AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 12

septum is straightened, and the outside of the nose may also be changed in form through various surgical maneuvers. The most common procedure is straightening the septum (septoplasty) , which is performed through the nostrils and entails realign- ment of the septum into the midline. Changing the external contour of the nose is called rhinoplasty . The most important part of rhinoplasty is main- taining or improving the airway, so a septoplasty is often performed in conjunction with this proce- dure. Common indications for rhinoplasty include previous trauma, with a resulting crooked nose as well as a dorsal hump. Many patients undergo rhinoplasty to achieve better proportion between the size of their nose and their face, or to improve the shape of the tip alone in an otherwise attrac- tive nose. Rhinoplasty can be accomplished using incisions that are entirely inside the nose (closed) or combined with a small incision across the colu- mella (open) for improved access for placing grafts and sutures. Facial Rejuvenation Rhytidectomy Rhytidectomy or “facelift” is a much more common procedure than in the past. There are many variations in technique, but most involve an incision hidden around the ear, with undermining of the skin and tightening of the muscle and tissue layers underneath. This is commonly combined with other procedures for more thorough facial rejuvenation (Figures 12.3 a, b). Blepharoplasty Blepharoplasty is often performed by otolaryngol- ogists who perform facial plastic surgery. When the upper eyelid skin becomes redundant, it can actually obstruct the upper and lateral fields of vision. When this is the case, the excessive skin

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Figures 12.3 a, b. Pre- and postop photographs of a woman who has undergone facial rejuvenation. She has had surgery to her eyelids (blepharoplasties), removal of fat from her neck (liposuction), and resection of excessive facial skin (facelift). Improvement in facial appearance is often dramatic (as in this case), and secondary benefits through enhancement of self-esteem may be even more dramatic.

can be removed to allow better vision. While this is the main functional benefit of a blepharoplasty, patients often also desire some cosmetic

Primary Care Otolaryngology