Nasal Tip Rotation by Exclusive Superficial Musculoaponeurotic System Deep Medial Ligament Management: An Objective Evaluation.

The nasal tip constitutes the mobile portion of the nose, in direct contraposition to the pyramid that is a fixed structure. Its configuration, position, and shape are derived mainly from the outline and from the thickness of the wing cartilages, important elements of the nasal tip, that together with skin and subcutaneous tissue can deeply influence the configuration and dynamics of this section of the nose as well. In reshaping the nasal tip, 2 fundamental concepts must be considered: projection and rotation; these may be modified, acting on the nasal cartilaginous framework and/or on the superficial nasal fibromuscular structure (SMAS).

Crushed Cartilage: A Rescue Procedure in Rhinoplasty.

While the use of crushed cartilage is now universally recognized as a valid procedure in rhinoplasty to mask irregularities and eliminate slight deficits, there is still no consensus as to the optimal degree of crushing and the rate of graft resorption over time. With a view to casting light on these 2 important aspects and providing some guidelines, the authors present a study of 123 patients subjected to grafts of cartilage with different degrees of crushing in the different areas of the nasal pyramid: upper third (45 patients), middle third (40), and lower third (38). The degree of crushing was medium for 95 patients and high for 28 who presented thinner and less elastic skin.

Dome Division: A Viable Technique Today?

Dome division can still be regarded as a valid surgical procedure today in some particular cases of revision rhinoplasty where the scarring is so extensive as to make precise isolation of the alar cartilages impossible. The presence of asymmetry of the nasal tip, a recurrent feature in the results of rhinoplasty, constitutes the primary indication, as division makes it immediately possible to restore balance between the two domes in such cases. The technique also proves useful in cases of overprojection of the tip as a result of rhinoplasty.

Treatment of the Crooked Nose: The Final Steps to Perfection.

Perfection is sometimes approached in treatment of the crooked nose today but not fully achieved due to the continued existence of flaws. While the traditional surgical algorithm envisages the use of 2 series of procedures to straighten the nasal bones and cartilaginous septum, the addition of a third appears very useful with a view to obtaining truly excellent results, above all in the case of marked deviation. The authors present their experience in the use of certain procedures designed to correct asymmetry of the upper lateral and lower lateral cartilages, as well as the soft covering tissues where necessary.

The "Anatomical Balance Correction" for Secondary Cleft Lip Nasal Deformities.

Secondary cleft lip nasal deformities corrective procedures are still a major concern for the maxillofacial surgeons.

Reshaping of the Anterior Nasal Spine: An Important Step in Rhinoplasty.

Unlabelled: The importance of analysis of the nasal spine should not be underestimated in the correct planning of rhinoplasty. Deformations in position with respect to the midline and/or in size are often present, and their correction to ensure harmony between the spine and the other components of the nasal pyramid constitutes a key step in rhinoplasty that can lead to excellent results.

Methods: The study includes 160 patients who underwent surgical treatment of the anterior nasal spine with or without other techniques of nasal reshaping.

Subtotal septal reconstruction by using conchal graft.

Loss of the cartilaginous nasal septum, a condition frequently encountered in the practice of nasal surgery, can vary in scale depending on its etiopathogenesis. Previous surgery, trauma, and infection can lead to subtotal absence of the septum with severe functional and aesthetic problems. Use of the auricular concha for reconstructive purposes proves an immediate and effective method making it possible to replace the missing tissue without involving operations of a more invasive nature.

The importance of the nasal septum in the deviated nose.

The nasal septum plays an important role in both the appearance and function of the nose. Deviation of the nose is common and correction requires a focused, anatomically based treatment. Reconstruction and support of the septum is a necessary component to a straight nose.

Barrel roll technique for the correction of long and concave lateral crura.

Objective: To describe the barrel roll technique that is capable of concurrently correcting 2 associated deformities--overprojection and ptosis of the nasal tip.

Methods: Thirty-two patients with concavity of the upper section of 1 or both lateral crura combined with a droopy tip were treated from January 1, 2005, through December 31, 2007. In all cases, the barrel roll technique was used, which involves rotating the lateral crus by 180° on its major axis so that the concavity is transformed into convexity, and carrying out lateral crural overlay to correct the overprojection concurrently.

The surgical approach to the Mediterranean nose.

The Mediterranean nose possesses some specific characteristics of the ethnic group in question that can appear unduly accentuated in some cases and reflect a situation of authentic nasal deformity. The problems most frequently encountered consist of a prominent hump and protruding dorsum, a ptotic tip, an acute nasolabial angle, and thick, sebaceous skin. The surgeon in his approach to the Mediterranean nose must be able to recognize these deformities and to resolve them in accordance with the aesthetic canons peculiar to this ethnic group.

Perichondrium graft: harvesting and indications in nasal surgery.

Irregularities in the nasal contour of patients who underwent multiple surgeries are frequently related also by skilled surgeons. The aim of this study was to describe the method of harvesting and the primary applications of erichondrium grafts in revision rhinoplasty to prevent postoperative irregularities.Conchal grafts were used in the reconstruction of structures missing as a result of rhinoplasty.

Gridplan midfacial analysis for alloplastic implants at the time of jaw surgery.

Background: Middle-third facial implants are primarily indicated for facial plastic surgery and orthognathic surgery as well as the secondary treatment of facial trauma and congenital malformations. Several methods of clinical analysis have been described both for defect classification and for surgical technique and implant materials. These prove very difficult to apply so as to establish a precise standard.

The conchal cartilage graft in nasal reconstruction.

Graft selection remains a problem in nasal reconstruction, where the use of autologous cartilage still provides the best resistance to infection and a low degree of resorption. As the nasal septum is often absent or insufficient in such patients, the auricular concha offers a valid alternative. A group of 53 patients suffering from developmental iatrogenic and post-traumatic nasal pathologies were treated surgically by means of conchal grafts.

Evolution of the septal crossbar graft technique.

The septal crossbar graft is a surgical technique used to correct crooked nose and solve the associated functional and aesthetic problems. Described for the first time in 2003, it combines staggered septal incisions with a spreader graft in the dorsal septum on the concave side of the deviation. The method has proved particularly useful in straightening the septum and ensuring postoperative results of lasting stability.

Difficult revision case: Two previous septo-rhinoplasties.

This article reviews the case of a 29-year-old woman who underwent revision rhinoplasties. Preoperative photographs and postoperative photographs 1 year after surgery are included.

Septal considerations in revision rhinoplasty.

Abnormalities of the nasal septum subsequent to septorhinoplasty include structural deficits connected with incorrect excision of the cartilaginous portion, the persistence of deviation to varying degrees, and deformity of the supratip region. In the course of revision, the correction of septal anomalies constitutes an indispensable preliminary stage upon which the end result depends. A straight, sturdy, and flexible supporting septal structure is, in fact, an essential prerequisite if satisfactory results are to be obtained.

Mini spreader grafts: a new technique associated with reshaping of the nasal tip.

Background: Reshaping of the nasal tip by excision of a strip of cartilage from the cephalic portion of the lateral crura is a commonly used procedure. This surgical technique is not completely free of risk, above all when associated with hump excision, as is often the case. It can lead to incompetence of the internal nasal valve and thus to postoperative respiratory disorders.

The use of spreader grafts in primary rhinoplasty.

Some candidates for primary rhinoplasty are at greater risk of postoperative complications due to the presence of certain very specific anatomic characteristics. The authors describe their experience with spreader grafts in primary rhinoplasty and provide an analytic method of identifying the types of patient needing such grafts who present a high risk of complications. Sixty patients were treated with spreader grafts during primary rhinoplasty.

Subtotal reconstruction of the nasal septum using a conchal reshaped graft.

The caudalmost section of the cartilaginous nasal septum performs the important function of supporting the middle and lower third of the nose. Its absence leads inevitably to deformation of the nasal pyramid and collapse of the internal nasal valve. The most frequent causes of its loss are iatrogenic and traumatic, and the mucoperichondrial lining remains intact in most cases.

Septal crossbar graft for the correction of the crooked nose.

Surgical management of the crooked nose still constitutes a problem that is difficult to solve because of the possibility of recurrence and the risk of weakening the supporting structures. The authors propose an innovative surgical technique for the correction of this deformity that takes into account both aspects of the problem. The technique combines septoplasty by means of staggered intracartilaginous incisions with the original positioning of a unilateral spreader graft.