Advanced Caucasian and Mediterranean Rhinoplasty

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

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

A medical doctor feels it is his first and main task, his duty, to take good care of his patients’
needs and to improve their condition as much as he can. With time, as his knowledge and
experience grows, his results will get better and better. This certainly applies to surgeons.

Only a few of them also feel the urge to communicate their experiences to their colleagues
by giving lectures, by publishing articles and finally by writing a book. Peter Lohuis belongs
to this rare category.

After a stay in the USA, where he did basic research on inner-ear physiology, he trained
in otorhinolaryngology at the University Medical Center Utrecht. While at the Academic
Hospital in Utrecht, he focused on the inner ear, defending a thesis on cochlear endolymph
homeostasis. There he was also exposed to the latest concepts and techniques in functional
reconstructive nasal surgery, one of the other major points of interest at his training clinic,
and inspired by the annual international nasal surgery courses that were presented at this
department.

After leaving this cradle he concentrated, both in the Netherlands and abroad, on the
surgical treatment and rehabilitation of head-and-neck-cancer patients and on rhinoplasty.
With his boundless energy, he became one of the few experts in all three fields and one of
the organizers of a successful international course, ‘Highlights of Functional and Aesthetic
Rhinoplastic Surgery’. His knowledge and experience now culminates in this book Advanced
Caucasian and Mediterranean Rhinoplasty.

As his teacher in ORL, I am proud of what he has achieved. I congratulate him on the
coming-out of his lucidly written and magnificently illustrated textbook. It will certainly find
its way into the hands of many readers as it clearly outstrips the quality of most books on
rhinoplasty that have been published in the past years.

Egbert H. Huizing
Professor emeritus of Otorhinolaryngology
University Medical Centre Utrecht

Advanced Caucasian and Mediterranean Rhinoplasty by Peter JFM Lohuis is a beautifully
illustrated textbook of advanced rhinoplasty techniques. The textbook consists of 14
chapters beginning with an interesting chapter discussing how to become a skilled
rhinoplasty surgeon. The final chapter presents methods of reconstructing the nose after
tumor ablation or trauma. Chapter 13 consists of 17 surgical cases together with detailed
diagrams of the surgical steps used for each case. The textbook is written in an outline
format with headings and subheadings that takes the reader directly to crucial information
without excessive language or redundancies. Each chapter makes use of detailed schematic
diagrams, charts, and algorithms to supplement the knowledge within the outline. Ample
use of intraoperative photographs within the book supplements the numerous illustrations.
Surgical techniques are presented by discussing step-by-step surgical procedures in a clear,
concise manner.

In addition to clarity and conciseness, the book has the advantage of being authored by
a single surgeon who is well-experienced in functional and aesthetic rhinoplasty. This
provides continuity of terminology and concepts. This textbook should prove to be a
valuable reference and informative surgical guide for any surgeon performing rhinoplasty.

Professor Shan R. Baker
Past president of the American Board of Facial Plastic and Reconstructive Surgery

It is an honor and pleasure to write a foreword in this excellent book on advanced Caucasian
and Mediterranean rhinoplasty.

The attractive structural setup with clear figures, tables and intraoperative pictures helps to
understand the complexity of rhinoplastic surgery, which still is the most challenging part
of facial plastic surgery. The author emphasizes contemporary surgical techniques such as
autospreader flaps, septal extension grafts, alar rim grafts, cephalic turn-in flaps and many
others.

The first chapter of this book is dedicated to the development of a new rhinoplasty learning
curve model. The awareness of this model will help the neophyte surgeon to manipulate his
learning process in a positive way and will help the more experienced rhinoplastic surgeon
to know where he stands and how to further improve.

There is in-depth information about psychological disorders, facial analysis and ethnic
variations. Special attention is given to the functional expects in rhinoplasty and their
surgical solutions, which is often under-emphasized in rhinoplasty textbooks.

There are extensive chapters about the structural approach of the fundamental and more
advanced aspects of nasal tip surgery, followed by the discussion of important aspects of
different nasal tip techniques and how to prevent their pitfalls. There is a set of beautifully
illustrated chapters on dorsum surgery, grafts, special problems and complications. The book
ends with an interesting set of skillfully operated patient cases with abundant intraoperative
pictures and an outstanding chapter on the nasal reconstruction of skin cancer defects.

Peter JFM Lohuis has to be congratulated for this book, which clearly stands out and will be
of great practical use for every surgeon who is involved in rhinoplasty.

Gilbert J. Nolst Trenité MD, PhD
Past president of the European Academy of Facial Plastic Surgery
and past president of the International Federation of Facial Plastic Surgery Societies

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 rhino￾plasty, 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

I know of no other book that considers and describes in such exceptional detail about topics such as the rhinoplasty learning curve, the Utrecht questionnaire, and special problems. When I reviewed the references, I can see that the author has done an extensive amount of reading and collated a tremendous amount of valuable information into the book. It has been clearly, concisely and beautifully presented, not just in the form of the photographs, diagrams and graphics, but in its intellectual integrity and clarity. It is one of the most valuable rhinoplasty textbooks that I have had the privilege to read.

Peter A. Adamson, MD, FRCSC, FACS
Past president of the American Academy of Facial Plastic and Reconstructive Surgery

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.

Simon Watts FRCS (ORL HNS) Brighton UK