precision with template rhinoplasty€¦ · rhinoplasty paul o’keeffe sydney . disclosure of...
TRANSCRIPT
![Page 1: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/1.jpg)
The Precision of Template Rhinoplasty
Paul O’KeeffeSydney
www.oknoses.com.au
![Page 2: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/2.jpg)
Disclosure of Relevant Financial Interests
• Nothing to disclose
![Page 3: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/3.jpg)
Objective
• To determine a new stable nose profile– Calculate soft tissue changes that control the tip tripod position
Lateral alarligament
Elastic cuff
Depressor septi muscle
LAL shortening
Mucosa excision above EC
Caudal margin cartilage excision
![Page 4: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/4.jpg)
Objective
• To determine a new stable nose profile– Calculate soft tissue changes that control the tip tripod position
– Add a dorsal reduction that matches the tip
![Page 5: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/5.jpg)
Objective
• To determine a new stable nose profile– Calculate soft tissue changes that control the tip tripod position
– Add a dorsal reduction that matches the tip–Make a template to gauge the changes
Polycarbonate sheet
![Page 6: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/6.jpg)
Closed rhinoplasty preferred
• Better skin control because tip skin moves with the tip skeleton
Tip skin remains attached to alas
![Page 7: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/7.jpg)
Closed rhinoplasty preferred
• Better skin control because tip skin moves with the tip skeleton
• Can safely detach soft tissue from the whole of the pyramid and move it back towards the narrowed pyramid base
![Page 8: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/8.jpg)
Closed rhinoplasty preferred
• Better skin control because tip skin moves with the tip skeleton
• Can safely detach soft tissue from the whole of the pyramid and move it back towards the narrowed pyramid base
• Greater nasal reductions are possible compared with open rhinoplasty
![Page 9: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/9.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 10: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/10.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 11: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/11.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 12: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/12.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 13: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/13.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 14: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/14.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 15: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/15.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 16: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/16.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 17: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/17.jpg)
Operative procedure• Inject beneath the elastic cuff and release it from the
caudal margin• Inter-cartilaginous or supra-cartilaginous incisions extend
to pyriform margins• Shorten lateral alar ligaments• Totally release soft tissue from pyramid • Low to osteotomies and in-fracture• Bone grafts into osteotomies• Reattach elastic cuff• Kaltostat pack for 2 days• Aquaplast splint for 6-8 days then wear splint at night for
up to 6 weeks
![Page 18: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/18.jpg)
Results
2 months post-op
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Results
1 year post-op
Template on life size photograph confirms stability
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Results
6 years post-op
![Page 21: Precision with Template Rhinoplasty€¦ · Rhinoplasty Paul O’Keeffe Sydney . Disclosure of Relevant Financial Interests •Nothing to disclose. Objective •To determine a new](https://reader033.vdocument.in/reader033/viewer/2022050222/5f6757c8c38c26499754dc14/html5/thumbnails/21.jpg)
The concepts behind Template Rhinoplasty were first presented to the Australasian Society of Aesthetic Plastic Surgery in 1989