In our daily practice, we usually perform the rhinoplasty without considering the dynamic functions.The depressor septi nasi muscle (DSNM) is very important in nose dynamics. Its hyperactivity in some rhinoplasty patients while they smiling or speaking causes a deformity that includes drooping of the nasal tip, elevation and shortening of the upper lip, and increased maxillary gingival show. The dissection of the depressor septi muscle during rhinoplasty can improve the tip-upper lip relationship in appropriately selected patients. To manage this functional part of rhinoplasty, we aimed to clarify the anatomic study, surgical indications, rationale for the operative technique, and clinical cases are presented.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The anatomic alterations of the columella may compromise aesthetically both the nasal base and its function.This article describes how to diagnose compromised structures and how to solve them in a simple and minimally invasive way. In addition, we show how to anticipate the changes that we create according to the chosen technique in the nasal tip (the dynamic of the nasal tip).

We describe our technique using polydioxanone (PDS) foil for the correction and stabilization of caudal septal deviation. In addition, we evaluate the effectiveness of this technique in the treatment of the C-shaped craniocaudal sepal deviation. A retrospective review was conducted of 55 patients who underwent open septorhinoplasty with PDS splinting for the correction of a caudal septal deviation. The mean age was 35 years (range, 25-45 years), 38 of 55 (69%) were females and all had symptomatic nasal obstruction. Preoperatively, there were osteocartilaginous involvement and hypertrophy of the inferior turbinate at the opposite side of the septal deviation in all cases; whereas 30 (54.5%) patients had a bone spur, 20 (36.3%) had collapse of the external nasal valve due to septal deviation. Five patients complained of sinus headache that resolved after surgical correction. All patients were pleased with their functional improvement and 52 (95%) with their aesthetic results. Only 1 patient required surgical revision, which was due to the development of asymptomatic posterior septal perforation identified at follow-up endoscopy. There were no additional postoperative complications. Splinting of the septal cartilage with a PDS foil was feasible, safe, and effective for the treatment of severe caudal septal deviation. This technique emerges as an alternative to traditional cartilage grafting, especially in patients with insufficient cartilage for harvest or in patients with thin nasal dorsum in whom the use of a spreader graft can widen the nose and modify the normal nose contours, providing long-term support and stability of the septum.

Introduction: Nasal tip revision remains one of the most challenging procedures for plastic surgeons. Performing 3-dimensional anatomic nasal tip reconstruction by complete replacement of alar cartilages with ear cartilage allows optimal nasal tip correction in patients with severe alar distortion. We aim to describe this reconstructive surgical technique and report our experience with this procedure. Materials and Methods: We performed a retrospective analysis of patients who underwent complete replacement of alar cartilages as part of a revision rhinoplasty. Results: From January 2010 to December 2014, 569 patients underwent revisions, 20 (3.5%) of them with complete alar replacement. Additional grafts used were as follows: 8 columellar struts, 6 onlay grafts, and 3 spreader grafts. There were no in-hospital complications. At follow-up (mean 24 months), all patients reported satisfaction with the esthetic outcome and improvement in functional symptoms. No patient underwent further augmentation or repeat revision. Conclusions: Complete replacement of alar cartilages is an efficient surgical alternative for nasal tip reconstruction during revision rhinoplasty. This technique recreates the severely injured alar cartilage structure and returns the original nasal tip appearance.