Home > Articles > Comment

	Sign up for Newsletter
	Before & After Photos
	Dr. Kridel in Vogue Magazine, where he was the only facial plastic surgeon noted for Texas. Dr. Kridel voted top doc for women by H Texas Magazine. Dr. Kridel named as a Super Doctor in Texas Monthly Magazine.

Prevention and Correction of Nasal Tip Bossae in Rhinopasty Page 01 Page 02 Page 03 Page 04

While most agree that overzelaous cephalic or horizontal excision of the lower lateral cartilage is a strong etiologic factor for bossa formation, there exists debate over logic factor of bossa formation. Simons2 reported that "horizontak excision with intact caudal borders can lead to vectors of scar contracture that buckle and narrow intact alarm rims." Gilman et al1 suggest the preventive role of "vertically separating the alar cartilage ar their angles." We, however, agree with others that it is an intact caudal strip that resists the forces of scar contracture and thereby retards the formation of bossae.11 Therefore, we recommend that all incised edges be reconstituted to restore alar integrity whenever nasal tip cartilagesare vertically divided.

We believe that, by recognizing risk factors and preoperative asymmetries and by minimizing structural weakness by maintinnig, reinforcing, or reconstituting an intact alar cartilage, bossae can be prevented and correction of bossae can yield durable results.

Accepted for publication December 4, 2002.
This study was presented at the American Academy of Facial Plastic and Reconstrucive Surgery, combined Otolaryngology Spring Meeting; May 12, 2001; Palm Desert, Calif
Corresponding author and reprints: Russell W.H.Kridel, MD, Facial Plastic Surgery Associates, 6655 Travis, Suite 900, Houston, TX 77039 (e-mail: rkridel@todaysface.com)

REFERENCES

1. Gilman GS, Simons RL, Lee DJ.Nasal tip bossae in rhinoplasty: etiology, predisposing factors, and management techniques. Arch Facial Plast Surg. 1999; 1:83-89.
2. Simons RL. Verrtical dome division in rhinoplasty. Otolaryngol Clin North Am. 1987;20:785-796.
3. Tardy ME Jr, cheng EY, Jernstrom V. Misadventures in nasal tip surgery:analysis and repair. Otoralyngol Clin North Am. 1987;20:797-823.
4. Cayne BS, Lechner DE, eds. New Webster´s Dictionary and Thesaurus. Danbury, Conn: Lexicon Publications Inc; 1993:112.
5. Simons RL, Gallo JF. Rhinoplasty complications. Facial Plast Surg Clin North Am. 1994;2:521-529.
6. Goodwin WJ Jr, Schmidt JF. latrogenic nasal tip bossae: etiology prevention, and treatment. Arch Otolaryngol Head Neck Surg. 1987;113:737-739.
7. Karner FM, Churukian MM, Hansen L. The nasal bossa: a complication of rhinoplasty. Laryngoscope.1986; 96:303-307.
8. Parkes MH, Kanodia R, Kern EB. The universal tip: a systematic approach to aesthetic problems of the lower lateral cartilages. Plast Reconstr Surg. 1988;81:878-890.
9. Kamer FM, Pieper PG. Revision rhinoplasty. In: Bailey BJ, ed. Head and Neck Surgery-Otolaryngology. 2nd ed. Philadelphia, Pa:Lippincot-Raven Publishers; 1998:2663-2676.
10. Parkes ML, Bassilios MI.Removal of nasal bossa through unipedicle flap. Laryngoscope. 1978;88:184-186.
11. Adamson PA, McGraw-Wall BL, Morrow TA, Constantinides MS. Vertical dome division in open rhinoplasty: an update on indications, techniques, and results. Arch Otolaryngol Head Neck Surg. 1994;120:373-380.
12. Thomas JR , Tardy ME Jr. Complications of rhinoplasty. Ear Nose Throat J. 1986;65:19-34.
13. Kridel RWH, Konior RJ. Dome truncation for management of the overprojected nasal tip. Ann Plast Surg. 1990;24:385-396.
14. Perkins SW, Tardy ME Jr. External columellar incisional approach to revision of the lower third of the nose. Facial Plast Surg Clin North Am . 1993;1:79-98.