*Address for Correspondence: Dr. José Durán, MP 2339, Coronel PuchST. 497 C.P. 4600, Jujuy – Argentina; Telephone: +54 9 388 5842524; E-Mail: joseduran [email protected]
Received: April 19th, 2019; Date Accepted: June 12th, 2019; Date Published: June 13th, 2019
Dr. José DuránMP 2339, Coronel PuchST, 497 C.P. 4600, Jujuy-Argentina
AbstractThis work is focused on patients who present a little rhinodeformity. As plastic surgeons we believe we can make a least invasive operation by means of a simple rhinomodelling with thread (Vycril-Mononylon).
In cases of a greater rhinodeformity (osseous and cartilaginous hump of any type) we can make a combined rhinomodelling with thread (hump resection).
There are several rhinomodelling techniques. This technique is based on reducing the wing cartilage with lateral transections to skeletons, limited dissection of the back, depressor muscle miotomy, preserving the suspensory ligament of the tip through little incisions using a thread as a tutor not as a tensor, from the columella to the nasal radix, getting a refinement and a projection of the nasal tip, shortening the nasal length. It is also advised in cases of osseous and cartilaginous hump resection, making a combined rhinomodelling.
Keywords: : Rhinomodelling with thread; Wing Dissection; Suspensory Ligament; Depressor Miotomy; Tutor Thread; Plication of smas for radix increase.
useful characterization of serotonin receptor subtypes in the treatment of
Technique ISSN: 2572-6684
Rhinomodelling Technique with Thread - Anatomical Foundation
Because of this I started dissecting the wing cartilage through mini incisions of 6 to 8 mm on the edge, then dissecting on the deep adipose level. [Figure 1], adding lateral transection on the closing of the wing cartilage with the sesamoids [Figure 2], depressor muscle miotomy [Figure 3] and dissection of the nasal back; so when a thread is put from the columella to the radix SMAS, it becomes a tutor and not a tensor.
Introduction According to the advance presented from other specialities
such as Otorhyno laringology (in which open rhynoplasty is promo-ted) or Dermathology (hyaluronic acid) this technique is presented as an answer to the actual demands from patients (quick recovery, ambulatory and short treatment, mini invasive techniques, lasting results).
There are many rhinomodelling techniques, from hyaluronic acid fillings, tensor threads, as the ones described by Dr. Nikolay Serdev [1]. “Reins Barba®” Dr. Julio Barba Gómez (Mexico). The use of P.D.O. threads by Dr. Almir Nacul`s Bioplasty Works (GORE – TEX) [2]. Or what was described by M.B. Des Fernandes in "Percuta-neous Suspension Sutures to Change the Nasal Tip" [3].
The rhimodelling technique presented in this work, with mini incisions and quick recovery, should be taken into account by Plastic Surgeons.
Simple Rhinomodelling with Thread “I use this technique when the rhinodeformity is due to the
dynamic action of the depressor (bent or little defined nasal tip, wide base, low radix). It may be combined with the resection of any type of hump (osseous or cartilaginous) through the same mini incisions. I started to use thread after learning its use as a nasal rein with Dr. Guillermo Blugerman [4].
At the beginning I put a nasal thread in secondary rhinoplasty. Before a month , the ones performed had better results than the ones with a long post-surgery period.
In this way we get a shortening of the nasal length, a refinement and tip projection by means of the wing cartilage rotation towards the head, considering the intercartilaginous or suspensory ligament of the nasal tip as the rotation point [Figure 2]. So we get a good rhino-modelling that lasts longer by the cicatrization fibrosis”.
Anatomical Foundation
• Wing cartilage dissection with lateral transection.
• Depressor muscle miotomy.
• Back dissection.
• Tutor thread fixation on the SMAS.
• Tip suspensory ligament preservation.
• Cicatrization fibrosis.
Rhinomodelling Combined with Thread When the patient presents an osseous hump, it is resected by
means of scraping, and in cases of cartilaginous hump with a Nº 11 blade.
Directions• Simple Rhinomodelling: little defined nasal tip, bent nasal tip,
long nose (genetics or aging), in secondary rhinoplasty (bent tip).
• Combined Rhinomodelling: in cases with any type of hump.
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Dr. Sulamanidze, Department of Clinic of plastic and aesthetic surgery, TotalCharm, Moscow, Tbilisi 18 , Georgia, V. Orbeliani str. 0105, Tel: +99532 2920371; E-Mail: [email protected]
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Florida, USA, Tel: 305-596-7585; Fax: 305-596-7591;
Materials and Methods Poliglactina (Vycril) and Mononylon.Patients are treated with
these techniques since 2014, with a total amount of 120 patients up to now. All of them with local anaesthesia; ambulatory.
Surgical Technique
In all the cases, local anaesthesia was used (Xylocaine 2% and Epinephrine). The wing cartilage, the entrance to the columella, the radix and the thread path were previously marked. Infiltration with a 30 G needle in radix, following with the back of the tip level, I make the infiltration into the wing marginal edge, hydrodissecting them. Infiltration in the columella, infiltration on the depressor muscle level, infiltration in the closing of the wing with the accessory cartilage. Point incision with a Nº 11 blade in the radix, columella, accessory wing closing, incision in the columella foot. A 6-8 mm incision in the wing marginal edge on both sides. Subcutaneous dissection of the previous incisions in the radix and the columella (to prevent a dermis depression because of the thread path). Wing marginal dissection using curve scissors, searching for the deep adipose plane (easy dissection surgical plane). The wing cartilage dissection is completed using a Freer dissector, performing a cross dissection followed by the back dissection with a Joseph curette. Then bilateral depressor muscles miotomy, lateral transection of the closing of the wing with the accessory cartilage. A thread is put using a Poget straight needle, inserting it into the incision in the columella, with the eye of the needle towards the head, wrapping the wing cartilage to appear through the incision on the left of the radix, then it is threaded and extracted through the columella, remaining an end of the thread on the columella.
The needle is threaded again and inserted on the left of the radix, taking the SMAS getting out through the incision on the right, the needle is released. The needle is inserted through the columella, the right wing cartilage emerging on the radix is wrapped, the needle is threaded and extracted through the columella, remaining both ends of the thread at the same level. Then the knot is made. To control the patient, I ask him/her to raise the eyebrows and smile. In this way I can see if the thread is tight, and correct it if it is necessary. At this moment we can see how the nasal length is reduced, and the refinement and projection of the tip by the wing rotation towards the head is produced, taking the tip suspensory ligament as the rotation point. For this reason it is important to preserve this ligament. Columella injuries, have not been observed. In case a patient requires it, an additional rese-
ction of the tabical caudal border would be made. Up to now it has not been necessary.
Then a micropore band is used during 48-72 hr. See figures “Rhinomodelling with simple thread. Esthetic Evaluation”. Pre and post surgery;¸in this case a 3 days post surgery.
Complementary Methods When the patient presents a low radix, this is smoothed putting a thread. A stitch can be put in it with Vycril 3 0 in the SMAS, making a pleat as a filling [Figure 4].
Figure 4
Plication of Smas for Radix Increase
Adv Plast Reconstr Surg, 2019 Page 263 of 266
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When the patient presents a wide base, a stitch is put in it with mononylon 3.0. If the patient has open pillars in the columella, a stitch is put with mononylon 5.0 [Figure 5].
Figure 5
Combined Method
When the patient presents any type of osseous or cartilaginous hump, a Combined Rhinomodelling is performed, resecting the hump with a scraper and a Nº 11 blade through the marginal mini incision.
External osteotomy can be performed in the case of wide nasal pyramid.
In these cases, plaster is used for 5 days. See figures “Combined Rhinomodelling with thread. Esthetic Evaluation”. Pre and post surgery. In this case 5 days post surgery.
Simple Rhinomodelling: Conclusions
• Simple technique and low learning curve.
• Early recovery.
• Natural result.
• Revertible (within 14 days).
Combined Rhinomodelling: Conclusions• Shorter post-surgery period than the traditional rhinoplasty.
• Natural results.
Results This work involves patients operated from 2014 to 2017; a total
amount of 120 cases (82 women, 38 men), all of them with local anaesthesia, ambulatory. Ages: 18 to 70.
Complications• Nonconformity: 2 cases
• Pinching on the skin in the radix: 2 cases
• Hematoma: 0
• Infection: 0
Adv Plast Reconstr Surg, 2019 Page 264 of 266
Figure 7
Figure 8: Combined Rhinomodelling with thread. Esthetic Evaluation
