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.

Correction of the Nasal Ala.

The alar-columellar relationship is an important concept for the rhinoplasty surgeon to master. The alar rim in particular is a critical component of the nasal tip, contributing to both overall symmetry and proportion of the nasal base. The retracted ala creates a displeasing aesthetic to the tip complex, distorts the nostril openings, and may have functional implications of the external nasal valve.

Management of Lip Complications.

This article discusses complications that may occur after procedures on the lips, specifically focusing on injectable fillers. Evidence-based guidelines and suggested methods to manage these complications are presented in a systematic format.

Biomechanical analysis of anchoring points in rhytidectomy.

Objective: To quantify tissue tearing force at various anchoring points on the face.

Methods: This is a prospective anatomic study using 4 fresh cadavers of persons aged 60 to 70 years at the time of death, for a total of 8 sides. Standardized 1-cm distances were measured at the various anchor points, and a single 0 Prolene suture loop was tied at each standardized anchoring point.

Treatment of dorsal deviation.

The deviated nasal dorsum is a complex problem with a variety of proposed solutions. Straightening the deviated nose should be focused on maximizing cosmetic outcome while preserving or improving nasal function. Deviations can occur in one or a combination of the nasal thirds.

The subzygomatic fossa: a practical landmark in identifying the zygomaticus major muscle.

Objective: To test the validity of the subzygomatic fossa as a possible landmark in identifying the origin of the zygomaticus major muscle (ZMM).

Methods: Twenty-three fresh cadaver facial halves were dissected. Four references points were identified in each cadaver head: the zygomatic arch, the malar eminence, the modiolus, and the ZMM insertion notch.

The evolving surgeon: how, when, and why change is for the better.

Change is an inevitable part of a surgeon's practice. There are several positive and negative forces encouraging a surgeon to change. Whether a surgeon should modify and how to do it are the focus of this article.

Direct Facial-to-Hypoglossal Neurorrhaphy with Parotid Release.

Objective: Facial nerve paralysis or compromise can be caused by lesions of the temporal bone and cerebellopontine angle and their treatment. When the facial nerve is transected or severely compromised and primary end-to-end repair is not possible, hypoglossal-facial nerve anastomosis remains the most popular method for accomplishing three main goals: restoring facial tone, restoring facial symmetry, and facilitating return of voluntary facial movement. Our objectives are to evaluate the surgical feasibility and long-term outcomes of our technique of direct facial-to-hypoglossal neurorrhaphy with a parotid-release maneuver.

Structural approach to endonasal rhinoplasty.

The marriage of endonasal rhinoplasty with structural grafting has resulted in more consistent rhinoplasty results. The nasal base can be stabilized by tongue-in-groove techniques, a columellar strut, or extended columellar strut. The middle vault can be addressed with spreader grafts or butterfly grafts.

Computerized plastic surgery office.

Purpose Of Review: Technology in general and computer capabilities in particular are growing at an exponential rate. Keeping current with the latest technological capacities and means of incorporating this technology into the facial plastic surgeon's office poses a significant challenge. This review will document the most appropriate method of incorporation and the latest available technological tools.

Expanded polytetrafluoroethylene implants in rhinoplasty: literature review, operative techniques, and outcome.

Gore-Tex, a form of expanded polytetrafluoroethylene (ePTFE), over the past 30 years has attracted much attention as an alloplast for use in rhinoplasty, both from advocates and opponents of its use. It has many desirable traits as an alloplast implant, but many surgeons harbor hesitation and reluctance for alloplast use in rhinoplasty based on historical data of previous nasal implants. Only when objective data from large series of patients with long-term follow-up become available will such skepticism be resolved.

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.