5Tip recoil. ใช้นิ้วกดปลายจมูกลงไปหาริมฝีปากบน If the recoil is instantaneous and vigorous, and the tip cartilages resist the deforming influence of the finger, more definitive tip surgery can usually be performed.
25Noncaucasian Rhinoplasty Nasal tip skin is thick and sebaceous, lower lateral cartilages and septum are paradoxically small, weak, and deficient.The nasal bones are broad and flat.The low radix and underprojected nasal tip are common features.
26Noncaucasian Rhinoplasty Augmentation to the tip and dorsum remain the workhorse maneuversImplants should not leave pressure on the overlying skin.Alar base surgery should be performed only judiciously.
28preparing the recipient site and corresponding surface of the implant, so that the implant will fit snugly against roughened nasal bones.The undersurface of the implant should be concave to fit the curvature of the dorsum of the nose.
29A three-dimensional concept must be kept in mind when shaping the graft. The dorsal aspect of the graft should be nearly straight and extend the full length of the nose.Grafts may be layered to increase the magnitude of augmentation.
42The nasofacial angle represents the angle formed from a vertical line tangent from the glabella through the pogonion intersecting a line from the nasion through the nasal tip. This angle ideally measures 36 degrees but can vary from 30 to 40 degrees.
44In patients with extremely thin skin, delicate alar side walls, and bulbous cartilage, predictable narrowing refinement can be achieved by transdomal suturing of the complete strips with horizontal mattress sutures.
47Solid medical grade silicone rubber, have been used for restoration of tip, alar, and septal defects and for saddle deformitiesDisadvantages include a high extrusion rate, foreign body reaction, and susceptibility to infection.
48Nasal Base SculptingAn incision is made from the base of the sill and carried out 1 to 2 mm above the alar-facial crease. The alar flap can be advanced medially, and a conservative amount of the ala can be excised. To avoid visible scaring, the cut edges should be carefully reapproximated.
49Nasal Base SculptingA 5-0 chromic suture should be used to reapproximate the alar rim, and one or two subcutaneous 5-0 Vicryl sutures should be placed to reapproximate the alar-facial junction incision.A few 6-0 nylon sutures are used to reapproximate the skin edges.
58Hemitransfixion or transfixion incision made at the caudal border of the septum allows access to the deviated caudal septum and any posterior deflections.
59The incision is created within the squamous epithelium of the vestibule .
60The No. 15 blade is then used to incise mucosa down to and through the perichondrium. Identification of the proper plane is now of utmost importance.
61It is created by first identifying the caudal end of the septum itself. Inserting the nasal speculum into the nose and gently retracting the slightly opened speculum clearly reveals the caudal septal edge.
62Dissecting within a subperichondrial plane ensures little bleeding and a hardier flap with less likelihood of perforation.