Minimally invasive techniques in rhinoplasty

Area of Science:

• Plastic Surgery
• Surgical Innovation
• Facial Anatomy

Background:

• Rhinoplasty involves significant tissue manipulation of both soft and skeletal nasal structures.
• Surgical trauma can occur through various mechanisms including mechanical forces and thermal injury.
• Assessing the minimally invasive nature of rhinoplasty techniques requires evaluating the extent of the approach and tissue dissection.

Purpose of the Study:

• To define criteria for minimally invasive surgery in rhinoplasty.
• To analyze current rhinoplasty techniques based on their minimally invasive characteristics.
• To identify techniques that best align with minimally invasive surgical principles.

Main Methods:

• Review of recent publications on rhinoplasty techniques.
• Analysis of surgical approaches, dissection planes, and osteotomy methods.
• Evaluation of endoscopic applications in rhinoplasty.

Main Results:

• Nasal structure comprises approximately 60% soft tissue and 40% skeletal elements.
• Techniques like single-incision endonasal approaches, specific dissection planes (subperichondrial, subperiosteal), and limited undermining with endoscopic visualization were identified.
• Various osteotomy methods (percutaneous, piezo, drill) and contouring techniques were assessed for their minimally invasive potential.

Conclusions:

• A single endonasal incision approach is optimal for minimally invasive rhinoplasty.
• Specific dissection planes and advanced osteotomy techniques (piezo, percutaneous) best fulfill minimally invasive criteria.
• A proposed classification system can guide the assessment of minimally invasive rhinoplasty techniques.