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Importance
An open approach has been adopted for rhinoplasty because of its wide and undistorted exposure. The formation of a columellar incision scar is the main drawback of this approach.Objective
To evaluate the incidence and evolution of and risk factors for columellar incision scars in an Asian population.Design, Setting, and Participants
A...
Context in source publication
Context 1
... our revision surgery, she developed columellar skin necrosis. Wound revision was performed using a subnasal ro- tational flap at POD 7. 20 The necrosis resolved after wound re- vision, but skin dimpling and wound depression still per- sisted until POD 138 ( Figure 3). Copyright 2016 American Medical Association. ...
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We describe the endoscopic-assisted rib harvesting technique for secondary rhinoplasty as minimum - invasive and safe harvesting method. Endoscopic-assisted rib harvesting was performed on 52 patients for revision rhinoplasty in last two years (2017-2019). Adequate amount of cartilage was obtained through 1-2 cm incision. The 30 degrees angled endo...
Citations
... Favorably, most patients do not develop wounds at the transcolumellar incision site after open rhinoseptoplasty. Kim et al 6 reported that surgeons should not feel discouraged over concerns regarding incision scars. However, rhinoplasty surgeons can encounter some cases of wound dehiscence or even skin necrosis immediately after removing stitches. ...
Most patients who undergo open rhinoseptoplasty do not develop any wound at the transcolumellar incision site. However, some patients require wound care immediately post-operation. Dressing is difficult to perform in the columellar region because of the location. Here, we report 2 cases of columellar wound as a complication of open rhinoseptoplasty. A patient developed mild wound dehiscence immediately after primary rhinoseptoplasty, whereas another developed partial columellar skin necrosis after the revision operation. We applied DuoDERM Extra Thin dressing (ConvaTec Group, Deeside, UK) for columellar wound and achieved healing. DuoDERM Extra Thin can be a simple and easy dressing material for immediate care of transcolumellar wounds.
... It allows accurate postoperative assessment of changes made and provides natural pockets for the placement of grafts within the nose, all without causing the prolonged postoperative swelling and trans-columellar scarring seen with the open technique. [8] The closed rhinoplasty is not a blind operation. The operative strategy, making skeletal changes through limited incisions and judging progress by feeling the surface, is precisely the same discipline required by suction-assisted lipectomy. ...
Introduction: The cleft lip nose has been the classical case of an unsolved mystery in the history of plastic surgery. As Kernahan aptly stated, “a repaired cleft is revealed more by the associated nasal deformity than by the repair line.” Cleft lip nasal deformity becomes a surgical challenge due to various reasons: 1. Wide variation in clinical presentation, requiring a host of surgical techniques. 2. Deformity may be quite asymmetric, making correction difficult. 3. Patients might have undergone several previous operations, which lead to scarring. Aim: We aim to assess the surgical outcome of the closed approach of unilateral cleft lip nose deformity correction. Methodology: We perform the cleft lip nose correction with the primary cleft repair as well as a secondary rhinoplasty in preschool age group and adults depending on the esthetic concerns. Our approach is the closed (endonasal) rhinoplasty technique to dissect the slumped alar cartilage of its soft-tissue attachments and cutaneous skin flap and reshape and reposition it with the help of sutures inserted percutaneously. Results: We have evaluated our results by comparing the pre- and post-operative photographs in standard views and represented the correction of several esthetic nasal parameters with a simple numerical rating. We have compiled the overall result by taking into account the collective numerical ratings at 6 months of follow-up. Our results of primary rhinoplasty ranked in the “good” or “excellent” category in 85% of the cases while it was “fair” or “good” in 82% of the secondary rhinoplasties. Conclusion: We conclude that the closed rhinoplasty is less invasive, takes less surgical time, avoids tedious dissection, gives better on table predictability of the outcome, and shortens postoperative recovery and tissue healing, providing a stable and acceptable result.
This chapter focuses on the most commonly performed aesthetic surgeries of the nose and lower face, which include rhinoplasty (nasal augmentation), genioplasty (chin augmentation), and rhytidectomy (facelift). The nonsurgical modalities for these facial regions include nasal augmentation with filler injections, or liquid rhinoplasty, and aesthetic skin treatments (among others) which are discussed in detail within chapter “Non-surgical Facial Aesthetic Procedures”. When nonsurgical treatments are incapable of producing the patient’s desired results, often because of deep rhytids or severe nasal or mental aesthetic deformity, surgical modalities are recommended. It should be noted that rhytidectomy is used to target age-related facial changes in the upper and lower face, both of which is discussed in this chapter.KeywordsAnatomical review of nasal structure and anomaliesIndications for surgical rhinoplasty and techniquesAssessment of nasal aestheticsSurgical cosmetic chin augmentationAesthetic surgeries of the midfacial and lower facial compartmentsAesthetic surgical rhytidectomy (facelift) techniques and indicationsGenioplasty techniques and advancementsComplications of lower facial aesthetic surgery
Background and Objectives Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach.Results The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8).Conclusion Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.
Rhinoplasty is widely regarded as one of the more technically challenging surgeries, owing in part to the many possible short- and long-term complications that can arise. Although severe complications are uncommon, unforeseen complications can lead to esthetic and functional compromise, patient dissatisfaction, and need for revision surgery. The rhinoplasty surgeon must be prepared to counsel patients and identify and manage the range of complications that may result from this procedure. This article reviews some of the most frequently encountered complications related to rhinoplasty and their management approaches.
Background:
Adverse events after rhinoplasty vary in etiology and severity, a fact that is reflected in the current American Society of Plastic Surgeons Rhinoplasty Consent. However, there is currently no literature providing a comprehensive summation of evidence-based quantifiable risk of adverse events after rhinoplasty. Given this limitation, patients considering rhinoplasty are unable to fully ascertain pre-operative risk, and the ability of physicians to obtain true informed consent is similarly flawed. This systematic review provides the first rigorous, comprehensive and quantitative reporting of adverse events after rhinoplasty.
Methods:
This review was registered on PROSPERO (CRD42018081826) in April 2018. Eligible articles were published in peer-reviewed journals with available abstracts and full-text articles. Interventions included primary functional, aesthetic, and combined functional/aesthetic rhinoplasty. The following data were extracted: Study size, population characteristics, indication, surgical approach, concomitant procedures, and incidence of adverse events.
Results:
A search yielded 3,215 publications for title and abstract screening. Two hundred and ninety-nine were eligible for full-text review. Thirty-six met final inclusion criteria. A total of 14 adverse events were reported among these studies, and included: need for revision, 0-10.9%; infection, 0-4%; dehiscence, 0-5%; bleeding, 0-4.1%; septal perforation, 0-2.6%; nasal airway obstruction requiring revision, 0-3%; hypertrophic scarring, 0-1.5%.
Conclusions:
This systematic review presents the first comprehensive and quantitative reporting of adverse event frequency after rhinoplasty. This is a crucial tool for pre-operative patient counseling and an essential adjunct in the acquisition of informed consent. Future investigations will benefit from transparency and standardization of reporting to further quantify adverse event rates.
Background:
The most challenging part of rhinoplasty is nasal tip management. For East Asian patients with a bulbous under projected nasal tip with thick skin, autologous cartilage is considered the gold-standard graft material to provide strong support to the nasal tip and effectively increase tip projection. The present study aimed to evaluate the outcomes of closed rhinoplasty with a mushroom-shaped costal cartilage graft in East Asian patients.
Methods:
From February 2018 to May 2019, 52 patients underwent rhinoplasty with a mushroom-shaped costal cartilage graft in our institution. Rhinoplasty was performed through a bilateral endonasal incision. Postoperatively, all patients were photographed and asked to complete a satisfaction survey online or by telephone.
Results:
The mean follow-up period was 15.8 months (range 12-21 months). Twenty-four of 52 patients agreed to participate in this study. Postoperatively, the mean nasofrontal angle was 137.7 ± 3.7°, mean nasolabial angle was 94.1 ± 6.2°, mean nasal tip angle was 79.4 ± 5.2°, and mean columellar/lobular angle was 44.7 ± 2.4°. The mean tip projection/nasal length index was 0.53 ± 0.07, and the mean columellar/lobular length index was 1.21 ± 0.22. There were no prolonged functional complications. Most patients (23/24; 95.8%) were satisfied with the aesthetic results.
Conclusion:
The present results suggest that the mushroom-shaped costal cartilage graft in closed rhinoplasty is a good choice for the correction of a bulbous under projected nasal tip.
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.
Open septorhinoplasty with an inverted-V incision is an established technique for primary and revision cases. Achieving an aesthetic scar is often a paramount concern for the patient and surgeon and can influence patient satisfaction with the overall procedure. This article is protected by copyright. All rights reserved.
Purpose of review:
The review summarizes the basic concepts and recent updates on the management of saddle and short noses, with a particular focus on the selection of septal reconstruction techniques and dorsal augmentation material.
Recent findings:
Different techniques have been reported for septal cartilage reconstruction, including various combinations of extended spreader and caudal septal extension grafts, as well as L-strut grafts. For dorsal augmentation, materials that help avoid costal cartilage warping including, diced costal cartilage with or without fascia, costal cartilage obtained by oblique cutting, diced conchal cartilage with perichondrial attachments, and lipofilling of the nasal dorsum have been reported.
Summary:
The article highlights the importance of rebuilding the septal cartilage support system by the proper use of costal cartilage and selection of an appropriate technique for the successful management of saddle and short noses. In addition, the importance of selecting suitable dorsal augmentation materials and other adjunctive maneuvers are emphasized.
