Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty.

Purpose: Rhinoplasty is amongst the most challenging surgeries to perfect and can take decades. This process begins during residency; however, residents often have limited exposure to rhinoplasty during their training and lack a standardized method for systematically analyzing and formulating a surgical plan. The DESS (Deformity, Etiology, Solution, Sequence) is a novel educational format for residents that serves to increase their pre-operative comfort with the surgical evaluation and intraoperative planning for a rhinoplasty.

Evidence-Based Performance Measures for Rhinoplasty: A Multidisciplinary Performance Measure Set.

The American Society of Plastic Surgeons, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned the multidisciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty. One outcome measure and three process measures were identified. The outcome looked at patient satisfaction with rhinoplasty procedures.

Rhinoplasty: panel discussion.

Should one use an open or closed rhinoplasty approach? How appropriate is the endonasal approach in modern-day rhinoplasty? Should the tip lobule be divided or preserved? Are alloplastic implants inferior to autologous implants? Does release and reduction of the upper lateral cartilages from the nasal dorsal septum always require spreader graft placement to prevent mid one-third nasal pinching in reduction rhinoplasty? Over past 5 years, how have rhinoplasty techniques and approaches evolved?

Alar retraction: etiology, treatment, and prevention.

Importance: The effect of different rhinoplasty maneuvers on alar retraction remains to be elucidated.

Objective: To determine the etiology and treatment of alar retraction based on a series of specific rhinoplasty maneuvers.

Design: Retrospective review of a single surgeon's rhinoplasty digital photo database, examining preoperative alar retraction from January 1, 2002, to December 31, 2005, in 520 patients.

Nonmelanoma skin cancer of the head and neck: molecular mechanisms.

Histopathologic examination is the gold standard for the diagnosis of skin cancer. Because analysis of molecular parameters such as nucleic acids and DNA are also gaining importance in diagnosis, prognosis, and therapy, an understanding of the molecular mechanisms underlying the pathogenesis of nonmelanoma skin cancer of the head and neck is of growing importance for the diagnostician and surgeon alike. This article presents a description of the effect on cells and impact on DNA of ultraviolet radiation, with a discussion of squamous cell and basal cell carcinoma in terms of the effects of genetic pathways and apoptosis.

Reformatted computed tomography to assess the internal nasal valve and association with physical examination.

Objectives: To assess the cross-sectional area and angle of the internal nasal valve more accurately by reformatting computed tomography (CT) scans of the nasal airway according to a more appropriate orientation than scans traditionally sectioned in the coronal plane and then to compare the results with clinical data on the nasal valve obtained from physical examination.

Methods: We performed a retrospective review of the medical records of 24 rhinoplasty patients treated at a private practice facial plastic surgery office affiliated with a tertiary care university hospital. The patients had fine-cut (0.

Subjective and objective improvement in breathing after rhinoplasty.

Objective: To determine whether rhinoplasty improves subjective and objective nasal patency.

Design: Retrospective study including subjective breathing scores and acoustic rhinometry before and 6 to 9 months after septorhinoplasty among a cohort of 31 patients. We used a paired t test to analyze the difference between preoperative and postoperative values.

Osteotomies in the crooked nose.

The crooked nasal pyramid and upper third of the nose can be straightened with various osteotomes. Appropriate solutions to maximize successful nasal straightening require a thorough knowledge of the anatomy, a comprehensive preoperative plan, and the appropriate osteotomy choice.

Cartilage grafting in nasal reconstruction.

Nasal reconstruction after resection for cutaneous malignancies poses a unique challenge to facial plastic surgeons. The nose, a unique 3-D structure, not only must remain functional but also be aesthetically pleasing to patients. A complete understanding of all the layers of the nose and knowledge of available cartilage grafting material is necessary.

Nasal soft tissue trauma and management.

The nose is the most prominent of all facial structures and is susceptible to many types of trauma. All soft tissue injuries of the nose have the potential to distort its appearance and adversely affect the patient's self-image and self-esteem. Once life-threatening injuries are stabilized, a careful history and physical exam should be completed and treatment individualized.

Management of acute soft tissue injury to the auricle.

The external ear is commonly involved in facial trauma. Injuries to the ear can range from simple lacerations to complete avulsions. We review the normal auricular anatomy and vascular supply, as well as the initial management of any auricular injury.

Quantitative comparison between microperforating osteotomies and continuous lateral osteotomies in rhinoplasty.

Objective: To determine the difference in nasal bone narrowing between 2 techniques: the low lateral intranasal perforating osteotomy technique and the low lateral continuous osteotomy technique.

Methods: A retrospective analysis of preoperative and postoperative photographs to determine the changes of the dorsal width of the nose (width of plateau of the nose, or dorsal nasal highlight) and the ventral width (junction of the flattened surface of the maxilla and the ascending nasal process of the maxilla).

Results: Twenty patients underwent continuous osteotomies, and 40 underwent intranasal perforating osteotomies.

Franchise medicine: how I avoid being a commodity in a global market.

As facial plastic surgery becomes more global, pressures for practices to become commoditized will increase. Commoditized practices are those in which price drives the quality of the product. Franchised surgical practices have also recently increased within the United States and abroad.

Trends in functional rhinoplasty 2008.

Purpose Of Review: This article reviews the recent literature on functional rhinoplasty for the most important contributions in the field.

Recent Findings: Surgical techniques for improving the internal nasal valve include upper lateral cartilage fold-in flap, splay graft, alar batten graft, Z-plasty, and the alloplastic Monarch implant. The Nasal Obstruction Septoplasty Effectiveness (NOSE) score and the Rhinoplasty Outcomes Evaluation score have been applied to objectify outcomes in functional rhinoplasty.

Surgical and nonsurgical treatments of the nasal valves.

Nasal obstruction is known to be associated with a major decrease in disease-specific quality of life, and nasal valve dysfunction can play a considerable role in nasal airflow obstruction. Diagnosis and treatment of nasal valve dysfunction requires a thorough understanding of normal anatomy and function as well as pathophysiology of common abnormalities to properly treat the exact source of dysfunction. As the pathophysiology of the nasal valves has become better understood, surgery designed to treat its dysfunction has evolved.

The rhinoplasty consultation and the business of rhinoplasty.

The business of rhinoplasty has undergone changes in keeping with increased competitive pressures locally, nationally, and internationally. Patient demands and progress in the field have abolished the "cookie-cutter" nose, with patients now requesting extensive discussions and predictions with computer photoimaging. The R-Factor Question and The D.

Aesthetic repair of small to medium-sized nasal defects.

Reconstruction of small and medium-sized defects of the nose poses a challenge to the facial plastic surgeon. Flaps for small to medium-sized defects most often are closed in single-staged procedures as opposed to larger-sized defects. A variety of techniques can be used including secondary intention, primary closure, full-thickness skin grafts, composite grafts, rhomboid flaps, bilobe flaps, dorsal nasal flaps, island flaps, and inferiorly based meliolabial flaps.

Quantitative analysis of lateral osteotomies in rhinoplasty.

Objective: To statistically analyze the long-term results of osteotomy after rhinoplasty.

Design: In a consecutive series of 51 patients who underwent reduction rhinoplasty from May 1, 2000, through September 30, 2003, all underwent the same method of bilateral lateral osteotomies, performed by one of us. Twenty patients agreed to participate in this study.

Development of nasal skin necrosis associated with rituximab treatment for Waldenström's macroglobulinemia and subsequent spontaneous resolution.

We report the unusual case of a 72-year-old man who developed acute and extensive necrosis of the nasal skin and soft-tissue envelope while undergoing chemotherapy for Waldenström's macroglobulinemia, a lymphoproliferative disorder The patient's treatment involved infusions of rituximab, a chimeric monoclonal antibody that is directed against B cell surface membrane protein CD20. The patient refused surgery to restore the nose, and he was treated conservatively with wet-to-dry dressings and antibiotic ointment. Approximately 5 weeks after admission, the eschar had exfoliated, revealing that the underlying skin was pink and healthy; no significant areas of necrosis remained.

Nuances in tip modification: specific applications of cartilage splitting in rhinoplasty.

Division of the lower lateral cartilages in rhinoplasty has long been maligned for producing unnatural results. However, recognition of medial, intermediate, or lateral crural discrepancies allows for their division and overlay. By identifying variant nasal anatomy and understanding the anticipated postsurgical dynamics, the rhinoplasty surgeon will be able to produce consistent, natural outcomes.

Aligning the bony nasal vault in rhinoplasty.

The bony nasal vault represents a complex three-dimensional structure, analogous to a truncated pyramid or pyramidal frustrum. By analyzing the nasal bones and determining the length and width of the nasal bones, appropriate surgical measures can be employed. In addition, a review of several different osteotomy techniques is performed.

The long-term effects of alar base reduction.

Objective: To statistically analyze the long-term results of alar base reduction after rhinoplasty.

Methods: Among a consecutive series of 100 rhinoplasty cases, 19 patients required alar base reduction. The mean (SD) follow-up time was 11 (9) months (range, 2 months to 3 years).

A simple and reliable method of patient evaluation in the surgical treatment of nasal obstruction.

We have developed a simple method of evaluating nasal obstruction both before and after corrective surgery. With our system, patients self-rate their nasal patency on a 10-point visual analog scale under different conditions. After a baseline self-assessment, patients rate their breathing while the examiner lifts the lower lateral nasal cartilage with an ear curette and again during lifting of the upper lateral cartilage.