Bulbous Nasal Tip: An Anatomical and Histological Evaluation

Garramone, Ralph R.; Sullivan, Patrick K.; Devaney, Kenneth O.

doi:10.1097/00000637-199503000-00011

Cited by 22 publications

(13 citation statements)

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“…Although risks of nasal tip soft tissue removal such as skin necrosis or skin irregularity should be noted, complication rate will be decreased if you do not violate the dermis and remain in correct plain; on the other hand Garramone et al [6] showed that fibrous tissue comprising the majority of subdermal tissue and skeletal muscle was the second most prevalent component of nasal tip subdermal tissue, and it is believed that this fibromuscular tissue can be safely resected without violating the dermis, thereby decreasing the soft-tissue bulk of the nasal tip and not interfering with vascular supply to the skin envelop, and also there is no difference in sensory recovery time of nasal skin “which is a common source of discomfort for rhinoplasty patients” with or without subdermal soft tissue removal in tip and supratip areas.…”

Section: Discussionmentioning

confidence: 99%

“…An anatomical and histological evaluation of the tissue specimens obtained from the tip and supratip regions showed that collagenous fibrous tissue, adipose tissue, and skeletal muscle were the predominant subdermal tissue type present; fibrous tissue, in fact, comprised the majority of the subdermal tissue so this fibromuscular tissue can be safely resected without violating the dermis thereby decreasing the soft tissue bulk of the bulbous nasal tip and not interfering with the vascular supply to the skin envelope [6]. One of the complications that commonly are seen after rhinoplasty is hypesthesia; the terminal branch of the anterior ethmoidal nerve supplies tip sensation and is usually transected during intercartilaginous incision [7].…”

Section: Introductionmentioning

confidence: 99%

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Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with and without Soft Tissue Removal

Bakhshaeekia

Ghiasi-hafezi

2012

Plastic Surgery International

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In this study we evaluated sensory alteration in nasal tip and adjacent upper columella (territory of external nasal nerve) after open rhinoplasty. Two groups were randomly selected, each containing 25 patients with thick nasal skin; sensory testing was done preoperatively in all patients; in group one, subdermal soft tissue in tip and supratip areas was removed but in group two no soft tissue removal was done; we compared sensory pressure threshold values 3 weeks and 6 months postoperatively. Results showed no statistical difference between the two groups in nasal skin sensibility at these times; also this study showed that 6 months after rhinoplasty normal sensation of nasal skin will be achieved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with and without Soft Tissue Removal

Bakhshaeekia

Ghiasi-hafezi

2012

Plastic Surgery International

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“…6,19,23 This dissection must respect the vascular plexus in the subcutis that supplies the skin. 10,19,23,62 Care must be taken not to compromise the paired lateral arteries that supply the vascular plexus of the subcutis, especially while working in the alar crease area. 10,19 The SMAS-debulking is contraindicated if the SSTE is less than 3 mm in thickness or in patients with a history of irradiation.…”

Section: Stretching Of the Ocfmentioning

confidence: 99%

Surgical and Nonsurgical Management of the Nasal Skin-Soft Tissue Envelope

Saadoun

Riedel²,

D’Souza

et al. 2021

Facial Plast Surg

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Management of the skin-soft tissue envelope (SSTE) in rhinoplasty is challenging and critical for the overall outcome. The preoperative identification of patients with thick or thin skin and with preexisting skin conditions may contribute significantly to the postsurgical result. Most publications and textbooks focus on the management of the osseocartilaginous framework, but the SSTE management is often not addressed in detail. However, nonsurgical treatments, such as skin preconditioning, topical steroid-injections, oral isotretinoin, and topical vitamin A derivatives, may provide strong benefits. In this article, we reviewed the literature to present a comprehensive review on the available surgical and nonsurgical approaches pre-, intra-, and postoperatively dealing with SSTE in rhinoplasty.

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“…However, the subcutaneous fibromuscular tissue layer (located just below the subdermal fat) is markedly hypertrophic in noses with ultrathick skin, and this accounts for nearly all of the observed additional SSTE thickness. 3 This layer has been dubbed the "nasal superficial muscular aponeurotic system (SMAS)" since it resembles the SMAS found elsewhere in the face. 4 A significantly thickened nasal SMAS can substantially widen the nasal tip complex, obscure the underlying tip architecture, blunt surface definition, and ultimately create an amorphous and decidedly unattractive tip contour.…”

Section: Ultrathick Nasal Skinmentioning

confidence: 99%

Surgical Management of the Thick-Skinned Nose

Davis

Hrisomalos

2018

Facial plast Surg

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When executed properly, open structure rhinoplasty can dramatically improve the consistency, durability, and quality of the cosmetic surgical outcome. Moreover, in expert hands, dramatic transformations in skeletal architecture can be accomplished with minimal risk and unparalleled control, all while preserving nasal airway function. While skeletal enhancements have become increasingly more controlled and precise, the outer skin-soft tissue envelope (SSTE) often presents a formidable obstacle to a satisfactory cosmetic result. In noses with unusually thick skin, excessive skin volume and characteristically hostile healing responses frequently combine to obscure or sometimes even negate cosmetic skeletal modifications and taint the surgical outcome. For this challenging patient subgroup, care must be taken to optimize the SSTE using a graduated treatment strategy directed at minimizing skin thickness and controlling unfavorable healing responses. When appropriate efforts are implemented to manage thick nasal skin, cosmetic outcomes are often substantially improved, sometimes even negating the ill-effects of thick skin altogether.

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Bulbous Nasal Tip: An Anatomical and Histological Evaluation

Cited by 22 publications

References 0 publications

Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with and without Soft Tissue Removal

Comparing the Alteration of Nasal Tip Sensibility and Sensory Recovery Time following Open Rhinoplasty with and without Soft Tissue Removal

Surgical and Nonsurgical Management of the Nasal Skin-Soft Tissue Envelope

Surgical Management of the Thick-Skinned Nose

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