Preferences for the white female nasal supratip break.

BACKGROUND: The debate on how to create ideal facial proportions--once the remit of artists and sculptors--has been reignited during the past 5 decades, with the emergence of aesthetic facial surgery. Classic ideals exist, but few individuals actually satisfy these criteria. Aesthetic ideals are culturally and temporally variable. For centuries, the optimum nasal profile, particularly the supratip break (STB), has long been a matter for debate. Little is published on preferences for the STB. We therefore undertook a population study to determine the preferred angulation of the STB. METHODS: Lateral profile photographs of 10 models were taken under standard conditions in forward gaze. The angulation of the STB was altered in one of the photographs of each model, so that one photograph had a subtle angulation of the STB and the other had a more marked angulation. Participants in the study were shown 2 photographs of each of the 10 models. One hundred male and female participants were recruited to the study and asked to indicate their preference for the nasal tip for each of the models. Statistical analysis was performed using the Wilcoxon signed-rank test to determine significance. RESULTS: Both male and female participants in the study indicated an overall, and statistically significant, preference for lateral profile photographs showing a nasal tip with a very subtle angulation of the STB, compared with a larger angulation of the STB. CONCLUSIONS: This study provides strong evidence that a subtle STB in the white female subject is most favorable.

Cartilage recycling in rhinoplasty: polydioxanone foil as an absorbable biomechanical scaffold.

BACKGROUND: Primary and secondary rhinoplasty often requires multiple cartilage grafts. Polydioxanone foil may be used as a temporary biomechanical scaffold on which routinely discarded cartilage fragments can be assembled to make maximal use of harvested material. METHODS: The authors performed an outcome analysis of 58 primary and secondary rhinoplasties in which polydioxanone foil was used in combination with autologous cartilage for aesthetic and valvular reconstruction of the nose. Graft performance, complications, and technical points are reported. RESULTS: The temporary scaffold (polydioxanone foil) was used most often to construct columellar struts, septal extension grafts, and alar battens. Other uses included revision septoplasty and upper lateral replacement grafts. Two minor complications occurred: one infection and one partial extrusion. The long-term stability of the nose following this technique was found to be satisfactory (mean follow-up, 18 months), for both structural and aesthetic purposes. CONCLUSIONS: This technique is both simple and effective. By making maximal use of otherwise discarded cartilage fragments, it protects other graft harvest sites and decreases the incidence of the "graft-depleted" patient.

Orbital volume augmentation with autologous micro-fat grafts.

PURPOSE: The purpose of this study is to present an alternative procedure for rehabilitation of the volume deficient anophthalmic or enophthalmic socket. METHODS: A retrospective review of clinical and photographic records of 12 patients with either an anophthalmic or enophthalmic orbit (14 orbits) undergoing volume augmentation by micro-fat grafting, or lipostructure, as initially described by Coleman. Patients with orbital volume deficiency seen in the oculoplastic clinic at Chelsea and Westminster Hospital, London, UK, were invited to participate in the study. The technique is discussed in detail. RESULTS: The volume of fat injected ranged from 0.8 mL to 4.5 mL (median, 3.05 mL) per orbit, with a median increase in exophthalmometry measurements (available in 9 patients) of 2 mm (range, 0-7.5 mm). Subjective improvement in cosmetic outcome was experienced in all patients. Repeat grafting was required in 1 patient, and will be required in another patient. There were no embolic complications. The procedure was well tolerated in all patients. Median follow-up was 14.5 months (range,12-30 months). CONCLUSIONS: Micro-fat grafting to the anophthalmic or enophthalmic socket appears to be a safe alternative technique for orbital volume enhancement. It has the advantages of avoiding alloplastic infectious complications, ease of technique, minimal donor site morbidity, acceptable graft take rate, low embolic complication rate, and good cosmetic outcome.

Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation.

BACKGROUND: Augmentation of the nasal dorsum using autologous cartilage remains an exacting task in rhinoplasty. Precise, long-term control over graft contour and alignment can be difficult to achieve. In an attempt to alleviate these problems, the use of diced cartilage wrapped in a supportive sleeve has recently seen a resurgence of interest. The Turkish delight technique uses Surgicel as the sleeve material, whereas Daniel and Calvert have proposed autologous fascia. METHODS: The objective of this study was to assess the efficacy and reliability of diced cartilage-fascia grafts in the treatment of dorsal nasal volume deficiencies. RESULTS: Over a 2-year period, 20 adult patients underwent nasal augmentation using diced cartilage-fascia grafts. The indications for dorsal grafting were congenital saddling, racial refinement, or iatrogenic or posttraumatic deformities. Apart from one infection, all of the hybrid grafts retained their original volume and had not undergone resorption by a mean time of 16 months postoperatively. A critical analysis of the radix-dorsum aesthetics led to a minor modification of the original technique. CONCLUSION: This series supports the use of diced cartilage-fascia grafts for the correction of difficult dorsal nasal defects with grafting in the 3- to 5-mm range in primary and secondary rhinoplasty.

A standardized digital photography system with computerized eyelid measurement analysis.

BACKGROUND: The authors have developed a slit-lamp mounted digital photography system. This ensures that the patient's head is consistently positioned in the same plane in relation to the camera and generates standardized images of the eyelids, which are then analyzed using commercially available computer measurement software. The aim of this study was to assess the repeatability and reproducibility of this system compared with traditional methods of eyelid measurement. METHODS: Both eyes of 10 patients were photographed and then measured by three clinicians using a handheld ruler for five eyelid parameters (i.e., palpebral aperture, superior marginal reflex distance, inferior scleral show, levator function, and upper eyelid skin crease height). The photographs were then assessed using computer software by the same clinicians (twice by a consultant and once by a clinical fellow and a specialist registrar). At all times, each observer was masked to their colleagues' results. Data were analyzed using Bland-Altman plots. RESULTS: There was a good level of agreement between measurements obtained by computer analysis of digital photographs and measurements obtained by traditional methods. A higher level of reproducibility (interobserver variability) was demonstrated in all digital measurements compared with those obtained by handheld ruler. Repeatability (intraobserver variability) with the digital photograph technique was also high and consistent for each of the five eyelid parameters. CONCLUSIONS: These results suggest that a digital photography system with computer analysis is comparable to, and offers advantages over, traditional methods of measurement. This system offers a simple, standardized, and rapid method of patient assessment with important applications in electronic patient records, audit, and research.

Forehead flap method for total nasal reconstruction.

One of the very first recorded methods developed over the ages to correct the mutilating deformity of rhinectomy was the forehead flap. While many other techniques have also been devised, this surgical method has stood the test of time better than any other. Further refined during the 20th century, it has now become the gold standard for obtaining the best results in nasal reconstruction. We present an illustrative case of a young man who was assaulted outside a night club and who suffered a clean separation of the nasal pyramid from the facial plane. We highlight the novel use of osseous, as opposed to cartilaginous, reconstruction of the upper lateral cartilages, which has not previously been reported in the literature.