Tip Projection Research Articles

Septal Reconstruction With Folded Porous Polythylene Implants: An Alternative Technique for the Correction of Severe Saddle Nose Deformities in Asian Populations.

Congenital or secondary deficiency in septal cartilage leads to an unpleasant cosmetic appearance and compromised function as well. Rhinoplasty maneuvers such as spreader graft and septal extension graft with autologous tissue have been exhibited to correct the deformities. However, the relatively severe donor site morbidity stands as a main concern for both surgeons and patients. From January of 2014 to April of 2018, 52 patients presenting septal deformities underwent rhinoplasty with our modified technique. A piece of Medpor (8438) was tailored, folded and then placed as a combination of spreader and septal extension graft. The surgical outcomes were evaluated both objectively and subjectively. All the patients were followed up for 12 to 24 months postoperatively. The ratio of tip projection and the nasal length exhibited significant improvement in all our patients. Nasal obstruction subjectively mended among the 24 patients who had airway obstruction complaint preoperatively. Only 2 patients had severe adverse events and the implants were removed instantly. With our modified technique, Medpor proved to be an effective and reliable material for the reconstruction of septal cartilage, which provides us an alternative way to achieve extended spreader and septal extension graft with one single implant in the correction of saddle nose.Level of Evidence: Level IV, therapeutic study.

Correction of secondary unilateral cleft lip nasal deformity in adults using lower lateral cartilage repositioning, columellar strut, and onlay cartilage graft on the nasal tip with open rhinoplasty combined with reverse-U incision

A rhinoplasty technique involving lower lateral cartilage (LLC) repositioning and grafting of ear cartilage allows for nasal lengthening and nasal tip mobility. For better esthetic outcomes in patients with cleft lip nasal deformity (CLND), we combined cosmetic nasal tip plasty with standard techniques. We performed open rhinoplasty combined with reverse-U incision and V-Y plasty in 62 patients with secondary unilateral CLND from October 2013 to June 2018. Both LLCs were isolated, repositioned, approximated medially, and advanced with a Medpor strut, followed by tip suture technique. To further project and enhance the nasal tip and columella, application of ear cartilage onlay graft was used. As adjunctive procedures, septoplasty or osteotomy was carried out for correction of septal or nasal bone deviations, respectively. Photogrammetric evaluations of patients and statistical analyses were performed. Average age at operation was 23.5 years (range: 18-42 years). Of the 62 patients, 15 underwent dorsal augmentation with silicone implant. Two-layer conchal cartilage onlay grafting was performed to manage tip height. Outcomes in 34 patients were analyzed with pre- and postoperative photography. Nasal tip projection increased, alar base width index decreased, and alar and columellar symmetry significantly improved. No Medpor implant exposure or other adverse outcomes occurred. The proposed technique is effective for correcting secondary unilateral CLND and achieving a satisfying nasal appearance in adults.

Preservation Rhinoplasty for the Dorsum and Tip.

By performing a preservation rhinoplasty, the surgeon can achieve natural and stable results by intraoperative replacement of resection with preservation and excision with manipulation of ligaments, cartilages, soft tissues, and the osseocartilaginous dorsum. In this article, the authors explain step by step the dorsal preservation rhinoplasty with low septal strip and a combination of nasal bones osteoplasty and osteotomies, the tip preservation rhinoplasty based on nose tip polygons, and the authors' technique for modify the nasal tip projection and rotation with a posterior strut or anterior septal strip.

A new technique in Asian nasal tip plasty: Non-incisional double-layered conchal cartilage graft

The columellar strut graft based on the use of back-to-back autogenous conchal cartilage is one of the most commonly employed invisible grafts used for nasal tip projection. This graft provides an effective means of achieving nasal tip projection but is limited by its flexibility, especially with respect to cephalic rotation. We designed an effective technique that addresses these limitations. A total of 38 patients received augmentation rhinoplasty with non-incisionally bent double-layered conchal cartilage columellar strut graft with nasal tip onlay graft. Projection and location of the nasal tip, nasal length, and nasolabial angle were measured using lateral view photographs. Pre- and postoperative results were compared. Pre- and postoperative nasal tip projection ratios and nasal tip location ratios were significantly different. Revision surgery was not required in any case and no direct graft-associated complication occurred. We performed tip plasty with a modified columellar strut graft, that is, a non-incisionally bent double-layered conchal cartilage columellar strut graft. In most cases, this method resulted in a significant tip projection increase.

A novel lower bound for tip-apex distance.

The cut-out of the cephalomedullary nail is among the most common post-surgery complications for intertrochanteric fractures. As a risk predictor, a tip-apex distance (TAD) below 25mm, observed from orthogonal fluoroscopic views, is recommended in the literature. This study aims to demonstrate that TAD < 25mm is a mathematically insufficient risk definition and to complement the TAD upper bound with an appropriate lower bound, with the introduction of a novel distance parameter, TADX, based on the orthogonal projection of the nail tip on the central femoral midline. Through a mathematical simulation software, all the possible points that lie inside the AP and lateral views of the proximal femoral hemisphere are utilized to create a 3D grid that is sorted into geometrically safe and risk-bearing regions. Extending this methodology, TAD < 25mm, 10mm < TAD < 25mm, and the ideal tip position volumes are simulated. Finally, intersection volumes are created by a combination of different candidate lower TADX bounds and TAD < 25mm upper bound to determine satisfactory TADX limits. Simulation of TAD-bound zones exposed that TAD is only a mathematically suitable parameter for defining the upper boundary but not the lower boundary for the optimal region. However, using a TADX lower limit creates a 3D volume that is much closer to the optimal tip region volumetrically and can still be as quickly calculated from 2D AP and lateral views. According to the mathematical simulations, the use of a TADX lower bound of 9mm for small, 7.5mm for medium, and 7mm for large femoral heads in conjunction with a TAD upper bound of 25mm is suggested.

Management of Ala Columella Disproportion in South East Asian Noses.

South East Asian noses have a characteristic ala and columella disproportion and mostly manifest as hanging ala. Simultaneous correction during rhinoplasty is recommended to achieve a good aesthetic result. Since hanging ala is a common feature, a classification system is presented as a guide for surgical management. The classification is based on the frontal view showing the alar rim connecting to the columella lobule area simulating the wings of a gull in gentle flight. A mild deformity has the gull's wing in the horizontal direction. A moderate deformity has the gull's wing in a slight inferior direction. A severe hanging deformity has the gull's wing in the inferior direction, ending below the columella lobule area, and this is mostly accompanied by retracted columella. There are various techniques for the surgical correction of hanging ala. The author has made a modification of the internal approach called "sail excision" using the groove within the lateral nasal vestibule as a landmark. The author terms this area as the vestibular groove. Sail excision involves removal of a triangular portion of tissue anterior to this vestibular groove. Another aesthetic deformity noticed in South East Asian noses is that the alar rim base is lower than the columellar base. In correcting hanging ala with involvement of the alar rim base, the sail excision is extended posteriorly following the vestibular groove as its guide to the amount to be excised. To enhance the overall aesthetic outcome, the acute columella labial angle seen in South East Asian noses has to be made fuller through surgery. This is accomplished using septal extension graft for tip projection, with preservation of the posterior angle of the caudal septum. Plumping grafts are used as filler material in the premaxillary area.

Comparing the Effects of Tongue-In-Groove and Septocolumellar Suture With Short and Floating Columellar Strut of Open Rhinoplasty on Nasal Tip Rotation and Projection

In rhinoplasty, it is important to maintain the desired tip projection and rotation. The aim of the present study was to compare the tongue-in-groove (TIG) method and the septocolumellar suture method with short and floating columellar strut methods over a six-month follow-up period. A total of 69 patients were evaluated. The TIG method was used on 39 patients (group 1, TIG group), and the remaining 30 patients received septocolumellar suture supported with short and floating columellar strut (group 2, suture+graft group). Standardized right profile images were taken preoperatively and 6 months after the operations. Goode's method and nasofacial angle were used to evaluate nasal tip projection, and the nasolabial angle was measured to evaluate tip rotation. The outcomes of the 2 surgical approaches were compared, and P values lower than 0.05 were considered significant. Although nasal tip rotation in the postoperative sixth month was higher than that in the preoperative period in both groups (TIG: 96.8° vs 108.2° and suture+graft: 100.8° vs 104.2°, respectively), this change was significant only in the TIG group (P<.001). Goode's ratio increased significantly in both groups compared with the postoperative period (TIG: 0.62 vs 0.57 and suture+graft: 0.62 vs 0.58; P<.001 and .047, respectively). On the other hand, nasofacial angle decreased significantly in both groups compared with the postoperative period (TIG: 147.8° vs 144.0° and suture+graft: 149.1° vs 146.3°; P<.001). As per the results of the present study, both studied methods can be safely used in nasal tip surgery. Compared with the septocolumellar suture+columellar strut method, the TIG method resulted in a higher rotation increase. Both methods led to significant increases in projection, and these increases did not differ between the groups.

The Horn Technique for Nasal Tip Support in Rhinoplasty

Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

The evaluation of various morphological aspects of septal cartilage-a cadaveric study: a 6 months observation study in KLEs, Dr. Prabhakar kore hospital, Belagavi

&lt;p class="abstract"&gt;The nasal septum provides support for the portion of cartilaginous nasal dorsum, and it is responsible for determining the projection of the nasal tip. Septal cartilage plays an important role as a donor graft material in modern rhinoplasty. An anatomical study was performed on 10 adult cadavers. The excised septal cartilage was placed on grid paper; digital images were taken; all septal cartilage was divided into nine equivalent quadrants; and quantitative measurements for length, height, and area were calculated and compared. The average length of the septum was 35.8 mm, while the average height was 25.9 mm. The average septal area was 679.7 mm&lt;sup&gt;2&lt;/sup&gt;. The septal thickness mean values were analysed in nine quadrants, ranging from 1.21 to 2.08 mm. Specifically, the central and cranial areas were thickest, and the area corresponding to the L-strut was thinnest. Anatomical variations of the thickness of septal cartilage excisions were found to be statistically significant, and these differences play an important role in the proper selection of the septal grafts.&lt;/p&gt;

Double Columellar Strut: A New Method for Tip Surgery-A Study of 642 Cases with a 15-Year Follow-up.

Of the first nasal tip modeling procedures performed, the Anderson tripod concept is the most well known, and many anatomy-related studies have analyzed the components involved in tip surgery. The main goals of nasal tip surgery are to stabilize the tip complex, which largely affects the shape, projection and rotation of the nasal tip. The present study describes a new, original method, the double columellar strut and its main advantages compared to conventional techniques used for structural rhinoplasty. The study involved 642 patients (496 women and 146 men, with an average age of 38.67years) who underwent surgery between 2004 and 2018 by two operators. The patients were re-examined to evaluate the outcomes at least 1year after surgery, and long-term results (15years) were recorded for the oldest patients in regard to esthetics (projection, shape, rotation) and breathing function. Of the 642 patients, 34 required a surgical revision for minor defects of the tip due to asymmetry, and the natural appearance after the first surgery was not affected. For the primary rhinoplasties, there were no breathing disorders that required revision surgery due to systematic restoration or preservation of the middle third. The double columellar strut could be performed in the same conditions that the others conventional structural grafts. As a polyvalent alternative, it can be used with closed or open approaches and involves the use of only a limited amount of cartilaginous material. This anatomical approach yields natural results, acting as a foundation for controlling the shape, projection and rotation of the nasal tip. In addition, with or without complementary techniques such as the "tongue-in-groove" technique or tip grafts, the double columellar strut can be considered a "multifunction pocket knife" for tip surgery. 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 .

The Utility of Diced Cartilage Fascia Graft Augmentation of the Nasal Dorsum in Transgender Feminizing Rhinoplasty.

Facial feminizing surgery can have a profound impact on a transgender woman’s ability to “pass” as their identified gender. The brow-nasal complex deservedly gets much attention from facial feminizing surgeons because of well-established differences in male and female anthropometry. In general, these differences include the frontonasal angle (with femininity correlating with obtuseness), dorsal morphology (i.e., concave versus straight or convex, presence of supratip break), dorsal aesthetic line width, bony framework size, and nasal-lip relationship. Feminizing rhinoplasty is intuitively often focused on a “reduction” rhinoplasty, given the generally smaller dimensions of the female nose.1 The utility of the diced-cartilage wrapped in fascia graft has become well established for indications such as in Asian augmentation rhinoplasty and correction of iatrogenic and acquired dorsal deformities. We have been unable to find a previous article focusing on diced cartilage wrapped in fascia as a useful tool in transgender feminizing rhinoplasty, and believe that in select cases, augmentation of the nasal radix and dorsum using this construct serves as a valuable adjunct. We have been pleased with the results that we have seen in transgender facial feminization cases wherein the patient presents with a deep, masculine nasofrontal angle, low radix, and ill-defined dorsal aesthetic lines. This is especially valuable when standard facial feminizing surgery techniques such as a frontal sinus recontouring are inadequate to effectively blunt and soften the nasofrontal region. Of the past 50 transgender feminizing rhinoplasties performed by one of the authors (J.W.C.), seven (14 percent) have used diced-cartilage wrapped in fascia grafts, typically augmenting from the radix to the mid dorsum, while tapering to the supratip area. The surgical technique for this is already well described in the literature.2,3 All diced-cartilage wrapped in fascia cases were in African American transgender women. The indications for diced-cartilage wrapped in fascia graft in six of these patients was in primary rhinoplasty, with preoperative low dorsum and radix, acute nasofrontal angle, and broad, ill-defined dorsal aesthetic lines. In one patient, diced-cartilage wrapped in fascia graft was used in a revision rhinoplasty to replace a malpositioned silicone implant. Tip grafting was used in all cases to increase tip projection and augment harmony with the new dorsum and radix position. In the majority of these cases, the diced-cartilage wrapped in fascia rhinoplasty was performed in conjunction with frontal bone and sinus remodeling, in an effort to maximize feminization of the nasal-orbital-brow complex. Conveniently, a portion of deep temporal fascia can be easily harvested by means of the concomitant coronal approach to create the diced-cartilage wrapped in fascia construct. We have found the combination of these two procedures quite effective in improving feminine appearance and softening the frontonasal angle in appropriately selected patients (Figs. 1 and 2). (See Figure, Supplemental Digital Content 1, which shows the patient preoperatively before facial feminization surgery, https://links.lww.com/PRS/E243. See Figure, Supplemental Digital Content 2, which shows the patient 12 months postoperatively after frontal bone and sinus remodeling, and rhinoplasty with diced cartilage-fascia graft, https://links.lww.com/PRS/E244.)Fig. 1.: Preoperative view, before facial feminization surgery.Fig. 2.: Twelve months postoperatively, after frontal bone and sinus remodeling and rhinoplasty with diced cartilage-fascia graft, with feminized frontal-nasal relationship.It is worth pointing out that the transgender women in my practice who benefited most from diced-cartilage wrapped in fascia grafting were African American. There is a clear intersection in the goals of ethnic rhinoplasty and transgender feminizing rhinoplasty in obtaining nasal-facial harmony, a narrower appearing dorsum, and enhanced tip projection and definition,4 especially when starting with a masculine nose that falls on the platyrrhine spectrum. PATIENT CONSENT The patient provided written consent for the use of her images. DISCLOSURE The authors have no conflicts of interest to disclose.

Evaluation of nasal tip shape in patients with severe caudal septal deviation after modified extracorporeal endonasal septoplasty

ObjectivesThe aim of this prospective study was to evaluate the effect of modified extracorporeal endonasal septoplasty on nasal tip shape and function in patients with severe caudal septal deviation. MethodsThe study population comprised of 55 patients undergoing modified extracorporeal endonasal septoplasty, which called marionette septoplasty. To analyse the aesthetic objective outcomes, postoperative photographs were measured for projection index (PI), tip projection (TP), nasolabial angle (NLA), tip deviation angle (TDA), nasofrontal angle (NFA), supratip height (STH), columellar height (CH), at three times (2 weeks, 3, and 6 months after surgery) and were compared with preoperative photographs. Functional and aesthetic outcomes were also evaluated using nasal obstruction symptom evaluation (NOSE) scale and standardized cosmesis and health nasal outcomes survey (SCHNOS). ResultsBetween the pre- and post-operative 6th-month examinations, a significant increase in PI and TP were 7%, and 5% respectively. There was a significant alteration in the NLA and TDA values following the last examination (mean difference ± standard error of mean 9.68 ± 0.9° and 1.5 ± 0.8°, respectively). Moreover, the technique did not make a significant change in the final NFA, STH, and CH, measurements. Following surgery, the NOSE and SCHNOS scores were decreased significantly and the improvement continued over time until the last examination. ConclusionThe present study findings suggest that the marionette septoplasty technique is an effective to correct and stabilize severe caudal septal deviations. This technique also can provide tip support and protection with a low incidence of dorsal irregularity.

The utilization of diced cartilage-fascia (DC-F) graft in the augmentation rhinoplasty of a case with Binder syndrome

The Binder syndrome is a congenital anomaly mostly seen in females characterized by a flat facial profile and flat nose with absent nasal spine, short columella, flat nasal dorsum, hypoplastic lower lateral cartilages (LLC) and septum, class-III malocclusion, and cleft lip and palate. A 26-year-old female patient with a Binder syndrome was referred to the clinic with a flat nasal dorsum, hypoplastic LLC, deformed nostrils, and hypoplastic columella. She had a history of bilateral cleft lip and palate, ocular strabismus, hypothyroidism, and growth retardation. An augmentation rhinoplasty with an open approach was performed in January 2019. The seventh costal cartilage and the rectus fascia were preferred as autologous grafts. An extended columellar strut graft was prepared and fixed to the nasal spine. Two lateral crural strut grafts was prepared and placed. The hypoplastic LLC were fixated to these grafts. A dorsal onlay graft was settled. Then, the diced cartilage-fascia (DC-F) graft was prepared and it was settled in over the nasal dorsum. A smaller and spherical DC-F graft was constructed to be placed over the extended columellar strut graft for increasing the tip projection. One-year postoperative results of this case confirm that the DC-F graft conserved its volume and shape. The growth retardation has not been described in Binder syndrome in the current literature, and this is the first case of nasal augmentation with DC-F graft in Binder syndrome. DC-F graft is a reliable alternative for the augmentation of the nasal dorsum in Binder syndrome. Level of evidence: Level V, therapeutic study.

Comparative clinical study with a novel technique for stabilization of the nasal tip projection and rotation: fixation of the septum and the strut graft through the septal cartilage autoextension.

It is important to reinforce nasal tip support for long-term satisfactory results. Two workhorses of tip support are strut grafting and the tongue-in-groove technique. Tongue-in-groove causes retraction and stiffness; the strut causes loss of rotation and projection of tip. We introduced a novel technique that avoids these consequences. Between February 2018-February 2019, 40 female underwent primary rhinoplasty. Mean age: 27years (18-41years). 1-2years. In first group (20 patients), caudal septum was resected and strut was not fixated to caudal septum. In second group (20 patients), tongue-like extension (septal autoextension) was preserved at caudal septum and sutured to strut. Preoperative, peroperative, and postoperative images were compared. Tip projection ratio calculations, nasolabial angle measurements were evaluated by statistical analyses. The change in projection ratios between peroperative period and 1-year postoperative period of strut-only group was higher than septal autoextension group (p = 0.001). This result indicates that nasal tip projection loss in strut-only group was higher compared to septal autoextension group. The change in nasolabial angle measurements from peroperative period to 1-year postoperative period differed significantly between two groups (p = 0.001). Significant difference was observed between 1-year postoperative nasolabial angle measurements of two groups (p = 0.006); septal autoextension group measurements were higher than strut-only group. These results showed that fixation of strut graft to the septal autoextension provides better preservation of the nasolabial angle and stabilization of nasal tip projection. CONCLUSıON: Fixation of septum and strut graft through septal autoextension provides satisfactory stabilization of tip projection and rotation without stiffness or rigidity.

Evaluation of the Esthetic and Functional Outcomes of Extracorporeal Septoplasty for Rhinoplasty in Asian Patients.

ObjectivesIn extracorporeal septoplasty (ECS), the entire septal cartilage is harvested, and a neo-L strut is built extracorporeally. Thus, ECS can simultaneously achieve septum straightening and tip projection. This study evaluated the functional and esthetic outcomes of the ECS technique for rhinoplasty in Asian patients.MethodsWe conducted a retrospective review of 64 patients who underwent rhinoplasty using ECS between January 2016 and March 2018. Subjective patient satisfaction was assessed and objective surgical outcomes were evaluated. Improvement in nasal obstruction was rated using a visual analog scale (VAS). Anthropometric changes were compared between preoperative and postoperative facial photographs. Complications and revisions were also analyzed.ResultsThe participants comprised 64 patients (48 males and 16 females, with a mean age of 29.3 years). The mean operative time was 89.3 minutes. In total, 61 patients were satisfied with the esthetic outcome, and the overall objective rhinoplasty outcome score was 3.45. Preoperative nasal obstruction symptoms (7.9±1.2 on VAS) improved postoperatively (3.1±1.3, P<0.001), and significant improvements were also observed in the nasofrontal angle (152.3° to 148.1°, P<0.001), nasolabial angle (88.8° to 92.0°, P<0.001), and nasal tip projection (0.62 to 0.66, P<0.033). Recurrent deviation of the nasal septum and external nose or tip deprojection did not occur in any patients, and there were no cases of revision during the mean follow-up period of 13.3 months.ConclusionECS might be an esthetically and functionally satisfactory alternative rhinoplasty technique for Asian patients with a shortage of septal cartilage.

Morpho-Functional Septorhinoplasty in Adult Patients With Unilateral Cleft Lip Nasal Deformity: A Comprehensive Approach

The aim of this study was to introduce a morpho-functional technique of rhinoplasty for correction of defective nasal morphology of the secondary unilateral cleft lip and improvement of air passage through the nose. The described comprehensive approach follows the rule of 5R's: relieve, resect, reposition, restructure, and restrengthen. The extended septal graft serves as a columellar strut on the one hand and as a spreader graft on the other hand. The described morpho-functional septorhinoplasty technique is effective for correction of the unilateral cleft lip nasal deformity because it improves the symmetry of the nose, improves the morphology of the alar cartilage, and increases the nasal tip projection. An improvement in breathing occurs as a result of restored symmetry of the ala and nasal vestibule. Morpho-functional septorhinoplasty is a practical tool to handle adult patients with secondary cleft nasal deformities.

The effect of the tongue in groove technique on the nasolabial angle and nasal tip projection

BackgroundThe tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society.MethodsThis is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation.ResultsFifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant (P = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant (P < 0.01)ConclusionThe study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation.

3D photogrammetric analysis in hump nose correction based on nasal tip projection without dorsal augmentation in Asian rhinoplasty

IntroductionHump nose in Asians should be managed differently in consideration of the lateral profile and the balance between the dorsal height and nasal tip projection. We suggest an alternative approach comprising mild rasping and nasal tip projection using a septal extension graft. Material and methodsIn this retrospective study, patients who underwent hump nose correction with rhinoplasty between March 2012 and July 2015 were recruited. Instead of applying conventional dorsal augmentation after humpectomy, our approach involved only smooth dorsal contouring in limited cases. 15 patients were evaluated, with surgical outcomes demonstrated using three-dimensional photogrammetry. ResultsOver the postoperative period, hump height decreased (pre 2.77 ± 2.07, post 0.31 ± 0.55, p = 0.001). Regarding the efficacy of tip projection, both nasal tip protrusion (pre 17.64 ± 4.82, post 20.46 ± 4.05, p = 0.001) and tip projection (pre 19.75 ± 4.26, post 21.83 ± 4.17, p = 0.023) were increased. The hump nose reduction ratio was 84.94% after 6 months and 76.47% after 1 year, whereas increases in nasal tip projection and dorsal augmentation were minimal, with ratios of 14.75% and 12.76%, respectively, after 6 months). ConclusionTherefore, creating a balance between the nasal tip and nasal dorsum in hump nose correction is more important than dorsal augmentation after hump resection in Asians.

Comparative Analysis and Long-Term Results of Various Septal Extension Graft Types.

Shape, tip projection, and position can be controlled by the use of septal extension grafts (SEG). A retrospective cohort study of patients undergoing primary and secondary rhinoplasty was reviewed. The purpose of this study was to analyze maintenance of nasal length, dorsal length, and nasolabial angle postoperatively comparing different types of SEG using standardized photography and digital measurement. Two-hundred twenty-one patients undergoing rhinoplasty were included. There was a statistically significant change regarding the nasolabial angle during the time of follow-up decreasing from 97.53 to 95.30 degrees. No changes could be found in dorsal and nasal length. There was no significant difference among the techniques used to fixate the SEG. The nasolabial angle appeared to decrease from the position 2 weeks postoperatively without changes in the dorsal and nasal length. This means that the decrease in the nasolabial angle depends on the swelling effect and not on drooping of the tip confirming the reliability of SEG over time.

Pitanguy Ligamentous Flap: A New Method to Prevent Supratip Deformity in Rhinoplasty.

A supratip deformity (SD) is an iatrogenic convexity that occurs in the cephalic region of the nasal tip. SD is still a major problem after rhinoplasty surgery. With the method we have described a ligamentous flap was used to create a supratip transition, with adjustable sharpness, while the refinements of the tip rotation and definition were ensured. The aim of the study is to present the results of this technique, which, to the best of our knowledge, has been described here for the first time. Our ligamentous flap technique was applied to 24 patients between August 2017 and March 2018. All of the patients were evaluated in terms of the formation of an SD, a hanging columella, tip projection, and the loss of rotation at the postoperative followups. The photos of patients were evaluated by another independent plastic surgeon and patients themselves at 3 months after the surgery. There were no early or late complications, such as an infection, excessive bleeding, or prolonged edema. Moreover, SDs, hanging columellas, tip projections, and rotational losses, which would require revisions, were not detected in any of the patients. Postoperative scores given by the patients and surgeons were significantly higher than the preoperative values (P < 0.05). Only 2 patients required minor revisions due to dorsal irregularities in the upper 1/3 of the nasal segment. The early results of this Pitanguy composite flap technique, which can be easily applied in every case with thin or thick skin in an open rhinoplasty, are promising. However, there is a need for an evaluation of the long-term results, as well as the advantages and disadvantages in a larger case series. Level IV.