Abordagem gradativa para definição da ponta nasal

Abstract

Width of the nasal tip is a frequent complaint during consultations for rhinoplasty. Due to the multiplicity and complexity of nasal deformities, no single technique can correct the numerous anatomic presentations of the nasal tip. Therefore, one must use a graduated approach to the refinement of the nasal tip that allows the surgeon to correct small deformities with conservative techniques whereas aggressive techniques are used to greater deformities. Objectives: To present a graduated approach to refinement of the nasal tip, based on anatomic features, and analyze the outcomes and complications of rhinoplasties performed following this approach. Casuistic and Methods: A retrospective evaluation of charts of 1.152 patients undergoing rhinoplasty (January 2003 to December 2006) was performed, and 641 patients (55,6%) fulfilled criteria for our study. Exclusion criteria were follow-up of less than one year or lack of data and/or post-operative photograph. Outcomes were assessed by comparing results of pre-operative and last follow-up photographs. Patients satisfaction, complications, and rates of revision were recorded. Cases were allocated into seven groups, depending on the surgical technique employed: (1) No surgery on the nasal tip; (2) Interdomal breakup; (3) Cephalic trim; (4) Domal suture; (5) Shield-shaped graft; (6) Vertical dome division; (7) Replacement of lower lateral cartilages. Results: Of the 641 patients in the study, 435 (67,8%) were female and 206 (32,2%) were male. Average age was 25,2 ± 8,9 years. Mean follow-up period was 1,5 years. An asymmetric tip was present in 28 patients (4,4%). At the post-operative evaluation, persistent width of interdomal space was found in 34 (5,3%). No patient presented overnarrowing of interdomal space. The combined rate of surgical revision to enhance refinement of the tip was 5,6%. Patient s satisfaction rate was 95,6%. Conclusions: This graduated approach to refinement of the nasal tip has shown excellent outcomes, a high rate of patients satisfaction, and a low rate of revision. We validate that definition of the nasal tip can be achieved with predictable outcomes and that surgical maneuvers should be selected based on anatomic features.