[Predictable tip suture techniques in rhinoplasty]. / Berechenbare Nahttechniken für die Nasenspitze bei Rhinoplastik.

Recontouring the nasal tip in rhinoplastic procedures has generated a wide range of surgical techniques. These range from aggressive cartilage resection, division, grafting, or suture methods. Each of these categories contains many variations described in hundreds of publications. The goal of this communication is to describe a predictable, reproducible technique that can be used in a wide variety of rhinoplasty operations. Based on pre-existing anatomy variations of this technique can be adopted. The author described the basic technique in 2004 [1].The cornerstone of the technique is a predictable method of narrowing the interdomal space utilizing a suture technique. This procedure employs a pair of permanent sutures designed to minimize distortion, valve impingement and overcorrection. It can be performed through intranasal or external approaches. This paper will define the wide interdomal space, describe the technique, and demonstrate the efficacy of the technique in 250 rhinoplasty procedures. In addition, variations of the technique for specific goals will be shown.

Botulinum toxin A for mentalis muscle dysfunction.

OBJECTIVE: To describe the use of botulinum toxin A for treatment of mentalis muscle dysfunction secondary to failed augmentation mentoplasty. DESIGN: Clinical observations were made in the treatment of mentalis muscle dysfunction. Patients with the postmentoplasty signs of mental skin dimpling and soft tissue ptosis were injected with 20 U of botulinum toxin A and observed for visual and functional improvement. Photographs were taken for documentation. SETTING: Private facial plastic surgery practice. PATIENTS: Three patients with a history of failed augmentation mentoplasty were identified and signs/symptoms recorded. Each patient was treated with 20 U of botulinum toxin A and observed for clinical improvement. MAIN OUTCOME MEASURES: Pretreatment and posttreatment photographs of active and passive mentalis function together with patient satisfaction surveys. RESULTS: Of the 3 patients treated, all reported alleviation of the mentalis dysfunction and improved appearance. The symptoms began to return as the botulinum toxin A effects subsided. CONCLUSIONS: Botulinum toxin A is a safe and effective treatment of mentalis dysfunction secondary to failed augmentation mentoplasty. The effects are predictable, although temporary.

Deprojecting the nasal profile.

The nose is the most prominent aesthetic feature of the facial profile. Nasal length, tip rotation, and tip projection are integral aspects in analysis of the nasal profile. In most rhinoplasties the surgeon has the difficult task of increasing or maintaining tip projection of an underprojected or normally projected nasal tip. Less commonly, the rhinoplastic surgeon is presented with an overprojected nasal tip, and efforts are focused on deprojecting the nasal profile. In this article, the authors present a discussion of the overprojected tip, elucidating strategies of analysis, etiologies, and management of the nasal profile and give clinical examples.

Modification of the subunit principle for reconstruction of nasal tip and dorsum defects.

This article reports our observations on, and modification of, the subunit principle with regard to reconstruction of nasal tip and dorsum defects. Forty-two patients who underwent reconstruction of a nasal tip and/or dorsum defect with a forehead flap were reviewed. These patients were categorized by how the subunit principle was used in their reconstruction and graded on the aesthetic outcome of the reconstruction. We found that the patients who had both the nasal tip and dorsum replaced obtained better results than those who had just 1 subunit replaced (P = .008). Review of postoperative photographs shows that the reason for this discrepancy in aesthetic outcomes is the line of transition between the forehead skin and remaining nasal skin if only 1 subunit is replaced. With this observation in mind, we feel that patients undergoing reconstruction of the nasal tip and/or dorsum should be evaluated for discrepancies in tissue type between the recipient nasal site and forehead donor site. If the tissues are noted to be significantly disparate, the reconstructive surgeon may consider replacing both subunits with a single forehead flap.

Advances in computer imaging/applications in facial plastic surgery.

Rapidly progressing computer technology, ever-increasing expectations of patients, and a confusing medicolegal environment requires a clarification of the role of computer imaging/applications. Advances in computer technology and its applications are reviewed. A brief historical discussion is included for perspective. Improvements in both hardware and software with the advent of digital imaging have allowed great increases in speed and accuracy in patient imaging. This facilitates doctor-patient communication and possibly realistic patient expectations. Patients seeking cosmetic surgery now often expect preoperative imaging. Although society in general has become more litigious, a literature search up to 1998 reveals no lawsuits directly involving computer imaging. It appears that conservative utilization of computer imaging by the facial plastic surgeon may actually reduce liability and promote communication. Recent advances have significantly enhanced the value of computer imaging in the practice of facial plastic surgery. These technological advances in computer imaging appear to contribute a useful technique for the practice of facial plastic surgery. Inclusion of computer imaging should be given serious consideration as an adjunct to clinical practice.

Complications of injectable synthetic polymers in facial augmentation.

BACKGROUND: Injectable synthetic materials have been used for augmentation of soft tissue defects, correction of wrinkles, and augmentation of facial features such as the nasal dorsum. Success has been limited by inflammatory reactions, material migration, and the difficulty of removal should complications occur. OBJECTIVE: To evaluate complications resulting from soft tissue augmentation with injectable alloplastic materials. METHODS: Retrospective review of seven cases. Clinical history, treatment, histopathologic findings, and outcomes are assessed. RESULTS: Inflammatory reaction and tissue damage were refractory to antibiotics and steroids, and surgery was required to remove the foreign material. Histologic examination revealed giant cell foreign body reaction in all cases. CONCLUSION: Injectable synthetic polymers can produce significant complications including deformity and inflammatory tissue destruction, the control of which is complicated by the difficulty of removing the materials. Removable tissue fillers, such as e-PTFE, or natural materials such as collagen, autologous, fat, or Alloderm, should be considered instead.

The male facelift: considerations and techniques.

Facelift in the male patient presents unique challenges with respect to maintenance of normal hairline and management of bearded skin. With careful psychological preparation, surgical planning, and attention to detail, these male characteristics can be retained with a good rejuvenative result. The combination of a deep-plane rhytidectomy technique with modified incisions and endoscopic brow intervention has provided the authors with consistent surgical results. Complications have been minimal, with no significant hematomas, skin loss, or nerve injuries to date.

A graduated method of tip graft fixation in rhinoplasty.

Projection of the nasal tip has gained increased recognition as a measurable and visual characteristic that has an impact on the results of aesthetic rhinoplasty. Autologous cartilage tip grafts have been used in many techniques to increase tip projection and contour the tip during rhinoplasty. This article introduces a graduated method of tip graft fixation correlated with specific clinical measurements related to tip projection. After careful analysis of tip projection and contour, a predictable graft fixation technique can be selected to obtain the desired degree of nasal tip projection and sculpting.

Rehabilitation of the paralyzed face.

Rehabilitation for facial paralysis is a highly individualized task that relies on a complex set of physical, physiologic, social, and emotional factors. A wide range of surgical techniques exist for establishing partial rehabilitation of facial expression and motion. The facial surgeon must analyze these factors and work with the patient in a realistic approach to the problem.

Functional and cosmetic surgery of nose and ear deformities in children and adolescents.

Congenital and traumatic disorders of the nose and ear in children and adolescents must be dealt with on an individual basis. The indications for surgical correction must be guided by functional, psychologic, and aesthetic considerations.