Rhinoplasty

To describe a novel calibration technique for photographs of different sizes and to test a new method of chin evaluation in relation to established analysis measurements. Design: A photograph analysis and medical record review of 14 patients who underwent combined rhinoplasty and chin correction at an academic center. Patients undergoing concurrent orthognathic surgery, rhytidectomy, or submental liposuction were excluded. Preoperative and postoperative digital photographs were analyzed using computer imaging software with a new method, the soft tissue porion to pogonion distance, and with established measurements, including the cervicomental angle, the mentocervical angle, and the facial convexity angle. Results: The porion to pogonion distance consistently increased after the chin correction procedure (more in the os-seous group). All photograph angle measurements changed toward the established normal range postoperatively. Conclusions: Surgery for facial disharmony requires artistic judgment and objective evaluation. Although 3-dimensional video analysis of the face seems promising, its clinical use is limited by cost. For surgeons who use computer imaging software, analysis of profile photographs is the most valuable tool. Even when preoperative and postoperative photographs are of different sizes, relative distance comparisons are possible with a new calibration technique using the constant facial landmarks, the porion and the pupil. The porion-pogonion distance is a simple reproducible measurement that can be used along with established soft tissue measurements as a guide for profile facial analysis.

To propose a new surgical technique for fixing the nasal septum to the midline, for long term prevention of nasal obstruction, in secondary and select cases of primary septoplasty. Patterns of septal deformity, materials used for titanium plates, surgical results, symptom improvement, and surgical complications were investigated.

We establish criteria for aesthetic forehead flap reconstructions and evaluate the effect of mathematical models and computer simulation of the operation in preoperative and perioperative planning. We study a case series of 13 patients in an academic tertiary referral medical center. Most patients had nasal defects after Mohs' surgery for tumor ablation. Patients were followed up for 2 years after reconstructive surgery. Three patients underwent midline forehead flap nasal reconstructions, and t0 patients underwent paramedian forehead flap nasal reconstructions. We used patient satisfaction and physician evaluation of aesthetic form and function restoration as the main outcome measures. There were no major complications. Minor complications included short-term pincushioning in all patients, scar contrac-Lure that resolved after 8 months in one patient, and forehead necrosis after primary closure of the upper forehead in one patient. Computer simulation correlated two-dimension flap design to the transposition process. We conclude that the forehead flap is the optimal reconstructive modality for resurfacing large nasal defects. The paramedian forehead flap is superior to the midline forehead flap for nasal reconstruction, especially for distal tip reconstructions. Mathematical models and computer simulation of the reconstructive procedure that relate the two-dimensional flap design to the transposition process reveal subtle geometric relationships of the flap transposition that facilitate the design of the optimal flap for reconstruction. (OTOLARYNGOL HEAD NECK SURG 1995; 113: 740-7.) rain I¥1any surgeons consider forehead skin the best match of color and texture in reconstructing nasal defects. Unfortunately, because of the thickness of forehead skin, composite grafts cannot survive reliably solely on imbibition. Thus surgeons traditionally transpose the tissue from the forehead onto the nose by a two-stage procedure: the first stage transfers the tissue on a vascular pedicle, and the second stage divides the pedicle after inosculation and

Thirty-four female patients who underwent rhinoplasty were followed through assessment of postsurgical satisfaction (pss), perception of subjective improvement, objective improvement (surgeon's ratings), and objective post-surgical nasal deformity. Assessments of pss and subjective improvement were obtained on 3 occasions: TI, 1 week after surgery, on cast removal; T2, 1 month after cast removal; and T3, 3 months after cast removal. The investigation was aimed at examination of the relationship of patients' subjective post-surgical appraisals of the operation with objective indices of outcome of rhinoplasty. Results indicated that at Tj, pss is totally dissociated from objective outcome or its appraisal by the patient. At T2 an association between objective outcome and pss and subjective appraisal of outcome is evident, but seems to reflect the total reliance of the patients' judgment on surgeons' appraisals. At T3 a paradoxical trend is indicated: slim objective favorable outcomes correlate with high pss, while a considerable share of patients with whom a highly favorable outcome has been attained express relatively low pss. This paradoxical trend may be well understood when applying Cognitive Dissonance Theory. The whole pattern of results point again at highly complex and powerful psychological processes, some of them seemingly irrational, operating within patients when relating to rhinoplasty, a simple superficial surgical procedure.

Aim: Self-esteem is one's attitude towards oneself. It is one of the most important psychological aspects of rhinoplasty, a common aesthetic operation. Prior studies have indicated an improvement in patients' self-esteem after this operation. The aim of current study was to preoperatively compare self-esteem in patients seeking aesthetic rhinoplasty with that of functional rhinoplasty patients. Methods: A total of 42 patients completed the validated Rosenberg Self-Esteem Scale preoperatively (21 aesthetic surgery patients and 21 functional surgery patients). Those with both aesthetic and functional purposes were categorized regarding their primary objective. The t-test for independent groups was used for analysis of the data, and Cohen's d was calculated as a measure of effect size. Results: The mean level of self-esteem in the aesthetic surgery group was significantly lower than that of the functional surgery group (P < 0.05). Age, gender, socioeconomic status, and educational backgrounds were analyzed and comparative analysis of each showed no significant difference between the two groups. The value of effect size measure was very high (d = 1.04). Conclusion: The findings of the present study showed that aesthetic rhinoplasty patients had lower self-esteem in comparison with functional rhinoplasty patients.

Rhinoplasty modifies the aesthetic appearance and functional properties of the nose with operative manipulation of the skin, underlying cartilage, bone, and linings. A long nose is an aesthetically undesired feature disturbing the harmony of the face. The underlying pathology of the long nose may be due to either a long septum that invades the lip or dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. The increase in the nasal height due to a dorsal nasal hump may give an illusion of a long nose. An absent or shallow frontonasal angle also gives the illusion of a long nose. With the introduction of the dynamics of the nasal structures and dynamics in rhinoplasty, recreation of a straight nasal dorsum and a normal frontonasal angle dynamically shortens the long nose. This study presents a multicenter experience (three centers) in rhinoplasty of long noses. The study included 138 patients who complained of having a long nose. The study employed the concept of structure rhinoplasty to address the threedimensional nasal structures contributing directly or indirectly to the appearance of the long nose rather than the traditional excisional techniques. Based on objective and subjective evaluation, shortening of the nose was achieved in 122 patients (88.4%) with better overall nasal aesthetics. The study concluded that structure rhinoplasty, which addresses the three-dimensional nasal anatomy, maximizes the aesthetic and functional outcomes when treating the long-nose deformity.

Background: Rhinoplasty and septal surgery often require the use of cartilage grafts. Autologous cartilage may be thin or deviated, and the use of an absorbable scaffold material to support the reimplanted cartilage during healing can improve technique and outcomes. Objective: To describe the use of a polydioxanone plate not only as a template in extracorporeal septoplasty but also for various other grafts commonly used in rhinoplasty and for the repair of septal perforations. Methods: A retrospective case note review was performed between November 1, 2007, and February 28, 2011, for all patients treated using a polydioxanone plate. Surgical outcomes are discussed. Results: A polydioxanone plate was used in septal and/or rhinoplasty surgery in 102 patients treated during a 40month period. Follow-up was 9 to 18 months (mean, 12 months), with 96 patients reporting a good cosmetic or functional result. Up to 15% of patients experienced temporary septal swelling, but there were only 2 postoperative infections and no other significant complications. Conclusions: The polydioxanone plate is a safe and reliable absorbable implant that has many different applications in rhinoplasty and septal surgery. It not only acts as a scaffold but also stimulates and guides cartilage regeneration.

A one-stage procedure combining a V-Y advancement flap with a composite graft for the reconstruction of alar-lobule and alar-groove defects is described. After tumour resection, a V-Y flap is advanced and retained at the level of the piriform margin to fill the dead space. To provide vascular support to the composite graft and to recreate the alar groove the advancing edge of the flap is de-epithelialised. In the same stage the composite graft is harvested and placed into the alar defect. A series of 12 patients underwent this procedure, with good results. 9 2002 The British Association of Plastic Surgeons

The aim of this paper is to discuss an updated technique for dorsal augmentation during rhinoplasty using diced cartilage wrapped in fascia. The usage of diced cartilage has been variously described in the literature with consistently satisfactory results. Herein, we present our experience with patients undergoing dorsal augmentation during rhinoplasty using an updated method of diced cartilage wrapped in fascia. Diced cartilage fascia techniques have become the technique of choice for dorsal augmentation for an ever-increasing number of rhinoplasty surgeons. The term is broadly descriptive and there remains a wide-range of ways to execute. Updating and enhancing the technique with greater attention to precision, and creating an aesthetically optimal and predictable result, may result in even improved outcomes for future patients.

Rhinoplasty is a collection of surgical procedures performed on nose for the purpose of correcting functional and shape deformities. Nose is a facial feature which naturally draws attention during everyday contact. Any operation performed on nose has to blend well with the other facial features of the face. For this reason rhinoplasty is a type of surgery which requires artistic skills from surgeon as well as surgical skills. In this paper we present an artistic simulation tool which manipulates the shape of the nose on the bases of rhinoplasty procedures to be used during the surgery. Unlike other artistic simulation tools which can modify shape with no constraints, this tool simulates the e ect of individual operations. Simulation tool can be valuable only if it predicts the outcome of the surgery with accuracy. Ultimately the outcome of the simulation depends largely on the experience of the surgeon. This is also the case with the tool presented in this study, so with experience the tool can be useful for predicting outcome more and more accurately. In this paper, the mechanical model of the nose and tools used for simulation are discussed. The simulation results are compared with actual rhinoplasty results to see the ÿdelity of the approach. A owchart of the decision process and how rhinoplastic simulation together with the ideal nose data can be used to aid actual rhinoplastic surgery is given at the end. ?

Background: In addition to odor perception, the nose also plays an important role in breathing
and speech. In Iran, 70% of plastic surgeries is performed on the nose.
Methods: In the present study, all patients underwent rhinoplasty during 5 years from April 2012
to March 2017 and were evaluated using a census method. A researcher-made questionnaire
including the following variables were used: age, gender, level of education, season of performing
the operation, length of hospitalization, occupational status, type of surgery, surgical procedure, and
type of repair surgery. The obtained data were analyzed by SPSS.
Results: A total of 106 individuals, with the mean age of 27.37 years were enrolled into the study.
Most of the rhinoplasty surgeries were performed in summer and the lowest frequency was in
spring. Most clients had a diploma, and in terms of occupational status, most subjects were students.
Conclusion: There was a significant relationship between gender, educational level, and
type of surgery.

A variety of surgical methods have been developed to reduce the volume of the inferior turbinates, in order to create a more patent nasal airway. We describe a technique used in our department since February 2002 for all patients undergoing inferior turbinectomy. We resect with endoscopic assistance the lateral mucosa and bony inferior turbinate. This technique can reduce a large volume of the turbinate while preserving the mucosal continuity and the submucosa by covering the raw surface with a mucosal flap. We believe our method minimises post-operative side effects and complications such as dryness, infection, bleeding and pain.

To review nasal alar support mechanisms, introduce the concept of tractional forces on the nasal ala, and describe a reconstructive technique to correct nasal tip deformities associated with weakened tractional force on the nasal ala. Design: Photographic study and retrospective medical chart review. Results: We noted that patients with weakened support at the dome of the lower lateral cartilage had lateral alar deformities. Strengthening the cartilaginous deficiency improved the nasal appearance and function in 90% of patients. Conclusions: Deformities of the nasal tip are among the most difficult to correct. Tractional forces provided by dome strength help to maintain the ala in its normal anatomical position. Structural tip grafts restore the tractional force and, thereby, help to correct the alar deformity.

Reconstruction of nasal defects presents a particularly unique challenge for the surgeon. Complex aesthetic subunits and limited available adjacent mobile skin with varying color, texture, and thickness all contribute to this task. The ideal reconstruction of nasal defects recruits tissue of similar color, texture, and thickness to that of the defect. Two versatile local flaps for nasal reconstruction are the glabellar flap and an extension of the glabellar flap, the dorsal nasal flap. The authors describe the use of these two local flaps for reconstruction of nasal defects and modifications of these procedures for certain indications, as well as their use in medial canthal reconstruction.

Lateral rhinotomy is an established approach to the midfacial skeleton. 1-3 The standard incision for lateral rhinotomy is placed in the nasofacial groove . This is not without complications. 4,5 Several modifications of the incision have been proposed to improve the esthetic results. 6,7 We describe the esthetic and anatomic basis for this modified incision and analyze the esthetic outcome of the technique.

Background The term ''bulbous nose'' is used to describe a large or boxy nasal tip. Typically, correction of the bulbous tip has been achieved through a variety of cartilagemodifying maneuvers based on incision or excision of the lower lateral cartilage. Methods Horizontal reduction with a cephalic hinged flap of the lateral crura was used for 28 patients during open rhinoplasty. Effort was made to preserve the structural integrity of alar cartilage as much as possible with this technique. Results The average follow-up period was 14 months. Satisfactory results were achieved. External nasal valve collapse and pinch deformity were not observed during the postoperative period. Conclusions The described technique improves nasal tip reduction while maintaining nasal tip support and strength. The hinged flap used with this technique can both prevent weakness of the lateral crura and support it.

Background
Rhinoplasty continues to be among the most popular surgical cosmetic treatments around the world. This is often a reflection of the significance of nose shapes in sociocultural, ethnic, and psychological contexts. Despite developments in the therapeutic field of cosmetic surgery, there is scarce information available within current literature concerning the effects of cosmetic procedures on quality of life (QOL), particularly in Iran. The purpose of this study was to survey QOL among Iranian adults before and after rhinoplasty.

Methods
From July 2015 to July 2016, 83 patients over 16 years of age seeking cosmetic rhinoplasty were included in this study. Demographic information such as age, sex, marital status, education, occupation, and monthly income of patients were recorded. SF-36 version 2, Rosenberg self-esteem scale (RSES), and WHOQOL-BREF questionnaires were completed by a single trained interviewer for all patients, before and 6 months after rhinoplasty. Data analysis was conducted using SPSS ver. 16. Results before and after surgery were compared.

Results
The mean age of the subjects was 24.87 ± 5.8 years, with a median of 24 years. The female-to-male ratio was 4.53:1. In all cases and all questionnaires, QOL was improved after rhinoplasty. Significant differences were observed on six subscales of SF-36 comprised bodily pain (p = 0.003), general health (p = 0.002), vitality (p = 0.005), social functioning (p < 0.001), emotional role (p = 0.02), and mental health state (p = 0.012). According to RSES and WHOQOL-BREF questionnaires, self-esteem (p = 0.002), psychological health (p < 0.001), social relationships (p < 0.001), and general quality of life (p = 0.011) indicated significant differences.

Conclusions
Our data suggest that QOL can be improved after rhinoplasty in Iranian adult patients. With proper patient selection and a successful operation, improvement of QOL can be expected.

Level of Evidence: Level III, risk / prognostic study

Background: Dorsal hump reduction is a critical step in rhinoplasty. Most of the reasons behind revisional procedures are related to incorrect hump reduction.Methods: The authors used a modified dorsal hump reduction method in their primary cases, the steps of which are as follows: 1) dissection of the nasal vault; 2) bilateral submucoperichondrial dissections to free the cartilaginous septum; 3) separation of the upper lateral cartilages from the cartilaginous septum; 4) partial dissection of the upper lateral cartilages from the inner surfaces of the nasal bones bilaterally; 5) separation of the bony septum from the nasal bones bilaterally; 6) reduction of the partially isolated nasal bones; 7) en bloc cartilaginous and bony septum removal. The authors have operated on 68 primary cases over a 2 year period (30 mo).Results: In the great majority of cases, the results were satisfactory. No revisions were performed in this patient group.Conclusions: This method is a good alternative to traditional techniques in noses with a high and narrow roof, thin skin, and weak middle nasal vault. Revision could be performed more easily when required. Initially, wide noses may not seem good candidates for this procedure; however, careful case-based preoperative planning may overcome this difficulty.

The long nose with a ''plunging'' tip is a deformity that involves an inferiorly rotated nasal tip, leading to an increase in the length of the nose. The anatomic basis of the long nose with a plunging tip may be divided into two types. Type 1 presents a normal alarÀcartilage complex inferiorly displaced by a long nasal septum and long upper lateral cartilages. Type 2 is caused by a dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. During the study period, the authors identified 60 patients with long noses and plunging tips. For 22 patients with type 1 long noses, the high septal incision technique was used in 12 cases and the step technique in 10 cases. The invagination procedure alone was used for 22 of 38 patients with type 2 plunging noses. Also, an extension graft with the invagination procedure was used for 6 patients, and a columellar strut graft was used for 10 patients. A high septal incision increased tip rotation without significantly changing the amount of tip projection. However, the step procedure, the invagination technique alone, septal extension graft with the invagination technique, and columellar strut grafts increased nasal tip rotation and projection. During the study period, 38 patients were identified as having a smiling deformity, which was improved using the authorsÕ modification procedure. On the basis of the results, the authors recommend that the appropriate treatment for each patient with a long nose and a plunging tip must be determined by preoperative and intraoperative examination findings with the patient at rest and while smiling.

Rhinoplasty remains one of the most challenging aesthetic procedures to master. Astute surgeons must consider a continually evolving societal perception of beauty with their own sense of aesthetic proportion when planning surgical intervention. Optimal results are achieved when the outcome is anticipated and satisfying to patient and surgeon. This requires a careful, thoughtful, systematic approach to preoperative analysis. Patients should leave with a clear understanding of the surgeon&#39;s perspective of their nose, aesthetically and anatomically. Understanding the interplay of surface deformities and their underlying anatomic counterpart is critical, involving a systematic analysis to create a surgical plan that avoids landmines leading to a suboptimal result.

Background: A complete subperichondrial and subperiosteal dissection technique during rhinoplasty may minimize soft tissue disruption, resulting in less scar tissue formation and preservation of ligamentous structures. Objectives: The authors describe their results with subperichondrial dissection of the nasal framework and manipulation of the preserved nasal ligaments. Methods: The charts of 228 consecutive patients who underwent rhinoplasty with complete subperichondrial dissection via an open or closed approach between May 2008 and April 2011 with the senior author (BÇ) were retrospectively reviewed. Intraoperatively, the scroll ligament and Pitanguy's midline ligament were repaired to stabilize the internal valve and tip position, respectively. Results: Patients in this series (182 women, 46 men) ranged in age from 18 to 54 years (mean, 24.3 years). A total of 203 procedures were primary rhinoplasties; 14 were secondary, and 11 were revisions. The open approach was used in 92 patients, whereas a closed dome delivery was used in the remaining 136 patients. Follow-up ranged from 9 months to 3 years. A complete subperichondrial dissection technique resulted in relatively limited edema and more rapid patient recovery compared with the authors' previous experience with the sub-superficial musculoaponeurotic system (SMAS) approach. Repeat elevation in the subperichondrial plane was easier and less traumatic in revision cases compared with secondary rhinoplasty cases. Conclusions: Subperichondrial dissection of the nasal framework allows reshaping and redraping of the nasal tip and controlled manipulation and repair of ligaments without disturbing the overlying soft tissue.

Rhinoplasty modifies the aesthetic appearance and functional properties of the nose with operative manipulation of the skin, underlying cartilage, bone, and linings. A long nose is an aesthetically undesired feature disturbing the harmony of the face. The underlying pathology of the long nose may be due to either a long septum that invades the lip or dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. The increase in the nasal height due to a dorsal nasal hump may give an illusion of a long nose. An absent or shallow frontonasal angle also gives the illusion of a long nose. With the introduction of the dynamics of the nasal structures and dynamics in rhinoplasty, recreation of a straight nasal dorsum and a normal frontonasal angle dynamically shortens the long nose. This study presents a multicenter experience (three centers) in rhinoplasty of long noses. The study included 138 patients who complained of having a long nose. The study employed the concept of structure rhinoplasty to address the threedimensional nasal structures contributing directly or indirectly to the appearance of the long nose rather than the traditional excisional techniques. Based on objective and subjective evaluation, shortening of the nose was achieved in 122 patients (88.4%) with better overall nasal aesthetics. The study concluded that structure rhinoplasty, which addresses the three-dimensional nasal anatomy, maximizes the aesthetic and functional outcomes when treating the long-nose deformity.

Reconstruction options for columellar defects together with membranous septum, nasal base, and upper lip are restricted. We present a case successfully treated with bilateral cheek advancement flaps with upper medial, perialar skin flaps to reconstruct the upper lip, columella, nasal base and membranous septum in a single session. This method provides adequate tissue with minimal cosmetic deformity in a single stage for repairing such compound defects.

Background Supratip deformity is an iatrogenic convexity that occurs cephalically to the nasal tip. This is also known as ''parrot beak'' deformity and causes an unnatural appearance of the nose. In the literature there are several explanations of the mechanism of the deformity and methods to correct it. One of the most accepted theories about the cause of supratip deformity is overresection of the caudal dorsum. Healing soft tissues fill in the gap created between the septum and the tip of the lower lateral cartilages, leading to fullness in the supratip area. The lower third and basically distal third of the middle third of the nose include several muscle groups, ligamentous structures, and perichondrium as the subcutaneous soft tissues. Methods With the idea of elevating a reverse-based flap basically from the lower third and the lower third of the middle third of the nose, including the perichondrium and SMAS tissue, we aimed to reduce this gap, which has the potential to accumulate soft tissues that cause supratip fullness. Between December 2008 and July 2010, the reverse nasal SMAS-perichondrium flap was used in 42 primary rhinoplasty patients.

Rhinoplasty surgery remains one of the most difficult operations of the face. Improving aesthetic appearance and maintaining nasal function are inseparable goals in rhinoplasty surgery, and failure to achieve either of these objectives can be devastating for the patient. After evaluating a variety of rhinoplasty complications, increased attention was devoted to the surgical technique for reconstruction of the dorsal aesthetic lines and nasal tip projection in the patient with a prominent dorsal hump. Based on the modern concept of cartilage conservation, the autospreader flap rotation technique should be considered when dorsal reduction is required. Autospreader flaps are a useful tool in the prevention of postoperative nasal obstruction, segmental (inverted V) appearance, midfacial axial asymmetry and an overdone supratip break. In addition, they assist in preserving ethnicity of the nose when desired. The patient with a long nose, prominent dorsal hump, short nasal bones and low lower lateral cartilages are considered to be an ideal candidate for an autospreader flap.

Developing cartilage constructs with injectability, appropriate matrix composition, and persistent cartilaginous phenotype remains an enduring challenge in cartilage repair. Fourteen patients with minor contour deformity were treated with fluid cartilage filler gently injected as autologous fluid graft in deep planes of defect of the nose that were close to the bone or the cartilage. A computerized tomographic scan control was performed after 12 months. Pearson's Chi-square test was used to investigate differences in cartilage density between native and newly formed cartilages. The endpoints were the possibility of using fluid cartilage as filler with aesthetic and functional improvement and versatility. Patients were followed up for two years. The constructs of fluid cartilage graft that were injected in the deep plane resulted in a persistent cartilage tissue with appropriate morphology, adequate central nutritional perfusion without central necrosis or ossification, and further augmented nasal dorsum without obvious contraction and deformation. This report demonstrated that fluid cartilage grafts are useful for cartilage regeneration in patients with outcomes of rhinoplasty, internal nasal valve collapse, and minor congenital nose aesthetics deformity

The value of spreader grafts in rhinoplasty cannot be underestimated. Various studies have demonstrated that they play a valuable role in the restoration of nasal dorsum aesthetics, provide support for the nasal valve and maintain the straightened position of the corrected deviated cartilaginous septal dorsum. However, there is still controversy on the extent of its value in nasal patency. This study reviews the literature and describes the values and limitations of spreader grafts in rhinoplasty and the alternatives to classic spreader grafts.

Purpose: Restoration of the aesthetic neck contour is an integral component of facial rejuvenation. Multiple deformities of the neck and chin complex can make treatment of the cervical region daunting. An algorithmic approach to neck rejuvenation based on individual anatomic and clinical analysis is prudent. The authors created a simplified anatomic approach to the most common cervical deformities encountered in the patient seeking facial rejuvenation. Methods: Retrospective analysis of the senior author's (R.J.R.) technique evolution over the last 15 years was performed. The operative techniques used in neck rejuvenation were evaluated and the long-term postoperative results were reviewed. Results: Recurrent patterns of cervical deformity are present in patients presenting for facial rejuvenation. These patterns can be classified into categories based on specific anatomic deformities. Conclusions: Facial rejuvenation requires appropriate identification of deformity to effect the desired changes. Cervical deformities are classified into clinically useful categories based on careful preoperative analysis. A thorough understanding of the anatomic bases for the deformities allows the surgeon to choose the appropriate treatments to achieve consistent and reliable results. (Plast.

This course will examine aspects of gender in the Jewish tradition. Students are expected to develop a sense of the historical evolution of Judaism, and hence an understanding of its plurality. The first half of the course will focus on the canonical sources of ancient Judaism, namely the Hebrew Bible and rabbinic literature. Themes will include the constructions of gender through narrative, metaphor, and law, as well as the problem of the gender of God. The second half of the course will explore topics i Jewish mysticism and asceticism, and finally the challenges of modernity, especially as they relate to egalitarian worship, feminist theologies, and Judaism as it is constructed as part of an ethno-national identity, in Israel and the United States.

In addition to developing an historical understanding of Judaism (in contrast to an essentialist dogmatic understanding of it), students will also reflect on the construction of gender identities as a social-political product. The diversity of readings will suggest that both Judaism and gender are not stable unified essences, found in a person by virtue of their birth, but rather a complex set of performative choices, resulting in the identity including what a person chooses to make of it. Students will be invited to question the validity of any specific example or claim found in a text, and to consider its relevance to present-day discourse in their own lives.

The primary objective of rhinoplasty surgery is to create an attractive, functional nose without any surgical stigmata. However, this goal can only be achieved if the surgeon understands the direct linkage between surface aesthetics, underlying anatomical structures, and functional factors. The appearance of an attractive nose is created by certain lines, shadows, and highlights covering the nasal dorsum, tip, and base. During rhinoplasty surgery, these surface aesthetics, with their proportions and breakpoints, must be maintained, emphasized, and created where they are absent. The following aesthetic concepts and surgical techniques have been used in 257 consecutive rhinoplasties performed in the past 3 years. Patients in this series were 80% female and 20% male, with an age range of 19 to 56 years (average, 27 years) and an average follow-up period of 1.5 years. Two cases of bleeding (0.78%) were observed, with no cases of infection. The overall rate of revision was 5% for the whole series.

To the plastic surgeon, the nose is one of the most interesting and challenging facial structures and its anatomy is well defined. From the point of view of aesthetic surgery, the nasal tip area is an especially important structural unit, and the most difficult to address in rhinoplasty. The objective of this study was to demonstrate the existence of the nasal interdomal fat pad as a distinct anatomical structure that occupies the interdomal space and is apart from subcutaneous fat. In our study we proved the existence of the interdomal fat pad by histochemical studies and anatomical observations in 88 patients who underwent primary external rhinoplasty and three fresh cadavers. All specimens were examined by hemotoxylen-eosin, Sudan black, and oil red staining, as well as S100 protein immunoreactivity staining. The mass of the interdomal fat pad was greater in patients with bulbous noses and/or divergent alar cartilage than in patients with thin skin. We speculated that the interdomal fat pad may be the major anatomic structure contributing to unexpected results in difficult cases, such as those involving bulbous noses. According to our study, the existence of the interdomal fat pad should be kept in mind during the preoperative planning of rhinoplasty.