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Contents
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35 Chin Augmentation With Implants or So Tissue Fillers 723
Fadi C. Constantine, Jamil Ahmad, Rod J. Rohrich
36 Management of the Chin in Rhinoplasty Patients 747
S. Anthony Wolfe, addeus S. Boucree
xix
■ ■ ■ ■ ■ ■
VolumE II
PART EIGHT
Secondary Rhinoplasty
37 Open Approach in Secondary Rhinoplasty 775
C. Spencer Cochran, Jack P. Gunter
38 Closed Approach in Secondary Rhinoplasty 803
Mark B. Constantian
39 Harvesting Rib Cartilage Gras for Secondary Rhinoplasty 843
C. Spencer Cochran, Jack P. Gunter
40 e Tripod Concept for Correcting Severely Deformed
Nasal Tip Cartilages
C. Spencer Cochran, Jack P. Gunter
855
41 Structural Graing in Secondary Rhinoplasty 869
Dean M. Toriumi, Jaimie DeRosa, Deborah Watson
42 Advances in Secondary Rhinoplasty: Personal Perspective 899
Georges N. Tabbal, Sean G. Boutros, Nicolas G. Tabbal
43 Achieving Consistent Results in Secondary Rhinoplasty 931
Rod J. Rohrich, Michael R. Lee, Jamil Ahmad
xx
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Contents
PART NINE
Management of Airway Dysfunction
44 Surgical Management of the Nasal Airway 975
Jamil Ahmad, Rod J. Rohrich, Michael R. Lee
45 Classication of Septal Deviation and Reconstructive
Technique
Bahman Guyuron
46 Acute Nasal Fracture Management: Minimizing Secondary
Nasal Deformities
Rod J. Rohrich, William P. Adams Jr., Jamil Ahmad
47 Comprehensive Management of the Deviated Nose 1029
Rod J. Rohrich, Jack P. Gunter, William P. Adams Jr., Fadi C. Constantine,
Jamil Ahmad
999
1011
PART TEN
Special Topics and Advances
48 Surgical Correction of the Long Nose 1067
Rod J. Rohrich, Purushottam A. Nagarkar, Jamil Ahmad
49 Elongation of the Short Nose 1091
Bahman Guyuron
50 Enhancing the Nasal Tip−Upper Lip Relationship: Importance
of the Depressor Septi Nasi Muscle in Rhinoplasty
Rod J. Rohrich, William P. Adams Jr., Jamil Ahmad
51 Spreader Flap and Spreader Gra 1119
Ronald P. Gruber, Patrick O. Lang, omas Satterwhite, Stephen W. Perkins
52 e Black Nose 1139
Rod J. Rohrich, Arshad R. Muzaar, Ashkan Ghavami
1105
53 e Hispanic Nose 1171
Rollin K. Daniel
54 e Middle Eastern Nose 1195
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Rod J. Rohrich, Ashkan Ghavami
55 e Asian Nose 1225
Dean M. Toriumi, Jaimie DeRosa
56 e Aging Nose 1261
Rod J. Rohrich, Jerey E. Janis, Jamil Ahmad, Jack P. Gunter
57 e Male Nose 1281
Rod J. Rohrich, Jerey E. Janis, Jack P. Gunter
58 Cle Rhinoplasty 1305
Richard Y. Ha, Jerey D. Cone, Jr., H. Steve Byrd
59 Management of the Cocaine Nose 1331
Bahman Guyuron, Paul N. Afrooz
Contents
xxi
60 e Role of So Tissue Fillers in Rhinoplasty 1345
Rod J. Rohrich, T. Jonathan Kurkjian, Jamil Ahmad
61 Prevention and Management of Rhinoplasty
Complications 1361
C. Spencer Cochran, Alan Landecker
PART ELEVEN
Personal Approaches and Philosophies
62 Gunter’s Approach 1391
Jack P. Gunter
63 Rohrich’s Approach 1417
Rod J. Rohrich, Jamil Ahmad
64 Toriumi’s Approach 1461
Dean M. Toriumi, Jaimie DeRosa
65 Guyuron’s Approach 1495
Bahman Guyuron
xxii
11
D V D
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Contents
66 Gruber’s Approach 1515
Ronald P. Gruber
67 Constantian’s Approach 1539
Mark B. Constantian
68 Byrd’s Approach 1583
H. Steve Byrd
Credits C-1
Index I-1
■ ■ ■ ■ ■ ■
DVDs
Rhinoplasty Techniques: Anatomy Dissection
Rod J. Rohrich, Jamil Ahmad, Jack P. Gunter
Harvesting Septal Cartilage
Jack P. Gunter
Harvesting Rib Cartilage
Jack P. Gunter
Harvesting and Preparing Diced Cartilage Fascia Gras
Rollin K. Daniel
Structural Tip Graing
Nazim Cerkes
PDF Forms
Informed Consent
Operative Plan
Patient Letter
Photographic Consent
Postoperative Instructions
Systematic Nasal Analysis
Rhinoplasty Worksheet
Secondary Rhinoplasty With Nasal Airway Restoration
2
2
33
44
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Rod J. Rohrich
Secondary Male Rhinoplasty
Rod J. Rohrich
Secondary Male Rhinoplasty Using Autologous Rib Cartilage
Jack P. Gunter
Primary Rhinoplasty for the Severely Deviated Ethnic Nose
Rod J. Rohrich
Primary Male Rhinoplasty for the Long Nose
Rod J. Rohrich
Primary Rhinoplasty
xxiiiContents
Jack P. Gunter
Primary Rhinoplasty
Bahman Guyuron
Primary Rhinoplasty
Ronald P. Gruber
Primary Rhinoplasty
H. Steve Byrd
Interpreting the
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Gunter Rhinoplasty Diagrams
T
he Gunter rhinoplasty diagrams were introduced in to pictorially document the intraoperative maneuvers in rhinoplasty. At a glance one can see and
understand the dierent techniques used in each patient. Knowing exactly what
was done, the surgeon can relate the eect that dierent surgical techniques have
on postoperative results and evaluate their ecacy. e diagrams are also useful for teaching other surgeons the technical steps performed in a rhinoplasty.
e following is the color key for reading the diagrams:
Red 5 Incisions and excisions
Black 5 Sutures and outline of anatomic structures
Green 5 Autologous gras
Blue 5 Implants
Orange 5 Previous incisions or excisions
Pink 5 Homogra (irradiated cartilage or dermal homogra)
e basic diagrams used for this book were made from a soware application
developed by Caneld Scientic, Inc. ese are generic diagrams; that is, there
is only one size dorsal reduction. us, if a dorsal reduction is documented, it
only tells the reader that one was performed and may not represent the actual
size of the reduction. e same is true for resection of the cephalic margins of
the lateral crura—there is only one size resection. However, in some of the more
unusual cases the diagrams were customized to clarify the author’s technique.
e diagrams illustrate only what the author described in the text. For example,
in some of the clinical photographs it may appear that a hump was removed, but
this is not included in the diagrams, because we felt uncomfortable trying to interpret what was done by looking at the postoperative photographs and elected
to illustrate only what the author specically described.
REFERENCE
1. Gunter JP. A graphic record of intraoperative maneuvers in rhinoplasty: the missing link for evalu-
ating rhinoplasty results. Plast Reconstr Surg :, .
xxiv
■ ■ ■ ■ ■ ■
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PART ONE
Basic Perioperative
Concepts
Nasal bones
Lower lateral
cartilage:
Lateral crus
Medial crus
Upper lateral
cartilage
Piriform aperture
Accessory
cartilages
Maxillary crest
Anterior nasal
spine
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■ ■ ■ ■ ■ ■
Fig. 1-1
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1
Preferred Anatomic Terms
for Rhinoplasty
Rod J. Rohrich Jamil Ahmad Robert M. Oneal
P
recise and universally understood terminology is essential for clear communication in any eld. Rhinoplasty surgeons have individually developed and dened
a variety of terms to use in nasal analysis and to describe their anatomic ndings.
During our -year experience with presenting the Dallas Rhinoplasty Symposium, we have assembled and rened a lexicon of preferred anatomic terms for
use in rhinoplasty. ese are terms and denitions derived from and used by the
leading educators of the present generation of rhinoplasty surgeons. We hope
the following terminology will provide a standardized and universal vocabulary
for rhinoplasty surgeons.
accessory cartilages Cartilages connecting the lateral ends of the lateral crura
to the piriform aperture edge (Fig. -).
Nasal bones
Upper
lateral
cartilage
Sidewall
Ala
Lower
lateral
cartilage
Anatomy
Topography
Radix
Dorsum
Tip
3
Lower lateral
cartilage:
Lateral crus
Medial crus
Nasal bones
Upper lateral
cartilage
Piriform aperture
Accessory
cartilages
Maxillary crest
Anterior
nasal spine
Part One Basic Perioperative Concepts4
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alae e lateral wings. e rounded eminence forming the lateral nostril wall
that extends from the tip medially to the nasolabial fold laterally and the nasal
sidewall superiorly to the alar rim inferiorly.
alar groove e external oblique skin depression that follows the caudal margin
of the lateral crus as it leaves the alar rim to run in a more cephalic direction.
It separates the tip superomedially from the thickened portion of the ala inferolaterally and joins the face at the superior cheek-lip junction.
alar rim
e inferior free edge of the ala that extends from the tip medially to
the nasolabial fold laterally.
anatomic dome Junction of the medial and lateral crura, also known as the
middle crus.
anterior septal angle e anterior edge of the cartilaginous septum at the junc-
ture of the dorsal and caudal cartilaginous septum (Fig. -).
bony vault e superior third of the nose comprising the nasal bones, frontal
processes of the maxilla, and nasal processes of the frontal bone.
caudal
caudal septum
cephalic
Means the same as inferior when referring to the nose.
Free inferior border of the septum.
Means the same as superior when referring to the nose.
clinical dome e anteriormost projecting portion of the lower lateral carti-
lage. e external projection of the dome is the tip-dening point (Fig. -).
Wing of
premaxilla
Quadrangular
septal cartilage
Anterior septal angle
Anterior nasal spine
Upper lateral cartilage
Crest of premaxilla
Perpendicular plate of
ethmoid bone
Sella turcica
Sphenoid sinus
Vomer
Crest of palatine bone
Crest of maxillary bone
Fig. 1-2
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