Research

Essential Facial Plastic and Reconstructive Surgery. Volume 2: Rhinoplasty, Cosmetic Surgery, Gender Affirmation and Non-Surgical Facial Rejuvenation (2024)

The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty (2021)

Lee, Yan Ho M.D.; Lee, Jonathan Y. M.D., M.P.H.; Luo, Jiajun M.P.H.; Lawson, William M.D., D.D.S.; Westreich, Richard M.D.

Seeing through the Envelope: The Cartilage Shape Requirements for an Aesthetically Pleasing Nasal Tip (2020)

Malika Atmakuri, MD, Jaclyn Klimczak MD, Richard Westreich, MD, FACS

The Subalar Graft and Its Role in Nasal Tip Medialization and Improved Nostril Symmetry (2013)

Behrad B. Aynehchi MD, Miguel E. Mascaro MD, Richard M. Rosenfeld MD, MPH, Richard W. Westreich MD

This paper looked at patient measurements before and after crooked nose repair. The study demonstrated the degree of nasal deviation correction that can be obtained from the use of a cartilage graft placed underneath the nostril from inside the nose.

The subalar graft can be harvested during routine surgery on the septum. The use of this graft allows for correction of the crooked nose without having to perform nasal tip surgery. When used as part of a Foundation Rhinoplasty technique, this graft adds approximately 35% of the total straightening effect. It also helps to normalize nostril attachment height and visibility on the frontal view, increasing the overall improvement in symmetry from the surgery.

The Effect of Facial Asymmetry on Nasal Deviation (2011)

Richard W. Westreich, David Burstein, Marika Fraser

This chapter explored the current understanding of facial asymmetry and how it affects nasal positioning. Before the recent studies done by Dr. Westreich and colleagues, this issue was poorly understood by the medical community. In the past, the pattern of the Cleft Lip nose was used to analyze patients with severely deviated noses and facial asymmetry. As shown in the study done by Yao, Lawson, and Westreich in 2009, this is incorrect.

Linear nasal deviation has a consistent pattern which is typically seen in patients with developmentally crooked noses and can be measured pre-operatively. The Foundation Rhinoplasty technique effectively addresses most of the anatomical issues in these cases.

Lateral Nasal Artery Pedicled Island Flap for Repair of Nasal Alar Defects (2011)

Behrad B. Aynehchi, MD, and Richard W. Westreich, MD

The lateral nasal artery island flap is a novel technique for nostril reconstruction that was developed by Dr. Westreich. This technique is useful in repair after skin cancer resection.

Effect of Midfacial Asymmetry on Nasal Axis Deviation: Indications for Use of the Subalar Graft (2009)

Francisca Yao, William Lawson, and Richard W. Westreich

This paper correlated measurements in “normal” and crooked noses to demonstrate that facial asymmetry has a significant role in developmentally deviated noses. Facial hypoplasia (underdevelopment) on one side of the face causes the nose to lean towards that side.

The greater the hypoplasia, the greater the deviation of the nose. These findings lead to the implementation of the Subalar graft as a method for correcting nasal tip deviation as part of a functional or cosmetic nasal procedure.

The Use of Combined Bernard-Webster and Karapandzic Flaps for Subtotal Lower Lip Reconstruction (2008)

Westreich, R M.D.; Meisner, J M.D.; Reino, A M.D.; Lawson, W M.D., D.D.S.

The Tripod Theory of Nasal Tip Support Revisited: The Cantilevered Spring Model (2008)

Richard W. Westreich, and William Lawson

This paper presented a new theory for nasal tip support which was based on biomechanical testing of cartilage strength as well as review of previous models. It provided a basis for determining whether structural grafting was needed for tip support and helped to increase the ability to predict post-operative changes in nasal tip position.

Components of this theory are part of a teaching course that Dr. Westreich is giving at the annual meeting of the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) in October, 2013.

Augmentation of nasal tip projection using the inferior turbinate: review of technique and evaluation of long-term success (2008)

Michael E Jones, Richard W Westreich, William Lawson

This paper was a review of a technique for using inferior turbinate bone as a structural nasal tip supporting graft. This graft can be used when septal cartilage is not available for this purpose.

Correction of caudal deflections of the nasal septum with a modified Goldman septoplasty technique: how we do it (2007)

William Lawson, Richard Westreich

The modified Goldman Septoplasty is useful in correcting the bottom or lower part of the septum, which often causes a secondary asymmetry of the nostrils. This is a closed technique as opposed to an Open technique. An Open Rhinoplasty has a visible incision placed on the lower part of the nasal tip. Open techniques are often used by other surgeons to correct this type of problem. Non-Plastic ENT surgeons do not typically operate on the lower part of the septum, due to structural concerns.

Defining Nasal Cartilage Elasticity: Biomechanical Testing of the Tripod Theory Based on a Cantilevered Model (2007)

Richard W. Westreich, Hayden-William Courtland, Philip Nasser, Karl Jepsen, and William Lawson

Fan septoplasty for correction of the internally and externally deviated nose (2006)

S M Ammar, R W Westreich, W Lawson

The Fan Septoplasty is useful in correcting the middle and upper part of the septum, which often causes a curved appearing nose. The fan septoplasty is a closed technique as opposed to an Open technique, where a visible incision is placed on the lower part of the nasal tip. Open techniques are often used by other surgeons to correct this type of problem.

Negative-Pressure Pulmonary Edema After Routine Septorhinoplasty: Discussion of Pathophysiology, Treatment, and Prevention (2006)

Richard Westreich, Ian Sampson, Christopher M. Shaari, and William Lawson

Perforating Double Lateral Osteotomy (2005)

Richard W. Westreich, and William Lawson

The perforating double lateral osteotomy is a technique used to correct asymmetry of the nasal bones, which are located in the top 1/3 to 1/2 of the nose. This technique is useful in certain types of crooked noses, where the nasal bones are different widths, and is often used as part of the Foundation Rhinoplasty procedure.

Validating the Subcutaneous Model of Injectable Autologous Cartilage Using a Fibrin Glue Scaffold (2004)

R Westreich, M Kaufman, P Gannon, W Lawson

Eastern Section, Triologic Society Presentation: January 2004.

This was a study on cartilage engineering. This study showed that chondrocytes in a fibrin gel could be injected with a needle to make new cartilage underneath the skin. It was the first study of its kind.

Autologous cartilage grafts enhanced by a novel transplant medium using fibrin sealant and fibroblast growth factor (2004)

Matthew R Kaufman, Richard Westreich, Sherif M Ammar, Asif Amirali, Andrew Iskander, William Lawson

Glial Growth Factor/Neuregulin Inhibits Schwann Cell Myelination and Induces Demyelination (2001)

George Zanazzi, Steven Einheber, Richard Westreich, Melanie-Jane Hannocks, Debra Bedell-Hogan, Mark A. Marchionni, James L. Salzer