Preface
Contents
Editor and Contributors
Editor
Contributors
Preoperative Evaluation and Postoperative Care
Asian Rhinoplasty
Characteristics of Asian Face and Nose
Preoperative Evaluation
General Preoperative Consideration
Initial Consultation
Patient Expectations and Suitability for Rhinoplasty
History
Preoperative Evaluation
Inspection
Physical Examination
Photographic Analysis
Imaging Analysis
Systematic Nasal Analysis
Postoperative Management
Immediate Postoperative Management
Dressings
Medications
Postoperative Care and Instructions for Patients
Edema and Ecchymosis
Epistaxis and Hematoma
Activity Restriction
Dressings and Stitch Removal
Further Reading
Nasal Dorsal Augmentation Using Implant and Autogenous Tissues
Dorsal Augmentation Using Implants
Selection of Implants
Operative Techniques
Preoperative Design
Incision and Dissection
Irrigation of Pocket
Implant Carving
Implant Insertion
Wound Closure and Dressing
Dorsal Augmentation with 3D Printing Technology
Design and Manufacturing Process
Advantages and Disadvantages of 3D Printed Nasal Implant
Dorsal Augmentation Using Autogenous Tissues
Dorsal Augmentation with Dermofat
Graft Harvest
Dorsal Augmentation Technique
Vertically-Oriented Folded Dermal Graft Technique
Harvest of the Graft
Fabrication of the Harvested Graft
Placing the Graft on the Dorsum
Dorsal Augmentation with Costal Cartilage
Harvesting the Costal Cartilage
Carving the Costal Cartilage
Concentric Carving Technique
Multilayered Costal Cartilage Graft Technique
Placing the Graft on the Dorsum
Dorsal Augmentation with Diced Cartilage Wrapped in Fascia
Operative Technique
Harvest of Temporal Fascia
Dicing the Cartilage
Packing the Diced Cartilage in the Tube-Shaped Fascia
Insertion of the Diced Cartilage in Fascia to the Pocket
Further Reading
Nasal Tip Techniques (1): Tip Augmentation Techniques
Tip Augmentation (Correction of Low Tip)
Suture Techniques
Transdomal Suture
Lateral Crural Mattress Suture
Interdomal Suture
Intercrural Suture
Lateral Crural Spanning Suture
Medial Crural Septal Suture
Lateral Crural Septal Suture
Columellar Septal Suture
Ear Cartilage Graft
Surgical Techniques
Ear Cartilage Harvesting and Fabrication
Application of Cartilage Graft
Tip Lengthening (Correction of the Short Nose)
Surgical Techniques
Flap Elevation
Caudal Release of Alar Cartilage
Fixation of Caudally Released Alar Cartilage
Further Reading
Nasal Tip Techniques (2): Bulbous Tip Correction
Introduction
Definition
Etiology and Types
Preoperative Analysis
Visual Analysis
Physical Analysis
Operative Consideration
Thinning and Debulking of Skin and Soft Tissue Envelope
Dual Plane Dissection and Debulking
Defatting Procedure
Nasal Tip Refining and Reduction for Bulbous Tip Correction
Intraoperative Analysis
Suture Technique and Procedures for Correction of Bullous Tip
Medial and Middle Crural Suture
Interdomal Suture
Transdomal Suture and Hemitransdomal Suture
Lateral Crural Spanning Suture
Cephalic Trimming of Lateral Crus
Rebuilding of Nasal Tip Tripod with Tip Refinement in Asian Rhinoplasty
Complete Release of Alar Cartilage
Rebuilding Nasal Tip Tripod
Ideal Nasal Tip Refinement of Alar Cartilage for Bulbous Tip Correction
Tip Extension Suture
Overcoming Obstacles of Tip Extension Suture with Dorsal Batten Graft
Septal Extension Graft
Other Considerations of Bulbous Tip Correction
Supratip Deformity
Tip Graft
Secondary Bulbous Tip Correction
Further Reading
Nasal Tip Technique (3): Tip Shortening
Preoperative Analysis and Surgical Planning
Classification and General Concept
Long Nose with Drooping Tip (Type I)
Anatomic Causes of Long Nose with Drooping Tip
Abnormal Position and Shape of Alar Cartilage and Septal Cartilage
Dynamic Pulling Forces on the Nasal Tip by Underlying Muscles
Correction of Long Nose with Drooping Tip
Correction of the Alar Cartilage
Modified Transdormal Suture for Medial Crus Lengthening
Making Cartilage Rein Flap or Partial Resection of the Cephalic Portion of Lateral Crura
Lateral Crura Shortening with Resection or Overlay Suture
Columellar Septal Suture and Excision of Caudal Septal Cartilage
Consideration of the Nasal Tip and Columella Support
Columella Strut Graft for Tip Support
Shield Graft
Solving Problems with the Muscles: The Dynamic Components
Excision of the Depressor Septi Nasi Muscle and Columella Base Augmentation
Weakening of Levator Labii Superioris Alaque Nasi Muscle and Peri-alar Augmentation
Debulking of Bulbous Tip and Redundant Nasal Skin Management
Strategy of Collaborative Approach for Long Nose with Drooping Tip
Long Nose with Normal Height Tip (Type II)
Long Nose with Overprojected Tip (Type III)
Long Nose with Bulbous Nasal Tip (Type IV)
Further Reading
Surgery of Columella, Alar Rim and Alar Base
Hanging Columella
Anatomic Causes of Hanging Columella
Correction of Hanging Columella
Columellar Septal Suture
Caudal Septal Reduction
Caudal Margin Trimming of Medial Crura
Latrogenic Hanging Columella
Retracted Columella
Anatomic Causes of Retracted Columella
Correction of Retracted Columella
Caudal Reposition of Medical Crura
Septal Extension Graft
Columellar Strut with Derotation Graft
Septal Extension with Derotation Graft
Rib Cartilage Graft
Retracted Ala
Anatomic Causes of Retracted Ala
Correction of Retracted Ala
Methods with Caudal Reposition of Lateral Crura
Methods Without Caudal Reposition of Lateral Crura
Latrogenic Retracted Ala
Hanging Ala
Anatomic Causes of Hanging Ala
Correction of Hanging Ala
Wide Alar Base
Anatomic Causes of Wide Alar Base
Correction of Wide Alar Base
Further Reading
Mid-vault Surgery
Introduction
“Nasal Septum Theory”
Hump Nose
Surgical Details: Nasal Tip Projection with Humpectomy
Saddle Nose
Further Reading
Deviated Nose Correction and Functional Surgery 1
Esthetic Analysis and Nasal Breathing Function
Surgical Treatment
Correction According to Anatomical Location
Correction of the Bony Pyramid
Correction of the Septal Cartilage, Upper Lateral Cartilages, and Lower Lateral Cartilages
In Situ Septal Correction
Spreader Grafts
Dorsal L-Strut Cutting and Suture Technique
Cutting and Suture Technique of the Caudal Septum
Septal Batten Graft
Interposition Batten Graft
The Use of Septal Bone for Correction of the Septal Cartilage
Resection of the Posterior Angle of the Septum
Caudal Septal Relocation Suture
Correction of Cephalo-Caudal Deviation
Extracorporeal Septoplasty
Correction of the Upper Lateral Cartilaginous Deformity
Correction of the Lower Lateral Cartilage
Significance of Dorsal Augmentation in Deviated Noses
Alar Base Modification and Tilted Ala Correction
Turbinoplasty
Prognosis and Complications of Surgery
Further Reading
Functional Surgery 2: Consideration of Internal Valve Problems in Asian Rhinoplasty, and Turbinate Reduction
Functional Aspects of Internal Valve
Anatomy
Cottle Test
Physiology
The Shape of Internal Valve and Collapse of ULC
Spreader Graft
Extended Spreader Graft
Specific Perspectives in Asian Rhinoplasty
Spreader Flap
Splay Graft (Spring Graft)
Internal Valve: The Impact on Asian Septorhinoplasty
The More Reduction, the More Spreader Graft
What Is the Cause of Nasal Obstruction after Septorhinoplasty?
Nasal Synechia
Ignorance of Internal Valve
Unique Internal Valve Problems in Asian Rhinoplasty
Exaggerated Tip Sutures
Exaggerated Supratip Graft
Possible Solutions
Turbinate
Inferior Turbinate Surgery
RAIT
MAIT
Further Reading
Secondary Rhinoplasty (1): Implant-Related Complications
Introduction
Dorsal Implant Movability and Migration
Causes of Movability (Unstable Moving) and Migration
Treatment of Movability and Migration
Dorsal Implant Deviation
Treatment of Dorsal Implant Deviation
Dorsal Implant Demarcation, Dorsal Irregularity and Envelope Thinning
Causes of Dorsal Implant Demarcation
Cause of Dorsal Skin Irregularity
Treatment of Demarcation, Irregularity, and Thinning
Nasal Skin Redness
Potential Causes of Tip Skin Redness
Treatment of Nasal Skin Redness
Tip Hardness and Discomfort
Causes of Tip Hardness and Discomfort
Treatment of Tip Hardness and Discomfort
Visible Implant onto the Tip
Implant Exposure Through the Nasal Skin
Implant Exposure Through the Intranasal Mucosa
Inflammation and Infection
Inflammation Related to Implants
Biofilms in the Operated Nose
Inflammation: As an Initiator for Contracture
Inflammation Due to Autologous Graft Failure
Viral Infection around Nose
Further Reading
Secondary Rhinoplasty (2): Mid-vault Correction
Post-humpectomy Dorsal Irregularities
Residual Dorsal Hump
Depressed Dorsum
Open Roof Deformity
Inverted-V Deformity
Correction Technique
Spreader Graft
Splay Graft
Saddle Nose Deformity
Causes and Classification
Correction of Saddle Nose Deformity
Camouflage Operation for Type I Static Saddle Nose
Anatomical Structural Reconstruction
Dorsal Augmentation
Correction of Type IV Saddle Nose
Further Readings
Secondary Rhinoplasty (3): Tip
The Features of Secondary Nasal Tip Surgery
The Goals of Secondary Nasal Tip Surgery
General Surgical Preparation for Secondary Nasal Tip Surgery
Precautions for Secondary Nasal Tip Surgery
Under-Projected Tip
Anatomic Cause of Under-Projected Tip
Correction of Under-Projected Tip
Supra-Tip Deformity
Anatomic Cause
Correction of Supra-Tip Deformity
Pinched Nasal Tip
Anatomic Cause
Correction of Pinched Nasal Tip
Big Tip Nose
Anatomic Cause
Correction of Big Tip
Asymmetry Nasal Tip
Anatomic Cause
Correction of Asymmetric Tip
Further Reading
Contracted Nose: My Preferred Technique
Introduction
Pathogenesis of a Short, Contracted Nose
Patient Evaluation
Timing of Revision Rhinoplasty
Materials and Approach
Strategies for Correction
Surgical Techniques
Rib Cartilage Harvesting and Carving
Skin Dissection
Building Structures to Lengthen the Tip
Release of Lower Lateral Cartilage
Additional Lengthening
Dorsal Augmentation
Closure of Wound
Adding Soft Tissue to the Skin Envelope
Further Reading
Contracted Nose and Difficult Complication Cases: My Preferred Technique
Case 1
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 3a, c, e, g and b, d, f, h)
Case 2
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 7a, c, e, g, i and b, d, f, h, j)
Case 3
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 10a, c, e, g, i and b, d, f, h, j)
Case 4
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 13a, c, e, g, i and b, d, f, h, j)
Case 5
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 16a, c, e, g, i and b, d, f, h, j)
Case 6
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 19a, c, e, g, i and b, d, f, h, j)
Cases 7
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 22a, c, e, g, i, k and 22b, d, f, h, j, l)
Case 8
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 26a, c, e and b, d, f)
Case 9
Pre-operative Findings
Intra-operative Findings
Operative Procedures: 1st Stage Operation
Pre-operative and Post-operative Photographs (Fig. 29a, c, e, g, i, k and b, d, f, h, j, l)
Operative Procedures: 2nd Stage Operation
Pre-operative and Post-operative Photographs (Fig. 31a, c, e, g, i, k and 31b, d, f, h, j, l)
Case 10
Pre-operative Findings
Intra-operative Findings
Operative Procedures: 1st Stage Operation (Skeletal Framework Reconstruction)
Pre-operative and Post-operative Photographs (Fig. 34a, c, e, g, i and b, d, f, h, j)
Operative Procedures: 2st Stage Operation (For More Tip Lengthening, Dorsal Augmentation, Tip Refinement)
Pre-operative and Post-operative Photographs (Fig. 36a, c, e, g, i and b, d, f, h, j)
Case 11
Pre-operative Findings
Intra-operative Findings
Operative Procedures: 1st Stage Operation
Pre-operative and Post-operative Photographs (Fig. 39a, b)
Operative Procedures: 2st Stage Operation
Operative Procedures: 3rd Stage Operation
Pre-operative and Post-operative Photographs (Fig. 42a, c, e, g, i and b, d, f, h, j)
Case 12
Pre-operative Findings
Intra-operative Findings
Operative Procedures
Pre-operative and Post-operative Photographs (Fig. 45a, c and b, d)
Case 13
Past Surgical History
Pre-operative Findings
Operative Procedures: 1st Stage Operation
Pre-operative and Post-operative Photographs (Fig. 48a, c, e and b–f)
Operative Procedures: 2st Stage Operation
Operative Procedures: 3rd Stage Operation
Pre-operative and Post-operative Photographs (Fig. 51a, c, e, g and b, d, f, h)
Secondary Cleft Lip Rhinoplasty
Introduction
Secondary Nasal Deformity
Preoperative Evaluation
Secondary Unilateral Cleft Rhinoplasty
Surgical Techniques
Repositioning the Alar Cartilage
Septal Repositioning with a Columella Strut
Alar Base Repositioning
Midvault Asymmetry
Nostril Rim Correction: Cleft and Non-cleft Sides
Nasal Dorsum
Outcome and Limitation
Further Reading
Injection Rhinoplasty
Anatomy for Injection Rhinoplasty
Layers of the Nose
Vascular Anatomy of the Nose
Considerations for Filler Injection
Needle/Cannula
Entry Point
Fate of Filler Injections
Filler Types
Hyaluronic Acid Fillers
Semipermanent/Permanent Fillers
Complications
Nonvascular Complications
Infection
Widely Looking Appearance
Vascular Complications
Skin Necrosis
Ocular Complications
Further Reading
