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The choice of primary rhinoplasty technique is based on preoperative diagnosis, external nasal contour, nasal anatomy, and expected changes in nasal contour. The author matches technique to nasal anatomy, describing procedures that have resulted in a high success rate. (Aesthetic Surg J 2002;22:72-84.)

Ronald P. Gruber, MD Nicolas Tabbal, MD Jack H. Sheen, MD Dean Toriumi, MD Dr. Gruber: The first patient (Figure 1) is a 45-year-old man with a history of cocaine use. He presents with symptoms of whistling and a dropped nasal tip, and he also complains of difficulty breathing. To facilitate breathing, this patient manually pushes up the tip of his nose. He has a caudally located 2- to 3-cm perforation, which leaves him with a 1-cm horizontal strut and a 1-cm caudal (columellar) strut. Dr. Sheen, how does this compare with your experience in seeing patients with a history of cocaine use? Figure 1 A , Front, B , lateral, and C , intranasal views of a 45-year-old man with a history of cocaine use. He presents with symptoms of whistling and a dropped tip and complains of difficulty breathing. He has a caudally-located 2-cm perforation. Dr. Sheen: Of the 18 to 20 cocaine noses that I have reconstructed, only 1 was in a male patient; he had mid-vault collapse associated with a large perforation. The rest of the patients were female. I also treated one man who had complete erosion of the caudal septum, membranous septum, and columella and had only 1 mm of skin remaining, so he literally had no caudal support. However, what you describe here is somewhat different. If this patient has a significant amount of caudal septum remaining, it is unlikely that cocaine use caused his present condition. Has he had prior surgery? Dr. Gruber: No, he has not. Dr. Sheen: When I see a patient with this type of problem, I ask to see photographs that were taken before the nasal deformity developed to compare the original state of the nose with its current condition. I do not believe that this 2-cm perforation would produce …

Dr. Guyuron: The main focus of this panel is the management of nasal length and projection. Dr. Gruber, how do you analyze a patient's nose in terms of length and projection? Dr. Gruber: In general, I take measurements with a video imager, which provides a one-to-one size. It is really by trial and error manipulation of the image using the video imaging system and then asking the patient what he or she thinks of my assessment that I determine a patient's ideal nose length and projection. I no longer use specific numbers because the distances and angles on the nose are different for each patient. I have found that it is best to use my aesthetic judgment with regard to how the particular length and projection of the nose relates to the rest of the face. Dr. Guyuron: Dr. Byrd, how do you determine the proper nasal projection and length for your patients? Dr. Byrd: First, I measure the patient directly. Then I measure life-size photographs of the patient. I correlate the measurements on the photograph with the ones that I've taken of the patient to avoid measurement errors that can occur as a result of the way in which the pictures were developed. This is a way of confirming my measurements. I determine the actual length of the nose by measuring roughly from the level of the supratarsal fold or 6 mm above the inner canthus down to the dome-projecting points. Basically I would like the nasal length to be equal to the chin vertical measured from where the lips come together (stomion) down to the undersurface of the chin (menton), or two thirds of the midfacial height. These are the ideal aesthetic relationships in the white female's nose. From my perspective, a nose is long if it exceeds …

A Blitzer, BE Benson, J Guss . Botulinum Neurotoxin for Head and Neck Disorders. New York: Thieme, 2012. ISBN-10: 1604065850 Botulinum Neurotoxin for Head and Neck Disorders is a moderately sized text covering a very specific, clinically relevant, and contemporary topic that is applicable to physicians in many specialties, including plastic surgery, facial plastic surgery, otolaryngology/head and neck surgery (Oto-HNS), neurology, and dentistry. An initial review of the contents of the text reveal several appealing color illustrations and diagrams and a moderately large, easy-to-read font. The 19 chapters are subdivided into 4 distinct topic sections: dystonia, other motor disorders, pain syndromes, and autonomic disorders. Following the Table of Contents is a listing of 22 online videos that demonstrate the injection techniques described in the text. The foreword provides the reader with a brief history of the medical uses of botulinum toxin (BoNT) to be described in the text, including strabismus, focal dystonias such as spasmodic dysphonia and blepharospasm, migraine headache, hyperhidrosis, and wrinkle reduction. The preface describes the intended audience for the book, which includes clinicians familiar with treating a variety of disorders affecting the head and neck—plastic surgeons, otolaryngologists, neurologists, dentists, and pain specialists. After reading this book, we would agree with the intended audience and add medical students and novice practitioners to the list. This book provides a comprehensive review of the more common clinical applications of BoNT, including the treatment of focal dystonias, pain syndromes, and cosmetic applications. Included in each section are descriptions of the pathology under consideration, important differential diagnostic considerations, accepted medical and surgical therapies for each condition, the role of BoNT in ameliorating …

Contour of the nose is determined by a series of shadows and highlights that emphasize the shape of the nose.1 The desired contours are curvilinear with smooth transitions from dorsum to mid-vault to nasal tip. Control of nasal contour requires precise management of the underlying nasal structures. The structure approach to rhinoplasty employs conservative reduction of the cartilage structures and reshaping using cartilage grafting.2 Cartilage grafts such as spreader grafts and lateral crural strut grafts help to control the shape of the middle nasal vault and lower third of the nose, respectively.3,4 Such grafts have helped surgeons improve their long-term outcomes as well as link nasal aesthetics and surgical technique. In the article entitled, “Rhinoplasty: Surface Aesthetics and Surgical Technique,” Dr Cakir and his coauthors have described how the nasal contour is composed of a series of polygons as aesthetic units and linked these concepts to their own techniques. The ideal contour on frontal view is typically described as having bilateral divergent concave lines that create symmetric “brow tip aesthetic lines.”5–7 In contrast, the authors describe the frontal view as a series of polygons, with a superior polygon that is narrow at the radix and widens toward the middle nasal vault and an inferior polygon that narrows at the supratip. This series of shapes more closely represents the shape of the underlying nasal structures (nasion, nasal bones, and upper lateral cartilages) rather than the superficial nasal contour. Transitions in skin thickness—from thick in the radix region, to …