Double Lateral Osteotomy: Not Only the Correction of Crooked Noses but a Relevant Aesthetical Refinement in Structural Rhinoplasty.

BACKGROUND: Osteotomy represents a crucial step in structural rhinoplasty; however, there is not a unique approach accepted. Double lateral osteotomy has proven to be effective in the long-term correction of a deviated nose. In this series, we evaluated its aesthetic value also in non-deviated cases. MATERIALS AND METHODS: 864 patients who underwent primary structural rhinoplasty from 2012 to 2020 were divided into four groups. Group A and B included patients with a crooked nose treated with asymmetrical double osteotomy and bilateral double osteotomy, respectively. Patients who did not present nasal deviation were divided into group C, including cases treated with bilateral single osteotomy, and group D, including patients who underwent bilateral double osteotomy. Postoperative evaluations were performed by three independent plastic surgeons blinded to the surgical technique. Patient's satisfaction was assessed through the FACE-Q rhinoplasty module. RESULTS: FACE-Q scores reported a satisfaction rate higher than 30% for every item in all groups; however, group B and group D showed statistically higher satisfaction (p < 0.01). According to the evaluations performed by physicians, group B and group D showed the most satisfactory outcomes (p < 0.01). CONCLUSIONS: bilateral double osteotomies represent a significant aesthetic refinement in structural rhinoplasty, not only in crooked noses but also in non-deviated cases, since the reduction in the width of the nose is an aesthetical aspect very appreciated by patients.

The Triple Plane, the Bra-Flap, and the Inverted Bra-Flap Modified Dual Plane Techniques for Breast Augmentation.

BACKGROUND: Breast augmentation (BA) is a very common procedure performed for a wide range of indications. The short-term and long-term outcomes are strongly correlated with the choice of the correct implant pocket, which should be tailored to the anatomic features of the breast. OBJECTIVES: The aim of this study was to report the safety and efficacy of the triple-plane technique and Bra-flap modified dual-plane techniques for BA. METHODS: From January 1995 to January 2016, 605 patients underwent BA procedures that utilized the triple-plane technique or Bra-flap modified dual-plane techniques. Patient evaluation was performed preoperatively and postoperatively at 6 and 12 months and every 5 years thereafter. The occurrence of ptosis and implant malposition, as well as breast animation deformity, were assessed. Patient satisfaction was evaluated with the BREAST-Q Augmentation Module. RESULTS: The average patient age was 39.3 years. The follow-up period ranged from 24 months to 20 years. The triple-plane technique was performed in 450 patients, the Bra-flap modified dual-plane technique in 97, and the inverted Bra-flap modified dual-plane technique in 58. No cases of double-bubble deformity or implant bottoming-out were observed. Regarding animation deformity, 209 patients presented with mild to moderate distortion, whereas no patients presented with severe distortion. The BREAST-Q questionnaire reported significant postoperative improvements in all scales. CONCLUSIONS: In over 20 years of experience, the triple-plane technique has proven to be a reliable procedure that offers natural and long-lasting results. The Bra-flap and inverted Bra-flap modified dual-plane techniques are efficient options to expand the range of breast conditions treated.

Rainbow graft for tip reconstruction in revision rhinoplasty.

Patients undergoing revision rhinoplasty can show complex tip deformities such as asymmetry, dome angulation with cartilage interruption, alar pinch and retraction, and underprojection. When these defects are present at the same time, often multiple cartilage grafts are needed to restore a pleasing tip and functional external nasal valve. This study reports our experience with the rainbow graft, a previously described technique that can repair with a single cartilage graft the above-mentioned defects. We performed a retrospective review of 21 patients who had undergone revision rhinoplasty between 2006 and 2017 employing the rainbow graft technique to correct complex tip deformities. The presence of tip deformities such as asymmetry, dome angulation with cartilage interruption, alar pinch, alar retraction, and under/overprojection was recorded preoperatively and postoperatively. Complete photographic documentation was done, and Rhinoplasty Outcome Evaluation (ROE) questionnaire was administered to the patients. Five patients were male and 16 were females. Mean age of patients was 40 ± 7.6 years. Follow-up ranged from 1 to 12 years, mean 5 ±â€¯3 years. Eight patients had undergone one rhinoplasty, 10 patients had undergone two, and three patients had undergone three. Before surgery, all patients showed asymmetry, 20 dome angulation, 19 alar pinch, and 18 retraction. Eight showed tip overprojection, six underprojection, and seven no alteration of tip projection. The mean ROE score was 20.23 ± 7.37. After surgery, two patients showed persistent asymmetry, none had dome angulation, one alar pinch, and two alar retraction. Projection was corrected in every patient. We observed no case of graft infection, malposition, or resorption, and corrections achieved remained stable during follow-up. Mean postoperative ROE score was 80.75 ± 6.24. Its improvement was statistically significant (p < 0.001). The rainbow graft is a safe and effective technique in revision rhinoplasty indicated for the total restoration of nasal tip appearance in the presence of complex secondary deformities.

The "triple-plane technique" for breast augmentation.

Breast augmentation is one of the most frequently performed aesthetic surgery procedures. In the United States, it is the second most commonly performed aesthetic surgery procedure among women, according to the American Society of Aesthetic Plastic Surgery statistics. Different choices available to the surgeon deal with the pocket plane, the skin incisions, and the type of implant. This report describes the results from a retrospective review of the authors' experience with the "triple-plane technique" and its different indications according to breast types. Findings have shown that this technique is suitable for many different types, shapes, and sizes of breasts; that it offers very good and natural results; and particularly, that these results last over time.

Secondary rhinoplasty.

Revision rhinoplasty is a complex aesthetic and reconstructive procedure in which both functional and cosmetic principles must be considered in the planning of an appropriate operation. Different techniques must be modified according to the specific defects. The modifications may vary from simple integration of a previous poorly performed surgery to complex grafting of homologous or heterologous material. The authors report their experience with 311 cases of revision rhinoplasty.

Our experience with the so-called pull-through technique combined with liposuction for management of gynecomastia.

Gynecomastia is a benign enlargement of male breast, common in adolescents and adults. To treat this deformity, we have been carrying out liposuction through small cutaneous incisions placed in the axilla and on the sternum. If necessary, we performed a surgical excision of glandular tissue through a periareolar incision. From 1995, we started to perform surgical excision of glandular tissue, if necessary, through the small incisions made for liposuction, thus avoiding the periareolar scars. We describe our experience with this technique, which we believe excellent for the correction of glandular and fatty glandular gynecomastia, obtaining excellent esthetic results and minimal local scarring.