The Cartilage Rhinoplasty with Goldman Technique for Correcting the Broad Nasal Tip

In this paper, A retrospective review was performed for all the patients who underwent surgery with the Goldman technique by the senior author from 2004 to 2009 for correction of the broad nasal tip. The clinical and pathologic findings of these patients were reviewed, and an independent observer evaluated the pre- and postoperative photos of the patients using five parameters: projection, rotation, symmetry, shape, and distance of the tip-defining points. The evaluation was performed using a scale of -1 to +1 for each of the five parameters. Of the 205 patients who underwent the technique, 115 (56%) were patients with broad tips, and 90 (44%) were patients with broad (boxy) tips. A total of 189 cases (92.2%) involved primary rhinoplasties, and 16 cases (7.8%) involved revision. During this period, complications were observed in five patients (2.4%), who underwent revision rhinoplasty with a successful result. The average score for the five parameters already mentioned for primary rhinoplasties according to the scale of -5 to +5 showed a significant postoperative improvement (score, +4.3). It implied that the cartilage rhinoplasty with Goldman technique is safe when performed by experienced surgeons and according to specific indications. This conclusion is indicated by the low rate of complications in the large series of patients in this study.

Compulsory auricular cartilage use: Modified septal extension graft application in revision rhinoplasty

OBJECTIVE: This study aimed to demonstrate how to perform a tongue-in-groove graft with the method we developed using auricular cartilage to provide adequate nasal tip support in 17 revision rhinoplasty cases. METHODS: This retrospective study was conducted on 17 patients (17 females; mean age: 23.9+3.7 years; range, 19 to 30 years) who underwent revision rhinoplasty (RR) operations for a low nasal tip between February 2019 and September 2020. After auricular cartilage was removed with a standard posterior auricular intervention, it was folded in two to increase its resistance and fixed to the caudal part of the nasal septum as a tongue-in-groove graft. RESULTS: Solid nasal tip support and satisfactory nasal tip projection and rotation were achieved in all patients. One (6%) patient developed auricular hematoma as a complication on the third postoperative day, and three (17%) of our patients complained of nasal obstruction in their postoperative follow-up. CONCLUSION: When the use of costal cartilage is limited due to social and cultural reasons in RR cases performed due to a low nasal tip, auricular cartilage can be used as a modified tongue-in-groove graft and provides a satisfactory aesthetic appearance.

In-office Endonasal Minor Revision Rhinoplasty

The revision rhinoplasty presents many unique challenges to the facial plastic surgeon. While many cases will require a full revision in the operating room, there are several isolated deformities which may be repaired in the office via an endonasal approach. This provides many benefits to the patient and surgeon including decreased cost, shorter recovery time, avoidance of general anesthesia, and less discomfort. It is critical to identify defects appropriate for endonasal repair, establish clear expectations with the patient, and work within one's skill set and level of experience. The surgeon who can comfortably navigate both open and endonasal techniques can offer their patients a comprehensive set of solutions for revision rhinoplasty. In this article we outline the defects amenable to this type of repair as well as technical considerations for each defect addressed. We hope it serves as a useful framework for the range of deformities the rhinoplasty surgeon may take on for in-office repair.