Challenging Rhinoplasty for the Cleft Lip and Palate Patient.

Cleft lip and palate patients represent one of the most challenging groups of patients for septorhinoplasty, presenting as a complex surgical obstacle for even the most seasoned surgeons. These individuals have undergone several surgeries throughout their lives, resulting in a considerable amount of scar tissue, significant asymmetries and structural deficits. Key factors in successfully treating cleft lip and palate patients are the reconstruction of the absent/asymmetric cartilages and the replacement of bony structures.

Rhinoplasty for the Cleft Lip and Palate Patient.

Septorhinoplasties in cleft patients are challenging procedures to perform for even the most experienced surgeon. Unilateral cleft rhinoplasties present a unique challenge given that the tissue bed has had previous manipulation and scarring is found around the tissue matrix, making it typically necessary to place several sturdy cartilaginous grafts to provide structural support. Rib graft provides an abundance of cartilage that can be used for multiple areas.

Revision rhinoplasty.

We partition this discussion of revisional surgery based on perceived problems with the primary rhinoplasty. This will focus on either underresection or overresection of tissues and the ensuing clinical result. We also discuss some select problems associated with manipulation of tissues via suturing or grafting and briefly discuss functional considerations in secondary surgery.

Complications of facial implants.

Facial implants are readily used for aesthetic and reconstructive efforts in lieu of autogenous materials due to obvious benefits. Alloplastic facial augmentation is not without potential complications. This article discusses the major factors that contribute to complications of facial implant surgery, based on alloplast composition, surgical technique, and facial region.

Submentoplasty and facial liposuction.

Submentoplasty and facial liposuction are techniques used alone or in conjunction with a standard face-lift that can provide dramatic improvement in facial esthetics. Appropriate patient selection and fundamental techniques are described. Avoiding common mistakes and managing complications also are addressed.

A simple and reliable landmark for identification of the supraorbital nerve in surgery of the forehead: an in vivo anatomical study.

Purpose: In this in vivo study, we set out to determine the reliability of the medial margin of the iris as a landmark for the course of the supraorbital neurovascular bundle at the supraorbital rim.

Patients And Methods: Seventy-five patients (73 women and 2 men) undergoing endoscopic brow lift procedures were enrolled, for a total of 150 sides. With the patient focused on a distant point, a line was constructed preoperatively along the mid-sagittal plane, tangential to the medial iris.