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      Rinoplastia funcional y estética, fusionando conceptos Translated title: Functional and aesthetic rhinoplasty, merging concepts

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          Abstract

          Resumen Introducción y Objetivo Es un hecho que la Cirugía Plástica es la parte más artística de la Medicina, y aunque está constituida por la Cirugía Reconstructiva y la Cirugía Estética, no existe un límite entre ambas. Una de las técnicas que mayormente realizamos dentro de nuestra especialidad es la rinoplastia, y de la misma manera, aunque dogmáticamente existen diferencias entre una rinoplastia estética y una reconstructiva o funcional, ambas pueden beneficiarse del mismo manejo. Algunos procedimientos empleados con buen resultado en la reparación de deformidades congénitas o adquiridas, pueden utilizarse en pacientes cuya morfología nasal es normal, sólo con fines estéticos. Material y método Realizamos una revisión de los procedimientos quirúrgicos reconstructivos nasales que pueden aplicarse de acuerdo a las subunidades estéticas, destacando los realizados en dorso, paredes laterales y punta, explicando el cómo y porqué del uso de injertos cartilaginosos o compuestos. Resultados Dichas técnicas acumulan la experiencia de los últimos 18 años del autor principal en cirugía nasal, tanto reconstructiva como estética. Es importante hacer notar que la correcta selección de los pacientes y el análisis preoperatorio serán siempre un instrumento valioso para lograr un buen resultado. Conclusiones La integración de procedimientos propios de la Cirugía Reconstructiva aplicados en la Cirugía Estética de la nariz, pueden proporcionar resultados óptimos en diferentes tipos de pacientes previamente seleccionados.

          Translated abstract

          Background and Objective It is a fact that Plastic Surgery is the most artistic specialty in Medicine and even though Reconstructive Surgery and Aesthetic Surgery constitute it, there is no limit between them. One of the techniques that we mostly perform within the specialty is rhinoplasty and in the same way, although dogmatically there are differences between an aesthetic rhinoplasty and a reconstructive or functional rhinoplasty, both can benefit from the same management. Some procedures used with good results in the repair of congenital malformations or acquired deformities, can be used in patients whose nasal morphology is normal and for cosmetic purposes only. Methods In order to describe the function of reconstructive rhinoplasty procedures applied to aesthetic rhinoplasty, a review of reconstructive surgical procedures that can be applied according to the aesthetics subunits was carried out, highlighting those performed on the dorsum, the lateral walls and the tip, explaining how cartilages or composite grafts are used. Results These techniques accumulate the experience of the last 18 years of the main author with the management of nasal surgery, both in the reconstructive and aesthetic field. It is important to consider that the selection of patients and the preoperative analysis will always be an invaluable tool to achieve a good result. Conclusions The integration of reconstructive surgery procedures applied in the aesthetic surgery of the nose can provide optimal results in different types of patients, previously selected.

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          Most cited references26

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          The subunit principle in nasal reconstruction.

          The nasal surface is made up of several concave and convex surfaces separated from one another by ridges and valleys. Gonzalez-Ulloa has designated the nose an aesthetic unit of the face. These smaller parts (tip, dorsum, sidewalls, alar lobules, and soft triangles) may be called topographic subunits. When a large part of a subunit has been lost, replacing the entire subunit rather than simply patching the defect often gives a superior result. This subunit approach to nasal reconstruction causes unsatisfactory border scars of flaps to mimic the normal shadowed valleys and lighted ridges of the nasal surface. Furthermore, as trapdoor contraction occurs, the entire reconstructed subunit bulges in a way that simulates the normal contour of a nasal tip, dorsal hump, or alar lobule. Photographs show five patients in whom this principle was followed and one in whom it was not.
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            The Turkish delight: a pliable graft for rhinoplasty.

            In nose surgery, carved or crushed cartilage used as a graft has some disadvantages, chiefly that it may be perceptible through the nasal skin after tissue resolution is complete. To overcome these problems and to obtain a smoother surface, the authors initiated the use of Surgicel-wrapped diced cartilage. This innovative technique has been used by the authors on 2365 patients over the past 10 years: in 165 patients with traumatic nasal deformity, in 350 patients with postrhinoplasty deformity, and in 1850 patients during primary rhinoplasty. The highlights of the surgical procedure include harvested cartilage (septal, alar, conchal, and sometimes costal) cut in pieces of 0.5 to 1 mm using a no. 11 blade. The fine-textured cartilage mass is then wrapped in one layer of Surgicel and moistened with an antibiotic (rifamycin). The graft is then molded into a cylindrical form and inserted under the dorsal nasal skin. In the lateral wall and tip of the nose, some overcorrection is performed depending on the type of deformity. When the mucosal stitching is complete, this graft can be externally molded, like plasticine, under the dorsal skin. In cases of mild-to-moderate nasal depression, septal and conchal cartilages are used in the same manner to augment the nasal dorsum with consistently effective and durable results. In cases with more severe defects of the nose, costal cartilage is necessary to correct both the length of the nose and the projection of the columella. In patients with recurrent deviation of the nasal bridge, this technique provided a simple solution to the problem. After overexcision of the dorsal part of deviated septal cartilage and insertion of Surgicel-wrapped diced cartilage, a straight nose was obtained in all patients with no recurrence (follow-up of 1 to 10 years). The technique also proved to be highly effective in primary rhinoplasties to camouflage bone irregularities after hump removal in patients with thin nasal skin and/or in cases when excessive hump removal was performed. As a complication, in six patients early postoperative swelling was more than usual. In 16 patients, overcorrection was persistent owing to fibrosis, and in 11 patients resorption was excessive beyond the expected amount. A histologic evaluation was possible in 16 patients, 3, 6, and 12 months postoperatively, by removing thin slices of excess cartilage from the dorsum of the nose during touch-up surgery. This graft showed a mosaic-type alignment of graft cartilage with fibrous tissue connection among the fragments. In conclusion, this type of graft is very easy to apply, because a plasticine-like material is obtained that can be molded with the fingers, giving a smooth surface with desirable form and long-lasting results in all cases. The favorable results obtained by this technique have led the authors to use Surgicel-wrapped diced cartilage routinely in all types of rhinoplasty.
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              Temporoparietal free fascia grafts in rhinoplasty.

              The temporoparietal fascial graft provides adequate coverage, contour, and bulk on the cartilage dorsum of the nose, as well as an inconspicuous donor site. In my opinion, this technique not only prevents the occurrence of noticeable sharp edges of the cartilage graft, but also adds to the smooth contour of the reconstructed nasal dorsum. The improved results either in primary and secondary rhinoplasty would seem to justify this technique. Some variations in fascia grafts are presented with clinical examples.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                December 2018
                : 44
                : 4
                : 355-362
                Affiliations
                [1] Ciudad de México orgnameHospital Médica Sur y Hospital General Naval de Alta Especialidad México
                [5] Ciudad de México orgnameUniversidad Nacional Autónoma de México Mexico
                [3] Ciudad de México orgnameCentro Médico ABC México
                [2] Ciudad de México orgnameHospital de Ortopedia Victorio de la Fuente Narváez México
                [4] Ciudad de México orgnameHospital Central Sur.PEMEX Picacho México
                Article
                S0376-78922018000400355
                10.4321/s0376-78922018000400003
                68447339-1f1b-41be-a8ba-857462c44584

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 25 November 2018
                : 27 October 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 8
                Product

                SciELO Spain

                Categories
                Estética

                Reconstructive nasal surgery,Rinoplastia,Cirugía nasal,Cirugía Estética nasal,Cirugía Reconstructiva nasal,Rhinoplasty,Nasal surgery,Aesthetic nasal surgery

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