New Technologies in Rhinoplasty: A Comprehensive Workflow for Computer-assisted Planning and Execution.

Rhinoplasty in facial cleft patients is among the most challenging types of reconstructive facial surgery due to its variability. Advances in 3-dimensional imaging enable improved preoperative assessment in rhinoplasty. In complex cases with bony support irregularities and asymmetry, it is rational to initiate planning with reconstruction of the aberrant substructure (ie, "bottom-up" planning) rather than starting the surgical design with soft-tissue morphing. We present a new comprehensive workflow in which novel advanced technologies are implemented to perform "bottom-up" computer-assisted planning and execution in complex rhinoplasty cases. This workflow enables meticulous planning, use of grafting templates, and 3-dimensional-guided osteotomies with integration of piezotome and intraoperative navigation. Previous reports separately discuss some of these innovations. However, greater benefit lies in the combination of these techniques, with emphasis on preoperative computer analysis, virtual planning, and transfer to the operation theater. Surgeons are seeking new ways to enhance minimally invasive approaches and to obtain predictable and favorable clinical results. The presently introduced workflow allows clinicians to plan complex cases in a simple, effective, and safe manner, with the combination of different techniques to produce consistent results.