PDF herunterladen
Facial Plast Surg
DOI: 10.1055/a-2577-2805
Original Article

When Reductive Rhinoplasty Goes Wrong and How to Make it Right

Ethan Moritz 
1   1FACE Toronto, Toronto, Ontario, Canada
2   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
,
Jamil Asaria 
1   1FACE Toronto, Toronto, Ontario, Canada
2   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Aim and Background

Over-resection leads to many complications in rhinoplasty. Here, we detail the most common of these pitfalls and strategies to both avoid and repair them.

Anatomy

The nose is frequently divided into thirds. The nasal bones represent the upper third. The middle third is composed of the dorsal septum and upper lateral cartilages. The lower third is comprised of the lower lateral cartilages and tip-supporting structures.

Techniques

The commonly seen sequelae of over-resection include a deep radix, saddle nose deformity, inverted-V deformity, pollybeak deformity, alar retraction, a pinched nasal tip, bossae, deep alar grooves, and external nasal valve collapse. The major mechanism to avoid these issues is avoidance; however, several grafting techniques are described here to correct overly aggressive reduction.

Conclusion and Clinical Relevance

It is critical to avoid the complications described in this manuscript. Just as important, it is necessary to know how to correct these deformities when patients present for revision rhinoplasty.

Keywords

rhinoplasty - saddle - inverted-V - pollybeak


Publikationsverlauf

Accepted Manuscript online:
08. April 2025

Artikel online veröffentlicht:
16. April 2025

© 2025. Thieme. All rights reserved.

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

 

  • References

  • 1 Heilbronn C, Cragun D, Wong BJF. Complications in rhinoplasty: a literature review and comparison with a survey of consent forms. Facial Plast Surg Aesthet Med 2020; 22 (01) 50-56
    CrossrefPubMedSuche in Google Scholar
  • 2 Knoedler S, Knoedler L, Wu M. et al. Incidence and risk factors of postoperative complications after rhinoplasty: a multi-institutional ACS-NSQIP analysis. J Craniofac Surg 2023; 34 (06) 1722-1726
    PubMedSuche in Google Scholar
  • 3 Sharif-Askary B, Carlson AR, Van Noord MG, Marcus JR. Incidence of postoperative adverse events after rhinoplasty: a systematic review. Plast Reconstr Surg 2020; 145 (03) 669-684
    CrossrefPubMedSuche in Google Scholar
  • 4 Adamson PA, Litner JA. Psychologic aspects of revision rhinoplasty. Facial Plast Surg Clin North Am 2006; 14 (04) 269-277 , v
    PubMedSuche in Google Scholar
  • 5 Davis RE, Bublik M. Psychological considerations in the revision rhinoplasty patient. Facial Plast Surg 2012; 28 (04) 374-379
    PubMedSuche in Google Scholar
  • 6 Nolst Trenite GJ, Paun S. External rhinoplasty. In: Gleeson M, Clarke R. eds. Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. 7th edition.. London: Arnold; 2008
    Suche in Google Scholar
  • 7 Kerolus JL, Nassif PS. Treatment protocol for compromised nasal skin. Facial Plast Surg Clin North Am 2019; 27 (04) 505-511
    CrossrefPubMedSuche in Google Scholar
  • 8 Şeneldir S, Dizdar D, Tuna A. Radix saw: a useful tool for rhinoplasty to correct high radix. Braz J Otorhinolaryngol 2021; 87 (01) 59-65
    PubMedSuche in Google Scholar
  • 9 Gerbault O, Daniel RK, Kosins AM. The role of piezoelectric instrumentation in rhinoplasty surgery. Aesthet Surg J 2016; 36 (01) 21-34
    CrossrefPubMedSuche in Google Scholar
  • 10 Rohrich RJ, Novak M, Cason R, Trost J. Soft-tissue filler for secondary nasal deformities. Plast Reconstr Surg 2024; 153 (05) 1052-1054
    PubMedSuche in Google Scholar
  • 11 Kontis TC. The art of camouflage: when can a revision rhinoplasty be nonsurgical?. Facial Plast Surg 2018; 34 (03) 270-277
    Thieme ConnectPubMedSuche in Google Scholar
  • 12 Lamperti T. Low Radix Augmentation. Lamperti Facial Plastic Surgery. 2020. Accessed February 3, 2025 at: www.rhinoplastyinseattle.com/service/seattle-plastic-surgery-treatments/rhinoplasty-treatments/low-radix-augmentation
    PubMed
  • 13 Becker DG, Pastorek NJ. The radix graft in cosmetic rhinoplasty. Arch Facial Plast Surg 2001; 3 (02) 115-119
    CrossrefPubMedSuche in Google Scholar
  • 14 Tasman AJ. Advances in nasal dorsal augmentation with diced cartilage. Curr Opin Otolaryngol Head Neck Surg 2013; 21 (04) 365-371
    CrossrefPubMedSuche in Google Scholar
  • 15 Mowlavi A, Masouem S, Kalkanis J, Guyuron B. Septal cartilage defined: implications for nasal dynamics and rhinoplasty. Plast Reconstr Surg 2006; 117 (07) 2171-2174
    PubMedSuche in Google Scholar
  • 16 Moubayed SP, Most SP. Revision of the nasal dorsum. Facial Plast Surg 2017; 33 (02) 202-206
    PubMedSuche in Google Scholar
  • 17 Hamilton III GS. Correction of the saddle nose deformity. Facial Plast Surg 2020; 36 (01) 7-17
    PubMedSuche in Google Scholar
  • 18 Toriumi DM, Kovacevic M. Correction of the saddle nose deformity using the “push up” technique. Facial Plast Surg 2022; 38 (05) 488-494
    PubMedSuche in Google Scholar
  • 19 Kim L, Papel ID. Spreader grafts in functional rhinoplasty. Facial Plast Surg 2016; 32 (01) 29-35
    Thieme ConnectPubMedSuche in Google Scholar
  • 20 Taştan E, Yücel OT, Aydin E, Aydoğan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plast Surg 2013; 15 (03) 198-203
    CrossrefPubMedSuche in Google Scholar
  • 21 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
    CrossrefPubMedSuche in Google Scholar
  • 22 Hanasono MM, Kridel RWH, Pastorek NJ, Glasgold MJ, Koch RJ. Correction of the soft tissue pollybeak using triamcinolone injection. Arch Facial Plast Surg 2002; 4 (01) 26-30 , discussion 31
    CrossrefPubMedSuche in Google Scholar
  • 23 Alexander AJ, Shah AR, Constantinides MS. Alar retraction: etiology, treatment, and prevention. JAMA Facial Plast Surg 2013; 15 (04) 268-274
    CrossrefPubMedSuche in Google Scholar
  • 24 Kao WTK, Davis RE. Postsurgical alar retraction: etiology and treatment. Facial Plast Surg Clin North Am 2019; 27 (04) 491-504
    PubMedSuche in Google Scholar
  • 25 Hyman AJ, Khayat S, Toriumi DM. Correction of nasal pinching. Facial Plast Surg Clin North Am 2019; 27 (04) 477-489
    CrossrefPubMedSuche in Google Scholar
  • 26 Taha MA, Hall CA, Zylicz HE. et al. Costal cartilage lateral crural strut graft for correction of external nasal valve dysfunction in primary and revision rhinoplasty. Ear Nose Throat J 2023; 102 (03) 175-180
    PubMedSuche in Google Scholar
  • 27 Kondo M, Orgain C, Alvarado R, Marcells GN, Harvey RJ. The effects of lateral crural tensioning with an articulated alar rim graft versus lateral crural strut graft on nasal function. Facial Plast Surg Aesthet Med 2020; 22 (04) 281-285
    PubMedSuche in Google Scholar
  • 28 Ballin AC, Kim H, Chance E, Davis RE. The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg 2016; 32 (04) 384-397
    Thieme ConnectPubMedSuche in Google Scholar
  • 29 Nguyen E, Flaherty AJ, Akkina SR, Kidwai S, Nuara MJ. Patient-reported functional and aesthetic outcomes of underlay articulated alar rim grafts in functional septorhinoplasty. Facial Plast Surg Aesthet Med 2023; 25 (03) 274-275
    PubMedSuche in Google Scholar