PDF herunterladen
Facial Plast Surg 2021; 37(01): 045-052
DOI: 10.1055/s-0041-1725154
Original Article

Indications for Preservation Rhinoplasty: Avoiding Complications

Mario Bazanelli Junqueira Ferraz
1   Department of Facial Plastic Surgery, Clinica Mario Ferraz, Campinas, Brazil
,
Guilherme Constante Preis Sella 
2   Curso de Medicina, UniCesumar Curso de Medicina, Maringa, Paraná, Brazil
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Nasal dorsal preservation surgery was described more than 100 years ago, but recently has gained prominence. Our objective is to show the surgical technique, the main indications and counterindications, and the complications. It is a technique that does not cause the detachment of the upper lateral cartilage (ULC) from the nasal septum, and has the main following sequence: preparation of the septum and its resection can be at different levels (high or low, i.e., SPAR [septum pyramidal adjustment and repositioning] A or B); preparation of the pyramid; transversal osteotomy; lateral osteotomy(s); and septopyramidal adjustment. The result is a nose with a lower radix than the original, a deprojection of the nasal dorsum tending to maintain its original shape; an increase in the interalar distance (IAD) and enlargement of the nasal middle ⅓; and loss of projection of the nasal tip and roundness of the nostrils. Thus, the ideal candidate is the one who benefits from such side effects, that is: tension nose, that is, high radix with projected dorsum, projected anterior nasal septal angle (ANSA), narrow middle ⅓, narrow IAD, thin nostrils and straight perpendicular plate of the ethmoid (PPE), and, depending on the characteristics, the deviated nose. The counterindications are low radix, irregularities in the nasal dorsum, ANSA lower than rhinion, and a wide middle ⅓. And the main stigmas are: a nose with a very low radix, middle ⅓ enlarged, residual hump, and saddling of the supratip area. Other issues of this technique are: the shape of the radix; the need or not to remove PPE; wide dorsum; irregular dorsum; ANSA lower than rhinion; weak cartilages; long nasal bone; deviated PPE; and obsessive patient. We conclude that this is a great technique for noses with characteristics suitable to it; care must be taken with the stigmas it can cause.

Keywords

rhinoplasty - preservation rhinoplasty - push-down - SPAR

Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
14. März 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Goodale J. A new method for the operative correction of the exaggerated Roman nose. Boston Med Surg J 1899; 140: 112
    CrossrefPubMedGoogle Scholar
  • 2 Lothrop OA. An operation for correcting the aquiline nasal deformity; the use of a new instrument; report of a case. Boston Med Surg J 1914; 170 (22) 835-837
    CrossrefPubMedGoogle Scholar
  • 3 Cottle MH. Nasal roof repair and hump removal. AMA Arch Otolaryngol 1954; 60 (04) 408-414
    CrossrefPubMedGoogle Scholar
  • 4 Cottle MH, Loring RM. Corrective surgery of the external nasal pyramid and the nasal septum for restoration of normal physiology. Eye Ear Nose Throat Mon 1947; 26 (04) 207-212
    PubMedGoogle Scholar
  • 5 Ferraz MBJ, Zappelini CEM, De Carvalho GM, Guimaraes AC, Chone CT, Dewes W. Conservative surgery of the nasal dorsum–the philosophy of the septal pyramid adjusting and repositioning (S.P.A.R.). Rev Bras Cir Cabeça Pescoço 2013; 42 (03) 124-130
    PubMedGoogle Scholar
  • 6 Gola R. Functional and esthetic rhinoplasty. Aesthetic Plast Surg 2003; 27 (05) 390-396
    CrossrefPubMedGoogle Scholar
  • 7 Saban Y, Daniel RK, Polselli R, Trapasso M, Palhazi P. Dorsal preservation: the push down technique reassessed. Aesthet Surg J 2018; 38 (02) 117-131
    CrossrefPubMedGoogle Scholar
  • 8 Úlloa F. Let Down Technique. 2011 https://www.rhinoplastyarchive.com/articles/bony-vault-nasal-dorsum/let-down-technique . Accessed February 11, 2021
    PubMedGoogle Scholar
  • 9 Joseph J. Beitr.ge zur Rhinoplastik. Berl Klin Wochenschr 1907; 16: 470-472
    PubMedGoogle Scholar
  • 10 Joseph J. The classic reprint: nasal reductions. Plast Reconstr Surg 1971; 47 (01) 79-83
    CrossrefPubMedGoogle Scholar
  • 11 Rohrich RJ, Hollier LH. Use of spreader grafts in the external approach to rhinoplasty. Clin Plast Surg 1996; 23 (02) 255-262
    CrossrefPubMedGoogle Scholar
  • 12 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73 (02) 230-239
    CrossrefPubMedGoogle Scholar
  • 13 Daniel RK. The preservation rhinoplasty: a new rhinoplasty revolution. Aesthet Surg J 2018; 38 (02) 228-229
    CrossrefPubMedGoogle Scholar
  • 14 Lee J, Abdul-Hamed S, Kazei D, Toriumi D, Lin SJ. The first descriptions of dorsal preservation rhinoplasty in the 19th and early- to mid-20th centuries and relevance today. Ear Nose Throat J 2020; DOI: 10.1177/0145561320925572.
    CrossrefPubMedGoogle Scholar
  • 15 Saban Y, Andretto Amodeo C, Hammou JC, Polselli R. An anatomical study of the nasal superficial musculoaponeurotic system: surgical applications in rhinoplasty. Arch Facial Plast Surg 2008; 10 (02) 109-115
    CrossrefPubMedGoogle Scholar
  • 16 Tuncel U, Aydogdu O. The probable reasons for dorsal hump problems following let-down/push-down rhinoplasty and solution proposals. Plast Reconstr Surg 2019; 144 (03) 378e-385e
    CrossrefPubMedGoogle Scholar
  • 17 Ribeiro L. Rhinoplasty-a new approach in the repair of the hump. Aesthetic Plast Surg 1978; 2 (01) 409-418
    CrossrefPubMedGoogle Scholar
  • 18 Saban Y, Braccini F, Polselli R. [Rhinoplasty: morphodynamic anatomy of rhinoplasty. Interest of conservative rhinoplasty.]. Rev Laryngol Otol Rhinol (Bord) 2006; 127 (1–2): 15-22
    PubMedGoogle Scholar
  • 19 Goksel A, Saban Y. Open piezo preservation rhinoplasty: a case report of the new rhinoplasty approach. Facial Plast Surg 2019; 35 (01) 113-118
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 20 Neves JC, Arancibia Tagle D, Dewes W, Larrabee W. The split preservation rhinoplasty: “the Vitruvian Man split maneuver. Eur J Plast Surg 2020; 43: 323-333
    CrossrefPubMedGoogle Scholar
  • 21 Öztürk G. New approaches for the let-down technique. Aesthetic Plast Surg 2020; 44 (05) 1725-1736
    CrossrefPubMedGoogle Scholar
  • 22 Huizing EH. Push-down of the external nasal pyramid by resection of wedges. Rhinology 1975; 13 (04) 185-190
    PubMedGoogle Scholar
  • 23 Pinto RM. On the “let-down” procedure in septorhinoplasty. Rhinology 1997; 35 (04) 178-180
    PubMedGoogle Scholar
  • 24 Drumheller GW. The Cottle push down operation. Am J Cosmet Surg 1995; 12 (03) 255-261
    CrossrefPubMedGoogle Scholar
  • 25 Rohrich RJ, Kurkjian TJ, Hoxworth RE, Stephan PJ, Mojallal A. The effect of the columellar strut graft on nasal tip position in primary rhinoplasty. Plast Reconstr Surg 2012; 130 (04) 926-932
    CrossrefPubMedGoogle Scholar
  • 26 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100 (04) 999-1010
    CrossrefPubMedGoogle Scholar
  • 27 Toriumi DM. Caudal septal extension graft for correction of the retracted columella. Oper Tech Otolaryngol--Head Neck Surg 1995; 6 (04) 311-318
    CrossrefPubMedGoogle Scholar
  • 28 Patel PN, Abdelwahab M, Most SP. A review and modification of dorsal preservation rhinoplasty techniques. Facial Plast Surg Aesthet Med 2020; 22 (02) 71-79
    CrossrefPubMedGoogle Scholar
  • 29 Cabbarzade C. A new algorithm for hump reduction according to dynamics of dorsal preservation. Aesthet Surg J 2019; 39 (12) NP547-NP549
    CrossrefPubMedGoogle Scholar
  • 30 Ishida J, Ishida LC, Ishida LH, Vieira JCR, Ferreira MC. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 1999; 103 (06) 1729-1733 , discussion 1734–1735
    CrossrefPubMedGoogle Scholar