The Blocking Points: The Keys to Consistent Success in Preservation Rhinoplasty.

SUMMARY: Preservation rhinoplasty is a growing area of interest amongst rhinoplasty surgeons. Dorsal preservation-a tenet of preservation rhinoplasty-is predicated on maintaining the integrity of the nasal midvault and effecting aesthetic change through alterations to the bony nasal pyramid and underlying septum. A challenge that is unique to dorsal preservation is the phenomenon of hump recurrence, owing to the existence of anatomical blocking points. Blocking points are resistant tensile forces that either impede dorsal lowering intraoperatively or push the dorsum back to its native convexity over time. Five anatomical blocking points have previously been described, which the authors expand upon and include an additional two. The seven anatomical blocking points are: the cartilaginous septum, perpendicular plate of the ethmoid, lateral osteotomy site, Webster's triangle, internal mucoperiosteum of the maxillary bone, medial canthal ligament, and the lateral keystone area. It is critical that the surgeon be aware of the particular blocking points relevant to his or her chosen technique, and to appropriately and methodically address them to ensure consistent long-term results.

Open Preservation Rhinoplasty Using the Piezo Electric Instrument.

Preservation rhinoplasty represents a growing shift in rhinoplasty philosophy toward preserving structurally sound anatomy and reshaping existing nasal structures into esthetic and functional ideals. It is fast gaining popularity owing to the theoretic functional and esthetic benefits of preserving the dorsal keystone area and dorsal esthetic lines. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose to the dorsum, as well as enables greater ease of powered instrument access. The addition of the Piezo-electric device, with its range of rhinoplasty inserts, enables more precise and accurate management of the osseocartilaginous vault, reduces the risk of surface irregularities, and hence optimizes the overall surgical outcome.

Incidence and Predisposing Factors of Postoperative Infection after Rhinoplasty: A Single Surgeon's 16-Year Experience with 2630 Cases in an East Asian Population.

BACKGROUND: This study evaluated the incidence and clinical characteristics of postoperative infection following rhinoplasty. METHODS: This article is a retrospective review of 2630 East Asian rhinoplasty cases performed by a single surgeon (Y.J.J.), from July of 2003 to June of 2018. There were 1595 male patients (69.9 percent) and 687 female patients (30.1 percent), and the median age was 31 years. The incidence of infection was compared between primary and revision cases and analyzed according to the materials used. The authors evaluated the organisms cultured and the timeframe of infection development and intervention. RESULTS: There were 2134 primary and 496 revision cases. Materials included autologous costal cartilage (413 cases), conchal cartilage (572 cases), homologous fascia lata (829 cases), homologous costal cartilage (102 cases), Gore-Tex (373 cases), and silicone (32 cases). The authors identified 22 cases (0.84 percent) of postoperative infection, 18 of which were revision. Revision surgery had a 19-fold greater infection rate than primary surgery (3.63 percent versus 0.19 percent). Women were 3.6 times as likely to develop an infection ( p = 0.002). The infection rate using autologous costal cartilage was 3.39 percent, and that for simultaneous correction of a septal perforation was 8.57 percent. In 11 cases (50 percent), infection developed within 1 month after surgery (12 ± 7 days). Methicillin-resistant Staphylococcus aureus was cultured in eight cases. Infection manifested at the nasal tip in 45 percent and the caudal septum/columella in 32 percent of cases. Twenty cases (90.9 percent) underwent surgical débridement. CONCLUSION: Revision rhinoplasty in women, requiring the use of costal cartilage or simultaneous correction of septal perforation, showed a higher risk of postrhinoplasty infection, which usually manifested at the nasal tip and caudal septum/columella and needed to be managed by surgical débridement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Incisional Blepharoplasty for the Asian Eye.

The goal of Asian blepharoplasty is to create a lid crease configuration that resembles the natural-appearing crease found in other Asians. Because the Asian upper eyelid contains more prominent preseptal fat resulting in greater lid fullness, soft tissue work in blepharoplasty of the Asian eye is even more diverse and essential than that of whites in order for there to be the sustainability of the eyelid crease. Hence, Asian blepharoplasty should be performed specifically following the orbital anatomy of Asians. This article details the incisional method of blepharoplasty to create natural-appearing creases for Asians with single eyelids.

Biomechanical Nasal Anatomy Applied to Open Preservation Rhinoplasty.

Preservation rhinoplasty is a new way to reshape the nose by preserving the dorsum, nasal ligaments, soft tissue envelope, and muscles. This new concept provides the opportunity to achieve a more natural aesthetic and functional result. To achieve a good aesthetic and functional outcome while maintaining surgical safety, knowledge of the relevant anatomy is key. This is especially true for the preservation rhinoplasty technique, where a firm grasp of the anatomy of the nasal soft tissue and bony-cartilaginous framework is critical. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose and the dorsum. Furthermore, tip plasty is easier to perform under direct vision, which is an advantage of the open approach. The goal of this article is therefore to make clear all the important anatomical structures and their relevance to the surgical steps taken when performing the open preservation rhinoplasty technique.