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Çelik V, Tuluy Y, Çakır Bozkurt G. Tip Surgery in Dorsal Preservation Rhinoplasty: The Effect of Modified Low Septal Strip Septoplasty on Tip Plasty. Aesthetic Plast Surg 2024:10.1007/s00266-024-04218-4. [PMID: 38977457 DOI: 10.1007/s00266-024-04218-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results. PATIENTS AND METHODS One hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively. RESULTS The mean age of the patients is 29.58±9.04 (17-65). The mean follow-up period was 14, 50±2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient. CONCLUSIONS A strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR. LEVEL OF EVIDENCE II 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 .
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Affiliation(s)
- Vasfi Çelik
- Private Practice, Plastic, Reconstructive and Aesthetic Surgery, Mersin, Turkey
| | - Yavuz Tuluy
- Department of Plastic, Reconstructive and Aesthetic Surgery, İzmir Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey.
| | - Gökçen Çakır Bozkurt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Manisa City Hospital, Manisa, Turkey
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Peters RD, Vasudev M, Hakimi AA, Dilley KK, Nguyen TV, Hu A, Wong BJF. Boomerang Modification of the Septal Extension Graft: Graft Design and Functional Outcomes. Facial Plast Surg Aesthet Med 2024; 26:469-474. [PMID: 38215259 DOI: 10.1089/fpsam.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Background: A "boomerang" graft is an end-to-end caudal septal extension graft (SEG) that conforms to the geometry of the anterior septal angle, and avoids septal overlap, unlike a side-to-side SEG. Objective: To compare breathing improvements in rhinoplasty patients receiving boomerang SEGs and patients receiving side-to-side SEGs. Methods: Retrospective cohort analysis of patients undergoing rhinoplasty with either end-to-end boomerang SEG or a side-to-side SEG. Functional outcomes were assessed through the Nasal Obstruction Symptom Evaluation (NOSE) survey. Results: The boomerang SEG cohort had a mean age of 34 years and were 68% female compared with 38 years and 67% female in the side-to-side SEG cohort (p > 0.05). The cohorts did not differ in the proportion of the lateral crural tensioning, spreader graft placement, or history of rhinoplasty. The boomerang cohort demonstrated a 67% reduction in NOSE scores compared with a 70% reduction among the side-to-side SEG cohort (p = 0.14). Men undergoing boomerang graft placement reported significantly less postoperative functional improvement than men undergoing placement of a side-to-side SEG (62% vs. 77%, p = 0.01). Conclusion: Use of a boomerang graft is not likely to negatively affect rhinoplasty functional outcomes when compared with a side-to-side SEG.
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Affiliation(s)
- R Daniel Peters
- Raleigh Capitol Ear, Nose, and Throat, Raleigh, North Carolina, USA
| | - Milind Vasudev
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Amir A Hakimi
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Katelyn K Dilley
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Allison Hu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Brian J F Wong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
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Kowalski HR, von Sneidern M, Wang RS, Laynor G, Lee JW. Complications of Nasal Tip Stabilizing Grafts with Autologous Versus Irradiated Homologous Costal Cartilage in Septorhinoplasty: A Systematic Review. Facial Plast Surg Aesthet Med 2024. [PMID: 38669105 DOI: 10.1089/fpsam.2023.0337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background: Complications associated with the use of autologous and homologous costal cartilage for nasal tip stabilizing grafts in septorhinoplasty are not well understood. Objective: The authors review current literature to evaluate complications associated with autologous and irradiated homologous costal cartilage (IHCC) used for septal extension and columellar strut grafts in rhinoplasty. Method: A comprehensive literature search was conducted in PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. Articles that used autologous or IHCC for either septal extension or columellar strut grafts in patients undergoing septorhinoplasty were included. The primary outcomes analyzed were postoperative complications. Results: A total of 14 studies representing 1358 patients were included. The pooled complication rate was 4.7%. IHCC grafts were associated with a higher incidence of complications (n = 21, 5.0% vs. n = 44, 4.6%, p = 0.01). Resorption was the most common complication in the IHCC group and occurred significantly more frequently than in the autologous costal cartilage (ACC) group (n = 10, 2.4% vs. n = 5, 0.49%, p = 0.002). Deviation/warping was the most common complication in the ACC group (n = 16, 1.7%). Conclusion: Autologous and irradiated homologous costal rhinoplasties remain safe procedures. The increased incidence of resorption associated with IHCC grafts should be considered during preoperative planning.
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Affiliation(s)
- Haley R Kowalski
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Manuela von Sneidern
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Ronald S Wang
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Gregory Laynor
- Medical Library at New York University Grossman School of Medicine, New York, New York, USA
| | - Judy W Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, USA
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Soylu E, Yenigun A, Ozturan O. Vertical Alar Lengthening technique in correcting short noses. Am J Otolaryngol 2023; 44:103979. [PMID: 37437336 DOI: 10.1016/j.amjoto.2023.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND It is crucial that the nose length must be compatible with the face in order to obtain beautiful results that suits the face. Shorter and upturned noses appear as if the tip of the nose is cut from the front and gives a piggy appearance to the patient's face. OBJECTIVE The aim of this study is to obtain longer noses with increased tip definition by effectively lengthening the medial and lateral crura's in patients with short nose and Asian noses. MATERIALS AND METHODS Vertical Alar Lengthening (VAL) technique was applied to 17 revision and 12 primary Asian noses. VAL technique consists of three steps. In the first step, the medial crus were lengthened by stealing from the lateral crus. Later, a lateral crural extension graft was applied to the shortened lateral crus, and the lateral crus was lengthened and sutured to the medial crus. In the final stage, a subdomal graft was placed and supported in the space formed underneath the alar tip between the mucosa and the new dome. They were followed in average 12 months (between 6 and 18 months). RESULTS VAL technique was applied to 17 revision and 12 primer Asian noses. Suggested surgical technique move the tip forward and downward reduced its cephalic rotation and lengthened the nose. Targeted tip point, rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. CONCLUSIONS In revision cases and short nose deformities in Asian noses, the nasal tip point was extended forward and downward with the VAL technique, reducing its rotation and lengthening the nose.
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Affiliation(s)
- Erkan Soylu
- Medipol University, Faculty of Medicine, Department of Otorhinolaryngology, Bagcilar, Istanbul, Turkey
| | - Alper Yenigun
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey.
| | - Orhan Ozturan
- Bezmialem Vakif University, Faculty of Medicine, Department of Otorhinolaryngology, Fatih, Istanbul, Turkey
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Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft. J Plast Reconstr Aesthet Surg 2023; 77:262-270. [PMID: 36592537 DOI: 10.1016/j.bjps.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND A 1-2-mm thin rib cartilage graft was used as a septal extension graft to overcome the drawbacks of traditional rib cartilage rhinoplasty, which often results in a stiff nasal tip. The remaining rib cartilage was placed on the nasal dorsum as an ultrafine diced cartilage wrapped in fascia (UDCWF) graft. This study aimed to assess the stability of thin rib cartilage grafts and measure the resorption rate of the UDCWF graft. METHODS This retrospective study included 53 patients who underwent rhinoplasty with septal extension grafting and nasal dorsum augmentation using a septal cartilage (SC group) or rib cartilage (RC group) graft between June 2017 and June 2020. The nasal length, tip height, sellion height, and nasolabial angle in the preoperative, immediate postoperative, and long-term postoperative periods were analyzed using three-dimensional photogrammetry. RESULTS A total of 26 patients received rib cartilage grafts and 27 patients received septal cartilage grafts. The RC group showed greater maintenance of tip height, nasal length, and tip derotation over time. The relapse ratio in tip height was -3.3 ± 1.6% and -8.4 ± 4.3% in the RC and SC groups, respectively (p = 0.001). The resorption rate of the UDCWF graft was -7.5 ± 3.6% and -7.8 ± 2.3% at the sellion and rhinion, respectively. CONCLUSIONS The thin rib cartilage provided sufficient intrinsic strength to maintain tip height and tip rotation. It can be an effective alternative to rhinoplasty in Asians with features such as thick skin and a short nose. Moreover, the UDCWF graft exhibited an approximately 7.5% resorption rate, leading to lower probabilities of dorsal irregularity and stepping deformity.
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Description of Novel Technique for Managing Insufficient Nasal Skin Volume. J Craniofac Surg 2023; 34:235-239. [PMID: 35882046 DOI: 10.1097/scs.0000000000008813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/29/2022] [Indexed: 01/14/2023] Open
Abstract
A short nose is a common esthetic problem faced by facial plastic surgeons. Rhinoplasty of the short nose has been recognized as a complex procedure to perform for achieving satisfactory results. The authors presented 4 cases of short nose in 4 Saudi men who underwent rhinoplasty using septal extension graft and closure the skin with secondary intention as an option to control skin tension after graft placement and to increase nose skin volume to prevent skin retraction, which may occur postoperatively during the healing process. Furthermore, the authors have also discussed the surgical outcomes of these 4 cases and overall satisfaction. Finally, the authors reviewed the literature to identify published papers on correcting the short nose technique.
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Chun MJ, Kumar T, O’Connell S, Metzinger S. Increasing Nasal Tip Projection Using Structural Grafts: A Review of Outcomes. South Med J 2022; 115:765-772. [DOI: 10.14423/smj.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Surgical Approaches and Outcomes of Short Nose Correction: A Descriptive Systematic Review of the Literature. J Craniofac Surg 2022; 34:991-995. [PMID: 36168123 DOI: 10.1097/scs.0000000000008965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The purpose of this study is to describe all published techniques of short nose correction released by surgeons over the years and summarize their outcomes in a descriptive systematic review of the literature. PATIENTS AND METHODS A computerized literature search was conducted using 5 major databases. All original studies discussing correction methods and/or outcomes of shortened noses were included. The risk of bias was evaluated blindly by 2 reviewers, and the data were descriptively presented. The study protocol was recorded in the International Prospective Register of Systematic Reviews. RESULTS A total of 24 studies including 1450 patients were included. Lengthening of the nose was performed through a cartilage-only graft in 14 studies, whereas bone graft was used in 3 studies. The mean increase in nasal tip projection in 5 reports ranged from 0.05 to 2.2 mm. The mean nasal length before and after rhinoplasty was reported in 8 studies, with a mean increase ranging from 0.28 to 6.2 mm. Regarding surgical complications, 30 patients had implant deviation or migration, 22 patients experienced postoperative infection, and 12 patients required corrective surgery. CONCLUSIONS Augmentation of a short nose is a challenging surgical procedure for rhinoplasty. There are several techniques for short nose correction; however, it is difficult to evaluate the outcomes in the absence of a standard tool of assessment. Further analytical studies are warranted to fully evaluate surgical techniques.
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The Ethmoid Bone is The Ideal Graft to Strengthen Nasal Septum L-strut Among Different Grafts: An Evaluation Based On Finite Element Analysis. J Plast Reconstr Aesthet Surg 2022; 75:4304-4311. [DOI: 10.1016/j.bjps.2022.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/27/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
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Lee SH, Cho J, Lee JS. Long-Term Outcomes of Secondary Nasal Tip Plasty After Degradation of a Polycaprolactone (PCL) Mesh. Aesthetic Plast Surg 2022; 46:2358-2365. [PMID: 35437665 DOI: 10.1007/s00266-022-02839-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND In secondary nasal tip plasty, it is often difficult to harvest appropriate septal extension grafts for sufficient tip projection. Therefore, studies using numerous alloplastic materials in rhinoplasty have been reported. This study aimed to evaluate the nasal tip change over time after tip plasty using a PCL mesh. METHODS We conducted a retrospective study of 86 Asian patients who received secondary tip plasty by septal extension grafting with a PCL mesh as a batten graft. Patient demographics and surgical outcomes were examined. The outcome variables were nasolabial angle, nasofrontal angle and Goode ratio. Measurements were performed with photographs obtained at short-term (postoperative 4-6 months) and long-term (more than postoperative 24 months) follow-ups. Aesthetic outcomes and safety were assessed using the Global Aesthetic Improvement Scale. RESULTS Among 86 patients, 56 had a long-term follow-up. The mean age was 33.33 years, and the male-to-female ratio was 17.44:82.56. The nasolabial and nasofrontal angles did not change significantly between the short-term and long-term follow-ups. The Goode ratio, which is a useful tool to evaluate nasal projection, was decreased by 5.00%. Nevertheless, all patients were satisfied, and the long-term aesthetic outcomes were improved in 54 (96.4%) patients. There were two cases (2.33%) of complications, including one infection and one case of PCL-mesh protrusion. CONCLUSIONS The present study demonstrated the usefulness and safety of PCL meshes when used in septal extension grafts as batten grafts. Although biodegradation seems to affect the nasal projection, PCL is still useful in secondary tip plasty along with other alloplastic materials. 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 .
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Yen CI, Lee PH, Chang CS, Chen HC, Yang SY, Chang SY, Yang JY, Chuang SS, Hsiao YC. A Comparative Study Between Classic Derotation Graft and Novel Double V Cutting Folded Derotation Graft. Aesthetic Plast Surg 2021; 45:1721-1729. [PMID: 33506322 DOI: 10.1007/s00266-020-02112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To introduce an innovative refinement, the "double V cutting folded derotation graft" (DVCFD graft), which is a method for nasal tip lengthening in aesthetic rhinoplasty with strong holding force and efficient cartilage use. METHODS A retrospective study was conducted from January 2018 to July 2019 with 101 patients, including 11 males and 90 females with an average age of 36.87 ± 10.12 years, at Chang Gung Memorial Hospital; the patients received classic derotation grafts (n = 49, 17 of them were one layer and 32 of them were two layers) and DVCFD grafts (n = 52) for cosmetic tip plasty. The tip projection, columella labial angle and nasolabial angle were measured through clinical photography at three different times (T0: pre-operation, T1: two weeks post-operation and T2: five months post-operation). The differences between the original derotation graft and the DVCFD graft were identified using paired-t and independent-t tests. RESULTS The final relapse ratios of the classic derotation graft and DVCFD graft were 36.78% versus 36.92% for tip projection, 40.65% versus 38.58% for columella labial angle and 45.00% versus 47.76% for nasal labial angle, respectively. The P values of the independent-t tests were 0.991, 0.564 and 0.439, respectively. CONCLUSIONS Both the classic derotation graft and DVCFD graft possess similar stability in tip plasty. The novel modification of the DVCFD graft has more efficient cartilage usage and is a feasible and safe surgical option for patients with limited harvestable cartilage for tip lengthening. 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 .
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Affiliation(s)
- Cheng-I Yen
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Ping-Hsun Lee
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Hung-Chang Chen
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Shih-Yi Yang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Shu-Yin Chang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Jui-Yung Yang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Aesthetic Medical Center of Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 5, Fu-Hsing Street, Kweishan, Taoyuan, 333, Taipei, Taiwan.
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Marianetti TM, Vellone V, De Angelis F, Ramieri V. The Caudal Septum Pivot Technique for Short Nose Correction. Facial Plast Surg 2021; 38:74-80. [PMID: 34058786 DOI: 10.1055/s-0041-1730385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22-53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p < 0.05) and an increase in the tip projection (p < 0.05) and in the nasal lengthening (p < 0.05) in both groups. In authors' experience, the CSP technique could be considered a safe, reliable, and effective alternative technique in selected patients.
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Affiliation(s)
- Tito M Marianetti
- Private Practitioner, Ortognatica Roma, Assunzione di Maria Santissima Clinic, Roma, Italy
| | - Valentino Vellone
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciale, "La Sapienza" Università di Roma, Roma, Italy
| | | | - Valerio Ramieri
- Private Practitioner, Ortognatica Roma, Assunzione di Maria Santissima Clinic, Roma, Italy
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13
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Patel PN, Abdelwahab M, Shukla ND, Wadwha H, Grimm DR, Kandathil CK, Most SP. Functional Outcomes of Septal Extension Grafting in Aesthetic Rhinoplasty: A Cohort Analysis. Facial Plast Surg Aesthet Med 2020; 23:172-179. [PMID: 32716730 DOI: 10.1089/fpsam.2020.0304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Septal extension grafts (SEGs) are used widely in rhinoplasty as a means of controlling tip position. Grafts positioned in a side-to-side configuration may cause nasal airway obstruction. Methods: Retrospective cohort analysis of patients undergoing cosmetic rhinoplasty. Patients undergoing SEG placement were grouped according to completion of the Nasal Obstruction Symptom Evaluation (NOSE) or Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). The latter has a cosmetic (C) and functional (O) domain. Each group was matched to a cohort that did not undergo SEG placement using criteria: preoperative NOSE or SCHNOS-O score, age, and gender. Patient demographics and outcomes, including NOSE, SCHNOS, and visual analog scale (VAS) scores, were compared between SEG and no-SEG groups using univariate and multivariate analyses. If patients underwent placement of an SEG and complained of obstruction, the laterality of the graft in relation to the complaint was examined. Results: SEGs were placed in 79 patients, of whom 77 completed the NOSE survey and 37 completed the SCHNOS-O both pre- and postoperatively. These patients were matched to patients without SEGs. For both the SCHNOS and NOSE-matched cohorts, functional outcomes (NOSE, SCHNOS-O, and VAS-F) did not significantly differ between SEG and no-SEG groups. These findings were also observed when patients were stratified by cosmetic surgery alone versus combined functional and cosmetic surgery. On multivariate linear regression analysis, when accounting for intraoperative techniques, there was no difference in postoperative NOSE or SCHNOS-O outcomes between the SEG and no-SEG cohorts. Side of postoperative nasal obstruction did not correlate with side of SEG placement. Conclusion: SEGs, when used in a unilateral side-to-side configuration, yield excellent aesthetic results without compromising functional outcomes.
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Affiliation(s)
- Priyesh N Patel
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Mohamed Abdelwahab
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Navika Dixit Shukla
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Harsh Wadwha
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David R Grimm
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
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14
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Abstract
BACKGROUND Little is known about contributory factors of unremoved periimplant capsule causing nasal deformities after postrhinoplasty silicone implant extraction. This study investigated the impact of retained capsule causing contracture deformity and effect of subsequent capsulectomy in preventing and correcting the deformity. METHODS A total of 103 patients underwent secondary surgery for silicone implant removal and grafted cartilage between May of 2015 and June of 2017. Among them, 67 patients without septal extension graft or open wound and with 8-week or more follow-up were analyzed retrospectively. All operations were approached with an intranasal incision. Three procedures were performed: (1) removal of implant plus tip graft only (n = 12), (2) removal of implant plus tip graft plus subtotal capsulectomy (n = 47), and (3) removal of implant plus tip graft plus subtotal capsulectomy in patients with contraction and thick capsule (n = 8). Preremoval/postremoval of nasal bridge length index and nasolabial angle were measured with the lateral view. RESULTS In group 1, nasal bridge length index decreased by 6.2 percent and nasolabial angle increased by 5.7 percent. In group 2, nasal bridge length index increased by 2.5 percent and nasolabial angle decreased by 2.2 percent. In group 3, nasal bridge length index increased by 8.6 percent and nasolabial angle decreased by 7.9 percent. CONCLUSIONS For patients undergoing surgical removal of a nasal silicone implant with or without cartilage, a concomitant capsulectomy is required to prevent potential contractures and to minimize tip deformity. Capsulectomy can release and lengthen the contracted nose without septal extension or derotation grafting. Dorsal skin irregularity did not occur regardless of whether capsulectomy was performed. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Gürsoy K, Teymur H, Kiziltay A, Hasirci N, Koçer U. Biomechanical analysis of a modified suture technique for septal extension grafts: Transloop suture. J Plast Reconstr Aesthet Surg 2019; 72:1825-1831. [PMID: 31277927 DOI: 10.1016/j.bjps.2019.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND A successful rhinoplasty procedure requires a well-defined and properly projected nasal tip; however, surgical control of the nasal tip is difficult. The aim of this investigation was to assess the efficacy and safety of a modified suture technique, which can be used to fix the caudal septal extension graft during primary rhinoplasty of the Asian population and revision septorhinoplasties of the Caucasian population, and to compare it with those of other commonly used techniques. METHODS After peeling of perichondrium of scapular cartilages, cartilage pieces of 3 × 1 cm in size and 2 mm in thickness were divided into two from the midline. These pieces were repaired end-to-end using three different repair techniques: two simple interrupted in Group A (n = 40), vertical figure-of-eight in Group B (n = 40) and modified vertical figure-of-eight (transloop) in Group C (n = 40). All repaired cartilage specimens were subjected to a biomechanical analysis, in which four different forces were applied: tension, lateral bending, shearing and buckling. RESULTS According to the tensile test, Group C had statistically significantly higher strength than Group A at 2 mm range. The lateral bending test similarly revealed that Group C had statistically significantly higher strength at 1.5 mm and 2 mm range than Group A. However, there was no statistically significant difference between the three groups in the assessment of shearing and buckling forces. CONCLUSION The modified transloop suture technique provides a more stable repair, and we consider that it can be used as an alternative suture repair method.
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Affiliation(s)
- Koray Gürsoy
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ulucanlar Cd, Altindag, 06230, Ankara, Turkey.
| | - Hakan Teymur
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ulucanlar Cd, Altindag, 06230, Ankara, Turkey
| | - Aysel Kiziltay
- Middle East Technical University, Central Laboratory, Dumlupinar Bulvari, 06800 Ankara, Turkey
| | - Nesrin Hasirci
- Middle East Technical University, Faculty of Arts and Sciences, Department of Chemistry, METU BIOMATEN-Center of Excellence in Biomaterials and Tissue Engineering, Dumlupinar Bulvari, 06800, Ankara, Turkey
| | - Uğur Koçer
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ulucanlar Cd, Altindag, 06230, Ankara, Turkey
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Use of Irradiated Homologous Costal Cartilage in Rhinoplasty: Complications in Relation to Graft Location. J Craniofac Surg 2018. [PMID: 29521744 DOI: 10.1097/scs.0000000000004440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nasal septal cartilage and conchal cartilages are preferred sources of grafts in augmentation rhinoplasty. Rib cartilage can also be used, but it may evoke a patient's concerns about a scar and an extensive surgery. In such cases, irradiated homologous costal cartilage (IHCC) can be a useful alternative. However, controversy still exists in many literatures regarding complications with use of IHCC. Therefore, the authors reviewed our experiences with IHCC in rhinoplasty and analyzed the complications in relation to graft location. METHODS A retrospective chart review was made of all patients who underwent rhinoplasty with IHCC between 2007 and 2015. A total of 323 patients were included. The authors considered the cases that required revision surgery for external aesthetic changes as complications. The authors defined major complications, including resorption, infection, fracture, or warping. RESULTS The total complication rate was 8%. Two fractures (0.6%), 4 fragmentation (1.2%), 4 resorptions (1.2%), 4 infections (1.2%), and 2 warpings (0.6%) were noted. Most of these complications occurred for the septal extension graft. Other complications, including 1 nasal obstruction, 2 visible contours, 3 caudal septal deviations, and 4 cases of unfavorable results (patient unsatisfactions), were noted. CONCLUSIONS Based on the outcomes of this study, the authors concluded that IHCC is a useful and reliable source of cartilage graft and can serve as an alternative graft material for rhinoplasty. However, care must be taken in use of IHCC graft in areas under tension such as septal extension graft, though its complication rate is low.
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Abstract
A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.
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Affiliation(s)
- Na-Hyun Hwang
- Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-Gu, Seoul 152-703, Republic of Korea
| | - Eun-Sang Dhong
- Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-Gu, Seoul 152-703, Republic of Korea.
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18
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Abstract
To correct an Asian short nose with low dorsum, short columella, and poorly defined nose tip, augmentation rhinoplasty has been popularized. A simple augmentation no longer is considered an efficient rhinoplasty approach for Asians aesthetically; most surgeons simultaneously perform nasal elongation and augmentation during rhinoplasty. To extend the nose length successfully, important factors are cartilages, mucosal and skin conditions, and presence and degree of fibrotic changes. In addition, surgeons should consider preoperatively how much should be extended from an aesthetics perspective. This article introduces the current practice of surgical correction of the short nose in Asians.
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Affiliation(s)
- Dong Hak Jung
- Shimmian Rhinoplasty Clinic, 375, Gangnam-daero, Seocho-gu, Seoul 06620, Republic of Korea.
| | - Sang Gyun Jin
- Shimmian Rhinoplasty Clinic, 375, Gangnam-daero, Seocho-gu, Seoul 06620, Republic of Korea
| | - Sang Min Hyun
- Shimmian Rhinoplasty Clinic, 375, Gangnam-daero, Seocho-gu, Seoul 06620, Republic of Korea
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