Comprehensive Diagnosis and Planning for the Difficult Rhinoplasty Patient: Applications in Ultrasonography and Treatment of the Soft-Tissue Envelope
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.