Control of nasal tip contour is often the most challenging aspect of performing rhinoplasty surgery. The goal of rhinoplasty is to achieve an aesthetically pleasing balance in contour such that attention is drawn away from the nose and refocused toward the eyes and face. In this innovative article, Dean M. Toriumi, MD, demonstrates how specific contours create highlights and shadows that impart a 3-dimensional perspective to the nasal tip. He emphasizes stabilization of the nasal base, preservation of tip projection, and the use of cartilaginous grafts to decrease the forces of scar contracture and achieve a more predictable result. His 3-dimensional concept of tip contouring emphasizes preservation of favorable contours and modification of those that are unfavorable.
Deformities of the nasal tip are among the most difficult to correct. Tractional forces affect the nasal alar support mechanism and can result in significant alar retraction or collapse. Oren Friedman, MD, and colleagues describe a 3-dimensional structural model to evaluate the nasal tip and lower lateral cartilages. They add a lateral alar cephalocephalic dimension to the tripod concept of Jack Anderson, MD. This novel design incorporates traction in the lateral aspect of the lower lateral cartilages to allow prediction of the lateral alar position. In this retrospective review of 130 patients who underwent 3-dimensional nasal tip reconstruction, the authors demonstrate that through structural strengthening of the lateral alar deformity, a 90% improvement was achieved in both nasal appearance and function.
Few studies have focused on objective measurable outcomes when comparing various rhytidectomy techniques. We often ponder whether the relative benefits of more complex rhytidectomy procedures merit the accompanying increased operative time, potential complications, and requisite surgical aptitude. Thirty-two patients undergoing primary deep-plane rhytidectomy were sequentially treated with a series of 3 progressively more complex lifts: superficial musculoaponeurotic system plication, imbrication, and a modified deep-plane technique. Jason A. Litner, MD, FRCSC, and Peter A. Adamson, MD, FRCSC, FACS, evaluated each technique intraoperatively by using inventive means to measure skin redundancy and the repositioning of soft tissues. They concluded that that the modified deep-plane rhytidectomy is superior in achieving significant intraoperative lift relative to comparable techniques. Commentaries by Ferdinand F. Becker, MD, and Frank M. Kamer, MD and Alexander Markarian, MD, provide their perspectives on the techniques.
One of the most common findings in patients with symptomatic nasal obstruction is septal deviation. Although most septal deviations can be treated by traditional septoplasty, severe deviations warrant more extensive procedures. Sam P. Most, MD, describes his technique of modified extracorporeal septoplasty, anterior septal reconstruction, for severe deviations. Anterior septal reconstruction improves on the traditional extracorporeal septoplasty by preserving dorsal support and improving external contour deformities. Twelve patients who underwent anterior septal reconstruction were evaluated using a nasal obstruction symptoms evaluation scale and preoperative and postoperative photodocumentation. The author demonstrates that this technique results in statistically significant improvement in nasal obstruction and improved cosmesis.
The Power of Music by William Sidney Mount (1807-1868).Article
This issue's Highlights were written by Jenifer L. Henderson, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2006;8(3):152. doi:10.1001/archfaci.8.3.152