The nasal bossa: a complication of rhinoplasty

To identify preoperative risk factors and surgical techniques that influence the risk of developing postoperative nasal tip bossae in rhinoplasty. A secondary objective was to review the characteristics, management techniques, and outcomes of those study patients with postoperative bossae.Design: Univariate and multivariate analysis carried out in a case series.Setting: Private facial plastic surgery practice.Patients: All patients who underwent aesthetic nasal surgery that included surgical modification of the nasal tip, and in whom documentation was complete and photographic follow-up was available, were considered eligible. The study group consisted of 875 patients of whom 37 (4.2%) developed bossae postoperatively.Main Outcome Measures: Potential risk factors for postoperative bossae included age, sex, previous nasal surgery, preoperative tip asymmetry, preoperative lobular bifidity, preoperative bossae, skin thickness, surgical tip technique, use of columellar struts, columellar battens, lobular crushed cartilage grafts, and tip shield grafts.Results: In the univariate analysis, females, patients undergoing primary rhinoplasty, younger age groups (12to 22-year-olds), thin skin, and widened interdomal distance (bifidity) were all noted to have moderate or strong associations with nasal tip bossae. In the multivariate analysis, the younger age group, thin skin, and bifidity were statistically significant and independently associated with nasal tip bossae, independent of the type of tip surgery. In addition, clinically relevant associations were noted in females and patients undergoing primary rhinoplasty. Recognition of risk factors, preventive measures, and treatment methods is recommended.

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Nasal Tip Bossae in Rhinoplasty

Gillman

Simons

Lee

1999

Archives of Facial Plastic Surgery

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Prevention and Correction of Nasal Tip Bossae in Rhinoplasty

Kridel

Koch

2003

Arch Facial Plast Surg

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To describe our experiences with nasal tip bossae, suggest a standard nomenclature, discuss causative factors, and provide a comprehensive, analytic approach to the prevention and correction of bossae.Background: Nasal tip bossae are knoblike protuberances of the alar cartilages that can arise after rhinoplasty. Early bossae are due to uncorrected or inadvertently created asymmetries, while late bossae are due to fibrosis and scar contracture acting on a weakened or unreconstituted cartilaginous framework. Numerous techniques may be used to prevent and treat bossae; however, we found no article in the existing literature that presents an in-depth, analytic description of management techniques.Methods: We analyzed the predisposing factors and techniques leading to bossa formation and studied principles of prevention and correction. All rhinoplasty cases that presented for revision from 1985 through 2000 were reviewed for bossae formation via internal computer search. Previous operative records for rhinoplasty cases were examined when available. Intraoperative notes and photgraphs of the revision surgery were examined.Results: Etiologies for bossae were consistently found, and successful treatment modalities were noted.Conclusions: Nasal tip bossae are most often due to dynamic forces acting on iatrogenic changes and/or weakness in the alar cartilages. By minimizing cartilage excision, reinforcing areas of weakness, avoiding asymmetry and irregularity, and maintaining alar integrity, formation of bossae may be prevented. The treatment of bossae must be individualized and can range from simple suture stabilization techniques to complex domal cartilage replacement grafts, depending on the observed defect.

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Revision Rhinoplasty: Analysis and Treatment

Kamer¹,

McQuown²

1988

Archives of Otolaryngology - Head and Neck Surgery

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The nasal bossa: a complication of rhinoplasty

Cited by 13 publications

References 1 publication

Nasal Tip Bossae in Rhinoplasty

Nasal Tip Bossae in Rhinoplasty

Prevention and Correction of Nasal Tip Bossae in Rhinoplasty

Revision Rhinoplasty: Analysis and Treatment

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