Ptotic Nasal Tip Research Articles

A Prospective Randomized Trial of N-butyl-cyanoacrylate + Metacryloxysulfolane Adhesive versus Suture Alone for Grafting in Rhinoplasty: 9 year Follow-up.

Use of cyanoacrylate glue in facial plastic surgery is still controversial due to the absence of long-term follow up showing the results. Aim of our study is comparing the long-term outcomes of N-butyl-cyanoacrylate + Metacryloxysulfolane versus traditional sutures in rhinoplasty. Prospective comparative study. One hundred forty-two patients affected by ptotic nasal tip were included and randomized in two groups. In group A, the surgeon fixed the graft by using the glue and suture and in group B by using the traditional suture only. The following data were collected and compared by statistical analysis: nasolabial angle before and after surgery, dimensions of the graft, duration time (in minutes) for graft application during the surgery, number of sutures applied to fix the graft, presence of post-surgery negative outcomes. All patients statistically improved their nasolabial angle after surgery (ANOVA: P < .0001) without statistically significant differences between the two groups both at short and long follow-up (χ:P = 1 and P = .9 respectively). A statistically significant difference in graft fixation time (P < .00001) and number of sutures (t: P < .00001) used was observed between the two groups. No statistically significant difference was observed in prevalence of infection after surgery. N-butyl-cyanoacrylate + Metacryloxysulfolane could be a valid tool to reduce the necessary number of sutures and to reduce the time required for graft fixation graft fixation with consistent results in long-term follow-up.

Premaxillary Deficiency: Techniques in Augmentation and Reconstruction.

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Aesthetically, premaxillary retrusion may be coincident with an acute nasolabial angle and ptotic nasal tip. Minor deformities may be addressed with use of either alloplastic implants, autogenous tissue, lipotransfer, or injectable filler. Larger composite defects may require reconstruction with implementation of free tissue transfer. Herein, we describe techniques that aim to augment, or reconstruct, the premaxillary region in the context of nasal deformity, osseous resorption, or composite maxillofacial defects.

Surgical Consediration in Correcting Ptotic Nasal Tip

Surgical Consediration in Correcting Ptotic Nasal Tip

Management of the Overprojected Nose and Ptotic Nasal Tip

Ensuring consistent and reproducible results during cosmetic tip rhinoplasty can be extremely difficult. The unpredictable forces of wound contracture and scarring have humbled even the most experienced rhinoplasty surgeons in various cases throughout their careers. Armed with a knowledge of tip dynamics, however, one can combat the various nasal tip deformities with reasonable accuracy. In this article, we present techniques that are specifically used to correct tip overprojection and tip ptosis. The medial crural tuck-up is a procedure that can be used to deproject the nose while maintaining an overall harmonious tip aesthetic. The lower to upper lateral cartilage suspension has been used in our practice to specifically modify the droopy nasal tip. Both procedures have produced excellent long-term results.

Rhinolift: A Uniquely Simple Technique to Address the Ptotic Nasal Tip

In patients with nasal tip ptosis due to senile elastosis, both the soft tissue envelope and underlying cartilaginous framework must be properly addressed to achieve satisfactory results. The rhinolift, when performed on properly selected patients, is one the most rewarding procedures in any facial plastic surgeon’s armamentarium. The procedure is simple to master, expeditious, and has little morbidity.

Management of severe tip ptosis in closed rhinoplasty: the horizontal columellar strut

Tip ptosis is a relatively common nasal deformity, with an incidence as high as 72% in rhinoplasty patients. Different techniques were described for surgical correction of the droopy tip, such as the lateral crural steel, the lateral crural overlay, the tongue-in-groove technique and others. Most authors agreed that an external rhinoplasty approach is necessary for effectively conducting the alar cartilage-modifying techniques mentioned above. In this article we challenge this paradigm and introduce an efficient method for aesthetic correction of severe tip ptosis through an internal rhinoplasty approach. Twenty-three patients with severe ptosis of the nasal tip were operated on by the senior author (MH) between 2000 and 2005 using the described technique. After carrying out the necessary manoeuvres to achieve the desired tip rotation (reduction of cephalic border of alar cartilages, modification of the caudal septum, reduction of upper lateral cartilages), the desired tip position was maintained with the horizontal columellar strut, whose initial operative description appears here. The desired rotation and projection were maintained in all but three patients over the first year after the surgery. In three patients we observed some loss of tip projection after 1 year. We did not witness complications directly related to the horizontal columellar strut. The horizontal columellar strut is an efficient tool for stabilising the corrected position of a severely ptotic nasal tip. We recommend adding the horizontal columellar strut to the array of available rhinoplasty techniques.

Evaluation of Nasal Obstruction in Rhinoplasty

Nasal obstruction is commonly due to septal deviation, enlarged turbinate mucosa, enlarged bony turbinates, nasal valving or, occasionally, a ptotic nasal tip. Correct preoperative diagnosis using the algorithm presented will lead to the appropriate selection of treatment for the patient groups discussed. The same diagnostic system will help the surgeon avoid patients who are likely not to be helped by operative intervention.

Case three: The ptotic nasal tip

Case three: The ptotic nasal tip

Rhinolift Operation in the Treatment of the Aging Nose

Disturbance of the normal relationship between the caudal border of the upper lateral cartilage and the cephalic margin of the lobular cartilage--the so-called "cul-de-sac" area--can result in alar collapse and nasal airway obstruction. This may be caused by either the aging process or trauma, both surgical and nonsurgical. Rhinolift is a surgical procedure that was developed for the treatment of the aging ptotic nasal tip. We have applied this technique to patients with nasal airway obstruction resulting from alar collapse. Elevation of the cephalic margin of the lobular cartilage to a position superficial to the upper lateral cartilage restores the normal relationship between these two structures. The upper lateral cartilage then assists in stenting the vestibule open, and thereby improves nasal breathing. Over the past 10 years, 20 patients have had rhinolifts at our institution for the relief of nasal airway obstruction. Concomitant surgery included nasal septal reconstruction in 12 patients, polypectomy in one patient, and placement of a silicone rubber septal prosthesis for closure of a large septal perforation in three patients. Rhinolift was the sole procedure used for the correction of valvular pathology in 10 patients. The other 10 patients had modifications made in their upper lateral cartilage along with the rhinolift. Five patients described restoration of normal nasal breathing, while 14 patients showed partial symptomatic improvement. One patient reported no improvement in nasal breathing. Rhinolift is a safe effective surgical technique for functional improvement of nasal breathing in patients with alar collapse resulting from inadequate cartilaginous support.