Article
Tip plasty in secondary rhinoplasty
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Authors
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Wolfgang Gubisch
- Klinik für Plastische Gesichtschirurgie, Stuttgart, Germany
| Published: | September 7, 2006 |
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Outline
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Background: The goal in each rhinoplasty is a good projection, an adequate rotation as well as a good configuration of the tip. Therefore a detailed analysis of these parameters is necessary.
Method: To reveal the complexity of the anatomical structures in most secondary rhinoplasties an open approach is necessary. Only then the reason for an over- or an underprojection, for an increased derotation or excessive cranial rotation or for an insufficient configuration can be detected.
In cases of overprojection we recommend a sliding technique. Only in a thick skin patient a direct cartilage resection after dome division is indicated. Underprojection of the tip mostly needs some kind of autogenous cartilage grafting.
Increased derotation leads to an elongated nose. This deformity can be combined with a hidden columella. Both maybe caused by an insufficient anterior septum pillar and need a strong cartilage graft for example a sandwich graft from the concha. To shorten a long nose an internal and external nose lift as well as a tip suspension suture maybe helpful. The overrotated tip and consecutive short nose needs an elongation by extension grafts.
The inadequate configuration may result from insufficient suture techniques or excessive cartilage resection. Therefore exact suturing and/or reconstruction of a symmetric cartilagenous framework will give a good contour of the tip. In some cases insufficient shrinking of the thick seborrhoic skin may lead to a bulky disconfiguration. In such cases we recommend an external skin excision in the midline (supratip excision).
Result: Because of the complexity of the tip deformity in secondary rhinoplasty we recommend an open approach for revision. According to the deformity a detailed concept of reconstruction has to be evaluated.
Conclusion: From 01.01.2004 - 30.12.2004 we operated 212 secondary rhinplasties, according to the above principles. The idea, we follow is new orientation instead of resection and therefore we prefer suture techniques or combined suture cutting techniques (sliding technique or the secondary tip corrections) and grafting. In cases of a thick skin which is not able to shrink adequately we do supratip excision with good and satisfying results.
