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
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CENTRALNew Jersey
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  • 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

Chapter 5 -Transcartilaginous or Cartilage-Splitting Approach

As demonstrated in the accompanying figures, use a two-prong retractor and the middle finger of the nondominant hand to expose the lower lateral cartilage (LLC).

Locate the caudal and cephalic margins of the lateral crura. (The surgeon must identify the cephalically positioned lateral crus when it is present before executing this incision.) Make an incision through vestibular skin only 5 mm to 8 mm cephalic to the caudal 4 margin of the lateral crux of the LLC incision. Figure I illustrates the site of a transcartilaginous incision and the more cephalic location of an intercartilaginous incision. With scissors, dissect free the vestibular skin in a cephalic direction to just beyond the cephalic edge of the lateral crus (Fig. 2). Then incise the lateral crural cartilage and free the cephalic portion (to be removed) from its remaining soft-tissue attachments by dissecting superficial to it in the supraperichondrial plane. Use a skin hook to retract the caudal vestibular skin and another skin hook to retract the nostril margin. An assistant may hold the skin hook that re -tracts the nostril margin, while the surgeon grasps the cartilage to be removed and completes the excision by dividing any last soft-tissue attachments with scissors (Fig. 3) (1,2).


Figure 1.
Retraction with a wide two-prong retractor and the middle finger of the nondominant hand exposes the transcartilaginous incision site and also the more cephalically located intercartilaginous incision site.

Rhinoplasty Incisions Becker Rhino
Figure 1


Figure 2.
In a cartilage-splitting approach, dissect the vestibular skin in a cephalic direction to just beyond the cephalic edge of the lateral crus. Then assess how much lateral crus should be removed, and incise the lateral crural cartilage. Be sure to leave ?7 mm to 9 mm of intact strip.

Rhinoplasty Incisions Becker Rhino
Figure 2.

Figure 3. A:

Use a skin hook to re-tract the caudal vestibular skin and the nostril margin. Free the cephalic portion (to be removed) from its remaining soft-tissue attachments by dissecting superficial to it in the supraperichondrial plane. Grasp the cartilage to be removed, and complete the excision by dividing any last soft-tissue attachments with scissors. B: The cartilage incision must come far enough medially to include the cephalic lateral crus at the dome region, or else supratip fullness may persist. However, it is important not to incise too far inferomedially, or the cartilage (which is typically narrow at this region) may be excessively weakened or divided. C: A 30-gauge needle placed percutaneously at the dome can help guide the medial aspect of the transcartilaginous incision in selected cases.

Rhinoplasty Incisions Becker Rhino
A
Rhinoplasty Incisions Becker Rhino
B
Rhinoplasty Incisions Becker Rhino
C

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REVIEWS

"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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