Mastering Rhinoplasty: Basic to Advanced Techniques

Review by L Flood
Middlesbrough, UK

At first glance this looked a very impressive text, and I was not surprised that it seemed expensive in Indian Rupees (₹9,500.00 INR), with no idea of the exchange rate of course. But then I found its UK price, at £70. Frankly at three times that price it would be cheaper than some current books with very similar (almost identical, do not confuse them) titles. This book can claim priority as its first edition appeared in 1995. I am always grateful for a Preface that tells me what is new in the latest edition, as it saves the reviewer much work. New chapters here cover Dorsal Preservation Rhinoplasty, local cutaneous flaps, closure of nasal septal perforations and cleft lip nose repair we are assured.

The authorship is multinational, but there is no doubt that it is Dr Brajender V. Baser who has done the “lion’s share”, with 6 chapters as sole author and 3 co-authored, out of a total of 16. Indian authors predominate, there is a significant Italian input, but we do have three UK contributors listed, Guy Kenyon (of JLO fame), Hesham Saleh and Ullas Raghavan.

Any browser will immediately be struck by both the sheer number, but also the quality, of the colour illustrations. Whether before and after surgery as outcomes, perioperative views, cadaver dissections or diagrams, they are superb and consistently so, no easy task in a muti-author text. Some illustrations have the eyes covered with black rectangles or pixilation, but fortunately they are a minority.

The book is a credit to the publishers, especially to my generation which can recall decades times (many decades) ago when that Indian versions of classical textbooks were printed on rough paper, with bindings that could not survive postage and hazy illustrations. What a transformation. A very nice feature in many chapters is the use of case studies, presenting the problem, illustrating and explaining in step-wise detail how the challenge was met and with the, now smiling, subject post operatively. The Augmentation Rhinoplasty Chapter has no fewer than 19 of these and I will freely admit that Binder’s Nose Deformity was new to me. But seeing how that and saddle nose deformity could be corrected did impress. Equally a surprise was Napoleon’s Hat as a cartilage tip graft. Two days before the anniversary of Waterloo that did amuse.

If I must choose favourite chapters I would start with Psychological Aspects and Pre Operation Assessment. The author advises against routine psychiatric referral, feeling that the experienced surgeon can spot when there is that need. The concern is that an offended or hostile patient would fail to return, which I think many of us would see as avoiding a near-miss. It seems that males are far more likely to seek Rhinoplasty in Indian practice and there is an interesting observation on the use of self-imaging on mobile phones. On a full face from 12 inches away the nose looks much wider than at 5 feet on a selfie. Although not mentioned, Ethnic Rhinoplasty is a popular literature topic now and the nasal hump or dropped tip can be a characteristic (but now undesired) feature in Northern India.

I must mention the chapter by our former Editor Guy Kenyon, who knows more than most about the upper and lower lateral cartilages, alar collapse, and the role of external muscles in preserving the nasal airway. I did tease him about the profusion of commas, but he insisted they are post-submission. There are pages of recommended reading for each chapter at the close of the book, but I am unclear whether they were the authors’ or Editor’s choice. In some cases they do seem very dated.

I had expected the book to concentrate on the nasal skeleton and cartilages but was delighted to see an excellent review on management of cutaneous lesions and defects with excellent illustrations of flap repair. Another nice addition was the closure of septal perforations which, although brief, involved a review of 56 studies. An expected chapter, plus coverage elsewhere on Cleft rhinoplasty repair proved the most rewarding and gratifying, with some great results. I will not just list all the contents but will say that the Italian contributors do tackle children’s deformities, that “liquid rhinoplasty” may have a place, and that thick or thin skin prove to be very different challenges. I forgot to mention the videos of course and there are 35 just for the Basic Techniques chapter.

As no expert on this topic, my occasional effort in septorhinoplasty did everything to avoid tip work and usually just involved a few osteotomies with a percutaneous 2mm osteotome and much thumb pressure and was restricted to those whom God had given a straight nose until very recently. I hope the Editor and authors will then excuse this review by a total amateur, who was better in the ear.

I am amazed by the value for money this book represents. That is a price we would associate with a relatively slim and sparsely illustrated softback. At a bargain price it should attract much interest in facio-plastic surgeons of any seniority.