Abordaje de la punta nasal problemática / Approach to problematic nasal tip

Las puntas nasales globulosas, cuadradas, bífidas, hipoproyectadas, hiperproyectadas o asimétricas, son consideradas problemáticas o dificultosas. Para su tratamiento, en las rinoplastias primarias, debemos abordar los cartílagos alares a través de las incisiones intercartilaginosa y transfixiante interseptocolumelar, primero y paramarginal después. Se disecan por ambas caras y se exteriorizan por una de las narinas. Así expuestos, se les pueden realizar con mayor precisión las correcciones necesarias. Una vez repuestos los cartílagos a su nueva posición, llevaremos a cabo la síntesis de la incisión paramarginal con puntos separados. Los demás pasos de la rinoplastia se pueden efectuar según técnica de elección para cada cirujano (AU)

The nasal tips when are wide, amorphous, bulbous, bad defined, with insufficient projection, overprojection or assymetry, are considered as problematical or difficult nasals tips. At primary rhinoplasty, through a intercartilaginous, transfixion and pararim incisions, the lower lateral cartilages are dissected in both surfaces and are exteriorizated through the nostril; then, they are corrected under direct vision. After these corrections, the cartilages are placed back into their new position. The other steps of the basic aesthetic rhinoplasty can be made according to the technique of choice for each surgeon (AU)

Anestesia troncular en rinoplastias / Troncular anesthesia in rinoplasty

Se describe la técnica de anestesia troncular para Rinoplastia en tres etapas: premedicación, aplicación tópica e infiltración. Se pretende con solamente 5 cc. de lidocaína al 2% con epinefrina más media ampolla de adrenalina, bloquear selectivamente los filetes nerviosos en sus lugares específicos, sin deformar el contorno nasal. De esta manera suprimimos las molestias durante la infiltración y logramos muy buena analgesia para la realización de la Rinoplastia, con mínimos riesgos (AU)

A 3 steps tecnique for local anesthesia in Rinoplasty is described: premedication, topical anesthesia and infiltration. With only 5 cc of 2% lidocaine plus 0,5 cc of adrenaline, nerves are specificaly blocked at the accurate emerging points, without nasal contour deformity. This way discomfrot sensation during infiltration is avoided and a very good level of analgesia for Rinoplasty is achieved (AU)

Rhinoplasty and facial expression.

Based on the philosophical concept that facial beauty is not merely harmony of static anatomical structures but also the dynamic expression of the face (especially when one smiles), I propose that plastic surgeons approach the problem of aesthetic improvement of the human face not only in response but also when the face moves. I call this "surgery of the facial expression." I describe here the use of a new surgical procedure to correct a certain condition with which plastic surgeons are frequently confronted when patients consult and request rhinoplasty. Many patients have added defects that are exposed only when they begin to make facial movements and gestures; moreover, these added defects become even more manifest when they smile. I call this phenomenon "rhino-gingivolabial syndrome of the smile," and describe the technique I have used not only to improve the form of the nose but also to enhance the patient's smile.

Surgical lengthening of the short columella: division of the depressor septi muscles.

A new surgical procedure is described to correct the difficult problem of the short columella without resorting to cartilage grafts. The ready recourse to these grafts, so much in vogue at the present time in primary rhinoplasties, should be carefully and completely re-examined, since the final result very frequently yields no real benefits and may permanently deface the area from which the cartilage has been taken. The present technique combines trimming of the upper lateral nasal cartilages with approximation of the alar cartilages and excisions of the depressor septi muscles and/or contiguous orbicularis oris muscle.

Lateral approach in mammary implants.

The lateral approach in mammary implants is recommended, especially in patients with a marked hypomastia. In these patients, submuscular implants are mandatory. Routinely, hyaluronidase is injected in situ before implantation to favor immediate reabsorption of possible bleeding that could lead to capsular contraction. A circular pattern has been designed to reach symmetry both in incisions and the surgical pocket. Advantages of the lateral approach are described.

Aesthetic treatment of the columella.

Through a transfixion incision, a rhomboidal portion of both the depressor muscle of the nasal septum and the orbicular muscle of the mouth are excised. The remaining columellar tissues are brought nearer to each other by means of a mattress suture tied over a double-foam bolus. This simple procedure yields three advantages: (1) Tip projection, (2) nasolabial angle opening, (3) Interalar distance reduction, especially in the black population, avoiding the Weir-Joseph procedures. This simple and harmless procedure renders better results than the use of cartilage grafts or silicone implants aiming to project the tip or to open the nasolabial angle. Also, in some cases the patients' smile is enhanced.

Nuestra experiencia con los detergentes catiónicos antisépticos eficaces / Our experience with cationic detergents as efficient antiseptics

Con una experiencia de 20 años los autores destacan las bondades de los detergentes catiónicos como antisépticos eficaces siempre que se utilicen en la forma adecuada

Nuestra experiencia con los detergentes catiónicos antisépticos eficaces / Our experience with cationic detergents as efficient antiseptics

Con una experiencia de 20 años los autores destacan las bondades de los detergentes catiónicos como antisépticos eficaces siempre que se utilicen en la forma adecuada (AU)