Current Clinical Practices of the Rhinoplasty Society Members

Lee, Michael; Unger, Jacob G.; Gryskiewicz, Joe M.; Rohrich, Rodney J

doi:10.1097/sap.0b013e3182503ca1

Cited by 18 publications

(9 citation statements)

References 17 publications

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“… 4 The external (open) rhinoplasty approach has gained in popularity over the last several decades, especially as a form of secondary rhinoplasty. 17 , 38 Lee et al 20 reported that 72% of surgeons use the open approach for primary rhinoplasty, whereas the remaining 28% implement a closed approach. For secondary rhinoplasty, 76% of surveyed practitioners reported using the open approach.…”

Section: Discussionmentioning

confidence: 99%

“… 17 – 19 The open approach is perhaps more commonly used due to its advantages of improved visualization and, when utilizing grafts, potentially more accurate fixation of the cartilage grafts. 20 , 21 The main disadvantages of this technique include the relative invasiveness of the procedure and the possibility of compromising the integrity of the middle nasal vault when the upper lateral cartilages (ULCs) are divided from the septum if the ULCs are disarticulated from underneath the nasal bones; postoperative swelling following an open approach to the nose is an additional significant consideration. 19 The endonasal approach, which provides recovery without scar formation, is a similar procedure in select cases where there is less deformity; however, it is limiting because it does not clearly expose the anatomical structures.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Paul

Kamali

Chen

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Rhinoplasty is 1 of the most common aesthetic and reconstructive plastic surgical procedures performed within the United States. Yet, data on functional reconstructive open and closed rhinoplasty procedures with or without spreader graft placement are not definitive as only a few studies have examined both validated measurable objective and subjective outcomes of spreader grafting during rhinoplasty. The aim of this study was to utilize previously validated measures to assess objective, functional outcomes in patients who underwent open and closed rhinoplasty with spreader grafting.Methods:We performed a retrospective review of consecutive rhinoplasty patients. Patients with internal nasal valve insufficiency who underwent an open and closed approach rhinoplasty between 2007 and 2016 were studied. The Cottle test and Nasal Obstruction Symptom Evaluation survey was used to assess nasal obstruction. Patient-reported symptoms were recorded. Acoustic rhinometry was performed pre- and postoperatively. Average minimal cross-sectional area of the nose was measured.Results:One hundred seventy-eight patients were reviewed over a period of 8 years. Thirty-eight patients were included in this study. Of those, 30 patients underwent closed rhinoplasty and 8 open rhinoplasty. Mean age was 36.9 ± 18.4 years. The average cross-sectional area in closed and open rhinoplasty patients increased significantly (P = 0.019). There was a functional improvement in all presented cases using the Nasal Obstruction Symptom Evaluation scale evaluation.Conclusions:Closed rhinoplasty with spreader grafting may play a significant role in the treatment of nasal valve collapse. A closed approach rhinoplasty including spreader grafting is a viable option in select cases with objective and validated functional improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Paul

Kamali

Chen

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…A common goal in cosmetic rhinoplasty is nasal tip improvement, be it rotation, projection, or bulbosity correction. 6 In this context, the NLA becomes a parameter of interest. Just as NLAs vary widely between individuals, there are many NLA definitions, and the slight variations between them can yield large discrepancies on the same photograph.…”

Section: Discussionmentioning

confidence: 99%

Varied Definitions of Nasolabial Angle: Searching for Consensus Among Rhinoplasty Surgeons and an Algorithm for Selecting the Ideal Method

Harris¹,

Nagarkar²,

Amirlak³

2016

Plastic and Reconstructive Surgery - Global Open

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Background:The nasolabial angle (NLA) is an important aesthetic metric for nasal assessment and correction. Although the literature offers many definitions, none has garnered universal acceptance.Methods:To gauge the consensus level among practitioners, surveys were administered to a convenience sample of rhinoplasty surgeons soliciting practice characteristics, self-assessment of rhinoplasty experience and expertise, and preferred NLA definition. Choices of NLA definition included the angle between: (A) columella and line intersecting subnasale and labrale superius; (B) columella and line tangent to philtrum; (C) nostril long axis and Frankfort perpendicular; and (D) nostril long axis and vertical facial plane.Results:Of the 82 total respondents, mean age was 50 years (range, 30–80years), and mean professional experience was 17 years (range, 0–67 years). Nineteen described themselves as novice rhinoplasty surgeons, 27 as intermediates, and 36 as experts. Mean number of lifetime rhinoplasties performed was 966 (range, 0–10,000). Twenty respondents (24%) agreed with definition A, 27 (33%) with B, 16 (20%) with C, and 13 (16%) with D. Six chose “other,” offering their own explanations of NLA. Self-identified novices were more likely to prefer definition D than were experts (P = 0.009).Conclusions:No majority consensus was reached regarding the definition of NLA. Each method has its benefits and drawbacks, and establishing a single one may be unnecessary and even counterproductive in some cases. Having options available means that surgeons can tailor to each encounter, as long as they adopt a systematic methodology. We submit an algorithm to facilitate this effort.

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“…In revision rhinoplasty, the external approach is favored due to increased visualization of nasal structures to facilitate proper diagnosis and correction. 29 The internal approach should be reserved for more minor revisions with deformities in single anatomic region. 13 It is best used for dorsal hump reduction, osteotomies, or single graft strut placement for tip support.…”

Section: Surgical Planningmentioning

confidence: 99%

Revision Rhinoplasty: With Introduction of a Novel Preoperative Assessment Classification System

2021

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Revision rhinoplasty presents several complex surgical challenges. Proper patient selection for revision rhinoplasty, along with thorough preoperative examination and surgical planning, is key to achieving ideal outcomes. Along with achieving a high level of understanding of primary rhinoplasty techniques, surgeons performing revision rhinoplasty must understand and diagnose deformities created by the primary surgery. A systematic approach to diagnosing rhinoplasty deformities assists in forming a suitable surgical plan. A classification system based on nasal analysis, described here, may be used to differentiate the degree of difficulty of the surgery as well as assist in surgical planning. Surgeons have a multitude of options available in their armamentarium for addressing common nasal deformities encountered during revisional surgery, and a stepwise surgical approach may facilitate the creation of an optimal aesthetic and functional result.

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Current Clinical Practices of the Rhinoplasty Society Members

Abstract: Of the responding members of The Rhinoplasty Society, the open approach is the preferred choice for both primary and other surgeons' revision rhinoplasties. Spreader grafts are commonplace in both functional and aesthetic rhinoplasties.

Cited by 18 publications

References 17 publications

Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Assessment of Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated Outcome Measurements

Varied Definitions of Nasolabial Angle: Searching for Consensus Among Rhinoplasty Surgeons and an Algorithm for Selecting the Ideal Method

Revision Rhinoplasty: With Introduction of a Novel Preoperative Assessment Classification System

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