A New Understanding and a Minimalist Approach for Rhinoplasty.

SUMMARY: In this article, a new understanding and minimalist rhinoplasty approach is presented. This technique has many novelties, and this article aims to simplify, make the operation more predictable, and correct primary deformities with a 20-step procedure.

Osteoectomy in Rhinoplasty: A New Concept in Nasal Bones Repositioning.

BACKGROUND: Modern techniques of osteotomy have evolved to take into account the effects of bony repositioning on functional as well as aesthetic outcomes. Although a variety of methods have been described to appropriately mobilize and reposition the bony nasal vault, there is still no single procedure that can successfully manage nasal bones in its entirety. MATERIAL AND METHODS: We present the bone chisel scraping osteoectomy technique for lateral and medial osteotomies with the aim of managing nasal bone deformities that can overcome diverse shortcomings of the conventional methods. The new operative method was performed in 184 nasal bone osteoectomies (92 patients, 22 men and 70 women), ranging in age from 18 to 69 years (mean age, 38 years). The functional results were evaluated postoperatively by the Nasal Obstruction Symptom Evaluation scale, a brief and easy to complete validated questionnaire with a final score grading from 0 to 100 at 3 and 6 months postoperatively. RESULTS: With this new approach, no functional problems were reported. The mean Nasal Obstruction Symptom Evaluation scale score was 5.3 at 3 months and 1.9 at 6 months. Only 1 primary case was reoperated for open roof deformity. Comparing the results with the previous osteotomy series of the senior author osteoectomy and osteotomy revision rates for inadequate bone mobilization were similar but osteoectomy technique did not create functional problems as the osteotomy technique did. CONCLUSIONS: Although this technique prolongs the operating time, it could offer considerable advantages in comparison with the classical techniques using osteotomies and hammer. This is because it offers a greater respect to the nasal respiratory function and gives a much better nasal base width control, resulting in more predictable results, less trauma, and therefore a lower risk of postoperative complications.

Rhinoplasty: surface aesthetics and surgical techniques.

Surface aesthetics of the attractive nose are created by certain lines, shadows, and highlights, with specific proportions and breakpoints. Our evaluation of the nasal surface aesthetics is achieved using the concept of geometric polygons as aesthetic subunits, both to define the existing deformity and the aesthetic goals. Surgical techniques have been developed and modified to achieve the desired surface appearance, and those are detailed in this article. The principles of geometric polygons allow the surgeon to analyze the deformities of the nose, to define an operative plan to achieve specific goals, and to select the appropriate operative technique. These aesthetic concepts and surgical techniques were used in 257 consecutive rhinoplasties performed in the past 3 years by the principal author (B.Ç.).

Mastoid fascia tissue as a graft for restoration of nasal contour deformities.

A wide variety of autologous grafts have been used for the coverage of contour deformities in rhinoplasty. Mastoid fascia tissue (MFT) grafts are easy to harvest and very versatile, and the resulting donor site scar is not visible. Natural looking results can be obtained with MFT grafts when used for the coverage of dorsal irregularities, for dorsal augmentation, for camouflaging abnormalities related to skin atrophy, and even for tip-of-nose coverage and tip augmentation. Mastoid fascia tissue was used as a graft in 8 primary and 22 secondary cases for various purposes. All patients had satisfactory cosmetic results. Used in conjunction with a rigid graft such as cartilage, MFT grafts, which are ideal fillers, can be successfully used in rhinoplasty.

A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments.

BACKGROUND: A complete subperichondrial and subperiosteal dissection technique during rhinoplasty may minimize soft tissue disruption, resulting in less scar tissue formation and preservation of ligamentous structures. OBJECTIVES: The authors describe their results with subperichondrial dissection of the nasal framework and manipulation of the preserved nasal ligaments. METHODS: The charts of 228 consecutive patients who underwent rhinoplasty with complete subperichondrial dissection via an open or closed approach between May 2008 and April 2011 with the senior author (BÇ) were retrospectively reviewed. Intraoperatively, the scroll ligament and Pitanguy's midline ligament were repaired to stabilize the internal valve and tip position, respectively. RESULTS: Patients in this series (182 women, 46 men) ranged in age from 18 to 54 years (mean, 24.3 years). A total of 203 procedures were primary rhinoplasties; 14 were secondary, and 11 were revisions. The open approach was used in 92 patients, whereas a closed dome delivery was used in the remaining 136 patients. Follow-up ranged from 9 months to 3 years. A complete subperichondrial dissection technique resulted in relatively limited edema and more rapid patient recovery compared with the authors' previous experience with the sub-superficial musculoaponeurotic system (SMAS) approach. Repeat elevation in the subperichondrial plane was easier and less traumatic in revision cases compared with secondary rhinoplasty cases. CONCLUSIONS: Subperichondrial dissection of the nasal framework allows reshaping and redraping of the nasal tip and controlled manipulation and repair of ligaments without disturbing the overlying soft tissue.

Umbilicoplasty in abdominoplasty: a new approach.

Various techniques have been suggested in the literature for umbilicoplasty. These techniques result in a reconstructed umbilicus with a deep cavity shape, and visible suture line. Furthermore, these techniques have in common the difficult step of suturing the umbilicus to the base of the abdominal fascia to create a periumbilical concavity. The new technique described in this article results in a noticeably smaller and shallower cavity while the scar is hidden inside the natural umbilical scar. This new technique's procedural simplicity gives it an important additional advantage. The umbilicus is incised within a very large skin island on its tip which is subsequently exteriorized out of a 2-cm vertical incision. The stalk is then opened by 4 clamps in the 12, 3, 6, and 9 o'clock positions. The skin between the clamps is incised up to the umbilical base, fixed, and the excess skin flaps are resected. The technique was successfully implemented in 62 consecutive cases.

[Treatment of metacarpal fractures with open reduction and low-profile plate and screw fixation]. / Metakarp kiriklarinin açik redüksiyon ve düsük profilli plak vida sistemi ile tedavisi.

OBJECTIVES: We evaluated functional results and effectiveness of open reduction and low-profile plate fixation for the treatment of low-severity metacarpal fractures. METHODS: We retrospectively reviewed 50 metacarpal fractures of 43 patients (37 men, 6 women; mean age 31+/-9 years; range 17 to 52 years) who were treated with open reduction and low-profile plate fixation. Fractures of the first metacarpal were excluded. There were 26 oblique, 12 transverse, and 12 comminuted fractures. Three fractures were open. Objective assessment included total active motion (TARM) and grip strength. Subjective assessment was made using the Turkish version of the Quick-DASH scale. Radiographic evaluations were made on anteroposterior/lateral and oblique roentgenograms. Complications were classified as major or minor according to the Page-Stern system. The mean follow-up was 62.2+/-24.8 months (range 12 to 96 months). RESULTS: At final evaluations, the mean TARM was 220.5+/-43.9 degrees (range 30 degrees to 260 degrees ). The results were excellent in 25 patients (58.1%), good in 12 patients (27.9%), fair in five patients (11.6%), and poor in one patient (2.3%). The mean loss of grip strength was 5.2+/-7.3%. The mean Quick-DASH score was 2.0+/-2.8 (range 0 to 11). All fractures were united. Ten patients had major complications (23.2%), which included extensor tenosynovitis and plate-related discomfort requiring plate removal in four patients (9.3%), and less than 180 degrees of TARM in six patients (14%). CONCLUSION: Low-severity metacarpal fractures can be treated successfully with open reduction and low-profile plate fixation, allowing early and safe functional use.