Columellar Aesthetics in Open Rhinoplasty.

Detailed descriptions of the ideals of columellar aesthetics and nostril shape are conspicuously lacking from the medical literature. Achieving an aesthetic nasal base is critical to an optimal rhinoplasty result. Deviations in the columella and variations in its width and height lead to distortion of nostril shape and frequently compromise function. Six types of columellar disproportion are presented with detailed explanations of how to treat each. By properly recognizing and addressing columellar deformities, the surgeon can optimize both the aesthetic and functional results that are achieved.

Asian cosmetic facial surgery.

Within the past decade, Asian economies have grown exponentially, resulting in increased personal wealth and subsequent consumption of cosmetic procedures. Asian cosmetic surgery procedures in Western countries have also seen a growth pattern parallel to Asia. As this growth continues, facial plastic surgeons in Western nations will inevitably witness increased Asians in their patient population base. To meet this demand, the surgeon must incorporate a set of different aesthetic norms from the traditional Western philosophies. In addition, the plastic surgeon must also understand the unique cultural motivations for surgery. The Asian face has distinguishing features that are unique. As such, surgical techniques and aesthetic goals for a particular cosmetic procedure will be different than those for other ethnic groups. This article will review three of the most common cosmetic procedures unique to the Asian face: Asian blepharoplasty, lower facial contouring, and Asian rhinoplasty.

Correction of severe alar retraction with use of a cutaneous alar rotation flap.

BACKGROUND: Severe alar retraction is one of the most challenging problems to correct in nasal surgery. Management for severe alar retraction traditionally requires multiple stages and uses several surgical techniques. This article introduces a single-stage technique to correct severe alar retraction deformities using a cutaneous alar rotation flap in conjunction with alar batten grafts. METHODS: Patients with severely retracted alae underwent ala reconstruction using a cutaneous alar rotation flap and autogenous cartilage batten grafts. RESULTS: Thirteen patients with severe alar retraction underwent alar reconstruction using cutaneous alar rotation flap and alar batten grafts. The alar retraction was corrected in all cases, achieving improvements functionally and aesthetically. No recurrence of alar retraction was noted. The incision sites for the patients healed with acceptable cosmetic results, with only one patient requiring scar revision. CONCLUSIONS: The cutaneous alar rotation flap is an effective and reliable surgical option to correct severe alar retraction. Advantages of this technique include a single-stage approach, ease of design, tissue match, and rich blood supply. Scar from the flap design can be kept inconspicuous by precise placement of the incision within the junction of the ala and the nasal dorsum, following principles of the aesthetic nasal subunits.

Revision rhinoplasty using porous high-density polyethylene implants to reestablish ethnic identity.

BACKGROUND: This study aimed to evaluate a surgical technique used for patients requiring revision rhinoplasty to reestablish their ethnic identity. METHODS: A retrospective review involved 29 patients who underwent revision rhinoplasty to reestablish their ethnic identity using residual septal cartilage and porous polyethylene implants. The follow-up period ranged from 6 month to 7 years. RESULTS: For all patients undergoing revision rhinoplasty, multiple porous polyethylene implants were used to reestablish ethnic identity and to restore nasal function. Implant extrusion developed in one (3.4%) of the 29 patients. There were no cases of postimplant infection. CONCLUSIONS: In our experience, patients who feel they have lost their ethnic identity after primary rhinoplasty tend to have overresected dorsal cartilage and bone and overresected tip cartilages. The use of multiple porous polyethylene implants in revision rhinoplasty to restore ethnic identity can provide the necessary grafting material needed for reconstruction. Many grafting options are available. According to our experience, porous polyethylene provides safe, effective, and reliable results.

Nasal grafts and implants in revision rhinoplasty.

Problems associated with primary rhinoplasty are often due to overresection of the nasal skeleton. One of the primary goals in revision rhinoplasty is to restore nasal architecture. To do so, the facial plastic surgeon can choose from numerous grafting materials. A key understanding of the benefits and limitations of each implant or graft and implants commonly used in revision rhinoplasty surgery.

Difficult revision case: Overaggressive resection.

This article reviews the case of a 45-year-old female who had undergone previous rhinoplasty in which there had been overaggressive resection of the nasal skeletal architecture. A revision rhinoplasty was preformed using available autogenous septal cartilage and various porous high-density polyethylene implants. One year after the procedure, the patient demonstrated restoration of nasal architecture and persistent aesthetic outcomes.