Rhinoplasty in Male Patients

Abstract

The complexities of rhinoplasty are further emphasized when this operation is undertaken in the male patient, and a growing percentage of the rhinoplasty population comprises men. We review the senior author's approach to rhinoplasty analysis, preoperative consultation, and surgical techniques that have been successfully employed for over 40 years. Specific recommendations and modifications to these techniques are discussed as they relate to the rhinoplasty operation in male patients.

Preserving Structural Integrity of the Alar Cartilage in Aesthetic Rhinoplasty Using a Cephalic Turn-in Flap

“…This can lead to formation of bossae, alar retraction, and alar collapse. 2,5 Excessive resection of the alar cartilage and failure to eliminate interdomal width may have a role in the development of bossae, which result after contracture of an overly narrowed complete rim strip. Weakening of the lateral cartilage can result in lateral collapse with negative pressure forces created during inspiration.…”

Prevention and Correction of Nasal Tip Bossae in Rhinoplasty

“…4 The most commonly found variation in the literature is the Latinized feminine bossa, with bossae as its plural form. 1,5,6 However, multiple other variations can be found, including boss as the singular and bossa, 7 bossas, 8 and bosses 9 as plural forms. We propose standardization of the terminology, with bossa as the singular term and bossae the plural, which is more true to the Latin origin and proper declension.…”

“…7,10 They may also result from inadvertently created asymmetries. More commonly, bossae are a later finding, observed 1 to 2 years after surgery, 5 although they have been noted to develop as late as 10 years after rhinoplasty.…”

“…We strongly oppose one technique that has long been recommended: simple shaving or excision of the knob. 3,5,10,12 While this may temporarily solve the problem, this removal of cartilage ultimately contributes to further weakening and distortion of the nasal tip framework. Additionally, long-term follow-up shows that disrupted lower lateral cartilages will lead to further bossae, as we have noted in patients with vertical dome division (Figure 9).…”

Nasal Bossae

“…B and D, Result following a major secondary reconstruction including tip grafts. Classically, a bossa was considered an isolated entity that could be shaved off under local anesthesia as a simple office revision-a concept supported by the quoted references from Parkes and Bassilios, 5 Simons and Gallo, 6 Tardy et al, 7 and Thomas and Tardy. 8 In contrast, Kridel et al 1 state the following: "We strongly oppose one technique that has long been recommended: simple shaving or excision of the knob."…”