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Introduction: Recent developments in our understanding of facial ageing have led to a greater appreciation of the part played by dynamic wrinkles. Botulinum toxin is increasingly used to lessen hyperdynamic muscular activity and to rejuvenate the ageing face. Materials and method: A group of international experts convened to consider the literature and, in the light of their own clinical experience, discuss the optimal uses of abobotulinum toxin A (aboTA ) for myomodulation. To assist doctors, the international expert group here presents consensus guidelines for the use of AboTA in various clinical indications. Discussion: To achieve optimal results, the clinician requires a detailed understanding of facial anatomy, correct dilution technique, injection procedure and aftercare. Conclusions: AboTA may be used to rejuvenate the face and other areas. AboTA treatment is effective, safe, and relatively easy to perform and has high patient satisfaction. Duration of action is up to 5 1/2 months. [ABSTRACT FROM AUTHOR]

Background: The dorsal roof flap (DRF) technique was developed as a modification of the retractable roof method, which is a variant of dorsal preservation (DP)., Objective: The paper aims to present new results of the DRF technique and dorsal deformity analysis created for the technique., Methods: A total of 57 primary rhinoplasty patients treated with DRF technique between 2022-2023 years were included in the study. A dorsal deformity classification based on the anticipated amount of dorsal reduction, nasal bone shape, and hump content was used. According to the classification, the noses were categorized into 3 types. All data were obtained from patient records, computed tomography views, and pre-and postoperative photographs. Aesthetic and functional results were assessed pre-and postoperatively using a visual analog scale (VAS) (0-10, 0 points means very poor)., Results: The mean follow-up period was 10.1 ± 3.9 months. 23 cases were type 1, 14 were type 2, and 20 were type 3. The anticipated amount of dorsal reduction in type 1 was 2-4 mm, 5-7 mm in type 2, and 8-10 mm in type 3 deformity. Of the total, 27 cases had a V-shaped nasal bone and 30 had an S-shaped. The hump composition was cartilaginous in 13 cases and bone and cartilage in 44 cases. Pre- and postoperative aesthetic and functional VAS scores were significantly different (p ≤ 0.001). No complications and therefore no revisions were observed during the follow-up period., Conclusion: It is a versatile method to reshape the nasal dorsum and minimize the revisions associated with dorsal preservation when used in appropriate cases., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: The large mixture of races in Brazil gives the nose its distinctive composition, which makes rhinoplasty difficult for these patients. Every patient should have their anatomy thoroughly examined on an individual basis, as there is no unique strategy that works for all situations., Methodology: This is a narrative overview of the last 10 years' worth of literature that describes the ethnic traits of each nose, with a particular emphasis on the Brazilian nose, and talks about the major surgical approaches that can be applied in these situations., Results: The low dorsum, broad nasal bones, thick skin, and bulbous tip are the primary features of the Brazilian nose. Many times, lateral osteotomies, root grafting, isotretinoin treatment for skin thickness, and neodomus formation are required., Conclusion: The Brazilian nose presents a surgical challenge that calls for the mastery of multiple procedures, not simply structured rhinoplasty. In certain cases, preservation rhinoplasty may even be used., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Summary: To achieve a more aesthetic and narrower columella, most of the required changes concern the middle and base of the columella. Narrowing and reshaping the columellar base require a sequential approach with good anatomical knowledge and aesthetics analysis. The columellar base is a three-dimensional structure that must be analyzed following three axes: transverse (thickness or width), frontal (height), and sagittal (nasolabial angle). Sutures that aim to close the distance between the medial crura footplates frequently result in modifying the nasolabial angle because of caudal protrusion of the columellar soft tissue. Methods to keep an adequate nasolabial angle are needed. A transverse columellar base stabilizing suture acting on these three axes, which enables maintenance of results after columellar base management, is described in this article., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: A deviated nose is a common problem among patients for both cosmetic and functional reasons. The correction remains a major challenge for the rhinoplasty surgeon. Unrecognized nasal septal deviations stand as the primary reason for failed rhinoplasty outcomes. There is a paucity of data in the literature about septoplasty classifications and technical details in preservation rhinoplasty (PR) for various crooked noses., Materials and Methods: The aim of this article is to provide a comprehensive overview of the various septum deviations according to the nasal axis. Moreover, a treatment algorithm is suggested with technical details based on PR principles., Results: The directions and curvature of the cartilaginous deviation of crooked nose such as C-shaped, reverse C-shaped, straight axis deviations (I-shaped), and S-shaped are described. According to the deviation, a septoplasty classification (Type 1-Type 4) is suggested., Conclusions: On the basis of septal deviation, different PR techniques are proposed to achieve the desired straight nasal dorsum with an optimal functional outcome. Compared to the classical L-strut concept, the quadrangular cartilage remains preserved in the swinging door technique. The cartilage might be further used in the future for grafting in the hybrid structural/preservation technique if needed, ultimately saving rib cartilage and/or conchal cartilage. Finally, surgery time is reduced, and patient's morbidity remains minimal., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2023. The Author(s).)

The rapid resurgence of interest in performance of dorsal preservation (DP) rhinoplasty techniques in recent years has come with scarcity of data for long-term outcomes. In this article, the authors aim to contribute to preservation rhinoplasty (PR) literature by providing long-term follow-up with dorsal preservation, specifically presenting data related to superior strip DP functional and esthetic complications, followed by a detailed analysis of the same., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: A new technique for dorsal preservation rhinoplasty that minimizes recurrent hump deformity is introduced., Objectives: The authors sought to present a novel dorsal roof flap (DRF) technique for modifying the nasal hump and dorsum while reducing morbidity., Methods: Twenty-two primary and 3 secondary rhinoplasty patients had 1 of 2 types of nasal DRF depending on hump composition. A triangular roof flap was created utilizing 2 incisions from W-point to lateral Keystone junction in cartilaginous humps (cartilaginous DRF) and to the nasion in osseocartilaginous humps (osseocartilaginous DRF). Then, septal strip excisions were conducted to lower the profile followed by nasal base narrowing. The DRF was then lowered to the desired profile line, any excess lateral wall height trimmed, and the DRF sutured to the upper lateral cartilages. Preoperative and postoperative nasolabial and nasoglabellar angles were measured on the photos., Results: Mean follow-up was 10.3 (standard deviation, 4.41) months (range, 6-20 months). A total 22 humps were V-shape and 3 were S-shape. The composition of the hump was cartilaginous in 5 cases, bone in 7 cases, and combined in 13 cases. A cartilaginous DRF was utilized for the 5 cases with a cartilaginous hump and osseocartilaginous DRF was employed in the other 20 cases. There were no complications observed in the follow-up period and thus no revisions., Conclusions: The DRF technique allows preservation of the nasal dorsum and elimination of the dorsal hump while minimizing hump recurrence., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Rhinoplasty is a challenging procedure, and the ultimate goal is not only to restore the function and youthful appearance, but also to improve the quality of life (QoL). Little is known about the QoL after preservation rhinoplasty (PR). The aim of this study was to assess patient satisfaction after PR by using a validated questionnaire., Patients and Methods: Patients undergoing primary PR were included in this prospective cohort single-centre (private) study. Overall, 58 patients (41 female and 17 male patients, mean age 32 ± 9.7 years) were operated on between 2017 and 2021. Patient assessment regarding their outcome was evaluated before surgery and at final follow-up using a validated questionnaire (Rhinoplasty Outcomes Evaluation Questionnaire = ROE). Subgroup analyses were performed between the ROE questions and radiological analysis by using the cone-beam computed tomography (CT) before surgery and at final follow-up., Results: After a mean follow-up of 19.7 ± 7.9 months (range = 1-50 months), a high overall patient satisfaction was observed (37.9 ± 9.2 vs. 81.25 ± 14.17, p < 0.0001). Subgroup analysis showed the highest improvement in nose appearance, breathing, and self-confidence after surgery. The improvement of subjective breathing (1.471 ± 0.90 vs. 3.1 ± 0.88; p<0.0001) goes in line with an overall improved internal nasal valve (INV) angle (19.88° ± 3.3° vs. 22.04° ± 4.1°, p = 0.0231)., Conclusions: Our study showed a high patient satisfaction after PR as evaluated by the ROE, which goes in line with aesthetics and function., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Preservation rhinoplasty (PR) is considered to be an innovative approach with high patient satisfaction. However, little is known about its functional outcomes and radiological analyses., Patients and Methods: In this prospective clinical study, 30 patients (20 female and 10 male patients, mean age 30.7 ±9.8 years) were operated on between 2017 and 2021. Radiological assessment was evaluated by cone beam computed tomography before surgery and at final follow-up. Patient assessment regarding their outcome was assessed at final follow-up using a validated questionnaire (rhinoplasty outcomes evaluation questionnaire = ROE)., Results: After a mean follow-up of 8.4 ± 5 months (range = 1 - 18 months), radiological analyses denoted an overall improved internal nasal valve (INV) angle after surgery (preoperative = 20.77° ± 3.2° vs. postoperative = 21.82° ± 5.7°, p = 0.18). Those results are in accordance with an overall high patient satisfaction for both function and aesthetics (ROE score 18.4 ± 4.3)., Conclusion: Our study showed a preserved and widened INV angle after PR, along with high patient satisfaction., Level of Evidence: III., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest, (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Botulinum toxin A (BoNT-A) has grown tremendously in aesthetic dermatology since 2002 when the United States Food and Drug Administration (FDA) first approved its use for treating moderate-to-severe glabellar lines. Blepharoptosis, due to local spread of toxin, is a reported side effect of BoNT-A which, although rare, more frequently occurs among inexperienced practitioners., Objectives: The purpose of this review is to highlight the causes and management of eyelid ptosis secondary to BoNT-A administration including new anatomic pathways for BoNT-A spread from the brow area to the levator palpebrae superioris muscle., Methods: A literature search was conducted using electronic databases (PubMed, Science Direct, MEDLINE, Embase, CINAHL, EBSCO) regarding eyelid anatomy and the underlying pathogenesis, presentation, prevention, and treatment of eyelid ptosis secondary to BoNT-A. Anatomic dissection has been performed to assess the role of neurovascular pedicles and supraorbital foramen anatomic variations., Results: Blepharoptosis occurs due to weakness of the levator palpebrae superioris muscle. Mean onset is 3-14 days after injection and eventually self-resolves after the paralytic effect of BoNT-A wanes. Administration of medications, such as oxymetazoline hydrochloride or apraclonidine hydrochloride eye drops, anticholinesterase agents, or transdermal BoNT-A injections to the pre-tarsal orbicularis, can at least partially reverse eyelid ptosis. Anatomic study shows that a supraorbital foramen may be present in some patients and constitutes a shortcut from the brow area directly into the orbital roof, following the supraorbital neurovascular pedicle., Conclusion: Providers should understand the anatomy and be aware of the causes and treatment for blepharoptosis when injecting BoNT-A for the reduction of facial wrinkles. Thorough anatomic knowledge of the supraorbital area and orbital roof is paramount to preventing incorrect injection into "danger zones," which increase the risk of eyelid ptosis., (© 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

The multiplication of scientific articles related to the fast-growing interest in preservation rhinoplasty (PR) may lead to confusion in the decision-making process, thus requiring a need for guidelines through a focus on benefit-risk ratio and revisions. This study analyzes a 352 consecutive primary rhinoplasties series during a 3 year (2016 to 2019) period with 1-year follow-up. The evaluation of the most appropriate procedure to the patient's nasal anatomy and expectations requires to correlate (1) a convenient classification of nasal profile lines; (2) a review of the dorsum preservation techniques (DP) classified as: full DP, DP + resurfacing, bony cartilaginous disarticulation, and finally traditional rhinoplasty; (3) the role of septoplasties, subdividing this series in two main groups; (4) analyzing the revisions in the different subgroups and to the literature. Thirty-five revisions (9.94%) were done. Correlations between profile lines, surgical procedures, and revisions show (1) 129 straight noses underwent full DP in 88 cases with 5.68% revisions; however, DP+ hump resurfacing in 32 patients with no revision. (2) Among 71 tension noses, 33 underwent full DP with 6 revisions (18.18%), while 32 patients had bony cap resurfacing, 1 revision (3.13%). (3) Among 109 kyphotic noses, 64 patients underwent DP + resurfacing with 10 revisions (15.63%); 27 patients had cartilage-only DP with two revisions (7.41%). (4) In the 43 difficult noses group, revisions were done equally in DP + resurfacing and cartilage-only subgroups. Septum stability modifies the correlations, introducing Cottle's septorhinoplasty in the paradigm. The revision rate is jumping ×2.50% when a septoplasty is associated with the rhinoplasty. Correlated to the benefit-risk ratio and the revisions, the following guidelines may be suggested in primary rhinoplasty: (1) Straight noses: full DP, (2) tension noses: DP + dorsum resurfacing and/or Cottle's variations, (3) kyphotic noses: cartilage-only DP, and (4) difficult noses: traditional rhinoplasties., Competing Interests: None., (Thieme. All rights reserved.)

Preservation rhinoplasty is a new way to reshape the nose by preserving the dorsum, nasal ligaments, soft tissue envelope, and muscles. This new concept provides the opportunity to achieve a more natural aesthetic and functional result. To achieve a good aesthetic and functional outcome while maintaining surgical safety, knowledge of the relevant anatomy is key. This is especially true for the preservation rhinoplasty technique, where a firm grasp of the anatomy of the nasal soft tissue and bony-cartilaginous framework is critical. The preservation technique is made more accessible by the open approach, which provides an opportunity for the deformity to be clearly visualized from the tip of the nose and the dorsum. Furthermore, tip plasty is easier to perform under direct vision, which is an advantage of the open approach. The goal of this article is therefore to make clear all the important anatomical structures and their relevance to the surgical steps taken when performing the open preservation rhinoplasty technique., Competing Interests: None declared., (Thieme. All rights reserved.)

Background/aim: We hypothesized that improved functional outcome after preservation rhinoplasty can be validated by radiological analyses., Patients and Methods: In this retrospective study, five patients were included. Radiological assessment was evaluated by cone-beam computed tomography. Patient satisfaction regarding nasal function was evaluated by a Likert scale from 0 to 10 (0=poor result; 10=very satisfied)., Results: After a mean follow-up of 5±1 months (range=4-6 months), significantly improved function was noted by all patients, with a mean Likert scale of 9.2±0.45 (preoperative score=2.8±0.8, p=0.0079). These results are in line with the radiological results, showing an improved internal nasal valve angle (preoperative=26.2°±1.8° vs. postoperative=32.3°±1.2°, p=0.02)., Conclusion: Our study showed that besides nasal appearance, nasal function can also be dramatically improved after preservation rhinoplasty., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Dorsal preservation rhinoplasty in cases of a convex or overprojected noses has significant advantages over resection and reconstruction of the dorsum. Analysis of the subdorsal septum in relation to the radix osteotomy to achieve a drop or hinge of the natural dorsum is important in avoiding possible complications involving the skull base, frontal sinus, and subsequent radix position. In the majority of patients, simple cut release of the perpendicular plate rather than resection superiorly may be necessary where the quadrangular cartilage junction with the perpendicular plate is caudal to the radix osteotomy. Computed tomography is helpful in delineating this position as well as providing information on the frontal sinus and position of the cribriform plate prerhinoplasty., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Published studies regarding Bichat fat pad focused, quite exclusively, on the implant of this adipose depot for different facial portions reconstruction. The regenerative components of Bichat fat pad were poorly investigated. The present study aimed to describe by an ultrastructural approach the Bichat fat pad, providing novel data at the ultrastructural and cellular level. This data sets improve the knowledge about the usefulness of the Bichat fat pad in regenerative and reconstructive surgery. Bichat fat pads were harvested form eight patients subjected to maxillofacial, dental and aesthetic surgeries. Biopsies were used for the isolation of mesenchymal cell compartment and for ultrastructural analysis. Respectively, Bichat fat pads were either digested and placed in culture for the characterization of mesenchymal stem cells (MSCs) or, were fixed in glutaraldehyde 2% and processed for transmission or scanning electron microscopy. Collected data showed very interesting features regarding the cellular composition of the Bichat fat pad and, in particular, experiments aimed to characterized the MSCs showed the presence of a sub-population of MSCs characterized by the expression of specific markers that allow to classify them as multilineage differentiating stress enduring cells.  This data set allows to collect novel information about regenerative potential of Bichat fat pad that could explain the success of its employment in reconstructive and regenerative medicine.

Management of the nasal dorsum remains a challenge in rhinoplasty surgery. Currently, the majority of reduction rhinoplasties results in destruction of the keystone area (K-area), which requires reconstruction with either spreader grafts or spreader flaps, both for aesthetic and functional reasons. This article will present the senior author's current operative technique for dorsal preservation in reduction rhinoplasty based on 320 clinical cases performed over a 5-year period. The author's operative technique is as follows: (1) endonasal approach; (2) removal of a septal strip in the subdorsal area whose shape and height were determined preoperatively; (3) complete lateral, transverse, and radix osteotomies; and (4) dorsal reduction utilizing either a push down operation (PDO) or a let down operation (LDO). The PDO consists of downward impaction of the fully mobilized nasal pyramid and is utilized in patients with smaller humps (Less than 4 mm). The LDO consists of a maxillary wedge resection and is performed in patients who need more than 4 mm of lowering. A total of 320 patients had a dorsal preservation operation (DPO). Postoperatively, there were no dorsal irregularities nor inverted-V deformities. Among our 44 personal revision cases, 27 patients (8.74%) had had a previous DPO, 16 of whom required tip revisions with no further dorsal surgery. Of the remaining 11 patients, the main problems were either hump recurrence and/or lateral deviation of the dorsum or widening of the middle third, which required simple surgical revision. Based on the authors' experience, adoption of a PDO/LDO is justified in selected primary patients. The key question before any primary rhinoplasty procedure should be "Can I keep the nasal dorsum intact?" Precise analysis and surgical execution are required to preserve the dorsal osseocartilaginous vault and K-area. Dorsal preservation results in more natural postoperative dorsum lines and a "not operated" aspect without the need for midvault reconstruction. Moreover, this technique is quick and easy to perform by any rhinoplasty surgeon. Rhinoplasty surgeons should consider incorporating dorsal preservation techniques in their surgical armamentarium rather than relying solely on the Joseph reduction method or an open structure rhinoplasty., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

An approach for performing hyperspectral imaging is introduced. The hyperspectral imaging is based on Fourier transform spectroscopy, where the interference is performed by wavefront division interference rather than amplitude division interference. A variable phase delay between two parts of the wavefront emanating from each point of an object is created by a spatial light modulator (SLM) to obtain variable interference patterns. The SLM is placed in the exit pupil of an imaging system, thus enabling conversion of a general imaging optical system into an imaging hyperspectral optical system. The physical basis of the new approach is introduced, and an optical apparatus is built.

In the context of nasal obstruction treatment, an alternative, no invasive technique is described. It consists in the suspension of the nasal valve or in the association of the suspension of the valve and rotation of the tip, through the placement of one or two absorbable threads, already known in aesthetic medicine. This technique allows to open the nasal valve and to correct the moderate closure of the nasolabial angle obtaining an immediate benefit of breathing. Functional improvement has been evaluated at regular intervals, that is, 1, 3, 6, and 12 months and then provided for every 6 months, through the use of a visual scale of 0/10 to 10/10. In our experience, the technique allows to obtain satisfactory results, avoiding more invasive techniques and postoperative recovery days., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Currently, most rhinoplasty surgeons focus their analysis and operative techniques on the upper nasal base, with its alar cartilages. They tend to minimize the lower nasal base, composed of the columellar base, nostril sills, and alar lobules. The requisite operative techniques are often considered ancillary techniques. In this article, the authors describe anatomical composition of the columellar base, nostril sill, and alar lobule; discuss the presence of a distinct lower nasal base; and reevaluate the nasal musculature and the nasal superficial muscular aponeurotic system in an anatomical cadaver model. They also discuss the results of both a detailed literature review (for articles related to the levator labii superioris alaeque nasalis, orbicularis oris, depressor septi nasalis, myrtiformis, and dilator naris) and the results of their own dissection of 45 fresh cadavers.

Objectives: To discuss overprojected nasal tips, to overview treatment options, and to introduce a new method of nasal tip modification., Patients and Methods: A retrospective study was conduced on 29 patients who underwent rhinoplasty where the domes crossover technique was employed. Patients were stratified into 3 groups: 18 patients presented with homogeneous overdevelopment of the LLC (nasal tip over projection type 1), 5 patients with predominant over development of the lobular portion of the LLC (nasal tip overprojection type 2), 6 patients with a true Pinocchio-type nose and a predominant overdevelopment of the columellar portion of the LLC (nasal tip overprojection type 3). Before and after photographs were compared to evaluate nasal tip characteristics. Analysis of results was performed by the use of 3 measurements: Goode's ratio, nasofacial angle and lobule-to-columella ratio., Results: Final nasal tip projection, rotation, volume and shape were satisfactory in all cases. No complication was observed during the follow-up period., Conclusion: This new method of nasal tip modification presents the advantage of preserving natural domes, being quick and allowing the achievement of desirable nasal tip projection, rotation, volume and shape. Moreover according to the alar ring concept, the crossover technique preserves the continuity of the inferior cartilaginous arch and gives an excellent support to nasal tip.

Objectives: To analyze the nasal superficial arterial vasculature and to compare these anatomic findings with the results of ultrasonography Doppler investigations to evaluate nasal blood flow in physiological and pathologic conditions., Methods: We performed 40 ultrasonography Doppler investigations in patient volunteers, 20 facial anatomic dissections in fresh cadavers, and a review of the literature on nasal blood supply. In cadavers, facial arteries were dissected to analyze nasal arterial supply., Results: When the facial artery, the ophthalmic artery, or both were compressed on 1 side in volunteers, blood flow inversion was proved by ultrasonography Doppler investigation at the level of the nasal area. These results confirm anatomic findings that demonstrate a polygonal system., Conclusions: A schema of nasal blood supply as a polygonal system connecting the external and internal carotid systems is proposed. This facilitates our understanding of anatomic variations, physiological and pathologic modifications of blood flow, and nasal reconstructions with local flaps and medical rhinoplasties using filler injections.

Objective: To give a unifying description of nasal muscles and ligaments corresponding to anatomical and surgical findings such as the dermocartilaginous ligament described by Pintanguy in 2001., Methods: In 30 fresh cadavers of white individuals, nasal dissections were performed, divided into 3 different approaches: from radix to nasal tip, from nasal tip to radix, and from midline to lateral. The anatomical and surgical planes of dissection were followed to isolate the nasal superficial musculoaponeurotic system (SMAS). Correlations between the nasal SMAS and the nasal framework were noticed. In 9 specimens, the left nasal wall was resected for histologic examination., Results: The nasal SMAS consists of a unique layer, and it divides at the level of the nasal valve into deep and superficial layers. Each layer has medial and lateral components. The dermocartilaginous ligament corresponds to the deep medial expansion. Both the deep and the superficial medial expansions correspond to the lowering ligaments of the nasal tip; the cephalic rotation of the nasal tip is allowed by their cut. The histological examination showed that the deep lateral expansion is composed of fat., Conclusions: This description of the nasal SMAS explains the relationship between the nasal muscles and ligaments, including the dermocartilaginous ligament described by Pitanguy. Furthermore, it is helpful to surgeons during rhinoplasty.

Objective: To assess the efficacy and tolerability of once-daily treatment with budesonide aqueous nasal spray in patients with nasal polyps., Design: Randomized, double-blind, placebo-controlled, parallel-group study., Setting: Sixteen hospital clinics., Patients: One hundred eighty-three patients with moderate-sized nasal polyps causing clinically significant symptoms during a 1-week run-in period., Interventions: Patients were randomized to receive 1 of the following 4 budesonide aqueous nasal spray treatments: 128 microg once daily in the morning and placebo in the evening, 128 microg twice daily, 256 microg once daily in the morning and placebo in the evening, or placebo for 8 weeks. Nasal polyp size was scored and peak nasal inspiratory flow was measured at clinic visits at the beginning and end of the run-in period and after 4 and 8 weeks' treatment. Patients recorded daily peak nasal inspiratory flow, symptom scores (ie, blocked nose, runny nose, and sneezing) and sense of smell on diary cards., Main Outcome Measures: Mean change in nasal polyp size at the end of treatment; mean changes in combined and individual symptom scores., Results: All doses of budesonide aqueous nasal spray significantly (P<.01) reduced polyp size; no significant differences were noted between the 4 treatment groups. The mean improvement in clinic peak nasal inspiratory flow at 8 weeks was 65.9 L/min with budesonide aqueous nasal spray, 128 microg twice daily; 71.6 L/min with budesonide aqueous nasal spray, 256 microg once daily; and 54.6 L/min with budesonide aqueous nasal spray, 128 microg once daily (all P<.001 vs placebo). Combined and individual symptom scores and sense of smell improved significantly in all budesonide-treated groups; the effect on symptoms became apparent within 1 to 2 days of the first dose. Budesonide aqueous nasal spray was well tolerated., Conclusions: Doses of budesonide aqueous nasal spray, 128 microg once daily, were found to be effective in the treatment of nasal polyps, and doses of budesonide aqueous nasal spray, 256 microg once daily, did not show any significant additional efficacy.