Lipoabdominoplasty without undermining enhances aesthetic results with fewer complications than traditional abdominal aesthetic surgery. Aesthetic Surg J 2001;21:518-526.).
Since 1993 the authors have been using a new approach to the treatment of the muscles intimately related with the nasal tip and the upper lip, today known as dynamic rhinoplasty. With the idea of improving the dorsum-tip-labial relationship, the dynamic rhinoplasty technique is based on performing an intraoral zetaplasty at the labial frenum, allowing the access to the local musculature, represented by the depressor septi nasi muscle and its three fascicles. Next, we perform a subperiosteal undermining of the medial bundles, releasing them from the lower nasal spine, followed by the treatment of the intermedial bundles (which substitute the former by the special kind of plication at the median line, according to the primary characteristics of the upper lip). Initially, we used the new method only for the treatment of negroid nose or for cases of exuberant droopy nasal tip. Today, with improvements in the surgical technique, it is possible to operate on almost any kind of nasolabial combination, including mouth-breather patients and even cases with long upper lip and upright nose tip. Thus, the authors have established a semiotic classification, discussing both surgical indication and technique, and also showing the importance of combining several surgical stages (septoplasty, dynamic rhinoplasty, rhinosculpture, and turbinectomy) involved in each group.
When a person smiles and talks, everyone in his or her own specific way, it can be noticed that the tip of the nose drops and the upper lip shortens, making the nasolabial angle more acute. The importance of the upper lip in the dynamics of the nose makes necessary a more detailed study of the morphology and anatomical relations of the median part of the nasal septum depressor muscle, contributing in this way to new techniques in plastic surgery. The authors proposed to study the anatomy of the nasal septum depressor muscle and its relationship with the dermocartilaginous ligament of Pitanguy and the upper lip, important components of the nasal dynamics of facial expression. In this way they seek to contribute to the treatment of the nasal tip in aesthetic rhinoplasties.
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