Facial Plastic Surgery Clinics of North America

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Dorsal preservation involves eliminating the dorsal hump by performing reduction while preserving the patient's natural dorsal anatomy. This can involve surface manipulation or foundational techniques or a combination of both. When surgeons begin performing dorsal preservation, there are important factors to consider to avoid complications. In an effort to inform surgeons on how to avoid unfavorable outcomes, I will discuss my first 20 cases where I performed dorsal preservation. I review less than ideal outcomes and how these issues can be prevented...

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...

Classical dorsal preservation rhinoplasty is typically done with impaction osteotomies (push/let down) and a low septal strip. These approaches are potentially highly destabilizing maneuvers in the architecture of the nasal pyramid. This is one of the reasons why these approaches did not have a popular acceptance in the 1960s and 1970s. More recently, the surgeon interested in preservation rhinoplasty has the possibility to do so with surface techniques with more control and, if needed, is easily converted to the standard structured techniques if the surgeon does not feel safe with the procedure...

Preservation rhinoplasty entails the preservation of the supportive ligaments, preservation of the cartilage structure, and preserving the anatomy of the nasal dorsum. The preservation methods I use are described in this article.

Experiencing great worldwide scientific excitement, the number of nose preservation surgeries has increased rapidly, promoting a considerable percentage of drawbacks and complications, causing many surgeons to recoil and return to classic resective techniques. In this study, we develop concepts that allow us to operate noses with preservation rhinoplasty that were previously considered to be among the absolute contraindications. Redefining new dorsal aesthetic lines, controlling the nasal lateral wall and the naso-facial groove surfaces, avoiding mid-vault widening and being precise in the design of bony and cartilaginous nasal profile, avoiding any type of irregularity, are strategies that will be presented...

Ultrasonic rhinoplasty and ultrasonic septoplasty reshape the nasal bones using piezoelectric instruments specifically developed for these operations. They allow the realization of precise osteotomies under direct visual control after having performed first an open or closed extended approach, but also ostectomies and rhinosculpture. Piezoelectric instruments preserve bone stability by not damaging bone support structures and avoiding unwanted fractures. They allow precise control of nasal bone movements, their orientation, and their final position...

Brazil has always been a fertile place for plastic surgery techniques, especially cosmetic, and it was not different in rhinoplasty. In Brazil surgeons started using the dorsal preservation rhinoplasty in the 1970s. Techniques have changed, the problems and contraindications were challenged, and solutions proposed. As a result, indications were expanded to almost every kind of nose. Surface working executed with power tools, such as the piezoelectric device and the power drill, complemented the techniques and allowed for refinement in execution...

The rapid resurgence of interest in performance of dorsal preservation (DP) rhinoplasty techniques in recent years has come with scarcity of data for long-term outcomes. In this article, the authors aim to contribute to preservation rhinoplasty (PR) literature by providing long-term follow-up with dorsal preservation, specifically presenting data related to superior strip DP functional and esthetic complications, followed by a detailed analysis of the same.

The subdorsal cantilever graft (SDCG) is a costal cartilage graft that is positioned below the nasal dorsum to control the position of the nasal bones and middle nasal vault. SDCG type A is used to raise the middle nasal vault and caudal nasal bones to correct the saddle nose deformity. SDCG type B can be used to raise the entire dorsum of the nose (radix, bony vault, and middle vault) in the ethnic augmentation rhinoplasty patient. This article will discuss the indications and technique of the SDCG in dorsal preservation rhinoplasty...

Severe septal deviations are a constant challenge for rhinosurgeons. As the septum is the most important pillar of the nasal framework, septal deformities require correction to insure a straight nose. The septum should be on the midline without any tension to ensure a correct healing of the external nasal pyramid. In certain cases, the association of a correct septoplasty and dorsal preservation allows the treatment of the crooked nose and at the same time gives natural results with rapid postoperative recovery...

Renewed interest in dorsal preservation rhinoplasty (DPR) stems from theoretic esthetic and functional advantages over conventional hump resection. DPR fundamentally consists of en bloc dorsal lowering via a combined septal resection and mobilization of the bony pyramid. Several technical modifications exist, allowing for the expansion of DPR indications. Although studies suggest success with these techniques, comparative data to conventional hump resection are limited. Challenges and stigmata of DPR include a radix step-off, hump recurrence, supratip saddling, and widening of the midvault...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Both nonsurgical and surgical modalities for the treatment of hair loss are being used by providers at an increasing rate worldwide. Men and woman are affected by hair loss, but the pathophysiology of the hair loss is thought to be different between sexes; therefore, gender must play a role in treatment decisions. Currently, there are 3 Food and Drug Administration-approved nonsurgical androgenetic alopecia treatments: minoxidil, finasteride, and low-light laser therapy. Platelet-rich plasma injections are showing promise as a single modality and as an adjunct to other nonsurgical and surgical treatments of androgenetic alopecia...

Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic platysmal bands may benefit from botulinum toxin injections. Mild to moderately lax skin can be addressed with microfocused ultrasound or radiofrequency with microneedling. Significant sun damage and laxity can both be addressed with fractional ablative lasers. Options for submental preplatysmal fat include percutaneous radiofrequency, radiofrequency-helium plasma, deoxycholic acid injections, and cryolipolysis...

No abstract text is available yet for this article.

Microneedling, also referred to as percutaneous collagen induction therapy, uses small needles to create mechanical injury to the skin, stimulating the wound-healing cascade and new collagen formation. Compared with other skin resurfacing techniques, microneedling preserves the epidermis and is nonablative, therefore reducing inflammation, downtime, and risk of dyspigmentation. In addition to increasing collagen production in fibroblasts, microneedling also helps normalize cell function of keratinocytes and melanocytes and can be used to increase absorption of topical medications, growth factors, or deliver radiofrequency directly to the dermis...