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DOI: 10.1055/s-0041-1723825
Rhinoplasty Dissection Planes (Subcutaneous, Sub-SMAS, Supra-perichondral, and Sub-perichondral) and Soft Tissues Management
Abstract
Rhinoplasty as an operation is akin to a game of chess, where every maneuver will influence the eventual outcome. Undoubtedly, more than one approach to the nasal soft tissues envelop can produce beautiful and safe results as will be described in the paper namely, the subcutaneous, sub-superficial musculoaponeurotic system, supra- and sub-perichondral planes. For different justifiable reasons surgeons have their preferences, regarding dissection planes on the tip, middle and upper thirds, and regarding the manipulation of the soft tissue layers and nasal ligaments. The concept of the nasal layers and the presence of relevant ligamentous structures and how to restore them in an anatomical fashion, will help to understand the logic behind various approaches.
Publication History
Article published online:
25 February 2021
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References
- 1 Saban Y, Andretto Amodeo C, Hammou JC, Polselli R. An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 2008; 10 (02) 109-115
- 2 Ozturk CN, Larson JD, Ozturk C, Zins JE. The SMAS and fat compartments of the nose: an anatomical study. Aesthetic Plast Surg 2013; 37 (01) 11-15
- 3 Pitanguy I. Surgical importance of a dermocartilaginous ligament in bulbous noses. Plast Reconstr Surg 1965; 36: 247-253
- 4 Gruber RP, Belek KA, Barzin A. Commentary on a complete subperichondrial dissection with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 575-577
- 5 Resuli AS. Is Pitanguy's ligament a true ligament? A prospective cohort study. J Surg Med. 2020; 4 (04) 251-254
- 6 Cakir B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
- 7 Daniel RK, Palhazi P. The nasal ligaments and tip support in rhinoplasty: an anatomical study. Aesthet Surg J 2018; 38 (04) 357-368
- 8 Daniel RK, Letourneau A. Rhinoplasty: nasal anatomy. Ann Plast Surg 1988; 20 (01) 5-13
- 9 Mann DG, Sasaki CT, Fukuda H, Mann DG, Suzuki M, Hernandez JR. Dilator naris muscle. Ann Otol Rhinol Laryngol 1977; 86 (3 Pt 1): 362-370
- 10 Cunningham B, Mckinney P. The alar scroll: an important anatomical structure in lobule surgery. Operative Techniques in Plastic and Reconstructive Surgery 2000; 7: 187-193
- 11 Öztürk G. Scroll ligament preservation and improvement in nasal tip with the room concept. Aesthetic Plast Surg 2020; 44 (02) 491-500
- 12 Irmak F, Ertaş A, Kaleci B. et al. The keystone, scroll complex, and interdomal area of the nose: histologic and anatomical observations. Plast Reconstr Surg 2020; 146 (01) 75-79
- 13 Daniel RK, Pálházi P. Rhinoplasty: An Anatomical and Clinical Atlas. Cham: Springer Nature; 2018
- 14 Simon PE, Lam K, Sidle D, Tan BK. The nasal keystone region: an anatomical study. JAMA Facial Plast Surg 2013; 15 (03) 235-237
- 15 Gruber RP, Park E, Newman J, Berkowitz L, Oneal R. The spreader flap in primary rhinoplasty. Plast Reconstr Surg 2007; 119 (06) 1903-1910
- 16 MacArthur FJ, McGarry GW. The arterial supply of the nasal cavity. Eur Arch Otorhinolaryngol 2017; 274 (02) 809-815
- 17 Daniel RK, Palhazi P, Gerbault O, Kosins AM. Rhinoplasty: the lateral crura-alar ring. Aesthet Surg J 2014; 34 (04) 526-537
- 18 Rohrich RJ, Hoxworth RE, Thornton JF, Pessa JE. The pyriform ligament. Plast Reconstr Surg 2008; 121 (01) 277-281
- 19 Zholtikov V, Golovatinsky V, Palhazi P, Gerbault O, Daniel RK. Rhinoplasty: a sequential approach to managing the bony vault. Aesthet Surg J 2020; 40 (05) 479-492
- 20 Gerbault O, Daniel RK, Palhazi P, Kosins AM. Reassessing surgical management of the bony vault in rhinoplasty. Aesthet Surg J 2018; 38 (06) 590-602