External valve rhinoplasty

BACKGROUND: Rhinoplasty in older adults requires unique consideration of the ageing nose. The purpose of this study was to systematically review the literature pertaining to rhinoplasty in this population, review the senior author's experience, and describe techniques aimed at addressing such features. OBJECTIVES: We hypothesized consistent age-related nasal dysmorphology is described in the literature and standard rhinoplasty techniques may effectively address these changes...

Accurate assessment of facial symmetry is a key component of successful rhinoplasty surgery but is often overlooked by both surgeon and patient. Up to three-quarters of patients with a significantly crooked nose have been found to have concurrent marked facial asymmetry. Whilst not a contraindication to rhinoplasty, provided that facial asymmetry is identified in advance and expectations realistic, the correction of nasal deformities can improve perceived facial asymmetry. In the aging face, aside from soft tissue and bony resorption that can amplify facial asymmetry, there are specific surgical challenges to the aging nose; the normal tip support mechanisms deteriorate with age giving rise to distinctive changes to the aging nose-typically tip ptosis and a hanging columella; bone quality becomes more brittle and skin overlying this area becomes thinner...

OBJECTIVE: To evaluate and compare the costal cartilage lateral crural strut graft's (LCSG) ability to support a weak lateral crus in patients with external nasal valve dysfunction (EVD) undergoing primary versus revision functional rhinoplasty. METHODS: This is a prospective cohort study of 26 patients (mean [SD]: 40.23 [6.75] years of age; 10 [38%] females) with clinically diagnosed EVD, who underwent primary versus revision functional rhinoplasty with the use of a costal cartilage LCSG (10 [38%] primary functional rhinoplasty patients and the 16 [62%] revision patients)...

OBJECTIVES/HYPOTHESIS: To evaluate the lateral nasal wall stability, nasal function, and cosmesis when creating an aesthetically pleasing nasal tip subunit utilizing lateral crus (LC) altering procedures. STUDY DESIGN: Retrospective cohort. METHODS: In this retrospective cohort study, cosmetic rhinoplasty patients undergoing LC procedures with available lateral wall insufficiency (LWI) scores were included. An LWI grading system was used to evaluate internal (zone 1) and external (zone 2) nasal valves objectively...

In an era with smartphone photography and social media (specifically, "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints. This article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis...

Rhinoplasty is a double-edged sword regarding the functional nasal airway; it can enhance and improve the nasal airway if done properly, and can severely compromise the nasal airway if not done properly. The composition of the nasal airway includes the internal and external nasal valves, nasal septum, and inferior turbinates. Each of these areas can be addressed by several techniques, described in the body of the text. Nasal septal perforation is another potential complication that may result from septal surgery, which has nonsurgical and surgical methods to treat, and is also described in the body of the text...

BACKGROUND: The posterior cephalic soft triangle is formed between the posterior cephalic border of the lower lateral cartilage, posterior caudal border of the upper lateral cartilage, and the caudal edge of the nasal bone. PCST is an important component of the external nasal valve which provides resistance against dynamic collapse. OBJECTIVES: The objective of this study was to describe the anatomy of the PCST and to demonstrate its anatomic variations, dynamic interplays, and surgical implications...

In an era with smartphone photography and social media (specifically "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both an aesthetic and functional standpoint.Our article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis...

BACKGROUND: As rhinoplasty techniques have evolved to more extensive dissections, the incidence of iatrogenic deformities, such as alar rim retraction, has risen. Its mechanism is presently unknown. This study examined the microscopic anatomy of the nasal ala to define architectural support elements at the histologic level to determine why rhinoplasty dissection creates such deformities. METHODS: Eight cadaveric noses were harvested and sectioned through the soft triangle and ala...

BACKGROUND: Many Asian patients desire a narrower nasal base with less flaring of the alar lobules. However, patients who underwent multiple rhinoplasty surgeries with nostril contracture or an overreduction of the alar base may experience nostril contracture and deformity, which may lead to further airway obstruction. We present a technique that combines paranasal augmentation with composite chondrocutaneous graft transfer to overcome this problem. METHODS: Nine patients underwent composite chondrocutaneous graft transfer to the soft triangle or alar base combined with paranasal augmentation using preshaped porous polyethylene implants to correct nostril contracture and airway obstruction between September of 2014 and May of 2018...

Comprehensive knowledge of nasal anatomy is essential for obtaining aesthetically and functionally pleasing results in rhinoplasty. In this study, the authors described the anatomy, histology, and clinical relevance of the interdomal region, keystone, and scroll complex. The current study examined these areas in 26 fresh cadaver heads. All cadavers were fresh, and no conservation or freezing processes were applied. All dissections were performed by the first author. It was determined that the structure that connected the middle crura in the interdomal region actually came together in the transverse plane and contained abundant capillaries within...

BACKGROUND: Rhinoplasty is one of the most popular procedures in facial plastic surgery. It is a technically demanding surgery with a long learning curve. The outcome may be very beneficial to the function of the nasal breathing as well as the patient's social life but harbors many pitfalls and sequelae from minor to devastating. This grants a high demand on the knowledge of the nose's anatomy and the implication of each conducted maneuver or grafting during the surgery both short and long term...

BACKGROUND: Musculus depressor septi nasi and its tendon, the dermocartilaginous ligament, play an important role in external nasal valve and nasal respiration. If the ligament is cut during septorhinoplasty operations, nasal functions of the nose and facial expressions are affected. Therefore, the aim of this study was to investigate the role of M. depressor septi nasi in nasal respiration at open rhinoplasty operations using rhinomanometry and electromyography. METHODS: The study included 29 patients who had only external nasal deformity (nasal hump deformity)...

Background and objective Cephalic excision of the lateral crus is the most used procedure in rhinoplasty when attempting to make the nasal tip smaller or narrower to improve the definition. However, due to its several drawbacks as external valve collapse, bossae formation, and alar retraction, a technique, known as the Turn-in flap, has been developed to overcome these complications and to provide better aesthetic and functional nasal tip outcomes. Therefore, we conducted this investigation to determine the long-term outcomes of such procedure...

Rhinoplasty is one of the most challenging cosmetic surgical procedures. Although different techniques have been introduced for grafting the osteocartilaginous part of the nose, the alar rim remains vastly unexamined. The form and strength of the alar rim are crucial in nasal tip esthetics and function. External valve collapse may occur owing to trauma, congenital weakness, or malposition of the lower lateral cartilage (LLC). Alar pinching and collapse are possible outcomes if there is any over-resection of the cephalic portion of the LLC...

BACKGROUND: Management of nasal valve collapse (NVC) in patients with a septal deviation can be challenging. Our objective was to determine the opinions of Canadian Otolaryngologists regarding the diagnosis and management of nasal obstruction in patients with septal deviation and NVC. METHODS: A twenty-question survey was developed for the purpose of our study. Questions were divided into the following areas: diagnosis, management and prognosis. We included all otolaryngologists who were members of the Canadian Society of Otolaryngology...

IMPORTANCE: The design, use, and indications for the articulated alar rim graft (AARG) and the functional and aesthetic improvements that can be achieved have not been fully characterized. OBJECTIVE: To analyze the functional and aesthetic outcomes of AARG placement on nasal airway function, nasal base shape change, and appearance. DESIGN, SETTING, AND PARTICIPANTS: A case series study of patients who underwent septorhinoplasty with placement of AARG at University of California, Irvine Medical Center, from 2015 to 2018 was carried out...

Patients undergoing revision rhinoplasty can show complex tip deformities such as asymmetry, dome angulation with cartilage interruption, alar pinch and retraction, and underprojection. When these defects are present at the same time, often multiple cartilage grafts are needed to restore a pleasing tip and functional external nasal valve. This study reports our experience with the rainbow graft, a previously described technique that can repair with a single cartilage graft the above-mentioned defects. We performed a retrospective review of 21 patients who had undergone revision rhinoplasty between 2006 and 2017 employing the rainbow graft technique to correct complex tip deformities...

Alar deformities are frequently sequels of the incorrect primary rhinoplasties. Malpositions and irregular cartilage as consequence of either inadequated or exaggerated resection are the skeletal representation not only of aesthetic deformities but also collapse or depression, airway obstruction, valve narrowing by scarring, etc. Replace of alar cartilage is mandatory and many techniques have been described using autogenous cartilage graft since either ear or costal areas. Basically, a pocket must be made inside the thickness of ala permitting the placement of the graft...

BACKGROUND: Cephalic trimming of the alar (or lower lateral) cartilage may cause weakening leading to external nasal valve collapse. Numerous methods have been proposed to combat this weakening in order to maintain lateral crural stiffness. The purpose of this study was to quantify the effect of mucosal stripping, cephalic trimming, cephalic turn-in flap, and lateral crural strut grafting on lateral crural stiffness. METHODS: In situ cyclic compressive loading was performed on eight lateral crura in 4 fresh frozen cadaveric specimens...