Rhinoplasty Techniques Research Articles

Evolution of preservation rhinoplasty

Rhinoplasty is one of the most common aesthetic and functional surgeries. To overcome negative outcomes, surgeons have been seeking for years to develop the safest and most predictable rhinoplasty techniques with the best possible results. Despite modern advances in surgery that have significantly improved outcomes, every case of preserving rhinoplasty must be considered challenging because of the possible negative outcomes of this surgery. This paper presents a literature review of the development of techniques for preserving rhinoplasty and suture fixation of the nasal pyramid to prevent deviation or recurrence of a hump.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Key stone plasty and asymmetric hump resection in crooked nose deformity

ObjectiveThe aim of this study is to propose a new approach in crooked nose deformity with key-stone plasty and asymmetric hump resection. MethodTwelve patients with crooked nose deformities were operated using the open rhinoplasty technique. Our method, unlike other methods, has two different steps. Following asymmetric hump resection, cartilaginous and osseous septum were cut separated at the key stone area or more caudally and fix the septum with sutures again by allowing them to slide over each other in a way that directs the septum to the midline. If there is an inability to reveal the septum, we apply a longer spreader graft to the cartilage septum side. ResultsThe mean ages were 27.4 years. The mean follow-up time of the patients was 19.1 months. No complications were observed due to this technique. This technique was effective in the treatment of all our patients with crooked nose deformities. ConclusionA novel surgical approach with key-stone plasty and asymmetric hump resection method was proposed in crooked nose deformity with a video animation.

Assessment of Functional Outcomes of an Autospreader Flap and Spreader Graft in Rhinoplasty.

Nasal obstruction after rhinoplasty occurs due to narrowing of the internal nasal valve. Narrowing is due to osteotomy performed to close the open roof of nose after dorsum hump resection. Spreader grafts and autospreader flaps are used to prevent such narrowing. in this study, we aimed to compare the effects of these 2 rhinoplasty techniques on olfactory function, nasal air passage opening, quality of life, and patient satisfaction. In this prospective study, 48 rhinoplasty patients were randomly divided into 2 groups according to graft technique used, either spreader graft or autospreader flap. These 2 groups were compared for patient satisfaction. The sinonasal outcome test-22, peak nasal flowmetry, and Connecticut Chemosensory Clinical Research Center test were applied to all patients before and 8 weeks after surgery. The study enrolled 48 patients. Nasal airflow increased in both groups postoperatively. in the preoperative and postoperative comparison of odor functions, postoperative odor functions were similar in both groups. In the autospreader flap group, the preoperative rhinoplasty outcome evaluation questionnaire score was 4.1 ± 2.2 versus 21.3 ± 2.6 in the third postoperative month. The preoperative rhinoplasty outcome evaluation score was 3.9 ± 2.1 in the spreader graft group and 19.7 ± 1.9 in the third postoperative month. In the present study, postoperative nasal airflow improved in the patients in both the spreader graft and autospreader flap groups. in the patient satisfaction surveys after rhinoplasty, the satisfaction of the patients in the autospreader flap group was higher than that of the patients in the spreader graft group.

Evaluation of Paranasal Sinus Volumes and Anatomic Variations in Patients With Rhinogenic Headache

Background: Rhinogenic headache is a common finding that may occur due to features related to the nasal cavity and paranasal sinuses without any underlying rhinological disease. It is thought that paranasal sinus volumes and anatomical variations may have an effect on this symptom. The aim of this study is; to investigate the paranasal sinus volumes and remarkable anatomical variations in patients with rhinogenic headache. Materials and methods: Paranasal sinus tomography images and hospital files of 72 patients who were referred to the otolaryngology department were evaluated retrospectively. The volumes were calculated by the sinus volume index method and the presence of septal spur, concha bullosa, onodi cell, haller cell, agger nasi cell and paradoxical middle turbinate were evaluated as anatomical variations. As the control group, the data of 40 patients who were operated with open technique rhinoplasty for esthetic purposes were taken and the results were compared statistically. Results: The frontal sinus volume index was 4.57 cm3 in the patient group and 6.02 cm3 in the control group, and this difference was statistically significant. No significant difference was found between the two groups in other paranasal sinus volumes. The presence of septal spur was observed more frequently in the patient group, and this result was found to be statistically significant. There was no significant difference between the two groups regarding other anatomical variations. Conclusions: The low sinus volume may have an effect on the formation of rhinogenic headache. The presence of a septal spur may create a possible mucosal contact point, leading to rhinogenic headache.

Dorsal Preservation Surgery: A Novel Modification for Dorsal Shaping and Hump Reduction.

A new technique for dorsal preservation rhinoplasty that minimizes recurrent hump deformity is introduced. The authors sought to present a novel dorsal roof flap (DRF) technique for modifying the nasal hump and dorsum while reducing morbidity. Twenty-two primary and 3 secondary rhinoplasty patients had 1 of 2 types of nasal DRF depending on hump composition. A triangular roof flap was created utilizing 2 incisions from W-point to lateral Keystone junction in cartilaginous humps (cartilaginous DRF) and to the nasion in osseocartilaginous humps (osseocartilaginous DRF). Then, septal strip excisions were conducted to lower the profile followed by nasal base narrowing. The DRF was then lowered to the desired profile line, any excess lateral wall height trimmed, and the DRF sutured to the upper lateral cartilages. Preoperative and postoperative nasolabial and nasoglabellar angles were measured on the photos. Mean follow-up was 10.3 (standard deviation, 4.41) months (range, 6-20 months). A total 22 humps were V-shape and 3 were S-shape. The composition of the hump was cartilaginous in 5 cases, bone in 7 cases, and combined in 13 cases. A cartilaginous DRF was utilized for the 5 cases with a cartilaginous hump and osseocartilaginous DRF was employed in the other 20 cases. There were no complications observed in the follow-up period and thus no revisions. The DRF technique allows preservation of the nasal dorsum and elimination of the dorsal hump while minimizing hump recurrence.

Lamb Head as a Training Model for Septoplasty and Rhinoplasty.

Septoplasty and rhinoplasty are difficult operations to learn and teach. Many modalities have been proposed to make the teaching process of these operations easier. In this study, it was investigated if lamb heads were good training models to teach septoplasty and rhinoplasty to trainees or experienced surgeons. In the first part of the study, 21 lamb heads were dissected according to a dissection protocol and several anatomical distances were measured to compare them with human cadavers. In the second part, eight lamb heads were dissected and different preservation rhinoplasty techniques were practiced. The study on 21 lamb heads used showed that the lateral crura were 17.8 × 11.6, the average interdomal distance was 8.1 mm, and the average domal width was 3.7 mm. The average length of the upper lateral cartilages was 31.1 mm laterally and 21.2 medially. The average length of the nasal bones was 63.9 mm, and the width was 16 mm. In the second part of the study, 8 lamb heads were used to experience where high-strip techniques were used in 5 and the Cottle technique in 3. This study revealed that lamb heads should be considered as an excellent training model for septoplasty and rhinoplasty. Its very low cost, ease of availability, and close similarity to the human cadavers can be counted as the main advantages. This study also proved that it was not only a tool for beginners, but also a very helpful tool for experienced surgeons to try new methods.

Assessment of Different Middle Vault Reconstruction Techniques in Rhinoplasty from Multiple Patient-Reported Outcome Measures.

It is important to assess the patient satisfaction with shape and function by patient-reported outcome measures (PROMs) following structural or dorsal preservation rhinoplasty (DPR) techniques on the middle nasal vault. To analyze the results of different middle vault rhinoplasty techniques with multiple PROMs and compare their differences according to the findings of PROMs. Four different techniques were performed for the middle vault: spreader graft, L-strut graft, DPR with high strip (DPRwHS), DPR with low strip. The outcomes were evaluated preoperatively, 2 and 12 months postoperatively with the following PROMs: Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation, and Standardized Cosmesis and Health Nasal Outcomes Survey. This study included 129 patients. All techniques provided significant improvements in all PROMs (p < 0.001), except DPRwHS in NOSE. Between postoperative short- and longer-term, no significant differences were observed in DPR groups (p > 0.05), unlike structural techniques. In this comparative study of different middle nasal vault rhinoplasty techniques, we did not detect a difference in the improvement of the patient-reported outcomes of DPR techniques from as early as 2 months to 1 year postoperative.

Reductive rhinoplasty principles applied to the curative treatment of different nasal diseases.

Reductive rhinoplasty is generally intended as a facial plastic procedure aiming for functional and aesthetic outcomes in patients affected by nasal dysmorphism and/or obstruction. However, when applied to different pathologies of the nasal pyramid it holds great potentialities, beyond the solo cosmetic and functional objectives. We retrospectively analyzed preoperative conditions, surgical charts, and postoperative results of patients who underwent reductive rhinoplasty for different nasal diseases at our Institution. Principles and techniques of reductive rhinoplasty were described in the different possible applications to the treatment of nasal disease, from nasal septal perforation to benign and malignant diseases of the nose. Reductive rhinoplasty showed to play a crucial role in the curative purpose of different nasal diseases, representing a versatile tool in the expert hand of rhinoplasty surgeons who approach them. N/A.

Three-dimensional analysis of autologous costal cartilage in Asian secondary unilateral cleft rhinoplasty

This study describes a surgical technique for secondary unilateral cleft rhinoplasty using autologous costal cartilage grafts. The grafts were designed preoperatively and analysed three-dimensionally in 15 Asian patients using a photogrammetric camera. Detailed measurements of the nasal anatomy were taken both preoperatively and postoperatively; the same measurements were also taken from the pre-planned images of the anticipated result. When compared to the preoperative measurements, the postoperative three-dimensional outcome analysis revealed several statistically significant improvements in the nasal appearance: nasal dorsal length (P < 0.001), nasal column height (P = 0.001), nasal column width (P = 0.002), nasal lobule height (P = 0.008), cleft side nostril height (P < 0.001) and width (P < 0.001), columella–labial angle (P = 0.001), and nasal tip projection to nasal dorsum length ratio (NTP/NDL) (P = 0.001). Conversely, the comparison of the postoperative and preoperative design measurements showed mostly no statistically significant differences. Thus, utilizing autologous costal cartilage is a reliable approach with predictable and consistent results in secondary cleft rhinoplasty.

Twelve-Year Experience With Nasofrontal Angle (Radix) Augmentation in Rhinoplasty.

The nasofrontal angle (radix) has a great impact on the rhinoplasty outcome. Minimal alterations in this area can give an unusual nasal appearance and midfacial length. Different management approaches have been described with regard to radix augmentation. This study aimed to describe the techniques of rhinoplasty, different materials used in the procedure, and results of at least 1 year of follow-up in our 12-year experience in this field. The authors retrospectively reviewed the data of patients who underwent rhino-plasty/septorhinoplasty with radix augmentation performed by 1 of the authors (a senior surgeon at our institution) using different graft materials, between January 2007 and December 2019. Patients younger than 18 years or who were followed up for less than 1 year were excluded from the study. In total, 387 patients (235 [60.7%] female; age range, 19–39 years) were included. Primary procedures were performed in 311 patients (80.5%), and revision procedures were performed in 76 patients (19.6%). Most patients (97%) were satisfied with the aesthetic result. There was no incidence of infection, displacement, or extrusion of the graft. The only complications observed were irregularities; 3% required revision surgery. It is important to consider the nasal radix when pursuing a balanced profile in rhinoplasty. Many graft materials can be used safely and can achieve good aesthetic outcomes. Proper anatomical analysis and patient selection are essential for successful graft placement.

Repair of Primary Bilateral cleft Lip

Bilateral cleft lips have traditionally been a challenge to repair and the results have not been very favorable. However, advances in the recent past in the understanding of the nature of the deformity, especially the nasal component have brought a revolutionary change in the approach to these patients, with remarkable improvement in the outcome. The management of the premaxilla and its alignment with the maxillary shelves presurgically is crucial for the optimal treatment of such patients. The treatment protocol and technique followed at our center are described. It is a modification of the Mulliken technique. The philtrum is designed to be small in keeping with its rapid growth potential. The philtral flap is raised and the orbicularis oris muscles from the two sides are mobilized and brought together in the mid-line. Adequate mobilization of the muscles is necessary to avoid closure under tension. The evolution of the concept of primary rhinoplasty is described. The technique of preschool columellar lengthening and open rhinoplasty that is followed at our center is described. Unfavorable results include scarring, dehiscence, and central vermillion deficiency.

Aerosol and Droplet Generation from Open Rhinoplasty: Surgical Risk in the Pandemic Era.

Introduction: The coronavirus disease 2019 pandemic has led to concerns over transmission risk from head and neck operations including facial cosmetic surgeries. Objectives: To quantify droplet and aerosol generation from rhinoplasty techniques in a human anatomic specimen model using fluorescein staining and an optical particle sizer. Methods: Noses of human anatomic specimens were infiltrated using 0.1% fluorescein. Droplets and aerosols were measured during rhinoplasty techniques including opening the skin-soft tissue envelope, monopolar electrocautery, endonasal rasping, endonasal osteotomy, and percutaneous osteotomy. Results: No visible droplet contamination was observed for any rhinoplasty techniques investigated. Compared with the negative control of anterior rhinoscopy, total 0.300-10.000 μm aerosols were increased after monopolar electrocautery (p < 0.001) and endonasal rasp (p = 0.003). Opening the skin-soft tissue envelope, endonasal osteotomies, and percutaneous osteotomies did not generate a detectable increase in aerosols (p > 0.15). Discussion and Conclusions: In this investigation, droplets were not observed under ultraviolet light, and aerosol generation was noted only with cautery and endonasal rasping.

Diced Cartilage Techniques in Rhinoplasty.

Diced cartilage has been widely applied in rhinoplasty, especially for segmental dorsal augmentation, with favorable outcomes over time. Various techniques were developed to increase both stability and viability of diced cartilage, including wrappings with non-blood material/blood products and changing the shapes of the diced cartilage, while the optimal technique is inconclusive. This article systematically reviews the current strategies of diced cartilage technique for rhinoplasty in the databases and emphasizes different wrapping materials. Free diced cartilage has a potential risk of gathering in certain regions and causing postoperative irregularities. Among non-blood wrapping materials, Surgicel is now rarely used due to severe foreign body reactions. The obvious drawbacks of fascia are donor site morbidity, inadequate quantity, and time-consuming. Although diced cartilage wrapped in tutoplast-processed fascia lata, AlloDerm, or esterified hyaluronic acid has achieved primary encouraging results, the increased inflammation raised controversies regarding their clinical use. Diced cartilage wrapped with blood products, such as platelet-rich fibrin or concentrated growth factor, achieved long-term reliable aesthetic results, and shaved cartilage and ultra-diced cartilage have recently shown satisfactory clinical outcomes, while further study is still needed. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Novel Technique for Autologous Supratip Augmentation: Septal Gap Graft.

Although it has been common to use artificial implant to augment nasal dorsum in Asian rhinoplasty, the demand for not using it is increasing due to the long-term complications of implants. However, if only the tip is raised without raising the dorsum with implant, it is difficult to avoid supratip depression, so it is difficult to obtain good cosmetic results. The authors would like to report good results, performing an augmentation rhinoplasty that raises the supratip area using the nasal septal cartilage without using an implant. Septal gap graft was used in 22 patients undergoing nasal tip surgery from January 2019 to April 2021. Septal gap graft refers to a graft that increases the height of the supratip area by using septal cartilage. Firstly, the authors perform a septal extension graft using the septal cartilage, then the authors fix the lower lateral cartilage in an ideal position, and lastly the authors heighten the nasal tip with onlay graft. The height difference between the nasal bone and the nasal tip, is solved by placing the septal cartilage. Before, during and after surgery, photometric analysis was done by taking clinical pictures. Through the septal gap graft, the supratip depression index was decreased and the nasal tip projection was increased. It was confirmed that the septal gap graft was well maintained at long-term follow-up, and the patients' postoperative satisfaction was also high. The authors presented a new technique for augmentation rhinoplasty in Asians. Septal gap graft can be used safely and effectively to raise supratip area without using implant.

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.

Comparison of Free Diced and Multiple Toothpick-Shaped Costal Cartilage Injection Techniques for Augmentation Rhinoplasty.

The free diced costal cartilage (FDCC) injection technique has been used in the augmentation rhinoplasty for a long time. In order to lower the incidence of nasal contour irregularities and graft displacement, we developed the multiple toothpick-shaped costal cartilage (MTCC) injection technique. This comparative study was conducted to introduce and assess this new technique. This retrospective analysis included 51 patients who underwent augmentation rhinoplasty with either the FDCC or MTCC injection technique at the 17th Department of Plastic Surgery in the Plastic Surgery Hospital between July 2014 and May 2020. The patients were divided into the FDCC (n = 30, 58.82%) and MTCC (n = 21, 41.18%) groups. General data, postoperative patient satisfaction, complications and revision rate were compared between the groups. Except for the follow-up period, there were no significant differences in general data (age, sex, preoperative dorsum deformity, preoperative rhinoplasty history) between the groups. Postoperative patient satisfaction, complications and revision rate were similar between the two groups. The MTCC injection is a safe and effective technique for augmentation rhinoplasty. Like the FDCC injection technique, the new technique is relatively easy to perform and time-saving with concealed scarring and minimal postoperative edema. Most of its revision surgeries are also easy to perform by simple rasping and reinjection. According to our experience, the new technique may have wider indication as well as lower incidence of nasal contour irregularities and graft displacement. Therefore, we suggest that the MTCC injection technique is reliable and worthy of recommendation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Useful Approach to I-Shaped Crooked Nose Correction: Cross-Spreader Graft Technique.

Correction of crooked nose with long-term functional and aesthetic success remains a great challenge for rhinoplasty surgeons. The aim of this study was to present the aesthetic and functional results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose. A retrospective examination was made of 25 patients applied with open technique rhinoplasty using cross-spreader graft for the correction of I-shaped crooked nose between March 2016 and June 2019. The functional results of the patients were evaluated using the Nasal Obstruction Symptoms Evaluation scale. The Rhinoplasty Outcomes Evaluation was used to evaluate the subjective aesthetic results, and the external nose deviation angle was measured from the frontal aspect to evaluate the objective aesthetic results. Evaluation was made of 25 patients comprising 11 males and 14 females with a mean age of 26.64±7.08 years. The post-operative mean NOSE and ROE scores were significantly improved compared to the preoperative values (p<0.001). A statistically significant improvement was determined in the deviation angle values from preoperative to postoperative (p< 0.001). According to the current study functional and aesthetic results of the cross-spreader graft technique applied for the correction of I-shaped crooked nose, this new technique appears to be an effective method for the treatment of I-shaped crooked nose deformity. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative Effectiveness of Cartilage Grafts in Functional Rhinoplasty for Nasal Sidewall Collapse.

Objective: To compare the patient-reported outcomes among patients with nasal obstruction undergoing two rhinoplasty techniques to a control group. Methods: Prospective longitudinal study in a university-based tertiary care medical center. All patients undergoing functional septorhinoplasty for correction of lateral wall insufficiency between October 2015 and March 2019 were included; n = 704, mean age (standard deviation) 39.0 (15.4) years, 52.7% females. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) and FACE-Q subscales pre- and postoperatively. Patients were divided into three cohorts: spreader and lateral crural strut (LCS) grafts (n = 141), spreader and alar rim (AR) grafts (n = 104), and the control spreader grafts alone (n = 218). Results: The median NOSE scores at last postoperative visit were improved from baseline (p < 0.001) for all cohorts. The FACE-Q nasal satisfaction median scores also improved postoperatively in all cohorts, AR, LCS, and spreader, respectively (p = 0.001, p < 0.001, and p < 0.0001). Conclusions: There was no detectable difference in the improved subjective nasal function, nor adverse aesthetic outcomes in the patients with lateral wall insufficiency treated with functional rhinoplasty techniques in this study.

Component Restoration in the Bilateral Intermediate Cleft Tip Rhinoplasty.

The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length-to-alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes.