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Arch Facial Plast Surg. 2002;4:138.

The Girl With a Pearl Earring by Johannes Vermeer.

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A New Technique for Reconstruction of the Nasal Dorsum: Underlay Autografting
Farahmand Sabeti, MD, and Abbas Nadimi Tehrani, MD, present a modification of the Skoog technique that preserves the complex and structurally important contours of the upper cartilaginous vault when resecting the nasal dorsum. This technique relies on the excised hump to reconstruct the nasal vault and to prevent valve collapse while preserving the natural contour of the middle third of the nose. The authors present an excellent review of similar techniques and give appropriate credit to those authors. A main goal is to reconstruct the springlike junction of the upper lateral cartilages and septum, which provides excellent function and prevents excessive broadness of the dorsum. Although their technique is done through an endonasal approach, it could be performed through the external approach. The authors present 15 patients who underwent this procedure with excellent results and describe the variations available.

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The Versatile Autogenous Costal Cartilage Graft in Septorhinoplasty
Ozcan Cakmak, MD, and Tan Ergin, MD, present their experience in 20 patients with severe nasal deformities reconstructed with autogenous costal cartilage grafts. Grafts were used for both structural and nonstructural purposes and there was excellent long-term follow-up. Complications were minimal, with 3 cases of minor warping and no problems with graft resorption or extrusion. In his commentary, David A. Sherris, MD, discusses the relative benefits of autogenous costal cartilage grafting vs alternative techniques in septorhinoplasty. Recommended materials for septal replacement, spreader grafts, columellar struts, dorsal onlay grafts, and tip and alar replacements are presented.

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Biophysical and Microscopic Analysis of Homologous Dermal and Fascial Materials for Facial Aesthetic and Reconstructive Uses
Anthony P. Sclafani, MD, Steven A. McCormick, MD, and Rubina Cocker, MD, studied homologous tissue grafts that are commonly used in aesthetic and reconstructive facial surgery. Dr Sclafani and his colleagues analyzed the microscopic structure and physical properties of 2 decellularized dermal materials (AlloDerm and DuraDerm) and 2 fascia lata tissue grafts (Tutoplast fascia lata and cadaveric fascia lata). These materials were examined with both light microscopy and scanning electron microscopy; physical properties examined included maximal sustainable load, strain, conformability, and elasticity. AlloDerm and Tutoplast fascia lata retain more natural architecture and physical properties than the other materials. The authors discuss the effects of these physical characteristics on the long-term survival and performance of the grafts. Safety issues are also addressed.

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Laser Septochondrocorrection
Yuri Ovchinnikov, MD, and associates present a clinical series demonstrating the results of 110 patients with symptomatic nasal obstruction due to septal deviation who underwent office-based laser nasal septal cartilage reshaping. A modified nasal speculum is inserted into the nostril on the convex side of the deformed septum and a laser fiber is aimed at the region of the septum under maximum mechanical deformation. The pulsed holmium:YAG laser is used to heat the cartilage. This procedure takes approximately 6 to 8 minutes to perform. The procedure was well tolerated by patients in the series. Results with an average follow-up of 18 months showed 30% of patients with a median nasal septum, 45.5% with a significant reduction in septal deformity, and 24.5% with no improvement in the septal deformity. In the patients who had no improvement, the septum had initially been straightened but had later resumed its original shape. The authors analyze the results of these failures and make recommendations for future applications in this and other areas of facial plastic surgery.

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