A

Abscess, with extracorporeal septoplasty, 18–19

Aesthetics. See Profile aesthetics.

Agenesis, of nasal dorsum, DC-F grafts for, 78

Airway dysfunction, DC-F grafts for, 76, 78

with lateral crural repositioning, for cephalic malposition, 60, 70

with L-strut deformities, 13

with nasal tip deformities, 24, 30

Alach clamp, for neoseptum creation, in extracorporeal septoplasty, 15

Alae, in nasal lengthening, 83

Alar base insertion, in lateral crural repositioning, tip contouring and, 62–63

Alar batten grafts, for tip contouring, in lateral crural repositioning, 67–68

Alar cartilage, in nasal tip anatomy, 95

in tip deprojection, with crural cartilage overlap, 102–104

Alar retraction, in CTD, sidewall tensioning for, 30–33

in lateral crural repositioning, tip contouring and, 62–63

in nasal lengthening, 84, 87

Alar rim, in nasal lengthening, 82

Alar rim grafts, articulated, for LCT, 46, 48–49

for nasal lengthening, 84, 89

Alar sidewalls, in tip deprojection, with crural cartilage overlap, 102–104

tension of, in LCT, for wide/underprojected nasal tip, 30–33

tensioning of, columellar-alar relationship improvement with, 30–31

Anchoring suture, internal, for basic spreader flaps, for middle vault, 2–3, 7

Ancillary procedures, in extracorporeal septoplasty, for scoliotic nose, 16–18

augmentation of premaxilla with DC-F graft, 17–18

columellar retraction as, 16–17

internal nasal valve reconstruction with polydioxanone foil, 18

in nasal lengthening, 82–83, 87

outcomes of, 88–89

Anderson’s tripod concept, of tip dynamics, in rhinoplasty, 57–58, 93–95

tip deprojection and, 96–97

Anesthesia. See Local anesthesia.

Anterior isolated deficiency of infratip lobule, 83–84

Anterior nasal spine (ANS), in extracorporeal septoplasty, 12, 14, 16–17

Anterior-posterior septal deviations, septal deviations associated with, 13

Asian rhinoplasty, DC-F graft construct for, 75

tip contouring in, 67

Asymmetry. See Symmetry/asymmetry.

Aufricht retractor, 77

B

Bandages, postoperative. See Wound bandaging.

Basal support, in tip deprojection, with crural cartilage overlap, 101–102

Basic spreader flaps, with internal anchoring suture, for middle vault, 2–3, 7

Bleeding, excessive intraoperative, with nasal lengthening, 87–88

Bone grafts, in lateral crural tensioning, 39–41

in nasal lengthening, 34, 37

in septal reconstruction, 14

Bony pyramid, straightening of, in extracorporeal septoplasty, 15

Bony-cartilaginous (B-C) junction, in septal reconstruction, for scoliotic nose, 14

Bulbosity, of lateral cura, lateral crural repositioning for, 58–63

lateral crural steal for, 30–33

lateral crural tensioning for, 26, 28

B

Bandages, postoperative. See Wound bandaging.

Basal support, in tip deprojection, with crural cartilage overlap, 101–102

Basic spreader flaps, with internal anchoring suture, for middle vault, 2–3, 7

Bleeding, excessive intraoperative, with nasal lengthening, 87–88

Bone grafts, in lateral crural tensioning, 39–41

in nasal lengthening, 34, 37

in septal reconstruction, 14

Bony pyramid, straightening of, in extracorporeal septoplasty, 15

Bony-cartilaginous (B-C) junction, in septal reconstruction, for scoliotic nose, 14

Bulbosity, of lateral cura, lateral crural repositioning for, 58–63

lateral crural steal for, 30–33

lateral crural tensioning for, 26, 28

C

Camouflage, DC-F grafts for, 75

for crooked nose, 16

in tip deprojection, with crural cartilage overlap, 102–103

Cartilage. See also specific anatomy or type.

excision of, for CTD, lateral crural tensioning vs., 23–24

in nasal tip anatomy, 94–95

Cartilage grafts, diced, 73–80 . See also Diced cartilage with deep temporalis fascia (DC-F) graft.

in lateral crural repositioning, for cephalic malposition, 56

in nasal lengthening, 82–83

in septal reconstruction, for scoliotic nose, 14–15

in tip deprojection, 93–104 . See also Crural cartilage overlap.

Carving block, silicone, for preparing DC-F graft, 76

Carving board, metal, for dicing cartilage, 74

Caudal edge, of nasal tip, 94–95

Caudal excess deformity, of nasal base, in lateral crural tensioning, 39–40

Cephalic adhesions, in lateral crural tensioning, 32–33

Cephalic border, of nasal tip, 94–95

Cephalic malposition, lateral crural repositioning for, 55–71

complications of, 70

deformity indications for, 55, 58–59

ideal tip in, frontal vs. lateral view of, 56

introduction to, 55

key points of, 55

preoperative planning for, 55–56

preoperative preparation for, 56

procedural approach to, 56–70

base reduction in, 69–70

closure in, 69

opening the nose in, 56–57

overview of, 56

stabilizing the nasal base in, 57–58

tip contouring in, 58–62

summary overview of, 70

tip contouring in, 58–69

additional considerations for, 66–69

alae retraction and, 62–63

alar base insertion asymmetries and, 62–63

nasal length change and, 62, 66–68

specific procedure for, 58–62

tip projection change and, 66–68

tip rotation change and, 62–65

Cephalic positioning, of LLC, in orientation along long axis, 66–68

lateral crural repositioning for, 58–60

Cephalic resection, in lateral crural tensioning, 30

Cephalic trim maneuver, for tip projection change, in lateral crural repositioning, 69

with vertical arch division, 97

in lateral crural tensioning, 26–29

paradomal trim vs., 43–48

Cephalometric analysis, in nasal lengthening, 82

Columella, in nasal lengthening, 82–83

Columellar retraction, in extracorporeal septoplasty, for scoliotic nose, 16–17

Columellar strut graft, in nasal lengthening, 85–87

interface with spreader grafts, 86–87

in tip deprojection, with crural cartilage overlap, 101–102

modified, septal extension graft vs., 33–34

Columellar-alar relationship, sidewall tensioning improvement of, 30–31

Columellar-lobular relationship, in VLD, 98, 102

Composite grafts, for nasal lengthening, 84, 89

Compound tip deformity (CTD), lateral crural steal for, 30–33

lateral crural tensioning for, 24–30

Computer imaging, of lateral crural repositioning, for cephalic malposition, 56

of lateral crural tensioning, 34, 42

of middle vault contour and stabilization, 2

Conchal cartilage, in extracorporeal septoplasty, for columellar retraction, 16–17

for neoseptum creation, 15

in lateral crural repositioning, 56

in nasal lengthening, 87, 89

Contour, middle vault, spreader flaps for, 1–9 . See also Middle vault contouring.

nasal dorsum, in extracorporeal septoplasty, for scoliotic nose, 18–19

pre- and postoperative photographs of, 19–21

nasal tip. See Tip contouring.

Contracture, soft tissue, in nasal lengthening, 83, 87

Convex cupping, in CTD, lateral crural steal for, 30–33

lateral crural tensioning for, 26, 28

Counter-rotation, of nasal tip, deprojection and, 99

Crooked nose, extracorporeal septoplasty for, 11–22

ancillary procedures in, 16–18

augmentation of premaxilla with DC-F graft, 17–18

columellar retraction as, 16–17

internal nasal valve reconstruction with polydioxanone foil, 18

bandaging of, 16–17

camouflage techniques for, 16, 75

complications of, 18–20

discussion on, 20–21

in situ, 21

indications for, 12–13

introduction to, 11–12

key points of, 11

modification of original, 12

modifications of original, 12, 19–20

results of, 18–21

summary overview of, 21

surgical technique for, 13–16

analysis and correction of anterior nasal spine, 12, 14

dissection and en bloc removal of septum, 13–14

final adjustments in, 16–17

septal reconstruction, 14–15

from conchal cartilage, 15

implantation of neoseptum, 12, 15–16

straightening of bony pyramid, 15

middle vault contouring and stabilization for, 5–6

Crura length, discrepancies in, with CTD, lateral crural tensioning for, 25–27

frequent neglect of, 28–30

Crural cartilage overlap, tip deprojection with, 93–104

conservative maneuvers vs., 102

introduction to, 93–94

key points of, 93

M-arch model of, 94, 97–102

excessive length of, 100–101

potential causes of, 100

potential pitfalls of, 103

procedural steps for, adjustment requirements evaluation in, 101

columellar strut graft in, 101–102

excision as, 102

open rhinoplasty approach in, 101

preoperative assessment and planning in, 100–101

septal work in, 101

vestibular preservation technique for, 102–104

summary overview of, 104

tip anatomy and definitions for, 94–95

tip dynamics in, 95–96

tripod concept and, 96–97

vertical arch division and, 97–102. See also Vertical arch division.

Crural tensioning, for wide and underprojected nasal tip refinement, 23–53 . See also Lateral crural tensioning (LCT).

C-shaped septal deviations, septal deviations associated with, 13

CTD. See Compound tip deformity (CTD).

D

DC-F graft, 73–80 . See also Diced cartilage with deep temporalis fascia (DC-F) graft.

DC-F graft construct, creation of, 75–76

Dehiscence, of wound, with nasal lengthening, 87–88

Deprojection, tip. See also Tip deprojection.

with crural cartilage overlap, 93–104 . See also Crural cartilage overlap.

Diced cartilage with deep temporalis fascia (DC-F) graft, 73–80

complications of, 78–79

management of, 79–80

current techniques for, 74–79

construct creating in, 75–76

construct preparation in, 76

dicing cartilage in, 74

harvesting cartilage in, 74

description of, 73

examples of, 76–79

for primary septorhinoplasty, 77

for septal deviation and difficulty breathing, 76

historical evolution of, 73–74

in extracorporeal septoplasty, for columellar retraction, 17

for premaxilla augmentation, 17–18

key points of, 73

operative uses of, 75

examples of, 76–79

technical points of, 77–78

postoperative edema as, 77

postoperative molding as, 78

temporalis fascia harvest as, 77–78

typical width of, 76

Digital image morphing. See Computer imaging.

Domal arches, in VLD, with crural overlap, 98–99

of nasal tip, 94–95

Domal fold, creation and suturing of, in LCT, 27, 42

Dome repositioning, for tip projection change, in lateral crural repositioning, 66–67

Dome suture, for lateral crura stabilization, in lateral crural repositioning, 60–61, 67–68

Dorsal agenesis, DC-F grafts for, 78

Dorsal contour, in extracorporeal septoplasty, for scoliotic nose, 18–19

pre- and postoperative photographs of, 19–21

Dorsal elongation, 83

tongue-and-groove technique for, 84–87

outcomes of, 88–89

Dorsal graft silicone sizers, for DC-F graft construct, 75–76

Dorsal implant, infected, DC-F graft construct for, 75, 79

Dorsal reconstruction, DC-F grafts for, 75

following postoperative infection, 79

Doyle splints/stents, 88

E

Edema, postoperative, with DC-F grafts, 77

En bloc removal, of septum, in extracorporeal septoplasty, 11, 13–14

Epistaxis, with nasal lengthening, 87–88

Ethmoid bone, for lateral crural tensioning, 39

for nasal lengthening, 34, 37

in septal reconstruction, for scoliotic nose, 14

Extracorporeal septoplasty, for scoliotic nose, 11–22

ancillary procedures in, 16–18

augmentation of premaxilla with DC-F graft, 17–18

columellar retraction as, 16–17

internal nasal valve reconstruction with polydioxanone foil, 18

bandaging of, 16–17

camouflage techniques for, 16

complications of, 18–20

discussion on, 20–21

in situ, 21

indications for, 12–13

introduction to, 11–12

key points of, 11

modifications of original, 12, 19–20

results of, 18–21

summary overview of, 21

surgical technique for, 13–16

analysis and correction of anterior nasal spine, 12, 14

dissection and en bloc removal of septum, 13–14

final adjustments in, 16–17

septal reconstruction, 14–15

from conchal cartilage, 15

implantation of neoseptum, 12, 15–16

straightening of bony pyramid, 15

F

Fascia grafts, in extracorporeal septoplasty, for columellar retraction, 17

for premaxilla augmentation, 17–18

Fascial attachments, in nasal tip anatomy, 95

Figure-of-8 sutures, for lateral crural tensioning, 37, 40

Finely diced cartilage (FDC) paste, in extracorporeal septoplasty, for scoliotic nose, 16, 19

injection device for, 16

Flaring-type spreader flaps, for middle vault, 3–4

Foam packing, in extracorporeal septoplasty, for scoliotic nose, 16

Force vectors, in nasal tip, balancing of, 95–96

in LCT, 43–45

in VLD, 98, 102

suspensory, 96–97

G

Goode ratio, of nasal length to nasal projection, 81

Grafts/grafting. See also specific anatomy, graft, or procedure.

in lateral crural repositioning, for cephalic malposition, 56, 68–69

in nasal lengthening, 82–85, 87, 96

in tip deprojection, with crural cartilage overlap, 102–104. See also specific crural overlay.

Gubisch/Alach clamp, for neoseptum creation, in extracorporeal septoplasty, 15

Guyuron classification, of septal deviations, 13

H

Head wrap, gauze, in extracorporeal septoplasty, for scoliotic nose, 16–17

History taking, for lateral crural tensioning, 34

for nasal lengthening, 82

Hump reduction. See Nasal hump.

Hydro dissection, of vestibular mucosa/skin, in lateral crural repositioning, 60–61, 66

I

ICO. See Intermediate crura overlay (ICO).

Incision marking, for lateral crural tensioning, 38

for temporalis fascia harvesting, 74

Infection, of DC-F grafts, 79–80

of dorsal implant, DC-F grafts for, 75, 79

with lateral crural repositioning, 70

with lateral crural tensioning, 34

with nasal lengthening, 87–88

Infratip lobule, anterior isolated deficiency of, 83–84

Infratip lobule height, nostril length vs., in VLD, with crural overlap, 100

Intermediate crura (IC), in nasal tip anatomy, 94–95

Intermediate crura overlay (ICO), in VLD, 97–98

vestibular preservation procedure in, 102–104

Interrupted-type spreader flaps, for middle vault, 4–5

Inversion, of lateral crura, in lateral crural tensioning, 46

Inverted V deformity, with hump reduction, 6

with middle vault narrowing, 1–2

Inverted V incision, for nose dissection, in lateral crural repositioning, 56–57