Becker Rhinoplasty Center
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DR BECKER IS NOW TREATING RHINOPLASTY PATIENTS BY TELEHEALTH.

During the COVID-19 state of emergency, in order to protect our patients and staff, but in order to communicate with patients and plan for the future, Dr Becker will communicate with potential rhinoplasty patients by Telehealth. Telehealth appointments may be scheduled on the phone (our operators our working remotely). Visits will be performed by audio or video discussion.

Becker Rhinoplasty Center
Central New Jersey
609-436-5740
Southern New Jersey
856-772-1617
CONTACT US
CENTRALNew Jersey
SouthernNew Jersey
EMAIL
  • Meet the Doctor
  • Procedures
    • Rhinoplasty
    • Revision Rhinoplasty
  • Photos
    • Bulbous Tip
    • Droopy Nose
    • Ethnic Rhinoplasty
    • Finesse Rhinoplasty
    • Nasal Bump
    • Nasal Fracture
    • Narrow Nose
    • Overprojected
    • Revision Rhinoplasty
    • Saddle Nose
    • Twisted Nose
    • Underprojected
    • Unique Issues
    • Upturned Nose
    • Wide Nose
  • Testimonials
    • Patient Reviews
    • Testimonial Videos
  • Videos
    • Testimonial Videos
    • Educational Videos
  • Patient Education
    • Nose Form & Function
    • A Patient’s Guide
    • Books & Publications
    • Revision Rhinoplasty Textbook
    • Rhinoplasty Education
    • Rhinoplasty Dissection Manual
  • Locations
    • Sewell Office
    • Voorhees Office

Appendix G – Selected Complications of Rhinoplasty

Bossae: A knuckling of lower lateral cartilage at the nasal tip caused by contractural healing forces acting on weakened cartilages. Patients with thin skin, strong cartilages, and nasal-tip bifidity are especially at risk. Excessive resection of lateral crux and failure to eliminate excessive interdomal width may play some role in bossae formation.

Polly beak: Postoperative fullness of the supratip, with an abnormal tip-supratip relation. This has several etiologies: Failure to maintain adequate tip support (postoperative loss of tip projection), inadequate cartilaginous hump (anterior septal angle) removal, and/or supratip dead space/scar formation.

Treaent depends on anatomic cause. If the cartilaginous hump was underresected, then resect additional dorsal septum. One also must ensure adequate tip support. Ma neuvers such as placement of a columellar strut may be of benefit. If the bony hump was overresected, consider a graft to augment the bony dorsum. If a polly-beak is from excessive scar formation, consider triamcinolone (Kenalog) injection or skin taping in the early postoperative period, before any consideration of surgical revision.

Inverted V deformity: Inadequate support of the upper lateral cartilages after dorsal-hump removal can lead to inferomedial collapse of the upper lateral cartilages and an inverted V deformity. In this deformity, the caudal edges of the nasal bones are visible in broad relief. Inadequate infracture of the nasal bones is also a frequent cause. When executing hump excision, it is helpful to preserve the underlying nasal mucoperichondrium (extramucosal dissection), which provides significant support to the upper lateral cartilages and helps decrease the risk of inferomedial collapse of the upper lateral cartilages after hump excision. When undertaking osteotomies after hump excision, appropriate infracture and narrowing of the bony vault must be achieved.

Rocker deformity: If osteotomies are taken too high, into the thick frontal bone, the supe rior aspect of the osteotomized nasal bone may project or rock laterally when the bone is infractured. This is a rocker deformity. A 2-mm osteotome may be used percutaneously to create a more appropriate superior fracture line and correct the rocker deformity.

Dorsal irregularities: After creation of an open roof by hump removal, the bony mar-gins should be smoothed with a rasp. Any bony fragments should be removed, making sure that all obvious particles are removed from under the skin/soft-tissue envelope. Fail ure to remove all fragments may lead to a visible and/or palpable dorsal irregularity.

Nasal valve collapse: The surgeon should recognize the existence of the internal and external nasal valve. The internal nasal valve area is bounded by the caudal margin of the upper lateral cartilage, septum, and floor of the nose. The external nasal valve refers to the area delineated by the cutaneous and skeletal support of the mobile alar wall. Exces sive narrowness in either of these locations may cause nasal obstruction. Weakness at ei ther of these locations may result in collapse with the negative pressure of inspiration, resulting in nasal airway obstruction. Nasal valve collapse is seen most often as a sequela of overresection of lateral crura or middle vault collapse. Overaggressive resection of the lateral crura and the subsequent postoperative soft-tissue contraction frequently leads to nasal valve compromise.

REFERENCES

  1. Simons RL, Gallo IF. Rhinoplasty complications. Facial Plast Surg Clirr North Am 1994:2:521-529.
  2. Kamer FM, Pieper PG. Revision rhinoplasty. In: Bailey B, ed. Head and Neck Surgery Otolaryngology. Philadelphia : Lippincott, 1998:2663-2676.
  3. Tardy ME, Kron TK, Younger RY, Key M. The cartilaginous pollybeak: etiology, prevention, and treaent. Facial Plast Surg 1989:6:113-120.
  4. Larrabee WF Jr. Open rhinoplasty and the upper third of the nose. Facial Mast Surg C/in North Am 1993;1: 23-38.
  5. Toriumi DM. Management of the middle nasal vault. Opel- Tech Plast Recoostr Surg 1995;2:16-30.
  6. Becker DG, Toriumi DM, Gross CW, Tardy ME. Powered instrumentation for dorsal nasal reduction. Facial Plast Surg 1997;13:291-297.

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"Dr. Daniel Becker is the sweetest most caring person. It’s almost a year since I had a really bad nose bleeds and he was there for us, came to hospital in the snow on a Sunday just to fix me. He is so very special and always there when you need him. Love him!!!"

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