Lip Lift Techniques in Smile Design.

The lips are the main aesthetic component of the facial lower third and simultaneously a substantial element for an ideally perceived smile. One of the most accepted and common procedures that is widely used to enhance the shape and contours of the upper lip is the lip lift. With a careful treatment plan and a professional surgery, a lip lift can reliably be used for the reduction of the philtrum height, enlargement of the upper vermilion, improvement of the dental show, restoration of facial aesthetic proportions, and creation of an enchanting smile.

Smile Management: A Discussion with the Masters.

Smile design is an ongoing challenge in both dentistry and facial cosmetics surgery. Herein, some very common smile design scenarios are shared with six world known masters. Each case will be reviewed by 2 cosmetic dentists, 2 periodontists, and 2 oral and maxillofacial surgeons. At the end, contributors will describe current advances and future prospects of this evolving field.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation.

BACKGROUND: Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties. OBJECTIVES: The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates. METHODS: We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews. RESULTS: The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%. CONCLUSIONS: Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

Autologous Fat Injection for Augmentation Rhinoplasty: A Systematic Review.

BACKGROUND: Autologous fat has become more frequently used for nasal volume augmentation and nasal correction. Nasal lipofilling refers to the use of injectable autologous fat grafts for nonsurgical aesthetic corrections. OBJECTIVES: This systematic review aims to assess the satisfaction, complication, and retention rates of fat injection in nasal shape corrections. METHODS: The authors searched PubMed/Medline and Google Scholar up to and including October 2020 with no time and language restrictions for pertinent materials. Two authors conducted a duplicate searching process independently to determine proper materials based on the inclusion and exclusion criteria. One author retrieved the following data from the finally included studies based on a predefined checklist worksheet. RESULTS: The included studies report data from a total of 564 patients undergoing nasal fat injection in 12 studies. The mean score in our included materials was 6.08 with a range of 4 to 7 scores. In most of our included materials, no complication was reported for the peri/postsurgical period. Although some papers reported manageable complications such as an insufficient volume or decreased volume by resorption, tip excess and supratip fillness, and mild displacement, more than half of our included materials reported on patient satisfaction with aesthetic results of fat injection. The satisfaction rates were mostly high and ranged from 63% to 100%. CONCLUSIONS: Autologous fat injection is an effective and minimally invasive treatment for nasal aesthetic and contour correction with a high satisfaction rate and low complication rate. Clinical expertise is essential to have a safe injection and to minimize the potential complications.

Management of the Cephalic Positioning of the Lower Lateral Cartilage in Modern Rhinoplasty: An Algorithmic Approach.

Cephalic positioning of lateral cruras literally means that the cartilage does not support the nasal rim. Cephalic positioning is a relatively common anatomic variant of lower lateral cartilages that shows an extremely vulnerable rhinoplasty patient. In these patients, any reductive technique, such as cephalic trimming without compensation, worsens the situation and may lead to esthetic failures and airway compromise. True cephalic malpositioning needs to be diagnosed from pseudomalpositions preoperatively. The presence of the pseudomalposition does not mean that it can be ignored. Either malposition or pseudomalposition is best diagnosed and considered in the treatment plan.

Preservation Dorsal Hump Surgery: A Changing Paradigm.

Preservative dorsal hump surgery is an old approach that has revitalized recently. Preservation rhinoplasty aims to shape the existing structures instead of resection/reconstruction approaches. A thorough understanding of the applied anatomy of the nose is the backbone of preservative hump surgery. In preservative hump surgery keystone works as a joint, and by lowering this joint the hump is eliminated.

New Concepts in Dorsal Nasal Augmentation.

Dorsal augmentation is commonly indicated in many primary and secondary aesthetic nose surgeries. Throughout the history, various synthetic and autogenous materials have been used for dorsal augmentation. In this article, we give an overview of basic concepts of cartilage grafting, review new concepts of dorsal augmentation, and discuss some emerging engineering modalities.

The effect of the tongue in groove technique on the nasolabial angle and nasal tip projection.

BACKGROUND: The tongue in groove technique (TIG) is a useful technique for the correction of the nasal tip projection and the nasolabial angle. The purpose of this study was to determine the utility of this technique for nasal tip rotation and projection correction in the Iranian society. METHODS: This is a retrospective clinical trial study of 20 patients undergoing open septo-rhinoplasty using TIG technique from January 2017 to August 2019 at the oral and maxillofacial unit of Bu Ali Hospital and private sector. Preoperative and postoperative profile view photographs were compared to assess the changes in tip projection and rotation. RESULTS: Fifteen patients (75%) had normal angular size, and 5 of them (25%) were not within the normal range after the surgery. The Fisher exact test showed that this success was statistically significant (P = 0.006). Ten patients (50%) had normal projection size, postoperatively. The Fisher exact test showed that this effect was statistically significant (P < 0.01). CONCLUSION: The study demonstrated the benefit of TIG on the correction of nasal tip projection and rotation.

Treatment of mandibular angle fracture: Revision of the basic principles.

Biodynamics of mandibular angle fractures has been extensively discussed in the literature in search for the best way to fixate and expedite recovery of trauma patients. Pioneers like Michelet and Champy had the greatest impact on evolving of osteosynthesis in maxillofacial traumatology; they introduced their basic principles frequently used to describe the biomechanics of mandibular fixation. Their concept states when a physiologic load is applied on mandibular teeth a negative tension will be created at superior border and a positive pressure will appear at inferior border. These simple definitions are the basis for the advent of fixation modalities in mandibular angle fracture. This article sought to reassess these principals based on load location via finite elements method.

Esthetic Rhinoplasty in the Multiply Operated Nose.

PURPOSE: The present study assessed the most common deformities in often-revised noses and their predictable surgical treatments. PATIENTS AND METHODS: This retrospective case series was designed to review different aspects of patients with rhinoplasty who had more than 2 failed previous rhinoplasties. The main requests of patients, number of operations, and final surgical plan for management of these deformities were reviewed and analyzed. RESULTS: This study included 38 patients (27 women, and 11 men) who underwent multiple (2 to 10) unsuccessful rhinoplasties before being operated on by the author from 2011 to 2016. Pinch deformity (14 patients), breathing problems (13 patients), and irregularities were the most common complaints. The conchal cartilage (31 patients) and fascia (19 cases) were the most common graft donor sites in definitive treatments. CONCLUSION: The present study shows that multiple failed rhinoplasties can be properly corrected. Effective management of these patients is best started after a comprehensive preoperative assessment. Then, a conservative predictable approach can be used to overcome the flaws of previous surgeries.

Nasal Framework Osteotomy: An Innovative Approach to Manage an Extremely Long Nose With Meningoencephalocele.

Meningoencephlocele is a relatively rare deformity, usually characterized by penetration of brain or meningeal tissues through a defect in skull. This protruding tissue may affect facial structure and subtle to severe facial deformities may appear. Surgical treatments of these deformities are usually done by a team including a neurosurgeon and craniofacial surgeon. The conventional treatments includes several complicated operations to relocate herniating tissues, then correcting malformed facial structure. The nasal framework osteotomy, is an innovative approach that uses transfacial incisions to gain access to herniating tissue. Then, by completing the osteotomy around the nose, the entire nasal structure is lifted and transposed to it is original position. The authors believe that this technique may considerably reduce the complexity and risks of conventional approaches, while aesthetic demands are readily achieved at the same stage.

Do the Size and Extension of the External Nasal Splint Have an Effect on the Osteotomy, Brow Lines, and Long-Term Results of Rhinoplasty: A Prospective Randomized Controlled Trial of 2 Methods.

PURPOSE: While performing a lateral nasal wall osteotomy during a rhinoplasty, an intentional fracture is produced and the fractured segments are medialized to narrow a wide nasal base. The purpose of this study was to investigate the effect of size, shape, and extension of the external nasal splint on the osteotomy, brow lines, and long-term results of rhinoplasty. MATERIALS AND METHODS: The authors designed a randomized prospective clinical trial. The study population was composed entirely of patients who were voluntarily referred to the authors' department from May 2012 to May 2013. They were randomly divided into 2 equal groups. The primary predictor variable was splint type. For group 1, the external splint was extended beyond the osteotomy lines laterally and covered the overlying skin of the frontal process of the maxillary bone. For group 2, the external splint was trimmed above the osteotomy lines. The primary outcome variables were the levels of satisfaction with the dorsal esthetic lines, brow lines, and distinct osteotomy lines at 12 months after the operation. Demographic variables were gender and age. Mann-Whitney U test, χ(2) test, and t test were used to analyze the data. Results with a P value less than .05 were considered significant. RESULTS: Forty healthy patients (American Society of Anesthesiologists status I and II; 18 men and 22 women; age range, 19 to 41 yr; mean, 31.4 yr) were selected. Although the level of satisfaction with the dorsal esthetic lines was higher in group 2, it was not significantly different from group 1 (P > .05). The levels of satisfaction with the brow lines and the distinct osteotomy lines were significantly higher in group 2 (P < .05). CONCLUSION: The results of this study showed that when a nasal splint is extended beyond the frontal process of the maxilla rather than the base of the nasal bones, positioning of the bones and long-term results are unpredictable.

Dorsal Nasal Augmentation: Is the Composite Graft Consisting of Conchal Cartilage and Retroauricular Fascia an Effective Option?

PURPOSE: Augmentation of a deficient nasal dorsum remains a challenge in rhinoplasty. Different methods and materials have been described in the literature. The purpose of this study was to present the authors' experiences using a composite graft consisting of conchal cartilage and retroauricular fascia for dorsal augmentation. MATERIALS AND METHODS: Patients with moderate to severe dorsal deficiencies were included in this study. The postauricular sulcus was used to gain access to the auricular cartilage and the retroauricular fascia. If the dorsal deficiency was moderate, then 1 layer of conchal cartilage was used. In more severe deficiencies, the cartilage pieces were superimposed, and a multilayer conchal graft was used. To fix the cartilage segments to each other, 6-0 polydioxanone (PDS) suture was used. Then, the cartilage segment was fixed to the retroauricular fascia with 6-0 PDS suture. The nasal dorsum was undermined carefully to create adequate space for chondrofascial graft placement. After performing required maneuvers for solving the functional disorders, tip plasty, and the lateral nasal wall osteotomy, the prepared chondrofascial graft was placed in the dorsal pocket. RESULTS: Fourteen patients (5 men and 9 women) participated in this study. The average follow-up duration was 25.4 months (range, 16 to 42 months). The patients' age ranged from 14 to 54 years (average, 25.9 yr). Follow-up showed no cases of infection, hematoma, major graft resorption, asymmetric graft resorption, and displacement of grafts. No postoperative scars were visible at the donor sites. Mild to moderate ecchymosis occurred at the donor sites in 8 patients, which were solved after 10 days without any complications. In 3 male patients, slight graft resorption was noted. The esthetic results were not compromised in these patients, and revision surgery was not performed. CONCLUSION: This small series of cases with relatively adequate follow-up showed that a composite graft consisting of conchal cartilage and retroauricular fascia is a reliable technique for nasal dorsal augmentation in patients with moderate to severe dorsal deficiency.