Wide-Open Dorsal Approach Rhinoplasty for Droopy Noses.

Abstract

Because rhinoplastic surgery predominantly deals with the osseocartilaginous skeleton, droopy noses with thick skin remain a problem to be solved. In these noses, neglecting excess skin can impair long-lasting and complete correction of the nasal deformity. As these noses already require redundant dorsal skin resection, surgical manipulations can be executed entirely through the dorsal skin excision window instead of the transcolumellar approach. The wide-open dorsal approach rhinoplasty (WoDAR) was developed to allow removal of excess dorsal skin and reconstruction of the nasal osseocartilaginous framework through the excised dorsal skin avoiding a transcolumellar incision. Nine male patients with thick skin and significantly ptotic noses were operated with WoDAR. The cosmetic appearance of the noses was evaluated by the patients before and after the operation using a visual analog scale (VAS). The nasal obstruction symptom evaluation (NOSE) scale was evaluated individually preoperatively and postoperatively. The nasolabial angle (NLA) was measured preoperatively, at the third, twelfth, and twenty-fourth months postoperatively. Dorsal scars were evaluated by means of the Stony Brook's scar evaluation scale (SBSES). Patients (mean age: 51.4 ± 4.8 years) were followed for an average duration of 20.6 ± 8.4 months. Cosmetic evaluation revealed that the mean patient preoperative VAS score was 23.3 ± 25.6, whereas the postoperative VAS score was 92.6 ± 14.8. Preoperative and postoperative NOSE scores were 79.5 ± 16.5 and 11.5 ± 11.5, respectively. The mean preoperative NLA was 72.9 ± 2.9° and at the third and twelfth month postoperatively was 92 ± 6.5 and 91 ± 5.4. The NLA measurements of all four patients followed for 24 months revealed less than 2° derotation compared to third postoperative month. The mean SBSES score was 4.1 ± 0.8 out of 5. WoDAR allowed esthetically and functionally pleasing outcomes. This advantageous technique can be regarded as a surgical alternative for carefully selected aged patients with severely ptotic, thick-skinned noses who might otherwise end up with unsatisfying results both for surgeon and patients.