State of the Art Rhinoplasty Techniques: Perspectives from Korean Masters

Preface
Contents
Editor and Contributors
Editor
Contributors
Preoperative Evaluation and Postoperative Care
	Asian Rhinoplasty
		Characteristics of Asian Face and Nose
	Preoperative Evaluation
		General Preoperative Consideration
			Initial Consultation
			Patient Expectations and Suitability for Rhinoplasty
			History
		Preoperative Evaluation
			Inspection
			Physical Examination
			Photographic Analysis
			Imaging Analysis
			Systematic Nasal Analysis
	Postoperative Management
		Immediate Postoperative Management
			Dressings
			Medications
		Postoperative Care and Instructions for Patients
			Edema and Ecchymosis
			Epistaxis and Hematoma
			Activity Restriction
			Dressings and Stitch Removal
	Further Reading
Nasal Dorsal Augmentation Using Implant and Autogenous Tissues
	Dorsal Augmentation Using Implants
		Selection of Implants
		Operative Techniques
			Preoperative Design
			Incision and Dissection
			Irrigation of Pocket
			Implant Carving
			Implant Insertion
			Wound Closure and Dressing
			Dorsal Augmentation with 3D Printing Technology
			Design and Manufacturing Process
			Advantages and Disadvantages of 3D Printed Nasal Implant
	Dorsal Augmentation Using Autogenous Tissues
		Dorsal Augmentation with Dermofat
			Graft Harvest
			Dorsal Augmentation Technique
			Vertically-Oriented Folded Dermal Graft Technique
				Harvest of the Graft
				Fabrication of the Harvested Graft
				Placing the Graft on the Dorsum
		Dorsal Augmentation with Costal Cartilage
			Harvesting the Costal Cartilage
			Carving the Costal Cartilage
				Concentric Carving Technique
				Multilayered Costal Cartilage Graft Technique
			Placing the Graft on the Dorsum
		Dorsal Augmentation with Diced Cartilage Wrapped in Fascia
			Operative Technique
				Harvest of Temporal Fascia
				Dicing the Cartilage
				Packing the Diced Cartilage in the Tube-Shaped Fascia
				Insertion of the Diced Cartilage in Fascia to the Pocket
	Further Reading
Nasal Tip Techniques (1): Tip Augmentation Techniques
	Tip Augmentation (Correction of Low Tip)
		Suture Techniques
			Transdomal Suture
			Lateral Crural Mattress Suture
			Interdomal Suture
			Intercrural Suture
			Lateral Crural Spanning Suture
			Medial Crural Septal Suture
			Lateral Crural Septal Suture
			Columellar Septal Suture
		Ear Cartilage Graft
			Surgical Techniques
				Ear Cartilage Harvesting and Fabrication
				Application of Cartilage Graft
	Tip Lengthening (Correction of the Short Nose)
		Surgical Techniques
			Flap Elevation
			Caudal Release of Alar Cartilage
			Fixation of Caudally Released Alar Cartilage
	Further Reading
Nasal Tip Techniques (2): Bulbous Tip Correction
	Introduction
		Definition
		Etiology and Types
	Preoperative Analysis
		Visual Analysis
		Physical Analysis
	Operative Consideration
		Thinning and Debulking of Skin and Soft Tissue Envelope
			Dual Plane Dissection and Debulking
			Defatting Procedure
		Nasal Tip Refining and Reduction for Bulbous Tip Correction
			Intraoperative Analysis
			Suture Technique and Procedures for Correction of Bullous Tip
				Medial and Middle Crural Suture
				Interdomal Suture
				Transdomal Suture and Hemitransdomal Suture
				Lateral Crural Spanning Suture
				Cephalic Trimming of Lateral Crus
		Rebuilding of Nasal Tip Tripod with Tip Refinement in Asian Rhinoplasty
			Complete Release of Alar Cartilage
			Rebuilding Nasal Tip Tripod
		Ideal Nasal Tip Refinement of Alar Cartilage for Bulbous Tip Correction
			Tip Extension Suture
			Overcoming Obstacles of Tip Extension Suture with Dorsal Batten Graft
			Septal Extension Graft
		Other Considerations of Bulbous Tip Correction
			Supratip Deformity
			Tip Graft
			Secondary Bulbous Tip Correction
	Further Reading
Nasal Tip Technique (3): Tip Shortening
	Preoperative Analysis and Surgical Planning
	Classification and General Concept
	Long Nose with Drooping Tip (Type I)
		Anatomic Causes of Long Nose with Drooping Tip
			Abnormal Position and Shape of Alar Cartilage and Septal Cartilage
			Dynamic Pulling Forces on the Nasal Tip by Underlying Muscles
		Correction of Long Nose with Drooping Tip
			Correction of the Alar Cartilage
				Modified Transdormal Suture for Medial Crus Lengthening
				Making Cartilage Rein Flap or Partial Resection of the Cephalic Portion of Lateral Crura
				Lateral Crura Shortening with Resection or Overlay Suture
			Columellar Septal Suture and Excision of Caudal Septal Cartilage
			Consideration of the Nasal Tip and Columella Support
				Columella Strut Graft for Tip Support
				Shield Graft
			Solving Problems with the Muscles: The Dynamic Components
				Excision of the Depressor Septi Nasi Muscle and Columella Base Augmentation
				Weakening of Levator Labii Superioris Alaque Nasi Muscle and Peri-alar Augmentation
			Debulking of Bulbous Tip and Redundant Nasal Skin Management
		Strategy of Collaborative Approach for Long Nose with Drooping Tip
	Long Nose with Normal Height Tip (Type II)
	Long Nose with Overprojected Tip (Type III)
	Long Nose with Bulbous Nasal Tip (Type IV)
	Further Reading
Surgery of Columella, Alar Rim and Alar Base
	Hanging Columella
		Anatomic Causes of Hanging Columella
		Correction of Hanging Columella
			Columellar Septal Suture
			Caudal Septal Reduction
			Caudal Margin Trimming of Medial Crura
			Latrogenic Hanging Columella
	Retracted Columella
		Anatomic Causes of Retracted Columella
		Correction of Retracted Columella
			Caudal Reposition of Medical Crura
			Septal Extension Graft
			Columellar Strut with Derotation Graft
			Septal Extension with Derotation Graft
			Rib Cartilage Graft
	Retracted Ala
		Anatomic Causes of Retracted Ala
		Correction of Retracted Ala
			Methods with Caudal Reposition of Lateral Crura
			Methods Without Caudal Reposition of Lateral Crura
			Latrogenic Retracted Ala
	Hanging Ala
		Anatomic Causes of Hanging Ala
		Correction of Hanging Ala
	Wide Alar Base
		Anatomic Causes of Wide Alar Base
		Correction of Wide Alar Base
	Further Reading
Mid-vault Surgery
	Introduction
		“Nasal Septum Theory”
	Hump Nose
		Surgical Details: Nasal Tip Projection with Humpectomy
	Saddle Nose
	Further Reading
Deviated Nose Correction and Functional Surgery 1
	Esthetic Analysis and Nasal Breathing Function
	Surgical Treatment
	Correction According to Anatomical Location
		Correction of the Bony Pyramid
		Correction of the Septal Cartilage, Upper Lateral Cartilages, and Lower Lateral Cartilages
			In Situ Septal Correction
				Spreader Grafts
				Dorsal L-Strut Cutting and Suture Technique
				Cutting and Suture Technique of the Caudal Septum
				Septal Batten Graft
				Interposition Batten Graft
				The Use of Septal Bone for Correction of the Septal Cartilage
				Resection of the Posterior Angle of the Septum
				Caudal Septal Relocation Suture
		Correction of Cephalo-Caudal Deviation
			Extracorporeal Septoplasty
			Correction of the Upper Lateral Cartilaginous Deformity
			Correction of the Lower Lateral Cartilage
	Significance of Dorsal Augmentation in Deviated Noses
	Alar Base Modification and Tilted Ala Correction
	Turbinoplasty
		Prognosis and Complications of Surgery
	Further Reading
Functional Surgery 2: Consideration of Internal Valve Problems in Asian Rhinoplasty, and Turbinate Reduction
	Functional Aspects of Internal Valve
		Anatomy
		Cottle Test
		Physiology
	The Shape of Internal Valve and Collapse of ULC
	Spreader Graft
		Extended Spreader Graft
		Specific Perspectives in Asian Rhinoplasty
	Spreader Flap
	Splay Graft (Spring Graft)
	Internal Valve: The Impact on Asian Septorhinoplasty
		The More Reduction, the More Spreader Graft
		What Is the Cause of Nasal Obstruction after Septorhinoplasty?
		Nasal Synechia
		Ignorance of Internal Valve
		Unique Internal Valve Problems in Asian Rhinoplasty
			Exaggerated Tip Sutures
			Exaggerated Supratip Graft
				Possible Solutions
	Turbinate
		Inferior Turbinate Surgery
		RAIT
		MAIT
	Further Reading
Secondary Rhinoplasty (1): Implant-Related Complications
	Introduction
	Dorsal Implant Movability and Migration
		Causes of Movability (Unstable Moving) and Migration
		Treatment of Movability and Migration
	Dorsal Implant Deviation
		Treatment of Dorsal Implant Deviation
	Dorsal Implant Demarcation, Dorsal Irregularity and Envelope Thinning
		Causes of Dorsal Implant Demarcation
		Cause of Dorsal Skin Irregularity
		Treatment of Demarcation, Irregularity, and Thinning
	Nasal Skin Redness
		Potential Causes of Tip Skin Redness
		Treatment of Nasal Skin Redness
	Tip Hardness and Discomfort
		Causes of Tip Hardness and Discomfort
		Treatment of Tip Hardness and Discomfort
	Visible Implant onto the Tip
	Implant Exposure Through the Nasal Skin
	Implant Exposure Through the Intranasal Mucosa
	Inflammation and Infection
		Inflammation Related to Implants
		Biofilms in the Operated Nose
		Inflammation: As an Initiator for Contracture
		Inflammation Due to Autologous Graft Failure
		Viral Infection around Nose
	Further Reading
Secondary Rhinoplasty (2): Mid-vault Correction
	Post-humpectomy Dorsal Irregularities
		Residual Dorsal Hump
		Depressed Dorsum
	Open Roof Deformity
	Inverted-V Deformity
		Correction Technique
			Spreader Graft
			Splay Graft
	Saddle Nose Deformity
		Causes and Classification
		Correction of Saddle Nose Deformity
			Camouflage Operation for Type I Static Saddle Nose
			Anatomical Structural Reconstruction
			Dorsal Augmentation
			Correction of Type IV Saddle Nose
	Further Readings
Secondary Rhinoplasty (3): Tip
	The Features of Secondary Nasal Tip Surgery
	The Goals of Secondary Nasal Tip Surgery
	General Surgical Preparation for Secondary Nasal Tip Surgery
	Precautions for Secondary Nasal Tip Surgery
	Under-Projected Tip
		Anatomic Cause of Under-Projected Tip
		Correction of Under-Projected Tip
	Supra-Tip Deformity
		Anatomic Cause
		Correction of Supra-Tip Deformity
	Pinched Nasal Tip
		Anatomic Cause
		Correction of Pinched Nasal Tip
	Big Tip Nose
		Anatomic Cause
		Correction of Big Tip
	Asymmetry Nasal Tip
		Anatomic Cause
		Correction of Asymmetric Tip
	Further Reading
Contracted Nose: My Preferred Technique
	Introduction
	Pathogenesis of a Short, Contracted Nose
	Patient Evaluation
	Timing of Revision Rhinoplasty
	Materials and Approach
	Strategies for Correction
	Surgical Techniques
		Rib Cartilage Harvesting and Carving
		Skin Dissection
		Building Structures to Lengthen the Tip
		Release of Lower Lateral Cartilage
		Additional Lengthening
		Dorsal Augmentation
		Closure of Wound
		Adding Soft Tissue to the Skin Envelope
	Further Reading
Contracted Nose and Difficult Complication Cases: My Preferred Technique
	Case 1
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and  Post-operative Photographs (Fig. 3a, c, e, g and b, d, f, h)
	Case 2
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and  Post-operative Photographs (Fig. 7a, c, e, g, i and b, d, f, h, j)
	Case 3
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and  Post-operative Photographs (Fig. 10a, c, e, g, i and b, d, f, h, j)
	Case 4
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and  Post-operative Photographs (Fig. 13a, c, e, g, i and b, d, f, h, j)
	Case 5
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and Post-operative Photographs (Fig. 16a, c, e, g, i and b, d, f, h, j)
	Case 6
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and  Post-operative Photographs (Fig. 19a, c, e, g, i and b, d, f, h, j)
	Cases 7
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and  Post-operative Photographs (Fig. 22a, c, e, g, i, k and 22b, d, f, h, j, l)
	Case 8
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and Post-operative Photographs (Fig. 26a, c, e and b, d, f)
	Case 9
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures: 1st Stage Operation
		Pre-operative and  Post-operative Photographs (Fig. 29a, c, e, g, i, k and b, d, f, h, j, l)
		Operative Procedures: 2nd Stage Operation
		Pre-operative and Post-operative Photographs (Fig. 31a, c, e, g, i, k and 31b, d, f, h, j, l)
	Case 10
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures: 1st Stage Operation (Skeletal Framework Reconstruction)
		Pre-operative and  Post-operative Photographs (Fig. 34a, c, e, g, i and b, d, f, h, j)
		Operative Procedures: 2st Stage Operation (For More Tip Lengthening, Dorsal Augmentation, Tip Refinement)
		Pre-operative and  Post-operative Photographs (Fig. 36a, c, e, g, i and b, d, f, h, j)
	Case 11
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures: 1st Stage Operation
		Pre-operative and Post-operative Photographs (Fig. 39a, b)
		Operative Procedures: 2st Stage Operation
		Operative Procedures: 3rd Stage Operation
		Pre-operative and Post-operative Photographs (Fig. 42a, c, e, g, i and b, d, f, h, j)
	Case 12
		Pre-operative Findings
		Intra-operative Findings
		Operative Procedures
		Pre-operative and Post-operative Photographs (Fig. 45a, c and b, d)
	Case 13
		Past Surgical History
		Pre-operative Findings
		Operative Procedures: 1st Stage Operation
		Pre-operative and Post-operative Photographs (Fig. 48a, c, e and b–f)
		Operative Procedures: 2st Stage Operation
		Operative Procedures: 3rd Stage Operation
		Pre-operative and Post-operative Photographs (Fig. 51a, c, e, g and b, d, f, h)
Secondary Cleft Lip Rhinoplasty
	Introduction
	Secondary Nasal Deformity
	Preoperative Evaluation
	Secondary Unilateral Cleft Rhinoplasty
	Surgical Techniques
		Repositioning the Alar Cartilage
		Septal Repositioning with a Columella Strut
		Alar Base Repositioning
		Midvault Asymmetry
		Nostril Rim Correction: Cleft and Non-cleft Sides
		Nasal Dorsum
	Outcome and Limitation
	Further Reading
Injection Rhinoplasty
	Anatomy for Injection Rhinoplasty
		Layers of the Nose
		Vascular Anatomy of the Nose
	Considerations for Filler Injection
		Needle/Cannula
		Entry Point
		Fate of Filler Injections
	Filler Types
		Hyaluronic Acid Fillers
		Semipermanent/Permanent Fillers
	Complications
		Nonvascular Complications
			Infection
			Widely Looking Appearance
		Vascular Complications
			Skin Necrosis
			Ocular Complications
	Further Reading