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, 154 caudal excess, 148, 160 cephalic dome sutures, 156 cephalic migration, 150 cephalic resection, 155 cephalic trimming, 147 columellar strut graft, 156 convex lateral crura, 149 C suture, 157 desired facet polygon, 152 dissection, 154 dome lights, 159 facet polygon, 145 lateral crus caudal resections, 145 medial crus, 153 mucosa, 153 narrow facet polygon, 152 nostril, 162 preoperative photograph, 158 in situ cartilages, 151 structural grafts, 159 subperichondrial plane, 154 thin skinned patient, 146 Awareness, 40 B Bayonet forceps, 257, 325, 330 Black dots, 18 Block cartilage, 52, 53, 336 337, 374, 395 Blunt perichondrium elevator, 164 Bone paste, 85 Bone scissors, 35 36, 128, 328 C Cakir perichondrium elevator, 36 Cakir periosteum elevator, 36, 113, 115 Camouflage techniques, 85, 183, 324 Cartilage anatomy, 47, 48, 55, 69 Cartilage hump, 126, 274, 281, 359 Cavity polygon, 61 Cephalic malpositioning patient analyses autorim flap, 377 columellar polygon, 378 domes and strut graft, 377 infralobule polygon, 378 lateral crural steal, 377 single flash photo, 376 resting angle autorim flap technique, 79 insufficient cartilage in nose wings, 79 lateral crus repositioning surgery, 78 medial canthus, 78 repositioning technique, 80 subperichondrial dissection, 79 Choking graft sutures, 222 Closed approach healing rate closed technique, 365 depressor, 364 infralobule polygon, 364 scroll facets, 366 soft tissue resection, 364 ideal patient for, 401 402 revision lateral steal simulation, 380 marking and symmetry test, 380 operation, 380 tip surgery, 381 Springer International Publishing Switzerland 2016 B. Çakır, Aesthetic Septorhinoplasty, DOI 10.1007/978-3-319-16127-3 415
416 Columellar show autorim flap technique, 340 closed technique, 340 hanging columella closed technique and extreme cephalic resection, 341 lateral crural cephalic strut graft, 343 345 medial crus caudal resection, 346 349 scroll graft, 345 346 surgery, 342 343 retracted nasal alae, 339 upper lateral cartilage caudal resection, 340 Computer imaging designs, 10, 16 Concha hypertrophic concha, 101 radiofrequency cauterization, 101 SMR bone pieces, 103 cavernous tissue, 102 concha bone, 105, 106 conchal mucosa, 104 electro cautery, 104 elliptic resections, 102 inward collapsed maxillary base, 106 local anesthesia, 101 normal anatomy, 106 saline solution, 101 segmental outfracture, 106 107 septum base, 105 silicon splint, 104 Webster triangle out fracture, 106 D Daniel perichondrium elevator, 36, 37, 124, 125, 166 Defatting, 297 Degussit (Al2O3), 38 Dome anatomy, 57 Dome spanning, 57, 63 Dome symmetry test, 195 196, 326 Dome triangles, 54 57, 204, 217 Dorsal bone polygon, 53, 84 85 Dorsal cartilage polygon, 53, 83 84 E Esthetician, 18 Extreme grafting, 61 F Fish-eyed photo, 7 Focus settings, 8 Forehead fat grafting cannula, 19 chin prostheses, 19 fat injection, 19 lipofilling, 19 nose aesthetics, 19 nose radix, 19 technique alae rim resection, 25 blunt radix, 25 dorsal aesthetic lines, 24 fat injection, 21, 25 forehead nose transition, 21 nose surgery, 20 postoperative results, 21 rhinoplasty, 21 sagging alae, 25 surgical plan, 26 tip shadows, 24 F value, 8 G Glabellar polygon, 53 Gummy smile deformity, 138, 139 H Hanging columella closed technique and extreme cephalic resection, 341 lateral crural cephalic strut graft, 343 345 medial crus caudal resection, 346 349 scroll graft, 345 346 surgery, 342 343 Hematoma, 123 Hemitransdomal suture, 196, 199 I Intracath, 19, 28, 288 ISO, 8 J Jaw and cheek arkansas stone, 38 bone scissors, 35 36 under chin approach, 28 chin augmentation, 28 elevator, 36 37 eyelash and nose relation, 33 forehead fat injection, 30 gray intracath, 28 hook, 37 illusion effect, 32 lateral osteotomes, 37 medpor implants, 28 monocryl stitch, 28 needleholde, 35 osteotomes, 36 osteotomy chisels, 37 rasp and saw, 36 scissors, 35 subperichondrial dissection, 34 sutures, 38
417 L Lateral crus subperichondrial dissection autospreader flap technique, 162 blunt perichondrium elevator, 164 cephalic malposition, 177 Daniel elevator, 166 domes, delivering, 168 175 ellipse model, 184 185 internal bandaging, 165 marking and resections, 175 177 observations, 177 181 scroll ligament, 165 secondary rhinoplasty, 167 168 sesamoid cartilages, 165 thoery, 181 183 tools, 163 Learning, nose drawing polygons, 39 sculpture classes, 39 sketch from front, 40 41 Little Cottle elevator, 36, 37 M Mass polygons, 53, 65 Maxillary spine, 325 Menstrual delaying medicine, 19 Millimeter autorim flap, 242 Mucosa surplus, 330 Mucosa vasoconstriction, 96 Muscle function impairment, 122 N Nasal dorsum surgery bone dust and cartilage paste, 276 278 dorsal bone resection, 128 130 dorsal cartilage resection, 126 127 dorsal reconstruction, males, 280 281 dorsum height, 252 intercartilaginous incision, 108 nasal radix, 130 131 nasal tip, stabilization of, 281 283 osteoectomy technique aspirator tip, 258 blind chisel, 257 bone massage, 266 267 bone saw dusts, 257 bone surface problems, 263 breathing problems, 265 bruising, 263 control, 262 function, 263 instruments, 258 262 Libra graft, 269 271 nasal dorsum cartilage, 274 nasal dorsum control, 271 274 rasp, 255 reconstruction, nasal dorsum, 267 268 redrape problems, 264 scratching movements, 257 superficial bone asymmetries, 256 unsuccessful osteotomy, 263 osteotomy, 252 254 periosteum dissection, 114 122 scroll groove, reconstruction of 5/0 Monocryl, 283 scroll sesamoid cartilage, 284 286 septum mucosa, 283 septal angle, 108 110 short nasal bones, 278 280 subperichondrial dissection bleeding, 123 camouflage effect, 123 ligaments, 123 124 muscle function, 122 123 nose healing, 122 open approach, 110 114 transfixion incision, 107 upper lateral cartilage mucosa dissection, 124 126 Nasal polygons Cakir polygons vs. Sheen s aesthetics, 51 53 columellar polygon, 61 62 dome triangles cartilage anatomy, 55 cephalic dome suture, 56, 57 cubic forms, 57 facet polygon, 56, 57 horizontal mattress suture, 57 lateral and medial crura, 55 organic models, 57 tip sutures, 55 Ti, Ts and Rm points, 54 dorsal aesthetic lines fusiform anatomy, 87 Libra graft technique, 87 nasal dorsum, 87 nose aesthetic design, 87 oblique view, 87 review, 90 rib graft, 88, 89 dorsal bone polygon, 84 85 dorsal cartilage polygon, 83 84 facet polygons destruction, 64 dome polygon, 63, 65 infralobular polygon, 63 lateral crus, caudal edge of, 63 middle crus, 63 non-anatomical sutures, 63 open surgery technique, 64 pinched nose deformity, 64 footplate polygon, 62 63 infralobular polygon, 60 infratip triangle, 53 interdomal triangle
418 Nasal polygons (cont.) dome divergence, 59 60 facet polygon, 58 photoshop, 58 rim graft, 58 rotation differences, 58 lateral aesthetic lines, 92 lateral bone polygons, 86 lateral crus polygons, 65 mobile tip area space polygons, 53 54 mass polygons, 53 non-mobile nose, 53 polygon model, 93 94 resting angle cephalic dome suture, 66 cephalic malpositioning, 78 80 convex lateral crura, 78 incorrect resting angle, 70 71 long lateral crura, 71 77 surgical techniques, 66 vertical compression test, 67 70 wide lateral crura, 71 scroll facet cephalic dome suture, 80 dome cartilages, 81 open technique, 82 transdomal sutures, 82 scroll line, 83 tip breakpoints, 54 tip defining point, 53 upper lateral cartilage polygons, 85 86 Nasal surgery additional grafts extra columellar strut, 297 298 rim graft, 298 basic surgical steps, 101 cartilage grafts rib cartilage, 334 339 septal cartilage, 334 cleaning, 99 columellar show autorim flap technique, 340 closed technique, 340 hanging columella, 339, 341 349 retracted nasal alae, 339 upper lateral cartilage caudal resection, 340 concha, 101 107 deviated nose left axis noses, 320 321 nasal dorsum resection, 323 324 reference points, 321 323 septoplasty, 324 325 septum deviation, 320 tip surgery, 325 334 drains, 288 drawings, 100 101 footplates anterior maxillary spine resections, 142 contralateral footplate, 141 septum cartilage, 140 suturing of, 143 transfixion incision, 141 head lamp, 99 internal splints, 288 internal taping new SMAS anatomy, 291 292 Pitanguy ligament, 292 294 internal valve functions, 288 lights, operating room, 99 100 local anesthesia Bupivacaine, 98 infiltration, 97 infraalveolar and supratrochlear blocks, 98 Lidocaine, 98 nasal dorsum dissection, 99 nasal dorsum surgery, 107 131, 252 287 nostril surgery avulsion advancement flap, 302 307 avulsion advancement flap and elliptic resection combination, 307 311 composite graft, 316 317 hanging alae, 311 316 problems and solutions, 299 thick alar base, 299 302 patient position and tracheal intubation, 95 96 Pitanguy ligament, 289 290 postoperative care, 318 320 prescription, 349 redrape camouflage, 297 dissection borders, 295 296 internal taping, 296 297 ligaments, 296 results cephalic dome suture, 196 198 cephalic malpositioning, 238 251 cephalic malposition view, 186 C graft, 221 222 closure of tip incisions, 231 232 columellar breakpoint (C point), 218 columellar polygon stabilization, 229 230 columellar strut graft, 213 218 Control 1, 198 Control 2, 198 205 C suture, 218 221 domes, suturing, 211 213 dome symmetry test, 195 196 footplate setback, 187 193 infralobular caudal contour graft, 222 228 interdomal graft, 251 252 lateral crus steal procedure, 193 195 medial crus overlap, 205 211 nose movement, 186 surgery, 187 tip asymmetry, 232 238 septum, 131 140 superficial SMAS, 290 291 taping, 317 318 tip surgery, 143 185
Nasolabial angle, 42, 184 Needle hooks, 229 Nose drawing design, 39 learning polygons, 39 sculpture classes, 39 sketch from above and below, 44 47 sketch from front, 40 41 sketch from side, 42 44 patient photographs, analysis of, 48 49 Nose sculpture, 45, 51 Nostril sill anatomy, 40, 302, 307 O Open roof, 36, 85, 262, 264 Oral Vitamin A, 18, 119 Organic models, 53, 57 Osteoectomy technique aspirator tip, 258 blind chisel, 257 bone massage, 266 267 bone saw dusts, 257 bone surface problems, 263 breathing problems, 265 bruising, 263 control, 262 function, 263 instruments, 258 262 Libra graft, 269 271 nasal dorsum cartilage, 274 nasal dorsum control, 271 274 rasp, 255 reconstruction, nasal dorsum, 267 268 redrape problems, 264 scratching movements, 257 superficial bone asymmetries, 256 unsuccessful osteotomy, 263 P Paraflash system, 5, 7, 8 Patient analyses after surgery, 414 bulbous tip, 396 397, 403 404 cephalic malpositioning autorim flap, 377 columellar polygon, 378 domes and strut graft, 377 infralobule polygon, 378 lateral crural steal, 377 single flash photo, 376 closed approach healing rate, 364 366 ideal patient for, 401 402 revision, 378 381 common patient alar edge resection, 354 lateral crus caudal edge, 353 nose tip cartilages, 353 419 nose tip rotation, 402 resection, 353 rotation, 352 subperichondrial dissection, 352 dermocartilaginous ligament, 359 dome triangles, 359 droopy tip, 411 413 footplate setback effect, 362 fractured nose, operated twice calvarium bone graft, 372 cartilage chip grafts, 373 fusiform nasal dorsum graft, 373 resection, 372 silicon graft, 373 surgery, 374 long nose, 374 375 mid-thick skin surgery, 407 408 surgery photographs, 408 411 open technique, 359 overrotated saddle nose cymba conchae, 382 first operation, 382 383 second operation, 383 surgery, 383 386 Pitanguy ligament, 360 6/0 Prolene suture, 360 saddle nose and hanging nostril, 395 396 and notched nostril, 391 393 subperichondrial dissection, 360 supratip healing period depression, 366 nasal dorsum, 368 Pitanguy ligament, 366 scroll ligament, 366 tip surgery, 367 before surgery, 413 414 tension nose, 399 400 tension nose and thin skin, 400 401 thick skin bulbous tip and deviated nose, 406 407 and huge hump, 362 363 low radix and cephalic malpositioning, 390 391 and oily skin, 357 358 patients, 355 357 thin skin axis deviation and breathing problems, 404 405 big nose, 397 398 deviated nose and tip asymmetry, 388 389 patients, 386 387 pseudocephalic malpositioning and tip asymmetry, 398 399 tip asymmetry, 389 390 very short infralobule and very narrow facet polygon, 394 395 wide dorsum, wide radix and bulbous overprojected tip first surgery, 369 infralobule polygon length, 368 two year revision, 370 372
420 Patient photographs camera settings, 7 8 fish-eye, 7 image workout, 10 12 light tricks, 6 7 paraflash settings, 8 peroperative photographs, 6 photography system, 5 6 shadpowing, workout JPG, 13 layer adjustment menu, 13 Macintosh: cmd-a (Windows: CTRL-A), 12 Macintosh: cmd-c (Windows: CTRL-C), 12 photograph work, 14 17 PSD format, 13 shaded picture, 14 surgery drawings, 14 smartphone, 7 Peck graft, 204, 227 Perpendicular (portrait) photos, 5 Photograph work aesthetic information feedbacks, 15 beauty perception, 15 brain perception, 14 computer design, 16 design, 14 front, lateral views and shadowed photos, 16 integrated photo, 16 nose ridge, 14 operation room, 16 Photography techniques, 10 Photoshop, 10 12, 58, 100, 184 Polygon drawings, 54, 211 Portrait photographs, 8 Poviodine, 99 Preoperative photographs forehead fat grafting, 19 27 jaw and cheek, 28 33 menstruation, 19 patient photographs camera settings, 7 8 fish-eye, 7 image workout, 10 12 light tricks, 6 7 paraflash settings, 8 10 peroperative photographs, 6 photography system, 5 6 shadowing, 12 17 smartphone shooting, 7 rhinoplasty instrument set, 34 38 skin care and rhinoplasty, 18 19 surgery notes and archiving, 17 18 Pseudoephedrine spray, 96, 349 R Resting angle cephalic dome suture, 66 cephalic malpositioning autorim flap technique, 79 insufficient cartilage in nose wings, 79 lateral crus repositioning surgery, 78 medial canthus, 78 repositioning technique, 80 subperichondrial dissection, 79 convex lateral crura, 78 incorrect resting angle, 70 71 long lateral crura airway, 73 caudal excess, 72 closed technique rhinoplasty, 71 depression, 74 height of, 71 herniation, 71, 73, 75 nose length, reduction, 71 perichondrium, 72 skin pit, 75 subperichondrial dissection, 72 surgical techniques, 66 vertical compression test, 67 70 breathing, 67 cartilage anatomy, 69 cartilage thickness, 67 cephalic malposition deformity, 69, 70 corrupted resting angle, 69 deep inspiration, 67 lateral crus, 67 nares, 67 resistance, 68 septum deviation, 67 tip shaping techniques, 70 wide lateral crura, 71 Reverse-V deformity, 87, 254, 262 Rhinoplasty closed technique, 71 instrument set closed surgery, 34 dorsum retractor, 34 little retractor, 34 35 Medicon company, 34 speculums, 34 surgical tools, 34 polygon model, 93 94 skin care and, 18 19 Rib cartilage block cartilage, 336 337 cartilage chips, 335 ear cartilage, 335 strip cartilage grafts, 338 339 surgery, 335 336 Roaccutane treatment, 18 S Saddle nose and hanging nostril, 395 396 and notched nostril, 391 393 Self-sticky prints, 6 Septal extension graft, 228, 267, 293
Septum dissection blunt dissectors, 136 ethmoid bone, 135 excised vomer bone, 135 L-strut septoplasty, 132 maxillary spine deviations, 134 mucosa tears, 133 nasal passage, 137 open approach, 132 perichondrium, 131 revision rhinoplasty, 132 rib cartilage, 132 septoplasty, 137 thin Cottle elevator, 132 transfixion incision, 136 extreme gummy smile, 138 140 gummy smile, 138 septum out, 137 138 Septum base surgery, 329 Shadowed photos, 100 Shield graft, 52, 53 Shutter rate, 8 Skin color, 8 Skin ecchymosis, 119 SLR camera, 5 7 Surgery notes and archiving autorim flap technique, 18 backups, 18 drawings, 17 epicrisis report, 17 patient archiving programs, 17 photography archive, 18 pre-written surgery note, 17 recordings, 17 T Tebbett s technique, 105 Telangiectasia, 296 Thick skin bulbous tip and deviated nose, 406 407 and huge hump ala resection, 362 avulsion flap and elliptic resection, 363 patient s infralobule polygon, 362 low radix and cephalic malpositioning, 390 391 and oily skin alar edge resection, 357 columella, 357 fat injection, 357 long inflammatory period, 357 nostril edge resection, 358 vitamin A, 358 patients closed technique, 355 Libra grafts, 357 osteotomies, 357 pitanguy and scroll ligaments, 355 strut graft, 356 Thin skin axis deviation and breathing problems, 404 405 big nose, 397 398 deviated nose and tip asymmetry, 388 389 patients, 386 387 pseudocephalic malpositioning and tip asymmetry, 398 399 Time Machine, 18 Tip surgery autorim flap ala retractions, 145 alar support, 158 bulbous cartilage, 150 cartilage surface, 154 caudal excess, 148, 160 cephalic dome sutures, 156 cephalic migration, 150 cephalic resection, 155 cephalic trimming, 147 columellar strut graft, 156 convex lateral crura, 149 C suture, 157 desired facet polygon, 152 dissection, 154 dome lights, 159 facet polygon, 145 lateral crus caudal resections, 145 medial crus, 153 mucosa, 153 narrow facet polygon, 152 nostril, 162 preoperative photograph, 158 in situ cartilages, 151 structural grafts, 159 subperichondrial plane, 154 thin skinned patient, 146 infracartilaginous incision, 144 145 lateral crural length, 143 lateral crus subperichondrial dissection autospreader flap technique, 162 blunt perichondrium elevator, 164 cephalic malposition, 177 Daniel elevator, 166 domes, delivering, 168 175 Ellipse model, 184 185 internal bandaging, 165 marking and resections, 175 177 observations, 177 181 scroll ligament, 165 secondary rhinoplasty, 167 168 sesamoid cartilages, 165 thoery, 181 183 tools, 163 nasal dorsum and septal surgery, 143 Tongue-in-groove, 228 Topographic anatomy, 53, 92 Transdomal suture, 64, 82, 196, 202 421
422 Triamcinolone, 314 Turkish Aesthetic Surgery Society, 161 U Upper lateral cartilage polygons, 53, 85 86 W Webster s bone triangle, 92 Webster triangle, 92, 106, 254, 263 White steroid cysts, 296