Defining the Infratip Lobule in Rhinoplasty: Anatomy, Pathogenesis of Abnormalities, and Correction Using an Algorithmic Approach
ABSTRACT : Excess infratip lobule projection is often the result of deformities of the middle crus and lower lateral cartilage. The causes and correction of excess projection have not been well described. The classification of the deformities causing excess infratip lobule projection is defined and a surgical algorithm for addressing the infratip lobule is presented.
: A retrospective review of primary rhinoplasties was combined with the use of a cadaver model to identify the causes of excess infratip lobule projection and develop an algorithm for its correction. Specific cases are presented to demonstrate the consistency and predictability of these techniques.
: The classification of excess infratip lobule projection is divided into intrinsic (i.e., long middle crus, wide middle crus, lower lateral malposition, and combination) and extrinsic causes (i.e., prominent septum). After correcting extrinsic causes, the algorithm progresses from medial to lateral, working from the medial crus to the lateral crus. Final refinement using transdomal sutures establishes the endpoint for infratip lobule projection and alar rim position when the cephalic and caudal edges (rotational orientation) of the lower lateral cartilage lie in the same plane.
: A simple classification and logical algorithm are established to help rhinoplasty surgeons achieve aesthetic and consistent infratip lobule projection in cosmetic rhinoplasty. Establishing appropriate infratip lobule projection is essential for an aesthetic result in the lower third of the nose. The appearance of this complex area with the tip, columella, ala, and lobule has great importance in the final outcome in rhinoplasty.
: Therapeutic, V.
- Plastic and Reconstructive Surgery 02/2013; 131(2):404-16. DOI:10.1097/PRS.0b013e318278d288 · 3.33 Impact Factor
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ABSTRACT: Background: Although much has been published with regard to the columella assessed on the frontal and lateral views, a paucity of literature exists regarding the basal view of the columella. The objective of this study was to evaluate the spectrum of columella deformities and devise a working classification system based on underlying anatomy. Methods: A retrospective study was performed of 100 consecutive patients who presented for primary rhinoplasty. The preoperative basal view photographs for each patient were reviewed to determine whether they possessed ideal columellar aesthetics. Patients who had deformity of their columella were further scrutinized to determine the most likely underlying cause of the subsequent abnormality. Results: Of the 100 patient photographs assessed, only 16 (16 percent) were found to display ideal norms of the columella. The remaining 84 of 100 patients (84 percent) had some form of aesthetic abnormality and were further classified based on the most likely underlying cause. Type 1 deformities (caudal septum and/or spine) constituted 18 percent (18 of 100); type 2 (medial crura), 12 percent (12 of 100); type 3 (soft tissue), 6 percent (six of 100); and type 4 (combination), 48 percent (48 of 100). Conclusions: Deformities may be classified according to the underlying cause, with combined deformity being the most common. Use of the herein discussed classification scheme will allow surgeons to approach this region in a comprehensive manner. Furthermore, use of such a system allows for a more standardized approach for surgical treatment.Plastic and Reconstructive Surgery 12/2013; 133(4). DOI:10.1097/PRS.0000000000000022 · 3.33 Impact Factor
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ABSTRACT: Correction of the deviated nose poses a challenge in even the most experienced hands. Frequently, the surgeon is faced with both a functional (airway obstruction) and aesthetic problem that must be addressed conjointly. Accurate preoperative analysis and intraoperative diagnosis are integral to good outcomes. Caudal septal deviation is frequently present in patients presenting for rhinoplasty. Our current graduated technique for simplifying the management of the caudally deviated septum both aesthetically and functionally is described. If there is a persistent caudal septal deviation that has not been addressed by standard maneuvers, the caudal portion of the anterior septum is resected at the osseocartilagenous junction with the anterior nasal spine and maxillary crest then sutured back to the periosteum of the anterior nasal spine with 5-0 PDS. We have found this to be a safe and effective way to address the caudally deviated septum in the majority of cases.Plastic and Reconstructive Surgery 02/2014; 134(3). DOI:10.1097/PRS.0000000000000236 · 3.33 Impact Factor