By Enrico Robotti, MD

Join Dr. Robotti in the operating room in this unique two-volume video series covering structural and preservation primary hybrid rhinoplasty and secondary rhinoplasty with finesse rib grafting techniques.

Volume 1 provides viewers with a wide array of techniques, details, subtleties, and pitfalls in state-of-the-art “hybrid” primary rhinoseptoplasty, combining the very best of preservation and structural technique. All variations of cartilaginous push-down, full let-down, and modified cartilaginous push-down with enclosure of a portion of bony cap are shown. Structural management of the tip is demonstrated, with preservation–reconstruction of ligaments. Tip and dorsal dissection are shown on subperichondrial–subperiosteal planes and the use of three-point compartmentalization is demonstrated, to decrease edema and to provide proper surface contour. The new concepts of sublaminar septal dissection and interdomal ligament–septal perichondrial sling are demonstrated. The combined use of piezoelectric and power tools for osteotomies and osteoplasty is widely shown in every case. Management of the septum and turbinates is demonstrated for achieving proper function.

Volume 2 demonstrates the techniques, details, subtleties, and pitfalls of using rib in four unique secondary rhinoplasty cases. This includes state-of-the-art reconstruction of the dorsum with Dr. Robotti’s innovative techniques of SPF–SPLF grafts as well as “rib cartilage plaster.” The septal T “push-up” technique, which combines elements of preservation and structure with the use of rib is also demonstrated. Secondary rhinoplasty is a complex surgery which requires dedication and a long learning curve. This video series will provide viewers with a clear algorithm, flexibility and strategy in intraoperative choices, attention to detail, and mastery of numerous tips and tricks. The use of contemporary instrumentation, combining piezoelectric and power tools, and the specific technique for rib harvesting with proper attention to the donor site, rib shaping, and laminating is extensively covered. The importance of using finely crafted rib grafts and avoiding unnecessary bulk is demonstrated in all cases. The techniques for obtaining a proper airway with proper management of the valves, as well as better aesthetics, is also extensively covered.

Each case in the 2-volume set includes full preoperative discussion with proposed surgical plan and comprehensive demonstration of dissection, step-by-step surgical techniques, and final dressings.

Volume 1
5 Cases With Approximately 20 Hours of Operative Video!

Case 1: 46-year-old female patient with dorsal hump, drooping tip, bulbous tip, wide nasal bones, with associated chin hypoplasia.
Modified dorsal split hybrid preservation: osteoplasty, full let-down, structural tip reediting with septal extension graft, ligament reconstruction, and septal fusion sling. Sublaminar septal dissection, septoplasty, piezoelectric turbinoplasty, three-point compartmentalization sutures. Chin augmentation with anatomic silicone implant inserted intraorally.

Case 2: 18-year-old female patient with major dorsal hump, septal deviation, weak tip cartilages, mildly recessed chin.
Modified dorsal split hybrid preservation: osteoplasty, full let-down, structural tip reediting with septal extension graft, spacer strut, alar contour grafts, ligament reconstruction, and septal fusion sling. Sublaminar septal dissection, septoplasty, piezoelectric turbinoplasty, three-point compartmentalization sutures, lipostructuring of chin.

Case 3: 24-year-old male patient with wide, asymmetric nasal bones; middle vault asymmetry; septal deviation; thin skin; dorsal hump; open nasolabial angle; severe functional issues.
Modified dorsal split hybrid preservation: modified cartilaginous push-down including a portion of bony cap, midvault reconstruction, osteotomies, and osteoplasty. Piezoelectric septoplasty and turbinoplasty. Structural tip reediting with auto septal extension graft, ligament sling, asymmetric turn-under/turn-over of lateral crura, spacer strut, mini alar contour grafts.

Case 4: 25-year-old female patient with bulbous tip, major dorsal hump, very thin skin.
Modified dorsal split hybrid preservation: osteoplasty, full let-down, structural tip reediting with septal extension graft, ligament reconstruction, and septal fusion sling. Sublaminar septal dissection, septoplasty, piezoelectric septoplasty and turbinoplasty. Deep temporalis fascia harvesting for tailored dorsal camouflage. Structural tip reediting with auto septal extension graft, ligament sling, asymmetric turn-under/turn-over of lateral crura, spacer strut, articulated grafts.

Case 5: 23-year-old male patient with crooked, posttraumatic nose; bony and midvault asymmetry; septal deviation; drooping, long, asymmetric tip; excess volume; major septal deviation.
Modified dorsal split hybrid preservation: cartilaginous push-down, piezoelectric septoplasty and turbinoplasty. Rib harvesting and use of rib laminations for proper L-strut septal reconstruction. Osteoplasty–osteotomies, transosseous sutures bony fixation, tip reconstruction, camouflage by “rib plaster.”

Volume 2
4 Cases With Over 13 Hours of Operative Video!

Case 1: Tertiary rhinoseptoplasty in 32-year-old female patient with deviation, pollybeak, inverted-V, asymmetric tip, bilateral alar retraction, functional obstruction.
Burr osteoplasty, rib full L-strut reconstruction, rib extended lateral crura struts, transposition, bilateral composite grafts, SPLF graft, turbinoplasty, rib cartilage plaster.

Case 2: Primary rhinoseptoplasty in 22-year-old female patient with congenital maxillary hypoplasia and saddling, bulbous tip, septal and medial crura deficiency.
Burr osteoplasty and piezoelectric osteotomies, rib L-strut reconstruction by septal T push-up technique, premaxillary augmentation, SPLF graft.

Case 3: Quaternary rhinoseptoplasty in 33-year-old female patient with severe tip asymmetry, pinching, external and internal valve stenosis, deviation, R alar retraction, severe functional obstruction.
Burr osteoplasty, piezoelectric wedge ostectomy, full tip reconstruction, rib lateral crura struts, transposition rib full L-strut reconstruction, perichondral graft, turbinoplasty, SPLF graft.

Case 4: Tertiary rhinoseptoplasty in 32-year-old male patient after previous traumas, with deviation, saddling, tip collapse, alar asymmetry, severe functional obstruction.
Burr osteoplasty, piezoelectric opening osteotomies, internal valve reconstruction, rib full L-strut reconstruction, tip definition, rib lateral crura struts, transposition, SPF graft.

Available in HD Streaming format. 9 cases with over 33 hours of operative video. 2024.