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Published in: Aesthetic Plastic Surgery 5/2020

01-10-2020 | Rhinoplasty | Review

Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach

Authors: John R. Peleman, Michael T. Chung, Jared Johnson, Hani Rayess, Caitlin R. Priest, Houmehr Hojjat, Moustafa Mourad, Michael A. Carron, Henry C. Vasconez

Published in: Aesthetic Plastic Surgery | Issue 5/2020

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Abstract

Background

Nasal aesthetics can be significantly affected by the interdependence of the surrounding bone and soft tissues of the face. These include the maxilla, septum, frontal bone, mandible, and the soft tissues and cartilage surrounding the nose. Therefore, it is pertinent to analyze and address these critical relationships of the nose in order to achieve a successful rhinoplasty. This work seeks to describe the battery of adjunct procedures available to supplement a rhinoplasty. Furthermore, each preoperative finding or indication for the adjunct is described in an algorithmic fashion.

Methods

A literature search using PubMed, Google Scholar, and a university library database was performed to locate papers describing adjunctive procedures to rhinoplasty. Indications and preoperative analysis were extracted from each paper. If the indication or finding was unclear, supplementary literature describing rhinoplasty and adjunctive analysis were sought in order to supplement our findings.

Results

Sixteen papers in total described adjunctive procedures for rhinoplasty. Each work highlighted a procedure or set of procedures on a surrounding facial feature including the forehead, brow, cheeks, lips, and chin, and neck. In total, 13 adjunct procedures for rhinoplasty are described with their respective indications. Additional literature and techniques were researched to clarify indicated procedures.

Conclusion

The ability to correctly understand the critical relationships of the nose can help the surgeon correctly recognize the indication for a rhinoplasty adjunct procedure, leading to better aesthetic balance and surgical outcomes.

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.
Literature
2.
go back to reference Pressa JERR (2013) Nasal analysis and anatomy. In: Neligan PCWR (ed) Plastic surgery. Elsevier Sounders, New York, pp 373–386 Pressa JERR (2013) Nasal analysis and anatomy. In: Neligan PCWR (ed) Plastic surgery. Elsevier Sounders, New York, pp 373–386
3.
go back to reference Devgan L, Singh P, Durairaj K (2019) Surgical cosmetic procedures of the face. Otolaryngol Clin North Am 52:425–441PubMedCrossRef Devgan L, Singh P, Durairaj K (2019) Surgical cosmetic procedures of the face. Otolaryngol Clin North Am 52:425–441PubMedCrossRef
4.
go back to reference Kosins AM, Obagi ZE (2017) Managing the difficult soft tissue envelope in facial and rhinoplasty surgery. Aesthet Surg J 37:143–157PubMedCrossRef Kosins AM, Obagi ZE (2017) Managing the difficult soft tissue envelope in facial and rhinoplasty surgery. Aesthet Surg J 37:143–157PubMedCrossRef
5.
go back to reference Guyuron B, Lee M (2017) An effective algorithm for management of noses with thick skin. Aesth Plast Surg 41:381–387CrossRef Guyuron B, Lee M (2017) An effective algorithm for management of noses with thick skin. Aesth Plast Surg 41:381–387CrossRef
6.
go back to reference Sazgar AA, Majlesi A, Shooshtari S et al (2019) Oral isotretinoin in the treatment of postoperative edema in thick-skinned rhinoplasty: a randomized placebo-controlled clinical trial. Aesth Plast Surg 43:189–195CrossRef Sazgar AA, Majlesi A, Shooshtari S et al (2019) Oral isotretinoin in the treatment of postoperative edema in thick-skinned rhinoplasty: a randomized placebo-controlled clinical trial. Aesth Plast Surg 43:189–195CrossRef
7.
8.
go back to reference Monreal J (2011) Fat grafting to the nose: personal experience with 36 patients. Aesthetic Plast Surg 35:916–922PubMedCrossRef Monreal J (2011) Fat grafting to the nose: personal experience with 36 patients. Aesthetic Plast Surg 35:916–922PubMedCrossRef
9.
go back to reference Isik S, Sahin I (2012) Contour restoration of the forehead by lipofilling: our experience. Aesth Plast Surg 36:761–766CrossRef Isik S, Sahin I (2012) Contour restoration of the forehead by lipofilling: our experience. Aesth Plast Surg 36:761–766CrossRef
10.
go back to reference Kornstein AN, Kornstein AN, Nikfarjam JS (2015) Fat grafting to the forehead/glabella/radix complex and pyriform aperture: aesthetic and anti-aging implications. Plastic Reconstr Surg. Global open. 3:e500CrossRef Kornstein AN, Kornstein AN, Nikfarjam JS (2015) Fat grafting to the forehead/glabella/radix complex and pyriform aperture: aesthetic and anti-aging implications. Plastic Reconstr Surg. Global open. 3:e500CrossRef
11.
go back to reference Webster RC, Davidson TM, Smith RC (1978) Browplasty as an adjunct to rhinoplasty. Head Neck Surg 1:112–122PubMedCrossRef Webster RC, Davidson TM, Smith RC (1978) Browplasty as an adjunct to rhinoplasty. Head Neck Surg 1:112–122PubMedCrossRef
12.
go back to reference Daniel RK, Kosins A, Sajjadian A, Cakir B, Palhasi P, Molnar G (2013) Rhinoplasty and brow modification: a powerful combination. Aesthet Surg J 33:983–994PubMed Daniel RK, Kosins A, Sajjadian A, Cakir B, Palhasi P, Molnar G (2013) Rhinoplasty and brow modification: a powerful combination. Aesthet Surg J 33:983–994PubMed
13.
go back to reference Yaremchuk MJ, Vibhakar D (2016) Pyriform aperture augmentation as an adjunct to rhinoplasty. Clin Plast Surg 43:187–193PubMed Yaremchuk MJ, Vibhakar D (2016) Pyriform aperture augmentation as an adjunct to rhinoplasty. Clin Plast Surg 43:187–193PubMed
14.
go back to reference Fanous N, Yoskovitch A (2002) Premaxillary augmentation for central maxillary recession: an adjunct to rhinoplasty. Facial Plast Surg Clin North Am 10:415–422PubMed Fanous N, Yoskovitch A (2002) Premaxillary augmentation for central maxillary recession: an adjunct to rhinoplasty. Facial Plast Surg Clin North Am 10:415–422PubMed
15.
go back to reference Fanous N, Yoskovitch A (2000) Premaxillary augmentation: adjunct to rhinoplasty. Plast Reconstr Surg 106:707–712PubMed Fanous N, Yoskovitch A (2000) Premaxillary augmentation: adjunct to rhinoplasty. Plast Reconstr Surg 106:707–712PubMed
16.
go back to reference Kim WS, Kim CH, Yoon JH (2010) Premaxillary augmentation using autologous costal cartilage as an adjunct to rhinoplasty. J Plast Reconstr Aesthet Surg 63:e686–e690PubMed Kim WS, Kim CH, Yoon JH (2010) Premaxillary augmentation using autologous costal cartilage as an adjunct to rhinoplasty. J Plast Reconstr Aesthet Surg 63:e686–e690PubMed
17.
go back to reference Stucker FJ Jr (1988) Reduction cheiloplasty. An adjunctive procedure in the black rhinoplasty patient. Arch Otolaryngol Head Neck Surg 114:779–780PubMed Stucker FJ Jr (1988) Reduction cheiloplasty. An adjunctive procedure in the black rhinoplasty patient. Arch Otolaryngol Head Neck Surg 114:779–780PubMed
18.
go back to reference Bessler S (2018) Combining rhinoplasty with upper lip-lift using a single incision line. JAMA Facial Plast Surg 20:166–167PubMed Bessler S (2018) Combining rhinoplasty with upper lip-lift using a single incision line. JAMA Facial Plast Surg 20:166–167PubMed
19.
go back to reference Jung JA, Kim KB, Park H, Dhong ES, Han SK, Kim WK (2019) Subnasal lip lifting in aging upper lip: combined operation with nasal tip plasty in Asians. Plast Reconstr Surg 143:701–709PubMed Jung JA, Kim KB, Park H, Dhong ES, Han SK, Kim WK (2019) Subnasal lip lifting in aging upper lip: combined operation with nasal tip plasty in Asians. Plast Reconstr Surg 143:701–709PubMed
20.
go back to reference Chasmar LR, Henderson PD (1979) Concomitant treatment of developmental jaw deformities with rhinoplasty. Ann Plast Surg 3:64–71PubMedCrossRef Chasmar LR, Henderson PD (1979) Concomitant treatment of developmental jaw deformities with rhinoplasty. Ann Plast Surg 3:64–71PubMedCrossRef
21.
go back to reference Davis PK (1983) Chin augmentation with rhinoplasty: a tutorial dissertation. Br J Plast Surg 36:204–209PubMedCrossRef Davis PK (1983) Chin augmentation with rhinoplasty: a tutorial dissertation. Br J Plast Surg 36:204–209PubMedCrossRef
22.
go back to reference Stambaugh KI (1992) Chin augmentation. An important adjunctive procedure to rhinoplasty. Arch Otolaryngol Head Neck Surg 118:682–686PubMedCrossRef Stambaugh KI (1992) Chin augmentation. An important adjunctive procedure to rhinoplasty. Arch Otolaryngol Head Neck Surg 118:682–686PubMedCrossRef
23.
go back to reference Sykes JM, Suarez GA (2016) Chin advancement, augmentation, and reduction as adjuncts to rhinoplasty. Clin Plast Surg 43:295–306PubMedCrossRef Sykes JM, Suarez GA (2016) Chin advancement, augmentation, and reduction as adjuncts to rhinoplasty. Clin Plast Surg 43:295–306PubMedCrossRef
24.
go back to reference Maia M, Lukash FN (2019) Autologous fat grafting in young patients: a simple and effective way to achieve facial balance. Ann Plast Surg 83:253–257PubMedCrossRef Maia M, Lukash FN (2019) Autologous fat grafting in young patients: a simple and effective way to achieve facial balance. Ann Plast Surg 83:253–257PubMedCrossRef
25.
go back to reference Greer SE, Matarasso A, Wallach SG, Simon G, Longaker MT (2001) Importance of the nasal-to-cervical relationship to the profile in rhinoplasty surgery. Plast Reconstr Surg 108:522–531PubMedCrossRef Greer SE, Matarasso A, Wallach SG, Simon G, Longaker MT (2001) Importance of the nasal-to-cervical relationship to the profile in rhinoplasty surgery. Plast Reconstr Surg 108:522–531PubMedCrossRef
26.
go back to reference McKinney P, Sweis I (2002) A clinical definition of an ideal nasal radix. Plast Reconstr Surg 109:1416–1418PubMedCrossRef McKinney P, Sweis I (2002) A clinical definition of an ideal nasal radix. Plast Reconstr Surg 109:1416–1418PubMedCrossRef
27.
go back to reference Pessa JE, Peterson ML, Thompson JW, Cohran SC, Garza JR (1999) Pyriform augmentation as an ancillary procedure in facial rejuvenation surgery. Plast Reconstr Surg 103:683–686PubMedCrossRef Pessa JE, Peterson ML, Thompson JW, Cohran SC, Garza JR (1999) Pyriform augmentation as an ancillary procedure in facial rejuvenation surgery. Plast Reconstr Surg 103:683–686PubMedCrossRef
28.
go back to reference Raffaini M, Cocconi R, Spinelli G et al (2018) Simultaneous rhinoseptoplasty and orthognathic surgery: outcome analysis of 250 consecutive patients using a modified Le Fort I osteotomy. Aesth Plast Surg 42:1090–1100CrossRef Raffaini M, Cocconi R, Spinelli G et al (2018) Simultaneous rhinoseptoplasty and orthognathic surgery: outcome analysis of 250 consecutive patients using a modified Le Fort I osteotomy. Aesth Plast Surg 42:1090–1100CrossRef
29.
go back to reference Sun AH, Steinbacher DM (2018) Orthognathic surgery and rhinoplasty: simultaneous or staged? Plast Reconstr Surg 141:322–329PubMedCrossRef Sun AH, Steinbacher DM (2018) Orthognathic surgery and rhinoplasty: simultaneous or staged? Plast Reconstr Surg 141:322–329PubMedCrossRef
30.
go back to reference Veeramani A, Sawh R, Steinbacher DM (2017) Orthognathic surgery and rhinoplasty to address nasomaxillary hypoplasia. Plast Reconstr Surg 140:930–932PubMedCrossRef Veeramani A, Sawh R, Steinbacher DM (2017) Orthognathic surgery and rhinoplasty to address nasomaxillary hypoplasia. Plast Reconstr Surg 140:930–932PubMedCrossRef
31.
go back to reference Apaydin FMD (2016) Projection and deprojection techniques in rhinoplasty. Clin Plast Surg 43:151–168PubMedCrossRef Apaydin FMD (2016) Projection and deprojection techniques in rhinoplasty. Clin Plast Surg 43:151–168PubMedCrossRef
32.
go back to reference Armijo BS, Brown M, Guyuron B (2012) Defining the ideal nasolabial angle. Plast Reconstr Surg 129:759–764PubMedCrossRef Armijo BS, Brown M, Guyuron B (2012) Defining the ideal nasolabial angle. Plast Reconstr Surg 129:759–764PubMedCrossRef
33.
go back to reference Marianetti TM, Cozzolino S, Torroni A, Gasparini G, Pelo S (2015) The, “beauty arch”: a new aesthetic analysis for malar augmentation planning. J Craniofac Surgery 26:625–630CrossRef Marianetti TM, Cozzolino S, Torroni A, Gasparini G, Pelo S (2015) The, “beauty arch”: a new aesthetic analysis for malar augmentation planning. J Craniofac Surgery 26:625–630CrossRef
34.
go back to reference Niamtu JDMD (2010) Lip reduction surgery (reduction cheiloplasty). Facial Plast Surg Clin North Am 18:79–97PubMed Niamtu JDMD (2010) Lip reduction surgery (reduction cheiloplasty). Facial Plast Surg Clin North Am 18:79–97PubMed
35.
go back to reference Garfein ES, Zide BM (2008) Chin ptosis: classification, anatomy, and correction. Craniomaxillofac Trauma Reconstr 1:1–14PubMedPubMedCentral Garfein ES, Zide BM (2008) Chin ptosis: classification, anatomy, and correction. Craniomaxillofac Trauma Reconstr 1:1–14PubMedPubMedCentral
36.
go back to reference de la Torre JI, Martin SA, Al-Hakeem MS, De Cordier BC, Vasconez LA (2004) Minimally invasive approach for correction of chin ptosis. Plast Reconstr Surg 113(1):404–409PubMed de la Torre JI, Martin SA, Al-Hakeem MS, De Cordier BC, Vasconez LA (2004) Minimally invasive approach for correction of chin ptosis. Plast Reconstr Surg 113(1):404–409PubMed
37.
go back to reference Ellenbogen R, Ellenbogen R, Karlin JV, Karlin JV (1963) Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980(66):826–837 Ellenbogen R, Ellenbogen R, Karlin JV, Karlin JV (1963) Visual criteria for success in restoring the youthful neck. Plast Reconstr Surg 1980(66):826–837
38.
go back to reference Lekakis G, Picavet VA, Gabriëls L, Grietens J, Hellings PW (2016) Body dysmorphic disorder in aesthetic rhinoplasty: validating a new screening tool. Laryngoscope 126:1739–1745PubMed Lekakis G, Picavet VA, Gabriëls L, Grietens J, Hellings PW (2016) Body dysmorphic disorder in aesthetic rhinoplasty: validating a new screening tool. Laryngoscope 126:1739–1745PubMed
39.
go back to reference Khansa I, Khansa L, Pearson GD (2016) Patient satisfaction after rhinoplasty: a social media analysis. Aesthet Surg J 36:1–5 Khansa I, Khansa L, Pearson GD (2016) Patient satisfaction after rhinoplasty: a social media analysis. Aesthet Surg J 36:1–5
40.
go back to reference Carvalho B, Ballin AC, Becker RV, Berger CA, Hurtado JG, Mocellin M (2012) Rhinoplasty and facial asymmetry: analysis of subjective and anthropometric factors in the Caucasian nose. Int Arch Otorhinolaryngol 16(4):445–451PubMedPubMedCentral Carvalho B, Ballin AC, Becker RV, Berger CA, Hurtado JG, Mocellin M (2012) Rhinoplasty and facial asymmetry: analysis of subjective and anthropometric factors in the Caucasian nose. Int Arch Otorhinolaryngol 16(4):445–451PubMedPubMedCentral
41.
go back to reference Sadeghian S, Shirvani A, Azamian Z (2018) Assessment of the effect of simulated rhinoplasty and genioplasty on the facial profile attractiveness of patients with a convex face. J Contemp Dent Pract 19:719–725PubMedCrossRef Sadeghian S, Shirvani A, Azamian Z (2018) Assessment of the effect of simulated rhinoplasty and genioplasty on the facial profile attractiveness of patients with a convex face. J Contemp Dent Pract 19:719–725PubMedCrossRef
42.
go back to reference Ozkurt FE, Akdag M, Yorgancilar E, Baylan MY (2014) The need for mentoplasty following rhinoplasty. B-ENT. 10:215–219PubMed Ozkurt FE, Akdag M, Yorgancilar E, Baylan MY (2014) The need for mentoplasty following rhinoplasty. B-ENT. 10:215–219PubMed
43.
go back to reference Seah TE, Bellis H, Ilankovan V (2012) Orthognathic patients with nasal deformities: case for simultaneous orthognathic surgery and rhinoplasty. Br J Oral Maxillofac Surg 50:55–59PubMedCrossRef Seah TE, Bellis H, Ilankovan V (2012) Orthognathic patients with nasal deformities: case for simultaneous orthognathic surgery and rhinoplasty. Br J Oral Maxillofac Surg 50:55–59PubMedCrossRef
44.
go back to reference Ahmed J, Patil S, Jayaraj S (2010) Assessment of the chin in patients undergoing rhinoplasty: what proportion may benefit from chin augmentation? Otolaryngol Head Neck Surg 142:164–168PubMedCrossRef Ahmed J, Patil S, Jayaraj S (2010) Assessment of the chin in patients undergoing rhinoplasty: what proportion may benefit from chin augmentation? Otolaryngol Head Neck Surg 142:164–168PubMedCrossRef
45.
go back to reference Rohrich RJ, Villanueva NL, Small KH, Pezeshk RA (2017) Implications of facial asymmetry in rhinoplasty. Plast Reconstr Surg 140(3):510–516PubMedCrossRef Rohrich RJ, Villanueva NL, Small KH, Pezeshk RA (2017) Implications of facial asymmetry in rhinoplasty. Plast Reconstr Surg 140(3):510–516PubMedCrossRef
Metadata
Title
Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach
Authors
John R. Peleman
Michael T. Chung
Jared Johnson
Hani Rayess
Caitlin R. Priest
Houmehr Hojjat
Moustafa Mourad
Michael A. Carron
Henry C. Vasconez
Publication date
01-10-2020
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 5/2020
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-020-01744-9

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