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ixContributors
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Purushottam A. Nagarkar, MD
Resident, Department of Plastic Surgery, University
of Texas Southwestern Medical Center, Dallas, Texas
Nirmal Nathan, MD
Chief Resident, Division of Plastic and Reconstructive
Surgery, University of California, San Francisco,
San Francisco, California
Robert M. Oneal, MD
Clinical Professor, Section of Plastic Surgery,
Department of Surgery, University of Michigan
Medical Center, Ann Arbor, Michigan
Stephen W. Perkins, MD
Clinical Associate Professor, Department of
Otolaryngology−Head and Neck Surgery, Indiana
University School of Medicine; President, Meridian
Plastic Surgeons−Meridian Plastic Surgery Center,
Indianapolis, Indiana
Jordan J. Rihani, MD
Resident, Department of Otolaryngology–Head and
Neck Surgery, University of Texas Southwestern
Medical Center, Dallas, Texas
Rod J. Rohrich, MD, FACS
Crystal Charity Ball Distinguished Chair in Plastic
Surgery, Betty and Warren Woodward Chair in
Plastic and Reconstructive Surgery, Distinguished
Teaching Professor, Department of Plastic Surgery,
University of Texas Southwestern Medical Center,
Dallas, Texas
Jason Roostaeian, MD
Clinical Instructor, Department of Plastic Surgery,
University of California, Los Angeles,
Los Angeles, California
omas Satterwhite, MD
Resident, Division of Plastic Surgery, Department
of Surgery, Stanford University Medical Center,
Palo Alto, California
Georges N. Tabbal, MD
Resident, Department of Plastic Surgery,
University of Texas Southwestern Medical Center,
Dallas, Texas
Nicolas G. Tabbal, MD, FACS
Clinical Associate Professor of Plastic Surgery,
Institute of Reconstructive Plastic Surgery,
New York University Langone Medical Center;
Attending Surgeon, Manhattan Eye Ear and
roat Hospital, New York, New York
Dean M. Toriumi, MD
Professor, Division of Facial Plastic and
Reconstructive Surgery, Department of
Otolaryngology–Head and Neck Surgery,
University of Illinois at Chicago,
Chicago, Illinois
Deborah Watson, MD, FACS
Professor and Residency Program Director,
Department of Otolaryngology−Head and Neck
Surgery, UC San Diego Health System,
San Diego, California
S. Anthony Wolfe, MD, FACS, FAAP
Chief of Plastic Surgery, Department of Plastic
Surgery, Miami Children’s Hospital, Miami,
Dade County, Florida
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Preface
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The rst annual Dallas Rhinoplasty Symposium was held in . Having
trained in both otolaryngology and plastic surgery, Dr. Jack Gunter recognized
a need for rhinoplasty education and an exchange of ideas to further knowledge
about this complex surgery. He was one of the rst to champion the open approach and to teach the art of rhinoplasty to plastic surgery and otolaryngology
trainees, as well as practicing surgeons. Dr. Gunter organized the rst symposium
and has been an integral part of its growth and evolution into one of the most
popular aesthetic plastic surgery meetings. e Dallas Rhinoplasty Symposium
has evolved to include didactic lectures, panel discussions, case presentations,
surgical video demonstrations, and the anatomy dissection laboratory.
Although attendance has grown dramatically over the years, the Symposium
continues to oer an intimate and congenial atmosphere where attendees and
faculty have the chance to interact and discuss strategies and approaches for rhinoplasty surgery. Now in its thirty-rst year, the Symposium has hosted many
preeminent rhinoplasty surgeons over the past three decades and has served to
inspire the interest of young plastic surgeons and otolaryngologists with aspirations to develop the necessary knowledge and skillset to perform this complex
yet fascinating surgery.
In , the rst edition of Dallas Rhinoplasty: Nasal Surgery by the Masters was
published to compile the knowledge and concepts that had been, in large part,
developed by faculty who have attended the Dallas Rhinoplasty Symposium.
A second edition followed in , with updates to existing chapters and new
chapters covering the latest advances in rhinoplasty. e second edition included
video content demonstrating anatomy dissections and surgical technique to enhance the multimedia experience for the user.
In the years since the publication of the rst edition, we have seen the con
tinued evolution of rhinoplasty surgery, including increased interest in and application of the open approach as well as the further development of techniques
that increase precision, control, and consistency. In this third edition, we have
updated all chapters with concepts and techniques that have become widely accepted and used by the foremost rhinoplasty surgeons. We have added many new
chapters providing practical approaches to key rhinoplasty concepts and other
-
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xii Preface
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chapters focusing on ideas and innovations that have been introduced over recent
years and have quickly become accepted and practiced, given their utility. We
have signicantly improved the multimedia experience with greatly expanded
video content and new online access to these materials. roughout the book
we have attempted to present information in a thorough yet clear and concise
manner so that both novice and expert rhinoplasty surgeons will nd this book
an ecient and easy to use resource.
Although this book has grown as knowledge in our eld has expanded, our objectives remain the same: to assist the nasal surgeon in attaining consistent results
using careful preoperative analysis, precise operative planning, meticulous intraoperative execution, and long-term follow-up with critical evaluation of results.
It is our sincere hope that this third edition of Dallas Rhinoplasty: Nasal Surgery
by the Masters will continue to be a key resource for surgeons with an interest in
rhinoplasty—both those who perform rhinoplasty routinely and those early in
their journey to becoming master nasal surgeons.
Rod J. Rohrich
William P. Adams Jr.
Jamil Ahmad
Acknowledgments
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T
remendous time and eort go into publishing any plastic surgery textbook,
and the third edition of Dallas Rhinoplasty: Nasal Surgery by the Masters is no
exception. We gratefully acknowledge and thank Karen Berger, Amy Debrecht,
and the entire sta at Quality Medical Publishing, who have been with us on this
-year journey for three editions of this textbook. eir tireless dedication and
attention to detail are what make the dierence between a medical textbook and
a work of art that can be enjoyed by the reader. We would also like to acknowledge Sue Hodgson and CRC Press, who have assumed the role of publishing and
distributing this third edition. We would like to thank Sue for her advice and
support during production.
We are grateful to the contributing authors who willingly gave of their time, talent, and knowledge to make this edition the best yet. We would like to thank the
entire sta, faculty, and residents in the Department of Plastic Surgery at the University of Texas Southwestern Medical Center at Dallas for their contributions
and support for all educational endeavors that we undertake. A special thanks
goes to Patti Aitson and Martha Aceves, whose expertise in photography, video,
and graphic design is seen in many of our publications. We gratefully thank
Diane Sinn, senior administrator to Dr. Rohrich for more than years, whose
tireless eorts and dedication have made all of us more focused and ecient so
we could produce this remarkable book. We also thank Aaron Weinstein, the
managing editor for the Journal of Plastic and Reconstructive Surgery; Lippincott
Williams & Wilkins has generously allowed us to use content that has been previously published in the Journal.
We would like to express our appreciation to the following at the University of
Texas Southwestern Medical Center at Dallas for their contributions and support of the Dallas Rhinoplasty Symposium over the past years: the Continuing Medical Education Department, the Medical Television Department, and the
Willed Body Program. We are grateful to all of the visiting surgeons who have
participated as faculty for the Symposium; your ideas and innovations have undoubtedly inuenced the evolution of Dallas Rhinoplasty: Nasal Surgery by the
Masters.
xiii
xiv Acknowledgments
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We owe a tremendous debt of gratitude to Dr. Jack P. Gunter, Editor Emeritus of this third edition. Dr. Gunter has been instrumental in the evolution of
rhinoplasty technique and the dissemination of knowledge about this complex
surgery. Dr. Gunter was the driving force behind the annual Dallas Rhinoplasty
Symposium. Over the past years the Symposium has become one of the most
popular aesthetic plastic surgery meetings. Dr. Gunter’s omnipotent presence and
great sense of humor are a fundamental part of what makes the Symposium an
excellent educational experience and so enjoyable to attend. Dr. Gunter provided
a key impetus behind this textbook and brought the rst edition to fruition in
. Since then, Dallas Rhinoplasty: Nasal Surgery by the Masters has become a
global educational staple in rhinoplasty and has enjoyed great popularity among
surgeons of all levels interested in learning more about rhinoplasty. Dr. Gunter’s
endless contributions to nasal surgery have elevated the standard of this surgery
to a new stratosphere, ultimately to the benet of patients and surgeons alike.
Contents
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■ ■ ■ ■ ■ ■
VolumE I
Interpreting the Gunter Rhinoplasty Diagrams xxiii
PART ONE
Basic Perioperative Concepts
1 Preferred Anatomic Terms for Rhinoplasty 3
Rod J. Rohrich, Jamil Ahmad, Robert M. Oneal
2 Advanced Rhinoplasty Anatomy 11
Rod J. Rohrich, William P. Adams Jr., Jack P. Gunter, Jamil Ahmad
3 Nasal Physiology 31
Michael R. Lee, Rod J. Rohrich, Jamil Ahmad
4 Medical Management of Rhinologic Disorders in the Rhinoplasty
Patient
C. Spencer Cochran, Bradley F. Marple
45
5 Preoperative Concepts for Rhinoplasty 63
Rod J. Rohrich, Jamil Ahmad
6 Nasofacial Proportions and Systematic Nasal Analysis 85
Rod J. Rohrich, Jamil Ahmad, Jack P. Gunter
7 Digital Imaging and Standardized Photography
in Rhinoplasty 111
Paul N. Afrooz, Bardia Amirlak
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xvi Contents
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8 Postoperative Management of the Rhinoplasty Patient 133
9 Coding of Reconstructive and Cosmetic Rhinoplasty
10 Getting Rhinoplasty Right the First Time 159
11 Frequently Used Gras in Rhinoplasty: Nomenclature
Rod J. Rohrich, Jamil Ahmad
Procedures
Raymond V. Janevicius
147
PART TWO
Basic Surgical Concepts
Rod J. Rohrich, Jamil Ahmad
and Analysis 177
Jack P. Gunter, Alan Landecker, C. Spencer Cochran
12 Harvesting Autologous Gras for Primary Rhinoplasty 197
Rod J. Rohrich, Stefan O.P. Hofer, Jamil Ahmad
PART THREE
e Dorsum
13 Evaluation and Surgical Approach to the Nasal Dorsum:
Component Dorsal Hump Reduction and Dorsal
Reconstitution 219
Rod J. Rohrich, Jamil Ahmad, Jason Roostaeian
14 Nasal Osteotomies 249
Rod J. Rohrich, William P. Adams Jr., Jamil Ahmad
15 Dorsal Augmentation: Onlay Graing Using Shaped Autologous
Septal Cartilage 275
C. Spencer Cochran, Jack P. Gunter, Rod J. Rohrich
16 Dorsal Augmentation: Temporal Fascia–Wrapped Diced
Cartilage 293
Rollin K. Daniel
PART FOUR
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e Tip
17 Basic Nasal Tip Surgery: Anatomy and Technique 321
Jack P. Gunter, Michael R. Lee, Jamil Ahmad, Rod J. Rohrich
18 Advanced Suture Techniques 351
Ronald P. Gruber, Aaron J. Berger, Edwin Kwon
19 Achieving Aesthetic Balance of the Infratip Lobule 373
Rod J. Rohrich, Jerome H. Liu, Jamil Ahmad
20 Structural Graing of the Nasal Tip 393
Nazim Cerkes
21 A Predictable and Algorithmic Approach to Tip Renement
and Projection 441
xviiContents
Rod J. Rohrich, Jerey E. Janis, Ashkan Ghavami, Jamil Ahmad
22 Correction of the Boxy Nasal Tip Using the Open
Approach 473
Rod J. Rohrich, William P. Adams Jr., Jamil Ahmad
23 Predictable Control of Tip Projection and Rotation:
Septal Extension Gras 495
Rod J. Rohrich, Jamil Ahmad, T. Jonathan Kurkjian, H. Steve Byrd
24 Decreasing Nasal Tip Projection: An Incremental
Approach
C. Spencer Cochran, Jordan J. Rihani, Michael R. Lee, Rod J. Rohrich
515
25 Adjusting Rotation of the Nasal Tip 529
Rod J. Rohrich, Georges N. Tabbal, T. Jonathan Kurkjian, Jamil Ahmad
26 Importance of the Alar-Columellar Relationship 557
Jack P. Gunter, Rod J. Rohrich, T. Jonathan Kurkjian, Jamil Ahmad
xviii
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Contents
PART FIVE
Alar Rims
27 Correction and Prevention of Alar Rim Deformities:
Alar Contour Gras
Rod J. Rohrich, Jason Roostaeian, Jamil Ahmad
28 Lower Lateral Crural Turnover Flaps 591
Michael R. Lee, Jerey E. Janis, Rod J. Rohrich
29 Lateral Crural Strut Gras 605
C. Spencer Cochran, Jack P. Gunter
30 Correction of Alar Rim Deformities: Alar Spreader Gras 623
Jack P. Gunter, Rod J. Rohrich, Jamil Ahmad
569
PART SIX
Alar Base
31 Aesthetics and Surgical Renement of the Nasal Base 641
Jamil Ahmad, Rod J. Rohrich, Michael R. Lee
32 Alar Base Surgery 665
Bahman Guyuron
33 Nasal Base Reduction 675
Ronald P. Gruber, Nirmal Nathan, Ryan D. Endress
PART SEVEN
e Chin
34 Dimensional Approach to Rhinoplasty: Perfecting the Aesthetic
Balance Between the Nose and Chin 701
H. Steve Byrd, P. Craig Hobar
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