ABSTRACT
Failure to control the projection, shape, and rotation of the nasal tip is a common occurrence among patients with weak lower lateral cartilages. These patients' noses are characterized by a weak midvault, a plunging tip with "Polly beak," and drawn-up alae. The purpose of our study was to identify methods for controlling the position and shape of the nasal tip in these high-risk patients. Twenty patients at risk of losing nasal tip projection were retrospectively identified, and measurements made from their preoperative and postoperative photographs were compared. Loss of tip projection occurred in all but one patient whose columella strut was fixed to the caudal septum. Prompted by these failures, we studied the relationship between the dorsum and tip in cadaveric specimens with and without a supratip break. From our observations, a structural extension of the septum-an anterior septal extension graft-was developed to predictably control this relationship. The clinical application of septal extension grafts in open rhinoplasty was subsequently evaluated in 20 patients who were deemed to be at risk of losing tip projection. Postoperative photographic analysis showed nasal tip projection to be maintained or increased in all but one patient with the use of septal extension grafts. A stable caudal septum is essential to the success of the technique.
Subject(s)
Nasal Septum/surgery , Rhinoplasty/methods , Adult , Cadaver , Child , Female , Humans , Nasal Septum/transplantation , Retrospective Studies , Suture TechniquesABSTRACT
An extended brow upper facelift technique employing a multiplanar, temporal approach is described. Fresh cadaver dissections are utilized to demonstrate the anatomic basis of the approach. A complete mobilization of the orbital portion of the orbicularis oculi muscle away from the orbital rim is described. Release of the malar orbicularis (zygomatic cutaneous ligament) above the zygomaticus major muscle and over the origin of the masseter muscle is emphasized. Indications and patient selection are reviewed and the clinical benefit to the brow, lateral canthus, lower lid, and malar orbicularis cheek pad is demonstrated in different patient groups.
Subject(s)
Rhytidoplasty/methods , Adult , Biocompatible Materials , Cadaver , Durapatite , Female , Humans , Ligaments/surgery , Middle Aged , Oculomotor Muscles/surgery , Patient Selection , Prostheses and ImplantsABSTRACT
Excellent results from TRAM flap reconstruction depend on proper patient selection and proper surgical planning and execution. It is difficult to achieve perfection and completion of the reconstruction in a single operative procedure. The second stage gives the surgeon an excellent opportunity to not only perform the nipple-areola reconstruction but also to enhance the quality of the initial procedure and give the patient the best possible result as well.
