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Sutures in rhinoplasty

Sameep Kadakia, Alexander Ovchinsky
UNLABELLED: Achieving stable and desirable changes in tip rotation (TR) and tip projection (TP) is among the primary goals of modern day rhinoplasty. The tongue-in-groove (TIG) technique is one technique in rhinoplasty used to improve TR and/or TP. Performing TIG endonasally using a permanent suture can be quite cumbersome as the suture needs to be buried under the skin. We describe a variation of TIG technique for endonasal rhinoplasty using a permanent suture buried in small columellar skin incisions...
October 2016: Facial Plastic Surgery: FPS
Marcos Harel, Lior Leibou
BACKGROUND: The use of interdomal sutures for tip refinement is common in open rhinoplasty and in endonasal rhinoplasty using a delivery technique, but there is paucity of reports in the literature regarding the use of interdomal suturing techniques when the nondelivery endonasal approach is chosen. OBJECTIVE: The authors describe a technique designed to refine the nasal tip with an interdomal suture placed through a nondelivery endonasal approach. METHODS: In this study, the authors retrospectively review the cases of 45 patients who underwent endonasal rhinoplasty with the authors' interdomal suturing technique between the years 2011 and 2013...
August 2016: Plastic and Reconstructive Surgery. Global Open
Fernando Casanueva, Deniz Gerecci
Importance: The dome binding suture (DBS) used for nasal tip refinement creates the unwanted effects of nasal tip pinching owing to shadowing and loss of alar support. The hemitransdomal suture (HTS), however, refines the nasal tip while maintaining a natural contour between the nasal tip and the alar lobule. To our knowledge, no objective comparison between the DBS and HTS techniques has been described in the literature to date. Objective: To determine whether the DBS or HTS technique results in an objectively satisfactory outcome in nasal tip contouring when assessed from the perspective of the basal view...
September 1, 2016: JAMA Facial Plastic Surgery
Seyed Esmail Hassanpour, Ataollah Heidari, Seyed Mehdi Moosavizadeh, Mohammad Reza Tarahomi, Ali Goljanian, Sanaz Tavakoli
BACKGROUND: Although the assignment and suturing of the spreader graft to the septum is a routine part of rhinoplasty, it is a time wasting procedure and some problems may occur. Rather, autospreader flap is a new method that the dorsal part of the upper lateral cartilage is used as its own graft. In the present study, we intended to compare the functional and aesthetic outcomes of these two techniques of rhinoplasty. METHODS: In a clinical trial, patients who referred to 15 Khordad Hospital for elective rhinoplasty during 2013-2014 were enrolled...
May 2016: World Journal of Plastic Surgery
Frank R Datema, Peter J F M Lohuis
The tongue-in-groove (TIG) is a conservative but powerful surgical suture technique to control tip rotation and projection, to set an appropriate alar-columellar relationship, to straighten a caudal septal deviation, and to stabilize the nasal base. TIG is suitable in primary and most revision cases and is easily combined with other surgical techniques. Seventeen years after its popularization, the TIG technique is embedded in modern-day rhinoplasty literature and teaching material. This article describes indications and considerations during external primary and revision rhinoplasty, based on clinical experience and the available literature...
August 2016: Facial Plastic Surgery: FPS
Fazil Apaydin
During rhinoplasty, the most stressful areas of the nasal cartilaginous septum are at the key area and anterior nasal spine. A stable fixation of the caudal septum to respond to these stresses is of utmost importance. The prerequisite for a successful fixation is a well-prepared recipient bed for caudal septum and suture fixation. The bed can be opened by using scissors, osteotome, or powered instrumentation. Simple or multiple sutures passing from the bone and/or surrounding soft tissues are used for fixation...
August 2016: Facial Plastic Surgery: FPS
Jordan P Farkas, Michael R Lee, Rod J Rohrich
BACKGROUND: Cartilage warping has plagued reconstructive and cosmetic rhinoplasty since the introduction of extraanatomical cartilage use. The authors' group theorized that, rather than focusing on the prevention of the innate tendency of rib graft warping, it may be possible to redirect the stressors toward themselves and use these forces with oppositional suturing techniques to compensate for these intrinsic characteristics. METHODS: Fresh cadaver cartilage was obtained from the costosternal junction of two rib cages (aged 77 and 99 years)...
August 2016: Plastic and Reconstructive Surgery
Reginaldo de Oliveira Silva Filho, Victor Diniz de Pochat
BACKGROUND: Lateral crural strut graft has been used in rhinoplasty to correct deformities such as bulbous nasal tip, lateral crus malposition, alar retraction, collapsed external valve, lateral crus concavity, and alar deformity after domal suture. Despite its widespread use, the lateral crural strut graft has not been the subject of studies that show its benefits objectively and statistically. OBJECTIVES: To assess nasal anatomical variations in cadavers that underwent rhinoplasty using the lateral crural strut graft, considering the clinical applications of this graft...
September 2016: Aesthetic Surgery Journal
Leila Freire Rego Lima, Helena Hotz Arroyo, José Roberto Parisi Jurado
PURPOSE OF REVIEW: The purpose of this article is to further explore the techniques available for alar base reduction by a recent review in this topic, focusing in the current advances in the field, in a clear and readable format. RECENT FINDINGS: Among the numerous techniques available, the management of cases with wide nasal base and alar flaring remains limited to three options: cinching sutures to pull in the alae together; or to use alar base excisions that remove tissue from the alar lobule to decrease flare and from inside the nostril to decrease width; and flap advancement...
August 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
Hayati Akbaş, Caglayan Yagmur
BACKGROUND: Tip plasty is an important procedure that contributes much to obtaining an aesthetically pleasant nose. To increase precision during the tip plasty procedure, control over the lower lateral cartilages should be maximized. This can be accomplished by extending the exposure of the cartilage framework. We present our "Freed Lower Lateral Cartilages With Intact Lateral Attachments" approach through which inferior lateral cartilages are being dissected free from their attachments, while only their lateral bases (lateral crural parts) are left intact...
August 2016: Aesthetic Plastic Surgery
Michelle Lee, Bahman Guyuron
BACKGROUND: The authors examined the dynamics of the subdomal graft and its frequency of use in primary and secondary rhinoplasty in detail. METHODS: One hundred consecutive primary and 100 consecutive secondary rhinoplasty patients with at least 1 year of follow-up were reviewed retrospectively. The nose sheet containing a detailed intraoperative recording of all rhinoplasty maneuvers was reviewed to analyze the frequency of subdomal graft use. Intraoperative observations of the effects of the subdomal graft on the nasal tip and the surrounding structures were recorded...
June 2016: Plastic and Reconstructive Surgery
Bailin Pan, Qingfang Ke
OBJECTIVE: To investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision. METHODS: From 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested...
January 2016: Zhonghua Zheng Xing Wai Ke za Zhi, Zhonghua Zhengxing Waike Zazhi, Chinese Journal of Plastic Surgery
Fred G Fedok
PURPOSE OF REVIEW: The middle vault of the nose continues to be a topic of interest among surgeons interested in aesthetic and functional rhinoplasty. The purpose of this review is to present currently accepted concepts regarding the significance of the middle vault of the nose in rhinoplasty and to review the more frequently advocated methods to be used in the correction of deficiencies. RECENT FINDINGS: Spreader grafts may be at least as effective as flaring sutures in improving the airway...
August 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
Holger G Gassner, Franziska Schwan, Frank Haubner, Gustavo A Suárez, Veronika Vielsmeier
Secondary cleft rhinoplasty represents a particular surgical challenge. The authors have identified the deficit in skeletal projection of the cleft-sided piriform rim as an important contributor to the pathology. A graft is described to augment the piriform crest on the cleft side. This foundation graft is suture fixated to the piriform crest after complete release of all soft tissue attachments to the alar base. The foundation graft is articulated with a long alar strut graft, which allows for powerful projection of the cleft-sided nasal tip...
April 2016: Facial Plastic Surgery: FPS
Selcuk Inanli, Adem Binnetoglu
BACKGROUND: Crooked nose deformity is a complex anatomical deformity; therefore, repair remains a challenge. Here, we introduce a new technique for crooked nose deformity repair. MATERIALS AND METHODS: Twenty-two patients underwent intraoperative evaluations and measurements, followed by surgery using the open rhinoplasty technique. Our method involves three major steps. First is the creation of an asymmetric medial oblique osteotomy using piezoelectric ultrasonic surgery and double lateral osteotomies, wherein the asymmetric bony ascending part of the maxillary bone at the base of the nasal vault is fractured, pushed in, and delivered to the face...
June 2016: Aesthetic Plastic Surgery
Jessica R Gandy, Cyrus T Manuel, Ryan P Leary, Brian J F Wong
IMPORTANCE: The contribution of columellar strut grafts (CSGs) to nasal tip support has not been determined via structural mechanics. Optimal graft dimensions have yet to be objectively determined. OBJECTIVES: To use a finite element model (FEM) of the human nose to (1) determine the effect of the CSG on nasal tip support and (2) identify how suture placement contributes to tip support. DESIGN, SETTING, AND PARTICIPANTS: A multiple-component FEM of the human nose consisting of bone, skin/soft tissue, and cartilage was rendered from a computed tomographic scan...
May 1, 2016: JAMA Facial Plastic Surgery
Denis Codazzi, Stefano Bruschi, Riccardo F Mazzola, Maria Alessandra Bocchiotti, Paolo Bogetti, Luca Ortelli, Enrico Robotti
BACKGROUND: Rhinoplasty is considered the most challenging chapter of plastic surgery due to its variability and the continuing evolution of surgical maneuvers. Worksheets became essential to unequivocally record surgical steps and to demonstrate their reciprocal effects/interactions during the follow-up period. After 1989, no other software was created to upgrade the Gunter Rhinoplasty Diagrams, the forefather and benchmark of the rhinoplasty "virtual" worksheet maker. METHODS: The authors built a new standard three-dimensional nasal framework model in STL format...
February 2016: Plastic and Reconstructive Surgery
Marina Serrato Coelho Fagundes, Ana Tereza Moreira, Elizabeth Mila Tambara, Sérgio Bernardo Tenório, Rogério de Fraga, Rogerio Hamerschmidt
INTRODUCTION: In rhinoplasty, facial esthetic analysis is critical for proper surgical planning. Parameters such as rotation and nasal projection should be routinely evaluated. Few studies have objectively assessed changes in facial angles postoperatively. OBJECTIVE: To evaluate the effectiveness of medial intercrural sutures and of rotation of the nasal tip on the increase of rotation and nasal projection in Caucasian patients undergoing primary rhinoplasty. METHODS: A prospective study carried out between 2011 and 2013, with 27 patients treated with primary rhinoplasty with a basic technique by the same surgeon, with medial intercrural sutures and rotation of the nasal tip...
January 2016: Brazilian Journal of Otorhinolaryngology
Charles A Pierce, Petros Konofaos, Sonia Alvarez, Robert D Wallace
Nasal tip dermoid cysts that are present in pediatric patients can be complicated by mass effect causing compression and distortion of underlying cartilaginous structures. The purpose of this report is to describe a single surgeon's technique and results of nasal tip dermoid cyst excision in pediatric patients through an open rhinoplasty approach followed by tip reconstruction and immediate fat grafting. A series of 3 pediatric patients presented with 1 to 1.5 cm nasal tip dermoid cysts that were causing distortion of the lower lateral cartilages...
January 2016: Journal of Craniofacial Surgery
M Samaha, A Rassouli
BACKGROUND: Spreader grafts are widely considered to be the mainstay of treatment for insufficient internal nasal valve and are commonly placed preventively during rhinoplasty, after hump removal, to avoid middle vault collapse. Although the placement and suturing of spreader grafts in open rhinoplasty is fairly easy, their positioning and stabilization in endonasal rhinoplasty is associated with a learning curve. METHODS: A review of the technique with tips for the novice surgeon is presented, particularly as pertains to correct placement...
2015: Plastic Surgery
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