What ever rhinoplastic procedure is performed on its completion the surgeon tries to shape the nose in a proper way and applies a compressive plaster as described by F. Burian or a colloid bandage as described by G. l .Pakovich to preserve this shape [ 1,2,3].

After tissue edema reduces, this bandage may be replaced by a new one. It is also prepared ex temporane directly on the patient's face and preserves the nose shape.

However, the shape resulting from rhinoplasty may be rather poor while the plaster or colloid bandage fixes this shape.

Further the doctor may improve the surgery outcome by applying plaster bandages, massage, physical and drug treatment [4] which in parallel with the patient's getting accustomed to the new nose shape gives sometimes rather good results. Although more often, the patient is not satisfied with his or her new appearance and insists on a reoperation.

The purpose of this report was to present a technique of plaster bandage prefabrication using nose mode is made on the patient's face plaster model.

We report results of 452 rhinoplasties using the prefabricated plaster bandage as shaped on the patient's face plaster model.

Time of followup was ranging from two to seven years.

The rhinoplastic procedure offered consists of several stages.

Stage 1 is manufacture of a patient's face mask at several days before surgery and prefabrication of a plaster model as usual (fig.1 A, B). Then the doctor together with the patient choose the nose shape satisfying esthetic requirements of the patient basing on the prefabricated face model.

Then nose parts (arch, lateral surfaces, end, wings) are modelled gradually using various tools (plaster knife, spatula, etc.) to obtain a shape corresponding to face proportions and satisfying the patient's requirements (fig.1, C, D).

These manipulations are carried out with due respect to the nose initial shape, size, volume and the capacity of rhinoplasty, i.e. the possibility of obtaining the designed nose shape from the initial material.

Making forecast of the patient's future appearance is an act of art, and the surgeon improves his or her skills as experience is gained.

The prefabricated plaster face and nose model is used both for the patient getting acquainted with the future appearance and as a reference model during surgery. Although the main purpose of the plaster model is to be a matrix for manufacture of a 8 layer gauze plaster bandage whose inner surface takes the designed nose shape after setting.

The bandage covers a part of the forehead, superciliary arches and jaw bone region which is necessary to fix the bandage on the face properly after the plasty (fig.1, E). After the solid bandage is taken off from the model, its edges are cut evenly and it is ready to use.

Stage 2 is a surgical procedure during which we try to shape the patient's nose according to the reference model.

Sometimes we manage to do this, though more offen the nose shape after surgery is only generally similar to or even differs considerably from the designed model shape. Whatever the shape resulting from surgery is, we apply the model plaster bandage on the nose and thus fashion the separate bone and cartilage fragments according to the designed shape. By pressing the nose, the bandage fulfils its function as a shaping tool during several postoperative days.

At 2 - 3 days following surgery we take off the bandage for several minutes to examine the skin.to treat the bandage with alcohol and to remove the intranasal tampons, then the bandage is applied again to be kept on the patient's face for 4 - 5 days.

From day 6 - 8 the bandage is taken off for 2 hours in the morning and in the evening with the bandage free period increasing by 1 hour daily. From day 12 - 14 the bandage is applied only in the night for 1 - 2 weeks.

This methodology was first applied in November 1988. Since then 452 patients with various nose deformation underwent this procedure. 64 patients refused the procedure because they did not like their future appearance.

To analyze the efficiency of nose modelling using prefabricated bandages, we measured the patients' noses at various terms following rhinoplasty according to Joseph and G.Shadow (as cited by G.Peshkova, 1967) and the model noses, but our findings failed to be statistically significant. In many cases the patient's and model noses though having similar measurements visually had little in common. And vice versa similar noses had different measurements.

Therefore, we stopped to make measurements and relied on visual assessment only. For this purpose, we kept the initial plaster model till final nose shape was achieved (usually at 6-8 months after rhinoplasty) to compare it with the original. Sometimes we made a new face mould and manufactured a new model to be compared with the previous one.

• nose shape after rhinoplasty corresponds to reference model nose shape this finding was considered good result;

• satisfactory result when nose shape after rhinoplasty was quite similar to reference modelshape;

• poor result : nose shape after rhinoplasty was different from reference model shape. The table summarizes results of the comparison. We had 165 (36.5%) good results (fig.2), 192 (42.5%) satisfactory results and 95 (21%) poor results. The results were improving as we gained the experience (see the tabl. 1).

Table 1. RESULTS OF RHINOPLASTY USING PREFABRICATED MODEL PLASTER BANDAGES

The main requisites of the success are:

First, the surgeon's skills in forecast of the future nose shape and the patient's appearance, and in manufacture of appropriate mode is.

Secondly, the surgeon should try to do his or her best to shape the nose according to the reference model during the Operation,

Thirdly, if the latter is not possible, to achieve at least an acceptable shape by removing a strictiy limited amount of bone, cartilaginous and soft tissues to make the nose as dose to the sample and to fit the model bandage as much as possible.

In some deformation (duck nose or coneshaped nose) there always occurs excessive skin even if all the above mentioned conditions are met, and the nose (especially the end and wings) fails to fit the model bandage.

In view of this we make in advance additional plaster bandages of larger size to be further replaced by smaller ones which often gives good results.

Advantages of the plaster model bandage are as follows. The bandage shapes the nose from separate fragments, fixes the separate bone and cartilaginous fragments according to the designed shape, i.e. plays an active part, while common bandages provide but passive fixation of the nose shape obtained as a result of rhinoplasty.

We believe therefore that the use of prefabricated model plaster bandages is anatomically reasoned and by our experience gives quite good esthetic results in most cases.