The Importance of Sheen's Ground Rules in Secondary Rhinoplasty

ABSTRACT

Sheen's ground rules can help avoid many of the pitfalls in secondary rhinoplasty. There are 1) establish realistic patient expectations; 2) defer surgery until the final resolution of the tissues; 3) have a well-defined aesthetic concept; 4) make a proper diagnosis; 5) limit the dissection and 6) use only the autogenous materials. The authors tried to ascertain which rule is the most important and should be strictly obeyed, what is the effect if the rules not obeyed, and what is the important aspects of any other rules not mentioned. Eight females cases(n=8) of secondary rhinoplasty from 1992 to 2002 were analyzed according to Sheen's ground rules. After surgery, the implants or the grafted tissues were either exposed or extruded, in two out of the five cases that did not follow the second principle, in two out of the four cases that did not the sixth principle, and in one case that did not the fifth principle. The authors conclude that all the principles of the ground rules should be obeyed if possible, most of all, it is very important to obey the first principle i.e. establishing the a realistic expectation, and second principle i.e. deferring the surgery until more than a year. Though it is undoubtful that the use of the autogenous materials is the best choice, the authors believe that a limited incisions and dissections and the use of smaller implants can help reduce the risk of complication if the alloplastic implants should be used.