Sách phẫu thuật thẩm mỹ mũi (Tiếng anh) Aesthetic rhinoplasty

Sách phẫu thuật thẩm mỹ mũi (Tiếng anh) Aesthetic rhinoplasty Sách phẫu thuật thẩm mỹ mũi (Tiếng anh) Aesthetic rhinoplasty Sách phẫu thuật thẩm mỹ mũi (Tiếng anh) Aesthetic rhinoplasty Hướng dẫn chi tiết về phẫu thuật nâng mũi, sửa mũi, cắt gọt cánh mũi, các phâu thuật tái tạo mũi.

Aesthetic Septorhinoplasty Barış Çakır 123 Aesthetic Septorhinoplasty Barış Çakır Aesthetic Septorhinoplasty Barış Çakır Private Practice Fulya Teras Istanbul Turkey English translation by Ali Rıza Öreroğlu ISBN 978-3-319-16126-6 ISBN 978-3-319-16127-3 DOI 10.1007/978-3-319-16127-3 (eBook) Library of Congress Control Number: 2015949109 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) In memory of my dear father Kemal Çakir who passed away in 2012 Foreword Dr Baris Çakır has written a worthy successor to Jack Sheen’s monumental text Aesthetic Rhinoplasty As a resident, I remember reading Sheen’s textbook and suddenly seeing rhinoplasty in a fundamentally new way Sheen set specific aesthetic goals and achieved them with a range of new techniques which he had developed For the next 30 years, I learned a great deal in the operating room and from lectures by my colleagues However, I had not had that feeling of excitement of witnessing a new era in rhinoplasty surgery until I attended the Combined Rhinoplasty Meeting of the Turkish and American Rhinoplasty Societies held in Istanbul in 2011 As usual, I was taking notes and trying to stay awake late in the afternoon during the presentations Suddenly, I became aware that something dramatic was happening A speaker was talking about new concepts for tip aesthetics (polygons), bony vault remodeling (bony sculpting), and nostril sill excision When the session was over, I went up to Dr Çakır and asked him if he would present the talk again for me the next morning He did and I had him repeat it three times I was totally amazed at his concepts, but wondered if he could really in the operating room what he was presenting Therefore, I asked him if he could a case for me The conversation went as follows: “I’d like to see you a case.” “When?” “Tomorrow.” “Okay.” The next day, Dr Çakır did a rhinoplasty employing a wide range of techniques which he had developed and achieved a superb result Later that day at lunch, my head was still reeling from trying to understand the nasal polygons, his advanced tip suture techniques, and repair of numerous ligaments that I had routinely cut I reasoned that the only way I could understand his concepts was to help Dr Çakır write up his techniques which he had thus far been unable to publish Subsequently, he came to me and said he had more ideas for journal articles I told him that he would always have too many ideas and too little time I advised him to go ahead and write a book as it would clarify his thinking and allow others to build on his concepts Naively, I thought he would be preoccupied for a couple of years Six months later, he sent me the manuscript and months after that the Turkish Edition was published to be followed by the English Edition In reading Dr Çakır’s masterpiece, I am struck anew by how original and advanced his concepts truly are Something as mundane as nasal photography and analysis suddenly becomes an art form and the use of preoperative “shadow photographs” a brilliant break through Some of his polygon concepts require multiple readings before one fully understands them For vii Foreword viii example, the concept of a “resting angle” between the lower lateral and upper lateral crura is totally new At first one may think it is of little importance, but when linked to the long lateral crus and herniation of the lateral crus into the vestibule its relevance becomes obvious One suddenly has an answer for a previously inexplicable problem as well as a method of treatment and more importantly a method of prevention The discussion of multiple tip points and definition of the soft tissue facets as well as their relation to specific tip sutures is crucial information In the surgical technique chapter, the importance of the continuous subperichondrial-subperiosteal dissection plane becomes apparent The novice surgeon should remember that many of his techniques were perfected through the open approach before Dr Çakır progressed to the closed approach There are certain ideas with which I disagree, including scoring of the septum, leaving a mm gap between the septal base and the anterior nasal spine, and resection of the membranous septum I also recognize that the book may prove daunting to some given the plethora of new concepts and the quality of the English translation Yet, this is a book to be savored and read multiple times before returning to specific chapters for greater insight into the challenges of rhinoplasty surgery For the younger surgeon, the book provides in-depth discussion of how to analyze and photograph the patient while formulating an individualized patient-specific operative plan The linkage of surface aesthetics to nasal anatomy to surgical techniques is the foundation of this text For the experienced surgeon, the book will be a revelation of how to set and achieve higher aesthetic standards using the described methods For the master surgeon, Dr Çakır challenges many of our accepted principles and techniques ranging from the aesthetic dorsal lines to the need for lateral crural transposition Every surgeon performing nasal surgery should purchase a copy of Aesthetic Septorhinoplasty as Dr Çakır’s concepts, principles, and techniques represent the future of rhinoplasty surgery Newport Beach, CA, USA Rollin K Daniel, MD Preface to the Turkish Edition Who is Barış Çakır? After graduating from the Electronics Department of the Çukurova Technical High School, I studied at the Faculty of Medicine upon my parent’s wish, and during the fifth year of my studies I had to undergo rhinoplasty, followed by revision surgery six months later Within my own medical career in plastic surgery, I focused on microsurgery and performed many such operations, but my strongest interest has been in nose surgery because it requires both technical skill and aesthetic understanding Even for someone like me who has both undergone and then continually performed nose surgery, this specialization continues to present interesting challenges because it is constantly developing Several years of drawing and sculpting courses have contributed to my own professional development, and in my own practice of eight years— ninety percent of which consists of rhinoplasty—I have made changes to almost half of all the techniques I learned in medical school For instance, I began nose remodeling surgery with the open technique, but since 2008 turned to closed technique instead—a rather unusual turn, as most surgeons move in the opposite direction Today, I am performing approximately 200 to 300 closed-technique rhinoplasties per year In 2012, at the ASAPS Congress, Dr Rollin Daniel encouraged me to write this book in the format of an instruction manual, so as to allow others to benefit from my experiences with rhinoplasty as well as visual documentation surrounding this type of surgery, since in the framework of this book, I have defined proper standards for surgical photography and technical drawings It is my hope that readers will find the present work most useful for their own practice What Kind of Book is this? This book describes closed rhinoplasty in which open rhinoplasty techniques are used In order to make the information presented here quickly and easily accessible, the writing style has deliberately been kept simple and more emphasis is put on the images, so that the book reads like detailed surgery notes No extensive explanation accompanies the photographs, but text, photographs, and drawings complement each other and the images illustrate the ix 408 31.2 Patient Analyses Surgery Photographs 31 Case Analysis: Medium-Thick Skin 409 410 Patient Analyses 32 Case Analysis: Revision for Droopy Tip 411 32 Case Analysis: Revision for Droopy Tip Previous open surgery Droopy tip Forehead and cheeks are retruded 412 32.1 Surgery A rib graft was harvested Domes were delivered with infracartilaginous incision Cephalic excision was made from the lateral crus mm Left lateral crus steal of mm Right lateral crus steal of mm With a cephalic dome suture, the lateral crus resting angle was corrected A strut graft was placed Upper lateral caudal trim mm Osteoectomy Projection control suture Radix was reduced Fat injection to forehead and cheeks Patient Analyses 33 What Not to Eat Before Surgery 413 33 What Not to Eat Before Surgery Sulphur-containing garlic is known to increase the risk of bleeding, and therefore it must be discontinued before surgery Flatulent foods like mixed herbal tea, beans, broccoli, and milk should not be consumed excessively It is necessary to avoid mineral water which has a high sodium content and pickles which have a high salt content to prevent edema Foods and spices that cause acquired platelet function disorders, such as are onion, cumin and Chinese food, should not be consumed Fruits: Apricot, Pineapple Vegetables: Lettuce, green peppers, tomatoes Spices: Red pepper, thyme, rosemary, anise, sage Phenol-containing foods: Raisins, blueberries, raspberries, strawberries, peanuts, green tea, plum, pear, cherry, pomegranate, grape, oranges, broccoli, cabbage, chervil, onions, cocoa Mainly anthocyanidins: Cyanidin (peaches, cherries, figs, plums, raspberries, currants, red cabbage), Malvidin (at some grapes), Pelargonidin 414 Patient Analyses (strawberries, red radish, mulberry), Peonidin (bogs cranberry), Petunidin (American grapes) Containing catechins: cocoa and green tea Containing Omega 3: Walnut, almond, soy, flax seeds, legumes can wet the splint However, not expose it to vapor – It is not necessary to apply cold or ice to your face – Internal splints placed in the nose create a flu-like feeling and cause a sneezing reflex 34 Do not panic Sneeze with your mouth open Sneezing will not disturb the nose After Surgery: A Few Notes – For the next five nights, sleep with three pillows – Do not stay in very warm places – Keep away from bleeding-enhancing food for the first ten days – Do not use vitamin pills or other nutritional supplements – Avoid activity that can increase your blood pressure Do not bend your head – Try to remain in a vertical position except when sleeping – You can go outside after the second day – Plastic splints are not affected by water You can shower every day for 2–3 minutes You – Do not exercise for one month – Do not swim in the sea for one month and in the pool for two months – Do not wear glasses for two months – You can use lenses after nose surgery – It is not necessary to avoid the sun if you not have bruising Do not sweat because of heat – You can use anti-edema foods like green tea, chervil, and pineapple starting from the tenth days THANK YOU FOR YOUR ATTENTION Barış Çakır, MD For inquiries and comments, please e-mail drbariscakir@gmail.com Index A Alar rim edge excision incision, 311 marking, 311 resection, 312 suture, 312–317 Arkansas stone, 254 Autorim flap technique ala retractions, 145 alar support, 158 bulbous cartilage, 150 cartilage surface, 154 caudal excess, 148, 160 cephalic dome sutures, 156 cephalic migration, 150 cephalic resection, 155 cephalic trimming, 147 columellar strut graft, 156 convex lateral crura, 149 C suture, 157 desired facet polygon, 152 dissection, 154 dome lights, 159 facet polygon, 145 lateral crus caudal resections, 145 medial crus, 153 mucosa, 153 narrow facet polygon, 152 nostril, 162 preoperative photograph, 158 in situ cartilages, 151 structural grafts, 159 subperichondrial plane, 154 thin skinned patient, 146 Awareness, 40 B Bayonet forceps, 257, 325, 330 Black dots, 18 Block cartilage, 52, 53, 336–337, 374, 395 © Springer International Publishing Switzerland 2016 B Çakır, Aesthetic Septorhinoplasty, DOI 10.1007/978-3-319-16127-3 Blunt perichondrium elevator, 164 Bone paste, 85 Bone scissors, 35–36, 128, 328 C Cakir perichondrium elevator, 36 Cakir periosteum elevator, 36, 113, 115 Camouflage techniques, 85, 183, 324 Cartilage anatomy, 47, 48, 55, 69 Cartilage hump, 126, 274, 281, 359 Cavity polygon, 61 Cephalic malpositioning patient analyses autorim flap, 377 columellar polygon, 378 domes and strut graft, 377 infralobule polygon, 378 lateral crural steal, 377 single flash photo, 376 resting angle autorim flap technique, 79 insufficient cartilage in nose wings, 79 lateral crus repositioning surgery, 78 medial canthus, 78 repositioning technique, 80 subperichondrial dissection, 79 Choking graft sutures, 222 Closed approach healing rate closed technique, 365 depressor, 364 infralobule polygon, 364 scroll facets, 366 soft tissue resection, 364 ideal patient for, 401–402 revision lateral steal simulation, 380 marking and symmetry test, 380 operation, 380 tip surgery, 381 415 Index 416 Columellar show autorim flap technique, 340 closed technique, 340 hanging columella closed technique and extreme cephalic resection, 341 lateral crural cephalic strut graft, 343–345 medial crus caudal resection, 346–349 scroll graft, 345–346 surgery, 342–343 retracted nasal alae, 339 upper lateral cartilage caudal resection, 340 Computer imaging designs, 10, 16 Concha hypertrophic concha, 101 radiofrequency cauterization, 101 SMR bone pieces, 103 cavernous tissue, 102 concha bone, 105, 106 conchal mucosa, 104 electro cautery, 104 elliptic resections, 102 inward collapsed maxillary base, 106 local anesthesia, 101 normal anatomy, 106 saline solution, 101 segmental outfracture, 106–107 septum base, 105 silicon splint, 104 Webster triangle out fracture, 106 D Daniel perichondrium elevator, 36, 37, 124, 125, 166 Defatting, 297 Degussit (Al2O3), 38 Dome anatomy, 57 Dome spanning, 57, 63 Dome symmetry test, 195–196, 326 Dome triangles, 54–57, 204, 217 Dorsal bone polygon, 53, 84–85 Dorsal cartilage polygon, 53, 83–84 E Esthetician, 18 Extreme grafting, 61 F Fish-eyed photo, Focus settings, Forehead fat grafting cannula, 19 chin prostheses, 19 fat injection, 19 lipofilling, 19 nose aesthetics, 19 nose radix, 19 technique alae rim resection, 25 blunt radix, 25 dorsal aesthetic lines, 24 fat injection, 21, 25 forehead nose transition, 21 nose surgery, 20 postoperative results, 21 rhinoplasty, 21 sagging alae, 25 surgical plan, 26 tip shadows, 24 “F” value, G Glabellar polygon, 53 Gummy smile deformity, 138, 139 H Hanging columella closed technique and extreme cephalic resection, 341 lateral crural cephalic strut graft, 343–345 medial crus caudal resection, 346–349 scroll graft, 345–346 surgery, 342–343 Hematoma, 123 Hemitransdomal suture, 196, 199 I Intracath, 19, 28, 288 ISO, J Jaw and cheek arkansas stone, 38 bone scissors, 35–36 under chin approach, 28 chin augmentation, 28 elevator, 36–37 eyelash and nose relation, 33 forehead fat injection, 30 gray intracath, 28 hook, 37 illusion effect, 32 lateral osteotomes, 37 medpor implants, 28 monocryl stitch, 28 needleholde, 35 osteotomes, 36 osteotomy chisels, 37 rasp and saw, 36 scissors, 35 subperichondrial dissection, 34 sutures, 38 Index L Lateral crus subperichondrial dissection autospreader flap technique, 162 blunt perichondrium elevator, 164 cephalic malposition, 177 Daniel elevator, 166 domes, delivering, 168–175 ellipse model, 184–185 internal bandaging, 165 marking and resections, 175–177 observations, 177–181 scroll ligament, 165 secondary rhinoplasty, 167–168 sesamoid cartilages, 165 thoery, 181–183 tools, 163 Learning, nose drawing polygons, 39 sculpture classes, 39 sketch from front, 40–41 Little Cottle elevator, 36, 37 M Mass polygons, 53, 65 Maxillary spine, 325 Menstrual delaying medicine, 19 Millimeter autorim flap, 242 Mucosa surplus, 330 Mucosa vasoconstriction, 96 Muscle function impairment, 122 N Nasal dorsum surgery bone dust and cartilage paste, 276–278 dorsal bone resection, 128–130 dorsal cartilage resection, 126–127 dorsal reconstruction, males, 280–281 dorsum height, 252 intercartilaginous incision, 108 nasal radix, 130–131 nasal tip, stabilization of, 281–283 osteoectomy technique aspirator tip, 258 blind chisel, 257 bone massage, 266–267 bone saw dusts, 257 bone surface problems, 263 breathing problems, 265 bruising, 263 control, 262 function, 263 instruments, 258–262 Libra graft, 269–271 nasal dorsum cartilage, 274 nasal dorsum control, 271–274 rasp, 255 reconstruction, nasal dorsum, 267–268 417 redrape problems, 264 scratching movements, 257 superficial bone asymmetries, 256 unsuccessful osteotomy, 263 osteotomy, 252–254 periosteum dissection, 114–122 scroll groove, reconstruction of 5/0 Monocryl, 283 scroll sesamoid cartilage, 284–286 septum mucosa, 283 septal angle, 108–110 short nasal bones, 278–280 subperichondrial dissection bleeding, 123 camouflage effect, 123 ligaments, 123–124 muscle function, 122–123 nose healing, 122 open approach, 110–114 transfixion incision, 107 upper lateral cartilage mucosa dissection, 124–126 Nasal polygons Cakir polygons vs Sheen’s aesthetics, 51–53 columellar polygon, 61–62 dome triangles cartilage anatomy, 55 cephalic dome suture, 56, 57 cubic forms, 57 facet polygon, 56, 57 horizontal mattress suture, 57 lateral and medial crura, 55 organic models, 57 tip sutures, 55 Ti, Ts and Rm points, 54 dorsal aesthetic lines fusiform anatomy, 87 Libra graft technique, 87 nasal dorsum, 87 nose aesthetic design, 87 oblique view, 87 review, 90 rib graft, 88, 89 dorsal bone polygon, 84–85 dorsal cartilage polygon, 83–84 facet polygons destruction, 64 dome polygon, 63, 65 infralobular polygon, 63 lateral crus, caudal edge of, 63 middle crus, 63 non-anatomical sutures, 63 open surgery technique, 64 pinched nose deformity, 64 footplate polygon, 62–63 infralobular polygon, 60 infratip triangle, 53 interdomal triangle 418 Nasal polygons (cont.) dome divergence, 59–60 facet polygon, 58 photoshop, 58 rim graft, 58 rotation differences, 58 lateral aesthetic lines, 92 lateral bone polygons, 86 lateral crus polygons, 65 mobile tip area space polygons, 53–54 mass polygons, 53 non-mobile nose, 53 polygon model, 93–94 resting angle cephalic dome suture, 66 cephalic malpositioning, 78–80 convex lateral crura, 78 incorrect resting angle, 70–71 long lateral crura, 71–77 surgical techniques, 66 vertical compression test, 67–70 wide lateral crura, 71 scroll facet cephalic dome suture, 80 dome cartilages, 81 open technique, 82 transdomal sutures, 82 scroll line, 83 tip breakpoints, 54 tip defining point, 53 upper lateral cartilage polygons, 85–86 Nasal surgery additional grafts extra columellar strut, 297–298 rim graft, 298 basic surgical steps, 101 cartilage grafts rib cartilage, 334–339 septal cartilage, 334 cleaning, 99 columellar show autorim flap technique, 340 closed technique, 340 hanging columella, 339, 341–349 retracted nasal alae, 339 upper lateral cartilage caudal resection, 340 concha, 101–107 deviated nose left axis noses, 320–321 nasal dorsum resection, 323–324 reference points, 321–323 septoplasty, 324–325 septum deviation, 320 tip surgery, 325–334 drains, 288 drawings, 100–101 footplates anterior maxillary spine resections, 142 contralateral footplate, 141 septum cartilage, 140 Index suturing of, 143 transfixion incision, 141 head lamp, 99 internal splints, 288 internal taping new SMAS anatomy, 291–292 Pitanguy ligament, 292–294 internal valve functions, 288 lights, operating room, 99–100 local anesthesia Bupivacaine, 98 infiltration, 97 infraalveolar and supratrochlear blocks, 98 Lidocaine, 98 nasal dorsum dissection, 99 nasal dorsum surgery, 107–131, 252–287 nostril surgery avulsion advancement flap, 302–307 avulsion advancement flap and elliptic resection combination, 307–311 composite graft, 316–317 hanging alae, 311–316 problems and solutions, 299 thick alar base, 299–302 patient position and tracheal intubation, 95–96 Pitanguy ligament, 289–290 postoperative care, 318–320 prescription, 349 redrape camouflage, 297 dissection borders, 295–296 internal taping, 296–297 ligaments, 296 results cephalic dome suture, 196–198 cephalic malpositioning, 238–251 cephalic malposition view, 186 C’ graft, 221–222 closure of tip incisions, 231–232 columellar breakpoint (C’ point), 218 columellar polygon stabilization, 229–230 columellar strut graft, 213–218 Control 1, 198 Control 2, 198–205 C’ suture, 218–221 domes, suturing, 211–213 dome symmetry test, 195–196 footplate setback, 187–193 infralobular caudal contour graft, 222–228 interdomal graft, 251–252 lateral crus steal procedure, 193–195 medial crus overlap, 205–211 nose movement, 186 surgery, 187 tip asymmetry, 232–238 septum, 131–140 superficial SMAS, 290–291 taping, 317–318 tip surgery, 143–185 Index Nasolabial angle, 42, 184 Needle hooks, 229 Nose drawing design, 39 learning polygons, 39 sculpture classes, 39 sketch from above and below, 44–47 sketch from front, 40–41 sketch from side, 42–44 patient photographs, analysis of, 48–49 Nose sculpture, 45, 51 Nostril sill anatomy, 40, 302, 307 O Open roof, 36, 85, 262, 264 Oral Vitamin A, 18, 119 Organic models, 53, 57 Osteoectomy technique aspirator tip, 258 blind chisel, 257 bone massage, 266–267 bone saw dusts, 257 bone surface problems, 263 breathing problems, 265 bruising, 263 control, 262 function, 263 instruments, 258–262 Libra graft, 269–271 nasal dorsum cartilage, 274 nasal dorsum control, 271–274 rasp, 255 reconstruction, nasal dorsum, 267–268 redrape problems, 264 scratching movements, 257 superficial bone asymmetries, 256 unsuccessful osteotomy, 263 P Paraflash system, 5, 7, Patient analyses after surgery, 414 bulbous tip, 396–397, 403–404 cephalic malpositioning autorim flap, 377 columellar polygon, 378 domes and strut graft, 377 infralobule polygon, 378 lateral crural steal, 377 single flash photo, 376 closed approach healing rate, 364–366 ideal patient for, 401–402 revision, 378–381 common patient alar edge resection, 354 lateral crus caudal edge, 353 nose tip cartilages, 353 419 nose tip rotation, 402 resection, 353 rotation, 352 subperichondrial dissection, 352 dermocartilaginous ligament, 359 dome triangles, 359 droopy tip, 411–413 footplate setback effect, 362 fractured nose, operated twice calvarium bone graft, 372 cartilage chip grafts, 373 fusiform nasal dorsum graft, 373 resection, 372 silicon graft, 373 surgery, 374 long nose, 374–375 mid-thick skin surgery, 407–408 surgery photographs, 408–411 open technique, 359 overrotated saddle nose cymba conchae, 382 first operation, 382–383 second operation, 383 surgery, 383–386 Pitanguy ligament, 360 6/0 Prolene suture, 360 saddle nose and hanging nostril, 395–396 and notched nostril, 391–393 subperichondrial dissection, 360 supratip healing period depression, 366 nasal dorsum, 368 Pitanguy ligament, 366 scroll ligament, 366 tip surgery, 367 before surgery, 413–414 tension nose, 399–400 tension nose and thin skin, 400–401 thick skin bulbous tip and deviated nose, 406–407 and huge hump, 362–363 low radix and cephalic malpositioning, 390–391 and oily skin, 357–358 patients, 355–357 thin skin axis deviation and breathing problems, 404–405 big nose, 397–398 deviated nose and tip asymmetry, 388–389 patients, 386–387 pseudocephalic malpositioning and tip asymmetry, 398–399 tip asymmetry, 389–390 very short infralobule and very narrow facet polygon, 394–395 wide dorsum, wide radix and bulbous overprojected tip first surgery, 369 infralobule polygon length, 368 two year revision, 370–372 Index 420 Patient photographs camera settings, 7–8 fish-eye, image workout, 10–12 light tricks, 6–7 paraflash settings, peroperative photographs, photography system, 5–6 shadpowing, workout JPG, 13 layer adjustment menu, 13 Macintosh: cmd-A (Windows: CTRL-A), 12 Macintosh: cmd-C (Windows: CTRL-C), 12 photograph work, 14–17 PSD format, 13 shaded picture, 14 surgery drawings, 14 smartphone, Peck graft, 204, 227 Perpendicular (portrait) photos, Photograph work aesthetic information feedbacks, 15 beauty perception, 15 brain perception, 14 computer design, 16 design, 14 front, lateral views and shadowed photos, 16 integrated photo, 16 nose ridge, 14 operation room, 16 Photography techniques, 10 Photoshop, 10–12, 58, 100, 184 Polygon drawings, 54, 211 Portrait photographs, Poviodine, 99 Preoperative photographs forehead fat grafting, 19–27 jaw and cheek, 28–33 menstruation, 19 patient photographs camera settings, 7–8 fish-eye, image workout, 10–12 light tricks, 6–7 paraflash settings, 8–10 peroperative photographs, photography system, 5–6 shadowing, 12–17 smartphone shooting, rhinoplasty instrument set, 34–38 skin care and rhinoplasty, 18–19 surgery notes and archiving, 17–18 Pseudoephedrine spray, 96, 349 R Resting angle cephalic dome suture, 66 cephalic malpositioning autorim flap technique, 79 ‘insufficient cartilage in nose wings, 79 lateral crus repositioning surgery, 78 medial canthus, 78 repositioning technique, 80 subperichondrial dissection, 79 convex lateral crura, 78 incorrect resting angle, 70–71 long lateral crura airway, 73 caudal excess, 72 closed technique rhinoplasty, 71 depression, 74 height of, 71 herniation, 71, 73, 75 nose length, reduction, 71 perichondrium, 72 skin pit, 75 subperichondrial dissection, 72 surgical techniques, 66 vertical compression test, 67–70 breathing, 67 cartilage anatomy, 69 cartilage thickness, 67 cephalic malposition deformity, 69, 70 corrupted resting angle, 69 deep inspiration, 67 lateral crus, 67 nares, 67 resistance, 68 septum deviation, 67 tip shaping techniques, 70 wide lateral crura, 71 Reverse-V deformity, 87, 254, 262 Rhinoplasty closed technique, 71 instrument set closed surgery, 34 dorsum retractor, 34 little retractor, 34–35 Medicon company, 34 speculums, 34 surgical tools, 34 polygon model, 93–94 skin care and, 18–19 Rib cartilage block cartilage, 336–337 cartilage chips, 335 ear cartilage, 335 strip cartilage grafts, 338–339 surgery, 335–336 Roaccutane treatment, 18 S Saddle nose and hanging nostril, 395–396 and notched nostril, 391–393 Self-sticky prints, Septal extension graft, 228, 267, 293 Index Septum dissection blunt dissectors, 136 ethmoid bone, 135 excised vomer bone, 135 L-strut septoplasty, 132 maxillary spine deviations, 134 mucosa tears, 133 nasal passage, 137 open approach, 132 perichondrium, 131 revision rhinoplasty, 132 rib cartilage, 132 septoplasty, 137 thin Cottle elevator, 132 transfixion incision, 136 extreme gummy smile, 138–140 gummy smile, 138 septum out, 137–138 Septum base surgery, 329 Shadowed photos, 100 Shield graft, 52, 53 Shutter rate, Skin color, Skin ecchymosis, 119 SLR camera, 5–7 Surgery notes and archiving autorim flap technique, 18 backups, 18 drawings, 17 epicrisis report, 17 patient archiving programs, 17 photography archive, 18 pre-written surgery note, 17 recordings, 17 T Tebbett’s technique, 105 Telangiectasia, 296 Thick skin bulbous tip and deviated nose, 406–407 and huge hump ala resection, 362 avulsion flap and elliptic resection, 363 patient’s infralobule polygon, 362 low radix and cephalic malpositioning, 390–391 and oily skin alar edge resection, 357 columella, 357 fat injection, 357 long inflammatory period, 357 nostril edge resection, 358 vitamin A, 358 patients closed technique, 355 Libra grafts, 357 osteotomies, 357 421 pitanguy and scroll ligaments, 355 strut graft, 356 Thin skin axis deviation and breathing problems, 404–405 big nose, 397–398 deviated nose and tip asymmetry, 388–389 patients, 386–387 pseudocephalic malpositioning and tip asymmetry, 398–399 Time Machine, 18 Tip surgery autorim flap ala retractions, 145 alar support, 158 bulbous cartilage, 150 cartilage surface, 154 caudal excess, 148, 160 cephalic dome sutures, 156 cephalic migration, 150 cephalic resection, 155 cephalic trimming, 147 columellar strut graft, 156 convex lateral crura, 149 C suture, 157 desired facet polygon, 152 dissection, 154 dome lights, 159 facet polygon, 145 lateral crus caudal resections, 145 medial crus, 153 mucosa, 153 narrow facet polygon, 152 nostril, 162 preoperative photograph, 158 in situ cartilages, 151 structural grafts, 159 subperichondrial plane, 154 thin skinned patient, 146 infracartilaginous incision, 144–145 lateral crural length, 143 lateral crus subperichondrial dissection autospreader flap technique, 162 blunt perichondrium elevator, 164 cephalic malposition, 177 Daniel elevator, 166 domes, delivering, 168–175 Ellipse model, 184–185 internal bandaging, 165 marking and resections, 175–177 observations, 177–181 scroll ligament, 165 secondary rhinoplasty, 167–168 sesamoid cartilages, 165 thoery, 181–183 tools, 163 nasal dorsum and septal surgery, 143 Tongue-in-groove, 228 Topographic anatomy, 53, 92 Transdomal suture, 64, 82, 196, 202 Index 422 Triamcinolone, 314 Turkish Aesthetic Surgery Society, 161 U Upper lateral cartilage polygons, 53, 85–86 W Webster’s bone triangle, 92 Webster triangle, 92, 106, 254, 263 White steroid cysts, 296 .. .Aesthetic Septorhinoplasty Barış Çakır Aesthetic Septorhinoplasty Barış Çakır Private Practice Fulya Teras Istanbul Turkey... Sheen’s monumental text Aesthetic Rhinoplasty As a resident, I remember reading Sheen’s textbook and suddenly seeing rhinoplasty in a fundamentally new way Sheen set specific aesthetic goals and... feeling of excitement of witnessing a new era in rhinoplasty surgery until I attended the Combined Rhinoplasty Meeting of the Turkish and American Rhinoplasty Societies held in Istanbul in 2011