Preservation rhinoplasty is a new way to reshape the nose by preserving the dorsum, nasal ligaments, soft tissue envelope, and muscles. This new concept provides the opportunity to achieve a more natural aesthetic and functional result. To achieve a good aesthetic and functional outcome while maintaining surgical safety, knowledge of the relevant anatomy is key. This is especially true for the preservation rhinoplasty technique, where a firm grasp of the anatomy of the nasal soft tissue and bony–cartilaginous framework is critical. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose and the dorsum. Furthermore, tip plasty is easier to perform under direct vision, which is an advantage of the open approach. The goal of this article is therefore to make clear all the important anatomical structures and their relevance to the surgical steps taken when performing the open preservation rhinoplasty technique.

A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.

No abstract

Prevention of unfavorable sequelae following humpectomy in reduction rhinoplasty by restoration of the middle nasal vault complex today has become imperative in the majority of patients with perhaps the exception of small humps. In general, the techniques used for preservation and reconstruction of these important anatomical structures can be divided into two main categories: spreader graft and spreader flap techniques. Oversimplified spreader graft techniques require donor cartilage, whereas spreader flap techniques use the excess height of the medial portion of the upper lateral cartilages in patients with a cartilaginous hump. In principle, both donor cartilage and preserved upper lateral cartilages usually are positioned along both sides of the dorsal septum to provide natural and harmonious contours as well as to avoid functional impairment (valve collapse). However, the considerable number of publications on this topic attests to existing downsides of both surgical principles. To overcome these shortcomings, we illustrate additional modifications in the application of spreader grafts as well as spreader flaps. However, the main goal of this article is to provide an algorithm helping to decide which technique is best suited to meet the requirements of each individual patient.

Malposition of the lower lateral cartilage (LLC) is a relatively common anatomical variation, described as any displacement of the lateral crura from the usual parallel direction with the nostril rims. Cephalic malpositioned LLC has the following characteristics: abnormal axes of the lateral crura, bulbous and broad nasal tip, parenthesis deformity, long alar creases, alar wall hollows, nostril deformities, and incompetence of the external valve. Numerous techniques were founded to correct this aesthetic and functional unpleasant variation, although all of them have some limitations. The authors described and evaluated the efficacy of the oblique turnover flap (OTOF) technique in the management of cephalic malposition of LLC (CMLLC). The advantages of this technique are: it does not need any additional grafting; it is quick and safe to perform; it has stable results. In the present study, 24 primary rhinoplasties using OTOF technique were performed between January 2014 and September 2016. There were 21 females (87.5%) and 3 males (12.5%), with age ranging from 23 to 46 years. The mean follow-up period was 12.1 months (range: 8–28 months). All patients were treated by the senior author (A.G.) in the RinoIstanbul Clinic. Three parameters were measured and compared pre- and postoperatively, using a t-test and a p value criteria of 0.05. The difference was found to be statistically significant: the angle between the central axis of the lateral crura and the septum on each side, satisfaction scale rating of the patients' nasal tip appearance and the satisfaction scale rating of patients' nose breathing. The angle of the central axis of lateral cruras to the midline significantly increased, the mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved. OTOF is a quick, useful, efficient technique for repositioning and flattening of the lateral cruras of CMLLC with a good, predictable, and stable long-term results in our hands if used on right candidates.

No abstract

No abstract

Augmentation mentoplasty is a cosmetic surgical procedure to correct chin retrusion or microgenia which usually requires placement of an alloplastic material over the pogonion, and which results in increased chin projection and a more aesthetically balanced facial profile. Polypropylene mesh is easy to purchase, widely available in a general hospital and most commonly used by general surgeons. In this series of 192 patients, we wanted to demonstrate our simple mentoplasty technique using prolene mesh that can easily be combined with a rhinoplasty procedure, with possible causes of infection and the rationale for using prolene mesh in such procedures.