title: Superior rhinoplasty outcomes with precise nasal osteotomy: an individualized approach for maintaining function and achieving aesthetic goals.
abstract: BACKGROUND
  Although frequently performed in rhinoplasty, nasal osteotomies have been unpredictable in consistently controlling postoperative alterations in bony morphology in many patients. Consequently, a detailed algorithm for an individualized approach to osteotomy is needed to achieve superior aesthetic and functional outcomes.
  
  
  OBJECTIVE
  The authors aimed to propose a component-oriented and individualized approach for nasal osteotomy in rhinoplasty.
  
  
  METHODS
  Clinical outcomes were reviewed for 150 consecutive patients who underwent rhinoplasty. Type and frequency of specific osteotomy procedures and preoperative and postoperative photographs were examined.
  
  
  RESULTS
  A total of 97 cases with at least 12 months of follow-up data were evaluated. In 92 of 97 patients (95%), a lateralized medial oblique osteotomy was performed; 70 (72%) required bilateral intermediate osteotomy, and 21 (22%) required unilateral osteotomy. Forty-one patients (42%) underwent bilateral base osteotomy and 24 (25%) underwent unilateral base osteotomy. No base osteotomy was performed in 32 patients (33%) who had aesthetically pleasing lateral wall width and no convexity of the posterior portion of the lateral bony wall.
  
  
  CONCLUSIONS
  The osteocartilaginous vault is asymmetric in the majority of patients undergoing rhinoplasty. Anatomic variations in the height, length, and/or width of the bony vault can significantly influence its shape and symmetry. Various principles and techniques for nasal osteotomy increase predictability of outcomes while improving nasal aesthetics and function. LEVEL OF EVIDENCE 4: Therapeutic.
authors.affiliation: Dr Ghanaatpisheh is a plastic surgeon in private practice in Tehran, Iran. Drs Sajjadian and Daniel are plastic surgeons in private practice in Newport Beach, CA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ghanaatpisheh
authors.affiliation: Dr Ghanaatpisheh is a plastic surgeon in private practice in Tehran, Iran. Drs Sajjadian and Daniel are plastic surgeons in private practice in Newport Beach, CA.
authors.forename: Ali
authors.initials: A
authors.lastname: Sajjadian
authors.affiliation: Dr Ghanaatpisheh is a plastic surgeon in private practice in Tehran, Iran. Drs Sajjadian and Daniel are plastic surgeons in private practice in Newport Beach, CA.
authors.forename: Rollin K
authors.initials: RK
authors.lastname: Daniel
mesh_terms: D000293:Adolescent; D000328:Adult; D004954:Esthetics; D005146:Facial Asymmetry / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009295:Nasal Bone / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D012225:Rhinoplasty / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult