Revision rhinoplasty: panel discussion, controversies, and techniques

Overview

The article is a moderated panel on revision rhinoplasty. The abstract lists the questions put to the panelists and a closing request for each to describe how their technique has evolved over five years. The answers are not in the abstract.

Sections of note

• Panel discussion; no patient data, studies or outcomes are cited in the abstract.
• Question 1: the single most difficult challenge in revision rhinoplasty and how each surgeon addresses it.
• Question 2: the best material for dorsal augmentation in revision when septal and ear cartilage are unavailable.
• Question 3: technique to prevent warping when rib cartilage is used for the dorsum.
• Question 4: alloplast in the nose: when, where and for what purpose.
• Question 5: whether releasing the upper lateral cartilages always requires spreader grafts to prevent middle third pinching.
• Closing: how each panelist's revision technique has evolved over the past five years.

What it means for a patient

• In revision surgery the patient's own cartilage supply is often used up, and experts differ on what to use instead.
• Rib cartilage is the common answer for rebuilding the bridge, and preventing it from bending is a recognized problem.
• The abstract gives no answers; the article must be read for the panelists' positions.

Why this paper matters

The questions map the unresolved technical problems of revision rhinoplasty in 2014: graft supply, warping and implants. Expert opinion, not evidence, is what the format delivers.

Terms

• Revision rhinoplasty: a repeat operation on a nose that has already had surgery.
• Dorsal augmentation: raising the height of the nasal bridge.
• Rib cartilage graft: cartilage harvested from the patient's own rib.
• Warping: a cartilage graft bending after it is placed.
• Alloplast: a manufactured synthetic implant.
• Spreader graft: a cartilage strip placed beside the septum to hold the middle vault open.