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Facial Plast Surg 2012; 28(04): 427-439
DOI: 10.1055/s-0032-1319844
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Revision of the Overresected Nasal Tip Complex

Richard E. Davis
1   The Center for Facial Restoration, Miramar, Florida
2   Division of Facial Plastic Surgery, Department of Otolaryngology, The University of Miami, Miller School of Medicine, Miami, Florida
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Publikationsdatum:
07. August 2012 (online)

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Abstract

Tip deformities resulting from previous nasal surgery range from mild to profound. For the mild deformity, morbidity is low and successful correction is usually achieved with a modest and targeted surgical adjustment. However, for the profound deformity, overt cosmetic deformities and corresponding functional impairment are the byproducts of severe derangements in skeletal architecture. Hence, for the severely damaged nasal tip, a complex surgical revision in which the decimated nasal tip framework is reconstructed with autologous cartilage grafts is essential. However, rebuilding the decimated nasal tip is a challenging and risky procedure that is best left to the seasoned rhinoplasty specialist. Careful assessment of the previously operated tissues, combined with an accurate cosmetic analysis, must be juxtaposed with the patient's cosmetic desires to derive an individualized and effective treatment plan. Atraumatic soft tissue technique, combined with a strategic yet balanced and judicious application of graft material, often culminate in satisfactory surgical outcomes. Proper assessment, technical skill, and sound clinical judgment are all critical ingredients in successful restoration of the surgically compromise nasal tip.

Keywords

revision rhinoplasty - cephalic trim - overresected tip - sidewall tensioning - septal extension graft
 

  • References

  • 1 Holden PK, Liaw LH, Wong BJ. Human nasal cartilage ultrastructure: characteristics and comparison using scanning electron microscopy. Laryngoscope 2008; 118: 1153-1156
    CrossrefPubMedGoogle Scholar
  • 2 Patel JC, Fletcher JW, Singer D, Sullivan P, Weinzweig J. An anatomic and histologic analysis of the alar-facial crease and the lateral crus. Ann Plast Surg 2004; 52: 371-374
    CrossrefPubMedGoogle Scholar
  • 3 Hatzis GP, Sherry SD, Hogan GM, Finn RA. Observations of the marginal incision and lateral crura alar cartilage asymmetry in rhinoplasty: a fixed cadaver study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 97: 432-437
    CrossrefPubMedGoogle Scholar
  • 4 Johnson Jr CM, Godin MS. The tension nose: open structure rhinoplasty approach. Plast Reconstr Surg 1995; 95: 43-51
    CrossrefPubMedGoogle Scholar
  • 5 Adams Jr WP, Rohrich RJ, Hollier LH, Minoli J, Thornton LK, Gyimesi I. Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty. Plast Reconstr Surg 1999; 103: 255-261 ; discussion 262–264
    CrossrefPubMedGoogle Scholar
  • 6 Gubisch W, Eichhorn-Sens J. Overresection of the lower lateral cartilages: a common conceptual mistake with functional and aesthetic consequences. Aesthetic Plast Surg 2009; 33: 6-13
    CrossrefPubMedGoogle Scholar
  • 7 Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 1997; 99: 943-952 ; discussion 953–955
    CrossrefPubMedGoogle Scholar
  • 8 Weber SM, Baker SR. Alar cartilage grafts. Clin Plast Surg 2010; 37: 253-264
    CrossrefPubMedGoogle Scholar
  • 9 Toriumi DM. New concepts in nasal tip contouring. Arch Facial Plast Surg 2006; 8: 156-185
    CrossrefPubMedGoogle Scholar
  • 10 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100: 999-1010
    CrossrefPubMedGoogle Scholar
  • 11 Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 2003; 112: 1929-1935
    CrossrefPubMedGoogle Scholar
  • 12 Guyuron B, Varghai A. Lengthening the nose with a tongue-and-groove technique. Plast Reconstr Surg 2003; 111: 1533-1539 ; discussion 1540–1541
    CrossrefPubMedGoogle Scholar
  • 13 Naficy S, Baker SR. Lengthening the short nose. Arch Otolaryngol Head Neck Surg 1998; 124: 809-813
    CrossrefPubMedGoogle Scholar
  • 14 Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Oper Tech Otolaryngol Head Neck Surg 1995; 6: 311-318
    CrossrefPubMedGoogle Scholar
  • 15 Kridel RW, Konior RJ, Shumrick KA, Wright WK. Advances in nasal tip surgery. The lateral crural steal. Arch Otolaryngol Head Neck Surg 1989; 115: 1206-1212
    CrossrefPubMedGoogle Scholar
  • 16 Kridel RW, Scott BA, Foda HM. The tongue-in-groove technique in septorhinoplasty. A 10-year experience. Arch Facial Plast Surg 1999; 1: 246-256 ; discussion 257–258
    CrossrefPubMedGoogle Scholar
  • 17 Rohrich RJ, Raniere Jr J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 2002; 109: 2495-2505 ; discussion 2506–2508
    CrossrefPubMedGoogle Scholar
  • 18 Boahene KDO, Hilger PA. Alar rim grafting in rhinoplasty: indications, technique, and outcomes. Arch Facial Plast Surg 2009; 11: 285-289
    CrossrefPubMedGoogle Scholar