A. Saddle nose People often say that the collapsed nose, also known as saddle nose. It can be divided into mild, medium and severe. Collapsed nose is lower than the normal height, the back of the nose is different degrees of concave deformity, but the tip of the nose up in a saddle shape so named. Mostly caused by trauma, infection and congenital malformation. Mild saddle nose: the bridge of the nose is low and the tip of the nose is mostly upward. Moderate saddle nose: the dorsum of the nose is obviously concave, the root of the nose is wide, the two nostrils are facing the sky, the tip of the nose and the nasal column are low, and the length of the nose is short. Severe saddle nose: severe depression of nasal dorsum, almost no nasal bridge, external nasal bony structure, nasal septal cartilage and nasal mucosa are all deformed. Saddle nose is mostly caused by trauma, infection, and also seen in congenital developmental malformation. Traumatic saddle nose is mostly caused by depressed fracture of nasal bone without proper treatment or by excessive removal of cartilage from nasal septum surgery. Repair surgery Silicone rubber Silicone rhinoplasty: Silicone rubber prosthesis can be prefabricated into various shapes and models with nasal tip, nasal wing and nasal column, etc. Two types of prosthesis are commonly used: one is willow leaf-shaped and the other is “L” shaped. Although silicone rhinoplasty is a simple surgery, improper handling will increase the chance of post-operative movement, distortion, exposure, infection, rejection and even complications such as skin breakdown, necrosis and erosion. The use of silicone implants for rhinoplasty must strictly follow the general surgical principles of plastic and cosmetic surgery such as sterility and non-invasiveness. Advantages: It was used as early as 1972, and after more than two decades of observation, despite its complication rate of up to 5% – 20%, it is still one of the preferred clinical materials for rhinoplasty because of its good biocompatibility and low price. Disadvantages: can not establish blood circulation with the body, the formation of tissue connections, only fibrous tissue encapsulation, so the skin can be penetrated in the tissue weakness, due to the contracture of the fibrous envelope, can cause the body surface projection of silicone prosthesis, and affect the appearance of rhinoplasty surgery. The material of expansion body rhinoplasty: expansion body was previously used for vascular reconstruction in human organ transplantation, and later used in plastic surgery. The material used for rhinoplasty is the most compatible with the human body, non-toxic, non-cancerous, non-allergenic, and does not need to be replaced for life. The texture and feel of the expanded material is very close to the normal nasal tissue, the expansion of rhinoplasty beautiful and natural, hard to detect, with a special microporous structure, the body tissue cells and blood vessels can grow into it, forming tissue connections, as perfect as autologous tissue. Tumescent rhinoplasty material does not move, does not deform, and the nasal tissue is integrated, more impossible to penetrate the skin, no silicone “transparent feeling”, light weight, no sense of falling. Rhinoplasty is suitable for: 1, subjective rhinoplasty is required for nasal beauty candidates. 2, low nasal bridge. 3, eyes, cheekbones and the forehead of the poor shape of the visual effect of the nose caused by poor. 4.People who have failed in rhinoplasty. Advantages: It is the most ideal biological tissue substitute at present. Due to its good biocompatibility and unique microporous structure, it is non-toxic, non-cancerous, non-allergenic and other side effects, and human tissue cells and blood vessels can grow into its microporous pores to form tissue connections, just like autologous tissue. Disadvantages: expensive, the average candidate can not accept the high cost of rhinoplasty. Both expansion and silicone materials can be carried for life, and silicone rhinoplasty is also a more common method of rhinoplasty. Autologous cartilage Autologous cartilage is currently the most ideal material for rhinoplasty, including ear cartilage, nasal septum and rib cartilage. Ear cartilage and nasal septum cartilage can only be used for tip rhinoplasty due to limited bone source. Ear cartilage elevates the tip of the nose and increases the curvature of the tip; septum cartilage is used for elevation and lengthening of the nasal tip and nasal column; rib cartilage can improve both the bridge and tip of the nose due to abundant bone source. Autologous cartilage rhinoplasty is more suitable for patients with mild saddle nose or low nose, and of course, it has no stimulating effect on the tissue after implantation, can maintain its original volume and cell shape for a long time, and is easy to cut into the required size and shape, so after rhinoplasty, the appearance is natural and realistic in specific effect. Advantages of autologous cartilage rhinoplasty: 1. Good and stable tissue compatibility. It is easy to be fixed and will not be displaced as it heals with the local tissue of the nose. 2.No rejection reaction will occur. 3.Low absorption, the absorption rate of autologous cartilage is low, and it can survive without blood supply. 4.Simple operation, taken from the body, easy to obtain, autologous cartilage rhinoplasty can generally be taken from ear cartilage, nasal septum cartilage and rib cartilage. 5.It is easy to sculpt and trim the model, which is the ideal material for rhinoplasty. Usual nasal prosthesis materials, the shape is more fixed (L-shaped), and can not make a beautiful nasal tip, while the use of ear cartilage can completely achieve the effect of shaping the tip of the nose. It eliminates the deformation and perforation of the nose. 6, realistic to the touch, no need to worry about normal contact with the nose after surgery, you can push and press the nose, and feel soft and realistic. Injectable rhinoplasty materials The commonly used injectable rhinoplasty materials hyaluronic acid and Ivanhoe, both are safe injectable rhinoplasty materials. Hyaluronic acid: Hyaluronic acid is a part of human dermal tissue. Hyaluronic acid is injected as a filler into the depressed areas of the dermal folds to achieve an immediate plumping and rounding effect. Rhinoplasty with hyaluronic acid, an injectable rhinoplasty material, has the advantages of short treatment time, obvious effect and high safety. 2.Fast results: on-the-spot results. 3.Safety, avoiding the risk of surgery. 4.Free from the fear of surgery. 5.No recovery time is needed. 6.Fill evenly, there will be no prism or granular material residue. 7.Natural hyaluronic acid: It comes from biological tissue, so there is no foreign body feeling and foreign substances left. Autologous fat: suitable for the needs of different people. First of all, the autologous fat is injected into the nose bridge or nasolabial folds, and then it is kneaded into the best shape by hand to achieve the result of rhinoplasty. The following advantages: 1.Natural: no trace of the appearance of the part, soft to the touch and no hard knots. 2.Fast: It is done on arrival and requires almost no recovery period. 3.Safety: Controlled physical process. 4, controllable: according to the needs and personal wishes, the duration can be arbitrarily selected, filling deep and shallow wrinkles, scars, facial reshaping and lip augmentation, etc., any part at will filling or correction. Second, the hump nose and hawk nose The hump nose is a congenital deformity. The clinical manifestation is a wide nasal bridge with angular projection to the front. It is common to see a long nasal diameter, hypertrophy at the lower end, and a hook-like drooping nasal tip. Because of the hook shape, it is also known as hawk nose. The hump nose is mostly due to congenital reasons, caused by overgrowth of local tissues during the development process, or occasionally due to distorted healing of nasal bone trauma or late bone scab growth. In addition to morphological abnormalities, there is no functional disorder and it does not affect the sense of smell, pronunciation and respiratory function. Treatment can be done by rhinoplasty, which includes chiseling away the bone and cartilage tissue protruding from the angle, shortening the long diameter of the nose, and repairing the end of the nose. For trauma, the above principles can be applied to surgical correction combined with the specific characteristics of the deformity Treatment principles: 1, surgical removal of abnormal protrusion of the nasal bone, and both sides of the nasal bone chiseled or sawed off after the manual compression, so that the nasal bone fracture, to the central squeeze narrow nasal dorsum. 2.At the same time, the length of the nose should be shortened. 3.The repair of the tip of the hawk nose. Congenital long nose and short nose Congenital long nose is due to long septal cartilage and lateral nasal cartilage development, poor nasal wing cartilage development, long and narrow anterior nostril, and if combined with nasal tip drooping, it forms hawk nose. The appearance of the nose is long, nostrils are narrow and long, and the tip of the nose is sagging. And rhinoplasty can change our image. Rhinoplasty, long nose shortening surgery is a surgery to cut short the nasal bones and raise the height of the nasal tip. This surgery is particularly effective for moderate and severe long nose deformity without nasal cartilage prolapse from the septum angle. Short nasal column with defect is the result of trauma or infection of the nose, resulting in damage to the nasal column and partial or total defect. The clinical manifestation is partial or total defect of the nasal columella, deformation of the nasal tip occurs due to scar pulling, and the nasal wing and nasal tip may be adhered together if combined with septal defect. Short nasal columns and defects are not uncommon in clinical practice. The treatment depends on the degree of defect and whether it is combined with nasal septal lesion to determine the surgical method. Surgical methods: 1.Wedge-shaped nasal base excision method: If the nasal head is in good shape and only slightly low, a wedge-shaped piece of full-thickness tissue is excised from the nasal base bilaterally to make the nostrils inward and the fornix upward, that is, the nasal head is elevated. 2.Bilateral nasal cartilage inner foot leaning method: this method can raise the nose head about 2-3mm. Make a lateral incision on both sides of the nasal column, reveal the medial foot of the nasal cartilage and the fornix, excise the soft tissue between the two medial feet, and then make a mattress suture at the upper and lower ends of each of them, that is, bring the two medial feet together. 3.Cartilage transplantation method: Make a nasal margin incision in the nostril, or make an incision inside the cartilage to expose the nasal cartilage and lateral nasal cartilage, and remove the cephalic part of the nasal cartilage or the caudal part of the lateral nasal cartilage as appropriate. The cartilage is cut and shaped, and then sewn to the top of the fornix to elevate the nose, or the cartilage of the ear turbinates can be cut for transplantation. The specific choice should pay attention to the choice of different treatment methods. If there is inflammation of the nose, do not blindly go to surgery, which can easily cause damage to the body and also affect the effect of surgery, but also if there is cardiovascular disease, do not go to surgery. After the surgery, you also need to do a good job of care. Advantages: 1. While raising the bridge of the nose, the dorsum of the nose is lengthened and the nose is lowered. 2.Safe surgery, no need to worry about skin breakage and exposed prosthesis after surgery. 3, the scar is hidden in the nostrils, is not to show traces of the surgical certificate every day, and is a long time to take care of, so to fundamentally improve the short nose, or rely on surgery. The precautions before nasal pillar lengthening surgery: 1, 2 weeks before surgery to avoid taking drugs containing aspirin, because aspirin will make our body platelet coagulation function is reduced. 2, before the surgery must determine their own health, no infectious diseases and other body inflammation. Patients suffering from hypertension or hyperglycemia should inform the doctor of their condition during the initial consultation so that the doctor can design a plan for the surgery. 4. Makeup is absolutely not allowed before surgery because the chemical substances contained in cosmetics will reflect with the drugs and affect the treatment effect. 5, female friends should avoid the physiological period when doing delayed nasal column surgery. Postoperative care for nasal Column lengthening: 1, it is best not to let the surgical site touch water within a week after surgery. 2, to clean up every day, to ensure the cleanliness of the surgical nose. 3, do not use spicy food, so as not to stimulate the nose. 4.Take medication and follow up on time in strict accordance with the doctor’s instructions. 4.Crooked nose and oblique nose Crooked nose is a kind of nasal deformity, caused by trauma or nasal cartilage and bone tissue dysplasia. According to the distorted part, clinically it can be divided into the following two kinds, which can be corrected by surgery. 1.Cartilage distortion is in the cartilage below the nasal bone, mainly in the lower part of the nose and the tip of the nose. 2.Bone distortion is mostly in the upper part of the nasal bridge and the root of the nose, mostly caused by the asymmetry of the bone tissue. The above two types can sometimes exist at the same time, that is, the entire external nose, the nasal root to the tip of the nose are crooked phenomenon. Skewed crooked nose: This type is also known as simple crooked nose, the lower part of the nasal cartilage, that is, the lower part of the nose is skewed, can also be accompanied by mild nasal bone skew, characterized by the lower part of the nasal bridge is skewed to the side of the central axis, the tip of the nose is farthest from the central axis. Most of them are congenital or caused by trauma in early childhood. C-shaped crooked nose: The nasal root and tip are located on the axis, and the middle of the nose is bent in a C-shape away from the central axis. S-type crooked nose: also known as complex crooked nose, the nasal cartilage and bone cone are deviated in different directions in an S-shape. Applicable people: 1.The nasal dorsum is crooked or tilted to one side. 2.The deviation of the external nose is a pointer to the septum and nasal triangle correction surgery. Whenever possible, the cartilage and bone of the nasal septum should be preserved as much as possible. That is, because the septum is the main supporter of the nasal dorsum, and in some cases, it is also the cartilage donor area for subsequent surgery. If the nasal septum deformity causes nasal blockage, the disease-causing cartilage piece should be removed and the septum formation and correction of external nasal deviation should be performed at the same time. 3.Seriously crooked nose and nasal blockage need to remove the whole nasal septum, and then cut and splice the septal cartilage, as a free cartilage piece back to the septum. Fifth, the tip of the nose and nasal deformity The tip of the nose is what we often call the nose, the beauty of the nose, are supported by the structure of the nasal scaffolding resolution, the main role is to play the nasal Hebe cartilage medial and lateral foot and the fornix; the second is the nasal cartilage, the nasal septum cartilage. Rhinoplasty is a surgical procedure to correct congenital and acquired nasal tip malposition or nasal tip hypertrophy. Surgery method: low tip Cartilage grafting method – make a nasal margin incision in the nostrils, or make a cartilage incision, remove the cephalic part of the nasal cartilage or the caudal part of the lateral nasal cartilage, cut down the cartilage, cut and shape it, and sew it on the top of the fornix to raise the tip of the nose, or cut the auricular cartilage for transplantation. Bilateral nasal cartilage medial feet together method – make a bilateral lateral incision of the nasal minors, excise the soft tissue between the two medial feet, and then make a mattress suture at its near upper and lower ends, that is, bring the two medial feet together. Wedge-shaped nasal base excision method – If the nasal tip is in good shape and only slightly low, a wedge-shaped piece of full-thickness tissue is excised at the base of both nasal wings to make the nostrils inward and the fornix upward, that is, the nasal tip is elevated. Super high nasal tip Super high nasal tip correction can effectively make an intercartilage incision according to the symptoms of the patient, separate the fornix of the nasal cartilage retrograde to the caudal side, excise a section of the most prominent part of the fornix in a proper full layer, and suture the broken end. This can effectively weaken the cartilage on both sides of the joint when performing interrupted superficial slicing, and the nasal tip formed is craggy but not sharp. Blunt flat nasal tip The blunt flat nasal tip surgery takes a nasal margin incision within the nostril, makes 3-6 incisions on the surface of the vault of the bilateral nasal cartilage, removes the soft tissue between the medial feet of the nasal cartilage, and pulls together the two medial feet with mattress sutures. Hypertrophic nasal tip The correction of hypertrophic nasal tip is known as nose reduction. The surgery takes a marginal incision or intercartilage incision, and the fibrofatty tissue is cut from each part of the nasal cartilage and lateral nasal cartilage evenly. The lateral 1/2-2/3 of the nasal cartilage head is excised and the lateral foot is rotated medially and cephalad, at which point the nasal wing is seen to be inwardly retracted. The cartilage is interrupted at the vault of the nasal cartilage and not cut. Nasal tip cryptorchidism Having a slight longitudinal bifid foot at the tip of the nose is a sign of beauty, however an overly pronounced transverse nasal tip bifid is a nasal tip cryptorchid deformity that must be corrected. The surgical approach is to remove the fatty fibrous tissue between the two medial nasal pedicles and close both medial pedicles with a through mattress suture. If necessary, the nasal cartilage can be cut at the dome to reshape it, and autologous ear cartilage and tissue substitutes can be obtained to fill the apical cleft. Nasal tip reshaping nasal tip reshaping is the most advanced technique of nasal tip reshaping, its principle is to achieve the effect of nasal tip reshaping through the displacement and reshaping of own nasal tip tissues, its advantages are: 1, microplasty, less pain, no injury to the ear. 2.No foreign body tissues, there will not be any rejection phenomenon. 3, nasal tip tissue remodeling, nasal tip shape is stable, enhance the maximum bearing capacity of the nasal tip. 4.Self with blood supply tissue, there will not be any ablation phenomenon. 5, shaping the tip of the nose at the same time, but also shaped nostrils and other whole nose proportion, nasal aesthetics perfect presentation. Rhinoplasty refers to the nasal wing upward contraction is mostly congenital deformity, easy to cause the illusion of nasal small column sagging. Indications: Rhinoplasty can shrink or increase the size of the nose; change the tip or dorsum or shape of the nose; reduce and change the angle of the nostrils, nose and upper lip, etc. Rhinoplasty can also correct some congenital or post-traumatic deformities. The treatment method is: make an incision above the nasal vestibule or the lateral base of the nose, subconsciously separate the nasal margin, separate a cavity between the skin of the external nose and the skin of the vestibule to accommodate the implant, cut an elliptical or rectangular cartilage above the lateral foot of the nasal cartilage, implant it into the cavity separated from the upper shrunken nose, fix the graft in a mattress style and leave the line downward traction, and fix it with adhesive tape on the upper lip. The nasal hypertrophy is mostly seen in yellow and black races, and the nasal hypertrophy is often accompanied by nasal sagging. Contraindications: 1, nasal reduction within two weeks before the surgery, nasal correction patients do not take drugs containing aspirin, aspirin will make the platelet coagulation function is reduced. 2, patients with high blood pressure and diabetes should inform the nasal correction surgeon of their condition during the initial consultation, so that the doctor can confirm the nasal correction program. 3, nasal reduction should be sure that the patient is in good health, no infectious diseases or other body inflammation. 4, nasal reduction before surgery do not wear makeup. 5, female nasal reduction patients should avoid menstruation. 6, male nasal reduction patients should quit smoking one week in advance. Six, the nasal column deformity nasal column deformity requires surgery to correct: 1, nasal column defect. The repair method of the nasal column plastic parts is to make an I-shaped incision at the tip of the nasal septum and the base of the nasal column, separate the skin mucosal flap, fully loosen the scar, increase the contact surface of the recipient area, according to the size of the defective trauma, cut the skin fat composite tissue below the ear wheel or the earlobe, the auricular composite tissue surface slightly dissected to increase the height. 2, nasal small column inversion. Deformed nasal column plastic surgery can use the nasal septum cartilage or auricular cavity cartilage curl transplantation to fill the nasal column. If the nasal column is sunken and the nasal tip is low, autologous bone or substitutes can be used to form an L-shape to correct the above two deformities. If the septum is tight, a relaxation incision of the nasal septum is feasible, the upper tissue is slid downward and the nasal spine is partially chiseled away to relax the lower septum tissue, while a nasal septal cartilage is implanted. 3, the nasal small column is too low. This deformity nasal column plastic commonly used methods are V-Y molding method, as well as local flap method. It is possible to change the nasal deficiency limit. 4, if the nasal column is too wide and too short. It is only necessary to remove the excess tissue of the crescent at the inner edge of the anterior nostril. When the nasal column is too wide, the deformed nasal column plastic surgery only need to remove the excess tissue in the inner edge of the nostril will be crescent-shaped. When the nasal column is short and wide, you can do a pike excision, but also both sides of the medial foot of the nasal cartilage pulled together and sutured, so that the width of the nasal column is reduced, while increasing the height of the nasal column. 5.Prolapse of nasal column can be done by removing the whole septum tissue and lifting the nasal column, or by removing part of the skin and soft tissues through the nasal column edge incision. 6.Nasal column deviation. The deviation of the nasal column is often accompanied by the deformity of the nasal tip of the anterior nostril and even the nasal wing, which requires comprehensive treatment. While correcting the nasal column, it is also necessary to correct the position of the nasal tip, the symmetry of the nostrils and the balance of the entire lower part of the nose. VII. Total nasal defect Total nasal defect can be due to congenital or acquired causes. Congenital partial or total nasal defects are rare or uncommon deformities. Acquired nasal defects are more common, mostly due to trauma, burns, frostbite, infection, or after tumor removal. If the defect is more serious, not only does it damage the appearance, but also the cold wind blows in winter, directly into the throat, easy to catch respiratory tract infection, and affects the voice because of poor nasal resonance. If the nose is completely missing, the pear-shaped hole is exposed and directly communicates with the outside world. The repair of total nasal defects is called nasal reconstruction, which includes the repair of three main components: lining, external skin and scaffold. Clinically, frontal flaps, ductal and forearm ductal flaps, and free flaps with anastomosed vessels are commonly used for total nasal reconstruction. Despite the difficulty of the procedure, plastic surgeons are confident that good results will be obtained. Treatment principles: 1, the whole nose reconstruction methods are more, should be selected according to the specific circumstances of the patient suitable methods. 2, the cavity has a chronic inflammatory disease must be treated first. 3.Insufficient height of the nasal bridge can be implanted with cartilage or bone material, etc. 4.Prevent nostril contraction after surgery.