Skin Excision as an Adjunctive Technique to Rhinoplasty in Middle-Aged and Elderly Patients

The Impact of Age on Anthropometric Changes Following Rhinoplasty

Background: There are several factors affecting the results of rhinoplasty, and the predictability of outcomes still remains insufficient. Objective: To associate the rhinoplasty results with patients' age by anthropometric measurements. Methods: Retrospective chart review of patients undergoing rhinoplasty who were divided into decades of age. Anthropometric measurements were carried out using Rhinobase® Software. Wilcoxon t test was used for the postoperative 3 months and 2 years analysis. p values of <0.05 were considered statistically significant. Results: A total of 243 patients (median age: 37.1; M:F = 68:175) were included in the study: group I (19-29 years) n: 80; group II (30-39 years) n:71; group III (40-49 years) n: 48; and group IV (50-61 years) n: 44. In group IV, the highest value of difference (Δ) was seen in the midfacial height with the number of 5.5 ± 1.1 (mm) (<0.001). The values of nasal length, tip projection, and midfacial height parameters showed significant differences in both group III and group IV. Conclusions: Unfavorable age-related changes in long-term postoperative period following rhinoplasty can occur in patients above 40 years of age.

Skin Tensioning Concept in Rhinoplasty Using a Semifixed Support Mechanism

BACKGROUND

As the skin on the nose shows outwardly, if we do not consider the volume of skin on the nose that is reduced, the results may be unsatisfactory. Although redraping the skin over a wide area may help, excess skin cannot be adequately controlled in some cases.

MATERIALS AND METHODS

During skin tensioning, a semifixed support mechanism was applied to keep the nasal tip stable and maintain its position while simultaneously allowing stretching and mobility in accordance with its normal function. The dorsal and infratip/columellar skin was stretched by using the support of the most projected part of the nasal tip. The skin was pulled posteriorly to obtain sufficient tensioning and excised at the columellar incision line.

RESULTS

Of the 94 patients who underwent skin tensioning, 82 were women, and 12 were men. The ages of the patients ranged from 18 to 59 years. Ninety-one patients were primary rhinoplasty patients, and 3 patients were secondary rhinoplasty patients. Skin tensioning was performed in 31 patients with overprojection, 24 patients with thick skin, 17 patients with low skin elasticity, 12 patients with excessive skin elasticity, 7 patients with an advanced long nose, and 3 patients with scar tissue due to previous surgery. No serious complications, either functional or aesthetic, related to skin tensioning was encountered.

CONCLUSION

The skin tensioning technique using a semifixed support mechanism helped to achieve a required reduction with a sufficiently defined appearance of the nose in patients with difficult skin.

Surgical and Nonsurgical Management of the Nasal Skin-Soft Tissue Envelope

Management of the skin-soft tissue envelope (SSTE) in rhinoplasty is challenging and critical for the overall outcome. The preoperative identification of patients with thick or thin skin and with preexisting skin conditions may contribute significantly to the postsurgical result. Most publications and textbooks focus on the management of the osseocartilaginous framework, but the SSTE management is often not addressed in detail. However, nonsurgical treatments, such as skin preconditioning, topical steroid-injections, oral isotretinoin, and topical vitamin A derivatives, may provide strong benefits. In this article, we reviewed the literature to present a comprehensive review on the available surgical and nonsurgical approaches pre-, intra-, and postoperatively dealing with SSTE in rhinoplasty.

External Approach for the Treatment of the Aging Nasal Tip

Changes seen in the nose from increased skin elasticity, weakened nasal cartilages, and detachment of ligaments can lead to cosmetic and functional impairment. Esthetically, the nasal tip droops, the nose lengthens, the columella shortens, and the ala collapse. Functionally, the internal and external nasal valves weaken, the anterior nares narrow, and airway turbulence increases, thus contributing to the effect of nasal obstruction. Skin redundancy of the elderly nose may compromise outcomes when typical rhinoplasty techniques are applied. Herein is described a technique pioneered by Fred Stucker, involving a direct external approach to address the aging nasal tip. The technique can be performed under local anesthesia and in combination with other procedures for the aging nose, such as rhinophyma excision or septoplasty for the aging nose.

How to cite this article

Hu M. External Approach for the Treatment of the Aging Nasal Tip. Int J Head Neck Surg 2016;7(3):165-167.