Contemporary Male Rhinoplasty Surgery.

In general, fewer male patients seek rhinoplasty surgery than females. The surgical principles are similar in both populations with some special anatomic considerations that will need attention. There is a higher rate of body dysmorphic syndrome in males seeking rhinoplasty as well as greater challenges with patient satisfaction, and the consultation process needs to be thorough and deliberate when undertaking aesthetic surgery in this population to maximize positive outcomes.

Osteotomies in rhinoplasty surgery.

PURPOSE OF REVIEW: To review the current literature on nasal osteotomies with an emphasis on new techniques as well as evaluations of existing procedures. RECENT FINDINGS: Powered instrumentation has seen greater use and is felt to offer an improvement by some over more traditional methods. The enbloc osteotomy may be an alternative procedure to straighten a deviated bony dorsum that does not require hump reduction. Osteotomy sequence can have a significant effect on final outcomes. Comparisons of continuous vs. perforating osteotomy shows only a difference in ecchymosis and edema rather than effectiveness. SUMMARY: The often frustrating and inconsistent nasal osteotomy has been carefully scrutinized by many surgeons over the years. Evolutionary improvements have been developed that may reduce outcome variability and enhance reliability.

Ethical considerations in revision rhinoplasty.

The problems that arise when reviewing another surgeon's work, the financial aspects of revision surgery, and the controversies that present in marketing and advertising will be explored. The technological advances of computer imaging and the Internet have introduced new problems that require our additional consideration.

Rhinoplasty and the nasal SMAS augmentation graft: advantages and indications.

We evaluated the nasal superficial musculoaponeurotic system (SMAS) as an autologous augmentation graft material in the thick-skinned patient undergoing cosmetic rhinoplasty using a retrospective review. Representative case reports demonstrated preliminary long-term results after augmentation with the nasal SMAS graft in an academic rhinoplasty practice. En bloc excision of the nasal SMAS in thick-skinned patients produced uniformly favorable improvements in nasal tip definition without adverse sequelae. Moreover, in 10 patients, the harvested material was also used for volume augmentation at various adjacent nasal sites, including the radix, nasal sidewall, and nasal dorsum. Long-term follow-up ranging from 1 to 3 years suggests stable volume augmentation in this initial patient series. No donor morbidity was observed in properly selected patients, and enhancements in nasal tip definition were uniformly favorable. Additional studies are needed to more accurately characterize long-term nasal SMAS graft survival in all patients.

Anatomical guides to precisely localize the frontal branch of the facial nerve.

OBJECTIVE: To define the relationship between the frontal branch of the facial nerve and a series of blood vessels that are encountered during endoscopic forehead procedures. DESIGN: Anatomical study using 6 fresh cadavers (12 sides). RESULTS: In 11 of 12 dissected specimens, the blood vessels in the temporal region were found to lie within 2 mm of the frontal branch of the facial nerve. CONCLUSIONS: We believe that a series of veins encountered during endoscopic forehead procedures provide the surgeon with the ability to identify the precise location of the frontal branch of the facial nerve. During endoscopic surgery, these vessels are found in a plane between the deep temporal fascia (below) and the superficial temporal fascia (above). We believe that these vessels can be thought of as arrows pointing superiorly to a frontal branch of the facial nerve as it courses through the superficial temporal fascia.