Evaluation of Nasal Tip Support in Septorhinoplasty

Resistance Measurements with Dynamometer in Foundation Dorsal Preservation Rhinoplasty Techniques

INTRODUCTION AND AIM

Some recommendations have been reported about nasal hump recurrence and its possible reasons or mechanisms after dorsal preservation rhinoplasty. In this study, we aimed to measure how additional maneuvers affect recoil on the dorsum with the help of a dynamometer during the dorsal preservation rhinoplasty operation.

MATERIALS AND METHODS

Twelve patients who underwent closed approach dorsal preservation rhinoplasty at the Ege University Hospital ENT department between September and December 2022 were included in this prospective study. During the dorsal preservation rhinoplasty operation in all patients, the pressure values caused by the recoil of the dorsum on the probe of the dynamometer placed on the rhinion were measured and recorded in 4 steps. (1: Push down (PD), 2: Let down (LD), 3: Lateral keystone dissection, 4: Rasping) RESULTS: Of the 12 patients included in the study, 6 (50%) were female and 6 (50%) were male. The mean age was found to be between 29.9 ± 6.5 (minimum 22-maximum 42). Mean follow-up time was 36.6 ±15.3 (minimum 15 -maximum 60). 3 patients (25%) had a straight nose, 7 patients (58.3%) had a tension nose and 2 patients (16.7%) had a kyphotic nose. The scores of all four stages measured were statistically significant (p < 0.001). In the comparison of the stages against each other, there were significant differences between PD-LD, LD-LKA dissection, and LKA dissectionrasping (p < 0.001). The scores of all four stages measured were statistically significant (p<0.001). In the comparison of the stages against each other, there were significant differences between PD-LD, LD-LKA dissection, and LKA dissection-rasping (p < 0.001). In the comparative analysis of nose types with each other, the difference between straight nose and kyphotic nose was found to be significant (p < 0.05). There was no significant difference between tension nose and other nose types (p > 0.05). There were differences in pressure values according to nose types (Straight, Tension, Kyphotic) and all nose types were found to be statistically significantly affected by additional maneuvers.

CONCLUSION

The effect of maneuvers performed on areas defined as resistance points in dorsal preservastion rhinoplasty have been evaluated with objective measurement methods. In selected cases, noses with severely angled and kyphotic humps require additional maneuvers, including resection of the bony cap, to flatten the nasal dorsum and the cartilaginous roof.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nasal Tip Deprojection in Rhinoplasty

BACKGROUND

Rhinoplasty is one of the most commonly performed facial operations in the United States, and many major and minor nasal tip support structures affect tip projection. Overprojection may result from anatomical factors or occur iatrogenically during primary rhinoplasty. Achieving reliable, reproducible, and stable results is the aim of nasal tip deprojection rhinoplasty. The authors' technique is designed to decrease nasal tip deprojection in patients with an overly projected nasal tip.

METHODS

A retrospective chart review of 2003 rhinoplasty cases in the senior author's (R.G.R.) practice was conducted for the period between July of 2014 and June of 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases with nasal tip deprojection, with a minimum of 12 months of follow-up. Outcomes of interest included the rate of operative revisions and the rate of postoperative infection.

RESULTS

A total of 447 patients met the inclusion criteria. The mean age of our study group was 32.1 years, with 409 female patients, and 291 cases were primary rhinoplasties. The mean follow-up period was 22.4 months. Eight patients (1.8%) required empiric antibiotics postoperatively, and 17 patients (3.8%) required operative revision.

CONCLUSIONS

The authors' case series demonstrates that combining resection of the medial crura with lateral crural steal and a columellar strut graft allows the surgeon to achieve considerable nasal tip deprojection. The comprehensive patient follow-up (mean, 22.4 months) further supports the reliability of the authors' technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Interdomal ligament of the nose: Clarifying the anatomy through a cadaveric study

BACKGROUND

Over the years, the anatomical description of the nasal ligaments has been revisited several times. Although several authors have studied the structures supporting the nasal tip, there is a lack of literature that consistently describes the anatomy of the interdomal ligament. This study analyzed the anatomical variations of the interdomal ligament by describing the possible shapes and dimensions and confirming its ligamentous nature histologically.

METHODS

Twenty-five fresh cadaver noses of Caucasian descent, without signs of previous nasal surgery were dissected using an open approach. The interdomal ligament was identified, isolated, measured, and sent for histological examination. The statistical analysis was conducted using Prism9.

RESULTS

The average area of the interdomal ligaments of the whole cohort was 0.39±0.22 cm2. The mean ligament depth was 0.16±0.05 cm, and the mean interdomal distance was 1.38±0.32 cm. Overall, 58.3% of the ligaments showed a fusiform shape and the rest showed a trapezoidal shape. A correlation between the interdomal distance and length of the ligament was demonstrated with r=[0.7536]. The histological analysis of the interdomal ligament displayed a "fibrous-connective nature of the structure compatible with a ligament."

CONCLUSIONS

This study confirmed the ligamentous nature of the interdomal ligament and demonstrated its consistent presence in 24 cadavers, with the depth from the dome ranging from 0.10 to 0.24 cm. The data demonstrated that this ligament may have a fusiform or trapezoidal shape with a mean area of 0.39±0.22 cm2. Furthermore, a correlation exists between the major base of the ligament and the interdomal distance, with a ratio of 1.633.

Effect of Dorsal Preservation Techniques on Septum Strength: An Experimental Animal Study

This experimental animal model study investigates the impact of different methods employed in preservation rhinoplasty (PR) on the strength of the nasal roof, focusing on three techniques: high strip, low strip, and intermediate strip. Using 15 lamb heads as surgical models, the study addresses key questions related to the strengths of each PR techniques, the influence of septal cartilage harvesting on septum strength, and the effectiveness of spreader grafts for stability. The research involves detailed dissection steps and measurements at various nasal points, evaluating the resistance at each stage. Results indicate that the low strip technique demonstrates the most significant reduction in strength. Furthermore, the combination of PR techniques with structural grafts, specifically spreader grafts, is assessed, revealing the classical rectangular spreader graft to be more effective in stabilizing the dorsum. Despite the limitation of using the lamb heads as models, this study offers valuable insights into the effects of PR on nasal septum strength and provides a foundation for further research on the biomechanics of preservation techniques.

Way Forward in Improving Rhinoplasty Outcomes

Rhinoplasty is an elective surgical procedure to attain an aesthetic and functional improvement of the nose. The level of expectation of the patient-and the surgeon-regarding the outcome of a rhinoplasty is usually high, and any result that is less than perfect can be seen as a failure. To achieve consistently good results in rhinoplasty, the surgeon should be meticulous at every step of the procedure. Fully understanding the patient's desires, careful preoperative evaluation of the face, and proper selection of patients are crucial to achieving improved outcomes. Furthermore, an individually tailored surgical planning according to the unique features of the specific case, preferring remodeling over resection and reinforcing the nasal framework support, and careful surgical execution will likely ensure a satisfactory and long-lasting surgical outcome. Rhinoplasty requires lifelong dedication of the surgeon for providing the best outcomes to patients entrust their noses to the surgeon's surgical skills. The rhinoplasty surgeon has been labeled an "eternal student," and this should reflect the delicateness and humbleness of the rhinoplasty surgeon.

Nasal Tip Flexibility and Stability: Comparison of Septal Extension Grafts and Columellar Strut Grafts in a Prospective Trial

BACKGROUND

The stability of nasal tip rotation and projection, and providing a flexible nasal tip, are important elements in rhinoplasty. Two common options to provide these requirements are the septal extension graft (SEG) and the columellar strut graft (CSG). This study aims to compare nasal tip stability and flexibility between the 2 graft options.

METHODS

A prospective randomized study was carried out in 60 patients operated on with either the CSG or the SEG. Tip rotation and projection stability were analyzed with photographic evaluation at the immediate postoperative period, the first month, and the first year. Nasal tip flexibility was evaluated with a newton meter at the preoperative period and postoperative first, third, and sixth months and the first year.

RESULTS

The CSG showed a significant loss of projection and rotation, whereas the SEG showed better preservation of projection and rotation. However, both options showed a greater loss of projection and rotation in the first month and then a slight decrease in the following months. Although the SEG had lesser flexibility compared with the CSG anteroposteriorly, there was no flexibility difference between them in the lateral direction in the long term.

CONCLUSIONS

The SEG provides better nasal tip stability compared with the CSG. The greatest downside of the SEG is decreased flexibility compared with the CSG. Surgeons should be aware of the loss of projection and rotation with both graft options and adjust their operation plan according to these points.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Reconstruction of Scroll and Pitanguy's Ligaments in Open Rhinoplasty: A Controlled Randomized Study

INTRODUCTION

In the preservation rhinoplasty era, ligament management represents a hot topic. The aim of this study is to analyze the role of ligaments as indispensable elements of support of the nasal tip to have an adequate, safe, and predictable aesthetic and functional result.

MATERIAL AND METHODS

Patients meeting the following criteria were included in the study: primary rhinoplasty, minimum 2-year follow-up, proficiency in Italian language, signed consent, and standardized pre- and postoperative photographic documentation. The study was performed with a double-blinded randomized design; both the patients and two of the authors measuring outcomes were blinded to the treatment methods. All patients were asked to answer the FACE-Q satisfaction with the nose postoperative scale. Two plastic surgeons reviewed all postoperative photographs, rating the outcome on a 1-5 VAS scale.

RESULTS

One hundred and twelve patients were enrolled, 47 males and 65 females, aged between 20 and 50 years. Patients were randomly divided in three groups: group 1, ligament reconstruction and grafts; group 2, only grafts (shield, single and double onlay, umbrella); and group 3, only ligament reconstruction with columellar strut. All rhinoplasties were performed with an open approach. Both the FACE-Q and VAS scores were in groups 1 and 2, which were also the ones undergoing fewer secondary procedures compared to group 3.

CONCLUSIONS

The best surgical option appears to be the combination of ligament repair and grafts. It reduces dead space and enables a better redraping of soft tissues, obtaining a better control of tip projection, position, and rotation.

LEVEL OF EVIDENCE II

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The ideal technique nasal tip surgery for Asians, understanding best technique, and post-operative improvement: Systematic review/meta-analysis

Introduction

Asian nose is characterized by thick skin, abundant soft tissue, and weak cartilage framework, resulting in under-projection of the nasal dorsum and tip. Anatomical knowledge consideration is needed to achieve an ideal and natural-looking Asian nasal tip. Various nasal tip surgery techniques for Asian nose have been introduced recently. However, a comparison of techniques and postsurgical results has not yet been undertaken.

Objective

This systematic review aims to highlight the basic understanding of nasal tip dynamics aesthetic Asian nose and analyze related studies in search for the best technique and post-operative improvement for Asian tip-plasty.

Method

Two independent reviewers conducted a comprehensive database search from four major medical databases (PubMed, Scopus, EBSCOhost, and EMBASE). Methodology quality and risk of bias in each study were assessed with the Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I tools).

Result

The initial literature search (May-July 2023) yielded 53 articles, of which 26 were removed (duplicated). The title and abstract screening reduced the count to 6 articles, and two were excluded for specific reasons. Finally, four articles were included in the systematic review and proceeded to methodological quality check and risk of bias assessment.

Conclusion

New techniques such as combining spreader graft, septal extension graft, and columellar strut graft for Asian tip-plasty show promising effect after surgery. Increasing nasal length, projecting the tip, and strengthening the nasal tip framework become key points for Asian tip-plasty.

Current Surgical Outcomes of Nasal Tip Grafts in Rhinoplasty: A Systematic Review

BACKGROUND

Refinement of the nasal tip plays an important role in rhinoplasty surgery outcomes and may be considered the most technically challenging aspect of the procedure. Numerous techniques have been described for nasal tip augmentation utilizing grafts. The aim of this study was to systematically review the existing literature on nasal tip grafts and appraise it critically.

METHODS

A PubMed search was performed to identify journal articles related to nasal tip grafts from the past decade. A total of 44 studies met inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale and Jadad scale were used to appraise 38 observational studies and six randomized trials, respectively, to determine the quality of the studies.

RESULTS

Critical assessment revealed that the studies were highly variable in focus and encompassed autologous, homologous, and alloplastic grafts. The quality of the data included an average Newcastle-Ottawa Quality Assessment Scale score of 6.5 (out of 9) and Jadad score of 2.5 (out of 5). A majority of studies (86.4%) included objective outcomes using anthropometric measurements and a portion of studies (27.3%) also included patient-reported outcomes.

CONCLUSIONS

The results of this systematic review suggest that more than one type of nasal tip graft may result in satisfactory outcomes. This review provides an expansive collection of studies on nasal tip grafts, which can serve as an invaluable tool for the plastic surgeon engaging in rhinoplasty.

Hinge Strut: A New Septal Strut for Nasal Tip Projection, Definition, and Stability in Latino Noses

Background

Obtaining ideal support to maintain the nasal tip has been investigated in several rhinoplasty studies. We aimed to describe a support technique, namely the use of a "hinge strut" (HS) for the nasal tip in Latino noses and to evaluate nasolabial angles at 6-months follow-up.

Methods

In total, 46 Latino patients who had undergone rhinoplasty using the HS technique between June 2021 and June 2022 were recruited in Lima, Peru. All patients had nasolabial angle measurements taken preoperatively and at 1, 3, and 6 months postoperatively in active and passive positions to evaluate angle changes during this 6-month period.

Results

We evaluated 38 women and six men aged 18-45 years (mean age, 25.74 years). In the passive position, the mean nasolabial angles were 91.5 degrees preoperatively and 106, 104, and 103 degrees at 1, 3, and 6 months, respectively, postoperatively. In the active position, the mean nasolabial angles were 85.5 degrees preoperatively and 102.6, 99.1, and 98.1 degrees at 1, 3, and 6 months, respectively, postoperatively (P < 0.0001, using Friedman chi-square test).

Conclusions

The HS technique is safe and reproducible, with nasal tip maintenance and an adequate angle elevation trend observed at 6-months follow-up. Further studies and longer observation times are necessary to determine longer-term outcomes.

The advanced concepts for septal l-strut re-designing in septorhinoplasty for better strength and stability by considering of center of gravity

PURPOSE

This study contributes to the multidisciplinary understanding of septal L-strut reshaping and introduces innovative surgical design concepts based on engineering principles of static equilibrium. The objective is to enhance structural strength and stability, ultimately leading to improved surgical outcomes.

METHOD

Finite element analysis is employed to model the three-dimensional septal cartilage in septoplasty. A significant contribution of this work is the introduction of an innovative redesigns for the septal L-strut structure. These redesigns represent the first-ever attempt to incorporate the center of gravity theory into the modeling of the septal L-strut.

RESULTS

Our findings emphasize the significance of attaining a lower center of gravity in the design of the septal L-strut, as it contributes to optimal core strength and stability. To achieve this, we recommend widening the caudal septum and shaping the interior fillet corner to its maximum size, taking into account its specific shape. Notably, the utilization of a standard 20x20 mm septal L-strut, the C-shaped technique, and the septal support graft technique provide superior strength due to enhanced basement support.

CONCLUSION

To enhance surgical outcomes in septal L-strut procedures, design modifications are proposed to improve strength and stability, resulting in optimized performance. Recommendations include widening the caudal septum and incorporating fillet shapes in the geometry to lower the center of gravity.

Nasal Tip and Alar Groove Plasty Through External Nasal Cutting in Asians: A Clinical Study

OBJECTIVE

Nasal tip hypertrophy is common in Asians, and its reshaping is very critical in rhinoplasty. For patients who refuse any implant placed in the nose, there are limited options for tip reshaping. Herein, we introduce a new procedure of nasal tip and alar groove plasty through external nasal cutting in Asians.

METHODS

A total of 20 patients who had hypertrophic nasal tip and refused to have any implants were included in this study. They were performed this procedure of nasal tip and alar groove plasty through external nasal cutting. The authors carefully reviewed the patients' medical records and preoperative and postoperative photographs. Self-reported satisfactions of patients with the scar morphology and correction effect were assessed at postoperative every follow-up using a questionnaire survey.

RESULTS

All of the patients' procedures were completely successful, and the hypertrophic nasal tip was improved. In the long-term postoperative follow-up, the patients' wound showed no abnormalities such as scar contracture deformity, scar bumps, and nasal deformation. In 1 patient, the nasal wound developed significant scarring, and we performed reoperation to remove the superficial scar tissue. Surgical scars in the remaining patients were not obvious. Eight patients (8/20) reported "very satisfied" with scar shape and nasal tip shape improvement results, and 10 patients (10/20) reported "satisfied" with the outcomes.

CONCLUSIONS

This procedure of nasal tip and alar groove plasty could be an alternative for making the nasal tip more refined. However, the surgical indications for this procedure need to be strictly limited to specific patients.

LEVEL OF EVIDENCE

Level IV.

A Modified Technique in Rhinoplasty: A Septal Extension Graft Complex Using Septal Cartilage, Ethmoid Bone, and Auricular Cartilage

BACKGROUND

Due to the small and weak septal cartilage of Asians, it is a challenge to obtain ideal tip projection and nose lengthening in this population by performing septal extension grafts with only septal cartilage.

OBJECTIVES

The aim of this study was to introduce a septal extension graft complex incorporating nasal septal cartilage, the perpendicular plate of the ethmoid bone, and bilateral auricular cartilage, and to examine its effectiveness in terms of morphological and mechanical support.

METHODS

Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of the perpendicular plate of the ethmoid bone, placed on either side of the "L" strut, served as 2 spreader grafts. A double layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of 3 parameters. Nasal tip resistance was evaluated by a digital Newton meter.

RESULTS

In total, 25 patients were followed up postoperatively for a mean of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance: nasal length (mean [standard deviation], 41.4 [4.0] vs 46.2 [3.4] mm, P < 0.05) and nasal tip projection (21.3 [3.2] vs 24.4 [2.7] mm, P < 0.05) appeared to increase postoperatively, whereas nasolabial angle (117.6° [5.9°] vs 109.5° [5.3°], P < 0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (P < 0.05) at displacements of 1, 2, and 3 mm. All patients were satisfied with the aesthetic results, and no serious complications occurred.

CONCLUSIONS

This kind of modified septal extension graft technique can effectively adjust nasal morphology for short-nose East Asians.

LEVEL OF EVIDENCE: 4

Biomechanics of Septal L-Strut on Lamb Head Models

It is very crucial to know the biomechanics of the septal cartilage and adjacent structures during septoplasty. The aim of this study was to investigate the strength changes of different L-strut models after mucoperichondrium elevation, application of septal extension grafts and spreader grafts on an experimental lamb model. Ten lamb heads were dissected according to a dissection protocol and septal resistances were measured with the newton meter at six zones. Three different L-strut types were designed, and all the L-strut models were created at different widths of 15mm, 10mm, and 5mm. In addition, effects of two different types of septal extension grafts and spreader grafts were compared. After mucoperichondrium elevation and harvesting the septum cartilage, there was a significant decrease in the septum resistance (p <0.05). As the width of the L-strut decreased, the septum strength decreased significantly (p <0.05). There was no significant difference between three chondrotomy types at different widths (p >0.05). There was no significant difference between the overlapping SEG and end-to-end SEG in terms of septum resistance (p >0.05). This was the first study to measure septal resistance in lamb heads. The mucoperichondrium and L-strut width were important structures for maintaining septal resistance. Chondrotomy style was not crucial, but as the width of the L-strut increased, the septal resistance increased. The septal extension grafts regardless of suturing style and the spreader grafts added strength to the caudal septum.

Comparative Functional Effect of Alternative Surgical Techniques Used in Rhinoplasty

OBJECTIVE

The purpose of this investigation is to compare the functional effect of the different surgical techniques used for addressing each section of the nose.

METHODS

Prospective study of 57 consecutive rhinoplasty patients. Patients were evaluated with peak nasal inspiratory flow (PNIF), Nasal Obstruction Symptom Evaluation (NOSE), and Visual Analog Scale (VAS) for nasal obstruction before and 1 year after rhinoplasty. Additionally, esthetic evaluation of the nose was obtained with Rhinoplasty Outcomes Evaluation (ROE). According to the surgical technique used to address each portion of the nose, groups of patients were created and the functional improvement of these groups was compared.

RESULTS

Using the TukeyHSD multiple pairwise-comparison test, the estimated difference of the increase of PNIF between using spreader grafts and using spreader flaps was 94.9 (95% CI 24.3, 165.5, P = .004) between spreader grafts and neither grafts or flaps was 79.2 (95% CI 5.8, 152.6, P = .03), between spreader grafts and bilateral spreader flaps plus a unilateral spreader graft was 90.2 (95% CI 22.1, 158.2, P = .005). In all other portions of the nose, no significant difference was found in the functional improvement between different surgical techniques.

CONCLUSIONS

Spreader grafts increase PNIF more significantly than other surgical techniques used for dorsal mid-vault reconstruction. Spreader grafts should be preferred over other techniques whenever an improvement of nasal airflow is required. No significant differences were found between the functional effect of alternative techniques used in other sections of the nose. Additional cohort studies will be necessary to further confirm data from this investigation.

The Plug-in Graft, the Essential Supplement for a Stable Cartilaginous Framework in Rhinoplasty

BACKGROUND

A stable cartilaginous framework sets up the foundation for a successful rhinoplastic procedure. However, the curvature of the anterior septal angle usually does not match the added tip graft, leaving a structural gap that potentially causes postoperative rotation of the nasal tip. A supplementary graft is required to fill this gap, consolidating this structure at three dimensions.

OBJECTIVES

To detail and validate the utilization of a graft that fills the structural gap for a more stabilized framework and better-sustained tip position in the long term.

METHODS

Intraoperative counter-rotating Newton force and complications were retrospectively collected. Three-dimensional stereophotogrammetric evaluations were performed. Anthropometric points were analyzed in a blinded fashion. Outcome variables were tip projection, nasal length, the Goode ratio, and tip rotation. Results were compared statistically.

RESULTS

Thirty-one female patients, ranging in age from 18-41 years, finished the study. Intraoperative rotating measurement indicated an unequivocal stabilizing effect of the plug-in graft. Postoperative analysis showed great maintenance of tip position over time. Tip projection and nasolabial angle had a slight decrease over time, the differences were not statistically different.

CONCLUSIONS

The plug-in graft effectively consolidates the entire cartilaginous framework in rib-based rhinoplasty procedures. This anatomically integrated structure sets up the fundamental groundwork which provides uncompromising support for the tip graft, so as to achieve an aesthetically pleasing outcome that endures. When executed properly, this graft is effective in maintaining postoperative tip positions, which warrants the technical challenges and the prolonged operating time.

A Novel Modification of Tongue in Groove Technique (Auto-Septal Projection Graft) in Rhinoplasty

INTRODUCTION

Derotation of the nasal tip with narrow nasolabial angle is a common nasal deformity that leads to a long nose appearance, named drooping nose. In these patients, there are various techniques described to fix droopy tip and to achieve a desirable nasal tip rotation such as caudal septal extension graft, extended columellar strut graft, tongue in groove, columellar strut graft, and tip rotation sutures. This study aimed to evaluate changes in nasal tip support after modified tongue-in-groove technique (auto-septal projection graft).

MATERIALS AND METHODS

Forty-two patients who underwent a primary open approach septorhinoplasty using the modified tongue-in-groove technique between June 2017 and March 2019 were retrospectively analyzed. Postoperative and preoperative photographs were analyzed, and nasolabial angle and the nasal tip projection ratio were recorded and compared before and average of 17.3 months after the surgery.

RESULTS

Forty-two patients (33 female and 9 male) were included the study. The mean nasolabial angle was 85.7° preoperatively and 99.3° postoperatively. The nasal tip projection ratio was 0.60 preoperatively and 0.64 postoperatively. Both the tip rotation and the tip projection increased significantly after the modified tongue in groove (p<0.05).

CONCLUSION

It seems that modified tongue-in-groove method (auto-septal projection graft) is an effective technique in maintaining tip projection and rotation in rhinoplasty and safe method to correct droopy nasal tip in selected cases.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative clinical study with a novel technique for stabilization of the nasal tip projection and rotation: fixation of the septum and the strut graft through the septal cartilage autoextension

PURPOSE

It is important to reinforce nasal tip support for long-term satisfactory results. Two workhorses of tip support are strut grafting and the tongue-in-groove technique. Tongue-in-groove causes retraction and stiffness; the strut causes loss of rotation and projection of tip. We introduced a novel technique that avoids these consequences.

METHODS

Between February 2018-February 2019, 40 female underwent primary rhinoplasty. Mean age: 27 years (18-41 years).

FOLLOW-UP

1-2 years. In first group (20 patients), caudal septum was resected and strut was not fixated to caudal septum. In second group (20 patients), tongue-like extension (septal autoextension) was preserved at caudal septum and sutured to strut. Preoperative, peroperative, and postoperative images were compared.

RESULTS

Tip projection ratio calculations, nasolabial angle measurements were evaluated by statistical analyses. The change in projection ratios between peroperative period and 1-year postoperative period of strut-only group was higher than septal autoextension group (p = 0.001). This result indicates that nasal tip projection loss in strut-only group was higher compared to septal autoextension group. The change in nasolabial angle measurements from peroperative period to 1-year postoperative period differed significantly between two groups (p = 0.001). Significant difference was observed between 1-year postoperative nasolabial angle measurements of two groups (p = 0.006); septal autoextension group measurements were higher than strut-only group. These results showed that fixation of strut graft to the septal autoextension provides better preservation of the nasolabial angle and stabilization of nasal tip projection. CONCLUSıON: Fixation of septum and strut graft through septal autoextension provides satisfactory stabilization of tip projection and rotation without stiffness or rigidity.

Age- and Gender-Related Variability in Nasal Tip Support

BACKGROUND

The age at which nasal tip support changes start to occur is unknown. Evaluation of nasal tip support is difficult, especially as the ideal nasal tip support pressure remains elusive. The aim of this study is to determine the nasal tip support pressure alterations relative to age and sex.

OBJECTIVES

The aim of this study is to determine the changers in resistance of the nasal tip support in relation to age and sex.

METHODS

This prospective clinical study was conducted between January and April 2019 at a tertiary health facility. Nasal tip resistances were measured in four different age-groups (20-29, 30-39, 40-64, and > 65 years) with a digital Newton meter. A total of 159 patients with a minimum of 36 patients per group were included in the study. Nasal tip resistance measurements were compared among nasal tip displacement distances of 2, 3, and 4 mm, focusing on age and sex.

RESULTS

The nasal tip resistance of the 20-29 age-group was significantly higher at 2, 3, and 4 mm nasal tip displacement distances, when compared with the 30-39 and 40-64 age-groups, whereas compared to the > 65 years group, it was significantly higher at 3 and 4 mm nasal tip displacement distances (p < 0.005). Nasal tip resistance of males was found to be significantly higher than that of females, at 3 and 4 mm nasal tip displacement distances (p < 0.001).

CONCLUSIONS

Nasal tip resistance is higher in males and universally decreases significantly after 30 years of age while remaining constant at later ages. Therefore, surgeons should prefer nasal tip resistance increasing techniques in the rhinoplasty operations that are performed on patients even from early years of age, in order to maintain and strengthen the nasal tip resistance.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.