Süreyya-Dani technique, a new technique to address notching of soft triangle and opening external nasal valve.

Introduction: While different methods are employed for fixing narrowed nasal valves and preventing the notching of soft triangles, this study aims to demonstrate the effectiveness of a new technique called Süreyya-Dani Technique. Methods: This prospective study composed 100 patients who underwent rhinoplasty using the Süreyya-Dani technique. All patients presented with either notching of the soft triangle and/or external nasal valve dysfunction. Patients with the absence of soft triangle notching and external nasal valve dysfunction were excluded from this study. Facial analysis was conducted for all patients to identify any asymmetry in the face, and all nasal defects were identified. Descriptive statistics were calculated for different variables. Analytical statistics, namely Chi-Square test, was conducted with a significance level set at P < 0.05. Results: In the current study, 100 patients were involved, out of which 63 (63%) were female and 37 (37%) were male. The participants' ages ranged from 18 to 46 years, with a mean age of 30 years. various chief complaints were found among patients, with the majority 37(37%) expressing cosmetic concerns. A statistically significant difference was found for the association of nasal tip defects with genders, intraoperative findings, and chef complaints, and the association between the degree of external valve insufficiency and crural weakness (P-value < 0.05). Conclusion: Despite many techniques that have been put forward to fix narrowed nasal valves and prevent notching of the soft triangle, the Süreyya-Dani Technique could work to prevent its occurrence successfully.

Use of lateral alar caudal graft to increase nasal tip definition in rhinoplasty.

OBJECTIVE: The aim of this study is to demonstrate use of Lateral Alar Caudal Graft to increase nasal tip definition in primary or revision rhinoplasty cases. METHOD: Lateral Alar Caudal Graft was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023 years. Fourteen of the patients were female and 10 were male. This technique was applied in revision or primary cases where the caudal part of the lateral alar crura of the lower lateral cartilage was lower in the vertical plane than the cephalic part. The Lateral Alar Caudal Graft was sutured over the caudal edge of the lateral alar crura of the lower lateral cartilage. RESULT: The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. CONCLUSION: We have successfully demonstrated that in primary or revision rhinoplasty cases, nasal tip definition will be enhanced by positioning the caudal level of the lateral alar crura of the lower lateral cartilage higher than the cephalic level using an onlay lateral alar crural graft and eliminated the need for alar rim graft.

The Comparison of Conventional Osteotomes and Magic Saws in Terms of Edema and Ecchymosis After Rhinoplasty.

OBJECTIVE: The goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients. STUDY DESIGN: A retrospective, case-control study. METHODS: In this prospective, randomized study, we evaluated the results of 258 rhinoplasty patients who underwent osteotomy by either conventional osteotomes or new designed saws called; "Magic Saws." On postoperative days 2 and 7, the patients were photographed by the surgeon; photographs were evaluated by another otolaryngologist, blinded from the osteotomy procedure. RESULTS: There were no statistically differences between the groups, in terms of age, sex, weight, or average arterial blood pressure (P > 0.05). The postoperative periorbital edema (days 2 and 7) and ecchymosis (day 2) scores were significantly higher in the conventional osteotomy group, as compared to Magic Saw group (P < 0.05). However, on postoperative day 7, the differences in the periorbital ecchymosis scores between the groups, were not statistically significant (P > 0.05). CONCLUSIONS: As compared to conventional osteotomes, Magic Saws were reported to be associated with minimal soft tissue injury, as well as decreased edema and ecchymosis, in the early postoperative period after rhinoplasty.

The Effect of the Vertical Alar Resection (VAR) Technique on Tip Stability; Long-Term Results.

Objectives: Main properties of nasal tip are the nasal tip projection (NTP), the nasal tip rotation (NTR), and the definition. Its surgery is difficult due to anatomic variations, pathologies, and various surgery possibilities. The ideal technique must also provide good results in long-term. The aim of the study was to analyze long-term results of vertical alar resection (VAR) technique in rhinoplasty. Methods: Forty-eight patients who underwent rhinoplasty operations that VAR method was used by senior author between 2001 and 2017 were included into the study (42 women and six men). The mean age of patients was 35.5 years (range 18-56 years). Mean post-operative follow-up period was 86.8 months (range 25-225 months). We analyzed pre=operative, early, and late post-operative photographs of patients. NTP and NTR changes in years were objectively evaluated. Patients also completed Rhinoplasty Outcome Evaluation questionnaire in their last control visit. Results: Mean NTP (through Goode Method) was changed from 0.60 in early to 0.59 in late post-operative control, mean nasofacial angle from 29.4 in early to 28.7 in late post-operative control. Mean nasolabial angle (NLA) changed from 97.3 to 94.5 and Tip rotation angle (TRA) from 35.2 to 35.4 between early and late post-operative control. Differences between early and late post-operative measures of NTP and NLA were significant (p<0.001 for all), but TRA did not changed significantly (p>0.001). Conclusion: VAR is a useful method for modifications of lateral crura and nasal tip. With VAR, we can control NTP and NTR, length of lateral crus and nose; get satisfying and long lasting results.

Radix saw: a useful tool for rhinoplasty to correct high radix / Serra de radix nasal: uma ferramenta útil na rinoplastia para corrigir o radix alto

Abstract Introduction: The most difficult aspect of radix lowering is determining the maximum amount of bone that can be removed with osteotomes; here, we describe use of a radix saw, which is a new tool for determining this amount. Objective: In this study, we describe use of a radix saw, which is a new tool to reduce the radix. Methods: The medical charts of 96 patients undergoing surgery to lower a high radix between 2016 and 2017 were assessed retrospectively. All operations were performed by the senior surgeon. Outcomes were assessed by comparing preoperative photographs with the most recent follow-up photographs (minimum of 6 months postoperatively). The photographs were all taken using the same imaging settings, and with consistent subject distance and angulation. The photographs were subsequently analysed by authors. Results: The study population consisted of 96 patients (70 women, 26 men) who underwent rhinoplasty between 2016 and 2017. The mean age of the patients was 28.8 years (range: 18-50 years) and the mean clinical follow-up period was 1.8 years. No patient required revision surgery due to radix problems, and there were no cases with unwanted bone fragments or radix asymmetry. The swelling and oedema seen immediately after surgery subsided after an average of 7-10 days. Conclusion: In conclusion, a radix saw can be used for rhinoplasty requiring delicate bone removal in patients with a high radix. Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Resumo Introdução: O aspecto mais difícil do rebaixamento do radix nasal é determinar a quantidade máxima de osso que pode ser removida com o osteótomo; aqui, descrevemos o uso de uma serra para radix nasal, uma nova ferramenta para redução dessa estrutura. Método: Prontuários médicos de 96 pacientes submetidos a cirurgia para redução do radix entre 2016 e 2017 foram avaliados retrospectivamente. Todas as cirurgias foram realizadas pelo cirurgião sênior. Os resultados foram avaliados comparando-se fotografias pré-operatórias com as fotografias de acompanhamento mais recentes (mínimo de 6 meses de pós-operatório). Todas as fotografias foram tiradas utilizando as mesmas configurações de imagem e com distância e ângulo consistentes do indivíduo. As fotografias foram posteriormente analisadas pelos autores. Resultados: A população do estudo foi composta por 96 pacientes (70 mulheres, 26 homens) que realizaram rinoplastia entre 2016 e 2017. A média de idade dos pacientes foi de 28,8 anos (18 a 50 anos) e o tempo médio de acompanhamento clínico foi de 1,8 anos. Nenhum paciente necessitou de cirurgia de revisão por problemas relacionados ao radix nasal e não houve casos com fragmentos ósseos indesejados ou assimetria do radix. O inchaço e o edema observados imediatamente após a cirurgia diminuíram após uma média de 7 a 10 dias. Conclusão: Uma serra para radix nasal pode ser utilizada para rinoplastia, exige manipulação óssea delicada em pacientes com radix alto, com nível de evidência IV. Evidência IV é obtida de várias séries temporais com ou sem intervenção, como estudos de caso. Resultados significativos em ensaios não controlados também podem apresentar esse tipo de evidência.

Radix saw: a useful tool for rhinoplasty to correct high radix.

INTRODUCTION: The most difficult aspect of radix lowering is determining the maximum amount of bone that can be removed with osteotomes; here, we describe use of a radix saw, which is a new tool for determining this amount. OBJECTIVE: In this study, we describe use of a radix saw, which is a new tool to reduce the radix. METHODS: The medical charts of 96 patients undergoing surgery to lower a high radix between 2016 and 2017 were assessed retrospectively. All operations were performed by the senior surgeon. Outcomes were assessed by comparing preoperative photographs with the most recent follow-up photographs (minimum of 6 months postoperatively). The photographs were all taken using the same imaging settings, and with consistent subject distance and angulation. The photographs were subsequently analysed by authors. RESULTS: The study population consisted of 96 patients (70 women, 26 men) who underwent rhinoplasty between 2016 and 2017. The mean age of the patients was 28.8 years (range: 18-50 years) and the mean clinical follow-up period was 1.8 years. No patient required revision surgery due to radix problems, and there were no cases with unwanted bone fragments or radix asymmetry. The swelling and oedema seen immediately after surgery subsided after an average of 7-10 days. CONCLUSION: In conclusion, a radix saw can be used for rhinoplasty requiring delicate bone removal in patients with a high radix. Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Vertical Alar Folding (VAF): A Useful Technique for Correction of Long and Concave Lateral Crura in Rhinoplasty.

BACKGROUND: The tripod theory explains the dynamics of the nasal tip, where surgery is difficult because of anatomic variations and pathologies and the various surgical possibilities. Abnormalities or weaknesses of the lateral crura can result in concavity in ala or alar collapse and cause aesthetic and functional impairments of the nose. Several tip plasty techniques and lateral crura modifications are used in rhinoplasty. OBJECTIVE: To describe the vertical alar folding (VAF) technique for making modifications in the lateral crura (LC) and rotation of the tip. METHODS: Included in the study were 83 patients (59 women, 24 men) undergoing rhinoplasty using VAF with the senior author as surgeon between 2013 and 2018. The mean age was 26.3 years (range 18-47). Mean postoperative follow-up period was 26.7 months (range 12-64). Patients who completed the 1-year postoperative period completed the rhinoplasty outcome evaluation (ROE) questionnaire. Outcome measures were performed at examinations, and preoperative and postoperative photographs of the patients were analyzed. RESULTS: In the span of 5 years, no revision surgery was required for technique-specific reasons. In patients who had a droopy or asymmetric tip or long and concave lateral crura, we saw remarkable functional and aesthetic improvements with VAF. According to the ROE questionnaire, 90.3% (75 out of 83) of the patients were content with the aesthetic and functional results. CONCLUSION: VAF is a useful and effective method for modifying the LC and tip of the nose. VAF allowed for controlling the rotation and projection of the tip, changing the length of the lateral crus and nose with durability and smooth, symmetric contours, and correcting concavity of a lateral crus for better functioning and aesthetics. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An Innovative and Easy Dome Holding Technique for Transdomal Suture in Rhinoplasty.

Suture tip plasty is one the most used methods in nasal tip surgery. Transdomal suture (TDS) used for this purpose is utilized for providing the dome symmetry, thinning the nasal tip, and enhancing the nasal tip projection and rotation. However, there are not sufficient visual data on what the dome position should be during TDS. In this study, it was aimed to be directive in tip plasty and to define the convenient dome holding technique during TDS. Patients, 510 male and 621 female at the age of 18 to 50 years, who underwent the open technique septorhinoplasty between the years of 2003 to 2015 were included in the authors' study. The length of the patient follow-up varies between 1 and 10 years. Patients, on which the lateral crural strut graft was used and which underwent dome division/vertical dome division in tip surgery, and patients who were diagnosed with the alar cartilage asymmetry and underwent dome excision for any pathological reason to demonstrate the effectiveness of the TDS holding technique. During the TDS, the dome area was administered with 5/0 polydioxanone by being held at an angle close to the cranial in the posterior and the caudal in the anterior with a dentated forceps. In this study according the authors' pre and postoperative conclusions, the authors consider that this is a sufficient visual data on what the dome position should be during TDS by presenting video.

Cutting the Holy Dome: The Evolution of Vertical Alar Resection.

INTRODUCTION: Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. In this study, we retrospectively analysed our rhinoplasty patients in whom we used vertical alar resection (VAR) to assess the advantages and disadvantages of this technique. To our knowledge, this is one of the most exhaustive studies of VDD, including over 3000 patients. MATERIALS AND METHODS: This retrospective case series reviewed the charts of 3965 patients who underwent VAR between 2000 and 2015. All patients were operated on by the senior surgeon. Dome division was used for various reasons, including a deformed tip area in revision rhinoplasties, droopy nose, wide tip, pinched nose, tip asymmetry, and overprojected nasal tip. Patients were excluded if they had septal deviation that enabled tip rotation, or a dorsum problem that caused tip asymmetry. RESULTS: The study included 3965 patients (3172 women and 793 men) who underwent open rhinoplasty from 2000 to 2015. The mean patient age was 28.3 years (range 18-50 years). The mean clinical follow-up duration was 11.2 years. CONCLUSION: In conclusion, this technique is capable of modifying all parameters of the nasal tip (projection, rotation, and volume), as required, at the same time, addressing many tip problems. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Novel Method for Smooth Contouring of Nasal Tip: Camouflaging Alar Tip Graft.

The aim of this article is to define a tip graft that provides camouflage for a smoothly contoured, natural-looking tip and that prevents long-term graft visibility. When traditional grafts are used to substantially increase tip projection, there is a possibility for thinning of the skin and subsequent graft visibility. To avoid such unwanted results, the authors have developed a novel graft: the camouflaging alar tip (CAT) graft. In this study, the authors provide a retrospective analysis of the long-term follow-up of 742 patients from 2003 to 2013 in whom a CAT graft was placed. This article is a synopsis of the authors' 10 years experience in nasal tip surgery.

Does the open rhinoplasty incision decrease nasal projection?

To evaluate the effects of open rhinoplasty incisions on tip projection using digitized photographs. Thirty-one patients, who underwent open technique rhinoplasty were prospectively included in the study. The lateral aspect photographs were taken before the operations. Following midcolumellar incision septal elevation was done until septal cartilage was shown. After replacing the skin totally back and suturing midcolumellar incision, the intraoperative photographs were taken. The projection indexes were measured by Goode method from the photographs and the measurements were compared. A statistically significant decline of the nasal projection was established after open technique approach. Open rhinoplasty approach led to the decrease of the nasal tip projection. This result was thought to be the effect of ligamentous disruption.

Unilateral osteotomies for external bony deviation.

OBJECTIVE: Deviated nose is a challenge for rhinoplasty surgeons. We applied a new technique to correct nasal bone asymmetry in selected patients. We assessed the efficacy of the technique and discussed the surgical outcomes. METHODS: We retrospectively analyzed 29 patients with deviated nose who received unilateral osteotomy alone or unilateral osteotomy with camouflage graft placement to the other side of the nose. Preoperative and postoperative photographs were studied to evaluate the outcomes. RESULTS: Twenty-nine unilateral osteotomies were done. Camouflage grafting was performed to 20 of the 29 patients. Nasal humps were removed in all patients. No postoperative complications occurred during the follow-up period. Twenty-six of 29 deviated noses were corrected with unilateral osteotomy. CONCLUSIONS: The unilateral osteotomy technique seems to be a useful method for correcting deviated nose.