Correction of the asymmetric nose
main goal is the presentation of the surgical techniques used in the correction
of the Asymmetric Nose.
Asymmetric Nose includes the differences in the shape, size, position, and the
orientation of each one of the structural parts of the right half of the nose,
comparing it to the left half and the relation with the medial nasofacial
vertical axis. One hundred patients are
analized from a total of more than three thousand rhinoplasties performed in
private practice in a period of time of 15 years (1981-1996). The ethiology of the Asyummetry may be
congenital, traumatic, secondary to the facial development and iatrogenic. The surgical technique is directed to
achieve the symmetry of each one of the nasal parts in relation to the medial
facial axis, it includes the asymmetries of the bony and cartilaginous dorsum,
of the nasal tip and of the nasal alae.
The techniques exposed are preferably used according to each particular
case: 1. In the nasal dorsum: resections, rasp, osteotomies, grafts and
implants; 2. In the nasal tip:
redistribution of the lobular cartilage, creation of new domes,
interdomal and transdomal sutures, partial resections, partial grafts or total
reconstruction of the cartilages;
3. In the nasal alae: vestibular alae Dresection and advancing
sutures from the resection borders.
Comparative slides are shown pre and post-operative of the patients
which illustrate the results of the techniques used, as well as trans-operative
slides. In conclusion, it is necessary
a detailed observation of the patient and its photographs to diagnose the nasal
asymmetries and plan the adequate correction.
The achievement of the nasal symmetry is very difficult but it is
necessary to know the most conservative techniques which offer a better result
to be able to correct the nasal asymmetries.
Septal perforation closure
main objective is the explanation of the techniques used in the Closure of big
Septal Perforations between 1 to 3 centimeters of diameter, successful in 90%
of the cases treated.
cases of patients operated of big septal perforations performed in private
practice are presented in a period of time of 10 years (1981-1998).
the cases are documentated with photographs pre and post-operative of the
are an analysis of the ethiology, size of the perforation, simptomatology, age,
sex, surgical approach, grafting, follow-up and results obtained.
surgical technique used is illustrated, and shown several patients operated.
conclusion, the technique used for big septal perfortion, although it is
difficult to achieve, permit successful results of the closure perforation, in
more than 90% of the cases.
Endoscopic forehead lift fixation technique
this paper I present the indications for the realization of the Frontoplasty:
A) In young patients with ptosis of the eye-brow
which produces a sad look, we perform an attractive rejuvenated look with
bigger eyes and a fresher appearance.
B) In patients with signs of aging like wrinkles
in the forehead or crow-foot (wrinkle at the corner of the eyes), and ptosis of
the eye brow, it is also possible to leave a younger and fresh looking.
use the endoscopic approach through 5 incisions from 2 to 3 centimeters long in
do a sub-galeal dissection at the posterior area of the hair implantation,
dissection between the superficial and deep fascia of the temporal muscle, and
sub-periostical dissection in the frontal area. Then, I do the communication and unification in between the
show the technique in video-tape, including the cutting of the periosteum at
the superior rim of the orbit, preserving the neuro-vascular pedicle, the
cutting of the corrugate and procerus muscles, and the fixation with
non-absorbable sutures for the stabilization of the lifting of the Eye Brow.
show the slides pre and post op. with patients operated with this endoscopic
technique used during the past two years.
advantage of this endoscopic technique over the coronal incision is to avoid
the large incision, the cutting of the supra-orbital nerve, and the resection
of scalp with bigger alopecia and scar.
Total reconstruction of the nasal tip cartilages
in revisional rhinoplasties 20 years experience - personal technique
present the personal technique used for obtention of the Autologus Graft from
the Auricular Conchae for the total reconstruction of the inferior lateral
crura of the nasal lobule, including the lateral and media Crura in a unique
block, similar to the normal anatomic structure of the nasal tip.
show in detail with slides and video-tape, the anterior incision, the exact
place for obtention of the Cartilage, its sculpturing and how I perform an
almost exactly anatomical, an physiological structure as that of the normal
nose lobule, obtaining support for the nasal tip, natural projection and a
normal appearance in patients with severe iatrogenic secuelaes. I present the technique to fit position and
fixation of the graft, using the endonasal or external approach to nasal tip
surgery. I also show the successful
results obtained in patients of Revisional Rhinoplasties, the long term results
with an experience of 16 years, being operated the first patient in 1981, and
obtaining a recognition award during the Colombian Congress of Otolaryngology
in 1985. Also the Award “ERMIRO DE
LIMA” in September 1993 in Sao Paulo, Brazil, during the celebration of the
Latin-American Meeting of Rhinology and Facial Plastic Surgery.
comparative pre and post operative photographs show the correction of
iatrogenic secuelaes, like asimetries of the nasal tip, non-definition and
non-projection of the nasal tip, pinching, retractions, alar colapsing, hanging
columella, anti-aesthetic appearance, etc.
Total reconstruction of the nasal tip cartilages
in revisional rhinoplasties – 20 years experience personal technique. “Sea
Gull Wings” technique
Objective. I present the personal technique used with success in patients with
notorious nasal tip secuelaes of previous Rhinoplasty surgeries, who could not
obtain a natural look with partial grafting, because they required a Total
Reconstruction of the lobular cartilages with autologous graft of auricular
Design. I describe the surgical
technique of: 1) Obtention of the
autologous graft of auricular conchae; 2) Sculpturing of the graft obtaining
cartilages of anatomic threedimentional conformation, similar to the normal
lobular cartilages; 3) Placing and fixation via Endonasal or External. The results are obtained at long term
following patients for as long as 16 years.
Setting. The patients were
institutional and private and the intervention was ambulatory or with 1 day of
Patients. A total of 65 patients were
examined with photography controls pre and post surgery, for a period of 16
years between 1981-1997. The consultation
were to correct the Rhinoplasty iatrogenic secuelaes, as assimetries of the
nasal tip, non-definition and non-projection of the nasal tip, pinching,
retractions, alar colapsing, hanging columella, anti-aesthetic appeareance,
nasal obstruction, etc.
Intervention. I show in detail the anterior auricular incision, the exact place
ant the way to obtain the autologous conchae cartilage, its sculpturing and how
I perform an almost exactly anatomical and physiological structure, as that of
the normal nasal lobule, its position and fixation using endonasal or external
approach, obtaining support for the nasal tip, natural projection and a normal
appearance in patients of severe iatrogenic secuelaes.
Main outcome Measure. Analyzis of the
improvement of the Aesthetic appeareance in the inferior nasal third, in
patients with Nasal Surgery secuelaes.
Results. The comparative pre and post operative photograps show the success in
the correction of iatrogenic tip nose secuelaes and its permanent good results,
by long term follow-ups.
Conclusions. This personal technique of Total Reconstruction of the Lobular
Nasal Cartilages, including the lateral and media crura in a unique block, with
autologous conchae cartilage is recommended for the surgical treatment of
severe iatrogenic secuelaes in Tip Nose Rhinoplasties, obtaining excelent
results similar to the normal anatomic structure of the nasal tip.
Dynamics and successful technology
for nasal tip surgery
Objective. Present a basic and successful personal technique to modify in a
conservative way the shape and position of the nasal tip remodeling the
cartilages, and using sutures through the domo level to re-distribute the
length of the lateral and medial crura, without vertical section of cartilage
to conserve its continuity. The purpose
of this technique is to narrow, project and rotate the nasal tip. Also to present other complementary
techniques to correct additional difficulties as weakened cartilages, thick
skin, short collumela, sub-projected and over-projected tip, asymmetric tip,
revisional tip, secuelaes of leporine nose, etc.
Design. Completion of the expose technique, has been the result of the
utilization, analysis and control at long term, in a period of 18 years, with
pre, post and inter-surgical photograph and slide studies, and examination of
the results of this technique.
Setting. Patients were institutional and private, and the surgical
interventions ambulatory or with 1 day of hospitalization.
Patients. Have been analized and grouped according to the degree of nasal tip
problems and difficulties of correction, observing the use of the various
techniques and the results in more than 3.000 patients.
Intervention. Show in detail the pre
and post cartilaginous incisions, the endonasal access way with liberation of
lobular cartilages, and the complementary techniques with partial cartilaginous
grafting in the columella, in the tip or in the lateral part of the lobule, or
with total reconstruction of the lobular cartilages using cartilaginous conchae
graft in difficult Revisional Tips.
Main outcome measures. Determine the right utilization of the surgical
techniques, to correct the shape and position of the nasal tip, based in
pre-operative analysis and the determination of the surgical plan by each
Results. Comparative pre and post operative photographs show the dynamics and
success of the conservative techniques utilized to correct nasal tip deformities,
based on the progressive difficulties presented in each case.
Conclusions. This personal basic technique for the re-distribution of the
lobular cartilages, based on the dynamics of those cartilages and the
complementary techniques used in the deformity of the nasal tip of each
patient, is a conservative but successful one, recommended to obtain an
attractive and natural nasal tip.
The New Domes Technique –
15 years of experience
tip surgery, which has been considered the most interesting and difficult part
of Rhinoplasty, obliges the surgeon to perform a detailed pre-surgical study of
each individual patient, analyzing characteristics, skin thickness, cartilage
strength and nasal tip shape and position, and requires millimetric precision
in the surgical techniques used in order to achieve nasal tip placement in the
desired and appropriate position for each patient’s face.
this presentation, we deal with a patient with a drooping nasal tip whose skin
is not very thick and who has good alar cartilage in terms of thickness and
consistency. The nasal tip must be
projected, rotated and narrowed for aesthetic improvement. We shall clearly describe the
post-cartilaginous and pre-cartilaginous incisions, the endonasal approach with
cartilage release, and conservational, predictable and stable technique—“the
new dome technique”, which places these new domes in a position which is more
lateral to the patient’s own domes, and then suturing one to the other, thus
forming an aesthetic triangle which results in a natural-looking nasal
tip. This technique is generally
complemented with the resection of the vestibular skin of the fibrous septum,
the resection of the septal caudal edge and, if necessary, the placement of a
columellar strut and columellar-septal fixation in order to sustain the
“new domes technique” allows us to obtain a nasal tip which is more projected,
cephalically rotated and narrowed natural in appearance, through the use of a
procedure which preserves the integrity and continuity of the lower lateral