhance tip projection minimally and occasionally to refine the infratip lobule area Columella strut (floating/fixedfloating) Between the medial crura through a small incision caudal to the feet of the medial crura Maintain tip support and increase tip projection and aid in shaping the columella-lobular angle Columellar strut (fixed) Fixed to the nasal spine or premaxilla Increase tip projection and perhaps aid in lengthening the nose Extended columella strut tip graft (extended shield graft) In the precrural space or by placed caudal to or between the medial crura and sutured in place to the crura Provide tip support, projection, definition, and fullness caudal to the medial crura to aid in shaping the columella Onlay tip graft Placed horizontally over the alar domes Minimally increase tip projection but mainly to camouflage tip irregularities Shield graft (Sheen or infralobular graft) Placed adjacent to the caudal edges of the anterior middle crura, extending into the tip Increase tip projection, define the tip, and improve contour of the infratip-lobule Subdomal graft Placed under the domes Correct dome asymmetry by controlling the horizontal and vertical orientation of the domes Correct the pinched nasal tip deformity Umbrella graft Transverse component placed in a small tight pocket or sutured to the domes of the lateral crura Increasing both tip projection and support

5 636 Aesth Plast Surg (2008) 32: marked by two parallel developments. On the one hand, the increased use of cartilage excision techniques in aesthetic rhinoplasty often resulted in disruption of the nasal tip components, with inconsistent outcomes. Thus, sutures served to hold the disrupted tip components and then reposition them in place. On the other hand, a concurrent evolution was taking place in the field of cleft nose surgery. The ensuing two decades leading to the 21st century were marked by a rapid transition from disruptive cartilagealtering techniques to procedures that made use of precision suture placement for reshaping of the nasal tip cartilages without serious disruption of the components. In this innovative field, it is not surprising that many techniques have developed in tandem but with varying nomenclature. Invariably, this creates confusion for the novice and the experienced surgeon alike. It is of great importance to extend credit to the pioneers of tip rhinoplasty techniques. Surgical results are more predictable with increased reliance on sutures placed with precision and with an understanding of the dynamic that they induce when used singly or in combination. Currently, instead of excising and repositioning of the tip cartilages, the focus is on lateral crus preservation and tip cartilage modification through precise suture placement and tension control (Table 6). Assistant Technique To some extent, the characteristic of an Asian nasal tip is its bulbous nature. It is different from the tip of Western noses, which is characterized by a strong nasal cartilage. Five soft tissue layers overlying the osseocartilaginous framework are identified: the skin, the subcutaneous areolar plane, the vascular-fibromuscular layer, the deep areolar plane, and the perichondrium/periosteum. The cartilaginous framework provides projection, support, and shape to the dorsum and tip of the nose. The skin of the nose is specialized, capable of retaining its shape even after dissection due to an arrangement of elastin fibers in the upper dermis and the subcutaneous areolar plane that confers elasticity to the skin, especially in the region of the alar lobule, which is a skin and fibromuscular sandwich [28]. To thin out the tip, most surgeons thin the Table 5 Indications for donor cartilage related to the area to be reconstructed [2] Donor site Advantages Disadvantages Septum Easy harvest May be deficient No separate donor-site morbidity Auricle Easy harvest Separate donor site Relatively abundant Curved (less desirable for some purposes) Curved nature ideal for certain purposes Rib Large volume (abundant, even for significant augmentation) Donor-site morbidity Distant donor site (2-team approach possible) Warping possible Reliable Table 6 Evolution of suture placement in the nasal tip [4, 11, 26] Surgeon Joseph 1931 Goldman 1954 McIndoe and Rees 1959 McCollough and English 1985 Tardy and Cheng 1987 Daniel 1987 Kridel et al Tebbetts 1989,1994 Gruber 1997 Guyuron 1998 Technique Orthopedic suture: columella septal suture (interdomal and medial crura anchor sutures) Lateral crura divided just lateral to domes, medial crura sutured together (medial crural, middle crura, and interdomal sutures) Cleft nose repair: alar cartilage repositioned with medial crural and lateral crural sutures (medial crura anchor and medial crural sutures) Double-dome unit: morselization of domes; horizontal mattress through both medial and lateral crura under domes (early transdomal and interdomal sutures) Transdomal suture: horizontal mattress through both domes with knot placed interdomally Domal creation sutures: an individual horizontal mattress suture placed across each dome Lateral crural steal technique Systematic nondestructive approach: specific sequence of suture placement; medial crura anchor suture, medial crura footplate suture, medial crura suture, lateral crura suture, tip rotation sutures Lateral crura convexity control suture Medial crura footplate suture refinement

6 Aesth Plast Surg (2008) 32: undersurface of the raised skin flap, then excise and discard the fibrofatty areolar tissue over the tip and between the lower lateral cartilages. This latter tissue is in fact a useful source of interpositional tissue between implant and skin, which also can be used to mold the tip [27]. Conclusion In summary, because of the Asian nasal tip s innate qualities, including weak cartilages and abundant subcutaneous tissue, success with nasal tip procedures for Asians depends on the combined application of appropriate suturing, grafting, and defatting, with grafting techniques contributing the most. References 1. Ahn JM (2006) The current trend in augmentation rhinoplasty. Facial Plast Surg 22: Araco A, Gravante G, Araco F, Castri F, Delogu D, Filingeri V, Casciani CU, Cervelli V (2006) Autologous cartilage graft rhinoplasties. Aesth Plast Surg 30: Aung SC, Foo CL, Lee ST (2000) Three-dimensional laser scan assessment of the Oriental nose with a new classification of Oriental nasal types. Br J Plast Surg 53: Behmand RA, Ghavami A, Guyuron B (2003) Nasal tip sutures part I: The evolution. Plast Reconstr Surg 112: Cetinkale O, Altintas O, Yakut H, Yucel A (2004) Labiocolumellar graft combined with tip graft in the management of inadequate tip projection. Aesth Plast Surg 27: de Benito J, Fernandez Sanza I (1995) Rhinoplasty and the aesthetic of the smile. Aesth Plast Surg 9: Deva AK, Merten S, Chang L (1998) Silicon in nasal augmentation rhinoplasty: A decade of clinical experience. Plast Reconstr Surg 102: Erdoğan B, Ayhan M, Gŏrgü M, Deren O (2002) Umbrella graft of columella tip: 20 years experience. Aesth Plast Surg 26: Gruber RP, Grover S (1999) The anatomic tip graft for nasal augmentation. Plast Reconstr Surg 103: Gunter JP, Landecker A, Cochran CS (2006) Frequently used grafts in rhinoplasty: Nomenclature and analysis. Plast Reconstr Surg 118:14e 29e 11. Guyuron B, Behmand RA (2003) Nasal tip sutures part II: The interplays. Plast Reconstr Surg 15: Han SK, Lee DG, Kim JB, Kim WK (2004) An anatomic study of nasal tip supporting structures. Ann Plast Surg 52: Hodgkinson DJ (2007) The Eurasian nose: Aesthetic principles and techniques for augmentation of the Asian nose with autogenous grafting. Aesth Plast Surg 31: Jang TY, Choi YS, Jung YG. Kim KT, Kim KS, Choi JS (2007) Effect of nasal tip surgery on Asian noses using the transdomal suture technique. Aesth Plast Surg 31: Juri J, Juri C, Grilli DA, Zeaiter MC, Vazquez GD (1988) Correction of the secondary nasal tip and of alar and/or columellar collapse. Plast Reconstr Surg Lam SM, Kim YK (2003) Augmentation rhinoplasty of the Asian nose with the Bird silicone implant. Ann Plast Surg 51: Leaf N (1996) SMAS autografts for the nasal dorsum. Plast Reconstr Surg 97: Lee KC, Kwon YS, Park JM, Kim SK, Park SH, Kim JH (2004) Nasal tip plasty using various techniques in rhinoplasty. Aesth Plast Surg 28: Lin J, Tan X, Chen X, Lin J, Shi S, Tian F, Shen J (2006) Another use of the alar cartilaginous flap. Aesth Plast Surg 30: McKinney P (2000) Management of the bulbous nose. Plast Reconstr Surg 106: McLure TC (1991) A modified Goldman nasal tip procedure for the drooping nasal tip. Plast Reconstr Surg 87: Peck GC Jr, Michelson L, Segal J, Peck GC Sr (1998) An 18-year experience with the umbrella graft in rhinoplasty. Plast Reconst Surg 102: Sheen JH (1993) Tip graft: A 20-year retrospective. Plast Reconstr Surg 91: Shin KS, Lee CH (1994) Columella lengthening in nasal tip plasty of Orientals. Plast Reconstr Surg 94: Shirakabe Y, Suzuki Y, Lam SM (2003) A systematic approach to rhinoplasty of the Japanese nose: A thirty-year experience. Aesth Plast Surg 27: Tardy ME Jr, Cheng E (1987) Transdomal suture refinement of the nasal tip. Facial Plast Surg 4: Wu W (2006) Application of cartilaginous flap in the bulbous and saddle nose. Aesth Plast Surg 30: Wu W (1992) The oriental nose: An anatomical basis for surgery. Ann Acad Med Singapore 21:176

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery

The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery DOI 10.1007/s00266-010-9562-2 ORIGINAL ARTICLE The Onlay Folded Flap (OFF): A New Technique for Nasal Tip Surgery Hani Abou Mayaleh Received: 11 April 2010 / Accepted: 15 July 2010 Ó Springer Science+Business

More information

Rhinoplasty - Tip Augmentation by Extended Columellar Strip

Rhinoplasty - Tip Augmentation by Extended Columellar Strip World Articles of Ear, Nose and Throat ---------------------Page 1 Rhinoplasty - Tip Augmentation by Extended Columellar Strip Authors: Vikas Sinha*, Viral A. Chhaya**, Dilavar A. Barot***, Keyur Mehta****,

More information

Secondary rhinoplasty

Secondary rhinoplasty Free full text on www.ijps.org Secondary rhinoplasty Gaith Shubailat American Board of Plastic Surgery Address for correspondence: Gaith Shubailat, P. O. Box 5180, Amman, Jordan 11183. E-mail: gaith@shubailat.com

More information

There are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE

There are numerous suture techniques described for nasal. Septocolumellar Suture in Closed Rhinoplasty ORIGINAL ARTICLE ORIGINAL ARTICLE Erdem Tezel, MD, and Ayhan Numanoğlu, MD Abstract: Several surgeons advise a variety of tip sutures and describe their own techniques in open approach. Septocolumellar suture is one of

More information

Compared with other ethnicities, Asians have

Compared with other ethnicities, Asians have Original Article Correction of Asian Short Nose with Lower Lateral Cartilage Repositioning and Ear Cartilage Grafting Jin Suk Byun, MD, PhD* Kenneth K. Kim, MD, FACS, Background: Asians with short nose

More information

Nasal Soft-Tissue Triangle Deformities

Nasal Soft-Tissue Triangle Deformities 339 Hossam M.T. Foda, MD 1 1 Division of Facial Plastic Surgery, Otolaryngology Department, Alexandria Medical School, Alexandria, Egypt Facial Plast Surg 2016;32:339 344. Address for correspondence Hossam

More information

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair

Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Original Article Columella Lengthening with a Full-Thickness Skin Graft for Secondary Bilateral Cleft Lip and Nose Repair Yoon Seok Lee 1, Dong Hyeok Shin 1, Hyun Gon Choi 1, Jee Nam Kim 1, Myung Chul

More information

The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty

The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty IJMS Vol 36, No 3, September 2011 Original Article The Effectiveness of Modified Vertical Dome Division Technique in Reducing Nasal Tip Projection in Rhinoplasty Behrooz Gandomi 1, Mohammad Hossein Arzaghi

More information

A new classification system of nasal contractures

A new classification system of nasal contractures Original Article J Cosmet Med 2017;1(2):106-111 https://doi.org/10.25056/jcm.2017.1.2.106 pissn 2508-8831, eissn 2586-0585 A new classification system of nasal contractures Geunuck Chang 1, Donghak Jung

More information

Alloplastic Implants and Homografts in Nasal Reconstruction

Alloplastic Implants and Homografts in Nasal Reconstruction Alloplastic Implants and Homografts in Nasal Reconstruction Sarah Rodriguez, MD Faculty Advisor: David Teller, MD The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation

More information

Fundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty.

Fundamental to the evolution of rhinoplasty COSMETIC. Classifying Deformities of the Columella Base in Rhinoplasty. COSMETIC Classifying Deformities of the Columella Base in Rhinoplasty Michael R. Lee, M.D. Georges Tabbal, M.D. T. Jonathan Kurkjian, M.D. Jason Roostaeian, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background:

More information

Surgical Treatment of Short Nose

Surgical Treatment of Short Nose Surgical Treatment of Short Nose Dr. Otto YT Au MD (JEFFERSON, USA) 1957, MCPS (MANITOBA) 1963, FHKAM (SURGERY) 1995 Diplomate American Board Plastic Surgery Plastic Surgery Specialist Dr.OttoYTAu A nice

More information

Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report

Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report 220 Nasal septal reconstruction Case Report Fibular Bone Graft for Nasal Septal Reconstruction: A Case Report Yakup Cil1* Diyarbakır Military Hospital, Department of Plastic Surgery 21000 Diyarbakır, Turkey

More information

Correction of the Retracted Alar Base

Correction of the Retracted Alar Base 218 William D. Losquadro, M.D. 1 Anthony Bared, M.D. 2 Dean M. Toriumi, M.D. 2 1 Mount Kisco Medical Group, Katonah, New York 2 Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology

More information

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods

Alireza Bakhshaeekia and Sina Ghiasi-hafezi. 1. Introduction. 2. Patients and Methods Plastic Surgery International Volume 0, Article ID 4578, 4 pages doi:0.55/0/4578 Clinical Study Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with

More information

Analyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection

Analyzing and controlling nasal tip projection COSMETIC. A Multivariate Analysis of Nasal Tip Deprojection COSMETIC A Multivariate Analysis of Nasal Tip Deprojection Jacob G. Unger, M.D. Michael R. Lee, M.D. Robert K. Kwon, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background: Projection of the nasal tip is a

More information

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors

We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our

More information

Augmentation Rhinoplasty with Rib Cartilage Graft

Augmentation Rhinoplasty with Rib Cartilage Graft Elaine Marie A. Lagura, MD Eduardo C. Yap, MD Anna Victoria G. Garcia, MD Augmentation Rhinoplasty with Rib Cartilage Graft Department of Otolaryngology Head and Neck Surgery Ospital ng Makati ABSTRACT

More information

Scientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim

Scientific Forum. Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the Alar Rim Nostrilplasty: Raising, Lowering, Widening, and Symmetry Correction of the lar Rim Richard Ellenbogen, MD; and Greg azell, MD ackground: lthough the alar rim has frequently been neglected in correction

More information

Use of tent-pole graft for setting columella-lip angle in rhinoplasty

Use of tent-pole graft for setting columella-lip angle in rhinoplasty Agrawal et al. Plast Aesthet Res 2018;5:13 DOI: 10.20517/2347-9264.2018.17 Plastic and Aesthetic Research Letter to Editor Open Access Use of tent-pole graft for setting columella-lip angle in rhinoplasty

More information

Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide

Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step Guide 537643AESXXX10.1177/1090820X14537643Aesthetic Surgery JournalÇakır et al research-article2014 INTERNATIONAL CONTRIBUTION Featured Operative Technique Surface Aesthetics in Tip Rhinoplasty: A Step-by-Step

More information

Component Rhinoplasty

Component Rhinoplasty 18 Original Article Component Rhinoplasty Muhammad Humayun Mohmand*, Muhammad Ahmad Cosmetic Plastic Surgeon, La Chirurgie, Islamabad Cosmetic Surgery Centre, Islamabad, Pakistan ABSTRACT BACKGROUND According

More information

The goal of septorhinoplasty is the reconstruction of the

The goal of septorhinoplasty is the reconstruction of the Otolaryngology Head and Neck Surgery (2007) 137, 862-867 ORIGINAL RESEARCH FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY The use of autogenous costal cartilage graft in septorhinoplasty Ali Moshaver, MSc,

More information

Achieving a consistent functional and aesthetic

Achieving a consistent functional and aesthetic Special Topic Simplifying the Management of Caudal Septal Deviation in Rhinoplasty Fadi C. Constantine, M.D. Jamil Ahmad, M.D. Palmyra Geissler, M.D. Rod J. Rohrich, M.D. Dallas, Texas; and Mississauga,

More information

The overprojected ( Pinocchio ) tip and the ptotic

The overprojected ( Pinocchio ) tip and the ptotic Featured Operative Technique Management of the Overprojected Nose and Ptotic Nasal Tip William E. Silver, MD, FCS; and Giancarlo F. Zuliani, MD The overprojected ( Pinocchio ) tip and the ptotic tip are

More information

Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses

Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Triple Plane Dissection in Open Primary Rhinoplasty in Middle Eastern Noses Ahmed Elshahat, MD Plastic Surgery Department, Faculty of Medicine, Ain Shams University; and Eldemerdash Hospital, Cairo, Egypt

More information

Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear

Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear The British Association of Plastic Surgeons (2004) 57, 238 244 Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear Yong Oock Kim*, Beyoung Yun Park, Won Jae Lee Institute

More information

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective

Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective Plastic Surgery International, Article ID 202560, 7 pages http://dx.doi.org/10.1155/2014/202560 Clinical Study Augmentation Rhinoplasty in Cleft Lip Nasal Deformity: Preliminary Patients Perspective William

More information

Augmentation Rhinoplasty with Autologous Grafts

Augmentation Rhinoplasty with Autologous Grafts Aesth Plast Surg (2008) 32:136 142 DOI 10.1007/s00266-007-9052-3 REVIEW Augmentation Rhinoplasty with Autologous Grafts D. J. Bottini Æ P. Gentile Æ A. Donfrancesco Æ L. Fiumara Æ V. Cervelli Published

More information

Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery

Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery Specially Processed Heterogenous Bone and Cartilage Transplants in Nasal Surgery By GRAEME M. CLARK (Melbourne) IN nasal surgery, cartilage or bone transplants are required for support or correction of

More information

Nature and Science 2016;14(7) Rhinoplasty: Grafts and Sutures

Nature and Science 2016;14(7)   Rhinoplasty: Grafts and Sutures Rhinoplasty: Grafts and Sutures Hossam Abd-El Hay 1, Elsayed El Fayoumy 1, Hesham Abd-El Rahman 1, Ahmed M. Eliwa 2 1 Department of Otorhinolaryngology, Benha Faculty of Medicine, Benha, Egypt. 2 Resident

More information

The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation

The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation Med. J. Cairo Univ., Vol. 83, No. 1, September: 585-589, 2015 www.medicaljournalofcairouniversity.net The Use of Spreader Grafts and Columellar Strut as Septal Extention Graft in Dorsal Nasal Deviation

More information

UCL Repair: Emphasis on Muscle Dissection and Reconstruction

UCL Repair: Emphasis on Muscle Dissection and Reconstruction UCL Repair: Emphasis on Muscle Dissection and Reconstruction Unilateral cleft lip repair is performed using rotation-advancement technique. Markings are made on columella base, redlines, Cupid s bow on

More information

Cosmetic surgery is very popular in certain

Cosmetic surgery is very popular in certain Current Update in Asian Rhinoplasty Original Article Cosmetic Clyde H. Ishii, MD, FACS Summary: There has been a tremendous growth of cosmetic surgery among Asians worldwide. Rhinoplasty is second only

More information

Index. Blunt perichondrium elevator, 164 Bone paste, 85 Bone scissors, 35 36, 128, 328

Index. Blunt perichondrium elevator, 164 Bone paste, 85 Bone scissors, 35 36, 128, 328 A Alar rim edge excision incision, 311 marking, 311 resection, 312 suture, 312 317 Arkansas stone, 254 Autorim flap technique ala retractions, 145 alar support, 158 bulbous cartilage, 150 cartilage surface,

More information

Regina Rodman, MD Faculty Mentor: Tamara Watts, MD PhD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds

Regina Rodman, MD Faculty Mentor: Tamara Watts, MD PhD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds Regina Rodman, MD Faculty Mentor: Tamara Watts, MD PhD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds Presentation March 29, 2012 Anatomic landmarks Photography

More information

Dome Division: A Viable Technique Today?

Dome Division: A Viable Technique Today? 664 Rapid Communication Dome Division: A Viable Technique Today? Armando Boccieri, MD 1 Sebastiano Sciuto, MD 1 Valerio Cervelli, MD 2 Michele Pascali, MD, PhD 2 1 Department of Facial Plastic Surgery,

More information

Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips. Rollin K. Daniel

Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips. Rollin K. Daniel Mastering Rhinoplasty: A Comprehensive Atlas of Surgical Techniques with Integrated Video Clips Rollin K. Daniel Rollin K. Daniel Mastering Rhinoplasty A Comprehensive Atlas of Surgical Techniques with

More information

UNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1

UNCORRECTED PROOF. The conchal cartilage graft in nasal reconstruction * ARTICLE IN PRESS. Armando Boccieri*, Alessandro Marano 1 Journal of Plastic, Reconstructive & Aesthetic Surgery (2006) -, -e- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

More information

Original Article Case analysis of triangular bracket from autogenous nasal septal and auricular cartilage for the correction of short nose

Original Article Case analysis of triangular bracket from autogenous nasal septal and auricular cartilage for the correction of short nose Int J Clin Exp Med 2018;11(2):1337-1342 www.ijcem.com /ISSN:1940-5901/IJCEM0070763 Original Article Case analysis of triangular bracket from autogenous nasal septal and auricular cartilage for the correction

More information

implementation of modern rhinoplasty techniques to yield an aesthetic result well balanced with other facial components.

implementation of modern rhinoplasty techniques to yield an aesthetic result well balanced with other facial components. : J Dentistry and Otolaryngology Volume 14 Issue 3 Version 1.0 Year 2014 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Inc. (USA) Online ISSN: 2249-4618 & Print

More information

Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse

Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse Aesth Plast Surg (2009) 33:625 634 DOI 10.1007/s00266-009-9349-5 ORIGINAL ARTICLE Alar Batten Cartilage Graft: Treatment of Internal and External Nasal Valve Collapse Valerio Cervelli Æ Diana Spallone

More information

Hospital das Clinicas, Brazil

Hospital das Clinicas, Brazil THE IMPORTANCE OF THE CARTILAGINOUS FRAMEWORK IN PLASTIC SURGERY OF THE NOSE By ROBERTO FARINA, M.D., OSVALDO DE CASTRO, and RICARDO BAROUDI, M.D. Hospital das Clinicas, Brazil As far as plastic surgery

More information

Bony hump reduction is an integral part of classic

Bony hump reduction is an integral part of classic Rhinoplasty Nasal Hump Reduction With Powered Micro Saw Osteotomy INTERNATIONAL CONTRIBUTION Yakup Avşar, MD Background: Hump reduction with manual osteotomy is an invasive procedure in aesthetic rhinoplasty.

More information

Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length

Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Research Original Investigation Effect of Depressor Septi Resection in Rhinoplasty on Upper Lip Length Yan Ho, MD; Robert Deeb, MD; Richard Westreich, MD; William Lawson, MD, DDS IMPORTANCE Resection of

More information

Shuttle Lifting of the Nose: A Minimally Invasive Approach for Nose Reshaping

Shuttle Lifting of the Nose: A Minimally Invasive Approach for Nose Reshaping INTERNATIONAL CONTRIBUTION Rhinoplasty Shuttle Lifting of the Nose: A Minimally Invasive Approach for Nose Reshaping Kemal Tunc Tiryaki, MD Aesthetic Surgery Journal 30(2) 176 185 2010 The American Society

More information

Nose Reshaping (Rhinoplasty)

Nose Reshaping (Rhinoplasty) Nose Reshaping (Rhinoplasty) Are you interested in improving the appearance of your nose? If so, you re not alone. Nose reshaping, or rhinoplasty, is one of the most common plastic surgery procedures performed

More information

Modified Endonasal Tongue-in-Groove Technique

Modified Endonasal Tongue-in-Groove Technique Rapid Communication 569 Sameep Kadakia, MD 1 Alexander Ovchinsky, MD 1 1 Department of Otolaryngology - Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York Facial Plast

More information

INTRODUCTION. Typical secondary bilateral cleft lip nasal deformities present a short columella, a laterally-spreading dome of the alar cartilages

INTRODUCTION. Typical secondary bilateral cleft lip nasal deformities present a short columella, a laterally-spreading dome of the alar cartilages The Correction of a Secondary ilateral Cleft Lip Nasal Deformity Using Refined Open Rhinoplasty with Reverse-U Incision, V-Y Plasty, and Selective Combination with Composite Grafting: Long-term Results

More information

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY THE NASAL SEPTUM IN RHINOPLASTY: BASIC SEPTOPLASTY TECHNIQUES FWA Otten Introduction Septal corrections form an important step in rhinoplastic

More information

There is no uniform grading system for nasal dorsal deformities currently in general use

There is no uniform grading system for nasal dorsal deformities currently in general use ORIGINAL ARTICLE A Grading System for Nasal Dorsal Deformities Matthew A. Kienstra, MD; Holger G. Gassner, MD; David A. Sherris, MD; Eugene B. Kern, MD There is no uniform grading system for nasal dorsal

More information

ORIGINAL ARTICLE. Reconstruction of the Nasal Columella. David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A.

ORIGINAL ARTICLE. Reconstruction of the Nasal Columella. David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A. ORIGINAL ARTICLE Reconstruction of the Nasal Columella David A. Sherris, MD; Jon Fuerstenberg, MD; Daniel Danahey, MD, PhD; Peter A. Hilger, MD Objective: To report techniques successful for nasal columella

More information

RECONSTRUCTION OF MICROtia

RECONSTRUCTION OF MICROtia ORIGINAL ARTICLE A 2-Stage Ear Reconstruction for Microtia Haiyue Jiang, MD; Bo Pan, MD; Yanyong Zhao, MD; Lin Lin, MD; Lei Liu, MD; Hongxing Zhuang, MD Objective: To introduce our 2-stage reconstruction

More information

The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty

The upper buccal sulcus approach, an alternative for post-trauma rhinoplasty British Journal of Plastic Surgery (2003), 56, 218 223 q 2003 The British Association of Plastic Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/s0007-1226(03)00117-6 The

More information

RHINOPLASTY (NOSE RE-SHAPING)

RHINOPLASTY (NOSE RE-SHAPING) PROCEDURE FACT SHEET PLASTIC SURGERY RHINOPLASTY (NOSE RE-SHAPING) This is a guide for people who are considering having a nose re-shaping (Rhinoplasty) operation. We advise that you talk to a plastic

More information

Shamouelian et al.: Rethinking Nasal Tip Support: A Finite Element Analysis

Shamouelian et al.: Rethinking Nasal Tip Support: A Finite Element Analysis The Laryngoscope VC 2014 The American Laryngological, Rhinological and Otological Society, Inc. Rethinking Nasal Tip Support: A Finite Element Analysis David Shamouelian, MD; Ryan P. Leary, MD; Cyrus T.

More information

Correction of Secondary Deformities of the Cleft Lip Nose

Correction of Secondary Deformities of the Cleft Lip Nose CME Correction of Secondary Deformities of the Cleft Lip Nose Samuel Stal, M.D., and Larry Hollier, M.D. Learning Objectives: After studying this article, the practitioner should be able to: 1. Describe

More information

Rotation-Advancement Principle. in Cleft Lip Closure. D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida

Rotation-Advancement Principle. in Cleft Lip Closure. D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida Rotation-Advancement Principle in Cleft Lip Closure D. RALPH MILLARD, JR., M.D., F.A.C.S. Miami, Florida Correction of prealveolar, alveolar, and postalveolar clefts poses a fivefold project: natural appearance,

More information

Changing the Convexity and Concavity of Nasal Cartilages and Cartilage Grafts with Horizontal Mattress Sutures: Part I. Experimental Results

Changing the Convexity and Concavity of Nasal Cartilages and Cartilage Grafts with Horizontal Mattress Sutures: Part I. Experimental Results Cosmetic Changing the Convexity and Concavity of Nasal Cartilages and Cartilage Grafts with Horizontal Mattress Sutures: Part I. Experimental Results Ronald P. Gruber, M.D., Farzad Nahai, M.D., Michael

More information

Revision of the Cleft Lip Nose

Revision of the Cleft Lip Nose Revision of the Cleft Lip Nose Tom D. Wang, MD, FACS* Professor and Chief of Facial Plastic & Reconstructive Surgery Department of Otolaryngology / Head & Neck Surgery Oregon Health & Science University

More information

Perichondrium Graft: Harvesting and Indications in Nasal Surgery. Armando Boccieri, MD, and Tito M. Marianetti, MD

Perichondrium Graft: Harvesting and Indications in Nasal Surgery. Armando Boccieri, MD, and Tito M. Marianetti, MD ORIGINAL ARTICLE Perichondrium Graft: Harvesting and Indications in Nasal Surgery Armando Boccieri, MD, and Tito M. Marianetti, MD Abstract: Irregularities in the nasal contour of patients who underwent

More information

ORIGINAL ARTICLE. about the resorption and complication rates for irradiated. grafts (IHRGs) in rhinoplasty and facial plastic and reconstructive

ORIGINAL ARTICLE. about the resorption and complication rates for irradiated. grafts (IHRGs) in rhinoplasty and facial plastic and reconstructive ORIGINAL ARTICLE Irradiated Homologous Rib Grafts in Nasal Reconstruction Dirk J. Menger, MD; Gilbert J. Nolst Trenité, MD, PhD Objective: To assess the long-term efficacy of irradiated homologous rib

More information

Management of Nasofrontal Angle in Rhinoplasty

Management of Nasofrontal Angle in Rhinoplasty Iranian Red Crescent Medical Journal REVIEW ARTICLE Management of Nasofrontal Angle in Rhinoplasty SB Pousti 1, M Jalessi 1, A Asghari 1 * 1 Department of Otolaryngology, Head and Neck Surgery, ORL-HNS

More information

Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D.

Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Techniques in Cosmetic Surgery Rhinoplasty with Advancing Age Rod J. Rohrich, M.D., Larry H. Hollier, Jr., M.D., Jeffrey E. Janis, M.D., and John Kim, M.D. Houston and Dallas, Texas Rhinoplasty in the

More information

Surgical Treatment of Nasal Obstruction

Surgical Treatment of Nasal Obstruction Surgical Treatment of Nasal Obstruction P. Daniel Knott, MD FACS Director, Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology/Head and Neck Surgery UCSF Medical Center Nothing

More information

Primary Repair of Unilateral Cleft Lip Nasal Deformity

Primary Repair of Unilateral Cleft Lip Nasal Deformity CLEFT THE IRAQI LIP POSTGRADUATE NASAL DEFORMITY MEDICAL JOURNAL VOL.8, NO.3, 2009 Primary Repair of Unilateral Cleft Lip Nasal Deformity Zakaria Y.Arajy*, Ahmed A.M.Nawres** ABSTRACT: BACKGROUND: There

More information

Patients undergoing rhinoplasty occasionally

Patients undergoing rhinoplasty occasionally Special Topic Decreasing Nasal Tip Projection in Rhinoplasty Michael R. Lee, M.D. Palmyra Geissler, M.D. Spencer Cochran, M.D. Jack P. Gunter, M.D. Rod J. Rohrich, M.D. Dallas, Texas Background: Decreasing

More information

New Instruments for Submembranous Dissection in Rhinoplasty

New Instruments for Submembranous Dissection in Rhinoplasty Letter to the Editor New Instruments for Submembranous Dissection in Rhinoplasty Aesthetic Surgery Journal 2017, Vol 37(7) NP73 NP78 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints

More information

Combining Rhinoplasty with Septal Perforation Repair

Combining Rhinoplasty with Septal Perforation Repair Combining Rhinoplasty with Septal Perforation Repair Hossam M.T. Foda, M.D. 1 and Emad A. Magdy, M.D. 1 ABSTRACT A combined septal perforation repair and rhinoplasty was performed in 80 patients presenting

More information

Closed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas.

Closed rhinoplasty. Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD. From the Center for Aesthetic Surgery, Colleyville, Texas. Operative Techniques in Otolaryngology (2007) 18, 233-242 Closed rhinoplasty Yadranko Ducic, MD, MSc, FRCS(C), FACS, Robert DeFatta, MD, PhD From the Center for Aesthetic Surgery, Colleyville, Texas. KEYWORDS

More information

Associate Professor of Plastic Surgery, Karol. Institute; Plastic Department, Serafimerlasarettet, Stockholm, Sweden

Associate Professor of Plastic Surgery, Karol. Institute; Plastic Department, Serafimerlasarettet, Stockholm, Sweden A NEW METHOD OF SHAPING DEFORMED EARS By A. RAGNELL, M.D. Associate Professor of Plastic Surgery, Karol. Institute; Plastic Department, Serafimerlasarettet, Stockholm, Sweden NUMEROUS methods of shaping

More information

Rhinoplasty: Personal Evolution and Milestones

Rhinoplasty: Personal Evolution and Milestones Cosmetic Rhinoplasty: Personal Evolution and Milestones Jack H. Sheen, M.D. Santa Barbara, Calif. Over the past 35 years, aesthetic rhinoplasty has evolved from a generic, reductive operation to a highly

More information

Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N.

Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N. CME Cleft Rhinoplasty Allen L. Van Beek, M.D., Agnieszka S. Hatfield, M.D., and Ellie Schnepf, B.S.N. Edina and Minneapolis, Minn. Learning Objectives: After studying this article, the participant should

More information

Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty

Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty Niveditha J Sagar, Chidananda R Devasamudra Original article 10.5005/jp-journals-10013-1254 Intermediate Osteotomy and other Unique Techniques used in Reduction Rhinoplasty 1 Niveditha J Sagar, 2 Chidananda

More information

We conducted a contemporary review covering advances and trends in primary

We conducted a contemporary review covering advances and trends in primary JOURNAL CLUB CONTEMPORARY REVIEW Contemporary Review of Rhinoplasty Patrick C. Angelos, MD; Mark J. Been, MD; Dean M. Toriumi, MD We conducted a contemporary review covering advances and trends in primary

More information

Rhinoplasty & Revision Rhinoplasty

Rhinoplasty & Revision Rhinoplasty Rhinoplasty & Revision Rhinoplasty Edward S. Kwak MD ... Rhinoplasty is a very technique-oriented surgery. Each change to the underlying cartilage and bone structure of the nose affects everything else.

More information

Advances of Plastic & Reconstructive Surgery

Advances of Plastic & Reconstructive Surgery Chapter 1 Advances of Plastic & Reconstructive Surgery Cleft lip nasal deformity: Analysis and treatment Martínez-Capoccioni Gabriel*; Martín-Martín Carlos Servizo Galego de Saúde, Service of ENT Head

More information

Spreader Graft in Closed Rhinoplasty: The Rail Spreader

Spreader Graft in Closed Rhinoplasty: The Rail Spreader Original Article 515 Spreader Graft in Closed Rhinoplasty: The Rail Spreader Alberto Scattolin, MD 1 Niana Orlando, MD 1 Luca D Ascanio, MD 2 1 Department of Otolaryngology, Villa Donatello Clinic, Piazzale

More information

Fundamental Principles in Aesthetic Rhinoplasty

Fundamental Principles in Aesthetic Rhinoplasty Clinical and Experimental Otorhinolaryngology Vol. 4, No. 2: 55-66, June 2011 DOI 10.3342/ceo.2011.4.2.55 Review Fundamental Principles in Aesthetic Rhinoplasty Stephen S. Park, MD Division of Facial Plastic

More information

Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients *

Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients * Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, 27e33 Evaluation of the outcome of secondary rhinoplasty in cleft lip and palate patients * N. Chaithanyaa a, *, K.K. Rai b, H.R. Shivakumar

More information

RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland

RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP. By MICHAL KRAUSS. Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION OF SUBTOTAL DEFECTS OF THE NOSE BY ABDOMINAL TUBE FLAP By MICHAL KRAUSS Plastic Surgery Hospital, Polanica-Zdroj, Poland RECONSTRUCTION of the nose is one of the composite procedures in

More information

Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes

Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes DOI 10.1186/s40064-016-1714-7 RESEARCH Open Access Selective salvage of zones 2 and 4 in the pedicled TRAM flap: a focus on reducing fat necrosis and improving aesthetic outcomes Chi Sun Yoon and Kyu Nam

More information

Assessment of Nasal Function After Tip Surgery With a Cephalic Hinged Flap of the Lateral Crura: A Randomized Clinical Trial

Assessment of Nasal Function After Tip Surgery With a Cephalic Hinged Flap of the Lateral Crura: A Randomized Clinical Trial 529647AESXXX10.1177/1090820X14529647Aesthetic Surgery JournalAmali et al research-article2014 INTERNATIONAL CONTRIBUTION Rhinoplasty Assessment of Nasal Function After Tip Surgery With a Cephalic Hinged

More information

The Crooked Nose and its Functional Surgical Correction

The Crooked Nose and its Functional Surgical Correction The Crooked Nose and its Functional Surgical Correction Armando González Romero Introduction The nose is a highly specialized organ of the respiratory system and is essential for homeostasis. The pathological

More information

Anatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC

Anatomy of. External NOSE. By Dr Farooq Aman Ullah Khan PMC Anatomy of External NOSE By Dr Farooq Aman Ullah Khan PMC 24 th Nov. 2017 The External Nose Descriptions of the nose always begin with that part of it which is covered by the skin, i.e., the EXPOSED PART

More information

Surgical Anatomy of the Nose

Surgical Anatomy of the Nose Chapter Surgical Anatomy of the Nose Natalie P. Steele and J. Regan Thomas Core Messages Expert knowledge of nasal anatomy and function is the key to success in rhinoplasty surgery. Facial analysis and

More information

The correction of nasal septal deviations in rhinoplasty

The correction of nasal septal deviations in rhinoplasty Page 1 of 9 Aesthetic Surgery & Medicine The correction of nasal septal s in rhinoplasty P Persichetti 1 *, V Toto 1, M Signoretti 1, R Del Buono 1, B Brunetti 1, F Segreto 1, D Lazzeri 2, GF Marangi 1

More information

ORIGINAL ARTICLE. Quantitative Study of Nasal Tip Support and the Effect of Reconstructive Rhinoplasty. accomplish both an excellent

ORIGINAL ARTICLE. Quantitative Study of Nasal Tip Support and the Effect of Reconstructive Rhinoplasty. accomplish both an excellent ORIGINAL ARTICLE Quantitative Study of and the Effect of Reconstructive Rhinoplasty Holger G. Gassner, MD; William J. Remington, MD; David A. Sherris, MD Objectives: To develop a method to quantify nasal

More information

The Importance of a Conchal Bowl Element in the Fabrication of a Three-Dimensional Framework in Total Auricular Reconstruction

The Importance of a Conchal Bowl Element in the Fabrication of a Three-Dimensional Framework in Total Auricular Reconstruction The Importance of a Conchal owl Element in the Fabrication of a Three-Dimensional Framework in Total uricular Reconstruction Young Soo Kim ona Microtia and esthetic Ear Surgery Clinic, Seoul, Korea Original

More information

OPEN STRUCTURE RHINOPLASTY

OPEN STRUCTURE RHINOPLASTY OPEN STRUCTURE RHINOPLASTY A Manual of Surgical Skills Training 2 nd Edition Edited by Paul S. WHITE, FRACS, FRCS (Ed) Peter D. ROSS, FRCS (ORL) Department of Otolaryngology, University of Dundee, Scotland

More information

Jae Hee Kim, Dong Ju Jung, Hyo Seong Kim, Chang Hyun Kim, Tae Yeon Kim

Jae Hee Kim, Dong Ju Jung, Hyo Seong Kim, Chang Hyun Kim, Tae Yeon Kim Analysis of the Development of the Nasal Septum and Measurement of the Harvestable Septal Cartilage in Koreans Using Three-Dimensional Facial Bone Computed Tomography Scanning Jae Hee Kim, Dong Ju Jung,

More information

Guide to Writing Oral Protocols

Guide to Writing Oral Protocols Guide to Writing Oral Protocols CONTENTS PAGE Structure and Purpose of the Oral Examination 2 When Planning a Protocol 2 Selecting Photos, Illustrations, and Other Art 2 Standard Views for Major Facial

More information

Rhinoplasty in the Patient of African Descent

Rhinoplasty in the Patient of African Descent Author's personal copy Rhinoplasty in the Patient of African Descent Monte O. Harris, MD a,b,c, * KEYWORDS African American rhinoplasty Ethnic rhinoplasty African American Black American Culture Ancestry

More information

Vertical mammaplasty has been developed

Vertical mammaplasty has been developed BREAST Y-Scar Vertical Mammaplasty David A. Hidalgo, M.D. New York, N.Y. Background: Vertical mammaplasty is an effective alternative to inverted-t methods. Among other benefits, it results in a significantly

More information

ORIGINAL ARTICLE Correlation between projection of the ear, the inferior crus, and the antihelical body: analysis based on computed tomography

ORIGINAL ARTICLE Correlation between projection of the ear, the inferior crus, and the antihelical body: analysis based on computed tomography ORIGINAL ARTICLE Correlation between projection of the ear, the inferior crus, and the antihelical body: analysis based on computed tomography (brief title): Ear projection and inferior crus HIROSHI SHINOHARA

More information

Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate

Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate Surgical Treatment of the Nasal-Maxillary Complex in Adolescents With Cleft Lip and Palate Fernando D. Burstein MD, FACS, FAAP Atlanta, Georgia, USA Rather than treating nasal, maxillary, and soft tissue

More information

CHAPTER 17 FACIAL AESTHETIC SURGERY. Christopher C. Surek, DO and Mohammed S. Alghoul, MD. I. BROW LIFT (Figures 1 and 2)

CHAPTER 17 FACIAL AESTHETIC SURGERY. Christopher C. Surek, DO and Mohammed S. Alghoul, MD. I. BROW LIFT (Figures 1 and 2) CHAPTER 17 FACIAL AESTHETIC SURGERY Christopher C. Surek, DO and Mohammed S. Alghoul, MD I. BROW LIFT (Figures 1 and 2) A. Open Coronal Brow Lift Technique 1. Coronal incision is made in the hair-bearing

More information

Construction of the congenitally missing columella in midline clefts

Construction of the congenitally missing columella in midline clefts Construction of the congenitally missing columella in midline clefts Kurt-Wilhelm BÜTOW Department of Maxillo-Facial and Oral Surgery (Head: Prof. Kurt-W. Bütow, MChD(OMFSurg), DMD, PhD, DSc(Odont), FCMFOS),

More information

Endoscopic septoplasty

Endoscopic septoplasty Endoscopic septoplasty Claudiu Manea, MD, PhD University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Septal deviation is a common clinical finding in patients reporting nasal obstruction.

More information