Advanced Aesthetic Rhinoplasty

Melvin A. Shiffman • Alberto Di Giuseppe

Editors

Advanced Aesthetic
Rhinoplasty
Art, Science, and New Clinical
Techniques
Editors
Melvin A. Shiffman, M.D., J.D. Alberto Di Giuseppe, M.D.
Section of Surgery Department of Plastic
Newport Specialty Hospital and Reconstructive surgery
Tustin Torrette hospital
CA Ancona
USA Italy

ISBN 978-3-642-28052-8 ISBN 978-3-642-28053-5 (eBook)

DOI 10.1007/978-3-642-28053-5
Springer Heidelberg New York Dordrecht London

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This book is dedicated to the memory of Dr. Antonella Belligolli
M.D., Plastic Surgeon, aged 48, who died after a long struggle
with breast cancer, which affected her 15 year back.
She was part of the staff of the Department of Plastic and
Reconstructive Surgery of the University of Ancona, since its
foundation.
She worked since 1991 in the Ancona General Regional
Hospital, and she was a prominent Breast Plastic Surgeon.
But mostly, she was a real doctor: she came to learn plastic
surgery, but finally she taught and showed us how a doctor
should be.
Honesty, humanity, tenderness and firmness were her
principles, which she applied to her life and her work.
We had the great privilege to work closely with her, and to
learn from her.
To her dear husband Massimo, to her lovely daughter Ilaria
and to her son Pietro, the tough job of continuing their lives,
inspired by the great heart of this splendid woman.

Ciao Antonella

Alberto, Giovanni, Alessandro, Antonello, Marina, and all the

Medical and Paramedical Staff of the Plastic Surgery
Department 1991–2012
Foreword

Head Professor of the Post-Graduate Courses in Plastic Surgery of the

Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-
Graduate Medical Institute. Visiting professor, I.S.A.P.S.
For many years, I have been involved in the teaching of plastic surgery,
having trained many generations of young surgeons eager to learn the prac-
tice of our specialty. Among the diverse anatomical regions that fall under our
care, I believe the nose presents – even to the experienced surgeon – one of
our greatest challenges. Placed in the fulcrum of the face, this complex struc-
ture commands our full attention. A slight defect, a minimal asymmetry, and
harmony is unbalanced. The nasal pyramid must be approached with a per-
fect understanding of anatomy and function, through many different options
of tissue manipulation, with an aesthetic result that is pleasing and in equilib-
rium with the patient’s physiognomy. To operate a primary case, and espe-
cially a secondary nose, requires our utmost skill. The editors of this book
have excelled in bringing together a large team of experts in the art and sci-
ence of rhinoplasty. All aspects of this fascinating area of plastic surgery are
covered, starting with the fundamental principles, moving on to the clinical
evaluation and planning, and including a rich description of surgical tech-
niques, elaborated by authors of large practice. Novel concepts and nonsurgi-
cal approaches are introduced, expanding the scope of a traditional textbook
on rhinoplasty. I congratulate Dr. Shiffman and his collaborators for this
important book, as it will prove to be a valuable contribution to the literature
of plastic surgery.

Rio de Janeiro, Brazil Ivo Pitanguy

vii
Preface

There are many books on rhinoplasty, but most are limited to the editor’s
techniques or those of a few contributors. These give restricted information
on the variety of procedures that are available and are mainly for teaching the
inexperienced and somewhat experienced surgeons how to do rhinoplasty
and possibly stay out of trouble.
This book on Advanced Aesthetic Rhinoplasty: Art, Science, and New
Clinical Techniques gives a detailed analysis of the newer techniques that are
available in primary and secondary rhinoplasty. This allows the presentation
by international experts of the very newest procedures available with subjects
covering nasal anatomy, psychological aspects of rhinoplasty, surgical tech-
niques of primary rhinoplasty and secondary rhinoplasty, the use of fillers in
rhinoplasty, and the possible risks and complications of rhinoplasty. This
concept of gathering new techniques from international experts is not present
in any other book on rhinoplasty, and the information is extensive and quite
different from even recent books on rhinoplasty. The book is for the inexpe-
rienced, experienced, and the very experienced surgeon doing rhinoplasties.
The editors wish to present advanced technology and clinical techniques
in rhinoplasty from unique contributors experienced with these procedures
that are modified or original procedures. The contributors are inventive and
eloquent in presenting to the reader a way to progress from inexperienced or
experienced surgeons in rhinoplasty to better understanding that there is more
than following simplified techniques as a template to performing a procedure
that is fraught with possible risks and complications. Understanding the
patient through psychological profiling will make it easier for the surgeon
to stay out of trouble with patients who are not really candidates for
rhinoplasty.
All cosmetic surgeries are potential problems if the patient is not properly
evaluated preoperatively, not only physically but also mentally. This is most
true with the patient considering rhinoplasty. However, the satisfaction of the
patient who has a good result is inestimable.

Tustin, CA, USA Melvin A. Shiffman, M.D., J.D.

ix
Contents

Part I Anatomy

1 Muscles, SMAS, and Vascular Anatomy of the Nose. . . . . . . . 3

Yves Saban, Chiara Andretto Amodeo, and Roberto Polselli
2 Neurologic Anatomy of the Nose . . . . . . . . . . . . . . . . . . . . . . . . 17
Peter M. Prendergast
3 Anatomy of the Dermocartilaginous Ligament
of the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Seung-Kyu Han
4 Surgical Anatomy of the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Robert M. Oneal and Richard J. Beil

Part II Perspectives and Psychology

5 Rhinoplasty in the Ageing Face . . . . . . . . . . . . . . . . . . . . . . . . . 63

James W. Rainsbury and Darryl J. Hodgkinson
6 Self-Esteem and Personality in Patients with Body
Dysmorphic Disorder Undergoing
Cosmetic Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Carla Gramaglia and Enrica Marzola
7 Psychological Aspects of Rhinoplasty . . . . . . . . . . . . . . . . . . . . 93
Mauro Ercolani and Alessandro Agostini
8 Psychological Considerations in Revision Rhinoplasty . . . . . . 99
Bryan T. Ambro and Richard J. Wright

Part III Preoperative

9 Computer Simulated Imaging in Rhinoplasty . . . . . . . . . . . . . 109

Robert T. Adelson
10 Rhinometry: Clinical Index for Evaluation of the Nose . . . . . 119
Abdoljalil Kalantar-Hormozi and Arash Beiraghi-Toosi

xi
xii Preface

Part IV Primary Rhinoplasty

11 History of Cosmetic Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . 133

Melvin A. Shiffman
12 Trends in Functional Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . 137
Joshua D. Weissman and Sam P. Most
13 Primary Caucasian Female Rhinoplasty . . . . . . . . . . . . . . . . . 147
Babak Azizzadeh and Michael J. Reilly
14 Asian Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Yong Ju Jang
15 Hispanic Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Ali Sajjadian
16 Middle Eastern Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Ali Sajjadian
17 Rhinoplasty in the Multiracial Nose . . . . . . . . . . . . . . . . . . . . . 197
Thomas Romo III, Manoj T. Abraham, and Whitney Pafford
18 Aesthetic Rhinoplasty Utilizing Various
Techniques Depending on the Abnormality . . . . . . . . . . . . . . . 207
Fernando D. Burstein
19 Sonic Rhinoplasty: Sculpting with the Ultrasonic
Bone Aspirator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Edmund A. Pribitkin, Leela S. Lavasani,
Carol Shindle, and Jewel D. Greywoode
20 Extracorporeal Rhinoseptoplasty . . . . . . . . . . . . . . . . . . . . . . . 233
Francois Disant, Delphine Vertu-Ciolino, and Nicolas Beck
21 External Marginal Approach Rhinoplasty
(EMA Rhinoplasty) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Peter Chanwoo Kim and Dae Hwan Park
22 The Controversy Between Open and Closed
Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Arturo Grau
23 Open Technique Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Alberto Di Giuseppe
24 The Upper Buccal Sulcus Approach
in Posttrauma Rhinoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Christian Vacher
25 Rhinoplasty: Open Techniques . . . . . . . . . . . . . . . . . . . . . . . . . 357
Vladimir Kljajic, Jovan Radmanovic, Ljiljana Vlaski,
and Slobodan Savovic
26 The Intranasal Z-Plasty for Nasal Valve Collapse . . . . . . . . . . 367
Jay M. Dutton, John S. Schneider, and Catherine A. Ray
Preface xiii

27 Nasal Alar Rim Reconstruction for Nasal

Rim and Valve Collapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Robert J. Troell
28 Lateral Osteotomy in Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . 387
Rauf Tahamiler and Murat Yener
29 Double-Guarded Osteotome for Internal
Lateral Nasal Osteotomies to Prevent Mucosa Tearing . . . . . 401
A. Aldo Mottura
30 Correcting the Convex Lateral Crura
of the Lower Alar Cartilages . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Alexis D. Furze, Lynn L. Chiu-Collins, Jason Gilde,
and Brian J.F. Wong
31 Alar Base Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
Sara R. Dickie, Peter A. Adamson, and Jeremy P. Warner
32 The Anchor Graft: A Technique for Pinched
Nasal Tip and/or Retracted Nasal Ala . . . . . . . . . . . . . . . . . . . 435
C.W. David Chang
33 Stabilizing Cartilage Grafts in Functional-Aesthetic
Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Wolfgang Wagner, Frank Riedel, and Gregor M. Bran
34 Costal Cartilage Grafting for Dorsal Augmentation . . . . . . . . 479
Waleed H. Ezzat and Babak Azizzadeh
35 Split Calvarial Bone Grafting in Rhinoplasty . . . . . . . . . . . . . 491
Babak Azizzadeh and Grigoriy Mashkevich
36 Ultradiced Rib Cartilage Graft Without Wrapping
for Augmentation Rhinoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . 497
Peter Chanwoo Kim and Dae Hwan Park
37 Biomechanical Properties of Facial Cartilage Grafts . . . . . . . 533
Sepehr Oliaei, Cyrus Manuel, Dmitriy Protsenko,
and Brian J.F. Wong
38 Structural Grafts and Suture Techniques
in Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
Uwe Mueller-Vogt and Holger G. Gassner
39 Fascia Lata Graft for Nasal Dorsal Contouring
in Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Mehmet Veli Karaaltin
40 Augmentation Rhinoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Jose Guerrerosantos
41 Sublabial Approach for Columellar
Reconstruction in Corrective Rhinoplasty . . . . . . . . . . . . . . . . 657
Sarit Cohen and J. Shem Tov
xiv Preface

42 Caudal Septal Extension Grafts . . . . . . . . . . . . . . . . . . . . . . . . 667

Lynn L. Chiu-Collins, Alexis D. Furze, and Brian J.F. Wong
43 Septal Surgery in the Crooked Nose . . . . . . . . . . . . . . . . . . . . . 679
Hossam M.T. Foda
44 Secondary Cleft Rhinoplasty: Combining an
Open Rhinoplasty with the Dibbell Technique
and Tajima Incision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 689
Roberto L. Flores and Court B. Cutting
45 Rhinoplasty for Cleft and
Hemangioma-Related Deformities . . . . . . . . . . . . . . . . . . . . . . 699
Judy Pan and Sherard A. Tatum III
46 Postoperative Care of the Rhinoplasty Patient . . . . . . . . . . . . 711
C. Spencer Cochran

Part V Fillers

47 Use of Integra™ in Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . 721

Jorge Planas
48 Fat Grafting to the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733
Juan Monreal
49 Orbital Fat Pad for Nasal Tip Augmentation
in Far Eastern Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . 745
Young Kyoon Kim
50 Permacol in Augmentation Rhinoplasty . . . . . . . . . . . . . . . . . . 753
Claire Hopkins and David Roberts
51 Use of Aquamid as a Filler
for Rhinoplasty in Orientals. . . . . . . . . . . . . . . . . . . . . . . . . . . . 767
Yoichi Yagi
52 Nonsurgical Rhinoplasty: Cosmetic
Nasal Contouring Through the Use of Fillers . . . . . . . . . . . . . 773
Cameron K. Rokhsar and Molly M. Murray
53 Spreader Graft Injection with Calcium
Hydroxylapatite. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783
Christopher P. Nyte
54 Filler, Botulinum Toxin, and Rhinoplasty:
The Medical Rhinoplasty Concept . . . . . . . . . . . . . . . . . . . . . . 791
Frédéric Braccini and Alessio Redaelli
55 Non-surgical Nasal Augmentation and Correction
of Post-rhinoplasty Contour Asymmetries
with Hyaluronic Acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 799
Dominic Bray
Preface xv

56 GORE-TEX Implants in Rhinoplasty . . . . . . . . . . . . . . . . . . . . 809

Krzysztof Conrad and Andrew J. Conrad
57 Simultaneous Rhinoplasty and Orthognathic
Double Jaw Procedures: How to Get the Nasolabial
Unit Harmony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
Mirco Raffaini

Part VI Tip Procedures

58 Suture Nasal Tip Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 837

Hassan Abbas Khawaja and Melvin A. Shiffman
59 Resection of Strips of Alar Cartilages
for the Difficult Projected Tip with Thin Skin . . . . . . . . . . . . . 845
Abder-Rahman Mounir and Edward Latimer-Sayer
60 Tip Shaping in Primary Rhinoplasty . . . . . . . . . . . . . . . . . . . . 853
Ashkan Ghavami
61 A Modified Delivery Approach . . . . . . . . . . . . . . . . . . . . . . . . . 869
Rui Xavier
62 The Double Columellar Strut: An Adjunct
to Improve the Nasal Tip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 877
Mark Berman
63 Surgery on the Primary Nasal Tip: New Domes
Technique and Banner Technique . . . . . . . . . . . . . . . . . . . . . . . 887
Eduardo Morera Serna and Felipe Culaciati Tapia
64 The Medial Crural Suture Technique:
Long-Term Columellar Narrowing Resulting
in Increased Tip Projection and Rotation. . . . . . . . . . . . . . . . . 911
Helen Perakis and Achih H. Chen
65 The Onlay Folded Flap (OFF) for Nasal
Tip Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 919
Hani Abou Mayaleh

Part VII Complications

66 Complications of Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . 933

Brian C. Harsha

Part VIII Revision Rhinoplasty

67 Functional and Aesthetic Concerns

of Patients Seeking Revision Rhinoplasty . . . . . . . . . . . . . . . . . 947
Kathy Yu, Alyn Kim, and Steven J. Pearlman
xvi Preface

68 Revision Rhinoplasty: Evaluating the Patient

and the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 957
Keith Ladner and Edward H. Farrior
69 Airway Patency in Aesthetic Rhinoplasty:
Primary and Revisional Techniques . . . . . . . . . . . . . . . . . . . . . 969
Fernando D. Burstein
70 Secondary Rhinoplasty in the Middle Eastern Patient . . . . . . 983
Ashkan Ghavami
71 Revision Rhinoplasty of Asian Noses . . . . . . . . . . . . . . . . . . . . 1001
Chan Hum Park
72 Open Rhinoplasty in Secondary Cases . . . . . . . . . . . . . . . . . . . 1037
Alberto Di Giuseppe and Luca Grassetti
73 The Decision Process in Choosing Costal
Cartilage During Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . 1057
Robert J. DeFatta
74 Harvesting Rib Cartilage Grafts
for Secondary Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1067
Vincent P. Marin and C. Spencer Cochran
75 Aesthetic and Functional Restoration Using
Dorsal Saddle-Shaped Medpor Implant
in Secondary Rhinoplasty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1075
Murat Türegün
76 Management of the Middle Third
in Revision Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1083
Jonathan Liang, Ji-Eon Kim, and Jonathan Sykes
77 Restoring the Drooping Tip and Hanging
Columella in Revision Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . 1095
A. Joshua Zimm and Samieh Sam Rizk

Part IX Miscellaneous

78 Advancing the Art of Rhinoplasty

with Tissue Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1107
Deborah Watson and Marsha S. Reuther
79 Algorithm for Posttraumatic Rhinoplasty . . . . . . . . . . . . . . . . 1119
Tirbod Fattahi
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1123