Nuances of the Nasal Tip: Rhinoplasty of the Thin-Skinned Nose

Farrior, Edward H.; Ballert, John A.

doi:10.1055/s-0032-1309296

Cited by 11 publications

(8 citation statements)

References 5 publications

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“…Fascia grafting in this population is often helpful along with meticulous attention to cartilage grafting and suturing to be sure that edges of grafts are beveled or hidden when possible. 36…”

Section: The Skin-soft Tissue Envelope and Scarringmentioning

confidence: 99%

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Moyer

2018

Facial plast Surg

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Dissatisfaction with the appearance of the nasal tip is a common compliant in patients seeking revision surgery after rhinoplasty. Revision rhinoplasty is more technically difficult and unpredictable given the frequent presence of scar contracture, impaired skin envelope quality, and missing alar cartilage. This article describes some of the more common causes for tip revision surgery and techniques to address these abnormalities.

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Section: The Skin-soft Tissue Envelope and Scarringmentioning

confidence: 99%

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Moyer

2018

Facial plast Surg

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“…Different materials and grafts to address areas that may result in a contour irregularity postoperatively include diced or crushed cartilage, temporalis fascia, fascia lata, and AlloDerm. 1 These are time-tested and potentially require cartilage or a second surgical site, adding time and potential morbidity to the operation. The ideal graft would be easy to harvest, be accessible in the same operative site, have low long-term resorption rate, and be soft.…”

mentioning

confidence: 99%

Supracrural Ligament Graft in Rhinoplasty

2020

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Irregularities of the nasal dorsum or tip are a potential risk after rhinoplasty. Patients with thin skin are considered to be at a higher risk of these irregularities. Different materials and grafts to address areas that may result in a contour irregularity postoperatively include diced or crushed cartilage, temporalis fascia, fascia lata, and AlloDerm. We describe a new graft, the supracrural ligament graft, which can be used to camouflage or add bulk during primary rhinoplasty. The graft is harvested easily during the initial exposure and does not require additional surgical sites or extra dissection. In this research, we described the use of the supracrural ligament graft in 49 patients. We found the average graft size to be 0.6 × 0.4 cm. The graft was used in the following locations: nasal tip (49%), radix (40%), and nasal dorsum (10%). No complications were seen using the graft in any of the 49 patients. In conclusion, the supracrural ligament graft is a safe, simple, and effective camouflage graft for commonly encountered irregularities in rhinoplasty. Common areas of use include the nasal dorsum and nasal tip. Routine harvest of this graft may obviate the need to use either additional grafting material or an additional surgical site to help camouflage areas of concern in thin skin patients.

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confidence: 99%

“…A variety of grafting materials have been described to help camouflage irregularities . Crushed cartilage, temporalis fascia, fascia lata, and acellular dermis have been used to cover irregularities in the tip or rhinion region.…”

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confidence: 99%

The Intercrural Fascia Graft in Primary Rhinoplasty

Courson

Adamson

2018

JAMA Facial Plast Surg

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A variety of grafting materials have been described to help camouflage irregularities. 1 Crushed cartilage, temporalis fascia, fascia lata, and acellular dermis have been used to cover irregularities in the tip or rhinion region. Crushed cartilage, temporalis fascia, and fascia lata can have problems with irregularities, resorption, additional morbidity, and increased surgical time for harvest. Acellular dermis has the inherent issues of being a foreign substance and a substantial resorption rate. 2 An ideal camouflage graft would be present in necessary amounts, located within the operative site, easily harvested in a short amount of time, and provide long-term benefit with a low resorption rate.The superficial musculoaponeurotic system of the nose has been well described. 3 As part of this system, the fibrous tissue between the medial and intermediate crura has been characterized and referred to by several names. The terms Pitanguy's ligament, the in-terdomal ligament, interdomal sling, dermocartilaginous ligament, and intercrural soft tissue are likely all in reference to this fibrous tissue in between the crura. 4,5 The senior author (P.A.A.) has previously described harvest of this tissue as a vascularized rotational flap for premaxillary augmentation. 6 This same tissue can be harvested in primary rhinoplasty and used as a camouflage graft, a graft we term the intercrural fascia graft. Our technique and experience is described.

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Nuances of the Nasal Tip: Rhinoplasty of the Thin-Skinned Nose

Cited by 11 publications

References 5 publications

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Dissatisfaction with Nasal Tip Shape: Secondary Tip Maneuvers

Supracrural Ligament Graft in Rhinoplasty

The Intercrural Fascia Graft in Primary Rhinoplasty

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