Clin Exp Otorhinolaryngol.  2011 Jun;4(2):55-66.

Fundamental Principles in Aesthetic Rhinoplasty

• Park SS

Abstract

This review article will highlight several fundamental principles and advances in rhinoplasty. Nasal analysis has become more sophisticated and thorough in terms of breaking down the anomaly and identifying the anatomic etiology. Performing this analysis in a systematic manner each time helps refine these skills and is a prerequisite to sound surgical planning. Dorsal augmentation with alloplastic materials continue to be used but more conservatively and often mixed with autogenous grafts. Long term outcomes have also taught us much with regards to wound healing and soft tissue contracture. This is best demonstrated with a hump reduction where the progressive pinching at the middle vault creates both aesthetic and functional problems. Correcting the twisted nose is challenging and requires a more aggressive intervention than previously thought. Both cartilage and soft tissue appear to have a degree of memory that predispose to recurrent deviations. A complete structural breakdown and destabilization may be warranted before the nose is realigned. This must be followed by careful and meticulous restabilization. Tip refinement is a common request but no single maneuver can be universally applied; multiple techniques and grafts must be within the surgeon's armamentarium.

Keyword

Rhinoplasty

MeSH Terms

Cartilage
Contracture
Memory
Nose
Rhinoplasty
Transplants
Wound Healing

Figure

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  Fig. 1 Twisted middle vault secondary to twisted dorsal septum.

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  Fig. 2 Lateral view showing small chin with a prominent nose.

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  Fig. 3 Lateral view showing low radix and psuedohump.

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  Fig. 4 Twisted tip (A) and anatomic etiology of deformity (B).

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  Fig. 5 Costal cartilage (A) and carved into an "L" strut (B).

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  Fig. 6 Split calvarial bone (A) and drilled into a dorsal implant (B).

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  Fig. 7 Upper lateral cartilage's disarticulated off dorsal septum. Note the narrow septum.

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  Fig. 8 Lateral view of low radix and dorsal hump (A), radix graft (B), post operative lateral view showing balanced dorsum (C).

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  Fig. 9 Septal bone with holes drilled for dorsal splint.

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  Fig. 10 Conservative cephalic trim.

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  Fig. 11 Vertical dome division (A), vestibular mucosa spared (B), new edges reapproximated (C).

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  Fig. 12 Obtuse intermediate crus (A), dome binding suture (B), narrowed tip with increased projection (C).

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  Fig. 13 Oblique view of broad tip and thick skin (A), cap graft (B), post operative oblique view showing improved definition to tip (C).

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