Mediterranean Rhinoplasty

255 Pages·2022·24.906 MB·English

by  Pier Giorgio Giacomini

Mediterranean
Rhinoplasty
Pier Giorgio Giacomini
Editor
123
Mediterranean Rhinoplasty
Pier Giorgio Giacomini
Editor
Mediterranean
Rhinoplasty
Editor
Pier Giorgio Giacomini
Department of Clinical Sciences and Translational Medicine
University of Rome Tor Vergata
Rome, Italy
ISBN 978-3-031-05550-8 ISBN 978-3-031-05551-5 (eBook)
https://doi.org/10.1007/978-3-031-05551-5
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This book is dedicated to my wife Antonella
and to my children Giorgio and Livia, to
whom I owe much for their patience and
understanding over the years, when the
passion for my job took me away too often.
Foreword
Rhinoplasty has always been a difficult operation requiring a high level of skill and
artistry not usually demanded to the same extent in many other facial plastic proce-
dures. The outcome must produce a nose that not only fills the aesthetic goals of the
patient but must also breathe well, and the effort to achieve one of these goals can-
not be allowed to compromise the other. So form and function must be balanced.
The aesthetic rhinoplasty surgeon must also be a master airway surgeon as many
maneuvers to achieve a pleasing cosmetic result can lead to a smaller intranasal
airway; even a small deviation of the septum can be a larger problem when reduc-
tion rhinoplasty is done, unless it is addressed at the same time of surgery.
Aesthetically, in rhinoplasty there is no dotted line that tells the surgeon when the
maximum aesthetic goal has been reached; there must be a learned sixth sense, as
well as knowledge of nasal proportions that tells the surgeon when enough has been
done and it’s time to put on the nasal splint. And there must be the learned knowl-
edge of following patients post-operatively for years that tells the surgeon what to
expect long term after the nose has settled and all swelling has subsided.
Also challenging the nasal surgeon are the expectations of the patient on a sur-
gery with very many psychological overlays. Will improvement be accepted over a
desired perceived perfection? Does the patient have realistic expectations?
And so, as the rhinoplasty surgeon approaches the patient with all these chal-
lenges, wouldn’t it be least stressful and easier for the surgeon to only have to
change or modify one limited anatomic area on the nose, say a dorsal hump? But
indeed, if Mediterranean noses do have fairly consistent characteristics as described
herein, they must be one of the most technically challenging and complex types of
noses to tackle because so much must be done in one setting. Not just a dorsal
hump, but also a droopy tip that must be rotated and supported through a myriad of
techniques and grafts, a thick skin envelope and wide tip that weigh heavily and
fight against definition and refinement, weak lower and upper lateral cartilages that,
if trimmed too much, may cause nasal valve collapse, alar retraction, or tip bossae.
It is precisely for that reason that the esteemed Prof. Pier Giorgio Giacomini has
brought together world-renowned nasal experts to contribute to this masterful
work—surgeons who deal with Mediterranean noses in a large percentage of their
operations and who are respected for their great ability to teach, for their innovative
techniques, and for their consistently reproducible pleasing results. On a personal
note, I’ve had the distinct pleasure to both operate and/or share the lecture podium
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viii Foreword
with many of the authors, with whom I share a great friendship. Readers of this text
will benefit from discussions on the anatomy, function, aesthetics, and common
characteristics of problems encountered in Mediterranean noses. They will be
treated to multiple techniques in both endonasal and external rhinoplasty that pre-
serve anatomic structures but modify them considerably while still maintaining and
reinforcing support and produce natural looking outcomes.
May all of you, by reading this text, add to your armamentarium of nasal surgery
knowledge and gain an understanding and appreciation of the nuances of the
Mediterranean nose that will guide you in future surgeries. It is my honor to provide
these introductory comments, and I congratulate Prof. Giacomini and his contribu-
tors on a great addition to the rhinoplasty literature.
With best wishes for great surgeries and happy patients.
Russell W. H. Kridel
Department of Otorhinolaryngology/Head and Neck Surgery
McGovern Medical School, University of Texas
Health Science Center
Houston, TX, USA
Preface
The approach to such a difficult task as remodeling the nose with rhinoplasty has
changed overtimes. Current policy is to include the choice of different approaches
and techniques to pursue and fulfill the aesthetic needs of the single patient, main-
taining or restoring the correct nasal function. These different goals vary depending
on the culture, anatomy, and age of each patient, but also of each surgeon. In this
scenario, the geographical area where both patient and surgeon live has a consider-
able impact in terms of cultural background and anatomical cues related to racial
characters.
Contemporary surgeons must therefore consider all the aforementioned topics
when planning aesthetic rhinoplasty. This is the reason that prompted us to realize
the present work. Achieving this goal has been possible only with the precious con-
tribute of re-known and experienced authors daily facing the specific problems and
solutions posed by rhinoplasty in patients dwelling the Mediterranean area.
To all of them, my deep and respectful thanks are due for their friendship, sup-
port, and cooperation and in the realization of this project.
Rome, Italy Pier Giorgio Giacomini
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Contents
1 Shape and Function of the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mariapia Guerrieri, Goran Latif Omer, Rekawt Hama Rashid,
and Stefano Di Girolamo
2 Nasal Biotypes in the Mediterranean Area . . . . . . . . . . . . . . . . . . . . . . . 15
Antonio Moretti
3 Mediterranean Noses: The Tension Nose Deformity
and Preservation Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Yves Saban, Masoud Saman, and Abdülkadir Göksel
4 Morphological and Diagnostic Tools in Rhinoseptoplasty:
Italian Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Stelio Antonio Mocella, Rosario La Rosa, Riccardo Nocini,
Mariapia Guerrieri, and Giorgio Giacomini
5 Functional Diagnostic Tools in Rhinoplasty: Italian Experience . . . . . 65
Francesco Maria Passali, Eleonora Ciaschi, Laura Loccisano,
and Stefano Di Girolamo
6 Northern Mediterranean Nose Correction: Italian
Experience—Closed Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Pier Giorgio Giacomini, Giorgio Giacomini, and Mariapia Guerrieri
7 Northern Mediterranean Nose Correction: Italian
Experience—Open Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Armando Boccieri
8 Northern Mediterranean Nose Correction: Italian
Experience: Preservation Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Valerio Finocchi and Valentino Vellone
9 Northern Mediterranean Nose Correction: The Italian
Experience: Tip Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Marianetti Tito Matteo
10 Western Mediterranean Rhinoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
José Carlos Neves and Diego Arancibia Tagle
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xii Contents
11 Southern Mediterranean Nose Correction . . . . . . . . . . . . . . . . . . . . . . . 211
Samit Unadkat and Hesham Saleh
12 Eastern Mediterranean Nose Correction . . . . . . . . . . . . . . . . . . . . . . . . 221
Fazil Apaydin