Pietro Palma, Iman Khodaei, Irina Vasilenko
The Milan Face Clinic, Milan, Italy.
Department of Ear, Nose & Throat, Chesterfield Royal Hospital, Chesterfield, United Kingdom.
Facial Plast Surg. 2016 Dec;32(6):587-598. doi: 10.1055/s-0036-1597146. Epub 2016 Dec 29.
Numerous beautiful rhinoplasty results have been created by closed rhinoplasty techniques over the past 100 years. This operation was mainly a "reduction" surgery. Overaggressive reduction rhinoplasty is not a hallmark of the closed approach per se, but represents the result of inappropriate aesthetic appraisal, inadequate technical execution, or lack of sound anatomical understanding. Clearly, an operation based primarily on reduction intrinsically exposes the surgeon to the possibility of excessive diminution of support structures and consequently undesirable side effects. The advent of the external approach in the 1970s marked a paradigm shift. In the early 1990s, the external approach witnessed further development with the introduction of "structural rhinoplasty," a deconstruction procedure followed by structural reconstruction. Opponents of the external approach felt that opening every nose can result in an overkill, specifically because the vast majority of patients presenting for cosmetic rhinoplasty neither desire nor require major reconstruction of the nose. In the last decade, the poorly named "closed" approach, once the pariah of rhinoplasty, has been rethought especially in the light of the undesirable long-term side effects, reappraised, and found a new lease of life as "endonasal rhinoplasty." The personal surgical evolution of the senior author (P. P.) has created the concept of "hybrid endonasal rhinoplasty" (HER), where the term "hybrid" implies the incorporation of anatomical concepts and sophisticated suturing-grafting techniques developed by "openers" into the theoretical and technical corpus of HER. The senior author (P. P.) pondered over heterogenous concepts such as filling-reshaping, derived from the so-called medical rhinoplasty, and embodied these concepts into a purely surgical endonasal perspective. Consequently, aesthetic rhinoplasty can be considered a "surface-contour" operation. Nasal analysis, preoperative work-up, surgical logic, and operative techniques have been rethought. The patient is only interested in nasal appearance, not in its anatomy, so deconstructing the nose to change the subtle and demanding interplay of light and shadow is in many cases an overkill. Our emphasis should be on those structures that can be tackled and result in the ultimate aim of altering the aesthetic aspects of surface anatomy. Surface HER can deliver on all these counts.
在过去的100年里，闭合式鼻整形技术创造了众多出色的鼻整形效果。这种手术主要是一种“缩小”手术。过度激进的缩小性鼻整形本身并非闭合式手术方法的特点，而是审美评估不当、技术操作不充分或缺乏扎实解剖学理解的结果。显然，主要基于缩小的手术本质上使外科医生面临支撑结构过度减少以及随之而来不良副作用的可能性。20世纪70年代开放式手术方法的出现标志着一种范式转变。在20世纪90年代初，随着“结构性鼻整形”的引入，开放式手术方法得到了进一步发展，这是一种解构手术，随后进行结构重建。开放式手术方法的反对者认为，对每个鼻子都进行开放可能会做得过头，特别是因为绝大多数接受美容性鼻整形的患者既不希望也不需要对鼻子进行重大重建。在过去十年中，曾经被视为鼻整形禁忌的名称不当的“闭合式”手术方法，特别是鉴于不良的长期副作用，得到了重新思考、重新评估，并以“鼻内镜下鼻整形”的形式获得了新的生机。资深作者（P.P.）个人的手术演变创造了“混合鼻内镜下鼻整形”（HER）的概念，其中“混合”一词意味着将“开放式手术者”开发的解剖学概念和复杂的缝合 - 移植技术纳入HER的理论和技术体系。资深作者（P.P.）思考了诸如填充 - 重塑等源自所谓医学鼻整形的不同概念，并将这些概念融入纯粹的鼻内镜下手术视角。因此，美容性鼻整形可被视为一种“表面轮廓”手术。鼻分析、术前检查、手术逻辑和手术技术都得到了重新思考。患者只关心鼻子的外观，而不是其解剖结构，所以在许多情况下，解构鼻子以改变光线和阴影的微妙且要求苛刻的相互作用是一种过度行为。我们的重点应该放在那些可以处理并实现改变表面解剖学美学方面这一最终目标的结构上。表面HER在所有这些方面都能做到。
