In general, fewer male patients seek rhinoplasty surgery than females. The surgical principles are similar in both populations with some special anatomic considerations that will need attention. There is a higher rate of body dysmorphic syndrome in males seeking rhinoplasty as well as greater challenges with patient satisfaction, and the consultation process needs to be thorough and deliberate when undertaking aesthetic surgery in this population to maximize positive outcomes.

Facial Plastic Surgery & Aesthetic MedicineAhead of Print Hyper-Beveled Composite Skin Graft for Nasal ReconstructionAniruddha C. Parikh, Robert Rhodes, Lacy S. Brame, and Ivan WayneAniruddha C. Parikh*Address correspondence to: Aniruddha C. Parikh, MD, Department of Otolaryngology—Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. E-mail Address: aniruddhaparikh1@gmail.comhttps://orcid.org/0000-0002-1212-978XDepartment of Otolaryngology—Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.Search for more papers by this author, Robert Rhodeshttps://orcid.org/0000-0003-0646-567XW Facial Aesthetics, and Oklahoma State University Center for Health Sciences, Oklahoma City, Oklahoma, USA.Search for more papers by this author, Lacy S. BrameDepartment of Otolaryngology—Head and Neck Surgery, Oklahoma State University Center for Health Sciences, Oklahoma City, Oklahoma, USA.Search for more papers by this author, and Ivan WayneW Facial Aesthetics, and Oklahoma State University Center for Health Sciences, Oklahoma City, Oklahoma, USA.Search for more papers by this authorPublished Online:24 May 2023https://doi.org/10.1089/fpsam.2023.0021AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUBView Supplemental Data Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Hyper-Beveled Composite Skin Graft for Nasal Reconstruction." Facial Plastic Surgery & Aesthetic Medicine, , pp. FiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, American Academy of Facial Plastic and Reconstructive Surgery, Inc.To cite this article:Aniruddha C. Parikh, Robert Rhodes, Lacy S. Brame, and Ivan Wayne.Hyper-Beveled Composite Skin Graft for Nasal Reconstruction.Facial Plastic Surgery & Aesthetic Medicine.ahead of printhttp://doi.org/10.1089/fpsam.2023.0021Online Ahead of Print:May 24, 2023PDF download

Auricular cartilage grafts may be the most frequently used autologous graft material in facial plastic surgery. These versatile grafts can be used to address both functional and aesthetic problems. They are nearly universally available, even in patients who have had prior nasal surgery, and they avoid the potential problems of graft rejection or extrusion that can occur with synthetic materials. Often, insufficient cartilage is available in patients who have undergone prior septal surgery if grafts are needed for revision surgery, and the auricular site is a preferred source. Costal cartilage is an additional option, but most patients prefer the reduced morbidity of an auricular graft and the advantage of a hidden incisional scar. Common uses for auricular cartilage grafts include alarbattengraftsto treat nasal sidewall collapse; dorsal onlaygrafts to treat the over-resected nasal dorsum or the low radix or, when shaved thin, to camouflage dorsal irregularities in rhinoplasty surgery; nasaltipgrafts in primary and secondary rhinoplasty; postauricular perichondrium grafts to overlay the nasal tip and dorsum in the thin-skinned rhinoplasty patient; nasalalar reconstruction after skin cancer resection; lower lid space graftsto treat ectropian in the paralytic lower lid; and cartilage graft material to assist in repairing septal perforations. While some surgeons prefer harvesting the auricular cartilage from an anterior approach, we favor a retroauricular incision. The posterior approach minimizes

The problems that arise when reviewing another surgeon's work, the financial aspects of revision surgery, and the controversies that present in marketing and advertising will be explored. The technological advances of computer imaging and the Internet have introduced new problems that require our additional consideration.

We evaluated the nasal superficial musculoaponeurotic system (SMAS) as an autologous augmentation graft material in the thick-skinned patient undergoing cosmetic rhinoplasty using a retrospective review. Representative case reports demonstrated preliminary long-term results after augmentation with the nasal SMAS graft in an academic rhinoplasty practice. En bloc excision of the nasal SMAS in thick-skinned patients produced uniformly favorable improvements in nasal tip definition without adverse sequelae. Moreover, in 10 patients, the harvested material was also used for volume augmentation at various adjacent nasal sites, including the radix, nasal sidewall, and nasal dorsum. Long-term follow-up ranging from 1 to 3 years suggests stable volume augmentation in this initial patient series. No donor morbidity was observed in properly selected patients, and enhancements in nasal tip definition were uniformly favorable. Additional studies are needed to more accurately characterize long-term nasal SMAS graft survival in all patients.

We evaluated the nasal superficial musculoaponeurotic system (SMAS) as an autologous augmentation graft material in the thick-skinned patient undergoing cosmetic rhinoplasty using a retrospective review. Representative case reports demonstrated preliminary long-term results after augmentation with the nasal SMAS graft in an academic rhinoplasty practice. En bloc excision of the nasal SMAS in thick-skinned patients produced uniformly favorable improvements in nasal tip definition without adverse sequelae. Moreover, in 10 patients, the harvested material was also used for volume augmentation at various adjacent nasal sites, including the radix, nasal sidewall, and nasal dorsum. Long-term follow-up ranging from 1 to 3 years suggests stable volume augmentation in this initial patient series. No donor morbidity was observed in properly selected patients, and enhancements in nasal tip definition were uniformly favorable. Additional studies are needed to more accurately characterize long-term nasal SMAS graft survival in all patients.

OBJECTIVE:To define the relationship between the frontal branch of the facial nerve and a series of blood vessels that are encountered during endoscopic forehead procedures.DESIGN:Anatomical study using 6 fresh cadavers (12 sides).RESULTS:In 11 of 12 dissected specimens, the blood vessels in the temporal region were found to lie within 2 mm of the frontal branch of the facial nerve.CONCLUSIONS:We believe that a series of veins encountered during endoscopic forehead procedures provide the surgeon with the ability to identify the precise location of the frontal branch of the facial nerve. During endoscopic surgery, these vessels are found in a plane between the deep temporal fascia (below) and the superficial temporal fascia (above). We believe that these vessels can be thought of as arrows pointing superiorly to a frontal branch of the facial nerve as it courses through the superficial temporal fascia.

Modern techniques and better understanding of nasal functional anatomy and physiology have improved the results offered by rhinoplasty. Computer imaging is helping patients better understand and visualize the acceptable results. An understanding of the common problems seen after rhinoplasty will help the surgeon anticipate and prevent them. Quick recognition, reassurance, and eventual successful treatment when problems do occur after rhinoplasty will help maintain patient confidence in the surgeon and lead to a satisfactory conclusion.