The lateral crural strut graft is a new, versatile technique for reshaping, repositioning, or reconstructing the lateral crura. These grafts are strips of autogenous cartilage that are sutured to the deep surface of the lateral crura. Lateral crural struts are useful in the correction of the boxy nasal tip, malpositioned lateral crura, alar rim retraction, alar rim collapse, and concave lateral crura. We describe the surgical technique and demonstrate representative results of our experience with these grafts in 118 patients.
Autogenous rib cartilage grafts have gained more widespread use in rhinoplasty as dorsal onlay grafts and columellar struts. However, the usefulness of rib as a donor site has been limited by difficulties with postoperative cartilage warping. We hypothesized that the internal stabilization of rib cartilage grafts with Kirschner wires would prevent warping. The costochondral cartilages of a fresh cadaver were harvested and carved into 4 x 10 x 40 nm blocks. A single 0.035-in K-wire was placed longitudinally into the center of each of the study specimens (n = 9), whereas no internal stabilization was utilized in the control group (n = 9). Over a 10-day study period, a mean of 2.2 degrees of warping was observed in the grafts with K-wires as compared to 8.9 degrees in the control group. This indicates that internal stabilization of rib grafts significantly reduces warping (p < 0.001). In a subsequent clinical study, 28 patients underwent placement of internally stabilized columellar struts (n = 19) and/or dorsal nasal grafts (n = 12) using autogenous rib cartilage. At a mean follow-up of 13.5 months (range 3 to 36 months), graft warping was not observed in any patient. Satisfactory aesthetic results were achieved in all but one patient, in whom mild displacement of a dorsal onlay graft occurred. Palatal extrusion of the K-wire occurred in 3 of the first 9 columellar struts. This prompted an alteration in technique with no subsequent extrusions. We conclude that the internal stabilization of autogenous rib cartilage grafts with K-wires effectively prevents graft warpage.
Advances in surgical techniques and instrumentation have led to an increased popularity of brow-lifting procedures. However, because of patient variability and differing surgeon opinions, eyebrow aesthetics and thus surgical goals remain to be clearly defined. We performed an in-depth evaluation of current eyebrow aesthetics using two study groups. Popular fashion models were evaluated and compared with our own patient population. Important differences in eyebrow position and shape between these groups are delineated and the surgical implications defined. Criteria that contribute to the aesthetics of the eyebrow are reviewed, and guidelines to optimize surgical results and avoid potential complications are discussed.
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