Table 1 Desired characteristics of nasal skeleton anatomy, required grafts, and maneuvers for algorithmic approach in revision rhinoplasty for enhanced repeatability and outcomes
Anatomical characteristic | Detailed description of ideal characteristics | Required grafts | Specific maneuvers for achieving ideal characteristics |
|---|---|---|---|
1. Nasal dorsal contour | • Smooth, continuous dorsal contour without irregularities • Adequate height and projection with a natural slope from radix to tip | Spreader graft, onlay graft | o Precise sculpting of spreader grafts for maintaining dorsal width and enhancing projection • Application of onlay graft for smooth contour and augmentation |
2. Nasal bridge symmetry | o Bilateral symmetry along the nasal bridge • Even width and alignment of bony and cartilaginous components for balanced appearance | Spreader graft, lateral crural graft | o Symmetrical placement of spreader grafts for maintaining bridge width • Application of lateral crural grafts for balance and alignment |
3. Septal integrity and alignment | o Straight and well-aligned nasal septum • Preservation of septal support to ensure proper structural foundation | Septal extension graft | o Utilization of septal extension graft for straightening and aligning the nasal septum • Preservation and reinforcement of septal support during surgery |
4. Nasal tip definition | o Well-defined tip with appropriate projection • Symmetrical and proportional tip contour contributing to overall facial harmony | Lower lateral cartilage graft (LLCG) | o Sculpting of LLCG for tip projection and contouring • Precise placement for symmetrical and proportional tip definition |
5. Alar rim symmetry and positioning | o Symmetric alar rims with consistent positioning • Proper alignment with the midline for balanced nostril shapes | Alar rim graft | o Application of alar rim grafts for achieving symmetry and proper positioning • Real-time adjustments for balanced nostril shapes |
6. Adequate internal valve function | o Patent internal nasal valves for unobstructed airflow • Preservation or restoration of internal nasal valves to prevent functional issues | Spreader graft, septal extension graft | o Placement of spreader grafts for maintaining internal valve patency • Utilization of septal extension grafts to reinforce and support internal valves |
7. Nasal base width proportionality | o Harmonious nasal base width in relation to other facial features • Avoidance of excessive flaring or constriction | Alar base reduction graft, columellar strut | o Utilization of alar base reduction grafts for proportional width • Application of a columellar strut for support and proportional base width |
8. Smooth transition zones | o Seamless transitions between dorsal contour, sidewalls, and tip • The absence of abrupt changes for a pleasing overall nasal appearance | Spreader Graft, Onlay Graft | o Incorporation of spreader grafts to ensure smooth transitions between dorsal and sidewalls • Application of onlay grafts for gradual and natural contour changes |
9. Adequate columellar show | o Appropriate columellar show contributing to balanced nasal proportions • Avoidance of excessive or insufficient columellar visibility | Columellar strut | o Placement of a columellar strut for controlled and balanced columellar show • Real-time adjustments for the desired aesthetic proportions |
10. Nostril shape and size harmony | o Well-defined and symmetric nostril shapes • Proportional nostril size in relation to overall nasal structure and facial aesthetics | Alar rim graft | o Application of alar rim grafts for shaping and defining nostrils symmetrically • Real-time adjustments to ensure proportional nostril size and shape |
11. Satisfactory nasolabial angle | o Optimal nasolabial angle for a natural aesthetic appearance • Avoidance of excessive upward or downward rotation for facial harmony | Septal extension graft | o Utilization of septal extension grafts for precise control over the nasolabial angle • Dynamic assessment for refinement during surgery |
12. Consistent nasal tip rotation | o Consistent and balanced tip rotation on both sides • Avoidance of tip asymmetry and unnaturally high or low tip positioning | Lower lateral cartilage graft (LLCG) | o Sculpting of LLCG for achieving consistent tip rotation • Real-time adjustments to ensure symmetrical and balanced tip positioning |