Objectives: There are many publications about surgeon technique in rhinoplasty, if we deal with wide nose tip and thick skin of it, asymmetry and deformation of nose tip, lacking of supratip depression or vice versa it’s too deep.
However, we still lack of straight recommendations about operative technique to solve above mentioned problems.
Thus, searching of decisions is quite relevant to improve results in rhinoplasty technique of tip and supratip area.
Introduction: The work with the tip of the nose is one of the most difficult stages in aesthetic rhinoplasty, and it has remained in the focus of the world's leading rhinosurgeons attention already for several decades.
Unsatisfactory results of the nose plasty are very often associated with incorrectly performed surgical intervention in the area of the tip and the supratip zone. There are aesthetic aspects that must always be taken into account when working in this field: the outcome of the aesthetic operation is an elegant and symmetrical contour of the tip and the supratip area of the nose, the competent camouflage of the thin skin irregularities and tendency of the thick skin to elegantly cover the created cartilaginous skeleton maintaining a stable position of the tip of the nose.
Materials / method: We observed 486 patients with deformity of the tip and the supratip area of the nose in our clinic from 2003 to 2018. When working with the nose tip thick skin, dissection was performed in two layers, often with resection of the nose tip SMAS-flap in order to reduce the thickness of the covering tissues. For the thin skin of the tip of the nose a variety of camouflage techniques were used: cartilage graft or SMAS-transplant. When the tip of the nose was deformed, sparing techniques of working with the cartilage of the nose were applied: arc precision suture techniques, the use of a smas-flap or cartilage grafts for the purpose of hiding defects, sliding LLC, if the supratip recess was deep used were a SMAS-flap or cartilage flap created from the LLC cephalic portions. In order to stabilize the tip of the nose, we used a "suture-rafter", which was specially developed in our clinic. If the nasal septum was curved or turbinates were hypertrophied, the functional stage of rhinoplasty was performed in conjunction with the ENT surgeon.
Sutures from the nose skin were usually removed on the 7th day, the gypsum langet – on the 7th-10th day, and self-absorbable suture material was used for the vestibule of the nasal cavity.
Results: Among of 486 operated patients, with complaints of deformation tip and supratip area of the nose in a year after operation, 316 patients (65%) recognize excellent results, 92 patients (19%) – as good result, 50 patients (11%) – as satisfactory result, and of 28 patients (5%) – as unsatisfactory.
Conclusion: The application of abovementioned recommendations can reduce the number of repeated operations in the area of the tip of the nose. These techniques are easy to implement and do not require significant time. The use of autologous tissues guarantees low resorption of grafts and flaps. Stabilization of the nose tip prevents its ptosis in the long-range outlook. The combination of all actions significantly improves the results of the treatment and the quality of patient’s life.
Disclosures
Did you receive any funding to support your research for this TOPIC?
No
Were you provided with any honoraria, payment or other compensation for your work on this study?
No
Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No
Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
Yes
Please specify date...: Patent
and status : 15/12/2005
This work was not supported by any direct or non direct funding. It is under the author's own responsability
