The senior surgeon has found that common incorporation of certain maneuvers offers more consistent, aesthetically pleasing, and superior functional outcomes. Careful review of this article may guide the reader to consider the more frequent use of some maneuvers or reduction of other maneuvers to reflect that of a streamlined and higher-volume rhinoplasty practice.
There has been minimal attention paid in the literature to the aesthetics of the perioral area, either in youth or in senescence. Aging around the lips traditionally was thought to result from a combination of thinning skin surrounding the area, ptosis, and loss of volume in the lips. The atrophy of senescence was treated by adding volume to the lips and filling the deep nasolabial creases. There is now a growing appreciation for the role of volume enhancement in the perioral region and the sunken midface, as well as for dentition, in the resting and dynamic appearance of the perioral area (particularly in youth). In this article, the authors describe the senior author's (BG) preferred methods for aesthetic enhancement of the perioral region and his rejuvenative techniques developed over the past 28 years. The article describes the etiologies behind the dysmorphologies in this area and presents a problem-oriented algorithm for treating them.
Several articles have been published about the short nose, many of which begin with a statement about the difficulty and complexity that this deformity poses for the rhinoplasty surgeon. Regardless of the challenges, many surgeons have undertaken the task of elongating the short nose and have subsequently shared with the rhinoplasty community the subtle techniques they have developed through their experience. The authors present a review of the literature that has contributed to the understanding of the etiology, evaluation, assessment, and operative procedures in the reconstruction of the short nose, specifically with regard to septal extension grafts. Additionally, the senior author's (BG) technique and experience of nearly 30 years of practice is described.
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