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A graduated approach to rhinoplasty incisions

2000; Oxford University Press; Volume: 20; Issue: 6 Linguagem: Inglês

10.1067/maj.2000.111658

1527-330X

P A McKinney,

Cleft Lip and Palate Research

There are 5 commonly used incisions in rhinoplas-ty: intercartilaginous, transcartilaginous, bipedi-cle, infracartilaginous, and open (Figure). In determining the choice of incision for each patient, perhaps the most important consideration is the possible long-term distortion created by the incision itself. Figure A drawing of the 5 incisions used in rhinoplasty. Intracartilaginous and transcartilaginous incisions may connect with the transfixion incision through the membranous septum. The infracartilaginous incision is made at the caudal margin of the lateral crus and may extend along the caudal border of the medial crus for more exposure. A combination of intracartilaginous or transcartilaginous incisions combined with the infracartilaginous incision allows conversion to the bipedicle technique. The columellar incision is used to convert an infracartilaginous incision to the open technique. Because of the delicate nature of the alar cartilages, wound bed contraction affects the nasal tip more than most other areas of the body. In fact, the greater the undermining, the greater the possible distortion. These changes may take a number of years to be fully appreci-ated.1 Traditionally referred to as “shrink-wrappage,” this effect is unpredictable and depends on the strength of the underlying cartilage and on many as-yet-unknown factors.2 In general, minimizing the extent of the undermining optimizes the predictability of the long-term …