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Semin Plast Surg 2020 May 6;34(2):92-98. Epub 2020 May 6.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Progressive premaxillary retrusion is a common sequela of the facial aging process. In most cases, this manifests with central maxillary recession. Central maxillary insufficiency is also commonly encountered within certain ethnic communities, or in cleft lip nasal deformity, and may represent a challenge for the plastic and reconstructive surgeon attempting correction in the setting of facial contouring, rhinoplasty, or reconstruction following oncologic resection or trauma. Read More

Plast Reconstr Surg 2020 Feb;145(2):378-389

Istanbul, Turkey From private practice.

Background: The current literature on rhinoplasty focuses mainly on the nasal profile (sagittal plane); however, the nose is a three-dimensional structure, and alignment of the nose in consideration of other aspects is important to achieve an aesthetic result. The author aimed to introduce the fix down concept, which includes fix down technique and the adjunct maneuvers for achieving alignment of the nose in three anatomical planes and improving the results of rhinoplasty in terms of symmetry.

Methods: Between March of 2017 and December of 2017, a total of 102 patients (78 women and 24 men), 13 revision and 89 primary cases, underwent septorhinoplasty with the fix down concept. Read More

J Craniofac Surg 2019 Nov-Dec;30(8):2464-2468

Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menofiua University, Menoufia.

Despite the improvement of primary repair of nasal deformities during the management of cleft lip in infancy, this does not exclude the need for revision rhinoplasty in adulthood for complete patients' rehabilitation. The purpose of this study was to evaluate the aesthetic outcome of secondary rhinoplasty using costal cartilage grafts in patients with unilateral cleft lip nasal deformity. Twenty patients who were operated at earlier ages for correction of cleft lip and had a residual unilateral cleft lip nasal deformity were included in this study. Read More

Indian J Plast Surg 2016 Sep-Dec;49(3):314-321

Contours Plastic Surgery Center, Hyderabad, Telangana, India.

Background: Nasomaxillary hypoplasia is a rare congenital disorder involving the central face. It imparts a distinctive appearance to the individual face as the age advances. Severity of the disorder varies, so do the manifestations. Read More

Aesthetic Plast Surg 2017 Feb 28;41(1):135-139. Epub 2016 Dec 28.

Case Western Reserve School of Medicine, 29017 Cedar Road, Cleveland, Lyndhurst, OH, 44125, USA.

Background: Smiling involves dynamic movements that include nasal tip descent and upper lip ascent. The effect of rhinoplasty on upper lip position is poorly described.

Methods: One hundred charts were reviewed in reverse chronologic order. Read More

Arch Craniofac Surg 2016 Jun 21;17(2):82-85. Epub 2016 Jun 21.

Aesthetic, Plastic and Reconstructive Surgery Center, Good Moonhwa Hospital, Busan, Korea.

We report two cases of cleidocranial dysplasia, which was managed without significant craniofacial osteotomy. A mother and daughter, both of normal intelligence, presented with central forehead depression, mid-face hypoplasia, and blepharoptosis. The fact that they have an identically deformed face implied a genetic basis. Read More

PLoS One 2016 13;11(4):e0153056. Epub 2016 Apr 13.

Department of Mechanical Engineering, POSTECH, Pohang, Korea.

During septorhinoplasty, septal cartilage is frequently resected for various purposes but the L-strut is preserved. Numerous materials are inserted into the nasal dorsum during dorsal augmenation rhinoplasty without considering nasal structural safety. This study used a finite element method (FEM) to redefine the septal L-strut, to prevent collapse as pressure moved from the rhinion to the supratip breakpoint on the nasal dorsum and as the contact percentage between the caudal L-strut and the maxillary crest changed. Read More

Semin Plast Surg 2015 Nov;29(4):262-8

VIP International Plastic Surgery Center, Seoul, Korea.

An Asian rhinoplasty is one of the most popular procedures in plastic surgery. The anatomical characteristics of the Asian nose are quite different from those of other races, including low dorsum height, short columella, a thick soft tissue covering on the tip with flaccid lower lateral cartilage, and a sunken midface with relative protrusion of the mouth due to maxilla or premaxillary retrusion. For augmentation and lengthening of the nose, a silicone implant has been commonly used in Asian countries. Read More

Plast Reconstr Surg 2015 May;135(5):838e-848e

New York, N.Y.; and Shreveport, La. From the Department of Plastic Surgery, New York University; and The Wall Center for Plastic Surgery.

Background: Although the majority of nasal alterations in rhinoplasty result from either augmentation or reduction of bone and cartilaginous substructure, modifications of influential soft-tissue provide significant contribution to the final result. The depressor septi nasi muscle is a soft-tissue structure well known to influence the final result in rhinoplasty. The objective of this study was to perform a standardized, comprehensive review of relevant data published with regard to the depressor septi nasi muscle. Read More

Microsurgery 2016 Jan 4;36(1):66-9. Epub 2014 Dec 4.

Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Complex nasal defects present a surgical challenge, particularly in cases with a full-thickness defect that extends into the nasal septum. Although the superficial inferior epigastric artery (SIEA) flap has been widely used as a bulky flap for soft tissue augmentation, reports on its use as a thin flap are limited. We present a case of complex nasal defect reconstruction using a free, thin SIEA flap. Read More

Clin Oral Implants Res 2015 Dec 16;26(12):1476-81. Epub 2014 Oct 16.

Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.

Objectives: To report our experience with combined one-stage double-team maxillary sinus floor elevation (SFE) and endonasal endoscopic sinus surgery (ESS) procedure for concomitant inflammatory sinonasal pathologies.

Material And Methods: Clinical records of all patients that underwent maxillary SFE in conjunction with endonasal ESS for the treatment of inflammatory sinonasal pathologies between 2011 and 2013 were retrospectively reviewed. All included patients had a sinonasal-related pathology that was first suggested by the referring physician and was later confirmed clinically and radiographically by our combined team comprised of otorhinolaryngologist and maxillofacial surgeons. Read More

J Craniofac Surg 2014 Sep;25(5):e449-51

From the Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Republic of Korea.

In syndromic craniosynostosis, such as Crouzon syndrome, midfacial hypoplasia can cause exophthalmos and concave facial profile. Though midfacial hypoplasia in Crouzon syndrome patients can be treated with midface advancement, known as a Le Fort II or Le Fort III osteotomy, such method can change nasal appearance and frequently fails to achieve class I occlusion after surgery. This report presents a case of an aesthetically and functionally successful midfacial augmentation using rib and cartilage graft along with orthognathic surgery (Le fort I and bilateral sagittal split ramus osteotomy) for patients with Crouzon syndrome. Read More

J Craniomaxillofac Surg 2014 Oct 13;42(7):1397-401. Epub 2014 Apr 13.

Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Bucheon 420-767, Republic of Korea. Electronic address:

Here we report a case of a Tessier number 14 cleft, the rarest form of craniofacial cleft, and our step-wise approach to its surgical correction. The patient's appearance was analyzed over a 20-year follow-up period. At the fourth and final operation, the interorbital distance was reduced, the maxilla was advanced, rib and costal cartilage were grafted for augmentation of the nasal bone, and a double eyelid fold operation was performed. Read More

J Plast Reconstr Aesthet Surg 2013 Nov 30;66(11):1477-81. Epub 2013 Jul 30.

Department of Plastic Surgery, Frenchay Hospital, Bristol, South Gloucestershire BS16 1LE, United Kingdom. Electronic address:

Introduction: This paper reviewed the outcome of cantilevered costochondral grafts used for dorsal nasal augmentation in the management of patients treated at the Australian Craniofacial Unit (ACFU), Adelaide over a 29-year period.

Materials And Methods: All patients undergoing dorsal nasal augmentation with costochondral grafts as part of their craniofacial management between 1981 and 2009 were identified using the ACFU database, and their medical notes were reviewed.

Results: 107 patients (50 M, 57 F), with a mean age of 12. Read More

Ear Nose Throat J 2012 Dec;91(12):524-6

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Wayne State University School of Medicine, Detroit, MI, USA.

Ann Plast Surg 2013 Jun;70(6):659-62

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.

Background: Binder syndrome is a congenital deformity around the maxillofacial area. Its 2 most distinctive characteristics are flattened nose and midfacial retrusion. Various methods and materials, such as the use of silicon, costal bone, and costal cartilage, have been proposed for the treatment of the disease. Read More

J Craniofac Surg 2012 Sep;23(5):1338-42

Department of Plastic Surgery, C.S.M. Medical University, Lucknow, India.

Background: The cleft lip nose is a complex 3-dimensional (3D) midfacial soft tissue and bony deformity. The contribution of maxillary hypoplasia to the etiology of this deformity has often been implicated for the suboptimal results of surgical treatment. The dimensions of the maxilla in unilateral cleft lip and palate (UCLP) have not been studied especially in relation to the volumetric and other asymmetries on the either side in unilateral clefts. Read More

J Oral Maxillofac Surg 2012 May 27;70(5):1177-82. Epub 2011 Jul 27.

Universidad Mayor, Hospital del Salvador, Chilean Society of Oral and Maxillofacial Surgery, Providencia 2330, Appt. 23, Santiago, Chile.

J Craniofac Surg 2010 Nov;21(6):1666-9

Jalisco Plastic and Reconstructive Surgery Institute, Plastic Surgery Division of the University of Guadalajara, Medical School, Guadalajara, Jalisco, Mexico.

Background: Most plastic surgeons in the past used bone grafts for nasal augmentation and for augmentation of the middle third of the face, and we, in our service, also used bone grafts at that time. Later, however, most plastic surgeons changed, and cartilage grafts are now the favorite material for rhinoplasty. For many years, we used cartilage grafts in rhinoplasty, and we now report the use of cartilage grafts to augment the length of the middle third of the face. Read More

Aesthetic Plast Surg 2010 Dec 5;34(6):722-30. Epub 2010 Jun 5.

Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Gueishan, Taoyuan, Taipei, Taiwan.

Maxillonasal dysplasia, commonly known as Binder's syndrome, is unmistakably characterized by midfacial hypoplasia and a retruded flat nose. The condition is variably expressed, and reconstruction must be tailored to the individual. Controversy still exists over the optimal age for surgery and the ideal treatment strategy. Read More

Laryngoscope 2007 May;117(5):803-7

Department of Otolaryngology-Head & Neck Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.

Objective: The objective of this study is to review our favorable experience in performing rhinoplasty in aging patients.

Methods: All patients aged 65 years or greater who underwent rhinoplasty, either esthetic or functional, by the senior author (Y.D. Read More

B-ENT 2006 ;2 Suppl 4:102-8

Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, The Netherlands.

Secondary surgery of the cleft lip nose is very complex due to its specific pathological anatomical characteristics. In this article, the general and specific characteristics of the nose of the unilateral and the bilateral cleft patient are described, and careful preoperative assessment is emphasized. Considerations concerning the timing of the operation before or after the puberty growth spurt are discussed. Read More

J Craniofac Surg 2006 Jan;17(1):147-51; discussion 151-2

Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan.

Patients with Apert syndrome show hypertelorism and midfacial hypoplasia, and their features are significantly improved through facial bipartition surgery. In addition, because patients with Apert syndrome demonstrate cranial deformity as well as other deformities, they require multiple surgical interventions throughout their development. We present herein a girl with Apert syndrome for whom subcranial facial bipartition was performed. Read More

Aesthet Surg J 2004 Jul-Aug;24(4):324-30

From the Department of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.

Background: Aesthetic correction of the non-Caucasian nose may require a high volume of graft material to achieve an aesthetically pleasing shape and contour while maintaining characteristics in keeping with the patient's ethnicity.

Objective: We report our experience with the long-term use of irradiated homograft costal cartilage (IHCC) in 17 non-Caucasian patients.

Methods: Individually packaged specimens of IHCC were obtained from government-approved tissue banks for intraoperative use in the augmentation of the dorsum as an onlay graft and, when necessary, to create maxillary-columellar-tip (MCT) struts and crural and spreader grafts. Read More

Facial Plast Surg Clin North Am 2002 Nov;10(4):415-22

Department of Otolaryngology-Head and Neck Surgery, McGill University, 1 Westmount Square, Suite 1380, Westmount, Montreal, Quebec, H3Z2P9 Canada.

Aesthetic Plast Surg 2003 Jul-Aug;27(4):269-74

Service de Stomatologie, Chirurgie Maxillo-Faciale et Plastique de la Face, CHU Nord, Marseille, France.

Patients with a narrow face have often a defect in expansion of the maxillary-malar complex. A malar osteotomy, separating the malar-zygomatic complex from the orbit and the maxilla, allows an anterolateral cheek projection when performing an external rotation. This technique changes facial contour and improves facial aesthetics. Read More

Facial Plast Surg 2002 Aug;18(3):179-86

Department of Otorhinolaryngology, Academic Medical Center of the University of Amsterdam, The Netherlands.

Secondary rhinoplasty in bilateral clefts is very complex due to its specific pathological anatomical characteristics. In this article, the general and specific characteristics of the nose of the bilateral clefts are described and careful preoperative assessment is emphasized. We discuss the timing of the operation considering growth inhibition and psychological aspects and a systematic rational surgical approach, dividing the operative procedure into: septal surgery, tip surgery, osseocartilaginous vault surgery, maxillary augmentation, and alar base reallocation. Read More

Plast Reconstr Surg 2002 Jul;110(1):17-24

Department of Burns and Plastic Surgery, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi 110 002, India.

Almost 25 percent of unilateral cleft lip and palate patients present with their deformity in their teens or later years in the developing world. Because more than 80 percent of the world population lives in the developing world, the established protocol for repair of these deformities is not applicable to these patients. Despite the magnitude, there are no significant reports in the literature that deal with this problem. Read More

Plast Reconstr Surg 2001 Oct;108(5):1127-35

Department of Burns and Plastic Surgery, Lok Nayak Hospital, New Delhi, India.

It is universally acknowledged that correction of a cleft lip nasal deformity continues to be a difficult problem. In developing countries, it is common for patients with cleft lip deformities to present in their early or late teens for correction of severe secondary lip and nasal deformities retained after the initial repairs were carried out in infancy or early childhood. Such patients have never had the benefit of primary nasal correction, orthodontic management, or alveolar bone grafting at an appropriate age. Read More

Br J Plast Surg 2001 Oct;54(7):588-96

Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Taegu, South Korea.

A total of 45 patients with cleft lip nasal deformities were operated on between September 1997 and December 1999. We reviewed 35 of them. Out of these, 31 patients had unilateral cleft lip nasal deformities and four patients had bilateral cleft lip nasal deformities. Read More

Aesthetic Plast Surg 2001 Jan-Feb;25(1):8-14

Department of Plastic and Reconstructive Surgery, Ewha Woman's University, School of Medicine, Seoul, Korea.

There is often a preexisting acute columella-labial angle in Asian noses and in most of these cases, the nasal spine is underdeveloped or sometimes even absent. Moreover, nasal tip projection by a tip graft or cephalic rotation of the nasal tip may get worse at the retracted columella-labial junction in the Asian nose with an underdeveloped anterior nasal spine, thus requiring the use of a maxillary spine graft or an implant. In many instances, however, the ideal source of autogenous tissue may not be available or the donor site for these tissues may be objectionable. Read More

Plast Reconstr Surg 2000 Sep;106(3):707-12

Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada.

Recession of the premaxillary area is a relatively common deformity. Typically, it presents as a mild weakness of the central maxilla, but in certain instances, such as in the Black and Asian communities, it may be moderate to severe. This condition can be compounded by a narrow nasolabial angle, recessed alar bases, and sunken cheeks. Read More

J Craniofac Surg 1999 Jul;10(4):346-64

Children's Hospital Oakland, CA 94609, USA.

The nose can be conceptualized as a soft-tissue structure, the orientation of which depends externally on its osseous foundation and internally on the shape and position of its cartilaginous struts. If the soft-tissue envelope of the cleft nose can be given volumetric symmetry, if it can be positioned correctly in space, and if physical forces imposed on it by cleft pathology (i.e. Read More

Plast Reconstr Surg 1997 Apr;99(4):961-73; discussion 974-5

Department of Plastic Surgery, Georgetown Craniofacial Center, Georgetown University Medical Center, Washington, D.C., USA.

The present study prospectively assesses the skeletal stability in a consecutive series of Binder syndrome patients (n = 7), aged 16 to 20 years, who underwent LeFort I osteotomy fixed with miniplates and the associated morbidity. All patients underwent a one-piece LeFort I osteotomy fixed with four miniplates in conjunction with orthodontic treatment during the period of 1986-1992. Five of seven patients underwent iliac grafting to their deficient premaxilla and interpositionally at their osteotomy sites. Read More

Clin Plast Surg 1996 Apr;23(2):315-26

Children's Medical Center of Dallas, Texas, USA.

Our favorable experience with use of porous hydroxyapatite granules to augment the craniofacial skeleton (more than 200 patients during an 8-year period) has led us to use this method to augment the nasal skeleton in selected cases. Extensive experience has been achieved in augmenting the perialar, maxilla, and glabellar area with very favorable results. A much more limited experience has been gained in augmenting the nasal dorsum, and this method must be considered investigatory at present. Read More

Ann Plast Surg 1996 Feb;36(2):206-11

Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan.

The two major surgical methods for improving the midface and its profile of Binder's syndrome (commonly referred to as "dish face" deformity of "C-shape" deformity) are bone or cartilage graft and osteotomy. The bone or cartilage graft limited to the nasal sill area is ineffective in changing the flatness of the paranasal area. Furthermore, Le Fort II osteotomy has distinct disadvantages with possible damage to the patients and an additional Le Fort I osteotomy or orthodontic therapy is required to rearrange the occlusion of the patient with no malocclusion. Read More

Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1995 Nov;11(6):419-20

Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital.

Machinable bioactive glass ceramics (MBGC) has been employed in maxillofacial augmentation as a substitute for bone grafts in 36 patients with satisfactory results. Two years' follow-up did not show inflammatory reaction and rejection of the implant. Clinical applications of MBGC proved its reliability. Read More

Otolaryngol Clin North Am 1994 Oct;27(5):891-910

Yale University School of Medicine, New Haven, Connecticut.

Autogenous nonvascularized bone grafts play an important role in the reconstruction of complex craniomaxillofacial defects. Experimental animal data have demonstrated that grafts from membranous bone donor sites tend to undergo less resorption than grafts from endochondral donor sites, probably because of the different bony architecture of each of these types of grafts. Of all the potential donor sites, the harvest of bone graft from the calvarium is associated with the least overall morbidity. Read More

J Oral Maxillofac Surg 1994 Jun;52(6):633-8; discussion 638-9

Department of Oral and Maxillofacial Surgery, David Grant Medical Center, Travis AFB, CA 94535-1800.

J Craniomaxillofac Surg 1987 Dec;15(6):312-25

St. Jude Medical Center, Kenner, LA.

This study measures the changes in nasal morphology which accompany simultaneous rhinoplastic and orthognathic reconstruction. The sample includes 25 patients treated over a four-year period, using either facial degloving access or more limited nasal skeletonization in combination with oral incisions. Midfacial and maxillary procedures were performed, as were mandibular osteotomies, intercurrent to both nasal reduction and augmentation. Read More

Arch Otolaryngol Head Neck Surg 1986 Mar;112(3):280-4

In the quest for a material other than autograft and homograft bone for use in facial augmentation and replacement, materials scientists have developed numerous inert materials, some of which have a porous structure allowing scar tissue ingrowth to aid in stabilization of the implant. This study investigates a bioactive, nonporous, transparent glass (Bioglass) in a dog model for use in facial bone augmentation. In 18 dogs studied in three groups at 1, 3, and 6 months, Bioglass implants developed a bond to bone or soft tissue in 54 of 72 instances (75% of the time). Read More

Ann Plast Surg 1984 Jan;12(1):16-24

A simple technique for correction of a gummy smile by partially transecting the levator labii superioris, the major lip elevator, and decreasing its cephalic excursion using an implant spacer is presented. Results are given for 21 patients, and 3 representative patients are discussed, in whom a silicone implant with maxillary augmentation with concomitant rhinoplasty; cartilage from the nasal septum with concomitant rhinoplasty; and a silicone implant independent of rhinoplasty without maxillary augmentation were utilized. Read More

Arch Otolaryngol 1979 Jul;105(7):399-403

In this report the pathophysiology of maxillary hypoplasia is reviewed, and two patients who underwent surgical treatment described. Included in the analyses are illustrations and photographs of the face, cephalometric measurements, predictive tracings, and model surgery. Corrective surgical techniques, consisting primarily of LeForte III osteotomies, are presented in detail. Read More