Primary rhinoplasty is the most difficult of aesthetic operations for three reasons: 1) nasal anatomy is highly variable thereby precluding a “one operation fits all” approach; 2) the procedure must correct both form and function; and 3) the final highly visible result must meet the patient’s high expectations. Currently, we are fortunate to be able to reap the benefits of the rhinoplasty revolution that have occurred in the previous decade. Four major advances appear to have come from this period. First, a clear set of aesthetic goals has evolved allowing formulation of an individualized operative plan for each patient rather than the specific surgeon s signature nose. Second, functional surgery for both correction and preservation of the airway has become an integral part of cosmetic procedures thereby minimizing the incidence of postoperative nasal obstruction. Third, the open approach has shortened the learning curve for the less-experienced surgeon and offered solutions for many of the problem noses that plagued the endonasal era. Fourth, a graded sequence allows the surgeon to select the appropriate maneuver to fit the severity of the patient’s deformity. We are truly at a wonderful moment in the ever-changing evolution of rhinoplasty with current questions being tip sutures vs. tip grafts, the search for an ideal alloplastic graft, and increasing precision with computer-driven medical devices.
In Part I of this chapter and on the enclosed DVD, I will present a step-by-step approach to a primary aesthetic rhinoplasty case (see DVD) . The emphasis will be on the basic techniques that every new surgeon should master during residency. In Part II of this chapter, I will review each step in the operative sequence with emphasis on which techniques I actually utilize on a routine basis. This information was gleaned from a review of 100 consecutive cosmetic primary rhinoplasties. Excluded from this group were ethnic, cleft, and traumatic cases as well as those with function as the primary goal. The results of this review were rather startling to me and may prove surprising to the reader.
KeywordsAlar Base Alar Cartilage Spreader Graft Anterior Nasal Spine Open Rhinoplasty
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