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Highlights of Archives of Facial Plastic Surgery
September 2006

Highlights of Archives of Facial Plastic Surgery

Arch Facial Plast Surg. 2006;8(5):292. doi:10.1001/archfaci.8.5.292
Lateral Crus Pull-up

Surgical correction of external nasal valve collapse often involves cartilage batten grafts or suspension sutures to support the lateral wall during inspiration. Dirk J. Menger, MD, presents a novel endonasal suture technique to provide superolateral rotation and additional support to the lower lateral crura. The lateral crus pull-up was performed on 7 patients who were followed up for 3 to 13 months after surgery. All patients demonstrated improved subjective nasal breathing with no significant aesthetic nasal tip disturbances or complications. This technique represents an additional method to correct the weak and medially displaced lower lateral cartilage, thereby improving nasal obstruction attributed to collapse of the external nasal valve.


The Evolution of Midface Rejuvenation

Many of the current facial rejuvenation strategies emphasize lifting what has fallen and tightening what has become lax but often neglect the importance of restoring age-related loss of volume. Allison T. Pontius, MD, and Edwin F. Williams III, MD, present a comparative study of patients who underwent midface-lifts with or without combined fat transfer to determine if the addition of fat transfer resulted in an improved aesthetic outcome. Preoperative and postoperative photographs of both patient groups were assessed by 3 independent observers, who rated improvement in 4 midfacial zones. A statistically significant difference in improvement of the tear trough and nasolabial region was found in the group who underwent midface-lift with fat transfer. This study demonstrates that combining fat transfer to midfacial procedures can yield more natural and aesthetically pleasing results along the infraorbital rim and nasolabial fold.


Analysis of Outcomes After Functional Rhinoplasty Using a Disease-Specific Quality-of-Life Instrument

Obstruction of the nasal valve is often multifactorial. Septoplasty, turbinectomy, and rhinoplasty techniques, performed alone or in combination, are often used to improve the impaired nasal airway. Numerous studies investigating quantification of airway improvement after functional procedures have been published; however, recent efforts have focused on patient-based outcomes measures. Sam P. Most, MD, reports a prospective outcomes study of 41 patients with severe nasal obstruction who underwent functional septorhinoplasty with or without turbinectomy. Preoperative and postoperative evaluations were performed using the Nasal Obstruction Symptoms Evaluation (NOSE) scale. Significant improvement in mean postoperative NOSE scores was seen in all patients. Patient scores were also subdivided according to the type of procedures that were performed (spreader grafts, septoplasty, external valve suspension, and turbinectomy). Each of these subgroups also demonstrated improved nasal breathing.


Alar Expansion and Reinforcement

Generally speaking, functional rhinoplasty techniques used to improve nasal valve impairment fall into 2 categories: those that correct structural narrowing by increasing surface area and those that decrease dynamic collapse by strengthening the sidewalls. Martyn S. Mendelsohn, FRACS, and Kambiz Golchin, MMed (Sci), FRCS, describe a novel technique that addresses both of these functional concerns. By placing a series of spanning sutures from the caudal margin of one lower lateral crus to the other, the nasal valve is expanded and reinforced. Forty-one patients who underwent this technique were followed up clinically for 6 months to 3 years. Ninety-four percent of patients (30 of 32) who were surveyed by a questionnaire reported improved nasal breathing. No major complications were encountered. This technique should be a welcome addition to the surgical armamentarium of the functional rhinoplasty surgeon.


Saint Justa by Bartolomé Esteban Murillo (1617-1682). Article


This issue's Highlights were written by Bryan Ambro, MD.