Facial Plastic Surgery最新文献

Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients.We aimed to assess whether the Princess and the Pea (PP) graft-a solid, conical costal cartilage tip graft-can improve tip projection and definition in thick-SSTE patients. We hypothesized that it would yield reliable aesthetic and functional results with minimal complications.Prospective clinical study with 12-month postoperative follow-up.Sixty patients of East, South, and Southeast Asian descent received a PP graft anchored to the lower lateral cartilages. Outcomes were measured using SCHNOS and a 5-point Likert satisfaction scale.Mean satisfaction was 4.5/5, average SCHNOS score 0.54, and no graft-related complications occurred.The PP graft is a safe and effective method for enhancing nasal tip projection and definition in thick-SSTE patients.

Revision or secondary rhinoplasty involving the nasal tip is challenging due to distorted anatomy, scarring, and compromised tip support. This article presents a framework for surgical approach and decision-making in secondary rhinoplasty.Contemporary principles emphasize stability, conservative cartilage handling, and restoring native architecture.The nasal tip depends on the soft-tissue envelope and lower lateral crura, whose relationship with the septum determines projection, rotation, and contour.High-resolution photography, endoscopy, and improved grafting materials enhance the diagnosis and correction of nasal tip deformities.Optimal patients should undergo in-depth assessment with special attention to skin thickness, previous complications, and unrealistic expectations.Structure and support of the tip cartilages are the foundation and critical for the appearance and longevity of your results. As part of building the structure and support, the lower lateral cartilages can be repositioned and reshaped to the ideal appearance. Further refining of the definition and contour then occurs, with management of the soft tissue envelope being part of the decision process throughout.Scar modulation and protection of graft constructs are critical for long-term stability.Regenerative therapies, advanced biomaterials, and minimally invasive contour solutions continue to evolve.A regimented, anatomy-driven approach provides consistent and durable outcomes in revision tip rhinoplasty.

This article aims to provide a comprehensive overview of nasal tip support, tensioning mechanics, and suture-based techniques that refine projection, rotation, and stability in rhinoplasty. Modern approaches emphasize predictable, structurally sound methods that balance form and function while accommodating individual anatomic variability. Understanding tension vectors and ligamentous relationships is essential for optimizing both aesthetics and long-term outcomes.The evolution of nasal tip surgery reflects a shift from primarily reductive maneuvers to graft- and suture-based strategies that reinforce and shape the tip framework. Early innovators recognized the limitations of aggressive cartilage excision, leading to the development of both structural cartilage grafts and suture-based techniques to provide tip stability.Tip anatomy is governed by the relationship between the lower lateral cartilages (LLCs), medial crural base, the caudal septum, and the soft-tissue envelope. Cartilage grafts bolster weak or asymmetric native structures, reinforcing the medial crural pillar or lateral crural support, while sutures fine-tune shape, redistribute tension, and harmonize graft-induced forces. Optimal outcomes depend on understanding how grafts and sutures interact biomechanically within the intrinsic support system.Integrating cartilage grafting with targeted suture techniques enables surgeons to control projection, rotation, and definition with greater precision. A combined structural and tension-modulating strategy enhances long-term stability, counteracts postoperative contracture, and provides durable, natural tip aesthetics across primary and secondary rhinoplasty.

The increasing use of filler rhinoplasty has led to more patients presenting with complications such as fibrosis, granuloma formation, skin irregularities, and filler migration, including the characteristic "Avatar nose." These cases require a systematic, algorithm-driven approach for safe and predictable correction.Nonsurgical rhinoplasty has gained popularity due to its minimally invasive nature, yet complications requiring surgery have become increasingly recognized.Distorted soft-tissue planes and altered skin-soft-tissue envelopes (SSTE) after filler placement influence both dissection and reconstruction.High-frequency ultrasound can assist in identifying residual filler and guiding hyaluronidase dissolution before surgery.Patients with persistent deformity, migration, granuloma, or long-standing fillers unresponsive to nonsurgical measures are appropriate surgical candidates.Revision rhinoplasty involves open approaches, selective removal of residual filler, and structural reconstruction with autologous cartilage. Redundant SSTE may require increased dorsal augmentation, conservative trimming, and adjunctive intraoperative doxycycline.Postoperative corticosteroid injections can limit fibrosis and improve contour.Algorithm-based evaluation and operative planning continue to refine management of these complex cases.Thoughtful surgical execution is essential for achieving stable, natural outcomes in patients with filler-related nasal complications.

This article describes the senior author's (M.S.) approach to nasal tip management in primary rhinoplasty, integrating preservation concepts with selective structural reinforcement to enhance long-term stability and refined definition.Over 15 years, the technique transitioned from routine columellar strut grafting, effective early but prone to late ptosis, to a septal-based philosophy centered on the Teostrut and the septal extension graft (SEG), providing more predictable projection control.Clinical decision-making relies on assessment of skin thickness, lower lateral cartilage strength, and inherent tip support, which together determine the degree of preservation or reinforcement required.The operative approach combines preservation of native support when feasible, controlled strengthening through Teostrut or SEG when indicated, conservative cephalic adjustments, and precise dome-suture modulation. This sequence balances structural stability with aesthetic subtlety while respecting tissue dynamics.Refinements continue to evolve through improved mapping of cartilage responsiveness, integration of regenerative strategies, and advancements in suture-based modulation.This experience-based approach offers reproducible, stable, and naturally refined results in primary rhinoplasty, emphasizing durable tip support and patient-specific aesthetic goals.

The soft tissue envelope is inherently disrupted during rhinoplasty, especially in the open approach and during tip plasty. To avoid adverse outcomes such as pollybeak deformity and nasal valve collapse, these soft tissue structures should be reconstructed. Instead, preservation philosophy aims to preserve rather than reconstruct. The aim of this study is to present a technique that facilitates the preservation of the soft tissue envelope using the cephalic lateral crus-scroll-Pitanguy flap (CLC-SP flap) in open rhinoplasty.A retrospective analysis was performed on 22 patients with thick skin who underwent open approach rhinoplasty in the supra-perichondral plane.During the dissection, the cephalic portion of the lateral crus (LC) is elevated as part of the skin, with the LC's attachments to the soft tissues via the scroll and Pitanguy ligaments as a composite flap. In this way, the soft tissues are preserved. Reinsertion of the cephalic LC with its attached soft tissues restores normal anatomy and minimizes dead space.Nineteen patients reported improved nasal breathing, and 21 patients reported aesthetic satisfaction after a mean follow-up of 5.4 months; no pollybeak deformity occurred. Using this technique, we were able to control tip definition by limiting dead space and supporting the nasal valve. Additionally, the cephalic LC was utilized as a caudally advancement flap to reinforce and straighten the caudal LC, improving its position and resting angle.The CLC-SP flap is a useful technique for controlling and preserving the soft tissue envelope, improving tip definition, supporting the nasal valve, and minimizing dead space, thus preventing pollybeak deformity in thick-skinned patients.

This study aims to review contemporary principles of structural nasal tip grafting and provide a practical framework for selecting techniques that achieve durable aesthetic and functional outcomes.We summarize the evolution from reduction rhinoplasty toward preservation and structural approaches that prioritize long-term tip support.Key osteocartilaginous and soft tissue support mechanisms of the nasal tip are outlined with emphasis on major and minor tip support structures.Open and endonasal approaches, autologous cartilage sources, and ancillary materials such as fascia are described as tools to modify tip contour and support.Clinical assessment focuses on skin-soft tissue envelope, cartilage strength, airway function, and dynamic deformities.Stepwise algorithms for columellar strut and septal extension grafts, plumping grafts, alar rim and batten grafts, lateral crural struts, shield and cap grafts, and articulated alar rim grafts are presented.Postoperative management to protect graft position and control edema is reviewed.Emerging trends toward individualized, data-informed rhinoplasty and objective outcomes assessment are discussed.Thoughtful selection and execution of structural tip grafts allow surgeons to achieve stable, reproducible tip shape while optimizing nasal airway function.

Asian augmentation rhinoplasty has seen marked transitions in both its technical and aesthetic aspects over time, to address the distinct anatomical needs of Asian patients while aligning with their individual standards of beauty. This study provides an in-depth exploration of the evolution of augmentation rhinoplasty techniques to enhance nasal projection and overall facial harmony in a population characterized by unique nasal anatomy-typically featuring a lower nasal dorsum, limited septal cartilage, and thicker soft tissue coverage.A review of augmentation techniques is provided with an emphasis on diced cartilage fascial grafting.It is critical to understand the unique anatomy of the Asian rhinoplasty patient-typically featuring a lower nasal dorsum, limited septal cartilage, and thicker soft tissue coverage.Patient selection is critical in any facial plastic surgery. Preoperative assessment is key in identifying ideal candidates with appropriate goals.This study will explore general considerations for Asian augmentation rhinoplasty, along with a review of the commonly used augmentation techniques. Emphasis will be placed on the surgical approaches utilizing autologous grafting techniques such as costal cartilage and diced cartilage fascia, as the authors feel autologous grafts have generally shown to provide superior results, safety, and permanence when compared with alloplastic implants.We hope to stress the individualized approach in Asian augmentation rhinoplasty, where the choice of technique is determined by patient-specific factors such as skin quality, anatomical structure, and desired aesthetic outcome. With appropriate preoperative planning, advanced surgical techniques, and attentive postoperative care, surgeons can achieve natural, lasting results with augmentation Asian rhinoplasty that improves nasal aesthetics but also enhances overall facial harmony.

To discuss good and poor outcomes in Structure and Preservation rhinoplasty.Dorsal preservation and structure rhinoplasty are time tested techniques.Pertinent anatomy will be discussed.Use of the piezotome is mentioned.Proper indications will be covered.Structure and preservation techniques are discussed.Postoperative care is discussed.Structure and preservation rhinoplasty are effective techniques in rhinoplasty.