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Rhinoplasty
Thomas Procedures in Facial Plastic Surgery
Stephen W. Perkins, MD, FACS
Clinical Associate Professor
Department of Otolaryngology-Head and Neck Surgery
Indiana University School of Medicine
Indianapolis, Indiana, USA
2012
PEOPLE’S MEDICAL PUBLISHING HOUSE—USA
SHELTON, CONNECTICUT
People’s Medical Publishing House-USA
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© 2012 PMPH-USA, Ltd.
All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise), without the prior written permission of the publisher.
11 12 13 14/PMPH/9 8 7 6 5 4 3 2 1
ISBN-13: 978-1-60795-152-0
ISBN-10: 1-60795-152-5
Printed in China by People’s Medical Publishing House
Copyeditor/Typesetter: Spearhead Global, Inc.
Cover designer: Mary McKeon
Library of Congress Cataloging-in-Publication Data
Perkins, Stephen W.
Rhinoplasty : Thomas procedures in facial plastic surgery / Stephen W. Perkins.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-1-60795-152-0
ISBN-10: 1-60795-152-5
I. Title.
[DNLM: 1. Rhinoplasty—methods. 2. Nose—anatomy & histology. 3. Nose—surgery. WV 312]
LC classifi cation not assigned
617.5’230592—dc23
2011033016
Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication.
However, since research and regulation constantly change clinical standards, the reader is urged to check the product
information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particularly
one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the benefi ts
anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information contained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment.
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https://t.me/medicina_free
Contributors
https://t.me/medicina_free
Rami K. Batniji, MD, FACS
Diplomate, American Board of Facial Plastic & Reconstructive Surgery
Diplomate, American Board of Otolaryngology
Fellow, American College of Surgeons
Batniji Facial Plastic Surgery
Newport Beach, CA
Henry D. Sandel, IV, MD
The Sandel Center for Facial Plastic Surgery
Annapolis, MD
https://t.me/medicina_free
Table of Contents
https://t.me/medicina_free
Chapter 1 Nasal Anatomy, Nasal Analysis, and the
Rhinoplasty Consultation ....................................................................................1
Rami K. Batniji, MD, FACS and Stephen W. Perkins, MD
Applied Nasal Anatomy .................................................................................................................................1
Facial Analysis ................................................................................................................................................2
Nasal Analysis ................................................................................................................................................3
Consultation ..................................................................................................................................................4
Acknowledgments .........................................................................................................................................6
References ......................................................................................................................................................6
Chapter 2 Primary Rhinoplasty: Intermixed Use of
Endonasal and External Columellar Approaches ......................................... 7
Stephen W. Perkins, MD
Consultation ..................................................................................................................................................8
Preoperative Examination and Analysis ........................................................................................................8
Choosing the Appropriate Surgical Approach ............................................................................................10
Photographic Documentation and Computer Imaging .............................................................................12
Surgical Approach........................................................................................................................................12
The Order of the Procedures Performed in Primary Endonasal Rhinoplasty ............................................13
Tip Support and the Incisional Approach to the Nose ...............................................................................14
Profi le Plasty ................................................................................................................................................14
Radix Grafts .................................................................................................................................................15
Dorsal Augmentation ..................................................................................................................................15
Spreader Grafts ............................................................................................................................................16
Osteotomies .................................................................................................................................................16
Tip Grafts .....................................................................................................................................................17
Specifi c Tip-Sculpting Techniques ..............................................................................................................17
Operative Effects or Results that are Achieved by Sutured Double-Dome Tip Surgery ............................17
Alar Recurvature and Alar Collapse ............................................................................................................27
Finishing Touches Using Refi nement Techniques ......................................................................................28
Postoperative Nasal Dressings and Care .....................................................................................................29
Summary .....................................................................................................................................................30
References ....................................................................................................................................................30
viii / Table of Contents
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Chapter 3 Tip Rhinoplasty .................................................................................33
Rami K. Batniji, MD, FACS and Stephen W. Perkins, MD
Introduction ................................................................................................................................................33
Facial Analysis ..............................................................................................................................................33
Preoperative Considerations .......................................................................................................................33
Technique .....................................................................................................................................................34
Postoperative Care .......................................................................................................................................41
Complications .............................................................................................................................................43
Acknowledgments .......................................................................................................................................44
References ....................................................................................................................................................44
Chapter 4 Profi le-plasty: The Bony and Cartilaginous
Nasal Vault .............................................................................................................45
Stephen W. Perkins, MD and Henry D. Sandel, IV, MD
Consultation ................................................................................................................................................45
Computer Imaging ......................................................................................................................................47
The Procedures of Profi le-plasty .................................................................................................................49
Osteotomies .................................................................................................................................................52
Radix Grafts .................................................................................................................................................53
Complications of Profi le-plasty and Management of the Bony Nasal Vault ..............................................53
References ....................................................................................................................................................55
Chapter 5 Posttraumatic Nasal Deformity and Nasal
Fracture Management .........................................................................................57
Rami K. Batniji, MD, FACS and Stephen W. Perkins, MD
Introduction ................................................................................................................................................57
Incidence ......................................................................................................................................................57
Mechanism of Injury ...................................................................................................................................58
Diagnosis .....................................................................................................................................................59
Treatment .....................................................................................................................................................61
Complications .............................................................................................................................................63
Conclusion ...................................................................................................................................................64
Acknowledgments .......................................................................................................................................64
References ....................................................................................................................................................64
Chapter 6 Secondary Rhinoplasty with Total
Lobular Reconstruction .....................................................................................65
Henry D. Sandel IV, MD and Stephen W. Perkins, MD
Indications for Revision Nasal Surgery .......................................................................................................69
Indications for Total Lobular Reconstruction .............................................................................................70
Surgical Approach to the Nose ....................................................................................................................70
Systematic Approach to Defects ..................................................................................................................70
Secondary Rhinoplasty for Correction of Errors of Commission ..............................................................75
Grafts used in Secondary Rhinoplasty for Correction of Dorsal Deformities ...........................................77
Alar Collapse and Retraction ......................................................................................................................80
Summary .....................................................................................................................................................86
References ....................................................................................................................................................88
Table of Contents / ix
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Chapter 7 Lengthening the Short Nose ........................................................ 89
Henry D. Sandel IV, MD and Stephen W. Perkins, MD
Introduction ................................................................................................................................................89
Facial Analysis ..............................................................................................................................................89
Literature Review .........................................................................................................................................90
The Short Nose ............................................................................................................................................91
Case Studies .................................................................................................................................................92
Conclusion ...................................................................................................................................................99
References ..................................................................................................................................................101
INDEX 103
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