It was a pleasure to be in Regensburg, Germany again for Professor Gassner’s facial plastic surgery meeting. It’s a privilege to be with a world class faculty.

I performed one of the rhinoplasties. My case was of a twisted nose. This was an interesting case of a young man who’d received a nasal injury which had caused severe trauma particularly to the nasal septum.  He also has asymmetry of the bones.  I used a symmetrically placed osteotomies and corrected the position and differential slope of the bony nose and used spreader grafts to straighten the septum.  I’m very pleased the case went well.

One of the interesting areas we presented and discussed was on the mal positioned tip cartilages.

In discussion with Grant Hamilton from The Mayo Clinic we both recognised that classically these patients have an under projected, under rotated tip, retraction of the nostril margins and an oval or as Grant calls it an egg shaped nasal tip. Marked examples of these cases are best treated with repositioning of the lateral crura of the tip cartilages.  Mark Constantian commented that the risk versus reward equation of this manoeuvre can be of some concern and I agree with him.  He tries hard to avoid repositioning now and prefers to use grafts to support the nostril rims to reshape the tip.  My feeling is that if the lateral crura aren’t curved and the mid third of the nose isn’t abnormally full because of this abnormal position then repositioning isn’t needed but for the the typical appearance that I’ve described above I think repositioning is important.

Professor Holger Gassner again ran a great course full of collegial spirit and honest sharing of ideas.

It’s a pleasure for me to be able to have many of the colleagues from the German meeting who I respect and admire over to London for my meeting, myrhinoplasty.org next month.  Stephen Perkins from Indianapolis was in Regensburg and will be coming to London so it will be great to catch up again and Holger Gassner will be coming too.  Our next London meeting will be in 2014 and I hope my other American and European colleagues will be free for that meeting.