Facial Plast Surg [JOURNAL]
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200 papers
First Insights on the Upcoming Role of Next-generation PLLA-LASYNPRO in Aesthetic and Regenerative Medicine: A Survey of Experts-the PLLA-LASYNPRO Rationale.
Bertossi D, Cavallini M, Camporese A … +10 more , Dell'Avanzato R, Kefalas N, Massidda E, Papagni M, Patalano M, Quartucci S, Renga M, Santorelli A, Sciuto C, Trocchi G
Facial Plast Surg · 2026 Feb · PMID 41760129 · Publisher ↗
INTRODUCTION: Injectable collagen stimulators have traditionally been linked to inflammatory foreign-body reactions (FBR) as a mechanism of action. However, the next-generation PLLA-LASYNPRO microspheres, contained in th...
INTRODUCTION: Injectable collagen stimulators have traditionally been linked to inflammatory foreign-body reactions (FBR) as a mechanism of action. However, the next-generation PLLA-LASYNPRO microspheres, contained in the CE-marked JULÄINE medical device, may represent a paradigm shift. Preclinical data suggest these microspheres can promote collagen and extracellular matrix (ECM) regeneration with minimal inflammatory response. OBJECTIVES AND HYPOTHESES: This study aimed to evaluate the scientific soundness and clinical relevance of a non-inflammatory mechanism of action for PLLA-LASYNPRO. The central hypothesis was that design and manufacturing innovations could enable effective biostimulation while reducing inflammation and long-term tissue reactions. STUDY DESIGN: A structured expert board meeting was convened to assess the rationale and implications of this emerging mechanism. The process included a preliminary survey and an in-person consensus meeting involving multidisciplinary specialists in aesthetic and regenerative medicine. METHODS: On January 24, 2025, 13 experts in aesthetic medicine, dermatology, and plastic surgery participated in a board meeting held in Milan, Italy. Scientific literature and preclinical data were reviewed in advance. Discussions were organized around biophysical characteristics, tissue integration, inflammatory profile, and safety considerations. RESULTS: The board considered the non-inflammatory mechanism of PLLA-LASYNPRO both biologically plausible and clinically promising. Key differentiating features included particle morphology, lack of excipients, and manufacturing purity. The panel highlighted the potential to reduce chronic inflammation, a known limitation of traditional collagen stimulators. Early clinical impressions supported this hypothesis, although prospective data are still forthcoming. CONCLUSION: This manuscript presents the consensus of a multidisciplinary board on the rationale for PLLA-LASYNPRO in aesthetic and regenerative medicine. It forms the first part of a two-paper series. The second manuscript will provide practical clinical guidance for the deep dermal administration of PLLA-LASYNPRO and real-world use of JULÄINE.
Surgical Anatomy and Patient Assessment of the Nasal Tip.
Jones EA
Facial Plast Surg · 2026 Jun · PMID 41734786 · Publisher ↗
AIMS AND BACKGROUNDS: The success of a rhinoplasty procedure is dictated by a complete understanding of nasal surgical anatomy and keen patient assessment. Conscientious surgeons will create realistic expectations for pa...
AIMS AND BACKGROUNDS: The success of a rhinoplasty procedure is dictated by a complete understanding of nasal surgical anatomy and keen patient assessment. Conscientious surgeons will create realistic expectations for patients based on the anatomy in front of them and their surgical expertise. The surgical consultation frames both patient and surgeon goals with the ultimate objective of creating a shared vision, which can be achieved in the operating room. CONCLUSIONS AND CLINICAL RELEVANCE: Reproducible photography and excellent physical examination are key elements of rhinoplasty assessment. They enable the surgeon to focus on functional and aesthetic components of the nose and the rhinoplasty procedure. The nasal tip is complex and requires surgeons to analyze the dynamics, structure, and resultant implications of their surgical modifications. Considerations of the individual and their identity in society further promote the realization of preoperative goals for the nasal tip.
Corrigendum: Structural Nasal Tip Grafting: Anatomy, Evaluation, and Technique Selection for Durable Aesthetic and Functional Outcomes.
Lee NK, Winkler AA
Facial Plast Surg · 2026 Jun · PMID 41713870 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Importance of Tip Support and the Caudal Septal Extension Graft.
Boochoon KS, Barrera JE
Facial Plast Surg · 2026 Jun · PMID 41698420 · Publisher ↗
AIMS AND BACKGROUNDS: The dynamics of nasal tip aesthetics and function is a complex balance of inherent cartilage structure and surrounding soft tissue characteristics. A thorough understanding of form and function is p...
AIMS AND BACKGROUNDS: The dynamics of nasal tip aesthetics and function is a complex balance of inherent cartilage structure and surrounding soft tissue characteristics. A thorough understanding of form and function is paramount in achieving optimal rhinoplasty results. Controlling the appearance and the shape of the nasal tip remains a challenging task for surgeons. TECHNIQUES: This paper discusses the caudal septal extension graft (CSEG) as a useful tool for controlling nasal tip projection, rotation, nasal length, and shape in rhinoplasty. Additionally, we highlight the importance of cephalic turn in flaps as a preservation technique to achieve aesthetic results while maintaining nasal function. CONCLUSION AND CLINICAL RELEVANCE: We discuss the role of the CSEG in cosmetic and functional rhinoplasty while highlighting improvements in patient-reported outcome measures (PROMs). In conclusion, the CSEG and cephalic turn in flaps demonstrate effective techniques to improve tip control and achieve more predictable and long-lasting rhinoplasty results.
Scroll Turbinate Inter-cartilaginous Graft (STIG).
Rose O, Jumeau P
Facial Plast Surg · 2026 Feb · PMID 41688058 · Publisher ↗
BACKGROUND: Scroll tension is a complex problem often associated with some of the most difficult nasal deformities to address. This is particularly challenging in cases with excessive vestibular skin loss and scar tissue...
BACKGROUND: Scroll tension is a complex problem often associated with some of the most difficult nasal deformities to address. This is particularly challenging in cases with excessive vestibular skin loss and scar tissue contraction. Several surgical techniques have been described with all sharing the same goal: the creation of a functionally and aesthetically pleasing nasal tip/alar complex. BACKGROUND: The choice of graft is crucial for optimal long-term results. Some techniques can result in donor site morbidity, nasal valve problems, and suboptimal cosmesis. BACKGROUND: Inferior turbinate mucosa is readily available, thin yet robust, and easily harvested with minimal donor site morbidity. METHOD: We present a retrospective analysis of 22 patients with scroll tension related to alar retraction, nasal stenosis, and saddle nose deformity managed with the scroll turbinate intercartilagenous graft (STIG) technique employed in combination with a septal extension graft, lateral crural tensioning, and articulated alar rim grafts. RESULTS: Our technique was successfully employed in all patients with correction of both external deformity and functional problems. The minimum follow-up period was 12 months. There were no complications and no significant graft failure. CONCLUSION: The STIG technique is a relatively easy, safe, and effective technique that provided a favorable outcome in all patients.
Contemporary Management of Caudal Septal Deformities: An Algorithmic Approach.
Coviello CM, Varghese J, Ramirez A … +1 more , Brissett AE
Facial Plast Surg · 2026 Jun · PMID 41605420 · Publisher ↗
AIM AND BACKGROUND: Septal deformities are highly prevalent in the population and septoplasties are one of the most common procedures performed by otolaryngologists and facial plastic surgeons. Caudal septal deformities...
AIM AND BACKGROUND: Septal deformities are highly prevalent in the population and septoplasties are one of the most common procedures performed by otolaryngologists and facial plastic surgeons. Caudal septal deformities represent a challenging component when managing septal deviations given the caudal septum's critical role as a tip supporting mechanism. As a result, they are a frequent cause for revision procedures. TECHNIQUES: Caudal septal deformities can range from mild to severe and require careful assessment and strategic operative planning. Depending on the deformity, a variety of techniques can be employed for correction. These range from conservative approaches such as reshaping maneuvers and suture techniques to complete excision and reconstruction with grafting. Rhinoplasty surgeons must be prepared with a wide repertoire of interventions to address the caudal septum depending on the deformity present. CONCLUSION AND CLINICAL RELEVANCE: This article provides a comprehensive review of septal anatomy, patient evaluation, and an updated algorithm for management of caudal septal deformities.
Injectable Nuances for the Male Face.
Indeyeva YA
Facial Plast Surg · 2026 Apr · PMID 41576967 · Publisher ↗
Minimally invasive cosmetic procedures consistently lead the aesthetic landscape year after year. Men are increasingly requesting aesthetic interventions with a focus on maintaining a youthful, powerful, and natural look...
Minimally invasive cosmetic procedures consistently lead the aesthetic landscape year after year. Men are increasingly requesting aesthetic interventions with a focus on maintaining a youthful, powerful, and natural look. There are significant anatomical, physiological, and behavioral differences in the aging male face that warrant specific treatment considerations.Literature review of male gender-specific facial anatomy, aging patterns, treatment motivations/preferences. Description of the author's preferred injection techniques.Male and female faces are shaped by different aesthetic standards, impacting what is deemed attractive. Men are keenly aware of the sexual dimorphism in facial characteristics and often seek to preserve or enhance traits associated with traditional masculinity. Minimally invasive procedures can be customized to enhance or retain masculine features.Gaining a deeper understanding of factors affecting male rejuvenation patterns and learning specific injectable techniques will empower aesthetic providers to tailor cosmetic treatments for men, achieving success and encouraging continued growth of this burgeoning demographic.
Skin and Soft Tissue Management in Primary Rhinoplasty.
Eskander PN, Crawford KL, Loyo M
Facial Plast Surg · 2026 Jun · PMID 41500249 · Publisher ↗
AIMS AND BACKGROUNDS: Rhinoplasty outcomes are determined by the complex interplay of modifications to both the osseocartilaginous framework and the behavior of the overlying skin-soft tissue envelope (SSTE). Successful...
AIMS AND BACKGROUNDS: Rhinoplasty outcomes are determined by the complex interplay of modifications to both the osseocartilaginous framework and the behavior of the overlying skin-soft tissue envelope (SSTE). Successful surgery demands attention to several soft tissue characteristics including skin thickness, elasticity, sebaceous content, and fibrous ligamentous attachments, which together influence tip definition, support, and long-term aesthetic outcomes. AIMS AND BACKGROUNDS: This review summarizes evidence-based principles and practical strategies for soft tissue management in primary rhinoplasty. By integrating anatomical knowledge, meticulous surgical technique, and attentive postoperative management, surgeons can enhance tip definition, minimize complications, and achieve durable, aesthetically satisfying results. Emphasizing both structural and soft tissue considerations provides a comprehensive framework for optimizing rhinoplasty outcomes through thoughtful SSTE management. HISTORICAL ASPECTS: This article thoroughly reviews the body of literature on skin and soft tissue management in primary rhinoplasty, providing a historical and contemporary account on this complex topic. ANATOMY: The surgeon's understanding of nasal anatomy continues to evolve since the advent of facial plastic surgery. This review provides a detailed description of all the layers of the nose and how they relate to surgical considerations in rhinoplasty. CURRENT AND FUTURE DEVELOPMENT: This review provides both current and future insight into the management of skin and soft tissue management in rhinoplasty largely centered around strong understanding of nasal anatomy, soft tissue analysis and preservation, and refined grafting techniques. CONCLUSION AND CLINICAL RELEVANCE: Contemporary rhinoplasty has shifted away from a "one-size-fits-all" approach and more toward a deliberate and methodical approach based on the biochemical, structural, and nuanced subtleties of the nasal SSTE that makes every nose a unique challenge. This review hopes to inform readers on the many complexities that must be taken into account in rhinoplasty with the goal of supplementing the modern surgeon's intellectual toolbox when approaching this challenging surgery.
The Princess and the Pea Graft-A Solid Cartilaginous Tip Graft for Noses with Thick Skin Envelope.
Ng CL, Loh SBJ, Chua NYM … +1 more , Di Pierro F
Facial Plast Surg · 2026 Jan · PMID 41490608 · Publisher ↗
INTRODUCTION: Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients. OBJECTIVES & HYPOTHESES: We aimed to assess whether the Princess and the P...
INTRODUCTION: Thick skin-soft tissue envelope (SSTE) and weak cartilage make nasal tip definition challenging in many Asian rhinoplasty patients. OBJECTIVES & HYPOTHESES: We aimed to assess whether the Princess and the Pea (PP) graft-a solid, conical costal cartilage tip graft-can improve tip projection and definition in thick-SSTE patients. We hypothesized that it would yield reliable aesthetic and functional results with minimal complications. STUDY DESIGN: Prospective clinical study with 12-month postoperative follow-up. METHODS: Sixty patients of East, South, and Southeast Asian descent received a PP graft anchored to the lower lateral cartilages. Outcomes were measured using SCHNOS and a 5-point Likert satisfaction scale. RESULTS: Mean satisfaction was 4.5/5, average SCHNOS score 0.54, and no graft-related complications occurred. CONCLUSION: The PP graft is a safe and effective method for enhancing nasal tip projection and definition in thick-SSTE patients.
Advances in Rhinoplasty Evidence: A Narrative Overview of Recent Meta-analyses (2015-2025).
Seidel DU, Rotter N, Scheithauer M … +2 more , Ebeling O, Bode S
Facial Plast Surg · 2026 Jan · PMID 41461204 · Publisher ↗
INTRODUCTION: Septoplasty and septorhinoplasty are key procedures in functional and aesthetic nasal surgery. Over the past decade, evidence on diagnostics, techniques, and outcomes has expanded significantly. OBJECTIVES:...
INTRODUCTION: Septoplasty and septorhinoplasty are key procedures in functional and aesthetic nasal surgery. Over the past decade, evidence on diagnostics, techniques, and outcomes has expanded significantly. OBJECTIVES: To provide a structured summary of current evidence from systematic reviews and meta-analyses, focusing on diagnostics, surgical techniques, perioperative treatment, and patient-reported outcomes. STUDY DESIGN: Narrative review of 86 articles, reviews, and meta-analyses published within the past 10 years. METHODS: Studies were screened for relevance to functional and aesthetic rhinoplasty. Extracted data covered diagnostic methods, surgical techniques, medications, PROMs, and functional outcomes. RESULTS: Four-phase rhinomanometry offers promise but lacks validation. Body dysmorphic disorder (BDD) screening is gaining relevance. Evidence supports perioperative corticosteroids and tranexamic acid; routine antibiotics appear unnecessary. PROMs (NOSE, ROE, SNOT-22) are widely used. CONCLUSION: Evidence for rhinoplasty is growing but heterogeneous. Standardized diagnostics, PROM-linked objective measures, and long-term data are needed to guide future patient-centered care.
A Comparative Analysis of Nasal Valve Surgery Methods.
Caetano G, Matos R, Santos M … +5 more , Morgado D, Pinto C, Veloso I, Robles R, Fonseca R
Facial Plast Surg · 2026 Jan · PMID 41429143 · Publisher ↗
INTRODUCTION: Internal nasal valve insufficiency is a major cause of nasal obstruction. Alar batten grafts (ABGs) are commonly used, but data on lateral crural tensioning (LCT) remain limited. OBJECTIVES AND HYPOTHESES:...
INTRODUCTION: Internal nasal valve insufficiency is a major cause of nasal obstruction. Alar batten grafts (ABGs) are commonly used, but data on lateral crural tensioning (LCT) remain limited. OBJECTIVES AND HYPOTHESES: To compare the efficacy of ABG and LCT techniques in improving nasal airflow. Primary outcomes were nasal obstruction symptom evaluation (NOSE) score and revision surgery rate; secondary outcome was complication rate. STUDY DESIGN: Retrospective cohort study (PICOS). METHODS: The study included 22 patients undergoing rhinoplasty for nasal valve insufficiency (2017-2023): ABG ( = 8) and LCT ( = 14). NOSE scores were obtained via telephone survey. Data were collected from clinical records. RESULTS: Mean NOSE scores improved from 55 to 30.6 overall. ABG improved from 51.7 to 31.7, LCT from 56.7 to 30. One ABG patient required revision (12.5%), none in LCT group. Differences were not statistically significant between groups. CONCLUSION: LCT showed greater symptom improvement and no revisions. Further randomized trials are needed to confirm efficacy.
Enhancing Nasal Tip Control: The Role of Septum Anchorage Sutures in Modern Rhinoplasty.
Espinosa-Reyes JA, Ochoa-Álvarez JC, García RFFP
Facial Plast Surg · 2026 Jan · PMID 41418809 · Publisher ↗
INTRODUCTION: The septocolumellar suture technique has shown consistent efficacy in achieving precise nasal tip aesthetics for over 20 years. This study aims to evaluate the long-term outcomes of primary endonasal rhinop...
INTRODUCTION: The septocolumellar suture technique has shown consistent efficacy in achieving precise nasal tip aesthetics for over 20 years. This study aims to evaluate the long-term outcomes of primary endonasal rhinoplasty. METHODS: Retrospectively analyze 1,096 consecutive patients who underwent primary endonasal rhinoplasty using the septocolumellar suture technique between March 2005 and March 2025. The procedure anchors the medial crura to the caudal septum at variable distances from the anterior nasal spine, allowing control of tip projection and rotation. Objective and photographic analyses assessed the nasal tip parameters, including projection, rotation, shape, deviation, alar width, and flare. Statistical significance was set at < 0.001. RESULTS: Long-term stability of nasal tip projection and rotation was maintained in 96% of the patients at a minimum 12-month follow-up. All the evaluated parameters demonstrated statistically significant improvement ( < 0.001). The revision and complication rates were 3.2 and <1%, respectively. CONCLUSION: The septocolumellar suture technique is a reliable and minimally invasive method for nasal tip refinement in rhinoplasty. It ensures stable aesthetic outcomes while preserving nasal support and functional integrity. This technique effectively enhances tip projection in mestizo patients using intrinsic anatomy and can be applied in both open and closed approaches.
Surgical Management of Filler Rhinoplasty Complications.
Wong EHC, D'Souza A
Facial Plast Surg · 2025 Dec · PMID 41412200 · Publisher ↗
AIM AND BACKGROUND: The increasing use of filler rhinoplasty has led to more patients presenting with complications such as fibrosis, granuloma formation, skin irregularities, and filler migration, including the characte...
AIM AND BACKGROUND: The increasing use of filler rhinoplasty has led to more patients presenting with complications such as fibrosis, granuloma formation, skin irregularities, and filler migration, including the characteristic "Avatar nose." These cases require a systematic, algorithm-driven approach for safe and predictable correction. HISTORICAL ASPECTS: Nonsurgical rhinoplasty has gained popularity due to its minimally invasive nature, yet complications requiring surgery have become increasingly recognized. ANATOMY: Distorted soft-tissue planes and altered skin-soft-tissue envelopes (SSTE) after filler placement influence both dissection and reconstruction. TECHNOLOGY: High-frequency ultrasound can assist in identifying residual filler and guiding hyaluronidase dissolution before surgery. PATIENT SELECTION: Patients with persistent deformity, migration, granuloma, or long-standing fillers unresponsive to nonsurgical measures are appropriate surgical candidates. TECHNIQUES: Revision rhinoplasty involves open approaches, selective removal of residual filler, and structural reconstruction with autologous cartilage. Redundant SSTE may require increased dorsal augmentation, conservative trimming, and adjunctive intraoperative doxycycline. POSTOPERATIVE CARE: Postoperative corticosteroid injections can limit fibrosis and improve contour. CURRENT AND FUTURE DEVELOPMENT: Algorithm-based evaluation and operative planning continue to refine management of these complex cases. CONCLUSION AND CLINICAL RELEVANCE: Thoughtful surgical execution is essential for achieving stable, natural outcomes in patients with filler-related nasal complications.
Combining Preservation Concepts and Structural Techniques in Nasal Tip Management: A Practical Approach.
Buttarelli F, Saman M
Facial Plast Surg · 2026 Jun · PMID 41412199 · Publisher ↗
AIMS AND BACKGROUNDS: This article describes the senior author's (M.S.) approach to nasal tip management in primary rhinoplasty, integrating preservation concepts with selective structural reinforcement to enhance long-t...
AIMS AND BACKGROUNDS: This article describes the senior author's (M.S.) approach to nasal tip management in primary rhinoplasty, integrating preservation concepts with selective structural reinforcement to enhance long-term stability and refined definition. HISTORICAL ASPECTS: Over 15 years, the technique transitioned from routine columellar strut grafting, effective early but prone to late ptosis, to a septal-based philosophy centered on the Teostrut and the septal extension graft (SEG), providing more predictable projection control. ANATOMY: Clinical decision-making relies on assessment of skin thickness, lower lateral cartilage strength, and inherent tip support, which together determine the degree of preservation or reinforcement required. TECHNIQUES: The operative approach combines preservation of native support when feasible, controlled strengthening through Teostrut or SEG when indicated, conservative cephalic adjustments, and precise dome-suture modulation. This sequence balances structural stability with aesthetic subtlety while respecting tissue dynamics. CURRENT AND FUTURE DEVELOPMENT: Refinements continue to evolve through improved mapping of cartilage responsiveness, integration of regenerative strategies, and advancements in suture-based modulation. CONCLUSIONS AND CLINICAL RELEVANCE: This experience-based approach offers reproducible, stable, and naturally refined results in primary rhinoplasty, emphasizing durable tip support and patient-specific aesthetic goals.
Management of Nasal Tip Deformities in Revision Rhinoplasty.
Ramirez A, Coviello C, Farrior E … +1 more , Sturm A
Facial Plast Surg · 2026 Jun · PMID 41412191 · Publisher ↗
AIM AND BACKGROUND: Revision or secondary rhinoplasty involving the nasal tip is challenging due to distorted anatomy, scarring, and compromised tip support. This article presents a framework for surgical approach and de...
AIM AND BACKGROUND: Revision or secondary rhinoplasty involving the nasal tip is challenging due to distorted anatomy, scarring, and compromised tip support. This article presents a framework for surgical approach and decision-making in secondary rhinoplasty. HISTORICAL ASPECTS: Contemporary principles emphasize stability, conservative cartilage handling, and restoring native architecture. ANATOMY: The nasal tip depends on the soft-tissue envelope and lower lateral crura, whose relationship with the septum determines projection, rotation, and contour. TECHNOLOGY: High-resolution photography, endoscopy, and improved grafting materials enhance the diagnosis and correction of nasal tip deformities. PATIENT SELECTION: Optimal patients should undergo in-depth assessment with special attention to skin thickness, previous complications, and unrealistic expectations. TECHNIQUES: Structure and support of the tip cartilages are the foundation and critical for the appearance and longevity of your results. As part of building the structure and support, the lower lateral cartilages can be repositioned and reshaped to the ideal appearance. Further refining of the definition and contour then occurs, with management of the soft tissue envelope being part of the decision process throughout. POSTOPERATIVE CARE: Scar modulation and protection of graft constructs are critical for long-term stability. CURRENT AND FUTURE DEVELOPMENT: Regenerative therapies, advanced biomaterials, and minimally invasive contour solutions continue to evolve. CONCLUSION AND CLINICAL RELEVANCE: A regimented, anatomy-driven approach provides consistent and durable outcomes in revision tip rhinoplasty.
Structural Nasal Tip Grafting: Anatomy, Evaluation, and Technique Selection for Durable Aesthetic and Functional Outcomes.
Lee NK, Winkler AA
Facial Plast Surg · 2026 Jun · PMID 41349578 · Publisher ↗
AIMS AND BACKGROUNDS: This study aims to review contemporary principles of structural nasal tip grafting and provide a practical framework for selecting techniques that achieve durable aesthetic and functional outcomes....
AIMS AND BACKGROUNDS: This study aims to review contemporary principles of structural nasal tip grafting and provide a practical framework for selecting techniques that achieve durable aesthetic and functional outcomes. HISTORICAL ASPECTS: We summarize the evolution from reduction rhinoplasty toward preservation and structural approaches that prioritize long-term tip support. ANATOMY: Key osteocartilaginous and soft tissue support mechanisms of the nasal tip are outlined with emphasis on major and minor tip support structures. TECHNOLOGY: Open and endonasal approaches, autologous cartilage sources, and ancillary materials such as fascia are described as tools to modify tip contour and support. PATIENT SELECTION: Clinical assessment focuses on skin-soft tissue envelope, cartilage strength, airway function, and dynamic deformities. TECHNIQUES: Stepwise algorithms for columellar strut and septal extension grafts, plumping grafts, alar rim and batten grafts, lateral crural struts, shield and cap grafts, and articulated alar rim grafts are presented. POST OPERATIVE CARE: Postoperative management to protect graft position and control edema is reviewed. CURRENT AND FUTURE DEVELOPMENT: Emerging trends toward individualized, data-informed rhinoplasty and objective outcomes assessment are discussed. CONCLUSIONS AND CLINICAL RELEVANCE: Thoughtful selection and execution of structural tip grafts allow surgeons to achieve stable, reproducible tip shape while optimizing nasal airway function.
Tip Tensioning in Rhinoplasty.
Schertzer JS, Farrior EH, Toman J
Facial Plast Surg · 2026 Jun · PMID 41349577 · Publisher ↗
AIMS AND BACKGROUND: This article aims to provide a comprehensive overview of nasal tip support, tensioning mechanics, and suture-based techniques that refine projection, rotation, and stability in rhinoplasty. Modern ap...
AIMS AND BACKGROUND: This article aims to provide a comprehensive overview of nasal tip support, tensioning mechanics, and suture-based techniques that refine projection, rotation, and stability in rhinoplasty. Modern approaches emphasize predictable, structurally sound methods that balance form and function while accommodating individual anatomic variability. Understanding tension vectors and ligamentous relationships is essential for optimizing both aesthetics and long-term outcomes. HISTORICAL ASPECTS: The evolution of nasal tip surgery reflects a shift from primarily reductive maneuvers to graft- and suture-based strategies that reinforce and shape the tip framework. Early innovators recognized the limitations of aggressive cartilage excision, leading to the development of both structural cartilage grafts and suture-based techniques to provide tip stability. ANATOMY: Tip anatomy is governed by the relationship between the lower lateral cartilages (LLCs), medial crural base, the caudal septum, and the soft-tissue envelope. Cartilage grafts bolster weak or asymmetric native structures, reinforcing the medial crural pillar or lateral crural support, while sutures fine-tune shape, redistribute tension, and harmonize graft-induced forces. Optimal outcomes depend on understanding how grafts and sutures interact biomechanically within the intrinsic support system. CONCLUSIONS AND CLINICAL RELEVANCE: Integrating cartilage grafting with targeted suture techniques enables surgeons to control projection, rotation, and definition with greater precision. A combined structural and tension-modulating strategy enhances long-term stability, counteracts postoperative contracture, and provides durable, natural tip aesthetics across primary and secondary rhinoplasty.
Advanced Preservation Technique for the Soft Tissue Envelope in Open Approach Rhinoplasty-Cephalic Lateral Crus, Scroll, Pitanguy Flap.
Ben Ner D, Busel A, D'Souza A … +1 more , Hazan A
Facial Plast Surg · 2025 Dec · PMID 41338277 · Publisher ↗
AIMS AND BACKGROUND: The soft tissue envelope is inherently disrupted during rhinoplasty, especially in the open approach and during tip plasty. To avoid adverse outcomes such as pollybeak deformity and nasal valve colla...
AIMS AND BACKGROUND: The soft tissue envelope is inherently disrupted during rhinoplasty, especially in the open approach and during tip plasty. To avoid adverse outcomes such as pollybeak deformity and nasal valve collapse, these soft tissue structures should be reconstructed. Instead, preservation philosophy aims to preserve rather than reconstruct. The aim of this study is to present a technique that facilitates the preservation of the soft tissue envelope using the cephalic lateral crus-scroll-Pitanguy flap (CLC-SP flap) in open rhinoplasty. PATIENT SELECTION: A retrospective analysis was performed on 22 patients with thick skin who underwent open approach rhinoplasty in the supra-perichondral plane. TECHNIQUES: During the dissection, the cephalic portion of the lateral crus (LC) is elevated as part of the skin, with the LC's attachments to the soft tissues via the scroll and Pitanguy ligaments as a composite flap. In this way, the soft tissues are preserved. Reinsertion of the cephalic LC with its attached soft tissues restores normal anatomy and minimizes dead space. POST OPERATIVE CARE: Nineteen patients reported improved nasal breathing, and 21 patients reported aesthetic satisfaction after a mean follow-up of 5.4 months; no pollybeak deformity occurred. Using this technique, we were able to control tip definition by limiting dead space and supporting the nasal valve. Additionally, the cephalic LC was utilized as a caudally advancement flap to reinforce and straighten the caudal LC, improving its position and resting angle. CONCLUSION AND CLINICAL RELEVANCE: The CLC-SP flap is a useful technique for controlling and preserving the soft tissue envelope, improving tip definition, supporting the nasal valve, and minimizing dead space, thus preventing pollybeak deformity in thick-skinned patients.
Comment on: Nasal Septal Perforation Reconstruction with Polydioxanone Plate: A Systematic Review.
Yıldırım YSS
Facial Plast Surg · 2026 Jun · PMID 41338276 · Publisher ↗
Abstract loading — click title to view on PubMed.
Unilateral Versus Bilateral Spreader Grafts to Correct Cartilaginous Deviations in Structural Rhinoplasty: A Comparative Study on the Aesthetic and Functional Outcomes.
Gimeno-Torres L, Calvo-Gómez J, Pérez-Carbonell T … +4 more , Roselló MV, Vallejo-García A, Marrero-Pérez JC, Marco-Algarra J
Facial Plast Surg · 2025 Nov · PMID 41265885 · Publisher ↗
INTRODUCTION: Spreader grafts (SG) are used in rhinoplasty to correct cartilaginous deviations. There are no studies that compare aesthetic and functional outcomes of unilateral (USG) and bilateral SG (BSG). OBJECTIVES A...
INTRODUCTION: Spreader grafts (SG) are used in rhinoplasty to correct cartilaginous deviations. There are no studies that compare aesthetic and functional outcomes of unilateral (USG) and bilateral SG (BSG). OBJECTIVES AND HYPOTHESES: Compare whether USG or BSG is better to correct cartilaginous deviations, if there are differences in dorsal width ratio (DWR) and in patient-perceived aesthetic and functional outcomes. METHODS: Retrospective study of 35 patients who underwent septorhinoplasty with USG or BSG. Deviation angle and DWR were calculated in frontal images before and 6 months postsurgery. Aesthetic and functional results were measured using nasal obstruction symptom evaluation (NOSE) and visual analog scales (VAS). RESULTS: BSG significantly improved postoperative nasal deviation compared to USG (179.6 degrees vs. 172.9 degrees; < 0.05). In minor preoperative deviations, there were no significant differences between BSG and USG (179.57 degrees vs. 177 degrees, respectively; > 0.05). In major preoperative deviations, BSG provided better correction (179.62 degrees vs. 170.5 degrees; < 0.05). DWR increased more with BSG compared to USG (0.12 vs. 0.04; < 0.05). VAS and NOSE scores were similar in both groups. CONCLUSION: BSG is more effective in correcting major cartilaginous deviations, while both USG and BSG effectively correct minor deviations. Though BSG increases DWR, this does not negatively impact patient-perceived aesthetic or functional outcomes.
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