Triple plane dissection in open primary rhinoplasty in middle eastern noses

Area of Science:

• Plastic Surgery
• Facial Plastic Surgery
• Otolaryngology

Background:

• Open rhinoplasty offers precise visualization and manipulation of the nasal cartilaginous skeleton.
• Dissection planes in open rhinoplasty include subcutaneous, submuscular (under the superficial musculoaponeurotic system), and subperiosteal, each with unique benefits and drawbacks.

Purpose of the Study:

• To evaluate a combined triple plane dissection technique in open primary rhinoplasty.
• To maximize the advantages and minimize the disadvantages of individual dissection planes.

Main Methods:

• The study involved 38 Middle Eastern patients (23 female, 15 male) undergoing primary rhinoplasty.
• Patients were stratified into 5 groups based on skin thickness.
• A sequential dissection approach was employed: subcutaneous over lower lateral cartilages, sub-superficial musculoaponeurotic system over upper lateral cartilages, and subperiosteal over the bony skeleton.

Main Results:

• The triple plane dissection yielded acceptable cosmetic results without complications.
• Subcutaneous dissection effectively thinned thick skin in the tip and alar regions.
• Sub-superficial musculoaponeurotic system dissection provided direct exposure of upper lateral cartilages without compromising thin skin.
• Subperiosteal dissection concealed bony irregularities post-osteotomy.

Conclusions:

• The triple plane dissection technique is safe and effective for open primary rhinoplasty in Middle Eastern patients.
• This combined approach optimizes surgical outcomes by leveraging the benefits of each dissection plane.
• The technique results in favorable cosmetic results with minimized risks.