Rhinoplasty: panel discussion

Overview

The article is a moderated panel in which four rhinoplasty surgeons give their positions on standing controversies. The abstract lists only the questions, not the answers. It serves as a snapshot of what the specialty was arguing about in 2014.

Sections of note

• Panel discussion format; no patient data, studies or outcomes are cited in the abstract.
• Question 1: open or closed approach.
• Question 2: how appropriate the endonasal approach is in modern rhinoplasty.
• Question 3: whether the tip lobule should be divided or preserved.
• Question 4: whether alloplastic implants are inferior to autologous grafts.
• Question 5: whether releasing and reducing the upper lateral cartilages from the dorsal septum always requires spreader grafts to prevent middle third pinching.
• Question 6: how techniques and approaches have evolved over the past five years.

What it means for a patient

• Respected surgeons disagree on basic choices such as whether to open the nose and whether to use synthetic implants.
• Different surgeons will propose different operations for the same nose, each with reasons.
• The abstract gives no answers, so the article must be read for the panelists' views.

Why this paper matters

Panel discussions record expert opinion at a point in time and reveal where evidence is missing. Each of the six questions later generated comparative studies; none is settled by this article.

Terms

• Open approach: rhinoplasty through a small cut across the columella, lifting the skin off the framework.
• Endonasal (closed) approach: rhinoplasty through incisions hidden inside the nostrils.
• Tip lobule: the rounded lower part of the tip formed by the tip cartilages.
• Alloplastic implant: a manufactured synthetic implant.
• Spreader graft: a cartilage strip placed beside the septum to hold the middle vault open.
• Middle third pinching: narrowing of the cartilage section of the bridge after hump removal.