Aesthetic Septorhinoplasty

Foreword
Preface to the Second Edition of the Aesthetic Septorhinoplasty
What Kind of Book Is This?
	About the Second Edition
Acknowledgments
Contents
About the Author
Part I: Before Surgery
	1: Photography
		1.1	 Patient Photographs
			1.1.1	 Reference Photographs
			1.1.2	 Photography Angles
		1.2	 The Photography System
			1.2.1	 Intraoperative Photographs
			1.2.2	 Light Illusions
			1.2.3	 Fish-Eye
		1.3	 Camera Settings
			1.3.1	 Focus Settings
			1.3.2	 ISO
			1.3.3	 Shutter Speed
			1.3.4	 F
			1.3.5	 Skin Color
			1.3.6	 Color Settings
			1.3.7	 Soft box Light Settings
			1.3.8	 Shooting with a Smartphone
			1.3.9	 Video Camera
		1.4	 Imaging
			1.4.1	 Shadowing the Images
		1.5	 The Importance of Photography and Imaging
		1.6	 Surgery Notes and Archiving
		1.7	 Photography Archive
			1.7.1	 Backup
	2: How to Draw a Nose
		2.1	 Exercises
			2.1.1	 Sketch from the Front
			2.1.2	 Sketch from the Side
			2.1.3	 Sketch from Above and Below
		2.2	 Analysis of Patient Photographs
	3: Nasal Polygons
		3.1	 Infratip Triangle
		3.2	 Tip Defining Point
		3.3	 What Is a Facet?
		3.4	 The Non-mobile Nose
		3.5	 The Mobile Tip Area
			3.5.1	 Mass Polygons
			3.5.2	 Space Polygons
		3.6	 Tip Breakpoints
		3.7	 Dome Triangles
		3.8	 Interdomal Triangle
			3.8.1	 Dome Divergence
		3.9	 Infralobular Polygon
		3.10	 Columellar Polygon
		3.11	 Footplate Polygons
		3.12	 Facet Polygons
			3.12.1	 Relation of the Facet and Dome Polygons
		3.13	 Lateral Crus Polygons
		3.14	 Resting Angle
			3.14.1	 Vertical Compression Test
			3.14.2	 Incorrect Resting Angle and Its Effect on the Ala
			3.14.3	 Wide Lateral Crura
			3.14.4	 Long Lateral Crura
			3.14.5	 Convex Lateral Crura
			3.14.6	 Cephalic Malpositioning
		3.15	 Scroll Facet
		3.16	 Scroll Line
		3.17	 Dorsal Cartilage Polygon
		3.18	 Dorsal Bone Polygon
		3.19	 Upper Lateral Cartilage Polygons
		3.20	 Lateral Bone Polygons
		3.21	 Dorsal Aesthetic Lines
			3.21.1	 Summary: Dorsal Aesthetic Lines
		3.22	 Lateral Aesthetic Lines
		3.23	 The Polygon Model
	4: Instruments
		4.1	 The Rhinoplasty Instrument Set
		4.2	 Magnetic Instrument Mat
		4.3	 Nasal Speculum
		4.4	 Dorsum Retractor
		4.5	 Small Retractor (Crile)
		4.6	 Forceps
		4.7	 Needle Holder
		4.8	 Scissors
		4.9	 Bone Scissors
		4.10	 Rasp
		4.11	 Elevators
		4.12	 Hooks
		4.13	 Ninety-Degree Bone Raspatory
		4.14	 Rongeur
		4.15	 Chisels and Osteotomes
		4.16	 Hammer
		4.17	 Arkansas Stone
		4.18	 Sutures
		4.19	 Taştan-Çakır Saws
		4.20	 Forceps
		4.21	 Ayhan PPE Forceps
		4.22	 Headlamp
Part II: Surgery
	5: Skin, Chin, Cheek, and Forehead
		5.1	 Skin Care and Rhinoplasty
		5.2	 Oral Isotretinoin Treatment
		5.3	 Menstruation
		5.4	 Forehead Fat Grafting
			5.4.1	 Why Is the Forehead Important in Rhinoplasty?
			5.4.2	 Technique
		5.5	 Jaw
		5.6	 Importance of Cheeks
		5.7	 Periorbital Fat Grafting
	6: Surgical Preparation, General Anesthesia, and Local Anesthetic Infiltration
		6.1	 Patient Position and Tracheal Intubation
		6.2	 Cleaning
		6.3	 Local Anesthesia
			6.3.1	 For the Nose
			6.3.2	 For the Septum
		6.4	 Injection Points
		6.5	 Lighting in the Operating Room
		6.6	 Drawings
	7: Turbinate Surgery
		7.1	 Turbinates
		7.2	 Turbinate SMR
			7.2.1	 Normal Anatomy
			7.2.2	 Inwardly Collapsed Maxillary Base
			7.2.3	 Segmental Out-Fracture
	8: Incisions and Dissection in Rhinoplasty
		8.1	 Hemitransfixion and Transfixion Incisions
		8.2	 Entering the Nasal Dorsum from the Septal Angle
		8.3	 Infracartilaginous Incision and Auto-rim Flap
		8.4	 Markings
		8.5	 Lateral Crural Subperichondrial Dissection
		8.6	 How Is Lateral Crural Subperichondrial Dissection Performed?
		8.7	 Combining Tip and Dorsum Dissections
		8.8	 Periosteal Dissection
		8.9	 Subperichondrial Dissection in Secondary Rhinoplasty
		8.10	 Delivering the Domes
		8.11	 Supratip Break Point
		8.12	 Subperichondrial Dissection in Open Approach
		8.13	 Why Subperichondrial Dissection?
			8.13.1	 Subperichondrial Dissection and Healing
			8.13.2	 Subperichondrial Dissection and Muscle Function
			8.13.3	 Subperichondrial Dissection and the Camouflage Effect
			8.13.4	 Effect of Subperichondrial Dissection on Bleeding
			8.13.5	 Effect of Subperichondrial Dissection on Ligaments
	9: Septoplasty
		9.1	 Dissection
		9.2	 Extracorporeal Septoplasty
	10: Classic Dorsal Resection
		10.1	 Dissection of the Upper Lateral Cartilage Mucosa
		10.2	 Dorsal Cartilage Resection
		10.3	 Dorsal Bone Resection
		10.4	 Radix
	11: Osteotomy, Ostectomy, and Dorsal Reconstruction
		11.1	 Setting the Dorsal Height
		11.2	 Checking the Open Roof
		11.3	 Lateral Osteotomy
		11.4	 Transverse Osteotomy
		11.5	 Medial Oblique Osteotomy
		11.6	 Lateral Ostectomy
			11.6.1	 Ostectomy Technique
			11.6.2	 Instruments for Ostectomy
			11.6.3	 Why Ostectomy?
				11.6.3.1 Improved Control
				11.6.3.2 Function
				11.6.3.3 Steps
				11.6.3.4 Unsuccessful Osteotomy
				11.6.3.5 Bone Surface Problems
				11.6.3.6 Bruising
				11.6.3.7 Re-drape Problems
		11.7	 Out-Fracturing the Nose with Ostectomy
		11.8	 Bone Check
		11.9	 Bone Massage
		11.10	 Reconstruction of the Nasal Dorsum
		11.11	 Dorsal Aesthetic Lines
		11.12	 The Libra Graft
		11.13	 Nasal Dorsum Control
		11.14	 Bone Dust and Cartilage Paste
		11.15	 Short Nasal Bones
		11.16	 Dorsal Reconstruction in Men
	12: My First 500 Dorsal Preservation (October 2019)
		12.1	 Dorsal Preservation and Classic Dorsal Resection
		12.2	 On Which Patients Should Dorsal Preservation Be Used?
		12.3	 Which Technique to Do First?
		12.4	 What Are the Types of DP?
		12.5	 When Do I Use Total Preservation and When Cartilage Only DP?
			12.5.1 Cone Beam
		12.6	 Total Preservation Versus Cartilage Only Preservation
		12.7	 Low Septal Strip Versus High Septal Strip?
			12.7.1 The Relationship of Septoplasty and Rhinoplasty with Skull Base
			12.7.2 Removing the Septal Strip
				12.7.2.1 Low septal strip
				12.7.2.2 High septal strip:
			12.7.3 The Resistance Points of DP
				12.7.3.1 Cartilage Only Dorsal Preservation
				12.7.3.2 Osseocartilaginous Dorsal Preservation
		12.8	 Dorsal Fixation
		12.9	 Dorsal Cartilage Fine-Tuning
		12.10	 No-Dissection DP
			12.10.1 Case #1
			12.10.2 Case #2
			12.10.3 Case #3
			12.10.4 Case #4
			12.10.5 Case #5
			12.10.6 Case #6
			12.10.7 Case #7
			12.10.8 Case #8
			12.10.9 Case #9
			12.10.10 Case #10
			12.10.11 Case #11
			12.10.12 Case #12–13
			12.10.13 Complications: Case #1
			12.10.14 Complications: Case #2
		12.11	 Conclusions
	13: How Did the Nose Get Deformed?
		13.1	 Observation and Theory
			13.1.1	 Observations
			13.1.2	 Theory
		13.2	 Discussion
	14: TIP Surgery
		14.1	 Auto-Rim Flap
			14.1.1	 When to Apply an Auto-Rim Flap
			14.1.2	 Is the Auto-Rim Flap Difficult to Perform?
			14.1.3	 What Is the Rationale for the Auto-Rim Flap?
			14.1.4	 How to Perform an Auto-Rim Flap
		14.2	 Marking and Lateral Crural Resection
		14.3	 Lateral Crura Preservation
			14.3.1	 Lateral Crural Steal
				14.3.1.1 The Ellipse Model
				14.3.1.2 Results
				14.3.1.3 Surgical Technique of Lateral Crural Steal
				14.3.1.4 Dome Symmetry Test
		14.4	 Cephalic Dome Suture
			14.4.1	 How I Started Using the Cephalic Dome Suture
		14.5	 Dome Equalization
		14.6	 Figure-of-Eight Suture
		14.7	 Columellar Strut Graft
			14.7.1	 Where Is the Best Graft Donor Area?
			14.7.2	 Strut Graft Placement
		14.8	 Loop Suture for Strut Graft Stabilization (Tie Suture)
		14.9	 C Suture
			14.9.1	 Columellar Breakpoint
			14.9.2	 Technique
		14.10	 Stabilization of the Columellar Polygon
		14.11	 Bow-Tie Suture (Figure-of-Eight, Horizontal Mattress Suture)
		14.12	 Medial Crura Overlap
			14.12.1	 What Is the Most Reliable Lower Lateral Cartilage Cutting Point?
			14.12.2	 Total Medial Crural Overlap
			14.12.3	 Partial Medial Crural (Caudal) Overlap
	15: Tip Projection and Rotation
		15.1	 Projection
			15.1.1	 Nostril Apex Projection
			15.1.2	 Lobule Projection
		15.2	 Tip Rotation
	16: Tip Asymmetry
	17: Cephalic Malposition
		17.1	 Treatment
		17.2	 Summary
		17.3	 Transposition of the Lateral Crural Tail
	18: Fine-Tuning
		18.1	 Narrowing of the Footplate Polygon
			18.1.1	 Asymmetrical Footplates
		18.2	 Dissection and Augmentation of the Origin of Depressor Nasi Muscle
		18.3	 Additional Transdomal Sutures
			18.3.1	 Increasing Dome Definition
			18.3.2	 Expanding the Interdomal and Infralobular Polygons
		18.4	 Resection of the Caudal Edge of the Dome
		18.5	 Infralobular Caudal Contour Grafts
		18.6	 Tip Grafts
			18.6.1	 Boomerang-Shaped Peck Graft
		18.7	 Deprojection of Nostril Apex Projection (NAP)
		18.8	 C′ Graft
		18.9	 Tip Camouflage
		18.10	 Extra Columellar Strut
		18.11	 Rim Grafts
	19: Stabilization of the Nasal Tip
		19.1	 Vertical Scroll Reinsertion
		19.2	 Suturing the Pitanguy Ligament in the Open Technique
			19.2.1	 Repairing the Superficial SMAS
			19.2.2	 Membranous Tongue in Groove
	20: Nostril Surgery
		20.1	 Problems and Solutions
		20.2	 Thick Alar Base: Simple Elliptic Resection
		20.3	 Big Nostrils: Nostril Sill Advancement Flap
		20.4	 Superior Repositioning of the Nostril Sill
		20.5	 Big Nostril and Thick Alar Base: Combination of Nostril Sill Advancement Flap and Elliptic Resection
		20.6	 Common Mistakes
		20.7	 Hanging Alae
		20.8	 Alar Rim Excision
			20.8.1	 Marking
			20.8.2	 Incision
			20.8.3	 Resection
			20.8.4	 Suture
	21: Deviated Nose
		21.1	 Problems with Left Axis Noses
		21.2	 Reference Points
		21.3	 Nasal Dorsal Resection
		21.4	 Septoplasty
		21.5	 Tip Surgery
		21.6	 Swinging Door Septoplasty
	22: Secondary Rhinoplasty
		22.1	 Septal Cartilage
		22.2	 Rib Cartilage
		22.3	 Cartilage Chips
			22.3.1 Surgery
		22.4	 Block Cartilage
		22.5	 Oblique Split Rib Grafts
		22.6	 Partial Oblique Split Rib Grafts
			22.6.1 Surgery
		22.7	 Cartilage Paste
		22.8	 Turkish Delight
		22.9	 Rib Perichondrium
		22.10	 Nasal Dorsal Dissection in Secondary Rhinoplasty
		22.11	 Hanging Columella
			22.11.1 Preventing Alar Retraction
			22.11.2 Surgery
		22.12	 Lateral Crural Cephalic Strut Graft
		22.13	 Pinched Nose Deformity
	23: Taping and Splinting
		23.1	 Fixing the Silicone Splints:
		23.2	 Drains
		23.3	 Taping and Splinting
			23.3.1	 Prevent Fossa Formation Under Domes
		23.4	 Postoperative Care
			23.4.1	 Postoperative Order
		23.5	 Prescription After Rhinoplasty
		23.6	 Recommendations After rhinoplasty
24: Case Studies
References
	Further Reading
Index