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… [Read More]
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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]
Saddle Nose Deformity: Selection of Augmentation Materials and Management
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,… [Read More]
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. Resulting from a broad spectrum of etiologies, and presenting with a wide degree of variation and… [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]
Rib Grafts In Rhinoplasty
This lecture covers the use of rib grafts in Rhinoplasty. The rhinoplasty surgeon often encounters the need to utilize grafts when performing primary or revision surgery. Septal cartilage is typically the graft material of choice and this is especially true for primary cases. However, patients who have had prior nasal surgery or traumatic nasal collapse… [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]
Alar Base Modification
INTRODUCTION / BACKGROUND The alar base plays an important role in the overall appearance and proportion of the nose. An overly wide or flared alar base will lead to a “bottom heavy” nose and disrupt the delicate balance of an otherwise properly executed rhinoplasty. Alar base refinement is often incompletely and inadequately described.1 The techniques… [Read More]
African American Rhinoplasty
Introduction Rhinoplasty in African-Americans has become an increasingly common and accepted procedure, and facial plastic surgeons must be skilled in creating a harmonious “ethnic” nose. In a recent study by the American Academy of Facial Plastic and Reconstructive Surgery, when given multiple options for facial plastic surgery, African Americans most commonly choose a rhinoplasty (1)…. [Read More]