Tip Bossing in Rhinoplasty Workup

  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Nov 29, 2011
 

Laboratory Studies

  • CBC count
  • Prothrombin time (PT)
  • Activated partial thromboplastin time (aPTT)
  • International normalized ratio (INR)
  • Chem-7 battery of tests
  • Any additional labs needed per history
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Imaging Studies

  • Chest radiograph
  • Preoperative photographs to document the following:
    • Frontal view
      • Brow-tip aesthetic line
      • Upper one third of nose (width, symmetry, concavity/convexity)
      • Tip-defining point
      • Location and size of asymmetry
      • Lobule dimension
    • Lateral view
      • Nasal take-off point
      • Nasofrontal angle
      • The presence of convexity or concavity
      • Projection (in Goode's ratio, projection is 0.55-0.6 of nasal length)
      • 2-4 mm columellar skin
      • Pogonion
      • Comment about asymmetry of tip
    • Basal view
      • Shape
      • Columella-to-lobule ratio
      • Nasal sidewalls
      • Nostril size
      • Asymmetry of lobule
      • Medial footplates
    • Oblique view - Confirms other findings
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Other Tests

  • ECG (if patient smokes regularly, has hypertension, or has other cardiac history)
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Contributor Information and Disclosures
Author

Aaron G Benson, MD  Clinical Adjunct Professor, Division of Neurotology, Department of Otolaryngology Head and Neck Surgery, University of Michigan; Consulting Staff, Toledo Ear, Nose and Throat, Inc

Aaron G Benson, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Ali Sepehr, MD  Staff Physician, Department of Otolaryngology, Head and Neck Surgery, University of California, Irvine

Ali Sepehr, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physicians, American Medical Association, California Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Hamid R Djalilian, MD  Associate Professor of Otolaryngology, Director of Neurotology and Skull Base Surgery, University of California Irvine Medical Center

Hamid R Djalilian, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Neurotology Society, American Society of Gene Therapy, Association for Research in Otolaryngology, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Mind:Set Technologies Ownership interest Other

Daniel G Danahey, MD, PhD  Consulting Staff, Department of Otolaryngology, DuPage Medical Group

Daniel G Danahey, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, and Sigma Xi

Disclosure: Nothing to disclose.

Peter Hilger, MD  Professor, Department of Otolaryngology, University of Minnesota Medical School

Peter Hilger, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and Minnesota Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

S Valentine Fernandes, MBBS, MCPS, FRCSEd, FRACS, FACS, LLB  Conjoint Senior Clinical Lecturer, Department of Otorhinolaryngology, Newcastle University; Senior Consultant Surgeon, Department of Otorhinolaryngology-Head and Neck Surgery, John Hunter, Warners Bay Private Hospitals, Australia

S Valentine Fernandes, MBBS, MCPS, FRCSEd, FRACS, FACS, LLB is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Dean Toriumi, MD  Associate Professor, Department of Otolaryngology, University of Illinois Medical Center

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Kamer FM, McQuown SA. Revision rhinoplasty. Analysis and treatment. Arch Otolaryngol Head Neck Surg. Mar 1988;114(3):257-66. [Medline].

  2. Parkes ML, Waller TS. Practical application of nasal asymmetries in rhinoplasty. Am J Cos Surg. 1988;5:37-43.

  3. Chang CW, Simons RL. Hockey-stick vertical dome division technique for overprojected and broad nasal tips. Arch Facial Plast Surg. Mar-Apr 2008;10(2):88-92. [Medline].

  4. Kridel RW, Yoon PJ, Koch RJ. Prevention and correction of nasal tip bossae in rhinoplasty. Arch Facial Plast Surg. Sep-Oct 2003;5(5):416-22. [Medline].

  5. Daniel R. Nasal bossae. Arch Facial Plast Surg. Sep-Oct 2003;5(5):424-6. [Medline].

  6. Adamson PA. Refinement of the nasal tip. Facial Plast Surg. Winter 1988;5(2):115-34. [Medline].

  7. Allen BC, Rhee JS. Complications associated with isotretinoin use after rhinoplasty. Aesthetic Plast Surg. Mar-Apr 2005;29(2):102-6. [Medline].

  8. Cohen S. Complications following rhinoplasty. Plast Reconstr Surg. 1956;18:213-227.

  9. Gillman GS, Simons RL, Lee DJ. Nasal tip bossae in rhinoplasty. Etiology, predisposing factors, and management techniques. Arch Facial Plast Surg. Apr-Jun 1999;1(2):83-9. [Medline].

  10. Goodwin WJ Jr, Schmidt JF. Iatrogenic nasal tip bossae. Etiology, prevention, and treatment. Arch Otolaryngol Head Neck Surg. Jul 1987;113(7):737-9. [Medline].

  11. Holt GR, Garner ET, McLarey D. Postoperative sequelae and complications of rhinoplasty. Otolaryngol Clin North Am. Nov 1987;20(4):853-76. [Medline].

  12. Kamer FM, Churukian MM, Hansen L. The nasal bossa: a complication of rhinoplasty. Laryngoscope. Mar 1986;96(3):303-7. [Medline].

  13. Klabunde EH, Falces E. Incidence of complications in cosmetic rhinoplasties. Plast Reconstr Surg. Aug 1964;34:192-6. [Medline].

  14. McCollough EG. Surgery of the nasal tip. Otolaryngol Clin North Am. Nov 1987;20(4):769-84. [Medline].

  15. Rees TD. Postoperative considerations and complications. In: Aesthetic Plastic Surgery. Rees TD, ed. Philadelphia, Pa: WB Saunders Co; 1980:337-386.

  16. Steiss CF. Errors in rhinoplasty and their prevention. Plast Reconstr Surg Transplant Bull. Sep 1961;28:276-8. [Medline].

  17. Thomas JR, Tardy ME. Complications of rhinoplasty. In: Johns ME, ed. Complications of Head and Neck Surgery. Philadelphia, Pa: BC Decker; 1986:269-270.

  18. Wise JB, Becker SS, Sparano A, et al. Intermediate crural overlay in rhinoplasty: a deprojection technique that shortens the medial leg of the tripod without lengthening the nose. Arch Facial Plast Surg. Jul-Aug 2006;8(4):240-4. [Medline].

 
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Unilateral nasal tip bossing.
An open excision of a nasal boss.
 
 
 
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