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A Accessory Cartilages Lower Lateral Cartilage, 90 Minor Alar Cartilage, 91

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A Accessory Cartilages Lower Lateral Cartilage, 90 Minor Alar Cartilage, 91 Index A ARS, 234, 236 Accessory cartilages lateral crural strut graft, 235 lower lateral cartilage, 90 tension hinge, 233 minor alar cartilage, 91 Alar rim graft (ARG), 234, 328 pyriform ligament, 91 Alar rim structure graft (ARS), 234, 236 ring, 90, 91 Alar wedge (Weir) excision, 243 shape and location, 91 AlloDerm®, 291 tripod analogy, 90 Angular artery, 23, 217 upper lateral cartilage, 89 ANS, see Anterior nasal spine (ANS) Acellular dermal matrix (ADM), 291 Anterior nasal spine (ANS), 168, 173, 176, 179, 181, 212, 213, Aesthetics 219, 248 extrinsic, 51, 214 modification, 316 intrinsic, 50, 215 relocation, 317 layer, 288, 296–298 Anterior septal angle (ASA), 112, 113 medial crus, 47 Anterior septal prominence (ASP), 144 nasal (see Nasal aesthetics) Anterior subperichondrial tunnel, 173 radix and dorsal, 114–115 Articulated alar rim graft (AARG), 235 septum, 168 Asymmetric developmental deviated nose (ADDN), 151, 154 surface, 6–11 Alar arcade, 217 Alar cartilages, 33, 41, 47 B anatomy Balanced approach, 111, 126, 152 cadaver dissections, 47 Bony cap concept, 314 columella-lobular junction, 48 Bony-cartilaginous junction, 175 columellar base, 47, 52 Bony valve, 204–205 columellar segment, 53 Bony vault, 112 footplate segment, 53, 56 bony cap, 6 position, 49 concept, 130 subunits, 48 dorsal keystone area, 118 surface aesthetics, 47 removal, 118, 136, 137 lateral crus (see Lateral crus) surgical implications, 119 medial crus (see Medial crus) caudal portion, 116 middle crus (see Middle crus) cephalic portion, 116 nasal tip surgery definition, 116 extrinsic aesthetics, 51 dorsal modification, 314 intrinsic aesthetics, 51 lateral bony wall, 117 lateral crus–accessory cartilage junction, 108 nasion, 112 lateral crus tensioning, 72, 107 nasofrontal suture line, 112 medial crus, 106, 107 nasomaxillary suture line, 112 modified tongue-in-groove procedure, 107, 108 sellion, 112 patient with snarl tip, 106 transillumination, 116 preoperative and postoperative photos, 108 septo-columellar graft, 107, 108 septo-columellar strut, 108 C three-crus concept, 106 Cap graft, 269 tip analysis, 106 Cartilage grafts, 268 Alar cinch procedure, 248–249 Cartilaginous vault, 112 Alar rim caudal-point, 112 AARG, 235 dorsal modification, 315 alar rim support, 233, 236–237 junction-point, 112 anatomical and functional perspective, 232 keystone-point, 112 ARG, 234 lateral and distal portions, 121 340 Index Cartilaginous vault (cont.) case analysis, 272 paraseptal cleft, 120, 121 constricted internal valve angle, 271 scroll-point, 112 donor site defect, 270 separation-point, 112 ipsilateral cymba conchae, 270 spreader grafts and spreader flaps, 120 operative technique, 272 ULC–septum junction, 121 reserve graft, 370 Y/T shape, 120 skin-to-cartilage ratio, 270 Caudal border (Ca), 86, 88 standard, 270 Caudal extension grafts (CEGs), 264, 298 Cranial tip suture (CTS), 77 Caudal septal relocation, 176 Crural advancement and tip grafts, 299 Caudal septum, 33, 36, 55, 61, 144 Crural strut, 260 modification, 316 relocation, 317 Central subcutaneous fat, 15 D Cephalic border (Ce), 33, 88, 89 Deep foundation layer, 296 Cephalic dome suture (CDS), 78–79, 107, 108 Deep temporal fascia grafts Cephalic subcutaneous fat, 15 DC-F (see Diced cartilage in fascia (DC-F) grafts) Chondro-osseous joint, 122, 157 fascial blanket graft, 275 Classic conchal bowl harvest, 268 full-length dorsal graft, 275 Coblation, 190–192 harvesting technique, 274 Columella inclination angle, 52, 215, 224, 230 radix grafts, 275 Columella-labial angle (CLA), 212, 213 Depressor septi nasalis muscle (DSN), 17, 36, 53, Columellar angle, 214 218, 240 Columellar base Dermis grafts before and after surgery, 220 before and after implantation, 292, 293 analysis, 220 case analysis, 292 depressor septi nasalis muscle, 218 harvesting, 290 layers, 218, 219 operative technique, 292 narrowing, 219, 220 Diced cartilage (DC) grafts, 251, 287 operative technique, 220 Diced cartilage in fascia (DC-F) grafts, 111, 124, 188 tela subcutanea cutis, 211, 218, 219 before and after reconstruction, 278, 279 Columellar breakpoint, 222, 226 before and after refinement, 280, 281 Columellar grafts, 298 case analysis, 278, 280 Columellar–septal suture, 80 facial sleeve construction, 276 Columellar struts, 286 fascial harvest, 276 before and after surgery, 262, 263 filling, 276 case analysis, 262 graft insertion, 277 crural strut, 260 operative technique, 278, 280 extended, 260–261 postop course, 277 operative technique, 262 radix graft, 280 septocolumellar, 261 spurt test, 276 Columellar suture (CS), 71 Domal creation suture (DC), 72 Combined alar base, 246–247 Domal equalization suture (DE), 74 Complete lateral osteotomy, 138 Dorsal aesthetics, 114–115 Composite conchal grafts Dorsal keystone area (DKA), 118, 123 before and after reconstruction, 272, 273 Dorsal modification applications, 270 bony vault, 314 case analysis, 272 cartilage vault, 315 constricted internal valve angle, 271 Dorsal reduction donor site defect, 270 bony cap concept, 130 ipsilateral cymba conchae, 270 dorsal modification, 144–145 operative technique, 272 with piezoelectric instrumentation, 146147 reserve graft, 270 sequence, 131 skin-to-cartilage ratio, 270 split-hump reduction technique, 130, 131 standard, 270 two-step approach, 128 Composite reconstruction technique, 188 Dynamic lateral wall, 206–207 aesthetic layer, 297 Dynamic nasal valves deep foundation layer, 296 anatomical chokepoints, 166–167 Conchal grafts classification, 164 cartilage, 268 classic conchal bowl harvest, 268 composite grafts E before and after reconstruction, 272, 273 Ear grafts, 268 applications, 270 External valve, 164, 194, 196–197 Index 341 F I Facial artery, 217 Inferior turbinate, see Turbinates Fascial blanket graft, 275 Infralobular graft, 327 Full-length dorsal graft, 275 Infralobule Full-length tapered shield-shape before and after surgery, 224, 225 grafts, 287 anatomy, 222 Functional factors, 164 definition, 222 modification, 224 operative technique, 224 G seagulls, 223 Glabellar graft, 124 Sheen’s concept, 222 Grafts Interdomal suture (ID), 73, 325 caudal extension grafts, 264 Internal valve, 167, 200–201 columellar strut angle, 164 before and after surgery, 262, 263 area, 164 case analysis, 262 obstruction, 202–203 crural strut, 260 extended, 260–261 operative technique, 262 L septocolumellar, 261 Lateral bony wall, 117 conchal grafts Lateral border (L), 88, 229 cartilage, 268 Lateral crural convexity mattress suture (LCCS), 94 classic conchal bowl harvest, 268 Lateral crural grafts, 287 composite (see Composite conchal grafts) Lateral crural rim graft (LCRG), 235 deep temporal fascia grafts Lateral crural spanning suture (LCSS), 102 DC-F (see Diced cartilage in fascia (DC-F) grafts) Lateral crural steal suture (LCS), 75 fascial blanket graft, 275 Lateral crural strut grafts (LCSGs), 299 full-length dorsal graft, 275 alar transposition, 99 harvesting technique, 274 extended types, 98 radix grafts, 275 patient before surgery and after dermis grafts correction, 101 before and after implantation, 292, 293 standard, 98 case analysis, 292 Lateral crural tensioning, 198 harvesting, 290 Lateral crus operative technique, 292 accessory cartilages silicone implant replacement, 292 lower lateral cartilage, 90 pennant grafts, 265 minor alar cartilage, 91 rib graft pyriform ligament, 91 carving, 285 ring, 90, 91 case analysis, 288 shape and location, 91 columellar struts, 286 tripod analogy, 90 composite reconstruction, 288 upper lateral cartilage, 89 diced cartilage grafts, 287 alar malposition, 92, 93 full-length tapered shield-shape anatomy, 47 grafts, 287 borders, 88–89 inframammary approach, 282, 283 cephalic lateral crus preservation, 95 lateral crural grafts, 287 flip-over flap, 105 operative technique, 288 lateral crus shape, 87 rib strips, 285 LCCS, 96–97 septal struts, 286 LCSGs (see Lateral crural strut short domal/infralobular grafts, 287 grafts (LCSGs)) spreader grafts, 286 transverse axis, 86 subcostal approach, 282, 284 turn-under and turn-over flap, 102–104 tip grafts, 291 vertical axis, 86, 87 septal extension graft, 266–267 Lateralized medial oblique osteotomy, 134 septal graft harvest, 258–259 Lateral keystone area (LKA), 122, 123 septal reconstruction (see Septal reconstruction grafts) Lateral nasal artery, 217 subtotal septoplasty, 294 Lateral nasal wall, 206 total septoplasty, 294 Lobular reconstruction, 298 Guyuron classification, 170 Lower lateral cartilage (LLC), 121 Low-intermediate osteotomy, 135 Low-to-high osteotomy, 132 H Low to low osteotomy, 132 High intermediate osteotomy, 135 L-shape strut, 178, 181 342 Index M N MCL, see Medial canthal ligament (MCL) Nasal aesthetics Medial border (M), 88 anatomical layers Medial canthal ligament (MCL), 132–134, 137 osseocartilaginous foundation, 4 Medial crus skin envelope, 4 anatomy and aesthetics, 47 STE (see Soft tissue envelope (STE)) characteristics, 52 arterial anatomy, 22 columella inclination angle, 52 ligament columella-labial angle, 52, 58 columellar base, 36 columellar base, 53–55 footplate ligament, 36 columellar breakpoint, 54 intercrural ligament, 36 columellar pillar, 54 interdomal ligament, 32 columellar segment, 56, 64–65 longitudinal scroll ligament, 38 columellar struts, 55, 56 Pitanguy’s ligament (see Pitanguy’s midline ligament) footplates, 53–56 pyriform ligament, 37, 39 hanging and retracted columella, 55 surface landmarks, 2 normal columellar base, 55 Terminologia Anatomica, 32 position, 79 topographic landmarks, 3 retracted columella, 58–59 vertical pyriform attachments, 39
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