Nâng Mũi Thẩm Mỹ Nâng Cao: Nghệ Thuật, Khoa Học Và Các Kỹ Thuật Lâm Sàng Mới

1127
subnasale position , 671, 674
nose length
anterior/caudal position , 674
anterior septal angle , 676, 677
cephalocaudal dimension , 674
nasolabial angle , 669, 674
potential limitation , 676
skin-soft tissue envelope , 674
soft tissue envelope , 674, 676
surgical technique
cartilage harvest , 669
cheese wiring , 670
design , 670–671
hypodermic needle , 669, 670
infratip lobule shape , 670
multiple mattress sutures , 669, 670
open rhinoplasty , 669
PDS plates , 670
size and shape , 670
thin splinting graft , 669, 670
tongue-in-groove approach , 668
Cell-associated matrix (CAM) , 1110, 1111
Central retinal artery , 739
Chang, C.W. , 436
Chen, A.H. , 913, 915
Christophel, J.J. , 960
Chua, K.H. , 1111, 1114
Cil, Y. , 406
Clark, J.M. , 1080
Classen, D.C. , 714
Cleft lip nasal deformity
algorithm , 699
bilateral
aggressive tip rhinoplasty , 705
alar base , 702
bolsters application , 705, 707
characteristics of , 701
Cronin procedure , 705
de fi nitive rhinoplasty , 705
fi brofatty tissue remove , 705
intermediate rhinoplasty , 705, 706
LLC , 702
nasal tip , 701
septo-premaxillary ligament , 701
clinical judgment , 699
cosmetic/functional outcome , 699, 700
multidisciplinary approach , 702–703
myriad technique/modi fi cation , 699
nasal hemangioma , 707–708
postoperative complication , 705–706
preoperative planning , 702
presurgical treatment , 702
unilateral
cleft-side tip projection , 704
columella deviation , 701
de fi nitive rhinoplasty , 704
deformation , 700
hypoplastic growth , 700
intermediate rhinoplasty , 704
lower lateral cartilage , 700, 701
malformation , 700
maxillary/medial nasal process , 700
medial columellar tunnel , 704
Milliard advancement rotation lip repair
incision , 704
multiple cartilage graft , 704
orbicularis oris , 700
septoplasty , 704
septo-premaxillary ligament , 700
upper lateral cartilages , 700, 701
vestibular Z-plasties , 704
Cleft nose deformity, upturned nose , 513
outcome analysis and critique , 518
patient’s facial analysis , 513, 518
preoperative series , 513, 517
surgery technique , 513
intraoperative procedures , 519
standard brief operation note , 520
Cleft rhinoplasty
airway obstruction , 690
anterior and caudal aspect , 690
Dibbell technique , 691–692
fetal and neonatal development , 689
greater/lesser segment , 689, 690
nasal reconstruction , 690–691
residual deformity , 690
septal deviation , 690
Tajima incision , 692–739 ( see also Dibbell
technique)
three-dimensional shape , 690
U shape, upper jaw , 689
Closed reduction rhinoplasty , 327
Closed rhinoplasty , 1075
anesthesia , 296–297
case study , 307–311, 314
complication , 326
irregular alar cartilage (AC) resection
with , 296
misplacement of strut graft with , 297
postoperative care , 303, 306
preoperative care , 297
preoperative markings , 295–296, 299
surgical technique , 297–302
technique , 295
wrapping , 301, 303, 305–306
Cognitive-behavioral models , 81
Cohen, L.S. , 85
Coleman, S.R. , 742
Columellar reconstruction
aesthetic/functional rami fi cation , 657
airway dynamics , 657
anatomic tip graft , 664
clinical importance of , 665
complication , 663
ideal tip projection , 663
indication , 657–658
nasolabial angle , 663
operative technique
cartilage harvest , 658
conchal graft insertion , 661
Index

1128
Columellar reconstruction (cont.)
conservative hump removal , 660, 662
crescent-shaped graft , 658
medial crura , 658, 659
oblique and worm view , 661
sublabial tunnel creation , 658, 659
V-shaped incision , 658
tip augmentation , 664
traumatic dislocation , 657
Columellar strut grafts , 460, 466–469, 546
aesthetic rhinoplasty , 975, 981
drooping tip restoration, revision rhinoplasty , 1099
Complete osteotomy , 391
Computer simulated imaging (CSI)
accuracy of , 110–111
bene fi ts , 109
2D and 3D model , 114
digital imaging system , 109
ethical issues , 112–113
guidelines , 115–117
legal issues , 113–114
patient satisfaction , 111–112
SLR cameras , 109
technical advance , 109
Conchal cartilage , 445–446, 482
Conchal graft , 383, 661, 973, 978–979, 982
Connolly, F.H. , 96
Conrad, K. , 364, 847
Constantian, M.B. , 293, 664
Continuous osteotomy , 391
Contour deformities, dorsal nasal augmentation
camou fl age graft , 485
defects
autologous rib graft , 488
calvarial bone , 487
cephalic portion , 488
Kirschner wire , 488
titanium plate fi xation , 488
loss of structural support , 486–487
middle nasal vault collapse , 485–486
tongue-in-groove fashion , 486
Cosmetic nasal contouring . See Nonsurgical rhinoplasty
Cosmetic rhinoplasty
BDD , 81–82
CSI , 111–112
history of , 133–134
Costal cartilage
advantages , 1023
applications , 1030–1032
case history , 1033–1034
decision process
alloplastic materials , 1057
autogenous grafts , 1058
carving , 1060
harvesting , 1059–1060
history , 1058
implantation , 1060–1061
indications , 1058–1059
oncologic reconstruction , 1062, 1065
revision rhinoplasty , 1061–1062
trauma , 1062–1064
disadvantages , 1023
grafts , 447–448, 973
harvesting techniques , 1024–1027
inserting techniques , 1027–1028
precautions , 1024
trimming , 1027, 1028
Cottle, M.H. , 48, 68, 134, 137, 200, 227, 349, 358, 362,
369, 375, 379, 406, 680, 877, 1080, 1085,
1120
CRCG . See Carved rib cartilage graft (CRCG)
Creole nose , 179
Crerand, C.E. , 87
Crescent-shaped graft , 658, 663
Crooked nose
deformity , 1088, 1089
septal surgery ( see Septal surgery)
spreader grafts, use of , 454
Crumley, R.L. , 913, 915
CSEG . See Caudal septal extension graft (CSEG)
CSI . See Computer simulated imaging (CSI)
D
Daniel, R.K. , 35, 36, 39, 42, 177–179, 182, 485, 486,
583, 634, 758, 878, 1087
DAPI . See Dimensional Assessment of Personality
Impairment (DAPI)
Davisson, T. , 1114
Deformity
cleft lip nasal deformity ( see Cleft lip nasal
deformity)
hemangiomas , 707–708
lower third , 1003
middle third , 1003
open roof , 160
pollybeak
cartilaginous vault , 941–942
extracorporeal septoplasty , 474
preoperative and postoperative , 44
Supratip AlloDerm removal , 810
supratip structure , 714–715
revision rhinoplasty , 1002
crooked nose , 1088, 1089
narrow middle nasal vault/inverted “V” deformity ,
1087–1088
open roof , 1088
pollybeak , 962, 964–966, 1087
saddle nose , 1086–1087
saddle nose , 720, 722
bilateral alar rim and batten graft , 578–579
bilateral spreader graft , 578–579
costal buttress graft , 576–577
nasal tip distortion and valve incompetence ,
576–577
radix augmentation , 801, 802
secondary , 984, 985
upper third , 1003
Index

1129
Dermal autologous graft , 727
Dermal regeneration template (Integra ™ )
autologous dermic tissue , 719
cost of , 728
de fi nition , 719
demineralized bone matrix, PGF , 719
dorsum deformity , 720, 726
dorsum nasi , 720, 724
fi brosis removed , 720, 725
osseous dorsum nasi defect , 719
overresected dorsum , 720, 723
saddle nose deformity , 720, 722
silicone layer , 720, 721
Dermis-fat , 28, 1034, 1035
Dermocartilaginous ligament
author’s fi ndings , 25–26
bulbous/Negroid noses , 28
dermis-fat , 28
histology
chondrocytes and muscle fi bers , 27
columella , 26, 29–30
musculocartilaginous fascia , 28
nasal dorsum convexity , 26, 29–31
nasal midline tissue , 28
periosteum/perichondrium , 26, 28
orbicularis oris muscle , 26, 27
Pitanguy’s fi ndings , 25
septal cartilage , 26, 27
subcutaneous dissection , 28, 31–32
upper and lower lateral cartilages , 25, 26
Derotation wing graft , 252, 256
Deviated nose
fi lling treatment , 797
OFF technique , 923
outcome analysis and critique , 287, 291
patient’s facial analysis , 287, 289
postoperative series , 287, 291
preoperative series , 287, 288
surgical technique
intraoperative procedures , 287, 289
standard brief operation note , 287, 290
Dibbell technique
basilar view , 695, 697
evolution of , 693
hemi-transcolumellar incision , 694
indication , 693–694
limitations of , 693
nostril apex overhang , 695, 696
open rhinoplasty exposure , 694, 695
tip re fi nement procedure , 695
upper/lower lateral cartilage , 694, 695
Diced rib cartilage graft (DRCG) , 528
cleft nose deformity , 513, 518
problem nose , 518, 523, 524
saddle nose , 509, 513, 514
short nose , 508
Dieffenbach, J.E. , 133
Dimensional Assessment of Personality Impairment
(DAPI) , 85
Dion, M.C. , 46, 58
Dobratz, E.J. , 1114
Dorsal augmentation
anatomy
goals for , 480
lower third of nose , 480
middle third of nose , 480
upper third of nose , 479–480
Asian rhinoplasty , 1003–1004
alloplastic implants , 164
autologous tissue , 164–166
Caucasians , 163–164
Gore-Tex , 168
homologous tissue , 164, 166, 167
revision surgery , 163
silicone , 166, 168
cartilage graft, intraoperative , 553
cartilaginous rib grafts
electrocautery , 484
muscle-sparing approach , 484
perichondrium , 484
segments of , 483, 484
contour deformity
camou fl age graft , 485
defects , 487–488
loss of structural support , 486–487
middle nasal vault collapse , 485–486
tongue-in-groove fashion , 486
costal cartilage ( see Costal cartilage)
dermis-fat , 1034, 1035
materials for
alloplastic , 480–481
autografts , 482
homografts , 481–482
patient evaluation , 483
preoperative considerations , 1004
rolled Permacol graft , 756–761
sources , 987
Dorsal bone grafts, open rhinoplasty
ethnic nose , 1046, 1054
nose restructuring , 1042
Dorsal reduction, EMA rhinoplasty
fi nal tip projection
cartilage positioning and shaping , 257, 258, 262
cephalic rotation , 262
nasal tip asymmetry , 262
postoperative nasal pro fi le , 257, 261
pro fi le templates , 258, 262
septal and turbinate surgery
submucosal resection , 255, 257, 261
turbinoplasty , 255, 260
wound closure and splinting technique , 258
Dorsal saddle-shaped medpor implant . See Secondary
rhinoplasty
Dorsal septal deviation , 680–681
Double columellar strut
aging face , 881
cartilage harvest , 880
delivery technique , 883
Index

1130
Double columellar strut (cont.)
internal incisions , 879
lateral and medial osteotomies , 881
lateral crura , 879
lowering dorsum , 881
medial crura , 879
mild hump deformity , 881, 882
open/closed technique , 879
poor tip support , 876, 877
recessive premaxilla , 881
septal cartilages , 880
wide and laterally displaced domes , 883
Double-guarded osteotome
mucosa tearing , 406
signi fi cance of , 407
technique
anesthesia , 401
hump removal and tip remodeling , 407
internal lateral osteotomy , 406
internal nasal bone mucoperiosteum , 401, 402
low-to-low fracture , 401, 402
mucosa integrity control , 403, 404
preoperative patient , 407
pyriform crest , 403
vertical incision for buccal approach , 404
V-shaped osteotome , 406
Double jaw orthognathic surgery
downrotated nasal tip , 829, 830
maxillary de fi ciency , 831
postrotated mandible and overprojected nose , 832
small mandible and severe deformation , 828, 829
unsupported nasal tip , 829–831
DRCG . See Diced rib cartilage graft (DRCG)
Drooping tip restoration, revision rhinoplasty
pertinent anatomy and etiology
nasal tip , 1095, 1096
origin , 1095, 1097
surgical evaluation and management
columellar strut placement , 1098
external approach , 1096–1097
lateral crural overlay , 1097–1098
onlay tip graft, columellar strut and shield graft ,
1099
preoperative and postoperative , 1099, 1100
Dutton, J.M. , 367
E
Ear cartilage , 448, 498, 1042
Ecchymosis , 937
Edwin Smith Papyrus , 133
Elder, S.H. , 1115
Electrocautery , 746
Elwany, S. , 959
Embryonic stem cells (ESCs) , 1116
Ercolani, M. , 97, 100
Erikson, E.H. , 93
EriMir, F. , 389
Erol, O.O. , 485, 497, 536, 634, 758
Ethnic nose. See also Ethnic rhinoplasty
Hispanic nose ( see Hispanic nose)
Latino nose , 197–198
open rhinoplasty
cartilage grafts , 1046, 1054
dorsal bone grafts , 1046, 1054
features , 1046
South American noses , 1046, 1054–1056
Ethnic rhinoplasty
African-American patients , 197
Hispanic nose ( see Hispanic nose)
Latino nose , 197–198
Middle-Eastern patient ( see Middle Eastern
rhinoplasty)
non-Caucasian nose
anatomic features , 198–199
autologous and homologous graft materials , 205
complications , 203, 205
Medpor implants , 205–206
nasal valve physiology , 198–199
operative technique and postoperative care ,
200–203
osteotomies , 205
patient satisfaction , 203–204
preoperative evaluation , 199–200
synthetic materials , 205
Oriental nose , 198
Etiology, revision rhinoplasty
alar-columellar relationship , 965–966
bony vault , 967
bossae , 965, 967
dorsum , 961
inverted-V deformity , 963, 967
pollybeak , 962–966
saddle nose , 961–963
short nose , 963
tip , 963–965
Extended spreader grafts , 456, 681, 685, 974, 975, 978
External marginal approach (EMA) rhinoplasty , 293
advantages and disadvantages , 241, 242
bi fi d nose
outcome analysis and critique , 277, 281
patient’s facial analysis , 277, 279
preoperative series , 277, 278
surgical technique , 277, 279, 280
combined adjuvant aesthetic bone surgery
facial contouring surgery , 263, 269–270
genioplasty , 261, 265
orthognathic surgery , 261, 263, 265–266
paranasal augmentation , 263, 266–268
submental intubation , 261, 264
complications
nostril asymmetry , 292
tip asymmetry , 292
deviated nose
outcome analysis and critique , 287, 291
patient’s facial analysis , 287, 289
preoperative series , 287, 288
surgical technique , 287, 289, 290
Index

1131
endoscopic-assisted rhinoplasty
light source , 260, 263
operation procedure , 261, 263
osteocartilaginous hump , 261, 263
setting for , 261, 264
upper lateral cartilage , 261, 263
fi nal tip projection
cartilage positioning and shaping , 257, 258, 262
cephalic rotation , 262
nasal tip asymmetry , 262
postoperative nasal pro fi le , 257, 261
pro fi le templates , 258, 262
indications and contraindications , 242–243
low to high osteotomy , 253, 255, 258
nasal tip exposure , 242
operative technique
caudal extension suture , 252, 255
cephalic trim , 252, 254
CRCG , 252, 257
derotation wing graft , 252, 256
incision and dissection , 247, 248, 251, 253
local anesthesia , 245
orotracheal intubation , 245, 247
retromolar intubation , 247, 251
shield graft , 252, 254
submental intubation , 247, 252
tip projection , 251–257
polly beak nose
outcome analysis and critique , 271, 276
patient’s facial analysis , 271, 273
preoperative series , 271, 272
surgical technique , 271, 274, 275
preoperative planning
facial analysis , 244–250
standard series , 243
three-dimensional software , 244
septal and turbinate surgery
submucosal resection , 255, 257, 261
turbinoplasty , 255, 260
wide ala and low height of dorsum
intraoperative procedures , 282, 284
outcome analysis and critique , 282, 286
patient’s facial analysis , 282, 284
preoperative series , 282, 283
standard brief operation note , 282, 285
wound closure and splinting technique , 258
External nasal valve (ENV) , 373, 548–549
alar batten grafts , 141
anchor system , 142
cephalic turn-in fl ap , 142, 144
lateral crural strut graft , 141–142
lateral crus pull-up , 143
periosteum , 142
postsurgical/traumatic , 143
subperiosteal tunnel , 143
suture suspension , 142
zone collapse , 143
External nasal vascularization
anastomotic polygonal blood supply concept , 12–13
blood supply variation , 11–12
internal and external carotid anastomosis , 12
nasal arteries , 11
primary nasal blood supply , 11
primary rhinoplasties , 14–15
revision rhinoplasties , 15
sub-SMAS plane , 13–14
External perforated osteotomy , 406
External rhinoplasty incision , 208–209
base width , 215, 218
dorsal hump and wide nostrils , 216, 220
dorsum
cartilaginous component , 211, 212
dead space and hematoma , 210–211
dissection , 210
fl attened dorsum , 213
lateral osteotomies , 211
resorbable mattress sutures , 210, 211
septal harvesting , 210
fi bro fatty collection , 220
lateral narrowing osteotomies , 220
location and design , 209, 210
lower lateral cartilage dissection , 209–210
nasal tip
aesthetic improvement , 215, 217
alar cartilage bruising , 214
columellar strut graft , 214, 215
dorsal hump and plunging tip , 215, 217
excessive tip and alar width improvement , 216,
219
hooked and droopy tip , 215, 216
lack of tip de fi nition , 216, 219
lower lateral cartilage trimming , 212, 214
shield-type tip graft , 214, 215
septal and or cephalic trimmings , 220
stair-step incision , 209
Extracellular matrix (ECM) , 1108
Extracorporeal rhinoseptoplasty
advantage , 234
airway obstruction and C-shaped nose , 238
Aufrich ecarteur , 235
cartilaginous onlay graft , 234
closed approach , 234
dorsal hump and retrogenia , 237, 238
framework in situ , 236
framework positioning , 235, 236
internal valve collapse , 237
LEGO modelization , 235
nasal deviation , 237–238
septal cartilage stability , 233
septal L-shaped strut , 234
spreader grafts , 234
triangular cartilage repositioning , 233
Extracorporeal septoplasty , 472–475
F
Facial analysis
cleft nose deformity, upturned nose , 513, 518
Index

1132
Facial analysis (cont.)
EMA rhinoplasty
bi fi d nose , 277, 279
deviated nose , 287, 289
2D facial analysis , 246
orthobars , 244, 247, 248
Peter’s analyzer ruler , 244, 245
polly beak nose , 271, 273
postoperative changes , 244, 246
pro fi le template , 244, 246
standard brief operation record , 249–250
problem nose , 518, 523
saddle nose, lower height dorsum , 508, 513
short nose , 506, 508
wide ala and low height of dorsum , 282, 284
Facial cartilage grafts, biomechanical properties
autologous grafts
cantilever model , 535
laser irradiation , 538
mechanical cartilage cutter , 536, 537
computer modeling , 539–540
estimation of mechanical stability , 538–539
native facial cartilages
LLCs , 535
stress–strain graph , 534
swelling problem , 534
Facial contouring surgery , 263, 269–270
Falces, E. , 197, 198, 205
Farhadi, J. , 1114
Fascia graft
moderate depression of nasal dorsum , 600–603
nasal deviation , 604–606
nasal hump , 607–609
primary rhinoplasty , 634
rolled fascia graft , 610
depressed nasal dorsum , 610–613
depressed radix , 614–616, 623–630
dorsal hump , 628
fallen nasal tip , 614–616, 629–630
hump of nasal dorsum , 614–616
lateral nasal dorsum , 617–619
moderate deformity , 620–622
moderate hump of nasal dorsum , 623–625
nasal alae , 631–633
nasal hump , 629–630
nasal septum , 626–627
nasal tip , 623–625, 628, 631–633
retracted columella , 629–630
retraction of columella , 614–616
thick skin nose , 629–630
secondary rhinoplasty , 644
thin skin and subcutaneous tissue , 604–606
Fascia lata (FL) graft
advantages of
adequacy , 558, 559
durability , 557, 558
pathogenicity , 558
pliability , 557
comminuted nasoethmoidal fracture
glabellar region , 580
postoperative view , 580, 581
rigid fi xation , 580
donor site closure
donor scar appearance , 560, 561
purse-string method , 560, 561
harvesting and application, surgical technique in , 558,
559
cephalic corner , 560
rectangular form , 559, 560
sutures , 560, 561
patient selection , 558
previously operated patients
costal cartilage graft , 572–575
deformed lateral crus, alar cartilages , 572–575
minimal dorsal rasping , 570–571
nasal vault , 570–571
primary rhinoplasty
asymmetric nasal tip , 564–565
bilateral spreader grafts , 564–565
corrective septorhinoplasty, bilateral spreader
graft , 568–569
crooked nose, thin dorsal nasal skin , 566–567
inverted V deformity , 562–563
total septal correction , 566–567
upper lateral cartilages , 562–563
saddle nose deformity
bilateral alar rim and batten graft , 578–579
bilateral spreader graft , 578–579
costal buttress graft , 576–577
nasal tip distortion and valve incompetence ,
576–577
Fat graft
adverse reaction , 733
dorsal and tip contours , 733–735
dorsal deviation , 733, 736
facial pro fi le , 737
nasal danger zones
arterial supply , 739
blunt-tip cannulas , 739–740
dressing and splinting , 741
glabella and radix , 740–741
lateral nasal artery , 739
lipoimplants , 741
multi-ori fi ce cannula , 740
ophthalmic artery , 739
skin quality , 736, 741
SMAS plane , 740
postrhinoplasty deformity , 738
primary indication , 733
Female Caucasian rhinoplasty . See Caucasian female
rhinoplasty
Feusner, J. , 80
Fillers , 794, 802
contraindications , 796
deviated nose , 797
hump fi lling , 794–795, 797
indications , 796
injection technique , 794
Index

1133
nonsurgical rhinoplasty ( see Nonsurgical rhinoplasty)
protocol , 795–796
secondary rhinoplasty , 797
tip de fi nition , 795, 797
vessels and nerves , 793–794
Finesse rhinoplasty , 182
Finite element modeling (FEM) , 539
Fitzpatrick skin type , 148, 187, 848
Flaring sutures , 544, 1092
Foda, H.M. , 946, 958, 1086
Fomon, S. , 899
Fournier, P.F. , 838
Fry, H.J. , 536
Fu, B. , 754
Functional-aesthetic rhinoplasty . See Cartilage grafts
Functional rhinoplasty
ENV ( see External nasal valve (ENV))
inferior turbinate , 144
internal nasal valve
autospreader , 140
fl aring suture , 140
inverted V deformity , 139
middle nasal vault , 139
septal cartilage , 141
Skoog techniques , 141
splay graft , 140
spreader graft , 139
ULC , 139
mucosal edema , 137
outcomes , 138–139
septum , 144
surgical techniques , 139
terminology , 137–138
G
Garcia-Diaz, E. , 364
Garcia-Velasco, J. , 926
Genioplasty , 222–223, 261, 265
Gibson, T. , 482, 536, 1058
Gilles , 482
Gillies, H.D. , 536
Glasgow Bene fi t Inventory (GBI) , 74
Global Assessment of Functioning scale (GAF) , 79
Gola, R. , 350, 352
Goldman, I.B. , 358, 413, 847, 911
Goldman, J.B. , 97
Goldman tip , 989, 993, 994
Goodman, W.S. , 134
GORE-TEX implant
advantages of , 816–817, 1013
Asian noses , 168
biological complications , 816
block-shaped (reinforced) Gore-Tex , 1015–1016,
1018
characteristics , 810–812
disadvantages , 1013
intranasal approach , 1018–1023
open approach technique , 1016–1018
orbital fat pad , 750, 751
patient selection , 813, 814
precautions , 1013–1014
selection , 1014–1015
sheet-shaped Gore-Tex , 1015–1017
surgical technique
antibiotic solution , 815
complications , 816
Conrad Introducer , 815
Keith needle , 816
sterilization , 813
two guide pull-in sutures , 813, 815
types , 1011, 1013
Goria , 390
Gorti, G.K. , 1114
Grabb, W.C. , 1058
Grellmann, W. , 536
Griesman, B.L. , 36, 48
Gruber, R.P. , 664, 1091, 1111
Grymer, L.F. , 351, 969
Guarded osteotome , 390
Gubisch, W. , 233
Guerrerosantos, J. , 293, 704, 722
Gunter, J.P. , 134, 141, 430, 481, 482, 487, 538, 585, 686,
1058
Guyuron, B. , 686, 712, 715, 945
H
Hage, J. , 140
Haisch, A. , 1114
Hanasono, M.M. , 715, 1087
Hanging columella restoration, revision rhinoplasty
pertinent anatomy and etiology , 1100–1102
surgical evaluation and management , 1102–1103
Han, S.K. , 801
Harvesting technique, costal cartilage
cartilage carving instrument , 500
chest incision , 499, 500, 502
dicing technique
fi ne and ultra fi ne diced cartilage , 502, 504
manual digital molding , 503, 504
multiple rotating blades , 502, 503
insertion technique , 503
lidocaine solution , 498
piezoelectric surgery , 500, 501
pro fi le template , 499
scooping technique , 500, 501
ultrasonic vibration , 500, 501
Hay, G.G. , 95, 96
Helidonis, E. , 538
Hellings, P.W. , 945
Hemangioma nasal deformity , 707–708
Hematoma , 523, 527, 936–937
Hemorrhage , 936
Henderson, J.H. , 1113
Hernandez-Perez, E , 839
Heterografts , 363
Hicks, D.L. , 1112
Index

1134
High-density porous polyethylene (HDPP) , 142
Hinderer, K.H. , 367
Hispanic nose
aesthetic rhinoplasty , 181
African-American nose , 179
anatomical characteristics and surgical procedures ,
179
anatomic features , 177
archetypes , 179
augmentation rhinoplasty , 181
balanced rhinoplasty , 182
Castilian nose , 178
challenges , 179–180
Creole nose , 179
cultural competence , 176
ethnic identity , 176
facial plastic surgery , 175
fi nesse rhinoplasty , 182
functional reduction rhinoplasty , 182
Mediterranean/Middle Eastern noses , 179
Mestizo nose , 179, 180
Mexican American nose , 178
patient and surgeon goals , 177
preoperative and postoperative , 183–185
primary rhinoplasty , 176
race , 176
secondary rhinoplasty , 176
structural grafts/transplants , 181
treatment goals
nasal function , 177
patient satisfaction , 176
patient-surgeon communication , 176–177
Hoffman, D.F. , 713
Homografts , 363, 364, 481–482
Honigman, R.J. , 98, 100
Horizontal Osteotomy of the Mandible (HOM) , 221–223
Horner, W. , 369
Houseman, N.D. , 12
Huizing, E.H. , 364
Hu, K.S. , 20
Humpectomy
endoscopic-assisted rhinoplasty , 260, 263
external marginal approach , 255, 258
preoperative and postoperative , 255, 259
rasping procedures , 255, 259
Hyaline cartilage , 1109
Hyperbaric oxygen therapy , 663
Hypertension , 66, 68, 69
Hypertrophic scars , 527, 528
I
Implant trimming, revision rhinoplasty
nasal dorsum , 1006–1007
nasion (nasal root) , 1006, 1007
supratip , 1007, 1008
Incomplete osteotomy , 391
Injection rhinoplasty technique , 799–800
calcium hydroxylapatite , 806
complications of , 807
dorsal hump and tip ptosis , 801, 802
fanning and cross-hatching injection techniques , 801,
805
fi ller shield’ graft , 801, 805
haemostasis , 800
hyaluronic acid , 801, 802, 806
linear threading , 800
Restylane ® lidocaine , 799, 800
right internal nasal valve dysfunction , 801, 805–806
saddlenose deformity , 801, 802
serial puncture , 800
supratip depression , 803–804
tip scar, volume replacement to , 801, 805–806
Insulin-like growth factor I (IGF-1) , 1112
Integra ™ . See Dermal regeneration template (Integra ™ )
Intercartilaginous grafts , 545
Interdomal suture , 155, 456, 544, 860, 861, 895
Intermediate osteotomy , 392, 393
Internal alar base reduction , 427–429
Internal nasal valve (INV) , 373
autospreader , 140
distortion and patency , 787, 788
fl aring suture , 140
inverted V deformity , 139
left INV , 784
nasal inspiration , 785
primary injection site , 787
middle nasal vault , 139
normal anatomy , 784
reassess patency , 788
right INV , 784
nasal inspiration , 785
primary injection site , 787
septal cartilage , 141
Skoog techniques , 141
splay graft , 140
spreader graft , 139
ULC , 139
Intradomal suture , 154, 218, 544, 975
Intranasal Z-plasty (INZP)
con fi guration , 369
intravenous sedation or general anesthesia , 369
nasal valve collapse
anatomy , 367–368
physiology , 368
patient selection , 368–369
procedure , 369–371
results , 371
INV . See Internal nasal valve (INV)
Inverted-V deformity
etiology, revision rhinoplasty , 963, 967
FL graft , 562–563
functional rhinoplasty , 139
INZP . See Intranasal Z-plasty (INZP)
Israel, J. , 134
J
Janeke, J.B. , 911
Joseph, J. , 134, 358, 390, 911
Joseph’s technique , 302, 317
Juri, J. , 436
Index

1135
K
Kaiser, M.L. , 848
Kara, C.O. , 713
Karen, M. , 363
Kazikdas, K.C. , 364
Kesselbach’s plexus , 55–56, 58
Killian approach , 271, 277, 282
King, E.D. , 233
Knorr, N.J. , 67
Koltun, R.K. , 134
Konior, R.J. , 481, 1097, 1098
Kridel, R.W. , 481, 894, 1103
Kuran, I. , 389, 401, 406
L
Lassau, J.B. , 12
Lateral crural mattress suturing , 415–416
Lateral crural overlay technique , 154–156, 416–417
Lateral crural reversal , 422–423
Lateral crural spanning sutures , 413–415
Lateral crural steal technique , 156, 414, 676
Lateral crural strut grafts , 420–422, 451–459
Lateral crural turnover graft
cephalic lateral crus limitations , 419–420
opertative technique , 418–420
Lateral crus
anterior alar rim , 45
Caucasian noses , 48
caudal septum , 47
de fi nition , 44
fl are and fullness , 46
infracartilaginous , 45
lateral crural strut grafts , 421, 456
malpositioned/parenthesis , 45
nasal skeleton , 46, 47
nostril , 47
repositioning , 421
rotation of , 363
scroll area of , 43
side-to-side asymmetry , 46
skin/armor , 46
variation , 46
Lateral osteotomy
anatomy
bone and cartilage framework , 387–388
external landmarks and soft tissues , 388
complications
bleeding , 397
bony vault deformities , 397–398
edema and ecchymosis , 397
hematoma , 397
overmobility , 398
postoperative , 396–397
trauma , 397
evaluation , 388–389
general aspects , 387
historical development , 390
indications of , 393
instrumentation , 389–390
surgical approach
endonasal osteotomies , 394
osteotomy sequence , 395–396
percutaneous osteotomies , 394–395
types
complete osteotomy , 391
double osteotomy , 392, 393
high to low to high osteotomy , 391–392
incomplete osteotomy , 391
linear or continuous osteotomy , 391
low-to-high osteotomy , 391
low-to-low osteotomy , 391, 392
midlevel or intermediate osteotomy , 392, 393
perforating osteotomy , 391
Lateral wall insuf fi ciency (LWI) , 138
Latham, R.A. , 700
Lawson, W. , 915
LePesteur , 47
Leptorrhine nose , 357
Lessard, M. , 35
Linear osteotomy , 391
Linn, L. , 97
Litner, J.A. , 74, 99, 100
Lower lateral cartilage (LLC) , 535
clinical evaluation , 410–411
dome division , 413
FEM , 539
frontal view of , 540
history , 410
lateral crural mattress suturing , 415–416
lateral crural overlay , 416–417
lateral crural reversal , 422–423
lateral crural spanning sutures , 413–415
lateral crural strut graft , 420–422
lateral crural turnover graft , 417–420
management , 411–412
scoring/cartilage weakening , 412–413
unilateral cleft lip nasal deformity , 700, 701
Lower lateral crura (LLC)
fi nal assessment , 991
Goldman tip , 989
tip shaping
long noses with plunging tips , 857–858
lower lateral turnover fl ap , 858, 859
transection , 989–990
Low middle third, nose
deformity , 1003
revision rhinoplasty , 952–953
Low-to-high osteotomy , 391
Low-to-low osteotomy , 391, 392
M
Mabry, R.L. , 230
Mahmoudifar, N. , 1116
Malda, J. , 1113
Marcus, G.R. , 83
Marketa Duskova, M. , 742
Mark, K.A. , 716
Martin, J.G. , 198
Maruyama, M. , 912
Matory, W.E. Jr. , 197, 205
Index

1136
McCollough, E.G. , 877
McComb, H.K. , 702
McIndoe, A. , 912
McKiernan, D.C. , 74
McKinney, P. , 49
Medial crural overlay technique , 155–158
Medial crural suture technique , 544
Anderson’s model , 916
blunt dissection , 915
Pythagorean theorem , 913–917
role of , 917
skin incision , 915
tripod model , 916
Medpor implants
dorsal saddle-shaped medpor implant ( See Secondary
rhinoplasty)
non-Caucasian nose , 205–206
Mehta, U. , 110, 112
Mestizo nose , 179, 180
Methicillin-resistant Staphylococcus aureus (MRSA) ,
375, 714
Mexican American nose , 178
Middle crus
bi fi d tip , 43
caudal/cephalic edge , 42–43
domal segment , 42, 43
fresh cadaver dissection , 43, 45
lobular segment , 41–42
Pitanguy , 43, 44
pollybeak deformity , 44
supratip slope , 43
tripod , 43, 44
Middle Eastern rhinoplasty
nasal anatomic features
alar base , 188
bony and cartilaginous dorsum , 188
depressor septi muscle , 189
nasal tip , 188
nostril shape , 188–189
septum , 189
skin-soft tissue envelope , 187–188
operative techniques , 189–191
preoperative and postoperative , 192–194
treatment goals , 189
Middle nasal third management, revision rhinoplasty
anatomy , 1083–1084
deformities
crooked nose , 1088, 1089
narrow middle nasal vault/inverted V deformity ,
1087–1088
open roof , 1088
pollybeak , 1087
saddle nose , 1086–1087
etiology, problems , 1085–1086
fl aring sutures , 1092
onlay grafts , 1091–1092
patient evaluation , 1084–1085
spreader grafts , 1090–1091
techniques , 1089–1090
Middle vault
and internal nasal valve
autospreader grafts , 551
bilateral spreader grafts , 552
residual cartilaginous hump , 551
spreader graft , 549, 550
and supratip
conchal cartilage , 552, 553
costal cartilage , 552, 553
saddle nose augmentation , 554
Midlevel osteotomy , 392, 393
Mild hump deformity , 881, 882
Milgrim, L.M. , 197
Mink, A. , 233
Mink, P.J. , 137, 367
Minnesota Multiphasic Personality Inventory
(MMPI) , 84
Monks, G. , 134
Morris Rosenberg, M. , 83
Morselization , 412–413
Mottura, A.A. , 390
Mowlem, R. , 1058
Mow, V.C. , 534
Muhlbauer, W. , 110, 112
Murakami, C.S. , 390, 1088
Musculocartilaginous fascia , 28
N
Narrow middle nasal vault , 1087–1088
Nasal alar rim reconstruction
alternative internal and external valve reconstructive
options , 373–374
cartilage harvesting and grafting sources , 374–375
external nasal valve , 373
indications for , 374
internal nasal valve , 373
nasal rim and valve collapse, diagnosis of , 375
surgical approach , 374
surgical technique
anesthesia , 375
auricular cartilage graft acquisition , 380, 382–384
cartilage graft fabrication , 376, 377
cartilage harvesting , 376
closure and dressing placement , 380, 382,
384–385
dissection , 377–379
graft placement , 378–381
incisions , 375–377
surgical preparation , 375–376
Nasal anastomotic polygonal blood supply concept ,
12–13
Nasal dorsal contouring . See Fascia lata (FL) graft
Nasal hump , 357
Nasal muscles
classic anatomy
compressor naris major and minor , 3–4
depressor septi nasi muscle , 4, 7
dilator naris , 3
myrtiformis , 4, 6
procerus muscle , 3, 5
Index

1137
transversus nasalis , 3, 6
medical applications , 5
medical rhinoplasties , 5–6
nasal super fi cial musculoaponeurotic system
composition , 7
injury , 10
medial canthal tendon , 8
nasal ligaments , 7–8
open rhinoplasty , 8–9
rhinoplasty access , 11
surgical applications , 8
tip rotation and valve improvement , 11
as vessels carrying layer , 6–7
physiologic anatomy , 4–5
surgical applications , 4
Nasal Obstruction Symptom Evaluation (NOSE) , 138
Nasal tip surgery
OFF surgical technique ( see Onlay folded fl ap
(OFF))
structural grafts and suture techniques
alar rim grafts , 546
alar strut grafts , 546
bilateral spreader grafts , 546, 547
cap graft , 545
caudal septal extension graft , 546–548
columellar strut graft , 546
fl aring suture , 544
high interdomal suture , 544
intercartilaginous grafts , 545
interdomal suture , 544
intradomal suture , 544
lateral mattress suture , 544
medial crural suture , 544
shield-type graft , 545
spreader grafts , 545
tongue-in-groove technique , 545
vertical alar batten grafts , 546
Nasal tip sutures
Anderson’s tripod model , 912
evolution , 911
preservation techniques , 911–912
trigonometry , 912–913
Nasal valve collapse
alternative internal and external valve reconstructive
options , 373–374
cartilage harvesting and grafting sources , 374–375
diagnosis of , 375
external nasal valve , 373
indications for , 374
internal nasal valve , 373
intranasal Z-plasty ( see Intranasal Z-plasty (INZP))
surgical approach , 374
surgical technique
anesthesia , 375
auricular cartilage graft acquisition , 380, 382–384
cartilage graft fabrication , 376, 377
cartilage harvesting , 376
closure and dressing placement , 380, 382,
384–385
dissection , 377–379
graft placement , 378–381
incisions , 375–377
surgical preparation , 375–376
Nasolabial unit concept
dentoalveolar maxillary part , 820
dentomaxillary deformities , 829
facial volumes and contours , 819
Le Fort I osteotomy
drawbacks , 829
lip and nasal region , 827
upper jaw , 825, 827
mucosal incision , 827
nasal pedestal de fi ciency
preoperative and postoperative , 825, 826
tripod excess , 821, 824
nasal pedestal reduction , 821, 823
nose and maxilla , 825
soft tissue envelope , 820, 821
tension nose , 821, 822
tripod-pedestal skeleton , 820, 821
upper lip , 819
National Health Service (NHS) , 74
Naumann, A. , 1110
New domes technique , 904–905
caudal extension graft , 894, 895
closed approach , 891
columellar retraction , 894, 895
columellar strut , 894
external marking , 890–891
hanging columella , 894, 895
in fi ltration , 891
interdomal suture , 895, 896
internal marking , 891–893
normal columella , 894, 895
open approach , 891
tip cartilages , 896
tip support reinforcement , 893–894
tongue-in-groove technique , 894
Non-surgical nasal augmentation . See Injection
rhinoplasty technique
Nonsurgical rhinoplasty
calcium hydroxylapatite , 776
candidates , 774–775
consultation , 775
contraindications , 775
fi ller injection sites , 777
history , 774
hyaluronic acid , 776
patient satisfaction , 778, 779
post-procedure aftercare , 777, 778
pre-procedure , 777
procedure , 777
droopy tip, aesthetic effects , 779
facial symmetry and appearance , 781
Latin-American patients , 780
slimmer nose , 782
straighter nose , 778
saddlenose , 775
safety , 775–776
side effects , 776
Index

1138
NOSE . See Nasal Obstruction Symptom Evaluation
(NOSE)
Nose
dermocartilaginous ligament ( see Dermocartilaginous
ligament)
fat graft ( see Fat graft)
Hispanic nose ( see Hispanic nose)
multiracial nose ( see Ethnic rhinoplasty)
neurologic anatomy
anesthesia , 21
anterior ethmoidal nerve , 18–19
anterior superior alveolar nerve , 18, 20
autonomic nerves , 21, 22
infraorbital nerve , 19–20
infratrochlear nerve , 19
motor nerves , 21–22
olfactory nerves , 18
palatine nerves , 20
parasympathetic and sympathetic pathways , 21,
22
posterior superior nasal nerves , 19, 20
tip and columella , 17, 18
trigeminal nerve , 17
restructuring, open rhinoplasty
angle of inclination , 1040, 1042
buckled medial crura , 1040, 1041
columella structure , 1040, 1041
crural septal suture , 1043
different-sized tip grafts , 1040, 1042
dome suture , 1043, 1044
dorsal graft , 1042
intercrural suture , 1043, 1044
manoeuvres , 1040
nasal tip cartilages , 1040
shape and natural-looking appearance , 1046–1053
spreader graft , 1043
tip grafting , 1040, 1041
well-shaped nose tip , 1040
rhinometry ( see Rhinometry)
surgical anatomy
alar base , 48
alar cartilage morphology , 39–40
base view , 33, 35
bony septum , 53–54
bony vault , 50–51
cartilaginous septum , 54–55
cartilaginous vault , 48–50
dorsal esthetic line , 33, 34
frontal view , 33, 34
infratip lobule , 33, 34
internal structure , 33
lateral crus ( see Lateral crus)
lateral view , 33, 34
lateral wall , 55, 56
medial crus , 40–42
middle crus ( see Middle crus)
muscles , 36
nasal cavity , 51–53
nasolabial angle , 33
nerves/blood supply, and lymphatics , 55–58
non-Caucasian nose , 33
nostril , 48
sensory nerve supply , 38, 39
skin thickness , 35
subcutaneous layer , 35–36
super fi cial arterial supply , 37–38
vestibule , 48
vascular anatomy ( see External nasal vascularization)
Nose-lip-chin plane (NLCP) , 853
O
Obsessive-compulsive disorder (OCD) , 80
Ofodile, F.A. , 197
Onlay dome graft , 856, 861, 866
Onlay folded fl ap (OFF)
arti fi cial materials , 926
autogenous onlay cartilage grafts , 926
cartilage fl aps , 926
columellar cartilage strut , 926
conchal cartilage , 926
excessive thick skin and broad nose , 925
interrupted alar techniques , 926
nasal tip projection , 920, 921
poor nasal tip rotation and projection , 924
post-traumatic dorsum and septum deviation , 924, 925
short columella , 923
short deviated nose , 923
slight dorsal hump and wide nasal dorsum , 922
surgical technique , 920, 921
thick skin and decreased columellar-labial angle , 922
Onlay tip grafting , 1099
Asian noses , 171
Hispanic patient , 866
Open rhinoplasty
alar cartilage asymmetry , 298
anesthesia , 296–297
case study , 312–313, 315–325
closed reduction rhinoplasty , 327
vs. close techniques , 358
complication , 326
Dibbell technique ( see Dibbell technique)
dorsum resection , 297
fi xed spreader grafts , 361
globous tip
alar cartilage resection , 341
anatomical landmarks , 332
anterior nasal septum resection , 338
bone hump removal , 336
interdomal mucosal apposition mattress suture , 343
limited septum excision , 338
local anesthesia in fi ltration with dental syringe , 333
midcolumellar transverse skin incision , 334
nasal anatomy , 331
nasal mucosa dissection , 340
osteotomy and tip corrections , 331–333
postoperative , 346–447
resected and reshaped dome , 343
Rubin osteotome , 344
suturing and reshaping , 342
Index

1139
transcutaneous osteotomy , 345
trimming of septum and upper lateral cartilages , 337
wedge resection , 342
grafting materials
autografts , 363–364
homografts , 364
synthetic materials , 364–365
types , 363
history , 358
incisions , 358–359
nasal valve problem , 362, 363
open structure rhinoplasty , 327–328
postoperative care , 303, 306
preoperative care , 297
preoperative markings , 296, 299
problems with nose tip , 361–362
secondary cases
categories , 1037
debulking fi brofatty tissue , 1038, 1039
ethnic nose , 1046, 1054–1056
fi brofatty tissue , 1038, 1039
interdomal ligaments , 1037, 1038
medial crural , 1037, 1038
nose restructuring ( see Nose)
scar contracture , 1038, 1039
S-STE , 1037
tripod-like structure , 1037, 1038
shield graft and tip implant , 361–362
spreader grafts fi xation , 361
surgery indications , 358
surgical technique , 295, 300–305, 328, 359–361
wrapping , 301, 303, 305–306
Open roof deformity , 160, 1088
Open sky deformity , 227, 228
Ophthalmic artery , 14, 739
Orbital fat pad
anesthesia , 745
auricular cartilage , 748
Bird silicone implant
deep radix , 749, 750
substantial aesthetic , 747–748
dissolvable suture , 746
fi ne-toothed forceps , 745–746
Gore-Tex implant , 750, 751
incision line design , 745
L-shaped implant , 745
complication , 747
nasal dorsum , 749, 750
nasal tip contouring , 749
Metzenbaum scissor , 746
nasal tip contouring , 749
orbicularis muscle , 745
pelican’s beak , 749, 750
skin soft tissue envelope , 747
thin skin , 745
Orthognathic surgery , 261, 263, 265–266
Ortiz-Monasterio, F. , 205, 585
Orton , 363
Osseocartilaginous costal grafts , 482
Osteotomy
low to high osteotomy , 253, 255, 258
secondary rhinoplasty , 986–987
Overprojected nasal tip reduction
complications , 847
endonasal approach
alar cartilage , 845, 846
alar cartilage integrity , 848
asymmetries and distortions , 846
dorsum reduction , 845
membranous septum , 846
multiple transverse incisions , 845, 846
palisade-shaped alar cartilage , 845, 846
perichondrium and mucosa , 848
recovery period , 846–835
splint application , 846
steri-strips , 846
partial multiple excisions , 847
preoperative and postoperative , 849–852
P
Paniello, R.C. , 142
Paranasal augmentation , 263, 266–268
Park, B.Y. , 700
Park, C.H. , 1003
Park, S.S. , 140, 1092
Patel, N. , 716
Pazzano, D. , 1113
Peck, G.C. , 169, 664
Pedroza, F. , 887, 894, 899, 903
Pelican’s beak , 749, 750
Perforating osteotomy , 391
Permacol
abdominal and gynaecological surgery , 754
acellular dermis , 754
acellular pig intestinal mucosa , 754
autogenous graft , 753
autologous and non-autologous graft , 753
camou fl age tip irregularities , 755–756
complication rates , 762–763
concurrent cartilaginous graft , 759, 763
dorsal aesthetic line , 754–755
hernia repair and soft tissue damage , 753
infection and extrusion rates , 754
infection risks/safety , 762–763
limitations of , 763–764
manufacturing process , 753
result , 762
sausage roll
naso-ethmoid fracture , 758–759
open/closed approach , 757, 758
over-resected dorsum and lower lateral , 758,
761–762
tip derotation , 758, 760–761
Turkish delight grafts , 758
volume of augmentation , 756, 757
surgical techniques , 754
Wegener’s syndrome , 759, 762, 764–765
Perrotti, J.A. , 714
Personality disorder , 102–103
Index

1140
Phillips, K.A. , 78, 79, 83, 85
Pinched nasal tip
alar-columella disharmony , 435
alar rim graft , 436
alar spreader grafts , 436
causes , 435
comments , 437–444
lateral crus , 436
operative technique , 436–437
Pitanguy, I. , 25, 43, 198
Platelet-derived growth factor (PDGF) , 1112
Platelet growth factors (PGF) , 719
Platyrrhine nose , 159, 480, 668
Plumping grafts , 674, 1096, 1098, 1102
Poiseuille’s law , 368
Pollybeak
deformity
cartilaginous vault , 941–942
extracorporeal septoplasty , 474
preoperative and postoperative , 44
revision rhinoplasty , 962, 964–966, 1087
Supratip AlloDerm removal , 810
supratip structure , 714–715
etiology, revision rhinoplasty , 962–966
nose
intraoperative procedures , 271, 274
outcome analysis and critique , 271, 276
patient’s facial analysis , 271, 273
postoperative series , 271, 276
preoperative series , 271, 272
standard brief operation note , 271, 275
Polyglycolic acid (PGA) , 1110
Polysurgical syndrome , 102
Porter, J.P. , 197
Postauricular dermis-fat , 1034, 1035
Postoperative care
contact dermatitis , 712
epidermolysis , 712–713
external splinting , 711–712
intranasal splint , 712
nasal airway obstruction , 712
report and graphic record , 711
septal hematoma formation , 712
skin necrosis, treatment of , 713
steroids , 713–714
suboptimal result/deformities
deviation , 715
pollybeak deformity , 714–715
revision surgery , 715
skin change , 715–716
supratip taping , 715
TSS , 713
Posttraumatic rhinoplasty
de fi nition , 1119
postoperative considerations , 1122
preoperative evaluation , 1119–1120
sequence, surgical procedures , 1120–1121
surgical approach , 1120
surgical pearls , 1121–1122
timing of repair , 1120
upper buccal sulcus approach
advantages , 355
disadvantages , 355
history , 349
indications , 351, 353–354
technique , 349–353
Primary nasal tip
aesthetic analysis , 887–889
Banner technique , 906–908
batten-type grafts , 899–900
caudal septal shortening , 900–901
cephalic resection , 899
columellar-septal fi xation , 899–900
crura lateralis , 899
Sheen-type tip graft , 897
short shield graft , 897, 898
vestibular skin reduction , 901
new domes technique , 904–905
caudal extension graft , 894, 895
closed approach , 891
columellar strut , 894
external marking , 890–891
hanging columella , 894, 895
in fi ltration , 891
interdomal suture , 895, 896
internal marking , 891–893
normal columella , 894, 895
open approach , 891
reinforcement, tip support , 893–894
retracted columella , 894, 895
tip cartilages , 896
tongue-in-groove technique , 894
pertinent anatomy , 889–891
Primary rhinoplasty
cartilage graft , 634
depressed radix , 647–654
nasal dorsum , 647–649
nasal tip , 647–649
sharp nasolabial angle , 647–649
supratip and valvular collapse , 647–654
FL graft
asymmetric nasal tip , 564–565
bilateral spreader grafts , 564–565
corrective septorhinoplasty, bilateral spreader
graft , 568–569
crooked nose, thin dorsal nasal skin , 566–567
inverted V deformity , 562–563
total septal correction , 566–567
upper lateral cartilages , 562–563
Hispanic patients , 176
patient satisfaction , 100
tip shaping ( see Tip shaping)
Pterygopalatine fossa , 19, 21
Punthakee, X. , 110
Pyriform aperture , 546, 548, 549
Pythagorean theorem , 913–915
Q
Quality of life (QOL) , 74–75
Index

1141
R
Ramirez, O.M. , 686
Reconstructive rhinoplasty. See Airway patency
Rees, T.D. , 715, 912
Reich, J. , 95
Reinforced Gore-Tex , 1015–1016, 1018
Restylane ® lidocaine , 799, 800
Réthi, A. , 134
Retracted nasal ala
alar-columella disharmony , 435
alar rim graft , 436
alar spreader grafts , 436
causes , 435
comments , 437–444
lateral crus , 436
operative technique , 436–437
Revision rhinoplasty
aesthetic concerns
crooked middle third , 949–950
frequency , 949, 950
tip asymmetry , 949
upper third irregularity , 950–951
Asian nose ( see Asian noses, revision rhinoplasty)
costal cartilage , 1061–1062
drooping tip restoration
pertinent anatomy and etiology , 1095
surgical evaluation and management , 1095–1099
etiology
alar-columellar relationship , 965–966
bony vault , 967
bossae , 965, 967
dorsum , 961
inverted-V deformity , 963, 967
pollybeak , 962–966
saddle nose , 961–963
short nose , 963
tip , 963–965
functional concerns
incidences , 951
intranasal examination , 953–954
hanging columella restoration
pertinent anatomy and etiology , 1100–1102
surgical evaluation and management , 1102–1103
incidences, objective deformity , 945, 946
low middle third , 952–953
middle nasal third management ( see Middle nasal
third management, revision rhinoplasty)
nasal obstruction , 947
patient population, characteristics of , 949
poor tip de fi nition , 952
preoperative evaluation
examination , 959
grafts and implants , 959–961
patient considerations , 957
photos , 959
surgical approach , 959
timing and referral , 958–959
psychological considerations
patient characteristics , 103–105
patient satisfaction/dissatisfaction , 100–101
personality disorder , 102–103
polysurgical syndrome , 102
psychiatric conditions , 101
reinforces , 99
suggestions for surgeon , 103–105
unique anatomy , 99
questionnaire , 947–949
Rhinoplasty Outcomes Evaluation , 945, 947
short-nose deformity , 957, 958
subtle dorsal prominence , 957, 958
survey validity , 954
troublesome concerns , 951–952
wide middle third , 952
Rhee, J.S. , 138, 139
Rhinometry
aesthetic surgeons , 119
clinical index
mean reduction , 122–123
nasal length , 123, 128–129
pre and postoperative data , 123–127
tip projection , 122
neoclassical canons , 119
parameters
alar base width , 121
bony base width , 121
left alar base , 122
lower facial third , 122
nasal length , 120
right alar base , 120
tip projection , 121
upper facial third , 122
photographs , 120
preoperative planning , 119–120, 123
Rhinoplastik , 133
Rhinoplasty
ageing face
age-related changes , 64
anaesthesia and preoperative , 68–69
anatomical requirements , 73
augmentation technique , 65, 70
cosmetic change , 66
de fi nition , 63
dorsal pseudo-hump , 65, 66
facial rejuvenation surgery , 72–73
graft material , 70
history of , 66–67
hump reduction , 70–71
inspection of , 68
macroscopic effect , 64
musculoskeletal function , 63
nasal packing , 71
post-operative care , 71–72
pre-existing septal deviation , 64, 65
preoperative assessment , 66
psychological considerations , 67–68
quality of life , 74–75
risks , 68–69
SMAS layer , 64
surgical approach , 70
Warhol’s iconic , 64, 65
Index

1142
Rhinoplasty (cont.)
anatomical basics , 791
muscles , 793
osteocartilaginous frame , 792
bony vault , 942–944
botulinum toxin
contraindications , 796
indications , 796
nasolabial angle, opening of , 795
objectives , 795
protocol , 795–796
treatment of columella , 795
cartilaginous vault , 941–942
computer simulated imaging ( see Computer
simulated imaging (CSI))
early postoperative complications
edema and ecchymosis , 937
hematoma , 936–937
hemorrhage , 936
infection , 937
septal perforations , 938
skin abnormalities , 937–938
fi llers , 794
contraindications , 796
deviated nose , 797
hump fi lling , 794–795, 797
indications , 796
injection technique , 794
protocol , 795–796
secondary rhinoplasty , 797
tip de fi nition , 795, 797
vessels and nerves , 793–794
GORE-TEX ( see GORE-TEX implant)
Hispanic nose ( see Hispanic nose)
Integra ™ ( see Dermal regeneration template
(Integra ™ ))
intraoperative complications
bone and cartilage injuries , 935–936
soft tissue injuries , 934–935
lateral osteotomy ( see Lateral osteotomy)
minor irregularities , 934
nasal tip
over reduction , 938–939
underresection , 939–941
postoperative care ( see Postoperative care)
psychological aspects
body image disorders , 94–95
concept of , 93
cosmetic surgery , 98
expectations and motivations , 94
medical/cosmetic indications , 96–98
minimal defect , 95–96
skin thickness , 934
structural grafts and suture techniques ( see Structural
grafts and suture techniques)
Supratip AlloDerm removal , 809, 810
surgical procedure , 791, 792
technological advances , 933
three-dimensional manipulation , 933
Rib cartilage grafts harvest, secondary rhinoplasty
calci fi ed cartilage , 1073
complications , 1073
distinct donor sites , 1067
operative technique
angiocath dressing , 1073
blunt elevator , 1072
blunt posterior dissection , 1071
exposed rectus fascia , 1070
penetrating needle tip , 1071
re fl ected superior perichondrium , 1071
rib stripper , 1071
scored anterior perichondrium , 1070
super fi cial cut , 1072
postoperative pain management , 1073–1074
preoperative marking , 1069
rib grafts , 1068–1069
Ricketts “Golden Rule,” 208
Robin, A.A. , 96, 97
Rodríguez-Camps, S. , 722
Roe, J.O. , 133, 134, 358
Rohrich, R.J. , 67, 134, 205, 401, 406, 664, 665, 686
Roman nose , 147
Romo, T. III , 70, 203, 205
Rosenberg Self-Esteem Scale , 83
Roy, J.N. , 134
Rubin osteotome , 225–226
S
Saddle nose
aesthetic and functional restoration , 975–977
deformity , 1086–1087
FL graft , 576–579
radix augmentation , 801, 802
lower height dorsum , 509
intraoperative procedures , 508, 514
outcome analysis and critique , 513, 516
patient’s facial analysis , 508, 513
preoperative series , 508, 512
standard brief operation note , 508, 515
revision rhinoplasty , 961–963
Sa fi an, J. , 847
Sage, A. , 1110
Salmon, M. , 12
Saray, A. , 754
Schlosser, R.J. , 1092
Schultz, A.H. , 197
Secondary rhinoplasty
aesthetic and functional restoration
Medpor , 981
nasal valve collapse , 980
results , 980
saddle nose deformity , 975–977
serious breathing problem , 975, 978–979
surgery , 980
Hispanic patients , 176
Middle Eastern patient
alar base/sill , 992
Index

1143
bone ( see Bone, secondary rhinoplasty)
cartilage frame , 987–988
common secondary deformities , 984, 985
Lebanese-American female , 995–996
lower lateral crura ( see Lower lateral crura (LLC))
medial crura , 988–989
persistent long nose and droopy tip , 997–999
primary goals , 984
sequence of techniques , 985, 986
skin/soft tissues , 991–992
tip overprojection , 993–994
upper lateral crura (ULC) , 988
rib cartilage grafts harvest ( see Rib cartilage grafts
harvest, secondary rhinoplasty)
Seigel, M.I. , 700
Senyuva, C. , 233
Septal cartilage grafts , 445–446
Septal replacement graft. See Extracorporeal septoplasty
Septal surgery
bony cartilaginous framework , 679
caudal septal deviation , 681–682
challenges and limitation of , 679
Cottle elevator , 680
dorsal septal deviation , 680–681
extended spreader graft , 682, 685
extramucosal septal splint/spreader graft , 686
facial evaluation , 679
hanging columella , 682, 687
hump reduction and osteotomies , 682, 684
internal cartilage splint , 686
L-shaped strut , 680
nasal evaluation , 679–680
photographic documentation , 679
silicon intranasal extramucosal septal splints , 686
tongue-in-groove technique , 682, 684
unilateral spreader graft , 682–683
Sercer , 358
Sharp, H.R. , 110, 112
Sheehan, J.E. , 134
Sheehy, E.J. , 1114
Sheen cartilage graft , 596, 597, 631
Sheen, J.H. , 39, 42, 45, 50, 134, 139, 169, 201, 351, 426,
585, 596, 597, 631, 664, 704, 783, 877, 897,
969, 1041, 1090
Sheet-shaped Gore-Tex , 1015–1017
Shield grafts
drooping tip restoration, revision rhinoplasty , 1099
nasal tip surgery , 169, 361–362
wide ala and low height of dorsum , 282
Shone, G.R. , 714
Short nose
revision rhinoplasty , 963
rib cartilage graft , 506
intraoperative procedures , 508, 509
outcome analysis and critique , 508, 511
patient’s facial analysis , 506, 508
preoperative series , 506, 507
standard brief operation note , 508, 510
Short shield graft , 897, 898
Shulman, J. , 67
Shulman, O. , 67
Silicone
advantages , 1007–1008
disadvantages , 1008
inserting method , 1009–1012
nasal dorsal augmentation , 166, 168
precautions , 1008–1009
types , 1008
Simons, R.L. , 413
Single cut osteotomy , 391
Single lens re fl ex (SLR) , 109
Sino-Nasal Outcome Test (SNOT) , 138
Skin abnormalities , 937–938
Skin-soft tissue envelope (S-STE) , 169, 483, 747
Skoog techniques , 141, 607–609
Sleep apnea , 977, 979
SMAS . See Super fi cial muscular aponeurotic system
(SMAS)
Smith, T.W. , 848
SMR . See Submucosal resection (SMR)
Snyder, G.B. , 198
Social and Occupational Functioning Scale (SOFAS) ,
79
Soest, T. , 81, 83
Song, H.M. , 364
Song, R. , 912
Sonic rhinoplasty . See Sonopet ultrasonic bone aspirator
Sonopet ultrasonic bone aspirator
application of
brow-tip aesthetic line , 230, 231
conchal bone emulsi fi cation , 230, 231
costeffective , 232
glabella prominence , 229, 230
nasal spin reduction , 227, 229
bony/cartilaginous avulsion , 226, 227
concurrent irrigation and suction , 225, 226
control unit , 225, 226
histologic analysis , 226, 228
nasal hump reduction , 226
open sky deformity , 227, 228
Rubin osteotome , 225–226
surgical technique
clean surgical fi eld , 227, 228
medial and lateral osteotomies , 227, 229
open sky deformity , 227, 228
Spetzler Claw tip , 227, 228
Spetzler Claw tip , 227, 228
Spielmann, P.M. , 139
Split calvarial bone grafting
clinical indications for , 492, 493
complications , 495, 496
grafting considerations , 491–492
surgical considerations , 492
surgical steps , 492–495
Spreader grafts , 545, 549, 550, 552
aesthetic dorsal line correction , 450–453
bene fi cial effects of , 448
crooked nose correction , 454
Index

1144
Spreader grafts (cont.)
dorsal hump reduction , 449–450
for medialization and stabilization , 450, 456
middle nasal third management, revision rhinoplasty ,
1090–1091
nose restructuring, open rhinoplasty , 1043
unilateral concavity correction , 455
Stahl, S. , 45
Stark, R.B. , 585
Steroids
adjunctive medication , 714
antibiotics , 714
dexamethasone effect , 713
double-blind study , 713
Straatsma, C.R. , 390
Structural grafts and suture techniques
external nasal valve , 548–549
graft materials , 543–544
middle vault
and internal nasal valve , 549–552
and supratip , 552–554
nasal tip surgery
alar rim grafts , 546
alar strut grafts , 546
bilateral spreader grafts , 546, 547
cap graft , 545
caudal septal extension graft , 546–548
columellar strut graft , 546
fl aring suture , 544
high interdomal suture , 544
intercartilaginous grafts , 545
interdomal suture , 544
intradomal suture , 544
lateral mattress suture , 544
medial crural suture , 544
shield-type graft , 545
spreader grafts , 545
tongue-in-groove technique , 545
vertical alar batten grafts , 546
Stucker, F.J. , 197, 198
Submental intubation , 247, 252, 261, 264
Submucosal resection (SMR) , 255, 257, 261
Super fi cial muscular aponeurotic system (SMAS)
ageing nose , 64–66
subcutaneous layer , 35–36
Supratip
Asian noses, revision rhinoplasty , 1007, 1008
taping , 715
Suture nasal tip lift technique
advantages , 839
anesthesia , 836, 837
buried knots, position of , 836
depressor septi muscle bellies , 836
fi brosis , 840
16/18-gauge needle , 839
original suture nasal tip lift , 835
patient selection , 835
simpli fi ed suture nasal tip lift , 836
surgical technique , 837–840
Swanepoel, P.F. , 553
T
Tajima open rhinoplasty , 692–739. See also Dibbell
technique
Tajima, S. , 912
Tardy, M.E. , 390, 395, 480, 487
Tay, A.G. , 1112
Taylor, G.I. , 12
Telangiectasias , 715–716, 937
Temporal fascia technique
fi broadipose covering , 704, 723
muscular fi bre , 704, 723
nasal reconstruction , 704, 716–718
postoperative period , 705
reconstruction , 704
resection
crus medialis feet , 704, 720
elongated nasal base , 704, 720
equilateral nasal base , 704, 719, 721
fl at and negroid nose , 704, 722
tip-shaped band , 704, 721
secondary rhinoplasty
high cartilaginous asymmetry , 704, 710–711
nasal tip , 704, 708–709
projection and cartilaginous broken , 704,
712–713
technical resources , 705
traumatic technique , 704, 714–715
uses , 704, 722
Tension nose , 821, 822
Tessier, P. , 825
Tham, C. , 480
Thinakarajan, T. , 754
Thomassin, J.M. , 487
Thomson, C. , 953
Thomson, J.A. , 67, 96
Three-dimensional tissue culture
alginate-recovered-chondrocyte (ARC) , 1110
cell-associated matrix (CAM) , 1110
collagen , 1111
polyglycolic acid (PGA) , 1110
redifferentiation, expanded cells , 1109
Tip bulbosity , 451
Tip shaping
Armenian-Persian patient , 865
depressor septi nasi muscle , 863
domes , 858–859
dorsum/septum/tip balance , 855–856
grafts
alar contour graft , 862
infratip shield , 861–862
onlay tip grafts , 861
soft triangle grafts , 862
Index

1145
subdomal grafts , 862
thick-skinned patients , 862
Hispanic patient , 866
interdomal suture , 860, 861
medial crural-columellar suture , 859
medial crural-septal sutures , 860–861
nasal skin, fi nal taping of , 863
nose-lip-chin relationship , 853, 854
onlay tip grafts , 861
pitfalls , 856
postoperative patient , 864
preoperative patient , 864
skin and soft tissue , 855
tip position/projection
algorithmic guide , 856–857
assessment of , 853, 854
lower lateral crura , 857–858
medial crura , 858
techniques , 856
transdomal suture , 859, 860
Tissue engineering
autologous chondrocyte implantation (ACI) ,
1108
biochemical properties, hyaline cartilage , 1109
bioreactor culture systems , 1113–1114
cartilage
adipose tissue-derived stem cells , 1116
bone marrow-derived mesenchymal stem cells
(BMSCs) , 1115–1116
embryonic stem cells (ESCs) , 1116
chondrocytes isolation , 1109
de fi nition , 1107
extracellular matrix (ECM) , 1108
implants and grafts , 1107
modulation, oxygen tension , 1112–1113
optimization, culture medium , 1111–1112
septal cartilage specimen , 1108
three-dimensional tissue culture
alginate-recovered-chondrocyte (ARC) , 1110
cell-associated matrix (CAM) , 1110
collagen , 1111
polyglycolic acid (PGA) , 1110
redifferentiation, expanded cells , 1109
in vivo cartilage maturation , 1114–1115
Tobin, H.A. , 953
Tomooka, L.T. , 714
Tongue-in-groove technique , 545, 668, 682, 684
Toriumi, D.M. , 11, 205, 448, 667, 952, 1090
Tosun, Z. , 364
Toxic shock syndrome (TSS) , 713
Transdomal suturing , 414–415
Transforming growth factor beta (TGF- b ) , 1113
Traumatic technique , 704, 714–715
Turbinoplasty , 255, 260
Turkish delight grafts , 536, 758
Tutoplast-processed fascia lata (TPFL) ,
166, 167
U
Ultradiced rib cartilage graft
cleft nose deformity, upturned nose
outcome analysis and critique , 518
patient’s facial analysis , 518
preoperative series , 517
surgery technique , 513, 519, 520
donor scar and morbidity , 523, 527
hematoma , 523, 527
wound dehiscence , 527
hypertrophic scar , 527, 528
operative technique , 499
closure and splinting technique , 505–506
harvesting technique , 498–504
preoperative planning , 498, 499
problem nose , 518
outcome analysis and critique , 523, 526
patient’s facial analysis , 523
preoperative series , 522
surgery technique , 518, 524, 525
recipient complication
dorsal deviation , 528, 532
infection , 527, 529–531
partial resorption , 527, 528, 531
saddle nose, lower height dorsum
outcome analysis and critique , 513, 516
patient’s facial analysis , 513
preoperative series , 512
surgery technique , 508, 509, 514, 515
short nose , 506
outcome analysis and critique , 508, 511
patient’s facial analysis , 508
preoperative series , 507
surgery technique , 508–510
use of cartilage , 498
Upper buccal sulcus approach
advantages , 355
disadvantages , 355
history , 349
indications , 351, 353–354
technique , 349–353
Upper cartilaginous vault , 1083
Upper lateral cartilages (ULCs) , 480, 700,
784–788
Upper lateral crura (ULC) , 988
Upper third deformity , 1003
V
Veale, D. , 82, 85
Vertical alar batten graft , 546
Vertical dome division (VDD) technique ,
169, 171, 847
Visual analogue scale (VAS) , 138
von Gräfe, K.F. , 133
Von Mangoldt, F. , 926
Vuyk, H.D. , 110, 112
Index

1146
W
Wang, D. , 198
Watson, D. , 536
Wayhoff, M. , 349
Webster, R.C. , 390, 953
Wegener’s granulomatosis , 483, 764, 765
Wegener’s syndrome , 759, 762, 764–765
Weir, R.F. , 134, 358, 856, 937, 992
Wernike, E. , 1113
Wright, M.R. , 97, 101
Wright, W.K. , 911
Y
Yellin, S.A. , 198
Yu, K. , 101
Z
Zelnick, J. , 45, 46
Zhang, J. , 1116
Zojaji, R. , 84
Z-plasty . See Intranasal Z-plasty (INZP)
Index