Abstract
Rhinoplasty is one of the most complicated operations that a plastic surgeon will
encounter. In the early history of rhinoplasty, operations were done with a closed
approach, and the structures were shrouded in mystery while surgeons relied on surface
aesthetics for diagnosis and treatment. Finally, with the advent of the extended open
approach, power tools, and piezosurgery, the whole bony pyramid can be directly visualized,
shaped, and sculpted. Osteotomies can be done under direct vision with high precision.
Using this approach, every part of the osseocartilaginous vault and nasal tip can
now be directly observed, diagnosed, and surgically treated. However, this only occurs
once the patient is in the operating room. This article will detail the diagnosis
and treatment of the difficult soft-tissue envelope of the nose. It will also describe
the use of ultrasonography for preoperative planning as well as postoperatively for
diagnosis and treatment during the healing period and for planning possible revision
and secondary surgery.
Keywords
rhinoplasty - ultrasonography - diced-cartilage in fascia graft - rosacea
