Reducing Postoperative Swelling, Edema, and Ecchymosis after Open Rhinoplasty Using Intranasal Drainage.

Reducing postoperative strain on the patient after rhinoplasty is an important goal for the surgeon. Many strategies are described to reach that goal. One strategy is to remove blood from under the dissected soft tissue envelope by drains, before it can infiltrate the different layers causing ecchymosis, edema, and swelling.

My Approach to Preservation Rhinoplasty.

Preservation rhinoplasty entails the preservation of the supportive ligaments, preservation of the cartilage structure, and preserving the anatomy of the nasal dorsum. The preservation methods I use are described in this article.

Differences between Primary and Revision Rhinoplasty: Indications, Techniques, Grafts, and Outcomes.

Background: The nose is at the center of the face and has essential functional and aesthetic properties. Over recent years, rhinoplasty has gained increasing popularity through the influence of "selfies" and social media. As a result, a growing demand for secondary correction has also emerged.

40 Years of Total Extracorporeal Septal Reconstruction: The Past, Present, and Future.

Background: Even today, severe septal deformities are a challenging problem for any rhinoplasty surgeon. Standard techniques are often not able to achieve satisfactory long-term results regarding function or aesthetic form. In such severe cases, a partial or total extracorporeal septal reconstruction may be used, as these techniques provide reliable and lasting results.

Suture techniques and cartilage grafts in nasal tip surgery: An algorithm in primary and secondary rhinoplasty.

Objective: In most primary and secondary rhinoplasties, the adjustment of the nasal tip in terms of position, projection, and configuration is mandatory. Usually, this is one of the most challenging parts of the operation. The aim of this study was to present a step-by-step algorithm that evaluates popular techniques for a predictable outcome.

How to Reduce the Probability of a Pollybeak Deformity in Primary Rhinoplasty: A Single-Center Experience.

Being a very common and highly stigmatizing deformity following primary rhinoplasty, a pollybeak deformity should be avoided during any primary rhinoplasty, especially in patients with thick nasal skin. Two surgical techniques used in the authors' department to decrease the probability of its development in at-risk patients are described in this article: the authors' modification of the supratip suture initially described by Guyuron, and a direct excision of excessive skin that the authors term supratip excision, reserved for rare cases with massive skin excess. In addition, a brief overview of the results of the authors' case series of 74 patients treated with the supratip suture technique, and 21 patients treated with the supratip excision technique over a 5-year period, is given.

Bony Fixation of the Nasal Framework.

The importance of a straight and stable central framework is beyond dispute. Many authors allude to technical aspects how to achieve the above-mentioned requirements. Far less is said about the contact zones of the framework and how to achieve a long-lasting and solid fixation.

Free Diced Cartilage: A New Application of Diced Cartilage Grafts in Primary and Secondary Rhinoplasty.

Background: Irregularities or deformities of the nasal dorsum after hump reduction account for a significant number of revision rhinoplasties. The authors therefore developed a technique of meticulously dicing and exactly placing free diced cartilage grafts, harvested from septum, rib, or ear cartilage. The cartilage paste is used for smoothening, augmentation, or camouflaging of the nasal dorsum in primary or revision rhinoplasties.

Nasal Reconstruction: Extending the Limits.

Reconstructing the 3-dimensional structure of the nose requires the maintenance of its aesthetic form and function. Restoration of the correct dimension, projection, skin quality, symmetrical contour, and function remains problematic. Consequently, modern approaches of nasal reconstruction aim at rebuilding the units rather than just covering the defect.

Refining the Nasal Dorsum with Free Diced Cartilage.

Refining the nasal dorsum has become a major challenge in modern rhinoplasty as irregularities of the nasal dorsum account for a significant number of revision surgeries. In our department, free diced cartilage is now routinely applied for smoothening of the nasal dorsum. In this retrospective study, the outcomes with regard to irregularities or contour deficits of the nasal dorsum of 431 rhinoplasty cases operated by a single surgeon between July 2013 and June 2015, using free diced cartilage, are compared with 327 cases operated by the same surgeon between January 2007 and December 2008, before the introduction of the free diced cartilage technique.

Aesthetic and Functional Outcomes of 2-Stage Versus 3-Stage Paramedian Forehead Flap Techniques: A 9-Year Comparative Study With Prospectively Collected Data.

Background: The 3-stage forehead flap technique has been described as an aesthetic improvement after nasal reconstruction compared with the 2-stage technique. A standardized evaluation of aesthetic and functional outcomes of the 2-stage versus 3-stage paramedian forehead flap after nasal reconstruction was performed.

Methods: Between July 2003 and December 2012, 102 patients underwent either 2-stage or 3-stage paramedian forehead flap techniques.

Reconstruction of the septum with an autogenous double-layered conchal L-strut.

Background: One of the most important preconditions for a straight nose is a straight and stable cartilaginous L-shaped frame with sufficient support for the nasal tip and the cartilaginous dorsum. Where the structure of the septal cartilage is destroyed, a sufficient L-strut must be reconstructed. This article presents a technique for reconstruction of an autogenous L-strut using double-layered conchal cartilages.

A Cohort Study of Paramedian Forehead Flap in 2 Stages (87 Flaps) and 3 Stages (100 Flaps).

Background: In nasal reconstruction, the paramedian forehead flap is traditionally performed in 2 stages. To minimize the risk of flap necrosis, Millard described a 3-stage technique in a series of 5 cases in 1974. In this technique, an intermediate step of flap thinning is performed after flap transfer and before pedicle division.

Lining in nasal reconstruction.

Restoring nasal lining is one of the essential parts during reconstruction of full-thickness defects of the nose. Without a sufficient nasal lining the whole reconstruction will fail. Nasal lining has to sufficiently cover the shaping subsurface framework.

Lower lateral crural reverse plasty: a technique to correct severe concavities of the lateral crus.

Background: Excessive concavities of the lower lateral crura can lead to heavy aesthetic disfigurement of the nasal tip and to insufficiencies of the external nasal valve. This study reviewed experience with the lower lateral crural reverse plasty technique that uses the existing cartilage to create the desired lower lateral cartilage contour and provides sufficient alar rim support.

Methods: A retrospective review was conducted with a follow-up period ranging from 9 to 33 months.

Stimulation of steroid-suppressed cutaneous healing by repeated topical application of IGF-I: different mechanisms of action based upon the mode of IGF-I delivery.

Background: Insulin-like growth factor-I (IGF-I) is accepted as a potent stimulus of wound healing when applied in combination with its binding proteins. However, there is only one study published that has investigated the effect of repeated topical application of unbound IGF-I on ischemic wound healing. The aim of this study was to show the effect of daily topical IGF-I therapy on cutaneous ulcer healing in a steroid-suppressed wound model.