Restorative Rhinoplasty in the Aging Patient

Abstract

Aging patients present unique technical challenges in rhinoplasty that warrant a comprehensive approach to restore internal and external valve competency and tip support. Consideration of prophylactic external valve grafts in addition to the routine use of internal valve grafts and columellar struts may help decrease the need for revision surgery in this patient population. Reasonable functional and esthetic outcomes can be expected in the aging patient.

Panel and patient perceptions of nasal aesthetics after secondary cleft rhinoplasty with versus without columellar grafting

“…According to the 'tripod/pedestal concept' by Anderson (1984), superior and anterior advancement of the lateral crura shortens the upper tripod limbs, increasing tip rotation and projection (Toriumi, 1995(Toriumi, , 1996. Spreader grafts, albeit rarely used in our practice, strengthen and stabilise a weakened or deviated septum (Cochran et al, 2007). The remaining of the harvested cartilage can be milled before being reunited with the aid of fibrin glue and replanted into the donor site.…”

“…Both nasal tip refinement and preservation of tip rotation are best corrected using interdomal and transdomal surtures (Byrd et al, 1997;Rohrich et al, 2004;Cochran et al, 2007). Transdermal suspension that anchors the alar cartilage to the external skin helps secure the desired position of the lateral crus of the cleft side (or both crura in bilateral clefts) (Stal and Hollier, 2002).…”

“…It should be borne in mind that open rhinoplasty can damage the supporting structures of the nose and the external value competency, as it frees the entire skin/soft-tissue envelope from the underlying nasal frameworks. Meticulous tissue handling is therefore mandatory during rhinoplasty, and radical operations on the nasal infrastructures should be avoided (Lam and Williams, 2002;Cochran et al, 2007).…”

The Caudal Septum Columellar Strut Graft

“…Increased medial crural support contributes to establishing and maintaining the desired degree of tip projection and rotation. 3 Strut grafts also help to correct midline columellar deviation resulting from weak and distorted medial crura. The tongue-in-groove concept of suturing the medial crura to the intact caudal septum is an alternative method to using columellar strut grafts, provided that there is adequate septal length and no significant deviation present.…”

Analyses and classification of complexities in rhinoplasties based on factors increasing the difficulty and their appropriate reconstruction

“…[5] Aging patients present unique technical challenges in rhinoplasty that warrant a comprehensive approach to restore internal and external valve competency and tip support. [6] Aging may cause a weakening of the tipsupporting mechanisms and de-rotation of the nasal tip. [7] Management of rhinoplasty in elderly patients generally did not differ from normal primary rhinoplasties except special care for above mentioned changes.…”