Developing the Optimal Osteotome Hand-Sharpening Method.

Rhinoplasty osteotomes can be sharpened in various ways: professional sharpening or hand sharpening using whetstones or rotary powered devices. To compare the effectiveness of sharpening osteotomes using various sharpening methods with that of professional sharpening as measured by a custom edge tester. We performed repeated serial osteotome impacts on bovine femoral cortical bone.

Management of the Nasal Valve.

The nasal valve is an important consideration in patients presenting with nasal obstruction. Controversy exists regarding the anatomy, terminology, evaluation, and management of the nasal valve. Innumerable techniques with variable effects have been described in the literature.

Complications associated with alloplastic implants in rhinoplasty.

Objective: To evaluate the incidence of infection and extrusion of porous high-density polyethylene (pHDPE) and expanded polytetrafluoroethylene (ePTFE) implants used in rhinoplasty at a high-volume, academic facial plastic surgery practice.

Methods: A total of 662 rhinoplasty procedures performed by 3 faculty surgeons from 1999 to 2008 were retrospectively reviewed. Patient demographics, medical comorbidities, operative details, and postoperative course findings were collected from patient records.

Correction of internal nasal valve stenosis: a single surgeon comparison of butterfly versus traditional spreader grafts.

Nasal obstruction due to internal nasal valve (INV) collapse is relatively common. This article evaluates 2 different methods repairing the INV.Our subject population is a single-surgeon group of 82 patients who underwent a septorhinoplasty for nasal airway obstruction.

The total nasal defect and reconstruction.

The structures of the nose are arguably the most complex within the face to reconstitute when absent. Total nasal reconstruction has evolved to encompass advanced surgical techniques in an effort to achieve increasingly satisfactory cosmetic results while restoring nasal function that mimics the function of a patient's natural nose. In this article, the history of total nasal defects and their reconstruction, relevant nasal anatomy, etiologies of the defect, and the surgical approaches to reconstructing each of the three-layered structure of the nose (ie, nasal skin, cartilage/bone, and lining mucosa) are explored.

Conchal cartilage butterfly graft in primary functional rhinoplasty.

Objective: To validate the use of the conchal cartilage butterfly graft in primary functional rhinoplasty and to review our experience using this technique.

Study Design: A retrospective analysis of patients who underwent conchal cartilage butterfly graft reconstruction of the nasal valve in primary rhinoplasty.

Method: A retrospective analysis using patient questionnaires was performed.

Facial resurfacing with coblation technology.

Objective: To describe our experience with coblation technology for facial resurfacing

Methods: Retrospective chart review of all patients treated with coblation at our institution

Results: Twenty-four patients (22 female) underwent a total of 29 coblation procedures for aging face (n = 21) or acne scarring (n = 3). The perioral region was the most frequently treated aesthetic subunit (n = 14), followed by the lower eyelid (n = 7). Five patients underwent full-face coblation.

Direct submentoplasty for neck rejuvenation.

Facial plastic surgeons commonly see patients with submental laxity and an excess of skin and fat in the upper neck. This has colloquially been called the "turkey gobbler" deformity. In some cases, this deformity is the patient's only aesthetic concern, and full face-lift surgery is not desired.

The utility of concurrent rhinoplasty and sinus surgery: a 2-team approach.

Objective: To evaluate the safety and efficiency of and patient satisfaction with a 2-team approach for combined rhinoplasty and sinus surgery.

Methods: We conducted a retrospective medical chart analysis of consecutive patients with sinus disease and functional nasal obstruction. Forty-four patients (29 women and 15 men; age range, 22-75 years) had severe nasal obstruction with chronic sinusitis and were found to have indications for this procedure.

The effect on snoring of structural nasal valve dilatation with a butterfly graft.

Objective: To evaluate the effect on snoring of structural nasal valve dilatation with butterfly spreader grafts in patients with nasal valve insufficiency.

Design: Retrospective medical chart review and telephone follow-up; mean +/- SD follow-up time, 20.7 +/- 11.

Irradiated homograft rib cartilage in facial reconstruction.

Objective: To evaluate long-term structural, functional, and cosmetic results as well as resorption with the use of irradiated homologous rib cartilage grafts (IHRGs).

Design: Cases in which IHRGs were used were reviewed for a long-term follow-up study for nasal and auricular reconstruction, dating back 18 years. A retrospective medical chart review was conducted in the cases in which the patients had returned for clinical examination with photographic documentation.

Self-induced nasal ulceration.

Background: Nasal ulcerations have many causes. Ulcerations that are self-induced are difficult to diagnose and treat. Two rare conditions with self-induced nasal ulceration are trigeminal trophic syndrome (TTS) and factitious disorder (FD).

Total nasal reconstruction: utility of the free radial forearm fascial flap.

Background: Total nasal defects present daunting challenges to the reconstructive surgeon. The nasal skeleton can be successfully fabricated with bone and cartilage. Reconstruction of the nasal skin with a forehead flap produces an excellent color match for nasal skin.

Evaluation of pericranial skull adherence during healing in the rabbit model.

Background: The endoscopic brow-lift is a popular technique for rejuvenation of the aging brow and forehead. Long-lasting results depend on readherence of the pericranium to the underlying skull in the newly elevated position. Determination of the time required for pericranial readherence to occur is important when considering optimal brow fixation time postoperatively; however, few studies of pericranial healing exist in the literature.

The 'butterfly' graft in functional secondary rhinoplasty.

Objective: To describe a surgical technique (the conchal cartilage "butterfly" graft) which, when used in properly selected patients, has been found to be a dependable method for alleviation of postrhinoplasty internal nasal valve dysfunction.

Study Design: Retrospective chart review.

Methods: Analysis of consecutive patients with weakness and/or collapse of the upper lateral cartilages following rhinoplasty.

Immediate reconstruction of extruded alloplastic nasal implants with irradiated homograft costal cartilage.

Objective: To describe a novel surgical protocol for the management of patients presenting with extruded nasal implants.

Study Design: Retrospective chart review.

Methods: Analysis of consecutive patients presenting with extruded nasal implants from 1986 to 2000.