Advanced Caucasian and Mediterranean Rhinoplasty

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In line with Darwin’s theory of evolution from 1859, three ingredients have determined the evolution in rhinoplasty during the last century: variation, reproduction and pressure.

On the shoulders of giants, a variety of philosophies and rhinoplasty techniques were consistently developed and modified. These techniques were reproduced by text books and journals as well as during conferences, working visits, and fellowship programs. Pressure, the result of both the drive of the surgeon and the high demands of patients seeking rhinoplasty, has subsequently increased the level of rhinoplastic surgery in our specialty dramatically, and over a broad range of colleagues. In our common efforts to achieve consistently good and reliable results, this book – for what it is worth – is my contribution to this rhinoplasty evolution.

The book follows the Chinese adage according to which ‘a picture is worth a thousand words’. The last decennium I developed the habit to take my camera into the operating room, thus creating the basis for the many full-color peroperative open-structure rhinoplasty photographs. The text is divided in small chapters that were written in pearl form and joined up in a string-like manner. Numerous comprehensible schematic drawings help to elucidate the text and most of them were made by a professional illustrator, Karin Spijker.

Another key feature of this rhinoplasty book is the fact that it is written by one surgeon. This avoided overlap and gave me the opportunity to display ‘my way’ of performing rhinoplasty from the first consultation to the last postoperative visit. Of course ‘my way’ of rhinoplasty is nothing more than the result of a slowly progressing process stacking techniques that were invented, modified and described by so many great rhinoplasty surgeons in the past.

I have strived to keep the content of this book simple and easy to read. Although the list of methods and techniques described might not be complete, I believe that the vision displayed will allow for 90% of all encountered Caucasian and Mediterranean rhinoplasty cases to be completed in an adequate manner. Reproducing my vision with the help of this book will hopefully enable young surgeons to develop a platform from where to accelerate their rhinoplasty skills into the third wave of their personal learning curve: the wave of consistently good results (see 1.6).

The book ends with a chapter on nasal reconstruction techniques for skin cancer defects. The incidence of nasal skin cancer will rise in the next decennium, and also the rhinoplastic surgeon should become familiar with these techniques. In addition, the knowledge gained in this specific area will serve as yet another learning curve accelerator for the regular rhinoplasty cases.

Peter J.F.M. Lohuis, MD PhD

Foreword by Egbert H. Huizing
Foreword by Shan R. Baker
Foreword by Gilbert J. Nolst Trenité
Preface
About the Author
About the Illustrator

1. The Rhinoplasty Learning Curve
2. Preoperative Considerations
3. Rhinoplasty Analysis
4. Functional Aspects in Rhinoplasty
5. Fundamentals in Nasal Tip Surgery
6. Advanced Solutions for the Tip
7. Nasal Dorsum and Nasal Pyramid
8. Graft Materials in Rhinoplasty
9. Complications in Rhinoplasty
10. The Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty
11. Postoperative Considerations
12. Special Problems
13. Cases
14 Nasal Reconstruction
15. References

This is a single author text book written by Peter Lohuis from Utrecht, and therefore differs from the majority of multi-author rhinoplasty texts. The book is essentially therefore a comprehensive ‘how I do it’ from first consultation through to patient discharge. In his introduction, Peter modestly admits that his “way of rhinoplasty is the result of a slowly progressing process, based on the great rhinoplasty surgeons of the past.” This is in my view a strength, not a weakness, and in reading the book I was impressed by his clarity of explanation and practical approach.

The book comprises some 400 pages with 14 chapters. The personal aspect of the text is illustrated by the first rather philosophical chapter about the rhinoplasty learning curve, so familiar to those of us with an interest in this operation. Although not comprehensive, most key aspects of functional and aesthetic rhinoplasty are then covered, with an excellent final chapter on nasal reconstruction reflecting Peter’s expertise in this area. The photographs and illustrations by Karin Spijker are of a very high standard, adding to the text. This book would be of great educational benefit and interest to trainees seeking a clear and easy-to-read practical guide to septorhinoplasty. For the more experienced surgeon, this book is a personal presentation of considerable expertise and I enjoyed it because of this.

Tim J Woolford MD FRCS (ORL-HNS)
Manchester Royal Infirmary, UK.

ENT and Audiology News
© 2016 Nov; vol 25(4)

Peter Lohuis is one of the rising stars or European and World facial plastics and it thus stands to reason that any tome that he publishes will be a very considered piece of work, with a lot of thought put into the detail. This book delivers exactly that, a thought provoking take on rhinoplasty.

It’s not ideal for the beginner surgeon, as there is an underlying thread that assumes you know what you are doing, but it’s a fabulous reference text for anyone wanting to check or, hopefully, reassure themselves that they are doing the right thing! It has the usual ingredients of a good, solid reference text, with copious good quality images / diagrams and sections that cover the usual rhinoplasty “staple diet” of analysis, function, dorsum, tip, materials, complications etc. etc. etc. There is also a refreshing approach to each subsection, as the information is appropriate but is presented in a bullet format, keeping them concise and thus holding the reader’s interest.

What sets this book apart from a lot of other publications are the unusual sections addressing the rhinoplasty learning curve (chapter 1), the Utrecht Questionnaire (chapter 10) and the chapter on special problems (chapter 11) where patients at different ends of the age spectrum plus skin disease are dealt with.

For those surgeons who practice rhinoplasty and want a book that is well written, beautifully illustrated but, above all, provides food for thought, then this is definitely the book for you!

Simon Watts FRCS (ORL HNS)
Middlesbrough, UK

The Journal of Laryngology & Otology.
© JLO (1984), Limited 2011

Our colleague from the Netherlands, Peter J. F. M. Lohuis, has authored his second book in the field of facial plastic surgery, this one tackling the complex field of rhinoplasty.Despite his broad training and research in several aspects of otorhinolaryngology, his experience and knowledge base in rhinoplasty specifically provide us with a systematic approach to the nasal framework. This text is a comprehensive manual that takes the reader through the entire process from nasal analysis to postoperative care. It is written in an outline format, making the text easy to quickly reference, concise to read, andwonderfully illustrated with drawings, diagrams, and representative photographs.

Lohuis dedicates the first chapter to considering the career of the rhinoplastysurgeonandhowoneachieves consistently great outcomes in a challenging field. He then discusses both facial and nasal analysis in the context of planning appropriate reconstruction, accompanied by representative photographs.

This book then guides us through the gamut of nasal corrective surgery. Lohuis describes his preoperative planning techniques, including considerations on patient selection, and then preparation. In his preoperative section, it is courteous of Dr Lohuis to even include photographs of his surgical sets. (Although, for the next edition I would submit that they would be more useful if the instrumentswere identified in the captions for our reference.)Moving into functional assessment and the anamnesis (philosophy) of rhinoplasty, he uses colorful diagrams and computer-aided reconstructions to demonstrate the interpretation of nasal airflow testing.

Throughout the chapters on functional and cosmetic reconstructive rhinoplastywe find succinct and complete descriptions of surgical options available to correct various deformities. He covers graft types (autospreader, lateral crural underlay, shield graft) and suturing techniques (mattress, alar-spanning sutures) aswell as repositioningmaneuvers (tonguein groove, lateral crural reversal).The nasal dorsum and pyramids are addressed in a separate chapter, as is the use of alternative grafting techniques (autologous vs allografts, tissue glues, Turkish delight [diced cartilage], and injectables). What follows are 17 case examples using some of the previously discussed techniques with detailed operative diagrams and preoperative and postoperative photographs.

The final (and most important) chapter focuses on reconstruction of traumatic and oncologic nasal defects, including excellent descriptions of the 3-stage paramedian forehead flap to achieve excellent reconstruction of full-thickness alar defects.

Like a good mentor, Lohuis strikes an informative tone throughout the book; he is never judgmental or self-promoting. Frequently referencing other experts in the field, his openness and passion for teaching and sharing his experience are clear. The techniques are up to date, and his recent references showthat his academic vigor has kept his techniques and text current. And despite his Dutch roots, Dr Lohuis’s mastery of the English language makes the communication clear, with only infrequent and endearing reminders of the differences between the Queen’s English and the American dialect. This is a transparent and thoughtful guide that rivals the best rhinoplasty texts we have today.

Scott E. Bevans,MD

JAMA Facial Plast Surg.
2015 Mar 1;17(2):152

Advanced Caucasian and Mediterranean Rhinoplasty is a masterful work by Peter J.F.M. Lohuis. The book covers the full range of external nose surgery and rhinoplasty as an indepth resource, covering the spectrum from insight into rhinoplasty surgical training and requirements, to consultation, complications, and of course techniques, evolving eventually into complex nasal reconstruction for skin cancer. The book focuses on the author’s own techniques with a critical eye, keeping discussion of even complex topics focused and simplified.

Not since Calvin Johnson and Dean Toriumi’s Open Structure Rhinoplasty in 1992 has a book on the topic elucidated the most modern techniques and theories. This book seems more geared toward a somewhat seasoned surgeon who may be interested in refining techniques than to a novice interested in learning rhinoplasty basics. I found the section on training requirements for rhinoplasty to be fascinating, and true from personal experience. The case studies and analysis of various techniques are also useful in their careful, thoughtful analysis and clear, colorful diagrams. The “Special Problems” section may be useful as an academic office or library resource, as it covers the more unique subcategories of patients who may seek rhinoplasty, such as aging patients or those with dermatologic problems. In all, the book is a fascinating compendium of the world of rhinoplasty as seen through Lohuis’ clear eyes, which anyone interested in the topic at any stage of his or her career would find useful, rewarding, and interesting. I could not recommend this book more highly.

Howard D. Stupak, MD,
Bronx, New York, USA

Annals of Otology, Rhinology & Laryngology
2015, Vol. 124(3) 250– 251

Collega Lohuis heeft een prachtig boek geschreven over de huidige technieken in de functionele en esthetische neuschirurgie. Dit boek is geen samenstelling van hoofdstukken door verschillende auteurs, maar geheel door hemzelf geschreven. Het maakt dat alle begrippen en technieken eenduidig zijn en in dezelfde stijl zijn uitgewerkt.

Het gehele boek is gestructureerd opgezet met veel nadruk op zowel de functie als de esthetiek van de neus. Alle verschillende technieken van bijvoorbeeld neusklep- of tipchirurgie worden systematisch beschreven en van een algoritme voorzien om aan te geven hoe groot het effect kan zijn. Nieuwe varianten – zoals het gebruik van autospreaders encefale turn-in flaps van de lower laterals – worden besproken en steeds wordt de eigen ervaring van de auteur gebruikt om de techniek te waarderen, te nuanceren en te plaatsen in het armamentarium. Dit maakt het boek, zoals de titel aangeeft, aantrekkelijk voor gevorderden. Aan bod komen ook de psychologie van de patiënt en hoe de aberrante persoonlijkheden te vinden, onrealistische verwachtingen te onderkennen en wanneer het beter is niet te opereren.

Het boek start met een hoofdstuk over de leercurve van een neuschirurg. Hij beschrijft hierin de opwaartse richting in golven over vele jaren door een goede opleiding met bijvoorbeeld een fellowship, invloed van enthousiasmerende experts, eigen toewijding en aantallen operaties. In paragraaf 1.7 toont hij zijn eigen leercurve. Dit is voor beginners nuttige informatie en voor de gevorderde neuschirurg zeer herkenbaar. Het educatieve karakter van het boek is systematisch goed opgebouwd en gaat steeds van simpel naar gedetailleerd complex. De invloed van zijn opleider E.H. Huizing – die ook een voorwoord heeft geschreven – is hier duidelijk. Het hoofdstuk met casus is zeer illustratief en voorzien van operatiefoto’s en schematische tekeningen en toont het talent van de auteur. Het boek eindigt met een hoofdstuk over neusreconstructies na ablatieve chirurgie en hier wordt de ladder van reconstructie van eenvoudig naar complex nog eens uitgelegd en gedemonstreerd. Het gehele boek is overvloedig voorzien van fraaie foto’s en tekeningen. De professionele illustrator heeft hier een belangrijke bijdrage geleverd.

E.J.C. Teunissen,
Den Haag, The Netherlands

Nederlands Tijdschrift voor Keel-Neus-Oorheelkunde
2015, 21e jaargang | nr. 1, 44