Mastering Revision Rhinoplasty by Michael Evan Sachs

By Michael Evan Sachs

This lavishly illustrated atlas can have broad entice the becoming variety of experts who practice rhinoplasty (aesthetic and/or reconstructive surgical procedure of the nose). as well as plastic surgeons, ENT/otolaryngologists, head & neck surgeons, dermatologists or even oral surgeons are actually incorporating rhinoplasties into their practices. Over 350,000 rhinoplasties have been played in 2003, and because the variety of situations raises, so does the variety of failed operations. stick with up surgical procedures to enhance shape or functionality are known as "revision" or "secondary" rhinoplasties. Michael Evan Sachs has perfected the paintings and technological know-how of revision rhinoplasty with hundreds of thousands of case, and readers will study not just the right way to fix a failed technique but additionally the way to hinder one within the first position.

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It can create either a strong masculine root or a soft gently curving feminine line with the rest of the face and the lower two-thirds of the nose. In both sexes the nose should have a high, strong defining point as it curves slightly downward from the forehead. Male and female aesthetics differ in many aspects and particularly in relationship with the slope and angulation of the bony nasal vault as it articulates with the forehead. Males and females both should have a high, well-defined nasal root, which adds strength and beauty to the nose; however, the male nose is invariably higher than the female's.

The manipulation of the bony nasal vault during rhinoplasty is essentially limited to removing the upper bony dorsum and narrowing the nasal bones medially. Both of these maneuvers are ideally performed underneath the protection and support of the periosteum. The periosteum actually serves to hold and support the nasal bones after osteotomy and secondarily adds smoothness to the nasal dorsum. Thus it is extremely important that the elevation of the periosteal envelope be exacting and limited. The ideal periosteal elevation should begin approximately 2 mm above the caudal edge of the nasal bones, leaving enough attachment to the upper lateral cartilages so that they will not become detached from the nasal bones and cause obstruction or a dorsal contour deformity.

This area has a dual concern during rhinoplasty, because, if deviated, it obstructs a significant amount of air, due to the nature of airflow during inspiration and additionally may not allow inward movement of the nasal bones after osteotomy. 28 Mastering Revision Rhinoplasty temperature, physical activity, airborne pathogens and allergens, topical and systemic medications, and food and alcohol ingestion. Since a finite amount of nasal resistance is a functional necessity, an alteration of either too much or too little denies effective airflow to the lungs.

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