We completed a retrospective review of sequential patients presenting
to the senior author’s private practice for rhinoplasty
and undergoing various methods of deprojection from January
1, 1991, through December 31, 2002. Deprojection procedures
used included full-transfixion incision, release of tension
septum, lateral crural overlay (LCO), dome truncation,
MCO, and ombinations of them. The surgical techniques and
our review of our experience with LCO and dome truncation
have previously been detailed in isolation.4-6 However, an overview
of these techniques and a complete description of our technique
for MCO are described herein.
Although this report is retrospective, patient management
was prospectively performed using an algorithm based on early
results among patients treated by the senior author (R.W.H.K.)
in the late 1980s. Medical charts reviewed had been logged into
our data bank postoperatively according to the surgical procedure code and diagnosis of overprojection after direct analysis at the time of surgery. Detailed operative schematics filled out at the time of surgery helped ensure the accuracy of our data analysis. Those patients who had undergone a deprojection procedure or who had been diagnosed as having overprojection were included in the medical chart review.
Figure 2. Computer-generated image demonstrates the importance of the radix in aesthetic analysis. The height and position of the radix affect each other, define the nasofacial angle, and serve as the counterpoise of the nasal base. Although projection is the same in parts A and B, the change in radix positioning causes the illusion of overprojection in part B.
Patients’ medical records, including preoperative and ostoperative photographs, were independently reviewed by the other author (P.S.) for facial analysis and the need for and achievement of deprojection. We excluded those patients judged to have undergone
LCO or truncation for reasons other than deprojection
on the basis of notes or a review of photographs.
Patients underwent preoperative and postoperative evaluation
during this period on a regular basis to record the effects
of various approaches on nasal projection, rotation, need for
revision, and patient satisfaction. We reviewed major and minor
secondary revision procedures that patients underwent, postoperative
complications, and any functional complaints.
