Rhinoplasty in the deviated nose: patterns of recurrence and role of facial asymmetry

Goffart, Y; Remacle, Sarah

doi:10.1007/s00238-019-01509-x

Cited by 2 publications

(15 citation statements)

References 28 publications

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“…An underestimated factor, in our opinion, is the extrinsic factor, namely the facial envelope effect [3]. Although most authors postulate that the long-term stability of the nose is derived from rigid or semi-rigid intrinsic structures, they also acknowledge the importance of facial muscles and soft tissues during development.…”

Section: Discussionmentioning

confidence: 89%

“…Over time, these tissues gradually stretch and accommodate. This soft tissue constraint may explain at least partially why a nose that is perfectly straight after surgery may re-deviate progressively toward the hypoplastic side over a relatively short period [3].…”

Section: Discussionmentioning

confidence: 99%

“…A deviated nose is a very common developmental feature in Caucasian populations and represents a frequent indication for rhinoplasty, either functional or esthetic. Nasal axis (NA) deviation is often associated with midfacial asymmetry [1][2][3]. Evolutionary biologists postulate that facial symmetry represents a sign of health and genetic quality, and therefore is attractive [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Most patients with a non-traumatic deviated nose present with an asymmetric face [3,6,7,12]. This asymmetry is present both in the maxillary support and in facial soft tissues.…”

Section: Introductionmentioning

confidence: 99%

“…The resulting imbalance between the sides of the face will even increase with facial expressions. It is unclear whether these tensile forces in facial soft tissues, fascia, and muscles play a role in the progressive re-deviation process over several months until healing of bony and cartilaginous structures is completed and definitive stretching of soft tissues is obtained [3].…”

Section: Introductionmentioning

confidence: 99%

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Rigging the nose: a pilot study using barbed sutures in patients with deviated nose

Goffart

Remacle

2020

Eur J Plast Surg

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Background A deviated nose is a very common developmental feature in Caucasian populations and represents a frequent indication for rhinoplasty, either functional or esthetic. We aim to assess the pattern of nasal axis stabilization after rhinoplasty in the deviated nose on the basis of anthropometric measurements: median face axis (MFA), interpupillary meridian axis (IMA), and scoliosis angle (SA); to study possible effects of rigging the nose in the midfacial soft tissues using absorbable soft sutures; to investigate possible side effects. Methods Seventy patients with a non-traumatic deviated nose (n = 50 as control group, n = 20 as treated group with placement of barbed suture in the midfacial soft tissues) underwent rhinoplasty procedures. We retrospectively examined the pattern of deviation recurrence over time in a consecutive series of 70 non-traumatic patients undergoing primary esthetic or functional rhinoplasty (n = 50 as control group, n = 20 as treated group with placement of barbed suture in the midfacial soft tissues). Patients were followed up at 1 week, 2 weeks, 1 month, 3 months, and 1 year postoperatively. Results Ninety-three percent (65/70) of the patients had an asymmetric face after comparing the two anthropometric angles MFA and IMA. Overcorrection of NA at one week postoperatively was observed in 1.25% and 35.7% of patients in the control and treated groups, respectively (p = 0.006). MFA shifted from 4.16° ± 3.1° preoperatively to 1.2° ± 1.4° at 1 week, 1.0° ± 1.1° at 2 weeks, 1.1° ± 1.4° at 1 month, 1.1° ± 1.5° at 3 months, and 1.7° ± 2° at 1 year in the control group. In the treated group, MFA shifted from 5.7° ± 2.9 preoperatively to − 0.34° ± 2.9° at 1 week, 1.0° ± 1.1° at 2 weeks, 0.59° ± 0.96° at 1 month, 1.22° ± 0.83° at 3 months, and 1.63° ± 0.8° at 1 year. Differences between the groups were significant at 1 week (p = 0.02), but differences were not significant at 2 weeks, 1 month, 3 months, and 1 year. Conclusions This pilot study demonstrates that the progressive re-deviation pattern is altered during the first weeks after surgery in the barbed sutures group. Absorbable barbed sutures in facial soft tissues are well tolerated. Longer lasting sutures may help to obtain definite advantage. Level of evidence: Level IV, therapeutic study.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Most patients with a non-traumatic deviated nose present with an asymmetric face [3,6,7,12]. This asymmetry is present both in the maxillary support and in facial soft tissues.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Rigging the nose: a pilot study using barbed sutures in patients with deviated nose

Goffart

Remacle

2020

Eur J Plast Surg

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Myomodulation Using Botulinum Toxin in Septorhinoplasty for Crooked Noses: Introducing the Concept and Application of Nasal Muscle Imbalance Theory

Wong

D’Souza

2023

Facial Plast Surg

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The role of septorhinoplasty for adequate correction of deviated nose is well documented but the rationales and patterns for recurrences after proper rhinoplasty remain unclear. There has also been little attention given to the influence of nasal musculatures on the stability of nasal structures after septorhinoplasty. The aim of this paper is to propose our nasal muscle imbalance theory (NMIT), which may explain the potential reason for re-deviation of the noses in the initial period after septorhinoplasty. We postulate that in a chronically deviated nose, the nasal muscles on the convex side will be stretched and develop hypertrophy after prolonged period of increased contractile activity. On the other hand, the nasal muscles on the concave side will undergo atrophy due to reduced load requirement. In the initial period of recovery after a septorhinoplasty to bring the nose back to midline, this muscle imbalance is still uncorrected with unequal pulling forces on the nasal structure because the stronger nasal muscles on the previously convex side is still hypertrophied and exert stronger forces compared to the previously concave side, therefore increasing the risk of re-deviation of the nose back to the pre-operative side until muscle atrophy occurs in the convex side and a balanced nasal muscle pull is achieved. We believe that post-septorhinoplasty botulinum toxin (PSB) injections can be used as an adjunct in rhinoplasty surgery to effectively block the pulling actions of the stronger or over-acting nasal muscles by speeding up the atrophy process, while allowing patient’s nose to heal and stabilise in the desired position. However, further studies to objectively confirm this hypothesis is required, which include comparing topographic measurements, imaging and electromyography signals before and after injections in post-septorhinoplasty patients. The authors have already planned a multi-centre study to further evaluate this theory.

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Rhinoplasty in the deviated nose: patterns of recurrence and role of facial asymmetry

Cited by 2 publications

References 28 publications

Rigging the nose: a pilot study using barbed sutures in patients with deviated nose

Rigging the nose: a pilot study using barbed sutures in patients with deviated nose

Myomodulation Using Botulinum Toxin in Septorhinoplasty for Crooked Noses: Introducing the Concept and Application of Nasal Muscle Imbalance Theory

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