A valuable resource for cosmetic and reconstructive surgeons at all levels of training and expertise, Rhinoplasty: A Case-Based Approach offers systematic, expert coverage of both common and complex rhinoplasty procedures performed in today’s practice. Each chapter offers a carefully written teaching case that outlines essential information related to fundamental aspects of the condition―all from the world’s leading experts in rhinoplasty and aesthetic surgery. Numerous high-quality illustrations and procedural videos help you master the techniques that lead to optimal outcomes and increased patient satisfaction.
Presents more than 150 teaching cases that represent the full range of today’s practice of cosmetic surgery. Cases are ones most commonly seen, or those that have significant implications for modern clinical practice.
Provides the presentation, physical exam findings, and laboratory and imaging studies for each case, along with an analysis of treatment options, complications, selected references, and other relevant information.
Reflects real-life clinical perspectives, presenting patients as they would before a surgery, followed by an expert walk-through of the procedure.
Features high-quality clinical images and clear anatomical artwork, as well as procedural videos for real-time visual guidance.
Shares the experience and knowledge of internationally renowned surgeons who draw from different training backgrounds to provide a multidisciplinary approach to the vast array of patient desires for beauty and functionality.
Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
Author(s): Husain Ali Khan, Shahrokh C. Bagheri, Foad Nahai, James D. Frame, Behnam Bohluli
Edition: 1
Publisher: Elsevier
Year: 2022
Language: English
Commentary: TRUE PDF
Tags: Rhinoplasty; Nose Surgery; Otorhinolaryngology; Plastic & Cosmetic Surgery
Front Cover
Rhinoplasty
Copyright Page
List of Contributors
Preface
Tribute to Jack P. Gunter, MD
Contents
1: Introduction
1 Ethnicity, Race and Culture: Its Influence on Rhinoplasty
Formation of Ancient Civilizations
The Mesopotamian Civilization
The Indus Valley Civilization
The Ancient Egyptian Civilization
The Maya Civilization
The Chinese Civilization
The Ancient Greek Civilization
The Persian Civilization
The Roman Civilization
Defining of Different Races, Cultures, and Ethnicity
Mixtures of Races
Race, Culture, and Ethnicity in Rhinoplasty
Further Reading
2 Nasal Anatomy
Anatomy of the Nose
Skin
Nasal Blood Supply
Nasal Musculature
Nasal Bones and Cartilage
Nasal Septum
Nasal Turbinates
Physiology
Conclusion
References
2: Patient Assessment
3 The Initial Examination
The Problem
The Background
The Indications
The Examination (Table 3.1)
The Limitations and Possible Disadvantages of Diagnostics Tests (Table 3.2)
The Composites
The Patient (Fig. 3.2)
The Patient (Fig. 3.3)
The Pearls
References
4 Photography in Rhinoplasty
Introduction
Basic Concepts for Standard Photography
Camera
Lens
Depth of Field
Light
Background
Film
Position
Archiving
Advanced Use of Pictures
References
5 Three-Dimensional Imaging in Rhinoplasty
The Problem
The Background
The Indications
The Patient
The Surgery/The Composites
Choosing Imaging Technology for Rhinoplasty
The Pearls
References
3: Nasal Airway Obstruction
Part I: Septoplasty
6 Conservative/Simple Septoplasty
The Problem
The Background
The Indications
The Patient
The Surgery
Surgical Technique in Detail
Limitations and Possible Complications
The Alternatives
The Pearls
References
7 Advanced Septoplasty: Correction of Caudal Septal Deflection
The Problem
The Background
The Indications
The Indications
The Surgery
Surgical Technique in Detail
The Composites (Fig. 7.3)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
8 Advanced Septoplasty: Correction of Dorsal Deflections
The Problem
The Background
The Indications
Linear
C-Shaped
S-Shaped
Revision Septoplasty
The Patient
The Surgery
The Composites (Fig. 8.2)
The Limitations and Possible Complications
The Pearls
References
9 Advanced Septoplasty: Extracorporeal Septoplasty—Septal Reconstruction
Summary
Introduction
Historical Background
Surgical Problem
Preoperative Evaluation
Development of the Technique
Removal of the Septum
Reconstruction of a Neo-Septum or Construction of a Straight Septal Frame
Refixation of the Septum
Contouring of the Nasal Dorsum
Outcome and Complications
Discussion
Summary
References
Part II: Turbinate Hypertrophy
10 Medical Management of Turbinate Hypertrophy
The Problem
The Background
The Case
What is the Medical Treatment of Turbinate Hypertrophy?
Conclusion
References
11 Functional Turbinoplasty
The Problem
The Background
The Indications
The Diagnosis
The Patient
The Surgery
The Limitations and Possible Complications
Further Reading
12 Turbinate Reduction Techniques in Rhinoplasty
The Problem
The Background
The Indications
The Surgery
Submucosal Inferior Turbinate Reduction
The Limitations and Possible Complications
The Alternatives
Partial Turbinectomy
Turbinate Outfracture
Laser-Assisted Inferior Turbinate Reduction
Radiofrequency Inferior Turbinate Reduction
Coblator Turbinoplasty
The Pearls
Conclusions
References
4: Graft Harvesting Techniques
13 Septal Graft: Preparation of Crushed Cartilage
The Problem
The Background
The Indications
The Patient
The Surgery
The Pearls
References
14 Septal Graft: Graft Harvesting Technique
The Problem
The Background
The Indications
Preoperative Evaluation
The Surgery
The Limitations and Possible Complications
The Alternatives
The Pearls
15 Conchal Cartilage Harvest (Anterior Approach)
The Problem
The Background
The Indications
Tip graft
The Patient
The Surgery
The Limitations and Possible Complications
The Alternatives
The Pearls
References
16 Conchal Cartilage Harvest (Postauricular Approach)
The Problem
The Background
The Indications
The Patient
The Surgery
The Limitations and Possible Complications
The Alternatives
The Pearls
References
17 Technique for Harvesting Deep Temporal Fascia
The Problem
The Background
Anatomy
The Indications
The Patient
The Surgical Approach
The Name of the Technique
Harvesting technique
The Complications
The Pearls
References
18 Temporalis Fascia: Neck Hairline Incision
The Problem
The Background
The Indications
References
19 Costal Cartilage Harvest
The Problem
The Background
The Indications
The Patient
The Surgery
The Limitations and Possible Complications
The Alternatives
The Pearls
References
5: The Dorsum
Part I: Overprojected Dorsum
20 Composite Hump Resection
The Problem
The Background
The Indications
The Patient
Patient 1
Patient 2
The Surgery
Patient 1 (Fig. 20.1)
Patient 2
The Limitations and Possible Complications
Composite Removal of Large Dorsal Hump
Alternative Techniques
The Alternatives
The Pearls
References
21 Component Hump Reduction With Midvault Reconstruction
The Problem
The Background
The Indications
The Patient
The Surgery (Table 21.1 Fig. 21.1)
Surgical Technique in Detail
The Limitations and Possible Complications
The Alternatives
The Pearls
References
22 Component Hump Resection With Placement of Spreader Grafts
Disclosure Statement
The Problem
The Background
The Indications
The Patient
The Surgery
Surgical Technique (Table 22.1 Fig. 22.1)
The Composites
The Limitations and Possible Complications
The Alternatives
The Pearls
References
23 Dorsal Hump Reduction With Simple Suturing
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
The Pearls
References
24 Dorsal Hump Deformity in Compromised Internal Valve
The Background
The Patient
The Problem
The Limitations and Possible Complications
The Alternative Techniques
The Pearls and Pitfalls
References
Part II: Nasal Radix Augmentation
25 Nasal Radix Augmentation With Crushed Cartilage
The Problem
The Background
The Indications
The Patient
The Surgery
The Pearls
References
26 Nasal Radix Augmentation With Temporalis/Mastoid Fascia Harvested Through Postauricular Approach
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
The Pearls
References
27 Dorsal Nasal Augmentation With Fascia Overlying Crushed Cartilage (Sandwich Technique)
The Problem
The Background
The Indications
The Patient
The Surgery (Overview of All Procedures)
The Surgery (Focused on Sandwich Technique)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
28 Internal Lateral and Medial Osteotomy
The Problem
The Background
The Indications
The Case
The Surgical Steps
The Surgical Steps (Focused on Internal Osteotomy)
Internal Continuous Osteotomy
Medial Osteotomy
The Composites
Main Technique
Limitations and Possible Complications
The Alternatives
The Pearls and Pitfalls
References
29 External Percutaneous Lateral and Transverse Osteotomies
Introduction
Method
Lateral Nasal Osteotomy and Its Effect on Nasal Breathing
Conclusion
References
30 Advances in Rhinoplasty—Piezoelectric Nasal Osteotomy
The Background
The Indication
The Patient
The Surgery
The Pearls
References
6: Nasal Tip
Part I: Tip Refining
31 Suture Tip Rhinoplasty
The Problem
The Background
The Indications
The Patient
The Surgery
Suture Tip-Plasty
Surgical Technique in Detail (Table 31.1 Fig. 31.2-31.3 Videos 31.1–31.3)
The Limitations and Possible Complications
The Alternatives (Table 31.3)
The Pearls
References
32 Boxy Tip: Combination of Techniques
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites (Fig. 32.2)
The Limitations and Possible Complications
The Alternatives
References
33 Tip Grafting
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives (Table 33.3)
The Pearls
References
Part II: Overprotected Tip
34 Lateral Crural Overlay
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites (Fig. 34.2)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
35 Medial Crural Overlay
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites (Fig. 35.2)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
36 Dome Division
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites (Fig. 36.3)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
Part III: Tip Underprojection
37 Structural Reconstruction in Difficult Secondary Cases
The Problem
Surgical Technique
Rectus Fascia and Rib Cartilage Harvest
Reconstruction of the Overresected Nose
Septum Reconstruction
Nasal Tip Reconstruction
Dorsum Reconstruction and Augmentation
The Patient
References
38 Dorsum Reconstruction and Osteoplasty Using Hand Instruments
The Problem
Surgical Technique
The Patient
References
39 Lateral Crural Steal (LCS)
The Problem
The Background
The Indications
The Patient
The Surgery (General LCS Technique)
The Composites (Fig. 39.2)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
40 Creating Adequate Projection With Closed Rhinoplasty
The Problem
The Background
The Indications
The Patient
Examination
The Surgery
The Composites (Figs. 40.1–40.14)
The Limitations and Possible Complications (Table 40.2)
The Alternatives (Table 40.3)
The Pearls
References
Part IV: Elongation of Short Nose
41 Dynamic Adjustable Rotational Tip Tensioning Technique
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
The Pearls
References
42 Tongue and Groove Technique for Nose Elongation
The Problem
The Background
The Indications
The Surgery
Name of Technique
Purpose
Indication
Effects
Surgical Technique in Detail
The Composites
The Limitations and Possible Complications
The Alternatives
The Pearls
References
43 Tongue-in-Groove Technique
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
The Pearls
References
Part V: Underrotated Tip
44 Tip Rotating in a Droopy Tip: Endonasal Approach
The Problem
The Background
The Indications
The Patient
The Surgery
Surgical Technique in Detail
The Composites (Fig. 44.3)
The Limitations and Possible Complications
The Alternatives
The Pearls
References
45 Reductive Rhinoplasty
The Problem
The Background
The Indications
The Patient
The Surgery
Reductive Rhinoplasty Techniques for an Underrotated Tip
Surgical Technique in Detail
The Composites (Fig. 45.4)
The Limitations and Possible Complications
The Alternatives
The Pearls
Disclaimer
References
Part VI: Cephalic Malpositioning
46 Cephalic Malpositioning: Use of Lateral Crural Strut Graft
The Problem
The Background
Characteristics of LCC Position
Surgical Correction of LLC Cephalic Position
References
47 Cephalic Malpositioning: Use of Alar Contouring Grafts
The Problem
The Background
Alar Contour Graft (Alar Rim Graft)
Alternatives to the Alar Region Graft
Gunter Graft and Its Modifications
Surgical Steps
Alar Batten Graft
Lateral Crural Turnover or Turn-In Graft (Cephalic Preserving Method) (see Fig. 47.2G)
Alar Spreader Graft (Lateral Crural Spanning Graft) (see Fig. 47.2H)
Soft Triangle Deficiency
The Composites
References
7: Nasal Base Surgery
48 Alar Preservation Rhinoplasty
The Problem
The Background
The Indications
The Patient
The Surgery
Alar Preservation
Purpose
Indication
Effects
Surgical Technique
The Composites
The Limitations and Possible Complications
The Alternatives
References
49 Correction of the Wide Nasal Base
The Problem
The Background
Alar
Sill
Alar and Sill
The Patients
Patient 1
Patient 2
The Surgery (Table 49.1 Fig. 49.3 Video 49.1)
The Alternatives
The Pearls
50 Nasal Base Modification
The Problem
The Background
The Indications
The Patient
The Surgery (Focused on Nasal Base Modification With Pyriform Ligament Release)
Surgical Steps
The Composites
The Limitations and Possible Complications
The Alternatives
References
8: Preservation Rhinoplasty
51 Lateral Crural Turn-In Flap (Preservation Tip Plasty)
The Problem
The Background
The Indications
The Patient
The Surgery
The Limitations and Possible Complications
The Composites (Fig. 51.3)
References
52 Preservation Rhinoplasty (Tip Plasty)
The Problem
The Background
The Indications
The Patient
The Surgery
Name of Technique
Purpose
Indication
Surgical Technique in Detail (Table 52.1 Video 52.1)
Low Septal Incision
Posterior Strut
Dorsal Dissection
Rim Flap
Dissection of Tip Cartilages
Markings and Resections
Cephalic Dome Suture
Placement of the Strut Graft
Tie Suture
C Suture
Fixation of the Columellar Polygon
Fixation of the Infralobular Polygon
Repair of Scroll Ligament
The Composites
The Limitations and Possible Complications
The Alternatives
References
53 K-Area Preservation in Primary Rhinoplasty
Introduction
A Few Words of the History of Preservation Rhinoplasty With High Septal Resection
Principles and Concepts
Important Reminders of Surgical Anatomy: Understanding Operative Biomechanics
Push-Down or Let-Down?
What are the Biomechanical Consequences of the K-Area Lowering on the Tip of the Nose?
How to Explain the Principles of This Preservation Rhinoplasty to Patients?
Technical Aspects of Dorsum Preservation Rhinoplasty
Endonasal Practice
Distinctive Features Related to the Transcolumellar External Open Approach
Indications and Contraindications of Conservative Rhinoplasty
Preoperative Assessment
What are the Pitfalls of Conservative Rhinoplasty?
How to Start Preservation Rhinoplasty and What Are the Best Indications?
Main Points (Table 53.1)
References
54 Dorsal Preservation in Rhinoplasty: A Deviated Nose
The Background
The Indications
The Surgical Technique
Reducing the Nasal Septum Height
Treating an Axis Deviation of the Nose
Limitations and Complications
The Alternative Techniques
References
9: Nonsurgical Rhinoplasty
55 Fat Grafting for Rhinoplasty
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
References
56 Medical Aesthetic Rhinoplasty—Liquid Rhinoplasty
Introduction
Case Reports
Background
Injecting HA
Tips and Tricks
Round Contour Defects (Fig. 56.1)
Eccentric Oval Shaped Defects (Fig. 56.5)
Longitudinal Defects (Figs. 56.1 and 56.6, Disguising a Hump or Scoop)
Elevating the Tip (Figs. 56.3 and 56.5, Filling the Philtral Groove and Supratip Video 56.2)
“Spreader” HA Injectate to Improve Valvular Nasal Obstruction (Figs. 56.4 and 56.6)
The Glabellar Notch (Fig. 56.1)
Considerations Prior to Injecting HA
Anecdotal and Subjective Observation Requiring Validation
The Limitations and Possible Complications
References
10: Ethnic Rhinoplasty
57 Dorsal Augmentation Using Glued Diced Costal Cartilage With Fascial Cap in Asian Nose
The Problem
The Background
The Indications
The Patient
The Surgery
Surgical Technique in Detail
The Composites
The Limitations and Possible Complications
The Alternatives
References
58 Indo-Aryan Nose
The Problem
The Background
The Indications
The Patient
Treatment Goals
The Surgery
External Septorhinoplasty
Purpose
Indication
Effects
Surgical Technique in Detail
The Composites
The Limitations and Possible Complications
The Alternatives
References
59 The Middle Eastern Nose
The Clinical Problem
Background: Defining the Middle Eastern Nose
The Patients
The Surgery
References
60 The Persian Nose: Characteristics and Management
The Problem
The Background
The Indications
The Patient
The Surger
Name of Technique
Purpose
Indications
Effects
Surgical Technique in Detail
References
61 Latino Nose
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
References
62 Grecian Nose
The Problem
The Background
The Indications
The Patient
The Surgery
Standard Open Rhinoplasty
Purpose
Indication
Effects
Surgical Technique in Detail
The Composites
The Limitations and Possible Complications
The Alternatives
References
63 Rhinoplasty in the Caucus Nose
Background
The Problem
Indications
The Patients
The Surgery
The Composites
The Limitations and Possible Complications
References
64 Russian Nose
The Problem
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
References
65 Northern European Nose
The Problem
The Background
The Patient
The Indications
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
References
66 The English Nose
The Problem
The Background—Defining the “English Nose”
The Assessment
The Surgical Procedure
Tips and Tricks
Elevating Marginal Tip Ptosis
References
67 African American Nose
The Problem
The Background
The Indications
The Patients
Patient #1
Patient #2
The Surgery
Patient #1
Patient #2
Examples of Other African American Rhinoplasty Patients
The Limitations and Possible Complications (Table 67.3)
Limitations
Complications
The Alternatives
68 Hispanic Nose
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
References
69 Brazilian Nose
The Problem
The Background
The Indications
The Patient
The Surgery
Technique
Operative Planning
Purpose
Indication
Effects
Surgical Technique in Detail
The Composites
The Limitations and Possible Complications
The Alternatives
References
70 The Mixed Race Nose (Mestizo Nose)
The Problem
The Background
The Indications
The Patient
The Surgery
Open-Approach Rhinoplasty
Purpose
Indication
Effects
Surgical Technique in Detail
The Composites
The Advantages and Possible Complications
The Alternatives
References
11: Complicated Rhinoplasty
71 Crooked Nose: Effective Treatment Strategies for Bony Contouring
Introduction
Anatomic and Clinical Considerations
Types of Osteotomies
Transverse or Medial Osteotomies
Intermediate or Midlevel Osteotomy
Base or Lateral Osteotomy
Nasal Bony Reshaping
Anterior versus Posterior Osteotomies
Narrowing the Base Width
Conclusions
References
72 Rhinoplasty in Thick-Skinned Patients
The Problem
The Background
The Patient (Composites 1, 2)
The Surgery
Purpose
Indication
Effects
Surgical Technique in Detail (Table 72.1)
The Composites
The Limitations and Possible Complications
The Alternatives
References
73 Rhinoplasty in the Aging Nose
The Problem
The Background
The Indications
The Patient
The Surgery (Focused on the Aging Nose)
The Composites
Limitations and Possible Complications
The Alternatives
References
74 Rhinoplasty in Cleft Lip and Palate Patients
Introduction
Anatomy
Surgical Timing in CLP Patients
Secondary Repair: Incisions and Technique
Rib Cartilage Graft
Critical Nasal Maneuvers for Most Cleft and Palate Patients
Nasal Septum
Spreader Grafts
The Nasal Dorsum and Osteotomies
Nasal Tip and Lower Lateral Cartilage
Premaxilla and Piriform Rim
Alar Base Reduction
Lip and Philtral Ridge
References
75 Simultaneous Orthognathic and Rhinoplasty Surgery
The Problem
The Background
The Indications
The Contraindications
The Patient
The Procedure
The Anesthesia
The Surgery
Surgical Steps
The Considerations
The Limitations and Possible Complications
The Alternatives
Further Reading
12: Complications and Revision Rhinoplasty
76 Management of the Ischemic Nose
The Problem
Background and Anatomy
The Indications
The Patient
The Surgery
Prevention During Open Rhinoplasty
Management of Ischemia
Surgical Technique in Detail
The Composites
References
Part I: Tip Deformities
77 Alar Pinch Deformity
General Condition of the Patient and Family History
Iatrogenic APD
Preoperative Analysis
Surgery
Lateral Crus Cartilage Interposition
Operative Technique
References
78 Correction of the Pinch Deformity by
Alar Batten Graft
The Problem
Introduction
Indications
Case Presentation
Surgical Steps
Surgical Steps (Focused on Alar Batten Graft)
The Composites
Limitations and Possible Complications
Alternative Techniques for Medial Osteotomy
References
Part II: Dorsal Deformities
79 Correction of Overresection With Crushed Cartilage
The Problem
The Background
The Indications
The Patient
The Surgery
References
80 Correcting the Overresected Nose
The Problem
The Background
The Indications
The Patient
The Surgery
The Composites
The Limitations and Possible Complications
The Alternatives
References
81 Correction of Overresection With Non-Rib Cartilage Wrapped in Fascia
The Problem
The Background
The Indications
The Patient
The Surgery
The Limitations and Possible Complications
The Alternatives
Further Reading
82 Correction of Overresection With Diced Cartilage Injection
The Problem
The Background
The Indications
The Patient
Examination/Assessment/Problem List
The Surgery
Name of Technique
Purpose
Indication
Effects
Surgical Technique in Detail
References
83 Diced Cartilage Glue Graft for Nasal Augmentation
The Problem
The Background
The Indications
The Patient
The Surgery
Surgical Technique in Detail
The Composites
The Limitations and Possible Complications
The Alternatives
References
Index
