Rhinoplasty Techniques Research Articles

Effects and Changes on Voice After Rhinoplasty: A Long-Term Report.

Vocal changes after rhinoplasty have been poorly investigated, although this surgical procedure is nowadays one of the most requested. The production of voice largely depends on the anatomy and the size of the pyramid and the nasal cavity. The authors report 51 cases of both closed and open rhinoplasty and propose a 2-year report to analyze potential effective changes on voice. Fifty-one patients were enrolled and evaluated from September of 2012 to January of 2018. All patients were studied before and 2 years after surgery. Vocal changes were assessed with an objective and a subjective evaluation. The first one allowed to perform the measurement of the intensity and frequency of vowel sound ("a") and nasal consonant sounds ("n" and "m"). For the subjective evaluation, our modified version of Voice Handicap Index Score allowed us to evaluate every single characteristic of the personal perception of voice. The objective evaluation showed an increased frequency of production of the consonant sounds in 62% of cases and an increased frequency of production of the vowel sound in 68% of cases. The subjective evaluation allowed us to notice significant changes after surgery (P = .044). No significant differences were noticed between closed and open approach. Reduction rhinoplasty technique proved to induce several alterations on vocal pattern. The surgeon should always inform patients about the potential effects on the voice, particularly when such changes may produce influences on the working life.

Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes.

The intermediate cleft tip rhinoplasty is performed in childhood to address residual tip asymmetries during the most critical period of psychosocial development. The authors describe and evaluate long-term outcomes of that approach for the unilateral cleft lip and palate patient based on the concept of individual restoration of each abnormal anatomical component. Photomorphometric analyses of unilateral cleft lip and palate patients (n = 50) who underwent intermediate cleft tip rhinoplasty using the component restoration technique were evaluated preoperatively (time 0) and postoperatively at less than 1 year (time 1), 1 to 3 years (time 2), and more than 3 years (time 3) and compared to age-matched unilateral cleft lip and palate control patients. Nasal relationships (alar symmetry, nasal tip protrusion-to-alar base width ratio, and height-to-width dimensions for the cleft and noncleft nostrils) were compared over time using a linear mixed-effect model. At time 0, both groups demonstrated similar nasal relationships, with the exception of a wider cleft-side nostril in relationship to height in the rhinoplasty group. The component restoration technique improved all four nasal relationships at all postoperative time points compared with time 0 in a statistically significant manner, whereas control patients did not demonstrate significant changes at the corresponding ages. Long-term differences at time 3 revealed a trend toward improved alar symmetry and cleft-side and non-cleft-side nostril dimensions, and a significant improvement in the nasal tip protrusion-to-alar base width ratio in intermediate cleft tip rhinoplasty-treated versus control patients (p = 0.002). The component restoration technique for the unilateral intermediate cleft tip rhinoplasty improves nasal relationships toward normal immediately and in a sustained manner for at least 3 years. Therapeutic, III.

New Tools and Proven Techniques in Rhinoplasty.

New Tools and Proven Techniques in Rhinoplasty.

Minimally Invasive Rhinoplasty Technique Using a Hyaluronic Acid Filler and Polydioxanone Threads: An Effective Combination

Minimally Invasive Rhinoplasty Technique Using a Hyaluronic Acid Filler and Polydioxanone Threads: An Effective Combination

Piezosurgery: Ten Years' Experience of Percutaneous Osteotomies in Rhinoplasty

The possibility to obtain precise osteotomies without major soft tissue damage represents a key point in modern approaches to rhinoplasty. In 2007, the authors first described their ultrasonic approach for percutaneous nasal bone osteotomies with minimal periosteal detachment. In this article, they retrospectively analyze the results of their piezo-surgical rhinoplasty technique through their 10-year experience and describe new perspectives of this technique. A series of 183 patients was retrospectively evaluated. Surgical technique was based on piezoelectric external nasal osteotomies, performed percutaneously, without periosteal detachment. For the last patients, the piezoelectric instrument also was tracked with a navigator (piezo-navigated approach). Data on surgery, hospitalization, ecchymosis, edema, and postoperative complications were evaluated. Of the 183 patients, 168 (91.8%) showed grade 0 or 1 edema. Grade 2 edema was noticed in only 15 of 183 patients (8.2%). In 6 of the 183 procedures (3.3%), postoperative complications potentially related to the piezoelectric osteotomy system occurred. The piezoelectric external approach can be considered a safe and reliable technique. Preliminary data suggest the possibility of using surgical planning and navigation in positioning the osteotomies in selected subsets of patients.

Spare roof technique in reduction rhinoplasty: Prospective study of the first one hundred patients.

Assess the aesthetic and functional outcomes of the first 100 patients who underwent reduction rhinoplasty with the spare roof technique (SRT). Prospective, interventional, and longitudinal study performed on consecutive patients undergoing primary rhinoplasty by SRT. All the surgical procedures were performed by the surgeon who first described this technique. The validated Portuguese version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty was used. Patients completed the questionnaire presurgery and again 3 and 12 months postsurgery. In addition, a visual analogue scale (VAS) was used to score nasal patency for both sides. The study population included 100 Caucasian Mediterranean patients (33 males; 67 females). Mean age at surgery was 32.8 years. Analysis of the preoperative and postoperative mean aesthetic VAS scores showed a significant improvement from 3.67 to 8.1 (P < 0.001) and 8.44 (P < 0.001), respectively, 3 and 12 months postsurgery. Analysis of the five aesthetic Likert scale questions all showed a highly significant improvement after rhinoplasty. The mean preoperative aesthetic sum score was 13.9, which improved to 8.26 and 7.08, respectively, 3 and 12 months postsurgery (P < 0.001), indicating a significant improvement of subjective body image in relation to nasal appearance. Analysis of the preoperative and postoperative mean functional VAS score showed a significant improvement on both sides. This prospective statistical study confirms that SRT significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in reduction rhinoplasty in Caucasian patients with dorsal hump seeking rhinoplasty. 2 Laryngoscope, 129:2702-2706, 2019.

Practical tips and techniques for injection rhinoplasty

Background:Nose is an important part of facial aesthetics and needs to be restored as part of overall facial rejuvenation. Nasal fillers containing hyaluronic acid give immediate results with minimal or no downtime. Materials and methods:The aim of this article was to give an insight and practical tips to enhance results with nasal fillers and at the same time minimize complications. All the procedures were performed at the author’s private clinic and by the author himself. Results:Dorsal correction has been the most common indication for nasal fillers, followed by the tip and alar correction. The patients are highly satisfied if proper care is taken during injections, which leads to gratifying results. Conclusion:Hyaluronic fillers are very effective for nasal reshaping for patients not willing for rhinoplasty and even for those with minor defects after rhinoplasty. They give immediate results with very minimal downtime.

Evaluation of aesthetic and functional outcome of different techniques of secondary cleft lip rhinoplasty

Objectives The objective of this article is to evaluate the esthetic and functional outcome of secondary rhinoplasty in patients who have unilateral cleft lip nasal deformity with the help of using costal cartilage as a source of different graft materials. Background Although there have been improvements in primary rhinoplasty techniques in patients with unilateral cleft lip nasal deformity, this does not exclude the possibility of later revision surgery. In secondary rhinoplasty for cleft lip patients, the underlying skeletal support of the nose should be addressed to improve projection of the nose. In addition, correction of the hypoplastic lower lateral cartilage requires insertion of cartilage or bone grafts to add better support and symmetry. Costal cartilage is considered a better source of graft material to be used in secondary rhinoplasty. Patients and methods This clinical trial included 20 patients who were managed in Plastic Surgery Department, Menoufia University Hospital, from January 2016 to January 2018. All patients had unilateral cleft lip in infancy with residual nasal deformity in adulthood. Costal cartilage rib graft was harvested, carved, and used for maxillary augmentation, columellar strut graft, and lateral crural strut graft. Results Three anthropometric measurements (nostril height, width, and gap area) were used for evaluation of esthetic results, and subjective evaluation of nasal obstructive symptoms was used for functional improvement. A significant improvement of both esthetic and functional results was reported in the study and satisfactory outcome for both surgeons and the patients. Conclusion Maxillary augmentation beneath the base of the nose is important in cleft lip secondary rhinoplasty for better support of the columella and lower lateral cartilage. Costal cartilage is a good source of nasal grafting materials owing to its strength, availability in large amount, and ability of being carved for different options.

Different techniques in tip rhinoplasty

Different techniques in tip rhinoplasty

Pediatric nasal septal perforation

Objective1.) Describe demographic and clinical characteristics of pediatric nasal septal perforations (NSP), 2.) Analyze efficacy of treatment modalities in symptom management and resolution of pediatric NSP, 3.) Describe the surgical technique of external rhinoplasty with vascularized nasal septal flaps in the treatment of nasal septal perforations. MethodsIRB-approved retrospective chart review of pediatric patients ages 0–18 years with nasal septal perforations treated at a tertiary care pediatric otolaryngology practice.Demographic and clinical characteristics including gender, age, race, and presenting symptoms, and location, size, and etiology of perforation were collected. Outcomes including persistence of perforation and symptoms at 1 year and most recent visit were recorded. A total of 20 patients were included. Statistical analysis used Fisher's t-test for categorical variables and Wilcoxon rank-sum for continuous variables. ResultsMedian age was 167.5 months (1.5–221.0). The most common etiology was iatrogenic (40%), followed by button battery (20%). Thirty percent of patients underwent surgical repair. Fifty percent of patients who underwent surgical repair achieved closure of their perforation at most recent follow up. ConclusionPediatric NSP is a challenging issue with limited literature to date. Iatrogenic causes (40%) and button batteries (20%) were the most common etiologies of nasal septal perforation in our study. We introduce an advancement in our center's surgical technique with a case illustration with repair via external rhinoplasty and bilateral vascularized nasal septal flaps. Future larger studies may further elucidate characteristics and treatment modalities associated with successful closure.

Cartilage Graft Donor Site Morbidity following Rhinoplasty and Nasal Reconstruction.

Although surgical techniques for rhinoplasty and nasal reconstruction are well established, prospective research on postoperative morbidity remains limited. The aim of this pilot study was to assess costal and auricular cartilage donor site pain and morbidity in patients undergoing rhinoplasty and nasal reconstruction. In this prospective cohort study, we enrolled 55 patients undergoing nasal surgery that required costal or auricular cartilage harvest from February 2015 through May 2016. Each patient was given a symptom-specific patient survey that assessed general pain, nasal pain, graft donor site pain, graft donor site itching, color variation, skin stiffness and thickness, and graft donor site appearance at 1, 4, and 12 weeks after surgery. Our patient group was 55% female ( n = 30); the mean age was 47 years. Rib cartilage graft patients had significantly greater nasal pain than cartilage donor site pain. There was no significant difference in rib versus ear cartilage donor site pain. Nearly all patients reported that they were not at all concerned about their scar appearance or ear shape and appearance. No prior studies compare cartilage donor site morbidity in patients undergoing nasal surgery. Our findings challenge the conventional wisdom that utilizing auricular and costal cartilage results in high levels of donor site pain. Surgeons should have a low threshold to harvest rib or ear cartilage when it can improve surgical outcome.

Middle Eastern Rhinoplasty: Update

Summary:Middle Eastern rhinoplasty requires especially precise preoperative planning to achieve a successful result. Among all aesthetic surgery procedures, there is a higher demand for rhinoplasty among Middle Eastern cultures. The key is to maintain the ethnicity of the patients while meeting their goals. In this brief overview, common features in Middle Eastern patients and Middle Eastern rhinoplasty techniques in men and women are highlighted.

A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients.

Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18-43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.

Intracorporeal Septorhinoplasty: Technique and Outcome.

Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used. Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017. Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative. Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation.

Tongue-in-Groove Technique for Rhinoplasty: Technical Refinements and Considerations.

A key concept in successful rhinoplasty surgery is maintaining or increasing tip support, and addressing tip projection and rotation. The tongue-in-groove (TIG) technique is a method to achieve this goal using sutures to create a strong connection between the septum and medial crura to change tip rotation and projection. Criticisms of this method include that it may cause stiffness of the nasal tip and columellar retraction. TIG is routinely used by the authors during anterior septal reconstructions (a modified extracorporeal septoplasty technique), as well as in primary and revision aesthetic and functional rhinoplasties. Through this review, technical aspects of the TIG technique are discussed, as well as how pitfalls of the technique can be avoided, as illustrated by several rhinoplasty patient examples.

Endonasal Triangular Technique for nasal valve rhinoplasty: a ten year review

The nasal valve is the main regulator of airflow in the nose. Consequently, the collapse of the nasal valve has a significant impact on nasal obstruction and hence quality-of-life of patients. Several nasal valve rhinoplasty techniques are being used, from cartilage grafts to endonasal resection of the upper lateral cartilage. We describe a new endonasal approach to nasal valve rhinoplasty, the Triangular Technique, and assess its efficacy and complication rate over ten years. A retrospective study of patients who underwent nasal valve rhinoplasty at three regional hospitals from Jan 2004 to May 2014 was conducted. Subjective reports were used to assess the improvement of nasal obstruction. 24 patients were included. 3 months postoperatively, 19 patients reported improvement in nasal obstruction. 4 patients required revision surgery. 2 of these 4 patients had substantial symptom resolution post revision surgery. 10 patients were followed up for more than 5 years (range: 5.8 to 10.3 years), 9 of who reported continued satisfaction and none or minimal nasal obstruction after nasal valve rhinoplasty compared to before surgery. There were no reported complications. The Triangular Technique is a straightforward endonasal technique to address collapsed nasal valves with minimal associated co-morbidities.

Superior-Based Transposition Flap: A Novel Technique in Rhinoplasty.

The cephalic trimming of the lower lateral cartilage (LLC) is an attempt to reduce tip bulbosity; unfortunately, it has the potential to cause a pinched nose deformity and valve collapse. The author sought to use the superior-based transposition (ST) flap to reshape, relocalize, and reinforce the LLC as a support material for both internal and external valves with aesthetic corrections, leaving the scroll area untouched. A total of 367 patients (female, 215; male, 152) were operated with the presented technique. The ST flap was simply used to prepare a cartilage flap based on the scroll area in the cephalic portion of the LLC, and then this flap was advanced over the remaining LLC. The data were evaluated retrospectively. Functionally, the ST flap was used to reshape and support the LLC and the internal valve by keeping the scroll intact and increasing the internal valve angle. The support and suspension of the LLC with this novel technique improve the functional results and prevent complications such as stenosis of both the external and internal valve angles. Aesthetically, the convexity and concavity of the LLC could be fixed with the adaptation of these two surfaces in different angles, thereby achieving a narrower, refined, and aesthetically pleasing tip. This study demonstrates that the ST flap can be one of the main maneuvers performed during rhinoplasty for many purposes, such as reshaping and supporting the LLC, increasing the tip rotation, achieving more aesthetically pleasing tips, suspending the internal and external valves, and protecting the scroll area.

Outcomes of Closed Versus Open Technique of Rhinoplasty During Primary Repair of Unilateral Cleft Lip: A Systematic Review.

Primary cleft rhinoplasty has almost become the norm in cleft practice. Although various closed and open rhinoplasty techniques are in use, there is no consensus as to which technique is superior in terms of outcome. The authors hypothesized that the long-term outcomes of open rhinoplasty during primary cleft lip repair in unilateral cleft is better than that of the closed method. This systematic review has been done to evaluate the hypothesis by a review and analysis of literature. Protocol was registered on the PROSPERO register of systematic reviews. PRISMA-P guidelines for the conduct of systematic review were followed. Literature search was done in various databases. The inclusion criteria were patients with nonsyndromic unilateral cleft lip undergoing rhinoplasty with primary cleft lip repair and preference given to studies comparing the 2 procedures. Sixteen articles were selected based on inclusion criteria after screening 522 articles-1 randomized controlled trial, 2 retrospective cohorts, and 13 case series. Both closed and open techniques have achieved good symmetry of nostrils with no impairment of growth. No advantage of one technique over the other was noted. There is a paucity of randomized controlled trials and prospective studies on the subject to arrive at an evidence-based recommendation as to whether open or closed rhinoplasty during primary cleft lip repair gives better long-term outcomes. Due to insufficient evidence, the authors are not able to support or refute the hypothesis put forward in the review.

The effect of lateral crural overlay surgical technique on elasticity of nasal ala.

The nasal tip refinement is the most difficult stages of rhinoplasty surgery; whereas, the most important part in terms of beauty and performance is the projection refinement. Lateral crural overlay (LCO) is a common technique in rhinoplasty used to reduce nasal tip projection and increase nasal tip rotation. Given the important role of lower lateral cartilage (LLC) in the non-collapse of nasal external valve and air passage, it is necessary to evaluate the changes in nasal elasticity caused by surgery. The design of this quasi experimental study was self-control (before-after). Tip plasty was performed on twenty-four samples (12 cases of rhinoplasty) using LCO technique. To examine the elasticity, the strain index of each ala was measured by a mechanical device, invented by the author, before and after the operation. Out of 24 samples 12 were female and 12 were male. The mean strain index of nasal ala before and after the surgery was 0.24 ± 0.046 and 0.19 ± 0.040 respectively (P < 0.001). The mean strain index of nasal ala before and after surgery for female was 0.27 ± 0.046 and 0.20 ± 0.050 respectively (P = 0.004). For male, it was 0.20 ± 0.018 before and 0.18 ± 0.020 after the surgery. (P < 0.001). Using LCO surgical technique for nasal tip refinement can lead to nasal elasticity increase regardless of gender; although, LLC is cut during implementing this technique.

Association of Nasal Tip Rotation Outcome Estimation With the New Domes Technique in Primary Rhinoplasty.

The postoperative changes in the rotation of the nasal tip in rhinoplasty must be estimated for the surgical planning. To determine whether the outcome in the rotation angle of the nasal tip can be estimated in patients undergoing primary rhinoplasty with the new domes technique. This retrospective analytic cohort study included 323 patients undergoing primary rhinoplasty with the new domes technique in a private clinic in Bogotá, Colombia, by a single surgeon from January 1, 2011, through January 31, 2016. Patients undergoing secondary rhinoplasty and those with less than 6 months of follow-up were excluded. Primary rhinoplasty using the new domes technique. Measurement of the rotation angle of the nasal tip before and 1 week and 6 months after surgery. The main variable taken into consideration was the measurement, in millimeters, of the lateralized nasal domes. A total of 323 patients (288 women [89.2%] and 35 men [10.8%]; mean age, 27.8 years; age range, 13-70 years) were included in the study. The mean (SD) preoperative nasolabial angle was 92.7° (4.4°; range, 77°-107°); at 1 postoperative week, 105.5° (4.9°; range, 92°-120°); and at 6 postoperative months, 102.1° (4.6°; range, 90°-115°). The mean (SD) increase of the rotation that was achieved per lateralized millimeter was 3.6° (2.0°). The mean (SD) rotation angle at 6 months decreased to 3.4° (2.4°). The new domes technique was reliable and reproducible in most patients. Despite the unpredictable inflammatory changes, the exact lateralization in millimeters with the new domes technique allowed precise estimation of the long-term outcome of the rotation of the nasal tip, enabling the surgeon to determine from the preoperative plan the definitive rotation angle of the nose. 4.