Dorsal Augmentation.

To manage the deficient nasal dorsum, a thorough knowledge of dorsal augmentation techniques should be mastered by the rhinoplasty specialist. Indications for dorsal augmentation may arise in both primary and revision rhinoplasty presentations. To direct operative planning, a complete facial analysis, noting the importance of maintaining overall nasofacial balance, is essential. An array of techniques, including autologous and nonautologous (ie, allogeneic and synthetic) sources, have been used globally-each carrying its own advantages and disadvantages. The authors believe autologous grafts to be the optimal source for dorsal augmentation because of their biocompatibility and ability to produce natural and long-lasting outcomes.

Safety in Female Genital Plastic Surgery.

LEARNING OBJECTIVES: After studying this article, participants should be able to: (1) Identify the most appropriate type of anesthesia for the female genital plastic surgical patient and minimize risks of nerve injury and thromboembolic event through proper preoperative evaluation and knowledge of positioning. (2) Define the vulvovaginal anatomy, including common variants, and assess vulvovaginal tissues after childbirth and menopause. (3) Apply surgical techniques to minimize complications in female genital plastic surgery. (4) Classify the types of female genital mutilation/cutting and design methods of reconstruction after female genital mutilation/cutting. SUMMARY: Female genital plastic surgery is growing in popularity and in numbers performed. This CME article covers several aspects of safety in the performance of these procedures. In choosing the best candidates, the impact of patient motivation, body mass index, parity, menopause and estrogen therapy is discussed. Under anesthesia, consideration for the risks associated with the dorsal lithotomy position and avoidance of compartment syndrome, nerve injury, deep venous thromboses, and pulmonary embolus are covered. Anatomical variations are discussed, as is the impact of childbirth on tissues and muscles. Surgical safety, avoidance of complications, and postoperative care of a variety of vulvovaginal procedures are discussed. Videos showing anatomical variations and surgical techniques of the most common female genital procedures with recommendations to reduce the complication rate are included in the article. Finally, female genital mutilation/cutting is defined, and treatment, avoidance of complications, and postoperative care are discussed.