Dyer Wallace K
Buckhead Facial Plastic Surgery, 1218 West Paces Ferry Road, Suite 108, Atlanta, GA 30327, USA.
Facial Plast Surg Clin North Am. 2004 Feb;12(1):1-13. doi: 10.1016/j.fsc.2003.12.001.
As noted by Drs. Johnson and Toriumi, "The keyto successful rhinoplasty lies in the restructuring of the lower third of the nose. The modified skeletal elements must have both proper form and sufficient skeletal strength to give shape to the overlying skin-soft tissue envelope. A skeleton that lacks this load-bearing integrity becomes distorted or collapses under the weight of overlying tissues and the forces of scar contracture" [6]. All facial plastic surgeons have seen (or caused)a weakened nasal tip and have been frustrated at attempts to correct the resultant aesthetic and functional deformities. In a well-reasoned plea for surgical conservatism Dr. Tardy states that "Tip cartilage reorientation and repositioning often produce more favorable and predictable appearances. Notching, pinching, cephalicalar retraction, over-rotation, asymmetries, and tip support loss are all almost entirely eliminated in long-term healing when this conservative philosophy is embraced" [3]. Though conservation of surgical injury will certainly improve rhinoplasty results, a midline tensegrity rebuild using the time-honored surgical technique of layered wound closure will provide the maximum level of surgical control presently available overnasal tip modification. The basic knowledge of architecture and engineering presented here, along with the application of these concepts to nasal tip support,will benefit all of our patients through improvement of surgical results. As surgical architect/engineers we should all em-brace the concept that "The resistant virtue of the(nasal tip) structure that we seek depends on its (architectural) form; it is through its form that it is stable,not because of an awkward accumulation of material. There is nothing more noble and elegant from an intellectual viewpoint than this: to resist through form" [12].
“鼻整形手术成功的关键在于鼻下部三分之一的结构重塑。经过改良的骨骼结构必须具备恰当的形态和足够的骨骼强度，以便塑造覆盖其上的皮肤软组织包膜。一个缺乏这种承重完整性的骨架，会在覆盖组织的重量和瘢痕挛缩力的作用下变形或塌陷”[6]。所有面部整形医生都见过（或导致过）鼻尖薄弱的情况，并且在试图纠正由此产生的美学和功能畸形时感到沮丧。塔尔迪博士在一篇关于手术保守主义的合理呼吁中指出：“鼻尖软骨的重新定向和重新定位往往能产生更有利且可预测的外观。当采用这种保守理念时，切口凹陷、捏鼻感、鼻尖鼻翼退缩、过度上旋、不对称以及鼻尖支撑力丧失等问题，在长期愈合过程中几乎都能完全消除”[3]。虽然减少手术创伤肯定会改善鼻整形手术的效果，但运用历史悠久的分层伤口闭合手术技术进行中线张拉整体重建，将为目前可用的鼻尖塑形手术提供最大程度的手术控制。这里介绍的建筑和工程基础知识，以及这些概念在鼻尖支撑方面的应用，将通过改善手术效果使我们所有的患者受益。作为手术建筑师/工程师，我们都应该接受这样一个理念：“我们所追求的（鼻尖）结构的抗力特性取决于其（建筑）形态；它因其形态而稳定，并非因为材料的笨拙堆积。从智力层面来看，没有什么比这更崇高、更优雅的了：通过形态来抵抗”[12]。
