Rhinoplasty Dissection Planes (Subcutaneous, Sub-SMAS, Supra-perichondral, and Sub-perichondral) and Soft Tissues Management

Neves, José; Zholtikov, Vitaly; Çakır, Barış; Coşkun, Erhan; Arancibia-Tagle, Diego

doi:10.1055/s-0041-1723825

Cited by 15 publications

(8 citation statements)

References 19 publications

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“…10 The nose is composed of bony and cartilaginous structures, having five layers: skin (1st layer); subcutaneous fat (2nd layer); the nasal superficial musculoaponeurotic system-SMAS (3rd layer); a loose areolar layer that includes deep adipose tissue (4th layer); followed by the perichondrium, connected to the cartilage, or the periosteum, connected to the bone (5th layer). [10][11][12] The skin of the upper and middle thirds of the nose is thin and pliable, while the skin overlying the tip is thicker and more attached to the cartilaginous structure. The interspace between skin and bone/cartilage averages 4.0 mm, being broader at the nasal root.…”

Section: Discussionmentioning

confidence: 99%

Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report

Magacho-Vieira¹,

Santana²

2023

CCID

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There has been considerable growth in the number of cosmetic injectable procedures in recent years. Consequently, physicians in general are seeing a greater number of patients who have previously had cosmetic implants. These patients often fail to mention or do not admit to having had previous cosmetic procedures, conditions that should be noted in their medical histories. In this article, the authors report a rare case of hyaluronic acid filler displacement resulting from injection in the nasal radix region that had been administered 10 months prior, which the patient failed to mention. The filler migration mimicked facial tumors, entangling an otherwise easy case and it was only recognized with the use of dermatological ultrasound. This serves as a warning and a reminder to include complications from cosmetic procedures in diagnostic hypotheses. Physicians need to be vigilant, question their patients' medical histories, and be familiar with diagnostic imaging options. The presence of dermal fillers should always be considered in cutaneous tumor lesions, since they can last for months to years, or be present in locations distant from the site of application.

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Section: Discussionmentioning

confidence: 99%

Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report

Magacho-Vieira¹,

Santana²

2023

CCID

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“…However, when we expose the cartilage, without the perichondrium protection, it becomes more fragile at the time of manipulation, as has also been observed in the lower lateral cartilages in nasal tip surgery (11). When applying traction forces on the septal cartilage, with no perichondrium protecting it, the cheese-wire phenomenon is very often observed, with the cartilage tearing with the purpose of the suture being lost.…”

Section: Nasal Septum Sub-laminar Dissectionmentioning

confidence: 95%

“…10 However, when we expose the cartilage, without the perichondrium protection, it becomes more fragile at the time of manipulation, as has also been observed in the LLCs in nasal tip surgery. 11 When applying traction forces on the septal cartilage, with no perichondrium protecting it, the cheese-wire phenomenon is very often observed, with the cartilage tearing with the purpose of the suture being lost. Even though this phenomenon is not evident during surgery, the force applied to the cartilage will condition some laceration in the immediate postoperation, which results from the constant force of suture over a weak cartilaginous tissue.…”

Section: Nasal Septum Sublaminar Dissectionmentioning

confidence: 99%

Cable and Mirror Sutures and the Nasal Septum Sublaminar Dissection

Neves

Martin

2023

Facial Plast Surg

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Managing the nasal septum position is crucial in septorhinoplasty. The analysis and the preparation of the anterior nasal spine and the quadrangular cartilage as well as the strategy defined to efficiently stabilize the septum will dictate considerably the success of the result. Moreover, what we see in the surgical table can suffer modifications during the healing process because of poor fixation or the cheese-wire effect of the cartilage. We will present a logical sequence and tools to achieve a proper and stable position of the nasal septum and the nasal pyramid. The sub-laminar (supra-perichondral) dissection of the quadrangular cartilage as an option to the sub-perichondral one and the use of cable and mirror sutures to three-dimensionally positioning and stabilizing the nasal septum will be described.

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“…Using a two-prong retractor, the assistant counter-tracts the flap upward. While performing supra-perichondrial dissection, the lateral crus is dissected along the previously made marginal incision [3]. During this process, 3-point traction around the LLC helps with the dissection [4].…”

Section: Flap Elevation Of Nasal Tip and Dorsummentioning

confidence: 99%

Dissection Manual for Open Rhinoseptoplasty in a Silicone Nose Model

et al. 2022

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Open rhinoseptoplasty has been widely performed in the field of otorhinolaryngology. However, from the perspective of beginners, rhinoseptoplasty is a hard-to-learn surgery that involves a relatively steep learning curve. Therefore, practical guidance is essential to enhance the skills needed for excellent surgical outcomes. Here, we provide a step-wise dissection manual using a commercialized silicone nose model designed for rhinoseptoplasty. The contents include general approaches with regard to transcolumellar inverted V incision, flap elevation, osteotomy, septoplasty, modification of the lower lateral cartilage for tip surgery, and dorsal augmentation using silicone implants. In addition, we introduce novel techniques such as dorsal augmentation using a ready-made mold with tissue glue applied to diced cartilage and polycaprolactone mesh for rhinoseptoplasty. The present study also provides photos of individual surgical procedures using a silicone nose model for actual guidance. The authors expect that this manual will help beginning rhinoseptoplasty surgeons improve their confidence.

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Rhinoplasty Dissection Planes (Subcutaneous, Sub-SMAS, Supra-perichondral, and Sub-perichondral) and Soft Tissues Management

Cited by 15 publications

References 19 publications

Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report

Displacement of Hyaluronic Acid Dermal Filler Mimicking a Cutaneous Tumor: A Case Report

Cable and Mirror Sutures and the Nasal Septum Sublaminar Dissection

Dissection Manual for Open Rhinoseptoplasty in a Silicone Nose Model

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