Frequency of the Preoperative Flaws and Commonly Required Maneuvers to Correct Them

Lee, Michelle; Zwiebel, Samantha; Guyuron, Bahman

doi:10.1097/prs.0b013e3182a01457

Cited by 35 publications

(29 citation statements)

References 21 publications

(20 reference statements)

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“…Examples of minor revision include addressing a residual highpoint on the nasal dorsum, deviation of the caudal septum, or nostril asymmetry. Function and form must also be addressed, [8][9][10]15 as common causes of dysfunctional noses after surgery include persistence of a deformity in the dorsal nasal septum and insufficiency of the nasal sidewall or vault, which will likely compromise valvular function either in a static or dynamic way. 16 This study attempts to categorize the commonly seen problems requiring revision and to propose strategies that could be applied to both primary and revision operations to minimize the need for further revision.…”

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confidence: 99%

Revision Rhinoplasty: What Can We Learn from Error Patterns? An Analysis of Revision Surgery

East

Kwame

Hannan³

2016

Facial plast Surg

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Of the many challenges in rhinoplasty, achieving a satisfactory outcome at the first operation is important. There are multiple reasons for secondary surgery, and generally revisions can be broadly classified into minor (often one area of deficit) or a total redo. Understanding the common technical reasons for failure in primary surgery by analyzing the deformities has resulted in various error patterns emerging. Understanding these patterns means we can modify techniques in primary surgery to reduce the incidence of revision. This article describes our prospective revision rhinoplasty experience over 5 and then 2 years, highlighting the main error patterns encountered. We also describe a stepwise analysis of four frequently encountered key problem areas alongside techniques to address them and offer pearls to help prevent further revision. Comparison of two cohorts of patients from a teaching hospital setting and private practice with the same operating surgeon indicates an increasing tendency to the open approach for revisions. The re-revision rates for these groups are 15.7 and 9%, respectively. Revision rhinoplasty is a difficult operation to perform to the satisfaction of both the surgeon and the patient. Understanding the common technical reasons for failure in primary surgery by fully analyzing the deformities means we can modify techniques in primary surgery to reduce the incidence of revision.

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confidence: 99%

Revision Rhinoplasty: What Can We Learn from Error Patterns? An Analysis of Revision Surgery

East

Kwame

Hannan³

2016

Facial plast Surg

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“…The surgeon will often identify more abnormalities than the patient and it is crucial that the surgeon have a clear understanding of the motivating factors for a patient to seek revision surgery so that an appropriate operative plan may be generated. 1 Most patients will present with clinically significant aesthetic and/or functional abnormalities that can be addressed, but there are the occasional patients with unrealistic expectations or have body dysmorphic disorder (BDD) where surgical intervention should be avoided. 6 A thorough, unhurried consultation will allow the surgeon the ability to gain insights into not only the anatomic abnormalities, but the psychological factors unique to that particular patient.…”

Section: Approach To the Revision Rhinoplasty Patientmentioning

confidence: 99%

“…Dissatisfaction with the nasal tip is a common compliant in patients seeking revision surgery and often includes complaints of nasal tip and nostril asymmetry. [1][2][3] The objective findings of tip and nostril asymmetry are often caused by lower lateral cartilage abnormalities that are frequently associated with subjective symptoms of nasal obstruction from poor nasal sidewall support and nasal valve insufficiency. Nasal obstruction is a very frequent compliant in patients seeking revision surgery with rates as high as 94% in some studies.…”

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confidence: 99%

“…Nasal obstruction is a very frequent compliant in patients seeking revision surgery with rates as high as 94% in some studies. 1,2 Often contributing to the tip irregularity in revision patients are caudal septal deformities that also promote ongoing nasal obstruction. Other common tip complaints include abnormal tip rotation or projection and excessive tip width and bulbosity.…”

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confidence: 99%

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Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Moyer

2018

Facial plast Surg

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Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities.

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“…A normally positioned (orthotopic) lateral crura diverges ≥45° from midline and is directed toward the ipsilateral lateral eye canthus (3). According to previous studies on alar cartilage malposition (4)(5)(6), cephalically positioned alar cartilages show a variety of characteristics including long alar creases, boxy (7) and ball-shaped nasal tip (8), parenthesis tip deformity and, finally, external valvular incompetence (9)(10)(11). Previous studies have suggested techniques to correct cephalic malposition (12)(13)(14)(15), but the gold standard is still lateral crural strut graft (Gunter graft) (16); however, many patients experience problems after this technique.…”

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Repositioned lateral crural flap technique for cephalic malposition in rhinoplasty

2015

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Background Cephalic malposition of the lower lateral cartilage (CMLLC) is a relatively common anatomical variant, particularly in Middle Eastern patients. The characteristics of CMLLC include long alar creases, a boxy and ball-shaped nasal tip, parenthesis tip deformity and external valvular incompetence. The gold standard for correcting CMLLC is the lateral crural strut graft (Gunter graft), but many patients experience problems after this technique. Objective To evaluate the efficacy of the repositioned lateral crural flap (RLCF) technique in correcting CMLLC, and to discuss the cosmetic and functional results. Methods In the present study, 123 primary septorhinoplasty operations using the RLCF technique were performed between May 2012 and March 2013. The mean follow-up period was 11.4 months (range nine to 24 months). Four parameters were measured and compared pre- and postoperatively: the angle between the line connecting the maximum convexity of the lower lateral cartilage (LLC) to the tip-defining point and midline on each side (angle of rotation); the total distance between the maximum convexity of LLC right and left to midline (representing the size of the parenthesis deformity); satisfaction scale rating of the patients' nasal tip appearance; and the satisfaction scale rating of patients' breathing through their nostrils. Results The mean angle of the LLC to the midline significantly increased and the mean distance between the maximum convexities was significantly reduced, indicating correction of the malposition and reduction of the parenthesis deformity, respectively. The mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved. Conclusion CMLLC can be corrected using the RLCF technique, resulting in both aesthetic and functional improvements.

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Frequency of the Preoperative Flaws and Commonly Required Maneuvers to Correct Them

Abstract: The high incidence of airway concerns among secondary rhinoplasty patients is alarming and emphasizes the urgent need to pay attention to the airway during primary rhinoplasty. There is often a disparity between what the patient sees and what the surgeon observes.

Cited by 35 publications

References 21 publications

Revision Rhinoplasty: What Can We Learn from Error Patterns? An Analysis of Revision Surgery

Revision Rhinoplasty: What Can We Learn from Error Patterns? An Analysis of Revision Surgery

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Repositioned lateral crural flap technique for cephalic malposition in rhinoplasty

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