Revision rhinoplasty is a term that encompasses a wide spectrum of problems, from straightforward to complex. In an established revision practice, patients seeking con- sultation include many who have all but lost hope. Commonly, the experienced revision surgeon will find that significant improvement is possible (Fig. 18–1). However, to achieve success, it is important that… [Read more]
Daniel Becker
Featured Techniques – Spreader Grafts
Abstract Spreader grafts are an essential tool in the armamentarium of the rhinoplasty surgeon. Spreader grafts provide support of the middle vault and widen the internal nasal valve, the narrowest portion of the nasal airway which contributes approximately half of the total airway resistance. Spreader grafts are frequently indicated in functional rhinoplasty and in revision… [Read more]
Lecture On Osteotomies
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. As you… [Read more]
Auricular Cartilage in Revision Rhinoplasty
ABSTRACT Revision rhinoplasty is a challenge in reconstruction to the rhinoplasty surgeon, both in the techniques of repair and the choice of implant material for augmentation grafting. Often, patients seeking revision or reconstructive rhinoplasty have previously undergone septoplasty with sacrifice of major amounts of septal cartilage. These situations confront the surgeon with the need for… [Read more]
Repair of Septal Perforations in Revision Septoplasty
Nasal septal perforations can be problematic to patients and challenging to surgeons. The perforated nasal septum often has obliterated surgical tissue planes that may be difficult to dissect. Although the literature suggests numerous techniques for management and repair, a more limited number of techniques have achieved widespread favor. In this chapter, we provide an overview… [Read more]
The Bulbous Nasal Tip: a review of current surgical techniques
ABSTRACT Objective: To review the described surgical techniques for addressing nasal tip bulbosity and present a novel application of a previously described technique. Study design: Review. Surgical Methods: Cephalic resection, suture techniques, grafting techniques, techniques involving transection of the dome or lateral crura, and lateral crura repositioning techniques. Conclusion: The surgical treatment of nasal tip… [Read more]
Surgical Treatment of Nasal Obstruction in Rhinoplasty
Abstract Often, rhinoplasty patients present not just for aesthetic correction, but for improvement of their nasal breathing due to functional abnormalities or problems. Because the aesthetic and functional problems must be addressed together, an understanding of both the internal and external anatomy is essential. In this article, the authors review the differential diagnosis of nasal… [Read more]
Infiltrative Anesthesia Technique
Proper local anesthesia is critical to allow atraumatic dissection with minimal bleeding and edema. A total volume of less than 3 ml of 1% lidocaine with 1:100,000 epinephrine is typically used to attain anesthesia for rhinoplasty alone. When performing septorhinoplasty, as much as 10 nil of local anesthetic may be used. The anesthetic is al-… [Read more]
Rhinoplasty Analysis
Development of an operative plan that will achieve the desired outcome requires an understanding of the patient’s wishes and selection of appropriate surgical maneuvers to effect the proposed changes. The surgeon must be able to identify anatomic constraints that will limit the ability to change contour (thick skin, weak cartilages, etc.). Experience with rhinoplasty over… [Read more]
Anatomy, Incisions and Approaches: Open and Closed Rhinoplasty
Introduction In the modern era of rhinoplasty, the introduction of external rhinoplasty was greeted by enthusiastic advocates and also met with spirited opposition. Over time, however, the tenor of this debate has become more ecumenical. Most surgeons now recognize the broad utility of both endonasal and external approaches. Most understand that there are situations when… [Read more]
