Rhinoplasty5 pearls: value of the endonasal approach and vertical dome division.

Successful outcomes in rhinoplasty depend more on diagnosis than on approach or technique. When the needs of each patient are assessed on multiple occasions, operative performance improves and revision rates decline. The evolutionary track from an endonasal and excisional operation to the more commonly preferred external and restructuring technique is outlined in this article. The senior author's rationale and preference for the endonasal approach and the repositioning of cartilage in the tip using vertical dome division techniques is emphasized.

Hockey-stick vertical dome division technique for overprojected and broad nasal tips.

OBJECTIVES: To discuss overprojected and broad nasal tips, to overview treatment options, and to relate our experience with the hockey-stick technique. DESIGN: A retrospective review (1975-2005) was conducted. Patients were selected from a computerized rhinoplasty database of operative cases. The database was used to extract a subset population that had received the hockey-stick tip procedure and had follow-up data for 1 year or more after surgery. Medical records and photographs were also analyzed in this review of results and complications. RESULTS: The hockey-stick modification of vertical dome division was used in 137 patients (9.9% of the rhinoplasties in the computerized database). Of these, 64 patients had 1 year or more of follow-up. Complications referable to the nasal tip (eg, bossae, persistent tip projection, and alar asymmetry) were seen in 8 patients (13%). Revisions for tip-related problems were performed in 4 patients (6%). CONCLUSIONS: The hockey-stick technique is an effective method for nasal tip deprojection and narrowing via an endonasal approach. The length of follow-up in this patient population allows good long-term evaluation of this technique.

Caudal septoplasty for treatment of septal deviation: aesthetic and functional correction of the nasal base.

OBJECTIVES: To describe our technique in the treatment of significant caudal septal deviation; to evaluate the effectiveness of our technique of caudal septoplasty in the treatment of caudal septal deviations. DESIGN: Retrospective review of cases taken from a database of more than 2000 patients who underwent rhinoplasty performed by 1 surgeon in a private facial plastic surgery practice. RESULTS: Medical charts were reviewed to determine the rate of preoperative nasal obstruction in 59 (95%) of 62 patients as well as nasal obstruction postoperatively 11 (17%) of 62 (P < .001). Photographs were reviewed to determine the severity of caudal deviation and the postoperative result. By photographic evaluation, we found that all but 3 patients had significant improvement in their postoperative appearance. Twenty-six patients had no evidence of residual asymmetry. The rate of revision was 5 (8%) of 62 patients. CONCLUSIONS: The caudal septoplasty technique is effective, relatively easy to perform, and shows long-term reliability in correcting caudal septal deviation. In properly selected patients, the technique is effective in improving cosmesis and nasal airflow.

Rhinoplasty in male patients.

The complexities of rhinoplasty are further emphasized when this operation is undertaken in the male patient, and a growing percentage of the rhinoplasty population comprises men. We review the senior author's approach to rhinoplasty analysis, preoperative consultation, and surgical techniques that have been successfully employed for over 40 years. Specific recommendations and modifications to these techniques are discussed as they relate to the rhinoplasty operation in male patients.

Evaluation of the Goldman tip procedure in modern-day rhinoplasty.

OBJECTIVES: To present a critical review of a single surgeon's long-term results using the Goldman tip procedure and to examine the current attitudes of a select group of experienced rhinoplasty surgeons concerning the Goldman tip procedure. DESIGN: A retrospective review was conducted of the medical records of all patients who underwent a Goldman tip procedure performed by the senior author (R.L.S.) between 1975 and 2001. Demographic data, long-term outcomes (minimum follow-up, 1 year), complications, and surgeon-patient satisfaction were analyzed. Also, surveys were mailed to a select group of 50 experienced rhinoplasty surgeons. The survey recipients were asked about their current use of the Goldman tip procedure and any concerns about the technique. RESULTS: A total of 166 cases were eligible for analysis. The mean age of the patients was 33.7 years, and a large percentage of the patients (43.4%) were male. The overall complication rate was 5.4%, with a revision rate of 1.2%. The survey response rate was 78% (39/50). Of the respondents, 14 (41%) are still using the Goldman tip procedure in their practice, although most of them use the technique relatively infrequently. The most common concerns regarding the procedure were unnatural appearance (41%), thin skin (13%), and adverse functional sequelae (8%). Nearly one third of the respondents had no major concerns about using the technique. CONCLUSIONS: The Goldman tip procedure is a safe, effective technique for a select group of patients. A polling of experienced rhinoplasty surgeons revealed that only a small subset of surgeons support the continued viability of the Goldman technique as a surgical option.

A personal report: emphasizing the endonasal approach.

The beauty and allure of rhinoplasty rests in its unending mystery of challenges. It is an operation that demands the surgeon's attention, and it is a procedure in which technical skill alone seldom assures successful outcomes. Following a 40-year involvement with rhinoplasty, the author awaits his next case with as much enthusiasm as the first. Few operations in the repertoire of the facial plastic surgeon can be thus characterized.