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Sutures in rhinoplasty

Rollin K Daniel, Peter Palhazi
Background: In 1971, Janeke and Wright1 published a now classic study on the support of the nasal tip in which they found four areas of anatomic support. These findings led to the "tripod concept" of tip support. Recently, surgeons have begun repairing and/or preserving the nasal ligaments as a method to control tip projection and rotation. Therefore, a reassessment of the nasal ligaments and tip support is warranted. Objectives: The present study was done to investigate the ligamentous and structural support of the nasal tip...
January 23, 2018: Aesthetic Surgery Journal
Neil Tanna, Khang T Nguyen, Ashkan Ghavami, Jay W Calvert, Bahman Guyuron, Rod J Rohrich, Ronald P Gruber
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Perform aesthetic and functional nasal analysis to guide septorhinoplasty. 2. Recognize common complications associated with rhinoplasty. 3. Select appropriate septorhinoplasty techniques to refine nasal aesthetics and treat nasal airway obstruction. 4. Identify factors leading to poor patient satisfaction following rhinoplasty. SUMMARY: Septorhinoplasty is among the most technically challenging procedures in the realm of plastic and reconstructive surgery...
January 2018: Plastic and Reconstructive Surgery
Fernando Casanueva, Deniz Gerecci, Felipe Cardemil
The dome-binding suture (DBS) and hemitransdomal suture (HTS) are suture techniques used to narrow and define the nasal tip. The DBS can create a pinched, unnatural appearance, while the HTS puts the lateral crus in a more favorable orientation. This allows a natural contour between the nasal tip and alar lobule while maintaining alar margin support. Objective measurement of the rotational axis of the lateral crus between the DBS and the HTS has not been reported in the literature. To determine whether the DBS or HTS technique results in a more favorable rotational axis of the lateral crus as measured by the alar surface septal angle (ASSA)...
December 26, 2017: Facial Plastic Surgery: FPS
R Cobo
Rhinoplasty is one of the main facial plastic procedures performed worldwide. Ethnic patients today are mainly mixed-race patients. Diagnosis is based on anatomical findings and surgery should be planned based on patients' needs and what they define as beautiful. Different surgical techniques are presented where a structural approach to rhinoplasty is explained. Very little tissue is resected and support structures of the nose are strengthened with sutures and grafts. A gradual approach to the nasal tip is also presented progressing from simple predictable techniques to more complex unpredictable ones...
December 22, 2017: HNO
Ahmet Erdem Kilavuz, Ali Alper Bayram, Gediz Murat Serin
No abstract text is available yet for this article.
December 2017: Facial Plastic Surgery: FPS
Chin-Ho Wong, Rollin K Daniel, Seng-Teik Lee
Background: Asian cleft rhinoplasty is a unique procedure with specific challenges. Objectives: This paper presents our experience with the use of an open structural technique for Asian cleft rhinoplasty utilizing a complete autologous approach. Methods: An open approach that reconstructs the malpositioned nasal cartilage was utilized. Centrally, the septocolumella graft fixed securely in the midline with extender spreader grafts was utilized to project and lengthen the nose...
December 13, 2017: Aesthetic Surgery Journal
Süreyya Şeneldir, Aytuğ Altundağ, Denizhan Dizdar
INTRODUCTION: Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. In this study, we retrospectively analysed our rhinoplasty patients in whom we used vertical alar resection (VAR) to assess the advantages and disadvantages of this technique...
October 12, 2017: Aesthetic Plastic Surgery
Rod J Rohrich, Paul N Afrooz
The open rhinoplasty technique facilitates accurate visualization of deformities and aesthetic disharmonies in addition to visualization for precise correction. Through a series of videos, this case represents the evolution of the open rhinoplasty technique, demonstrating a wide range in complexity of maneuvers to achieve the desired correction in rhinoplasty. The video demonstrates reduction of the nasal dorsum by way of a component dorsal reduction, reconstitution of the cartilaginous midvault, and suture techniques for reshaping the nasal tip...
October 2017: Plastic and Reconstructive Surgery
C Spencer Cochran, David A Sieber
Modification of the lower lateral cartilage complex is the sine qua non of modern rhinoplasty, and the open approach to rhinoplasty has expanded the number of techniques available to help achieve an aesthetically pleasing tip. The ideal tip has been described as having a diamond-shaped configuration, with the lateral points formed by the tip-defining points, the superior point by the supratip, and the inferior point by the columellar break point. Over the years, various techniques have been described to minimize isolation of the tip and to help achieve the ideal tip configuration: lateral crural strut grafts, alar contour grafts (i...
October 2017: Plastic and Reconstructive Surgery
Il Hwan Byun, Dahn Byun, Woo Yeol Baek
Perfect facial and body symmetry is an important aesthetic concept which is very difficult, if not impossible, to achieve. Yet, facial asymmetries are commonly encountered by plastic and reconstructive surgeons. Here, we present a case of posttraumatic facial asymmetry successfully treated with a unique concept of facial flap repositioning. A 25-year-old male patient visited our department with severe posttraumatic facial asymmetry. There was deviated nasal bone and implant to the right, and the actual facial appearance asymmetry was much more severe compared to the computed tomography, generally shifted to the right...
December 2016: Archives of Craniofacial Surgery
Jae Yong Jeong, Hyeokjae Kwon, Yibo Piao, Sang-Ha Oh
PURPOSE: Minimal deformity or instability after columellar strut graft (CSG) placement can be solved by placing a suture between the columella strut and the caudal septum, such as a medial crura anchor suture or a projection control suture. However, this is very tedious. MATERIALS AND METHODS: A trans-septal columellar stabilizing suture (TCSS) was developed for the management of final tip projection and location and increasing stability after CSG placement. RESULTS: Tip projection and rotation could be carefully controlled by changing the position of the TCSS...
July 15, 2017: Journal of Oral and Maxillofacial Surgery
David A Sieber, Rod J Rohrich
Nasal tip refinement is one of the most difficult aspects of rhinoplasty surgery. In this article, the senior author (R.J.R.) presents his technique for nasal tip analysis and identifies the factors that contribute to nasal tip shape. Various techniques for nasal tip modification using both sutures and soft cartilage grafts are described to help produce optimal results.
August 2017: Plastic and Reconstructive Surgery
Safvet Ors
Revision rhinoplasties and saddle nose deformities usually require grafting for reconstruction. Between January 1, 2000, and January 1, 2017, autologous rib grafts were used in 127 secondary and tertiary rhinoplasty patients [(57/127 females) and (70/127 males)]. Osseous-cartilaginous rib grafts (OCRGs) were divided into three parts (i.e., 1/3 upper peripheral, 1/3 central, and 1/3 lower peripheral). The harvested OCRGs were also shaped as vertical strips using a number 11 scalpel blade. These OCRGs were shaped to form the L-strut cartilaginous graft (LSCGs), osseous-cartilaginous spreader grafts (OCSGs), osseous-cartilaginous onlay grafts, nasal valve grafts (NVGs), and lower lateral cartilaginous grafts (LLCGs)...
October 2017: Aesthetic Plastic Surgery
P G Giacomini, S Mocella, S Di Girolamo, R De Berardinis, A Boccieri
Nasal tip under projection is often found in rhinoplasty cases both for congenital or post-traumatic deformity. Nasal trauma may result in alteration of the external and internal nasal structures with following aesthetic impairment and difficulties in breathing. Post-traumatic surgery is frequent, but restoration of pre-traumatic form and function remains a challenge. The present paper describes a new method to increase tip projection by a columellar strut harvested from the autologous nasal bone and cartilage of the resected hump...
May 22, 2017: Acta Otorhinolaryngologica Italica
Hui Young Kim, Joonhyoung Park, Ming-Chih Chang, In Seok Song, Byoung Moo Seo
BACKGROUND: Rehabilitation of normal function and form is essential in cleft lip repair. In 2005, Dr. David M. Fisher introduced an innovative method, named "an anatomical subunit approximation technique" in unilateral cleft lip repair. According to this method, circumferential incision along the columella on cleft side of the medial flap is continued to the planned top of the Cupid's bow in straight manner, which runs parallel to the unaffected philtral ridge. Usually, small inlet incision is needed to lengthen the medial flap...
December 2017: Maxillofacial Plastic and Reconstructive Surgery
Adem Topkara
Background: Nasal tip surgery is the most important and most difficult step of an aesthetic rhinoplasty operation. Various suture and grafting techniques have been described for adequate tip rotation and projection in nasal tip surgery. Objectives: The author describes his technique of "three-dimensional (3D) columellar strut graft" in nasal tip surgery. Methods: Each patient is treated using the open technique rhinoplasty. The author's technique uses a 3D dorsal columellar strut with a special anatomy in the shape of a Y- on a horizontal plane...
April 1, 2017: Aesthetic Surgery Journal
Sadrollah Motamed, Hamidreza Alizadeh Otaghvar, Feizollah Niazi, Seyed Mehdi Moosavizadeh, Babak Motaghedi, Adnan Tizmaghz
INTRODUCTION: Surgical manipulation of the lower lateral cartilages of nasal tip could cause subtle but significant responses to the manipulation. The suture-techniques almost always offer a reliable and dramatic method of tip reshaping without a need to break or interrupt the alar rim strip or even adding tip graft. AIM: The aim of this study was to describe and assess outcomes of a new suture technique in rhinoplasty by using cephalic dome septal rotation suture for better tip definition...
January 2017: Journal of Clinical and Diagnostic Research: JCDR
I Beegun, H A Saleh
Rapidly absorbable skin sutures have been found to be of use in numerous settings including for the closure of the columellar incision following open rhinoplasty. Its removal does not routinely require trimming, and the sutures tend to fall off with minimal intervention 10-14 days postoperatively. This practice has a good acceptance by patients and utilises less resources in the follow-up period. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www...
February 15, 2017: Aesthetic Plastic Surgery
Sun Hwa Park, Byeong Gon Yun, Joo Yun Won, Won Soo Yun, Jin Hyung Shim, Mi Hyun Lim, Do Hyun Kim, Sang A Baek, Yahya Dhafer Alahmari, Jun Ho Jeun, Se Hwan Hwang, Sung Won Kim
OBJECTIVES: Polycaprolactone (PCL) is an U.S. Food and Drug Administration-approved synthetic biodegradable polymer and is easily fabricated into three-dimensional (3D) structures. In this study, the 3D-printed PCL implant for nasal augmentation was further evaluated for its suitability for nasal surgeries such as septoplasty and rhinoplasty. METHODS: Ten New Zealand White rabbits were included and divided into study and sham groups (7 and 3, respectively). A lateral incision was made on the nasal dorsum and a pocket formed in the subperichondrial plane between the upper lateral cartilage and nasal septum...
May 2017: Laryngoscope
Bahman Guyuron, Michelle Lee
BACKGROUND: Thicker nasal skin blunts the definition of the underlying osseocartilaginous frame and the delicate topography of the nose posing additional challenges in producing desirable tip definition. Despite the recognized challenge in this patient population, there is a paucity of literature on how to overcome this problem. PURPOSE: The goal of this article is to provide a systematic algorithm to manage patients with thick nasal skin. METHOD: Approach to the thick nasal skin patient begins with an evaluation of the etiology of their skin thickness...
April 2017: Aesthetic Plastic Surgery
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