Discussion: Spare Roof Technique: A New Technique for Hump Removal-The Step-by-Step Guide

Septal Bony Paste Graft: A Life-Saving Material in Rhinoplasty Camouflage

BACKGROUND

Although cartilage tissue is a priority material in both structural grafting and camouflage, in some special cases, there is not enough material for camouflage due to cartilage insufficiency after it is used in structural grafting. In these cases, it is vital that the bony parts of the septum be prepared as a paste graft and applied for camouflage.

METHODS

The author retrospectively reviewed 62 rhinoplasty patients in whom septal bony paste grafts were applied during surgery from April 2018 to December 2019. A total of 56 patients were female, and 6 were male. The average age was 28 years old (range 18 to 52). The follow-up period ranged between 12 and 29 months (mean: 20.5). Septal bony paste grafts were prepared using a microrasp attached to a motor system.

RESULTS

Septal bony paste grafts were used for camouflage of osteotomy lines in 59 patients, dorsum smoothing in 47 patients, camouflage of tip grafts in 36 patients, and camouflage of dorsal onlay grafts in 21 patients. No serious complications related to septal bony paste graft application, including functional or aesthetic complications, were encountered.

CONCLUSION

A septal bony paste graft can be applied for camouflage in rhinoplasty in cases where there is not sufficient cartilage tissue for this purpose. A microrasp attached to a motor system can be used for effective and rapid preparation of the septal bony paste graft.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A New Understanding and a Minimalist Approach for Rhinoplasty

SUMMARY

In this article, a new understanding and minimalist rhinoplasty approach is presented. This technique has many novelties, and this article aims to simplify, make the operation more predictable, and correct primary deformities with a 20-step procedure.

Common Dorsal Flaws Following Preservation Rhinoplasty: A Systemic Analysis

BACKGROUND

There has recently been a resurgence of interest in preservation rhinoplasty (PR) for dorsal hump elimination or dorsal projection reduction. However, no studies have scrutinized aesthetic outcomes to identify common pattern of flaws seen in published images to aid those with ardent enthusiasm for this technique to become aware of the frequency of these flaws and find ways to reduce imperfections.

METHODS

A systematic literature review was performed using search terms ("preservation" OR "let down", "push down") AND "rhinoplasty" on PubMed, Cochrane, SCOPUS, and EMBASE databases for studies between January 2000 and December 2022. Patient images from these studies were analyzed by three reviewers (MWW, IAC, and BG) for dorsal flaws. Raw interrater agreement percentage and Krippendorff's alpha were calculated to determine interrater reliability. A descriptive and comparative analysis with Fisher's exact test was performed for the aggregate data.

RESULTS

There were 59 patient images with 464 views from 24 studies included for final analysis. Optimal dorsal aesthetic lines (DAL) were noted in 12 patients (20.3%), while optimal profile was observed in 15 patients (25.4%) (p = 0.66). Combined ideal front and profile view of dorsum was not observed on any patients. The most common flaws were DAL irregularities (n = 45; 78.0%), dorsal deviation (n = 32, 54.2%), and residual hump (n = 25, 42.4%). There was excellent interrater agreement.

CONCLUSIONS

While PR may have some advantages, it has shortcomings in outcomes, particularly dorsal irregularities, dorsal deviation, and residual humps. Awareness of these imperfections may compel those performing this procedure to modify their techniques and improve their results.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .