Objectives: Aim of the study is to verify how different osteotomies can produce a better light-shadow interplay in the nasal region.
Introduction: According to the traditional teaching, osteotomies are aimed to closing the open roof, straigthening bones, and narrowing a wide bony base. In rhinoplasty literature, there is scarce evidence about the cosmetic impact of osteotomies on the lights/shadows interplay on the frontal view.
Materials / method: 48 rhinoplasty patients (31 females, 17 males) were enrolled into the study. In all patients osteotomies were performed, monolateral (3 cases) or bilateral (45 cases). In 39 patients multiple osteotomies were performed. All rhinoplasty osteotomies were performed endonasally, in only 7 cases percutaneous osteotomies were added to the set of endonasal osteotomies.
All the procedures were performed under general anaesthesia. The mean follow-up was 11 months. The cosmetic effects of osteotomies was evaluated by comparing standard pre- and post-operative views (frontal, 3/4 and helicopter views).
Results: The traditional combination of basal and paramedian curved osteotomies does not provide valuable solutions in common conditions of deranged lights/shadows balance such as an excessive width of unilateral/bilateral sidewalls, washed-out appearance of the upper- and mid- thirds of the external nose, and asymmetry of the upper- and mid- thirds of the external nose.
Tailormade osteotomies showed to be effective in restoring more aesthetic lights/shadows relationships.
Conclusion: The lights/shadow balance of the nasal region can be aesthetically changed by tailormade osteotomies whose design and sequence are to be highly adapted to the individual anatomy. Cookie-cutter execution of nasal osteotomies does not provide satisfying aesthetic outcomes.
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