Dr. Dean Toriumi Refines His Secondary Rhinoplasty Technique to Better Match What Patients Want

    MARINA DEL REY, CA, January 10, 2010 /24-7PressRelease/ -- "Patients who undergo secondary rhinoplasty are in an extremely delicate situation, even moreso than when they undergo a primary rhinoplasty," says Dr. Dean Toriumi, a facial plastic surgeon at the University of Illinois at Chicago who specializes in secondary rhinoplasty.

"Secondary rhinoplasty patients have undergone a previously unsuccessful rhinoplasty. Many have an aesthetic problem as well as a functional problem. Everything about a secondary rhinoplasty is more complex, and patients require and deserve an even greater degree of sensitivity and conformity to their wishes as a result."

Rhinoplasty in general is a highly complex operation. In primary rhinoplasty, the anatomy of the nose is usually predictable. In secondary rhinoplasty, however, because the patient underwent a previous operation, the anatomy is exponentially more complex and variable, Toriumi said.

"This requires a different approach than in primary rhinoplasty. In secondary rhinoplasty, the surgeon must adapt to the findings at the time of surgery and develop a surgical plan 'on the go,' so to speak. That is why secondary rhinoplasty is usually performed by surgeons with extensive experience in rhinoplasty."

Toriumi, an internationally recognized surgeon who performs more than 200 rhinoplasties per year, has been performing the procedure for two decades. Over the years, he says, he has changed dramatically his approach to the operation.

"In the early years, I performed a less complicated operation using less extensive cartilage grafting. During the first ten years of my practice, I used primarily ear cartilage for secondary rhinoplasty cases and noted nice improvements in the patient's nasal contour. But the longer term outcomes were less favorable, showing some signs of pinching and collapse with compromise of nasal function."

The primary problem, Toriumi notes, was the recurrent issue of too little cartilage to support and contour the nose. He said he noticed that the areas where cartilage was deficient frequently left problems postoperatively. As a result, he adapted his protocol to use rib (costal) cartilage more frequently. Using costal cartilage, he said, provides more than enough high-quality, strong grafting material.

"A problem with costal cartilage grafting is that there is a tendency to make the cartilage grafts bigger and wider to prevent warping or bending of the cartilage. This can result in larger and wider noses," Toriumi said. More recently, to address this problem, Toriumi has refined a technique of using the costal cartilage that allows making very thin grafts without increasing the chance of warping or bending. He now also makes a 1.5 cm incision in the chest and uses less dissection to minimize postoperative pain.

"Another evolution I've made over the years incorporates intraoperative measurement techniques that help insure that the nasal structures are built to the proper size and shape," Toriumi said. "I make close to one hundred measurements at the time of surgery to insure proper sizing of the grafts," he said, noting that he measures cartilage grafts in width, thickness, and length and these measurements can be compared to norms for the specific anatomy noted at the time of surgery.

"For example, the width of the nose is measured at the outset of the operation and again during the surgery. This insures that the width of the nose is appropriate. Nasal tip projection, rotation, and length are also measured at the beginning of surgery and during the operation to make sure these parameters are set properly."

The photograph shown below shows an intraoperative measurement of the middle nasal vault width using a caliper measuring instrument. This intraoperative measurement helps to insure that the nasal width is appropriate.

For more information, please contact Dr. Dean Toriumi, MD
(312) 255-8812

60 East Delaware Place, Suite 1460
Chicago, IL 60611

email: [email protected]

Or visit us at http://deantoriumi.com/.

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