Use of Lacrimal Retractor in Rhinoplasty: A Boon for the Solo Rhinoplasty Surgeon

Open rhinoplasty is a complex procedure that requires precise exposure of multiple anatomic structures. Anatomic dissection typically proceeds from the tip cephalad to the dorsum. Although newer open rhinoplasty techniques exist, many surgeons still perform a bidirectional cartilage-splitting approach. This approach requires precise exposure of the septum while retracting the lower lateral cartilages at their midline. This retraction facilitates tip and dorsum dissection and allows adequate visualization of the septum for modification. Current lower lateral cartilage retraction techniques require either surgical assistants to hold hooks or clamps, or the solo surgeon to use weighted hooks or clamps that are simply allowed to fall laterally, thus providing exposure. Furthermore, for septal exposure, the surgeon often must use a nasal speculum in 1 hand while attempting to dissect and modify the septum with the other. In this article, the author described the technique of using a spring-loaded lacrimal retractor to facilitate dissection of the nasal tip, as well as to provide exposure for dorsal and caudal septal modification. This technique provides a constant and predictable retracting force to the midline cartilages; is atraumatic; and, most importantly, allows the operating surgeon to use both hands while performing the operation. The technical advantages of using such a device could serve as a boon to both structural and preservation rhinoplasty surgeons.