Facial Plastic Surgery最新文献

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.

Radix control remains a key concern in preservation rhinoplasty. Consistent techniques for managing this area are essential for optimal outcomes.This article presents the step-up maneuver, a novel technique for precise modulation of radix height while preserving structural integrity.Retrospective case series.A retrospective analysis of 245 consecutive primary preservation rhinoplasties using the step-up maneuver between 2022 and 2023 was conducted.The subdorsal Tetris flap was employed in 86.1% of cases, whereas the low strip approach was used in 13.9%. Intraoperative outcomes included: Radix maintained-91.0%; Radix projected-2.9%; Radix deprojected-6.1%.The step-up maneuver represents a significant advancement in preservation rhinoplasty, broadening its indications and reducing the risk of radix-related complications. These findings suggest that preservation rhinoplasty can be safely and effectively extended to a wider range of nasal anatomies, further refining surgical strategies and reducing revision rates.

Rhinoplasty continues to evolve, with small technical refinements yielding significant aesthetic and functional gains. This article reflects on nearly two decades of surgical experience, focusing on the balance between structural support and anatomical preservation.The study aims to evaluate the effectiveness of combining preservation and structural techniques in closed rhinoplasty. It is hypothesized that this hybrid approach enhances surgical consistency and long-term outcomes.A retrospective, experience-based review of a single surgeon's rhinoplasty evolution is presented, highlighting technical transitions and refinements over time.Key refinements include Pitanguy ligament preservation, controlled mucosal resection, scroll area preservation, dual-plane dissection, rim flap techniques, subdomal grafting, and wide subperiosteal dissection. Open and closed approaches were selected based on anatomical features and case complexity.The adoption of preservation principles in closed rhinoplasty led to improved tip definition, supratip contour control, and dorsal stability. Wide dissection techniques enhanced skin redraping and minimized postoperative complications. Combining structural support with anatomical preservation yielded more predictable outcomes in primary cases.Closed rhinoplasty techniques that integrate both preservation and structural strategies offer a reproducible and refined surgical result. Continuous evaluation and adjustment of technical details are key to optimizing long-term functional and aesthetic success.

This study aims to provide an overview of how rhinoplasty surgeons manage patients with previous nonsurgical rhinoplasty and facial fillers. A multicenter international cross-sectional study was conducted in accordance with strengthening the reporting of observational studies in epidemiology (STROBE) guidelines. A survey was distributed to members of the European Academy of Facial Plastic Surgery and associated colleagues, with responses analyzed from surgeons performing over 10 rhinoplasties annually. A total of 171 surgeons from 45 countries participated, with 165 meeting the inclusion criteria. The respondents included ear, nose, and throat (41%), plastic (7%), maxillo-facial (10%), and facial plastic surgeons (23%), averaging 116 rhinoplasties annually and 13 years of experience. Among the surgeons, 74% perform rhinoplasty on patients with prior nasal fillers, typically waiting 21 weeks after filler rhinoplasty before surgery. Additionally, 44% of surgeons remove nasal fillers preoperatively, primarily using hyaluronidase. During surgery, 76% of surgeons remove nasal fillers, and 25% modify their surgical steps for patients with a history of fillers. This study shows that there is no clear consensus in the management of patients with nasal fillers. Surgeons are often unaware of the preoperative existence of nasal and facial fillers, their potential complications, and their management. To address this, guidelines should be established to facilitate the management of the growing number of patients with facial fillers.

Rhinoplasty remains a leading facial plastic procedure globally. The term "ethnic patients" has been replaced by "mixed race patients" reflecting today's interracial mixing, globalization, and massive migrations."Hybrid rhinoplasty" combines two different philosophies: dorsal preservation and structural techniques to achieve optimal surgical results. Selection is dependent on anatomical findings for each patient.Mixed-race primary rhinoplasty patients with V- or S-shaped humps measuring less than 3 mm were included. Patients with important dorsal abnormalities humps greater than 3 mm, or platyrrhine noses were excluded.The different surface dorsal preservation and structural nasal tip procedures are explained in detail. A selection criteria for the dorsal surface techniques is presented.A total of 143 patients between January 2020 and February 2024, who had at least 1 year of follow-up were included. 85.2% were female and 17.48% were male. Surface preservation techniques comprised 56.6% cartilage modification techniques and 43.3% cartilaginous push-down techniques. Structural techniques were used for all nasal tips. The complication rate was very low, with no documented revisions.A hybrid mix-and-match philosophy has extended the application and utility of these concepts, improved outcomes, and minimized re-interventions and complications.

Optimal results in complex nasal reconstruction, particularly in the context of post-traumatic and revision septorhinoplasty, often require the use of cartilage grafts to provide additional structural support to the nose. While autologous costal cartilage (ACC) has been traditionally used, this can be limited by donor site morbidity, increased operative time, and in some cases, lack of suitable cartilage for grafting. There has been a trend towards using irradiated homologous costal cartilage (IHCC) as an alternative source of graft material. We review our departmental experience of using IHCC in functional septorhinoplasty surgery. We performed a retrospective review of electronic medical records of all patients who underwent septorhinoplasty using IHCC at a tertiary referral center between May 1, 2022, and April 30, 2024. Demographic data, surgical details, and postoperative outcomes, including rates of infection, resorption, warping, and revision were recorded and analyzed. Fifty-seven patients (34 males, 23 females) with a mean age of 41.0 years (range: 18-65 years) were included. Forty-one were revision septorhinoplasty operations, while 16 were primary cases. Almost all were performed via an open approach (98.2%). Three patients developed postoperative infection (5.3%) while one developed columellar dehiscence needing further revision surgery (1.8%). Functional and aesthetic results were otherwise satisfactory in all patients. We observed no cases of warping, resorption, or extrusion. The median length of follow-up was 279 days (interquartile range: 171-527 days). We present the largest United Kingdom series to date on the use of IHCC in septorhinoplasty surgery. Our findings support its use as a safe and effective graft material and a viable alternative to autologous sources, offering the benefits of a robust reconstructive material and shortened operative time, without the risk of donor site complications. A longer follow-up period is ideally required to evaluate its long-term structural stability.

Reduction structured rhinoplasty is a rhinoplasty technique that combines elements from two rhinoplasty philosophies: simple reductive rhinoplasty and structural rhinoplasty. The goal is to achieve decreased nasal size while supporting a life-long, lasting nasal shape by employing the use of structural grafts.Reducing nasal size without replacing disrupted nasal support structures has historically led to poor outcomes.Structural grafts include spreader grafts, onlay tip grafts, columellar strut grafts, caudal septal extension grafts, and more. They are utilized to prevent internal nasal valve collapse, provide tip support, and prevent tip ptosis, retraction, or poor healing outcomes due to scarring. Different materials, including autologous cartilage and allogenic implants (i.e., high-density porous polyethylene) can be used as graft material. Preference for specific graft use differs from surgeon to surgeon, and continuous debate exists surrounding which grafts provide the most optimal results.This study outlines Romo III's tenured approach to reduction structured rhinoplasty and discusses various trends and debates in grafts that are currently utilized.