Cosmetic rhinoplasty:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2009
|
| Schriftenreihe: | Facial plastic surgery clinics of North America
17,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XI, 176 S. Ill., graph. Darst. |
| ISBN: | 1437704735 9781437704730 |
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Datensatz im Suchindex
| _version_ | 1804141175348658176 |
|---|---|
| adam_text | Titel: Cosmetic rhinoplasty
Autor: Constantinides, Minas
Jahr: 2009
Contents
Preface xi
Minas Constantinides
The Rhinoplasty Consultation and the Business of Rhinoplasty 1
Minas Constantinides
The business of rhinoplasty has undergone changes in keeping with increased com¬
petitive pressures locally, nationally, and internationally. Patient demands and prog¬
ress in the field have abolished the cookie-cutter nose, with patients now
requesting extensive discussions and predictions with computer photoimaging.
The R-Factor Question and The D.O.S. Conversation are effective tools in rhino¬
plasty consultations. These tools provide patients with the clarity of what surgery
can do for their lives and help patients overcome the fear produced by the over¬
whelming amount of information available. By helping our patients achieve the
next level of success in their lives, we guarantee ourselves a busy practice filled
with happy patients. The rhinoplasty consultation is the key to beginning this rela¬
tionship of success.
Preoperative, Anesthetic, and Postoperative Care for Rhinoplasty Patients 7
Ravi S. Swamy and Sam P. Most
The perioperative period can be anxiety provoking for rhinoplasty patients. Patients
rely on the skill and confidence of the surgeon to attain optimal results. Having an
established strategy for the preoperative, anesthetic, and postoperative care of
this patient population is critical to achieving a successful outcome and to ensuring
a positive experience for the patient. Establishing a sincere rapport in the preoper¬
ative period and being able to properly address patient concerns regarding anesthe¬
sia helps patients develop a positive frame of mind and aids in their recovery. This
presentation reviews important elements of the preoperative, anesthetic, and post¬
operative care of rhinoplasty patients and provides insight to making the experience
a positive one for the patient and the surgeon.
Nuances of Profile Management:The Radix 15
Jacob D. Steiger and Shan R. Baker
Profile refinement is one of the most common reasons patients seek consultation for
rhinoplasty. Emphasis on creating a natural-appearing nasal dorsum demands a me¬
thodic nasal and facial analysis. Areas of dorsal excess and deficiency are identified,
quantitated, and considered when determining surgical goals. The radix is an essen¬
tial component of the profile and is carefully assessed from the standpoint of projec¬
tion and position. Height and contour are evaluated at the radix, rhinion, and nasal
tip. Each component of the dorsal profile is individually classified as overprojected,
underprojected, or of appropriate height. Case studies demonstrate the necessary
surgical steps to create a more balanced profile.
Nasal Tip Dynamics 29
PeterA. Adamson and Etai Funk
In rhinoplasty, the nasal tip remains the most challenging anatomic region to diag¬
nose and treat. This article presents a new concept, the M-arch model, to better un¬
derstand the functional and aesthetic anatomy of the tip. This M-arch can be
lengthened or shortened, or left as is, to establish the basis of ideal nasal length, pro¬
jection, and rotation. Additional suture, incisional, excisional, and grafting maneu¬
vers can be performed in a graduated fashion to further refine the M-arch,
including the lobule and soft tissue of the nasal base. A full description of the
M-arch model and its application is presented, and representative results are
illustrated.
Endonasal Suture Techniques in Tip Rhinoplasty 41
Stephen Perkins and Amit Patel
Suture modification techniques have long served as reliable methods to surgically
improve nasal tip contour by allowing control of width, projection, and rotation dur¬
ing rhinoplasty. Tip abnormalities characterized by a wide or broad shape are par¬
ticularly amenable to such techniques. In the senior author s hands (SWP), the
endonasal double-dome tip-sculpting technique has become a workhorse for the
correction of the wide tip complex. When combined with additional techniques,
the double-dome technique allows for the correction of various abnormalities falling
under the umbrella of a broad tip (ie, boxy, bifid, bulbous, trapezoid, amorphous),
while still adhering to the tenets of modern rhinoplasty philosophy. The authors pres¬
ent a paradigm for surgical planning, along with a series of case studies highlighting
the capabilities of various suture techniques performed with the endonasal
approach.
New Concepts in Nasal Tip Contouring 55
Dean M.Toriumi and Mark A. Checcone
The authors introduce the concept of favorable shadowing of the nasal tip surface.
Contouring the nasal tip is an advanced concept in rhinoplasty. Several tip altering
techniques exist, but proper selection of an appropriate technique or combination of
techniques first requires understanding of the impact of manipulating underlying tip
structure on nasal surface topography. Frequently, maneuvers that narrow the
domes, inappropriately create a pinched or unnatural-appearing nasal tip. Many
of these tip-narrowing techniques act to lower the caudal margin of the lateral crura
below the cephalic margin and decrease support along the junction between the tip
and alar lobule. The nasal tip skin can then collapse on this structure, creating a vis¬
ible line of demarcation between the tip and alar lobule. Patients will describe their
operated nasal tip as having the appearance of a round ball or bulbous tip, even
thought their nasal tip may be narrow. This pinched appearance is due to the shad¬
owing that isolates the nasal tip, creating a bulbous or pinched look to the nasal tip.
Maneuvers such as dome sutures, lateral crural strut grafts, repositioning of the lat¬
eral crura, and alar rim grafts can create a favorable tip structure to support the un¬
derlying skin envelope. Using the methods described will enable the surgeon to
focus less on narrowing the nasal tip and more on creating favorable shadowing
of the nasal tip.
Grafting in Rhinoplasty 91
Michael J. Brenner and Peter A. Hilger
Advances in grafting techniques have provided the basis for a paradigm shift in rhi¬
noplasty in which purely reductive techniques have been largely supplanted by
structurally sound framework surgery. Proficiency with autologous cartilage grafting
allows the rhinoplasty surgeon to achieve superior nasal definition and durable aes¬
thetic outcomes by building a stable nasal framework that resists the contractile
forces of healing responsible for delayed nasal airway compromise and aesthetic
distortion. Cartilage grafts may be used to reposition, augment, or reconstitute nasal
structure after cartilaginous resection and recontouring. The authors present various
grafting techniques that are reliably used to sculpt the nasal framework in rhino¬
plasty, with emphasis on the relevant anatomy, nomenclature, and clinical indica¬
tions for each approach. Judicious use of these methods results in predictable
rhinoplasty outcomes with enhanced aesthetics and function.
Functional Rhinoplasty 115
David W. Kim and Krista Rodriguez-Bruno
The complete rhinoplasty surgeon must possess an understanding of functional na¬
sal airway obstruction. An increasingly sophisticated grasp of the pathophysiology
of fixed nasal obstruction has led surgeons to develop and refine surgical techniques
aimed toward alleviating nasal valve insufficiency. This article reviews an assortment
of techniques within nasal valve surgery, highlighting the underlying pathophysiol¬
ogy, anatomy, and technical considerations.
Cleft Lip Rhinoplasty 133
Jonathan M. Sykes and Yong Ju. Jang
Many surgical approaches and techniques to repair cleft nasal deformities have
been described. Because the presenting patient with a congenital deformity is
young, the surgical plan must account for patient growth and surgical scarring.
The surgeon should understand the pathophysiology of the deformity and have
a systematic surgical plan. This article describes the classic nasal abnormalities as¬
sociated with clefting of the lip, and outlines surgical techniques and timing used to
minimize these deformities.
Complications in Rhinoplasty 145
J. Jared Christophel and Stephen S. Park
The surgical maneuvers employed in aesthetic rhinoplasty can result in unforeseen
structural complications that lead to an unsatisfied patient. Many of these problems
arise years after the primary surgery and include both aesthetic and functional los¬
ses. Contemporary rhinoplasty should always be designed with long-term perspec¬
tive and an eye on possible untoward outcomes. This article discusses the anatomic
and physiologic basis of rhinoplasty complications with a focus on primary rhino¬
plasty principles that will prevent their formation.
Tissue Engineering for Rhinoplasty 157
DeborahWatson
Tissue engineering is a rapidly evolving field of research, and its impact on clinical
health care solutions can be profound. It offers a unique opportunity to bridge the
gap between basic science and the application of a tissue-engineered cartilage
product for patients undergoing primary and revision rhinoplasty. Autologous tis¬
sue-engineered septal cartilage can be fabricated from a small sample of septal car¬
tilage taken from a patient. This tissue-engineered product would eventually provide
the surgeon with adequate grafting material with which to complete a rhinoplasty or
nasal reconstructive case without the known limitations of tissue availability and tis¬
sue quantity. An update on this technology is presented as it relates to our field.
Index 167
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| title | Cosmetic rhinoplasty |
| title_auth | Cosmetic rhinoplasty |
| title_exact_search | Cosmetic rhinoplasty |
| title_full | Cosmetic rhinoplasty guest ed. Minas Constantinides |
| title_fullStr | Cosmetic rhinoplasty guest ed. Minas Constantinides |
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