From private practice.
Plast Reconstr Surg. 2020 Feb;145(2):378-389. doi: 10.1097/PRS.0000000000006523.
The current literature on rhinoplasty focuses mainly on the nasal profile (sagittal plane); however, the nose is a three-dimensional structure, and alignment of the nose in consideration of other aspects is important to achieve an aesthetic result. The author aimed to introduce the fix down concept, which includes fix down technique and the adjunct maneuvers for achieving alignment of the nose in three anatomical planes and improving the results of rhinoplasty in terms of symmetry.
Between March of 2017 and December of 2017, a total of 102 patients (78 women and 24 men), 13 revision and 89 primary cases, underwent septorhinoplasty with the fix down concept. The noses were evaluated in coronal, sagittal, and axial planes and classified according to their deformities.
The functional and aesthetic results were satisfactory for the patients, examiners, and surgeon. No revisions were necessary during the follow-up period. In addition to the fix down technique, ethmoid bone grafting (16 patients), fix up technique (eight patients), dissection of the levator labii superioris alaeque nasi muscle (14 patients), plication of this muscle (four patients), superior-based transposition flap (39 patients), rim grafts (17 patients), mucosa grafts (12 patients), double-layer grafts (nine patients), maxillary deepening (five patients), maxillary augmentation with cartilage/bone grafts (21 patients), and supratip onlay grafts (seven patients) were used as adjunctive maneuvers to achieve symmetry in the frontal, base, and profile views.
The presented fix down concept will help to provide three-dimensional symmetric noses for rhinosurgeons.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
目前的鼻整形术文献主要集中在鼻轮廓（矢状面）上；然而，鼻子是一个三维结构，考虑到其他方面的鼻子对齐对于达到美学效果很重要。作者旨在介绍固定下概念，其中包括固定下技术和辅助操作，以实现三个解剖平面的鼻子对齐，并改善鼻整形术的结果，提高对称性。
在 2017 年 3 月至 2017 年 12 月期间，共有 102 名患者（78 名女性和 24 名男性），13 例修复和 89 例初次病例，接受了带有固定下概念的鼻中隔成形术。对鼻子进行冠状面、矢状面和轴面评估，并根据其畸形进行分类。
患者、检查者和外科医生对功能和美学结果均满意。在随访期间，无需进行任何修订。除了固定下技术外，还使用了筛骨骨移植（16 例）、固定上技术（8 例）、解剖上唇提肌（14 例）、肌肉折叠（4 例）、上蒂转位皮瓣（39 例）、边缘移植物（17 例）、黏膜移植物（12 例）、双层移植物（9 例）、上颌骨加深（5 例）、用软骨/骨移植物进行上颌骨增大（21 例）和鼻尖上置移植物（7 例）作为辅助操作，以实现正面、基底和轮廓视图的对称性。
所提出的固定下概念将有助于为鼻整形医师提供三维对称的鼻子。
临床问题/证据水平：治疗，IV。
