Rhynoplasty

SUMMARY
INTRODUCTION BY GIOVANNI BOTTI5 INTRODUCTION BY ALBERTO SCATTOLIN 7 PREFACE 11 NEWS OF THE AUTHOR 13 ACKNOWLEDGEMENTS 15
CHAPTER I – SURGICAL ANATOMY HINTS21
• Surgical anatomy 23 • Bone structure 24 • Cartilage structure 25 • Musculature 26 • Vascularization.27 • Innervation.28
CHAPTER II – TOOL SET AND BASIC TECHNIQUES 29
• Tool set and basic techniques 31 • Lancets 32 • Forceps33 • Needle holders34 • Scissors 35 • Hooks and retractors 36 • Rasps 37 • Speculums.38 • Perichondrial and periosteal elevators39 • Osteotomes40 • Hammer.41 • Sutures.42
CHAPTER III – MEDICAL CONSENT 43
• Medical consen 45 • Medical consent for rhinoplasty operation 45 – General informations on the aestethic plastic surgery 46 – Objective of the operation 46 – Preparation for the operation 47 – Anaesthesia 47 – Modality and duration of the operationo 48 – Post operative course 48 – Precautions.49 – Possible complications 49 – Scars.51 – Alternative methods 51 • Medical consent for rhinoplasty operation 52
CHAPTER IV – PHOTO DOCUMENTATION 55
• Pre operative pictures 57 • Digital photo edit 58
Rhinoplasty 17

Summary Alessandro Gualdi
CHAPTER V – PLANNING AND FIRST EXAMINATION 61
• Aestethic sketches 63 • Medical examination 66
CHAPTER VI – GENERAL ANAESTHESIA-SEDATION 67
• General anaesthesia-sedation 69 • Premedication71 • Local anaesthesia 73
– External infiltration74 – Internal infiltration 75
CHAPTER VII – PRE OPERATIVE PHASE 77
• Arrival and welcoming of the patient 79 – Explaining the mediacl consent80 – Pre anaesthesia 80 – The patient’s clothes change 80 – Preparation of the operation theatre and of the sterile field 81 – Respective positions during the operation 81
CAPITOLO VIII – DORSUM 83
• Summary of the operative technique 85 • Emitrans fixed incision 86 • Under perichondrial dissection of the septum 87 • Resection of the caudal edge of the quadrangular cartilage 90 • Access to the dorsum 92 • Dissection of the cartilage dorsum93 • Dissection of the bony dorsum94 • Union of the sub periosteal and sub perichondrial levels96 • Under mucosa unglue 97 • Cifectomy.98 • Removal of the gibbosity: cartilage and bone gibbotomy 100 • Removal of the bone-cartilage gibbosity 102 • Modelling of the dorsum with rasps 103 • Osteotomies: oblique paramedian (inter septum 105 • Osteotomies: lateral or basal 105 • External osteotomies 106 • Internal osteotomies107 • Mobilization of the nasal pyramid109
CHAPTER IX – THE EXTREMITY .111
• Summary of the surgical technique 113 • Edge incision 113 • Dissection of the extremity114 • Delivery of the alar cartilages115 • Cephalic alar incision 116 • Inter-dome suture118
CHAPTER X – THE HYPO-AND HYPER-PROJECTED EXTREMITY 121
• Summary of the surgical technique 123 • Removals and sutures 123 • Cartilage patches 125
– Strut graft type126 – Onlay graft type126 – Scudo graft type 126
• Constriction of the extremity 127 18 Rhinoplasty

Summary Alessandro Gualdi
CHAPTER XI – -SEPTUMPLASTY 129
• Anatomy of the nasal septum 131 – Nasal physiology and functional problems 132 – Defects of the nasal septum 132
• Septumplasty.133
• Nasal septum corrective techniques: functional, endoscopic, perforations, aesthetic 135 – The most common techniques are:135
• Septum perforations136 – Septum perforations 136
CHAPTER XII – SUTURE OF THE PASSAGES 137
• Summary of the technique 139 • Sutures.139
CHAPTER XIII – MEDICATION 141
CHAPTER XIV – POST OPERATIVE SUGGESTIONS AND FOLLOW-UP 147
CHAPTER XV – MEDICAL AESTHETIC AND FUNTIONAL RHINOPLASTY 153
• Medical rhinoplasty 155 – The fillers155 – The injection points are essentially 3: 158 – The nasal basis 158 – The nasal extremity 158 – The nasal spine 158 – Pros and cons 159 – Fillers159
• The botulinum toxin type a160 – Preparation160 – The injection points are basically 3: 160
– Collateral effects 160
– Reabsorbable filaments 161 – The anomalies taken into account are 3: 161 – To make the nasal-lip angle acute161
• Nasal spirometry 164 – Anterior valve angle less than 10°164
• Functional respiratory anomalies by artropic rhinitis 168
• Conclusions