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 IJCS / Year: 2003 / Volume 3 - Number 3 / Abstracts - 48th Meeting and World Congress of the IACS
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Title: FERNANDO PEDROZA, M.D.
Correction of the asymmetric nose; Septal perforation closure; Endoscopic forehead lift fixation technique; Total reconstruction of the nasal tip cartilages in revisional rhinoplasties 20 years experience - personal technique; Total reconstruction of the nasal tip cartilages in revisional rhinoplasties – 20 years experience personal technique. “Sea Gull Wings” technique; Dynamics and successful technology for nasal tip surgery; The New Domes Technique – 15 years of experience;
Pages: 30 - 34
 
 

FERNANDO PEDROZA, M.D.

Correction of the asymmetric nose

The main goal is the presentation of the surgical techniques used in the correction of the Asymmetric Nose.

The 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

The 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.

72 cases of patients operated of big septal perforations performed in private practice are presented in a period of time of 10 years (1981-1998).

All the cases are documentated with photographs pre and post-operative of the patients.

Described are an analysis of the ethiology, size of the perforation, simptomatology, age, sex, surgical approach, grafting, follow-up and results obtained.

The surgical technique used is illustrated, and shown several patients operated.

In 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

In 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.

I use the endoscopic approach through 5 incisions from 2 to 3 centimeters long in the scalp.

I 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 dissected areas. 

I 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.

I show the slides pre and post op. with patients operated with this endoscopic technique used during the past two years.

The 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

I 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.

I 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.

The 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

1. 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 conchae.

2. 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.

3. Setting.  The patients were institutional and private and the intervention was ambulatory or with 1 day of hospitalization.

4. 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.

5. 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.

6. Main outcome Measure.  Analyzis of the improvement of the Aesthetic appeareance in the inferior nasal third, in patients with Nasal Surgery secuelaes.

7. 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.

8. 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

1. 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.

2. 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.

3. Setting. Patients were institutional and private, and the surgical interventions ambulatory or with 1 day of hospitalization.

4. 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.

5. 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.

6. 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 patient.

7. 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.

8. 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

Nasal 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.

In 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 results.

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 cartilage.

 

 
 
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 IJCS / Year: 2003 / Volume 3 - Number 3 / Abstracts - 48th Meeting and World Congress of the IACS
 
 
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