Frédéric Braccini, MD
Institut Azuréen d'Orl et de Chirurgie de la Face
25 avenue Jean Médecin
06000 Nice , France
Mail contact: f_braccini@hotmail.com
Website: www.braccini.net

Jérome Paris, MD
Institut Euro Méditerranéen de Chirurgie Plastique & esthétique
13, rue Roux de Brignoles
13006 Marseille FRANCE
Mail contact: paris.J@wanadoo.fr
Website: www.iemcep.com

Rhinoplasty surgical procedure is one of the most interesting and complex aesthetic surgical procedure… proved by the number of secondary rhinoplasties.
The main goal of  aesthetic  and artistic rhinoplasty is to achieve a natural look of beauty enhancement and most harmonious face.
There is no one standart rhinoplasty but  many rhinoplasties that have to suit to each patient.
Quest of beauty is everyone demand for a better well being and self confidence.
Rhinoplasty has to improve facial aesthetics and to improve nasal breathing function which is also an important point for patients.

Sameer Ali Bafaqeeh, MD
Professor and Consultant, Department of Otorhino-laryngology - Head & Neck
Surgery, King Saud University, Riyadh, Saudi Arabia.
Dept. of ENT,
King Abdulaziz University Hospital
P.O.Box-245,
Riyadh 11411, KSA.
966 1 4775735
966 1 4775748 (fax)
Email: sa.bafaqeeh@gmail.com

Introduction

Rhinoplasty remains one of the most challenging operations, as exempli- fied in the Middle Eastern patient. Middle Eastern rhinoplasty (MER) is becom- ing more frequent, not only in the west in general and in the United States in particular but also in the region as more people break the cultural barrier locally and get international; mostly western exposure. This has meant a huge number of patients spend a huge amount of time and money on cosmesis. This can be seen by the many number of beauty centers seen in every major city of the Mid- dle East providing services ranging from holistic medicine to facial and body contouring procedures. Mature patients often request a more refined, feminine nose, whereas younger patients (aged 15 to 25 years) want a smaller, cuter nose. When patients consider cosmetic facial surgery, a multitude of factors sur- round their decisions, ideas of beauty change depending upon the social and cultural zeitgeist. The concept of beauty is and always will be subjective. In the past, standardized mathematical proportions have been used, such as "phi mask" of Marquardt. This mask is a model based on the golden, or "phi," ratio found in beautiful things in nature and validated by a large database of attractive faces. Modifications were made to include not only a Caucasians versions but also African and Asian versions, these models are incapable of including the full range of ethnicities that often present to the facial plastic surgeon. Nevertheless, there are some characteristics of beauty that are agreed upon across race and gender. These features include symmetry and a composite of average facial features.

Corresponding author for proof: Fred Fedok, MD FACS
Division of Otolaryngology-Head and Neck Surgery
H091
500 University Drive
Hershey, PA 17033
ffedok@hmc.psu.edu
717-531-6718
717-531-6160 (fax)

Coauthor: Eelam Adil, MD MBA
Division of Otolaryngology-Head and Neck Surgery
H091
500 University Drive
Hershey, PA 17033
eadil@hmc.psu.edu
717-531-6718
717-531-6160 (fax)

Coauthor: Ron Mitzner, MD
Division of Otolaryngology-Head and Neck Surgery
H091
500 University Drive
Hershey, PA 17033
rmitzner@hmc.psu.edu
717-531-6718
717-531-6160 (fax)

Introduction

Autologous costal cartilage is an excellent source of grafting material in the nose.  It has several advantages when compared to other autologous grafts.  First of all, it is versatile and can be carved into many different shapes and sizes depending on the patient's deformity.  It is also more abundant and usually stronger than other cartilages.  There are several situations where abundant, strong cartilage is necessary, precluding the use of other grafting materials.  Examples of such situations include nasal reconstruction following tumor resection, saddle nose deformity, ethnic rhinoplasty, congenital deformity, and revision (secondary) rhinoplasty.  Finally, it is relatively easy to harvest using a small incision.  In the senior author's experience, rib cartilage can be harvested in less than 30 minutes.

Sameer Ali Bafaqeeh, MD
Professor and Consultant, Department of Otorhino-laryngology - Head & Neck
Surgery, King Saud University, Riyadh, Saudi Arabia.
Dept. of ENT,
King Abdulaziz University Hospital
P.O.Box-245,
Riyadh 11411, KSA.
966 1 4775735
966 1 4775748 (fax)
Email: sa.bafaqeeh@gmail.com

Introduction

Post-operative persistent, unattractive nasal dorsal fullness in the lower half that distorts the profile and observes the nasal tip similar to the convex profile of the parrot's beak is colloquially termed Polly Beak deformity.

In general, rhinoplasty remains the most challenging of all esthetic facial procedures. Never are two procedures ever identical. Hence, it is important that rhinoplasty should be approached as an anatomical dissection and exposure of the nasal structures requiring alteration, conservatively shaping and reposition- ing these anatomic elements. Many problems including polly beak deformity and other complications arise from over correction of nasal abnormalities than from conservative correction. The statement "It is not what is removed in rhinoplasty that is important but what is left behind" stands true and will always stand true.

Miriam Boenisch, MD PhD
Medicent Linz
Untere Donaulaende 21-25
4020 Linz
Austria
Mail: Miriam.boenisch@rhinoplasty.at
Phone: +43 699 1180 6949

Abstract

What holds true for every surgery is also essentially true of rhinoplasty. Knowledge about and awareness of complications and the possible means to handle them is essential for every rhinoplasty surgeon. Referring to the time of occurrence, complications can be divided into early and late complications. Early complications such as bleeding or infection are rare; late complications related to postoperative failure to achieve the desired aesthetic or functional objectives are much more common. In this chapter the author will give an overview of the most frequent complications after rhinoplasty and describe prevention and techniques to correct the complication.

Introduction

The secondary cleft lip nasal deformity presents an extreme challenge to the facial plastic surgeon.  The deformity is complex and involves all tissue layers, including skeletal platform, inner lining, osseocartilaginous structure, and overlying skin.  It is often the characteristic cleft nasal deformity that is noticeable to the observer after a well performed cleft lip repair.
Secondary repair of the cleft lip nasal defect requires an understanding of the pathological nasal anatomy associated with congenital clefting.  The basic cleft nasal deformity is characteristic and defendant upon the original extent of clefting of the lip. However, the secondary nasal defect varies greatly and is a result of: 1) the original malformation, 2) any interim surgery performed, and 3) growth of the nose and face.  The cleft surgeon must therefore have a treatment philosophy and technique flexible enough to reconstruct a variable range of associated nasal problems.  This chapter describes the pathological anatomy associated with cleft deformities, and describes approaches and techniques designed to improve form and function of the cleft nose.

Corresponding author for proof: Fred Fedok, MD FACS
Division of Otolaryngology-Head and Neck Surgery
H091
500 University Drive
Hershey, PA 17033
ffedok@hmc.psu.edu
717-531-6718
717-531-6160 (fax)

Coauthor: Jacob Sedgh, MD
Division of Otolaryngology-Head and Neck Surgery
H091
500 University Drive
Hershey, PA 17033
jacobsedgh@gmail.com
717-531-6718
717-531-6160 (fax)

Coauthor: Eelam A. Adil, MD MBA
Division of Otolaryngology-Head and Neck Surgery
H091
500 University Drive
Hershey, PA 17033
eadil@hmc.psu.edu
717-531-6718
717-531-6160 (fax)

Introduction

A saddle nose deformity is characterized by a markedly depressed bony dorsum and an accompanying collapse of the middle nasal vault in relation to the tip and dorsum1.  This deformity is the result of a complex interplay of factors leading to the loss of structural support of the nasal septum and upper lateral cartilages, collectively known as the middle vault, and their junction with the bony dorsum and cartilaginous tip Saddle nose deformity can present as one of the more dreaded complications of nasal surgery.  Regardless of its cause, management poses one of the more daunting challenges for the reconstructive surgeon.

Saddle Nose Deformity

Nasal reconstruction has historically been a challenging art for surgeons.  Straddling the realm of aesthetics and anatomic function, rhinoplasties are temperamental procedures and leave little room for error.  Of nasal repairs, saddle nose is not uncommon and remains challenging. 

Daniel G. Becker MD FACS
Becker Nose and Sinus Center, LLC
400 Medical Center Drive, Suite B
Sewell and Princeton, New Jersey USA
856 589-6673
856 589-3443 fax
drbecker@therhinoplastycenter.com

Clinical Professor & Director of Facial Plastic Surgery
Department of Otolaryngology-Head and Neck Surgery
University of Pennsylvania Medical Center
Philadephia, Pennsylvania

Clinical Professor
Department of Otolaryngology-Head and Neck Surgery
University of Virginia Medical Center
Charlottesville, Virginia

Welcome to the 6th PENN Rhinoplasty Course. It is nice to have you all here at our course, which for the first time we are having here in the Chelsea Hotel in Atlantic City. My co-course directors are Dr. Ara Chalian and Dr. Stephen Goldstein, and we would like to welcome you all.

Dirk Jan Menger, MD
Department of Otorhinolaryngology / Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery.
Academic Medical Center, Amsterdam, The Netherlands.
Meibergdreef  9
1105 AZ Amsterdam
The Netherlands
Telephone: +31-20-5668586
Fax: +31-20-6913850
d.j.menger@amc.uva.nl

INTRODUCTION
Irradiated homologous rib grafts (IHRGs), might be an alternative for autologous cartilage grafts in case there is insufficient quantity-, or quality or when the shape of the autologous grafts is not adequate for a successful nasal reconstruction. IHRGs can be used to augment and/or to provide structural support in a recipient site. Alloplasts, like silicone, are less favorable compared with IHRGs due to the higher infection-, extrusion- and foreign body response rates. The accepted advantages of IHRGs are the elimination of additional incisions for graft harvesting and donor site morbidity, as well as ready availability. The first publication relating to the use of IHRGs in the human face dates back almost half a century [1]. Since that study, multiple clinical reports have been published, often with low complication and resorption rates [2-5]. The incidence of resorption however, increases with the duration of follow-up [6-9]. In addition to the time factor, the recipient site also seems to affect the rate of resorption [2,10,11]. This could be explained by two factors. Firstly, the vascularity of the implant in the recipient bed. Relatively low vascularity is thought to be associated with higher resorption rates [8,11].