Facial Plastic Surgery最新文献

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.

Over-resection leads to many complications in rhinoplasty. Here, we detail the most common of these pitfalls and strategies to both avoid and repair them.The nose is frequently divided into thirds. The nasal bones represent the upper third. The middle third is composed of the dorsal septum and upper lateral cartilages. The lower third is comprised of the lower lateral cartilages and tip-supporting structures.The commonly seen sequelae of over-resection include a deep radix, saddle nose deformity, inverted-V deformity, pollybeak deformity, alar retraction, a pinched nasal tip, bossae, deep alar grooves, and external nasal valve collapse. The major mechanism to avoid these issues is avoidance; however, several grafting techniques are described here to correct overly aggressive reduction.It is critical to avoid the complications described in this manuscript. Just as important, it is necessary to know how to correct these deformities when patients present for revision rhinoplasty.

Destigmatizing reduction rhinoplasty in a structural preservation era.Transition from the classic Joseph rhinoplasty to modern emphasis on structural preservation has imparted negative connotations to the term reduction.Anatomic features that predispose patients to functional compromise must be recognized and addressed in all approaches to ensure successful surgical outcomes.Piezo ultrasonic instruments provide a safe and precise way to reduce the bony framework and can be applied to all styles of rhinoplasty.Patients with no concomitant functional issues, reasonable and conservative cosmetic expectations, and strong cartilage framework, who are managed by a thoughtful surgeon can expect excellent results regardless of the approach.Reduction rhinoplasty techniques are some of the most enduring in rhinoplasty and safe limits are described.Patients should be followed for functional and/or quality of life performance.Precision recommendations regarding thresholds for resection and grafting, as well as standardized preoperative evaluation methods are required.Rhinoplasty techniques exist in a continuum as do features of the nose. A one-style-fits-all approach is not appropriate and leads to avoidable postoperative failures and revision surgery. Reduction rhinoplasty may not be the "buzz" but it still has a place in contemporary conservative cosmetic surgery.

Structural endonasal rhinoplasty, unlike traditional reductive rhinoplasty, achieves aesthetic and functional objectives while maintaining key structural anatomical elements and minimizing complications.Previously, rhinoplasty was performed using primarily reductive techniques that frequently led to poor functional and cosmetic consequences.Pertinent nasal framework anatomy is reviewed in select highlighted cases.Preferred tools/technology are reviewed for each procedure, including the use of ultrasonic devices.Indications for each endonasal technique are systematically outlined.The most common techniques are reviewed: dorsal hump reduction, spreader graft placement, alar batten and rim grafts, and columellar strut, and caudal extension grafts.Endonasal rhinoplasty allows for reduced postoperative swelling, loss of nasal tip support, as well as decreased scar tissue/contracture formation.Structural endonasal techniques continue to evolve and become more refined with studies demonstrating cosmetic and functional outcomes similar to that of open surgery while achieving less operating time, postoperative complications, and long-term complications. As a result, structural endonasal rhinoplasty is an important surgical principle and approach for the modern rhinoplasty surgeon.