Rhinoplasty Craft & Magic 9781626238435

Table of contents :
Frontmatter (PDF).pdf (p.1-30)
Chapter 1 Static Anatomy and Its Impact on Aesthetics.pdf (p.31-82)
Chapter 2 Dynamic Anatomy and Structural Relationships.pdf (p.83-136)
Chapter 3 Involving the Right Brain in Rhinoplasty Diagnosis and Planning.pdf (p.137-162)
Chapter 4 The Anatomy of Function and How Rhinoplasty Affects the Airway.pdf (p.163-216)
Chapter 5 Four Critical Anatomic Variants and “The Secret of Everything”.pdf (p.217-280)
Chapter 6 Why Rhinoplasty Is Difficult.pdf (p.281-308)
Chapter 7 Planning Rhinoplasty- Abstract Concepts and Aesthetics.pdf (p.309-346)
Chapter 8 Planning Rhinoplasty- Applied Concepts and Aesthetics.pdf (p.347-420)
Chapter 9 Creating the Preoperative Plan.pdf (p.421-448)
Chapter 10 How to Learn Rhinoplasty.pdf (p.449-492)
Chapter 11 Intraoperative Feedback and Technique in Primary Rhinoplasty.pdf (p.493-596)
Chapter 12 Adding Cartilage to the Nose- Why Grafts Are Necessary.pdf (p.597-764)
Chapter 13 The Uncomplicated Postoperative Course.pdf (p.765-780)
Chapter 14 Problems in the Postoperative Course.pdf (p.781-854)
Chapter 15 Common Problems in Anatomy and Proportion.pdf (p.855-980)
Chapter 16 Exceptions to the Usual.pdf (p.981-1114)
Chapter 17 Theory, Planning, and Technique.pdf (p.1115-1218)
Chapter 18 Regional Deformities.pdf (p.1219-1266)
Chapter 19 Generalized Deformities.pdf (p.1267-1430)
Chapter 20 Unhappy Patients and Those With Body Dysmorphic Disorder.pdf (p.1431-1484)
Index.pdf (p.1485-1494)
Hollywood Propaganda: How TV, Movies, and Music Shape Our Culture by Dice, Mark
Introduction
The Politics of Entertainment
War on Trump
War on America
Immigration
War on White People
Film and Television Liaison Offices
Climate Change
Sports “News”
Late-Night Comedy Shows
Award Shows
Feminism
The LGBT Agenda
Sexual Deviants
Crimes Inspired by Hollywood
Conclusion
Copyright Info
Footnotes
The Liberal Media Industrial Complex by Dice, Mark
Summary of Mark Dice's the Bohemian Grove by Everest Media
Insights from Chapter 1
Insights from Chapter 2
Insights from Chapter 3
Insights from Chapter 4
Insights from Chapter 5
Insights from Chapter 6
Insights from Chapter 7
Insights from Chapter 8
Insights from Chapter 9
Insights from Chapter 10
Insights from Chapter 11
The Bohemian Grove: Facts & Fiction by Mark Dice
Introduction
History of the Grove
Their Symbols, Saint, and Motto
The Different Subcamps
The Cremation of Care Ritual
The Lakeside Talks
Infiltrations and Leaks
Hookers and Homosexuality
Allegations of Murder
Talk Radio Hosts Dodge the Topic
The Belizean Grove
Depictions in Television and Film
Conclusion
Further Reading
About the Author
Footnotes
Causing Trouble: High School Pranks, College Craziness, and Moving to California by Dice, Mark
Table of Contents
Introduction
High School
College Craziness
Middle School
Moving to California
Looking Back on it All
Inside the Illuminati: Evidence, Objectives, and Methods of Operation by Mark Dice
Introduction
Early Evidence
The Thirteen Bloodlines Theory
Affiliated Secret Societies
Spiritual Beliefs
Symbolism
Insiders’ Hints
“Ex-Illuminati Members”
Conclusion
Further Reading
About the Author
Copyright Info
Footnotes
The New World Order: Facts & Fiction by Dice, Mark
About the Author
Introduction
Calls for a New World Order
World Governed by the Elite Through Occult Secret Societies
Mainstream Media Controlled
High Level Officials and Institutions within the NWO are Above the Law
Immorality and Destructive Behavior is Encouraged
Banking, Money, and Taxes
One World Currency
Population Reduction
One World Religion
A Global Dictator Claiming to be God
Global Police and Military Force
A Nation of Spies
Elimination of the Right to Bear Arms
Elimination of National Sovereignty
Monitoring the Population with Big Brother.
A Medicated and Sedated Population
Science and Technology
Global Warming / Climate Change
Fringe Topics
Conclusion
Footnotes
The Bilderberg Group: Facts & Fiction by Mark Dice
Introduction
The Attendees
Recent Meetings
How Were They First Discovered?
Tax Returns
Politicians Silent
Actions and Effects
Talk Show Hosts Play Dumb
Bilderberg’s Goals
Conclusion
Further Reading
About the Author
Copyright Info
Footnotes
Illuminati in the Music Industry by Dice, Mark
Introduction
Rap and Hip Hop
Pop Music
Rock and Heavy Metal
Country Music
Conclusion
Footnotes
The New World Order: Facts & Fiction by Mark Dice
About the Author
Introduction
Calls for a New World Order
World Governed by the Elite Through Occult Secret Societies
Mainstream Media Controlled
High Level Officials and Institutions within the NWO are Above the Law
Immorality and Destructive Behavior is Encouraged
Banking, Money, and Taxes
One World Currency
Population Reduction
One World Religion
A Global Dictator Claiming to be God
Global Police and Military Force
A Nation of Spies
Elimination of the Right to Bear Arms
Elimination of National Sovereignty
Monitoring the Population with Big Brother
A Medicated and Sedated Population
Science and Technology
Global Warming / Climate Change
Fringe Topics
Conclusion
Bibliography
Footnotes
Big Brother: The Orwellian Nightmare Come True by Mark Dice
Introduction
Surveillance Cameras
Global Positioning Systems
Radio Frequency Identification Devices (RFID)
Mind-Reading Machines
Neural Interfaces
Psychotronic Weapons
Information Technology
Orwellian Government Programs
The Nanny State
Orwellian Weapons
Artificial Intelligence
Cybernetic Organisms
A Closer Look at Nineteen Eighty-Four
Conclusion
Further Reading
About the Author
Copyright
Footnotes
Big Brother: The Orwellian Nightmare Come True by Mark Dice
Introduction
Surveillance Cameras
Global Positioning Systems
Radio Frequency Identification Devices (RFID)
Mind-Reading Machines
Neural Interfaces
Psychotronic Weapons
Information Technology
Orwellian Government Programs
The Nanny State
Orwellian Weapons
Artificial Intelligence
Cybernetic Organisms
A Closer Look at Nineteen Eighty-Four
Conclusion
Further Reading
About the Author
Copyright
Footnotes
True Story of Fake News by Mark Dice
Introduction
Real Fake News
The Media Circus
The Power of Propaganda
Lying by Omission
Fake Hate Crimes
Operation Mockingbird
White House Correspondents’ Dinner
Liberal Bias Confirmed
The Sun Valley Conference
The New Media
Facebook
Twitter
YouTube
Google
Wikipedia
CNN
NBC News
CBS News
ABC News
MSNBC
Conclusion
Further Reading
About the Author
Copyright Info
Footnotes
The Liberal Media Industrial Complex by Mark Dice
Introduction
Censorship
The Memory Hole
The War on Trump
The War on Trump Supporters
The War on Families
TV “News”
Internet “News” Sites
Wikipedia
Google
Rise of Social Media
Facebook
Twitter
YouTube
The Future of Fake News
Conclusion
Copyright Info
Footnotes
True Story of Fake News by Mark Dice
Introduction
Real Fake News
The Media Circus
The Power of Propaganda
Lying by Omission
Fake Hate Crimes
Operation Mockingbird
White House Correspondents’ Dinner
Liberal Bias Confirmed
The Sun Valley Conference
The New Media
Facebook
Twitter
YouTube
Google
Wikipedia
CNN
NBC News
CBS News
ABC News
MSNBC
Conclusion
Further Reading
About the Author
Copyright Info
Footnotes
Big Brother: The Orwellian Nightmare Come True by Mark Dice
Introduction
Surveillance Cameras
Global Positioning Systems
Radio Frequency Identification Devices (RFID)
Mind-Reading Machines
Neural Interfaces
Psychotronic Weapons
Information Technology
Orwellian Government Programs
The Nanny State
Orwellian Weapons
Artificial Intelligence
Cybernetic Organisms
A Closer Look at Nineteen Eighty-Four
Conclusion
Further Reading
About the Author
Copyright
Footnotes
B003Z0CUNC EBOK by Mark Dice
The
Illuminati
Facts & Fiction
Mark Dice
Table of Contents
Preface
About the Author
Introduction
Pre Illuminati Organizations
The Luciferian Doctrine
Inside the Mindset of the Illuminati
Why are the Jews Always Blamed?
Fixing the Fight
Mainstream Media
Economic Control
Nonfiction Books
Proofs of a Conspiracy
Memoirs Illustrating the History of Jacobinism
Proof of the Illuminati
Secret Societies and Subversive Movements
Occult Theocrasy
None Dare Call It Conspiracy
Bloodlines of the Illuminati
The Lexicon of Freemasonry
Morals and Dogma
The Secret Teachings of All Ages
Bohemian Grove: Cult of Conspiracy
Common Sense Renewed
Tragedy and Hope
The New World Order
America’s Secret Establishment
Fleshing Out Skull and Bones
Secrets of the Tomb
September 11th 2001 Terrorist Attacks
The Creature from Jekyll Island
The Satanic Bible
The Book of the Law
Magick: In Theory and Practice
The Secret Doctrine
The Externalization of the Hierarchy
Codex Magica
Jim Tucker’s Bilderberg Diary
The True Story of the Bilderberg Group
The Search for the Manchurian Candidate
The Reappearance of the Christ and the Masters of Wisdom
The Franklin Cover-Up
The most disgusting and disturbing book ever written is possibly The Franklin Cover-Up which was first published in 1992 and later released with revisions in 2005. The book was written by former Nebraska Senator John DeCamp, and uncovers a scandal so large and perverted, that most people simply do not want to hear about it, let alone believe it actually happened.
Furthermore, Bonacci says that a man named “Hunter Thompson” was the one who took video of this entire ordeal. Later, a man named Rusty Nelson, who was connected to the Franklin Cover-Up claimed that Hunter S. Thompson, the famous gonzo journalist offered him $100,000 to produce a snuff film when the two had met at a party.[102] (See Fear and Loathing in Las Vegas page 318) Rusty Nelson was the personal photographer for Lawrence E. King, the key perpetrator in the Franklin Cover-Up. Nelson admits that it was his job to secretly take photos of people who attended King’s parties when they were in “compromising positions with children.” Nelson denies taking any pornographic photos, but does admit that he would often witness and photograph grown men “making out with boys.” The men who attended these parties were often politicians who King would then blackmail with the photos.
On April 27, 1996 Colby died in what was called a canoeing accident. The incident happened at night which is strange, because Colby wouldn’t go canoeing after dark. He was alone when the incident happened, and had not told his wife that he was going canoeing. He was not wearing a life jacket, which his friends said he usually wore, and many believe he was murdered for aiding DeCamp or for knowing to much about such things.
David Rockefeller’s Memoirs
Foreign Affairs
Purported Illuminati Texts
The Necronomicon
Emerald Tablet
The Book of Thoth
The Book of Shadows
The Illuminati Manifesto
The Book of Dzyan
The Report From Iron Mountain
Protocols of the Elders of Zion
Excerpt from Protocol 1
Excerpt from Protocol 2
Excerpt from Protocol 3
Excerpt from Protocol 4
Excerpt from Protocol 5
Excerpt from Protocol 6
Excerpt from Protocol 7
Excerpt from Protocol 8
Excerpt from Protocol 10
Excerpt from Protocol 11
Excerpt from Protocol 12
Excerpt from Protocol 13
Excerpt from Protocol 14
The Holy Grail
Alleged Defectors and Victims
John Todd
Bill Schnoebelen
Mike Warnke
Cathy O’Brien
Johnny Gosch
MK-ULTRA Victims Testimony
Activists and Eyewitnesses
William Morgan
JFK Warns Against Secret Societies
Chris Jones
Ted Gunderson
One of the highest ranking government officials to publicly talk about the Illuminati and admit that organized child kidnapping rings were active in the United States is Ted Gunderson. Gunderson is a retired FBI agent who worked as the Senior Special Agent-in-Charge of the Los Angeles office who retired in March of 1979 and then became a private investigator.
Benjamin Fulford
Hal Turner
Anthony J. Hilder
In today’s modern world with the Internet, mp3s and YouTube, it can be somewhat simple to open the floodgates of information regarding the Illuminati and secret societies. Since 2006 and the creation of YouTube and Google Video, countless video clips and documentaries about such issues are literally a click away. But as we know, books on the Illuminati have been around since at least the late 1700s as in the case of John Robison’s Proofs of a Conspiracy and Abbe Barruel’s Memoirs Illustrating the History of Jacobinism. There seems to be a tremendous gap in history from the time these books were published, until other authors and researchers continued the work such as Nesta Webster and Edith Miller in the 1920s and 30s, and later Gary Allen with his 1972 book None Dare Call It Conspiracy.
Aliens and Reptilians
David Icke
William Cooper
Phil Schneider
Mentions in Mainstream Media
CNBC
Gerald Celente
Fox News Business
The Colbert Report
Fox News Channel
60 Minutes
NBC’s Meet the Press
Geronimo’s Skull Controversy
Inside Edition
CNN
CNN in London
PBS News Hour with Jim Laher
C-Span
Lou Dobbs Tonight
C-Span’s Washington Journal
Brian Lamb, the director of C-Span dedicated a segment of the show Washington Journal to the Bohemian Grove and slanted the coverage in an attempt to remove any suspicions surrounding the club. Professor Michael Barkun was the guest for the segment, who is the author of a book titled A Culture of Conspiracy.
National Geographic
ABC News Report on Bohemian Grove
On July 23, 1981 ABC News aired a segment about the Bohemian Grove which someone had obtained from their archives and posted on YouTube in 2006. This segment would mark possibly the only attention given to the Bohemian Grove by a mainstream news source. The fact that no other television news stations have since devoted any attention to the subject speaks volumes as to the control the organization has over the media.
Pitching the Bohemian Grove to Producers
The Mancow Show
Walter Cronkite
Henry Kissinger
President Bush at the United Nations
Maxim Magazine
Charlie Sheen’s 9/11 Comments
Jesse Ventura on Hannity & Colmes
The View
On March 6th, 2007 actress Christine Ebersole was a guest on the popular woman’s talk show The View when she brought up the topic of this author’s YouTube videos which consist of me visiting various college campuses in southern California and educating the students about 9/11. Rosie O’Donnell jumps in to explain, “He goes around the country with a bullhorn, like to UCLA or wherever he wants, and he says, “9/11 was an inside job! 9/11 was an inside job!” and within five or ten minutes, the police show up and his friends videotape him getting arrested, and boy does it annoy people, I can tell you that much.”
Operation Inform the Soldiers
On June 10th 2008, this author made an appearance on the Fox News Channel’s show America’s Newsroom, to discuss a campaign that I had started called Operation Inform the Soldiers, which involved mailing DVDs to troops stationed in Iraq to help educate them about the lies surrounding 9/11 and the war.
Kevin Barrett’s Comments
Coast to Coast AM
The largest syndicated radio show in America that deals with secret societies and conspiracies is Coast to Coast AM, which airs seven days a week from 10pm to 2am Pacific time. The show was created by UFO buff Art Bell, who has since retired. George Noory is currently the primary host.
Documentary Films
Dark Secrets: Inside Bohemian Grove
Secret Rulers of the World
British journalist Jon Ronson produced a series of four television programs titled The Secret Rulers of the World which included one episode about the Bohemian Grove, and another about the Bilderberg group where he investigated the claims of what he called “conspiracy theorists” surrounding such groups. Ronson takes a very skeptical approach to the subject matter, and seems as if his purpose is to prove the allegations wrong and “debunk” the claims surrounding these organizations.
Nazis: The Occult Conspiracy
In the show, it is also presented that the Nazis wanted to eliminate all Jews, and probably all non-whites, to create a New World Order comprised only of Aryans so that the purified race could then reawaken the mystical powers that they had lost since the destruction of the city of Atlantis. The Nazis believed that the white race is descended from a civilization that lived in the mythical lost city of Atlantis. They believed Atlantis was a real city, and not just a myth, and that its inhabitants were god-like supermen.
Terrorstorm
Loose Change: Final Cut
Fabled Enemies
The 9/11 Chronicles: Truth Rising
Endgame: Blueprint for Global Enslavement
Zeitgeist the Movie
The Clinton Chronicles
Monopoly Men
The Money Masters
Money as Debt
Riddles in Stone
The History Channel: Secret Societies
Conspiracy of Silence
Decoding the Past: The Templar Code
Another well done History Channel production is the two hour Decoding the Past episode titled The Templar Code. The program covers some interesting history surrounding the formation of the Knights Templar, and their ultimate demise. The show begins with the narrator saying they were “a society so secret that its true purpose is debated even to this day.”
Mysteries of the Freemasons
Hacking Democracy
Other films
Snuff Films
Sex Magic
Fictional Books
The Illuminatus! Trilogy
The Illuminati by Larry Burkett
Angels & Demons
Fear and Loathing in Las Vegas
Nineteen Eighty-Four
Games & Collector Cards
The Illuminati Card Game
New World Order Trading Cards
Conspiracy Cards
Fictional Films
V for Vendetta
The Matrix
Angels & Demons
The Texas Chainsaw Massacre
Teddy Bears’ Picnic
The Brandon Corey Story
The Long Kiss Goodnight
Network
Star Wars
Lara Croft: Tomb Raider
They Live
Hackers
The plotline involves a rivalry between groups of hackers, but there is a scene that stuck out to those aware of the New World Order when Eugene “The Plague” Belford (played by Fisher Stevens) sent a laptop containing a video message to a fellow hacker “Zero Cool” (played by Jonny Lee Miller). The message was, “You wanted to know who I am Zero Cool. Well let me explain the New World Order. Governments and corporations need people like you and me. We are samurai. The keyboard cowboys, and all those other people out there who have no idea what’s going on are the cattle. Moooo. I need your help. You need my help. let me help you earn your spurs. Think about it.”
The Skulls
The Good Shepherd
The Lord of the Rings
Eyes Wide Shut
The Brotherhood of the Bell
A Scanner Darkly
National Treasure
Shooter
Air America
Air America is actually the name of a cargo airline that was owned and operated by the CIA from 1950 to 1976 which supplied covert operations in Southeast Asia during the Vietnam War. This airline was believed to be used to also transport heroine into the United States. This would ultimately be the inspiration for Christopher Robbins’ book and Air America the film.
Wag the Dog
Oliver Stone’s JFK
Bulworth
Conspiracy Theory
The Manchurian Candidate
Enemy of the State
Batman Returns
Dragnet
Television Show References
South Park
Rescue Me
The Lone Gunmen
24
Gargoyles
A cartoon airing on the Disney Channel from 1994 to 1997 called Gargoyles included several episodes which mentioned the Illuminati and one of the main characters was shown to be a member.
Wild Palms
The Simpsons
In a 1995 episode of the popular animated cartoon, The Simpsons, Homer joins an all-male fraternity in Springfield called the Stonecutters, an obvious reference to the Freemasons. The Freemason fraternity evolved out of ancient stone masons and trade guilds who kept knowledge secret about how to work with stone and build cathedrals and castles. The episode is titled “Homer the Great” and starts of with Homer noticing that two of his friends, Lenny and Carl, are enjoying special privileges around town and at work such as comfortable chairs and premium parking spots. After Homer becomes suspicious, he finds out that they are members of the Stonecutters secret society, and is allowed to become a member himself.
The Cartoon Network
Corporate Logos
Music References
Eminem
Dr. Dre
Neil Young
Don Henley
“It was an inside job by the well-connected” Henley sings. Other lyrics include that they know what you’ve had for breakfast and what you’ve hid beneath the mattress. “Chalk it up to business as usual,” Henley concludes.
Megadeth
Ministry
Jadakiss
Flowbots
Conspirituality
Paris
Immortal Technique
Sean “P. Diddy” Colmes
Prodigy
Jay-Z
Nas
Tupac Shakur
Black Eyed Peas
Fat Boy Slim
Skinny Puppy
Poker Face
Killarmy
Meat Beat Manifesto
The Jurassic 5
Gamma Ray
The KLF
Agent Steel
Killer Squirrel
Hed PE
Bobby Conn
Malice Mizer
Infected Mushrooms
The Matthew Good Band
The Alan Parsons Project
Solutions
Illuminati Controlled Organizations
The Bilderberg Group
Council on Foreign Relations
The Trilateral Commission
The Bohemian Grove
The Federal Reserve
Freemasonry
Skull and Bones
The Military
The Vatican
Knights of Malta
Radical Islam
Communism
World Council of Churches
Election Fraud
The British Monarch
Royal Order of the Garter
MI-5 and MI-6
Council of Chatham House
The Group
The Triads
The CIA
The NSA
The FBI
The DEA
Pharmaceuticals
Entertainment
The Mormon Church
Jehovah’s Witnesses
Rhodes Trust
The Cosmos Club
Club of Rome
DARPA
Supreme Council of Wise Men
The Council of 13
The Committee of 300
The Jasons
MJ-12
The Mothers of Darkness Castle
The Pilgrims Society
The Priory of Sion
Satanic Cults and Churches
United Nations
International Monetary Fund
The World Bank
Foundations
Bank for International Settlements
Central Banks
Global Environmental Facility
Monopoly Corporations
Regional Federations
The United Grand Lodge of England
Unity Church
Unitarian Universalist Association
Unification Church
Temple of Understanding
Bahai
Rosicrucians
The Aspen Institute
World Trade Organization
KGB
La Cosa Nostra
FEMA
Mossad
UNESCO
Planetary Congress
Environmental Groups
Lucis Trust
World Union
Esalen Institute
Commission on Global Governance
Interpol
Information Awareness Office
Tavistock Institute
Underground Bases and Tunnels
The Project for a New American Century
Others
Bibliography
Books
Other Documents
Footnotes

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RHINOPLASTY Craft Magic

RHINOPLASTY Craft Magic Mark B. Constantian, MD Private Practice; Active Staff, Department of Surgery/Plastic Surgery, St. Joseph Hospital, Southern New Hampshire Medical Center, Nashua, New Hampshire

MEDICAL ILLUSTRATOR Amanda Yarberry Behr, MA, CMI

Director, Editorial Services: Mary Jo Casey International Production Director: Andreas Schabert International Marketing Director: Fiona Henderson International Sales Director: Louisa Turrell Director of Sales, North America: Mike Roseman Senior Vice President and Chief Operating Officer: Sarah Vanderbilt President: Brian D. Scanlan

Library of Congress Cataloging-in-Publication Data is available from the publisher upon request.

Important note: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book. Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility. The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

© 2009 Thieme Medical Publishers, Inc. Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, [email protected] Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, [email protected] Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, [email protected] Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda. Edifício Rodolpho de Paoli, 25º andar Av. Nilo Peçanha, 50 – Sala 2508 Rio de Janeiro 20020-906, Brasil +55 21 3172 2297 Printed in Italy eISBN 978-1-62623-843-5

54321

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.

For my wife Charlotte 

And now I know a wish comes true ...Because of you

FOREWORD Thirty years ago Mark Constantian, a young plastic surgeon fresh out of residency, asked if he could come from the East coast to visit and watch me operate. Because there was interest in my unorthodox approach to rhinoplasty and I was eager to spread the word, I arranged a date for his visit. For most of my years in practice, my operating room was open to observers, but even though I had many who came to watch, very few followed up. Mark Constantian was an exception. I was unprepared for the intensity of his interest in rhinoplasty and his insatiable desire for detail. We invested numerous hours discussing cases that I had operated on and reviewing a growing file of photographs of patients who were scheduled for surgery. Those visits became an annual event that lasted until I retired in 2004. Since then the yearly visits and animated discussions have continued, but now they involve his cases. Why another book on rhinoplasty? Because this particular book is the product of countless hours of thought, discussion, and analysis candidly presented by its author. It has distilled the most common pitfalls in diagnosis with a wealth of surgical material underscoring each anatomic variant or combination of variants. The young practitioner will benefit from the practical considerations laid out in detail— essentials such as how to approach the initial consultation or the value of dictating a preoperative plan with expected results and limitations. The more sophisticated surgeon will likely recognize that special problem patient he or she is about to operate on in one of the hundreds of cases that are detailed in these pages. The most important prerequisite for producing meaningful new ideas is an obsessive passion for the subject—Mark Constantian certainly has that for rhinoplasty. But he has brought more to the table than just passion. In his early training, Mark was exposed to research and quantitative analysis. He has used that background to quantify his new ideas, providing a scientific basis for the conclusions drawn. There is valuable information on every page, but as a member of the emeritus group of surgeons who has devoted most of a professional life to delving into the many mysteries of this surgery, I was especially impressed by one chapter that

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FOREWORD

should be mandatory reading for anyone performing nasal surgery—that is Chapter Four: “The Anatomy of Function and How Rhinoplasty Affects the Airway.” This chapter is scholarly, factual, and extremely important. It is in sharp contrast to the thinking that prevailed 30 years ago, when most plastic surgeons avoided looking inside the nose, preferring to refer internal nasal airway problems to ENT colleagues, most of whom did not have the wealth of information that has been presented in this outstanding chapter. This book is a gift to the profession by Dr. Constantian, beautifully presented and framed in the familiar excellence of QMP and its founder, Karen Berger. Every teacher, if fortunate, can, in retirement, relish the contributions made by a former student. I must say, I am justly proud of Mark Constantian for this superb addition to our understanding of the art and science of nasal surgery. Jack H. Sheen

viii

FOREWORD Dr. Mark Constantian is not just my colleague, but a close friend, as is his wife, Charlotte, his partner in work and in life. These two volumes are a labor of love and, if not a love of labor, at least a tolerance for expending prodigious effort to complete a task. Ralph Waldo Emerson was correct when he stated that “Nothing great was ever achieved without enthusiasm.” And there is no shortage of enthusiasm in these pages. Books of this size by a single person are increasingly rare in these times, and it is a refreshing departure from the usual multiauthor tomes. In his debut discourse when inducted to the French Academy in 1753, the naturalist George Buffon stated, “The style is the man himself.” So too with this book. Dr. Constantian is meticulously devoted to detail in everything he does, even when he accompanies himself on his guitar and when he records his playing with background band accompaniment. Who would not want their surgeon to be a perfectionist? Dr. Constantian’s professional life is proof that one need not be in a large metropolis to attract patients. Nashua, New Hampshire, where Dr. Constantian lives and works, has a population of about 90,000. I have been glad throughout the years to be able to refer some of my dissatisfied patients to Dr. Constantian, Nashua being about an hour’s drive from Boston. On more than one occasion I have sent to him a new patient with a difficult nasal problem. In every instance, Dr. Constantian’s rapport with the patient was excellent. He has often used the occasion of an unhappy patient to bridge the gap between us, even trying to lessen the patient’s financial burden. Dr. Constantian is more than a talented rhinoplastic surgeon; he is more than a student of rhinoplasty; he is a scholar of the various problems associated with nasal surgery. One will find in these pages honest appraisals of complications, some of them his own. Fortunately for the reader, he is an excellent teacher, more than willing to share his experience, the bad and the good, with anyone who is willing to

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FOREWORD

study, not just read, this chef d’oeuvre. Throughout each chapter one feels the author’s presence and benefits from his step-by-step pedagogy. He not only shows his techniques but discusses his reasons for choosing them. The reader soon becomes a participant. Plastic surgery’s ancient traces centered on the nose and its reconstruction. Through the centuries, the objective has always been a nose of normal appearance. In the latter part of the nineteenth century and the beginning of the twentieth, because of pioneers such as Roe and Joseph, improving the appearance of the nose became a desideratum. Not all patients are happy after rhinoplasty. Dr. Constantian shares his views on how he deals with this unpleasantness for both patient and surgeon. His admonitions about patient selection should be heeded. He discusses patients to avoid, such as those with body dysmorphic disorder and others whose expectations are unrealistic. He does not, however, mention surgeons to avoid, so let me tackle that question here. Briefly: The surgeon who does only an occasional rhinoplasty and the prospective patient should avoid each other. Does this mean that only experts such as Jack Sheen or Mark Constantian should undertake a rhinoplasty? No, but we must remember that every surgeon undertaking a procedure should be competent. The old saying “As plain as the nose on your face” should remind us that the result after rhinoplasty is visible to everyone. In this sense rhinoplasty is an unforgiving procedure. For most of us, rhinoplasty was a mysterious procedure during our residencies. In my days of training (1961-1963) I never saw an open rhinoplasty. I had trouble visualizing what my mentor was doing in the nose with his chisel, rasp, and hammer. I could see the submucous resection, but that was about all. Today the average trainee probably understands less about and feels less competent performing rhinoplasty than any other cosmetic procedure. Dr. Constantian and (the appropriately named) Quality Medical Publishing, in these beautifully presented and lavishly illustrated two volumes, have succeeded marvelously in providing a guide to improve the skills of anyone performing rhinoplasty—to the ultimate benefit of the patients to whose well-being every physician

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must be dedicated. Finally in this book we have a new tool—in addition to the historical methods of taking courses, watching videos, performing operations on cadavers, and visiting more experienced rhinoplastic surgeons to watch them work— that allows new rhinoplasty surgeons to become competent. I feel I should point out that there is no “real” magic in rhinoplasty. As Dr. Constantian mentions in his preface, magic does not mean pulling a rabbit from a nostril. Instead, he calls our attention to how a properly executed anatomic change produces a balanced nose that may look smaller even when it has been augmented. He makes a point with which most rhinoplasty surgeons would agree: “Good rhinoplasty is also brain surgery, and can rehabilitate damaged self-confidence.” Blaise Pascal, the seventeenth century French mathematician and philosopher, speculated, “Cleopatra’s nose, had it been shorter, the whole face of the world would have been changed.” If Dr. Constantian had been living then and Cleopatra had had the good sense to have sought his services, there would have been no romance with Julius Caesar and no enervating war with Ptolemy. That would have been magic. But it is not too late. After having read this classic (and it is a classic) I wrote to the secretary-general of the United Nations to suggest thinking of rhinoplasty as a resource to prevent or end wars. Magic for peace—what better goal! In this regard we await with high expectations Dr. Constantian’s next book. Robert M. Goldwyn

xi

PREFACE I do not know what I may appear to the world; but to myself I seem to have been only like a boy playing on the seashore, and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, whilst the great ocean of truth lay all undiscovered before me. SIR ISAAC NEWTON Brewster’s Memoirs of Newton

Why do so many smart surgeons struggle with rhinoplasty or stop performing it altogether? Is it the limited access? Is it the technical skill required, the complex anatomy, the narrow margin of error, or the lack of binocular vision? Or is it simply that the nose is an idiosyncratic little body part that will not follow the laws that Nature has established for every other type of surgery? It was not always this way. During my plastic surgery residency in the mid 1970s, rhinoplasty was a simple operation. There were very few rules. Every preoperative nose was too big, and so the solution was always reduction. We were taught to recognize thick-skinned patients and not operate on them. If the airway was obstructed, we would remove part of the septum and reduce the turbinates. Patients who had imperfect outcomes were rejected for further surgery, because nothing could be done to help them. They had been poor rhinoplasty candidates.

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Therefore many surgeons agreed with McDowell, writing in 1978: During the last 15 years, evidence has been increasing that the “pay dirt” lode in the great mine of rhinoplastic information is nearly exhausted. The nose is a small organ with a rather simple anatomical structure; in two-thirds of the century, the fine investigative surgeons at work seem to have exhausted most of the possibilities for desirable structural changes in this small and simple organ. The situation is not unlike that which has existed for 50 years with regard to operations for indirect inguinal hernia.

That very same year, the first edition of Dr. Sheen’s Aesthetic Rhinoplasty was published. I met Dr. Sheen in July 1978, just after finishing my residency, and read a typescript of his book, then at the printer. I was captivated. The logic and order of the surgical steps made more sense than anything I had read on the subject, and I saw how his principles of support and structure applied not only to the unoperated nose, but could also be used to rehabilitate secondary and tertiary patients, whose deformities had been considered inoperable until then. But Dr. Sheen’s words were only part of the spark that ignited my interest in rhinoplasty: he performed magic in the operating room. Dr. Sheen was a rapid, efficient, technically gifted surgeon; but it was his clarity of goals, energy, and excitement— and even more than that, his wonderment—that made his surgery so remarkable and such a catalyst for my own work. Dr. Sheen’s contributions to rhinoplasty expanded over the next 30 years. His techniques and innovative, often iconoclastic, observations became the modern framework within which we all discuss rhinoplasty: recognition of middle vault collapse, the inverted-V deformity, the patient’s aesthetic, the importance of the “ethnic” nose, and the unbalanced top-heavy or bottom-heavy nose (disproportion); and his concepts of less resection—not more—for thicker-skinned patients, omitting osteotomy and the low-to-high osteotomy, the airway ramifications of the narrow nose, inadequate tip projection, camouflage for asymmetry, the two-surface concept for alar wedge resection, and the use of the alar lobule as a composite graft. And these are the big contributions: dorsal and tip augmentation to treat supratip deformity; identification of the middle crus, the low radix, short nasal bones, and alar cartilage malposition; the techniques of spreader grafts, the shield tip graft, and crushed cartilage grafts; the use of the ear as a cartilage and composite graft donor site; and many new concepts for using rib grafts. His observations became our new paradigm, and his terminology became our rhinoplasty lexicon. Armed with this new information, I entered practice in New Hampshire, eager to apply what I had learned and create astonishing rhinoplasty results—I fell flat on my face. Nothing I saw or did resembled the diagrams in my atlases or the magic that I had seen in Dr. Sheen’s operating room. Nothing behaved the way it should.

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PREFACE

When I reduced the dorsum, why did the middle third look narrower, and why did the nose shorten? Why had the columella become lower, the alar rims more arched, and the nasal base larger and blunter? I had not touched them. Why was rhinoplasty so different from all the other operations I had learned? This was not magic— it was black magic. I determined to understand what was going on. I didn’t believe in idiosyncrasy; I believed in biological laws—but I had to decipher what they were. I tried to relate the postoperative changes to what I had done and to the preoperative deformity. When there were outcome differences between apparently similar noses, there had to be a reason. And most important, what was the relationship between nasal appearance at the end of the operation and its appearance a year later? It made no sense to discuss aesthetic goals with my patients if I had no idea how to achieve them. How could the surgeon learn to control the postoperative result? I resolved to break The Rhinoplasty Code. This book is a product of my 30-year adventure into nasal phenomenology, function, and technique. It summarizes what I know today. Because Dr. Sheen’s texts have become such standard reference works, the reader familiar with them will recognize comforting similarities. My Patient Studies have used Dr. Sheen’s format, describing the deformity and patient goals, the surgical plan, and the postoperative analysis. I have included many hundreds of intraoperative photographs that demonstrate those intraoperative changes that are important for the reader to learn and that show the grafts used in each patient. And I have included many examples of sequential postoperative changes so that the reader may observe how each type of nasal shape and intervention matures as time passes. But there is much here that I hope the reader will find new and educational, and that will help direct treatment. Part I describes not only static anatomy but dynamic nasal anatomy—how things move during surgery and afterward—a phenomenon almost unique to rhinoplasty and one reason that it is so difficult to learn. Chapter 3 explains why rhinoplasty is a right-brain operation that trades heavily in balance and proportion, and shows the reader how to access right-brain function on command. Chapter 4 summarizes the results of 17 years of airway research and relates physiology to surgical practice so that surgeons can reliably ensure that each of their patients breathes better postoperatively. Chapter 5 analyzes the four critical anatomic variants that most often make the difference between successful and unsuccessful results. Part II explores rhinoplasty as an operation: why rhinoplasty is difficult, rhinoplasty planning in the abstract, and applied concepts and aesthetics. It concludes with a widely applicable method for creating an operative plan.

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PREFACE

Part III covers basic concepts and techniques in the primary surgery. I explain how a surgeon can teach himself or herself rhinoplasty in the same way that I did. In the operating room, I demonstrate the interactive nature of rhinoplasty step by step, so that the reader can learn to interpret intraoperative signals and artifacts as they occur, understand them, and react to them. Part III also details graft harvesting and technique for each graft used in primary rhinoplasty. Following this is a chapter that discusses the typical postoperative course and a chapter devoted to postoperative problems, including my own complications. Rhinoplasty deformities may seem limitless, but they are not. By and large, they form patterns. Likewise, their surgical solutions form patterns. Part IV introduces an icon system that reduces the operative plan for each case to a schematic, located at the top corner of every page on which the case is described. Soon the reader will be able to link the schematics, relate the icons to the solutions and to the deformities that they correct, and therefore begin to see these deformities as recognizable groups with associated characteristics. This recognition is the beginning of familiarity with The Code. Part IV also contains analyses of the treatments of the common and less common primary rhinoplasty shapes. Part V discusses secondary rhinoplasty—its unique techniques and donor sites— and treatment of regional or generalized deformities. Not all unfavorable rhinoplasty results are technical. Perhaps even more unfortunate than unfavorable results are surgical successes in unhappy patients. These difficulties occur along a spectrum, and their pathophysiology is complex—related, I believe, to both the patient’s self-esteem and prior interpersonal relationships. Part V therefore concludes with a discussion of body dysmorphic disorder and lessons that I have learned from my own unhappy patients. As these volumes grew, so did the need for a certain amount of purposeful repetition. Though one clinical example might have sufficed in a few instances, I have tried to show several so that the interested surgeon might be able to match an upcoming case to elements of the clinical examples, and thus be more rapidly guided toward a successful solution. In doing so, I have tried to show ranges of outcomes; and where there were postoperative problems, I point them out. Showing only perfect results would not be teaching, but marketing, and that is not the purpose of this book. There is still a void in rhinoplasty learning; therefore there must be a void in rhinoplasty teaching. Some rhinoplasty techniques have become devilishly complex and abstruse. I have deliberately tried to do the opposite in my own work and in my teaching. The reader may therefore wonder why there aren’t many more technical variations. But rhinoplasty is not difficult because too few techniques have been

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PREFACE

described, but rather because many surgeons do not yet fully understand its rightbrain nature, how to make a diagnosis that directs treatment, the importance of controlling skin sleeve movement, and that no rhinoplasty is a success unless it ensures an optimal airway. Nature’s laws are consistent, regardless of the surgical approach. Thus the principles in this book apply whether the surgeon uses grafts or sutures, columellar or mucosal incisions. There is perhaps no other operation that so completely integrates balance and harmony with the surgeon’s technical skill and spatial intelligence, and so thoroughly tests the surgeon’s ability to uncover and produce the patient’s aesthetic goals. That is the craft of rhinoplasty. But there is also the magic: balanced noses look smaller than unbalanced noses, even when they have been augmented. Dorsal and tip grafts correct supratip deformity without skeletal reduction. Raising the dorsum decreases apparent nasal base size. There are many other apparently paradoxical effects unique to rhinoplasty. Good rhinoplasty is also brain surgery. It can rehabilitate damaged self-confidence in ways that are best measured by changes in the patients’ eyes. That is perhaps the greatest magic of all. Most rhinoplasty surgeons have been confounded by the operation at one time or another. Even Dr. John Roe, to whom we are indebted for much of what we do in rhinoplasty today (including the endonasal approach) noted, after performing only four rhinoplasties: There is no class of operations that demands in every case a more careful preliminary study of all the conditions presented—not only in respect to the abnormal state of the tissues to be operated on, but also in respect to the possibility of obtaining the desired surgical result—than the operations required for the correction of nasal deformities.

It is to the surgeons who may benefit from a better understanding of the operation, and to all of our patients, that I offer the text that follows. Tap into the magic. Mark B. Constantian

BIBLIOGRAPHY McDowell F. History of rhinoplasty. Aesth Plast Surg 1:321-348, 1978. Newton I. Quoted in Sagan C. Cosmos. New York: Random House, 1980, p 71. Roe JO. The deformity termed “pug nose” and its correction by a simple operation. Med Rec 31:621, 1887.

xvii

ACKNOWLEDGMENTS Just like performing surgery, writing a book is a team project. Bigger books, especially those that take decades to come together, need bigger teams. During these years, I have been assisted by many staff in my office and in the hospitals where I perform surgery. In my office: My operating room scrub and office nurse, Donna Morton, LPN; my patient coordinator and photo manager, Anita Serian; my aesthetician, Jennifer Cross; my typist, Melissa Rascoe; and Julie Murphy and my wife, Charlotte, who retrieved, logged, and scanned more than 5000 patient photographs and proofed and assembled the chapters. Were I to list all the other contributions that Charlotte has made to Craft and Magic, the readers might wonder if I did anything myself except the surgery. She was there from the beginning, in the rhinomanometry, the teaching concept, the organization and planning, the cover design, the end pages, the icons, the textural flow, the revisions, and the morale. Without her, there might have been no book at all. In the hospitals: Circulating nurses Susan Demers, RN; Carol Lajoie, RN; Patricia Hansen, RN; Kimberly Vissa, RN; and Christine Senel, RN. Scrub nurses Susan Harvey, RN; Patricia Manley, LPN; Catherine Porcello, CST; Dorothy Sowards, RN; and Janet Yorek, RN. Nurse anesthetists Jennifer Gagnon, CRNA; Laura Tashjian, CRNA; and Patricia Pare, CRNA. Intraoperative surgical sequences were patiently photographed by my wife, Charlotte, or by Christine Senel, RN. At Quality Medical Publishing: Olivia Ayes, assistant editor; Amanda Behr, illustrator; Michelle Berger, DVDs and preproduction coordination; Sandy Hanley, production assistant; Elaine Kitsis and Susan Trail, composition artists; Carolyn Reich,

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ACKNOWLEDGMENTS

vice president of production; Keith Roberts, project manager; Ngoc-Thuy Khuu, graphics technician; Brett Stone, director of graphics; Becky Sweeney, editing preparation; Suzanne Wakefield, director of editing; and Karen Berger, president of Quality Medical Publishing, who oversaw it all. And in my life: Those wonderful people who educated me, encouraged me, believed in my work, and provided examples for me to follow: Velda S. Berberian, Mary and Neil Halkyard, Rt. Revs. William H. and C. Gresham Marmion; Eugene H. Courtiss, MD; Robert M. Goldwyn, MD; Courtland L. Harlow, MD; John R. McGill, MD; and Jack H. Sheen, MD, and Anitra Sheen. To each one I express my deepest appreciation.

xx

CONTENTS VOLUME I PART I 1

NASAL ANATOMY AND PHENOMENOLOGY Static Anatomy and Its Impact on Aesthetics

3

Toward Refinement 4 Surface Planes and Light Reflexes 5 Structural Layers of the Nose 9 Effect of Dorsal Height on Nasal Length 10 Anatomic Nasal Layers 12 Bony and Upper Cartilaginous Vaults 15 Alar Cartilages 29 Nasal Base: Upper Lip Complex 45

2

Dynamic Anatomy and Structural Relationships

53

Why Rhinoplasty Is Diffic t 55 The Dynamic Nose 56 Two False Assumptions About the Reduction Model 56 Nasal Equilibrium 63 Specific Interrelationships 66 Dynamism in Practice: Making Noses Longer or Shorter 92

3

Involving the Right Brain in Rhinoplasty Diagnosis and Planning 107 History of Right-Brain Theory and Its Application to Rhinoplasty Experiencing Right-Brain Shift 110 Relating Right-Brain Observations to Rhinoplasty Strategy 118 How the Left Brain Deceives 121

108

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CONTENTS

4

The Anatomy of Function and How Rhinoplasty Affects the Airway 133 The Importance of the Airway Component to Cosmetic Rhinoplasty 134 Applied Anatomy: Fundamentals of Airway Correction in Practice 158

5

Four Critical Anatomic Variants and “The Secret of Everything” 187 Relevance of the Problem 188 Frontal View: Determining the Airway 191 Lateral View: Determining a Balanced, Straight Profile A Matched Pair of Problems 232 Relevance to Clinical Practice 244

PART II 6

208

RHINOPLASTY AS AN OPERATION Why Rhinoplasty Is Difficult 253 Rhinoplasty’s Hidden Anatomy 256 Why I Prefer Endonasal Rhinoplasty 265 Photography 268

7

Planning Rhinoplasty: Abstract Concepts and Aesthetics 279 Theoretical and Practical Aesthetics 280 The Reality of the Ideal in Facial Analysis 287 A Nose That Fits the Face 291 Practical Aesthetics and Parameters for Planning 292 Three Surface Parameters for Rhinoplasty Planning 300

8

Planning Rhinoplasty: Applied Concepts and Aesthetics 317 The Consultation 318 Specifics of the History 320 Details of the Interview 342 The Preoperative Examination 342 Cooperation and Rapport 347 Discussing and Agreeing on a Plan 348 Putting Yourself and the Patient on the Same Side 349 Helping the Patient Formulate a Practical Plan 349 The Male Aesthetic 359 Explaining the Surgical Plan 366 Showing Your Results in Other Patients 380

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CONTENTS

Computer Imaging 380 Explaining the Risks to Patient and Family 381 Patient Attitude and Behavior 381 Revisions 383 The Blue Sheet and a Written Surgical Plan 383 Closing an Unsuccessful Consultation 388

9

Creating the Preoperative Plan 391 A Template for Planning 392 Constructing a Formal Plan 414 The Preoperative Envelope 415

PART III CONCEPT AND TECHNIQUE IN PRIMARY

RHINOPLASTY

10

How to Learn Rhinoplasty

421

Learning Surgical Judgment 422 How to Teach Yourself Rhinoplasty

11

424

Intraoperative Feedback and Technique in Primary Rhinoplasty 463 Rhinoplasty as a Concept 464 The Uniqueness of Rhinoplasty as an Operation 465 Specifics of the Operation 466 The Operation Itself 478 Incisions and Planning 478 Steps in the Operative Sequence 479

12

Adding Cartilage to the Nose: Why Grafts Are Necessary 567 The Logic of Grafting 568 Selecting and Harvesting Donor Sites in Primary Cases 568 Prioritizing the Specimens 622 Constructing Specific Grafts in Primary Rhinoplasty 624

13

The Uncomplicated Postoperative Course 735 Value of the Postoperative Period to the Surgeon 736 Early Postoperative Instructions and Management 737 The First Postoperative Visit 737 Typical Postoperative Changes 738 Typical Early Postoperative Changes 744

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CONTENTS

14

Problems in the Postoperative Course

751

Iatrogenic Airway Obstruction 752 Skeletal Problems 758 Soft Tissue Problems 762 Graft Problems 772 Septal Perforation 804 Synechiae 807 Septal Collapse 808 Rhinitis 809 Circulatory Problems 810 Hemorrhage 815 Infection 816 Less Common Complications 819 Unhappy Patients 821

VOLUME II PART IV PRIMARY RHINOPLASTY 15

Common Problems in Anatomy and Proportion 827 Introducing the Icons 828 Dorsal Deformities 828 Middle Vault Problems 877 Tip Problems 892 Problems of Length and Balance Problems of Volume 936

16

Exceptions to the Usual

951

The Traumatized Nose 952 Rhinoplasty in Men 974 Ethnic Rhinoplasty 991 Older Patients 1035 Thin Skin 1052 Thick Skin 1059 Rhinophyma 1067

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CONTENTS

PART V 17

SECONDARY RHINOPLASTY Theory, Planning, and Technique 1087 Phenomenology and Diagnosis in Secondary Rhinoplasty 1088 Secondary Rhinoplasty Compared With Primary Rhinoplasty 1096 Applicable Techniques 1102 Donor Site Depletion 1185

18

Regional Deformities

1189

Dorsal Deformities 1191 Middle Vault Problems 1207 Nasal Base Problems 1220

19

Generalized Deformities

1237

Supratip Deformity 1239 Thick Skin and Thin Skin 1260 Septal Collapse 1270 Problems of Length and Balance 1292 Reconstruction in Patients With Prostheses 1304 Cleft Lip Nasal Deformity 1316 Deformities Resulting From Previous Open Rhinoplasty Complex Deformities 1364

20

1338

Unhappy Patients and Those With Body Dysmorphic Disorder 1401 The Problem for Surgeons 1403 The Link to Relational Trauma 1427 Trauma, Core Issues, Addictions, and Relational Problems 1427 Relational Addiction 1428 The Physician Component 1429 And So the Play Begins 1430 Evidence From a Patient’s Story 1435 Narcissism in the Classical Sense: A Factor in Body Dysmorphic Disorder 1442 The Incidence of Body Dysmorphic Disorder in Private Practice 1444 A Survey of 1000 Consecutive Rhinoplasty Patients 1446 Putting It All Together 1447 Who, Then, Are the Surgical Candidates? 1448

Credits C-1 Index I-1

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DVD Contents

VOLUME I

1

Primary Rhinoplasty With Lateral Crural Relocation

Rib Harvesting and Perichondrial/Cartilage Strip

2

Rib Graft Harvesting, Perichondrial/Cartilage Strip, and Laminate

VOLUME II

3 4

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Secondary Rhinoplasty With Composite Grafts and Maxillary Augmentation

Secondary Rhinoplasty With Ear Cartilage

A Note on Terminology Because of the shape and location of the nose, traditional terms signifying position may not be intuitively obvious when discussing nasal anatomy. For example, is superior at the radix or along the dorsal edge? Is inferior along the columella or the nasal floor? FONTAL VIEW

OBLIQUE VIEW Superior

Superior

Cephalic

Cephalic

Radix

Radix

Caudal

Caudal

Anterior Dorsal

Posterior

Dorsal Lateral

Lateral

Medial Nasal base

Inferior

Nasal base

Inferior

Therefore to avoid confusion we have adopted the following conventions when referring to various anatomic locations: Radix/root: The discernible point or origin of the dorsal line Nasal base: Composed of tip, columella, alar rims, lobules, and the anterior nasal floor Anterior: Along the dorsal edge, around and including the tip lobule Posterior: Toward the facial plane externally; toward the perpendicular ethmoidal plate internally Dorsal: Along the highest point of the nasal bridge Superior: Toward the nasal radix Inferior: Underside of tip lobule, columella, alar rims, and lobules Lateral: Sidewalls from the dorsal edge to the point at which the nose merges with the cheek Caudal, Cephalic: Locations within a specific structure (for example, caudal septum).

xxvii

Do not go where the path may lead; go instead where there is no path and leave a trail. RALPH WALDO EMERSON

PART I N asal Anatomy and P henomenology Superior

Cephalic

There is a grandeur in this view of life. . . . Radix

From so simple a beginning, endless forms most beautiful and most wonderful have been, and are being, evolved.

Caudal Posterior

Anterior Dorsal

Lateral

CHARLES DARWIN On the Origin of Species by Means of Natural Selection

Nasal base

Inferior

CHAPTER 1 Static Anatomy and Its Impact on Aesthetics The time will come when diligent research over long periods will bring to light things which now lie hidden. . . . And so this knowledge will be unfolded only through long successive ages. There will come a time when our descendents will be amazed that we did not know things that are so plain to them. . . . Many discoveries are reserved for ages still to come, when the memory of us will have been effaced. Our universe is a sorry little affair unless it has in it something for every age to investigate. . . . Nature does not reveal her mysteries once and for all. SENECA Natural Questions, First Century AD

3

PART I



NASAL ANATOMY AND PHENOMENOLOGY

N

ot so long ago, most rhinoplasty texts relegated nasal anatomy to a few introductory pages. It is not, after all, as complex as the anatomy of the brainstem—it consists of only two bones, two pairs of cartilages (upper and lower lateral [or alar]), and a central partition that has only three components (septal cartilage, vomer, and perpendicular plate of the ethmoid). There are small variations in size and substance among races and between individuals, but nasal anatomy always seemed relatively simple, and most surgeons wanted to proceed with the operation. The anatomy, these texts implied, was not critically important; what counted was what the surgeon did with it. However, the simplicity of nasal anatomy is deceptive. Almost more important than what the surgeon does is how the nose responds to what the surgeon does. Nasal structures have very little independence—all parts interrelate in complex ways, and these interactions determine both aesthetic outcome and postoperative function. As with both architecture and the hand, form and function in the nose cannot be separated. A nose that looks normal works well, and vice versa. By understanding the relationships between the parts of the nose and the way the nose is constructed, a surgeon can begin to understand what makes long noses long and short noses short, why postoperative airway obstruction develops, why supratip deformities occur, and how a straightforward operation can have become terribly complex.

Toward Refinement Most patients requesting rhinoplasty seek that elusive quality called refinement. The specific surgical request may be framed as narrowing the nose, thinning the tip, or removing the bump, but generally patients are trying to describe refinement, although few will use that exact word. The challenge of achieving that goal has sparked valuable contributions from many surgeons committed to achieving nasal contours that are both elegant and predictable. Does the key to finding refinement lie in a working knowledge of classical beauty and ideal proportion? There is, indeed, substantial literature on nasal aesthetics, but throughout this text I present the case that most aesthetic ideals of beauty have limited value for several reasons. First, although nasal soft tissues can shrink, their contractility is limited. This limit defines the amount of skeletal reduction that any

4

CHAPTER 1



STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

nose will tolerate without distortion. Second, not only skeletal size and shape but also the volume, character, and distribution of the skin sleeve have been predetermined by nature. Consequently, the surgical goal (in its broadest terms) desired by most patients (a straight, symmetric nose with an excellent airway) is already limited by preoperative tissue characteristics, over which neither the surgeon nor the patient has any control. For any given patient there is only one realistic way for a surgeon to produce a straight nose that is best for that patient. Unfortunately, this best straight profile lies on a continuum of straight profiles that ranges from inadequate reduction (producing a nose that is still too large) to excessive reduction (producing varying degrees of distortion with septal collapse and supratip deformity at the extreme).

Surface Planes and Light Reflexes The surface of the nose is critically important, because it is what the patient sees. Rhinoplasty is an operation for the nasal surface. The skeleton is irrelevant, except as it affects surface contour or function. Volumes of literature on nasal aesthetics detail the ideal shape of the profile line and the angles of intersection for various parts of the nose with the face. Sheen refined the measured aesthetic by establishing the relationship that each nasal area should have with its neighboring areas and by emphasizing the smooth, flowing lines that should compose the transitions from nose to brow, cheek, and lip.

Dorsal plane Lateral plane

Basal plane

It is helpful to visualize four nasal planes: one dorsal, two lateral, and one basal. The dorsal plane forms a slender trapezoid with two long, gently diverging sides: one

5

PART I



NASAL ANATOMY AND PHENOMENOLOGY

base at the radix and the other at the level of the domes of the alar cartilages. Each long edge of the dorsal plane articulates with a trapezoidal lateral plane that begins at the radix and extends caudal to a transverse line (which often appears as a light reflex) approximately 4 to 5 mm from the alar rim. Near the rim, the lateral planes articulate with the basal plane, also more or less trapezoidal. The basal plane, which is convex centrally, extends from the peaks of the domes of the alar cartilages laterally along the transverse limb of the lateral light reflex and ends at the junctions of the alae and columella with the upper lip. These planes, as I described them in 1984, are a less complex version of the more elegant nasal subunits defined by Burget and Menick. However, because rhinoplasty does not routinely need to accommodate surface scars, the simpler form is often sufficient.

The exact boundaries, even the exact shapes, of the nasal planes are not as important as the concept that smooth, well-defined planes add refinement to the appearance of the nose. In most primary rhinoplasty patients, including those with heavy soft tissues, surgeons can see the nasal planes preoperatively. However, occasionally only vestiges are apparent. Even in secondary rhinoplasty patients, the planes may be visible over the upper nose where the skin is thinner, whereas the basal plane may be distorted or poorly defined if the alar cartilages have been resected. There are many such examples throughout this text. If the surgeon can create or smooth these planes during rhinoplasty, the nose will appear more refined.

6

CHAPTER 1



STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

Dorsal reflex

Transverse reflex

Closely related to the nasal planes are two light reflexes. The first reflex begins at the radix and runs caudad along the junction of the dorsal and lateral planes to the dome of the ipsilateral alar cartilage, where it meets a second light reflex that runs transversely. Rohrich has linked these paired reflections to skeletal structures that he calls the dorsal aesthetic lines. The second reflex is continuous with the commonly described light reflex that connects the peaks of the domes of the alar cartilages. After passing the peak of the dome of each alar cartilage, this reflex touches the apex of the soft triangle and then crosses the alar wall transversely exactly where the external nasal skin changes planes as it folds toward the vestibular skin (that is, the caudal end of the lateral plane). Other surgeons have identified such surface facets and light reflexes, each holding his or her own opinion about where they are, what they mean, and how to create them. One long-held view suggested that the cephalic edge of the alar cartilage created the transverse reflex. Consequently, surgeons tried to control the reflex by cutting notches or sharp edges in the domes and lateral crura, thus digging out hollows that modeled the nasal tip. It was similar thinking that became the underpinning of the 2 to 4 mm rim strip that was the standard endpoint of lateral crural resection only 30 years ago.

7

PART I

A



NASAL ANATOMY AND PHENOMENOLOGY

B

Although the lateral light reflexes may correspond to the shoulders of the bony and upper cartilaginous vaults in many patients, neither light reflex corresponds to any single, discrete anatomic structure. Instead, both reflexes (particularly the transverse reflex) signify tension lines in the skin. Smooth, defined light reflexes, similar to well-defined nasal planes, add an illusion of refinement, a point that was not lost on many Renaissance sculptors (A). Furthermore, these reflections can point a surgeon toward a particular operative strategy. They allow a surgeon to see the nose as a whole and to better visualize the correct relative position of each nasal part. In fact, the reflections and planes may do more for surgeons than for patients, because they bring right-brain analysis into the diagnostic equation, encouraging surgeons to think holistically and in terms of spatial relationships and contours rather than underlying anatomic parts. Significant right-brain contributions are essential for optimal rhinoplasty results, as discussed in Chapter 3.

8

CHAPTER 1



STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

S tructural Layers of the Nose A

B

D

C

E

Anatomically the nose is cartilage and bone covered by soft tissue and muscle, but in practice it does not behave that way because of the unique position of the alar cartilages. It is, therefore, helpful to conceptualize the nose as two interrelated layers (A). The outer layer (B), similar to a soft elastic sleeve, slides over the inner, fixed, semirigid layer and contains the entire investing nasal soft tissues plus the alar cartilages and their associated lining. The inner layer (C) contains everything else (the bony and upper cartilaginous vaults, the nasal septum, and their associated linings). This two-layer concept associates those structures that behave together functionally and provides an explanation for the distant manifestations of some surgical changes (such as the effect of dorsal reduction or augmentation on nasal length [D and E]). 9

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NASAL ANATOMY AND PHENOMENOLOGY

Effect of Dorsal Height on Nasal Length A

B

Yellow card

C

After dorsal resection

D

Dorsal graft

After dorsal graft

This patient illustrates the two-layer concept. After dorsal reduction, many (but not all) noses shorten, and the tips rotate cephalad (A and B). Such shortening and rotation occur, because dorsal reduction decreases the anterior force on the upper nasal skin, which then falls posteriorly and pulls the alar cartilages cephalad. How much rotation and shortening occur depends on preoperative dorsal contour, skeletonization width, the degree of caudal septal resection, and (to a much smaller

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STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

degree) the strength of the investing musculature. Bony vault length has been marked; note that the middle vault has narrowed. When a radix graft is placed, the nose lengthens because of the counteracting force (compare B and D).

Preoperative

Postoperative

This patient demonstrates the same two-layer principle in reverse. Dorsal grafting increases the anterior projection on the dorsal nasal skin and rotates the nasal tip caudally. How much nasal lengthening occurs depends not only on the degree of dorsal augmentation but also on the condition of the soft tissues—that is, how pliable they are and how much lengthening they will therefore permit. Noses would not lengthen after dorsal grafting if the alar cartilages did not behave like a second, outer, moveable layer external to the remaining fixed skeleton.

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NASAL ANATOMY AND PHENOMENOLOGY

A natomic Nasal Layers NASAL SKIN The external nasal skin is loosely attached over the bony and upper cartilaginous vaults but becomes thicker and more heavily enriched with sebaceous glands caudally. In many patients, the skin is actually thinnest over the highest point of the dorsum. Skin thickness affects both diagnosis and surgical strategy.

Preoperative

Postoperative

This patient’s nasal skin is thin enough to reveal each convolution in her underlying skeletal structure. Nasal bone length, middle vault width, and lateral crural position can all be determined without palpating the nose. A surgeon can expect this

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type of skin to contract over a reduced skeleton, particularly in the upper nose, and contraction can be desirable. Still, there are two caveats. First, even thin skin has contractile limits, so it is possible to create a supratip deformity or other distortion. Second, thin skin will reveal postoperative skeletal flaws as readily as it reveals preoperative anatomy. The surgeon must pay particular attention to technique so that all skeletal edges are smooth and grafts are contoured and/or softened to suit the fine overlying soft tissue cover. Accordingly, this patient’s radix and tip grafts were lightly crushed.

Preoperative

Postoperative

This woman has the same anatomic characteristics as the previous patient: a narrow middle vault, alar cartilage malposition, low radix, and inadequate tip projection—but her soft tissues are much thicker. Nasal skin quality directly affects sur-

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NASAL ANATOMY AND PHENOMENOLOGY

gical strategy. For example, when the skin is thick, the outcome will be more predictable if the skeleton is rearranged rather than only reduced. There is less net decrease in skeletal volume and therefore less need for skin contraction to produce the desired result. The low radix (which lends itself to augmentation) and other skeletally deficient areas are, therefore, especially important when they support soft thick tissues, as this patient reveals (see Chapters 5 and 15).

NASAL MUSCULATURE

Musculus procerus Musculus levator labii superioris alaeque nasi Musculus nasalis pars transversa Musculus nasalis pars alaris

Musculus apicis nasi Musculus dilator naris

Musculus zygomaticus minor

Musculus depressor septi nasi

Although there are ten nasal muscles, seven intrinsic and three extrinsic, the ones of greatest clinical importance are those that affect the airway and can be compromised by trauma or facial paralysis. In the intrinsic group, these are the musculus nasalis pars alaris, musculus nasalis pars transversa, and musculus dilator naris, with its uniquely decussated fibers, the primary and secondary dilators.

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STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

Bruintjes et al demonstrated through histologic sections that the lateral nasal wall has three components, each with its own distinguishing characteristics. The nasal bone, upper lateral cartilage, and lateral crus form the most stable segment. Posterior to the lateral crus, in an area that is sometimes called the hinge, lesser stability is provided by the accessory cartilages embedded in soft tissue. The musculus nasalis pars alaris (originating on the maxilla and inserting on the accessory cartilages) presumably adds stability by drawing the hinge area laterally. The alar wall (posterior to the lateral crus) and lobule, which contains no cartilage, is the third and most mobile component, braced only by the musculus dilator naris. The musculus nasalis pars transversa overlies the nose but originates on the maxilla, above and lateral to the incisive fossa, its fibers running medially to an aponeurosis that bridges to its mate from the opposite side. It stabilizes the upper lateral cartilage (which itself has no muscle attachments), the hinge area, and the intercartilaginous junction. Minor contributions are made by the musculus apicis nasi (found inconsistently) and the musculus depressor septi, which arises from the incisor fossa and attaches to the posterior alar cartilage medial crus, therefore presumably preventing superior rotation of the medial and middle crura and indirectly stabilizing the lateral crus by reducing rotation at the hinge area. In the extrinsic group, the musculus levator labii superioris alaeque nasi and the musculus zygomaticus minor dilate and stabilize the lateral wall, respectively. These observations are based on static nasal anatomy, however. Everything changes when air moves through the nose, as detailed in Chapter 4.

B ony and Upper Cartilaginous Vaults Taken together, the bony and upper cartilaginous vaults create a surface pyramid for the upper two thirds of the nose. Their simple shape is deceiving; taken together, these two vaults affect nasal width, nasal length, internal valvular competence, and nasal aesthetics from all four views (frontal, oblique, lateral, and inferior). The two vaults also help balance the nasal base and provide the three-dimensional contour so necessary to the midface and its proportion to the maxilla.

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NASAL ANATOMY AND PHENOMENOLOGY

BONY VAULT

Supraorbital ridge Radix

Bony vault

The bony vault is formed by the paired nasal bones and the frontal processes of the maxilla. The edges of each nasal bone articulate with the nasal process of the frontal bone and with the frontal process of the maxilla. The caudal margin of each nasal bone overlaps the ipsilateral upper lateral cartilage for several millimeters, and the investing periosteal and perichondrial fibers interlace. The nasal radix, or the discernible point at which the dorsal line begins, lies caudal to the nasofrontal suture at varying levels. Along their medial articulating surfaces the nasal bones are thick, and extensions on their undersurfaces articulate with the perpendicular plate of the ethmoid. As a general rule, in younger individuals and in many of African and Asian heritage, the perpendicular plate of the ethmoid extends farther caudally than the caudal edge of the nasal bones, whereas in adult Caucasians the nasal bones extend farther caudally than the perpendicular plate of the ethmoid. This anatomic variation influences the anatomy of the nasal septum and therefore has implications for the length of cartilage grafts that can be harvested.

SUPRAORBITAL RIDGE CONTINUITY The edge of each lateral nasal plane (or the lateral nasal light reflex) should form a continuous extension of the supraorbital ridge. The desire to produce a narrow bony vault through aggressive osteotomies can destroy this fluid orbital/nasal continuity, as these patients demonstrate. Notice that the second patient has marked his original photographs to show where the disruption occurred.

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Preoperative

Before secondary surgery

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NASAL ANATOMY AND PHENOMENOLOGY

Nasal Radix

Radix

Bony vault

An ideal radix begins at the level of the upper lash margin, with the patient’s eyes in primary gaze. A low radix or dorsum is one of four key anatomic variants that, if ignored, can lead to an unfavorable result (see Chapter 5). The position of the radix has greater or lesser importance in different patients and, like nasal base size, always affects proportion. This anatomic characteristic is a continuum, with a high radix and an obliterated nasofrontal angle at one extreme and a flat, low dorsum at the other, as seen in these patients. An observer’s eye unconsciously balances the length of the dorsal line (from the radix to the tip) against the size of the nasal base (from the nasolabial junction to the tip). The length and height of the dorsal line influence this relationship—when the dorsum is longer or higher, the base seems smaller, and vice versa.

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NASAL ANATOMY AND PHENOMENOLOGY

Reducing a high radix shortens the dorsal line and makes a shorter, flatter nasal base seem larger by increasing the nasofacial angle. Conversely, when a low radix or dorsum is augmented the dorsal line lengthens, making the nasal base appear less prominent. The nasofacial angle also seems to have decreased.

Keystone Area The keystone, or K, area is the overlap of the nasal bones externally and the cephalic edges of the upper lateral cartilages internally. This overlap is greater toward the midline, where it is approximately 8 to 9 mm; it decreases as the attachment progresses toward the nasal process of the maxilla, at which point it is only approximately 2.5 mm. The nasal bone periosteum and upper lateral cartilage perichondrium form a continuous investing sheet, so that osteotomy also narrows the middle 20

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STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

vault. Exactly how much this occurs depends on the width and condition of the cartilaginous roof, as discussed later under Upper Cartilaginous Vault.

Nasal Bone Length Nasal bones vary greatly in length. Generally, broad high noses favor longer bones, whereas narrow noses favor shorter bones. However, there are many exceptions.

The short nasal bones in these primary rhinoplasty patients extend less than 15 mm along the lateral nasal wall, instead of occupying 30% to 50% of the span. This anatomic variation was first noted by Sheen, who recognized the effect that short bones have on the middle (upper cartilaginous) vault. 21

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NASAL ANATOMY AND PHENOMENOLOGY

The short nasal bone variant is easily visible in these secondary rhinoplasty patients after dorsal resection. The weakness of the support is evident: notice that the sidewalls narrow just distal to the bony arch, creating an inverted V. The long span of unsupported upper lateral cartilage created by short nasal bones creates airway obstruction in many of these patients and puts them at special risk for significant airflow compromise even before surgery. Nasal airflow will worsen further after dorsal resection.

UPPER CARTILAGINOUS VAULT

Upper cartilaginous vault

22

At the keystone area, the upper lateral cartilages are attached to the undersurfaces of the nasal bones, the perpendicular plate of the ethmoid, and the septal cartilage. As the paired cartilages progress caudally, they are braced in their lateral position by their confluence and by the septal edge, which is significantly wider anteriorly (toward the dorsum) than posteriorly (toward the nasal floor).

CHAPTER 1



STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

A Nasal bone Upper lateral cartilage

B

Septum Airway Cross section at A

Cross section at B

The upper lateral cartilages are fused to the cartilaginous septum and to each other in the cephalic 80% of their medial lengths; their caudal 20% diverge from the cartilaginous septum by 10 to 15 degrees. Histologically, the upper lateral cartilages and septum form a continuous sheet of cartilage; their junction is marked by a narrow cleft.

Anterior surface Anterior surfaceofof cartilaginous roof cartilaginous roof

Posterior surface Posterior surfaceofof cartilaginous roof cartilaginous roof

The resected cartilaginous roof displays this structural continuity on both surfaces. Given this anatomy, it should not be surprising that a major dorsal resection or septal collapse creates such functional and cosmetic disability.

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NASAL ANATOMY AND PHENOMENOLOGY

The flexible upper lateral cartilages form the internal nasal valves at their fused articulation with the anterior septal edge. Nasal bone length (and, therefore, the length of the upper lateral cartilages) directly influences the rigidity of the internal valves and their ability to withstand the significant transmural pressures that occur with inspiration. The shape of the paired internal valves correlates with nasal configuration and racial characteristics. In any patient with a low, broad dorsum, the angle of divergence from the septum is wider, and it is narrower in patients with a high dorsum. As a broad generalization, the angle is narrowest in Caucasians, intermediate in Asians, and widest in blacks, but there are significant individual variations and exceptions to each of these statements. The upper lateral cartilages are encased in an aponeurosis that also binds them to the sesamoid cartilages posteriorly and, more important, to the lateral crura of the alar cartilages. Each lateral crus characteristically overlaps the caudal edge of its neighboring upper lateral cartilage with a space between them that is always present histologically. This same aponeurosis continues between the alar cartilages and the anterior and inferior septal edge, accounting in part for the mobility of the nasal tip and columella. The caudal margin of each upper lateral cartilage often contains an external (outward) recurvatum that is most prominent medially and less noticeable laterally and posteriorly, where the curl more often turns toward the nasal lining. An actual scroll, in which the caudal edge of the upper lateral cartilage and the cranial edge of the lateral crus curl in opposite directions, is more famous than common and appears in no more than 50% of patients; its significance has been debated but is not yet clear. The presence of a scroll does not seem to affect tip projection or valvular stability (although is has been proposed to do so), but if present, I preserve it if I can.

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STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

Upper Lateral Cartilages as a Valve

Inspired air travels through an unobstructed nose at speeds of 12 to 65 km per hour—that is, up to the speed of gale force winds. This patient is shown during quiet and forced inspiration, and the difference in her sidewall positions is obvious. When the upper lateral cartilages are pliable and show this much movement with inspiration, the airway is poor even if the septum is straight and the turbinates are normal size. Although the loose aponeurotic attachments of the upper lateral to alar cartilages provide some stability, the greatest determinants of internal valvular competence are the position, length, and substance (that is, thin or thick, soft or rigid) of the upper cartilaginous vault.

Resection of the middle vault (cartilaginous) roof during dorsal reduction removes the most critical anterior stabilizing force on the upper lateral cartilages, which respond by falling medially to produce a characteristic inverted-V deformity and a narrowing at the internal valves. 25

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NASAL ANATOMY AND PHENOMENOLOGY

Middle vault collapse almost always occurs after the cartilaginous roof has been resected, regardless of whether osteotomy has been performed; but the collapse may not be visible if the overlying soft tissues are sufficiently thick. If the nasal skin is thin, the deformity can be impressive and distressing to patients. Middle vault collapse can be avoided or corrected (in secondary patients) by spreader grafts or dorsal grafts (see Chapter 4).

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A

B

C

D

E

F

The roof of the cartilaginous vault is surprisingly thin. In most patients, a dorsal resection of 2 mm or more (A and B) opens the cartilaginous roof and creates instability at the middle vault. C reveals the upper lateral cartilage/septal confluence on one surface, and D through F show the full-thickness roof resection on the other.

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NASAL ANATOMY AND PHENOMENOLOGY

Narrow Middle Vault

Narrow middle vault

The narrow middle vault seen in many secondary rhinoplasties is traditionally attributed to avulsion of the upper lateral cartilages from the nasal bones. Although this may occur in extraordinary circumstances, the direct attachments between the upper lateral cartilage and the nasal bone are so strong that tremendous downward traction is necessary to produce such a detachment. I have only seen it in a few cases of extraordinary trauma. On the other hand, any middle vault collapses visibly during surgery as soon as the surgeon resects the cartilaginous roof enough to open it (that is, more than 2 mm) (see Chapters 4 and 11). The deformity can be corrected consistently with spreader grafts or a substantial dorsal graft, as the 3-year postoperative view of this primary rhinoplasty patient demonstrates. A narrow middle vault creates a special risk for postoperative internal valvular obstruction; it is one of four anatomic variants in primary rhinoplasty patients that particularly predispose them to unfavorable results (see Chapter 5).

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A lar Cartilages The aphorism, “As the tip goes, so goes the rhinoplasty,” is no less true today than it was a generation ago. The small, paired tip cartilages create tip projection, may influence as much as the entire caudal half of the profile line, create the aesthetic attributes of the tip lobule and columella, and constitute the primary structural support of the external nasal valves. A model in which the alar cartilages function as part of the investing skin sleeve emphasizes the broad impact of alar cartilage support on nasal shape.

The tip, the lower nasal skin, and, in many patients, the lower half of the entire profile line depend on the suspension of the skin sleeve by the alar cartilages, which, like a cap anterior to the remaining skeleton, maintains lower nasal tension. Key to the alar cartilage structure is middle crural length, which tip grafts effectively increase. In this secondary rhinoplasty patient, notice that tip augmentation has altered almost the entire lower half of the profile line.

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It is the same lobular tension at the alar domes that drapes the skin to reveal the nasal planes and highlights. Thus the alar cartilages (or the tip reconstructed by grafts or sutures) carry a larger responsibility for lower nasal soft tissue support than may at first be evident.

Middle crus Lateral crus Medial crus Medial crus

Floating in their skin cover and lining, relatively independent of the bony and upper cartilaginous vaults, the alar cartilages are less mobile posteriorly than anteroinferiorly. A number of triangular or ellipsoid sesamoid cartilages lie in the hinge-area space, between the tip of the lateral crus and the piriform aperture edge, encased in a perichondrial sheet that unites them to the lateral crus. The hinge area is the point of alar cartilage axial rotation. Based on preoperative and postoperative anatomy, the degree of soft tissue fibrosis, muscle strength or atrophy, and nasal lining characteristics, the alar cartilages may translate (glide) superiorly or inferiorly, or rotate medially or laterally. Surgical alteration, scarring, and trauma each affect the alar cartilages’ pliability and ability to move. Thus the alar walls and external valves—which are relatively mobile because of their cartilaginous arrangement, muscle attachments, and dependency on dorsal skin length and position— become susceptible to changes in transmural pressure when air flows through the nose, as described in Chapter 4.

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MEDIAL CRUS Each of the three alar cartilage segments has its own specific task. The medial crura control the position of the columella, and the contour and size of their footplates influence nostril size and shape. The columella should create the lowest nasal base point in all views.

This patient had significant nasal trauma and septal collapse with scars crossing the supratip. The loss of caudal septal support allowed the medial crura and columellar skin to retract, creating a flat nasal base without angulation at the columella-lobular junction. Caudal septal and medial crural grafts with rib cartilage augmented the medial crural mass and increased columellar visibility below the alar rim. 31

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The medial crura in this patient were short, convex, and accompanied by long middle crura, producing a columella that was bowed inferiorly. The deformity occurred when the nose shortened and the alar rims retracted after dorsal and lateral crural resections. The lateral crura rotated at the lateral hinge areas, but the fixed medial end could not follow. During the secondary procedure, a membranous septal resection lifted the medial crura into a more appropriate position closer to the nostril rim. Adjustment of the medial crural caudal margins (not done here) may also be necessary in cases such as this.

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In this patient, whose nostrils were small relative to the size of her tip lobule, resection of the medial crural footplates has altered the nostril perimeter and created a more favorable nostril-lobular relationship.

MIDDLE CRUS Middle crural length and substance determine tip projection, and the angles between the middle crura and the medial and lateral crura influence tip lobular shape.

C

A

B

Angle of divergence

Middle crus Angle of rotation

Middle crus

In an ideal tip, the angle of rotation (A), which is created at the columella-lobular junction, and the angle of divergence (B), which separates the domes, are each approximately 60 degrees. 33

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NASAL ANATOMY AND PHENOMENOLOGY

⬎60 degrees

Boxy tip More than 60 degrees of divergence

As the angle of divergence exceeds 60 degrees and approaches 90 degrees, the nasal base develops a square perimeter, commonly called a boxy tip. The sharp angulation of the lateral genua creates the corners of the box. The lateral crura are usually convex.

⬍60 degrees

Ball tip Less than 60 degrees of divergence

Conversely, a ball tip has a narrower angle of divergence, usually less than 60 degrees, and lateral crural convexities that seem to efface the lateral genua entirely.

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A



STATIC ANATOMY AND ITS IMPACT ON AESTHETICS

B

C

Short middle crus

D

Short middle crus with tip graft

D

E

Angle of rotation

Middle crus

Middle crural length affects tip projection and therefore dorsal contour. When the middle crus is short (A and B), the tip is almost always inadequately projecting and seems to hang from the bridge line and septal angle. Tip grafting (C and D) effectively lengthens the middle crus, increasing tip projection and creating a visible angle of rotation (E)—that is, the angulation at the columella-lobular junction.

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F

G



NASAL ANATOMY AND PHENOMENOLOGY

H

I

Long middle crus

J

K

When the middle crus is long in primary rhinoplasty (F and G) or secondary rhinoplasty (H and I), it distorts not only the tip lobule but also the dorsal line. In rare cases when the middle crus is so short as to seem absent (J and K), the medial crus angulates and becomes the lateral crus. Inadequate tip projection, usually caused by a short middle crus, is the third of four common anatomic variants that predispose patients to unfavorable rhinoplasty results.

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Angle of rotation

Middle crus

Notice the profound alteration in tip aesthetics created by changing the angle of rotation downward or upward.

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NASAL ANATOMY AND PHENOMENOLOGY

As demonstrated by these two patients, middle crural length that equals or exceeds medial crural length creates excessive lobular height. The tip takes on an unwieldy, gangly appearance.

This patient was treated using middle crural resection and tip grafts, which are often also indicated to improve lobular contour and decrease soft tissue contraction and movement. Notice the stability of the reconstruction, even 22 years later.

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Middle crural length also influences apparent nasal length. Patients with inadequate tip projection often misidentify their deformities as droopy tips or hooked noses, presenting their surgeons with diagnostic traps. The nose is not long in any of the patients shown here: the nasolabial angles in these patients equal or exceed 90 degrees. However, tip grafting has raised the point of maximum tip projection by lengthening the middle crural segment. The nose appears to have shortened. It is a mistake to shorten the nose in any patient with this shape. The defect is not at the columella-labial angle. The problem is not nasal length, but tip lobular contour— a short middle crus.

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The hooked nose illusion created by inadequate tip projection is exaggerated further when combined with a low radix and a high dorsum, wherein every contour seems to force the tip visually downward. Nevertheless, although minor caudal septal adjustments may be needed incidentally, major cosmetic improvement will derive from lengthening the short middle crus, which has been accomplished with tip grafts in these patients.

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LATERAL CRUS Aside from influencing alar wall contour, the lateral crus provides critical structural support to the external nasal valve. The point of interception of the upper and lower cartilages creates a watershed area between the internal and external nasal valves, and aggressive surgery in this area affects valvular competence. The primary lateral crural characteristics that influence rhinoplasty are its contour and axis.

A

B

C

Flat lateral crus

E

F

Concave lateral crus

D

Convex lateral crus

G

H

Undulating lateral crus

A gently convex lateral crus (A and B) is the closest to ideal and requires no treatment if the external valve is supported. A bossed, or strongly convex, lateral crus (C and D), creates a shape that patients identify as a ball or broad tip. A concave lateral crus (E and F) may not be visible externally but often obstructs the airway internally. Finally, the lateral crus may have an undulating contour (G and H), obstructing the airway internally and distorting the nasal sidewall externally. 41

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LATERAL CRURAL AXIS: THE LATERAL CRUS AS A VALVE A

B

C

D

Ideally, the lateral crus should parallel the alar rim for approximately its anterior 50%, lying along an imaginary line that connects the lateral genu to the lateral canthus of the eye. In this location, the crus is favorably located to support the external valve. If resection is sufficiently aggressive, however, collapse still occurs. Note the unconscious nostril flare (D) needed to keep the flaccid airway open. Dorsal resection has also narrowed the middle vault.

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Alar hollow

At rest

Inspiring

However, when the lateral crus is rotated cephalad, so that its axis runs along a line from the lateral genu toward the medial canthus, the external valve is relatively unsupported. Notice the external valvular collapse that occurs when these patients inspire.

At rest

Inspiring

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Fifty percent of my patients with external valvular incompetence have cephalically rotated lateral crura. However, even more convincing is that most patients with cephalic rotation have external valvular incompetence. Specific alar wall deformities depend on the shape of the lateral crus itself, but there is always a hollow or concavity. Cephalic rotation of the lateral crus, or alar cartilage malposition, as originally designated by Sheen, is the fourth anatomic variant that predisposes patients to unfavorable rhinoplasty results.

A

B

Practicing surgeons see countless variations on these deformities. Shown here are two patients with undulating middle crura: one with an orthotopic lateral crural orientation (A) and the other cephalically rotated (B). Treatment objectives remain constant, however: creating smooth crural surfaces, adequate tip projection, and stable, adequate external valves.

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N asal Base: Upper Lip Complex The nasal base and upper lip should be considered a single unit, because each one influences the other.

Full upper lip and nasal spine

Long nose and retrusive upper lip

The dimensions and relevant proportions of the nasal base itself are complex and depend on the characteristics of each of its constituents: the alar cartilages, the dorsal and caudal septum, and their investing soft tissue covers. A prominent dorsal and caudal septum with or without substantial medial crura anteriorly displaces and shortens the upper lip, creating a web at the columella-labial junction. Conversely, when the caudal septum has been injured by trauma or surgery, and/or the maxillary arch is retrusive or hypoplastic, the upper lip lengthens, the subnasale sharpens and moves posteriorly, and the nasal base rotates caudally. The contours of the nasal base are so complex, and a surgeon’s ability to modify them favorably are so relatively restricted (even though possible postoperative distortions seem limitless), that detailed aesthetic ideals are impractical. However, the following five goals are important in every rhinoplasty: 1. Symmetry 2. External valvular stability 3. A nasolabial angle of 90 to 100 degrees (respecting each patient’s aesthetic) 4. The best possible lobular size/nostril size ratio 5. An ethnically appropriate upper lip carriage

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SYMMETRY

There are a number of problems with the surgical results shown here, but principal among them is asymmetry. Each side of the tip lobule is different—few structures are midline, and the alar walls and nostrils do not match. Imagine how these deformities impair the patients’ airways.

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External Valvular Stability

Quiet inspiration

Forced inspiration

This patient’s alar rims collapse so that her airway is poor, even though the internal valves are competent and stable and she has a straight septum and normal-sized turbinates. Notice the cephalically rotated position of the alar cartilage lateral crura, the proximate cause of external valvular obstruction in many cases.

Nasolabial Angle 90 to 100 Degrees A

B

Acute nasolabial angle

C

D

Obtuse nasolabial angle

When the nasolabial angle is either less than 90 degrees or more than approximately 110 degrees, the airstream is misdirected. When the airstream flows cephalad toward the superior meatus (A), it creates a long, turbulent airstream that increases the work of breathing. When flow is caudad along the nasal floor (C), it escapes normal turbinate baffling and resistance. Patients with acute nasolabial angles often discover that they can decrease the work of breathing and open their airways by pushing their nasal tips to 90 degrees with their fingers. 47

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Best Possible Nostril/Tip Lobular Ratio

x

1x to 2x

Notice that I have used the term best possible nostril rather than ideal. As is true in much of rhinoplasty planning, one starts with the ideal and then compromises to suit reality. Distortion in pursuit of the impossible is not a victory for the patient.

The proper balance between nostril and tip lobular size improves the appearance of both. From an inferior view, ideal nostril length should be 1 to 2 times the tip lobular length.

In these two secondary rhinoplasty patients whose tip lobules are nearly identical, notice the difference in alar wall thickness and columellar width created by differences in nostril size. In the nasal base, very little is absolute—the quality of proportion depends on the proportion of each part to its neighbor: nostril to tip lobule, nostril to columella and alar wall, and base width relative to tip lobular width.

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A

B

C

Between the preoperative (A) and the first postoperative (B) images shown here, this tertiary patient’s previous surgeons reduced nostril diameter excessively; notice that her tip lobule seems to have enlarged. Axially oriented composite grafts enlarged nostril diameter so that the basal relationships improved, despite the modest increase in tip lobular size produced by tip grafting (C). Her alar base scars were not revised but remodeled spontaneously after the composite grafts reduced skin tension.

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Ethnically Appropriate Upper Lip Carriage

Caucasian

Asian

Hispanic

Black

Upper lip carriage can vary according to race. In most Caucasians the plane of the upper lip is vertical, and the subnasale is softly blunted. In Asians, Hispanics, and blacks, the upper lip is variably more retrusive, and the subnasale is sharper. However, there are individual exceptions to each of these generalized descriptions.

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A

B

Preoperative

Septal collapse after primary surgery

The role of the nasal spine by itself in shaping the subnasale has probably been overstated; previous observations show that (1) the spine is 10 mm or more below its overlying cutaneous surface and (2) contour changes can be produced by septal collapse alone, when the spine has not been affected (B). Changes attributable to the spine derive largely from its position at the posterior end of the caudal septum.

B

A

Preoperative

C

Change in subnasale after primary surgery

After correction with maxillary augmentation

Resection of the caudal septum alone alters the vertical plane of the upper lip, even if the nasal spine is not touched (A and B). Maxillary augmentation restored the vertical lip position in this patient and softened the angle at the subnasale, returning it to a more racially appropriate appearance (C). 51

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BIBLIOGRAPHY Ali-Salaam P, Kashgarian M, Persing J. The soft triangle revisited. Plast Reconstr Surg 110:14-16, 2002. Bafaqeeh SA, Al-Qattan MM. Alterations in nasal sensibility following open rhinoplasty. Br J Plast Surg 51:508-510, 1998. Bernstein L. Applied anatomy in corrective rhinoplasty. Arch Otolaryngol 99:67-70, 1974. Bruintjes FD, Van Olphen AF, Hillen B, et al. A functional anatomic study of the relationship of its nasal cartilages and muscles to the nasal valve area. Laryngoscope 108:1025-1032, 1998. Burget GC, Memick FJ. Aesthetic Reconstruction of the Nose. St Louis: Mosby–Year Book, 1994. Burget GC, Memick FJ. Subunit principle in nasal reconstruction. Plast Reconstr Surg 76:239-247, 1985. Constantian MB. Functional effects of alar cartilage malposition. Ann Plast Surg 30:487-499, 1993. Constantian MB. Toward refinement in rhinoplasty. Plast Reconstr Surg 74:19-32, 1984. Dingman RO, Natvig P. Surgical anatomy in aesthetic and corrective rhinoplasty. Clin Plast Surg 4:111120, 1977. Doty RL, Frye R. Influence of nasal obstruction on smell function. Otolaryngol Clin North Am 22:397411, 1989. Fanous N. Narrowing of the wide nasal dorsum in the “minimal-hump” nose: a simplified universal approach. Can J Plast Surg 13:139-143, 2005. Figallo EE, Acosta JA. Nose muscular dynamics: the tip trigonum. Plast Reconstr Surg 108:1118-1126, 2001. Fontana AM, Muti E. Our “idèes fixes” in rhinoplasty: the naso-frontal angle and the alar lateral crus. Aesthetic Plast Surg 25:1-7, 2001. García-Velasco J, García-Casas S. Nose surgery and the vomeronasal organ. Aesthetic Plast Surg 19:451454, 1995. Ishida J. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 103:1729-1735, 1999. Lanza DC, Kennedy DW, Koltai PJ. Applied nasal anatomy and embryology. Ear Nose Throat J 70:416422, 1991. Lejour M. Routine reinsertion of the hump in rhinoplasty. Scand J Plast Reconstr Surg 20:55-59, 1986. Lessard ML, Daniel RK. Surgical anatomy of septorhinoplasty. Arch Otolaryngol 111:25-29, 1985. McKinney P. A clinical definition of an ideal nasal radix. Plast Reconstr Surg 109:1416-1420, 2002. Mommaerts MY. Rhinoplasty with nasal bone disarticulation to deepen the nasofrontal groove. J Craniomaxillofac Surg 23:109-114, 1995. Natvig P, Sether LA, Gingrass RP, et al. Anatomical details of the osseous-cartilaginous framework of the nose. Plast Reconstr Surg 48:528-532, 1971. Neu BR. Segmental bone and cartilage reconstruction of major nasal dorsal defects. Plast Reconstr Surg 106:160-170, 2000. Parkes ML, Waller TS. Practical applications of nasal asymmetries in rhinoplasty. Am J Cos Surg 5:3743, 1988. Rohrich RJ. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 114:1298-1312, 2004. Rohrich RJ, Huynh B, Muzaffar AR, et al. Importance of the depressor septi nasi muscle in rhinoplasty: anatomic study and clinical application. Plast Reconstr Surg 105:376-388, 2000. Safian LS. Cosmetic rhinoplasty: radiological features. Head Neck Surg 7:139-149, 1984. Seung-Kyu H, Shin Y-W, Kim W-K. Anatomy of the external nasal nerve. Plast Reconstr Surg 105:10551059, 2004. Sheen JH, Sheen AP. Aesthetic Rhinoplasty, 2nd ed. St Louis: CV Mosby, 1987, pp 828-858. Teller DC. Anatomy of a rhinoplasty: emphasis on the middle third of the nose. Facial Plast Surg 13:241252, 1997. Velideodeoglu H. Block and Surgicel-wrapped diced solvent-preserved costal cartilage homograft application for nasal augmentation. Plast Reconstr Surg 115:2081-2097, 2005. Wright WK. Study on hump removal in rhinoplasty. Laryngoscope 77:508-517, 1967. Zbar RIS. A classification schema for the vomeronasal organ in humans. Plast Reconstr Surg 105:12841288, 2000.

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It’s not what you don’t know that gets you in trouble; it’s what you do know that ain’t right. WILL ROGERS

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O

ne of the obstacles to learning rhinoplasty is the need to break old habits and abandon previous assumptions. The traditional view that nasal surgery is a blind operation—or worse, that the results are largely unpredictable—is intimidating, and the initial poor results that young surgeons obtain (and we all got them) only confirm that bias. Once, at the end of a course titled “Cause and Effect in Rhinoplasty” that I taught at our national meetings for many years, one surgeon disagreed with my proposition that nasal phenomenology was understandable: “There is no connection between what I do in the operating room and the way the nose looks a year later,” he said with resignation. The solution that many surgeons have found is the open approach. So much has been made recently of open rhinoplasty that the reason it became popular, and the strengths of the closed approach, have been almost completely forgotten. There is a reason that the pioneers of rhinoplasty performed the surgery endonasally: they instinctively recognized that the external shape of the postoperative nose, not the shape of the skeleton, was the critical determinant of a successful result. What they did not always appreciate was the interconnection and interdependence of the nasal skeletal parts and the fact that the soft tissues are more limited than the skeleton in the changes that they will tolerate. Thus the volume, thickness, and distribution of the nasal soft tissues (or skin sleeve) become the cardinal rate-limiting aspects in rhinoplasty. This is why all end-stage noses look the same and why the soft tissue cover must become the primary operative guide. Nasal phenomenology is both understandable and predictable. It is important for all rhinoplasty surgeons, whether they select the endonasal or open method, to realize that focusing on how the skeleton looks is the wrong emphasis. It is also incorrect to believe that the closed approach masks the important anatomy, and therefore the only way to understand the nose is to uncover it through a columellar incision. Instead, the surgeon must direct his or her attention to the way the nasal surface looks (both internally and externally). With few exceptions, all important surgical decisions should be based on the information gathered from these observations. By considering the dynamics of the nose in this way, the skeleton becomes only a means to an end—exact skeletal anatomy is therefore irrelevant unless it influences the surface or the airway.

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Surgeons intimidated by the presumed limited technical access and limited visibility of the endonasal route should remember that this route is similar to all endoscopic procedures and many body contour procedures. If you perform those procedures, you already possess the skills needed to perform endonasal rhinoplasty. Remember also that each of the great open rhinoplasty surgeons learned the closed approach first. Their success can be partially attributed to the conscious or unconscious grasp of nasal phenomenology that they acquired from their prior endonasal experience.

W hy Rhinoplasty Is Difficult The open approach derives its strength, and its many advocates, from the logic that rhinoplasty is difficult because:  The incisions are limited and internal.  Dissection is blind.  The structural anatomy is hidden from the surgeon and the observer (therefore it is harder to teach to residents).  Technical access is very limited.  The techniques themselves are difficult.  The anatomy is complex and the margin of error is very small. There is a small amount of truth in each of those statements. However,  Technical access is not as restricted as it is in endoscopic surgery.  The margin of error is broader than in microvascular or hand surgery.  The anatomy is simple compared with that of the hand or the head and neck.  Surgeons who perform liposuction already have the skills for modifying structures they cannot see while following their progress by feeling the overlying soft tissues. In actuality, rhinoplasty is primarily difficult because:  The nasal soft tissues have limited contractility.  Nasal regions are interrelated.  The operation itself is dynamic and interactive: each technical maneuver precipitates regional and often generalized changes in the nasal form or support that dictate subsequent steps.  Rhinoplasty is a right-brain operation.

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Ultimately, each surgeon must select a technical route that allows him or her to obtain the best results. With few exceptions, however, every postoperative problem that I have seen was caused by failure to diagnose anatomic variants, failure to understand the interconnectedness of the nasal structures, problems related to balance, or an adverse effect of rhinoplasty on the airway, not because the surgeon couldn’t see well.

T he Dynamic Nose It is easy for a surgeon to forget that the nose is dynamic, not static. In an unobstructed nose, air passes in and out easily. Although not a prominent feature of facial expression, the nostrils do flare; the nose changes its appearance during frowns and smiles and in response to unpleasant fragrances. The nose is also dynamic during surgery, and this dynamism is one of the things that confuses rhinoplasty students. Dorsal reduction alone can affect nasal length, middle vault width, bony vault width, apparent nasal base size, nostril contour, columellar position, and airflow at the internal valves. As expressed in the traditional song, “The ankle bone is connected to the leg bone,” nasal interrelationships are consistent and dynamic. Things move. The key is understanding that movement.

Two False Assumptions About the Reduction Model The belief that rhinoplasty is the most difficult plastic surgery operation is usually attributed to anatomic complexity, technical difficulty, the narrow margin of error, limited endonasal access, and unpredictable and idiosyncratic nasal healing. However, it has been my contention for many years that rhinoplasty is difficult primarily because the reduction model is insufficiently complex. Surgeons starting practice after 1980 may not realize that, until then, aesthetic rhinoplasty had been almost entirely a reduction operation: a good result would appear as the nasal soft tissues contracted around the smaller skeleton. The surgeon’s diagnostic and therapeutic tasks were always the same: decide which parts of the nose were too large and reduce them. If the result was not good, reduce some more. Patients’ complaints supported this model, and still do: “My bridge is too high,” “My tip is too bulbous,” “My bones are too wide,” “My nose is too long,” “My nostrils flare,” “My whole nose is too big.” These are all pleas for reduction. Although

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reduction rhinoplasty did sometimes work, in many cases it did not and instead compromised the airway, yielded a poor shape, or both. The explanation for these failures in diagnosis and treatment derives largely from two false assumptions underlying the traditional model. False Assumption Number One: The nasal soft tissue cover has an infinite ability to contract to the shape of any underlying skeleton. The success of the entire reduction rhinoplasty depends on this assumption.

A

B

C

This patient demonstrates that nasal soft tissue contractility is always finite, even in patients with thin skin (A). Skin contraction after rhinoplasty reached its limits without coapting the underlying skeleton (B). Maxillary augmentation, followed by dorsal, tip, and alar wall septal cartilage grafts expanded the scarred skin sleeve and re-created the patient’s preferred preoperative shape (C). Notice the preoperative low radix and inadequate tip projection—special anatomic traps that are best handled by altering, not just reducing, the relevant anatomy. If False Assumption Number One were true, supratip deformity would never occur, and augmentation would not correct it. The nasal skin sleeve contracts, not passively and infinitely, but along its own vectors according to its quality, thickness, and preoperative distribution. The degree of contraction is always limited; if skeletal reduction exceeds that limit, the skin assumes its own intrinsic, unsupported shape: the shape of supratip deformity.

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Notice also that in the preceding patient, in this woman, and in the many secondary patients throughout this text, skin texture undergoes significant, irreversible changes during contraction, similar to a dose/response curve. The skin becomes stiffer, thicker, and often coarser; surface details disappear, along with some of the refinement present in the preoperative nose. Although most primary rhinoplasties require some skeletal reduction, all such changes should be directly purposeful and limited. Reduction and contraction can be a Trojan horse in rhinoplasty, promising one thing but delivering another. The vectors of soft tissue contraction are independent of, but related to, the degree of skeletal reduction, and they collapse the nose caudally and medially over the pyramidal bony and cartilaginous vaults, cephalad at the caudal septum, medially along the alar base, and posteriorly and concentrically around the tip.

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A

B



DYNAMIC ANATOMY AND STRUCTURAL RELATIONSHIPS

C

Limited soft tissue contraction is one of two reasons that all end-stage noses share the same feature. Whether caused by previous rhinoplasty, trauma, polychondritis, or Wegener’s granulomatosis, the appearance is identical: a low, narrow, upper nasal pyramid; a collapsed middle vault; an obtuse nasolabial angle; and a contracted tip lobule. Although preoperative contour (A) may seem comfortingly improved immediately after skeletal reduction (B), soft tissue contraction and collapse alter the healed appearance (C).

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The second reason for the uniform appearance of end-stage noses is the structural interplay among the nasal regions, which is denied by the following assumption. False Assumption Number Two: Altering the nasal skeleton produces purely regional changes. The classic application of False Assumptions One and Two is the common preoperative plan in which the surgeon draws a line on the patient’s lateral photograph from the nasal radix to an idealized postoperative tip.

It is presumed that skeletal reduction anterior to that line will produce a straight profile. According to False Assumption Number One, the skin sleeve will contract uniformly to any skeletal size and shape. According to False Assumption Number Two, dorsal reduction will affect only dorsal height, and tip reduction will affect only tip shape. It is all very logical; it is just not true. Add the possibilities that the radix may be low, that the tip may be inadequately projecting, that the skin may be too thick to contract, that the lateral crura may be cephalically rotated, or that the middle vault may be narrow, and it becomes easy to imagine how the most logical plan can lead to surgical purgatory.

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Changes in the nasal skeleton are not independent, but each nasal region is functionally, structurally, and cosmetically interdependent, as seen in this patient. She is shown before surgery, after the first reduction, and after three more reductions. Nasal bridge resection affects nasal width and length, apparent nasal base size, middle vault support, nostril shape, and columellar position. Alar cartilage reduction affects tip contour and projection, nasal length, alar rim contour, and external valvular support. Far from being independent, each nasal region is functionally, structurally, and cosmetically interdependent. These relationships are not only predictable, but a commanding knowledge of them is necessary for accurate preoperative planning, interpretation of intraoperative nasal appearance, postoperative success, and the ability to correct secondary deformities.

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Consider the effect of septal collapse on this patient’s nasal appearance. If nasal regions were independent of each other, a saddle nose should only produce a localized supratip depression.

12 years postoperatively

However, loss of septal support has increased bony vault height (apparent), decreased middle vault width (real), shortened the nose (real), allowed the columella to retract (real), decreased tip support (real), increased bony vault width (appar-

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ent), affected the vertical carriage of the upper lip (real), and altered nasal balance and the nasofacial angle (apparent and real). Thus reconstruction was more complex than filling the supratip depression, but instead involved dorsal reduction to provide a level base, and rib cartilage grafts to the dorsum, lateral walls, columella, maxillary arch, and tip—all to restore this theoretically regional defect.

N asal Equilibrium It is helpful to consider the nose not as a static structure, but rather as a dynamic equilibrium—the sum of balanced, opposing forces. The nose represents an equilibrium between expansive and contractile forces. The nasal skeleton supports the skin, preventing skin sleeve contraction. At the start of a rhinoplasty, the nose is balanced in equilibrium. Skeletal reduction disrupts this equilibrium, not only between the skeleton and the skin, but also between the nasal parts (for example, the middle vault can collapse toward the septum once the cartilaginous roof is resected, and the alar rims can collapse medially or retract if lateral crural reduction has been significant). The degree of disequilibrium at the end of a rhinoplasty procedure determines the amount of redraping and contraction, and therefore the amount of change, that can occur postoperatively. The previously presented case examples supply ample evidence of this disequilibrium. However, if the surgeon reestablishes nasal equilibrium by reestablishing support so that the skeletal parts are balanced against each other, and uncontrolled soft tissue contraction cannot occur, he or she can powerfully influence postoperative nasal contour. The surgeon who controls the postoperative equilibrium controls the postoperative result.

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Preoperative

Appearance at conclusion of surgery

2 weeks postoperatively

1 month postoperatively

As this patient’s appearance progresses from the immediate postoperative period to 10 years after surgery, details change, but important elements do not. The nose deskeletonizes as edema resolves so that the nasolabial angle decreases slightly, and the underlying skeletal contours become more evident. However, bridge height, nasal length, tip projection, and tip contour have not changed appreciably since the conclusion of the procedure, indicating that the nose was equilibrated at that time. The limited dissection and maintenance of an intact skin sleeve that is never displaced intraoperatively are distinct advantages that help endonasal surgeons recognize and achieve intraoperative surgical equilibrium, but the principles hold with any access route. Nature has only one set of rules.

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4 months postoperatively

81⁄2 months postoperatively

13 months postoperatively

9 years postoperatively

9 years, 7 months postoperatively

10 years postoperatively

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S pecific Interrelationships DORSUM AND TIP The alar cartilages, invested by the external and vestibular skin and lining, are not anchored to the nasal septum, the nasal processes of the maxilla, or rigidly to the upper lateral cartilages, which means that they are mobile. Therefore they are more easily conceived of as external to, and independent of, the remaining skeleton (see Chapter 1). A

C

B

D

E

F

Notice the change in columellar position and nasal length following simple dorsal reduction (compare A to B, C to D, and E to F). According to False Assumption Number Two, this type of movement should not occur.

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Thus alar cartilage position depends on the height of the dorsum. Dorsal reduction decreases anterior pressure on the upper nasal skin, allowing it to fall posteriorly and pulling the alar cartilages cephalad with it. In most nasal configurations, dorsal reduction shortens the nose. Intraoperatively, tip movement itself may alter the relationship of the alar rim to the columella, requiring secondary adjustments to avoid a hanging columella. Surgeons performing open rhinoplasty must pay special attention to this interaction, because it is more difficult to observe with the open approach.

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Any interventions that decrease skeletal support can increase nasal length, especially if the nose was already long preoperatively. Dorsal reduction, osteotomies, and alar cartilage reduction all reduce the forces that maintain the position of a redundant skin sleeve.

A

B

C

Notice the increased nasal length that occurs with dorsal reduction only (A and B). Radix and tip grafts fill out the skin sleeve, and the nose shortens (C).

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It is not anatomic to create tip projection with an L-shaped implant that cantilevers the tip forward from the dorsum and maxilla—the tension produced eventually erodes the tip. A

B

The tip position in A was created by forcing the skin sleeve cephalad with a large L-shaped implant. The nose returned to its preoperative shape after the surgeon removed the implant because of patient discomfort (B). Similarly, it is neither anatomic nor effective to position the tip with sutures to the septum or the upper lateral cartilages, which fixes the independent alar cartilages to the remaining, relatively fixed, skeleton. Eventually the sutures disrupt: the long-term results are rarely satisfactory unless the surgeon has also performed maneuvers that independently shorten the nose, in which case it is the healed wound, not the sutures alone, that maintains tip position. 69

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DORSAL AND LATERAL COMPONENTS OF THE MIDDLE VAULT (UPPER CARTILAGINOUS VAULT) Equally important to the dorsum-tip dynamic relationship is that between the dorsal and lateral components of the middle vault.

Middle vault collapse: before and after correction

Reduction of the cartilaginous dorsum in this secondary patient accomplished two unintended effects that together usually decrease internal valvular competence and airflow: interruption of the intact cartilaginous roof and removal of the dorsal septal edge, which is wider than the portion directly beneath it. Together, the wider dorsal septal edge and intact roof compose the key structures that position the upper lateral cartilages, which, now medially unsupported, fall toward the new, narrower septal edge. The result is a characteristic inverted-V deformity (Sheen) that demarcates the caudal edge of the bony arch. Although the deformity is often obvious (and usually visible intraoperatively if the surgeon looks for it), many patients (and surgeons) incorrectly assume that the bony vault has not been narrowed enough and try to correct the upper/middle vault discontinuity by rasping the caudal nasal bone edges and repeating the osteotomies. These maneuvers are usually ineffective.

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A

B

C

D

Instead, the treatment should be spreader grafts, as demonstrated intraoperatively in this patient, whose concave middle vault, produced by roof resection (A and B), is realigned with spreader grafts (C and D). Notice the undersurface of the thin dorsal resection (A), which carries the dorsal edge of the septum/upper lateral cartilage complex. All three components are visible. If the dorsum is excessively low, a significant dorsal graft will push the middle vault sidewalls laterally and produce the same functional and cosmetic effect.

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Although a patient may recognize the cosmetic deformity of middle vault collapse, it is important not to forget the functional deficit, which may occur so slowly (as postoperative edema resolves) that it is not noticed. Our rhinomanometric data indicate that correcting internal valvular incompetence (with or without a concomitant septoplasty) doubles nasal airflow in most patients. One could therefore speculate that creating a new internal valvular incompetence can decrease airflow by 50% (see Chapter 4). Adequate middle vault width is imperative for normal nasal appearance and function. The middle vault does not need to be wide, and it should never bulge, but the bony and upper cartilaginous vaults should be confluent; the sidewalls must be adequately stable. The intrinsic stability of the middle vault depends not only on its width and the substance of the upper lateral cartilages but also on nasal bone length, as discussed in Chapter 1.

THE MIDDORSAL NOTCH On lateral view, the inverted V manifests as a sharp depression in the middorsum.

This notch occurs at the transition between the thinner upper nasal skin and the thicker lower nasal skin and marks the cephalic end of a supratip deformity when one is present. The notch is visible intraoperatively.

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Many surgeons misinterpret the notch as a divot or discontinuity at the junction of the bony and cartilaginous dorsa caused by their resection. In fact, in most cases the dorsum is straight (although it may not feel so by palpation).

Instead, the middorsal notch represents a soft tissue phenomenon and is a useful sign of overcorrection: treat these deformities with dorsal grafts, which are uniformly effective.

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BONY VAULT Unlike the middle vault, the bony vault is static, but it still has dynamic features during rhinoplasty. Although less important than the cartilaginous roof, the bony vault affects the lateral position of the upper lateral cartilages. Accordingly, invertedV deformities are more prominent in patients who have not undergone osteotomies (in other words, where there is a greater discrepancy between upper and middle vault widths).

In addition to osteotomies, the other major determinant of bony vault width is its height. This patient was treated in 1984, before the routine use of spreader grafts after roof resection. Note the inverted V in the frontal and oblique views; because dorsal height is correct, there is no middorsal notch in the lateral view.

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Only in retrospect did this patient seem to require osteotomies. Despite adequate dorsal height, her bony vault is unaesthetically wide.

Finally, bony vault height and width determine the three-dimensionality of the midface. This patient underwent a cosmetic rhinoplasty in which the septum apparently collapsed. The surgeon then reduced the bony vault height to match the height of the collapsed cartilaginous dorsum. Notice that her nose has shortened. Although osteotomies were performed in the first procedure, the surgeon repeated them several months later in a new effort to narrow the patient’s wide postoperative nose. Notice also the effect of dorsal reduction on nasal width and midfacial contour: the latter seems to have flattened.

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A rib cartilage dorsal graft not only elevated the dorsum in this patient but changed the entire appearance of the midface by increasing nasal projection. Although osteotomies were not performed in the tertiary surgery, the bony vault nonetheless appears significantly narrower. The visual impact of restoring normal nasal height, and therefore midfacial height, is significant. Notice also that the patient’s intercanthal distance seems narrower now that the dorsum is higher. Just as modification of the caudal septum affects upper lip position, modification of the bony vault affects the orbital area. Even though there are limitations on how much a surgeon can actually “make a nose that fits the face,” nasal contour and volume do influence midfacial shape.

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Compare the views of this woman before and after six reduction rhinoplasties. Her nose is smaller, but also wider and shorter. The low radix and inadequate tip projection remain, so these surgeries have only produced a smaller version of the same preoperative nose—with less contour, a flatter lip carriage, and a reduced airway. What goes up also comes down.

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DORSAL CONTOUR: THE CONVEX BRIDGE Aside from functional complaints, straightening a convex dorsum is the most common request of preoperative rhinoplasty patients. However, creating a straight bridge from a convex one is often more difficult than it sounds—and the technical aspects are often less complicated than the conceptual ones. Perhaps the most important concept is optimal balance, which requires both the patient and the surgeon to understand and work within the constraints imposed by skin sleeve thickness, volume, and distribution. The height of the bridge relates to the height and the position of the root cephalad to it and the tip caudad to it. The nasal root may be high, low, anterior, or posterior, and the tip may be excessively projecting, in line with the supratip, or inadequately projecting. Given these variations, the permutations add up quickly. These combinations are illustrated throughout this book, but relevant to this chapter are two concepts: 1. Dorsal length (from radix to tip) relative to nasal base size (from tip to subnasale) determines nasal balance. 2. The position and depth of the nasal radix and the degree of tip projection influence dorsal contour. Thus, in patients with inadequately projecting tips, the dorsum may seem higher than it is; and in patients with excessively projecting tips, the dorsum may seem lower than it is (the reverse is also true for the nasal tip).

These two patients each had the same goal—they wanted smaller versions of their preoperative noses. Aside from the soft tissue changes that have blunted contours and destroyed the nostril/lobular proportions, observe the effects of an upper nose that can contract but a base that cannot: the nasofacial angle is too acute—the lower nose seems to have enlarged. 78

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Numerous reductions, followed by stacked silicone dorsal implants, produced the same thick tissues but an opposite balance problem: a high radix and short nasal base, creating a nasofacial angle that is unaesthetically obtuse or vertical. Straight preoperative noses present a special problem—they are sometimes not improvable by methods that we understand today. But the experiences of these unfortunate men and women make the vague concept of balance easier to comprehend. The decisions for treating each patient cannot be made by examining photographs alone. The surgeon must also consider skin thickness, the quality of the underlying bony and cartilaginous framework, and the patient’s individual aesthetic goals.

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This nose seems to be a chimera from two patients: a low, narrow upper nose and a large, lower nose. Although it may at first seem logical to reduce the larger base to fit the smaller pyramidal nose, this strategy will not produce a good result because it requires the thicker nasal skin to contract more than it can. Instead, reduce the lower nose as much as possible without distortion and then augment the upper nose to fit. The postoperative base preserves its shape and seems smaller because (1) it actually is, and (2) dorsal augmentation has altered nasal proportion favorably.

ALAR CARTILAGES The alar cartilages, which determine columellar position, tip lobular contour and projection, and external valvular support, are enveloped within an external and vestibular skin pocket at the nasal base—one pliable structure invested by another. They are not fixed to the septum or the upper lateral cartilages except by yielding membranes that are pulled in every direction by the nasal and facial muscles and moved by air currents. It should not be surprising, therefore, that this fragile arch can be so easily damaged by surgery and so difficult to reconstruct.

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Normal lateral crura are 12 to 14 mm wide or wider. Rim strips of 2 to 4 mm, which have been a surgical goal for so long, do not have enough strength to shape the nasal base or support the external valves. Reducing the width of any alar cartilage component weakens it. Sufficiently compromised, the columella can become retracted (medial crura), the tip can inadequately project (or buckle and collapse on itself) (middle crura), and the external valves can become unsupported (lateral crura). The contractility and pliability of the investing soft tissues and the degree of skeletal resection determine how much distortion or retraction occurs at each location.

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NASAL SEPTUM Joining the bony vault and tip, the bony and cartilaginous septum is an excellent example of the interdependence of one nasal region with another. A

C

B

D

E

Loss of septal height alters apparent bony vault height, reduces internal valvular incompetence, and alters nasal length, tip projection, columellar position, nostril contour, and upper lip carriage. Each area must be corrected to restore the damage created by injury to the septum alone (E). Septal injury is so damaging to nasal form and function that any septoplasty technique should minimize the chance of its inadvertent occurrence.

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NASAL BASE

The nasal base suffers from injury to any of the structures above it. Dorsal reduction, septal fracture, any significant change in alar cartilage volume or integrity (such as a vertical resection of the arch without adequate reconstruction), and columellar or alar wedge resection can each have an impact on columellar position, nostril contour, tip shape and support, and external valvular competence.

A prominent caudal septum and maxillary spine propels the nasal base forward.

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B

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C

F

D

G

Similarly, septal loss from collapse (A and B), Wegener’s granulomatosis (C and D), and aggressive resection (E through G) can each retrodisplace the nasal base.

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Finally, maxillary retrusion, most commonly seen in patients with cleft lip, produces a recessive nasal base, as seen here. Maxillary size, caudal septal and medial crural strength, and tip projection all influence nasal base position. Consider strengthening each component if base retrusion is significant, as was done here using maxillary augmentation, caudal septal replacement, and columellar and tip cartilage grafts (all autogenous).

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TIP PROJECTION Given the frequency with which the term tip projection is used, it is paradoxical that there is so little consensus among rhinoplasty surgeons about what it means. It is important to realize that tip projection means alar cartilage projection, not skin projection or volume.

All of these patients have large nasal bases and significant amounts of lower nasal skin. I have provided many examples because the concept is important, yet it has eluded many surgeons, even some experienced in rhinoplasty. Notice that, among the subtle differences in skin type and dorsal height, there is nevertheless a uniformity of appearance shared by all, namely in the relationship of the tip lobule to the septal angle. Alar cartilage support is weak in each patient, so that the tip seems to hang from the septal angle—this is inadequate tip projection. It is crucial to understand that adequacy of tip projection is independent of nasal base size—one does not necessarily determine the other. A surgeon who equates them, determines that each of the noses shown here has excessive tip projection because the lower noses are large, and therefore attempts to reduce tip projection will only exaggerate the deformities.

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These patients, in contrast, have strongly supportive tip cartilages that project the tip beyond the supratip dorsum. This can be either adequate or excessive tip projection, depending on the degree. Tip projection is independent of nasal base size.

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Septal angle

Adequate tip projection must be adequate relative to some structure, which is the supratip dorsum (or the septal angle). Therefore alar cartilages strong enough to bring the tip to the height of the anterior septal angle create adequate tip projection. Alar cartilages that are not strong enough to bring the tip to the height of the anterior septal angle create inadequate tip projection. Tip projection has been defined in different ways by different authors. Some surgeons assess tip projection by measuring the distance of the most projecting point of the tip from a facial parameter (such as the dorsum, nasion, subnasale, or alar crease), by the relative proportion of the nasal base segments anterior to the facial plane (usually defined as 50% to 60%), or by the relative lengths of the nasal base and upper lip. Although each definition applies in some cases, there are patients whose nasal bases are large but whose tip cartilages are nonetheless inadequately projecting, as illustrated here.

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In these individuals, blessed with significant lower nasal skin but weak alar cartilages, tip projection may be inaccurately assessed as adequate or even excessive, even though the alar cartilages lack the substance required to create a straight bridge line. The practical value of determining tip projection relative to the septal angle is its ability to define treatment. Adequately projecting tips do not need increased support, whereas inadequately projecting tips do. Furthermore, by defining tip projection relative to the septal angle, a surgeon can distinguish between two associated but distinct entities: (1) intrinsic anterior supporting strength supplied by the alar cartilages and (2) skin sleeve volume and distribution in the lower third of the nose.

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To create a straight dorsum, the bony and upper cartilaginous vaults must be straight, and the tip must support itself independent of bridge height: that is, it must be adequately projecting.

Inadequate tip projection cannot be rendered adequate by tip reduction alone. Some maneuver must compensate for the fundamental defect of a short middle crural segment. For this reason I favor tip grafting, which seems to be the most anatomic of the methods yet described.

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Notice also that the nose lengthens when it loses tip projection. The reverse is also true: increasing tip projection can shorten the nose. Interestingly, rhinoplasty pioneer Jacques Joseph instinctively solved the problem of inadequate tip projection in his patients by limiting bridge resection and deliberately leaving a dorsal convexity to support the tip.

D ynamism in Practice: Making Noses Longer or Shorter By now you have all of the tools to create a general plan for shortening or lengthening a nose. Once you understand the phenomenology, it is a straight line to correction. Recall that:  Most noses shorten when the bridge is reduced.  A nose usually lengthens when the septum collapses, and shortens when the septum is resected.  Noses often lengthen when tip support decreases, and shorten when tip support increases.  A large maxillary nasal spine pushes the nasal base forward and cephalad.  A deficient maxillary arch lets the base fall posteriorly.  Excess skin or structural loss lengthen the nose.  Deficient lining or cover shortens the nose. Each of these phenomena leads to a solution. Therefore, to shorten a long nose, choose from the following as indicated for the patient:  Lower the bridge.  Shorten the caudal septum and its lining (membranous septum).  Shorten the caudal ends of the upper lateral cartilages submucosally.  Increase tip support.  Replace caudal septum (if it is missing following septal trauma and collapse or a previous resection).  Strengthen the medial crura.  Increase maxillary arch size.  Resect skin (transversely at the radix and only as a last resort).

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PATIENT STUDY ONE

The combination of low radix, high dorsum, inadequate tip projection, and maxillary retrusion in this woman produced a nose that appears to be sliding down her face. The goals of surgery were not only to shorten the nose but to move it visually higher on her face.

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SUMMARY OF THE SURGICAL PLAN

1. Maxillary augmentation with Gore-Tex roll 2. Wide skeletonization through bilateral intercartilaginous incisions 3. Dorsal reduction 4. Submucosal shortening of upper lateral cartilages 5. Transfixing incision, shortening the caudal and membranous septum 3 mm anteriorly, 2 mm posteriorly 6. Retrograde 2 mm reduction of alar cartilage lateral crura 7. Spreader graft tunnels

8. Septoplasty 9. Bilateral spreader grafts, thicker on right; thinner, curved graft on left, convexity toward the right 10. Radix graft, one layer crushed

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11. Multiple crushed cartilage tip grafts 12. Left low-to-high osteotomy

Nasal shortening, dorsal reduction, and radix and tip grafts have rebalanced the nose and moved it visually higher on the patient’s face.

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Postoperative Analysis

Postoperatively, the dorsum is straight; the radix graft altered nasal balance by lengthening the dorsal line. Tip grafts have brought the tip above the septal angle. The nose is straighter because of the dorsal resection (which removed part of the deformity) and because of asymmetrically thick spreader grafts and a unilateral osteotomy. Finally, the nose is shorter because the tip has moved anteriorly, the dorsum is lower, the lateral crura and upper lateral cartilages have been reduced (creating dead space that allowed the tip to rotate), and tip support is stronger. Of the dynamic structural interrelationships that have been described so far in this text, nearly every one was involved in this case.

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1 week postoperatively

3 months postoperatively

2 weeks postoperatively

8 months postoperatively

5 weeks postoperatively

38 months postoperatively

Notice that the postoperative nose deskeletonizes and lengthens slightly as edema resolves, but otherwise nasal shape remains essentially unchanged over the first 2 postoperative years. Nasal equilibrium was achieved intraoperatively. Lengthening a short nose is shortening in reverse, but because both skin and skeletal deficiencies exist, the options are more limited, and the result is often less striking.

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Therefore to lengthen a short nose, choose from the following as indicated for your patient:  Raise the dorsum.  Resect the posterior caudal septum.  Graft the caudal side of the tip lobule.  Add lining (in the form of composite grafts).

PATIENT STUDY TWO

This patient believed that two previous rhinoplasties had cost her her ethnic identity, creating a low dorsum, a rotated tip, and excessively visible nostrils.

She had a photograph of what she wished to restore: greater length and dorsal height with the suggestion of a dorsal hump, and less nostril visibility.

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SUMMARY OF THE SURGICAL PLAN

A

B

1. Limited skeletonization C

2. Septoplasty D

E

3. Layered septal cartilage dorsal graft; note the ablation of the inverted V, signifying middle vault collapse (D) after dorsal graft placement (E)

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F

G

4. Bilateral composite grafts are harvested and inserted; they are placed coronally into vestibular incisions 3 mm above each rim; both grafts are visible in their pockets (G)

H

5. Tip grafts; cephalic dissection limited to maintain caudal graft position; grafts placed on caudal side of tip lobule

I

J

K

L

6. Grafts placed through a lateral incision to displace columellar skin caudally (I and J) 7. Silhouettes demonstrate the immediate lengthening obtained (K and L); compare the equilibrated stability to the 8-year postoperative views

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Postoperative Analysis

This patient’s postoperative views at 8 years show the maximum length that can be regained for her within soft tissue limitations, but her goals have been met. When we compare these against the patient’s preoperative objective, the dorsal line seems longer because it begins higher (dorsal graft) and ends lower (caudal tip and columellar grafts). The skin added by composite grafting has allowed the alar rims to drop, showing less nasal interior, creating the illusion of greater length, and doubling airflow by reconstructing the external valves. Notice also that spreader grafts have widened the middle nasal third and improved the previous narrowness that marked the caudal bony vault as an inverted V. Airflow can be expected to double again with internal valve reconstruction. Thus in addition to the cosmetic reconstruction, mean nasal airflow in such circumstances can triple or quadruple postoperatively. This patient’s nose now has appropriate width, height, and length for her face and aesthetic perspective. She has regained an important ethnic characteristic and a functional nose.

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Each of the effects and dynamic structural interrelationships discussed in this chapter is illustrated in Parts IV and V by cases in which noses must be shortened or lengthened or those in which balance must be altered. The basic strategy in each case exploits these interrelationships by reducing the skeletal parts that created the deformity and augmenting those that are deficient. Lesser variables include incision placement, degree of skeletonization, and graft positioning. First, however, we must learn to use our right brains to set surgical strategy and then relate nasal shape and structure to its most important roles: transporting and cleaning air.

BIBLIOGRAPHY Byrd HS. Lengthening the foreshortened nose. Presented at the American Society for Aesthetic Plastic Surgery/Plastic Surgery Educational Foundation Rhinoplasty Symposium, Palm Springs, CA, 1992. Constantian MB. The middorsal notch: an intraoperative guide to overresection in secondary rhinoplasty. Plast Reconstr Surg 91:477-484, 1993. Constantian MB. A model for planning rhinoplasty. Plast Reconstr Surg 79:472-481, 1987. Constantian MB. Two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on the review of 100 consecutive patients. Plast Reconstr Surg 114:15-71, 2004. Fanous N, Amar YG. Narrowing of the wide nasal dorsum in the ‘minimal-hump’ nose: a simplified universal approach. Can J Plast Surg 13:139-143, 2005. Fontana AM, Muti E. Our “idèes fixes” in rhinoplasty: the naso-frontal angle and the alar lateral crus. Aesthetic Plast Surg 25:1-7, 2001. Freihofer HP Jr. Changes in nasal profile after maxillary advancement in cleft and non-cleft patients. J Maxillofac Surg 5:20-27, 1977. Gruber RP, Nahai F, Bogdan MA. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures. Part I. Experimental results. Plast Reconstr Surg 115:589594, 2005. Guyuron B. Dynamic interplays during rhinoplasty. Clin Plast Surg 23:223-231, 1996. Guyuron B, Varghai A. Lengthening the nose with a tongue-and-groove technique. Plast Reconstr Surg 111:1533-1539, 2003. Hamra ST. Lengthening the foreshortened nose. Plast Reconstr Surg 108:547-549, 2001. Hamra ST. Repositioning the lateral alar crus. Plast Reconstr Surg 92:1244-1253, 1993. Ishida J, Ishida LC, Ishida LH, et al. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 103:1729-1733, 1999. Ishida LC, Ishida J, Ishida LH, et al. Total reconstruction of the alar cartilages with a partially split septal cartilage graft. Ann Plast Surg 45:481-484, 2000. Joseph J. Nasenplastik und sonstige Gesichtsplastik. Leipzig: Kaden Verlag, 1931, pp 94, 98, 166. Kridel RW, Konior RJ. Controlled nasal tip rotation via the lateral crural overlay technique. Arch Otolaryngol Head Neck Surg 117:411-415, 1991. Labrakis G. The universal nose of early childhood: nature’s aid in understanding the supratip deformity and its correction. Ann Plast Surg 29:55-57, 1992. Lee Y, Kim J, Lee E. Lengthening of the postoperative short nose: combined use of a gull-wing concha composite graft and a rib costochondral dorsal only graft. Plast Reconstr Surg 105:2190-2199, 2000.

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Lejour M, Duchateau J, Potaznik A. Routine reinsertion of the hump in rhinoplasty. Scand J Plast Reconstr Surg 20:55-59, 1986. McKinney P, Sweis I. A clinical definition of an ideal nasal radix. Plast Reconstr Surg 109:1416-1418, 2002. Mommaerts MY, Van Butsele BL, Abeloos JS, et al. Rhinoplasty with nasal bone disarticulation to deepen the nasofrontal groove. Experimental and clinical results. J Craniomaxillofac Surg 23:109114, 1995. Naficy S, Baker SR. Lengthening the short nose. Arch Otolaryngol Head Neck Surg 124:809-813, 1998. Neu BR. Reduction of nasal tip projection with medial rotation of alar cartilages. Plast Reconstr Surg 108:763-770, 2001. Neu BR. Segmental bone and cartilage reconstruction of major nasal dorsal defects. Plast Reconstr Surg 106:160-170, 2000. Pontes R, Pontes G, Serpa N, et al. Case report: nasal lifting. Aesthetic Surg J 25:153-156, 2005. Rohrich RJ, Griffin JR. Correction of intrinsic nasal tip asymmetries in primary rhinoplasty. Plast Reconstr Surg 112:1699-1712, 2003. Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 114:1298-1308, 2004. Sheen JH. Middle crus: the missing link in alar cartilage anatomy. Perspect Plast Surg 5:31-50, 1991. Sheen JH, Sheen AP. Aesthetic Rhinoplasty, 2nd ed. St Louis: Quality Medical Publishing, 1997. Velidedeoğlu H, Demir Z, Sahin U, et al. Block and Surgicel-wrapped diced solvent-preserved costal cartilage homograft application for nasal augmentation. Plast Reconstr Surg 115:2081-2093, 2005.

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CHAPTER 3 Involving the Right Brain in Rhinoplasty Diagnosis and Planning The poet’s eye, in a fine frenzy rolling, doth glance from heaven to earth, from earth to heaven; and as imagination bodies forth the forms of things unknown, the poet’s pen turns them to shapes, and gives to airy nothing a local habitation and a name. WILLIAM SHAKESPEARE A Midsummer Night’s Dream Act V, Scene 1

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R

hinoplasty is a right-brain operation, probably the most right-brain operation that plastic surgeons perform, which is a chief reason why rhinoplasty is difficult for so many of them. Indeed, the right-brain epiphanies required of surgeons who perform rhinoplasty escaped me for many years. I only became aware of the need for these epiphanies, not in the operating room, but while reading Dr. Betty Edwards’ text, The New Drawing on the Right Side of the Brain. I made some vague references to right-brain analysis in my first paper on rhinoplasty, which was published in 1984. In it I listed three interrelated principles to increase nasal refinement in primary and secondary rhinoplasty procedures: (1) create or regularize, as much as possible, the nasal planes; (2) respect the nasal light reflexes; and (3) maintain or expand the size of the skin sleeve. Each of these principles is a right-brain, surface parameter that deals with shape, contour, and balance, and only indirectly reflects skeletal anatomy. Thus all three apply to any nose preoperatively, in either primary or secondary rhinoplasty, whether the skeleton influences surface contour or not. In the same fashion, rightbrain concepts are analogical rather than abstract (seeing relationships rather than analyzing details), spatial rather than numerical (seeing how parts form the entirety rather than measuring), and holistic rather than linear (seeing patterns, the thing as a whole rather than using an orderly series of linked ideas to reach a conclusion). I often used to state in my instructional courses that rhinoplasty is a nonlinear operation, by which I meant that observations and decisions sometimes seemed to come out of sequence. However, the right-brain element itself had eluded me.

H istory of Right-Brain Theory and Its Application to Rhinoplasty It was the work of Roger W. Sperry and his associates at the California Institute of Technology during the 1950s and 1960s that established specialized, differential functions for the right and left cerebral hemispheres, linked by the commissural fibers of the corpus callosum.

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Evidence accumulated that the two hemispheres processed information differently. Work by Levy, Sperry, and others determined that the left hemisphere analyzes, abstracts, plans step-by-step procedures, and verbalizes rational, logical statements. By contrast, right-brain processing is intuitive, subjective, relational, nonverbal, global, holistic, spatial, and perceptual. Some tasks are shared, and others are dominated by one hemisphere or the other. Our culture and educational system cultivate the verbal, rational, analytical, and numerical left side of the brain while tending to ignore the right side. This is one of the reasons that most adults draw with the same level of sophistication that they possessed as 10-year-old children, which is, not coincidentally, the age at which the left side of the brain becomes dominant in many children. After this age, most children stop drawing what they actually see and instead draw what they “know” that they see, articulated in the symbols and rudimentary sketches they learned at a much younger age. For example, trees remain circles supported by sticks, the sun remains a circle with radiating lines, and eyes remain lenticular shapes containing central dots. Whatever vestiges of right-brain activity persist after college, medical school and surgical residency further destroy. Our skills become increasingly calibrated and embedded with anatomic details, diagnostic algorithms, and the useful methodologic rituals of technique and suturing. Unless surgeons continue to stimulate the right sides of their brains through interests in sculpture, painting, or music, they may find it increasingly difficult to access their right brains on command. The ease with which surgeons can perform rhinoplasty correlates directly, I believe, with the facility with which they can access and involve right-brain function. For all its putative advantages, open rhinoplasty makes the operation even more leftbrain dominant. The emphasis becomes less related to surface shape, proportion, and balance and more dependent on calibrated measurements, particular needles, and the details of suture configuration. The left-brain dominance of open rhinoplasty is one of the reasons that the resurgence of that approach has not lowered the incidence of significant secondary deformities. The influence that one hemisphere may have over the other also explains why some surgeons have difficulty with rhinoplasty. For example, many experts in microvascular surgery or free flaps (both of which require a surgeon to be extremely adept at left-brain skills) have great difficulty not only with rhinoplasty but also with other operations that require right-brain function for optimal results (such as shaping transverse rectus abdominis myocutaneous [TRAM] flaps or breast reduction surgery). Plastic surgeons need to use both sides of their brains as individuals and in their specialty.

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Handedness may also play a role. Interestingly, although only 10% of the population at large is left handed, a survey by Edgerton in the 1970s documented that 28% of plastic surgeons were left handed. Although I am not aware of hard data on the subject, the proportion of left-handed persons in the arts is probably even higher. Michelangelo, Dürer, Holbein, Klee, da Vinci, Cole Porter, Albert King, Jimi Hendrix, Paul Simon, Don and Phil Everly, Glenn Campbell, and half of The Beatles, among others, have been left handed. The problem for us as surgeons is to escape left-brain dominance (that is, to stop “seeing” what we already “know”) sufficiently to recognize what is really there— anatomic variants, aberrant shadows, contour distortions, imbalances, and disproportions—so that our diagnoses and corrections are guided by thought processes that reflect accurate observations rather than preconceptions. During my general surgery residency, one of the attending physicians refused to allow any of his residents to name lesions after vegetables, fruits, or sports equipment (that is, he objected to descriptions such as “lemon-sized” masses or “footballshaped” tumors). Although I did not understand this idiosyncrasy at the time, he wanted us to describe what we actually saw. But nasal surgeons are still making these same mistakes. For example, terms such as “boxy” or “ball-shaped” tips distract surgeons from seeing what is actually there: alar cartilages whose lateral crura are cephalically rotated, indicating a functional problem that often eclipses the cosmetic one. The eye sees what the mind permits.

Experiencing Right-Brain Shift The cognitive shift to the right side of the brain is recognizable but must be experienced to be understood. In The New Drawing on the Right Side of the Brain, Dr. Betty Edwards draws a parallel to understanding the left-to-right-brain shift by quoting Fats Waller, “If you gotta ask what jazz is, you ain’t never gonna know.” Based on her methods and on my discussions with her, I have designed a series of exercises that I hope will facilitate the reader’s ability to access and experience right-brain mode and illustrate some of the functions that the right brain does best—that is, understanding proportion, balance, and global relationships.

LEARNING TO ACCESS THE RIGHT BRAIN ON COMMAND In their article entitled “The Split-Brain and the Culture-Cognition Paradox,” Paredes and Hepburn describe the method by which Trukese sailors navigate their small boats among the North Pacific islands in Micronesia: “. . . by imagining the position of his destination relative to the position of the other islands. As he sails along, he constantly adjusts his direction according to his awareness of his position thus

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far. . . . He navigates with reference to where he started, where he is going, and the space between his destination and the point where he is at the moment.” Edwards explains that a similar process is needed to draw most effectively. In a similar way, part of learning to access the right brain to perform rhinoplasty is learning to imagine the destination—that is, the surgical endpoint.

EXERCISE ONE: COMPLETING NAMELESS PROFILES This exercise is designed to help you imagine the destination. Examine the following four profiles, each of which has a segment missing.

For left-handed surgeons

For right-handed surgeons

Trace the outlines onto another piece of paper, and complete the missing segments by examining other profiles in which those segments are already present. If you are left handed, use the top row of drawings; if you are right handed, use the bottom row. As you draw, try not to name the individual parts (for example, forehead, nose, lips, chin), even if you see them. After you have finished, proceed to the next page.

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Why You Did This Exercise The act of inverting the images helps disable the left brain, which abandons drawing projects in which shapes are unidentifiable. It is not an accident that many surgeons learn that it is easier to achieve symmetry in cleft cheilorrhaphy by sitting at the patient’s head, thus performing the repair “upside down.” The point is that to draw (or see) a shape, you must make the shift to the brain mode that is specialized for visual perception. If you found the drawing slightly difficult, you are not alone. Particularly for surgeons, the need to follow a series of seemingly mundane tasks without identifying the object can be difficult at first. The exercise is not goal directed or immediately comprehensible; therefore it is considered a waste of time. You may have become impatient or completed only part of the exercise. There are other left-brain intrusions. For example, if you used your eraser, did you feel guilty? Again, if you did, you are not alone—but the question is why. Nothing in the instructions prohibits the use of an eraser. It is interesting that the left brain may intrude with a series of rules fabricated by you, not the exercise. Ignore them.

EXERCISE TWO: COMPARING NASAL PROPORTIONS Much of rhinoplasty is concerned with balance and proportion. Examine the following outlines.

As you examine these inverted drawings, given what you consider an ideal nose, ask yourself the following questions:  What is missing?  What is in excess?

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Which nose has the best balance? Which nose has the largest imbalance? At what point does the dorsal convexity begin? How high is that point on the nose? Which profile has the greatest nasofacial angle (dorsum to the facial plane)?

Why You Did This Exercise Two interesting observations should be noted: (1) Without being told, you already have a concept of an ideal nose; and (2) you can make aesthetic determinations without measuring angles, without defined ideal proportions, and without a reference nose. It is my experience that most plastic surgeons know proportion without being told.

EXERCISE THREE: COMPARING REGIONAL DIFFERENCES As you examine the following drawings, ask yourself these questions:  In which nose is the columella too low?  In which nose is the columella too retracted?  In which nose is the tip shape best?  In which nose is the dorsum too low relative to the size of the nasal base?  In which nose is the balance between nasal length and nasal base size most ideal? Least ideal?

Notice that even with few surface details, and with left-brain function still impaired by inverting the images, you can still make basic decisions about nasal proportion and aesthetics.

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EXERCISE FOUR: COMPARING TIPS In the two drawings that follow, examine the shapes of the tip lobules and notice their effects on apparent nasal length, dorsal contour, and overall profile shape. Ask yourself the following questions:  Which tip shape is better?  What is the effect of tip lobular shape on nasal length?  Is this difference real or perceived?

Why You Did This Exercise Notice how obvious the answers were, even though there were no aesthetic ideals or rules provided by which to judge the images. You already knew. The goal, of course, is to take the skills that you already possess and apply them to surgical analysis and to your intraoperative rhinoplasty decisions. In performing all of these exercises, it is easier not to think in words. Instead, make all of your comparisons spatial, relational, and comparable. Do not name each part of the nose as you draw it.

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EXERCISE FIVE: PLAYING WITH PROPORTIONS

For left-handed surgeons

For right-handed surgeons

Trace one of these outlines and then make the following changes:  Retrace the same dorsal line, but higher; leave the nasal base unchanged.  Retrace the same dorsal line, but lower; leave the nasal base unchanged.  Retrace the nose with a more acute nasolabial angle.  Retrace the nose with a more obtuse nasolabial angle.  Retrace the nose with a lower columella.  Retrace the nose with a higher alar rim.  Retrace the nose with a larger nasal base.  Retrace the nose with a smaller nasal base.  Retrace the nose with inadequate tip projection.  Retrace the nose with excessive tip projection.

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For left-handed surgeons

For right-handed surgeons

These images show the same profile, but with the requested changes. Compare these with the preoperative noses in Exercises 3, 4, and 5.

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Why You Did This Exercise Notice how altering only one area may significantly affect the shape and balance of the nose: (1) the nasofacial angle affects the apparent size of the nasal base; (2) tip lobular size affects the apparent length of the nostril; (3) columellar/alar rim relationships affect the apparent delicacy of the nasal base; and (4) tip projection affects the profile line. To learn to recruit the right brain on command, it is easiest to present your brain with a task that the left brain will refuse, such as drawing upside down, drawing shapes without details, or drawing shapes without naming the parts. The left brain quickly recognizes shapes and categorizes them; however, to perform rhinoplasty, you must turn your full visual attention to examining the nose in all its details, relating each detail to the whole. Your thinking must not be in words but in images. Think in terms of forms rather than labeled parts. Finally, avoid using words in your mental analysis for as long as possible.

EXERCISE SIX: CONTOUR DRAWING

Set a timer for 5 minutes. Then select and gaze at one of the squares in the grid of the drawing, and trace every detail within it. Keep drawing the lines until the timer sounds. Do not panic or become overwhelmed: your task is not to draw the whole nose but rather to study the details and become engrossed in the intricacies of the surface drawing.

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Why You Did This Exercise After you have finished your contour drawing, recall how you felt. If you became fascinated with the minutiae of the area you were drawing without worrying about whether the exercise was useful or relevant, you were experiencing right-brain mode. As Edwards notes, contour drawing is rejected by the left brain. The goal here is not primarily to develop your skill in rhinoplasty but to allow you to experience the time-insensitive trance that indicates right-brain thinking. Contour drawing is a powerful tool for eliciting right-brain consciousness to a greater degree. The more readily you can hyperfocus on the details of nasal surface contour and spatial relationships, the more you can improve your rhinoplasty analysis and intraoperative skills. You may have already experienced right-brain mode while playing or listening to music or gazing at a beautiful sunset. The right-brain sensation is a familiar experience, but what I want you to do is relate it to rhinoplasty.

R elating Right-Brain Observations to Rhinoplasty Strategy Perhaps the most serious problem with usual aesthetic measurements and proportion ideals is that they are left brain, which may be one of the reasons why many published rhinoplasty results can look assembled rather than unified. Each individual area—the dorsum, the tip, the alar bases—may be well shaped, but they do not quite fit together. There is no sense of a beautiful result. The most attractive noses in nature do not look assembled but unified as a whole in which every part seems to belong. This principle should also apply to rhinoplasty results. This book is subtitled Craft and Magic because there are some aspects of rhinoplasty that do seem magical. Perhaps the best example is the relationship of dorsal length and height to the apparent size of the nasal base.

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A

A⬘ B

B⬘

In this case, changing the position of the nasal root has changed the apparent size of the nasal base, even though the tip lobule has been expanded by grafts. Note the distance between the point of maximal tip projection (A, A⬘) and the anterior edge of the nostril (B, B⬘) in each photograph.

A silhouette, which contains a contour edge without any surface distractions, is an excellent way to train the right brain. The goal is to be able to examine any nose but see only its edge, ignoring surface contours and named anatomic structures. I take silhouette photographs at the beginning and end of every rhinoplasty so I can understand and document how my intraoperative changes have affected the proportion and balance of each patient’s nose. 119

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EXERCISE SEVEN: EXAMINING CONTOURS

As you examine these four images, try not to think in words. Ask yourself only right-brain questions such as:  Where does the nasal radix begin?  How do the dorsal contours differ—where are the relatively high and low spots?  Which silhouette has the most attractive nasofacial angle?  Which dorsal line seems most proportionate to the lower nose?  Which nose is better balanced?  Which tip shape is more attractive?

Why You Did This Exercise The following are right-brain words: spatial, relational, and comparative. No nasal parts are named. Employing the right brain during surgery is exactly the same process. Although the left brain is necessary to manage technique and operative sequence, and to recognize which anatomic structures must be altered to change nasal configuration, the surgeon’s visualization should optimally convert between the left and right modes repeatedly. The right brain can assess shape and balance without any assistance from the left brain. In fact, even when the left brain is armed with measurements and aesthetic ideals, the right brain will do a better job—its method of “knowing” is especially appropriate and superior for rhinoplasty. Learn-

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ing to operate with the right brain means learning to access that system at will. You must learn to see in the special way that an artist sees. Do not try to perform rhinoplasty with half a brain!

H ow the Left Brain Deceives One of the problems with either right- or left-brain visualization is the brain’s capacity to alter visual information to fit preconceived concepts. The left brain can make the nose look “the way it should,” deceptively enlarging data that the brain perceives as important and diminishing unimportant data. This process proceeds unconsciously—that is, we are not aware when it has happened. The process can be corrected or avoided only by seeing what is actually there.

Examine these schematics. Which nasal base is larger? It may surprise you to learn that both nasal bases are exactly the same size. However, because the length and angle of the dorsal lines differ, the brain unconsciously decides that the nasal base on the right is larger. This type of misinformation can lead to erroneous observations and therefore inaccurate intraoperative execution. The left brain overlays verbal concepts onto visual perceptions based on preconceived ideas. When assessing balance and proportion, that tendency is counterproductive. Because the volume and distribution of nasal skin are not infinitely variable, the surgeon must consider both proportion (which does not necessarily require a volume change) and size (which does).

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Examine these two nasal contours. What type of surgical plan would you devise?

Now examine the preceding lateral views as silhouettes. If you planned to reduce the tip, look again. Instead of concentrating on the size of the nasal base, can you now appreciate that there is also a discrepancy in size between the upper and lower noses—that the base is too large for the dorsum and the dorsum is too small for the base?

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Because nasal soft tissue does not have an infinite capacity to contract (classic False Assumption Number One [see Chapter 2]), balance and proportion considerations may suggest an alternate, more practical solution, such as reducing the base and enlarging the upper nose, as was done with these patients. Significant research has demonstrated that most children stop “seeing” at approximately 10 or 11 years of age, when they begin to make increasingly more realistic and less conceptual drawings. This is the age at which language becomes dominant, and therefore artistic sophistication and further right-brain development tend to slow. The left brain is satisfied with the symbols that have been created at younger ages—in other words, the left brain already knows what an eye looks like. Therefore

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many adults still draw the primitively symbolic eye images learned at a much younger age. The same is true of nasal shapes. The left brain goes no further than identifying a dorsal hump and ignoring a low radix, or seeing a wide tip and ignoring the lateral crural axis. In fact, our tendency as surgeons to create labels, comparative labels in particular (such as a “high” dorsum or “ball” tip), only reinforces left-brain dominance and inhibits us from really seeing. As soon as any nasal part has a descriptive label, the tendency is to stop looking at it. Left-brain dominance impairs the discovery of other important anatomic nasal characteristics: for example, (1) not every nasal radix is located at the same place; (2) not all dorsal convexities have the same shape; (3) not all middle vaults have the same width; (4) alar cartilages have three crura, not two; and (5) not every lateral crural axis parallels the alar margin. As useful as the left brain is, it does not perform all functions well. Instead, surgeons must turn their full visual attention— both halves of the brain—to what they are perceiving, noticing all details and how each element participates in the whole. To achieve optimal results, rhinoplasty surgeons must see in the same way that an artist sees. Silhouettes are an excellent way to excite right-brain interest, because all surface distractions are missing. For each of the following preoperative and postoperative silhouette pairs, you could ask yourself:

How much did I reduce these noses?

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How much did I elevate these nasal bridges?

How much did I reduce these nasal radixes?

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How much did I elevate these radixes?

How much did I shorten these noses?

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How much did I lengthen these noses?

How much did I even these undulating dorsa?

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How much did I increase tip projection?

How well did I redrape the tip lobular skin?

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How much did I decrease apparent nasal base size?

How much did I improve nasal balance?

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The method of photographing silhouettes is detailed in Chapter 6. Consider adding this discipline to your operative routine. Silhouettes provide a record of what surgery has accomplished before wound healing plays its confounding role. In addition, they display, as well as any modality, the redraping and redistribution phenomena that are unique to rhinoplasty and, in part, compose the magic that so distinguishes this operation. Earlier we examined contours and made contour drawings; these exercises are deliberately designed to discourage left-brain activity. Tracing contour lines and creases is a task in which the left brain quickly loses interest: it is not useful, it is boring, and the lines being drawn have no names.

EXERCISE EIGHT: PERCEIVING EDGES Now we proceed to edge perception. There are many ways to activate this skill, but for our purposes, we will try something simple.

Study the images above, proceeding from left to right. Do not move from one image to the next until you have memorized the first. Simply examine the relationships, the contours, and the proportions. Note where each area begins, how each curve changes orientation, how long each segment is, and the way the parts fit together. Do not name individual parts. Once you have examined the first image in detail, move to the second, and then the third. Keep progressing until you reach the final image. Here you should try to absorb all of the details, again not naming parts but rather examining contours and relationships, as if they merely created an interesting design.

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After you have finished absorbing the final image, concentrate on it again until everything disappears but the outline. Try to train your brain to ignore certain data, because during surgery you need to assess nasal balance and proportion without left-brain interference, which will try to name structures and determine whether the shape is right or wrong according to its own preconceived (and probably inaccurate) ideas. When you can make this transition successfully, you are beginning to access the type of skill needed for the right-brain mode that is so useful in performing rhinoplasty.

Conclusion Rhinoplasty is a right-brain operation, but it is certainly not limited to the right brain. Of the 21 chapters in this book, 20 are also dedicated to the left brain. However, the beauty of the assembled result, the finished surgical product, depends on the ability to see the preoperative excesses and deficiencies in shape and proportion as they really are, with no preconceptions; balance them against the patient’s surgical goals; and from those accurate observations create an effective surgical plan. The most direct means to this kind of analysis involves significant right-brain contributions, which the exercises in this chapter were designed to stimulate. Eventually you will be able to draw nasal shapes from memory and sit opposite your patient, re-creating the patient’s current nasal shape and surgical goal with lines that are inverted for you but correct for your patient. Most important of all, you will learn to see the nose in a manner unimagined by the left brain, and perhaps you will make observations that have not yet been made by any other rhinoplasty surgeon, thereby extending our knowledge and amplifying the solutions that we can offer our patients. The conclusion is inescapable—you must be in your right mind to perform the best rhinoplasty.

ACKNOWLEDGMENT I am indebted to Dr. Betty Edwards for historical information, conceptualization of right-brain function in art, and her kindness in reviewing the manuscript for this chapter and making helpful suggestions. I have borrowed heavily from her format and presentation. For a more complete experience, I strongly encourage you to complete Dr. Edwards’s drawing course as presented in her wonderful text.

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BIBLIOGRAPHY Constantian MB. Toward refinement in rhinoplasty. Plast Reconstr Surg 74:19-32, 1984. Edwards B. The New Drawing on the Right Side of the Brain. New York: Penguin Putnam, 1999. Franck F. The Zen of Seeing. New York: Alfred A. Knopf, 1973. Levy-Agresti J, Sperry RW. Differential perceptual capacities in major and minor hemispheres. Proc Natl Acad Sci 61:1151, 1968. Levy J. Psychobiological implications of bilateral asymmetry. In Diamond SJ, Beaumont JG, eds. Hemisphere Function in the Human Brain. New York: John Wiley & Sons, 1974. Levy J, Trevarthen C, Sperry RW. Perception of bilateral chimeric figures following hemispheric disconnection. Brain 95:61-78, 1972. Paredes J, Hepburn M. The split-brain and the culture cognition paradox. Curr Anthropol 17:320-322, 1976. Sperry RW. Hemisphere disconnection and unity in conscious awareness. Am Psychol 23:723-733, 1968. Sperry RW. Lateral specialization of cerebral function in the surgically separated hemispheres. In McGuigan FJ, Schoonover RA, eds. The Psychophysiology of Thinking. New York: Academic Press, 1973, pp 209-229. Sperry RW, Dazzaniga MS, Bogen JE. Interhemispheric relationships: the neocortical, commissures: syndromes of hemisphere disconnection. In Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology. Amsterdam: North-Holland Publishing, 1969, pp 273-289.

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You can prove anything with statistics, even a fact. J.A. ETHERIDGE Journal of The American Medical Association, 1891, criticizing a study advocating laparotomy for gunshot wounds

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T he Importance of the Airway Component to Cosmetic Rhinoplasty In many ways, this is the most important chapter in this book. Patients should almost always breathe better after rhinoplasty, whether primary or secondary; at the very least, they should never breathe worse. Because form and function are inseparable in the nose, as they are in the hands, surgeons must understand how changes in nasal appearance can affect airflow so that surgery maximizes both. Trauma, allergies, and (in particular) certain anatomic variants can create airway obstruction or predispose a patient to an unfavorable result following even the most conservative rhinoplasty. A patient who has been well counseled before surgery understands that nasal appearance may not always be improved, but the patient may not understand why an obstructed airway has not been corrected—and particularly may not forgive a surgeon who creates airway obstruction where none was present beforehand. This is easy to understand: patients only look in a mirror occasionally, but they breathe all day and all night. Airway obstruction interferes with speech, eating, exercise, and sleep, and worsens the symptoms of many preexisting allergic and sinus conditions. Because airway problems may be chronic or even lifelong, or because the airway diminishes slowly following a previous rhinoplasty (as sidewall edema resolves), many patients do not recognize the severity of their preoperative obstructions. Half of total airway resistance occurs in the nose, and half of all nasal resistance occurs at the internal valve. An initially cosmetic operation that improves function becomes value added to the cosmetic correction. The converse is worse, though: patients whose initial concern was purely cosmetic frequently place restoration of a normal airway above all else at the secondary operation.

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NASAL PHYSIOLOGY AS IT RELATES TO RHINOPLASTY There are a few precepts about nasal physiology that rhinoplasty surgeons should keep in mind while taking histories, examining patients, and performing surgery.

Nasal Air Conditioning The internal nose conditions inspired air (filtering and controlling temperature and humidity), shapes the airstream, and regulates its volumes and pressures. Temperature and Humidity. As inspired air passes from the nostril rim to the nasopharynx, its ambient temperature rises or drops to approximately body temperature in the space of less than 10 cm and in less than 0.25 seconds. Cold air causes blood to fill the turbinate cavernous sinusoids, allowing a greater transfer of heat to the incoming air. The process is reversed when air warmer than body temperature enters the nose. These remarkable physiologic changes explain why disruptions of mucosal health or airflow, or vascular or other disease states, can become so troublesomely symptomatic. Inspired air also reaches the nasopharynx at a constant relative humidity of 80% to 100%. When the air is cold and dry, large amounts of water (in many cases up to a liter) can be transferred to and lost by the mucous membranes during the course of a day. Submucosal glands replenish the supply to the mucosa unless the turbinates and nasal mucosa are atrophic, in which case dryness and crusting develop. Similarly, when areas of scarring develop on the septal mucosa, a stowage point occurs in mucous blanket transport. Crusting forms, and, if the patient dislodges the crust, bleeding and renewed crusting occur. Dynamics of Flow. Because airway pressures drop during inspiration, air flows out of the sinuses. During expiration, there is a small pressure increase and air flows into the sinuses. Sinus air exchange is minor, except during the act of sniffing. More than 50% of total respiratory resistance occurs in the nose, but only 20% of airway resistance occurs during mouth breathing. It should not be surprising that an increase in PCO2 has been measured by some investigators in individuals who chronically breathe orally because of nasal obstruction.

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Airstream and the Airway

Inspired air arcs in a parabolic curve as it passes through the nasal vault, entering the nose vertically, turning 80 to 90 degrees posteriorly, and then impacting the nasopharyngeal wall. Impact points within the nose and at the nasopharyngeal wall facilitate removal of particulate matter. This impingement is one of four primary mechanisms by which nasal filtration occurs. The others are entrapment by vibrissae, attraction of negatively charged air particles to the positively charged mucous blanket, and movement of the mucociliary blanket itself. The same flow pattern occurs during expiration, but the impact points at the internal valves and any septal obstructions cause eddying. Because of the differences in width between the airstream and the lateral nasal wall surface, there is ample room for contact of inspired air with the mucosa. Air speed approaching the internal valves varies from approximately 3 to 18 m per second (or approximately 12 to 65 km per hour), whereas the speed slows by approximately two thirds behind the internal valves before the inspired air reaches the bronchi. Flow is essentially laminar at lower speeds but becomes turbulent as flow increases. A related fact is that pulmonary resistance increases and compliance decreases as nasal obstruction increases; these changes are observed during both oral and nasal breathing. However, in most patients abnormal preoperative pulmonary resistance values return to normal 6 months after successful nasal surgery. At the level of the internal valves, the cross-sectional nasal airway varies markedly and has been measured in ranges as wide as 10 to 65 mm2. Differences among patients depend on nasal contour, race, and history of previous surgery. Inspired air reaches body temperature and 80% to 100% humidity by the time it reaches the nasal pharynx, a physiologic miracle that is aided by the countercurrent flow of air and blood. Nasal blood flow runs posterior to anterior (recall the posterior position of the major supplying vasculature), whereas the flow of air is just the opposite, facilitating temperature and humidity adjustments. In contrast, the nasal mucous membrane surface is cooler than body temperature, so there is a

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regenerative exchange of heat and moisture during exhalation. The cooler the inspired air, the more condensation of water occurs on the nasal mucosa, which explains the wet noses that everyone has experienced in cold weather.

Traditional Airway Diagnosis To extend the original intent of the phrase attributed to neoclassical sculptor Horatio Greenough, “form follows function” in the nose as it does in architecture, art, or in the hand. A poorly shaped nose almost never has an optimal airway, and vice versa. An excellent cosmetic result is never complete without an excellent airway. Even more important, surgeons should not inadvertently worsen the airway during rhinoplasty—but it is so easy to do so that some surgeons routinely expect it; at the very least, they are not surprised. I have heard surgeons advise their patients that a suboptimal airway is the price for a prettier nose. This poor bargain need never be made, but it is important to understand why the idea developed and became established. Only 30 years ago, just two principles guided the surgical treatment of airway obstruction: 1. A deviated septum may obstruct one or both nasal airways. 2. Compensatory hypertrophy of the contralateral inferior turbinate subsequently occurs so that both airways eventually become obstructed. Treatment was therefore logical and obvious: septal resection or septoplasty and some degree of inferior turbinectomy. Although many patients with obstructed nasal airways had improvement after such treatment, not all did. Adding to the frustration of patients and surgeons were three other common observations: 1. There was often poor correlation between a patient’s symptoms and the apparent site of clinical septal or turbinate obstruction. 2. Patients frequently breathed better (preoperatively and even postoperatively) on the narrower side (that is, ipsilateral to the septal deviation). 3. Many patients who had undergone previous successful septoplasty and turbinectomy (or those who had straight, unoperated nasal septa and normal turbinates) still complained of airway obstruction. Although these were frequent observations, most clinicians dismissed them as signs of inadequate septoplasty or turbinectomy (therefore indicating more aggressive repetitions of those procedures), allergies, or other nonsurgical conditions. Some textbooks explained the inconsistent correlation of symptoms with septal deviation as proof that patients were just not very good historians.

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Because surgeons considered the septum and turbinates to be the only sources of operable nasal obstruction, treatment was persistent even when it was repeatedly unsuccessful. One of my patients had undergone septoplasty and turbinectomy (twice each) for unrelieved nasal airway obstruction. When he told his next surgeon that his worst symptoms were at night, a diagnosis of sleep apnea (which the patient did not have) generated tonsillectomy, adenoidectomy, uvulectomy, and pharyngoplasty in several subsequent operations, each without success. Finally, when the surgeon proposed tracheostomy as the only possible remaining cure, the patient refused. Later, in my offi , he said, “Now I’m not a doctor, but when I pull my cheeks out I breathe fine. . . .”

Functional Anatomy: The Importance of Wall Movement The apparently inconsistent observations noted previously are more understandable if surgeons remember that nasal airway size is the product of at least four factors: (1) mucosal sensitivity to the environment, (2) inferior turbinate hypertrophy, (3) septal deviation, and (4) the position and rigidity of the mobile lateral nasal wall during the dynamic process of ventilation. It turns out that the last factor may well be the most important in many patients. Thus any congenital or acquired weakness or instability of the upper or lower lateral cartilages or their investing soft tissues (composing the internal and external nasal valves, respectively), along with septal and inferior turbinate size and position, become factors that profoundly influence the ability to draw adequate volumes of air through the nose.

Component Parts The internal nasal valve is formed by the articulation of the caudal and anterior (or dorsal) edges of the upper lateral cartilages with the anterior septal edge, from which they are embryologically derived. The external nasal valve is composed of the cutaneous and skeletal support of the mobile alar wall (the alar cartilage lateral crura with their associated external and vestibular skin coverings). The watershed area between the valves is at the transverse portion of the alar crease and the articulation of the caudal edge of the upper lateral cartilages with the alar cartilage lateral crura, an area named the limen nasi in rhinologic literature.

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Therefore:  Dorsal height and width determine internal valvular competence and stability.  Alar cartilage substance and position determine external valvular competence and stability.

Observe nasal sidewall movement in these preoperative and postoperative patient pairs (as well as those on pp. 140-141). When incompetence exists at one or both pairs of valves, the airway will be poor even if the septum and turbinates are normal or removed.

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Inspired air flows through an unobstructed nose at speeds of 12 to 65 km per hour. This latter speed is a gale force wind. Because of the Venturi effect, air passes through an obstructed nose at even higher speeds. Unstable sidewalls collapse under the associated transmural pressure. Surgeons making these observations for the first time are often surprised at the degree of sidewall movement during inspiration and the frequency with which subtotal or total collapse occurs. A routine part of the preoperative examination must therefore include observation of the patient during quiet and forced inspiration, looking for areas of collapse, degrees of asymmetry in sidewall movement, and the degree of transmural pressure needed (that is, how hard the patient must inspire) to collapse the sidewall. This last indirectly reflects the strength of the opposing force needed to correct valvular function. Observing nasal sidewall movement during a rhinoplasty consultation is no less important than observing finger movement during a hand examination.

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As the internal valves collapse, flow becomes obstructed. The degree of internal valvular competence in primary patients depends on both cartilaginous strength (rigidity) and skin thickness. Stiffer cartilages, or thicker, stiffer investing soft tissues provide more support than thinner cartilages and skin, but both are interrelated, because heavier skin requires more structural support. Nasal bone length, which affects the length of the attached upper lateral cartilages (and therefore the relative proportion of the mobile lateral wall) directly influences sidewall stability. Most patients with short nasal bones have incompetent internal valves, like those pictured above.

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Similarly, cartilaginous and investing soft tissue characteristics determine external valvular support, as does lateral crural orientation. Cephalically rotated lateral crura are poorly positioned to support the external valves. Although valvular incompetence can occur with any alar cartilage anatomy, most patients with cephalically rotated (malpositioned) lateral crura have external valvular incompetence. Unrecognized but reduced during primary rhinoplasty, malpositioned crura become even less able to stabilize the external valves, which explains why this anatomic variant is so common (approaching 80%) in secondary rhinoplasty patients.

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In this tertiary rhinoplasty patient, the entire sidewall caudal to the bony arch collapses with inspiration. Notice the grooves in the alar walls, which suggests that the alar cartilage lateral crura were cephalically rotated (or malpositioned) before the primary operation. The patient unconsciously flares her nostrils to support her airway. The septum lies to the left of the midline (note the position of its light reflection in relation to the midline of the upper lip); the right side can collapse more than the left because of a higher septal deviation toward the left.

A

B

C

D

Many patients with valvular obstruction reflexively (B) or constantly (C) flare their nostrils, flexing the muscular ring to stabilize a weak or flaccid sidewall. Spreader and alar wall grafts eliminate that need so that the unconscious flare disappears spontaneously as soon as the airway stabilizes (D).

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B

C

D

These primary patients’ septa deviate toward one side along their dorsal edges and caudally (deforming each membranous septum); yet the contralateral side collapses with inspiration (B and D). Thus the airway opposite each septal deviation is characteristically more symptomatic, a complaint that is hard to explain without considering sidewall movement. Of our patients with lateralized obstructions, half were more symptomatic on the side opposite the septal deviation.

Inconsistency in the Literature Previous efforts to correlate nasal airflow with clinical symptoms have yielded equivocal conclusions. There is argument on both clinical and rhinomanometric grounds that septoplasty either does or does not measurably improve nasal airflow. Because septal deviation is so commonly and easily diagnosed, one would expect to find more unanimity in clinical series. These observations are further clouded by the fact that some 80% of nasal septa in the population at large are deviated, and also by imprecision in defining and distinguishing incompetence in the internal or external valves, grouping the two together as a single valve. Nevertheless, mounting clinical evidence indicates that obstruction at either set of valves may profoundly obstruct the airway, even in the absence of septal deviation, and further, that patients with septal deviation and valvular obstruction have far more symptoms than those with septal deviation alone.

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Adding to the confusion about septal and valvular diagnosis is the absence of consensus about whether rhinoplasty itself (without septoplasty) impairs airflow, which is surprising in view of the number of patients who have postoperative airway obstruction. In fact, the second most common cause of malpractice litigation after rhinoplasty is unrelieved or new nasal airway obstruction (Gorney M., personal communication, 2000). Osteotomy (narrowing the upper nose), the intercartilaginous incisions (allegedly creating scar contracture as it heals), the transfixing incision (decreasing tip support), and inadequate turbinectomy have all been indicted with obstructing airflow, although many patients in whom none of these procedures have been performed (such as following an open rhinoplasty) are still obstructed postoperatively. However, one of the few common threads uniting almost all rhinoplasty patients is dorsal and tip reduction, which, as we shall see, can easily create valvular incompetence where none existed preoperatively.

AIRWAY STUDY To resolve some of the conflicting clinical observations and provide quantitative measurements of the nasal airflow increase that functional septal or valvular surgery provides, in 1991 we began studying consecutive rhinoplasty patients in whom airway surgery was being performed. Patients with septal perforation, atopic patients, and patients who required turbinectomy were excluded. A diagnosis of septal obstruction or valvular incompetence was made by observing the size and shape of the airway and any nasal sidewall movement, with and without a nasal speculum, during quiet and forced inspiration (see Chapter 8). When a flaccid or collapsible valve was supported during inspiration with a cotton-tipped applicator, patients could usually appreciate an immediate improvement in nasal airflow, which thereby directed appropriate operative treatment. Septoplasty and valvular reconstruction using cartilage or bone grafts were performed accordingly. Anterior active mask rhinomanometry was performed with a Storz rhinomanometer based on the method described by Mertz, McCaffrey, and Kern.

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Protocol The study created some of its own logistic problems. Because we were evaluating patients who had varying degrees of obstruction, some patients had much smaller airways than others, and some tertiary patients had negligible airflow from significant valvular incompetence or vestibular atresia. Each patient thus served as his or her own control.

During anterior mask rhinomanometry, a transducer in one occluded nostril measured pharyngeal pressure, while active inspiration through the mask allowed flow measurements. All airways were decongested with 1% phenylephrine hydrochloride to minimize the effects of mucosal congestion and nasal cycling. Although previously published rhinomanometric studies had compared pretreatment and posttreatment resistances, our patient cohort did not permit such data. Many preoperative patients had so little airflow that resistance calculations were impossible, and many postoperative patients had such low airway pressures that resistance calculations were likewise impossible for them. Simple averages or arithmetic means of the two airways would not yield representative results, because many preoperative patients had airways with very different flow measurements, allowing extremely high or low flows to skew the results. We therefore calculated geometric mean nasal airflow—the square root of the product of the flow through each airway (in milliliters) during a standard 14second test period. ᝽ left ⫻ V ᝽ right Geometric mean fl w ⫽ 兹V

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Relative Treatment Success Rates of Septal and Nasal Valvular Reconstruction in Primary and Secondary Rhinoplasty Population Studied  600 consecutive patients were treated for airway obstruction.  156 patients were followed more than 1 year. Female 78% Male 22% Primary rhinoplasty 36% Secondary rhinoplasty 64% Median follow-up 14.3 months Mean follow-up 27 months (range 12-108)  94% of secondary patients had undergone a previous septoplasty but still had an obstructed airway.  All reconstructions were endonasal and autogenous; no turbinectomies were performed.  In 45% of 219 patients with lateralized obstructions, the septal deviation was contralateral to the more symptomatic side.

Following examination, patients were divided into seven categories based on the clinical site of airway obstruction: 1. Septum alone 2. Septum and internal valves 3. Septum and external valves 4. Septum, internal valves, and external valves 5. Internal valves alone, without septal obstruction 6. External valves alone, without septal obstruction 7. Internal and external valvular obstruction, without septal obstruction

Results and Conclusions Preoperative

Postoperative

Geometric Mean Airflow (ml/14 sec)

800 700

Airway Improvement Following Septal and Valvular Surgery

600 500 400 300 200 100 0 Internal (all)

Internal (dorsal graft)

Internal (spreader grafts)

Septum/ internal

External only

Septum/ external

Internal plus Septum/ external internal plus external

Septum only

Site of Preoperative Obstruction

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Effectiveness of Septal and/or Valvular Airway Reconstruction in Primary and Secondary Rhinoplasty Improvement Over Preoperative Values Site of Obstruction

Primary Patients

Secondary Patients

Septum/internal/external valves Internal/external valves

4.5 4.5

3.8 2.5

Septum/internal valves Internal valves (all) Dorsal graft reconstruction Spreader graft reconstruction

3.0 2.2 4.0 2.0

1.8 1.9 2.0 1.8

Septum/external valves External valves

2.7 1.8

3.4 1.9

Septum only

0.8

0.9

Our rhinomanometric data are summarized by the above charts and the following 16 conclusions: 1. For the entire study group, septal and valvular surgery created subjectively normal airways in 95% of patients in one operation, without turbinectomy. 2. Although septoplasty improved airflow on the side ipsilateral to the deviation, there was no significant improvement in geometric mean nasal airflow after septoplasty alone. 3. Internal valvular reconstruction with dorsal or spreader grafts doubled nasal airflow. Thus it is reasonable to speculate that a rhinoplasty that creates a new internal valvular obstruction may decrease airflow by 50%. 4. Spreader grafts and dorsal grafts were equally effective in supporting the internal nasal valves. Thus secondary patients whose saddle noses are corrected with dorsal grafts do not also need spreader grafts, which is fortunate, because many secondary patients have already had their donor sites depleted (see Chapter 17). 5. External valvular reconstruction (using cartilage or bone grafts spanning the area of collapse) doubled mean nasal airflow in most patients. Thus it is reasonable to speculate that a rhinoplasty that creates new external valvular incompetence may decrease airflow by 50%. 6. The largest postoperative improvement was in patients for whom both internal and external valvular incompetence was corrected (with or without septoplasty); most of these patients increased geometric mean nasal airflow by three to four or more times over preoperative values. Thus it is reasonable to speculate that a rhinoplasty that creates new incompetence of all four valves can decrease the airway by as much as 75%.

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Site of Airway Obstruction in 600 Consecutive Rhinoplasty Patients Primary Patients (n ⴝ 175) 43% 35% 22%

 Septum ⫹ valves  Valves alone  Septum alone

Secondary Patients (n ⴝ 200) 69% 22% 9%

 Valves alone  Septum ⫹ valves  Septum alone

7. Valvular obstruction was four times more common than pure septal obstruction in primary rhinoplasty patients, and 12 times more common than pure septal obstruction in secondary rhinoplasty patients. Most primary surgeons perform adequate septoplasties, but traditional rhinoplasty itself can impair the airway by creating new valvular obstructions. 8. Interestingly, septoplasty plus valvular reconstruction did not significantly improve nasal airflow over the results obtained by valvular reconstruction alone at the internal and/or external valves, even in patients observed more than 100 months postoperatively. This conclusion (in addition to conclusion number 2) suggests that valvular competence may be more critical to patent airways than septal deviation. 9. These results were produced without performing inferior turbinectomy in any patients. Consequently, I reserve turbinectomy for patients in whom turbinate hypertrophy is primary (such as atopic patients) and not secondary to septal or valvular airway obstruction. In the latter group, secondary turbinate hypertrophy mostly reflects increased bone, not mucosa, and therefore can almost always be treated adequately by crushing and outfracture, as long as any primary septal or valvular pathologic condition has been simultaneously corrected. 10. In patients with lateralized symptoms, the septum was deviated toward the more symptomatically obstructed side in only 55% of cases: Presumably symptoms in the remaining patients were therefore primarily valvular, because turbinectomy was not indicated. 11. Among the secondary rhinoplasty patients, 94% had previously undergone adequate septoplasty and turbinectomy but were still symptomatically obstructed. Valvular reconstruction alone (without turbinectomy) corrected the airway in 97% of the patients in this group after one operative procedure. An optimal airway cannot exist in the presence of valvular incompetence. 12. When primary and secondary rhinoplasty results were stratified, the improvement in primary patients equaled or exceeded the improvement obtained in secondary rhinoplasty patients in five of the seven obstructed site categories examined, providing further evidence that no patient should breathe worse after rhinoplasty.

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Change in Nasal Sidewall Stiffness After Correction of Airway Obstruction Maximal flow (Postoperative decrease indicates a stiffer sidewall) Normal flow Primary Patients

Secondary Patients

Preoperative Postoperative Preoperative Postoperative

Septum/internal/external valves Internal/external valves

4.0 7.4

1.2 2.1

4.2 4.0

2.5 3.1

Septum/internal valves Internal valves (all) Dorsal graft reconstruction Spreader graft reconstruction

5.3

4.0

4.8

3.5

3.8 3.6

3.4 2.5

4.5 2.0

3.4 3.2*

Septum/external valves External valves

5.9 7.6

3.8 5.8

6.8 2.6

2.9 3.2†

Septum only

1.7

3.3*

2.6

8.1*

*Less stiff postoperatively. †p ⬎ 0.05, NS.

13. Airflow volume during forced inspiration divided by airflow volume during quiet inspiration (maximal flow ⫼ normal flow) served as an indirect assessment of sidewall stiffness. Sidewall stiffness could be quantified and shown to increase following valvular reconstruction with spreader grafts, dorsal grafts, or external valvular grafts. 14. In the entire patient group, the greatest improvement was observed in patients followed for more than 12 months, supporting the idea that the airway continues to enlarge as edema resolves. 15. Two patterns of postoperative improvement emerged from this study. In approximately 20% of patients, postoperative airflow measurements substantially exceeded preoperative measurements and continued to improve. In the remaining 80%, however, an initial improvement at 2 weeks was followed by a rhinomanometric decrease that lasted until approximately 8 weeks postoperatively, presumably reflecting rebound edema, after which measurements steadily improved during the measurement period. Interestingly, patients in the latter group almost always reported subjective improvements even during the 4- to 6-week period when their measurements indicated otherwise. 16. A postrhinoplasty decrease in nasal airflow is not inevitable, even in patients with preoperative airway obstruction.

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EFFECT OF SURGERY ON THE NASAL AIRWAY

PATIENT STUDY ONE A

B

C

D

At rest

On inspiration

Consider what happened to the airway of this tertiary rhinoplasty patient. Her dorsum was resected, opening the cartilaginous roof and creating internal valvular incompetence. Her lateral crura were resected, creating external valvular incompetence. Her alar creases reflect the footprints of a previous alar cartilage malposition, an anatomic variant that predisposes patients to external valvular incompetence. Because we know that airflow rates frequently quadruple after reconstruction in patients with preoperative internal and external valvular incompetence, it is reasonable to speculate the reverse: that creating new incompetence at both sets of valves can decrease the airflow by 75%. Secondary patients who indicate that they breathe worse than they did preoperatively are not exaggerating. Because this patient had obstruction despite a previous septoplasty, instability of her lateral nasal wall during inspiration permitted the sidewalls to collapse. At rest, note that her nasal bones compose less than 25% of the lateral nasal wall length (C). Immediately below the caudal edge of the bony arch, the sidewalls become concave. On inspiration, the sidewalls collapse, even though the patient unconsciously flares her nostrils in an effort to keep her airway open (D). The combination of a narrow middle vault and flared nostrils is extremely common among secondary rhinoplasty patients.

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SUMMARY OF THE SURGICAL PLAN 1. Harvesting of rib cartilage (no septum remaining) 2. Harvesting of skin/conchal cartilage composite grafts; repair of ear with a full-thickness graft A

B

C

3. Augmentation of the maxilla with rib cartilage 4. Bony vault rasped so the graft will adhere

D

5. Dorsal graft using rib cartilage; note profile change after the dorsal graft: the supratip has flattened

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E

6. Composite grafts to the alar rims (coronally oriented, through vestibular skin incisions)

F

G

H

I

7. Multiple rib cartilage tip grafts; blue card (G) and silhouettes (H and I) show the supratip skin redraping and a change in tip projection and balance that dorsal and tip grafting create (the nose is less bottom heavy)

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Postoperative Analysis

Three years after reconstruction with a rib cartilage dorsal graft (which supports the internal valves), composite conchal cartilage grafts (which brace the external valves and correct alar rim retraction), and tip grafts, the sidewalls have become smooth, and the upper, middle, and lower cartilaginous vaults are now confluent. The dorsal graft has widened and stabilized the middle vault. The dorsum is now straight, ending in a tip that projects beyond the septal angle. The upper lip is no longer retrusive. The sidewalls no longer collapse during inspiration. Airflow characteristically triples or quadruples after such reconstructions, even when septoplasty has not been performed concomitantly.

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Complete collapse does not occur in all patients because of the physical characteristics of a tube with a flow-limiting segment that resists collapse, thanks to alar muscle tone. The muscular ring can alter the patency and resilience of the airway at the external valve. As the external valve dilates, the transmural pressure becomes increasingly negative; when this occurs, the internal valve acts as a Starling resistor, and airflow increases. When patients with valve incompetence flare their nostrils, they are doing it to keep their airways open; the same is true of patients who have learned to pull their cheeks out. Conversely, as noted by Bridger, patients with facial paralysis cannot easily avoid airway collapse.

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1 month postoperatively

3 years postoperatively

The nose narrows as edema resolves, but general contours and valvular stability remain. The sidewalls have become confluent instead of unstable and concave. Even in the early postoperative period, the composite grafts have normalized the alar wall topography and reduced rim notching.

The middle and lower thirds of the patient’s nose are wider, but the aesthetics are more normal. Maxillary augmentation has brought the upper lip to a more normal, vertical position; this view is the one most often benefited by restoring proper upper lip carriage.

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IMPLICATIONS OF OUR STUDY FOR CLINICAL PRACTICE Current rhinomanometric data support the concept that lateral nasal wall movement caudal to the bony arch (which contains both the internal and external valves) constitutes a cause of airway obstruction that has a greater impact than septal deviation in many rhinoplasty patients. If we visualize the airway as a structure in which the septal partition forms one side and the mobile lateral nasal wall forms the other, and in which the turbinates and mucosa function as additional dynamic structures, the inconsistencies of our traditional clinical observations become easier to explain. Because air can flow through the normal nose at speeds approaching gale force winds, the size of any airway depends not only on the position and configuration of the septum and turbinates, but also on the stability and competence of the nasal valves under the significant transmural pressures that occur during normal breathing. The observation that patients often breathe worse on the side contralateral to the septal obstruction (46% of our patients with lateralized obstructions) can therefore be explained by valvular stability. In patients with septal deviation and valvular incompetence, the side with the greater airflow and the greater transmural pressure (that is, the side contralateral to the septal deviation) will collapse first and therefore become more symptomatic. This is the information that models in the earlier literature missed. Our study did not separately address the question of where turbinates fit in the hierarchy of nasal obstructions. In atopic individuals with gross turbinate hypertrophy or polyps, turbinectomy is unquestionably valuable. However, these patients constitute a small minority of all patients who undergo primary or secondary rhinoplasty. The important fact is that the mean nasal airflow improvements discussed earlier were achieved without turbinectomy, even in a population of patients that included those with secondary deformities, valvular incompetence, previous intranasal scars, or vestibular atresia. The turbinate obstruction seen in many patients with poor airways is therefore reactive or secondary, and turbinectomy is not always necessary if septal and valvular factors have been addressed properly. There is also mounting evidence from published studies that turbinectomy in addition to septoplasty does not yield results superior to those achieved by septoplasty alone in many patients. I now perform partial inferior turbinectomy only in atopic patients whose turbinates nearly abut the septum, and in those patients the resection is conservative (usually less than 20%). I do not perform subtotal or total turbinectomy. In many patients, reactive turbinate enlargement can be adequately treated by crushing the cystic bone (which is the part that enlarges in turbinate hypertrophy, not the mucosa, as noted by Berger et al) and outfracturing the affected turbinates toward the lateral wall.

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Resection of nasal lining, alar cartilage malposition, excessive alar wedge resection, inadequate or excessive nasal shortening, and aggressive osteotomy may also obstruct the airway and are considered separately in other chapters.

A pplied Anatomy: Fundamentals of Airway Correction in Practice SEPTUM

Septal cartilage

Ethmoid

Vomer

After Guyuron, Uzzo, Scull, 1999.

The septal partition is almost never perfectly straight, and modest septal deviations should be considered virtually normal; the surgeon should be wary of attributing airway obstruction solely to them. Most nasal septa have undulations in the sagittal plane. More significant coronal or axial deviations occur congenitally or following trauma, which is important because traumatic injuries can produce cartilaginous fractures or separations between the septum and the perpendicular plate of the ethmoid (often at the keystone area) that create instability and complicate septoplasty. However, because normal airflow passes anteroposteriorly just above and below the level of the middle turbinate (see p. 136), septoplasty for correcting the airway alone does not need to proceed all the way to the dorsal edge; at least 15 to 20 mm can be left undissected—a safe practice that avoids destabilizing old fractures. Even surgeons who perform septoplasty in connection with an open rhinoplasty are advised to dissect from a Killian incision 10 to 15 mm proximal to the caudal septal edge, progressing posteriorly but leaving 15 to 20 mm of mucoperichondrium undisturbed along the dorsal strut. I have seen two excellent surgeons create three separate septal collapses during live, videotaped surgeries by starting their dissections at the dorsal edge and entering unexpected old fracture lines. The technical details of performing septoplasty are provided in Chapter 11.

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INTERNAL NASAL VALVES

The stability of the internal valves depends partly on their dimensions and partly on the characteristics of the cartilage itself. When the nasal bones are short, a greater proportion of the sidewall is cartilaginous and therefore more likely to collapse during inspiration. In most patients, short nasal bones are accompanied by a middle third that is concave and unstable during inspiration.

A 2 mm dorsal resection will open the cartilaginous roof: notice that even the thin wafer trimmed from this patient’s dorsum contains the dorsal edges of the septum and each upper lateral cartilage. The roof is now open. Even if the middle vault were stable preoperatively, I have created an intraoperative incompetence—a disequilibrium—by dorsal resection. Consequently, I place spreader grafts routinely every time I open the cartilaginous roof, unless a substantial dorsal graft is independently indicated.

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PATIENT STUDY TWO

Even with nasal bones of normal length, however, the middle vault can be narrow, which places patients at special risk for preoperative incompetence, and particularly for postoperative incompetence after the cartilaginous roof has been resected. Notice also the cephalic position of the preoperative lateral crura—another anatomic variant, in addition to the narrow middle vault, that leads to, almost guarantees, increased airway obstruction after a rhinoplasty that does not take this critical anatomy into account. Notice that her long nose has lengthened following skeletal reduction, that alar hollows have appeared, and that her inadequate tip projection has increased; combined with the low dorsum, a supratip deformity has been created.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization over upper cartilaginous vault; narrow over bony vault 2. Trim anterior septal edge 3. Transfixing incision with 3 mm shortening of caudal septum and overlying mucosa 4. 3 mm submucosal resection of the caudal ends, upper lateral cartilages 5. Septoplasty 6. Spreader grafts 7. Septal cartilage dorsal graft, thicker at the radix, tapering into the supratip 8. Alar wall grafts 9. Multiple tip grafts of septal cartilage

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Postoperative Analysis

One-year postoperative views confirm the correction obtained by internal (with a spreader graft) and external (with alar wall grafts) valvular reconstruction, and the salutary effect of dorsal and tip grafts on the patient’s supratip deformity. Notice that spreader, dorsal, and tip grafts have made the upper and middle vaults confluent and have ablated the inverted-V deformity signalling middle vault collapse. The alar wall hollows have disappeared; and the dorsal/tip graft combination has created a more balanced nasal contour with a straight dorsum and adequate projection. With adequate skeletal support, noses that are long preoperatively will maintain their corrected, shortened position.

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The alar walls are supported and normally convex; the base remains unscarred.

Only augmentation can alter the primary imbalance contained in the preoperative nose: a radix that began too low and a tip that hung from the septal angle. Because postoperative skeletal support is greater, this nose, which was long preoperatively, should maintain its shorter posture postoperatively.

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DORSAL GRAFTING AND INTERNAL VALVE COMPETENCE

PATIENT STUDY THREE A

B

C

The only difference between A and C is the placement of an ear cartilage dorsal graft (B). The graft lifts the dorsal skin and transmits traction to the lateral nasal skin, which pulls the attached upper lateral cartilages outward. The graft reverses the events that occurred when this patient’s dorsum was lowered during his primary surgery. Notice also the associated global interactions that occur—the nose lengthens, the bony vault seems narrower, and the middle vault widens—refutations of the false assumption that says each nasal region is independent.

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Postoperative Analysis

As the dorsum rises, the nose lengthens, the apparent nasal base size diminishes, the apparent nasal width decreases, and supratip convexity disappears. The only procedure performed in this patient was the insertion of a dorsal graft. Mean nasal airflow typically doubles in such patients even if no septoplasty is performed.

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Postoperative photographs show the results 2 years after surgery. The final two images are masks made by the patient to show his aesthetic goals; these reveal that he intuitively understands tip projection.

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EXTERNAL VALVES

Internal valve

External valve

Even with orthotopic lateral crura that run along an axis connecting the nasal tip to the lateral canthus, a surgeon can create external valvular incompetence if the cartilages are suffici tly soft or the resection is large enough.

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A



THE ANATOMY OF FUNCTION AND HOW RHINOPLASTY AFFECTS THE AIRWAY

B

E

C

F

D

G

However, cephalic rotation of the alar cartilage lateral crura (along an axis running toward the medial canthus), an extremely common clinical finding (occuring in approximately 50% of the population), places the crura at relatively greater distances from the external valves (see Chapter 5). Collapse of the unsupported external and vestibular skin along the rim during inspiration is common, even in patients with strong alar cartilages. Bracing a soft, skeletally insuffici t alar wall is corrective (G). A point that escaped me for many years is that most boxy and ball tips also have malpositioned lateral crura (100% and 95% occurrences, respectively, in a 200patient series from 2005) (see Chapter 15).

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PATIENT STUDY FOUR A

B

C

D

These images demonstrate how to stabilize the alar wall. External valvular incompetence is obvious; unfortunately, the septum produced only ethmoid suitable for rim support (the remaining cartilage was used for spreader and tip grafts). Note in D that the left wall has already been grafted—the contour difference is noticeable.

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A



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B

C

D

E

F

G

A vestibular incision was made approximately 3 mm above the rim, at the point of collapse (A). The rim was filleted (B and C), the alar wall graft was sized and placed (D and E), and the incision was closed (F). Note the alar wall change in G compared with D.

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Postoperative Analysis A

B

C

D

Photographs taken 1 year postoperatively demonstrate normal alar wall support, even though the small, malpositioned lateral crura remain. Asymmetrical spreader grafts have opened and aligned the middle vault. Inspiratory collapse no longer occurs (C and D).

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PATIENT STUDY FIVE

In secondary patients, malpositioned lateral crura can be treated in any of several equally effective ways, depending on the degree of the deformity and assuming that the external valves are competent: (1) ignore the lateral crura and splint the area of collapse; (2) rotate the lateral crura closer to the rims; or (3) resect and flatten the deformed lateral crura and replace them with free grafts. The latter was done in this woman. The patient recognized that her nose was too narrow, and her airway obstruction was profound. Notice the stigmata of the collapsed middle vault and vestiges of malpositioned lateral crura.

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The malpositioned lateral crural remnants were dissected free using vestibular incisions, resected at the lateral genua, and replaced, paralleling the alar rims. Notice the immediate change in rim contour. Septoplasty yielded excellent building materials.

A

B

C

D

Spreader grafts (A) were placed in tight submucosal tunnels prepared along the anterior septal edge, maintaining adhesions at the edge to prevent dorsal displacement. A dorsal graft (B) created a new roof and elevated the dorsal depression. After the addition of two crushed tip grafts, the dorsal contour was established (compare C and D).

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Postoperative Analysis

One year after surgery, notice the normal alar topography following lateral crural replacement. The middle vault has widened; the sidewalls have become confluent. The patient has regained her desired preoperative dorsal height, and the nasal base seems smaller because the dorsum is slightly higher. Airflow generally quadruples in such patients, even when concomitant septoplasty is not performed.

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TURBINATES Middle turbinate Superior turbinate

Inferior turbinate

As discussed in detail on pp. 147-150, turbinate obstruction can often be satisfactorily eliminated by crushing and outfracturing toward the lateral nasal wall to reduce the size of the hypertrophic concha. This treatment is supported by histologic evidence in the literature indicating significant bone expansion (averaging a twofold increase in thickness), but only modest mucosal thickening (confined to the lateral side) in turbinates with hypertrophy compensatory to septal deviation (Berger et al). Therefore, significant resection of turbinate mucosa is hard to justify in many patients either anatomically or physiologically. Only if the turbinates are very large or if crushing is ineffective should surgical reduction be considered. In any case, turbinectomy should be conservative; postturbinectomy rhinitis is common in secondary patients and is extremely difficult to treat. Polypoid degeneration of the middle turbinate (concha bullosa) also occurs in significantly atopic patients; in such cases, as in atopic patients with inferior turbinate hypertrophy, excisional reduction to a more normal size is both logical and effective. I use a simple punch biopsy forceps for reducing an inferior turbinate or concha bullosa. It is important to remember that the turbinate shrinks further as the healing wound contracts; therefore the excision should be tempered accordingly.

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Postturbinectomy rhinitis must be distinguished from vasomotor rhinitis, which is attributed to an imbalance between parasympathetic and sympathetic nervous regulators—a kind of reflex dystrophy of the nose that can be almost as troublesome as the parallel syndrome in the extremities. Trauma may trigger vasomotor rhinitis, and there is evidence that it may in fact be an extraesophageal manifestation of gastroesophageal reflex because of the association of both diseases in many patients (70% in one series). Even if a surgeon reduces the inferior turbinates or removes a concha bullosa or intranasal polyps, nasal airway surgery does not routinely include direct sinus surgery. Rizk, Edelstein, and Matarasso demonstrated impressive results when (endoscopic) sinus and septal procedures are performed synchronously as indicated. However, it is both common and gratifying to discover that a patient’s preoperative sinus symptoms have significantly improved after a patent, stable nasal airway has been created following septal and valvular surgery alone. Sinus headaches and the need for sinus medications decrease, and intercurrent sinus infections often disappear. Constant rhinitis preoperatively may improve or clear entirely. Unless sinus surgery is independently justified, I treat the nasal airway obstruction first. In most cases, subsequent sinus surgery has not been necessary. Although the complete explanation for the improvement of sinus symptoms has not yet been adequately explained, there are several reasonable hypotheses for the phenomenon. One hypothesis is that a normal (and, in particular, correctly directed) laminar nasal airstream is created, replacing a turbulent, high-velocity blast that bombards the meatuses and sinuses with the impurities of inspired air (Proetz). A second hypothesis is that patients with allergies simply benefit from an increased airway size: when the airways are small, mucosal congestion provoked by inspired allergens may completely obstruct the airway, whereas the same degree of congestion will not obliterate a much larger airway. Finally, most patients with obstructed airways blow their noses constantly in a futile effort to clear them. Nose blowing forces all the impurities of inspired room air directly toward the middle meatus at speeds too rapid to allow the normal filtering mechanisms to function, which increases inflammation and rhinitis, and therefore perpetuates a positive-feedback loop of nose blowing. Patients must be instructed to blow their noses as little as possible postoperatively, and most individuals discover that it becomes necessary only infrequently.

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Consider these patients with airway obstruction, and notice their two common physical characteristics—narrow middle vaults and alar creases that identify previous cephalic rotation (malposition) of the lateral crura. These anatomic traits often occur together; in a recent review of 100 consecutive patients with airway obstruction, 75% had these characteristics. Each of these patients has an airway that permits only 25% of its preoperative airflow. They all flare their nostrils to keep their airways open. This phenotype is so characteristic and common that I consider it to be the face of secondary rhinoplasty.

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B

C

Notice how the nasal contour in this patient changed following surgery: both the middle and lower thirds have become narrower. Notice how the sidewalls narrow further with inspiration (C).

Added to the dual narrow middle vault and alar cartilage malposition problems in these two patients are short nasal bones, which decrease the length of the immobile sidewall segment. In such patients, 75% to 95% of the sidewall moves with inspiration. Many of these patients are partial or obligate mouth breathers but may be unaware of it.

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PRIMARY PATIENTS WITH NARROW MIDDLE VAULTS AND ALAR CARTILAGE MALPOSITION

All of these primary rhinoplasty candidates have the common characteristics of narrow middle vaults (threatened internal valves) and alar cartilage malposition (threatened external valves). Notice that the anatomic traits do not correspond with thick or thin tissues, although they are easier to observe in the latter. Even a conservative reduction rhinoplasty will create new incompetence at both sites: a 2 mm dorsal resection will open the middle vault roof, and alar reduction will compromise the weakly supportive malpositioned lateral crura. Watch for these patients: they are at special risk of having the same postsurgical problems that you have seen throughout this chapter.

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Conclusion Rhinoplasty can increase nasal airflow by two to four times—or decrease the airway by 75%. The difference depends entirely on the decisions, both diagnostic and technical, that the surgeon makes before the operation begins. There are few nevers in surgery, but it is never necessary for a patient to breathe worse following rhinoplasty, even if the airway was compromised preoperatively.

BIBLIOGRAPHY Adamson JE. Constriction of the internal nasal valve in rhinoplasty: treatment and prevention. Ann Plast Surg 18:114-121, 1987. Adamson P, Smith O, Cole P. The effect of cosmetic rhinoplasty on nasal patency. Laryngoscope 100: 357-359, 1990. Adamson PA. The nasal hinge. Otolaryngol Head Neck Surg 111:219-231, 1994. Adamson PA, McGraw-Wall BL, Strecker HD, et al. Analysis of nasal air flow following repair of vestibular stenosis. J Otolaryngol 27:200-205, 1998. Akcam T, Friedman O, Cook TA. The effect on snoring of structural nasal valve dilation with a butterfly graft. Arch Otolaryngol Head Neck Surg 130:1313-1318, 2004. Aldrich MS. Neurologic aspects of sleep apnea and related respiratory disturbances. Otolaryngol Clin North Am 23:761-769, 1990. Ali-Salaam P, Kashgarian M, Davila J, et al. Anatomy of the Caucasian alar groove. Plast Reconstr Surg 110:261-266; discussion 267-271, 2002. Andre RF, Paun SH, Vuyk HD. Endonasal spreader graft placement as treatment for internal nasal valve insufficie y: no need to divide the upper lateral cartilages from the septum. Arch Facial Plast Surg 6:36-40, 2004. Arbour P, Bilgen E. Understanding aerodynamics in the correction of the narrow nose. Rhinology 24:41-47, 1986. Baker DC, Strauss RB. The physiologic treatment of nasal obstruction. Clin Plast Surg 4:121-130, 1977. Bayiz U, Dursun E, Islam A, et al. Is septoplasty alone adequate for the treatment of chronic rhinosinusitis with septal deviation? Am J Rhinol 19:612-616, 2005. Beekhuis GJ. Nasal obstruction after rhinoplasty: etiology and techniques for correction. Laryngoscope 86:540-548, 1976. Benton CD Jr. Chemical cauterization of the inferior nasal turbinates. Eye Ear Nose Throat Mon 45:9091, 1966. Berger G, Hammel I, Berger R, et al. Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septums. Laryngoscope 110:2100-2105, 2000. Berlin WK. Industrial nasal problems. Rhinology 23:99-100, 1985. Berman WE. Post-operative internal valve stenosis and/or collapse. Ear Nose Throat J 73:786-787, 1994. Berry RB. Nasal resistance before and after rhinoplasty. Br J Plast Surg 34:105-111, 1981. Bridger GP. Physiology of the nasal valve. Arch Otolaryngol 92:543-553, 1970. Bridger GP. Split rib graft for alar collapse. Arch Otolaryngol 107:110-113, 1981. Bridger GP, Proctor DF. Maximum nasal inspiratory flow and nasal resistance. Condensed paper. Proceedings of the Symposium on the Nose and Adjoining Cavities, American Academy of Ophthalmology and Otolaryngology, Washington, DC, 1969, pp 481-488. Broms P. Rhinomanometry. III. Procedures and criteria for distinction between skeletal stenosis and mucosal swelling. Acta Otolaryngol 94:361-370, 1982. Broms P, Ivarsson A, Jonson B. Rhinomanometry. I. Simple equipment. Acta Otolaryngol 93:455-460, 1982.

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Broms P, Jonson B, Lamm CJ. Rhinomanometry. II. A system for numerical description of nasal airway resistance. Acta Otolaryngol 94:157-168, 1982. Broms P, Jonson B, Malm L. Rhinomanometry. IV. A pre- and postoperative evaluation in functional septoplasty. Acta Otolaryngol 93:523-529, 1982. Bruno JR, Papay FA. Dispelling the propagated myth: a quizzical look at the internal valve. Plast Reconstr Surg 116:685-686, 2005. Byrd HS, Meade RA, Gonyon DL. Using the autospreader flap in primary rhinoplasty. Plast Reconstr Surg 119:1897-1910, 2007. Calderon-Cuellar LT, Trujillo-Hernandez B, Vasquez C, et al. Modified mattress suture technique to correct anterior septal deviation. Plast Reconstr Surg 114:1436-1441, 2004. Camirand A, Doucet J, Harris J. Nose surgery: how to prevent a middle vault collapse—a review of 50 patients 3 to 21 years after surgery. Plast Reconstr Surg 114:527-534, 2004. Chand JS, Toriumi DM. Treatment of the external nasal valve. Facial Plast Surg Clin North Am 7:347356, 1999. Clement P, Marien J. The use of a mathematical model in rhinomanometry. Rhinology 18:197-207, 1980. Clement PA. Committee report on standardization of rhinomanometry. Rhinology 22:151-155, 1984. Clement PA, Daele JJ. Some statistical data about anterior rhinomanometry. A comparative study between passive anterior rhinomanometry and active anterior rhinomanometry. Rhinology 18:151154, 1980. Clement PA, Kaufman L, Rousseeuw P. Active anterior rhinomanometry in pre- and postoperative evaluation, use of Broms’ mathematical model. Rhinology 21:121-133, 1983. Clement PA, van Dishoeck A, van de Wal J, et al. Nasal provocation and passive anterior rhinomanometry (PAR). Clin Allergy 11:293-301, 1981. Cole P. Rhinomanometry 1988: practice and trends. Laryngoscope 99:311-315, 1989. Connell JT. An instrument for measuring the effective cross-sectional nasal airway. J Allergy 37:127134, 1966. Connell JT. A novel method to assess antihistamine and decongestant effic y. Ann Allergy 42:278-285, 1979. Constantian MB. The boxy nasal tip, the ball tip, and alar cartilage malposition: variations on a theme— a study in 200 consecutive primary and secondary rhinoplasty patients. Plast Reconstr Surg 116: 268-281, 2005. Constantian MB. Functional effects of alar cartilage malposition. Ann Plast Surg 30:487-499, 1993. Constantian MB. The incompetent external nasal valve: pathophysiology and treatment in primary and secondary rhinoplasty. Plast Reconstr Surg 93:919-931, 1994. Constantian MB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 98:38-54, 1996. Constantinides MS, Adamson PA, Cole P. The long-term effects of open cosmetic septorhinoplasty on nasal air flow. Arch Otolaryngol 122:41-45, 1996. Cottle MH. Concepts of nasal physiology as related to corrective nasal surgery. Arch Otolaryngol 72:2736, 1960. Cottle MH. The structure and function of the nasal vestibule. Arch Otolaryngol 62:173-181, 1955. Courtiss EH, Goldwyn RM. The effects of nasal surgery on airflow. Plast Reconstr Surg 72:9-21, 1983. Deylamipour M, Azarhoshangh A, Karimi H. Reconstruction of the internal nasal valve with a splay conchal graft. Plast Reconstr Surg 116:712-722, 2005. Doty RL, Frye R. Influence of nasal obstruction on smell function. Otolaryngol Clin North Am 22:397411, 1989. Fomon S, Gilbert JG, Caron AL. Collapsed ala: pathology, physiology, and management. Arch Otolaryngol 51:465-484, 1950. Foxen EH, Preston TD, Lack JA. The assessment of nasal air-flow: a review of past and present methods. J Laryngol Otol 85:811-825, 1971. Friedman M, Ibrahim H, Lee G, et al. A simplified technique for airway correction at the nasal valve area. Otolaryngol Head Neck Surg 131:519-524, 2004.

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Godley FA, Nemeroff RF, Josephson JS. Current trends in rhinoplasty and the nasal airway. Med Clin North Am 77:643-656, 1993. Goldman IB. Rhinoplastic sequelae causing nasal obstruction. Arch Otolaryngol 83:93-97, 1966. Goode RL. Diagnosis and treatment of turbinate dysfunction. Otolaryngol Head Neck Surg 101:20-26, 1989. Goode RL. Surgery of the incompetent nasal valve. Laryngoscope 95:546-555, 1985. Gordon AS, McCaffrey TV, Kern EB, et al. Rhinomanometry for preoperative and postoperative assessment of nasal obstruction. Plast Reconstr Surg 101:20-26, 1989. Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope 105:429-431, 1995. Grymer LF, Hilberg O, Elbrond O, et al. Acoustic rhinometry: evaluation of the nasal cavity with septal deviations, before and after septoplasty. Laryngoscope 99:1180-1187, 1989. Grymer LF, Petersen-Gregers C, Pedersen HB. Influence of lateral osteotomies in the dimensions of the nasal cavity. Laryngoscope 109:936-938, 1999. Guilleminault C. Clinical features and evaluation of obstructive sleep apnea, abnormal sleep. In Krieger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders, 1989, pp 552-558. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99:943-952; discussion 953-955, 1997. Gupta A, Brooks D, Stager S, et al. Surgical access to the internal nasal valve. Arch Facial Plast Surg 5:155-158, 2003. Guyuron B, Behmand RA. Caudal nasal deviation. Plast Reconstr Surg 111:2449-2460, 2003. Guyuron B, Michelow BJ, Englebardt C. Upper lateral splay graft. Plast Reconstr Surg 102:2169-2177, 1998. Guyuron B, Uzzo CD, Scull H. A practical classification of septonasal deviation and an effective guide to septal surgery. Plast Reconstr Surg 104:2202-2209, 1999. Hamra ST. Repositioning the lateral alar crus. Plast Reconstr Surg 92:1244-1253, 1993. Hardcastle PF, White A, Prescott RJ. Clinical or rhinometric assessment of the nasal airway—which is better? Clin Otolaryngol 13:381-385, 1988. Hirsch JA, Bishop B. Human breathing patterns on mouthpiece or face mask during air, CO2, or low O2. J Appl Physiol 53:1281-1290, 1982. Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg 109:1128-1146, 2002. Isono S, Remmers JE. Anatomy and physiology of upper airway obstruction. In Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders, 1993, pp 642-655. Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast Reconstr Surg 103:300-312, 1999. Jalowayski AA, Yuh Y, Koziol JA, et al. Surgery for nasal obstruction—evaluation by rhinomanometry. Laryngoscope 93:341-345, 1983. Jeradeh SS, Smith TL, Torrico L, et al. Autonomic nervous system evaluation of patients with vasomotor rhinitis. Laryngoscope 110:1828-1831, 2000. Jessen J, Jacobsson S, Malm L. On rhinomanometry in rhinoplasty. Plast Reconstr Surg 81:506-511, 1988. Joniau S, Wong I, Rajapaksa S, et al. Long-term comparison between submucosal cauterization and powered reduction of the inferior turbinates. Laryngoscope 116:1612-1616, 2006. Juto JE, Lundberg C. Human nasal mucosa reaction during chilling of the feet. Rhinology 23:131-136, 1985. Kemker B, Liu X, Gungor A, et al. Effect of nasal surgery on the nasal cavity as determined by acoustic rhinometry. Otolaryngol Head Neck Surg 121:567-571, 1999. Kern EB. Committee report on standardization of rhinomanometry. Rhinology 19:231-236, 1981. Kern EB. Rhinomanometry. Otolaryngol Clin North Am 6:863-874, 1973.

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Khosh M, Jen A, Honrado C, et al. Nasal valve reconstruction: experience in 53 consecutive patients. Arch Facial Plast Surg 6:167-171, 2004. Kortekangas AE. Problems in the standardization of rhinomanometry. Allergy 35:255, 1980. Kosoy J. Nasal surgery and airway resistance. Laryngoscope 89:1655-1680, 1979. Lavie P, Fischel N, Zomer J, et al. The effects of partial and complete mechanical occlusion of the nasal passages on sleep structure and breathing in sleep. Acta Otolaryngol 95:161-166, 1983. Lee JH, Sherris DA, Moore EJ. Confined open septorhinoplasty and functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 33:436-440, 2005. Lenders H, Pirsig W. Diagnostic value of acoustic rhinometry: patients with allergic and vasomotor rhinitis compared with normal controls. Rhinology 28:5-16, 1990. Leug EA, Irish JC, Roth Y, et al. An objective analysis of the impact of lateral rhinotomy and medial maxillectomy on nasal airway function. Laryngoscope 108:1320-1323, 1998. Lippert BM, Werner JA. Long-term results after laser turbinectomy. Lasers Surg Med 22:126-134, 1998. Lund V. The evolution of surgery on the maxillary sinus for chronic rhinosinusitis. Laryngoscope 112:415-419, 2002. Mackay IS. Measurement of nasal airflow and resistance. J R Soc Med 72:852-855, 1979. Mahler D, Reuven S. The role of turbinectomy in rhinoplasty. Aesthetic Plast Surg 9:277-279, 1985. Mahler D, Tovi F, Zirkin H. Bilateral nasal glandular cysts: an occasional finding in rhinoplasty. Aesthetic Plast Surg 8:119-121, 1984. Malm L. Rhinomanometric assessment for rhinologic surgery. Ear Nose Throat J 71:11-19, 1992. Marcus B, Patel Z, Brusguets J, et al. The utility of concurrent rhinoplasty and sinus surgery. Arch Facial Plast Surg 8:260-262, 2006. Mazzola RF, Felisati G. Rhinoplasty and endoscopic surgery for functional and inflammatory nasal/ sinus disorders. Plast Reconstr Surg 115:705-710, 2005. McCaffrey TV, Kern EB. Clinical evaluation of nasal obstruction. Arch Otolaryngol 105:42-45, 1979. McCaffrey TV, Kern EB. Rhinomanometry. Facial Plast Surg 3:217-223, 1986. McKee GJ, O’Neil G, Roberts C, et al. Nasal airflow after septorhinoplasty. Clin Otolaryngol Allied Sci 19:254-257, 1994. Mertz JS, McCaffrey TV, Kern EB. Objective evaluation of anterior septal surgical reconstruction. Otolaryngol Head Neck Surg 92:308-311, 1984. Meyer RL, Jovanovic B, Derder S. All about nasal valve collapse. Aesthetic Plast Surg 20:141-151, 1996. Miman MC, Keliktas H, Ozturan O, et al. Internal nasal valve: revisited with objective facts. Otolaryngol Head Neck Surg 134:41-47, 2006. Mink PJ. Physiologie der oberen Luftwege. Lipzig, 1920. Cited by Bridger GP. Physiology of the nasal valve. Arch Otolaryngol 92:543, 1970. Mori S, Fujieda S, Yamada T, et al. Long-term effect of submucous turbinectomy in patients with perennial allergic rhinitis. Laryngoscope 112:865-869, 2002. Most SP. Analysis of outcomes after functional rhinoplasty using a disease specific quality-of-life instrument. Arch Facial Plast Surg 8:306-309, 2006. Most SP. Anterior septal reconstruction outcomes after a modified extracorporeal septoplasty technique. Arch Facial Plast Surg 8:202-207, 2006. Mowlavi A, Masouem S, Kalkanis J, et al. Septal cartilage defined: implications for nasal dynamics and rhinoplasty. Plast Reconstr Surg 117:2171-2174, 2006. Nicklasson B, Sunden L. Rhinomanometry and septoplasty. J Laryngol Otol 96:991-995, 1982. Ochi JW, deWard DL. Surgery for bilateral nasal valvular collapse. Rhinology 26:105-110, 1988. Odkvist LM, Edling C, Hellquist H. Influence of vapors on the nasal mucosa among industry workers. Rhinology 23:121-127, 1985. Ogura JH, Nelson JR, Dammkoehler R, et al. Experimental observations of the relationship between upper airway obstruction and pulmonary function. Trans Am Laryngol Assoc 85:40-64, 1964. Olsen KD. The role of nasal surgery in the treatment of obstructive sleep apnea. Operative techniques. Otolaryngol Head Neck Surg 2:63-68, 1991. Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngol Head Neck Surg 89:804-810, 1981.

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Oneal RM. Upper lateral cartilage spreader flaps in rhinoplasty. Aesthetic Surg J 37:370-371, 1998. Ophir D. Resection of obstructing inferior turbinates following rhinoplasty. Plast Reconstr Surg 85:724727, 1990. Paniello RC. Nasal valve suspension: an effective treatment for nasal valve collapse. Arch Otolaryngol Head Neck Surg 122:1342-1346, 1996. Park SS. Treatment of the internal nasal valve. Facial Plast Surg Clin North Am 7:333-345, 1999. Pontell JW, Slavit DH, Kern EB. The role of outfracture in correcting post-rhinoplasty nasal obstruction. Ear Nose Throat J 77:106-112, 1998. Postema CA, Huygen PLM, Lecluse RGM, et al. The lateralization percentage as a measure of nasal flow asymmetry in active anterior rhinomanometry. Clin Otolaryngol Allied Sci 5:165-170, 1980. Proetz AW. Essays on the Applied Physiology of the Nose. St Louis: Annals Publishing, 1941. Quigley LF, Cobb CM, Vargervik K. Nasality ratings and airflow measures during speech. Plast Reconstr Surg 43:292-299, 1969. Reese BR. External rhinoplasty approach to unusual rhinologic procedures. Ear Nose Throat J 70:431437, 1991. Rettinger GP, Erlangen HM. Rotation of the alar cartilage in collapsed ala. Rhinology 19:81-86, 1981. Rhee JS, Book DT, Burzynski M, et al. Quality of life assessment in nasal airway obstruction. Laryngoscope 113:1118-1122, 2003. Rhee JS, Poetker DM, Smith TL, et al. Nasal valve surgery improves disease-specific quality of life. Laryngoscope 115:437-440, 2005. Rhee SC, Kim YK, Cha JH, et al. Septal fracture in simple nasal bone fracture. Plast Reconstr Surg 113:45-52, 2004. Riley RW, Powell NB, Guilleminault C. Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients. Otolaryngol Head Neck Surg 108:117-125, 1993. Rizk SS, Edelstein DR, Matarazzo A. Concurrent functional endoscopic sinus surgery and rhinoplasty. Ann Plast Surg 38:323-329, 1997. Robinson JK, Burget GC. Nasal valve malfunction resulting from resection of cancer. Arch Otolaryngol Head Neck Surg 116:1419-1424, 1990. Rohrich RJ, Hollier LH. Use of spreader grafts in the external approach to rhinoplasty. Clin Plast Surg 23:255-262, 1996. Rohrich RJ, Krueger JK, Adams WP, et al. Rationale for submucous resection of hyertrophied inferior turbinates in rhinoplasty: an evolution. Plast Reconstr Surg 108:536-546, 2001. Rohrich RJ, Raniere J, Ha RY. The alar contour graft: correction and prevention of alar rim deformities in rhinoplasty. Plast Reconstr Surg 109:2495-2508, 2002. Roithmann R, Chapnik J, Zamel N, et al. Acoustic rhinometric assessment of the nasal valve. Am J Rhinol 11:379-385, 1997. Saito A, Nishihata S. Nasal airway resistance in children. Rhinology 19:149-154, 1981. Schlosser RJ, Park SS. Functional nasal surgery. Otolaryngol Clin North Am 32:37-51, 1999. Schonsted-Madsen U, Stoksted P. Long-term results of functional and cosmetic rhinoplastic surgery. Ear Nose Throat J 71:61-69, 1992. Schonsted-Madsen U, Stokstead P, Christensen PH, et al. Chronic headache related to nasal obstruction. J Laryngol Otol 100:165-170, 1986. Seebohm PM, Hamilton WK. A method for measuring nasal resistance without intranasal instrumentation. J Allergy 29:56-59, 1958. Selkin SG. Laser turbinectomy as an adjunct to rhinoplasty. Arch Otolaryngol 111:446-449, 1985. Shapiro SL. Vacuum headache. Eye Ear Nose Throat Mon 49:46-51, 1970. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Clin Plast Surg 23:255-262, 1996. Sheen JH. Spreader graft revisited. Perspect Plast Surg 3:155-163, 1989. Simmen D, Scherrer JL, Moe K, et al. A dynamic and direct visualization model for the study of nasal airflow. Arch Otolaryngol 125:1015-1021, 1999. Sputh CB. The tension nose. Rhinology 23:79-80, 1985.

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Stal S, Hollier L. The use of resorbable spacers for nasal spreader grafts. Plast Reconstr Surg 106:922931, 2000. Stewart MG, Smith TL. Objective versus subjective outcomes assessment in rhinology. Am J Rhinol 19:529-535, 2005. Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg 130:283-290, 2004. Stewart MG, Witsell DL, Smith TL, et al. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130:157-163, 2004. Stoksted PF, Gutierrez C. The nasal passage following rhinoplastic surgery. J Laryngol Otol 97:49-54, 1983. Stucker FJ, Hoasjoe DK. Nasal reconstruction with conchal cartilage. Arch Otolaryngol 120:653-658, 1994. Stucker FJ, Smith TF. The nasal bony dorsum and cartilaginous vault. Arch Otolaryngol 102:695-698, 1976. Sulsenti G, Palma P. A new technique for functional surgery of the nasal valve area. Rhinol Suppl 10:119, 1989. Sulsenti G, Palma P. Tailored nasal surgery for normalization of nasal resistance. Tail Nasal Surg 12:333345, 1996. Teichgraeber JF, Wainwright, DJ. The treatment of nasal valve obstruction. Plast Reconstr Surg 93:11741182, 1994. Teller DC. Anatomy of a rhinoplasty: emphasis on the middle third of the nose. Facial Plast Surg 13:241252, 1997. Terris DJ. Cosmetic enhancement associated with surgery for obstructive sleep apnea. Laryngoscope 109:1045-1049, 1999. Toriumi DM, Josen J, Weinberger M, et al. Use of alar batten grafts for correction of nasal valve collapse. Arch Otolaryngol 123:802-808, 1997. Urquhart AC, Bersalona F. Septoplasty: correcting the nasal valve. Laryngoscope 107:537-539, 1997. Vidyasager R, Friedman M, Ibrahim H, et al. Inspiratory and fixed nasal valve collapse: clinical and rhinometric assessment. Am J Rhinol 19:370-374, 2005. Watkins AB. Middle turbinate headache. Med J Aust 1:382-384, 1970. Wei JL, Remington WJ, Sherris DA. Work-up and evaluation of patients with nasal obstruction. Facial Plast Surg Clin North Am 7:263-278, 1999. Williams MB, Santiago S. The nose and obstructive sleep apnea. Chest 104:1230-1235, 1993. Wustrow T, Kastenbauer E. Surgery of the internal nasal valve. Facial Plast Surg 11:213-227, 1995. Zijlker TD, Quaedvlieg PC. Lateral augmentation of the middle third of the nose with autologous cartilage in nasal valve insufficie y. Rhinology 32:34-41, 1994.

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CHAPTER 5 Four Critical Anatomic Variants and “The Secret of Everything” There may be more than four, but, for the sake of simplicity, we are tempted to put all the world of physics and perhaps all the biological world in the framework of these four properties. They are, of course, Space, Time, Matter, and Energy. Many quasi-entities are recognized, such as motion, velocity, metabolism, entropy, creation—but they are derivatives, or combinations among the four. HARLOW SHAPLEY Of Stars and Men

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R elevance of the Problem* One of my favorite guitar teachers, Matt Smith, a recording artist and session musician from New York City, teaches a composition principle that he calls, “The Secret of Everything.” His secret is a method for composing melodies from chord change tones or vice versa, and it is such an elemental yet universal tool that he considers it to be a musical secret of everything. With Matt’s permission, I have applied the term to rhinoplasty for the same reason. I see at least 200 new secondary rhinoplasty patients in consultation every year. Several years ago, I noticed that the problems I was diagnosing and discussing with patients were not limitless but consisted of only a few deformities and airway obstruction causes, repeated over and over. Sadly, in many cases, the deformities and airway obstructions were new problems (as opposed to uncorrected ones) resulting from previous surgeries. Patients are routinely advised to bring prerhinoplasty photographs with them to the consultation, because these photographs help me analyze a deformity and educate patients about the mechanisms by which it occurred. It was this combination of seeing the same postoperative deformities and the same predisposing preoperative shapes that led me to my own Secret of Everything in rhinoplasty. Like Matt Smith’s secret, the rhinoplasty secret has proved consistent and uniformly applicable over the years. It is simply this: A surgeon who can identify four preoperative variants and include their correction in the surgical plan will never make an important misdiagnosis in primary or secondary rhinoplasty. These four anatomic variants are: (1) narrow middle vault, (2) alar cartilage malposition, (3) low radix or low dorsum, and (4) inadequate tip projection. These four anatomic variants are the golden threads of rhinoplasty, because they unify anatomy, aesthetics, and function.

*Please be sure to read Chapter 4 before continuing if you have not yet done so.

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Anatomic Traits  Narrow middle vault (Narrow MV): At least 25% narrower than the upper or lower

nasal thirds  Alar cartilage cephalic malposition (Malp): Lateral crural axis leads toward medial

canthus  Low radix or low dorsum: Begins caudal to the level of the upper lash margins with

eyes in primary gaze  Inadequate tip projection (TIP): Does not project to the level of the supratip septum

The four variants should be remembered in pairs, because the first two (narrow middle vault and alar cartilage malposition) control the frontal view and allow the surgeon to protect or improve the airway; the middle vault width and lateral crural position may indicate an airway particularly threatened by common rhinoplasty techniques. The second pair (low radix or low dorsum and inadequate tip projection) controls the lateral view and allows the surgeon to create a straight profile with the best possible nasal balance. Even more important, failure to diagnose any of the four variants virtually guarantees the patient a suboptimal cosmetic result or a worse airway than was present preoperatively. It is not a coincidence that one or more of these variants occur in almost every secondary rhinoplasty patient.

Why Are These Anatomic Traits Important? Control the Frontal View  Narrow Middle Vault: Dorsal resection produces airway obstruction (internal valve)  Alar Cartilage Malposition: Lateral crural resection produces airway obstruction (external valve) and often alar notching Control the Lateral View  Low Radix or Low Dorsum: Reduction creates further imbalance (such as smaller upper nose, larger lower nose), and often a supratip deformity  Inadequate Tip Projection: Alar cartilage reduction reduces tip projection further, and often creates a supratip deformity

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The constellation of all four anatomic variants has the following appearance:

Low radix Narrow middle vault Alar cartilage malposition Inadequate tip projection

This combined deformity is common and to the unschooled eye may seem unremarkable. However, even a conservative rhinoplasty, as was performed here, produces a distinctive postoperative shape, characterized by the following: increased nasal disproportion, collapsed middle vault, retracted alar rims, deformed tip with buckled alar cartilages, and concave alar walls with extended creases that reach the nostril rims. Whether a patient develops these deformities depends entirely on what the surgeon does during the primary operation. I hope it is becoming evident that all paths eventually lead to the same place, whether analysis begins with static anatomy; dynamic anatomy; right-brain emphasis on shape, confluence, and proportion; or airway diagnosis. Nasal form and function are inextricable, and the structural interdependencies that determine nasal shape and behavior before surgery and afterward also control the ability to maintain a stable and functioning airway.

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F rontal View: Determining the Airway NARROW MIDDLE VAULT AND ALAR CARTILAGE MALPOSITION

These patients all share two common and important anatomic variants: a narrow middle vault (arbitrarily defined as any upper cartilaginous vault that is at least 25% narrower than the upper nasal third) and cephalic rotation (or malposition) of the alar cartilage lateral crura (defined as any lateral crus whose axis lies along a line running from the lateral genu to the medial canthus).

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Narrow middle vault 25% narrower than bony vault Cephalically rotated or malpositioned lateral crus

Orthotopic lateral crus

Incidence of Preoperative Low Radix/Narrow MV/TIP/Malp in 150 Secondary Rhinoplasty Patients Low radix: 93% Narrow middle vault: 87%

Inadequate tip projection: 80% Alar cartilage malposition: 42%

In one series I published, a narrow middle vault was present in 38% of 50 consecutive primary rhinoplasty patients and in 87% of 150 consecutive secondary rhinoplasty patients; malposition was present in 18% of the 50 primary patients and 42% of the 150 secondary patients. In a second review, those latter numbers were even higher: malposition was found in approximately 50% of primary rhinoplasty patients and approximately 80% of secondary rhinoplasty patients. In another review of 100 consecutive secondary patients, malposition was present in 80% and narrow middle vault in 93%.* The exact percentages are less important than recognizing that both deformities are very common. Not surprisingly, these two common problems occur together frequently.

*The incidences in secondary patients will always exceed those in primary patients, because the secondary group selects those patients in whom the variant was inadequately corrected previously.

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In the previously mentioned review, 73% of the 100 patients had both narrow middle vault and alar cartilage malposition, as seen in the following patients.

These are the preoperative views of the patients shown at the beginning of this section. Rhinoplasty produced significant deformities in each of them. After primary rhinoplasty, many of these patients unconsciously flared their nostrils to keep their airways open. Without contracting the muscular ring, the entire sidewall would collapse, even with gentle inspiration. Nasal reconstruction for these patients, including spreader or adequate dorsal grafts (for the internal valves) and alar wall grafts (for the external valves), can triple or quadruple geometric mean postoperative airflow.

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Why do these deformities occur? Consider the effects of routine rhinoplasty maneuvers on each of these anatomic variants.

Narrow Middle Vault A dorsal resection as small as 2 mm opens the cartilaginous roof and removes the widest part of the conjoined dorsal septum, thereby eliminating the force that laterally distracts the upper lateral cartilages; thus, the middle vault collapses medially as the nose heals. An observant surgeon can often see a newly narrowed middle vault intraoperatively as soon as he or she resects the cartilaginous roof.

The effect of resecting the cartilaginous roof is immediately visible as a shadowed inverted V straddling the middle vault and demarcating the caudal edge of the bony arch. Placing spreader grafts moves the upper lateral cartilages outward, because the wider preoperative anterior (or dorsal) septal edge replaces the stability previously provided by the intact cartilaginous roof. Spreader grafts are therefore an anatomic reconstruction, because they replicate the normal. In this particular case, the dorsal resection created disequilibrium in a middle vault that was already narrow preoperatively because of short nasal bones. By reestablishing both skeletal balance and equilibrium with spreader grafts, this patient’s airway was not only protected but also improved, because the postoperative middle vault is wider and more stable than it was preoperatively.

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PATIENT STUDY ONE

Before this patient’s primary surgery she had a low radix, a narrow middle vault, and alar cartilage malposition—note the lateral crural axis. Her tip is adequately projecting but barely reaches the septal angle. The alar sidewalls are convex, but the rims arch, indicating fragile support. Although it would be easy to consider routine reduction rhinoplasty for this patient, she is at high risk for increased airway obstruction from the narrow middle vault and alar cartridge malposition and for greater postoperative imbalance from the low radix.

Rhinoplasty unfortunately produced the expected results. The middle third has narrowed, a middorsal notch and supratip deformity have appeared, the tip has lost projection, the alar walls have become hollow, and an inverted-V deformity now demarcates the short bony vault.

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During her secondary procedure, the lateral crura were dissected through vestibular incisions 3 mm above and parallel to the rims and relocated. The external valves were now supported.

Septoplasty cleared the airway and produced graft material. Spreader grafts opened the middle vault and corrected the inverted V, and the internal valves were now supported.

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Dorsal grafts smoothed the dorsal line, helped redrape the supratip deformity, and improved nasal balance.

Tip grafts increased projection, assisted the dorsal graft in the supratip redrape, and reformed the tip lobule.

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Postoperative Analysis

One year postoperatively, the airway is stable, the repositioned lateral crura have formed normal alar sidewall topography, the inverted V and middorsal notch have disappeared, the supratip is flat, the tip projects adequately, and the dorsal graft has smoothed the dorsal line and improved nasal balance.

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The dorsum is straight, and the supratip is flat. Increased tip lobular tension has lifted the columella slightly. Repositioned lateral crura support the alar walls; the base remains unscarred.

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Notice the postoperative confluence of the upper, middle, and lower nasal thirds; mean nasal airflow quadrupled over preoperative values in this patient. The magnitude of postoperative change in patients with preoperative incompetence at all four valves, such as took place with this woman, is typical.

Alar Cartilage Malposition Each of the secondary patients previously shown also had alar cartilage malposition, the remnants of which leave characteristic features along the postoperative alar walls. Because the lateral crura are cephalically rotated, any reduction in the skeletal support of the external valves allows them to collapse, creating hollows in the sidewalls above the alar rims (often extending posteriorly to the hinge areas). In patients whose soft tissues are adequately thin, the alar rims retract, creating a real, rather than relative, soft tissue deficit, predominantly on the vestibular side.

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PATIENT STUDY TWO

This secondary patient has an appearance similar to the previous one: a low radix beginning at the midpupillary level, a slight supratip convexity, a narrow middle vault, and malpositioned alar cartilage lateral crura whose axes angle toward the medial canthi. After rhinoplasty and caudal septal reduction, the subnasale sharpened as the upper lip draped posteriorly. Alar hollows have appeared—dorsal and tip reduction have converted a slightly high dorsum and adequately projecting alar cartilages into a supratip deformity. The alar rims have retracted. Reducing cephalically rotated lateral crura does not create alar retraction in all patients (for example, it did not do so in the previous patient); however, if the soft tissues can contract and insufficient lateral crura remain to brace them, a real tissue deficit develops in the thinner lining and manifests as alar notches or superior translocation of both rims. Here the left rim has retracted more than the right. Such asymmetries are the rule, and the surgical plan must account for them.

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The patient recognized her deformities and represented her goals with this magazine photograph, which shows a straighter dorsum, more tip projection, and lower alar rims.

A 1 mm Gore-Tex sheet was rolled, fixed circumferentially, and placed subperiosteally over the maxillary arch through a short nasal floor incision.

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B

A septoplasty provided a small amount of usable cartilage—much of the specimen was ethmoid. The graft on the right side of the grid was conchal cartilage, lightly crushed for a dorsal graft: This is a compromise solution that I use infrequently. Note that once placed, the minor middorsal notch vanishes (B).

The cymba conchae were harvested for composite grafts, to be split obliquely to serve both sides. The rim defect and bony vault length were marked.

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A

B

C

D

After spreader, dorsal, composite, and multiple crushed cartilage tip grafts were placed, the dorsal line straightened, the supratip deformity disappeared, and tip projection once again became adequate. Tip grafts completed the redistribution and expansion of the contracted tip lobule (B). Silhouettes demonstrate how dorsal and tip grafting alter nasal skin support and therefore nasal balance, reversing the contraction that occurred after the primary rhinoplasty.

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Postoperative Analysis

The 1-year postoperative view confirms sidewall confluence created by dorsal and spreader grafts. The middle third now has adequate width—alar retraction has disappeared. Frontal contours have appropriate midnasal and lower nasal width, and alar flare is gone.

The thin ear cartilage graft has smoothed the dorsal line. The nasal base, though expanded by tip grafts, seems smaller.

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The supratip deformity has disappeared. Aesthetic goals have been met.

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Composite grafts have restored nostril contour by bracing the external valves and replacing the lining. Postoperative airflow has doubled because of external valvular reconstruction.

The donor ear barely shows traces of the skin graft that replaced the composite graft, harvested from the cymba conchae. Composite grafts have corrected both the aesthetic and external valvular functional deficits: the skin islands replace the vestibular deficit, and their cartilaginous backing stiffens the rims and prevents recurrent retraction as healing progresses. Composite grafting is detailed in Chapter 17.

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L ateral View: Determining a Balanced, Straight Profile LOW RADIX OR LOW DORSUM AND INADEQUATE TIP PROJECTION The two common anatomic variants of low radix or low dorsum and inadequate tip projection are considered together, because they influence the strategies for creating straight profiles and allow surgeons to obtain optimal balance within the limitations of a patient’s skin thickness and distribution. In addition, as with narrow middle vault and alar cartilage malposition, both anatomic variants frequently occur together and confer a characteristic profile configuration.

Notice the similarities in these three patients. In each, the radix begins at the level of the lower lash margin instead of its optimal location above the upper lash margin; a higher radix applies in these women because of their imbalances or disproportions, as described by Sheen: relatively large lower noses paired with smaller upper noses.

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In each patient, the tip lobule seems to hang from the septal angle, indicating that the alar cartilage middle crura are short and not strong enough to support the tip independent of dorsal height. In each patient, I reduced the dorsal convexity, and I placed spreader grafts to stabilize the middle vaults, radix grafts to lengthen the dorsal lines, and tip grafts to increase projection.

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B

C

The low radix/inadequate tip projection combination creates a formidable challenge that makes it all but impossible to create a straight, balanced dorsum by pure reduction. Without increasing tip projection, the dorsum will still appear to be convex, and without a radix graft, the base will remain too large. Because this woman and her surgeon had a logical but impossible plan that followed False Assumption Number One (“The nasal soft tissue cover has an infinite ability to shrink to the size of any underlying skeleton,” see Chapter 2)(B), the postoperative view remains unchanged (C).

The same held true for these two patients.

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C

D

This man came to me for secondary surgery and wanted his dorsum straightened at the same time that I corrected an airway obstruction. However, he was unwilling to accept either radix or tip grafts and would only permit reduction (B and C), which I predicted would not alter his preoperative contour, because of the low radix and inadequate tip projection. At the time of airway correction, the dorsum was reduced. The intraoperative views show the resulting promising change, without tip work. Spreader grafts reconstituted the internal valves. However, the radix and tip settled, revealing only a slightly smaller version of the same preoperative shape (D). Simple reduction in any patient with a low radix and inadequate tip projection creates neither a straight profile nor an optimal nasal balance. The upper dorsum may be lower, but the tip still hangs so that the dorsal profile is not straight, and many patients see this shape as a persistent dorsal hump. When a secondary patient comments that his or her nose looks the same as it did before surgery, he or she almost certainly had a low radix/inadequate tip projection combination preoperatively. Low radix and inadequate tip projection are common. In my review (2000), low radix or low dorsum was present in 38% of 50 consecutive primary patients and in 93% of 150 consecutive secondary patients; inadequate tip projection was present in 31% and 81% of primary and secondary patients, respectively. My subsequent series have yielded similar observations.

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PATIENT STUDY THREE

Despite a significant reduction of bridge and tip support in this patient, her nose does not look smaller. The mass of the nose lay in the lower two thirds preoperatively, and it is still there postoperatively. In addition, the new external valvular deformities are significant. A

B

C

D

After maxillary augmentation (B) (which moves the nasal base forward), placement of conchal cartilage alar wall grafts (C and D) (which reconstructed the external valves), spreader grafts for the internal valves (E), and multiple tip grafts (F) (which expanded the tip lobule), as well as dorsal elevation (G), the overall nasal balance improved so much that the entire nose looks smaller (H and J). 212

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E

F

G

H

I

J

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Postoperative Analysis

The postoperative photos of this patient were taken 3 years after surgery. As you examine the improvements in balance and contour achieved by the reconstruction, do not forget the patient’s original functioning nose, and the preventable deformities that followed.

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Make use of the powerful rebalancing illusion to correct a low radix or low dorsum. Scaling the larger parts down to smaller parts cannot always maximally help patients whose chief complaint is that the bottom of their noses stick out too far. Remember the real truth about False Assumption Number One: nasal skin cannot adapt infinitely. Improving balance by augmenting deficient areas decreases the amount of reduction needed elsewhere, which in turn decreases the amount of required skin sleeve contraction, which in turn decreases soft tissue thickening, which in turn maximizes contour and function. The more surgical principles that surgeons have at their disposal, the greater the chances of producing a good result, even from the most difficult configurations. The illusion of balance is one of these principles.

Any low radix affects the nasal proportion. Because both skin sleeve thickness and distribution have been predetermined in each patient, and because contractility without distortion is limited, a low radix or low dorsum creates an imbalance that patients interpret as a lower nose that is too large.

Note the contrast between the preoperative high radix in this tertiary patient and the postoperative view after the radix was reduced and her nasal base was expanded by tip grafts. Which nasofacial angle is preferable? By seeing these differences, you and your patient can make your own decisions.

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A low radix, elevated, contributes to diminution of nasal base size, even if tip grafts expand the lobule.

Two competent reductions did not rebalance the disproportion caused by this tertiary patient’s low radix.

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Tip knuckles were resected, and the radix, spreader, and tip grafts were added.

Silhouettes confirm the intraoperative balance change created by radix grafting.

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The balance persists 3 years postoperatively. The middle vault is more symmetrical and functional (asymmetrical spreader grafts); the longer dorsal line reduces the apparent nasal base size (dorsal graft). Multiple tip grafts diminish tip asymmetry, though the skin remains attenuated. Geometric mean nasal airflow increased to 25 times over preoperative values. Such unusually large improvements occasionally occur when the preoperative airway has been extremely compromised.

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PATIENT STUDY FOUR

Because reduction and redistribution, rather than reduction alone, requires less net skin sleeve volume change, a low radix is particularly relevant when a patient’s soft tissues are thick. Consider this patient: he has a high dorsum, large lower nose, thick skin, and inadequate tip projection. A surgeon might simply reduce the dorsum and increase tip projection, as shown here. But note how much soft tissue contraction is required—far more than the skin sleeve can accommodate.

Three reductions in this man, who had soft tissues and skeletal structure similar to the previous patient, produced a straight underlying skeleton covered by soft tissues that have not contracted passively, but according to their own vectors, contra220

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dicting False Assumption Number One. Alternatively, noticing that the radix is located at the midpupillary level, a surgeon could choose to straighten the dorsum by reducing the hump and augmenting the radix, as shown here. Less skeletal reduction is performed, and less soft tissue contraction is required with this method.

A

B

C

An extra element in this patient is the dislocated caudal septum at the distal end of the high septal deviation, distorting the left membranous septum (B). The patient reflexively flares his nostrils to stabilize his airway, because the internal valves narrow when he inspires (C).

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization to radix 2. Bony and cartilaginous dorsum reduced 2 mm to tissue limits 3. Submucosal reduction of the caudal ends of the upper lateral cartilages to facilitate tip rotation 4. Dislocated caudal septum resection through hemitransfixion incision 5. Septoplasty 6. Caudal septum replaced with septal cartilage 7. Unilateral right spreader graft 8. Radix grafts 9. Tip grafts 10. No osteotomies

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After dorsal reduction, the thick nose lengthened because it lost support.

A

B

The caudal septal graft (A) increased base support and shortened the nose in combination with dorsal reduction (B).

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D

A layered radix graft, contoured to the defect (A), straightened the dorsal line (B). Tip grafts (C and D) supported the base.

Silhouettes confirm the rearrangement that has occurred. The nose is rebalanced, so the base seems smaller. The thick skin sleeve is better supported, so the nose has more shape, particularly at the base, where tissues are thickest.

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Postoperative Analysis A

C

B

D

E

Twenty months postoperatively, the frontal view is symmetrical because of the unilateral (right) spreader graft, even though no osteotomies were performed (which would have decreased nasal width and therefore skin support). Even 12 days after surgery (D), the nose is shorter and straighter; the effect persists at 20 months (E).

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F

G

H

The base is unscarred and symmetrical (F through H); multiple tip grafts are smooth and invisible; the replaced caudal septum remains midline (H).

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The low radix and the low dorsum are only anatomic curiosities in some patients but are particularly important in two situations: (1) when the skin is thick, or (2) when there is a preoperative imbalance (small upper nose, larger lower nose). If a patient has thick skin or says, "The tip of my nose sticks out too far," examine the dorsum and radix.

Because skin contraction is limited and distribution is predetermined, this case becomes a strategic balance problem, not just a size problem. The patient's nasal base was reshaped (by relocating the malpositioned lateral crura and tip grafting), and her entire dorsum was augmented, all with septal cartilage.

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Why augment a dorsum that was already straight? Right-brain analysis supplies part of the answer: imagine how tip grafts without dorsal augmentation would have affected nasal contour.

The patient's preoperative imbalance would worsen, because the tip grafts used to increase tip projection also increase nasal base size. Though it may not be noticeable at first, the tip reduction/dorsal augmentation solution is not the long way around: with a thick skin sleeve, tip reduction/dorsal augmentation is a strategy that preserves the airway and maintains contour and skin quality. Regardless of dorsal height or contour, examine proportion if the base seems too large. Patients often describe inadequate tip projection as a "long" or "hooked" nose, suggesting that it should be shortened. This misperception has also deceived many surgeons. A change in tip configuration or nasal proportion is needed, but nasal shortening is unnecessary. Notice also that tip grafting itself appears to rotate the base; the shortening effect is an illusion created by the lobular shape change that grafting confers.

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PATIENT STUDY F I V E

Not every low radix should be treated—as with any anatomic characteristic in rhinoplasty, its aesthetic correctness depends on its relation to the whole, which in this case is nasal base size. In many Asian noses the radix and dorsal height are already appropriate for nasal base projection. In this case, these features were complicated by a left unilateral cleft lip. Only minor changes were needed in maxillary arch position, columellar visibility, and tip projection.

S U M M A R Y OF THE SURGICAL PLAN 1. Septoplasty 2. Maxillary augmentation with septal cartilage and bone (alloplasties are too risky under cleft lip repairs) 3. Asymmetrical spreader grafts for high septal deviation, thicker on left 4. Columellar grafts (for downward displacement, not struts) 5. Multiple tip grafts 6. Lip revision

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Despite a meager specimen, there was enough for the patient’s needs. The change in the lateral and oblique views is solely created by tip grafting, without alar cartilage reduction.

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Silhouettes dramatize the change in tip lobule contour created by effectively lengthening the middle crural segment with grafts.

Postoperative Analysis

At 2 years postoperatively, the dorsum is straighter, and both oblique views match, signifying improved symmetry. The increased nasal base size, not dorsal reduction, has improved the patient’s nasofacial angle. Tip grafts have increased apparent middle crural length and redraped the tip lobule.

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A Matched Pair of Problems PATIENT STUDY SIX

PATIENT STUDY SEVEN

On the left is the secondary patient whose deformity origins we traced at the beginning of this chapter, and on the right is a primary patient with the same configuration, though her skin is thicker and therefore reduction options are somewhat more limited. All four anatomic variants are present preoperatively in each woman.

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In the secondary patient, each unrecognized variant created an indication for secondary rhinoplasty and together yielded a nose with a low dorsum, a large nasal base, a knuckled tip lobule, and a new airway obstruction that was entirely valvular (visible as a collapsed middle vault and alar hollows below the remnants of the malpositioned lateral crura).

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TREATMENT OF THE SECONDARY PATIENT

During inspiration, the sidewalls collapse at both the internal and external valves. Given the patient’s original nasal width and structure, it is likely that her preoperative airway admits only 25% of its original airflow (see Chapter 4). The previous septoplasty left only small amounts of septal cartilage, so ear cartilage was harvested to reconstruct her lateral crura.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization through a single right-sided intercartilaginous incision 2. Minimal dorsal rasping 3. Resection of distorted middle crural segments through short infracartilaginous incisions 4. Resection and replacement of dislocated caudal septum 5. Preparation of spreader graft pockets 6. Septoplasty and harvest ear cartilage 7. Spreader grafts, thicker on right 8. Two-layer dorsal graft of septal cartilage, crushed and staggered 9. Conchal cartilage alar wall grafts 10. Multiple crushed septal and ear cartilage tip grafts

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B

E

C

F

D

G

The knuckled alar cartilages were resected through short infracartilaginous incisions; the deformities disappeared, but tip projection also decreased (B). Septoplasty (C) cleared the airway and yielded sufficient building supplies for spreader grafts (D) and dorsal grafts (E and F). Note in G that dorsal grafting immediately decreased apparent nasal base size.

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I

Because of its configuration, conchal cartilage was trimmed to the size of the absent lateral crura (H) and slipped through vestibular incisions into discrete pockets at the deficient sites. Multiple tip grafts, crushed to minimize tip distortion or visibility (I), completed the reconstruction.

Yellow and blue silhouettes dramatize the balance and contour changes that have taken place by resecting deformities and grafting deficiencies.

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Postoperative Analysis

Two years after surgery, the upper, middle, and lower nasal thirds have been rendered confluent by dorsal and spreader grafts; the tip is symmetrical without distorting alar cartilage remnants.

Internal and external valvular reconstruction has created four competent valves, so that only minimal sidewall movement occurs with inspiration (right).

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Tip grafts have reformed the lobule; and increased dorsal height has improved nasal balance. The alar walls are now supported, and the nasal base perimeter has improved. The patient’s geometric mean nasal airflow tripled over preoperative measurements.

Postoperative aesthetics match the patient’s preoperative goal.

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TREATMENT OF THE PRIMARY PATIENT

Contrast the surgical plan for this woman with a variant quartet that parallels that of the previous patient.

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SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization through a single intercartilaginous incision 2. Bony vault reduced by rasping 3. Cartilaginous dorsum reduced 4. Resection and relocation of lateral crura through short, bilateral infracartilaginous incisions 5. Dissection of spreader graft tunnels 6. Septoplasty 7. Spreader grafts 8. Radix graft—one layer with a second posterior to it at the cephalic end 9. Multiple septal cartilage tip grafts

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B

C

Intraoperatively, note that the nose shortened after dorsal reduction and tip cartilage relocation (B). By the conclusion of the operation, radix grafts diminished the overall nasal base size (despite tip grafting) by lengthening the dorsal line; and tip grafts fundamentally altered the dorsum/tip relationship by increasing projection, altering tip contour, and bringing the tip lobule from below the dorsal line to above it (C). Note also that increased tip lobular tension elevated the columella and altered the patient’s subnasale contour.

Silhouettes reveal the balance change conferred by radix grafting, and the projection and contour added by the tip grafts.

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Postoperative Analysis

Postoperatively, the changes persist. The middle vault is stable—there is no collapse or discontinuity. Repositioned lateral crura support the external valves. Grafts project the tip beyond the septal angle; and despite thicker soft tissues, improved nasal balance has made the whole nose seem smaller.

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Without the proportion afforded by the radix grafts, the lobular stability created by spreader graft and lateral crural repositioning, and the projection that tip grafts created, this woman would have had the same functional and cosmetic primary rhinoplasty results as the previous patient. The reduction/augmentation combination afforded her improvement that reduction/contraction could not match.

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R elevance to Clinical Practice Incidence of the Four Common Variants in Primary and Secondary Patients

Narrow middle vault Alar cartilage malposition Low radix or low dorsum Inadequate tip projection

Occurrence in Primary Patients

Occurrence in Secondary Patients

40% 50% 50% 30% to 40%

80% 80% 80% 80%

The importance of the common anatomic variants—narrow middle vault, alar cartilage malposition, low radix or low dorsum, and inadequate tip projection—will be encountered again throughout this text and in your own practice. Depending on the group of patients reviewed, narrow middle vault occurs in approximately 40% of primary patients and 80% of secondary patients; alar cartilage malposition occurs in approximately 50% of primary patients and 80% of secondary patients; low radix or low dorsum occurs in approximately 50% of primary patients and 80% of secondary patients; and inadequate tip projection occurs in approximately 30% to 40% of primary patients and 80% of secondary patients. It is extremely uncommon to see a secondary rhinoplasty patient who did not have at least one of these anatomic variants before the first operation. In our first such series (2000), 99% of the secondary patients had at least two variants, and 78% had three or all four in some combination. The combination of low radix or low dorsum, narrow middle vault, and inadequate tip projection occurred in 40% of patients; another 27% had those three plus alar cartilage malposition. Altogether, 78% of our series of 150 consecutive secondary patients had three or all four of these variants. It is safe to say that if these patients’ primary surgeons had recognized and compensated for the relevant variants, very few of them would have sought secondary correction.

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In this same reported series, 78% of 100 primary patients had two or more variants, and 58% had three or more. Only 22% had none of the four anatomic variants. The most common grouping in both primary and secondary patients was the triad of low radix, narrow middle vault, and inadequate tip projection (40% of primary patients and 28% of secondary patients). The second most common grouping was all four anatomic traits (28% of primary patients and 27% of secondary patients).

Characteristics, Impact, Deformities, and Treatment of the Four Anatomic Traits Anatomy

What It Controls

Frontal View Narrow middle vault

Airway

Alar cartilage malposition

Lateral View Low radix/low dorsum Inadequate tip projection

Airway

Optimal balance Straight prof le

Potential Threats

Surface Deformity

Treatment

Internal valvular incompetence External valvular incompetence

Inverted V

Spreader/dorsal grafts Lateral crural repositioning Composite grafts

Large base disproportion Supratip deformity

Alar grooves/hollow notched/retracted rims Often inadequate tip projection Ball tip/box tip Large base

Radix/dorsal graft

Tip hangs from septal angle

Preserve alar cartilages Tip grafts

In our series, less than one in four primary patients was a candidate for a traditional reduction-only rhinoplasty. These patients were those whose nasal balance was already correct, whose lateral crura were orthotopic, whose tip was adequately projecting (requiring no more than a simple lateral crural cephalic trim), and whose dorsal hump was small enough that reducing it would not open the cartilaginous roof. Such patients are uncommon, because people with these traits do not normally request rhinoplasty. Their rarity emphasizes the importance of recognizing the anatomic variants and including treatment for them in a surgical plan. Surgeons who do so will never make an important misdiagnosis in primary or secondary rhinoplasty. This is the Secret of Everything.

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Consider the deformities in these secondary patients. During their primary rhinoplasties, each patient had a different surgical outcome that depended on whether the four common critical variants were recognized and treated. As you examine each pair, notice the impact of rhinoplasty on the shape and airway in these patients. Notice also the change in the patients’ eyes.

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In each of these secondary and tertiary patients, which anatomic variants were originally present? What large base may have been preceded by a low radix? Which middle thirds were probably already narrow? Which alar walls show the footprints of malposition? Which tips may have been inadequately projecting? It is perilous to ignore these anatomic variants; that is why they are The Secret of Everything in rhinoplasty.

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BIBLIOGRAPHY Constantian MB. The boxy nasal tip, the ball tip, and alar cartilage malposition: variations on a theme— a study in 200 consecutive primary and secondary rhinoplasty patients. Plast Reconstr Surg 116: 268-281, 2005. Constantian MB. Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plast Reconstr Surg 105:316-331, 2000. Constantian MB. The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients. Plast Reconstr Surg 114:15711581, 2004. Shapley H. Of Stars and Men. Boston: Beacon Press, 1984. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 73:230-239, 1984. Sheen JH, Sheen AP. Aesthetic Rhinoplasty. St Louis: Quality Medical Publishing, 1998, pp 808-826, 989-1011, 1142-1165, 1322-1327. Smith M. Matt Smith’s Chop Shop for Guitar. Van Nuys, CA: Alfred Publishing, 2001, pp 56-63.

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PART II R hinoplasty as an Operation There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning . . . endless forms most beautiful and wonderful have been, and are being evolved. CHARLES DARWIN On the Origin of Species by Means of Natural Selection

CHAPTER 6 Why R hinoplasty I s Di ffic t The beautiful rests on the foundations of the necessary. The soul makes the body, as the wise Spenser teaches: So every spirit, as it is most pure, And hath in it the more of heavenly light, So it the fairer body doth procure To habit in, and it more fairly dight, With cheerful grace and amiable sight. For, of the soul, the body form doth take, For soul is form, and doth the body make.

Here we find ourselves, suddenly . . . in a holy place, and should go warily and reverently. We stand before the secret of the world, there where Being passes into Appearance. . . . RALPH WALDO EMERSON Essays: The Poet

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R

hinoplasty is difficult but not impossible to learn. Not every result will be good, even after many years of practice; but the same is true of any operation, no matter how expert the surgeon. The nature of each individual case, the quality of the building materials, and the nature of wound healing all add variables that can confound both surgeons and patients. It is, however, possible to perform rhinoplasty with confidence and with an understanding of the dynamic, structural, functional, and biologic processes at work so that the balance can be tipped as far as possible in a patient’s favor. Many surgeons do not share this view of rhinoplasty. They consider it a blind operation (hence one of the appeals of the open approach) or, at best, one that has become an intricate technical exercise of remodeling, suturing, and grafting. When the outcomes are not good, many of these surgeons may not understand why, and additional surgeries only compound the original deformity. As an operation, rhinoplasty is almost unique from a patient’s perspective: it is possible to go from an unattractive nose to a less attractive, less functional nose after each subsequent surgery, and thus to lose ground with each operation. Add to this mix the surgeon’s frustration and the patient’s anxiety, and it is no wonder that competent, experienced surgeons stop performing rhinoplasty, and others abandon it early in their careers, after concluding that the operation is impossible to perform successfully except by a few “experts.” The spark that ignited the rhinoplasty revolution was Sheen’s recognition that the traditional reduction model was insufficiently complex. The new paradigm that he described in the late 1970s added new precepts of balance, support, and anatomic analysis and required skeletal augmentation as well as reduction. The clincher for many surgeons was Sheen’s demonstration that these same methods also rehabilitated many secondary rhinoplasty patients, a group whose deformities had previously been considered largely untreatable. Therefore one caveat is this: any surgeon who views modern rhinoplasty as simply the old reduction model, to which grafts have been added, misses the point. Modern rhinoplasty is a new paradigm. Conceive of rhinoplasty as an operation in which the skin sleeve is more fixed than variable, and in which aesthetics, proportion, and function depend on structural interdependencies and skeletal balance. Rhinoplasty then becomes an operation of reducing excess, augmenting deficiency,

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and equilibrating the skeleton with the soft tissue cover whose shape it creates and whose function it preserves. In many ways, the trouble that surgeons have with rhinoplasty stems more from the thinking than the doing. However, it is important to point out that reduction rhinoplasty does work sometimes. Ideal for a pure reduction strategy is a thin-skinned nose (which permits maximal adaptation to a reduced skeleton) in which the nasal root is properly positioned (supplying good nasal balance, and therefore no radix graft is needed), in which dorsal reduction will not open the middle vault roof (no need for spreader grafts), and in which only modest tip refinement is required (all alar cartilage segments are well contoured, needing no reinforcement for a retracted columella, inadequate tip projection, or external valvular incompetence). In clinical practice, however, few such favorable circumstances occur.

A

B

C

D

This woman is about as close as patients come to having a nose that can be effectively treated with reduction alone (A); but though the lateral view looks generally good (B), the frontal view shows the middle vault penalty for a large dorsal resection (C), and the alar walls are unsupported—signaling a new airway obstruction at the internal and external valves (D). Surgeons should be wary of a pure reduction strategy: it does not solve most rhinoplasty problems. Rhinoplasty’s reputation as a difficult operation derives partly from the fact that it is different. Unlike many operations that can be portrayed step-by-step in atlases, rhinoplasty is a right-brain, feedback operation that cannot be premeasured and premarked before surgery, and as such has much more in common with Millard’s

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rotation-advancement cheiloplasty than with the Tennison-Randall triangular flap method. Rhinoplasty is “cut as you go.” Moreover, because nasal structures are interdependent, feedback in rhinoplasty is nonlinear, in the sense that an alteration in one area often produces effects distant from the part modified. However, these intraoperative changes are not idiosyncratic, but predictable and recognizable. Like a “call and response” blues solo,* many technical steps in rhinoplasty are answered by changes in balance, function, or shape. Things move. A surgeon who remembers the relevant interdependencies and understands skin sleeve movement and contraction limitations is able to interpret the changes and movement accurately.

R hinoplasty’s Hidden Anatomy MAKING A DIAGNOSIS

PATIENT STUDY ONE A

B

Consider this nose. In the frontal view you can see the thin skin, the bony vault width, the relative middle vault width, and the alar wall contour (A). Where is the lateral crural axis? Note the high dorsum and the low radix that begins at the midpupillary level (B). As a result of these, the nasal base seems large—but the largeness is relative. It al-

*A solo in which one phrase (the call) is answered by another musical phrase, voicing the response, like a conversation.

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ways is, because each nasal area must fit the whole appropriately. Largeness is only partly a size problem: it is also often a balance problem. Notice that tip projection is adequate (the tip projects beyond the septal angle), the columella is slightly low, the nasolabial angle is about 90 degrees, and the subnasale is full. Is the nose long? Cover the tip lobule. Is the nose still long? Note that tip lobular shape lengthens the nose artifactually, particularly when there is no well-defined point of maximal projection and the supratip is convex: the tip may seem to be pointing downward, despite a 90-degree nasolabial angle. This patient requires a change in tip lobular configuration rather than shortening.

A

B

This view confirms the diagnosis of a low radix and adequacy of tip projection (A). It also demonstrates concavity in the middle third, which signals a threatened airway at the internal valves that will worsen after resection of the cartilaginous roof. Assess alar rim support on the inferior view (B): it is poor in the posterior half because of the malpositioned lateral crura. Nostril length (approximately tip lobular length) balances lobular size appropriately. This woman is a primary rhinoplasty patient with a straight septal partition and bilateral airway obstruction who would like a symmetrical nose with a straight profile, and she is an excellent candidate, both physically and psychologically. What else must you know to form a surgical plan? Before answering, focus on what you can see, not what you cannot see.

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The answer is: nothing. Rhinoplasty need not be exploratory surgery. From the photographs and the history, you already know function, surface anatomy, the shape of important areas (the bridge height, middle vault width, tip support, and contour), and nasal balance. These are all you need to form a surgical plan. If there are anatomic details that are neither externally visible nor obstructing the airway, it does not matter if they exist. Every trained plastic surgeon has already developed the diagnostic and technical skills to perform endonasal rhinoplasty. Very little can be gained by opening the nose except access for certain suturing procedures. Surgeons who perform suctionassisted lipectomy (SAL) already base their decisions on surface parameters. Surgeons who perform endoscopic surgery already operate with limited technical access. The difference in rhinoplasty is simply a different set of surgical facts and a different set of technical skills—and an ability to see the nose appropriately and access right-brain analysis at will. From these observations and information about the patient’s goals, it is possible to construct the entire surgical plan.

SUMMARY OF THE SURGICAL PLAN 1. Resection and relocation of the lateral crura through short infracartilaginous incisions 2. Limited skeletonization to the radix 3. Minimal dorsal resection through single intercartilaginous incisions 4. Shorten caudal septum 2 mm through transfixing incision 5. Septoplasty 6. Symmetrical spreader grafts 7. Single-layer radix graft 8. Multiple, crushed cartilage tip grafts 9. Bilateral osteotomies

We will return to this patient later in the chapter.

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PATIENT STUDY TWO

This secondary patient has thicker tissues than the previous patient. Again, notice what you can see on the surface (which is also what the patient sees): relative upper and lower nasal width (appropriate for the patient’s facial width); tip projection (inadequate); radix position (low); columellar position (good); dorsum/base balance (base is relatively large); and any skeletal parts that create surface distortions (none). The only other piece of the examination is the condition of the septum: straight but partially resected. The only strategic decision to be made is whether enough septum remains for augmentation needs. This patient’s goals differ from those of the previous patient: she would like a narrower bony vault, more tip projection, and a smaller nasal base, by illusion if nothing else. Her surgical plan can

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be outlined as follows, using only the information gained from her photographs, history, and septal examination. Any intraoperative decisions will therefore become quantitative rather than qualitative.

SUMMARY OF THE SURGICAL PLAN 1. Minimal dorsal skeletonization to radix through intercartilaginous incisions 2. Rasping of the bony vault; trim cartilaginous dorsum less than 2 mm 3. Refinement of the lateral crura retrograde 4. Septoplasty for remaining cartilage and bone 5. Conchal cartilage harvested, if necessary 6. Thinning of spreader grafts 7. Radix/upper dorsal graft 8. Multiple crushed cartilage tip grafts 9. Bilateral osteotomies

After the dorsum is reduced, its relationship to the tip improves, but without rebalancing using an upper dorsal graft and without creating support and projection using a tip graft, the postoperative appearance will resemble the preoperative shape almost identically. A small amount of cartilage was trimmed from the septum (center top of grid); lateral crural scraps (bottom), the dorsal resection (center), and the conchal harvest (top) complete the specimen.

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A

B

C

D

The best piece of septal cartilage has been crushed, trimmed, and sized to the defect, and a second small piece has been sutured to its superolateral posterior surface (C). If these grafts are contoured and finished carefully, the need for revision is exceedingly low. Once placed, the graft raises the upper dorsum so that the radix is now located nearer the upper lash margin than the lower lash margin (D).

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A

B

C

D

Tip grafts are trimmed and crushed lightly to decrease their visibility. The graft toward the top will be placed first to set the point of greatest tip projection and the angle of rotation, after which the caudal end will be trimmed and tucked into the pocket. One of the remaining pieces will be crushed and placed anterior to the first graft to contour the lobule. In B, the grafts have been placed. The silhouettes indicate a complete rearrangement of the dorsal line. The radix is now higher, the middorsum is lower, and the tip is adequately projecting. Notice how close this appearance is to the postoperative views that follow.

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Postoperative Anaylsis

This woman is very proud of her Middle Eastern heritage. Therefore she was deliberately conservative in her directions to her primary surgeon, in retrospect perhaps more than she should have been. Because she now desired a straight dorsum with adequate tip projection, her skeletal and soft tissue structures needed a change in upper nasal height and effective middle crural strength—the soft tissues would not contract to more skeletal reduction. A change in ethnic character should be a conscious and explicit decision between patient and surgeon. The radix grafts have provided contour to the upper nose, hiding the bony vault edges. The shadows of the inverted-V deformity have disappeared because of the spreader grafts. From below, the tip remains symmetrical; the middle vault hollows have disappeared.

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The lateral and oblique views confirm the change in relationships among the radix, middorsum, and tip. Because intraoperative equilibrium was achieved, there has been little change in the year since the blue silhouette image was taken.

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W hy I Prefer Endonasal Rhinoplasty The fact that I perform rhinoplasty endonasally cannot be separated from the logic, the planning, or the technique of my approach. I organize my preoperative thoughts, interpret intraoperative changes, and make technical decisions based largely on surface indicators—that is, what the soft tissues (internally and externally) demonstrate. Endonasal rhinoplasty is an operation designed around changes in skin surface. The skeleton is only a means to that end. In contrast, surgeons who favor the external approach base most of their decisions on an analysis of skeletal structure, and that approach is designed to allow maximal access to that skeleton. It is a different thought process and a different anatomic emphasis from using the endonasal approach. However, critical indicators such as skin sleeve movement, balance changes, and the surface effects of reduction and augmentation, all depend on an ability to see the undisturbed nasal surface accurately. This is the anatomy that the patient sees and that determines the success of the surgical result; this is the right-brain part of the operation. Unfortunately, although designed to do so, the open approach has not diminished the incidence or severity of secondary deformities. Though no prevalence data exist, the severity of secondary deformities has unquestionably worsened.

Although not a new operation, open rhinoplasty has swamped endonasal technique like a tsunami during the past two decades, facilitated in part by the frustration that many surgeons experience in performing the newer rhinoplasty techniques. Reinforcing that stimulus is the traditional respect that all surgeons have for using longer incisions for greater anatomic exposure to solve difficult problems.

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The advocates of open rhinoplasty properly note that it allows binocular vision, that anatomic points obscured by the skin sleeve are uncovered, that certain techniques (such as tip suturing) can be performed more easily, and that the scar itself is ordinarily imperceptible.

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All of these arguments are valid. Open rhinoplasty does, however, impose its own constraints on surgeons and patients in addition to the constraints mentioned earlier. The dissection is slower and postoperative morbidity is higher. Poor scars do occasionally occur. These are the common objections, but there are others. When a surgeon separates the columellar skin from the medial crura, the nose loses an important component of tip stability and projection, and therefore something is needed to support the medial crura so that a new nasal tip can be formed (such as suture fixation or a columellar strut). A strut can impart unnatural rigidity (and often width) to the nasal base and increases graft requirements. This consideration may be inconsequential in primary patients, but in secondary patients, whose donor sites may already be depleted, every bit of graft material counts. In contrast, the limited pocket dissection of the closed approach minimizes the need for graft fixation and simplifies some procedures. Solid or crushed grafts can be used in ways that would be tedious or impossible through an open approach. Perhaps the most important consideration should be that freeing and displacing the nasal base tissues greatly reduces the feedback necessary to make accurate right-brain decisions, which is the aesthetic backbone for achieving balanced, symmetrical, and harmonious results. Open rhinoplasty access alone causes surgeons to forfeit details about nasal shape and balance that would otherwise guide intraoperative technique and decision-making. Finally, open rhinoplasty does not expose what is most needed for a successful result, namely a better understanding of the biologic and structural processes at work. The surgeon who does not understand rhinoplasty will not be successful through either route. Having failed by the endonasal method, it is false to hope that another attempt through open rhinoplasty will make matters clearer. Rhinoplasty is not made easier by a larger incision but rather by an accurate analysis of the surgical problem and adherence to a strategy that reflects the real biologic processes at work. Almost all secondary deformities result from inaccurate recognition of anatomic variants, tissue characteristics, or functional/structural interrelationships, and almost none occur because the surgeon could not see well. Throughout the images in this book and in the accompanying DVD, notice how much you can see from the surface and how that information guides subsequent decisions—seeing the undisturbed surface completes the critical second half of the feedback loop. Notice also how much I do under direct vision: essentially every step except osteotomy (which is not exposed through either surgical route) and tip grafting (for which the endonasal approach provides significant information on the details of tip contour, lobular tension, and degree of augmentation). The surgeon never needs to close a columellar incision under tension or perform a wider dissection than necessary for direct access to the parts needing modification. Finally,

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observe how much information is available about the details of dorsal and tip contour, and about what is happening in this supremely interactive operation. I will expand further on this concept in Part V, but there is a bigger issue here. If a surgeon analyzes a rhinoplasty problem in terms of maximizing function, identifying anatomic variants, and creating optimal balance, and if the surgical strategy uses economical incisions; maintains or establishes equilibrium; removes or repositions deforming parts; maximizes function; and uses grafts to create balance, contour, and structure, then there is no difference between primary and secondary rhinoplasty except the donor sites. The more difficult a case is, the greater any underlying scar, the more important it is to limit dissection, the more limited the donor material is, the more support that is required, and the more important it is to close the wound under tension, then the greater is the advantage of the endonasal approach. Limited dissection, limited morbidity, and safety: think of the closed approach as a short-scar rhinoplasty.

P hotography GENERAL POINTS Some years ago, a surgeon asked my advice about a rhinoplasty patient. Although he could produce several views of the postoperative result, his sole preoperative photograph was a single, lateral view taken from 4 feet away in the preoperative holding area. The patient was slumped half upright on the stretcher, head bowed from sedation. It is difficult to get much information from that kind of photograph, either as consultant or surgeon. How paradoxical it is that, in perhaps the most visual of surgical subspecialties, any plastic surgeon would take poor photographs. Consistent, accurate photographic documentation is a surgeon’s most valuable preoperative and postoperative record, and the most critical planning tool. Photographs are one of the primary means by which a surgeon can assess nasal structure and plan each important surgical step. Photographs educate patients about their own deformities, and, even more important, photographs permit surgeons to observe postoperative changes. They are the most effective method of self-education and the smoothest, most efficient pathway to improved postoperative results. Consistent, accurate photographs are available to every surgeon. Almost more important than picture quality is camera durability. I have irretrievably lost preoperative photographs or even entire rolls of film because my camera

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malfunctioned. One of the paradoxes of surgical life is that lost photographs seem to guarantee a perfect clinical outcome, which is both wonderful for the patient and terrible for the surgeon/teacher. It is forever the one that got away—therefore the possibility of losing photographs should be minimized as much as possible. It is wise to have two camera bodies so that the occasional mishap or mechanical failure does not stop the recording process. I have used a Nikon traditional film system for the last few years—the brand is durable and reliable in that medium. I use a standard 105 mm portrait lens in both the office and the operating room.

OFFICE PROCEDURE* Each new patient signs a photographic consent along with other questionnaires, because a signed consent at the beginning eliminates the need to find the patient later for consent. Each permission must be specific to the intended purpose. Comprehensive permission is important, particularly if the surgeon ever intends to use the patient’s photographs for medical education or publication. I do not routinely ask permission for Internet publication or for advertising. Some patients do not even want their photographs seen by other surgeons, and my staff marks the patient’s picture envelope accordingly. I take all photographs myself and review them with the patient during the preoperative visit. Each patient’s office and intraoperative photographs are labeled with a chart number and date, and they stay in the patient’s chart for reference during all postoperative visits. Most plastic surgeons have had patients react to their photographs after an operation by remarking, “I had forgotten how I looked.” Even patients who become content later may be temporarily disconcerted by a new appearance or alarmed by swelling. Accurate preoperative and interval photographs are reassuring and help to smooth the postoperative course. I have a reversing mirror to demonstrate preoperative nasal asymmetries, but photographs work even better. Seeing a reversed mirror image of themselves helps patients assess their features with fresh eyes and provides the surgeon with an opportunity to demonstrate surgically important anatomic areas and asymmetries and to explain relevant principles of balance and proportion.

*Surgeons who use digital photographs must adapt these offic procedures accordingly. The principles, however, still apply.

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One room in my office is dedicated to photography and has a wall-mounted, powered flash system that avoids shadows caused by camera-mounted flashes. One strobe is mounted above the patient’s head, and one is mounted on the opposite wall, both at ceiling height. Lighting can minimize or exaggerate surface contours, so a consistent system is vital for accuracy and reproducibility. Most surgeons have discovered that a patient’s head position and facial expression can improve or worsen nasal contours. A slight obliquity to a lateral photograph can hide supratip deformities, a smile can exaggerate inadequate tip projection, and head elevation changes apparent nasal length. It is important to standardize preoperative photograph positions, because they will affect your surgical decisions. Equally important is reviewing old photographs every time new ones are taken so that head position can be duplicated closely.

STANDARD VIEWS I take three frontal views (at 2.25, 2.5, and 3.5 feet), matching oblique views (at 2.25 feet), two lateral views (the left at 2.25 feet, the right at 2.5 feet), and an inferior view (at 1.75 feet). You may develop your own preferences, but each view provides specific information.

Frontal Views

The more distant frontal view shows patients at a typical conversational distance, whereas the closer views show more details.

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Oblique and Lateral Views

Oblique views

Lateral views

Each oblique view reveals the radix height and position, relative middle vault width (and any narrowing), tip lobular contour, tip projection relative to the septal angle, and nasal length. Matching obliques confirm symmetry. When the nose is crooked, the two oblique views always differ and exaggerate points of asymmetry in the bony or the upper or lower cartilaginous vaults. Oblique views are the ones that most patients consider the side view. Each lateral view shows radix height and position, dorsal configuration, tip position relative to the septal angle, and nasal balance and length. The right lateral view shows the patient at conversational distance, and the left (slightly closer) lateral view reveals details. Note also that even true laterals are not identical—they reveal differences in alar rim height and contour and any lateral crural asymmetries.

Inferior View The photographer may wish to align the nasal tip with the intercanthal line or the inferior orbital rim; it is only important to be consistent. The inferior, or basal, view indicates nostrillobular proportion, tip and alar wall contours, and middle and medial crural shape and strength, as well as details of tip symmetry and columellar width and contour.

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INTRAOPERATIVE PHOTOGRAPHY Good intraoperative photographs are priceless as a surgical record and even more important as a learning aid. I have taught myself rhinoplasty by photographing each step of the procedure and analyzing nasal shape as the surgery progressed and then comparing the immediate postoperative shape to the nasal appearance over the following months. Each intraoperative photograph should be staged: gloves, instruments, and drapes should be as clean and blood free as is practical; the focal length should be uniform and adequate to demonstrate the point being made; and each picture should make a surgical point as much as possible. Each operation may seem unique at the time, but over months and years the photographs become one long filmstrip of grafts, specimens, and colored cards. Thus it is important that each image be labeled as soon as it is processed and annotated with the surgeon’s notes.

A

B

This is the operative sequence of the young woman whose preoperative analysis was discussed on pp. 256-258. Notice the effect of the shortening that frequently follows dorsal reduction (A and B): as the alar rim moves cephalad, the columella looks too low. Through a short transfixing incision, a 2 mm membranous septal resection will correct the nostril-columellar relationship.

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C

D

E

F

Septoplasty yielded ample specimens (C). The spreader grafts are at the bottom of the grid and are shown again before insertion (D). The best septal piece was trimmed and crushed to serve as a radix graft, and it was fed into place through an intercartilaginous incision (E and F).

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H

The rest was crushed and trimmed for tip grafts (G). They were placed through a short infracartilaginous incision beneath the middle crus on one side (H).

At the very minimum, I photograph the lateral view at a standard distance (2.25 feet) at the beginning and end of every rhinoplasty. One of the ceiling-mounted operating lights is directed at the patient’s face, and the other is directed toward a colored card held behind the patient by the circulating nurse. I also use a cameramounted flash calibrated to the ambient operating room light.

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I photograph silhouettes in the same way, illuminating only the card with both operating lights but extinguishing all other ceiling lights and the camera flash. These views are particularly useful, because they demonstrate the immediate effect of skeletal rearrangement without the distraction of surface markings. Silhouettes are an excellent way to train your right brain, adjust your craft, and observe the magic.

Postoperative Analysis

Preoperative

1 week postoperatively

6 weeks postoperatively

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courses—there are many examples in the following chapters. Sequential photographs even more effectively teach what reduction and augmentation will accomplish in your hands and speed the development of your own judgment about which techniques work best, and when.

Only a few weeks after surgery, the dorsal skin has already adapted, repositioned lateral crura have filled the alar hollows, tip grafts have favorably reconfigured lobular shape, and the middle vault and tip have narrowed. Note that the nose still looks shorter in the oblique and lateral views, even though no more nostril is visible in the frontal view; this is partly a result of head position and partly a result of residual anterior skin edema that will resolve, allowing the tip lobule to drop. (Remember that the tip lobule is separate from the dorsum, not held in position by a strut or suture fixation.) 276

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Although early postoperative changes remain (including some cheek edema), the airway is widely patent. As the final appearance matures, postoperative adjustment should be easy for the patient. Notice that the combination of slight nasal shortening and rebalancing (from the radix graft) has diminished the size of the lower nose and reduced the apparent nostril length (from the tip grafts), even though the postoperative result is early. The distress that some patients feel in the postoperative course caused by unnatural contours or a diminished airway can be avoided in most cases by adherence to sound surgical principles, knowledge of nasal function and interrelationships, and good rapport with the patient.

BIBLIOGRAPHY Acland RD. Photomicrography through the operating microscope. Plast Reconstr Surg 60:730-734, 1977. Adamson PA, Smith O, Tropper GJ. Incision and scar analysis in open (external) rhinoplasty. Arch Otolaryngol Head Neck Surg 116:671-675, 1990. Anderson JR, Johnson CM Jr, Adamson P. Open rhinoplasty: an assessment. Otolaryngol Head Neck Surg 90:272-274, 1982. Baser B, Hiranandani N, Grewal DS. External rhinoplasty in the tropics. J Laryngol Otol 103:1198-1201, 1989. Jacobs SW, Schoenrock LD. The skyline view: a new perspective for rhinoplasty surgery. Facial Plast Surg 7:13-17, 1990. Kamer FM, Mayer TG, Fleming RW. Rhinoplasty record and retrieval system. Arch Otolaryngol 105:644-648, 1979. Mühlbauer W, Holm C. Computer imaging and surgical reality in aesthetic rhinoplasty. Plast Reconstr Surg 115:2098-2104, 2005. Sheen JH, Sheen AP. Aesthetic Rhinoplasty. St Louis: CV Mosby, 1987, pp 147-163. Webster RC, Davidson TM, Smith RC. “Practical suggestions on facial plastic surgery: how I do it.” External marking in rhinoplasty planning. Laryngoscope 87:126-133, 1977.

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Thou com’st in such a questionable shape that I will speak to thee. . . . WILLIAM SHAKESPEARE Hamlet Act I, Scene 4

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T heoretical and Practical Aesthetics Before planning any surgery, a surgeon must know his or her goals. To that end, at least for aesthetic nasal surgery, a great many sophisticated guidelines have been proposed based on absolute dimensions in millimeters, relationships to other facial landmarks, craniofacial cephalometrics, Renaissance ideals, and even the Golden Mean. Although each of these methods may apply in some circumstances, most are awkward or inapplicable for daily use. Despite these sophisticated parameters, rhinoplasty surgeons are more limited than they may wish to admit. Skin volume and thickness, skeletal strength and structure, and the bony and soft tissue elements of a patient’s face have all been predetermined. Unless the surgeon is planning a major rearrangement of craniofacial structures, it is impractical to create nasal aesthetics defined by ideal standards, because the surgeon does not really control any feature but the nose.

One common aesthetic guideline indicates that interalar width should equal intercanthal width. However, that guideline does not fit any of these patients. Should this fact influence their surgeon’s plan?

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If we do make the nasal base width equal to the intercanthal width, we create several new problems. Even in patients whose preoperative tips were narrow, their new, hypothetical tip lobules become too broad for their bases, and the bases are too narrow for the bony vault width.

But the narrow bases aren’t a problem, because we can narrow the bony vaults. However, with narrow bases, the patients’ tip lobules are too wide.

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Now assume that the tip lobule can be narrowed as significantly as shown here (which I do not believe is possible): where does that leave the patient? Alar base width now equals intercanthal distance, but other elements, including normal appearance and function, have been sacrificed. It is true that most surgeons do not perform alar wedge resections first, as we did in our exercise. However, the order of steps does not matter—if the object is to make the interalar and intercanthal distances equal, the final outcome will be the same.

Slavish observance of aesthetic rules is not a theoretical problem. In each of the patients on p. 283, the surgeon was trying to achieve a certain ideal, but presupposed soft tissue and skeletal changes that were not possible. The failure of the first plan was followed by an effort to compensate, which also did not work and was followed by further efforts to compensate, and so on. It was not the surgeon’s skill that was absent, but rather the establishment of a realistic preoperative plan.

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The skeletal plan was correctly executed in both of the patients on these two pages, but the soft tissues were biologically unable to adapt. Recall False Assumption Number One (see Chapter 2): the nasal soft tissue cover has an infinite ability to contract to the shape of any underlying skeleton. Nasal soft tissues can contract, particularly in the upper nose, but they cannot contract infinitely. Of the nasal skeleton and the skin sleeve, the skin sleeve is not the greater variable, but the lesser.

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If a surgeon could reduce skin volume beyond its natural capacity, which is occasionally done in exceptional cases (see Chapter 17), the size of any postoperative nose could be altered more radically to any patient’s facial measurements, body habitus, or other parameters. Even for breast reduction, in which skin resections match and support a reduced parenchyma, aesthetic limits are imposed by the size and configuration of the patient’s torso. Rhinoplasty surgeons work under greater constraints, governed by the skin sleeve’s volume, distribution, and relationship to other facial structures. Any aesthetic goals must reflect these real limits.

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T he Reality of the Ideal in Facial Analysis THE NEOCLASSICAL CANONS Renaissance artists, including Dürer, Alberti, Cousin, Audran, Francesca, Pacioli, Cennini, Savonarola, and da Vinci, formulated a series of canons that has continued to be used in art and subsequently in medicine through the influence of the artist-anatomists of the seventeenth to nineteenth centuries. They are given in the table below and compared with the findings of the actual occurrence of the ideal in three populations.

Occurrence of the Neoclassical Canons in Three Ethnic Populations

Neoclassical Canon

The head can be divided into halves at a horizontal line through the eyes The face can be divided into thirds, with the nose occupying the middle third The head can be divided into quarters, with the middle quarters being the forehead and nose, respectively The length of the ear is equal to the length of the nose The distance between the eyes is equal to the width of the nose The distance between the eyes is equal to the width of each eye The width of the mouth is 1½ times the width of the nose The width of the nose is ¼ the width of the face The nasal bridge inclination is the same as the ear inclination The lower face can be divided into equal thirds The lower face can be divided into equal quarters

Average Occurrence in White Population (%)

Average Occurrence in Black Population (%)

Average Occurrence in Chinese (Han) Population (%)

10

NA

NA

0

0

NA

0

NA

NA

4.9

1

NA

40.8

3

35.4

33.0

13

36.5

20.4

1

21.8

36.9

0

51.5

8.9

3

NA

0

NA

NA

0

NA

NA

Modified from Bashour M. History and current concepts in the analysis of facial attractiveness. Plast Reconstr Surg 118:741, 2006.

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As useful as these guidelines may be in art, they unfortunately do not apply very often to human beings. Farkas, Vegter and Hage, and Dawei have tested the validity of these ideals in white, black, and Chinese populations, and the reality is that they almost never apply (see the table on p. 287). Interestingly, when Farkas tested “attractive” and “average” faces in North American populations against the canons, none conformed to them.

One surgical goal in each of these women was to reduce the interalar width. As the data indicate in the table on p. 287, intercanthal distance equals nasal base width in only 3% of blacks. Imagine how many noses have been distorted by following this single aesthetic precept.

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The application of the ideal neoclassical canon to rhinoplasty was strengthened by Joseph, who performed his own measurements on the nasofacial angle and supported the da Vinci/Dürer canon that the ideal length of the nose must equal the length of the lower facial third. The Golden Ratio, or phi (defined as an angle ABC where the ratio AB/AC equals BC/AB), is also often cited as a standard for various nasal proportions. However, none of these rules apply to most rhinoplasties. Much more provocative are the studies that have investigated the psychology of facial attractiveness. It apparently takes only 150 milliseconds and no eye movement for a person to decide whether a face is attractive. Correlated with electroencephalographic activity, a number of studies have indicated that facial aesthetics, emotion, and speech factor equally to determine personal appeal and are processed separately by the brain. It appears that three components of facial attractiveness are critical: averageness, symmetry, and neoteny (juvenile features in an adult). Averageness indicates similarity to a typical phenotype for a group and therefore signals genetic diversity (and presumably greater health and disease resistance). Symmetry seems obvious as a characteristic of attractiveness; in fact, studies across a number of species have shown that less fluctuating asymmetry (that is, greater symmetry) is associated with both fitness and fertility. Interestingly, it is not simple youthfulness but neoteny that is particularly associated with facial attractiveness. A baby’s features (large eyes, small nose, round cheeks, smooth skin, glossy hair, and lighter skin tones) correlate with greater perceived attractiveness, more paternal attention, and even a lower incidence of child abuse. The preference for childlike facial features appears consistently across ethnic populations, regardless of sexual orientation. Attractiveness is also apparently associated with sexual dimorphism—that is, the degree to which a particular face resembles the prototype of his or her sex. In a man, this means a larger jaw and supraorbital ridge; more prominent cheekbones; smaller eyes; thinner lips; and a wider, larger nose. In a woman, dimorphism indicates prominent cheekbones; smooth, hairless skin; wider eyes; higher, thinner eyebrows; a smaller jaw; fuller lips; and a shorter, smaller nose. Therefore although facial attractiveness may not conform to phi or other mathematical proportions, it nevertheless does derive from species-specific psychological adaptations.

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RELEVANCE TO RHINOPLASTY These findings have several implications when planning rhinoplastic surgery: 1. The goal of surgery should be to produce average characteristics of a patient’s sexual prototype, not necessarily in measurement but contour (size and shape). 2. The result should be ethnically and racially appropriate. 3. Specific contours should be sexually dimorphic: in men, this may mean a larger nose; in women, perhaps a shorter nose. It thus appears that any patient’s desired aesthetic goals may derive, more than anything else, from their own DNA.

The upper and middle thirds of this patient’s nose were both narrow and asymmetrical—too narrow for a nasal base that could not be reduced successfully. Interalar distance realistically cannot always equal intercanthal distance—and does so in only 40.8% of whites. An upper dorsal graft and spreader grafts of different thicknesses straightened and camouflaged the anterior septal edge. Postoperatively, her nose is wider, but is that a problem? Cover the preoperative image and examine only the postoperative image without comparison: it is still appropriate for the patient’s face. In this case, it was neither possible nor desirable to maintain the width of the collapsed airway and attempt to match it to the rest of the nose, yet the nose was straightened without the risks associated with scoring or fracturing the anterior septal edge. A strategy that begins and ends with reduction may not always accomplish a patient’s goals, but such a strategy is easy to understand. Traditional rhinoplasty is 290

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framed as a reduction operation. Most patients come to a surgeon’s office requesting reduction and may not be aware of areas that are too small or that are collapsed, even when this is demonstrated to them. When patients express dissatisfaction with a wide nose, a bump, a fat tip, or large nostrils, they are pleading for reduction. Reduction is part of nearly all my surgical plans. Yet some reductions are not possible, others do not succeed, and still others are not safe. As with so many surgical operations, we must start with an ideal and then compromise.

A Nose That Fits the Face Can a surgeon really make a nose that fits the face? Perhaps, depending on the meaning attached to the phrase.

A

B

C

D

Any rhinoplasty goal must be tempered by characteristics that neither surgeon nor patient can modify significantly: skin sleeve volume and its ability to contract. Whether the two patients shown here are 5 feet 2 inches tall or 6 feet 2 inches tall, their frame and head sizes have no influence on their nasal skin sleeve size, distribution, or capacity to contract to smaller skeletal volumes. Contrary to much traditional thinking, the skin sleeve is not the greater variable: it is the lesser. The skeleton offers greater flexibility for reduction, augmentation, or rearrangement, with less risk of trading distortions in the process. Compare the preoperative noses of these two women: the patient in A and B was seen for a secondary procedure, and the patient in C and D underwent a primary procedure. The nose of the first patient had been reduced previously; the second patient’s nose was reduced and rebalanced with radix and tip grafts. Yet one of the postoperative noses looks larger at the base and one looks smaller. It is often possible to reach a patient’s goal of a smaller nose using a less conventional approach that respects the larger biologic processes at work. 291

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Really fitting the face, in the comprehensive sense of understanding the patient’s goals, preserving or modifying certain familial or ethnic traits, and maximizing function, is entirely possible, as we shall see.

P ractical Aesthetics and Parameters for Planning The following aesthetics may seem prosaic and oversimplified, but they are practical and largely achievable in most patients.

FRONTAL VIEW

Viewed from the front, the upper nose (nasal root and bony vault) should be narrower than the lower nose (nasal base), and symmetrical, confluent, divergent lines should connect the two. The highlights that define the edge of the dorsal plane should be continuations of the supraorbital ridge. Aesthetics are the same whether the skin is thick or thin, whether the nose is wide or narrow. 292

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Dorsal reduction altered the frontal balance in this patient: her upper nose is as wide as her nasal base, and the nasal sidewalls are parallel rather than divergent. A dorsal rib graft (without osteotomy) has narrowed the upper nose and reestablished the continuity of the dorsal lines with the supraorbital ridges. Adequate bridge height is important: note the subtle way in which dorsal height has favorably altered apparent nasal width and reduced apparent nasal size. The nasal tip highlights, formed by the lateral genua and their extensions into the lateral crura, should constitute continuations of the lateral dorsal lines and were re-created here with tip grafts. It is not important for the tip to be narrow; it is not important for the alar walls to be flat. Not all noses were meant to be identical.

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OBLIQUE VIEW

In oblique views, which many patients consider to be their “profiles,” there should be no regional discontinuities, and ideally the left and right oblique views should match as closely as possible.

The supratip should be flat, and the mass of the tip lobule should fall below the level of the peaks created by the lateral genua.

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LATERAL VIEW The lateral view is the one seen most often in the literature, despite the fact that most patients rarely see themselves from this angle. The aesthetic ideals of lateral views are similar to those of oblique views: smooth, confluent lines and a welldefined lateral genu, with nasal balance being critical. The surgeons who have defined lateral aesthetics in terms of facial angles are entirely correct, but how far those standards can be taken and applied depends on each individual case, especially on preoperative skin sleeve volume, thickness, and distribution. Nevertheless, the higher the nasal radix, the longer the distance is from radix to tip, and the smaller the nasal base seems.

A

B

Although both of these nasal bases are identical, the one on the left looks smaller because the dorsal line is longer: the radix in A begins at the upper lash margin, whereas the radix in B begins at the lower lash margin. Surgeons must recall the distinction between nasal base size (a reflection of lower nasal skin volume) and tip projection (a reflection of alar cartilage strength and dimension).

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A

B

C

D

The radix, however, is not an absolute landmark—it must relate to the size of the nasal base: If the nasal base is short, as in A and B, a nasal radix that begins at the midpupillary level may balance the face appropriately. If the base is large, as in C and D, it may not.

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INFERIOR VIEW As with the frontal, oblique, and lateral views, nasal base lines should be smooth, without regional discontinuities, notching, or asymmetries.

Nostrils should equal one to two times tip lobular length, a proportion that can be affected by changing either part. Depending on what is done to the alar cartilages (that is, the degree of resection) and how much tip projection increases, augmentation may or may not increase tip lobular size. The eye measures nostril length relative to tip lobular size, and vice versa. Tip grafting that enlarges the lobule therefore decreases apparent nostril length. The reverse is also true: tip reduction that decreases projection and lobular volume increases apparent nostril size, as in this patient.

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In this patient, alar wedge resections were not performed, but because the grafted tip lobule is longer, the nostril seems relatively shorter.

When the tip lobule cannot be reduced, the nostril can often be relatively increased by resecting the medial crural footplates.

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Minute changes—minimal dorsal reduction, a onelayer radix, and crushed cartilage tip grafts—can profoundly alter dorsum/tip relationships and nasal balance, as illustrated with this patient. The surgical details always depend on a patient’s skeletal framework, soft tissue cover, and aesthetic goals, but rhinoplasty offers, as much or more than any aesthetic procedure, the possibility of individualizing a result.

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T hree Surface Parameters for Rhinoplasty Planning The nasal skin sleeve ultimately limits the surgical plan more than any other single variable, so it is safest and often most practical to establish a surgical strategy based on soft tissue parameters. Because a normal skeleton is not necessary for establishing this plan, the following three parameters apply in primary and secondary cases alike, regardless of whether the skeleton influences surface contour. These parameters may at first seem hopelessly vague—too general, too undefined, too deficient in measurements and angles, too lacking in precision and rules. However, this is because they are all right-brain concepts: spatial, relational, holistic, and free-form. As you consider each planning principle, try to see the examples as you saw the illustrations in the section on right-brain analysis in Chapter 3: as shapes, edges, and planes, filled with as much detail as possible. Do not name parts; instead, observe patterns, likenesses, and spatial relationships.

Parameter 1: Skin Thickness and Distribution Most surgeons understand that skin thickness has an impact on any rhinoplasty plan and affects both reduction and augmentation. Thicker skin will contract less and requires more substantial grafts to effect a surface change. Thinner tissues allow greater reduction but require softer, more carefully constructed grafts to avoid surface distortions.

PATIENT STUDY ONE

PATIENT STUDY TWO

Here are two patients with almost identical configurations: short noses with short nasal bones and notched radixes, high dorsa, and inadequate tip projection.

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PATIENT ONE

A

B

C

PATIENT TWO

D

E

F

Because deformities and disproportions (imbalances) are similar, the plans for both patients can be similar. The main anatomic differences are skin sleeve character (thicker in Patient Two) and lateral crural orientation—orthotopic in Patient One, cephalically rotated (malpositioned) in Patient Two. Notice also in each woman that the cartilages are unable to support their valves: the entire sidewalls collapse with inspiration (B and C; E and F).

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Each woman has a defined aesthetic goal: a straight nose with adequate tip projection. The preoperative visit is a good time to point out the height of the radix in each mode—the upper lash margin— and explain the effect that its position has on nasal balance.

SUMMARY OF THE SURGICAL PLAN The specifics of the techniques given here are detailed in Chapter 11. 1. Limited skeletonization of the radix through a single intercartilaginous incision Patient One: No lateral crural reduction Patient Two: Lateral crural relocation through short, bilateral, infracartilaginous incisions 2. Dorsal reduction 3. Septoplasty 4. Spreader grafts (not shown for patient A) placed through the intercartilaginous incision 5. Radix grafts, layered and contoured to the defects, placed through the same intercartilaginous incision 6. Tip grafts, suited to the soft tissue cover, placed through an infracartilaginous incision opposite the intercartilaginous access wound 7. No transfixing incisions, no osteotomies

Aside from alar cartilage treatment, the only other major technical differences in the surgical plans are the degree of reduction and the stiffness and thickness of the grafts required. Both women had blunt tip contours and desired more shape; thus each needed tip augmentation. In each case, I exploited the same illusion: a longer dorsal line helps maintain optimal proportion and minimizes any increase in apparent nasal base size.

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PATIENT ONE

A

PATIENT TWO

D

Yellow card

B

E

After resection

C

F

Specimens

In each patient, dorsal reduction straightened the nose but did not increase the shape. If the procedure had stopped after resection of the cartilaginous roof and without spreader grafts, each woman would have lost some of her airway—arguably as much as 50% of her preoperative flow (see Chapter 4). Each septum yielded wonderful graft material. On each grid, the resected nasal skeletal cartilage is on the left, prepared spreader grafts are in the center, and the rest of the septal specimen is on the right. In both women, spreader grafts reestablished middle vault stability (as seen in J, p. 304), thereby preserving internal valvular function. 303

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PATIENT TWO

J

Spreader graft

PATIENT ONE

G

K

H

L

Radix graft

I

M

After radix graft

The radix graft in each patient was longer than the actual defect, but beveled and thinned distally to smooth into the dorsal line without visible or palpable discontinuity. In I and M the graft effect can be seen—compare against B and E on p. 303. These grafts must feel flawless at surgery, or the late result will not be ideal. 304

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PATIENT ONE

N

PATIENT TWO

P

Tip grafts

O

Q

Blue card

Tip grafts were sized, trimmed, and softened to accommodate skin thickness and resistance. Thicker, stiffer soft tissues require firmer grafts to maintain a desired postoperative correction. Thinner tissues need softer grafts. Multiple grafts are always used to distribute supportive forces and minimize postoperative asymmetries and graft visibility. At the conclusion of each procedure (O and Q), the tips were above their respective dorsal lines, radixes were optimally placed for each woman, and balance was improved. Note that the noses do not look identical: each tip was set to accommodate expected postoperative changes based on preoperative shape, tissue thickness and pliability (that is, how much each will resist augmentation), and each patient’s goal. Notice also how little dissection was performed: two short access incisions in Patient One, three in Patient Two, and separation of tissues only in areas to be modified.

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Postoperative Analysis

Six years postoperatively (Patient One) and 10 years postoperatively (Patient Two), the noses remain similar, and the soft tissues are unchanged. Large bases remain large.

PATIENT ONE

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PATIENT TWO

A surgeon’s goals should be to maintain function, retain skin quality, and reduce deformity with the least morbidity and the lowest chance of creating a new problem. Both of these patients were treated through short incisions and limited dissection, but shape and proportion were increased, and, most of all, function was improved. Geometric mean nasal airflow increased 5.4 and 1.5 times over preoperative values, respectively, for the two women.

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Parameter 2: Tip Lobular Contour

A

B

In their simplest terms, ideal tip aesthetics (A) require a point of greatest projection (created by the lateral genua) that is sufficiently high on the tip lobule (indirectly reflecting adequate middle crural length) to create adequate projection, a flat supratip, and a tip lobular mass that falls below the point of greatest projection. In contrast, a poorly shaped tip lobule (B) has a point of greatest projection that falls low on the lobule itself (reflecting a short middle crus), a convex supratip, and a tip lobular mass that lies cephalad to the point of greatest projection. These characteristics are easy to recognize.

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A

B

C

D

E

F

G

H

These patients all have poorly shaped tip lobules. In each case, the point of the tip is low, the supratips are convex, and tip lobular mass lies cephalad to the level of the lateral genua. Four of the patients (A through D) have poor tip projection (the tip does not project to the level of the supratip dorsum). Most inadequately projecting tips have poorly shaped tip lobules because of the short middle crural segment, which determines tip projection more than any other single structure. However, the other four patients (E through H) have adequate tip projection (tips projecting beyond the septal angle), but the tips are still poorly contoured. Tip projection and tip shape are usually independent variables, as are tip projection and nasal base size.

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A

B

C

D

E

F

G

H

These patients have well-shaped tip lobules. Their common characteristics are easily recognizable: the supratip is flat, the most projecting point of the tip is high (indicating adequate middle crural length), and the mass of the tip lobule falls below the point of greatest projection. Well-contoured tips may also project adequately (A through D) or inadequately (E through H). Thus in this parameter, the tip lobule is assessed by itself, independent of its relationship to other nasal areas.

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It is important to recognize that simple alar cartilage reduction cannot convert a poorly shaped lobule to a well-shaped lobule, although many earlier rhinoplasty atlases have indicated otherwise. If the point of greatest projection (also called the tip-defining point) is low, the responsible anatomy is a short middle crus.

A

Before hump removal

B

After hump removal

C

Good tip lobule

Even a conservative reduction, as demonstrated in the previous patient and in these illustrations, does nothing to alter middle crural length (B). To transform a poorly shaped tip lobule to a well-shaped tip lobule, a surgeon must, in effect, lengthen the middle crural segment by some method—sutures, struts, or grafts (C). The weaker

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the alar cartilages and the shorter the middle crural segment, the more dorsal height supplies tip support. Dorsal reduction and lateral crural resection each decrease tip projection in such patients. Because a poorly shaped lobule identifies a short middle crural length, augmentation (tip grafting) provides a direct and anatomically logical solution. Columellar struts also project the tip, but they focus their energy at the wrong crural segment: it is not the medial crus that is deficient.

Parameter 3: The Balance Between Nasal Base Size and Bridge Height This parameter has been discussed already as one of the critical elements of nasal aesthetics, and it is part of the magic of rhinoplasty. This is the principle through which a large nasal base can be better assimilated into the upper nose. It is a pure right-brain idea: the higher the nasal dorsum (and the longer the distance from nasal radix to tip), the smaller the nasal base appears.

Dorsal reduction profoundly affects apparent nasal base size, although fortunately not always as obviously as in this woman. Because the nasal root was already low, the surgeon worsened the problem by resecting the hump. Unable to contract, all of this woman’s nasal skin seems to have slid toward her nasal base.

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Fortunately for us and our patients, the same principle works in reverse. In these two patients, raising the dorsum has reduced apparent nasal base size, a paradoxic principle that most patients and surgeons have to see themselves to believe. These women’s tissues are thick. If the principle works here, it will work anywhere.

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BIBLIOGRAPHY Aharon I, Etcoff N, Ariely D, et al. Beautiful faces have variable reward value: fMRI and behavior evidence. Neuron 32:537, 2001. Alley TR. The effects of growth and aging on facial aesthetics. In Alley TR, ed. Social and Applied Aspects of Perceiving Faces: Resources for Ecological Psychology. Hillsdale, NJ: Erlbaum, 1988. Alley TR. Infantile head shape as an elicitor of adult protection. Merrill Palmer Q 29:411, 1983. Bashour M. History and current concepts in the analysis of facial attractiveness. Plast Reconstr Surg 118:741, 2006. Bashour M. An objective system for measuring facial attractiveness. Plast Reconstr Surg 118:757, 2006. Cunningham MR, Barbee AP, Philhower CL. Dimensions of facial physical attractiveness: the intersection of biology and culture. In Rhodes G, Zebrowitz LA, eds. Advances in Visual Cognition—Facial Attractiveness: Evolutionary, Cognitive, Culture, and Motivational Perspectives. Westport, CT: Ablex, 2001. Cunningham MR, Roberts AR, Barbee AP, et al. Their ideas of beauty are, on the whole, the same as ours: consistency and variability in the cross-cultural perception of female physical attractiveness. J Pers Soc Psychol 68:261, 1995. Dawei W, Gouzheng Q, Mingli Z, et al. Differences in horizontal, neoclassical facial canons in Chinese (Han) and North American Caucasian populations. Aesthetic Plast Surg 21:265, 1997. Eibl-Ebersfeldt I. Human Ethology. New York: Aldine DeGruyter, 1989. Farkas LG, Forrest CR, Litsas L. Revision of neoclassical facial canons in young adult Afro-Americans. Aesthetic Plast Surg 24:179, 2000. Farkas LG, Hreczko TA, Kolar JC, et al. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg 106:1090, 2000. Farkas LG, Katic MJ, Hreczko TA, et al. Anthropometric proportions in the upper lip-lower lip-chin area of the lower face in young white adults. Am J Orthod 86:52, 1984. Farkas LG, Kolar JC. Anthropometrics and art in the aesthetics of women’s faces. Clin Plast Surg 14:599, 1987. Farkas LG, Kolar JC, Munro IR. Geography of the nose: a morphometric study. Aesthetic Plast Surg 10:191, 1986. Goldstein A, Papageorge J. Judgments of facial attractiveness in the absence of eye movements. Bull Psychon Soc 15:259, 1980. Henss R. Perceiving age and attractiveness in facial photographs. J Appl Soc Psychol 21:933, 1991. Hildebrandt KA, Fitzgerald H. The infant’s physical attractiveness: its effects on bonding and attachment. Infant Ment Health J 4:3, 1983. Jones D. Physical Attractiveness and the Theory of Sexual Selection: Results from Five Populations, vol 90. Ann Arbor: University of Michigan Museum, 1996. Jones D. Sexual selection, physical attractiveness and facial neoteny: cross-cultural evidence and implications. Curr Anthropol 36:723, 1995. Jones D, Hill K. Criteria of facial attractiveness in five populations. Hum Nat 4:271, 1993. Joseph J. Nasenplastik und Sonstige Gesichtsplastik. Leipzig, Germany: Curt Kabitzch, 1931. Langlois JH, Roggman LA, Musselman L. What is average and what is not average about attractive faces? Psychol Sci 5:214, 1994. Leung B, Forbes MR. Fluctuating asymmetry in relation to stress and fitness: effect of trait type as revealed by meta-analysis. Ecoscience 3:400, 1996. Manning JT, Scutt D, Lewis-Jones DI. Developmental stability, ejaculate size and sperm quality in men. Evol Hum Behav 19:273, 1998. Manning JT, Scutt D, Whitehouse GH, et al. Breast asymmetry and phenotypic quality in women. Evol Hum Behav 18:223, 1997. Mathes EW, Brennan SM, Haugen PM, et al. Ratings of physical attractiveness as a function of age. J Soc Psychol 125:157, 1985.

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McCabe V. Abstract perceptual information for age level: a risk factor for maltreatment. Child Dev 55:267, 1984. Moller AP. Developmental stability and fitness: a review. Am Nat 149:916, 1997. Moller AP, Swaddle JP. Developmental Stability and Evolution. New York: Oxford University Press, 1997. Moller AP, Thornhill R. Bilateral symmetry and sexual selection: a meta-analysis. Am Nat 151:174, 1998. Moller AP, Thornhill R. A meta-analysis of the heritability of developmental stability. J Evol Biol 10:1, 1997. Nakamura K, Kawashima R, Nagumo S, et al. Neuroanatomical correlates of the assessment of facial attractiveness. Neuroreport 9:753, 1998. O’Doherty J, Winston J, Critchley H, et al. Beauty in a smile: the role of medial orbitofrontal cortex in facial attractiveness. Neuropsychologia 41:147, 2003. Pittenger JB, Shaw RE. Aging faces are viscal-elastic events: implications for a theory of nonrigid shape perception. J Exp Psychol Hum Percept Perform 1:274, 1975. Ricketts RM. The biologic significance of the divine proportions and Fibonacci series. Am J Orthod 81:351, 1982. Ricketts RM. Divine proportions in facial esthetics. Clin Plast Surg 9:401, 1982. Rubenstein AJ, Langlois JH, Roggman LA. What makes a face attractive and why: the role of averageness in defining facial beauty. In Rhodes G, Zebrowitz LA, eds. Advances in Visual Cognition—Facial Attractiveness: Evolutionary, Cognitive, Cultural, and Motivational Perspectives. Westport, CT: Ablex, 2001. Thornhill R, Gangestad SW. Facial attractiveness. Trends Cogn Sci 3:452, 1999. Todd JT, Mark LS, Shaw RE, et al. Perception of human growth. Sci Am 242:132, 1980. Tolleth H. Aesthetics and plastic surgery. In Terino EO, Flowers RS, eds. The Art of Alloplastic Facial Contouring. St Louis: Mosby–Year Book, 2000. Vegter F, Hage JJ. Clinical anthropometry and canons of the face in historical perspective. Plast Reconstr Surg 106:1090, 2000. Waynforth DC. Male mating strategies among the Mayas of Belize (men). PhD thesis, University of New Mexico, 1999. Zebrowitz LA, Olson K, Hoffman K. Stability of babyfaceness and attractiveness across the life span. J Pers Soc Psychol 64:453, 1993.

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CHAPTER 8 P lanning R hinoplasty: A pplied Concepts and A esthetics It is amazing what grand thoughts and great speculations we can logically develop on this planet—thoughts about the chemistry of the whole universe—when we have such a [small] sample here at hand. HARLOW SHAPLEY Of Stars and Men

To the physician, each man, each woman, is an amplification of one organ. RALPH WALDO EMERSON The Conduct of Life

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T he Consultation “Listen to your patient. He will tell you what is wrong with him.” This quote, attributed apocryphally to Sir William Osler, applies better to rhinoplasty than perhaps any other plastic surgical operation. Plastic surgeons are good diagnosticians. They are raised that way during their general surgical residencies: make an expeditious diagnosis and proceed with treatment. For most plastic surgery operations, even many cosmetic procedures, that principle holds, but for rhinoplasty it does not. Rhinoplasty offers, perhaps more than any other aesthetic procedure, the possibility of individualizing a result; but it is more than that: success in rhinoplasty demands that the result be individualized, because doing so will prevent a great many perioperative and postoperative problems. Rhinoplasty presents unique difficulties for surgeons, but it is difficult for patients as well. Surgeons who have seen secondary rhinoplasty candidates devastated by the results of one or more previous operations should immediately recognize the importance of a safe and biologically sound surgical plan and of an accurate understanding between patient and surgeon of the aesthetic goals and (in particular) realities of the surgical problem—that is, what is possible and what is not. Making the initial interview even more difficult are the prevailing misconceptions that many patients hold about their nasal deformities and therefore about the corrective plan. Patients do not often recognize that a simple nasal reduction may not achieve their goals. Patients without airway obstruction do not appreciate the importance of maintaining nasal function, and most do not recognize that an improperly performed rhinoplasty can jeopardize the airway. Patients must therefore be guided to understand that every rhinoplasty is a compromise between a patient’s preferred aesthetic goals and the limitations that a predetermined preoperative skeletal and soft tissue configuration imposes. We start with the ideal goal, and then compromise. Donor materials vary in quantity, character, and composition, which determine their usefulness. Furthermore, many patients’ noses already have some desirable features preoperatively; patients and surgeons must be careful not to destroy these.

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It is important to elicit a patient’s goals in the greatest possible detail and to prioritize them. Is the major issue bridge height, tip projection, nasal length, asymmetry, or airway? Frequently the language of the complaint itself provides a clue to the anatomic diagnosis. A patient who says, “My tip pulls down when I smile,” “The tip droops (or hangs),” or “I have a hook on the end” is likely describing inadequate tip projection. A patient who says, “My tip sticks out too far” is describing a balance problem, often associated with a relatively low radix or dorsum. A patient who says, “I have a ball (or a box) on the end of my nose” is probably describing alar cartilage malposition (cephalic rotation). How long has the patient had a sense of deformity regarding his or her nose? This question is more critical for older patients: one 60-year-old patient who has disliked her nasal shape for 40 years may tolerate a larger change than one troubled for only 5 years, who may be noticing signs of aging. Many patients can remember an exact instance in which the sense of deformity appeared: one woman said, “I was 12 and on the bus and the boy next to me said, ‘You have a big nose.’ I looked in the mirror that afternoon, and he was right—I have been self-conscious ever since.” I interview and examine any patient older than 14 years alone first (always with parental permission, if a minor), before involving the family, spouse, or others of significance in the discussion. Some protective family members or spouses initially object to this policy, but it is important to establish an individual relationship with the patient and to hear his or her concerns and complaints free of any outside influences. Not surprisingly, it is usually the family members who object most strongly who should be excluded most from the initial consultation. Their presence invariably distracts or intimidates the patient, and questions to the patient elicit responses from the family members instead, like some odd ventriloquist act. If, after an adequate explanation by my staff, the patient’s family or significant other will not accept an initial interview with the patient alone (which does occasionally happen), that response is an important sign that should not be overlooked.

BODY IMAGE A great deal has been published about body image and the ways in which patients become sensitized to perceived deformities and develop compensatory mechanisms before seeking plastic surgical consultation. Dr. Marcia Goin has defined body image as “the mental representation of one’s body at any given moment, . . . the picture one has of one’s self as seen through one’s own mind’s eye. . . . This mental picture is not necessarily static.”

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Frequently body image elements can be drawn from the patient during the interview, and in doing so the surgeon must try to assess not only the degree of the perceived deformity, but also how long and how significantly it has affected the patient’s life and relationships. In a single afternoon of plastic surgery practice, it is possible to meet patients who have been severely disfigured for two decades but who nevertheless have led productive lives in highly visible careers, and others with insignificant (or even imaginary) deformities who have become completely incapacitated by them. The most extreme examples, patients suffering from body dysmorphic disorder (BDD), are discussed in detail in Chapter 20. However, it should be mentioned that across all cultures, the facial feature most commonly focused on by patients with BDD is the nose.

S pecifics of the History RHINOLOGY Aside from the patient’s general medical condition and suitability for surgery, I inquire specifically about the elements that affect my diagnosis or treatment. Using the acronym ASSERT, I inquire about allergies (and any seasonal or periodic airway obstructions); suppurative sinusitis (requiring antibiotics); snoring; epistaxis; a history of episodic or chronic rhinitis; and previous trauma (which may signal an important and potentially unhealed or unstable septal fracture).

AESTHETICS The language a patient uses is important. Words have nuanced meanings, and most patients will select them specifically, even if unconsciously. There are patients who “hate everything” about their noses, patients who “like everything but the tip,” patients who “just want the bump taken off,” patients unhappy that they “inherited my father’s (or mother’s) nose,” and one delightfully memorable teenager who simply said, “My nose ruins my image.”

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PATIENT STUDY ONE

It is no secret that the nose conveys ethnic characteristics. This primary rhinoplasty patient, an Armenian woman, was adamant that she wanted to preserve the ethnic character of her nose. She wanted to shorten the nose only slightly, retain some of the dorsal hump, and refine the tip.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization of the root 2. Limited dorsal reduction 3. Transfixing incision; 2 mm resection of caudal and membranous septum, shortening the nose slightly 4. No alar cartilage reduction 5. Submucosal 3 mm resection of the caudal ends, upper lateral cartilages 6. Septoplasty 7. Spreader grafts 8. One-layer radix graft 9. Crushed cartilage tip grafts 10. Bilateral osteotomies

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Postoperative Analysis

Eighteen months after surgery, her nose is slightly shorter, but its major characteristics have not changed. A slight dorsal reduction and radix graft have softened dorsal height and improved overall balance while maintaining skeletal volumes so that the nose does not lengthen again postoperatively. Crushed tip grafts have added projection and effectively lengthened the middle crus without becoming visible underneath the thin skin. The flat anterior lobule persists postoperatively, however. It could have been improved with a small filler graft, but the patient never underwent revision.

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PATIENT STUDY TWO

This primary patient was referred to me after having seen several surgeons who either did not understand what he wanted or did not want to correct it. He was quite reasonable and consistent, and his surgical objective was specific: he wanted the angularity of his tip reduced. His relatively thin skin and strong alar cartilages produced knuckles at the domes, and he simply wanted “softer” tip contours.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization through a single intercartilaginous incision 2. Slight reduction of the cartilaginous dorsum, not opening the roof 3. Vertical 3 mm resection of the alar cartilages at the lateral genua bilaterally, through infracartilaginous incisions 4. Septoplasty 5. Crushed cartilage tip grafts, on the right side more than on the left (for a preoperative asymmetry) 6. Contour grafts to the anterior lobule and columella through vestibular skin incisions

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Postoperative Analysis

This is a result that no one but the patient should notice. The dorsum is slightly straighter, nasal balance is unchanged, and the tip, while maintaining the same good preoperative aesthetics, is less angular.

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As modest as these changes are, this is not a case to be performed as one of a surgeon’s first ten rhinoplasties. Too large a dorsal resection and heavy-handed tip refinement would have created a supratip deformity. A dorsal resection opening the roof could create internal valvular incompetence. A solid tip graft would have reproduced the same postoperative shape, including the surface deformities. I have learned to tread lightly when the deformity is modest.

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Occasionally patients are less specific and should be drawn out in the initial consultation. I hand each patient a mirror and ask him or her to show me which areas are liked and which areas are not. Some patients, particularly men, are unable to articulate specifics; this can signify a patient who needs to be focused (but not directed) or occasionally one whose complaint (about the hump, for example) may really be as simple as it sounds. Occasionally a patient needs a great deal of help: one fortyish woman responded to my question of how she wanted her nose to look by remarking, “I don’t know; surprise me, Doc!”

THE VALUE OF PHOTOGRAPHS THAT THE PATIENT BRINGS It is vital that patient and surgeon understand each other, not only in what they see but in how they describe it.

For example, a requested “straight bridge” can mean a straight line from radix to tip, a straight bony and cartilaginous vault with retroussé,* or even a bridge that remains convex but lower than what the patient currently has.

*The term retroussé, as used in English, is a misnomer. In French, retroussé means “turned up,” but American usage signifies tip projection beyond the dorsal line, not nasal length.

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A “better tip” can mean angular and sculptured or more softly rounded. It is curious but not surprising that patients usually want the opposite of what they have. I invite patients to bring photographs to the consultation when they first call to schedule the appointment, and if they do not, I encourage them to do so. Understandably, not every surgeon is comfortable with magazine photos presented as surgical goals, and I know surgeons who reject any patient who brings them.

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Patient responses differ: some resist or find it difficult to select photographic examples. Some women (more often teenagers) bring in notebooks arranged like term papers on which they have taped neatly clipped magazine photos, each with annotations: “Don’t like tip,” “Nose too short,” “Nostrils too big.” Some patients tear pictures from the magazines in my waiting room before they are admitted for the examination.

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I am explicit about the information that the photographs convey: “All of these tips are quite projecting—are you sure that is what you want?” or “You are showing me that you don’t want a drastic change from the bridge height that you have” or “I see that you want a much more angular tip.” For patients who are anxious about the appointment or that their goals will not be heard (much more common in secondary patients), a discussion of the patient’s stated goals together with my own patient photographs and any examples that the patient brings can calm many of those fears and are reassuring for both of us.

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From these discussions it is important to obtain not only information about nasal size, over which a surgeon has limited control, but also about bridge height and convexity, tip angularity, and balance. As one gains more control over postoperative nasal shape, this information becomes reassuring, rather than frightening.

PATIENT STUDY THREE

This woman had what she considered a large nose that needed simple reduction. If that seems like a good plan to you, refer again to the first few chapters, where the results of secondary patients with similar deformities are shown following simple reductions. The low radixes of those patients became even lower, the noses became more unbalanced; inadequate tip projections became supratip deformities; lateral crural resection deepened the alar creases; and the middle vaults narrowed, reducing airflow.

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Fortunately, this patient supplied a photograph of her surgical goal, allowing me to discuss not only bridge height, but also radix and upper dorsal height (lower on the patient, higher on the model) and tip projection (inadequate in the patient, adequate in the model). Thus the surgical plan logically followed.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization to the radix through a single intercartilaginous incision 2. A 2 mm dorsal reduction 3. Septoplasty 4. Spreader grafts 5. Radix graft (one main graft with second, shorter piece posterior at radix) 6. Crushed cartilage tip grafts

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The dorsum was reduced, not to a straight line, but only enough to accommodate the radix graft.

A

B

C

The septum provided excellent building materials, so the best piece was trimmed, contoured, and beveled to fit the radix, and a second piece was sutured to its posterosuperior surface (B). Notice that after the graft was placed, the dorsum became straight, but the tip projection remained inadequate (C).

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B

Three lightly crushed tip grafts were fed through an infracartilaginous incision on one side; I marked the cephalic end of the tip lobule to demonstrate the highest point of pocket dissection. Once in place, the grafts brought the tip lobule above the dorsal line and created adequate projection (B).

Silhouettes show the transformation that the reduction/augmentation combination conferred. Reduction removed the deformity, whereas augmentation created new relationships.

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Postoperative Analysis A

B

C

One year (B) and 12 years (C) postoperatively, the nose remains stable. Frontal contours have changed only slightly; the dorsum appears straighter, and the tip retains the contours that tip grafting conferred.

Inferior views show an unscarred base with improved tip projection; the sidewalls are smooth and without regional discontinuities.

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Preoperative

2 months postoperatively

2 weeks postoperatively

1 year postoperatively

12 years postoperatively

As time passes, nasal contours remain absolutely stable. Those surgeons who believe that crushed grafts are absorbed should be reassured, particularly by observing the effect of grafts at the radix and tip, which are under significant soft tissue pressures. When rhinoplasty is technically well performed, graft absorption is an exception rather than the rule.

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2 months postoperatively

6 months postoperatively

12 years postoperatively

Sequential postoperative views show the intraoperative equilibrium achieved. The patient has reached her objective. Airf ow increased 2.9 times over preoperative values.

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Some patients instinctively understand how photographs assist our discussion. Some worry that the examples they select will not suit their face, and others bring a series of extremely specific examples of what is acceptable. Either of these latter cases prompts me to discuss the limitations of skin sleeve volume, skeletal structure, and what a surgeon can and cannot control. I realize that there are surgeons (and even psychiatrists) who consider photographs brought to the consultation to be a danger sign that reflects a demanding, perfectionistic, narcissistic, or BDD patient. Although that may be true for some patients, it is more the exception than the rule. There are other, more common and less pathologic explanations for the patients-with-the-pictures. Some know what they want but cannot describe it. Many are anxious that the surgeon understand their goals, and specifically want to avoid large dorsal resections or overshortening. Finally, there are the concerns that many secondary patients have: “I should have told the surgeon more”; “He didn’t know what I wanted”; or worse, “I told him but he didn’t listen and said he knew what to do.” Under most of these conditions, acceptance and discussion of patient photographs can allay anxiety and help cement trust between patient and surgeon. At the very least, photographs educate the surgeon. Most patients are surprisingly consistent in the examples that they show (for example, all nasal dorsa will be high, all tips will be blunt or angular, and so on). In some context, “ideal” photographs are always instructive, and at some level, they always direct me, even when the tissue characteristics in the pictures are very different from the patient’s. I can respond, for example, that “Your skin is thicker/ thinner and your nose is much wider/narrower, so I cannot transform you into this person.” Except for a few of my BDD patients, everyone has understood this principle. Then I might continue with “But I see that you want no bump and a smaller lower nose. Look at where the radix begins in the model”; or “Notice that this dorsum is straight, not ‘scooped,’ but the tip projects beyond”; or “These noses are much shorter than yours—would you be comfortable seeing that much nostril afterward?” There are always useful teaching points to make, many of which guide me and save misunderstandings later.

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PATIENT STUDY FOUR

This young Jewish woman wanted a more delicate nose than she thought she had: narrower, with a less-blunt, more refined tip. She made it very clear from the outset that she wanted to maintain some height to the bridge, and did not want the nose shortened. Otherwise, her preoperative aesthetics were not bad: The nose was well balanced, and there was no collapsed middle vault or boxy tip requiring correction.

A

B

C

The patient supplied me with photographs that I marked “1” (B) and “2” (C) at her direction to indicate the order of preference. Comparing them with the patient’s oblique view, there was very little difference except for slightly more tip projection, less noticeable lateral crura, and a flatter supratip. 338

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SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization through single intercartilaginous incision 2. Slight dorsal reduction 3. Retrograde trim of the lower lateral cartilages 2 mm through intercartilaginous incisions 4. Septoplasty 5. Bilateral spreader grafts 6. Thin upper dorsal graft 7. Multiple tip grafts 8. Bilateral low to high osteotomies

The patient’s septum provided meager usable cartilage, but enough for our needs. Spreader grafts are seen at the bottom of the grid. The two remaining pieces were partitioned between the radix/upper dorsum and the tip. Silhouettes show the change produced in dorsal and tip contour. Notice that the nasolabial angle has not changed.

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Postoperative Analysis

This patient’s goal was to improve her nose but maintain her sense of self, including the ethnic characteristics conferred by her nasal shape. She provided consistent photographs to illustrate her surgical goal. Although the postoperative changes at 18 months are subtle, they are nevertheless real. On the frontal view, the nose is narrower, the tip less broad, the middle vault straighter. On the lateral view, the major change is a slight alteration in dorsal convexity contour, in keeping with the magazine illustrations she provided. The nose has not been shortened. In the oblique views, the tip retains its soft contour, but the supratip is flatter, and, despite the patient’s thicker tip tissues, the lobule has slightly more shape and projection. Inferior views are unscarred and show a narrower, symmetrical tip lobule.

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D etails of the Interview Rhinoplasty presents unique difficulties for both patients and surgeons because there is so much to discuss. To know what a patient wants and needs and to educate him or her about what must be done, a surgeon must collect detailed information that indicates all structural and functional complaints and the specifics of the patient’s aesthetic goals, area by area. The surgeon must construct and discuss a surgical plan and explain it so the patient understands what is required and why (which may be more complicated than the patient has expected)—and do all of this in the perspective of the patient’s ethnic and psychological background. After taking the initial history and having a broad discussion of aesthetic goals, I ask the patient to detail each area where change is desired (and where it is not) and to prioritize his or her goals. For example, a patient with an asymmetrical nose may prefer residual postoperative asymmetry to the increased width that an onlay graft (to the depressed side) would create. What does the patient mean by “a sculptured nose”? How much shortening will the patient tolerate? And so on. The notes I take reflect the patient’s own words so that the offic record and the written preoperative plan sent to the patient (see the “blue sheets” later in this chapter) will contain specific language that the patient has used and will recognize.

T he Preoperative Examination INTRANASAL EXAMINATION It is wise to make a habit of examining the internal nose first, so that this most critical functional area is not forgotten in the discussion of aesthetics. Patients are always grateful to breathe well, even when an inadequate airway is not a prominent preoperative complaint; patients who breathe poorly may be unaware of their obstructions. The surgeon must avoid unintentionally decreasing postoperative nasal function, which occurs more often than recognized—new or unrelieved postoperative obstruction dominates the complaints of most secondary rhinoplasty patients.

Nasal Valves I always examine the internal nose without manipulating the airway by asking the patient to breathe deeply and observing areas of collapse or asymmetry in the nasal sidewalls, any high septal deviations, columellar distortion, protrusion of the caudal septum, or alar rim collapse at the external valves.

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Sidewall collapse with inspiration at one or both sets of nasal valves is surprisingly common. Many of these patients reflexively flare their nostrils to support their airways. It is important to determine why valvular incompetence exists (such as from previous surgery, intrinsic weakness, or alar cartilage malposition). I tell the patient what I am going to do and that lightly anesthetizing the nose may make them want to sneeze. Patients should know ahead of time that the examination will not be painful. I then palpate the patient’s septum and the undersurface of the upper lateral cartilages with a cotton-tipped applicator dipped in 1% pontocaine hydrochloride.

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After I occlude one nostril, the patient inhales and exhales once. I then place the applicator under the edge of the contralateral upper lateral cartilage just below the dorsal septal edge and ask the patient to inspire again. Then I ask which is better, inspiring with applicator support, or without. For patients with internal valvular incompetence, the answer is usually obvious, and the amount of improvement often startles them. It is important not to distract the upper lateral cartilage too much, thereby giving a false impression of what can be done surgically. I then perform the same examination on the opposite side. It is not usually necessary to test the internal and external valves independently. Areas of collapse are obvious on inspection, and the maneuver is not primarily to make the diagnosis, but rather to demonstrate the diagnosis so that patients understand the significance of sidewall support. A surgeon may observe valvular collapse and substantial airway obstruction even in patients with straight, unoperated septums and without turbinate hypertrophy. For such patients septoplasty may be indicated for graft harvesting, but this by itself will not open the airway; the surgeon must also place appropriate valvular grafts. Remember that reconstruction of the internal and external valves can triple or quadruple airflow in most rhinoplasty patients, even when septoplasty is not simultaneously performed. Although the Cottle maneuver has been the standard test for valvular incompetence, I have not found it to be suffici tly specific. I prefer to inspect, palpate, and test the valves individually. Even an airway narrowed by septal deviation will improve if the cheek is pulled laterally, indicating nothing about the valves. In addition, valvular stability indicates competence under the transmural pressures that occur with inspiration. Pulling the cheek may only indicate that when the airway (any airway) widens, more air passes through it.

Nasal Septum The septum should be palpated to determine substance (reflecting the size and rigidity or pliability of its skeletal cartilage and bone), soft areas indicating previous resection, contour (locating areas of obstruction), and mucosal cover (indicating the stigmata of allergy, injury, perforation, or chronic cocaine use). It is also important to assess whether a high septal deviation exists (toward the dorsal or anterior edge).

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C

D

After this woman’s dorsum was reduced (A and B), her upper lateral cartilages fell medially, but because her anterior (dorsal) septal edge was deviated to the left, the contralateral (right) upper lateral cartilage could fall farther than the ipsilateral one, producing a “new” postoperative asymmetry (C and D). Many patients do not understand that the surgeon did not create a septal deviation, but merely uncovered it. Asymmetrically thick spreader grafts at the first operation would have avoided this complication.

Turbinates The inferior and middle turbinates are inspected for size, consistency (firm or covered in edematous mucosa), and position relative to the airway section along which the major airstream flows (arcing cephalad and caudad to the inferior turbinate, with a smaller arc cephalad to the middle turbinate). Ideally, the inferior turbinates should lie laterally enough to permit free airflow, and the middle turbinates should be medial enough to allow drainage from the middle meatus and normal sinus aeration. Although turbinates are time-honored causes of airway obstruction and clearly affect the airways of atopic patients or patients with chronic, severe septal deflection (in which the turbinate contralateral to the deviation typically hypertrophies), clinical and rhinomanometric data indicate that obstructing turbinates are relatively low in the hierarchy of common airway obstruction causes in both primary and secondary patients. Because turbinates warm and humidify inspired air, surgeons

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should plan conservative resections even in atopic patients. In most patients, and after adequate septal or valvular reconstruction, turbinate crushing and outfracture (or no treatment at all) suffices Compensatory hypertrophy usually reflects bony and not mucosal enlargement, making crushing and outfracture logical based on histologic data. Many surgeons favor turbinectomy, and some even propose radical resection, arguing that complications are low and the clinical effect is important, which is undoubtedly true in some patients. Chronic rhinitis is, however, extremely common following turbinectomy. Our data from more than 600 patients indicate that normal airways can be produced without turbinectomy in the overwhelming majority of cases. These physiologic structures should not be partially or completely removed without significant forethought and justification.

Information to Be Gained From Functional Examination Structure

Palpate for

Septum

Thickness Rigidity Displacement Areas of previous resection High septal deviation Stability under inspiratory pressures Size Evidence of bony or mucosal hypertrophy

Valves Turbinates

EXTERNAL EXAMINATION Palpate the external nose to gain information about cartilaginous size and substance, bony vault length, nasal sidewall stiffness (another assessment of valvular support), and soft tissue thickness. Consider tip lobular contour and the balance between nasal base size and bridge height (see Chapter 7). After doing so, I bring the spouse, parents, or others important to the patient into the discussion, and I explain what I have discovered, regardless of whether the patient has mentioned it previously: nasal width (area by area), length, bridge contour, tip shape, nostril size, columellar and upper lip position, and any asymmetries. As I do so, I try to imagine if and how well the nose will respond to the plan that I already have in mind: Will the skin contract adequately? Will the tip lobule narrow? How large a dorsal graft do I need? Which donor sites are available? (This last is more important in secondary cases, although some nonwhite patients who need significant dorsal augmentation may require autogenous rib grafts.) Will I treat the

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tip by reduction and/or augmentation, and does skin sleeve shape and distribution favor the result I am trying to achieve? It is important to decide not only what to do but how difficult that plan will be to achieve. Until I know that, I can neither advise the patient nor obtain the type and degree of informed consent that is necessary.

Information to Be Gained From External Examination Structure

Assess for

Soft tissues

Thickness, distribution, pliability (areas of scarring that will resist augmentation or reduction), how well the tissues coapt the skeleton (reflecting ability to contract further) Length, width, radix position relative to nasal base size Length, width, cartilage quality (stiff or easily compressible) Cartilage quality, relative length of middle crus (reflecting tip projection), lateral crural axis and shape (convex or concave or flat) Firm, retracted, tight, loose Full, vertical, retrusive

Bony vault Middle vault Nasal tip

Columella Maxillary arch/ upper lip carriage

Cooperation and Rapport Throughout the examination, I assess how easy or difficult it will be to carry this patient through the surgery, postoperative course, and management of any complications or postoperative imperfections that may occur. Most patients are at least mildly anxious during the initial consultation, but a patient whose fear or nervousness makes even the initial examination impossible creates a significant problem. A patient who does not like to be touched, one who jumps when I palpate the nose, or who cannot even tolerate a cotton-tipped applicator touching the septum will be extremely difficult to get through the surgery, dressings, and packing removal. My mental test is whether the patient could cooperate with the management of postoperative epistaxis; if not, surgery is probably inadvisable. If a patient is initially jumpy, I stop my examination, explain again what I am doing and why, and underscore the importance of patient attitude and cooperation. Many patients regain self-control at that point, but some cannot, a warning sign that I do not ignore. It is important to like your patients, at least enough to have a solid working relationship. During surgical residency, we learn to tolerate frightened, angry, difficult, or even abusive patients, but treating trauma or disease is not the same as performing cosmetic surgery. It is safe to assume that most patients are calmer preop-

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eratively in the offic than they will be postoperatively, when dressings, discomfort, swelling, drainage, and the physical restrictions and stressful demands of the postoperative course can fatigue and fray. Patients with difficult personalities rarely improve after surgery. My experience has been that anxious and/or significantly depressed patients make poor surgical candidates. If they get excellent results, they cannot believe or enjoy them, and if they have complications, everyone suffers. Roth et al observed the same thing in reconstructive patients. Each surgeon must know his or her limits, which is why it is impossible to provide a checklist of patients who should be accepted or rejected for surgery. In my rhinoplasty practice it has been necessary to accept a broader range of temperaments than might be asked of other offices But surgeons are individuals: some tolerate particular patient personalities better than I do, and others do not. Before you can set your own guidelines for which patients to accept, you must know your patients and yourself. Discussed more fully in Chapter 20, my criteria for accepting a patient for surgery are listed in the following box.

Five Criteria for Selecting Surgical Patients 1. Can I see the deformity? (Eliminates delusional patients.) 2. Can I fix it? (Measures the surgeon’s skill and comfort in correcting various problems.) 3. Can I manage the patient? (Will the patient cooperate suffici tly with examinations and dressings, report for laboratory tests, and keep appointments?) 4. If there is a complication, will the patient remain controlled and cooperate with treatment? (A patient too anxious or unrealistic to tolerate anything but success is not a surgical candidate.) 5. Does the patient accept the margin of error inherent in surgery? (This is the sine qua non: it tests whether the patient accepts that humans [patients and surgeons] are imperfect.)

D iscussing and Agreeing on a Plan The most important part of the plan is scope. It is important to help the patient focus and limit the surgery. Does the patient just want his or her nose restored to its pretrauma appearance? Does the patient only want function corrected? In the latter case, it is particularly important for the surgeon to accede to the patient’s plan. I never make external changes unless the patient requests them (no matter how unattractive the nose may seem to me). An offer to “make the nose a little prettier while fixing the airway,” as innocuous as it sounds, can launch a cascade of prob-

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lems: unless the result is perfect and meets the patient’s unconscious, unexpressed goals (which is nearly impossible), the result may generate anger rather than gratitude. Furthermore, when a functional correction can change appearance secondarily (for example, spreader grafts that may widen the middle third), I describe the changes explicitly and show examples.

P utting Yourself and the Patient on the Same Side It is much better if the patient and surgeon are on one side, and the surgical problem is on the other side. “This is what I understand that you want, this is what I see, and this is how I can help you” is better than, “This is your problem and I am going to fix it.” Particularly when the result is not perfect, it is better for the patient to remember that the nose was the problem, not the surgeon.

H elping the Patient Formulate a Practical Plan PATIENT AGE I have no specific upper or lower age limitations. There are 14-year-old girls who are cooperative, can articulate their surgical goals, are easy to examine, and behave like adults, and there are 45-year-olds whose parents still speak for them and who cry when I take out a nasal speculum. I require two things of my younger patients: they must be able to articulate their surgical goals by themselves in a consistent manner and understand my surgical plan, and I must believe that they will be sufficiently calm and cooperative postoperatively, even if unusual circumstances (such as the need to repack the nose because of bleeding) may occur. Similarly, I have no upper age limitation as long as the patient is medically sound and meets the other criteria. However, some modifications of the surgical plan are advisable in older patients (see Chapter 16).

THE PATIENT’S AESTHETIC Not all patients have the same concept of an ideal nose, and it is important to find out what that is. Some patients want a “scooped profile,” by which they mean retroussé. Some patients want a straight line from radix to tip; others want to retain some of the preoperative hump. Some patients (usually those with round tips) want an angular, sculptured, facetted tip; others (usually those with narrow, excessively angular tips) want softer, rounder contours. These specifics can be readily discovered by the patient’s reaction to case examples and by soliciting magazine photographs of “ideal” noses.

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PATIENT STUDY FIVE

This young woman, interested in fashion modeling, knew exactly the types of changes she wanted, particularly with regard to tip lobular shape and projection. The handwritten notes on the magazine photographs are the patient’s: “better angle” indicated a more vertical angle of rotation; “tip out too much” and “better” signified the amount of projection she preferred. This is an opportunity to educate the patient. The woman in the “better” magazine photograph has thinner skin, and less of it: I cannot make a nose exactly like hers. However, she also has a higher radix, which I pointed out to the patient; grafting the radix and reducing the dorsum would favorably alter nasal balance and partially offset any increase in nasal base size that increased projection might produce, and tip grafts (with a positioning buttress) would alter the angle of rotation. The nose in the photograph is also slightly shorter, giving me information about the patient’s tolerance for base rotation.

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Postoperative Analysis

A 2 mm dorsal and retrograde lateral crural reduction and a trim of the anterior membranous septum rotate the tip. Radix, spreader, and tip grafts alter nasal balance, stabilize the internal valves, and alter tip projection and contour. The patient achieves her goals within the limitations of her own soft tissue and skeletal type. Not every patient illustrates an aesthetic goal that a surgeon can (or should) realistically follow. Many surgeons have fallen into the trap of trying to produce something that cannot be produced or following a patient plan that is unrealistic or undesirable. Even in this case, what the patient showed me cannot literally be produced. But the overall shape is possible, as long as the patient accepts the surgical plan needed (including radix and spreader grafts) and understands that the surgeon’s goal is to produce a straight dorsum with similar aesthetics, not the identical nose pictured. The other necessary puzzle piece for success is a solid understanding by the surgeon of nasal phenomenology: what maneuvers produce what results, and what compensatory adjustments may be required. That is why every serious rhinoplasty surgeon must have a commanding knowledge of both static and dynamic nasal anatomy (see Chapters 1 and 2) so that most of the results produced are intended.

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PATIENT STUDY SIX

After two rhinoplasties, this patient had not yet achieved her original goal and did not understand why. Although the surgical result is acceptable, the patient thought that her nose was too long, too bottom-heavy, too wide and asymmetrical, and too blunt. A

B

The patient’s original preoperative view (A) illustrates where she had been; the magazine photograph (B) shows where she wanted to go. Having had osteotomies at the first operation, how did widening occur?

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B

C

The explanation lies in the original plan. The surgeon planned a modest skeletal reduction (B), to be followed by expected soft tissue contraction. Interestingly, the postoperative simulation actually produces a nose that is disproportionately small for the patient’s profile configuration (C). Balancing the nasal base against a radix that is already too low, the entire postoperative nose would have had an odd, flat shape. But that would never occur, because the patient’s nose defies False Assumption Number One: her soft tissues will not contract to the size of any underlying skeleton. Instead, the upper skin tightens more and the lower skin tightens less, until the soft tissues reach their contractile limits and begin to float above a skeleton that is now too small for them. Because base contraction lags behind upper nasal contraction, the base now seems too large for its smaller cephalic counterpart. The nose becomes wider rather than narrower, and the tip becomes broader and more blunt. If the patient wants a narrower nose and more shape, the skin volume that she has must be filled out; in this patient, further reduction would be a pointless and nonproductive option. In this case, the patient’s goal was reasonable and understandable, but it was necessary to achieve this by methods she did not anticipate. Here it is critical to obtain the patient’s understanding and consent before proceeding, because the surgical strategy will not be intuitively obvious. Unless the surgeon plans to reduce absolute nasal volume by resecting skin, skeletal augmentation is the only way to achieve the patient’s goal. Because previous caudal septal surgery has recessed her upper lip, maxillary arch augmentation is planned to restore lip posture and help shorten the nose.

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SUMMARY OF THE SURGICAL PLAN 1. Maxillary augmentation with Gore-Tex rolls 2. Minimal skeletonization through a right-sided intercartilaginous incision 3. Transfixing incision; 3 mm resection of caudal and membranous septum 4. Septoplasty 5. Bilateral spreader grafts, thicker on the left than on the right because of the preoperative asymmetry 6. Dorsal grafts of septal cartilage 7. Two firm but lightly crushed tip grafts to produce projection with angularity

Maxillary augmentation was performed first using a no-touch technique to avoid transferring skin organisms to the Gore-Tex. A 1 mm thick square of Gore-Tex sheeting was rolled starting at one corner, trimmed, fixed circumferentially with 6.0 nylon, and split in its center to produce two tapered implants. Through a short intranasal incision in the nasal floor, dissection was carried subperiosteally high over the maxillary arch, tight against the piriform aperture. Each implant was placed with its widest end in the perialar area; the amount of overlap in the midline, adjusted at surgery, controls the amount of central lip projection.

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A

B

C

D

Septoplasty provided adequate material and cleared the airway (A). The best piece was selected, contoured and beveled at its edges, and shaped. Matching the nasal deficits, the thickest end will go cephalically, tapering to a thin edge in the supratip (B and C). Following dorsal and tip grafts, the dorsum became straight, and the nasal base seemed smaller and had more contour (D).

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Postoperative Analysis

Delightful and magical paradoxes fill rhinoplasty. Among them is the principle that augmenting a skeletally deficient skin sleeve produces more shape, more angles, and an augmented nose that looks smaller than its reduced counterpart. Twelve months postoperatively, the patient’s nose, although not as narrow as the original, is narrower than it was preoperatively. Asymmetrical spreader grafts have camouflaged the high septal deviation. The dorsal and tip grafts have narrowed their respective areas. With better underlying support, the nose is slightly shorter. Close frontal views show how much the dorsum has narrowed.

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On the lateral view, the increases in dorsal height and tip projection are barely noticeable, although contour has improved and the nose is shorter. Compared with the patient’s presumed goal, she has achieved a straight dorsum without sacrificing width by respecting the character and limitations of her skin sleeve.

The inferior view is unscarred and confirms additional height and tip projection.

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All grafts are smooth and invisible, and the effect persists. There are two important tangential points here. The first is that I do not advocate making every nose larger. Many noses (certainly in most patients who are seen for primary rhinoplasty) have areas that will benefit from reduction. But reduction often costs something, because soft tissue contraction is not infinite and nasal regions are interdependent. A reduced dorsum can produce internal valvular incompetence. Dorsal reduction in the presence of a low radix worsens nasal proportion. Alar cartilage reduction can decrease tip projection and create external valvular incompetence. Soft tissue contraction changes skin character as the soft tissues thicken. These are not desirable postoperative effects, and that is where augmentation becomes relevant. Carefully crafted grafts can restore valvular competence, correct tip projection, and improve nasal balance. As such, reduction and augmentation become compatible, not competing, strategies for achieving each patient’s aesthetic and functional goals. Second, aesthetics are ideals, but ideals are not achieved in every case in this book or in practice. Not every preoperative shape and anatomy favors such an outcome. Donor quality and wound healing do not depend solely on surgical skill and planning. Thus perfection is an unrealistic surgical goal; a surgeon and patient will be most successful if they coordinate their efforts toward safety, balance, proportion, and a functional airway.

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T he Male Aesthetic When defining a surgical goal, men have particular trouble knowing and expressing what they want. Partly for these reasons, and partly because most men are less accustomed to stylistic changes in hair or cosmetics than women are, men compose a disproportionately large percentage of unhappy patients. In my recent review of 1000 consecutive rhinoplasties, men constituted 40% of the unhappy patients, even though they represented only 22% of the entire patient population. There are presumably other reasons, some not yet clear to me (see Chapter 20). It is therefore particularly important to establish rapport with a man who is a rhinoplasty candidate, to understand his surgical goals and familiarize him with all potential complications and the potential for an imperfect result. In this regard, men with careers in which precision is a central feature (such as engineers or mathematicians) may not at first understand the variability and imprecision inherent in surgery, but most can be educated and many become very good patients. Even though many men find it difficult to explain their surgical ideal, most men have a sense of what a “male nose” is. It is important for the surgeon to work within the limitations of that concept. Very commonly, secondary rhinoplasty patients state that there is “something missing” in a nose that has been reduced, and many would like the bridge restored to its original height. Especially in ethnic groups where a large nose or high bridge is common, surgeons must be careful about changes that may compromise ethnic identity or an important family trait. Recall also that there are sex-associated attractiveness traits (see Chapter 7). Particularly relevant to this discussion is sexual dimorphism. Most men want to look male: this means lower brows, heavier jaws, smaller eyes, and larger noses. Every cosmetic change in men or women should be deliberate and explicitly agreed on beforehand.

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PATIENT STUDY SEVEN

This Kenyan marathoner had undergone a primary rhinoplasty that produced a supratip deformity. Seeking reconstruction, he brought photographs of his father and brother, remarking sadly, “I don’t look like my family anymore.”

A

B

His father (A) and his brother (B) had broader noses and higher dorsa with inadequate tip projection and malpositioned lateral crura (almost the rule in black noses). Unwittingly, the surgeon had erased an important inherited trait. Notice also the discontinuous, collapsed middle vault and the flat alar walls in the patient’s nose. Septal cartilage had been resected. 360

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SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage (shaves of the eighth and ninth ribs) 2. Minimal skeletonization through a single, cartilage-splitting incision 3. Dorsal rib cartilage graft 4. Lateral wall graft 5. Multiple tip grafts—placed caudally to deliberately create inadequate projection 6. Alar wall grafts, each placed through separate vestibular incisions in separate pockets

Dorsal access was gained through a single cartilage-splitting vestibular incision placed distally to ensure good mucosal coverage over the dorsal graft.

This is a relatively long dorsal graft, measuring about 40 mm, and sized to help rotate the tip caudally (by elevating and elongating the dorsum, not pushing the tip down—the graft extends only into the supratip). Notice that the graft has been contoured to the defect and to the convexity that the patient desired.

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Alar wall and tip grafts add mass, length, and tip shape. The alar grafts are positioned to re-create the family’s malpositioned, convex lateral crura. A percutaneous suture coapts the vestibular and skin flaps and remains for 24 hours only.

Rib augmentation has achieved significant dorsal height and length. The tip has more shape but remains inadequately projecting.

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Postoperative Analysis

On the frontal view, the postoperative nose is longer, and the sidewalls are now confluent—the middle vault is wider; the inverted V has vanished. Although osteotomies were not performed, the bony vault seems narrower—another one of the global, magical interactions that are so characteristic of rhinoplasty. In contradistinction to False Assumption Number One, each nasal region is not independent of all the others. Alar grafts recreate cephalically rotated lateral crura.

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Expanded to safe tissue limits, the nose is still not large; in fact, rebalancing has diminished base size. There is a slight dorsal convexity, characteristic of the patient’s family. Unfortunately, the notches and rough scars produced by the previous alar resections remain.

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The patient was particularly bothered by a nose that felt “weak” or “empty.” This is characteristic terminology from men who believe that they have lost something indefinable but male through a previous rhinoplasty. This patient’s relatively straightforward nasal augmentation, uncomplicated by intricate secondary adjustments or large tissue movement, has restored an important familial characteristic—a nose with height, width, volume—and airway.

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Explaining the Surgical Plan Many patients who have previously had bad rhinoplasty experiences blame themselves—for not selecting the right surgeons, not explaining their surgical goals, or not asking enough questions. The fear that this experience might happen again drives many patients to seek multiple consultations, cataloging each surgeon’s plan and cross-checking each new idea with those that preceded it. That strategy has been compounded by the availability of the Internet, where science and marketing have become densely and inseparably intertwined—and exploded by puffery. I have had patients who brought three-ring binders filled with handwritten notes, and while I described my plan, flipped from page to page, scribbling intensely, hoping to discover which surgeon might have given the right answer and determine whether I might be the one to pass the audition. Some patients can be convinced that what they are trying to do is impossible: no patient can become a plastic surgeon in a 1-hour consultation. Ultimately the patient must find the plan to be logical and understandable and must believe that the surgeon has his or her best interests at heart.

PATIENT STUDY EIGHT

Two previous rhinoplasties for septal deviation following trauma created some interesting changes for this patient. The nose has shortened quite noticeably, and removal of an intranasal tumor (inverted papilloma) has retracted the right nostril.

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As discussed in Chapter 2, dorsal reduction shortens the nose. The middorsal notch is simply the highest point of the inverted-V deformity that signifies a collapsed middle vault. Note also the originally wide bony vault. Understandably anxious and discouraged after seeing several surgeons who saw no reason for her airway obstruction (because the septal partition was flaccid), the patient wanted to restore her airway and her previous nasal shape.

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A

B

C

D

E

F

After skeletonizing the nose through a single intercartilaginous incision (placed distally to ensure a tight closure over the graft), the dorsum was skeletonized to the radix and lightly rasped for graft adherence. A thick graft (B and C) made from the anterior surface of the ninth rib was slipped into the defect and immediately raised the dorsum, lengthening the nose (D). Tip grafts fashioned from the remaining rib shavings restored the tip projection, and a right composite graft corrected the alar retraction.

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Silhouettes dramatize the length gained.

Postoperative Analysis

This patient has benefited from two of the most powerful techniques for nasal lengthening: raising the dorsum and adding lining with composite grafts. The dorsal graft has rotated the tip caudally to regain much of the patient’s original length. This is fortunate, because soft tissue contraction following earlier surgeries often prevents recovery of length, particularly when the soft tissues are thin. A right composite graft has replaced the resected lining and aligned the nostril rims.

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The oblique views are smooth, without regional discontinuities in the middle vault; the airway is widely patent. Improved nostril symmetry derives from two improvements: the right composite graft and tip grafts (which align the axes by equalizing anteroposterior soft tissue tension). The length that can be regained is ultimately restricted by the amount of soft tissue available, particularly along the dorsum. Even if lining can be restored by composite grafts, an external skin sleeve that has contracted limits the degree of success that can be achieved.

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PATIENT STUDY NINE A

C

B

D

E

F

This young woman had undergone a previous conservative reduction, but dorsal resection had uncovered a high septal deviation. In addition to her airway obstruction, she did not like her low profile and blunt tip. However, she was quite specific in her tip aesthetic goals, showing me an earlier photograph of herself (C) and her surgical goal (“yes” [E]). She wanted to maintain her softly rounded tip (“no” [F]) but correct everything else.

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SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization through intercartilaginous incision; dorsum gently rasped for graft adherence 2. Septoplasty 3. Harvest composite grafts 4. Dorsal graft of septal cartilage 5. Left spreader graft 6. Tip grafts (multiple, crushed) 7. Bilateral, coronally oriented skin/cartilage composite grafts to alar rims, right wider than left 8. Revise columellar scar

A

B

C

D

The septoplasty yielded a sparse but adequate specimen. The prepared, crushed dorsal graft is at the bottom of the grid (B), with the spreader graft above it. The remainder will be split and crushed for the left lateral wall and tip. The dorsal graft is shown before insertion (C and D); note its deliberate pliability.

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A

B

C

D

A single composite graft was harvested to be split obliquely (to maximize length) and placed into short vestibular skin incisions 3 mm above each rim; the length to be spanned had been marked (A). After placement and tip grafting, rim notching and the supratip deformity disappeared (B through D).

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Postoperative Analysis

Two and a half years postoperatively, the nose remains more symmetrical. The left spreader and dorsal grafts have restored symmetry, and the dorsal and composite grafts have restored apparent and real nasal length. Postoperative airflow increased 16.6 times over preoperative values from septal and valvular correction.

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Dorsal and tip grafts have redraped the supratip deformity cephalad and caudad, but crushed tip grafts have created a softer, rounded contour without visible angles, as the patient desired. Scar revision has reduced the columellar discontinuity, but the stigma of a previous open rhinoplasty remains. When outlining an approach, how much detail is too much? Each surgeon must develop his or her own style and preference, but I provide a detailed plan, down to the last graft. This way I can help the patient understand my strategy and prefer it to the reasonable alternatives. In particular, I describe the potential for postoperative shape imperfections, by far my most frequent indication for additional surgery. It is particularly gratifying to hear, “I know the graft isn’t smooth, but you told me that might happen.”

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What if the patient wants a result that is not attainable? The answer depends on the cause. Truly delusional or unrealistic patients are not surgical candidates, but even today, despite the hyperbole purveyed on the Internet, such patients are not in the majority. I try to reach common ground by using a metaapproach: by reducing the patient’s goals to their essence, can I outline an acceptable objective?

PATIENT STUDY TEN

This primary patient has a deformity normally seen in secondary patients. Her thick skin sleeve is too large for her smaller skeleton, so it effectively assumes the shape of an unsupported, end-stage nose: obtuse nasolabial angle; low, upper dorsum; demarcated, concave middle vault; unsupported columella; and blunt, undefined, poorly projecting tip—the shape of supratip deformity.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization of the dorsum through right intercartilaginous incisions 2. Bony vault rasped for graft adherence 3. Septoplasty 4. Four-layer dorsal graft; solid and crushed septal cartilage 5. Lateral wall grafts 6. Multiple tip grafts, solid and crushed 7. Bilateral alar wedge resections

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A

B

C

D

E

F

Fortunately, the patient’s septum supplied ample cartilage for a layered dorsal graft: one main graft, two crushed, narrower, and anterior to it for contour, and one small posterior piece to fill the depth of the notch (C and D), and both solid tip grafts (to create the angle of rotation) and crushed tip grafts (to fill the lobule) (E). Through separate incisions in separate pockets, additional grafts were laid over each middle vault. When the bridge is raised this much, sidewall grafts help camouflage dorsal graft edges. Remember that you are reconstructing a pyramid. Alar base resections completed the reconstruction, removing 3 mm of external skin and 2 mm of vestibular skin. Except for the alar resection, this was an augmentationonly primary rhinoplasty, unusual even for me.

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Redistribution and support have made all the difference.

Postoperative Analysis

The supratip deformity has been redraped cephalad by the dorsal grafts and caudad by the tip grafts.

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B

E

C

F

D

G

Augmented or reduced, this could not be a small or narrow nose. But even at 1 week postoperatively (F), the redistribution is obvious: the dorsum is now straight, the tip adequately projecting, the nose better balanced. The result is seen at 1 year in B, D, and G. Dorsal reconstruction alone doubles airflow in such patients. Because of the angle at which the incisions crossed the nasal floors (a medial flap as described by Sheen) and a lack of tension on the closure, the scars are barely visible. Remember that augmentation is exactly that, and the effect should be visible at the time of surgery and immediately thereafter. I do not expect this patient’s soft tissues to contract around my grafts, which they are incapable of doing, but rather to be shaped by them. Like most, this primary rhinoplasty patient wanted a smaller nose, but her thick skin did not coapt the skeleton she had. Further reduction would have accomplished nothing. Would a straighter profile with more tip shape, even in the same

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size, be acceptable instead? It was, and so dorsal and tip grafts achieved contours that were satisfactory to the patient—not the original goal, but the metagoal. It is often possible to move the patient’s objective to one that can be achieved, but this must be done preoperatively; otherwise, it may feel to the patient like a forced compromise.

S howing Your Results in Other Patients I show all prospective patients examples of similar problems treated by the plan that I am proposing to them. For example, I may want a patient to understand the importance of recognizing and treating a low radix, especially its effect on nasal balance and contour. Many rhinoplasty concepts are difficult to comprehend (even for some surgeons) unless they are actually seen, particularly those that deal with balance and proportion and the illusions associated with augmentation and redistribution—the magic of Craft and Magic. Patient responses to proposed treatment plans are significant. There are rare patients who immediately grasp the concepts and immediately like all my results; there are patients who are uncertain at first but eventually become persuaded that my plan is better than the alternatives; there are occasional patients who need to be told which is the preoperative and which is the postoperative nose (this is a bad sign); and there are patients who do not like my results at all. I would rather know this beforehand.

Computer Imaging There are two applications for using computer imaging to obtain the intended results before the operation. The first is obvious—showing the outcome to the patient before surgery. However, a computer simulation may only demonstrate the physician’s artistic ability, not surgical skill. There are innumerable favorable outcomes that can be drawn but not produced. Imaging results are limitless; surgical results are not. The surgeon must be able to produce an image of what can be done at surgery, not what the patient (or surgeon) might wish to be done. I personally prefer to show actual results of patients with parallel deformities, which gives a more accurate idea of my own skill and limitations and illustrates what Nature will allow. A second application in which computer imaging may prove particularly helpful (although I have seen no evidence to support it) is screening body image distortions and therefore identifying patients with BDD preoperatively.

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Explaining the Risks to Patient and Family Including any accompanying family members or friends, I review the surgical procedure, show examples of patients with similar configurations, and discuss risks. I only discuss the common complications, not every one that I can imagine. In my practice, these include infection (extremely rare), unusual bleeding (also uncommon), and the possibility of an imperfect aesthetic result (the most common complication), and I cite percentages. Throughout this discussion, I try to educate patients about the differences between the elements that I control and those I do not. Revision rates, even in expert hands, are never zero, but good information, instead of increasing patient stress, usually does just the opposite.

P atient Attitude and Behavior ANXIOUS PATIENTS Many patients are anxious during the initial interview. Some anxiety is understandable, and it generally diminishes steadily during the consultation. However, some patients seem to have a self-generating anxiety disorder, usually manifested by repetitions of the same questions, inability to retain details of the surgical plan, and a recurring emphasis on guarantees, adverse outcomes, and the need for reassurance that “everything will be perfect this time.” Such anxiety is not exclusively a problem of secondary rhinoplasty patients, but it must be assessed and ameliorated preoperatively. If I do not believe a patient will be manageable during a stressful complication (postoperative hemorrhage or an imperfect surgical result), I have identified a danger signal that I try not to overlook.

CONTROLLING PATIENTS Most adults control their own lives, but some cannot relinquish any part of that control, even when it is necessary for their welfare in the perioperative period. Each surgical decision cannot be a tug-of-war between patient and surgeon. Patients must understand that it is not in their best interest for them to manage details of which they have only limited knowledge. This previously occasional problem has become much more common now that the Internet permits any motivated patient to research every aspect of the preoperative plan. You need grafts? They say that grafts always reabsorb. You use tip grafts? They say that columellar struts are better because “all tip grafts show.” You use rib? They say that implants are better. “Tell me,” asked one patient’s mother, examining me over her half-glasses, “Are you going to do a cephalic trim?”

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I used to joust with these unidentified critics of my preferred techniques, but now I rarely do so. Although I take great care to educate and disclose, there is a point at which the patient must be the patient, not the surgeon. It is important for the patient to understand and agree to the plan, but not dictate it. “I want you to correct my tip asymmetry by doing a vertical wedge resection at the dome and then graft these three areas, . . .” (a real quote) is a long way from, “My tip is asymmetrical; how can you help me?” The same principles apply to controlling families. There is a difference between caring spousal or parental interest and deciding for the patient how the nose should look. Some years ago I saw a psychiatrist’s daughter, who sat in the examination room with her arms folded across her chest, saying as I entered, “I’m only here because my mother brought me.” When her mother arrived, I explained that this was not the right time for her daughter to have surgery, but someday we could discuss matters further. “We are an old-fashioned family,” the mother said, “and in our family the children do what the parents say.” “I understand,” I replied, “but I am not an old-fashioned surgeon.” Unable to persuade me, the mother left in a huff, but the daughter and I were both happy—success without surgery.

OTHER CLUES TO DIFFICULT PATIENTS Experience teaches most plastic surgeons that a patient’s attitude toward surgery or even surgeons is less important than his or her attitude toward a surgeon’s staff. The surgeon has what the patient wants—the power to plan and execute an operation— so many patients become solicitous, even profusely flattering, to the surgeon, but abusive to his or her staff. This is a clear danger sign. Regardless of how well I am personally treated, I will not operate on a patient who is not courteous and respectful to my staff.

ABOUT GUARANTEES Despite everything I have said, some patients ask repeatedly for guarantees; this seems to be particularly true among secondary patients or those who have visited Internet chat rooms and read other patients’ unhappy stories. If after explaining what I can control and what I cannot the patient still insists on a guarantee, I say, “If you guarantee that you will give me perfect building materials (meaning septum, rib, and/or ear cartilage), that you will have no complications, and that you will heal exactly the way I expect, I will guarantee you an excellent result.” That usually elicits a smile from the patient, behind which (I hope) is a bit of understanding.

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R evisions Patient and surgeon alike must remember that revisions or additional procedures may be necessary, almost predictable in some difficult configurations, if the best possible result is desired. Revisions are frequently minor, but all patients should understand preoperatively what cannot be predicted and therefore not mistake the uncontrollable for the uncontrolled. Patients must know preoperatively that no revision will be undertaken until the end of the first postoperative year. Resolution of swelling and stabilization of the final appearance take at least that long after a primary procedure and often longer in patients undergoing secondary rhinoplasty. During that time, irregularities, asymmetries, or poor contours that initially seem to require revision may improve suffici tly without surgery. Occasionally, new problems appear that would have been overlooked if an early revision were performed. Nothing should be done until healing is complete and the tissues are suffici tly supple to permit the type of change the surgeon plans; this particularly applies to additional tip revision or grafting. The floor must stop moving, and the surgeon should control every possible variable. Who should perform the revision? To some degree, the answer depends on the same factors involved in the previous rhinoplasty. The surgeon’s model and proposed solution should be clear and acceptable to the patient, and the patient’s goals should be reasonable. Most of all, patient and surgeon must understand each other explicitly, because every operation is geometrically more difficult than the last.

T he Blue Sheet and a Written Surgical Plan Once a patient has scheduled surgery, I follow a custom learned from Dr. Sheen and send a letter typed on blue paper, our so-called blue sheet, in which I outline in detail the surgical problem as I see it, the plan, and the potential for revision: essentially a summary of the consultation discussion. No action is required of the patient at that time, but at the preoperative examination the patient signs a duplicate copy that remains in the patient’s permanent record, acknowledging and agreeing to the plan as I have outlined it. I do not consider this to be risk management, but rather patient education. It is naive to expect each patient to remember every detail, even after two preoperative visits. I do not want to hear “You never told me. . . .”

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SAMPLE BLUE SHEET LETTER 1 Physician’s name Name of practice Address Telephone and fax numbers e-mail address Patient name:____________________ Patient number:_______________ Date:______________ Dear_______________________: The purpose of this letter is to summarize the points that we discussed at your consultation. Nasal surgery is real surgery and not magic, an effort to correct both appearance and function by removing structures that deform or obstruct, and by adding cartilage or bone grafts (where necessary) to give the best possible airway and external shape. All human beings have their own unique tissue characteristics and medical backgrounds. Results therefore inevitably vary, no matter how much the surgeon works to achieve the same goals each time. Even the unoperated nose has its own traits, and noses that have undergone previous surgeries contain irreversible changes that limit how much can be achieved. Most rhinoplasties require cartilage or bone grafts because most noses require both reduction of areas that may be too large or poorly shaped and also augmentation of areas that are deficient or need better contour. There is no substitute for your own cartilage or bone. Once healed, these materials stand the best chance of providing a permanent and natural improvement. However, donor materials vary from patient to patient in both quality and character, and thus there is always some risk of absorption, distortion, or visibility as healing progresses. Please remember that your nose will not look wonderful at 7 days, although your airway should be much better at that time; it will be quite swollen. Your nose will improve for many months after surgery, and you must be patient for the final result. Although the major changes occur within the first 12 months, patients can often see improvements for up to 2 years. Areas that may seem to need correction early often improve spontaneously, just as small imperfections may appear as time passes. As I see you postoperatively, we can discuss any areas where I believe I might be able to obtain further improvement. The goal of any nasal surgery is not perfection, although that is what we want, it is the best possible surgical result. Sometimes an improvement that is not perfect is still the best that can be obtained without adding inadvisable risks. I shall strive to give you the most improvement I can, always putting safety first, then function and aesthetics. Following is a summary of our surgical objectives. Page 1 of 2

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You have a number of problems with your nose currently: airway obstruction that is caused by septal deviation and collapse of the middle third when you inspire, external asymmetry of the nose, a columella that is too low, a tip that is flat, and a nose that seems out of balance and “bottom heavy” on profile. Finally, your left nostril has lifted so that it is much different from the one on the right side. To rebalance the nose and recontour the tip and correct the airway, I will remove septal cartilage, support the sides so that they stay open when you breathe, elevate the upper nose slightly, lift the columella, and recontour the tip so that it has more shape, removing some of the deformed cartilage and adding tip grafts for shape. Finally, I will use a skin and cartilage “composite” graft from one of your ears (closing the space in the front of the ear with a skin graft from behind) to replace the lining that is contracted on the left side, which should bring the rim down closer to symmetry. I expect you to have a better airway, better balance, more tip shape, and better nasal and nostril symmetry postoperatively. It is likely, however, despite everything I do, that there will be some minor asymmetries because of the changes that your soft tissues and skeleton have undergone already. I anticipate an 85% chance that I can achieve what we both wish in one operation. Because I do not control the quality of your building materials or your healing, however, there may still be imperfections that I can improve in a second, smaller, touch-up procedure if you wish the best possible result I can provide. I enjoyed meeting with you, and I am confident that this is the right surgical plan for you. I will do the best I can to give you every improvement possible. These blue sheets summarize your consultation with Dr. ______________. They do not require your signature at this time. You will be asked to sign our office copy at your preoperative visit. ____________________________

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Patient’s Signature

Date

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Physician’s Name

Date

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SAMPLE BLUE SHEET LETTER 2 Physician’s name Name of practice Address Telephone and fax numbers e-mail address Patient name:____________________ Patient number:_______________ Date:______________ Dear_______________________: The purpose of this letter is to summarize the points that we discussed at your consultation. Nasal surgery is real surgery and not magic, an effort to correct both appearance and function by removing structures that deform or obstruct, and by adding cartilage or bone grafts (where necessary) to give the best possible airway and external shape. All human beings have their own unique tissue characteristics and medical backgrounds. Results therefore inevitably vary, no matter how much the surgeon works to achieve the same goals each time. Even the unoperated nose has its own traits, and noses that have undergone previous surgeries contain irreversible changes that limit how much can be achieved. Most rhinoplasties require cartilage or bone grafts because most noses require both reduction of areas that may be too large or poorly shaped and also augmentation of areas that are deficient or need better contour. There is no substitute for your own cartilage or bone. Once healed, these materials stand the best chance of providing a permanent and natural improvement. However, donor materials vary from patient to patient in both quality and character, and thus there is always some risk of absorption, distortion, or visibility as healing progresses. Please remember that your nose will not look wonderful at 7 days, although your airway should be much better at that time; it will be quite swollen. Your nose will improve for many months after surgery, and you must be patient for the final result. Although the major changes occur within the first 12 months, patients can often see improvements for up to 2 years. Areas that may seem to need correction early often improve spontaneously, just as small imperfections may appear as time passes. As I see you postoperatively, we can discuss any areas where I believe I might be able to obtain further improvement. The goal of any nasal surgery is not perfection, although that is what we want, it is the best possible surgical result. Sometimes an improvement that is not perfect is still the best that can be obtained without adding inadvisable risks. I shall strive to give you the most improvement I can, always putting safety first, then function and aesthetics. Following is a summary of our surgical objectives. Page 1 of 2

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You have the advantage of nasal structures that are symmetrical and have not been operated on before and a septum that is also present (our best building material). However, your bridge is too high and the tip and lower nose are too prominent from the side. Your septum is deviated toward your right, and the middle of your nose is narrow, so that there is airflow improvement when I support the internal valves with a Q-tip, particularly on the left. The bridge is too high but begins fairly low (so that there is a low spot at the top), and your tip cartilages are slightly asymmetrical (right broader than left, left more convex than right). I will reduce the width of your tip cartilages slightly and reduce the dorsum, also shortening the nose minimally (which will not reveal more nostril but will reduce the apparent size of the lower nose). I will take out the part of the septum that is blocking your airway, stiffen the sides so that your airway is stable, and use a very thin sliver of septal cartilage to raise the low point at the top about a millimeter, which will improve the balance of your nose on profile and make it appear less “bottom heavy.” I will also narrow the upper nose. I know that you do not want a “buttoned up” nose, and I will keep your bridge straight, not making it scooped, and I will strengthen the tip slightly so that it does not pull down when you smile. I anticipate a nose that will be straighter and more functional, with better proportion, but not one that looks noticeably different to others (although you will certainly notice the difference). I anticipate a 90% or better chance that I can achieve what we both wish in one operation. Because I do not control the quality of your building materials or your healing, however, there may still be imperfections that I can improve in a second, smaller, touch-up procedure if you wish the best possible result I can provide. I enjoyed meeting with you and will do my best to help you. These blue sheets summarize your consultation with Dr. ______________. They do not require your signature at this time. You will be asked to sign our office copy at your preoperative visit. ____________________________

____________________________

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Patient’s Printed Name

Patient’s Signature

Date

____________________________

____________________________

Physician’s Name

Date

____________________________

____________________________

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Closing an Unsuccessful Consultation Paradoxically, it is perhaps harder to reject than accept a patient for surgery. In some cases, it becomes clear to both the patient and the surgeon that either the plan or the personalities are not going to work. That is the easiest situation, and the consultation can almost always end cordially. More difficult are instances in which the patient wishes to proceed but the surgeon does not. Some patients will respond to a discussion of why the surgeon does not believe that the achievable result will meet the patient’s expectations. Other patients, however, are so aggressively or emotionally determined to proceed that the surgeon’s refusal might cause an offic disruption. If I sense that may be the case, I tell the patient that I am not sure that I am the right surgeon for this problem (which may be true), but that I will study his or her photographs and consider my decision (which I do) and then notify the patient. Occasionally, though infrequently, I change my mind on reflection and agree to accept the case. If not, a courteous and supportive written explanation closes the discussion but allows the patient to regain his or her equilibrium outside the surgeon’s offi .

Conclusion Governing my decision to operate is a five-point checklist: 1. Can I see the deformity? 2. Can I fix it? 3. Can I manage the patient? 4. If there is a complication, will the patient remain controlled and cooperate with treatment? 5. Does the patient accept the margin of error inherent in surgery? Positive answers to each question define a good working relationship; a single negative response is a contraindication to surgery. Although I have had many wonderful patients during my career, the perfect patient is a mythical creature. Each of us remembers our difficult or unhappy patients most clearly. No matter how precise and involved our preoperative evaluations may be, we get only small snapshots of these patient’s lives, and then we change the way they look. What could potentially disrupt a patient’s life more profoundly? It quite amazes me that we do not have problems all the time. In this regard, there is no substitute for Osler’s admonition: “Listen to your patient. . . .”

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BIBLIOGRAPHY Berger G, Hammel I, Berger R, et al. Histopathology of the inferior turbinate with compensatory hypertrophy in patients with deviated nasal septums. Laryngoscope 110:2100-2105, 2000. Bronz G. Predictability of the computer imaging system in primary rhinoplasty. Aesthetic Plast Surg 18:175-181, 1994. Engelhardt HT, Rie MA. Morality for the medical-industrial complex. N Engl J Med 319:1086-1089, 1988. Gallagher AG, Cates C. Approval of virtual reality training for carotid stenting: what this means for procedural-based medicine. JAMA 292:3024-3026, 2004. Goin JM, Goin MK. Changing the Body—Psychological Effects of Plastic Surgery. Baltimore: Williams & Wilkins, 1981. Goin MK. Psychological understanding and management of rhinoplasty patients. Clin Plast Surg 4:3-7, 1977. Harris DL. The symptomatology of abnormal appearance: an anecdotal survey. Br J Plast Surg 35:312323, 1982. Hirshfield EB. Should ethical and legal standards for physicians be changed to accommodate new models for rationing health care? [commentary] U Penn Law Rev 140:1809-1847, 1992. Lundberg GD, Bodine L. Fifty hours for the poor. JAMA 258:3157, 1987. McMahon KC v Finlayson WJ & another. 36 Mass App Ct 371-376, 1994. Phillips KA. The Broken Mirror—Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press, 1996. Roth RS, Lowery JC, Davis J, et al. Psychological factors predicting patient satisfaction with postmastectomy reconstruction. Plast Reconstr Surg 119:2008-2017, 2007. Schoenrock LD. Five-year facial plastic experience with computer imaging. Facial Plast Surg 7:18-25, 1990. Shapley H. Of Stars and Men. Boston: Beacon Press, 1958, p 94. Webb MS. Medical ethics under managed care: how can the patient survive? Ann Plast Surg 37:233-244, 1996.

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CHAPTER 9 Creating the Preoperative Plan This was the object of The Declaration of Independence. Not to find out new principles, or new arguments, never before thought of, not merely to say things which had never been said before; but to place before mankind the common sense of the subject, in terms so plain and firm as to command their assent, and to justify ourselves in the independent stand we are compelled to take. Neither aiming at originality of principle or sentiment, nor yet copied from any particular and previous writing, it was intended to be an expression of the American mind, and to give to that expression the proper tone and spirit called for by the occasion. THOMAS JEFFERSON Letter to Henry Lee 391

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A Template for Planning Sifted to their most basic principles, most rhinoplasties have only four goals: 1. Create a defined shape (for example, one that is less blunt) 2. Improve function 3. Improve nasal balance (for example, reduce a “bump” or a “tip that sticks out too far”) 4. Improve continuity (for example, create symmetry and confluence among all regions of the nose)

Questions to Consider in Formulating the Surgical Plan Taken together, these goals prompt 10 questions that help a surgeon formulate a biologically sound surgical plan: 1. What is the deformity relative to the patient’s goals? 2. What are the critical anatomic variants (low radix or dorsum, inadequate tip projection, narrow middle vault, malposition)? 3. What is the nasal shape relative to the three surface parameters (skin thickness and distribution, tip lobular shape, and the balance between nasal base size and dorsal height)? 4. What functional deficits exist? 5. What will be destabilized by the reduction phase? (For example, will hump reduction produce internal valvular incompetence? Will lateral crural reduction produce external valvular obstruction?) 6. What are the graft requirements? 7. What secondary donor sites will be needed? 8. What access incisions are needed and how can they be minimized? 9. What is the logical order of the operation? 10. What must be staged?

WHAT IS THE DEFORMITY RELATIVE TO THE PATIENT’S GOALS? All surgeons recognize that different patients have different goals, and, in general, surgeons try to accomplish these goals—but success can vary. By identifying anatomic variants and establishing postoperative equilibrium, a surgeon has much greater control over the result. With greater control, the details of a patient’s goals become more important, because the goals become more realistically achievable; less is left to chance.

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PATIENT STUDIES ONE AND TWO

These two women shared some preoperative characteristics—low radix, high dorsum, and adequate tip projection—but each had her own preoperative goals. Patient One (top) desired a straight bridge with a more angular tip. Patient Two (bottom) wanted to maintain much of her bridge height but wished to have her nose slightly shortened and her airway opened. Both had visible septal deformities; in Patient One the caudal septum protruded into the right airway.

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Patient One

SUMMARY OF THE SURGICAL PLAN 1. Resection and replacement of the dislocated caudal septum 2. Limited skeletonization through a right intercartilaginous incision 3. Dorsal reduction 4. Reduction of the lateral crura retrograde; resect the medial crural footplates 5. Septoplasty 6. Bilateral spreader grafts, thicker on the right than on the left 7. Layered radix graft 8. Left lateral wall graft 9. Tip grafts 10. Right alar wedge resection 11. Bilateral osteotomies

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The bony and cartilaginous dorsa were reduced 2 mm through an intercartilaginous incision; septoplasty was performed to clear the airway.

A

B

C

The best piece of septal cartilage was crushed and placed at the nasal radix (A), which leveled the dorsum (B).

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Multiple crushed cartilage tip grafts, filling the asymmetrical right side more than the left, improved tip symmetry. Asymmetrical spreader grafts (thicker on the right than on the left) were placed to improve the high septal deviation.

Silhouettes confirm the change in dorsal contour, the elevated radix, and the alteration in tip lobular contour conferred by tip grafting.

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Postoperative Analysis

Despite the lateral wall graft, some asymmetry remains 2 years postoperatively. Although a left osteotomy performed first seemed to indicate the need for bilateral infractures, in retrospect a unilateral left osteotomy would have been preferable.

The dorsum is straight and the radix is slightly higher, balancing the size of the nasal base. The tip is now above the septal angle, and tip grafts have reduced the preoperative bluntness by increasing postoperative skeletal support.

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A

B

C

D

Comparative inspiratory views, before surgery (A and B) and after surgery (C and D), illustrate the stability provided by the spreader grafts. Resection and replacement of the caudal septum, footplate resection, and a right alar wedge resection have improved the nostril symmetry (E and F). Note the improved symmetry in the postoperative oblique views (G through J ); this is one goal of surgery on the asymmetrical nose. In these 2-year postoperative views, note also the confluence between the upper, middle, and lower thirds of the nose, which was achieved using a thicker right spreader graft.

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E

F

G

H

I

J

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Patient Two

The nose of this young Jewish woman was relatively symmetrical. Her goal was to improve her airway and soften the overall nasal contour while preserving some dorsal height and maintaining the familial and ethnic characteristics important to her. These elements are present in the surgical plan.

SUMMARY OF THE SURGICAL PLAN 1. Moderate skeletonization 2. Shortening of the upper caudal ends, upper lateral cartilages retrograde 3. Leveling of the dorsum 4. Shortening of the anterior caudal septum 3 mm through a transfixing incision 5. Septoplasty 6. Long convex dorsal graft 7. Tip grafts 8. Bilateral osteotomies

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Dorsal reduction, shortening the upper lateral cartilages, resecting 2 mm of caudal and membranous septum through a transfixing incision, and no modification of the tip cartilages produced a straight profile.

Septoplasty yielded a perfect dorsal graft, although surgeons cannot count on this kind of luck. I had planned on minimal dorsal trimming and a radix graft; but the septal harvest offered a better alternative.

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A dorsal graft placed through the intercartilaginous incision restored the appropriate convexity.

Two small crushed tip grafts added a bit more contour and symmetry. Silhouettes demonstrate maintenance of a dorsal contour; the nose is better balanced and slightly shorter.

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Postoperative Analysis

One-year postoperative views confirm a stable appearance. The dorsal graft has improved the confluence and symmetry between the bony, upper, and lower cartilaginous vaults by hiding the high septal deviation. Septoplasty and internal valvular reconstruction (dorsal graft) resulted in a geometric mean nasal airflow that was a surprising 13.5 times greater than the preoperative value (caused by a combination of poor preoperative flow and greater postoperative stability). Maintenance of dorsal height and skin sleeve volume, along with improved tip support, resulted in a shortened nasal contour rather than the lengthening that is common when the preoperative nose is long. Important ethnic and individual aesthetics have been preserved. 403

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WHAT ARE THE CRITICAL ANATOMIC VARIANTS?

This secondary patient had a low radix, a narrow middle vault, and alar cartilage malposition. When the radix is low, even a conservative dorsal reduction will increase the apparent size of the nasal base; in addition, a weakened middle vault produced by roof resection creates a new airway obstruction. Reduced, but still malpositioned, the lateral crura allow the alar rims to retract cephalad. Despite a conservative rhinoplasty, the entire lower nose seems larger because of the imbalance created by the low radix. She had hoped for a straight dorsum and a defined tip. Now is the time to explain to the patient the difference between nasal size and nasal shape and how a higher radix (as in the magazine photo) can favorably alter nasal proportion. 404

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B

D

E

Relocation of the lateral crura and trimming the caudal and membranous septum reduced the deformity and moved soft tissues into the correct position, but the skin sleeve remained shapeless (B). Septoplasty cleared the airway and provided ample material for reconstruction. Radix grafts (D) and tip grafts restored tip projection and nasal balance.

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The magical effects of skeletal reduction and redistribution have altered the nasal contour considerably.

Postoperative Analysis

Relocation of the lateral crura has reduced the alar rim height without a need for composite grafts. Coupled with caudal septal elevation, the nostrils became less visible. Greater retraction would have required composite graft correction, which could still be performed as a secondary procedure.

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Tip projection has increased, apparent nasal base size has diminished, and the dorsum is now straight. Although they do differ somewhat, notice how similar the postoperative nasal contour is to the patient’s ideal image.

Spreader grafts have broadened the middle vault, and lateral crural repositioning has provided alar wall alignment and support. This combination of procedures typically triples or quadruples airflow in most patients. This patient’s airflow increased 1.9 times over preoperative values. Although the preoperative airway was compromised, there are significant measured variations in postoperative improvement that sometimes undervalue subjective changes. Patients with these types of preoperative deformities are not good candidates for standard reduction rhinoplasty. 407

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WHAT IS THE NASAL SHAPE RELATIVE TO THE THREE SURFACE PARAMETERS? A

B

C

D

The three surface parameters (skin thickness and distribution, tip lobular shape, and the balance between base size and dorsal height) must be considered when formulating the surgical plan. Both of these patients complained about their dorsal humps, but their different skin thicknesses required different graft substances. Because their lateral crural positions and shapes were also different, the patient below needed lateral crural resection, replacement, and tip grafts, whereas the patient above did not. Also, because their nasal balances differed, the first patient’s larger base benefitted from a radix graft (A and B), whereas the radix was deepened in the second patient, and the nasal base was brought forward with maxillary augmentation, columellar grafts, and tip grafts (C and D). Anatomy contributes to apparent dorsal height and configuration. Always assess bridge contour in the context of both radix height and tip projection.

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WHAT FUNCTIONAL DEFICITS EXIST? It is important for a surgeon performing cosmetic corrections to understand the anatomy and structure of the entire nose and to recognize that any functional correction must parallel aesthetic correction. We have already seen that a narrow middle vault and malposition create both anatomic and functional problems, because nasal form and function are inseparable. This is the principal reason why rhinoplasty surgeons should perform airway surgeries themselves. No surgeon will perform a septoplasty more carefully than one who needs the cartilage and bone for reconstruction. Furthermore, important intraoperative decisions are guided by the quality of the donor material and the specifics of the donor site. For example, if old fracture lines that extend toward the anterior septal edge are encountered during a septoplasty, the surgeon might handle the functional correction or the dorsal resection differently than in a patient without septal fractures.

WHAT WILL BE DESTABILIZED BY THE REDUCTION PHASE?

Before spreader grafts

Spreader grafts on patient

After spreader grafts

A 2 mm resection of the cartilaginous roof opens the middle vault, thereby destabilizing the upper lateral cartilages and creating instability and internal valvular incompetence that may not have existed preoperatively.

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B

C

Similarly, relocating malpositioned lateral crura can decrease tip projection. Note that resecting and moving this patient’s lateral crura have altered her tip contour from projecting (A) to flat and nonprojecting (C)—even though her middle crura remain undissected. Each of these maneuvers creates new instabilities; therefore correction of these instabilities must be included in the preoperative plan.

WHAT ARE THE GRAFT REQUIREMENTS? Once the surgeon has assessed the patient’s goals, critical anatomy, and functional deficits, the specifics of donor site requirements become clear.

The grids shown here contain the septal cartilage and bone from one primary rhinoplasty. In most patients, an unoperated septum will yield radix, spreader, tip, columellar, and lateral wall grafts. Septal cartilage and bone serve different purposes. I always use the flattest, straightest piece of septal cartilage for the dorsum and the

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less-ideal pieces and remaining cartilage for spreader, tip, and lateral wall grafts. Ethmoid or vomer can make serviceable spreader grafts if cartilage is insufficient, and they create secondary supporting grafts for the dorsum or lateral wall grafts to correct asymmetries, fill depressions, or stabilize alar rims. For scarred secondary tips that need expansion or for poorly shaped tips in which a middle crural segment must be created, an ethmoid graft establishes the correct angle of rotation. Cartilage tip grafts placed anterior to the ethmoid graft form the lobule itself.

WHAT SECONDARY DONOR SITES WILL BE NEEDED? If part of the septum has been harvested, or if the septum is predominantly bony, I reserve any remaining septum for the dorsum, substituting ear cartilage for spreader, tip, or lateral wall grafts. If the dorsal defect is long and shallow, rib cartilage and calvarial bone are the best autogenous alternatives. However, when calvarial bone is used, another site must be harvested for the tip. Rib cartilage does not share that restriction, which is why I use it more often. If the septum is absent and no dorsal graft is needed, ear cartilage makes excellent spreader, tip, and lateral wall grafts and can be used to re-create lateral crura alar cartilage.

If the septum is not present, but a dorsal graft is necessary, ear cartilage can substitute. For patients with a deep, slightly asymmetrical defect beneath a thick soft tissue cover, rolled ear cartilage (fixed circumferentially with sutures [Sheen]) makes an excellent dorsal graft, although it is not as good as rib cartilage. I do not advise using strips of ear cartilage for the dorsum, either stacked or in longitudinal segments, because as the dorsal skin heals and tightens, it compresses and flattens the elastic cartilage, making long-term results rarely satisfactory.

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In cases for which I do not harvest rib cartilage (except for patients with a repaired cleft lip), I use Gore-Tex rolls for maxillary augmentation. If rib is being harvested already, I prefer to use it for autogenous maxillary augmentation. I use only autogenous grafts over the maxilla in patients with clefts, even if the buccal sulcus is supple and unscarred, because extrusion rates are unacceptably high for other materials. The ear also yields two specialized boot-shaped grafts to support the caudal septum and composite grafts for nostril deformities or vestibular stenosis (see Chapter 12). The following algorithm summarizes my graft sources.

PREFERRED GRAFT DONOR SITES Septum present

Cartilage for: Dorsum Spreader grafts Lateral walls Tip

Columella Alar walls

Use Gore-Tex for maxillary augmentation

Septum absent

Ethmoid or vomer for: Dorsal (usually beneath main cartilage graft)

Spreader graft (second choice) Lateral walls Tip buttress Alar walls

Use Gore-Tex for maxillary augmentation

No dorsal graft needed

Conchal cartilage for: Spreader graft Lateral walls Tip Columella Alar walls

Use Gore-Tex for maxillary augmentation

Dorsal graft needed

Defect deep

Rolled conchal cartilage graft for dorsum

Rib graft for dorsum

Rib cartilage graft for dorsum

Use concha for tip, lateral wall, alar walls

Use rib for all other graft requirements in this patient

Use rib for all other graft requirements in this patient

Use Gore-Tex for maxillary augmentation

Specialized grafts Lateral crural replacement

412

Caudal support graft (Boot-shaped, to replace missing caudal septum)

Defect shallow

Composite grafts (Axial, coronal, or sagittal orientations)

Crushed conchal cartilage graft for dorsum (A compromise solution for special circumstances)

Use concha for all other graft requirements in this patient: Lateral walls Spreader grafts Tip Columella Caudal support Alar walls

Use Gore-Tex for maxillary augmentation

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WHAT ACCESS INCISIONS ARE NEEDED AND HOW CAN THEY BE MINIMIZED?

Every incision must have a reason and serve a purpose, although one incision can often serve many purposes. Do not make a transfixing incision unless you plan to shorten the nose. Do not make bilateral intercartilaginous incisions unless both upper and lower lateral cartilages require modification. It is always preferable to minimize dissection, thereby minimizing morbidity and the potential for complications. In some cases (such as with this patient), and except for the incision to harvest septal cartilage, an entire rhinoplasty can be performed through two short intranasal incisions: an intercartilaginous incision on one side for dorsal reduction and placement of radix and spreader grafts and a short infracartilaginous incision on the other side to place tip grafts.

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WHAT IS THE LOGICAL ORDER OF THE OPERATION? Certain combinations make the most sense for any operation: perform the dorsal resection before creating spreader graft tunnels (so the grafts can be placed precisely along the new dorsal edge). Perform dorsal resection before septoplasty (so the width of the dorsal strut can be accurately assessed, and rasping will not move or destabilize the dorsal strut). In a long nose with a large base and low dorsum, rotate the base first so that the dorsal height can be evaluated relative to the position and size of the newly repositioned postoperative base. If you are certain that a second donor site will be needed (for example, ear cartilage in addition to septum), harvest it as soon as you can assess the quantity and length of the necessary graft so that valuable time is not wasted while the nose swells.

WHAT MUST BE STAGED? Staging is rarely a consideration in primary rhinoplasty, but some deformities in secondary rhinoplasty cannot be safely or adequately corrected in one operation, and the patient must be informed about this beforehand. For example, in procedures involving rib cartilage for dorsal, tip, columellar, and maxillary reconstruction, I may defer composite grafts and place them in an isolated procedure 6 to 12 months later or at the time of any future revision. However, I always correct the airway and lay the foundation for the primary reconstruction at the first operation (accomplishing as many of the patient’s goals as possible). In most cases, the deferred procedures should be less important, because the patient may decide not to undergo them.

Constructing a Formal Plan I always test an idea by its simplicity. The simpler a concept, the more likely it is to be true. A rhinoplasty plan may have a number of steps, but there is a difference between intricacy and convolution. As long as important goals can be accomplished, it is always best to reduce any surgical strategy to its most direct form, trying as much as possible to achieve the patient’s goals with the least morbidity and the lowest chance of a complication.

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T he Preoperative Envelope

Once I have constructed a plan, I write out each of the steps, in order, on the envelope containing the patient’s photographs so I can refer to it during surgery. I formalize my plan the night before each operation so that it is fresh in my mind. I also look for any subtleties that may have escaped me. Have I located all of the asymmetries? Which side of the maxilla should be augmented more? Which side should receive a thicker spreader graft? Which oblique view shows a higher hump? Are there any steps that should be added or removed? Do I have the simplest plan? Am I trying to accomplish too much? What is the safest course? I also carry a photocopy of the patient’s consultation notes into the operating room for reference to ensure that the patient’s original complaints and highest priorities are not forgotten during the intensity of surgery.

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Once the surgery has been completed, I place checkmarks or indicate changes on the picture envelope, after which I complete a procedure sheet. This sheet notes every step performed or omitted and diagrams every graft as I inserted it, with notes indicating graft quality and any unusual intraoperative decisions or difficulties. The sheets are stapled to the inside cover of the patient’s chart for reference during follow-up appointments. If something works well, I want to know why; if not, I want to make future adjustments. My notes also influence any necessary revisions, because they tell the shape and substance of each graft and where it is located. Irregularities no longer become mysterious, and an occasional absored graft may indicate a need for a different donor site. Simplicity, directness, prioritization, staging, and knowledge of the principles of nasal function and structural interrelationships are all essential. Each skill is tested as the surgeon formulates the surgical plan. With experience, the exercise becomes a fascinating and delightful puzzle.

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S ummary Planning a rhinoplasty can be as complicated as the surgeon and patient wish, but it can also be simplified to its minimum requirements. Your results will be uniformly good if you remember the following points and include them in your surgical plan: 1. Identify the four critical anatomic variants (low radix/low dorsum, inadequate tip projection, narrow middle vault, and alar cartilage malposition). 2. Evaluate not only the septum and turbinates but also the preoperative competence of the internal and external nasal valves. 3. Graft the dorsum or place spreader grafts (depending on the preoperative configuration) to create internal valvular competence where it did not exist preoperatively or to correct the internal valvular incompetence created by dorsal resection. 4. Leave sufficient lateral crus to maintain external valvular competence, or create external valvular competence by splinting the area of collapse or repositioning a cephalically rotated lateral crus. 5. Increase tip projection if it is inadequate. 6. Graft the radix if necessary to create optimal nasal balance. 7. Make sure that all grafts look and feel perfect on the operating table; do not leave the finish work to nature.

BIBLIOGRAPHY Bronz G. Predictability of the computer imaging system in primary rhinoplasty. Aesthetic Plast Surg 18:175-181, 1994. Engelhardt HT, Rie MA. Morality for the medical-industrial complex. N Engl J Med 319:1086-1089, 1988. Gallagher AG, Cates C. Approval of virtual reality training for carotid stenting. JAMA 292:22-29, 2004. Hirshfield EB. Should ethical and legal standards for physicians be changed to accommodate new models for rationing health care? Univ Penn Law Rev—Commentaries 140:1809-1847, 1992. Kelley Carroll McMahon v William J. Finlayson, 36 Mass App Ct 371-376, 1994. Lundberg GD, Bodine L. Fifty hours for the poor. JAMA 258:3157, 1987. Pearson DC. Teaching Rhinoplasty to Residents. Toronto: University of Toronto, 1999, pp 3-7. Schoenrock LD. Five-year facial plastic experience with computer imaging. Facial Plast Surg 7:18-25, 1990. Webb MS. Ethics, Medical Ethics and Managed Care: Issues, Intersections and Directions. Preliminary Report for the Board of Directors. Arlington Heights, IL: American Society of Plastic and Reconstructive Surgeons, 1995.

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Our ignorance of the laws of variation is profound. . . . But whenever we have the means of instituting a comparison, The same laws appear to have acted. CHARLES DARWIN On the Origin of Species by Means of Natural Selection

CHAPTER 10 How to Learn Rhinoplasty

William James used to preach the “will to believe.” For my part, I should wish to preach the “will to doubt. . . .” What is wanted is not the will to believe, but the will to find out, which is the exact opposite. BERTRAND RUSSELL Skeptical Essays

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A

s an operation, rhinoplasty is different from many other surgical procedures, because it is so dynamic. Things move, not only during surgery but also postoperatively. As we have seen already and shall explore again in Part III, many intraoperative steps (such as skeletonization, dorsal resection, tip reduction, and others) affect not only their own regions but also the nose as a whole—in appearance, balance, or support. Many of these changes have not yet been well described in the literature. Therefore surgeons neither expect these changes nor look for them, and either become disoriented or fail to benefit from the feedback that occurs right before their eyes. Rhinoplasty is intensely interactive, and the more a surgeon learns to interpret intraoperative changes and understand what they represent, the better the judgment and the more control he or she will have over the postoperative result.

L earning Surgical Judgment How do surgeons develop judgment? Aside from the few simulators that have appeared, the only available means for a surgeon to develop judgment has been through experience: cumulative operations, textbooks, atlases, videos, and observation of other surgeons. Nevertheless, a common shortcoming exists in each of these methods. Surgeons learn heuristically, which is a term used by the artificial intelligence folks to indicate trial and error. Fully developed surgical judgment implies patterns of decision-making based on principles most aptly described as “rules of thumb,” and thereby includes not only discrete experiences but also inference and intuition. It is not easy for surgeons to develop their own judgment exclusively by watching other surgeons execute their judgment in specific operative circumstances. This is a limitation of videos and textbooks for teaching some kinds of surgical experience. The missing modality in human surgery is always safe, reversible experimentation, by which a surgeon might simulate complications or try different procedures without risk to an actual patient.*

*For this reason, I created “The Rhinoplasty Simulator” between 1984 and 1987, through which surgeons could experiment with four different nasal configurations on a computer and proceed through each step of the operation, with opportunities to explore different views, see anatomic or surface configurations at each step, backtrack, or obtain help at any time. At the conclusion of the operation, the computer would reconstruct the projected nasal appearance at the end of the first postoperative year.

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The lack of a safe form of experimentation handicaps surgeons most when learning noncalibrated, feedback operations such as rhinoplasty. Consider the inherent difference in surgical strategies between rhinoplasty and the many operations that are more calibrated, such as breast reduction. Despite the important technical niceties that add refinement to breast reduction, many reduction techniques require precise preoperative measurements followed by exact intraoperative reliance on those measurements. A surgeon who performs breast reduction recognizes that a supine patient’s surface anatomy is distorted and that symmetrical preoperative markings may appear inaccurate. Confident of his or her preoperative calibration, the surgeon trusts those measurements, and not just the operative appearance, to provide adequate guidance. This situation reverses in rhinoplasty. Many surgeons find that precise preoperative measurements cannot be rigidly followed in a structure whose parts are dynamically interrelated, where maneuvers carried out in one area influence function and appearance in the others. An experienced rhinoplasty surgeon, therefore, develops an entirely different strategy than that previously outlined for reduction mammaplasty. Instead of relying primarily on calibration, a rhinoplasty surgeon relies on feedback, noting the changing appearance of the nose as intraoperative maneuvers are executed and comparing this appearance to the imagined final outcome and to the appearances of other noses on which similar procedures have been performed. (Chapter 11 details many of these intraoperative changes in primary noses.) In addition, an experienced nasal surgeon operates within the framework of a model that explains nasal function and behavior not only intraoperatively, but also over the ensuing postoperative months. The more precise the model, the more the surgeon can control the postoperative result. I am self-taught in rhinoplasty, in the sense that every surgeon is self-taught in every operation. Regardless of the attentiveness and quality of the training, at some point each surgeon must perform his or her first rhinoplasty without supervision. It is during those anxious, undirected operations that each surgeon develops what is commonly called, for lack of a better word, feel. As elusive as the term seems, there is probably no better way to describe this accumulated skill.

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H ow to Teach Yourself Rhinoplasty I am commonly approached by surgeons who confess that they did not perform many rhinoplasties during residency and wonder how they can become experts, or even competent, at the operation. I was in exactly the same position when I started practice, having performed only a handful of rhinoplasties throughout my residency, and compounding the problem by settling in an area where there was, at the time, little demand for cosmetic surgery. When I recognized my fascination with rhinoplasty, I knew that I needed to develop experience somehow. Therefore I used the model that Dr. Radford Tanzer articulated as he was trying to develop new methods for auricular reconstruction in microtia. Asked how he had been able to conceive a revolutionary new method of ear reconstruction for microtia based on the experience of only four patients, Dr. Tanzer replied, “Before I did each case, I did it 1000 times in my head.” The same excellent model used by Tanzer can be applied to any operation, and it works well for rhinoplasty. Extract as much information as possible from each operation. Prepare meticulously. Take all the time necessary to accomplish the patient’s goals during surgery, and learn to interpret the intraoperative and postoperative signs that will serve as your future guide. The easiest way to discover these signs is through serial, sequential intraoperative and postoperative photographs.

SEQUENTIAL INTRAOPERATIVE PHOTOGRAPHS I recognized early in my career that the rhinoplasty steps that were so neatly drawn in atlases simply did not apply in the operating room. For example, dorsal reduction changed not only what it should change but also what it should not change: nasal length, upper and middle vault width, columellar position, nostril contour, and even tip projection. By the end of performing my third rhinoplasty, I knew there had to be a pattern to what I was seeing, but I had no idea what it was or how to recognize it; I needed time to think. Therefore I began taking sequential, intraoperative photographs after each critical step: one each after skeletonization, dorsal reduction, tip refinement, nasal shortening, graft, and so on; and I took lateral views at the beginning and end of each operation, showing both surface contours and silhouettes. Although I no longer take so many intraoperative photographs, at the very least I still photograph nasal appearance at the beginning and end of every operation. After 30 years of practice, these intraoperative sequences have become the warp and woof of this text and of my own rhinoplasty understanding.

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POSTOPERATIVE SEQUENCES After surgery, there is ample time to examine each image and learn to decode the feedback that the nose is giving. Although I describe many intraoperative changes and artifacts in this text, you will surely observe others and can learn from them. Dorsal reduction shortens most noses, but lengthens some—particularly long noses or those with humps positioned caudally. Tips respond differently to reduction and to augmentation, depending not only on what the surgeon actually does, but also on shape and condition of the preoperative tip lobular skin itself (such as skin thickness, cartilage strength, previous scars, and other factors). Although any text can present broad sweeps of information, each surgeon needs to learn how different augmentations and reductions behave in different noses, and in his or her own hands. Each surgeon needs to develop his or her own feel.

PATIENT STUDY ONE POSTOPERATIVE SKELETAL CHANGES

This case was part of my learning curve. Today I would recognize the low radix, narrow middle vault, and inadequate tip projection. In 1982, before Sheen’s descriptions of low radixes and spreader grafts, only this patient’s inadequate tip projection caught my eye.

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A

B



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

C

D

Intraoperatively, the dorsum was reduced, septal cartilage was harvested (B), and a single tip graft was added—note the percutaneous fixation suture (C). Immediate postoperative contours were promising (D).

Silhouettes demonstrate the tip projection changed and the dorsal contour altered for the better.

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11 days postoperatively

5 years postoperatively

13 weeks postoperatively

7 years postoperatively

At 11 days, the patient’s postoperative appearance still seemed promising. However, by 13 weeks it was obvious that the dorsum was too low at its midpoint (middorsal notch). The collapse of the middle vault and the overresected dorsum were grossly obvious at 5 years and at 7 years, when the patient returned for chin augmentation, not nasal revision (in which she was not interested). This type of happy patient saves young surgeons.

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Preoperative

Postoperative

Notice how the middle vault has progressively narrowed, predictable given this critical anatomic variant. The oblique view confirms the inverted-V deformity, beginning at the middorsal notch and extending laterally along the caudal edge of the bony arch. Aside from the changes in nasal contour, per se, notice also the change in the upper lip carriage from my caudal septal adjustment. Today I would reduce the dorsum less, add spreader and radix grafts, and use multiple, crushed cartilage tip grafts to better suit the patient’s thin skin. It is surprising that her single, solid tip graft has not become more visible.

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PATIENT STUDY TWO POSTOPERATIVE SOFT TISSUE CHANGES

There are some skin sleeves that simply will not adapt. In retrospect, this patient has one of them. Though today I would anticipate that response from the patient’s skin thickness, at the time I was eager to reduce her large nose. I anticipated that by decreasing the tip projection, I could produce a smaller version of the same feature, while remaining safely within tissue limits. However, that cannot be done.

After skeletonization and shortening the upper lateral cartilages, notice the tip rotation and the favorable improvement between the alar rim and the caudal septum when the skin sleeve moves cephalad, exposing more of the columella. 429

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A

C

B

D

The lateral crura were delivered through bipedicle flaps (A), and a vertical wedge was removed from each dome to reduce tip projection (B and C). Notice that as the tip flattens, the dorsal convexity appears to increase (D).

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A

B

C

D

By the time this case was performed, spreader grafts had been described, and I had learned to appreciate the narrowing of the middle vault after dorsal roof resection (which can be seen at my fingertip in A). Septoplasty yielded a small amount of usable material; the tip and spreader grafts are on the left side of the grid (at the bottom of the image) (B). After spreader graft placement, the middle vault became slightly broader, and the concavity that was appreciable after roof resection disappeared (C). The immediate postoperative appearance showed a straight dorsum and apparently adequate tip projection (sutures are from an incidental nevus excision).

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The nose is smaller, the dorsum is straight, and the tip is more defined and just in line with the dorsum: mission accomplished.

Preoperative

1 year postoperatively

One year postoperatively, thickened soft tissues obscure details of the postoperative changes that were revealed in the previous patient, but the nose is broader than it was preoperatively despite osteotomies.

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Preoperative

1 month postoperatively

1 year postoperatively

1 year after revision

At 1 month, the nose was still too short and the columella had retracted, but the lower nose had already begun to thicken. At this point, it was not yet too late for transient supratip swelling to disappear, so I remained hopeful. At 1 year, however, the upper dorsum was still too low, the supratip was high, the tip was blunt, and the columella had retracted, which was not an improvement over the preoperative nose. One year after upper dorsal and additional tip grafts, the final result is a minor improvement in dorsal contour but a loss for the nasal base. The tip has lost some of its landmarks, and the columella is still too high. This nose was essentially unwilling to conform to any reductions, and even the secondary correction never caught up. 433

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Preoperative

1 month postoperatively

1 year postoperatively

1 year after revision

Evolution from preoperative appearance to 1 month, 1 year postoperatively (just before revision), and 1 year after revision confirms the change in detail that has occurred, even with the thick skin. The alar crease has shortened and deepened as the nasal base has contracted. However, the combination of an upper dorsal graft placed during the revision and a slight reduction in tip projection have produced a slight decrease in overall nasal base size.

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1 year after revision

There is one other slight improvement demonstrated by the frontal views from before the first operation and 1 year after the second procedure: the asymmetrically thick spreader grafts (broader on the patient’s right side) have straightened the high septal deviation. The basal perimeter has also changed. Even at the same degree of head inclination, the tip is flatter and broader, and the nostrils are less oval.

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If I were to treat this patient today, I would not modify the tip cartilages at all; instead I would reduce the dorsum minimally through a single intercartilaginous incision, place spreader grafts for the high septal deviation, and place a thin radix graft to improve nasal balance. This would be a minimal operation with significant functional correction and improvement in nasal balance within the patient’s tissue limits.

PATIENT STUDY THREE A PARALLEL CASE—DIFFERENT SKELETON AND SKIN SLEEVE

This patient has almost the same nasal configuration as the previous patient: an obtuse nasolabial angle, adequate tip projection, and a low radix that creates the impression of an unbalanced nose. However, this patient’s tissues are noticeably thinner.

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Yet this benign appearance contains traps. Observe the alar collapse when the patient inspires. Imagine the middle vault collapse that would occur from resection of the cartilaginous roof, which occurred in the first patient in this chapter. Imagine the increased imbalance that would come from dorsal reduction without rebalancing the radix, which occurred in the second patient in this chapter.

The small size of the dorsal reduction produced almost no change in nasal contour and relatively little compensatory nasal shortening (which is ordinarily produced by a decrease in the pressure of the bony/cartilaginous hump against the dorsal skin).

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D



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

E

C

F

G

Septoplasty cleared the airway and produced excellent cartilage grafts: most of the septal specimen is at the right side of the grid (top of the image), the spreader grafts are in the center, and the resected dorsal skeleton is on the left (bottom of the image). A layered radix graft was planned (B), sized (C), and placed (D). Note the immediate change in apparent nasal base size compared with the view before graft placement (E). Tip grafts lifted the tip slightly above the dorsal line, and increased tip contour by adding skeletal volume (F and G).

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2 weeks postoperatively

6 months postoperatively

3 years postoperatively

A comparison of the 2-week, 6-month, and 3-year views reveals several interesting changes: as in the previous patient, spreader grafts have straightened and camouflaged the high septal deviation and have doubled geometric mean postoperative airflow—the patient no longer flares her nostrils to support her airways. As the months progress, the nose becomes slightly narrower, but very few other changes occur. No middle vault collapse appears, even beneath her thin skin.

Preoperative

2 weeks postoperatively

6 months postoperatively

3 years postoperatively

Sequential lateral views at the same intervals also show little change, because equilibrium was established intraoperatively. Notice how closely the result matches the immediate postoperative appearance shown earlier. 439

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Preoperative

3 years postoperatively

The opposite postoperative oblique view shows a smooth middle vault without signs of collapse or discontinuity below the bony arch, a slightly higher radix, and improved tip contour from stronger underlying cartilage support. The base is unscarred. The tip lobule is smooth and without irregularities: all tip grafts were crushed. This patient is structurally identical to the woman on p. 425 but with slightly greater tip projection, and the woman on p. 429, but with thinner skin.

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When this case was performed, Sheen had introduced radix grafts, spreader grafts, and multiple, crushed tip grafts. The patient benefited from those techniques, which preempted the problems that her own anatomy could cause: spreader grafts corrected internal valvular incompetence and prevented middle vault collapse, and radix and tip grafts rebalanced the nose and added tip contour that reduction alone could not have produced.

PATIENT STUDY FOUR LOW RADIX, NARROW MIDDLE VAULT, AND INADEQUATE TIP PROJECTION, WITH SUBTLE DIFFERENCES IN A POSTTRAUMATIC SETTING

A

B

Between this patient’s wedding (A) and her preoperative appearance (B), she was involved in a motor vehicle accident and sustained a nasal fracture. Of particular concern was the new upper lip retrusion with sharpening at the subnasale, the deepened perialar areas, and an ominous discontinuity at the caudal end of the bony vault, which provided circumstantial evidence of an occult septal collapse.

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The frontal and inferior views confirm the posttraumatic high septal deviation toward the right. In this setting, particularly with the nasal base changes, the possibility of a septal fracture with instability must be considered. The septum should be explored through a Killian incision, and in particular not from the anterior dorsal edge, because that approach may identify occult fractures only after they have been destabilized. In such cases, I explore the septum very cautiously, and, even if I find no significant fractures, I leave at least 20 mm along the dorsal strut. Notice also that the patient’s lateral crura are cephalically rotated or malpositioned, creating a flat nasal tip, alar hollows, and parentheses around the tip lobule (demarcating the caudal edges of the lateral crura).

SUMMARY OF THE SURGICAL PLAN 1. Maxillary augmentation with Gore-Tex 2. Relocation of the alar cartilage lateral crura 3. Cautious septoplasty 4. Dorsal reduction (only if the septum is stable) 5. Asymmetrical spreader grafts, left thicker than right 6. Columellar graft 7. Multiple crushed tip grafts

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After maxillary augmentation and relocation of the lateral crura, notice the change in upper lip position and nasal base projection. The dorsum seems straighter, because maxillary augmentation has restored the nasal base position. Thus the need for dorsal reduction diminishes.

A

B

C

Septoplasty yielded a superb specimen, including two large pieces, each of which would form a perfect dorsal graft. Accordingly, I decided to raise the entire dorsum to match the repositioned nasal base: the need for dorsal reduction had disappeared. A dorsal graft would camouflage the high septal deviation and provide an equivalent functional result to spreader grafts, doubling airflow (B). The dorsal graft was formed and placed (C). The increased skeletal volume will help maintain the position of the skin sleeve and avoid a postoperative relapse of nasal length.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

Notice the middle vault collapse that becomes evident after skeletonization (A), which is another sign that the septum itself has been compromised. After dorsal grafting, the dorsum becomes more symmetrical and the inverted V disappears (B). Here is a rare situation in which the preoperative surgical plan changed qualitatively, not just quantitatively, as the case proceeded. Base adjustment altered the nasal profile, no septal instability was encountered, and the septoplasty yielded a wonderful dorsal graft. This is the type of feedback and compensation that must occur in rhinoplasty.

Two cartilage grafts were placed through a separate incision in the left side of the columella into a separate pocket to downwardly distract the retracted columella (also the result of the septal injury). 444

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The rest of the specimen was placed into a separate pocket in the tip to increase tip contour. The endonasal approach has the advantage of allowing discrete pocket creation where augmentation is needed most: in this case, high in the tip lobule.

In this patient, the only reduction was lateral crural relocation. The nasal base was moved forward by maxillary augmentation, the dorsum was raised with a layered graft (second short layer at the radix), and columellar and tip grafts brought the nasal base farther forward. Cautious septoplasty and a dorsal graft provided functional improvement at the internal valves, and alar cartilage relocation corrected the external valvular incompetence.

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Preoperative

4 months postoperatively

2 weeks postoperatively

6 months postoperatively

21⁄2 years postoperatively

Preoperative views and comparable photographs at 2 weeks, 4 months, 6 months, and 21⁄2 years show few evolving changes. Without osteotomy, the nose has become narrower and more symmetrical, bony vault stability remains, lateral crural relocation has altered tip contour configuration, and maxillary augmentation has created a more vertical, less retrusive, upper lip carriage.

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Preoperative

2 weeks postoperatively

6 months postoperatively

21⁄2 years postoperatively

Sequential postoperative lateral views at the same intervals confirm a straight, stable dorsal contour with adequate tip projection.

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21⁄2 years postoperatively

Preoperative

21⁄2 years postoperatively

Matching obliques are symmetrical. Lateral crural relocation has ablated the alar wall hollows, the dorsal graft has eliminated the middorsal discontinuity, and tip grafts have re-created optimal middle crural length and contour. At 21⁄2 years, the upper lip position is stable.

Preoperative

21⁄2 years postoperatively

Inferior views show more dramatic changes. The alar flare has disappeared, because the lateral crura are now close enough to the rims to supply valvular support. The parentheses are diminished, and the tip has a narrower, more projecting contour. Dorsal height has improved the nostril perimeter. Supported internal valves (dorsal graft) and external valves (repositioned lateral crura) increase airflow two 448

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to four times in such patients, on average. In this patient, geometric mean nasal airflow increased 2.5 times over preoperative values.

PATIENT STUDY FIVE NONTRAUMATIC VARIATION ON A THEME—TISSUE LIMITS

This primary patient has a deformity similar to the previous patient’s, but without upper lip retrusion. She has a high dorsum, a low radix, inadequate tip projection, and alar cartilage malposition—the last three of which are critical anatomic variants. Only a narrow middle vault is missing (see Chapter 5). But she does actually have a narrow middle vault, as well—functionally. Despite seemingly sturdy tissues and cartilages, the nasal sidewalls collapse on inspiration at both sets of valves. All patients should be evaluated for dynamic ventilatory changes. 449

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SUMMARY OF THE SURGICAL PLAN 1. Relocation of the alar cartilage lateral crura 2. Dorsal reduction 3. Septoplasty 4. Spreader grafts 5. Radix graft 6. Tip grafts 7. Bilateral low to high osteotomies

Aside from the surprise created in the previous case by the changed appearance of the patient when maxillary augmentation brought the nasal base forward, this plan should have been as simple as the last surgery was supposed to have been.

A

B

C

After lateral crural relocation (note the percutaneous suture coapting the lining and skin, removed after 48 hours), the bony vault was rasped (B), and the cartilaginous dorsum was trimmed with a No. 11 blade (C). Notice that the nasal base now seems larger. Because lateral crural relocation reduces tip projection, the dorsum seems artificially high even though it is straight (compare A with C).

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A

B

C

D

Despite the thin dorsal resection (A), the roof showed the usual anterior-surface depression at the confluence of the septum with the upper lateral cartilages (B); and on its undersurface, the roof showed evidence of all three structures, confirming the open roof (C). Notice the middle vault depression after dorsal resection (D).

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A

B

C

D

Septoplasty (A) yielded sufficient material for spreader grafts (B) and a layered dorsal graft (C and D).

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F

Because of the patient’s tissue thickness and firm lobule, I believed that the scraps left for tip grafting would provide sufficient augmentation when placed in a pocket dissected high in the lobule to maximize their effect (E); the blue card image reassured this belief (F).

The silhouettes confirm the areas that were reduced, augmented, and redistributed. Overall nasal balance seems better, because the dorsum is lower, the radix is higher, and the tip now projects beyond the septal angle (that is, the tip is adequately projecting).

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Postoperative Analysis

Preoperative

1 month postoperatively

At the end of the first postoperative month the result was still promising, although the tip was less defined than it should have been at this point. Sequential views at 5, 12, and 18 months confirm the development of supratip deformity. As the tip lobule contracts circumferentially, the distance from the anterior nostril to the point of greatest tip projection decreases so that the entire tip lobule draws posteriorly and concentrically as the supratip elevates. Had I not relocated the lateral crura but only grafted the tip lobule, there would have been less net decrease in skeletal volume (as the lateral crura moved from the lobule to the alar sidewall), and the tip grafts that I placed might have sufficed. Notice also that the degree of postoperative change depends not only on the discrepancy between skin and skeletal volume, but also on the shape of the preoperative tip lobule. Tips try to resume their preoperative shape. A postoperative nose stabilizes as desired only if the surgeon matches the tendency of the tip to flatten with a sufficiently opposing supportive force.

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5 months postoperatively

12 months postoperatively

18 months postoperatively

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Second Postoperative Analysis

Preoperative to secondary tip revision

1 month postoperatively

6 months postoperatively

25 months postoperatively

Eighteen months after primary surgery, secondary augmentation of the tip lobule with crushed ear cartilage effectively lengthened the middle crural segment, brought the tip lobule forward, and redraped the tissues to produce a straight dorsal line. Notice also the evolution over several years as the tip matured. Between 2 and 4 months, the adequacy of projection that a surgeon obtains is tested, because the lobule begins to tighten. If tip support is insufficient, a supratip deformity begins to appear, and if tip support is adequate, tip shape begins to consolidate. 456

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27 months postoperatively

33 months postoperatively

50 months postoperatively

8 years postoperatively

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Preoperative

18 months postoperatively, before secondary revision

8 years postoperatively

Eighteen months after the primary surgery, in which the lateral crura were relocated, the malposition has been corrected, but the tip lobule still lacks projection and shape. Eight years after tip revision and further augmentation, the patient’s sidewalls are smooth, and tip anatomy appears normal, without the ball shape conferred by her originally convex, cephalically positioned lateral crura. Additional tip grafts narrowed the patient’s lobule, but so did the passage of time.

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Preoperative

18 months postoperatively, before secondary revision

8 years postoperatively

Lateral crural relocation during the primary surgery improved the alar hollow slightly, but tip projection remained inadequate. Spreader grafts protected the middle vault so that there was no collapse, but the supratip convexity created a discontinuity. The tip remained flat and still hung from the septal angle. Secondary tip grafts effectively lengthened the middle crus, flattened the supratip, and created an adequately high point of maximum projection. The dorsum was not resected in the secondary procedure.

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This case is a story about anatomy, graft supply, and tissue limits. The patient’s function and shape were determined by her anatomic variants. The surgical plan was correct, but septal cartilage is always limited. I believed that the tip grafts I placed should have been adequate, but they were not. Finally, like donor site supply, the skin sleeve has limits. This patient can have a straight nose with adequate tip projection in only one size. The final result is not a small nose, and that would bother some surgeons. “Making a nose that fits the face” is a laudable goal that nonetheless must always be tempered by a patient’s predetermined soft tissue and skeletal anatomy. Radix grafts have improved nasal balance. Spreader grafts have protected the middle vault, and valvular reconstruction increased postoperative flow to 5.5 times preoperative values. The tip lobule is narrower, alar walls are supported, and the tip projects without signs of underlying grafts. Multiple pieces distribute their forces evenly, simulating unoperated middle crura, and tip projection has been re-created without nonanatomic struts. The base remains unscarred.

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Conclusion Although its permutations seem frustratingly infinite at times, Nature’s rhinoplasty rules perform quite consistently. It is a matter of understanding the language. These five similar but different nasal configurations required variations in technique that depended on the original deformity, the soft tissue and skeletal characteristics, previous trauma, and the surgical interventions demanded by particular anatomic variations. When unfavorable changes occur, the question is always, “What could have been done differently?” Despite the complexity of rhinoplasty, the good news remains that most postoperative rhinoplasty problems are not idiosyncratic or unpredictable, but, happily, under a surgeon’s control. For monitoring a patient’s progress and decoding Nature’s mysterious signals, there is no substitute for sequential intraoperative and postoperative photographs and attentive long-term follow-up.

BIBLIOGRAPHY Constantian MB, Ehrenpreis C, Sheen JH. The expert teaching system: a new method for learning rhinoplasty using interactive computer graphics. Plast Reconstr Surg 79:278-283, 1987. Sagan C. Broca’s Brain: Reflections on the Romance of Science. New York: Random House, 1979. Satava RM. The future of surgical simulation and surgical robotics. Bull Am Coll Surg 92:13-19, 2007.

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Please be sure to read Chapter 4 before continuing if you have not yet done so. Form follows function.

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R

hinoplasty is difficult, at least in part, because the traditional reduction model is insufficiently complex (see Chapter 2). It is also difficult because a successful rhinoplasty requires considerable right-brain work. If you have read Chapter 3 and completed the exercises, your right brain already assisted you when you examined the case examples. Your right brain will need to work just as hard in the operating room, where using your right brain is critical to maximal success. Rhinoplasty is not an operation that can be premeasured and premarked, but rather it is an interactive operation in which a surgeon must recognize a changing intraoperative surface appearance and respond accordingly. Decisions affecting balance, shape, proportion, and contour are all right-brain missions. The surgeon can plan each step beforehand, because a complete preoperative diagnosis can be made from the external and internal examinations. With experience, it is possible to construct a series of operative steps that will not need to be changed very often during surgery. The judgments that are made intraoperatively are thus quantitative rather than qualitative.

R hinoplasty as a Concept Rhinoplasty is not an operation for the nasal skeleton, but rather for the nasal surface, which is, after all, what the patient sees. What a surgeon does to the skeleton is only a means to an end, not an end in itself. Rhinoplasty surgeons work beneath a soft tissue cover that is contractile, but within limits and with regional variations (for example, the upper skin contracts to a greater degree, with simpler vectors, than the lower nasal skin). The goal, therefore, is not just reduction. It is reduction and/or rearrangement to produce the best possible airway and the best possible shape with the greatest predictability. To that end, the soft tissues must be balanced against the skeleton after surgery, and the skeletal parts should be balanced against one another (for example, the middle vault should be properly supported to protect the internal valves). Thus modern rhinoplasty is not the old reduction operation complicated by grafts, but rather a combination of reduction and rearrangement to produce a nose that is both attractive and equilibrated. The surgeon who controls the nasal equilibria (between soft tissue and skeleton, and between one skeletal part and another) controls the postoperative result.

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T he Uniqueness of Rhinoplasty as an Operation Rhinoplasty is a technical operation, but lack of technique alone does not generate most unfavorable results. Aside from failure to make a proper diagnosis and failure to reach consensus with the patient, rhinoplasty as an operation is difficult because it is so dynamic. Things move. Changes in one area produce real and apparent changes in other areas. Intraoperative appearance does not always reflect postoperative appearance. Some intraoperative artifacts are routine, and the phenomenology of rhinoplasty is not intuitively obvious. As I describe each step of a primary rhinoplasty, therefore, I draw attention to the most important interrelationships that are evident and explain why they occur. Intraoperative feedback is both difficult and unconventional: anatomic perspective is limited; skin volume and texture, skeletal structure, and graft material produce constant variation among patients; strategies for similar deformities therefore differ according to the anatomic details or patients’ desires; and the final postoperative contour depends on soft tissue and skeletal changes and does not always appear immediately. The intraoperative changes that occur are more understandable if the surgeon remembers the equilibrium model and therefore interprets nasal appearance as the product of reduction, disequilibrium, augmentation, and skin sleeve movement. The surgeon who does not make a practice of observing intraoperative surface change forfeits the information that Nature is trying to provide and makes his or her task exponentially harder. Before surgery, the surgeon must be able to answer the following anatomic questions: 1. What is the dorsal shape? 2. What is the nasofacial angle? (Is the nose bottom heavy or top heavy?) 3. What is the nasolabial angle? (Is it correct, or is the nose too long or too short?) 4. Which of the critical anatomic variants are present?* a. What is the middle vault width relative to the upper and middle thirds? b. Are the alar cartilage lateral crura orthotopic or cephalically rotated? c. Is the radix/dorsum low relative to the nasal base size? d. Is tip projection adequate or inadequate? 5. What will be destabilized by planned dorsal or alar cartilage resections? (For example, will the patient need spreader or alar wall grafts?)

*If you are not yet intimately acquainted with these anatomic variants, please return to Chapter 5 before proceeding further.

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6. What is the relationship of the columella to the alar rim, and how will it change with dorsal resection? 7. What is the bony vault width relative to the nasal base width? (Will osteotomies be necessary?) 8. What are nasal base size and nostril size relative to tip lobular size? (Will alar wedge resections be necessary?)

S pecifics of the Operation SURGICAL SEQUENCE This section describes each operative step in the order in which I ordinarily perform them. The sequence might alter slightly and some steps may be omitted, depending on the specifics of the nasal configuration and surgical plan. Every incision and every surgical intervention should be necessary and performed for a clear purpose. Remember that no surgical step is automatically necessary except skeletonization (which itself varies in degree).

Operative Order The sequence of surgical steps should be logical: 1. Reduce or remove the deforming skeleton, or reposition anatomic parts to improve appearance or function. 2. Harvest graft material. 3. Augment for airway and shape, and to control the nasal equilibrium. The order of steps is important. In primary rhinoplasty, dorsal resection is generally performed first, because that step exerts the most profound influence on other areas. Establishing basic dorsal height allows adjustments in nasal length, balance, internal valvular competence, columellar position, and tip support to follow logically. Then the tip should be adjusted. Tip contour is second in importance to a straight dorsum; adequate tip projection, which itself influences nasal base size and therefore overall balance, is necessary for a straight dorsum. Some surgeons have been taught to begin with the tip and proceed to the dorsum. There is nothing wrong with that scheme. In an era when tip projection was even more poorly understood and defined than it is now, surgeons observed that poorly projecting tips affected the surgical outcome. The strategy of beginning with the

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tip therefore helped establish tip strength and guided dorsal resection. I begin at the dorsum, however, because dorsal resection so profoundly affects other nasal parameters and because augmentation can always increase tip projection. In most primary noses, all other steps (adjustment of the caudal septum and upper lateral cartilages; osteotomies; and spreader, tip, and radix grafts) logically follow primary changes in the dorsum and tip.

Instruments

The specialty instruments that I currently use are as follows: Nasal Retractors Sheen retractor (Padgett, Plainsboro, NJ) Tebbetts ribbon retractor (Snowden-Pencer, Tucker, GA) Aufricht nasal retractor, 7 inches, 60 mm (Storz, San Dimas, CA) Nasal Specula Vienna speculum, 30 mm (Storz) Proud inferior turbinate speculum (Storz) Rasps Webster glabella rasp (Snowden-Pencer) Fomon rasp No. 5 and No. 6 (Pappas Surgical, Tucker, GA)

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Septal Instruments Knight nasal scissors (Storz) Straight osteotome, 4 mm (Pappas Surgical) Freer septum elevator (Storz) Cottle septum elevator (Storz) Cottle elevator (broad) (Snowden-Pencer) Gruenwald nasal forceps (Storz) Sheen-Killian septum forceps (Padgett) Jackson turbinate scissors (Padgett) Bayonets Jansen bayonet dressing forceps (Snowden-Pencer) Rongeurs Synovectomy rongeur (Aesculap, Center Valley, PA) Hardee rongeur, slight curve, 2 mm wide (Padgett) Osteotomes Straight osteotome, RIGHT (Pappas Surgical) Straight osteotome, LEFT (Pappas Surgical) Elevators Joseph elevator (Pappas Surgical) Forceps Brown-Adson diamond 43⁄4-inch forceps (Snowden-Pencer) Castroviejo forceps, 0.9 mm (Snowden-Pencer) Adson dressing forceps (Snowden-Pencer) Scissors Aston 51⁄2-inch angled scissors (Snowden-Pencer) Joseph 51⁄2-inch curved scissors (Padgett) Mayo straight scissors (Snowden-Pencer) Cottle dorsal scissors (Storz) Knife Freer button knife (Snowden-Pencer) Hooks Joseph single hook (Snowden-Pencer) Joseph double hook (Snowden-Pencer) Miscellaneous Sheen cartilage crusher (Snowden-Pencer) Sheen grid (Padgett) Mallet, large (Snowden-Pencer)

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Ear Cartilage Graft Tray Cottle septum elevator (Storz) Joseph 51⁄2-inch curved scissors (Padgett) Castroviejo forceps, 0.9 mm (Snowden-Pencer) Adson dressing forceps (Snowden-Pencer) Adson dressing cross-serrated forceps (Snowden-Pencer) Sheen gripping forceps (Padgett) Rollet rake retractor (Snowden-Pencer) 3 Halstead mosquito forceps, 5 inches, curved (Snowden-Pencer) 2 Webster needle holders, 41⁄2 inches (Snowden-Pencer) Rib Cartilage Graft Tray 4 Army-Navy retractors (Snowden-Pencer) 2 Senn retractors, 61⁄4 inches (Snowden-Pencer) Rib forceps (Snowden-Pencer) Metzenbaum scissors, curved, 6 3⁄4 inches (Snowden-Pencer) Metzenbaum scissors, straight, 6 3⁄4 inches (Snowden-Pencer) Schnidt forceps, curved, 7 1⁄2 inches (W. Lorenz Surgical, Jacksonville, FL) DeBakey toothed forceps, 8 inches (Snowden-Pencer) Adson dressing cross-serrated forceps (Snowden-Pencer) Adson dressing forceps (Snowden-Pencer)

Preparing the Patient In the preoperative day surgery area, I always take the opportunity to greet the patient and accompanying family or friends and make certain that there are no lastminute questions from the family or instructions from the patient. Because I see each patient twice before surgery, there are usually very few questions or instructions. However, most patients and family are anxious. The family should be reassured and, in particular, be advised not to watch the clock during the surgery (which is easier said than done). Some apprehensive families otherwise assume that any delay during surgery signals a catastrophe. It is always surprising how elaborate the fantasies of family or friends can become: one husband, after watching an anesthesiologist hurry down the hallway while his wife’s surgery was in progress, became convinced that his wife had had a cardiac arrest and was being resuscitated, and that the mask over her face had moved the dorsal graft, none of which was true. On rare occasions, if a patient is particularly distraught or conflicted about the surgery, I will cancel the procedure on the morning it is scheduled.

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When the patient is brought to the operating room, I sit by his or her head and talk reassuringly while induction proceeds. Although most anesthesiologists recognize the importance of positive suggestions during induction, I prefer to do some of it myself so that the patient hears my voice. The patient is positioned supine on the operating table with arms and legs padded; his or her knees should be flexed with a supporting pillow to decrease the incidence of venous thromboembolism. Most rhinoplasties qualify as low or moderate risk (Young and Watson, 2006); and because anticoagulation is not an option, intermittent pneumatic compression devices are usually sufficient for venous thromboembolism prophylaxis. It is also important that the patient’s heels do not rest on the operating table: even a 2-hour procedure can produce painful erythema, signifying ischemia from venous obstruction. Because only 10 to 12 mm Hg of pressure is needed to completely obstruct venous blood flow, any heel pressure is too much. The head of the operating table is elevated 10 to 15 degrees in reverse Trendelenburg position to minimize bleeding.

General Anesthesia I use general anesthesia almost exclusively for rhinoplasty. Since the introduction of the laryngeal mask airway (LMA) (LMA North America, San Diego, CA), routine endotracheal intubation is no longer necessary except in cases where the anesthesiologist determines that an LMA is inadvisable. Some surgeons still prefer local anesthesia with sedation, which was standard practice for many years. However, modern anesthetic agents such as isoflurane (Forane), sevoflurane (Ultane), fentanyl (Sublimaze), and propofol (Diprivan) have invalidated previous objections to general anesthesia, including the inability to control blood pressure, increased intraoperative bleeding and edema, and cardiac irritability. I reserve local anesthesia, with or without sedation, for limited procedures in cooperative patients. It is important to protect a patient’s eyes during surgery. Many patients, particularly those who have previously undergone blepharoplasty, have lagophthalmos under anesthesia. I routinely place sterile ophthalmic ointment without preservative into each conjunctival sac and then seal the eyelids shut with a short piece of 1⁄ 2-inch Steri-Strip or, failing that, a 6-0 temporary tarsorrhaphy suture.

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The Surgeon’s Preparation Table

Vienna speculum, 30 mm (Storz) Jansen dressing bayonet forceps (Snowden-Pencer) No. 3 knife handle with No. 15 blade 10 ml control syringe 25-gauge, 11⁄2-inch needle Marking pen 4 ⫻ 4-inch gauze pads Cotton 4 Long cotton-tipped applicators 3 Medicine cups Povidone-iodine solution Mepivacaine hydrochloride 1%, 30 ml, with 0.3 ml epinephrine 1:1000 4% cocaine solution, 4 ml, tinted My scrub nurse prepares the Mayo stand with the components placed in the same locations each time: the three medicine cups; a short nasal speculum; scalpel, bayonet forceps; and a marking pen. Also included are several 4 ⫻ 4-inch gauze pads, a small amount of sterile cotton, and sterile gloves.

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Before infiltrating the nose, mark any asymmetries, particularly outlining any depressions that will be augmented later.

Local Anesthesia After induction of general anesthesia, I block the nose with a freshly prepared solution of 1% mepivacaine hydrochloride (Polocaine) with epinephrine (30 ml of 1% mepivacaine hydrochloride plus 0.3 ml of epinephrine 1:1000). Mepivacaine hydrochloride is used, because it is a weak vasoconstrictor, and because it provides anesthesia for 2 to 21⁄2 hours, so that patients awaken comfortable.

Infiltration begins at the nasal radix, placing a total of approximately 0.5 ml of anesthetic directly over it and to each side.

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The needle then passes along each nasal sidewall at its junction with the nasal process of the maxilla. The needle is introduced and then withdrawn, injecting approximately 1 ml of anesthetic on each side. A second pass is then made parallel to the first, about three fourths of the way to the dorsal edge, that anesthetizes and vasoconstricts further without disturbing the profile line.

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The alar margins and nasal tip are then infiltrated by passing the needle along the vestibular side toward the nasal tip. Less than 0.5 ml is introduced on each side. This injection stiffens the tissues to facilitate shaving the vibrissae.

Additional anesthetic is then placed directly into the columella.

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It is also placed across the maxillary arch and into each alar lobule to vasoconstrict the branches of the primary supplying vessels (the angular, anterior ethmoidal, and superior labial arteries) and the relevant nerves (the anterior ethmoidal, infraorbital, and infratrochlear nerves).

Area of injection

I also infiltrate near the dorsal edge of the septal mucosa, just below the location where spreader grafts will be placed. This injection vasoconstricts the vessels that come into the dorsal tissues directly from the septum and decreases bleeding during the dorsal resection. The entire infiltration usually consumes about 7 ml of anesthetic solution, the rest of which is saved for the septal surgery.

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The vestibules are cleaned with a cotton-tipped applicator soaked in povidoneiodine and shaved of vibrissae with a No. 15 blade. I take this opportunity to reexamine the septum under anesthesia. Quite often additional posterior deviations can be discovered. I also palpate the septum for firmness and substance with a cotton-tipped applicator. In secondary cases, I have occasionally been misled during my office examination and assumed that the resistance I was feeling in the septum was cartilage and bone when in fact it was scar (or vice versa). The difference is more noticeable during anesthesia. If any doubt remains, palpate the septum by infiltrating local anesthetic under the mucoperichondrium; the needle tip will provide the answer. The nose is then packed with cocaine-soaked cotton, using no more than 4 ml of a tinted 4% solution (or 160 mg—safely below the 200 mg maximum allowable dosage).

Sterile cotton is rolled tightly to form four packs. Each cotton pack is dipped into the cocaine, which is stripped down the cotton. The pack is dried with sterile 4 ⫻ 4-inch gauze and rotated 180 degrees so that the drier end enters the airway first, to lie nearer to the nasopharynx.

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Two cotton packs are placed on each side for hemostasis and anesthesia of the nasopalatine nerve, the internal nasal and posterior nasal branches of the anterior ethmoidal nerve, the internal branch of the nasociliary nerve, and the nasal branch of the anterior superior alveolar nerve.

The first pack is placed along the nasal floor, between the septum and the inferior turbinate.

The second pack is placed higher on the septum and should extend to the apex. The nasal packs prevent blood from running into the nasopharynx; therefore except during the septal surgery, the nose is always packed with cotton.

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Two more packs are placed on the opposite side. The nasal vestibules are then cleaned again with povidone-iodine solution, and small cotton packs soaked with this solution are placed into the vestibules while the patient’s face and neck are prepared and draped. Internal preparation of the nose should be even more fastidious than skin preparation, not the reverse, remembering that the nasal lining is the real operative surface.

The Operation I tself I ncisions and Planning Even though intranasal incisions are hidden, it is still important to minimize them and plan each one so that as many steps as possible can be performed through each incision. A single intercartilaginous incision provides access to the nasal dorsum and septal angle and to the lateral crus of the ipsilateral upper lateral cartilage. A transfixing incision should be made only if the nose will be shortened. A short nasal floor incision provides access to the maxillary arch, and short mucosal incisions at the edges of the piriform apertures provide direct access for osteotomy. Thoughtful simplification shortens operative time and decreases patient morbidity and the potential for complications.

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S teps in the Operative Sequence PHASE I: REMOVING THE DEFORMITY Skeletonization Skeletonization controls access to the underlying structures and also influences skin sleeve movement; by limiting skeletonization, a surgeon can use the undissected soft tissues to immobilize any cartilage grafts. Skeletonize widely over the upper cartilaginous vault only when significant nasal shortening is necessary. Otherwise, limit skeletonization to areas requiring skeletal alteration or areas in which grafts will be placed. Restricting skeletonization reduces morbidity and intraoperative artifacts. Artifacts Surgeons should remember that the alar cartilages are contained within the mobilized skin sleeve and therefore can be moved with skeletonization.

Because the alar cartilages move as if they are external to the dorsum and sidewalls, skeletonization can appear to shorten the nose, flatten the dorsum, move the radix anteriorly, and lower the columella, as seen in this patient. The surgeon may thus be misled into reducing the dorsum less than was planned or elevating the columella more than was planned. Accurate preoperative photographs are essential. It is often helpful to deskeletonize the nose by gently pulling the skin sleeve caudad into its proper position before making changes in the preoperative plan.

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Technical Details*

The skeletonizing incision for primary noses is intercartilaginous, begins at the apex, and proceeds laterally only as far as necessary. Right-handed surgeons skeletonize primarily through the patient’s left side, and in a more limited fashion from the right side. Left-handed surgeons, like me, do the opposite. If the surgeon does not need to shorten the upper lateral cartilages, a single intercartilaginous incision will suffice.

*Photographing endonasal rhinoplasty is not easy, because if the photographer can see, the surgeon cannot. For clarity, therefore, this sequence is a composite of two cases. However, all interval laterals demonstrating intraoperative changes were photographed during a single operation and are shown for only one of the patients.

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Using a double hook to evert the alar rim and applying counterpressure with the assisting ring finger, I begin the incision just below the caudal reflection of the upper lateral cartilage near the septal angle, and I proceed laterally as far as necessary (usually no more than 15 mm).

After incising laterally, I reverse the direction of the No. 15 blade to incise medially past the septal angle and continue as a transfixing incision, if needed (in this case to shorten the caudal septum).

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A B

C D

An identical incision is made on the opposite side. However, if no alar cartilage reduction is needed, the second incision is unnecessary. Every incision must fulfill a discrete purpose. Joseph scissors free the soft tissues over the cartilaginous vault. Note the position of the scissors tips in C. If the nose is to be shortened, I dissect to the lateral edge of the upper cartilaginous vault; if not, I dissect only over the dorsum itself, not the lateral nasal walls. It is important to remember where grafts will be placed and to skeletonize so that the edges of each pocket control and immobilize each graft.

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A broad Cottle periosteal elevator is then used to elevate the periosteum over the bony vault to the radix and the bony dorsum just to its shoulders. The subperiosteal position of the elevator can be confirmed by soft tissue resistance to lateral movement of the instrument and by feeling its tip against bone. The surgeon should obtain smooth, deep, even, and complete soft tissue elevation to ensure good dorsal cover and to avoid dermal injury.

Dorsal Resection Producing a straight dorsum from a convex one is not a simple matter. Any complete surgical plan must consider (1) the position of the nasal radix, (2) the height of the dorsum itself, and (3) the adequacy of tip support, as well as the intended postoperative balance. A patient with a nasal root at the lower lash margin and inadequate tip projection will have a deceptively high dorsum and therefore require a smaller dorsal resection than a patient with the radix at the upper lash margin and adequate tip projection. Artifacts Dorsal resection is one of the best examples of the global skeletal interrelationships that exist in rhinoplasty. Dorsal resection can affect nasal length, bony vault width, apparent nasal base size and width, middle vault position, apparent columellar position, and nostril contour. Because resection of the bony and cartilaginous vaults alters their dynamic anterior projection, reduced support to the upper nasal skin allows the alar cartilages to rotate cephalad or caudad, depending on the preoperative nasal configuration.

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B

C

Most noses shorten after dorsal resection, but long noses, especially ones in which a dorsal convexity has occupied the caudal half, can lengthen after dorsal resection. The surgeon should watch for these intraoperative changes and adjust subsequent steps accordingly. Here, bony vault reduction has created a new low radix (B), increasing the apparent nasal base size. Reducing the cartilaginous dorsum completes the dorsal reduction, and this preoperatively long nose lengthens even further (C). If the nasal radix is to be raised, it is helpful to reduce the dorsum incrementally, pausing to elevate the upper nasal skin by lateral finger pressure to simulate the effect of augmentation on postoperative contour. Similarly, if an increase in tip projection is planned, the nasal tip should be supported to simulate the effect of that subsequent surgical step. Dorsal resection affects sidewall support just as profoundly as bridge contour, and it is one of the two rhinoplasty steps that affect nasal function (lateral crural reduction being the other). A surgeon therefore must always observe the effect of dorsal resection on middle vault support. If the upper cartilaginous roof is resected 2 mm or more (occasionally less than 2 mm), the probable, and often visible, loss of support to the upper lateral cartilages becomes apparent. Intraoperative observations such as watching for the effect of dorsal resection guide the use of spreader grafts and help determine whether they should be placed symmetrically or asymmetrically to produce a symmetrical postoperative result.

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Technical Details

If the radix is to be grafted, as in this woman, roughen its surface with a glabellar rasp to aid graft adherence.

Reduce the bony vault with a Fomon rasp through the contralateral intercartilaginous incision, which makes it easier to stay centered over the dorsum. Pay attention to asymmetries demonstrated in your preoperative photographs—one side may need more reduction than the other.

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It is a misconception, compounded by many atlases, that reducing the bony vault always opens the roof. If the hump is not high, and particularly if the radix will be augmented, the amount of dorsal reduction usually leaves the bony arch intact, or only opens the caudal end a few millimeters. The surgeon can confirm an intact bony roof during the operation. The intact web of thick bone in the upper nose should also convince surgeons of the futility of trying to narrow the nasal radix, which is not possible unless radical changes are made, and which will disrupt the smooth dorsal lines that should continue as an extension of the superior orbital rims.

Notice what has happened to this patient’s appearance so far: as predicted, bony vault reduction has exaggerated the preoperative low radix, enlarging the nasal base. The nose has shortened, changing columellar-alar relationships. To produce an optimal result, a surgeon must react to observed changes such as this—surface feedback that is harder to duplicate using the open approach.

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Resection of the dorsal border of the septum is accomplished under direct vision with a No. 11 blade from which the tip has been broken to avoid lacerating the contralateral dorsal skin.

It is not necessary to separate the upper lateral cartilages from the anterior septal edge before dorsal resection. I have heard only one logical reason for performing this step: to use the excess upper lateral cartilages to distract the internal valves. Although to my knowledge no airflow measurements have been performed to demonstrate that the upper laterals function as well as spreader grafts made from septal or ear cartilages, the technique should work if the residual upper lateral is sufficiently long, wide, and substantial enough to buttress the remaining sidewall. Remember, however, that it is not the upper lateral cartilages that spreader grafts replace; it is the width of the anterior septal edge, which in most patients is significantly thicker and stiffer than either upper lateral or alar cartilage. Recent measurements by Coan et al indicate that spreader grafts must be at least 2 mm wide to create a measurable effect.

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Similarly, an argument has been made that the mucosal redundancy left after dorsal reduction is sufficient to maintain the lateral position of the upper lateral cartilages. However, I am not yet convinced that this is true. If it were true, the middle vault would never collapse and there would never be any need for spreader grafts. Currently, no functional data have been presented to support the technique. Also, if the nasal skin is thick enough, it is easy to conclude that middle vault collapse has not occurred simply because it cannot be seen. However, an attentive surgeon can still palpate internal valvular collapse, and the diagnosis can be reinforced by internal examination and by testing whether upper lateral cartilage support improves the airway as the patient inspires.

One advantage of using a blade over a chisel is that a blade gives a surgeon more opportunity to produce a smooth dorsum and less opportunity to overcorrect. With an Aufricht retractor in place, the resection can be performed easily under direct vision.

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Angled Cottle dorsal scissors smooth any minor irregularities remaining in the upper lateral cartilages. The dorsum should feel perfect after the resection. Remember that a middorsal notch often signals overresection (see Chapters 2 and 14). CAUTION: Despite the rasp and blade permitting more conservative resections than

saws or osteotomes, a surgeon can still overresect with them.

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B

The surgeon must check the dorsal skeletal edge from the outside, not just the inside. The dorsal skeletal edge will show any minor asymmetries or irregularities that remain; and it is paradoxically more accurate to see them externally than internally. After this dorsal resection, nasal contours are improved, but the columella is still low, and the lower lateral cartilages have been brought into relief (B). If the radix augmentation is planned, reduce the dorsum just enough for the radix graft to straighten it.

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From the front, the nose is wider, and the middle vault has become discontinuous from the bony vault—signaling a new internal vestibular incompetence. Without stabilization by spreader grafts, the patient’s airway will worsen.

Transfixing Incision and Adjusting the Nasal Base: Caudal Septum and Nasal Spine Resecting a dorsal hump frequently shortens the nose and therefore elevates the alar rim relative to the columella. Because dorsal resection so often affects apparent columellar position, a compensatory adjustment to the caudal septum is often necessary, even if its preoperative position was acceptable. This interaction is especially difficult for an untrained eye to observe through the open approach, and explains why hanging columellas have become more common. Even in this patient, we see the same interconnectedness belied by False Assumption Number Two (see Chapter 2): adjusting a single area can have ramifications beyond the region being treated. In this case, caudal septal resection alone can change the relationship of the columella to the nostril rim, nasal length, subnasale contour, and upper lip carriage. Artifacts Ballooning caused by injection of local anesthesia or excessive skeletonization may make the columella appear lower than it actually is and tempt the surgeon to perform a resection that is not necessary. Make sure that the dorsal skin is in the proper position before adjusting the nasal base.

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Technical Details The specific maneuvers for the nasal spine and caudal septum depend on the need. A

B

Caudal septal reduction without shortening

Nasal spine reduction only

If columellar position is satisfactory but the subnasale is full, a short incision in the posterior membranous septum and septal floor exposes the nasal spine, which is then resected with a small rongeur (A). If the columella is low but the nasolabial angle is satisfactory, the caudal or membranous septum is resected, paralleling the nostril rims so that wound closure will pull the columella cephalad without shortening the nose. A parallel resection does not shorten the nose (B).

A

B

Caudal septal reduction with shortening

Caudal septal reduction with lengthening

If the nasolabial angle is acute, a triangular caudal septal resection (with its base anteriorly) raises the anterior columella and shortens the nose (A). Finally, if the nose is short, a triangular posterior caudal septal resection (with its base facing posteriorly) rotates the base caudally and provides a small amount of additional apparent nasal length (B).

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Through the transfixing incision, the excess caudal septum is trimmed first.

After apposing the wound edges, the membranous septum is adjusted on each side so that it just fits.

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The effect can be judged by pushing the wound edges together. The wound should close without tension.

The nasal spine can be reduced through the transfixing incision or, when no caudal septal adjustment is necessary, through a short incision at the columellar base. A Joseph elevator is used to clear the periosteum, and a small double-action rongeur is used to perform the resection.

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Caudal Septal Preservation If a nose is excessively long, the caudal septum can be retained and slipped between the medial crura to retain base stability.

A

B

The amount of shortening is assessed, but only membranous septum is mentally marked and then excised (A), denuding the caudal septum. Cartilage resection should be minimized.

A

B

C

D

Joseph scissors separate the medial crura (A) so that the caudal septum will slip between them (B and C). Absorbable 5-0 sutures close the transfixing incision (D). A 4-0 transfixing suture may be added for additional temporary stability. 495

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Caudal septal and nasal spine resections are two of the most straightforward areas of nasal reduction: a 2 mm intraoperative resection produces a 2 mm postoperative surface change. But be conservative: overshortened noses trouble patients greatly and are difficult to correct. Surgeons should be aware that increasing tip projection also elevates the columella through an effect on its anteroposterior tension. Allow for this interplay if tip grafts are part of the operative plan. The traditional rule that a transfixing incision alone permanently decreases tip support is axiomatic but unproved and probably untrue. Any tip support generated by fibrous connections between the membranous septum and adjacent structures is insignificant compared with the support provided by the alar cartilages and the dorsum. Nevertheless, transfixing incisions should not be made unless some intervention at the caudal septum is required.

Shortening the Upper Lateral Cartilages Submucosal resection of the caudal ends of the upper lateral cartilages is a maneuver parallel to shortening the caudal septum—similar to shortening the lining of a jacket sleeve after shortening the outer fabric. Resection of the caudal ends of the upper lateral cartilages used to be a routine rhinoplasty step; however, this step is unnecessary unless significant nasal shortening is required. If the caudal septum is elevated less than 2 to 3 mm, the upper lateral cartilages can often remain untouched. The surgeon should confirm this, though, by checking for redundancy after closing the transfixing incision. The posterior edges of the upper lateral cartilages should abut the lateral crura, and mucosa is never resected. A number of nasal interventions shorten the nose. In descending order of their effect on nasal length, these interventions are: 1. Dorsal resection (rotates the tip) 2. Caudal septal resection (direct shortening) 3. Resection of the cephalic edges of the alar cartilage lateral crura (allows the tip to rotate by creating dead space) 4. Resection of the anterocaudal ends of the upper lateral cartilages (allows the tip to rotate by creating dead space) Each of these interventions is affected by the degree of skeletonization over the middle vault: skeletonize more widely if you want greater shortening and tip rotation. As always, conservatism is important.

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Technical Details

With the skin sleeve elevated by a curved retractor, the upper lateral cartilage can be drawn downward by a single hook in its attached lining, exposing the caudal edge for submucosal resection. The edges of the wound should fall together.

Submucosal resection area

Treat both sides symmetrically. The amount removed generally corresponds to the caudal septal resection and creates space into which the alar cartilages can rotate, steadied posteriorly at the hinge area.

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In Defense of the Intercartilaginous Incision The intercartilaginous incision was previously condemned by surgeons who believed that it caused a circular scar contracture and therefore diminished the airway. However, the intercartilaginous incision, carried along the septal angle and into the membranous septum, is an incision in three planes and should not cause a trap-door constriction unless lining is resected. Instead, those critics were observing postoperative collapse of the anterior ends of the upper lateral cartilages after resection of the cartilaginous roof when spreader grafts had not been placed, narrowing the mucosal angle near the incision at the internal valve.

Treating the Alar Cartilages Overview The aphorism “as the tip goes, so goes the rhinoplasty” is largely true and may account in part for the small, paired alar cartilages receiving exhaustive attention in the rhinoplasty literature. Countless techniques have been described to improve alar cartilage contour, most of which use various patterns and degrees of resection or reshaping with sutures. My approach to the alar cartilages has become simpler as my security with tip reconstruction has grown—preserve as much alar cartilage as possible, consistent with good aesthetics and external valvular support; interrupt the continuity of the alar cartilage arch only if tip projection is excessive or if the arch is distorted (such as with a severely boxy tip or a ball tip); and use cartilage grafts to restore equilibrium or improve tip contour. Anthropometric measurements and simple observation have repeatedly demonstrated that normal alar cartilage lateral crural width is 10 to 12 mm. It is therefore not reasonable to expect that a 2 mm rim strip remnant will adequately support the external valves or provide proper tip contour. In performing alar cartilage modification of any kind, several key principles should be remembered: 1. An accurate diagnosis of alar cartilage shape and substance can be made by examining the cartilages from the skin and vestibular sides. The cartilages do not need to be completely dissected. 2. Each of the three crura has its own separate function: the medial crus supports the columella; the middle crus controls the shape and projection of the tip lobule relative to the dorsum; the lateral crus controls alar wall shape and external valvular function. 3. Deficiencies or excesses of each crus result in characteristic deformities, as indicated in the following table.

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Alar Cartilage Segments and Their Functions Function

Deficien y

Excess

Medial crus

Supports columella

Columellar retraction

Middle crus

Determines tip projection and tip lobular contour

Lateral crus

Shapes alar wall and supports external valve

Inadequate tip projection (the dorsum appears higher than it actually is relative to the tip) Flaccid alar wall with external valvular incompetence

Prominent or hanging columella; occasionally contributes to excessive tip projection Excessive tip projection: overprojection or ultraprojection Deformed alar wall (as in box or ball); external valvular competence depends on whether the lateral crura are malpositioned or orthotopic

4. Strong alar cartilages can deform (knuckle or become excessively convex or concave) more readily than weak cartilages if resection sufficiently alters their internal stresses. 5. Weak cartilages usually need increased middle crural support (for tip projection) or lateral crural support (for external valvular function). 6. Thicker soft tissues require more skeletal support, not less. 7. The surgeon must locate the deficiencies and excesses in each crus and alter them to create a shape that maximizes external valvular function and meets the patient’s aesthetic objectives. It is in treatment of the alar cartilages that the techniques between the open and closed approaches differ most widely, and the thought processes underlying each method also differ. The exposure and access that facilitates fixation and molding sutures through the open approach are not available endonasally. Whereas the basic principle of the open approach is to create projection and contour with the patient’s own alar cartilages, using struts to stabilize the medial crura and grafts only when necessary, my goal instead is to resect deformities where they exist in any of the three crura, create external valvular stability, and then augment the tip for contour or support.

Lateral crus Middle crus Medial crus

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Medial Crura

In this case of septal collapse, a rib graft will brace the retracted medial crura. Through a short columellar incision, the columellar and membranous septal flaps are separated.

As my nurse withdraws the scissors from the wound, I slide the graft into place anteriorly.

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Then, aided by a single hook, I continue to slide the graft into place posteriorly. The incision closes without tension.

The medial crura can become distorted by interdomal sutures placed to narrow the tip, because they instead force the columellar-lobular junction to move inferiorly. In cases of real or apparent excess, resect a short cartilage segment through a short membranous septal incision.

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Middle Crura C A

B

D

If the middle crura are excessively long and create overprojection, resect the excess segment at the domes through a cartilage delivery technique. The forceps mark the area to be resected (A) and the resulting vertical wedge (B).

Notice the difference before and after tip reduction. Crushed tip grafts may be needed as overlays to shape the tip and hide cut cartilage edges.

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Lateral Crura I treat the lateral crura in one of only five ways: 1. No treatment: if the lateral crura are orthotopic and well shaped, I do nothing. 2. Reduce the cephalic margin: if the lateral crura are orthotopic but wide, I trim them no more than 2 to 3 mm by retrograde dissection or by delivery as a bipedicle flap, with or without interruption of the arch. 3. Splint the deficient area: if the lateral crura are malpositioned but flat, I do not treat the crura, but splint the external valves with septal cartilage or bone. 4. Resect and replace malpositioned crura: if the lateral crura are malpositioned and excessively convex, which is usually the case in a boxy or ball tip, each lateral crus can be resected, crushed if deformed, and replaced as a free graft. 5. Rotate malpositioned crura as flaps: malpositioned lateral crura can be rotated into position and fixed along the alar rims.

Reducing the Cephalic Margin Retrograde Dissection

A

B

A conservative lateral crural resection can be performed through the intercartilaginous incision. By everting the alar rim, the lateral crus can be dissected from its investing skin and vestibular lining and then reduced. I use this technique in most cases. Because the vestibular skin is more adherent than the external skin, the vestibular side is dissected first (A). The scissors are used to then free the lateral crus from its cutaneous surface (B).

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The cephalic portion is resected. I rarely resect more than 2 to 3 mm from the point of widening just lateral to the lateral genu, and I leave the area of the dome untouched. As much lateral crus as possible should be preserved, recalling that normal width is 10 to 12 mm. The lateral crus not only provides external contour but supports the airway. In secondary patients, it is far more common to find excessive, and not inadequate, lateral crural and dome resections. Dissection as a Bipedicle Flap

Because I judge lateral crural resection from the surface, I do not need to expose what I will not modify. If the lateral genua are knuckled or deformed, however, delivery provides direct and precise access.

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A



INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

Make an incision at the caudal reflection of the lateral crus (not the rim), beginning at the lateral genu and extending laterally 10 mm (A), only enough for access. Joseph scissors are used to free the cutaneous surface (B) so that a single hook can deliver the crus.

C

D

E

F

Use forceps to grasp the lateral crus as it widens just past the genu (C). About 3 mm is incised (D). Complete the resection with Joseph scissors, always sparing mucosa (E). Even this tiny resection creates a visible hollow when compared with the untreated right side (point of scissors) (F).

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Whether the lateral crura are resected retrograde or by delivery, the tip lobule remains undissected: the future tip graft pocket remains undisturbed. Dissection as a Bipedicle Flap With Interruption of the Arch If the arch needs interruption (such as to narrow the tip or resect a “knuckle” at the lateral genu), the alar cartilages can be delivered as bipedicle flaps by intercartilaginous and infracartilaginous incisions (see p. 502).

It is important that the incision be made exactly at the caudal reflection of the lower lateral cartilage and not at the rim. A true rim incision almost always leaves a visible scar and a thickened rim.

Splinting the Deficient Area If the lateral crura are malpositioned but flat, I do not treat the crura but splint the external valves with septal cartilage or bone.

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Resecting and Replacing Malpositioned Crura

If the lateral crura are malpositioned and excessively convex, which is usual for a boxy or ball tip, each lateral crus can be resected, crushed if deformed, and replaced as a free graft. A

B

C

This patient’s large, convex lateral crura were dissected free through incisions 3 mm above the rims (A). They were cut free at the lateral genua, crushed, trimmed to 8 mm wide, and replaced along the rims, catching the graft edges in the closure to maintain its position (B and C).

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Technical Details

A

B

C

D

E

In this patient, note the lateral crural axis leading toward the medial canthus in A, and its internal reflection at the inked line (B). Make an incision 3 mm above the alar rim (not at the rim), paralleling the normal location of an orthotopic crus (not its current, cephalically rotated position) (C and D). If the caudal skin edge is dissected for 2 mm toward the rim (E), the final wound will lie flatter.

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INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

B

C

D

I first free the lateral crus from its cutaneous side, beginning medially and extending laterally into the alar lobule, to make room for the repositioned crural tail. Remember to preserve a virginal tip lobular pocket so that tip grafts can be placed without jeopardizing the surgeon’s latitude to determine their position (A and B). Clear any soft tissue from the surface of the crus so that the cartilage can be seen and dissected precisely (C). I begin separating the lateral crus from the vestibular skin at the lateral genu, where the edge is generally most visible and easiest to separate. Dividing the crus from the lateral genu at this point, I pick up the medial end and dissect laterally (D).

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PART III

A



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

Proceeding toward the tail of the crus, free the crus completely (A and B). It is not necessary to proceed all the way to the accessory cartilages when resecting the lateral crus, because only the deformed part that is visible from the surface needs to be altered. Note that I have left a portion of the crus in situ (C).

The crus can then be crushed and replaced or simply trimmed of irregular edges, as in this case.

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A



INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

Trimming is more predictable than crushing and trimming, because trimming alters the internal cartilage stresses less radically (therefore decreasing the chances of postoperative deformation) and also preserves stability for reinforcing the external valve. The trimmed crus is replaced in the dissected pocket (A) and supports the rim (B).

The replaced lateral crural graft is fixed in position by catching it at several places in the wound closure with a 6-0 chromic suture. Additional interrupted sutures in the vestibular skin complete the repair.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

To ensure that no drop of blood between the flaps thickens the rim, I place a percutaneous suture, tied loosely so that it does not blanch the skin. This suture is always removed at 24 to 48 hours.

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Rotating Malpositioned Lateral Crura as Flaps Technical Details A

B

C

D

E

F

Alternatively, a surgeon can free the lateral crus from its cutaneous and vestibular attachments. It is important to free the cartilage sufficiently to avoid a secondary kink at the lateral genu (E). Remember that a normal lateral crus is 10 to 12 mm wide, and that heavier soft tissues require more, not less, cartilage support. I often preserve a natural convexity along the caudal edge, which provides additional rim support and decreases the chance of a postoperative notch (F).

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A



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

Dissect into the alar lobule to allow room for the newly repositioned crus (A), and rotate the minimally trimmed cartilage into the pocket (B), where it should lie smoothly and create the desired external contour.

A

B

C

D

Catch the lateral crus in two or three places with the wound closure, and add additional interrupted vestibular sutures to complete the repair (A and B). Place a percutaneous suture, tied lightly (C and D), and remove it at 48 hours.

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Occasionally, even a rotated crushed lateral crus will deform postoperatively, which seems to happen more frequently with stronger, stiffer lateral crura, as in these two women. Remember that, like costal or septal cartilage, the lateral crus also has its own intrinsic stresses; although crushed, enough internal force can remain to curve one or both lateral crura excessively. When the preoperative crura are particularly stiff or distorted, I prefer to replace them with septal cartilage grafts. Summary of Lateral Crural Treatment In order of frequency in my practice, orthotopic lateral crura (approximately 50% of the population) are either left untouched or are trimmed retrograde. Malpositioned lateral crura (the other 50% of the population) most commonly present as boxy or ball tips (approximately 75% of all patients with malposition); these lateral

515

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

crura are rotated or resected, crushed, and repositioned as free grafts, replaced by septal grafts, or treated as transposition flaps. Only about 25% of malpositioned lateral crura are flat and can be left untreated or splinted by alar rim grafts if there is associated external valvular incompetence.

PHASE II: AIRWAY CORRECTION The deformities have been resected or reduced. It is time to correct the airway and produce a nasal shape that meets the patient’s aesthetic goals.

Spreader Graft Tunnels* If they are needed, spreader graft tunnels are better performed before septoplasty but after the dorsal line has been set.

The septal angle and caudal septum can be seen through the transfixing incision (the forceps tip holds the right mucoperichondrial edges). If the caudal septum will not be adjusted and a transfixing incision is therefore unnecessary, extend the single intercartilaginous incision only around the septal angle. Like septal resection, spreader graft tunnels are facilitated by infiltration on each side beneath the mucoperichondrium with local anesthetic.

*The technical details and rationale of spreader grafts are provided in Chapter 12. For the sake of continuity, this step is repeated brief y here.

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By identifying the septal angle, a surgeon can incise to cartilage beneath each mucoperichondrial flap. The caudal septum is seen here exactly in the midline.

It is a misconception that spreader grafting is difficult to perform endonasally, which is doubly ironic, because that is the way Sheen originally described it. The entire procedure is done under direct vision, and even the camera sees it well.

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PART III

A



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

Each tunnel must follow the dorsal septal edge (A and B) and should extend beneath the caudal edge of the bony edge on each side (the left side is shown here). The forceps demonstrate the tunnel length (C). Only a narrow mucoperichondrial adhesion is left on the dorsal (anterior) edge to prevent displacement of the graft. Now that the dorsal resection has been performed and spreader graft tunnels have been developed, the width of the dorsal strut can be accurately determined. It is time to proceed with septoplasty.

Septoplasty Septoplasty is performed for two reasons: to relieve an airway obstruction caused by septal deflection, and to harvest graft material for reconstruction. In my practice, this means that septoplasty has become a component of virtually every primary rhinoplasty. A history of previous trauma is important, because unhealed fracture lines in the cartilaginous or bony septum may extend to the dorsal (anterior) septal edge and therefore threaten the stability of the dorsal strut; surgeons must watch for any such fracture lines during the dissection. A clue to such unhealed fractures may be unusual mobility when rasping the dorsum. Because of the threat of septal collapse, even without unhealed fractures, the surgeon should leave 15 mm of intact, undissected cartilage along the nasal dorsum and 15 mm caudally when performing any submucous resection. In this regard, it is preferable to perform the septoplasty through a Killian incision instead of beginning at the dorsal edge and proceeding inferiorly, because this last method has two potential dangers. If old fractures are present, the surgeon will enter and destabilize

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them even before reaching the obstructing area; and even if old fractures are not present, the surgeon will lose the support that undissected mucoperichondrium could otherwise provide. Recent trauma (within 3 months) is an indication to postpone rhinoplasty until any soft tissues consolidate around fracture lines and until postoperative edema allows accurate judgment of aesthetic contours. If significant previous trauma has occurred, even in the distant past, it may be preferable to avoid simultaneous septoplasty and bilateral osteotomies or to postpone osteotomy if the surgeon is not completely confident of dorsal septal support. The need for bilateral osteotomies in deviated noses is generally uncommon, because a unilateral osteotomy (on the previously outfractured side) ordinarily achieves better symmetry than bilateral osteotomies. Septal cartilage should be removed methodically and only by the surgeon performing the reconstruction. A second airway surgeon may not know the grafting requirements for a particular case and does not bear the same responsibility for the aesthetic outcome. Chips of cartilage harvested with a swivel knife cannot construct a good dorsal graft. Learn to perform your own airway surgery. Technical Details Spreader graft tunnels should be created before the septoplasty if the cartilaginous roof has been opened or if preoperative internal valvular incompetence exists (see earlier in this section).

Remove the cocaine packs. Infiltrate beneath the mucoperichondrial flaps with anesthetic solution used for the rhinoplasty (mepivacaine hydrochloride 1%, with epinephrine 1:100,000) using a 11⁄2-inch, 25-gauge needle, and then a spinal needle. Infiltration balloons the mucoperichondrium away from the cartilage and facilitates septoplasty considerably. Infiltrate the entire planned dissection area.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Incise 15 mm behind the caudal septal edge.

Holding a Frazier suction in the nondominant hand and using the sharp end of a Freer elevator in the other, proceed with dissection under the mucoperichondrial flap until a clean plane has been established. It is important to stay exactly on cartilage: too superficial a dissection will tear the mucoperichondrium. At this point, I also stay only over septal cartilage, and I do not yet dissect down toward the vomer.

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Now switch to the blunt end of the Freer elevator and sweep posteriorly onto the perpendicular plate of the ethmoid or as far as necessary to get behind any obstruction.

Then, using the sharp end of the Freer elevator, score through the cartilage at the site of the original incision and slide under the mucoperichondrium on the opposite side, checking through the other nostril to make sure that the lining has not been perforated. Proceed gently: the Freer elevator is sharp enough to cut through both cartilage and lining.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Continue the dissection on the second side until the cartilage has been exposed as far posteriorly as necessary. To add an element of safety to septoplasty or to rhinoplasty combined with septoplasty, never dissect the 15 mm dorsal and caudal struts free from their mucoperichondrial attachments.

Holding the mucoperichondrial flaps apart with the Freer elevator, use Knight septal scissors to make a cut 15 mm below and parallel to the dorsal edge and another cut parallel to that 8 to 10 mm toward the nasal floor. Assure yourself that both scissor blades are inside the flaps. It is easy for one blade (usually the one toward the surgeon) to slip out of the pocket and lacerate the mucosa as the surgeon closes the blades.

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Killian septal forceps can then be used to twist the strip of septal cartilage and bone, now cut on three sides, so that it breaks free at its posterior bony attachment.

What emerges is often one of the best pieces harvested, and under the most favorable circumstances, it provides a 3 cm length of straight cartilage and ethmoid that will make an excellent dorsal graft if one is necessary.

523

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Working in the space created by removing the first septal piece, place a long-bladed speculum between the flaps, and begin to dissect toward the vomerine groove. Periosteal and perichondrial fibers are interlaced at the junction of vomer and septal cartilage. Tears can easily occur at this point, because the periosteal fibers are stronger. Tears are less likely to occur and the dissection is easier if it is started beneath the vomerine periosteum and worked cephalad, rather than the reverse. As ethmoid or vomer is denuded, bony fragments are broken free and extracted by the septal forceps. Work patiently, always under direct vision.

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INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

The septal cartilage slotted in the vomerine groove can often be dislodged by judicious wiggling with a narrow osteotome; the second piece is often as good as the first.

The surgeon can harvest any remaining pieces obstructing the vomer or the ethmoid by holding the osteotome in one hand and the speculum in the other, with an assistant tapping with a mallet. The septal forceps can also be used to twist free any pieces of ethmoid necessary to remove. The surgeon should work posteriorly as far as necessary. Perforation of the hard palate by an osteotome during vomerectomy has been reported but should never occur, because resection is performed under direct vision. 525

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

If more cartilage is needed, and the dorsal strut is wider than 15 mm, the surgeon can use a button knife to produce another slice, which is usually a perfect spreader graft.

526

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INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

Repair the mucoperichondrial flaps with interrupted 4-0 chromic mattress sutures.

If mucosal tears occur, I repair each one with a running absorbable suture. When retrieving a needle from the posterior septum, bayonet forceps work more easily than a needle holder. I usually place my first suture at the posterior end and work anteriorly; however, with particularly difficult tears, starting at the anterior end and working in reverse is often easier. 527

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

I repack the nose with cotton so that blood does not drip into the nasopharynx during the rest of the procedure. Less packing should be placed now than at the beginning of the procedure so that the lateral walls do not balloon or distort.

If I have repaired any tears, I place silicone splints along the septal partition before placing any packs. These splints favor epithelialization and decrease the incidence of septal perforation (see Packs and Splints later). Inexpert septoplasty can create septal collapse, which is one of the worst complications after rhinoplasty. If the mucoperichondrial dissection is not at the right level, dissection is bloody and the surgeon cannot see. If the dorsal strut is too narrow or stripped of perichondrium, the chance of fracture is higher. It is not necessary for the airway or for adequate graft harvesting to reduce the dorsal or caudal struts below 15 mm. Caudal Septal Defle tion

If the caudal septum is dislocated into one airway, resection and replacement are far more effective than scoring and suturing, because internal stresses do not need to be overcome: the replaced piece will remain predictably in the midline.

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INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

After infiltrating with local anesthetic, and through a hemitransfixing incision, the displaced cartilage is dissected free from the mucoperichondrium and cut as far posteriorly as necessary to correct the visible deviation. In some cases, this procedure is more aesthetic than functional. Scalpel dissection is often simpler, but Freer or Cottle elevators may also be used.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Joseph scissors are used to dissect a pocket between the mucoperichondrial flaps. A percutaneous 4-0 plain catgut suture is passed through the columella, then the graft, and back out through the columella.

Traction on the suture pulls the piece between the medial crura and snugly into its columellar bed.

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The percutaneous suture is tied down loosely and the caudal septal graft is immobilized with one or two transfixing sutures. The hemitransfixing incision is then closed.

When the caudal strut has been resected, the surgeon should leave a 15 mm caudal bar posterior to the strut to support the dorsum; in this case, the septal remnant is an I rather than an L.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Turbinate Surgery Philosophy Turbinectomy is another emotional topic among rhinoplasty surgeons, and there is very little hard evidence to support most of the opinions. Very few surgeons undertreat turbinates, and most are too aggressive. Many surgeons, even those who perform radical excision of the inferior turbinates, believe that there are almost no unfavorable sequelae to such treatment. However, a constant, clear rhinitis is a common complaint among secondary rhinoplasty patients; and it is uncommon to hear that complaint from a patient without a history of turbinectomy. Turbinates are physiologically important, and the surgeon should remember that enlargement, except in very atopic individuals, is almost always a result of an associated airway obstruction from septal or valvular causes. Furthermore, histologic sections have demonstrated that turbinate hypertrophy secondary to septal deviation occurs in the bony, not mucosal, components. In a cohort of 600 consecutive patients (both primary and secondary), subjectively normal airways were created by valvular and septal reconstruction in more than 95% of cases in a single operation without turbinectomy. If enlarged turbinates are secondary to septal or valvular obstruction, I crush and outfracture them. Only in patients with extremely large turbinates (hypertrophied to within 2 mm or less of the septal edge) do I perform partial anterior turbinectomy after crushing and outfracture. This method has proved to be extremely effective: in the previous 1000 consecutive rhinoplasties that I have performed, just four patients have needed secondary turbinectomy.

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INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

Technique of Crushing and Outfracture

A

B

C

After infiltration with local anesthesia using a 25-gauge spinal needle (A), the turbinate is grasped between Killian septal forceps and infractured (B). This maneuver permits the forceps blades to grasp and crush the hypertrophied medial and inferior turbinate edges (C, shaded area). The forceps then slip medial to the turbinate and press it gently outward toward the sidewall. The cystic turbinate bone crushes easily. The goal is not to produce a specimen, but rather to enlarge the airway by reducing the pathologic hypertrophy. Do not incapacitate these vital structures.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Technique of Turbinectomy A

B Resection of inferior turbinate

In those few patients whose turbinates remain large after crushing, small Gruenwald punch biopsy forceps can nibble away the anterior edge (A). Resection must not extend beyond the hypertrophied area, and rarely beyond the junction of the middle and posterior thirds unless the clinical appearance warrants it (B). Like all rhinoplasty procedures, partial inferior turbinectomy has been overdone, and rhinomanometric data suggest that it is not routinely necessary if septal and valvular causes of obstruction have been adequately relieved. Turbinate crushing and outfracture suffice in patients whose turbinates contain significant hypertrophied, cystic bone (the usual case with enlargement secondary to septal deviation), and in whom adequate airway size can be achieved without resection. When resection is necessary, biopsy forceps allow smaller, more incremental changes than angled scissors. The raw surfaces left will contract and epithelialize, further reducing the size of the remaining turbinates. Underresection occurs less frequently, and it is much easier to treat than overresection (for which I know no uniformly effective treatment).

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PHASE III: ENSURING FUNCTION AND CREATING SHAPE AND PROPORTION Osteotomy Indications For many surgeons, osteotomy is such a routine part of rhinoplasty that they do not feel they have completed the operation until they have performed an osteotomy. However, this need not be the case. Like any rhinoplasty step except wound closure, everything is optional. Osteotomy presumably achieves two goals: reducing bony vault width and closing the open nasal roof. Because the bony vault may remain unopened or only partially open after conservative dorsal resections, the former of these two objectives is probably more important. Before performing any osteotomy, the surgeon should be certain that one is necessary. If the lower nasal third is already appropriately wider than the bony vault, narrowing the upper nose further may be counterproductive and make the nasal base appear relatively larger. If there is a high septal deviation, bilateral osteotomies may create a newly asymmetrical nose, because one nasal bone will move medially farther than the other: in this case, only an osteotomy on the lateralized side is indicated. The surgeon may wish to omit osteotomy in elderly patients (in whom nasal bone comminution may occur), patients who wear heavy eyeglasses, or patients with nasal bones extending less than one half the distance to the septal angle (short nasal bones as defined by Sheen), in whom middle vault width depends partially on bony vault width. Finally, osteotomy may lengthen a long nose further by reducing skeletal support beneath a large skin sleeve. It is important that surgeons not attempt to do too much with osteotomy, and recognize its limitations. Technical Details Morbidity from edema and ecchymosis is greater from osteotomy than from any other rhinoplasty step; it therefore follows that the gentlest effective maneuver is preferable.

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Multiple external incisions are a currently popular alternative preferred by some surgeons, but all incisions leave unnecessary scars that can be seen on close inspection.

A single lateral osteotomy that begins low at the piriform aperture and ends higher toward the nasal root is atraumatic, effective, and anatomically correct. Its course parallels the nasomaxillary suture and outlines the trapezoidal shape of the nasal sidewall.

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Making a short intranasal incision on each side places access exactly at the piriform aperture base.

The periosteal edge is lifted with a Joseph elevator and held open until the osteotome has been positioned.

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A

B

C

D

I perform intranasal osteotomies with a guarded, curved 4 mm osteotome (A), reversing the instrument from the way it was designed so that the button lies on the cutaneous, not vestibular, side, where the surgeon can feel it. Beginning at the base of the piriform aperture and advancing toward the nasal process of the maxilla (rather than in a direct line toward the medial canthus) the surgeon has complete control of the instrument with both hands while the assistant taps: the surgeon feels the button and controls medial pressure with the nondominant hand, and controls direction with the dominant hand (B and C). The surgeon maintains orientation. Injuries to the medial canthus, lacrimal apparatus, orbital floor, extraocular muscles, and even the anterior cranial fossa have been reported, but these should never occur. The pitch of the osteotomy drops when the instrument reaches the frontal bone, signaling completion of the fracture. The cephalic end weakens as a greenstick fracture; gentle digital pressure medializes the nasal bone (D). Carefully performed, intranasal osteotomies do not create mucosal tears.

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The procedure is repeated on the patient’s left side. The bony pyramid has been reformed, and the upper third has been narrowed.

Single osteotomies, multiple osteotomies, perforating osteotomies, external osteotomies through single or multiple incisions, intraoral osteotomies (with or without endoscopic control), and osteotomies with motorized equipment have all been described. However, if performed carefully and for the right indications, osteotomy can be the simplest of the rhinoplasty steps. Exceptions to Osteotomy The low-to-high osteotomy is straightforward and uniformly effective. However, there are exceptions to osteotomy. Surgeons should think twice before performing bilateral osteotomies in deviated noses or simultaneously with rhinoplasty in noses that have sustained significant previous trauma, where the septal partition may not have healed. The surgeon should also consider omitting osteotomy in older patients or patients with narrow bony vaults or short nasal bones.

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Alar Wedge Resection Performing an excellent alar wedge resection is much harder than it sounds. Like the columellar scar in open rhinoplasty, the quality of the scar can be suboptimal even if a surgeon’s technique is good. Scar quality also depends on skin texture and thickness, whether the cautery used has thinned subcutaneous fat, and how much tissue is resected. Overresection is disarmingly easy, and even 1 mm can make the difference between a smooth sill and a notch. Like every other preceding step, reducing nostril size used to be considered obligatory in a complete rhinoplasty; however, it is not. In fact, the more conservative the dorsal resection, the less secondary nostril flare develops and hence the need for alar wedge resection decreases.

Notice also that tip lobular size affects relative nostril size. The nostril lengths in these two images are identical, as is dorsal height; however, in the right photograph, where tip lobular size is greater, the nostril looks proportionally smaller. Sheen made two important observations about alar wedge resection that have guided my technique: (1) The alar wall has both cutaneous and vestibular surfaces, which can be treated differently, and (2) a medial flap preserved in the sill ensures smooth continuity.

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Remember also that the size of the nostril is large or small relative to something, in the same sense that tip projection has to be adequate relative to something. Nostril size also has its relationships to both the width and height of the nasal base, which are easiest to judge from the inferior view. Each of these patients had large preoperative tip lobules; alar wedge resection has only made them seem larger.

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Alar Wedge Subtypes External Excess (Sheen Type 1) When the nostril is adequately sized but the lobule is thick or the alar base is wide, resect the cutaneous surface only.

When the alar base is wide but the nostril-to-lobular size is correct (the nostril is less than 1.5 times the tip lobular height), reduce only the external surface.

The alar resection is marked. Notice that the posterior incision lies slightly outside the crease so that this important anatomic landmark is not destroyed. The surgeon performs the excision using counterpressure of the index finger.

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Resection width is usually no more than 3 mm. Cautery is not necessary and is inadvisable, because it may shrink the volume of subcutaneous fat. Notice that the vestibular skin is intact. Closure is begun with 6-0 nylon suture where the external skin turns toward the rim. After closure, the lobule has thinned, but nostril size is unchanged.

This patient is an example of Type 1 alar wedge excision. She is shown 3 years postoperatively.

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External and Vestibular Excess (Sheen Type 2) When the nostril itself is large, both surfaces must be resected.

A

B

C

D

The lateral cut is made just above the alar-facial groove. A small back cut, or medial flap, preserved on the medial sill edge (B), avoids a postoperative notch by decreasing resection size and changing the angle of the closure (Sheen). The surgeon makes both incisions with a No. 11 blade, watching the angle at which the blade crosses the floor (C).

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A

B

C

D

E

F

The key suture re-creates the point at which the external skin turns into the vestibular side (C). 6-0 nylon sutures complete the external closure (D), and 6-0 chromic sutures complete the internal closure (E). The right side has been completed, but the opposite side has not yet been reduced—notice the difference (F).

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B

The resection rarely exceeds 3 mm (A). The surgeon completes the left side in the same fashion, aiming for symmetry (B).

In most cases, the external surface requires a bigger resection than the vestibular side, as illustrated in this patient. The medial flap has preserved a smooth sill.

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In this unusual situation, the alar wall flares outward like a skirt, exaggerating nostril size. The nostril deformity is accompanied by cephalically rotated lateral crura, which cannot brace the rims properly. Although alar wedge resections were performed in this woman, the alar eversion was corrected first by rotating her malpositioned lateral crura caudally, thereby splinting and reforming more vertical alar rims (for this technique, see pp. 513-514). Treating Overresection A

B

In this patient, alar wedge resection seemed like a good idea, but as the second side was closed, it became obvious that it was not (A). Note the inversion of the left alar wall. Suture removal released the deformity (B).

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

The resected piece can be replaced as a free graft, after which alar wall posture normalizes. Take is uniformly complete in these cases.

Spreader, Radix, Tip, and Columellar Grafts Although spreader, radix, tip, and columellar grafts are covered in detail in Chapter 12, they are included briefly here for continuity. Spreader Grafts

When we left this patient, the septoplasty had been completed. The septum had yielded beautiful building materials. In the center of the grid is the perpendicular plate of the ethmoid that was impacted into the left airway. On the left (proceeding from the bottom of the grid up) are the dorsal, caudal, septal, and alar cartilage resections.

Toward the right is the first septal piece cut with the angled scissors—the straightest and most perfect of the group, to be used for the radix graft. The piece on the far right, recovered from the vomerine groove, is less uniform but can be used for spreader grafts.

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A

B

C

D

This last piece is trimmed and cut to form two grafts of appropriate width and thickness, long enough to span from the caudal end of the bony arch to the septal angle (A and B). Both grafts slide into their submucoperichondrial tunnels (C shows the right-side insertion). The only fixation needed is a transfixing suture at the caudal end of the pockets (D).

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

In this patient, a high septal deviation toward the left, much more obvious after dorsal resection (A), will make spreader graft placement more difficult, because the prepared tunnel curves in the coronal plane. Accordingly, a thicker spreader graft is planned for the right side than for the left. Because this graft will not slide easily, I pass the smooth end of a Cottle elevator into the tunnel first (B). As my assistant supports and then slowly withdraws the elevator, I slide the spreader graft past on its medial side (C). Spreader grafts should always be placed under direct vision.

At this point, the intercartilaginous incisions can be closed with 5-0 plain catgut sutures—they are fine enough for this task and absorbable enough when the wounds are healed at 7 days. No permanent suture is necessary internally or externally. As grafts are placed, the incisions are closed.

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Radix Grafts A

B

C

The best septal piece is sized and cut slightly longer than the radix defect so that no distal discontinuity will appear once it has been placed (A). The graft is then narrowed on each side (B), and shaped and beveled on its lateral and caudal ends for a perfect fit (C).

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However, the graft is still too stiff to conform to a rounded radix beneath thin nasal skin. Two taps in the crusher yield a graft that is supple.

Because of the defect depth at its cephalic end, a second, shorter piece is sutured to the posterosuperior surface of the main graft. The edges of the second piece, which are slightly long, are trimmed after the suture has been tied.

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A

B

C

D

E

F

The main graft has been crushed, beveled, and thinned to adjust it to the defect, and the second piece sutured to it will allow it to fill the radix contour exactly (A). Radix graft suturing with absorbable material is the only type of internal graft fixation that I use. As I open the wound with an Aufricht retractor, I can see the entire dorsal expanse so that I can place the radix graft under direct vision (B). I place the graft into the wound (C) and then remove the retractor and immobilize the graft with my nondominant fingers. I slide the bayonet forceps out and check the graft for position (D) (it can be maneuvered if necessary). Then the rest of the intercartilaginous incision is closed. If the radix graft does not feel perfect, I will remove and revise it; in this case, no revision was needed. All grafts were secured by their pockets.

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Tip Grafts

A

B

The lateral crura of this patient have been minimally reduced, but she needs slight projection and contour. Three lightly crushed grafts will be used (A). The tip grafts are firm enough to support the soft tissues but pliable enough to conform to the lobule (B).

A

B

C

D

A standard tip graft incision is made, beginning at the columellar lobular junction and extending behind the soft triangle (A), leaving a shoulder of vestibular skin above the rim to avoid notching during closure. The pocket is dissected deeply, just over the alar cartilages, maintaining a smooth soft tissue pad. In particular, it is important not to injure the dermis (B). The dimensions of the pocket extend from the columella-lobular junction (C) to the point at which the greatest projection is desired (D).

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INTRAOPERATIVE FEEDBACK AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

The first graft is positioned (A), and the tip is now more projecting but slightly angular. Accordingly, a second graft is placed. After it is deemed to be sufficient (the third graft will not be needed), the wound is closed. Columellar Grafts A

B

C

A slight discontinuity now exists at the caudal end of the tip grafts, at the columellalobular junction (A, point of scissors), as a result of increased anteroposterior lobular tension (by the tip grafts). A small columellar graft will fill this defect. Such fine tuning is impossible with the open approach, where these small defects simply cannot be seen. A short incision is made proximal to the defect through skin and medial crus (B), and Joseph scissors are used to dissect a pocket between the medial crura (C).

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

While my scrub nurse supports the scissors, I select a graft of the right size (A), and as she pulls the scissors out, I slide the graft into position (B). The small access incision is closed with a few fine sutures (C).

Interval Changes A

B

C

D

Rhinoplasty is a right-brain operation. Shown here is the patient’s profile at several cardinal points during the procedure: at the beginning (A), after all resections (B), after the radix graft (C), and at the conclusion (D).

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Silhouettes demonstrate the apparent change in nasal base size and the alteration of nasal length, dorsal contour, and tip aesthetics.

Packing and Splint Patients dread nasal packing, and most of them remember for years the experience of having it removed. Two technical changes can dramatically lessen patient discomfort: (1) using short packs over plastic tubing, which helps equalize Eustachian tube pressure, and (2) leaving the packs in until the airway has healed. Tight packing is not only uncomfortable, but it may also dislodge repositioned nasal bones. Although complete patency may last only a few days, the tubes do help equalize middle ear pressure and allow some airflow, for which patients (particularly those anxious about packing) are always grateful. Packing and tubes ordinarily remain for 1 week, by which time normal mucous production has resumed so that the packing and tubes can be removed painlessly. In the absence of septal resection or turbinectomy, smaller packs can be used, which need to remain for only 24 to 48 hours. I routinely prescribe oral antibiotics appropriate for upper airway organisms as prophylaxis against suppurative sinusitis while packs are in place (currently cefaclor, 250 mg po bid).

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When I repair septal tears, I place thin (1 mm) pieces of bivalved silicone sheeting along each septal partition. Although not otherwise necessary, the splints favor epithelization and can be removed painlessly at 7 days without disrupting the septal sutures. Premade splints are almost always too large and must be trimmed to fit, making sure there are no sharp edges. The splints are folded and placed into each airway, where they are held in position by small hemostats. Thicker, larger splints are unnecessarily painful in place and when removed.

Before surgery, my scrub nurse prepares a packing tray that includes a pair of No. 18 Fr suction catheters (cut to the same length) and strips of Adaptic gauze (Johnson & Johnson Medical, Arlington, TX). Each gauze piece is cut lengthwise into strips (approximately 2.5 ⫻ 20 cm), folded in thirds lengthwise, and coated with mupirocin calcium cream (Bactroban Nasal). The larger packs can be split further (right side of tray) to create smaller half-packs.

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A No. 18 Fr suction catheter is placed in the floor of each nasal airway, and short segments of the mupirocin-impregnated gauze are layered over the tubes. The nose should be packed securely, but not tightly. Excessive packing is uncomfortable for the patient and unnecessary.

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The catheters are suctioned, pulled forward so that the posterior end does not extend past the soft palate, and cut flush with the packing. Catheters, splints (if present), and packs are sutured to each other (not to the patient) to prevent movement.

A

B

C

Assuming no allergy, the nose is painted lightly with compound tincture of benzoin (A). To diffuse pressures around multiple tip grafts (particularly if crushed grafts have been used), I commonly cover the tip with a piece of adhesive paper that is used to cover pediatric stethoscopes (B). This is a practice that Dr. Sheen first adopted and I have found useful. It is imperative that the tip sling and paper not be applied tightly to avoid soft tissue injury. I then apply 1⁄2 -inch paper tape loosely around the tip lobule (C). The tip grafts are now locked in position.

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Successive overlapping paper tape layers cover the rest of the nose. Notice that I place my next piece of tape over the radix graft so that it will not be dislodged cephalad by other tape strips placed over the dorsum.

I then apply a second, identical layer of 1⁄2 -inch cloth tape and then trim several layers of 2-inch plaster, cut to fit the nose (four layers if osteotomies have been performed, two or three layers if not). The plaster is soaked in warm water and folded onto the nose, doubling back in the supratip to form three layers over the middle vault.

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Another layer of 1⁄2-inch cloth tape covers the plaster. The wet plaster soaks through the tape as it dries and conforms to the nose nicely, forming a single-unit dressing that immobilizes each unique nasal shape securely. A 2- ⫻ 2-inch gauze pad completes the moustache dressing, after which the patient is ready to be awakened and taken to the recovery area. The splint must be applied precisely but not too tightly. Nasal tip skin is particularly at risk in patients whose tip lobules have been expanded by grafts. Tip color must be checked in the postoperative period, the tip sling must be cut, and nasal packs or splint must be removed, as is occasionally necessary. Even in primary rhinoplasty patients, nasal circulation is not inviolable. Most patients are discharged when awake, ambulatory, and taking nourishment without nausea, condition permitting otherwise. Our perioperative instructions are included in Chapter 13.

BIBLIOGRAPHY Adamson PA, Morrow TA. Soft tissue rhinoplasty. J Otolaryngol 23:335-343, 1994. Adamson PA, Tropper GJ, McGraw BL. The hanging columella. J Otolaryngol 19:319-323, 1990. Anderson JR. New approach to rhinoplasty. A five-year reappraisal. Arch Otolaryngol 93:284-291, 1971. Aufricht G. Joseph’s rhinoplasty with some modifications. Surg Clin North Am 51:299-316, 1971. Aufricht G. Rhinoplasty and the face. Plast Reconstr Surg 43:219-230, 1969. Bafaqeeh SA, Al-Qattan MM. Simultaneous open rhinoplasty and alar base excision: is there a problem with the blood supply of the nasal tip and columellar skin? Plast Reconstr Surg 105:344-349, 2000. Barat M, Shikowitz MJ. Nasofrontal abscesses following rhinoplasty. Laryngoscope 95:1523-1525, 1985. Bartels JW, Burgess LPA. Nasal dorsal pseudocyst formation after rhinoplasty. Am J Rhinol 6:199-201, 1992. Becker DG, McLaughlin RB Jr, Loevner LA, et al. The lateral osteotomy in rhinoplasty: clinical and radiographic rationale for osteotome selection. Plast Reconstr Surg 105:1806-1819, 2000.

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Becker DG, Weinberger MS, Greene BA, et al. Clinical study of alar anatomy and surgery of the alar base. Arch Otolaryngol Head Neck Surg 123:789-795, 1997. Bruck HG. Corrective rhinoplasty. A study of 5,000 personal cases. Arch Otolaryngol 97:441-446, 1973. Bull TR. Mishaps in rhinoplasty. Rhinol Suppl 9:S73-S75, 1989. Bull TR. Rhinoplasty: aesthetics, ethics and airway. J Laryngol Otol 97:901-916, 1983. Cachay-Velásquez H. Rhinoplasty and facial expression. Ann Plast Surg 28:427-433, 1992. Cachay-Velásquez H. Surgical lengthening of the short columella: division of the depressor septi muscles. Eur Arch Otorhinolaryngol 249:336-339, 1992. Cachay-Velásquez H, Laguinge RE. Aesthetic treatment of the columella. Ann Plast Surg 22:370-379, 1989. Chait LA, Widgerow AD. In search of the ideal nose. Plast Reconstr Surg 105:2561-2572, 2000. Churukian MM, Zemplenyi J, Steiner M, et al. Postrhinoplasty epistaxis. Role of vitamin E? Arch Otolaryngol Head Neck Surg 114:748-750, 1988. Coan B, Neff E, Marcus J. When and how do spreader grafts work? Anatomic and physiologic effects on the internal nasal valve. Presented at the Annual Meeting of the Rhinoplasty Society, San Diego, May 2008. Cohen S. Complications following rhinoplasty. Plast Reconstr Surg 18:213-226, 1956. Conrad K, Gillman G. Refining osteotomy techniques in rhinoplasty. J Otolaryngol 27:1-9, 1998. Constantian MB. The boxy nasal tip, the ball tip, and alar cartilage malposition: variations on a theme— a study in 200 consecutive primary and secondary rhinoplasty patients. Plast Reconstr Surg 116:268-281, 2005. Constantian MB. Handwritten notes on primary rhinoplasty taken at Plastic Surgery Educational Foundation, instructional course symposium on rhinoplasty, Chicago, IL, March 1982. Constantian MB. The middorsal notch: an intraoperative guide to overresection in secondary rhinoplasty. Plast Reconstr Surg 91:477-484, 1993. Coursey DL. Staphylococcal endocarditis following septorhinoplasty. Arch Otolaryngol 99:454-455, 1974. Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. I. Primary rhinoplasty. Plast Reconstr Surg 103:1491-1502, 1999. Daniel RK. Rhinoplasty and the male patient. Clin Plast Surg 18:751-761, 1991. Daniel RK. Rhinoplasty: large nostril/small tip disproportion. Plast Reconstr Surg 107:1874-1883, 2001. Davis PK. Cosmetic rhinoplasty. Practitioner 227:965-979, 1983. Dicken CH. Treatment of the red nose with the argon laser. Mayo Clin Proc 61:893-895, 1986. Dieu T, Upjohn E. Negative pressure pulmonary edema in healthy cosmetic surgery patients. Aesthet Surg J 23:270-273, 2003. Egelund E, Jeppesen F. Respiratory tubes with nasal packings following septorhinoplasty. Rhinology 30:193-204, 1992. Eisenstein B, Beekhuis GJ. “How I do it”—plastic surgery. Practical suggestions on facial plastic surgery. Postoperative care following rhinoplasty. Laryngoscope 88:1050-1055, 1978. Ellis DA, Dindzans L. The geometry of alar base resection. J Otolaryngol 16:46-48, 1987. Fahoun K. Surgical techniques for narrowing the base of the nose. Acta Chir Plast 29:216-219, 1987. Farrior RT. Symposium: the supra-tip in rhinoplasty: a dilemma. Laryngoscope 86:43-44, 1976. Gilbert SE. Alar reductions in rhinoplasty. Arch Otolaryngol Head Neck Surg 122:781-784, 1996. Gola R, Nerini A, Laurent-Fyon C, et al. [Conservative rhinoplasty of the nasal canopy] Ann Chir Plast Esthet 34:465-475, 1989. Goldfarb M, Gallups JM, Gerwin JM. Perforating osteotomies in rhinoplasty. Arch Otolaryngol Head Neck Surg 119:624-627, 1993. Goodwin MR. Variables in rhinoplasties in identical twins. Eye Ear Nose Throat Mon 51:109-110, 1972. Grocutt M, Fatah MF. Recurrent multiple epidermoid inclusion cysts following rhinoplasty—an unusual complication. J Laryngol Otol 103:1214-1216, 1989. Gruber RP. Early surgical intervention after rhinoplasty. J Pediatr Surg 21:549-551, 2001. Gruber RP. Nasal base reduction: an updated technique. J Am Acad Dermatol 22:289-291, 2002.

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Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures. I. Experimental results. Plast Reconstr Surg 115:589-594, 2005. Gryskiewicz JM. Visible scars from percutaneous osteotomies. Plast Reconstr Surg 116:1771-1775, 2005. Gryskiewicz JM, Gryskiewicz KM. Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique. Plast Reconstr Surg 113:1445-1456, 2004. Gunter JP, Cochran CS. Management of intraoperative fractures of the nasal septal “L-strut”: percutaneous Kirshner wire fixation. Plast Reconstr Surg 117:395-402, 2006. Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 97:643-648, 1996. Guyuron B. Alar rim deformities. Plast Reconstr Surg 107:856-863, 2001. Guyuron B. Dynamic interplays during rhinoplasty. Clin Plast Surg 23:223-231, 1996. Guyuron B. Dynamics in rhinoplasty. Plast Reconstr Surg 105:2257-2259, 2000. Guyuron B, Ghavami A, Wishnek SM. Components of the short nostril. Plast Reconstr Surg 116:15171524, 2005. Guyuron B, Michelow BJ. Management of intraoperative nasal septal tears and perforations. Aesthetic Plast Surg 18:61-63, 1994. Guyuron B, Pinsky B. Calibrated lateral crus stabilizer. Plast Reconstr Surg 116:1776-1779, 2005. Haik J, Regev E, Bar-Meir E, et al. Necrotizing periorbital cellulitis following aesthetic rhinoplasty. Aesthet Surg J 25:270-272, 2005. Hamra ST. Repositioning the lateral alar crus. Plast Reconstr Surg 92:1244-1253, 1993. Harley EH. Dorsal nasal cyst formation. A rare complication of cosmetic rhinoplasty. Arch Otolaryngol Head Neck Surg 116:105-106, 1990. Harshbarger RJ, Sullivan PK. The optimal medial osteotomy: a study of nasal bone thickness and fracture patterns. Plast Reconstr Surg 108:2114-2121, 2001. Haye R. Septal perforations—prosthetic and surgical treatment. Rhinology 27:11-15, 1989. Hendley BJ. Convulsions after cocaine and propofol. Anesthesia 45:788-789, 1990. Hoffman HT, Davidson TM, Ward CF, et al. Anesthesia in septorhinoplasty. Effects of halothane vs nitrous oxide narcotic on bleeding. Arch Otolaryngol 108:83-86, 1982. Ishida LC, Ishida J, Henrique Ishida L, et al. Total reconstruction of the alar cartilages with a partially split septal cartilage graft. Ann Plast Surg 45:481-484, 2000. Jacobson JA, Kasworm EM. Toxic shock syndrome after nasal surgery. Case reports and analysis of risk factors. Arch Otolaryngol Head Neck Surg 112:329-332, 1986. Jan A, Khan MR, Ahmad I, et al. A new look at the nasal adhesions. J Pak Med Assoc 40:259-260, 1990. Kim JT, Kim SK. Endoscopically assisted, intraorally approached corrective rhinoplasty. Plast Reconstr Surg 108:199-207, 2001. Kotzur A, Gubisch W, Meyer R. Stenosis of the nasal vestibule and its treatment. Aesthetic Plast Surg 23:86-92, 1999. Kuriloff DB. Nasal septal perforations and nasal obstruction. Otolaryngol Clin North Am 22:333-350, 1989. Lavine DM, Lehman JA, Jackson T. Is the lacrimal apparatus injured following cosmetic rhinoplasty? Arch Otolaryngol 105:719-720, 1979. Lawson W, Kessler S, Biller HF. Unusual and fatal complications of rhinoplasty. Arch Otolaryngol 109:164-169, 1983. Lawson W, Reino AJ. Reduction columelloplasty. A new method in the management of the nasal base. Arch Otolaryngol Head Neck Surg 121:1086-1088, 1995. Leonard DW, Thompson DH. Unusual septoplasty complication: streptococcus viridans endocarditis. Ear Nose Throat J 77:827-831, 1998. Liu ES, Kridel RW. Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing. Plast Reconstr Surg 112:282-287, 2003. Lyle WG, Outlaw K, Krizek TJ, et al. Prophylactic antibiotics in plastic surgery: trends of use over 25 years of an evolving specialty. Aesthet Surg J 23:177-183, 2003. Mabry RL. Visual loss after intranasal corticosteroid injection. Incidence, causes, and prevention. Arch Otolaryngol 107:484-486, 1981.

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MacLeod AD, Maycock E. Awareness during anesthesia and post traumatic stress disorder. Anaesth Intensive Care 20:378-382, 1992. Margulis A, Bauer BS, Han H, et al. Reconstruction of the columella in a pediatric patient. Plast Reconstr Surg 112:1948-1949, 2003. Marshall DR, Slattery PG. Intracranial complications of rhinoplasty. Br J Plast Surg 36:342-344, 1983. Matarasso A. Alar rim excision: a method of thinning bulky nostrils. Plast Reconstr Surg 108:14251427, 2001. Matarasso A, Greer SE, Longaker MT. The true hanging columella: simplified diagnosis and treatment using a modified direct approach. Plast Reconstr Surg 106:469-474, 2000. McKinney P. A graduated approach to rhinoplasty incisions. Aesthetic Surg 20:519-520, 2000. McKinney PW, Mossie RD, Bailey MH. Calibrated alar base excision: a 20-year experience. Aesthetic Plast Surg 12:71-75, 1988. Meningaud JP, Pitak-Arnnop P, Bertrand JC. Osteosynthesis for open rhinoplasty of the hump nose. Plast Reconstr Surg 117:695-696, 2006. Metzinger SE. Diagnosing and treating nasal septal perforations. Aesthet Surg J 25:524-529, 2005. Meyer R. Complications tardives en rhinoplasties. Med Hyg 39:742-750, 1981. Meyers AD. Prophylactic antibiotics in nasal surgery. Arch Otolaryngol Head Neck Surg 116:1125-1126, 1990. Mitz V. Endoscopic control during rhinoplasty. Aesthetic Plast Surg 18:153-156, 1994. Naasan A, Page RE. The double cross plasty: a new technique for nasal stenosis. Br J Plast Surg 45:165168, 1992. Neu BR. Reduction of nasal tip projection with medial rotation of alar cartilages. Plast Reconstr Surg 108:763-770, 2001. Niranjan NS. A new tool for cartilaginous hump reduction. Br J Plast Surg 43:384-385, 1990. Osguthorpe JD, Lomax WR. Facial plastic surgery in an otolaryngology training program. Laryngoscope 95:1255-1257, 1985. Parkes ML, Kamer F, Morgan WR. Double lateral osteotomy in rhinoplasty. Arch Otolaryngol 103:344348, 1977. Patterson CN. Symposium: the supra-tip in rhinoplasty: a dilemma. I. Theories and causes of supra-tip convexities. Laryngoscope 86:45-49, 1976. Paulose KO, al Khalifa S, Raj SS, et al. Pilonidal sinus of the nose. J Laryngol Otol 103:1210-1213, 1989. Peck GC, Michelson LN. Anatomy of aesthetic surgery of the nose. Clin Plast Surg 14:737-748, 1987. Peixoto G. The infra-areolar longitudinal incision in reduction mammoplasty. Aesthetic Plast Surg 9: 1-5, 1985. Pincus RL, Bukachevsky RP. Medially based horizontal nasolabial flaps for reconstruction of columellar defects. Arch Otolaryngol Head Neck Surg 116:973-974, 1990. Pinto RM. On the “let-down” procedure in septorhinoplasty. Rhinology 35:178-180, 1997. Planas J, Planas J. Nostril and alar reshaping. Aesthetic Plast Surg 17:139-150, 1993. Pollet J, Weikel AM. Some technical considerations in primary rhinoplasty. Aesthetic Plast Surg 1:25-34, 1976. Prado AS. A new treatment for injuries to the anterior cranial fossa after rhinoplasty. Plast Reconstr Surg 117:721-722, 2006. Rajan GP, Fergie N, Fischer U, et al. Antibiotic prophylaxis in septorhinoplasty? A prospective, randomized study. Plast Reconstr Surg 116:1995-1998, 2005. Rees TD. Current concepts of rhinoplasty. Clin Plast Surg 4:131-144, 1977. Rohrich RJ, Griffin JR. Correction of intrinsic nasal tip asymmetries in primary rhinoplasty. Plast Reconstr Surg 112:1699-1715, 2003. Rohrich RJ, Janis JE. Osteotomies in rhinoplasty: an updated technique. Aesthetic Surg J 23:56-58, 2003. Rohrich RJ, Janis JE, Adams WP, et al. An update on the lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg 111:2461-2463, 2003. Rohrich RJ, Janis JE, Kenkel JM. Male rhinoplasty. Plast Reconstr Surg 112:1071-1086, 2003. Rohrich RJ, Krueger JK, Adams WP Jr, et al. Achieving consistency in the lateral nasal osteotomy during rhinoplasty: an external perforated technique. Plast Reconstr Surg 108:2122-2132, 2001.

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Sachs ME. Post-rhinoplastic nasal obstruction. Otolaryngol Clin North Am 22:319-332, 1989. Safian J. A new anatomical concept of postoperative complications in esthetic rhinoplasty. Plast Reconstr Surg 51:162-163, 1973. Selkin SG. Rhinoplasty and general anesthesia. Halothane vs enflurane as agent of choice. Arch Otolaryngol Head Neck Surg 115:802-803, 1989. Shafir R. Blindness as a complication of subcutaneous nasal steroid injection. Plast Reconstr Surg 104:1180-1184, 1999. Shapley H. The View From a Distant Star. New York: Basic Books, 1936. Sheen JH. Middle crus: the missing link in alar cartilage anatomy. Perspect Plast Surg 5:31-53, 1991. Shiba A, Hatoko M, Okazaki T, et al. A case of human adjuvant disease after augmentation rhinoplasty. Aesthetic Plast Surg 23:175-178, 1999. Silk KL, Ali MB, Cohen BJ, et al. Absence of bacteremia during nasal septoplasty. Arch Otolaryngol Head Neck Surg 117:54-55, 1991. Smith TW. Osteotomy and infraction in rhinoplasty. Arch Otolaryngol 100:266-268, 1974. Smithdeal CD. The sequential septo-rhinoplasty. Laryngoscope 85:1216-1226, 1975. Stallings JO, Sessions DG. Stenosis of the nostril. Repair by triplanar W-plasty. Arch Otolaryngol 93: 525-528, 1971. Swanepoel PF, Eisenberg I. Current concepts in cosmetic rhinoplasty. S Afr Med J 60:536-544, 1981. Talamas I. Cosmetic surgery. 2. Rhinoplasty. Postgrad Med 54:129-133, 1973. Tardy ME Jr, Patt BS, Walter MA. Alar reduction and sculpture: anatomic concepts. Facial Plast Surg 9:295-305, 1993. Tardy ME Jr, Walter MA, Patt BS. The overprojecting nose: anatomic component analysis and repair. Facial Plast Surg 9:306-316, 1993. Thomas JR. A useful rhinoplasty instrument: the nasal hump extractor. Otolaryngol Head Neck Surg 93:442-443, 1985. Thomas JR, Griner N. The relationship of lateral osteotomies in rhinoplasty to the lacrimal drainage system. Otolaryngol Head Neck Surg 94:362-367, 1986. Thomas SW, Baird IM, Frazier RD. Toxic shock syndrome following submucous resection and rhinoplasty. JAMA 247:2402-2403, 1982. Thompson AC. Nasal tip numbness following rhinoplasty. Clin Otolaryngol Allied Sci 12:143-144, 1987. Toback J, Fayerman JW. Toxic shock syndrome following septorhinoplasty. Implications for the head and neck surgeon. Arch Otolaryngol 109:627-629, 1983. Valeriani M, Mezzana P. Cocaine sniffing immediately after rhinoseptoplasty. Plast Reconstr Surg 107:1921, 2001. Wagner R, Toback JM. Toxic shock syndrome following septoplasty using plastic septal splints. Laryngoscope 96:609-610, 1986. Walton RL, Burget GC, Beahm EK. Microsurgical reconstruction of the nasal lining. Plast Reconstr Surg 115:1813-1829, 2005. Webster GV. Skin excisions in reduction rhinoplasty. Plast Reconstr Surg 51:289-292, 1973. Webster RC, Davidson TM, Smith RC. Importance of the columellar-labial junction in rhinoplasty. Head Neck Surg 1:423-434, 1979. Webster RC, Davidson TM, Smith RC. Practical suggestions on facial plastic surgery—how I do it. Laryngoscope 86:1280-1284, 1976. Webster RC, Smith RC, Kazda G. Columella-labial changes in solution of rhinoplastic problems. Laryngoscope 95:629-643, 1985. Webster RC, Smith RC, Smith KF, et al. External splinting of the nose. Laryngoscope 93:1615-1616, 1983. Williams WT, Ghorayeb BY. Incisive canal and pterygopalatine fossa injection for hemostasis in septorhinoplasty. Laryngoscope 100:1245-1247, 1990. Young VL, Watson ME. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthet Surg J 26:157-175, 2006.

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CHAPTER 12 Adding Cartilage to the Nose: Why Grafts Are Necessary He who receives an idea from me, receives instruction himself without lessening mine; as he who lights his taper at mine, receives light without darkening me. That ideas should freely spread from one to another over the globe, for the moral and mutual instruction of man, and improvement of his condition, seems to have been peculiarly and benevolently designed by nature, when she made them, like fire, expansible over all space, without lessening their density in any point, and like the air in which we breathe, move, and have our physical being, incapable of confinement or exclusive appropriation. THOMAS JEFFERSON Letter to Isaac McPherson

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T he Logic of Grafting The traditional “skeletal reduction, soft tissue contraction” rhinoplasty model that many of us were taught is insufficiently complex. Unless the radix is perfectly positioned, the dorsal hump small, the lateral crura orthotopic, and the skin so thin and contractile that it can assume the new skeletal shape, pure reduction rhinoplasty often causes a new airway obstruction, imbalance between bridge height and base size, and loss of definition. To achieve an optimal result, therefore, most noses require cartilage grafts for one or more of the following reasons: to render incompetent nasal valves competent; to increase contour in areas that lack it; to create optimal nasal balance; or to achieve equilibrium within the nasal skeleton and between skeleton and skin. Some noses are in disequilibrium preoperatively (such as noses with incompetent valves or excess soft tissue relative to skeletal volume), and some become disequilibrated intraoperatively (such as when a surgeon resects the cartilaginous roof, the alar cartilage domes, or a malpositioned lateral crus). This chapter outlines the strategies that allow augmentation to solve those and other problems.

S electing and Harvesting Donor Sites in Primary Cases NASAL SEPTUM An unoperated nose has an unoperated septum, and septal cartilage is by far the best building material for any rhinoplasty. The septum will be the only donor site needed in more than 90% of primary cases, because it yields both cartilage and bone (therefore grafts of varying rigidity), the grafts are generally flat or can be rendered flat, the donor site is hidden, and septal resection is often necessary anyway to correct an associated airway obstruction. Despite all of those advantages, some surgeons are still reluctant to perform septoplasty. I have seen many secondary and tertiary patients in whom both ears have been harvested (and occasionally even rib cartilage or even calvarial bone) but the

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septum virgin. It is possible that the reasons for this include unfamiliarity with a reliable septoplasty technique that generates usable pieces, concern about destabilizing the nose (particularly if a surgeon plans osteotomies or there has been previous trauma), or fear of complications (hemorrhage, collapse, or perforation). However, septoplasty is safe when the correct procedure is used (see Chapter 11), and the complication rate should be exceedingly low. Some racial differences apply. Although septal cartilage is almost always present in adequate amounts in Caucasians, it may not be so in Asians, Latinos, or Blacks, in which case, costal cartilage is often a better alternative (see next section).

Septal Cartilage Patient Examples

Some patients have deformities that appear too straightforward to require grafts. In such cases, why should the surgeon complicate the rhinoplasty with a septoplasty? Though each case could be performed by simple reduction, all contain traps that would produce a function, shape, or proportion deficiency.

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PATIENT STUDY ONE

This patient demonstrates these concepts. The dorsum is slightly high, the tip projects adequately, and the lateral crura are orthotopic; aside from a slightly long nose, there is very little here to be concerned about. But look again. The nose is slightly asymmetrical. There is a high septal deviation toward the patient’s left. The right alar wall is slightly flat. Because the soft tissues are of a medium thickness, the skin cannot be expected to tighten or shorten maximally, and two of the patient’s surgical goals are a shorter nose and more tip refinement. This nose can be treated through two basic incisions: an intercartilaginous incision on one side for access to the dorsum and septal angle and a short infracartilaginous incision on the other side for the tip grafts.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization over the upper cartilaginous vault, narrow over the bony vault 2. Submucosal shortening of the upper lateral cartilages 3. Transfixing incision, shortening the membranous septum only 4. Rasp bony vault; trim cartilaginous dorsum 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on the patient’s right 7. A one-layer radix graft 8. Two crushed tip grafts 9. An onlay graft to the right alar wall 10. Bilateral low to high osteotomies

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

B

C

After dorsal resection, note that only a thin trim opens the cartilaginous roof (B); in C, the anterior septal edge and the edges of both upper lateral cartilages are visible on the underside.

A

B

C

Notice here what has happened to the middle vault after dorsal resection; there is an obvious concavity on each side where the upper lateral cartilages have already fallen medially (A). At this point, without internal valvular reconstruction, the patient would lose some of her preoperative airway, arguably as much as 50% (see Chapter 4). After placement of asymmetrical spreader grafts to compensate for the high septal deviation (B)—thicker on the patient’s right, thinner on the left but with a convexity toward the right—the middle vault widens and becomes palpably firm and supported (C). 571

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After placement of the radix and tip grafts, the nose has taken on a different proportion: the root is slightly higher, altering nasal balance, and tip projection is minimally different, but greater skeletal support in the middle crural segment has added tip contour.

Postoperative Analysis*

The nose is now symmetrical and the dorsum straight. Although net reduction exceeds net augmentation, the nose has much greater tip contour and is less likely to lengthen again, because a supportive skeleton remains. Most importantly, airflow has not diminished. Spreader grafts have aligned the middle vault, and the right alar hollow has disappeared. *This patient underwent blepharoplasty shortly before the postoperative photographs were taken.

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PATIENT STUDY TWO

This young model said that her nose did not photograph well, because the tip seemed too large. Her photographer had told her to have it reduced. However, I chose to raise the dorsum instead, because her tip shape is actually perfect. Her skin is thin and her cartilages are strong, making the likelihood of postoperative knuckling or distortion moderately high, even with a conservative trim. In this case, it is much safer for the patient to have the dorsum raised and the tip left untouched than for the surgeon to attempt to re-create the same contours in a smaller size, which may not be successful.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. No transfixing incision 3. No modification of tip cartilages 4. Septoplasty 5. Crushed cartilage dorsal graft, with second short graft under caudal end 6. No osteotomies

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A

B

C

Through a right-sided intercartilaginous incision, the dorsum was lightly rasped, and a crushed septal graft was placed to level and raise it (B). A small second piece was placed posteriorly at the caudal end to level the supratip.

Postoperative Analysis

With minimal morbidity, the patient’s goal has been accomplished. The tip was never jeopardized. Is it smaller? No, but the safest course was followed. This patient’s most significant downside is late visibility of the dorsal grafts, which could easily be revised.

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PATIENT STUDY THREE A

B

C

D

This patient is interesting because of her multiple cartilaginous asymmetries: there is a high septal deviation toward the left; the caudal septum displaces the left side of the columella; and, most interestingly, the lateral crura are asymmetrical and the right lateral crus is orthotopic, whereas the left is cephalically rotated. Typical of most malpositioned lateral crura, the tip on that side is inadequately projecting (C), whereas the orthotopic lateral crus creates adequate projection on the patient’s right (D). (NOTE: Left lateral crural projection is most obvious from the right side, and vice versa).

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Dorsal reduction, more on the right than the left 3. Transfixing incision with a sagittal trim of the caudal septum on the left 4. Tip delivery technique, with reduction of both lateral crural, leaving 6 mm; vertical wedge resected from knuckled left dome 5. Septoplasty 6. Right spreader graft 7. Onlay graft, right middle vault 8. Multiple tip grafts, one solid with crushed anterior fill 9. Bilateral low to high osteotomies

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Postoperative Analysis

Symmetry remains 61⁄2 years after surgery. The bony vault is narrower, matching obliques are more symmetrical, the middle vault is supported on both sides, and tip projection is now adequate. Lateral views show a well-balanced nose that seems slightly shorter because of the change in tip lobular configuration, even though the nose was not shortened.

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Inferior views demonstrate a smooth tip lobule created by multiple tip grafts, which distribute the weight of projection; the caudal septal resection has improved nostril symmetry. Note that this was a sagittal resection: supportive cartilage remained to brace the membranous septum and support the columella.

PATIENT STUDY FOUR

This patient provided an intraoperative surprise. I had expected to shorten her nose slightly by trimming the cephalic margins of the lateral crura and the caudal ends of the upper lateral cartilages submucosally and trimming the anterior membranous septum. I had then planned to graft the radix and tip—my usual approach to a low-radix nose with inadequate tip projection. 578

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A

B

C

D

However, look at the size of the dorsal defect that suddenly appeared, without any dorsal reduction, once the base was rotated (C). The patient’s skin sleeve had hidden a relatively small skeleton. The septal specimen was hardly sufficient for both dorsal and tip grafts (B). Therefore I used most of the septum for the dorsal grafts, which decreased the discrepancy between the upper and lower nose (D).

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B

Ear cartilage grafts have been harvested and placed into the tip lobule. Compare the exaggerated immediate view (B) with the 1-year view (see below and opposite).

Postoperative Analysis

This is a case of unexpected intraoperative change and expected postoperative change. The skin sleeve was looser and more capacious than I had anticipated, but I recognized that the soft tissues would soon obscure the intraoperative changes. At 18 months, the postoperative nose remains shorter; the tip is now above the septal angle, and the columella is no longer obscured by the alar rim. In some ways, this case only differs from the last in the degree of preoperative discrepancy between skeletal and skin volume: had the tip cartilages been smaller, the skin would 580

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have also assumed the shape of the supratip deformity. If more septum had been available, another thin dorsal graft would have improved the postoperative shape. A surgeon does what nature permits. 581

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CONCHAL CARTILAGE When the septum is not present in sufficient amounts (for example, septal quality is poor or the septum is largely bony), conchal cartilage is my next choice. In such cases, I use septal cartilage where it is needed most (dorsum, radix, or lateral wall), and allow the concha to supply all other graft requirements. Conchal cartilage is an excellent grafting material as long as too much is not expected of it. The concha will supply tip grafts (solid or crushed), spreader grafts, lateral wall grafts (usually crushed), alar wall grafts (usually solid), columellar grafts (solid or crushed), caudal support grafts (solid, placed between membranous septal flaps to replace a resected or absent caudal septum), and, on rare occasion and as a compromise, crushed dorsal grafts. Solid ear cartilage can also be fashioned into a dorsal graft, but it must be wrapped circumferentially with permanent sutures to avoid edge visibility (Sheen) (see pp. 595-599).

Although they have been advocated, I do not recommend single-layer or stacked solid ear cartilage dorsal grafts. Although early results may look promising, graft edges will show later. Excellent long-term results are the rare exception rather than the rule.

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Harvesting Technique: Anterior Approach Unmodified cartilage from the conchal floor supplies excellent grafts for the nasal dorsum, lateral walls, tip, or internal valves. Although many surgeons harvest conchal cartilage through a postauricular incision, I prefer the anterior approach, because it provides a better view of the quality and contour of the cartilage that can be harvested. With either route, it is critical to preserve the posterior conchal wall to avoid deforming the donor ear.

The most common error that surgeons make is to harvest the posterior wall but leave the floor. Other surgeons harvest so aggressively that significant distortions occur. I have even seen through-and-through fistulas created, which should never happen.

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The anterior and posterior surfaces should be injected with local anesthesia, which facilitates the dissection.

Infection from gram-negative bacteria in the external auditory canal is the primary complication of the donor and recipient sites that follows conchal cartilage grafting. For that reason, surgeons should use scrupulous technique and use separate gloves and instruments from those used during other parts of the case. In addition, the ear should be isolated from the rest of the surgical field during harvesting with an adherent plastic drape. Such appropriate technical points greatly decrease the chance of introducing organisms from the external canal into the nasal incisions, which is particularly important in secondary cases where preoperative scarring exists and tissue resistance is impaired. The access incision does not need to be longer than 10 to 15 mm, but it must be placed at the base of the antihelical convolution. To avoid deforming the donor ear, surgeons should never resect the posterior conchal wall.

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After the surgeon finds the plane with the tips of Joseph scissors, the sharp end of a Cottle elevator easily strips the perichondrium from the anterior floor, providing a good view of the cartilage so that the surgeon can decide what parts and how much to harvest.

Because the anterior perichondrium is so thin and the skin so tightly adherent, the surgical exposure shows the surgeon the exact shape and quality of the donor cartilage far better than the view from the posterior approach, which is why I prefer this access. The surgeon can use the smooth tip of the Cottle elevator in the manner of a Cushing pituitary spoon retractor and then incise the perimeter of the cartilage to be harvested. Broad-toothed, specially designed forceps (Sheen gripping forceps with pins, Snowden-Pencer, Tucker, GA) are used to retract the cartilage without tearing it, allowing the rest to be dissected free. The entire concha, or the portion needed, is removed through the short access incision. 585

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Hemostasis is obtained with electrocautery, and in particular must include the anterior perforating branch of the postauricular artery that always penetrates the concha just lateral to the posterior edge of the external auditory canal. In this case, the cartilage is somewhat crumbly and brittle; a fragment of the cartilage can be seen under the forceps tips.

The wound is closed with a running 5-0 plain catgut suture.

3-0 nylon sutures are placed through the ear, and a medicated gauze cotton roll is slid into the retroauricular sulcus to protect the skin.

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A



ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

B

The external canal is irrigated and suctioned free of any residual preparation solution (A). After packing the conchal concavity with petrolatum gauze, the surgeon ties the transconchal sutures. The sutures should be tied purposefully but not tightly: it is possible to produce anterior skin necrosis with excessive pressure.

The dressing remains for 48 hours. At this point in the surgery, the surgeon must change gloves, instruments, and suction tip before returning to the nose.

Harvesting Technique: Posterior Approach Although I seldom use the posterior approach, it is a reasonable alternative in more darkly pigmented individuals where the possibility of an unfavorable scar is higher. However, the surgeon must proceed cautiously, because it is much more difficult to assess the location and quality of the donor material by this route.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

An access incision is made in the postauricular sulcus (A). Pressing a knife handle into the base of the helical convolution, where the posterior wall turns into the floor (B), helps locate the proper point for the superior incision (C).

A

B

C

Once the initial incision has been made, the surgeon uses Joseph scissors to begin the dissection, which is extended by the Cottle (B). The rest of the incision is then completed and the cartilage is removed with scissor dissection (C). The surgeon must continually check the anterior surface of the cartilage for guidance about the contour and length needed for the reconstruction.

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

B

D

C

E

The wound is closed in layers with 4-0 chromic catgut through the posterior perichondrium and muscle (A) and finished with an absorbable, running, horizontal mattress suture to evert the edges (B and C). After irrigating and suctioning the canal, the same tie-over dressing is placed with a posterior bolster (D and E). At this point, the surgeon should change gloves and instruments before returning to the nose.

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Preparing Graft for Insertion

Conchal cartilage is simply cut into strips for spreader grafts, but conchal cartilage is often crushed for use in the nasal tip. The cartilage is always thinned and crushed before placing it into the lateral walls, but it may be used either modified or unmodified (according to tissue type) for alar walls. Note how two mallet taps on the crusher have splayed the conchal cartilage slightly. It has become softer without fracturing. Cut into sections, this type of cartilage can form excellent lateral wall or tip grafts. A

B

C

D

Here, again with only two gentle taps, the cartilage is broader, flatter, and more pliable (A and B). Depending on tissue requirements, this may be sufficient, or more attenuation may be necessary. In the current case, the grafts are being prepared for tip grafts in a patient with thick skin, and so only light crushing is needed before the final thinning and preparation (C and D). 590

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Conchal Cartilage Patient Examples I have used ear cartilage for virtually every augmentation requirement: as dorsal, tip, lateral wall, alar wall, and columellar and maxillary arch augmentation; as spreader grafts; as a boot-shaped caudal support graft to replace missing distal septum; and as composite grafts in the coronal, axial, or sagittal orientations. As a dorsal graft, it is not as good as septal or rib cartilage, but for all other needs, it certainly suffices; and for particular requirements (lateral crural replacement or composite grafts), it is uniquely well suited.

PATIENT STUDY ONE

At rest

With inspiration

This secondary patient had alar cartilage malposition with the characteristic tip parentheses and its associated functional deficit. The remnants of the lateral crura are still visible, and the alar rims are flat, notched, and unsupported. Typical of most patients with alar cartilage malposition, she has inadequate tip projection with a short middle crus and tip skin that hangs from a prominent septal angle. Only a small amount of septal cartilage remained, enough for one graft; it would be used for the dorsum.

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SUMMARY OF THE SURGICAL PLAN 1. Harvest conchal floor from one ear 2. Minimal skeletonization 3. Resect lateral crural remnants (unusable fragments) 4. Reduce supratip dorsum 5. Resect medial crural footplates 6. Septoplasty 7. Bilateral spreader grafts, thicker on the right than left (high septal deviation toward the left) 8. Bilateral alar wall grafts to replace resected lateral crura 9. Single upper dorsal graft (septal cartilage) 10. Multiple crushed tip grafts 11. Columellar grafts

Dorsal and lateral crural resection appear to improve the nasal contour, but remember that everything is now unsupported: tip, middle vault (from the previous surgery), and alar walls. Septoplasty has yielded a small amount of bone and one usable graft (center of grid); the harvested ear is to the right of the grid and the scraps of resected alar cartilage and septum are to the left.

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

B

C

Because of limited supply of septal cartilage, ear cartilage was used for the spreader grafts (A). The concha provides a particularly good lateral crural replacement (B); note the difference in alar wall contour once the left side has been reconstructed (C).

A

B

C

The single usable piece of septal cartilage is trimmed, crushed, and used to elevate the depressed upper dorsum (A). Tip grafts complete the reconstruction (C).

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Postoperative Analysis

Seven years after surgery, the frontal contours are smooth and uninterrupted by concavities or protrusions. The tip is symmetrical and without visible graft edges, and the alar walls are supported and normally convex.

The dorsum is now straight, the nasal base appears smaller, and the tip is adequately projecting.

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PATIENT STUDY TWO A

B

C

This tertiary patient had undergone her first rhinoplasty 43 years before my surgery, and a revision 2 years later. Her primary problem was airway obstruction, which was easily diagnosed by the narrowness of the middle vault, the alar retraction, and the unconscious nostril flaring to support her airways (A). Before her first surgery, the patient had a low radix and inadequate tip projection (B). Thanks to excellent soft tissue contraction, she now has a straight dorsum but with a flat, unsupported tip. No septal cartilage remained.

SUMMARY OF THE SURGICAL PLAN 1. Harvest composite grafts and concha from one ear 2. Upper dorsal graft of rolled ear cartilage 3. Lateral wall grafts (crushed ear cartilage) 4. Tip grafts 5. Bilateral composite grafts

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A

B

C

D

Ear cartilage does not make my favorite dorsal graft, and not every ear supplies cartilage of the proper length for a good dorsal reconstruction. However, this patient needs more than a single, crushed piece of ear cartilage can provide, even though her ear donated a graft of the proper proportions (B). Trimmed, rolled, and fixed circumferentially with permanent sutures (as described by Sheen), the graft measured nearly 3 cm in length, which is perfect to fit from the proper radix height into the supratip (C). Once the graft was positioned, the dorsum became straight, and the supratip deformity disappeared (D). The perfect application for the rolled dorsal graft is the deep, asymmetrical defect beneath a thick soft tissue cover.

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After composite grafting, the remaining ear cartilage was split, crushed, and placed into the tip lobule.

The dorsum is now straight and begins at the proper level, so the base appears no larger even with an augmented tip.

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Postoperative Analysis

Dorsal grafting (without spreader grafts) has opened the middle vault; composite grafts support the alar walls and reduce rim retraction. The patient no longer flares her nostrils to support her airways. Airflow in such patients will triple or quadruple after valvular reconstruction, even without septoplasty or inferior turbinectomy. Indeed, airflow for this patient increased 3.2 times over the preoperative values. The crushed cartilage sidewall grafts minimize dorsal edge visibility; such grafts are often necessary with significant dorsal elevation. Tip projection is now adequate, and the elevated dorsum balances the base properly. The alar hollows have disappeared, and composite grafts have corrected the alar notching.

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COSTAL CARTILAGE In the absence of sufficient septal cartilage for the dorsum, costal cartilage is the next best alternative. Unlike conchal cartilage, the rib cage almost always supplies sufficient length for a single-unit dorsal graft. Its survival equals or exceeds that of calvarial grafts; and unlike the calvarium, the rib cage will also supply spreader, tip, maxillary, and lateral or alar wall grafts without the need for a second donor site. Asian or black patients may require long, straight dorsal grafts for primary augmentation, but they often lack sufficient septum. In those cases, costal cartilage is the best alternative; if I harvest costal cartilage, I use it for all the graft needs in that patient and spare the septum completely.

PRINCIPLES OF RIB GRAFTING

Like their owners, rib specimens come in varying sizes, shapes, and consistencies. But the good news is that most ribs can be configured into grafts that will be reliable and stable in the long term with limited morbidity for the patient.

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Costal cartilage presents relatively more technical difficulties than the septum or concha; surgeons who favor rib cartilage have devised a variety of methods for harvesting and preparing the graft to suit their particular techniques. The following principles govern my rationale for harvesting and graft preparation: 1. Similar to septal and ear cartilage, rib cartilage has tremendous internal stresses. Whereas intercostal muscle contraction expands the rib cage for inhalation, passive recoil alone accomplishes normal tidal volume exhalation. The internal stresses required to maintain a stable rib cage contour through hundreds of thousands of breaths during a lifetime make it easy to understand why ribs deform so frequently after they are surgically altered. 2. The less alteration a rib requires, the less its forces are disturbed, and therefore the less likely it is to distort postoperatively. It follows, therefore, that a surgeon should use the smallest rib that will suffice. 3. Although significant (5 to 6 mm) dorsal defects occur, shallow (1 to 3 mm) defects are more common; the ideal technique should supply rib cartilage for those defects as well. 4. As patients age, rib cartilage progressively calcifies, beginning at its core and progressing peripherally. As the rib calcifies, it becomes stiffer. 5. If the rib cartilage is sufficiently calcified, it can overcome the perichondrial forces that will otherwise distort the rib toward the perichondrial side. Therefore if the rib is sufficiently calcified or if the perichondrial surface can be weakened, the graft will not distort.

Rib Harvesting Technique

It is possible to harvest rib through incisions as small as 1 cm; however, because this technique frequently involves the use of tangential rib sections, an incision between 2.5 cm and 4.5 cm is more often necessary. Before the patient is prepared, the patient’s tissues are infiltrated with 1% mepivacaine hydrochloride with epinephrine 1:100,000.

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Rib Donor Scars Most patients, particularly women, do not want an obvious chest scar. To accommodate them, some surgeons harvest rib through an inframammary incision. However, that technique spares the perichondrium (which I prefer to harvest with the rib) and requires harvesting a larger rib than is optimal for the nose. Although a single dorsal graft can be harvested through an inframammary incision (see the following), reconstruction by the current technique necessitates an incision on the body of the eighth or ninth rib. Some patients are alarmed by the possibility of a scar that may be visible. Here, however, I give advice that parallels Gillies’ recommendation that the nose, not the forehead, should be the preeminent concern when designing a forehead flap: in these circumstances, the patient must decide whether the best possible nasal reconstruction or the best chest scar is more important.

In most patients, I plan an incision 3 to 4 cm long over the body of the eighth rib. This position allows me to harvest the ninth or tenth ribs if their dimensions seem better, and to have access to a tangential strip from the eighth rib. The incision is made through the skin and deepened through the subcutaneous tissue with a low coagulating current down to the rectus abdominis fascia, which is split transversely.

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The rectus muscle is separated in the direction of its fibers, and right-angle retractors are placed. The ribs are palpated for the proper donor site, and the overlying perichondrium is infiltrated with 0.25% bupivacaine with epinephrine 1:200,000.

A

B

I usually start with the ninth rib and work superiorly, but not every ninth rib is the same size: some are narrow enough to be mistaken for tenth ribs, and some would provide a stout dorsal graft. I try to identify the most serviceable area and rib, and begin there. Using a No. 10 blade on a long knife handle, I score through the rib to the needed depth (here about 2 mm), outlining an ideal dorsal graft (B).

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I then begin working my way around the graft from the edges, being careful to stay almost parallel to the surface.

A

B

As I slice off the top piece, I feel for areas of resistance or calcification while watching to see if the rib distorts as it is cut through. The first graft should be cut to the estimated required thickness for the dorsum; additional pieces can be used as underlay, if necessary. If the entire thickness of the ninth rib is needed, the surgeon should use forceps to grasp the tip of the rib and then dissect proximally with Metzenbaum scissors, being careful to hug the undersurface of the rib. Muscle should not be resected. The first harvested piece often yields an excellent dorsal graft, rounded on its surface and covered with perichondrium. The tips of the ninth (B) or tenth ribs provide a maxillary augmentation or columellar graft; more proximally, the ninth rib may be wide enough for some dorsal defects, or it can be cut into strips for lateral wall, alar wall, or tip grafts.

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After selecting the appropriate area, the surgeon proceeds cephalad and uses the scalpel to outline and cut a tangential piece from the eighth rib. Ideally, a graft approximately 8 to 9 mm wide by 35 mm long by 3 mm thick is resected. The white rib immediately beneath the perichondrium is almost never calcified; however, depending on patient age, varying degrees of calcifications will be encountered as the surgeon progresses deeper. Pay attention to the substance of the rib as you cut through it; you will be gathering important information about the quality of your building materials.

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This is a typical split graft harvested as described. Immediately deep to the first graft, a second layer may be removed; all resections are performed under direct vision. Using this method, pneumothorax almost never occurs.

After hemostasis has been obtained, the wound is filled with saline, and the anesthesiologist gives the patient a deep breath (30 mm H2O pressure) while the surgeon checks for bubbles signifying pleural air leaks. In children and in patients with very narrow rib cages or high xiphoids, the surgeon must be more wary about dissection around the eighth rib, which is usually above the diaphragmatic reflection. If bubbles are seen, the site of the air leak must be identified. A small red rubber catheter is placed into the plural space, and the surgeon repairs the plural space with an absorbable purse-string or figure-of-8 suture, without tying the knot. The

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anesthesiologist gives the patient another deep breath, at which point the red rubber catheter is pulled and the suture tied down tightly. Small air leaks are easily handled this way. An upright chest radiograph should be taken in the recovery area to confirm that the problem has been adequately handled.

Once hemostasis has been obtained and the remaining rib edges have been smoothed, a 7 Fr suction catheter is placed into the chest wound and arranged so that it drains all layers, and it is cut and fixed to the skin. The drain is removed at 48 hours or thereafter as indicated, but not sooner. Significant drainage can still occur after 24 hours, and trapped accumulation increases postoperative pain.

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A

B

C

D

The muscle and fascia are repaired with 2-0 and 3-0 absorbable sutures (A and B), assuring a secure closure to minimize postoperative discomfort. Scarpa’s fascia is closed as a separate layer, and the skin is repaired with a running, absorbable suture. I usually leave one end of the donor wound open temporarily so that excess cartilage not needed for the reconstruction can be banked later beneath the inferomedial skin flap (which overlies the softer abdominal cavity, not the rib cage, and will therefore be less bothersome to the patient). Rib Banking

In case any secondary procedures are necessary, the banked rib is always photographed for documentation.

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A

B

C

D

The surgeon uses Joseph scissors to dissect a subcutaneous pocket beneath the inferomedial skin flap (A), into which the bankable rib is slipped. Multiple pieces can be fanned out or layered in an effort to minimize the external deformity. Intradermal sutures and a tape closure complete the repair (C and D).

Alternate Rib Donor Site

Pectoralis minor muscle

Pectoralis major muscle

Donor site

A single dorsal graft, covered with perichondrium, can be harvested through an inframammary incision as a tangential slice of the fifth or sixth rib from the bare area that occurs between the origins of the pectoralis major and minor muscles.

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A graft about 4 cm long can be taken from this site; notice the whitish subperichondrial cartilage and the subjacent yellow, calcifying cartilage from this 55-yearold woman.

Preparing Rib Dorsal Graft

A

B

The length of the dorsal graft needed has been estimated at almost 3 cm; and this strip of ninth rib (perichondrially wrapped) will be excellent for the purpose. It is wide enough, and its tapered edges will meld nicely with the bony vault. In this particular patient, rib will replace a silicone implant that is being removed. The surgeon must prepare the undersurface of the graft as well (B).

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A

B

C

D

E

After the graft has been narrowed to its final thickness, I check its tendency to curl. Unless the cartilaginous component is sufficiently calcified, the graft will tend to curl toward the perichondrial surface. If it does so, I begin making a series of fullthickness interdigitating cuts through the perichondrium and cartilage (A and B), working from side to side (C through E) until the graft lies flat or is pliable enough that the dorsal skin will be able to hold it against its bed. Note that some of the cuts are in the center of the rib, and others are in the periphery; in this way, all of the perichondrial fibers have been divided at one point or another.

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In this patient, the cuts shown have rendered a graft that is flat, and that will augment the dorsum nicely.

Other Rib Modification Methods Throughout this text, you will see rib handled in a variety of ways. Besides being used as dorsal grafts, rib can be cut into slices or strips where curving makes less difference (for example, over the maxillary arch), or where a curve can be used to the patient’s advantage (for example, for spreader grafts to straighten a high septal deviation or to replace alar cartilage lateral crura). Sections from the center of a rib serve well to replace the caudal septum.

If the rib slices show a tendency to curl or when a thicker graft is needed, two perichondrial/cartilage strips can be sutured together (perichondrial surfaces outward,

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using fine, permanent sutures with all knots buried). Each graft neutralizes the tendency of the other to distort, creating a straight construct. Sheen had begun to explore and use this design before he retired.

When needed for lateral walls or tip, rib cartilage will crush; how easily it does so depends on patient age (younger rib crushes more easily than older rib). The crusher designed for that purpose by Sheen (Sheen cartilage crusher, SnowdenPencer) will render a rigid slice pliable enough to be used in the tip or elsewhere.

Rib Cartilage Data I have reviewed my rib experience, comparing the perichondrial strip and laminate to the split rib and to the split rib stabilized by a longitudinal, threaded K-wire (Gunter et al, 1997).

Comparison of All Rib Graft Techniques This review consisted of 167 consecutive rib grafts, 119 of which were in women and 48 of which were in men (median age 44 years; median postoperative followup 13 months); both the donor rib and the quality of the result were graded from 1 to 5 (5 being the best).

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Relationship of Patient Age to Rib Graft Quality (167 Patients) Rib Grade*

1, 2 3, 4, 5 4, 5

Patient Age (years)

Rib Grafts Rated 4 or 5*

⬍40 ⬎40 ⬍40 ⬎40 ⬍40 ⬎40

28% 14% 47% 56% 72% 86%

*Rib grade and result graded 1 to 5, 5 being best. Because all cases were secondary rhinoplasties with significant deformities and varying severity, case results were graded according to the quality of the dorsal graft, because its construction was the technique being assessed. Distortion, visible edges, and warping all counted against a high score.

As noted earlier, ribs calcify as patients age. Therefore (as a broad generalization) the older the patient, the stiffer the rib and the less likely that a dorsal graft will distort. The above table indicates this pattern: higher rib grades were associated with better rib quality; and at all rib grades, older patients produced a higher number of better quality grafts (grade 3, 4, or 5) and a lower percentage of poor quality grafts (grade 1 or 2).

Relationship of Rib Graft Technique to Result Quality Technique

Split rib Split rib, wire Perichondrial/cartilage strip Laminate

Patients Who Achieved Results Graded 4 or 5

72% 73% 78% 71%

When these data were collected in 2006, there was essentially no difference in the percentage of patients achieving results graded 4 or 5, regardless of which of the four techniques were used (split rib, split rib with wire, perichondrial/cartilage strip, or laminate).

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Absence of Learning Curve Portion of the Study

1st half 2nd half

Patients With a Result of 4 or 5

79% 82%

Because the techniques are all equally difficult, there was essentially no learning curve, in the sense that the percentage of patients who achieved results of 4 or 5 did not differ from the first half to the second half of the study.

Relationship of Rib Graft Quality to Result* Donor Rib Quality

1 or 2 3, 4, or 5 4 or 5

Patients With a Result of 4 or 5

50% 87% 91%

*p ⬍0.01.

As might be expected, therefore, the better the donor rib, the higher chance of a very good or excellent result: whereas only 50% of patients whose ribs were graded 1 or 2 achieved a result grade of 4 or 5, 91% of patients whose ribs were graded 3, 4, or 5 achieved a very good or excellent result. Good quality donor rib (grades 4 or 5) had an 87% chance of producing a result of 4 or 5.

Relationship of Patient Age to Result Quality—Perichondrial Strip, Any Rib Quality Age

Patient under age 40 Patient over age 40

Patients With a Result of 4 or 5

67% 81%

It therefore follows that the older the patient, the higher the chance of a good result. Of patients older than age 40, 81% achieved a result of 4 or 5 in one operation, whereas only 67% of patients under age 40 achieved those results.

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Perichondrial/Cartilage Strip Experience Relationship of Rib Quality to Result for Perichondrial/Cartilage Strip (150 patients) Rib Quality

1, 2 3, 4, or 5 4, 5

Patients With a Result of 4 or 5

50% 91% 94%

This table reflects a 2008 review of 150 consecutive perichondrial/cartilage strips (the technique demonstrated earlier in this chapter), which is now my preferred method for most patients who require dorsal rib grafts. The data indicate again what might be expected: at all ages, the better the donor rib, the better the quality of the result. Whereas patients with poor quality rib (grade 1 or 2) had only a 50% chance of achieving a result of 4 or 5, 94% of patients whose ribs were grade 4 or 5 achieved very good or excellent results. As might be expected, familiarity with any technique improves the quality of the surgical result. Of my last 50 consecutive perichondrial/cartilage strips, 46 patients (92%) achieved scores of 4 or 5. Because the perichondrial/cartilage strip technique does not require unusual skill, I believe that many surgeons, with experience, will be able to achieve similar results for their own patients.

Indications for Various Rib Graft Techniques In earlier years, surgeons reserved rib grafts for patients with deep defects (for example, caudal nasal collapse or saddle deformities). However, as the population of rhinoplasty patients has evolved, surgeons now see an expanding number of secondary rhinoplasty patients whose septal donor sites have been exhausted but who require a long, straight, thin dorsal graft for a relatively shallow (1 to 3 mm) defect. Ear cartilage will not routinely fulfill this need. Such circumstances are common, and have become the most frequent application for the perichondrial/cartilage strip. Deeper defects can be served in any of several ways: by the traditional split rib technique (carving the rib according to the balanced cross-section method, respecting its internal stresses); by carved rib transfixed by a threaded, longitudinal K-wire; or by a laminate constructed of perichondrial/cartilage strips. Because I prefer to

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perform reconstructions without implanting permanent foreign materials if possible, I now use the split rib or laminate techniques much more often than split rib with wire; however, the split-rib-with-wire method has served well in the past. Younger patients present a different litany of problems, because their ribs are whiter and more elastic. I have seen deforming forces so strong that the longitudinal K-wire cannot maintain the contour of the carved rib (in one case, the deforming rib pulled through the wire more than 3 years after the original reconstruction). In younger patients, therefore, I trust a perichondrial/cartilage strip only if it shows no sign of a contour change during surgery (the observation by Harris et al that cadaver costal cartilage deformities appear within 30 minutes usually holds [but not always]). However, in younger patients with deforming ribs in whom the split rib or perichondrial/cartilage graft does not work, I either construct a laminate or harvest bone from the tenth or eleventh rib.

PATIENT STUDY ONE COSTAL CARTILAGE

Like other patients in this chapter, the nose of this young African-American woman lacks definition, because it has too much soft tissue for the supporting skeleton. Further skeletal reduction will only compound her discrepancy. If her goal is more shape, then she needs more skeleton—unless her surgeon plans to resect skin.

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SUMMARY OF THE SURGICAL PLAN 1. Harvest rib perichondrial strips and tip of the ninth rib 2. Resect and replace malpositioned lateral crura 3. Perialar rib cartilage maxillary augmentation 4. Minimal dorsal skeletonization to root 5. Rib cartilage dorsal graft laminate 6. Grafts to columella and caudal septum 7. Multiple tip grafts

A

B

C

Strips of ninth rib tip, which are particularly well suited for this purpose, were slid into subperiosteal pockets dissected high over the maxillary arch (B and C), placing the widest ends in the perialar areas; the degree of overlap determines the amount of projection created in the midline. Grafts were placed through a short incision in the right nasal floor.

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D



ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

E

F

G

A laminate made of perichondrial/cartilage strips, weakened on the perichondrial surface with interdigitating cuts and sutured together with the perichondrial surfaces facing outward, is placed into the dorsal pocket (D through F). The surgeon places an additional rib graft through a separate membranous septal incision to support the columella (not as a strut, but for downward displacement, to replace the deficient caudal septum); and multiple tip grafts form the lobule (G).

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Postoperative Analysis

Two years after surgery, the patient’s dorsum is now narrower, because it is higher; no osteotomies were performed. The tip now projects beyond the septal angle, and the degree of dorsal and tip elevation have altered the basal perimeter favorably.

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The tip lobule is narrower and the nostril axes have rotated anteriorly from their preoperative horizontal position. Airflow has increased 2.6 times over preoperative values. The base is unmarked by columellar or alar scars.

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P rioritizing Specimens One of the important preoperative unknowns in rhinoplasty is the quality of the graft material needed. The great appeal of alloplastics lies in their predictable character, a luxury that does not accrue to a surgeon using autogenous grafts. However, the longevity and quality of the reconstructive result provided by autogenous materials still exceed those of any alloplastic substance yet to be introduced and tested. Autografts create a patient’s best hope for a lifetime reconstruction. Nevertheless, any surgeon struggling to complete an operation with poor-quality cartilage and bone develops great sympathy for those surgeons who have decided to use alloplastic materials instead. With the exceptions of the rib cage and calvarium, autogenous sites are limited; therefore the surgeon must inventory each specimen wisely, prioritizing according to the patient’s reconstructive needs.

Split obliquely for spreader grafts

Ethmoid

Radix graft

Ethmoid

Crush for tip grafts

The best, straightest, most uniform piece is used for the nasal dorsum, which is often covered by thin soft tissues and can be most unforgiving. In all other areas, compromises are possible. Wavy grafts can be rendered flat, thick grafts can be thinned, thin grafts can be layered, and pieces can be crushed or trimmed. Finally, the idiosyncrasies of a particular piece may perfectly suit those of a defect—do not cut or crush a graft without first checking your patient’s requirements!

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Crush for tip grafts

Spreader grafts or columellar filler grafts

Ethmoid for lateral wall graft

Radix graft and tip grafts

Vomer

Split for spreader grafts (alternate) or second layer of dorsal graft

Trim and crush if necessary for dorsum/radix

Trim and use solid or crushed for tip

Split for spreader grafts Ethmoid for lateral walls, or underlay for dorsum

Resected cartilaginous roof for radix or tip

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Constructing Specific Grafts in Primary Rhinoplasty SPREADER GRAFTS

A surgeon new to grafting should learn spreader grafts first. They are the easiest to perform, they are deep enough that visibility is not a problem, and they correct an exceedingly common functional deficit by at least doubling airflow in most patients. Endonasal placement, which is the method originally described by Sheen (1984), is straightforward, rapid, and performed under direct vision.

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Recall that septal cartilage is not uniform in thickness, but broadens along its dorsal border, where it becomes confluent with the upper lateral cartilages and forms the middle vault roof. Any dorsal resection thicker than 2 mm interrupts this cartilaginous arch and removes this widened septal area.

At this point, the surgeon has created a disequilibrium in which the upper lateral cartilages are no longer held in position by the spreading action of the intact roof. With or without bridging mucosa, the upper lateral cartilages fall medially toward the new septal edge, narrowing the internal valves. Spreader grafts re-create the former anterior septal width and reconstitute competent internal valves. Therefore spreader grafts are indicated whenever internal valvular incompetence presents preoperatively, or whenever a surgeon creates incompetence by opening the cartilaginous roof, unless the nasal contour independently suggests a substantial dorsal graft (which duplicates the functional effect).

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Technique The pocket is developed as described in Chapter 11, after hump removal but before septoplasty.

A

B

C

Infiltration of local anesthetic facilitates submucoperichondrial dissection (A and B). After incising down to bare cartilage at the septal angle through the intercartilaginous incision (C), the surgeon uses the sharp end of a Cottle elevator to begin the pocket (D through F). In an unscarred septum, the pocket dissection is usually rapid and smoothly unobstructed, done with a combination of direct vision and by feeling the tip of the elevator against the cartilage. When the perpendicular plate of the ethmoid is reached, a bit of judicious wiggling allows the elevator to pass over the ethmoid and just beneath the caudal end of the bony arch (G and H). The same pocket is developed on the patient’s left side. It is important to make the pocket as high as possible along the anterior (dorsal) septal edge without disrupting the thin mucoperichondrial adhesion that will keep the graft from popping out.

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D



ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

E

F

G

H

I

J

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A

B

C

D

Septal cartilage provides the straightest, most “ready-to-use” spreader graft, but almost any cartilage or bone donor site will work. Graft width should be appropriate for the amount of potential or real collapse, remembering that asymmetrical grafts can be placed to compensate for high septal deviations (B through D). An assistant holds a retractor so the surgeon can see that the graft has not poked through the remaining thin adhesion at the dorsal edge, whereupon the right spreader graft is slid into the snug pocket.

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Donor site

Note that the graft fits the tunnel snugly, making fixation essentially unnecessary.

Here I illustrate the method of placing a left spreader graft when the tunnel is scarred or difficult to develop, irregular from septal trauma, or curved from a high septal deviation. Slide the smooth end of the Cottle elevator into the tunnel first and then place the graft medial to it, using the retractor as an elevator to pull the mucoperichondrium laterally. As I slide the graft past the difficult area, my nurse pulls the retractor out.

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A



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

The graft is seated so that its proximal end lies just beneath the caudal end of the bony vault (A). After spreader grafts are placed, a single 4-0 plain catgut transfixing suture placed at the septal angle prevents caudal slippage (B). If the tunnel is intact on three sides, no other fixation is necessary. The graft must be long enough to reach at least from the caudal edge of the bony arch to the caudal edge of the upper lateral cartilages. Septal cartilage provides the ideal spreader graft, but strips of conchal cartilage, rib, ethmoid, or vomer may be used. Their width should provide confluence between the upper and lower nasal thirds, and may be used either singly or in pairs of unequal or equal widths to correct high septal deviations. If natural septal shape provides a tapered graft, or if there is a large discontinuity at the caudal bony arch, I place the wider end proximally, recalling that the anterior dorsal edge is widest at the junction of the bony and upper cartilaginous vaults. Lateral contour should be smooth when the grafts have been placed; the middle vault should feel symmetrical and supported but not too wide.

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Patient Examples

Asymmetrical noses must be treated differently on each side. In this patient, a right spreader graft and left osteotomy have corrected the left high septal deviation and the asymmetrical bony vault, respectively.

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Recall also that nasal asymmetry is related to dorsal height, because the anterior edge of the septum (which forms the dorsal hump) frequently constitutes the most deviated area. Therefore reducing the dorsum alone may straighten the nose.

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When the anterior septal edge is as asymmetrical as this one, there are two options: placing spreader grafts of unequal thickness or placing a spreader graft on the concave side only. I make that decision intraoperatively after the dorsal resection, and also based on the septal specimen. Ideally, in this nose, one would want a long, very thin left spreader graft (perhaps made of ethmoid) that extends underneath the bony arch and can pressure the displaced septum toward the midline, and a right spreader graft that extends only from the length of the right middle vault to the septal angle. My favorite combination uses a thin, curved spreader graft on the side toward which the septum is deviated, placing the convexity toward the septal side, and a thicker graft on the concave side. Surgeons most commonly make spreader grafts too long or too wide. If spreader grafts extend beyond the septal angle, the patient can feel them internally and will complain; or the grafts will displace the septal angle and increase the asymmetry. If spreader grafts are too wide, the middle vault becomes convex. Most spreader grafts are about 2 mm thick; after they are placed, the surgeon should palpate the middle vault for symmetry and firmness; its width should be equal to (or slightly less than) that of the bony vault. Some surgeons extend spreader grafts as a way of lengthening the nose. I have no experience with that technique. However, because dorsal height influences nasal length much more powerfully than nasal width, and because I prefer reconstructions that allow the tip to remain mobile and not restricted by the dorsum or middle vault beyond the septal angle, I use each nasal segment to do what it does best in the normal nose: spreader grafts for nasal function, middle vault width, and control of high septal deviation; and dorsal height to control its own contour and secondarily influence nasal length.

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RADIX AND DORSAL GRAFTS These grafts can be considered together, because one is simply a larger version of the other. The effect of each graft on the final result is the same, and the techniques are very similar. The reason that these grafts are important is that radix and dorsal height, more than any other single rhinoplasty step, control nasal function, balance, and the apparent size of the nasal base. Radix and dorsal grafts can:

1. Increase nasal length.

2. Decrease frontal width. 634

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3. Widen a collapsed middle vault.

4. Define dorsal lines.

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5. Provide an autogenous reconstruction in place of an alloplastic one.

6. Restore a familial characteristic.

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7. Replace missing septal structures.

8. Decrease apparent nasal base size.

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9. Support lax skin.

10. Restore an ethnic characteristic.

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11. Improve symmetry by covering a high septal deviation.

12. Help restore sidewall confluence and frontal aesthetics.

This list perhaps is not complete—you will be able to add to it. However, it is important to recognize that dorsal and radix grafts are extremely powerful; and though they may have drawbacks (real or imagined), these two graft types affect functional and aesthetic nasal reconstruction in a variety of common clinical situations.

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RADIX GRAFTS

Not every radix is located at the proper height. A few are too high, but most are too low. We have seen in Chapters 2 and 5 that the relationship of radix and dorsal height to nasal base size determines overall nasal balance, so much so that the low radix/low dorsum is one of four critical anatomic variants that form the Secret of Everything in rhinoplasty.

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In these two women, whose nasal bases are proportionately large, raising each radix from the level of the lower lash margin to the level of the upper lash margin reduces apparent nasal base size with little or no modification of the nasal tip.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

B

D

E

F

The height of every radix must be judged against relative nasal base size. A previous dorsal reduction in the first patient shown here had altered her nasal proportion toward the base (A). A radix/upper dorsal graft straightened the bridge and reduced the apparent base size (B). In the second patient, previous trauma had exaggerated an old imbalance, but raising the radix corrected the profile without the need for a tip adjustment (C and D). In the third patient, the dorsum and base were well matched, and the patient wished to retain some of her dorsal height; therefore the radix was left untouched (E and F). Even for a technique as useful as radix grafting, there can still be too much of a good thing.

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Radix Graft Principles The ability to graft the radix successfully with minimal complications is an important skill. For reasons that are not clear to me, many surgeons, even those who concentrate their practices in rhinoplasty, do not like radix grafts, perhaps not because they believe that the concept is poor but because they have trouble performing them successfully. This should not be the case. Radix grafts are not complicated to perform, and, with some effort, the long-term revision rate should be well below 5% by using them. There are only five important technical principles to apply when performing radix grafts: 1. Use the right donor material (septal cartilage, whenever available). 2. Always construct crushed grafts that conform to the defect. 3. Use the right cartilage crusher (the Sheen cartilage crusher). 4. Suit the contour and stiffness of the graft to the shape of the defect and the thickness of the soft tissue cover. 5. Do not make radix grafts too wide or too short. Use the Right Donor Material (Septal Cartilage, Whenever Available) No matter how poor the septal specimen is in primary rhinoplasty, there is almost always enough cartilage to form a radix graft. No other cartilage equals septal cartilage for this purpose. Ear cartilage is too thick and rubbery and crushes poorly; I use it only in rare circumstances when septal cartilage is not available, when there is insufficient justification to harvest rib, and when the patient’s soft tissues are thick enough to hide graft edges. In these cases, I crush the ear cartilage; I never place a solid conchal graft at the radix. However, this is always a compromise solution. Always Construct Crushed Grafts That Conform to the Defect Radix grafts will be located in a treacherous area, beneath thin skin and where eyeglasses rest. A graft that is too rigid or improperly contoured will annoy both patient and surgeon. Grafts must be narrow and soft enough to conform to the defect. Once placed intraoperatively, it should be nearly impossible to distinguish the radix graft from the bony vault; that is, although the correction should be palpable, the graft should not.

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The graft is placed on the center of the grid; the main block has serrated and nonserrated surfaces, which allows only one side to be crushed if desired (particularly useful with curved donor material). How much crushing is enough depends on the case. After a while, one can tell by sound and feel how much change is occurring with each mallet tap. After two or three taps, the surgeon must inspect and palpate the graft for rigidity and thickness, and particularly to look for any fracture lines that indicate the material will not tolerate further attenuation. Notice the change in graft consistency and appearance produced by only two taps: the graft is almost as thick, but it has become malleable. Use the Right Cartilage Crusher For many years I used another instrument, but I now only use a crusher designed by Sheen for rib cartilage, and I use it for septal and conchal cartilage as well, because it usually softens donor grafts without thinning or fracturing them. With practice, surgeons can create grafts with a variety of consistencies according to their needs.

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Suit the Contour and Thickness of the Graft to the Shape of the Defect and the Thickness of the Soft Tissue Cover

A

B

The skin of the patient in A was thin and the defect was shallow; therefore a single layer was required, thicker at the cephalic end and tapering distally where it meets the bony vault. In the second patient (B), the defect was also shallow, but the skin was thicker and no septal cartilage was available. Therefore here I used a compromise solution: crushed ear cartilage.

A

B

C

Placing the crushed piece on a wooden tongue depressor, I trim irregularities (A) and scrape the edges so that they are rounded and beveled (B), remembering to contour both sides of the graft so they are appropriately level (C).

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This graft is layered, with two thicknesses at the root, and the pieces are sutured together for ease of insertion. The height of the graft matches the depth of the defect, which has been assessed by palpation, and the distal end of the graft tapers to a thin edge. Do Not Make Radix Grafts Too Wide or Too Short The contour of the augmentation must match the contour of the deficient area. The soft tissues of every patient, however, modify this requirement. At the nasal root, where the soft tissue cover is the thinnest and graft visibility or palpability is particularly troublesome, grafts should always be crushed and layered as necessary to fit. They should not be too wide, rarely exceeding 6 to 7 mm. It is also important that the grafts be long enough to meld perfectly with the remaining dorsum; it is better to start with a graft that is longer and shorten it, because radix grafts must extend slightly beyond the defect they are filling. Distal discontinuities can be covered with a small additional overlapping graft, but this is a fussy step that is nice to avoid if possible.

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A

C

B

D

E

Once the graft has been sized (A), I lift the dorsal skin with an Aufricht retractor; then, viewing the entire dorsum all the way to the defect at the radix, I slide the graft in under direct vision (C). When the graft is in position, I remove the retractor and immobilize the graft with my nondominant hand (D) so that it does not move as the bayonet forceps slide out (E). At this point, the graft can be moved proximally, distally, or sideways and pressed into position, which is the advantage of avoiding percutaneous sutures. It must feel absolutely flawless: the edges should not be palpable, contour should be exactly right, and there should be no unintentional proximal or distal discontinuities.

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B

In this particular patient, notice the difference before (A) and after (B) placement of the radix graft. Dorsal grafts are inserted in the same manner. In my practice, radix grafting is extremely common—necessary in more than 90% of the primary rhinoplasties I perform. It is also worth remembering that 93% of the secondary patients in my previously reported series had a low radix or low dorsum that was overlooked by the primary surgeon. Any figures from my practice, however, are not meant to be benchmarks: each practice varies in ethnic composition and patient goals. However, the clue to the low radix often appears in the initial complaint: “The bottom of my nose sticks out too far.” The problem that the patient describes is not one only of size but also proportion. Remembering that all noses limit the amount of absolute reduction possible, a surgeon can maximize any result by ensuring that nasal balance is always optimal.

DORSAL GRAFTS In many ways, a dorsal graft is simply a long radix graft; therefore the logic and the technical elements are similar. Because dorsal height and length control so many elements of dynamic anatomy and nasal function (recall the interactions discussed in Chapters 1 and 2), dorsal grafts are powerful. Even a modest dorsal elevation will increase nasal length, increase middle vault support (providing equivalent functional improvement to spreader grafts), and decrease apparent nasal base size. Similar to radix grafts, dorsal grafts have the important technical elements of length, contour (that is, the number of layers), and substance (solid or crushed). Unlike radix grafts, however, a dorsal graft that is thick enough (and therefore raises the dorsum 2 mm or more), or a dorsal graft that covers a high septal deviation, may also require lateral wall grafts to camouflage its edges. 648

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Dorsal Graft Technique

Through a single intercartilaginous incision, the dorsum is skeletonized to the caudal end of the bony arch.

A

B

C

A broad Cottle elevator (A) slips into the skeletonized area and strips the soft tissues over the middorsum (B) all the way to the nasal root. The pocket is kept narrow to immobilize the dorsal grafts, but it must be wide enough so that the soft tissues will drape without dimpling. The rasp roughens the bony vault surface so that the grafts will adhere (C). Rasping must level the bony vault uniformly and extend to its shoulders. 649

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The best piece of septal cartilage has been trimmed, beveled, and very lightly crushed to correct its distortions. The graft must remain solid enough to effect a surface contour change. The graft is then slipped into the dorsal pocket. Once placed, the dorsum becomes slightly higher and narrower, but one graft has not been sufficient.

A

B

C

A second, slightly narrower graft will be crushed and placed on top of the first. Because it is irregular and convex, it must be flattened (A). Tapped twice, the graft is thinner, but it retains its convexity. The graft has been placed on the smooth surface of the crusher base so that only its concave surface will be attenuated (B). Two more taps flatten this graft, the edges of which will now be finished before placement (C).

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A

B

C

The second graft is placed anterior to the first; it is softer and narrower to provide a natural convexity to the dorsum and distribute forces over the grafts. After placement (C), the augmented dorsum is higher and narrower than the preoperative bridge (B), and nasal base size seems instantly smaller. The rest of this patient’s reconstruction is resumed under Tip Grafting With a Buttress. Some noses require layered dorsal grafts. The graft closest to the skin should be the most perfect. I place my main graft first, and then I slip other grafts anterior or posterior to it until the appearance is correct. It is paradoxically easier to place dorsal grafts this way than to suture them together. If the first suture is not perfect, the ensemble must be separated and another must be constructed. It takes only a few attempts to ruin these very fragile grafts, and the suture will not pass through any needed ethmoid grafts. If position is not perfect, unsutured grafts can be manipulated into the correct location. The surgeon confirms that the grafts are symmetrical and properly placed by surface appearance and palpation.

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Dorsal and radix grafts should feel perfect after insertion, without palpable discontinuities or irregularities. If they do not feel perfect, the grafts must be removed and redone. Although dorsal grafts do not require suture fixation, the surgeon must be confident that the grafts have not moved. With the proper crusher and with experience, it is possible to create a radix or dorsum that does not feel augmented, but smooth and continuous, without palpable edges or discontinuities. At most, the graft should be only barely palpable. With practice, the need for radix or dorsal graft revision should not exceed 5%.

Dorsal Graft Patient Examples Imbalance Correction It is a great temptation to reduce a dorsal hump, and most dorsal humps do require reduction. However, if the surgeon fails to assess nasal balance and the ability of the soft tissues to contract, any plan to reduce a dorsal hump cannot succeed.

A

B

C

In this case, the surgeon’s plan was logical and undoubtedly corresponded to what the patient had requested: a dorsal reduction (A). However, once the dorsum was reduced, the nose shortened and the nasal base looked larger. The obvious next step, which unfortunately only compounded the problem, was tip reduction to bring the base into better balance. This sequence is common when the preoperative nose is bottom heavy, the dorsum is high, and the patient requests reduction. Tertiary dorsal and tip augmentation paradoxically achieved what the patient had wanted to gain by reduction (C). A better original strategy might have been slight dorsal and tip reduction with a radix graft.

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In this similar primary case with the same type of imbalance but without a dorsal convexity, the malpositioned lateral crura were relocated and dorsal and tip grafts were used to reduce apparent nasal base size and improve overall balance, while minimizing the chance of creating new deformities. Although it is tempting to leave this dorsum alone and try to reduce the base enough to bring it in line, a soft tissue contraction of that magnitude is not possible in most cases unless the patient’s soft tissues are extremely thin. Even then, there is no guarantee that they will contract to the desired shape, instead of producing a result that is only thicker and blunter.

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PATIENT STUDY ONE

This is a primary nose with two different imbalances. First, the dorsum is out of balance with the nasal base size, as seen in the last two patients. Although the defect is more shallow, that observation by itself suggests the need for a thin dorsal graft. Second, the middle crus is too long for tip lobular height, and thus distorts the columella. Finally, notice the lateral crural axis and its functional result: malposition with external valvular incompetence. The patient flares her nostrils to support her airway, only exaggerating a large preoperative nostril size.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization through a single intercartilaginous incision 2. Transfixing incision with caudal septal resection 3. Middle crural resection through short, bilateral infracartilaginous incisions 4. Septoplasty 5. Thin dorsal graft 6. Right spreader graft for a high septal deviation 7. Crushed cartilage tip grafts 8. Bilateral alar wall grafts for external valvular incompetence 9. Bilateral alar wedge resections, removing external and vestibular skin

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After dorsal skeletonization and completion of the transfixing incision, the T created at the septal angle by the confluence of the upper lateral cartilages with the septum is visible; it is here that spreader graft tunnels are so easily created endonasally.

A

B

C

After caudal septal resection and reduction of the middle crura, the nasal base has come into balance. A thin, crushed, septal cartilage graft (B) raises the dorsum slightly and diminishes apparent nasal base size further, improving balance and reducing the need for further base reductions (C).

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C

B

Tip grafts create a smooth, lobular contour and reduce the possibility of visible edges at the site of the middle crural reduction. Alar wedge resections are performed to reduce external skin 3 mm and vestibular skin 2 mm. Note the angle at which the incision crosses the nasal floor, preserving the “medial flap” to avoid a notch at this site (Sheen, 1989). At the conclusion of the procedure, the tip and nasal base are better shaped, and the whole nose has improved proportion (C).

Silhouettes confirm the reduction and rebalancing that has occurred.

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Postoperative Analysis

One year postoperatively, the nose is more symmetrical because of a right spreader graft, and the base distortions have improved. Nostril size is slightly reduced and the lateral walls are now supported by thin ethmoid grafts (placed through the alar wedge incisions). Note that the nostril sills remain smooth and without notches because of the angle at which they were crossed (medial flap). Airflow in such patients will double after external valvular reconstruction alone. There are three reasons that the nostrils seem smaller in the frontal view, not counting the alar wedge resections: nasal lengthening from the dorsal graft, the columellar and middle crural resections, and alar rim bracing by ethmoid grafts.

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In the lateral views, the balance improvement is perhaps most striking, created by the combination of middle crura reduction and columellar elevation, as well as the dorsal graft. The tip lobule itself is slightly flatter and remains smooth because of crushed grafts. A larger tip lobule (expanded by grafts) and the caudal septal resection have reduced the apparent nasal base size over the effect produced by direct alar base excision.

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Matching oblique views show improved symmetry—the result of spreader and dorsal grafts. Ethmoid grafts have softened the hollows caudal to the malpositioned lateral crura. The nasal base seems smaller, and it has lost its gangly preoperative appearance.

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PATIENT STUDY TWO A

B

C

D

When I used to present this secondary patient’s preoperative photographs and her desired surgical goal (D) in my courses, I could hear chuckles throughout the audience, because the patient seemed to have such a long way to travel. However, although other aspects of her facial appearance are not within the purview of rhinoplasty, metagoals are possible: the dorsum can be straightened, the tip lobule can be supported and have a defined point of maximal projection, and the nasolabial angle can be brought to 90 degrees. “Ideal” photographs also provide other important information: the patient is not looking for a concave bridgeline or exaggerated contours, which this preoperative large nasal base would not favor.

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Notice also the imbalance between the narrowness of the patient’s upper nose and the width of the tip lobule and base. Previous tip reductions have left a soft, contracted tip lobule that cannot contract further; therefore a strategy that aims at further base reduction cannot succeed.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization through a right-sided intercartilaginous incision 2. Retrograde trim of upper lateral cartilages, no mucosal resection 3. Transfixing incision, shortening the anterior caudal septum and overlying mucosa 4. Septoplasty 5. Layered dorsal graft 6. Bilateral lateral wall grafts 7. Multiple crushed cartilage tip grafts

Although this procedure was performed in 1993, the amazing effects of reduction, augmentation, and redistribution, which are almost unique to rhinoplasty, still fascinate me.

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Postoperative Analysis

Eighteen months after surgery, the upper nose is wider, but the whole appearance suggests normalcy and appropriate width. Lateral wall grafts have widened the upper nose to form confluent lines with the nasal base and mask the dorsal graft edges.

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Notice how closely the overall contours resemble the patient’s preoperative goal. The nose is slightly shorter, supported by dorsal and tip grafts, as well as reduction of the caudal septum and upper lateral cartilages. Tip augmentation has produced a defined endpoint, and dorsal grafts have hidden the ends of the bony arch and the collapsed middle vault caudal to them, which were visible preoperatively. When a dorsum requires substantial augmentation, surgeons should remember that the lateral walls also frequently need augmentation to create normal contours and to hide the lateral edges of the dorsal grafts. The bony and upper cartilaginous vaults are pyramidal, a shape that cannot always be duplicated by midline dorsal grafts alone.

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It is a common error, when placing a dorsal graft and seeing visible edges, to keep reducing the graft width to make the edges invisible. However, a surgeon should set the dorsal graft at the proper width, make sure that its edges are properly contoured and that graft substance fits the overlying tissue thickness, and be prepared to augment the lateral walls to camouflage the graft edges—particularly if the preoperative upper nose is disproportionately narrow or if more than a single-layer dorsal graft is needed. Dorsal grafts equal spreader grafts in their functional correction of internal valvular incompetence, at least doubling airflow in most patients, even without septoplasty or turbinectomy. In this patient, whose airflow was severely obstructed, dorsal grafts increased flow 24.2 times more than preoperative values. Such occasional exceptional improvements do occur, especially in patients with subtotal preoperative instruction and complicated airflow analysis; however, they dramatize the impact of adequate support on nasal function.

TIP GRAFTS Evolution of Technique and Application

Tip grafts vary from patient to patient and by graft source. They hold a special place in modern rhinoplasty, not only because of their technical difficulty but also

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because they were the first grafts that represented a change in the former logic of augmenting simply to fill a regional defect. Although grafts had been used to correct a saddled dorsum, the concept of grafting the primary tip, or correcting supratip deformity, by augmentation rather than further reduction, sparked the evolutionary thinking from which the new rhinoplasty paradigm has derived. Technical variations have been described, but the principle remains the same. Surgeons who use tip grafts commonly find that the grafts not only increase tip projection but also alter tip lobular contour and nostril contour, increase lobular volume (reducing relative nostril size), impart a different ethnic character, alter real and apparent nasal length, and enlarge the nasal base, therefore changing the balance between dorsal height and tip projection. Surgeons whose patients develop a postoperative supratip deformity or have lost tip shape sometimes reason that these occur because of thick skin or the development of a scar or granulation tissue within the lobule. Sheen’s early results, however, overturned some of these earlier concepts. Augmented tips had more shape and looked smaller even though they were skeletally larger, and a supratip convexity flattened with tip augmentation.

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Creating an attractive tip is difficult by any method, with or without grafts. Although I perform tip grafts in almost every rhinoplasty, I revise them in my own practice more than any other single type. In fact, the frustrations that many surgeons felt with the original (single, solid) tip graft technique became one of the prominent stimuli for the resurgence of open rhinoplasty techniques that allowed graft fixation, or for suture methods designed to produce the same results without the difficulties intrinsic in tip grafts themselves. Yet the Sheen method is so versatile, and the varieties of problems that it solves and the tip contours that it creates are so varied, that mastering the technique is essential for surgeons who want to produce aesthetically pleasing tips without columellar struts or permanent sutures—and therefore without the rigidity, columellar widening, or distortions that can be associated with those methods. There is no easy tip technique that is applicable in a broad variety of primary and secondary cases, regardless of the deformity or the patient’s desired aesthetic outcome. But tip grafting comes very close. I use either Sheen’s techniques as they fully evolved or my derivation of the Sheen technique, which is applicable in some cases.

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Basic Technique The variations that tip grafts produce and the problems that they solve increase with experience, but the following generalities apply: 1. Graft number and substance must suit the soft tissue cover and the patient’s aesthetic goals. Thick tissues require more substantial grafts to produce a surface effect; thin tissues require softer grafts to avoid surface irregularities. 2. Tip angularity varies inversely with the number of grafts used. Remember that the normal nasal tip is supported by the broad surfaces of the two alar cartilage domes, not by the anterior presenting edge of a single rectangular or shield-shaped cartilage piece. A single, solid graft will support the tip only at its single projecting end; in the thin-skinned patient, this design produces an unnatural artifact. Each additional graft further defuses tip support, so that the tip becomes progressively less angular. To avoid graft visibility, multiple grafts should be used. 3. Tip symmetry is paradoxically easier to produce with multiple grafts than with a single graft. Anyone who has tried tip grafting knows how frustrating it can be to seat a single graft exactly in the right position, even if the soft tissue cover masks graft edges. Moreover, once the graft is placed, postoperative forces tightening around the graft’s six surfaces can displace the graft or produce an asymmetrical appearance. A single graft of any shape or design placed in the midline does not reproduce normal anatomy. Instead, I try to place at least two grafts, one of which is angled toward the lateral genu on each side to distribute forces and produce greater symmetry. If the second graft still leaves a deficiency, an additional piece can be added where necessary. The dressing fixes the grafts in position. 4. Ethmoid or vomer “buttresses” set the angle of rotation and prevent anterior (superior) graft displacement. Augmenting a tip lobule in which the alar cartilages are intact is different from augmenting a contracted postoperative lobule from which the alar cartilages have been partially or completely removed. The former case can be treated by selective augmentation of the deficient areas with two or more softened grafts, because the intrinsic alar cartilages will help to position them. In the latter case, there is no cartilage remnant to act as a “backstop” that will immobilize grafts placed anterior to it; therefore an initial buttress graft made of ethmoid or vomer and slightly smaller than the primary tip grafts should be inserted first to define the posterior edge of the pocket, to control the anterior position and angle of rotation in the lobule, and to prevent the retrodisplacement of the grafts by postoperative contraction. The same strategy is effective for patients who desire substantial tip projection.

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Technical Details With few exceptions (for example, placement of filler grafts), there is very little variation in the technique of graft placement. What changes are the graft substance, number, and position. A

B

C

The incision begins at the caudal reflection of the lateral genu (A). It is important to maintain adequate distance from the rim to avoid notching or distortion, and to create an inferior flap that can be sutured for a secure closure. The surgeon continues the incision caudally just to the columellar lobular junction (B). The knife is turned over, and an incision is made laterally behind the soft triangle, once again with care to avoid making a true rim incision (C).

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A

B

C

The surgeon then uses Joseph scissors to dissect a pocket that must be broad enough to allow the tissues to drape. In primary cases, this usually means the width of the lobule (C). It is important to dissect over the tip (note the direction of the scissors in B), and not toward the tip to avoid becoming too superficial. It is also critical not to make the pocket too low; remember that the purpose of tip grafts is usually to increase middle crural length and to create a point of maximal projection, which cannot be achieved from the columellar base.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

C

B

D

E

Septal cartilage pieces are selected, crushed as needed, and trimmed (A). Most patients take about three grafts, on average (either all crushed in varying degrees, or as one solid graft with two crushed pieces for anterior lobular fill). Notice in B that it is not necessary for all of the pieces to be perfectly shield shaped. It is important that the edges be reasonably smooth; in this patient, however, the cartilage began to fracture as I crushed it. Because I usually cut the grafts before dissecting the pocket, I can control graft position by the degree and location of the dissection: if the grafts are small and more fragmentary, the pocket should be set higher in the lobule. The first graft—a solid piece in this case—is placed, and the appearance is checked (D and E).

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

A

C

B

D

E

Once the position of the first graft is correct, the second graft (A) is placed anterior to it while the first is immobilized between the thumb and index finger of the surgeon’s nondominant hand (B). After checking graft position once again, a third piece is selected and placed (C), and the appearance is assessed once again. The pocket is then closed securely. The area behind the soft triangle is the most difficult to see, but the closure must be secure. If closure seems tight, remove a graft; if grafts are protruding from the incision, trim them. The closure must be tension free, and the lobule should not be overstuffed.

671

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Tip grafting is a place-and-assess process, as is virtually every rhinoplasty step. Tip grafts must produce the desired effect on the table. The surgeon must remember that the tip does not contract around grafts, but rather that grafts support the tip and create projection and contour where they were previously absent. A common mistake that I have often observed is that other surgeons’ tip grafts are too small. If tip grafts are too short or too few, the intraoperative appearance may be satisfactory, but postoperative lobular contraction envelops the grafts, obscuring their effects. A surgeon may incorrectly conclude that the grafts have been absorbed. Tip grafts must influence the surface. If you do not like what you see on the table, remove the grafts and start again. It is the only way to be consistently successful. Tip Grafting With Solid Cartilage Only

A

B

C

In this secondary rhinoplasty patient with supratip deformity, the dorsal graft has already been placed, but the tip is blunt and undefined (A). The same access incision is made (B), and dissection is carried around and over the tip lobule, being careful to maintain a continuous and thick soft tissue cover (C).

672

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A



ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

B

Because of the patient’s thick, scarred skin and his desire for an angular tip, only two solid grafts were planned. The surgeon must remember that a supratip deformity represents a contracted tip lobule; thus when the tip is expanded, the length of the graft needed to re-create the middle crus is often slightly longer than might be imagined initially. The safest strategy, therefore, is to place the graft at a trial size before cutting it (B).

673

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

B

C

Once the desired length has been assessed, the surgeon can trim the caudal end and tuck the tail of the graft into position (A and B). There is an immediate change in tip appearance after the first graft (C). At this point, the tip, although better proportioned and more angular, still feels soft. With one graft in place, the tip is more likely to be asymmetrical and more likely to revert (at least in part) to its preoperative shape.

674

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

A

B

C

D

Accordingly, a second, solid graft is placed anterior to the first. The tip expands further and feels more solid (B). The wound is closed securely (C). The blue card shows the straight dorsum with an adequately projecting, symmetrical tip. Compare also the columellar position in the sequence (B and D). As each tip graft is placed, the columella lifts slightly because of increased anteroposterior tension in the nasal base; this is just the opposite of a hanging columella produced by a tip reduction that causes supratip deformity. Surgeons must plan for this columellar elevation so that the tip grafts do not create a new retraction.

675

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Tip Grafting With a Buttress A

C

B

D

E

F

This is the patient in whom the dorsal graft was demonstrated previously (see p. 649). Although she is a primary rhinoplasty patient, her thick soft tissues require relatively few grafts, and she lacks a set angle of rotation or a tip-defining point. Thus a buttress plus two lightly crushed grafts are planned—in this case, ear cartilage will be used for the latter (on the left and right of the grid in B). The usual access incision is made at the caudal reflection of the middle crus (C), and scissors are used to dissect over and around the tip lobule (D). The first graft places a piece of ethmoid shaped like a tip graft (E). After its insertion, the angle of rotation has been established, and the tip now has a definite point of greatest projection (F). 676

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

A

B

C

D

Anterior to the buttress graft, a piece of lightly crushed ear cartilage is positioned, with its natural concavity facing anteriorly to provide the greatest projection. This graft should be angled toward the patient’s right lateral genu (A). After the second graft has been positioned, the lobule becomes rounder anteriorly and has a lessartificial appearance. Each additional graft distributes tension more widely so that the tip becomes progressively less angular (B). A second graft is be placed anterior to the buttress and angled toward the patient’s left lateral genu (C). In the blue card photo (D), note the change in tip projection and contour compared with the appearance of the tip before any grafts and after the buttress was placed (A and F, p. 676).

677

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Key Tip Grafting Technical Points

1. The incision begins at the columellar lobular junction and extends superiorly behind the soft triangle. In this area, it is important to be certain that the incision is not at the rim but approximately 3 mm above it so that the facets of the soft triangle are not distorted by wound closure. In a primary rhinoplasty, the incision is ordinarily just at the caudal edge of the lateral genu.

2. While immobilizing the tip lobule with the nondominant hand, the surgeon proceeds with dissection just on top of the alar cartilages, creating the thickest possible soft tissue cover. The pocket must be dissected widely enough to allow the skin to redrape over the grafts, but not so widely that maintaining the positions of the grafts will be impossible.

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

3. To avoid injuring the dermis, the surgeon must be careful not to dissect straight up toward the skin surface, but rather dissect over the cartilages and around the tip toward the top of the lobule.

4. Other grafts are then inserted, either toward the domes or centrally as fillers to provide lobular contour. The first graft must be immobilized as other grafts are placed. While slipping the forceps into the pocket, the surgeon must be certain that each additional graft slides in front of the first graft, not behind it.

5. Grafts support the tip. The skin cannot be expected to drape later to reveal the shape. Therefore the tip graft effect should be immediately apparent, and the tip should feel firm and supported. By assessing the immediate effect, the surgeon can see and control the postoperative result. 6. Things change as healing progresses. Overcorrection (which assumes some graft absorption) is unnecessary and unwise. However, with experience (and through sequential photography and careful follow-up), each surgeon will discover how different preoperative shapes and soft tissues evolve postoperatively. The fact that change occurs is what frustrates surgeons into believing that rhinoplasty follows no laws or that all tip grafts absorb. The laws and signs, however, are there: it is a matter of learning to recognize and interpret them.

679

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Tip Grafts in Practice Tip graft requirements and execution differ along a spectrum. At the two extremes are the patient with a thick, blunt lobule who desires the greatest postoperative angularity (in whom an ethmoid buttress and several solid cartilage grafts will be needed), and the thin-skinned patient whose well-shaped tip cartilages require only augmentation of the cephalic lobule for refinement (in whom only crushed grafts are necessary). The variations that tip grafts produce and the problems that they solve increase with a surgeon’s experience to the point that they can provide some improvement in most primary rhinoplasties. The following patient studies provide examples.

PATIENT STUDY ONE REDEFINING NASAL AESTHETICS A

B

C

D

This woman had undergone one conservative rhinoplasty that had left her with a mild supratip deformity. Her preoperative photograph shows a straight, broad nose with malposition and a blunt tip (A). Although narrower, the postoperative nose is not much different, but the patient now complains of airway obstruction that can be localized (on physical examination) to the internal valves, which were weakened by the roof resection. However, the patient’s soft tissues camouflage her true middle vault width (C). Her goal was greater tip projection and a more angular nose (D). The model pictured has different skin; and this is therefore the opportunity to educate the patient about radix height and the skeletal strength that is required to re-form her nasal shape.

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization to root 2. Light rasping of bony vault for graft adherence 3. Medial crural footplate resection 4. Septoplasty 5. Asymmetrical spreader grafts, thicker on right than left for middle vault asymmetry 6. Thin radix graft 7. Bone grafts to alar walls 8. Tip graft with buttress and two lightly crushed anterior pieces

Augmentation straightens the dorsum and immediately projects the tip.

681

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Postoperative Analysis

Preoperative

10 days postoperatively

3 months postoperatively

9 months postoperatively

1 year postoperatively

2 years postoperatively

21⁄2 years postoperatively

31⁄4 years postoperatively

Notice in this sequence how quickly the slightly exaggerated immediate postoperative appearance self-corrects, and how quickly the nose reaches postoperative equilibrium by 3 months. With only a single tip graft, concentric lobular contraction would re-create the preoperative deformity. A surgeon might erroneously conclude that the tip graft had been absorbed, whereas it was actually just too small and hidden inside the contracted lobule.

682

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Despite spreader grafts, the nose is not wider; and the dorsal graft has actually narrowed the nose (no osteotomies performed). Tip grafts have defined the lobule; and the medial crural footplate resections slightly enlarge the nostril diameter and therefore create a more favorable nostril/lobular ratio.

683

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Although the tip lobule is only minimally larger, tip grafts have created middle crural length that never existed in this patient; and the rebalanced, radix-grafted nose appears firm and structured. Airflow in this patient increased 1.7 times more than preoperative values.

684

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

PATIENT STUDY TWO ALTERING NASAL BALANCE

This is a primary patient with essentially no tip projection: the slightly high dorsum ends in a septal angle from which the tip skin hangs, seemingly empty from middle crural structure. On frontal view, notice the alar cartilage malposition, commonly associated with inadequate tip projection, and the marks left by the patient’s heavy eyeglasses, a warning against narrowing the bony vault.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over bony vault 2. Reduction of bony and cartilaginous dorsum 3. Delivery and cephalic trim of alar cartilage lateral crura 4. Septoplasty 5. Tip grafts 6. No osteotomy

685

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

C

B

D

E

Notice that skeletonization (B) creates its own artifacts: the radix seems higher, the dorsum lower, the tip more projecting, and the columella lower. Ink marks show the length of the short nasal bones and the point of maximal tip projection (current [lower tip line] and proposed [higher tip line]). Once the dorsum has been reduced, the tip seems more projecting (C). But we know that, without augmentation and still lacking middle crural structure, the tip would fall once again to resume its position below the septal angle. After lateral crural reduction, completing the steps of the standard reduction rhinoplasty, the nose has assumed its preoperative shape once again, in a slightly smaller size (D). However, tip grafts alone dramatically alter nasal contour by establishing middle crural support, tip projection, and redraping essentially the lower half of the profile line (E). The middle crura (and the alar cartilages in general) assume a much wider role in nasal shape than is often recognized.

686

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

The silhouette differences demonstrate a nose that truly is smaller although tip projection is greater. Nevertheless, the combination of dorsal reduction and tip grafts has completely altered nasal balance: the tip projects beyond the septal angle instead of hanging from it.

Postoperative Analysis

Even 13 months after surgery, the patient’s thick soft tissues are still shiny, and will continue to heal over the postoperative months. The preoperative ridges, indicating the caudal edges of the malpositioned lateral crura, have become less noticeable, and the solid tip grafts create a defined endpoint in the nasal profile. 687

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

This operation was performed in 1984. If I were to perform the same case today, I would not reduce the alar cartilages (more skeletal support, less stress on the tip grafts). Interestingly, on delivery and inspection of the alar cartilages, I noticed that this primary patient had an interruption of his arches between the medial and lateral genua, which is the only case of congenital absence of the middle crura that I have ever recognized. The columella remains narrow, despite the thick skin.

688

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Preoperative

4 weeks postoperatively

3 months postoperatively

13 months postoperatively

Notice how the tip lobule contracts as time passes after surgery, particularly between 4 weeks and 3 months, the same time period observed with the previous patient. As the edema resolves and dissected tissues respond, the tip begins to collapse around the new framework. If support is not adequate, the postoperative effect will not remain.

689

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY THREE TIP GRAFTS PRODUCING A TYPE CHANGE

This case dates from 1984, when I was just becoming aware of Sheen’s work on radix augmentation and the spectrum of changes that tip grafts could create. The patient had a slightly low radix, slight dorsal convexity, and an adequately projecting but blunt nasal tip. Her preferred contours indicated a more angular tip and a nose that appeared less bottom heavy.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization to radix 2. Slight dorsal reduction, 3 mm retrograde reduction of alar cartilage lateral crura 3. Transfixing incision, 2 mm resection of caudal and membranous septa 4. Septoplasty 5. Layered radix graft 6. Bilateral spreader grafts 7. Solid tip graft with one piece anterior fill 8. Bilateral low-to-high osteotomies

690

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

A

B

C

After dorsal and tip reductions, the contours are still blunt, and nasal balance is unchanged (B). A single radix graft reduces apparent nasal base size, even though the tip has been augmented. At the time, I was placing a percutaneous suture that was removed once the tip sling had been added.

Postoperative Analysis

Fourteen months after surgery, this patient has the same tip shape obtained at surgery. When tip volume is not altered (as in this case), there is much less lobular wound reaction and less postoperative change; therefore the surgeon must adjust accordingly. Contrast the postoperative change in this patient to that in the previous two cases. 691

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Essential elements of this patient’s aesthetic goal have been captured: alteration of nasal balance and tip contour. If I were performing this case today, I would use crushed tip grafts instead of solid ones, to give a softer shape.

692

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

PATIENT STUDY FOUR ALTERING TIP CONTOUR IN PRIMARY RHINOPLASTY—GRAFTING THE PROJECTING NASAL TIP

Although originally conceived as a treatment for inadequate tip projection and secondary rhinoplasty, tip grafts also work well in the primary patient whose projecting tip lobule is poorly contoured, as in this woman. The lateral crura are malpositioned, creating grooves or parentheses that frame the tip lobule and a supratip bulge on lateral view. Although the patient’s nasal base is wider than her intercanthal distance, tip lobular width cannot tolerate alar wedge resection; and her nostrils are not large. Because the bony vault is sufficiently narrower than the nasal base, osteotomies are not indicated.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization to root 2. Resect and relocate lateral crura 3. Slight dorsal reduction 4. Septoplasty 5. Layered radix graft 6. Bilateral spreader grafts 7. Tip graft with ethmoid buttress 8. No osteotomies

693

PART III

A



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

D

C

E

The lateral crura were dissected free through vestibular incisions 3 mm above the rims, at the proper position for their caudal edges, and resected at the lateral genua (B). Crushed and trimmed, the cartilage will be placed back through the same access incisions, and held in position by catching the grafts in the wound closures at several key points. I often add a percutaneous suture to coapt the external and vestibular skin (tied loosely and always removed by 48 hours). Unfortunately, the septal specimen was largely bony (D), and so ethmoid was used for spreader grafts (E).

694

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

A

B

The best piece of septal cartilage was trimmed, crushed, and layered, with the second piece sutured to it posteriorly to fit into the notch at the radix (A). Comparing nasal contour before (A) and after (B) grafting the upper dorsum, nasal base size has apparently diminished.

A

B

C

Once the alar cartilage arches have been interrupted, tip projection decreases. Because the lateral crura have been moved caudad, the tip lobule has a relative excess of skin. Multiple crushed grafts would not remain in position. An ethmoid buttress, shaped like a tip graft but slightly smaller, is placed into the tip first, and setting the correct angle of rotation (B). A single, additional crushed graft is placed anterior to the buttress to round the lobule (C). 695

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Postoperative Analysis

Preoperative

14 months postoperatively

Preoperative

14 months postoperatively

Preoperative

14 months postoperatively

Preoperative

14 months postoperatively

Even without osteotomies, nasal balance is still correct. The tip parentheses have softened and the alar rims are better supported. Airflow in this patient increased 3.2 times over preoperative values. The patient was not concerned about a dramatic change, and did not need one. Why graft the radix when preoperative lateral balance is good? Imagine instead postoperative balance if the tip had been grafted and the dorsum leveled: the nasal base would now appear slightly too large. 696

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Exceptions to Basic Tip Graft Technique Filler Grafts There are exceptions to basic technique. Full-length cartilage grafts, solid or crushed, increase tip lobular size; in some cases, that may not be an advantage or may not be necessary.

Skin sleeve recontours to new support

Area undermined as indicated, maintaining discrete pockets Access parts through separate vestibular incisions

Some patients do not require expansion of the entire lobule, but only correction of a flattened area in the center or creation of a more defined endpoint. In those patients, the tip can be augmented segmentally by filling smaller, discrete pockets with solid or lightly crushed cartilage. This technique reduces the volume placed in the tip (and therefore produces a smaller change in tip lobular size) and is particularly useful in patients whose donor sites have been partially exhausted (see Chapter 17). Any segment of the tip lobule can be filled alone or in combination with others. Here the endonasal approach holds two specific advantages: First, minor contour irregularities can be seen and corrected (particularly those that may have appeared intraoperatively because of changes in nasal base tension). Second, segmental defects can be corrected without the requirement for suturing each graft in position. Even small amounts of cartilage (fragments that may not seem suitable for any other use), alone or in combination, can make significant changes in nasal contour and projection when placed in sufficient amounts and in the proper places. As with any other technique, the effect must be visible intraoperatively, and the augmented area should feel firm enough to reassure the surgeon that postoperative changes will not blunt it.

697

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY FIVE SEGMENTAL METHOD—SUPERIOR LOBULE AND COLUMELLA

This patient had undergone two previous rhinoplasties. Her bony vault was still slightly wide, but her dorsum was straight and her nasal balance was good. However, her tip lobule was flat and her columella was slightly retracted. She is a good candidate for the segmental method, because it is preferable not to increase tip volume too much (thereby disturbing her good preoperative balance).

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage (no septum available) 2. Crushed tip grafts into superior lobule 3. Crushed grafts into anterior columella (separate pockets) 4. Bilateral low-to-high osteotomies

698

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Postoperative Analysis

It is interesting how much additional projection can be created by soft cartilage placed into a limited pocket; but this technique (with its superior tip lobule) is simply a minor variation on the Peck graft. The differences are that these grafts are usually crushed and always multiple, fed into the pocket until adequate projection, contour, and symmetry have been achieved. Comparing the skin outlines before and after surgery, you can see precisely where the tip and columellar pockets were created. This patient also demonstrates how changes in only tip lobular configuration and columellar position can favorably alter nasal aesthetics and appear to shorten the nose. 699

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY SIX SEGMENTAL TIP GRAFT METHOD—MIDLOBULE ONLY

Despite a conservative rhinoplasty by an excellent surgeon, a minimal dorsal trim had opened the cartilaginous roof enough to create an inverted-V deformity (exaggerating the narrow preoperative middle vault) and a middorsal notch. Reduced in width, the malpositioned lateral crura had become more prominent and asymmetrical; and a transverse onlay graft under the patient’s thin skin had left a ridge in the tip lobule.

700

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization to root; rasp bony vault for graft adherence 2. Septoplasty 3. Spreader grafts 4. Left alar wall graft 5. Layered dorsal graft 6. Segmental crushed cartilage fill of middle vault only

A

B

C

D

The patient’s septum yielded a superb amount of cartilage, easily enough to fulfill all graft requirements (B). The layered dorsal graft was constructed of one main piece, and a second, narrower, crushed piece anterior to it straightened the dorsum (C). Had insufficient cartilage been available for spreader grafts, the dorsal graft alone would have provided the same functional correction. The lateral wall graft filled the depression on the left side (D).

701

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

E

F

G

H

Two crushed tip grafts, trimmed to size, were fed through the usual incision into a limited pocket in the midlobule, diffusing forces over the rectangular graft and camouflaging it (E and F). Despite the change in lobular contour from additional augmentation, dorsal grafts have reduced apparent nasal base size, as confirmed by the silhouettes. Notice also that the middorsal notch, which is the cephalic end of the inverted-V deformity, has disappeared.

702

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Postoperative Analysis

Postoperatively, the upper, middle, and lower sidewalls are confluent without the distraction of the inverted V.

The segmental tip grafts have camouflaged the onlay graft by distributing tip forces more widely.

703

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY SEVEN SEGMENTAL TIP GRAFTS—INFERIOR LOBULAR /COLUMELLAR AUGMENTATION When a discrete columellar or inferior lobular deficiency exists, the lower third of the complex can be grafted by itself. This technique is particularly useful when revising previous open rhinoplasties with depressed scars.

A

B

C

D

This man has undergone a previous open rhinoplasty; the scar is depressed and the columella is slightly retracted. A septal graft is trimmed and crushed, retaining sufficient substance to match the patient’s stiff soft tissues (B). A short vertical incision is made through skin only (C), and Joseph scissors are used to dissect a pocket caudal to the medial crura (D). My fingertip shows the position of the scissors tip.

704

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

A

B

C

D

With the Joseph scissors still in the pocket and supported by the scrub nurse, and with the anterior edge of the incision held open with a single hook, the graft tip slides into the pocket (A). The nurse withdraws the scissors as the rest of the graft is slid into place (B). The additional augmentation should be immediately apparent and sufficient (tip of forceps in C). If any areas are excessive, the graft is dissected free and moved, or removed and repositioned. If more augmentation is needed, more is added; like tip grafts, columellar grafts can be fine tuned easily. A few fine sutures close the columellar incision (D).

705

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

The severely retracted columella must often be approached in stages. As more grafts are added, the columella eventually becomes wider, not more caudally positioned. This is the time to stop and wait until those grafts have healed, adding more at a later date when the tissues have become supple and amenable to additional augmentation without distortion.

About Projection and Struts

I do not use columellar struts. We have already seen that the substance and length of the alar cartilage middle crura are the chief determinants of projection and contour, more important than dorsal height, medial crural strength, or attachments of any of the other tip cartilage segments to the septum or upper lateral cartilages. Struts do not create anatomic tip support; and because the endonasal approach does not disrupt the medial crural/columellar skin attachments, struts are not needed to restabilize the tip complex.

706

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Struts create their own unique litany of problems by widening their columellae or becoming visible. They frequently create inadequate or excessive angles of rotation, and they impart an unnatural rigidity to their nasal bases. Even when preoperative views of the patient are not available, the resulting deformities are characteristic. Although strut advocates believe that rigidity and discomfort in the columella or lip do not cause postoperative problems, many of their patients would disagree. Except perhaps in the hands of the most sophisticated open-rhinoplasty surgeons, it is arguably harder to produce excellent results with struts than with tip grafts.

707

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY EIGHT INCREASING PROJECTION WITH LOBULAR FILL ONLY

Observe the similarities between the patient’s original nasal contours and her preoperative appearance: the combination of the low radix with inadequate tip projection is not adequately treated by reduction alone, because the basic imbalance and lack of tip support have not been corrected. Reduction simply creates a smaller version of the preoperative nose.

708

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

The patient’s goal was to achieve a straight dorsum with significantly greater tip projection but without angular contours. Notice the height of the radix in each of these women, and compare the radix height with that in the patient.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over the nasal dorsum 2. Reduction of cartilaginous dorsum; rasping bony vault for graft adherence 3. Submucosal shortening of the upper lateral cartilages 3 mm to rotate tip 4. Transfixing incision with trim of membranous septum only (no cartilage) 5. Septoplasty 6. Bilateral spreader grafts 7. Radix/upper dorsal graft 8. Multiple crushed tip grafts

709

PART III

A



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

D

C

E

The undersurface of the resected cartilaginous roof shows the dorsal septal edge attached to the upper lateral cartilages (B). An adequate septal specimen yielded excellent material for a crushed dorsal graft, long enough to span the distance from the radix to the supratip (C). Multiple crushed tip grafts expand the lobule (D).

710

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Postoperative Analysis

Preoperative

Preoperative

3 years postoperatively

3 years postoperatively

Preoperative

3 years postoperatively

Notice the change in subnasale contour from the membranous septal trim. The nasal spine was not altered. The balance changes, and the apparent nasal base size diminishes.

711

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY NINE CREATING DELIBERATE OVERPROJECTION WITH TIP GRAFTS A

B

C

Another method of dramatically increasing tip projection is to use an ethmoid buttress. This primary rhinoplasty patient had a slightly high dorsum and blunt tip; she preferred the retroussé illustrated in C. Although the bony and upper cartilaginous vaults were appropriately narrow to the patient’s wide tip lobule, there was a high septal deviation toward the left.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Slight dorsal reduction 3. Retrograde reduction of alar cartilage lateral crura 2 mm 4. Septoplasty 5. Thin radix graft 6. Right spreader graft 7. Tip graft with ethmoid buttress 8. Left osteotomy 9. Bilateral alar wedge resections, removing 2 mm of external and 1 mm of vestibular skin

712

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Postoperative Analysis

A combination of dorsal reduction (even with a thin radix graft) and tip augmentation has altered nasal length and balance and given the patient significant additional projection. Lateral crural reduction has narrowed the lobule slightly, and alar wedge resections have reduced nostril flare. The nose is slightly shorter; and the combination of a unilateral osteotomy and contralateral spreader graft has camouflaged and straightened the high septal deviation.

713

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY TEN THE POWER OF TIP GRAFTS TO OVERCORRECT

A

B

C

This primary patient had a high septal deviation toward the left, with a caudal septum that was dislocated into the left airway (C). Her tip was adequately projecting but blunt.

SUMMARY OF THE SURGICAL PLAN 1. Relocate caudal septum through hemitransfixing incision 2. Limited skeletonization 3. Slight dorsal reduction 4. Retrograde reduction of lateral crura 2 mm 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on the right than the left 7. Crushed cartilage tip and columellar grafts 8. Left osteotomy

714

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

Intraoperative photographs confirm the type of change that I was trying to produce: a straight dorsum with slightly greater tip projection and refinement.

715

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Postoperative Analysis

Preoperative

1 month postoperatively

4 months postoperatively

15 months postoperatively

In most of the cases discussed so far, the postoperative process reduced the projection created during the surgeries. In this unusual case, it added projection. As the tip tissues lost their edema and tightened around the grafts, excessive projection appeared. Remember that the strongest factor in normal or created tip projection is the strength of the middle crural segment: it is excessive length in this segment that creates the “overprojecting” nasal tip. Similarly, it is possible, if not easy, to create excessive tip projection with too many tip grafts. Remember also that no columellar struts were used in this case or any of the others in this text. Struts are not necessary for projection, and they are not even necessary to create overprojection. 716

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In a second procedure, the tip grafts were replaced, using less material. No other changes were made. The dorsum is now straight, and the high septal deviation has been camouflaged or corrected with spreader grafts and a left osteotomy. Airflow has increased 6.4 times over preoperative values.

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15 months postoperatively

24 months postoperatively (9 months after revision)

The caudal septum is now in the midline, creating better nostril symmetry and reducing the deformity in the left side of the membranous septum. The tip sits slightly above the dorsal line, but it is no longer overprojecting. In this rosycheeked, fair-complexioned redhead, two tip surgeries have produced a light blush over the lobule. This discoloration is usually self-correcting.

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

15 months postoperatively

24 months postoperatively (9 months after revision)

Matching obliques show the following: the asymmetries present preoperatively (higher dorsum on the right and narrower middle vault on the right from the high septal deviation); the exaggerated nasal balance created by excessive grafting during the interval before correction; and the final appearance achieved. There is another advantage gained by avoiding struts. No strut means one less graft requirement, a benefit that is even more appreciated in secondary patients, whose donor sites are often limited.

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PATIENT STUDY ELEVEN CORRECTION OF THE DEFORMITY CREATED BY A COLUMELLAR STRUT

This secondary rhinoplasty patient had a columellar strut placed at her first operation. The strut itself has produced a sharp deformity at the left side of the tip lobule, and yet the patient still has inadequate tip projection on the lateral view.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Relocation of the displaced caudal septum through a hemitransfixing incision 3. Minimal skeletonization over the bony vault with light rasping 4. Resection of the columellar strut 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on the right than the left 7. Dorsal graft of crushed septal cartilage 8. Bilateral alar wall grafts to support external valves 9. Tip grafts with buttress 10. Bilateral alar wedge resections transferred to alar rims as composite grafts

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A



ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

B

Before beginning the case, the area of the columellar strut has been circled, and the location of the greatest alar rim retraction has been marked externally (A). Septoplasty yielded an excellent building material; the best piece will be trimmed and used for the dorsum.

The dorsal graft is beveled, crushed, and trimmed; it is long enough to span from the radix into the supratip. Once the graft has been placed through the intercartilaginous incision, the dorsum becomes higher and the nasal base seems slightly smaller.

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A

B

C

One advantage of the endonasal approach is that the location and dimensions of the tip pocket can be adjusted to maximize the tip graft effect—in this case, to the size of the remnants that were not used for the rest of the reconstruction (A). A piece of ethmoid is placed first, which sets the angle of rotation and will minimize superior slippage of the other grafts in this flat secondary lobule (B). Additional grafts are placed anterior to the first. Alar wedge resections, placing the lobular tissue into vestibular incisions as composite grafts, reduce alar rim retraction (C).

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This secondary patient’s tip lobule was tight and scarred, which is one reason that a buttress was used. The final result is not overcorrected (in the sense that I expect some of the grafts to absorb) but rather augmented sufficiently to resist the anticipated postoperative lobular contraction.

Postoperative Analysis

Multiple tip grafts have softened the tip asymmetry. The high septal deviation has been corrected by asymmetrically thick spreader grafts (broader on the right than the left).

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The alar base is slightly narrower and less flared, supported by alar wall grafts. The rim retraction caused by resection of malpositioned lateral crura (note the preoperative skin shadows) has been softened by alar lobular composite grafts. However, some of the cutaneous distortion, which was created in the left side of the tip lobule by the strut, remains.

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ADDING CARTILAGE TO THE NOSE: WHY GRAFTS ARE NECESSARY

1 month postoperatively

Preoperative

5 months postoperatively

12 months postoperatively

12 months postoperatively

During the year after surgery, the tip contracted as expected. Note how the apparent overcorrection gradually disappears, and that transient, mild supratip swelling resolves, because tip projection is adequate. The hollows left by lateral crural resection have been filled by alar wall grafts, which increased flow 1.9 times over preoperative values. The dorsum is straight and slightly higher at the radix; maxillary augmentation has brought the subnasale forward and corrected some of the postsurgical upper lip retrusion.

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Tip Graft Complications Aside from overcorrection and undercorrection, both of which I have illustrated throughout this text, tip grafts occasionally become visible.

Despite care taken at surgery and solid ear cartilage used to support thick secondary tissues, this patient’s skin surprised me and tightened around only two grafts placed, producing an exaggerated appearance.

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Even early in the postoperative course, the tip grafts in this tertiary patient became visible, even though the cartilage was pliable and the soft tissues were thick. These grafts must be removed when the tissues are accommodating (usually at 1 year), and the tip must be regrafted. But now her surgeon knows more about how her wounds heal and will be better prepared.

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A

B

C

D

Although rib graft reconstruction produced a smooth, well-proportioned profile without excessive projection in this patient (A and B), his frontal view remained disappointing, despite revisions. Even 3 years after surgery, the nose remains unusually wide despite limited augmentation (D), and the skin over the tip graft has changed quality and color, producing a buttonlike appearance. This is an unusual postoperative change, particularly with thick, soft tissues, and it probably reflects a combination of unusual soft tissue characteristics and the prolonged inflammatory timetable in some patients.

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BIBLIOGRAPHY Abenavoli FM, Corelli R. A composite cartilaginous graft. Plast Reconstr Surg 116:1818, 2005. Adamson PA, McGraw-Wall BL, Morrow TA, et al. Vertical dome division in open rhinoplasty. An update on indications, techniques, and results. Arch Otolaryngol Head Neck Surg 120:373-380, 1994. Adamson PA, Morrow TA. The nasal hinge. Otolaryngol Head Neck Surg 111:219-231, 1994. Adham MN. New technique for nasal tip cartilage graft in primary rhinoplasty. Plast Reconstr Surg 110:693-696, 2002. Adham MN, Teimourian B. Treatment of alar cartilage malposition using the cartilage disc graft technique. Plast Reconstr Surg 104:1118-1125, 1999. Ağaoğlu G, Erol OO. In situ split costal cartilage graft harvesting through a small incision using a gouge. Plast Reconstr Surg 106:932-935, 2000. Aiach G, Levignac J. La Rhinoplastie Estetique. Paris: Masson, 1989, pp 84-90. Ali-Salaam P, Kashgarian M, Davila J, et al. Anatomy of the Caucasian alar groove. Plast Reconstr Surg 110:261-266, 2002. Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol 110:349-358, 1984. Arden RL, Crumley RL. Cartilage grafts in open rhinoplasty. Facial Plast Surg 9:285-294, 1993. Arregui JS, Elejalde MV, Regalado J, et al. Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose. Plast Reconstr Surg 106:1624-1629, 2000. Baum SJ. Nasal projection. Arch Otolaryngol 103:262-267, 1977. Beekhuis GJ. Nasal tip projection. Eye Ear Nose Throat Mon 51:92-99, 1972. Beekhuis GJ, Colton JJ. Nasal tip support. Arch Otolaryngol Head Neck Surg 112:726-728, 1986. Behmand RA, Ghavami A, Guyuron B. Nasal tip sutures part I: the evolution. Plast Reconstr Surg 112:1125-1129, 2003. Belinfante LS. Nasal tip modification using four distinct methods. J Oral Maxillofac Surg 51:506-516, 1993. Berman WE. Changing the nasal tip: Part III (of VI parts). Ear Nose Throat J 75:71, 1996. Berman WE. Changing the nasal tip: Part IV (of VI parts). Ear Nose Throat J 75:131, 1996. Berman WE. Changing the nasal tip: Part V (of VI parts). Ear Nose Throat J 75:198, 1996. Berman WE. Changing the nasal tip: Part VI (of VI parts). Ear Nose Throat J 75:280, 1996. Bernstein D. The present status of the homologous nasal hump graft. Ear Nose Throat J 62:37-49, 1983. Bernstein D. Proceedings: homologous nasal hump implant. Arch Otolaryngol 98:385-386, 1973. Bernstein L. A basic technique for surgery of the nasal lobule. Otolaryngol Clin North Am 8:599-613, 1975. Breadon GE, Kern EB, Neel HB III. Autografts of uncrushed and crushed bone and cartilage. Experimental observations and clinical implications. Arch Otolaryngol 105:75-80, 1979. Brenner KA, McConnell MP, Evans GR, et al. Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg 117:105-115, 2006. Burget G. Costal cartilage for nasal reconstruction: harvesting through a small incision. Perspect Plast Surg 7:129-137, 1992. Burres S. Tip points: defining the tip. Aesthetic Plast Surg 23:113-118, 1999. Cachay-Velásquez H. Surgical lengthening of the short columella: division of the depressor septi muscles. Eur Arch Otorhinolaryngol 249:336-339, 1992. Cardenas-Camarena L, Gomez RB, Guerrero MT, et al. Cartilaginous behavior in nasal surgery: a comparative observational study. Ann Plast Surg 40:34-38, 1998. Cardenas-Camarena L, Guerrero MT. Use of cartilaginous autografts in nasal surgery: 8 years of experience. Plast Reconstr Surg 103:1003-1014, 1999. Cardenas JC, Carvajal J, Ruiz A. Securing nasal tip rotation through suspension suture technique. Plast Reconstr Surg 117:1750-1755, 2006. Chait L, Ritz M. A new approach for the refinement of the very broad nasal tip. Br J Plast Surg 44:572574, 1991. Chapnik JS. Current thoughts on implants in rhinoplasty. J Otolaryngol 7:67-74, 1978.

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Close LG, Schaefer SD, Schultz BA. The over-projecting nasal tip: precise reduction without rotation. Laryngoscope 97:931-936, 1987. Collawn SS, Fix RJ, Moore JR, et al. Nasal cartilage grafts: more than a decade of experience. Plast Reconstr Surg 100:1547-1552, 1997. Conley J. Intranasal composite grafts for dorsal support. Arch Otolaryngol 111:241-243, 1985. Constantian MB. (Discussion) The anatomic tip graft for nasal augmentation, by Gruber RP, Grover S. Plast Reconstr Surg 103:1744-1753, 1999. Constantian MB. (Discussion) Management of the droopy tip: a comparison of three alar cartilagemodifying techniques. Plast Reconstr Surg 112:1418, 2003. Constantian MB. Elaboration of an alternative, segmental, cartilage-sparing tip graft technique: experience in 405 cases. Plast Reconstr Surg 103:237-253, 1999. Constantian MB. Four common anatomical variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plast Reconstr Surg 105:316-331, 2000. Constantian MB. Grafting the projecting nasal tip. Ann Plast Surg 14:391-402, 1985. Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty. Plast Reconstr Surg 103:1491-1502, 1999. Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part II: secondary rhinoplasty. Plast Reconstr Surg 103:1503-1512, 1999. Daniel RK. The role of diced cartilage grafts in rhinoplasty. Aesthet Surg J 26:209-213, 2006. Daniel RK, Calvert JW. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 113:2156-2171, 2004. Davidson TM, Murakami WT. Tip suspension suture for superior tip rotation in rhinoplasty. Laryngoscope 93:1076-1080, 1983. Dayan SH, Kempiners JJ. Treatment of the lower third of the nose and dynamic nasal tip ptosis with Botox. Plast Reconstr Surg 115:1784-1785, 2005. de la Fuente A, Martin del Yerro JL. Calibrated nasal tip: review of 100 cases. Aesthetic Plast Surg 18:357-361, 1994. Duarte A, Atilano J, Cuenca R. Apex columellar cartilage graft. Aesthetic Plast Surg 12:217-222, 1988. Elahi MM, Jackson IT, Moreira-Gonzalez A, et al. Nasal augmentation with Surgicel-wrapped diced cartilage: a review of 67 consecutive cases. Plast Reconstr Surg 111:1309-1318, 2003. Ellis DA, McDonald GA. Narrowing of the wide nasal tip. J Otolaryngol 13:55-57, 1984. Erdogan B, Tuncel A, Adanali G, et al. Augmentation rhinoplasty with dermal graft and review of the literature. Plast Reconstr Surg 111:2060-2068, 2003. Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 105:2229-2241, 2000. Erol OO, Gundogan H. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 116:1169-1171, 2005. Fahoun K. Homotransplants in rhinoplasty. Acta Chir Plast 29:172-179, 1987. Fahoun K. Secondary correction of the tip of nose. Acta Chir Plast 23:221-223, 1981. Falces E, Gorney M. Use of ear cartilage grafts for nasal tip reconstruction. Plast Reconstr Surg 50:147152, 1972. Fanous N. The “light reflex” tip-plasty: a new theory in tip esthetics and tip correction. J Otolaryngol 10:162-168, 1981. Fanous N. The light reflex tip plasty: surgical application of a new theory in tip esthetics. Laryngoscope 92:310-313, 1982. Fanous N, Webster R. Supramid tip implants in rhinoplasty. Review of 98 cases. Arch Otolaryngol Head Neck Surg 113:728-736, 1987. Farina R, Cury E, Ackel IA. The prominent nasal tip. Aesthetic Plast Surg 8:141-144, 1984. Farina R, Cury E, Ackel IA. S-shaped nasal wings: rhinoplasty. Case reports. Aesthetic Plast Surg 7:177178, 1983. Foda HM. Management of the droopy tip: a comparison of three alar cartilage-modifying techniques. Plast Reconstr Surg 112:1408-1417, 2003. Fontana A, Multi E. Alar lateral crus in nasal tip surgery. Aesthetic Plast Surg 21:43-47, 1997. Fredricks S. Tripod resection for “Pinocchio” nose deformity. Plast Reconstr Surg 53:531-533, 1974.

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Friedman WH, Biller HF. Evaluation of nasal tip surgery. Laryngoscope 85:1539-1549, 1975. Fry H. Cartilage and cartilage grafts: the basic propoerties of the tissue and the components responsible for them. Plast Reconstr Surg 40:526-539, 1967. Galli JJ, Zavalla CA, Vivas DG, et al. New surgical concepts: nasal tip function. Aesthetic Plast Surg 21:240-242, 1997. Garcia-Velasco J, Garcia-Velasco M. Tip graft from the cartilaginous dorsum in rhinoplasty. Aesthetic Plast Surg 10:21-25, 1986. García-Velasco J, Vidal JT, García-Casas S. Increasing the length of the middle crura for better tip projection in primary rhinoplasty. Aesthetic Plast Surg 22:253-258, 1998. Ghavami A, Janis JE, Guyuron B. Regarding the treatment of dynamic nasal tip ptosis with botulinium toxin A. Plast Reconstr Surg 118:263-264, 2006. Ghilardi C. An approach to nasal tip remodeling. Aesthet Surg J 21:345-348, 2001. Giberson WG, Freeman JL. Use of free auricular composite graft in nasal alar/vestibular reconstruction. J Otolaryngol 21:153-155, 1992. Gibson T, Davis WB. The distortion of autogenous cartilage grafts: its cause and prevention. Br J Plast Surg 10:257, 1958. Gillies H, Millard DR Jr. Principles and Art of Plastic Surgery. Boston: Little Brown, 1957, pp 180-253. Giunta SX. Nasal tip surgery: a simple technique to aid in symmetry. Laryngoscope 94:974-976, 1984. Godfrey NV. Augmentation rhinoplasty with mortised septal cartilage. Aesthetic Plast Surg 17:31-35, 1993. Goode RL, Ross J. Columellar advancement for nasal tip elevation. Laryngoscope 83:1123-1127, 1973. Gruber RP, Friedman GD. Suture algorithm for the broad or bulbous nasal tip. Plast Reconstr Surg 110:1752-1764, 2002. Gruber RP, Grover S. The anatomic tip graft for nasal augmentation. Plast Reconstr Surg 103:1744-1753, 1999. Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: part I. Experimental results. Plast Reconstr Surg 115:589-594, 2005. Gruber RP, Pardun J, Wall S. Grafting the nasal dorsum with tandom ear cartilage. Plast Reconstr Surg 112:1110-1122, 2003. Gryskiewicz JM. The “iatrogenic-hanging columella”: preserving columellar contour after tip retroprojection. Plast Reconstr Surg 110:272-277, 2002. Gryskiewicz JM. Recycling the distal dorsum as a sheen graft. Aesthet Surg J 20:457-464, 2000. Guerrero-Santos J. Cosmetic repair of the acute columellar-lip angle. Plast Reconstr Surg 52:246-249, 1973. Guerrero-Santos J, Trabanino C, Guerrero-Santos F. Multifragmented cartilage wrapped with fascia in augmentation rhinoplasty. Plast Reconstr Surg 117:804-812, 2006. Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 100:161-169, 1997. Gunter JP, Landecker A, Cochran CS. Frequently used grafts in rhinoplasty: nomenclature and analysis. Plast Reconstr Surg 118:14e-29e, 2006. Gunter JP, Rohrich RJ. Augmentation rhinoplasty: dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconst Surg 86:39-45, 1990. Gunter JP, Yu YL. The tripod concept for correcting nasal-tip cartilages. Aesthet Surg J 24:257-260, 2004. Guyuron B. Footplates of the medial crura. Plast Reconstr Surg 101:1359-1363, 1998. Guyuron B, Behmand RA. Nasal tip sutures part II: the interplays. Plast Reconstr Surg 112:1130-1145, 2003. Guyuron B, Poggi JT, Michelow BJ. The subdomal graft. Plast Reconstr Surg 113:1037-1040, 2004. Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 112:1929-1935, 2003. Hamra ST. Crushed cartilage grafts over alar dome reduction in open rhinoplasty. Plast Reconstr Surg 92:352-356, 1993.

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Hamra ST. Repositioning the lateral alar crus. Plast Reconstr Surg 92:1244-1253, 1993. Harris S, Pan Y, Peterson R, et al. Cartilage warping: an experimental model. Plast Reconstr Surg 92:912915, 1993. Hendler BH, Gatãeno J, Smith BM. Use of auricular cartilage in the repair of orbital floor defects. Oral Surg Oral Med Oral Pathol 74:719-722, 1992. Hinderer UT. Relationship between the protrusion of the nasal tip and the dorsum in rhinoplasty. Aesthetic Plast Surg 8:201-212, 1984. Hoefflin SM. Geometric sculpturing of the thick nasal tip. Aesthetic Plast Surg 18:247-251, 1994. Hubbard TJ. Exploiting the septum for maximal tip control. Ann Plast Surg 44:173-180, 2000. Ishida LC, Ishida J, Henrique Ishida L, et al. Total reconstruction of the alar cartilages with a partially split septal cartilage graft. Ann Plast Surg 45:481-484, 2000. Janeke JB, Wright WK. Studies on the support of the nasal tip. Arch Otolaryngol 93:458-464, 1971. Jovanovic S, Berghaus A. Autogenous auricular concha cartilage transplant in corrective rhinoplasty. Practical hints and critical remarks. Rhinology 29:273-279, 1991. Jung DH, Choi SH, Moon HJ, et al. A cadaveric analysis of the ideal costal cartilage graft for Asian rhinoplasty. Plast Reconstr Surg 114:545-550, 2004. Kamer FM, Churukian MM. Shield graft for the nasal tip. Arch Otolaryngol 110:608-610, 1984. Kamer FM, Cohen A. Median horizontal split tip. Arch Otolaryngol 93:35-40, 1985. Kamer FM, Churukian MM, Hansen L. The nasal bossa: a complication of rhinoplasty. Laryngoscope 96:303-307, 1986. Kenedi RM, Gibson T, Daly CH, et al. Biomechanical characteristics of human skin and costal cartilage. Fed Proc 25:1084-1087, 1966. Kobayaski S, Haramoto U, Ohmori K. Correction of the hypoplastic nasal ala using an auricular composite graft. Ann Plast Surg 37:490-494, 1996. Kridel RW, Konior RJ. Irradiated cartilage grafts in the nose. Arch Otolaryngol Head Neck Surg 119:2431; discussion 30-31, 1993. Kridel RW, Konior RJ, Shumrick KA, et al. Advances in nasal tip surgery. The lateral crural steal. Arch Otolaryngol 115:1206-1212, 1989. Kuran I, Tümerdem B, Tosun U, et al. Evaluation of the effects of tip-binding sutures and cartilaginous grafts on tip projection and rotation. Plast Reconstr Surg 116:282-288, 2005. Larabee WF Jr. The tripod concept. Arch Otolaryngol 115:1168-1169, 1989. Marin VP, Landecker A, Gunter JP. Harvesting rib cartilage grafts for secondary rhinoplasty. Plast Reconstr Surg 121:1442-1448, 2008. Martinez SA. The use of cartilage in reconstructive head and neck and otologic surgery. Ear Nose Throat J 65:497-500, 1986. Mavili ME, Safak T. Use of umbrella graft for nasal tip projection. Aesthetic Plast Surg 17:163-166, 1993. McCollough EG, English JL. A new twist in nasal tip surgery. An alternative to the Goldman tip for the wide or bulbous lobule. Arch Otolaryngol 111:524-529, 1985. McCollough EG, Fedok FG. The lateral crural turnover graft: correction of the concave lateral crus. Laryngoscope 103:463-469, 1993. McCollough EG, Mangat D. Systematic approach to correction of the nasal tip in rhinoplasty. Arch Otolaryngol 107:12-16, 1981. McGlynn MJ, Sharpe DT. Cialit preserved homograft cartilage in nasal augmentation: a long-term review. Br J Plast Surg 34:53-57, 1981. McKinney P. Management of the bulbous nose. Plast Reconstr Surg 106:906-917, 2000. Menick FJ. Anatomic reconstruction of the nasal tip cartilages in secondary and reconstructive rhinoplasty. Plast Reconstr Surg 104:2187-2198, 1999. Micheli-Pellegrini V. Cause d’insuccesso nella chirurgia estetica del naso (con alcuni elementi di tecnica per la rinoplastica correttiva) (Atti Congresso Soc Ital Chir Plast, Bari, ott, 1974). Riv Ital Chir Plast 7:419-445, 1975. Micheli-Pellegrini V. La tecnica per correggere la punta durante la rinoplastica. Il metodo delle orecchie di cane Doberman. Riv Ital Chir Plast 22:11-29, 1990.

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Millard DR Jr. Corrective rhinoplasty and augmentation mentoplasty. In Grabb WC, Smith JW, eds. Plastic Surgery: A Concise Guide to Clinical Practice. Boston: Little Brown, 1968, p 510. Mir y Mir L. Dissection of the medial crura as a standard procedure in rhinoplasty: case studies. Aesthetic Plast Surg 11:203-205, 1987. Mischkowski RA, Kübler AC. Correction of congenital nasal hypoplasia associated with Kallmann syndrome using self-inflating injectable tissue expander pellets. Plast Reconstr Surg 118:1447-1452, 2006. Mittelman H. A more precise technique of tip rhinoplasty with a cartilage-splitting incision. Arch Otolaryngol 107:425-427, 1981. Mocella S, Bianchi N. Double interdomal suture in nasal tip sculpturing. Facial Plast Surg 13:179-196, 1997. Muti E. Treatment of alar cartilages: should the “domes” be interrupted? Aesthetic Plast Surg 17:193198, 1993. Nagel F. Tip surgery and functional rhinoplasty. Facial Plast Surg 11:191-203, 1995. Neu BR. Combined conchal cartilage: ethmoid bone grafts in nasal surgery. Plast Reconstr Surg 106:171-175, 2000. Neu BR. Reduction of nasal tip projection with medial rotation of alar cartilages. Plast Reconstr Surg 108:763-770, 2001. Neu BR. Segmental bone and cartilage reconstruction of major nasal dorsal defects. Plast Reconstr Surg 106:160-170, 2000. Nicolle FV. The comma-shaped tip cartilage graft. Aesthetic Plast Surg 12:223-227, 1988. Nicolle FV. Secondary rhinoplasty of the nasal tip and columella. The choice of cartilage grafts. Scand J Plast Reconstr Surg 20:67-73, 1986. Nicolle FV, Chir M. Correction of the overshortened nose. Aesthetic Plast Surg 10:27-28, 1986. Orak F, Yücel A, Aydin Y. A new extrasupported tip graft in the treatment of bulbous nasal tip. Aesthetic Plast Surg 22:259-266, 1998. Ozbek S, Ozcan M, Uysal A, et al. Diced cartilage grafts in cosmetic surgery. Plast Reconstr Surg 117:678-680, 2006. Papadopulos A, Harada C. Compound implant to project the nasal tip. Aesthetic Plast Surg 11:181-185, 1987. Papel ID. A graduated method of tip graft fixation in rhinoplasty. Arch Otolaryngol Head Neck Surg 121:623-626, 1995. Papel ID, Mabrie DC. Deprojecting the nasal profile. Otolaryngol Clin North Am 32:65-87, 1999. Park C, Kim ES, Roh TS. Needle fixation technique in cartilage grafting. Ann Plast Surg 43:331-333, 1999. Parkes ML, Kamer FM, Merrin ML. “Practical suggestions on facial plastic surgery: how I do it.” Modifications of the Fomon technique in the approach to the lower lobule. Laryngoscope 87:1774-1778, 1977. Peck GC. The onlay graft for nasal tip projection. Plast Reconstr Surg 71:27-39, 1983. Peck GC. Techniques in Aesthetic Rhinoplasty, 2nd ed. Philadelphia: JB Lippincott, 1990, pp 59-74. Sheen JH. Achieving more nasal tip projection by the use of a small autogenous vomer or septal cartilage graft. A preliminary report. Plast Reconstr Surg 56:35-40, 1975. Sheen JH. Middle crus: the missing link in alar cartilage anatomy. Perspect Plast Surg 5:31-50, 1991. Sheen JH. Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg 105:1820-1852, 2000. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 73:230-239, 1984. Sheen JH. Tip graft: a 20-year retrospective. Plast Reconstr Surg 91:48-63, 1993. Sheen JH, Sheen AP, eds. Tip grafting. In Aesthetic Rhinoplasty. St Louis: CV Mosby, 1987, pp 506-530. Sherris DA, Kern EB. The versatile autogenous rib graft in septorhinoplasty. Am J Rhinol 12:221-227, 1998. Smith GA. Tip refinement in upturned noses. Ear Nose Throat J 62:14, 16-17, 20-23, 1983.

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Smith RA, Smith ET. A new technique in nasal-tip reduction surgery. Plast Reconstr Surg 108:17981804, 2001. Smith TW. Thoughtful nasal tip surgery. Arch Otolaryngol 97:244-246, 1973. Spina V, Kamakura L, Psillakis J. A new method for correction of the prominent nasal tip. Plast Reconstr Surg 51:416-420, 1973. Stal S. Cartilage grafts as an adjunct. Presented at the ASPRS Annual Scientific Meeting, Montreal, Oct 1990. Stoksted P, Ladefoged C. Crushed cartilage in nasal reconstruction. J Laryngol Otol 100:897-906, 1986. Tardy ME Jr, Becker D, Weinberger M. Illusions in rhinoplasty. Facial Plast Surg 11:117-137, 1995. Tardy ME Jr, Patt BS, Walter MA. Transdomal suture refinement of the nasal tip: long-term outcomes. Facial Plast Surg 9:275-284, 1993. Tasman AJ, Helbig M. Sonography of nasal tip anatomy and surgical tip refinement. Plast Reconstr Surg 105:2573-2579, 2000. Tebbetts JB. Letter to the editor. Plast Reconstr Surg 95:772-773, 1995. Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new systematic approach. Plast Reconstr Surg 94:61-77, 1994. Thibault J, Sevigny B. Use of isografts and homografts in reconsruction of the nasal pyramid. J Otolaryngol 11:9-13, 1982. Tjelmeland K, Stal S. Cartilage graft resorption: an animal model. Aesthet Surg J 20:471-476, 2000. Toriumi DM, Johnson CB. Open structure rhinoplasty: featured technical points and long term followup. Fac Plast Surg Clin North Am 1:1-22, 1993. Uhm KI, Hwang SH, Choi BG. Cleft lip nose correction with onlay calvarial bone graft and suture suspension in Oriental patients. Plast Reconstr Surg 105:499-503, 2000. Verwoerd CD, Verwoerd-Verhoef HL, Meeuwis CA, et al. Wound healing of autologous implants in the nasal septal cartilage. ORL J Otorhinolaryngol Relat Spec 53:310-314, 1991. Vuyk HD. Suture tip plasty. Rhinology 33:30-38, 1995. Vuyk HD, Oakenfull C, Plaat RE. A quantitative appraisal of change in nasal tip projection after open rhinoplasty. Rhinology 35:124-128, 1997. Walter CD. Composite grafts in nasal surgery. Arch Otolaryngol 90:622-630, 1969. Webster RC, Davidson TM, Rubin FF, et al. Nasal tip projection changes related to cheeks and lip. Arch Otolaryngol 104:16-21, 1978. Webster RC, Hopping SB, Hall B, et al. Intraoral insertion of grafts to project the nasal tip. Arch Otolaryngol 108:187-193, 1982. Webster RC, White MF, Courtiss EH. Nasal tip correction in rhinoplasty. Plast Reconstr Surg 51:384396, 1973. Webster TS, ed. Nasal redux: technical forum. Bull Int Soc of Clin Plast Surg 26:2, 2000. Williams JE. Pinched nasal tip. Clin Plast Surg 4:41-45, 1977. Yanaga H, Yanaga K, Imai K, et al. Clinical application of cultured autologous human auricular chondrocytes with autologous serum for craniofacial or nasal augmentation and repair. Plast Reconstr Surg 117:2019-2030, 2006. Yilmaz S, Ercöcen AR, Can Z, et al. Viability of diced, crushed cartilage grafts and the effects of Surgicel (oxidized regenerated cellulose) on cartilage grafts. Plast Reconstr Surg 108:1054-1060, 2001. Zijlker TD, Vuyk H. Cartilage grafts for the nasal tip. Clin Otolaryngol Allied Sci 18:446-458, 1993.

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CHAPTER 13 The Uncomplicated Postoperative Course Some years ago, I discovered in the heavens many things that had not been seen before our own age. The novelty of these things, as well as some consequences which followed from them in contradiction to the physical notions commonly held among academic philosophers, stirred up against me no small number of professors—as if I had placed these things in the sky with my own hands in order to upset Nature and overturn the sciences. . . . GALLILEO GALLILEI, Letter to the Grand Duchess Katrina

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V alue of the Postoperative Period to the Surgeon I know surgeons who do not remove their patients’ dressings, but for me it is just like opening presents on Christmas morning. I am excited to see how well the nose has healed and have my first opportunity to see how well my plan has worked. It is not, however, an easy office visit. Patients have varying degrees of anxiety. When they first see the results of their operations, a few are very happy, many are pleased, some are uncertain, some are worried, and a few are distraught. Rhinoplasty may be unique among plastic surgery operations for the degree of emotion that patients experience when they see the immediate surgical result and for how impatient some of them are to achieve the final results; they can sometimes be unreasonably anxious. The weeks and months after rhinoplasty are therefore critical in several respects. As difficult as nasal surgery is for surgeons, it is even more difficult for patients who, despite preoperative education, do not really know what to expect. Patient expectations can be quite high, perhaps even unrealistic, despite preoperative counseling, and patients are fearful of complications and anxious for perfect results. Added to the usual postoperative worries are the unsolicited advice and opinions of interested family members and friends, many of whom have little medical background but who intensify a patient’s concerns by volunteering their critiques. The postoperative course is complex and can be difficult, but it offers a surgeon the opportunity to make a positive experience out of what could be a negative one (and vice versa). Surgeons who do not see their patients after the dressings are removed (or even after surgery) are losing an opportunity to observe both common and uncommon postoperative situations and develop the skills and expertise that are essential for consistent postoperative success. These surgeons are missing the other half of the feedback loop, which is one of the most potentially rewarding aspects of medical practice.

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Early Postoperative Instructions and Management All patients are given printed postoperative instructions before surgery (see the samples at the end of this chapter). They are told to restrict their activities and exercise, advance their diet cautiously, and avoid alcohol and medications that affect platelet function. At the preoperative visit, as I review the surgical plan, prescribe medications, and answer any questions the patient may have, I emphasize what I expect to see at 7 days. I tell all patients that they will immediately notice an improvement in nasal airway function when I remove the packing, and it will improve further over the first 12 to 24 months. I warn patients that their noses will not look very good after a week for several reasons. When the dorsum has been high, it is often still not straight because the soft tissues have not had time to contract; therefore the nose will appear too wide and too short, and the nostrils will appear too large. I reiterate that swelling takes at least 12 months to resolve, and I ask the patients and their caregivers to reread the postoperative instructions (which raise all of these issues) before surgery and again when they come home from the hospital. I want them to remember most of all that the nose will be swollen and that postoperative changes occur over many months. Yet almost 100% of my patients ask me on day 7 if they are still swollen.

T he First Postoperative Visit At 7 days I remove the packing by first cutting the sutures that connect the airway tubes and the petrolatum gauze packs. I then remove the tubes and gently tease out the packs, layer by layer. At the end of 1 week, the lining is sufficiently healed and coated with mucus so that the packing can be removed without pain or bleeding. I then wipe the nose with phenylephrine hydrochloride and clip the tails of any absorbable sutures I can find. This eliminates any nidus where mucous or obstructing crust can form over the next few weeks.

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I remove the splint by sliding a cotton-tipped applicator, which has been dipped in an adhesive solvent, under the tape. I clean and dry the external nose and check the position of the osteotomies with my fingers. If, as rarely occurs, edema has caused one of the bones to move laterally, 2 or 3 minutes of very gentle, constant digital pressure will move the bone back into its intended position. This procedure is painless if performed carefully. Occasionally, a periosteal reaction will occur at or just lateral to the osteotomy site (on the maxillary side). Patients may be concerned about the temporary ridge, but it will subside without treatment. Then, with the aid of the patient’s preoperative photographs, I explain what procedures have been performed, what has been accomplished, and what I expect to occur over the ensuing months. Each patient returns home with a copy of his or her preoperative photographs, a gentle facial cleanser and moisturizer, and an appointment for the next visit. For patients who live in the immediate area, that visit will be at the second postoperative week, at which time I again clean the nose, reassess with the patient, and answer any questions. Patients who live far away return 3 to 5 days later and again at 10 to 14 days (depending on what has been done) before they return home. In general, I then see patients at 3, 6, and 12 months, and yearly or every 2 years for as long as they are willing to return.

Typical Postoperative Changes Some changes occur predictably during the postoperative period. If you have followed our adventure from the beginning, you have already seen a number of examples, and others will follow in the next chapter. As a rule, the degree of change depends on the disparity between the preoperative and postoperative skeletal volume, how well the interdependent skeletal areas have been rebalanced, and how well the reformed skeleton supports the soft tissues. The greater the disequilibrium, the greater the postoperative surprise.

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PATIENT STUDY ONE

This patient demonstrates some of the classic changes that occur when the skeleton has been rebalanced and soft tissue contraction is allowed to occur only where necessary and predictable. This young Latino man wanted a straight, strong bridge. In the frontal view, notice the high septal deviation toward the right and the alar cartilage malposition, with its characteristic footprints around the nasal tip. Although the radix is notched and slightly low, the nose is well balanced preoperatively (that is, it is not bottom heavy). Therefore no radix graft is needed. The tip is inadequately projecting, and the tissues are blunt.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization through a single intercartilaginous incision 2. Reduction of the bony and cartilaginous dorsum 3. No alar cartilage reduction 4. No transfixing incision 5. Septoplasty 6. Bilateral spreader grafts, thicker on the left than on the right 7. Tip grafts with buttress 8. Bilateral alar wedge resection (removing external skin only, no vestibular skin)

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B

Yellow card

C

After bony reduction

D

After dorsal resection

Specimen

Reduction of both the bony vault and the cartilaginous vault created the expected changes (B and C): the base became progressively larger, but the tip remained inadequately projecting. Septoplasty yielded excellent building material (D).

E

F

Preliminary tip graft

G

H

Blue card

A preliminary, solid tip graft set the angle of rotation (E) and was followed by crushed grafts anteriorly to fill the lobule. Notice that the additional grafts distributed the tip forces so that the sharp appearance of the single graft disappeared (F). Silhouettes confirm a nasal reduction with a newly supported tip.

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Postoperative Analysis

Preoperative

2 months postoperatively

1 week postoperatively

8 months postoperatively

3 weeks postoperatively

11 months postoperatively

2 years postoperatively

Because the reduction in this patient did not exceed the tissue’s contractile ability, the nose assumed its final shape rapidly in the postoperative course. However, the narrowing continued. Middle vault changes are evident even between 11 months and 2 years postoperatively.

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B

Preoperative

D

C

1 week postoperatively

E

2 months postoperatively

8½ months postoperatively

3 weeks postoperatively

F

G

11 months postoperatively

2 years postoperatively

Although the patient’s head is slightly rotated, the 1-week lateral view shows a nose that seems short (B). However, because of the minimal edema produced by the endonasal approach, recovery is rapid. Without any transfixing incision or caudal septal modification, and with no net change in dorsal height, permanent shortening should be negligible. Nasal length stabilizes at 3 weeks and remains unchanged over the first 2 years postoperatively. In particular, no change occurs in tip projection after 2 months.

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Preoperative

2 years postoperatively

The dorsum remains straight and strong, in accordance with the patient’s wishes. Proportion remains good.

Preoperative

2 years postoperatively

Multiple tip grafts distribute forces and reduce the likelihood of graft visibility; but the normal alar cartilage markings remain. Alar wedge resections have reduced lobular size, but nasal base width remains appropriate.

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Typical Early Postoperative Changes

Preoperative

2 months postoperatively

3 weeks postoperatively

10 months postoperatively

6 weeks postoperatively

2½ years postoperatively

8 years postoperatively

1. The nose becomes longer and deskeletonizes as the upper lip and nasal sidewall edema abates, decreasing the nasolabial angle. The nostrils also become less visible.

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2. The nasal base rotates caudally, depending on the elasticity of the skin and the degree of skeletal support. A nose that is long preoperatively has the greatest tendency to elongate again postoperatively if underlying support is not adequate (see Chapter 15).

Preoperative

1 month postoperatively

2 years postoperatively

3. The thicker the skin, the less postoperative contraction will occur, the greater the tendency for the skin sleeve to return to its preoperative shape, and the more slowly the edema resolves. The profile assumes its final postoperative shape sooner than the frontal view: the nose continues to narrow in the frontal view for at least 12 to 18 months, particularly in the middle third.

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Preoperative

Postoperative

4. During the first 12 to 18 postoperative months, an unsupported middle vault will narrow and demarcate from the caudal edge of the bony arch. If spreader grafts have been placed but are not wide enough (as in this patient), an invertedV deformity will appear. 5. Skeletal irregularities or asymmetries may appear (and sometimes disappear). 6. Areas of underlying skeletal change or grafts may become visible and suggest the need for revision; conversely, early postoperative improvement may become obscured by soft tissue contraction and thickening. 7. In some areas (for example, a flat nasal tip that has been expanded), the nasal skin will try to resume its preoperative shape (see Chapter 12). As a surgeon becomes more experienced, postoperative changes become easier to anticipate and interpret: the surgeon’s advice becomes more reliable. Just as with good physical therapy after hand surgery, at least 50% of the patient’s happiness and as much as 90% of the surgeon’s intraoperative and postoperative judgment are determined by lengthy and conscientious follow-up.

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Preoperative

Postoperative

Finally, it is important to remember the enormous beneficial psychological changes that come from a successful rhinoplasty. Although the unhappy or troubled patients are the ones you remember (see Chapter 20), the happy patients are fortunately more plentiful. Rhinoplasty is indeed brain surgery.

BIBLIOGRAPHY Gallileo G. Letter to Grand Duchess Katrina; quoted in Sagan C. Cosmos. New York: Random House, 1980, p 142.

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Mark B. Constantian, MD Professional Association 19 Tyler St. Nashua, New Hampshire 03060

Telephone: (603) 880-7700 Fax: (603) 880-6660 e-mail: www.drconstantian.com Plastic and Reconstructive Surgery

NASAL SURGERY INSTRUCTIONS BEFORE HYGIENE: Shampoo your hair and wash your face with pHisoderm (or any other antimicrobial soap) for 3 minutes the night before and the morning of surgery. Do not wear makeup or use hair-styling products the morning of surgery. SKIN CARE: Avoid sun exposure 1 week before surgery. Do not have a chemical peel on your face 1 month before surgery. Do not use Retin-A or any creams containing glycolic or azelaic acid, or any other medicated facial creams on your face for 1 month before surgery. Do not have any type of facial surgery (for example, lesion removal, laser treatment, and so forth) or waxing without contacting our office first. ATTIRE: Wear loose comfortable clothing that zips or buttons up the front. PRESCRIPTIONS: You will be given prescriptions on the day of your preoperative appointment. Have these filled before surgery. Also purchase 2- ⫻ 2-inch gauze pads and a roll of 1⁄2 -inch paper tape to use as a drip pad for your nose after surgery. ILLNESS: Notify the doctor if a cold or infection develops 1 week before surgery.

AFTER PAIN MEDICATION: For pain, take the prescription medications or Tylenol. Do not take aspirin or ibuprofen. For severe pain that is not relieved with Lorcet, call the office. DO NOT TAKE MEDICATION ON AN EMPTY STOMACH. HYGIENE: You may shower and shampoo your hair the day after surgery, as long as you keep the cast on your nose dry. If you have an ear dressing, you should keep this dry as well. You will probably have bloody nasal discharge under your nose for 2 to 5 days after surgery. Keep the inside edges of your nostrils and the skin under your drip pad clean; you may wash this area as often as needed. You may stop using a drip pad once the drainage has subsided. Some patients find it soothing to use a thin layer of Vaseline or Aquaphor ointment around the nostrils for protection from the drainage. SLEEPING: Sleep with your head elevated on at least two pillows for 7 days after surgery. You may also wish to use a humidifier to keep the air moist. DIET: Recovering from anesthesia is like recovering from the flu. Start with clear liquids; then advance to soft, nonspicy foods the day of and the day after surgery. Add things to your diet as you are able to tolerate them after that. Liquids should be cool to tepid only, not hot. For 2 weeks after surgery, avoid foods that require excess chewing (for example, apples, corn on the cob, etc). ACTIVITY: Remain reclined or seated and quiet for the first 24 hours. Avoid bending, heavy lifting, pushing, pulling, or straining for 4 weeks. Start exercising at 25% of your normal level after 4 weeks, and progress to your normal level over the next 2 weeks. FOLLOW-UP: Follow-up is 7 days after surgery for removal of the packs and splint. Ear dressings will need to be removed 1 to 2 days after surgery. Call the office to establish the date and time.

TEMPERATURE: A low-grade fever of 99° to 101° for 1 to 2 days is normal. Call the office if your temperature is over 101°. MAKEUP: Makeup can be worn on the face a few days after surgery, as long as the cast is kept clean. Do not wear eye makeup if your eyes are swollen. SWELLING: Swelling reaches its peak 48 to 72 hours after surgery. Some patients have swelling and bruising of the eyes and cheeks. The forehead area above the cast may also be swollen. DO NOT WORRY; THIS IS NORMAL! ICE: We will provide you with a LIGHT-WEIGHT ice pack at your preoperative visit to apply to your forehead and eyes. You can also use frozen peas in a clear plastic bag or a folded-up frozen face cloth. Apply this often for the first 48 hours to decrease the amount of swelling. DO NOT PUT PRESSURE ON THE NASAL CAST.

What to Expect: 1. We encourage you to breathe through your nose after surgery if you are able to get air through the tubes, although they will not stay open for the entire first postoperative week. 2. While the packing is in place, your nose may appear too turned up and the nostrils too big. It is the packing that is causing this. DO NOT WORRY. This will subside after the packing has been removed and as the swelling subsides. 3. The packs and splint are removed in the office on day 7. THIS DOES NOT HURT. YOUR NOSE WILL BE SWOLLEN!! It may also appear to be turned up. All we expect at this visit is that your breathing will be better. Over the following 2 to 3 weeks, the swelling will begin to subside and will not be noticeable to anyone but you. YOU MUST REMEMBER THAT THE NOSE WILL HAVE SOME SWELLING FOR AT LEAST A YEAR, AND SOMETIMES LONGER IN SOME PATIENTS. THIS IS VERY COMMON WITH RHINOPLASTY PROCEDURES, AND YOU MUST BE PATIENT. NATURE HEALS SLOWLY. 4. After the cast is removed, your skin will be irritated and sensitive. We will provide you with a gentle cleanser and moisturizer to use. You should wash your face and nose twice a day and apply moisturizer. 5. To prevent postoperative bleeding, do not sniff or blow your nose for 3 weeks after surgery. If you have to sneeze, sneeze through your mouth. 6. The tip of your nose will be numb. This will disappear over time. 7. The skin on your nose is sensitive to sunlight after surgery. Protect your nose from excess exposure to the sun for 8 weeks. Wear sunscreen and/or a wide-brim hat for 8 weeks. 8. After the cast is removed, do not allow eyeglasses or anything else to rest on your nose for 8 weeks after surgery. Glasses should not rest on the bridge. Simply use paper tape on the nosepiece taped to the forehead. 9. Contact lenses may be worn as soon as the swelling has decreased enough for them to be inserted. 10. Be careful to avoid hitting your nose for 8 weeks after surgery.

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Mark B. Constantian, MD Professional Association 19 Tyler St. Nashua, New Hampshire 03060

Telephone: (603) 880-7700 Fax: (603) 880-6660 e-mail: www.drconstantian.com Plastic and Reconstructive Surgery

RHINOPLASTY MEDICATION INSTRUCTIONS At your preoperative visit, you will receive prescriptions for the following: pain medication, an antibiotic, and a sleeping pill to be taken the night before surgery. Below is a review of the instructions on how to properly take these medications. For pain relief: 1. Darvocet N-100. Take one every 4 hours only as needed for moderate pain. This is a non-narcotic medication. 2. Lorcet 10/650. Take one every 4 hours as needed for severe pain. This is a narcotic medication. 3. You can also take Tylenol in place of the above medications if you wish. Do not take ibuprofen or aspirin products. 4. These drugs can sometimes cause constipation. You may take Senokot tablets, if needed, and/or use a Dulcolax suppository. These can be purchased over the counter at any pharmacy. For antibiotics: 1. Ceclor 250 mg. Take one in the morning and one in the evening for 7 days. Start the day after your surgery. This is used to help prevent infection, because you will have packing in your nose for 1 week. For sleep: 1. Dalmane 30 mg. Take at bedtime the night before surgery. This is used as a preanesthesia medication. If you get a good night’s sleep the night before surgery, you may require less medication for anesthesia during surgery. DO NOT TAKE ANY OF THESE DRUGS ON AN EMPTY STOMACH.

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Mark B. Constantian, MD Professional Association 19 Tyler St. Nashua, New Hampshire 03060

Telephone: (603) 880-7700 Fax: (603) 880-6660 e-mail: www.drconstantian.com Plastic and Reconstructive Surgery

MEDICATIONS AND SUPPLEMENTS TO STOP 2 WEEKS BEFORE SURGERY Please read the following instructions carefully so that you will have a safe surgery: Do not use Retin-A or any creams containing glycolic or azelaic acid, or any other medicated facial creams on your face for 1 month before surgery. If you have started a new medication or had changes in your medications within the last 3 months, please call the office and indicate the change on your presurgery questionnaire. Some medications, foods, vitamins, and dietary supplements can interfere with anesthesia, potentially causing abnormal bleeding during surgery or other undesirable side effects. THE ONLY MEDICATION ALLOWED FOR PAIN BEFORE SURGERY IS TYLENOL.

THE FOLLOWING DRUGS AND FOODS CANNOT BE TAKEN FOR 2 WEEKS BEFORE SURGERY AND 2 WEEKS AFTER SURGERY • Aspirin or any drugs that contains aspirin. Read the labels. • Nonsteroidal antiinflammatory drugs such as Aleve, Advil, Clinoril, Indocin, Ibuprofen, Motrin, Naprosyn, etc., or any drugs that contain these ingredients. Read the labels. • Vitamin E (a standard multivitamin is okay). • Herbal medications and herbal teas. • Curry, garlic, St. John’s wort, ginkgo, ginseng, echinacea. • Antidepressant medication. Please inform us immediately if you take any antidepressant medication. These drugs can cause abnormal bleeding during surgery, which cannot be detected on preoperative blood work. • Call your primary care physician for instructions on how to taper off the medication. If you have a question about medication, please call the office. Occasionally we can substitute safe drugs for those that you cannot do without or those that interfere with anesthesia.

✓✓✓CHECK WITH US FIRST

— BEFORE TAKING ANYTHING — BEFORE TAKING ANY OTHER HEALTH SUPPLEMENTS — IF YOU HAVE ANY QUESTIONS

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CHAPTER 14 Pr oblems in the P ostoperative Course In this world, everything changes except good deeds and bad deeds; these follow you as the shadow follows the body. UNKNOWN

Now the Sirens have a still more fatal weapon than their song, namely their silence. . . . Someone might possibly have escaped from their singing; but from their silence, certainly never. FRANZ KAFKA Parables

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F

or most surgeons, any postoperative problem is a contest of emotions—competing desires that range from correcting the problem immediately to running away. However, unlike other plastic surgical operations that are technically or conceptually difficult, rhinoplasty has fewer of the complications that traditionally plague surgeons. Most rhinoplasty surgeons never see injuries of the lacrimal duct or extraocular muscle after rhinoplasty; even septal perforation should be relatively infrequent. Because of its very nature, however, rhinoplasty has its own taxonomy of problems, most of which directly relate to an insufficiently sophisticated understanding of the structural interdependencies in the nose, incorrect diagnosis, or technical difficulties. This is actually good news, because the most common complications are therefore within the surgeon’s control and can be decreased by careful planning and good operative technique. Complications are listed here in decreasing frequency as I recognize them in my own patients or in other surgeons’ patients seen in consultation.

Complications Following Rhinoplastic Surgery 1. Iatrogenic airway obstruction 2. Skeletal problems 3. Soft tissue problems 4. Graft problems

5. 6. 7. 8. 9.

Septal perforation Synechiae Septal collapse Rhinitis Circulatory problems

10. Hemorrhage 11. Infection 12. Less common complications 13. Unhappy patients

I atrogenic Airway Obstruction VALVULAR CAUSES AND CONTRIBUTING ANATOMIC FACTORS More common than any of the other complications addressed here, and entirely preventable, is a postoperative decrease in airway size, which is particularly unfortunate if the patient did not have any obstruction preoperatively. I have heard lecturing airway experts state that patients must be willing to trade a certain reduction in airway size for an improvement in nasal shape. This is not true and should never be the case. In fact, our rhinomanometric study indicates that primary patients can achieve even more postoperative airway improvement than secondary patients at most of the common obstructive sites (see Chapter 4).

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For years the cause of new postoperative airway obstruction eluded investigators and was therefore sometimes attributed to the use of intercartilaginous access incisions or osteotomies. Assuming that the septum was not deviated preoperatively and the turbinates were not hypertrophied, however, any new change in static or dynamic airway size (at rest or with inspiration) can only logically be attributed to some change in the mobile nasal sidewall, the other side of each airway. The primacy of valvular obstruction among these possible causes is supported by three facts: (1) new airway obstruction can occur even though an osteotomy has not been performed; (2) new airway obstruction occurs even if an adequate septoplasty and turbinate reduction have been performed simultaneously; and (3) secondary septoplasty and turbinectomy do not relieve a postrhinoplasty obstruction in most cases, but valvular reconstruction does. If the surgeon resects sufficient cartilaginous roof (more than 2 mm in most cases) to create incompetence at the internal valves and/or resects sufficient lateral crura to create instability at the external valves, a previously stable lateral wall will not tolerate the significant transmural pressures that occur with normal inspiration. In-

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ternal valvular incompetence occurs more easily in patients predisposed to it (those with narrow preoperative middle vaults or short nasal bones). External valvular incompetence is particularly easy to create if the preoperative lateral crura are cephalically rotated, because from that position their ability to provide structural support to the external valves is already compromised. The surgeon may eliminate valvular incompetence as a source of postoperative airway obstruction by identifying pertinent preoperative anatomy (see Chapter 5) and by maintaining and establishing valvular competence in each patient. Substantial dorsal or spreader grafts correct internal valvular incompetence with equal efficacy; collapsing external valves can be stiffened by autogenous cartilage grafts or by repositioning cephalically rotated lateral crura.

LOSS OF TIP SUPPORT Less commonly, a new airway obstruction may be caused by the inadvertent loss of tip support (through septal collapse or excessive dorsal or alar cartilage reduction), excessive alar wedge resection (treated by composite grafts or local flaps; see Chapter 18), or resection of nasal lining (which should never be performed except at the membranous septum to shorten the nose).

In this woman, whose skin had become stiff and resistant to correction from several previous surgeries, limited improvement was achieved by dorsal resection, caudal septal and upper lateral cartilage shortening, maxillary augmentation, and spreader and columellar grafts. The deformed, malpositioned lateral crura were resected and replaced. Airflow increased 3.4 times over preoperative values during quiet inspiration and 2.9 times during forced inspiration (which tests sidewall stability). Postoperative views are at 3 years.

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NASAL LENGTH ALTERATION Overshortening

Excessive nasal shortening misdirects the airstream that should normally flow posteriorly along the nasal floor.

An overshortened nose can be improved by dorsal grafts (which rotate the base caudally), by resection of the posterior caudal septum, by cartilage grafting the anteroinferior tip lobule and columella (both of which provide the illusion of lengthening), or by coronally oriented composite grafts, which decrease alar rim height and therefore reduce nostril visibility in the frontal view. All of these techniques were used in this patient. 756

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Excessive Length

The axiom “Long noses become long again after surgery” almost always holds when the skeleton has been reduced and the skin cannot adapt. Patients with excessively long noses often relieve their airway obstructions by supporting their nasal tips, which redirects the errant airstream inferiorly.

A long nose can be shortened to some degree by wide skeletonization and resecting membranous septum and the caudal ends of the upper lateral cartilages. But increasing support to the skin sleeve is also important, and in such patients narrowing the nose by osteotomy may be counterproductive. 757

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OSTEOTOMY Excessive osteotomy has been indicted as a cause of decreased postoperative airflow, although many authors now conclude that osteotomy is unlikely to be the sole cause of postoperative obstruction in most patients, partly because septal and valvular surgery are so effective. The passion of many patients for “small” noses and the aggressiveness of some osteotomy techniques do produce narrow piriform apertures, in which case excising the lateral lips of the piriform apertures improves the patient’s symptoms.

TURBINATE SURGERY Inadequate turbinate resection may leave residual obstruction; more commonly, however, excessive turbinate resection produces a sense of obstruction (presumably from loss of its normal baffling and resistance functions), nasal dryness, and a clear, persistent rhinitis. Insufficient turbinate resection is easy to correct; excessive resection and its sequelae have no current accepted and uniformly effective treatment. An improvement in nasal appearance should never compromise airway size. Virtually all rhinoplasty patients can maintain or improve their nasal airflow if their surgeons identify the critical preoperative anatomic variants (particularly narrow middle vault and alar cartilage malposition) and the functional interrelationships that exist, and thereby plan their operations accordingly.

S keletal Problems Irregularities or asymmetries may occur in any modified skeletal structure; their visibility will vary with the thickness of the soft tissue cover.

MIDDLE VAULT Irregularities at the caudal edges of the bony vault are often attributed to inadequate reduction or narrowing, but more often these represent middle vault collapse, which causes the caudal end of the bony arch to stand out in relief.

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The appropriate treatment is with spreader or dorsal grafts, not further bony resection.

DORSUM

A palpable or visible low point may appear in the midline of the nasal bridge, either intraoperatively or postoperatively, as seen in this tertiary patient. The middorsal notch (see Chapter 2) has been previously interpreted as an untidy resection of the cartilaginous dorsum or the bony-cartilaginous junction, but it more commonly represents a soft tissue phenomenon that occurs precisely where the thinner upper

759

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

nasal skin thickens in its transition to the supratip. A middorsal notch therefore represents the cephalic end of the supratip convexity or the midpoint of the inverted V associated with middle vault collapse. The discontinuity indicates dorsal overresection and should be treated by augmentation as soon as it is seen intraoperatively to avoid the need for secondary correction.

NEW FRONTAL ASYMMETRY

A new frontal asymmetry may develop when dorsal resection uncovers a high septal deviation (for example, septal deviation at the anterior or dorsal edge). Patients are frequently upset by this unexpected change and believe that the surgeon has created the asymmetry, when he or she has only uncovered it. The asymmetry is exaggerated by collapse of the middle vault following dorsal resection, because the upper lateral cartilage on the concave septal side has more room to fall medially than its partner on the convex side. A high septal deviation can be camouflaged by splinting the anterior septal edge with spreader grafts of unequal thickness (adding any necessary onlay grafts for additional symmetry) or by a symmetrical dorsal graft, depending on the required profile change.

760

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

ALAR CARTILAGES

When deformed or malpositioned lateral crura are resected, crushed, and replaced, they may still deform postoperatively, as they did in this patient.

Even alar cartilages that have been crushed until supple may retain significant internal stresses. Although deformities are uncommon following this technique, they do occur. If the alar cartilages are strong and deformed by excessive convexity or irregular contour, I now replace them with strips of septal cartilage rather than reinserting the original lateral crura. 761

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

S oft Tissue Problems THINNING OR ADHERENCE OVER GRAFTS A

B

D

C

E

Two previous surgeries that reduced this patient’s malpositioned lateral crura (A) effectively lengthened her long middle crus and allowed her alar rims to retract (B). No septal cartilage was available. Reconstruction was performed with rib cartilage, dorsal and tip grafts, and composite skin/conchal cartilage grafts to reduce alar rim height. Although the lateral result was good, dissection beneath the patient’s thinned tip skin produced a tip that remained telangiectatic, with skin that was adherent to the underlying crushed grafts. If the patient desires correction, the tip grafts could be revised after an ample postoperative period, but correction would be difficult, because the problem lies in the repeatedly traumatized dermis. 762

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

POOR GRAFT–SOFT TISSUE MATCH

PATIENT STUDY ONE

This patient has long, thick soft tissues, with broad alar cartilages and a mismatch between the size of the nasal base and dorsal height. Because of the width and convexity of the lateral crura, my plan was to resect, reduce, and replace them, reform the tip with grafts, and raise the dorsum with septal cartilage.

763

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

B

C

D

However, the patient’s primary septum provided an unusually poor specimen (B). I selected the only possible candidate and formed a dorsal graft (C), using the other pieces to reform the tip (D).

764



CHAPTER 14

PROBLEMS IN THE POSTOPERATIVE COURSE

Postoperative Analysis A

B

Preoperative

C

2 weeks postoperatively

D

1 year postoperatively

E

Preoperative

1 year postoperatively

Although the early postoperative appearance seemed promising (B), at the end of the first year, the supratip tissues had become depressed and dimpled (C and E).

765

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

At the 1-year revision, I added crushed cartilage grafts into the dimpled areas in the dorsum and tip.

Preoperative

20 months postoperatively

Preoperative

20 months postoperatively

Once again, the immediate postoperative result was promising, but the dimples reformed after a few postoperative months.

766

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

Preoperative

13 months postoperatively

20 months postoperatively

Preoperative

13 months postoperatively

20 months postoperatively

Although there were minor early improvements, the supratip depression returned after 6 months, much to the family’s unhappiness and mine.

767

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Although the final appearance suggests a nose that is in better balance, with a base that is less disproportionately broad, the secondary deformities remain. The alar walls never became smooth; the supratip dimpling and excessive coaption to the underlying skeleton (which I would not have anticipated from tissues of this thickness) marred the result. The patient was referred to another surgeon for fat grafting.

768

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

DAMAGED DERMIS, DIFFICULT BUILDING MATERIALS

PATIENT STUDY TWO

Despite five rhinoplasties, this patient was left with airway obstruction and multiple skeletal irregularities.

Without available septal cartilage, my plan was to resect the deformities and place a dorsal graft. The rib was irregularly calcified but still deforming; I had hoped that forming a laminated dorsal graft with thin perichondrial slices weakened by partial-thickness cuts would create a smooth surface that would not deform. 769

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Postoperative Analysis A

Preoperative

B

C

1 week postoperatively

8 months postoperatively

By the end of the first postoperative year, however, the damaged skin and rigid graft had proved incompatible (A). I revised the dorsal graft and placed a composite graft to correct the left alar retraction. At the 1-week dressing removal the patient’s nose was symmetrical and smooth (B), but by the end of 8 months, some of the dorsal deformities and the left alar retraction had reappeared (C).

770

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PROBLEMS IN THE POSTOPERATIVE COURSE

Like the quality of the grafts, the quality of the soft tissues determines the beauty of the final result. Here, despite a cooperative and agreeable patient, the building materials were irregularly calcified and the skin had been damaged by previous surgeries. Although a closed approach and limited dissection were used, notice the unusual bruising at the end of the first postoperative week (see p. 770), indicating limited circulation, a fact supported by the highly unusual partial composite graft loss. Nasal circulation can never be taken lightly, and surgeons who routinely assume that the wider dissection of the open approach is superior in difficult secondary cases may wish to rethink their philosophy in similar circumstances. The biggest loss here was replaceable composite graft, not columellar or tip skin.

771

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Graft Problems Skeletal problems caused by grafts rank fourth only because fewer surgeons augment than reduce. For surgeons who augment frequently, as I do, graft imperfections are the most common reason for secondary revision. The very fact that cartilage grafts cause any complications at all alarms some surgeons, who use that possibility to justify treating every rhinoplasty as a reduction operation only. Yet there is a fallacy in that reservation. As surgeons, we must judge whether to use grafts by the same criteria we use for all other procedures. The argument that grafts should not be used because they absorb or become visible must be weighed against the potential complications associated with other plastic surgical procedures, or the complications of performing rhinoplasty without augmentation. Some surgeons refuse to use grafts because there has not yet been any multiple-decade follow-up, but how many other operations do we perform for which we have follow-up of that length? In deciding what sort of rhinoplasty technique to use, the surgeon must remember that the pure reduction operation itself causes its own headaches. Each graft should be used to preserve shape, create function, or improve balance. Thus cartilage grafts become the mechanism by which traditional rhinoplasty can become a more uniformly successful procedure.

DORSAL GRAFT PROBLEMS Dorsal grafts misbehave in the expected ways: they shift laterally or become visible or palpable. Almost all of those particular complications can be minimized by attention to detail, employing the methods described in Chapter 12. However, there are two dorsal graft problems that cannot be overcome so easily: insufficient or poor quality donor material, or idiosyncratic graft healing, most common with rib cartilage. I will illustrate both types of adverse outcomes in my own patients.

772

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

PATIENT STUDY THREE

This primary rhinoplasty patient had sustained previous trauma, and the slight discontinuity in the dorsum, the flat tip, and the slight upper lip retrusion suggested a previous septal fracture, so I proceeded cautiously.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Minimal dorsal reduction through a single intercartilaginous incision 3. Cautious septoplasty, with a search for old fractures (none found) 4. Spreader grafts 5. Radix graft 6. Multiple crushed tip grafts

773

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

The patient’s septum yielded only a small amount of cartilage and a few fragments of ethmoid. Knowing that I needed spreader grafts for internal valvular obstruction, I tried to make the most of my specimen. Spreader grafts were fashioned using strips of cartilage and ethmoid of appropriate width and length; the straightest piece was crushed and layered to fill the radix depression.

After radix and tip grafting, the dorsal convexity was eliminated and the nose rebalanced. All grafts felt smooth on the table, as they must.

774

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

Postoperative Analysis

Postoperatively, although the airway was significantly better, the dorsum still retained irregularities, particularly at the middorsal notch. The patient was very unhappy with the result: “If I had known it was going to be this bad, I never would have undergone surgery.” Given the nature of the septal specimen and without additional available septal cartilage, correction here would be difficult.

775

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY FOUR

This tertiary patient had undergone two reductions that left her with a supratip deformity and a partially resected septum. The malpositioned lateral crural remnants were asymmetrical, resulting in differing degrees of alar retraction. The patient was unhappy with the height of her bridge and a tip that she believed “hooked down.” This latter characteristic is a common misconception among patients, who interpret inadequate tip projection as a downward-turning nose, rather than poor tip contour. Note that the patient’s nasolabial angle is already slightly above 90 degrees. The surgeon who accepts this mischaracterization will try to correct it by shortening the nose rather than altering tip configuration and support.

SUMMARY OF THE SURGICAL PLAN 1. Harvesting of conchal cartilage 2. Resection and replacement of malpositioned lateral crura through infracartilaginous incisions 3. Minimal dorsal reduction, greater on the left than the right (preoperative asymmetry) 4. Submucosal shortening of upper lateral cartilages 5. Transfixing incision with resection of caudal and membranous septum, shortening the nose slightly 6. Septoplasty for dorsal graft 7. Bilateral spreader grafts, thicker on the right than the left 8. Radix graft 9. Tip grafts

776



CHAPTER 14

A

PROBLEMS IN THE POSTOPERATIVE COURSE

B

D

C

E

Resection of the malpositioned lateral crura, crushing, replacement (B), and slight dorsal trim removed the deformities, but the soft tissues remain unsupported (C). Unfortunately, the septum yielded only one short piece suitable for the dorsum (in the center of the grid [D]). Using the best piece to elevate the upper dorsum, resected ear cartilage (to the bottom of the grid) was split for spreader and tip grafts. On the table, the final result appeared to be a rebalanced nose with adequate projection (E).

777

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Postoperative Analysis

Preoperative

1 week postoperatively

2 weeks postoperatively

3 months postoperatively

12 months postoperatively

3 years postoperatively, 18 months after revision

Although nasal contours were otherwise good when the cast was removed, the patient had developed an unusual right alar retraction, a phenomenon that I have seen only twice in 30 years, presumably caused by a small hematoma in the right sidewall. Two weeks after surgery and 2 months after that, the rim asymmetry had improved almost to preoperative levels, emphasizing the importance of patience during the postoperative course. A hasty attempt to revise at this point would have only worsened the problem. Eighteen months after a secondary composite graft, alar rim symmetry has improved. 778

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

Three years after the first surgery, the nose has improved. The patient no longer flares her nostrils to support her airways. Sidewalls are symmetrical. Tip projection is now adequate and the tip has a better contour, although the nasolabial angle is almost identical to its preoperative value. However, the deficiency of the donor material has left a discontinuity in the dorsal line. Without an upper dorsal graft, the nose could not have been rebalanced, yet a meager septal specimen limited the quality of the final result.

779

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Graft Visibility Although my results with autogenous rib cartilage are largely reliable and continue to improve, not all results are good. As discussed in Chapter 12, rib quality varies with the age of the donor: younger rib is more elastic, and therefore more unreliable and likely to deform, than older rib.

We have already seen this patient’s preoperative photographs (see p. 760) and noted how a dorsal resection exposed the underlying asymmetry of a high septal deviation to the right. Because septal cartilage was unavailable, I placed a rib cartilage dorsal graft, but despite a right lateral wall graft, tightening soft tissues on the patient’s right side exposed the graft edges.

780

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

Preoperative

Early postoperative result

1 year postoperatively

Although the lateral result demonstrates some improvement, the overall result is not good because of a mismatch between soft tissue thickness and the limited plasticity of the patient’s donor material.

781

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

C

B

D

E

This young man’s left unilateral cleft lip nasal deformity was reconstructed with autogenous rib when he was 17 years old. Although the 3-week postoperative result was promising (C), by 6 weeks there was a suggestion of dorsal convexity (D), confirmed at 1 year (E).

782



CHAPTER 14

PROBLEMS IN THE POSTOPERATIVE COURSE

A

B

C

Preoperative

18 months after revision

Fifteen months after the first procedure, the first graft was removed and replaced with rib bone. Eighteen months later (C), the reconstruction remains stable. Accordingly, in younger patients I now prefer a perichondrial/cartilage rib laminate or autogenous costal bone.

783



PART III

CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY FIVE

Multiple previous surgeries had left this patient with significant airway obstruction, right vestibular atresia, nostril and columellar distortions, supratip deformity, and skin that had been damaged at several levels, despite the putative visibility afforded by the open approach. No septal cartilage was available.

SUMMARY OF THE SURGICAL PLAN 1. Harvesting of rib cartilage 2. Limited skeletonization through right intercartilaginous incision 3. Resection of dorsal and tip skeletal distortions 4. Rib cartilage maxillary augmentation 5. Rib cartilage dorsal graft 6. Right alar wall rib graft 7. Resection of the distorted right medial crus 8. Multiple tip grafts

784



CHAPTER 14

A

PROBLEMS IN THE POSTOPERATIVE COURSE

B

D

C

E

Before beginning the surgery, I marked the areas of underlying skeletal distortion on the skin so they could be accurately located after skeletonization. The patient’s rib cartilage has the white, pliable consistency of youth (A). The tip of the tenth rib was trimmed, split, and contoured into two maxillary augmentations (B). The thickest portions were placed in the perialar areas, and midline projection was controlled by the degree of augmentation overlap. After the right medial crus was trimmed and the skin closed, a vestibular incision in the right alar base provided access for an alar wall graft (C). The best piece of cartilage was trimmed for a dorsal graft (D); once this was placed, the dorsum was now straight (the point at the tip represents unsupported skin overlying a previous skeletal distortion) (E).

785

PART III



A

CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

C

Crushed and solid tip grafts provided structure for the lobule (A). Preoperative and immediate postoperative views show proper proportion, support, and contour (B and C).

Postoperative Analysis A

B

Preoperative

C

10 days postoperatively

D

1 month postoperatively

6 months postoperatively

The 10-day postoperative result appeared promising (B), but as the months progressed, three events occurred: the dorsal graft distorted and became convex, the nasal skin tightened around all the grafts, exposing some edges, and (despite multiple tip grafts) the tip contracted posteriorly, compressing the nasal base. 786

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

The patient’s airway was improved, the base distortion lessened, and overall symmetry was better, but the result was limited by previous soft tissue injury and dorsal graft distortion. Placement of an axial K-wire through the graft at the original procedure or use of rib bone might have avoided this problem. At a secondary procedure, I would have exchanged the dorsal graft and augmented the tip further, but the patient was so pleased with the outcome that she elected to do no more.

787

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Insufficient Augmentation

Dorsal and tip reductions, a radix graft, unequal spreader grafts (high septal deviation to the right), and tip grafts reshaped and rebalanced this primary patient’s nose. However, spreader grafts must be wide enough to do their job; in other words, they must preserve middle vault width appropriate to the bony vault width. Although the spreader grafts placed here looked and felt sufficient at surgery, the patient’s postoperative result shows a discontinuity in the middle third. Because function was adequate and the valves were stable, sidewall grafts would be an easier correction than attempting to replace with wider spreader grafts.

788

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

A

B

C

D

Although correction seemed sufficient on the table, dorsal augmentation was not sufficient to prevent a middorsal notch (D). The graft has not absorbed because the radix is still higher, but graft thickness was inadequate.

789

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

RADIX GRAFT PROBLEMS Aside from absorption, which is uncommon, radix graft visibility occasionally occurs early in the surgeon’s learning curve, but disappears with attention to detail. This is one of my early radix graft patients.

A

B

C

D

Preoperative

2 weeks postoperatively

Her malpositioned lateral crura were relocated (note the percutaneous sutures), the dorsum was reduced, and radix, spreader, and tip grafts were added (B). Although the immediate postoperative appearance was promising, the early frontal view indicated excessive fullness at the radix (D).

790



CHAPTER 14

PROBLEMS IN THE POSTOPERATIVE COURSE

E

F

Preoperative

2 weeks postoperatively

G

4 months postoperatively

The early postoperative lateral view confirmed excessive augmentation (F). Months of expectant waiting did not improve the result (G). This graft should be removed, reduced, and replaced. Such occurrences are uncommon with experience, and their incidence can be avoided by following the technical points in Chapter 12.

791

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

TIP GRAFT PROBLEMS Like dorsal grafts, tip grafts can be insufficient or excessive. Most tip graft problems are technical and therefore under the surgeon’s control; avoiding them depends on suiting graft substance to the soft tissue cover, using multiple grafts, and augmenting sufficiently but not excessively. Crushed cartilage grafts have solved many of the problems that solid grafts created, but some patients’ tissues are thin enough to show any structure beneath them, and others thin under the gentle stresses that tip grafts themselves produce.

PATIENT STUDY SIX

This secondary patient had undergone a careful primary rhinoplasty in which a single tip graft had been used, which tipped to the left. In addition, she had slight asymmetry and a narrow middle vault. Dorsal contours were good, but the remnants of her previous malposition remained. The patient stated, “My nose is too small for my face,” and she had airway obstruction that was both valvular (internal and external) and septal.

792

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

SUMMARY OF THE SURGICAL PLAN 1. Harvesting of ear cartilage (partial prior septoplasty) 2. Relocation of malpositioned lateral crura 3. Trimming of prior tip graft 4. Trimming of right medial crural footplates 5. Septoplasty 6. Crushed cartilage dorsal graft 7. Bilateral spreader grafts, thicker on the left than on the right 8. Left lateral wall graft 9. Multiple crushed tip grafts to distribute forces and minimize postoperative visibility

A

B

Harvested ear cartilage was reserved for lateral crural replacement; septoplasty cleared the airway and produced excellent building materials (B).

793

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

C

D

E

F

The best pieces were crushed for dorsal cover and left lateral wall grafts (C and D), and multiple tip grafts were placed to camouflage the primary surgeon’s single graft and create a symmetrical tip (E and F ).

794

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

Postoperative Analysis A

B

C

D

Preoperative

1 week postoperatively

6 weeks postoperatively

5 months postoperatively

Preoperative

1 year postoperatively

Preoperative

1 year postoperatively

At 1 week postoperatively, the tip was smooth and symmetrical (B), but as the months progressed following surgery, the tip skin tightened and thinned, producing a slightly more symmetrical (but still visible) grafted appearance (D). On the lateral view the nose is slightly larger, as the patient wished. Dorsal contours are similar but slightly more defined, footplate resection has created better nostril symmetry, and the alar walls are supported without the deformities created by malpositioned lateral crura. The tip skin remains adherent and telangiectatic.

795

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

A

B

C

D

Despite a scarred tip and thick overlying skin, grafts can still become visible, as occurred in this tertiary patient over several postoperative months (B and C). Sometimes grafts can be removed (although usually in fragments), softened, and replaced, but the surgeon should be prepared to place new grafts if the originals will not suffice (D). It is a mistake to assume that the grafts will slide out intact. Remember that they are healed to the surrounding tissues and to each other, so even the most careful dissection often produces short or broken fragments that may not supply an optimal reconstruction.

796

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

A

B

C

D

E

F

G

H

Occasionally thin skin can be blamed for visibility (G and H), but in each of these patients I placed multiple grafts that presumably diffused the forces supporting the tip. It is possible that some of the grafts did not survive; it is possible, but less likely, that the grafts were too rigid for the overlying soft tissues; and it is possible that the skin attenuated over grafts as the months and years passed following surgery. Thinning of tip skin is not idiosyncratic to tip grafts, but occurs when reduced alar cartilages knuckle, when suture-modified tips deform and protrude, when columellar struts thin overlying skin, and as normal tissues age. Thus the problem is not intrinsic to tip grafting as a technique, and fortunately, graft visibility in experienced hands is rare. It is only because I have grafted so many tips over 30 years that I can provide such examples. The majority of tip graft problems are still under the surgeon’s control—by using multiple grafts, by ensuring that they are firm enough to provide the desired effect but soft enough to mold beneath the tip skin, and by matching graft substance and number to their soft tissue cover and to the patient’s aesthetic goals.

797

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

GRAFT ABSORPTION Although uncommon, graft absorption does occasionally occur. The surgeon can control the degree of absorption by careful handling, not crushing grafts excessively, and ensuring maximal bed vascularity by limiting dissection. As a rough generality, bone grafts absorb more commonly than cartilage grafts, but fortunately, neither occurrence is frequent.

PATIENT STUDY SEVEN

This patient’s broad, malpositioned lateral crura and low dorsum suggested my usual strategy for such cases: resection and replacement of the lateral crura, dorsal graft, and tip graft.

798



CHAPTER 14

A

PROBLEMS IN THE POSTOPERATIVE COURSE

B

C

Intraoperatively, the septum yielded only a short cartilaginous segment, so that the dorsal graft was 60% ethmoid and 40% septal cartilage (B). Nevertheless, for a primary dorsal defect in a young patient, survival should be excellent.

799

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

Postoperative Analysis

Preoperative

13 months postoperatively

Thirteen months after surgery, the nose is better proportioned, tip projection is adequate, and the dorsum is straight. The patient returned 14 years after her surgery to seek minor nostril refinements; she had noticed (but was not troubled by) the change in her dorsal contour. The patient’s bridge had assumed a configuration that resembled a saddle nose, creating an apparent new convexity in the bony vault while flattening the upper cartilaginous vault. But this is not what happened. The bony part of the dorsal graft had absorbed, leaving the cartilaginous segment untouched. The tip (constructed only with cartilage grafts) had maintained its normal contour. If we had proceeded with revision, her thick soft tissues would have allowed minor reduction of the old dorsal graft and an onlay of crushed ear cartilage to the middle vault, or perhaps only a reduction of the remaining dorsal graft.

800

CHAPTER 14

Preoperative



PROBLEMS IN THE POSTOPERATIVE COURSE

13 months postoperatively

14 years postoperatively

801

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

PATIENT STUDY EIGHT

This patient’s low radix, high dorsum, and inadequate tip projection suggested the routine solution of dorsal reduction and radix, spreader, and tip grafts. A

B

C

D

The procedure proceeded unremarkably with what appeared to be an excellent and unremarkable septal specimen (A); the resected dorsal roof and upper lateral cartilage are seen at the bottom of the grid. Note the three components of this thin dorsal resection, signifying an open middle vault roof. Spreader grafts are in the center; the remainder to be used for the dorsum and tip are at the top. Malpositioned lateral crura were relocated (note the percutaneous sutures coapting with vestibular and external skin), and tip grafts were placed (D). 802

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

In this patient, even the early postoperative results were not encouraging, and at the end of a year, the nose had the appearance of reduction without any grafting: a high septal deviation twisted to the left with an inverted-V deformity; a low, unsupported dorsum; a middorsal notch; supratip convexity; and only scant evidence of remaining tip grafts. The dorsum is lower and therefore broader; and there are almost no vestiges of the result presumably obtained at surgery. Unlike some of my patients, but like others in this chapter, the patient was so pleased with her result that she saw no need for revision.

803

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

S eptal Perforation

Perforations occasionally occur after difficult septoplasties but can be minimized by cautious dissection over the vomer at its articulation with the quadrilateral cartilage, where the stronger periosteal fibers interlace with weaker perichondrial fibers. By dissecting from the vomer cephalad instead of the reverse, tears are less likely. I repair all tears in the mucoperichondrial flaps and place 1 mm thick silicone sheets on each side of the septal partition.

The sheets are cut to fit the airway, slipped into position before placing tubes and packing, and sutured to No. 18 Fr suction catheters placed on the floor of each airway—they are not sutured to the patient. The splints are removed at the seventh postoperative day with the rest of the packing and do not need to be replaced. 804

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

Even with these precautions, the occasional septal perforation may be unavoidable, particularly in a previously traumatized or operated septum. Small perforations may cause a curious whistling sound; larger perforations can cause crusting, epistaxis, and rhinitis as the turbulent airflow spins through the perforated mucosa. Epistaxis frequently reflects an area of exposed cartilage or bone. Repairing septal perforations is difficult: recurrence after repair with local or even distant flaps approaches 50% in large reported series. If the perforation is small (5 mm or less), it can be repaired by carefully separating the mucoperichondrial flaps after hydrodissecting with local anesthetic and creating a transposition flap on one side that closes over the perforation. I usually close small perforations only if I am performing secondary surgery for another reason; in most patients, a small asymptomatic perforation does not merit repair in itself. In symptomatic perforations, it is often possible to identify and eliminate areas of exposed septal skeleton and repair the mucoperichondrial flaps to obtain a healed, stable surface, though not a closed perforation. When that has been achieved, crusting diminishes, and intermittent epistaxis usually disappears. If the patient’s symptoms can be relieved by this usually successful operation, closure of the perforation itself is not necessary. On the rare occasion that I do fix a perforation, repair is often easier with distant tissue than by trying to raise other intranasal flaps, unless the perforation is small.

A

B

For this large anterior perforation (A), a medially based flap of labial mucosa (B) from the superior labiogingival sulcus (incorporating muscle fibers in its base) easily reaches. 805

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

C

D

E

F

This flap must be designed carefully with a pedicle that is wide enough and does not constrict as the flap passes through its tunnel into the nose (C and D). Once it is inset, often with the aid of an alotomy (E), the opposite side is repaired with auricular composite graft or retroauricular skin graft (F).

806



CHAPTER 14

PROBLEMS IN THE POSTOPERATIVE COURSE

S ynechiae Adhesions occasionally form between the septal and inferior or middle turbinate surfaces, particularly if the septoplasty has been difficult, leaving raw surfaces on both sides. Treatment is simple, by splitting the adhesion with a knife or Freer elevator and placing silicone sheeting along the septal side with routine packs (left in place for 1 week) to prevent recurrence.

A

B

C

Rarely, a broad intranasal web like this one will form, which occupied the cephalic 90% of the airway. Note the single 3 mm caudal opening in A and B. This particular obstruction was corrected by splitting the web coronally to form two opposing transposition flaps, based laterally and medially, and inset to resurface both sides. Complete correction was achieved (C).

807

PART III



CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

S eptal Collapse

Loss of cartilaginous support has protean effects, because the intact septal partition is necessary for normal bridge height and contour, nasal length, base support, middle vault competence (and therefore internal valvular competence), and upper lip carriage. The required reconstruction must correct each of these deficits, and is predictably more complex than simply filling the supratip depression. This patient is shown before and after her septal collapse, which followed a routine septoplasty. Notice that nasal length, dorsal height, and tip support have each decreased; the columella has become retracted; and the upper lip has fallen posteriorly, changing its carriage and sharpening the subnasale.

808

CHAPTER 14



PROBLEMS IN THE POSTOPERATIVE COURSE

In 30 years, I have so far had only two septal collapses: one I created by narrowing the dorsal strut to 10 mm, trying to harvest a dorsal graft of appropriate width; and the other, 30 years old and unhealed, found me as I attempted to correct a severe septal deflection in a secondary patient. The surgeon may minimize the possibility of septal collapse by identifying those patients with unhealed or unstable septal fractures and by leaving a minimum 15 mm width of undissected septum to support the dorsum. Be suspicious of a posttraumatic or postsurgical middorsal notch, soft supratip, unsupported columella, or retrusive lip position. Surgeons who prefer open septoplasty are similarly wise to preserve undissected mucoperichondrium along the dorsal edge (by performing septoplasty through a Killian incision and not “from the top down”) to avoid jeopardizing septal support if any unexpected, unhealed fracture lines are encountered.

R hinitis Temporary rhinitis may occur for several weeks postoperatively, particularly when an obstructed airway has been improved, presumably because the nasal mucosa must accommodate significantly increased airflow. Persistent rhinitis, however, is extremely uncommon unless excessive turbinectomy has been performed. The proponents of radical turbinectomy deny or minimize the sequela, but chronic postoperative rhinitis is a real and troublesome entity for which there is yet no consistently effective treatment.

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Circulatory Problems

Circulatory complications, including partial columellar loss, occur more commonly after open than after closed rhinoplasty, especially when cautery has been used to control columellar vessels, when rigid skeletal reconstruction or struts create excessive soft tissue pressure, or where strong retraction has been employed. Early reoperation or dissection under scarred tissues may perforate or split the dorsal skin. During primary rhinoplasty, the surgeon can make intercartilaginous and infracartilaginous incisions, with or without alar wedge resections, without fear of 810

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circulatory compromise as long as the incisions are not made longer than is necessary, skeletonization is limited only to the areas requiring modification, the dermis is not thinned, and packs and dressings are not placed tightly. Differentiation of the tip lobule from the dorsum (the desirable supratip break) reflects adequate tip projection. This factor absent, the surgeon cannot produce a real supratip break by overcorrecting the cartilaginous dorsum, suturing the dermis to it, excessively tight taping, or steroid injections. In the cases where any of those methods seem to have worked, they worked because tip projection was adequate. In fact, it is possible to produce an excessive break by overly enthusiastic tip grafting, as I have done in my own patients (see Chapter 12). Even in a primary rhinoplasty procedure, nasal circulation can be affected by grafts placed under tension, rough tissue handling, or constrictive dressings.

Preoperative

7 days postoperatively

16 years postoperatively

In this patient, on whom I operated early in my practice, I struggled to resect previous tip deformities and then place corrective grafts in a heavily scarred tertiary tip; the soft tissue trauma wrought is obvious. Fortunately, her tissues recovered completely. When tissues have been compromised by previous surgery or if dissection is difficult, I am particularly careful to place the tip sling loosely, check the patient at 48 and 72 hours postoperatively (when a tight dressing may first become obvious), and remove the sling at the first sign of a problem. In difficult tertiary cases, the occasional pink postoperative tip does appear, even when the closed approach has been used and grafts have not been placed under tension, but soft tissue loss should never occur. 811

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RED TIP The “postrhinoplasty red nose” is a cutaneous manifestation of postoperative circulatory readjustment and is displayed varyingly in patients: many never develop the condition, whereas others develop it after the first rhinoplasty.

Preoperative

2 weeks postoperatively

Patients with facial telangiectasias such as this one develop red noses more frequently; most improve spontaneously during the first postoperative year. When the condition persists, as it did in this woman even after 18 months, laser treatment is simple and effective.

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3 weeks postoperatively

Preoperative

PROBLEMS IN THE POSTOPERATIVE COURSE

4 months postoperatively

15 months postoperatively

18 months postoperatively

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PINK TIP Nontender discoloration, usually manifested as a blush in the nasal tip in the early postoperative period, can signal either low-grade infection or mild ischemia. Neither can be ignored. Even when the access wound has not been closed under tension, internal pressures caused by grafts, packing, postoperative edema, or taping may render even a carefully placed dressing too tight.

Preoperative

1 week postoperatively

1 month postoperatively

26 months postoperatively

This patient’s nasal tip looks infected, but there was no tenderness (which cannot always be trusted in the immediate postoperative course), fluctuance, or drainage, and the discolored area corresponded exactly to the skin restricted by the tip sling. With packs and tip dressing removed at 24 hours, all tissues recovered rapidly. Even at 24 hours, graft position will not be lost; much more can be jeopardized if a tight dressing remains. Poor technique, excessive tip graft manipulation, or introduction of external auditory canal organisms by ear cartilage grafts can produce a low-grade tip infection. Drainage is uncommonly necessary, but the surgeon should observe the wound closely and employ appropriate antibiotics when needed.

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H emorrhage Most patients, particularly those who have undergone septal or turbinate surgery, have moderate bleeding for the first 48 to 72 hours postoperatively, after which drainage subsides. Approximately 3% of patients, however, classically rebleed between postoperative days 5 and 10. At particular risk are patients who have taken drugs or vitamins that interfere with platelet function; increasingly, patients report using a variety of herbal supplements, which lack complete information. A surgeon’s major task is to elicit cooperation from frightened patients and family members. As so often occurs with upper gastrointestinal hemorrhage, a calmed patient frequently stops bleeding. Postoperative hemorrhage cannot be treated by the emergency department or office staff; the surgeon should see the patient personally, remove previously placed packs, suction the airway, and identify the site of bleeding (which frequently ceases after old blood and clots are removed). When anterior bleeding does not stop, reinsertion of an absorbent pack soaked in 1% phenylephrine hydrochloride is effective. Fortunately, the need for posterior packs occurs less frequently, but the surgeon should be familiar and comfortable with their use before the occasion arises. By examining the posterior pharynx with good lighting, suctioning, and a tongue blade, the surgeon can extract any clots and estimate the pace of any blood running down the posterior pharyngeal wall. Sheen has calculated that each drop adds approximately 0.1 ml to the accumulating blood loss. At 1 drop per second (6 ml per minute or 360 ml per hour), it is easy to see how hematemesis can occur, which naturally frightens the patient further and worsens the bleeding. When an airway suctioned clean of clots and packed with phenylephrine-soaked or epinephrine-soaked cotton does not promptly stop the bleeding, an effective posterior pack is essential. The technique involves passing a small-caliber catheter through the nose and retrieving the end with bayonet forceps through the patient’s mouth. The surgeon attaches a tonsil sponge (or an equivalent commercially prepared pack) to the catheter by its string tethers. By pulling the nasal catheter forward, the tonsil sponge can be drawn posteriorly around the soft palate and snugly against the choanae. The anterior nose is then packed, and the tonsil sponge strings, cut free from the catheter, are tied over ample padding to protect the alar rims. A bright headlight and good equipment are essential, and patient sedation is helpful. The posterior pack can be removed after 4 or 5 days, with negligible chance of rebleeding. Any posterior pack is unpleasant for the patient, but not nearly so troublesome as continued bleeding. This technique, based on that of Sheen and Sheen, can be found with detailed illustrations and description in the original text.

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I nfection Bacterial infection is mercifully rare after rhinoplasty and septal surgery. The surgeon must remember that the operative surface is not the cutaneous cover but rather the vestibular skin and mucosa, and prepare the internal nose thoroughly. I join many surgeons in administering antibiotics while postoperative packing is in place to minimize the chance of maxillary sinusitis, but the absolute necessity has not been established. Toxic shock syndrome, cavernous sinus and nasal frontal abscess, and even endocarditis are extremely rare but have been reported.

Limited but especially troublesome infections occur infrequently in areas of tissue compromise, following excessive intraoperative manipulation, or where conchal cartilage grafts have been placed, carrying gram-negative organisms from the external auditory canals; it is easy to follow the epidemiological trail in this single patient. In my experience, cellulitis is much more common than actual suppuration. Careful technique is critical, as is host defense: in the nose, this means the degree of scarring and adequacy of tissue vascularity. I performed a tertiary rhinoplasty on a woman who had developed postoperative infections in the last 5 of her 15 rhinoplasties. None of my procedures became infected, largely because I added a paramedian (arterialized) forehead flap to replace damaged nasal skin, which brought with it new vascularity.

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Methicillin-resistant Staphylococcus aureus (MRSA) has unfortunately become increasingly common in the United States. The rate of invasive MRSA in the United States was an astounding 31.8 per 100,000 in 2005, greater than the combined total rates for invasive pneumococcal, streptococcal, meningococcal, and Helicobacter influenzae disease; and in that same year, deaths from invasive MRSA exceeded those from HIV and AIDS (Bancroft; Klevens et al). Of outpatients seen in emergency rooms, from 30% to as many as 65% have community-acquired MRSA infections (Awad et al; Crum et al). In my own community, 50% of all outpatient staphylococcal infections grow MRSA, a rather astonishing number for a semirural city. Approximately 3% to 4% of the population in the United States now carries MRSA in its nasopharynx; yet postoperative rhinoplasty infections from this organism are still uncommon.

Preoperative

7 days postoperatively

4 months postoperatively

I have seen two cases of MRSA: one in this tertiary patient, shown at 7 days with erythema and cellulitis in her nasal tip. The nasopharynx cultured MRSA, and the patient responded to oral antibiotics (trimethoprim/sulfamethoxazole) to which the organism was sensitive.

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CONCEPT AND TECHNIQUE IN PRIMARY RHINOPLASTY

B

Preoperative

C

5 days postoperatively

5 months postoperatively

Given the 3% to 4% prevalence of MRSA in the nasopharynx and the volume of rhinoplasty patients in my practice, I should have seen a number of infections by this point, but this is only the second to date, and this patient’s history is more typical of patients troubled by this virulent organism. He had undergone five rhinoplasties when he saw me, and underwent a routine rib graft reconstruction for saddle nose. When I saw the patient on the fifth postoperative day (B), he told me that purulent nasal drainage had begun at 48 hours after surgery. In the operating room later that day, I removed all grafts; the power of this organism was manifested by infection of each graft pocket, including those over the maxillary arch (unscarred by previous surgery) and the chest wound where residual rib had been banked. Hospitalized and on parenteral vancomycin hydrochloride until the purulence disappeared and the packed wounds could be allowed to close, the patient lost no soft tissue, but the entire reconstruction failed (C). Linezoid, daptomycin, and tigecycline are newer FDA-approved agents to which MRSA currently remains sensitive, but the organism shows a remarkable and troubling adaptability and capacity for mutation, and increasing resistance to vancomycin. As the epidemiology of MRSA infections changes, so must our precautions. At present I screen all preoperative rhinoplasty patients with nasal swabs and treat carriers with 5 days of intranasal mupirocin calcium ointment 2% (Bactroban Nasal). Trimethoprim/sulfamethoxazole and tetracycline are fortunately still effective oral agents. Each surgeon should develop his or her own protocol based on local conditions and counsel from infectious disease specialists.

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L ess Common Complications A

C

B

D

E

Tape contact allergies (A and B), benzoine contact allergies (C and D), and the even more rare retained foreign body (in this case, the fractured tip of an osteotome) (E) occasionally occur. Unusual pruritus or drainage beneath the tape dressing should not be ignored; the surgeon and operating room personnel must ensure intact instruments at the beginning and end of each case. Persistent, unexplained drainage should be evaluated by radiographs and wound exploration as indicated. Lacrimal duct injury (presumably from lateral osteotomy) was described in a 1968 series in which the incidence of lacrimal obstruction in a 27-patient group was

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78%; later studies have confirmed this rare possibility. Reports have also appeared of orbital floor and extraocular muscle injury after osteotomy. Such events are unlikely if the surgeon knows and controls osteotome position. Cerebral spinal fluid rhinorrhea, cavernous sinus thrombosis, meningitis, permanent anosmia, recurrent intradermal cysts, and blindness after corticosteroid injection for supratip deformity have been reported but are fortunately very uncommon. Serious but rare complications have been reported after calvarial bone graft harvesting (0.02% in a pooled series of 12,672 cases; Kline and Wolfe): hemiparesis; hemiplegia (in a patient with a platelet disorder); epidural hematoma; subdural infection; dural, brain, or sagittal sinus lacerations; aphasia; persistent speech defects; and temporal hemianopia. Adverse events are extremely rare in the hands of surgeons experienced with proper bone harvesting technique (see Chapter 17). Alloplastics placed during rhinoplasty procedures have their own litany of postoperative problems. The decision never to use alloplastics in the nose was a philosophical one that I made when I first began practice, so I have not experienced any of these misadventures. Surgeons are encouraged to become familiar with the complications of implants before assuming that alloplastic reconstructions are inherently less troublesome than autogenous ones.

Preoperative

1 week postoperatively

Finally, on rare occasions, an unusual periocular discoloration occurs that might be mistaken for ecchymosis, but it is not: it is excessive melanin production signifying postoperative stress.

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PROBLEMS IN THE POSTOPERATIVE COURSE

1 week postoperatively

1 year postoperatively

Unlike the bruising that results from osteotomy, the hyperpigmentation seen in these two women is more symmetrical and bilateral, occurs around the entire orbit rather than only inferomedially, and lasts longer than 14 days (whereas routine postoperative bruising disappears earlier than that). Similar discoloration can be seen in patients who have not undergone surgery but have experienced significant stresses in their personal lives (such as the death of a spouse or serious illness) and is presumably the result of increased release of adrenocorticotropic hormone. The discoloration requires no treatment but should be recognized for what it signifies.

U nhappy Patients Unhappy patients will be discussed in more detail in Chapter 20, but a few remarks are appropriate here. In a perfect world, the relationship between the surgeon and the aesthetic surgery patient would be even more favorable than in other medical encounters. Although it may be optimal for patient and surgeon to like each other, this is not always necessary or even possible for a frightened cancer patient or an intoxicated emergency department patient. In an elective cosmetic case, everything should be different. Differences do exist in aesthetic surgery, but perhaps not as expected. Because the risks and complications are as real as in nonelective procedures, and because the emotional investment may be even greater, patients expect more than passable outcomes without complications. Patients desire excellent, even perfect results from procedures that are technically difficult, that change appearance, and that have pro-

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found ramifications for that complex part of the human psyche we call body image. In aesthetic surgery, as much as or more than in other surgical encounters, it is important for patient and surgeon to understand and (for lack of a better word) like each other. The surgeon-patient relationship is always tested when things do not go as planned. These circumstances measure the surgeon’s equanimity and test the degree to which “informed consent” has been obtained. It is here that the patient must understand the difference between the uncontrolled and uncontrollable. The patient may be seeing a “problem” that he or she cannot necessarily identify but that well-meaning but uninformed friends or family members have interpreted instead, making matters better or (more commonly) worse. In a sound relationship with the surgeon, education and reassurance will support the patient until the problem resolves or until it can be corrected. It is important to see unhappy patients just as often, if not more often, than happy ones, and I make a habit of doing so for at least the first postoperative year, until I determine that I can or cannot correct the problem that the patient sees, and whether I am the right surgeon to perform that correction. Conscientious followup may also be risk management, but it is primarily part of the responsibility that any surgeon assumes. I share the experience of many surgeons who have cared for patients with complications, only to have those patients refer many others because they were so pleased with their experiences. Perhaps patients react not to what they got, but to what they think they got, but fortunately, most respond instinctively to the personal care that is invested in every sound doctor-patient relationship.

BIBLIOGRAPHY Awad SS, Elhabash SI, Lee L, et al. Increasing incidence of methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: reconsideration of empiric antimicrobial therapy. Am J Surg 194:606-610, 2007. Bancroft EA. Antimicrobial resistance: it’s not just for hospitals. JAMA 298:1802-1804, 2007. Bartels JW, Burgess LP. Nasal dorsal pseudocyst formation after rhinoplasty. Am J Rhinol 6:199-201, 1992. Bull TR. Mishaps in rhinoplasty. Rhinology 9:73-75, 1989. Casaubon J, Dion MA, Larbrisseau A. Septic cavernous sinus thrombosis after rhinoplasty. Plast Reconstr Surg 59:119-123, 1977. Chirukian MM, Zemplenyi J, Steiner M, et al. Postrhinoplasty epistaxis. Role of vitamin E? Arch Otolaryngol Head Neck Surg 114:748-750, 1988. Cohen S. Complications following rhinoplasty. Plast Reconstr Surg 18:213-226, 1956. Constantian MB. The boxy nasal tip, the ball tip, and alar cartilage malposition: variations on a theme— a study in 200 consecutive primary and secondary rhinoplasty patients. Plast Reconstr Surg 116:268-281, 2005.

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Constantian MB. Functional effects of alar cartilage malposition. Ann Plast Surg 30:487-499, 1993. Constantian MB. The incompetent external nasal valve: pathophysiology and treatment in primary and secondary rhinoplasty. Plast Reconstr Surg 93:919-931; discussion 932-933, 1994. Constantian MB. The two essential elements for planning tip surgery in primary and secondary rhinoplasty. Plast Reconstr Surg 114:1571-1581; discussion 1582-1585, 2004. Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 98:38-54; discussion 55-58, 1996. Coursey DL. Staphylococcal endocarditis following septorhinoplasty. Arch Otolaryngol 99:454-455, 1974. Crum NF, Lee RU, Thornton SA, et al. Fifteen-year study of the changing epidemiology of methicillinresistant Staphylococcus aureus. Am J Med 119:943-951, 2006. Dicken CH. Treatment of the red nose with the argon laser. Mayo Clin Proc 61:893-895, 1986. Dieu T, Upjohn E. Negative pressure pulmonary edema in healthy cosmetic surgery patients. Aesthet Surg J 23:270-273, 2003. Farrior RT. Symposium: the supra-tip in rhinoplasty: a dilemma. Laryngoscope 86:43-44, 1976. Flowers RS, Anderson R. Injury to the lacrimal apparatus during rhinoplasty. Plast Reconstr Surg 42:577-581, 1968. Grocutt M, Chir B, Fatah MF. Recurrent multiple epidermoid inclusion cysts following rhinoplasty— an unusual complication. J Laryngol Otol 103:1214-1216, 1989. Gruber RP. Early surgical intervention after rhinoplasty. Aesthet Surgery J 21:549-551, 2001. Gunter JP. Management of intraoperative fractures of the nasal septal “L-strut”: percutaneous Kirschner wire fixation. Plast Reconstr Surg 117:395-402, 2006. Guyuron B. Management of intraoperative nasal septal tears and perforations. Aesthetic Plast Surg 18:61-63, 1994. Guyuron B. Nasal osteotomy and airway changes. Plast Reconstr Surg 102:856-860; discussion 861-863, 1998. Halk J. Necrotizing periorbital cellulitis following aesthetic rhinoplasty. Aesthet Surg J 25:270-272, 2005. Ham KS, Chung SC, Lee SH. Complications of oriental augmentation rhinoplasty. Ann Acad Med Singapore 12(2 Suppl):S460-S462, 1983. Harley EH, Erdman JP. Dorsal nasal cyst formation. A rare complication of cosmetic rhinoplasty. Arch Otolaryngol Head Neck Surg 116:105-106, 1990. Haye R. Septal perforations—prosthetic and surgical treatment. Rhinology 27:11-15, 1989. Herbst A. Extrusion of a expanded polytetrafluoroethylene implant after rhinoplasty. Plast Reconstr Surg 104:295-296, 1999. Jacobson JA, Kasworm EM. Toxic shock syndrome after nasal surgery. Case reports of risk factors. Arch Otolaryngol Head Neck Surg 112:329-332, 1986. Jan A, Khan MR, Ahmad I, et al. A new look at the nasal adhesions. J Pak Med Assoc 40:259-260, 1990. Erratum in J Pak Med Assoc 40:311, 1990. Klevens RM, Morrison MA, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 298:1763-1771, 2007. Kline RM Jr, Wolfe SA. Complications associated with the harvesting of cranial bone grafts. Plast Reconstr Surg 95:5-13, 1995. Kuriloff DB. Nasal septal perforations and nasal obstruction. Otolaryngol Clin North Am 22:333-350, 1989. Lavine DM, Lehman JA, Jackson T. Is the lacrimal apparatus injured following cosmetic rhinoplasty? Arch Otolaryngol 105:719-720, 1979. Lawson WF. Unusual and fatal complications of rhinoplasty. Arch Otolaryngol 109:164-169, 1983. Leonard DW. Unusual septoplasty complication: Streptococcus viridans endocarditis. Ear Nose Throat J 77:827-831, 1998. Liu ES. Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing. Plast Reconstr Surg 112:282-287, 2003. Lyle WG, Outlaw K, Krizek TJ, et al. Prophylactic antibiotics in plastic surgery: trends of use over 25 years of an evolving specialty. Aesthet Surg J 23:177-183, 2003.

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Mabry RL. Visual loss after intranasal corticosteroid injection. Arch Otolaryngol 107:484-486, 1981. MacLeod AD. Awareness during anesthesia and post traumatic stress disorder. Anesth Intensive Care 20:378-382, 1992. Marshall DR, Slattery PG. Intracranial complications of rhinoplasty. Br J Plast Surg 36:342-344, 1983. Metzinger S. Diagnosing and treating nasal septal perforations. Aesthetic Surg J 25:524-529, 2005. Meyer R. Complications tardives en rhinoplastie. Med Et Hyg 39:742-750, 1981. Meyers AD. Prophylactic antibiotics in nasal surgery. Arch Otolaryngol Head Neck Surg 116:1125-1126, 1990. Noe JM, Finley J, Rosen S, et al. Postrhinoplasty “red nose”: differential diagnosis and treatment by laser. Plast Reconstr Surg 67:661-664, 1981. Ophir D. Resection of obstructing inferior turbinates following rhinoplasty. Plast Reconstr Surg 85:724727, 1990. Pak ML, Chan ES, van Hasselt CA. Later complications of nasal augmentation using silicone implants, J Laryngol Otol 112:1074-1077, 1998. Patterson CN. Symposium: the supra-tip in rhinoplasty: a dilemma. I. Theories and causes of supra-tip convexities. Laryngoscope 86:45-49, 1976. Paulose KO. Pilonidal sinus of the nose. J Laryngol Otol 103:1210-1213, 1989. Prado AS. A new treatment for injuries to the anterior cranial fossa after rhinoplasty. Plast Reconstr Surg 117:721-722, 2006. Rajan GP, Fergie N, Fischer U, et al. Antibiotic prophylaxis in septorhinoplasty? A prospective, random mixed study. Plast Reconstr Surg 116:1995-1998, 2006. Sachs ME. Post-rhinoplastic nasal obstruction. Otolaryngol Clin North Am 22:319-332, 1989. Safian J. A new anatomical concept of postoperative complications in esthetic rhinoplasty. Rhinoplasty 51:162-163, 1972. Scheepers JH, Quaba AA. Clinical experience in the treatment of the “red nose” using the flashlamp pumped pulsed dye laser (585 nm). Aesthetic Plast Surg 18:57-60, 1994. Shafir R, Cohen M, Gur E. Blindness as a complication of subcutaneous nasal steroid injections. Plast Reconstr Surg 104:1180-1182; discussion 1183-1184, 1999. Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 7:230-239, 1984. Sheen JH, Sheen AP. Aesthetic Rhinoplasty, 2nd ed. St Louis: CV Mosby, 1987, pp 554-568. Shiba A. A case of human adjuvant disease after augmentation rhinoplasty. Aesthetic Plast Surg 23:175178, 1999. Shirakabe Y, Shirakabe T, Kishimoto T. The classification of complications after augmentation rhinoplasty. Aesthetic Plast Surg 9:185-192, 1985. Silk KL, Ali MB, Cohen BJ, et al. Absence of bacteremia during nasal septoplasty. Arch Otolaryngol Head Neck Surg 117:54-55, 1991. Slavin SA, Rees TD, Guy CI, et al. An investigation of bacteremia during rhinoplasty. Plast Reconstr Surg 71:196-198, 1983. Stallings JO. Stenosis of the nostril. Arch Otolaryngol 93:525-530, 1971. Stoll W. Complications following implantation or transplantation in rhinoplasty. Facial Plast Surg 13:4550, 1997. Thomas JR, Griner N. The relationship of lateral osteotomies in rhinoplasty to the lacrimal drainage system. Otolaryngol Head Neck Surg 94:362-367, 1986. Thomas SW. Toxic shock syndrome following submucous resection and rhinoplasty. JAMA 247:24022403, 1982. Thompson AC. Nasal tip numbness following rhinoplasty. Clin Otolaryngol 12:143-144, 1987. Toback J, Fayerman JW. Toxic shock syndrome following septorhinoplasty. Implications for the head and neck surgeon. Arch Otolaryngol 109:627-629, 1983. Tobin HA. Extruded nasal implant. Otolaryngol Head Neck Surg 109(3 Pt 1):552-553, 1993. Valeriani M, Mezzana P. Cocaine sniffing immediately after rhinoseptoplasty. Plast Reconstr Surg 107:1921, 2001. Wagner R, Toback JM. Toxic shock syndrome following septoplasty using plastic septal splints. Laryngoscope 96:609-610, 1986.

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PART IV P rimary Rhin oplasty Perhaps the sentiments contained in the following pages are not yet suffici tly fashionable to procure them general favor; a long habit of not thinking a thing wrong, gives it a superficial appearance of being right, and raises at first a formidable outcry in defense of custom. But the tumult soon subsides. Time makes more converts than reason. In the following pages, I offer nothing more than simple facts, plain arguments, and common sense; and have no other preliminaries to settle with the reader, than that he will divest himself of prejudice and pre-possession, and suffer his reason and his feelings to determine for themselves; that he will put on, or rather that he will not put off, the true character of a man, and generously enlarge his views beyond the present day. THOMAS PAINE Common Sense

CHAPTER 15 Common Pr oblems in Anatomy and P roportion And teach me how to name the bigger light, and how the less, that burn by day and night. WILLIAM SHAKESPEARE The Tempest, Act I, Scene 2

“Of course they answer to their names?” the Gnat remarked carelessly. “I never knew them to do it,” [said Alice.] “What’s the use of their having names,” said the Gnat, “if they won’t answer to them?” LEWIS CARROLL Through the Looking Glass

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I ntroducing the Icons Even though each human being has his or her own wonderful uniqueness, and each nose is in some way different, noses do not come in infinite varieties, which makes it much easier for a surgeon. Are the lateral crura orthotopic or malpositioned? Is the tip adequately or inadequately projecting? Is the dorsum low or high relative to the nasal base? What anatomy indicates preoperative airway obstruction? In different patients, common traits yield a common solution. The deformities can therefore be broadly classified into groups, which means that the reconstructive plans become similar, differing quantitatively but not qualitatively. In Part IV, therefore, we use a series of icons—one of which is located in the upper right corner of every page on which a case is being discussed. The relevant icon will show, in broad terms, the reconstructive plan for that patient. I do this for two reasons. First, it is important for a rhinoplasty surgeon to be able to quickly recognize patterns and relationships, decisions that can often be made by inspecting a nose without even touching it. Pattern recognition allows groupings of strategies and ideas, so that a surgeon does not become overwhelmed by apparently limitless combinations and permutations of reduction and augmentation techniques. It is helpful to know where to start for each case, to be able to begin to analyze the deformity within that patient group or pattern and therefore construct a surgical plan quickly and securely. Second, surgeons may wish to refer to portions of this text to find help for particular cases, and in that regard, the icons become a sort of visual index that should make the search easier.

D orsal Deformities THE STANDARD RHINOPLASTY In naming this section “The Standard Rhinoplasty,” I am not being entirely facetious. Although each of these patients had a “bump” and wanted a smaller nose (characteristics that most primary rhinoplasty patients share), each has subsidiary anatomic quirks that must be taken into account. As is often true in rhinoplasty, a deformity may not be as obvious as it seems.

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At this point you may wonder whether there is any rhinoplasty that I consider simple and straightforward or instead whether I secretly delight in composing convoluted solutions for even the simplest surgical problems. Why can’t a nose job just be a nose job? I have great sympathy for surgeons who feel that way. Remember, however, that traditional rhinoplasty has its own taxonomy of postoperative problems, from new airway obstructions to supratip deformities, loss of contour, and postoperative results that look pinched, artificial, and “surgical.” Each of these unfavorable outcomes can be traced to an inadequate understanding of nasal structure, critical anatomic variants, interdependence of anatomic parts, soft tissue limitations, and how rhinoplasty affects the airway. It is perhaps easier to justify complex solutions when treating significant deformities; but because biologic laws behave predictably once they are understood, the same surgical rules must apply even when the deformities may not be as severe. These cases illustrate that principle.

PATIENT STUDY ONE*

This woman’s radix was slightly low, increasing apparent nasal base size; her nasolabial angle was 95 degrees; and her tip was inadequately projecting (note the lobule hanging from the septal angle). Although this tip requires grafts for increased projection, it is important to be conservative so that a larger postoperative nasal base does not exaggerate the preoperative imbalance (that is, the preoperative nose is already bottom heavy). The patient’s goal was a straight dorsum without retroussé. *This patient’s intraoperative sequence is detailed in Chapter 11.

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SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over the bony and upper cartilaginous vaults 2. Dorsal reduction 3. Transfixing incision with trim of membranous and caudal septa (secondary adjustment after dorsal reduction) 4. Retrograde 2 mm trim of cephalic margins, lateral crura 5. Septoplasty 6. Spreader grafts 7. Thin radix graft 8. Tip grafts, crushed only 9. No osteotomy

Postoperative Analysis

At 7 days, the dorsum is already straight and tip projection is adequate. Note that tip grafts support the tip, producing their effect; the soft tissues do not contract around the tip grafts to reveal them.

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Without osteotomies, the relationship of the bony vault to nasal base width is appropriate, but the excessive middle vault narrowness has been corrected with thin spreader grafts, protecting the airway. On the lateral view, the tip is now adequately projecting and the nose appears less dominant in its lower third than it did preoperatively. The opposite obliques show an improved relationship between the elevated root and the augmented tip; contours are smooth and natural. Note also that the lateral crura were malpositioned, but were not resected and replaced. The strong cartilages and thin soft tissues combined to threaten postoperative distortion if more complex techniques had been used. The patient did not object to her tip, and therefore its contour was managed by a very conservative resection and by rotating the nasal base slightly, which decreased the deformity visually but minimized the chance of a postoperative irregularity.

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PRIMARY RHINOPLASTY

PATIENT STUDY TWO A

B

C

D

Likewise, this patient’s nose has some quirks. Although he had adequate tip projection, airway obstruction was profound (notice the middle vault collapse on the left and the flared nostrils, contracted to support his airway). The alar walls are asymmetrical, the left being concave and the right convex. Tip projection is adequate on the left side (C) but inadequate on the right (D), because of a difference in lateral crural rotation. Notice how much information is available from the surface, without exposing the anatomy during surgery.

832

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COMMON PROBLEMS IN ANATOMY AND PROPORTION

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over the bony and upper cartilaginous vaults 2. Dorsal reduction 3. Transfixing incision with modest trim of the caudal and membranous septum, anterior two thirds only 4. Resection and replacement of concave left lateral crus, inverting the cartilage so that the convexity faces laterally 5. Septoplasty 6. Asymmetrical spreader grafts: right graft thinner and convex to left, left graft thicker 7. Thin radix graft 8. Crushed cartilage tip grafts 9. No osteotomy

Soft tissue thickness makes significant reduction neither desirable nor possible in this patient. Even a slight dorsal reduction with tip grafts has allowed a dramatic change in the relationship of the dorsum to the nasal base.

833

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

One year postoperatively and without osteotomy, the bony vault remains appropriately wide in relation to the nasal base. Spreader grafts and left external valvular support have improved the airway (note that the patient no longer flares his nostrils); the middle and lower thirds are now symmetrical.

Tip symmetry has improved, the dorsum is now straight, and the tip projects above the supratip. The base remains unscarred, and the columella is narrow.

834

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The obliques now match more closely, after left middle vault support and correction of inadequate projection in the right tip. Note also that the left alar wall hollow has disappeared, and retraction in the midpoint of the left rim has improved. The dorsum remains strong and straight, appropriate for an adult male, and without the loss of shape that would have accompanied soft tissue contraction.

835

PART IV



PRIMARY RHINOPLASTY

LOW RADIX/LOW DORSUM

There is a sameness about the low radix/low dorsum variant (one of the four critical anatomic variants [see Chapter 5]), and the first clue is a preoperative imbalance. The base seems too large for the upper nose. Associated with a low radix and low dorsum may be orthotopic lateral crura; malpositioned lateral crura; and inadequate, adequate, or excessive tip projection. Remembering that malposition (or cephalic rotation of the lateral crura) often accompanies external valvular incompetence, and that a low dorsum often accompanies internal valvular incompetence, the surgical plan must therefore include three aesthetic goals: 1. Create adequate tip projection. 2. Improve alar wall contour by repositioning lateral crura, if necessary. 3. Improve nasal balance and proportion in one of two ways: a. If the dorsum is convex, reduce the high area and augment the low area. b. If the dorsum is straight, elevate the entire bridge to balance the base. Each alternative minimizes an overall reduction in dorsal height, which would otherwise only exaggerate the preoperative imbalance.

836

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

LOW RADIX

PATIENT STUDY ONE

Adequate tip projection accompanied the low radix in this patient. However, the tip was blunt and there was a high septal deviation toward the left. The caudal septum protruded from the left side of the columella.

SUMMARY OF THE SURGICAL PLAN 1. Resect and replace caudal septum as a free graft 2. Limited skeletonization 3. Slight dorsal reduction 4. Septoplasty 5. Spreader grafts 6. Radix graft 7. Crushed cartilage tip grafts 8. No osteotomies 9. No alar wedge resections (preoperative tip lobule is already broad)

837

PART IV



PRIMARY RHINOPLASTY

A thicker spreader graft was planned on the right to compensate for the high septal deviation toward the left.

A

B

C

The radix graft was layered and longer than the defect, so that it would produce a smooth line when inserted (A). The diminution in nasal base size after graft placement is immediate (compare B and C).

D

E

F

Multiple crushed tip grafts will support and refine the tip with less chance of visibility beneath thin skin (D). Silhouettes dramatize the change in contour and proportion that occurred. 838

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Postoperative Analysis

Fifteen months postoperatively, the nose is more symmetrical. From below, the dislocated caudal septum remains corrected. Tip grafts have narrowed the lobule. The base remains wide, but appropriately wide for tip lobular width.

839

PART IV



PRIMARY RHINOPLASTY

Lateral views show a straight dorsum with improved balance and apparent diminution in nasal base size, despite tip grafting. The oblique view reveals improved tip contour. Notice that increased tip lobular size has produced an apparent decrease in nostril length, even though alar wedge resections were not performed. Geometric mean postoperative airflow increased 2.6 times over preoperative values.

840

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

PATIENT STUDY TWO

This patient had a deformity similar to that of the previous patient, with three differences: the imbalance is worse (the nasal base is larger), and the lateral crura are cephalically rotated—accompanied by inadequate tip projection, as often happens.

SUMMARY OF THE SURGICAL PLAN 1. Resection and replacement of alar cartilage lateral crura 2. Limited skeletonization 3. Dorsal reduction 4. Transfixing incision, slight shortening of caudal and membranous septa 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on right 7. Radix graft 8. Multiple tip grafts

841

PART IV



PRIMARY RHINOPLASTY

A

B

C

After dorsal reduction and relocation of the lateral crura (B), the dorsum is straighter but the tip is still blunt and inadequately projecting. The dorsal resection is only 2 mm thick, but the span of the entire cartilaginous roof is visible on its undersurface (C).

842

CHAPTER 15

D

G



COMMON PROBLEMS IN ANATOMY AND PROPORTION

E

H

F

I

Septoplasty yields adequate material for spreader grafts (D), a thin radix graft (E), and tip grafts (solid and crushed) (F). Notice how the radix graft reduces apparent nasal base size (G). The silhouettes dramatize the changes in nasal balance and dorsum/tip relationships that have occurred.

843

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

One year after surgery, despite medium-thickness soft tissues, the nose has better balance and more normal surface markings. The sidewalls are smooth and confluent, tip grafts are not visible, and tip anatomy is symmetrical. The positions of the lateral crura have been visibly altered, converting the tip to a more favorable contour. On the oblique and lateral views, the dorsum is straight, the tip is slightly above the dorsal line at the septal angle, and the alar hollows are ablated. Notice also that improved lateral crural support has braced the alar rims, blunting the central notch.

844

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

PATIENT STUDIES THREE, FOUR, FIVE, AND SIX

Low radixes occur in 30% to 50% of preoperative noses; its typical pattern must become instantly familiar to a surgeon. In the preoperative views, notice that the combination of low radix and inadequate tip projection act together to increase dorsal height and apparent nasal base size. Postoperatively, note the change in nasal proportion created by leveling the dorsum and raising the radix. The decision to elevate the radix, therefore, affects the amount of dorsal resection required (altering apparent nasal base size), and is particularly helpful for patients with thick skin and those whose noses are bottom heavy. The traditional strategy of correcting a dorsal hump by removing everything above a line passing from the radix to the tip assumes three things: (1) the radix is optimally positioned; (2) the tip is adequately projecting; and (3) the skin can contract to the desired level dictated by the line. In many patients, at least one of these assumptions is wrong. The patterns, however, are consistent. Many other examples of the low radix follow in subsequent sections—note the similarities to these patients. 845

PART IV



PRIMARY RHINOPLASTY

LOW DORSUM

PATIENT STUDY ONE

When the dorsum is straight but low relative to nasal base size, the same logic and strategy used for the low radix apply. In these patients, it is always tempting to accept dorsal height and reduce the tip cartilages significantly, so that the soft tissues will contract to produce a smaller base with better shape and balance.

However, this is not what happens. Consider the operative sequence in this patient, whose nasal balance was similar. 846

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The patient’s goal was to reduce the size of her nasal tip, but to not alter anything else. What occurred instead was the consequence of nasal structural interrelationships. (1) The surgeon reduced the width and projection of the tip cartilages. (2) Decreased tip projection produced an apparent dorsal convexity. The surgeon then reduced the dorsum. (3) Deciding that the dorsum had been overresected, the surgeon performed a septoplasty for graft material, reducing the dorsal strut to less than 5 mm, and apparently fracturing the dorsal strut. (4) Losing dorsal support, the surgeon placed a silicone implant. (5) Noticing that the nostrils were now flared (because of a change in dorsal height), the surgeon performed alar wedge resections. The patient expected a tip reduction. She awoke with a saddle nose corrected by a silicone implant, a new airway obstruction, smaller nostrils, and incipient supratip deformity. Notice the changes that have occurred. On the frontal view, the nose is narrower (from the silicone implant and osteotomies). The upper lip has dropped posteriorly and lengthened. The midface seems to have flattened. On the lateral view, despite a dorsal implant, the dorsum/tip relationships are the reverse of what they were: the tip now hangs from the septal angle and implant, instead of projecting beyond it. Even without this sequence of unfortunate events, the case illustrates the futility of reducing a large tip suffici tly to match a lower, smaller dorsum. The degree of alar cartilage resection necessary to produce the proper shape often exceeds the ability of the tip lobular tissues to adapt; tip support is lost, and concentric lobular contraction proceeds to supratip deformity. In our case, the dorsum is even lower relative to nasal base size than it was in this historic parallel. However, patients do not see dorsal imbalance: they see the nasal base deformity and complain that their tips are too large. The surgical strategy is a combination of reshaping the tip and blending the dorsum to it as necessary.

847

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. Dorsal rasping for graft adherence 3. Resection and replacement of alar cartilage lateral crura 4. Septoplasty 5. Two-layer dorsal graft 6. Tip grafts with ethmoid buttress 7. Bilateral osteotomies

Silhouettes dramatize the resulting changes.

848

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Postoperative Analysis

Postoperatively, the dorsum is narrower and longer, the supratip is flat, the tip is better defined, and tip lobular mass has shifted from cephalad to caudad. A combination of tip reduction and dorsal augmentation has produced upper and lower hemi-noses that now fit, without producing a surgical appearance or loss of definition.

849

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDIES TWO AND THREE

Like the first patient, these two patients had preoperative imbalances; the difference in their treatment is the management of their alar cartilages. In each case, the malpositioned lateral crura were relocated and the tips were grafted. The tips lost the peculiar flatness and apparent downward rotation that is characteristic of inadequate tip projection, and dorsal augmentation decreased the nasofacial angle and therefore diminished apparent nasal base size.

850

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

HIGH RADIX A high radix is the exact inversion of the low radix, and therefore relevant considerations of dorsal and tip relationships also invert: 1. Dorsal reduction improves, rather than worsens, overall nasal balance. 2. Soft tissues at the radix, including the procerus muscle, may blunt or diminish adaption to the underlying skeleton in that area. 3. Particularly in men, the massiveness of the bony vault and overlying soft tissues often limit possible width reduction.

A

B

C

D

It is important to understand the imbalance. In the first patient (A and B), notice what happened to the nasal balance of this high-fashion model who followed her photographer’s advice to have her “whole nose reduced, just a little.” The subsequent cascade of operations, culminating in layered silicone dorsal implants and repeated base reductions, has completely altered her nasofacial angle. Conversely, in the gentleman (C and D), reducing the bony and upper cartilaginous vaults combined with tip grafts has done just the opposite, releasing and lengthening the nasal base and increasing the nasofacial angle.

851

PART IV



PRIMARY RHINOPLASTY

Here is the same preoperative deformity in two other patients. We consider them together.

852

CHAPTER 15

A



COMMON PROBLEMS IN ANATOMY AND PROPORTION

B

D

C

E

In this operative sequence, notice how the relationships of the nasal profile alter as the bony vault and then the cartilaginous dorsum are reduced (B and C, respectively). The 3 mm reduction of the cartilaginous vault has clearly opened the roof (D), thus requiring spreader grafts to reestablish equilibrium and internal valvular competence. After osteotomies and tip grafts, the amount of projection seems excessive, and the change in the nasofacial angle and dorsum/base prominence is significant (E).

853

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Notice, however, what happened as healing progressed: the apparent overcorrection disappeared. This characteristic postoperative change in such noses can be explained by the volume of skin covering the preoperative high bony arch: even in young patients, and more than 2 years postoperatively, the amount of soft tissue tightening that can occur is finite. Notice also the limited bony vault narrowing, despite a significant dorsal reduction. This is not to say that these noses should be overreduced, but the skeleton must be set to accommodate expected postoperative change. This type of technical fine-tuning is only possible to learn through serial intraoperative and postoperative photography. You will not remember 1 year later exactly how each nose appeared at the conclusion of the procedure.

854

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The common thread in each of these patients is dorsal resection with reduction of the radix, spreader grafts to reestablish middle vault continuity and valvular competence (asymmetrically thick, if necessary, to accommodate a high septal deviation), and multiple tip grafts for contour and support. In each patient, the nasofacial angle and the confluence among the upper, middle, and lower nasal vaults has improved. However, notice the limited postoperative narrowing, even late in the postoperative period. Frontal bossing is absent, leaving a relatively flat contour above the radix. Part of the difficulty of achieving a deeper nasofrontal notch is the lack of relief in the caudal frontal bone that might otherwise create more contrast; most patients with high radixes have this frontal bone configuration.

855

PART IV



PRIMARY RHINOPLASTY

UNDULATING BRIDGE There are some dorsal contours that cannot seem to make up their minds: some parts are too high, and some are too low. The most common configuration is a low radix, high mid dorsum, and low supratip, usually with adequate tip projection, cephalically rotated lateral crura, and thin skin. This combination makes the deformity tricky, because complex maneuvers on the lateral crura, whose postoperative flaws might be hidden by thicker soft tissues, will be visible under thin cover. Similarly, attempts to fill in the low spots at the radix and supratip, although logical and conceptually simple (and often successful for patients with thick skin), become disturbingly obvious in these configurations. Assuming that a good septal specimen can be obtained, I prefer to reduce the high point and recreate the entire dorsum with a single, straight graft, crushed and contoured to fit the deformity, and to add a second layer beneath its caudal end as needed to level the supratip.

PATIENT STUDY ONE

There are many women with this nasal shape who never seek rhinoplasty; the ones who do, therefore, are probably fastidious. The plan should be one that is going to work. Note the narrow middle vault, the site of this patient’s airway obstruction. Notice also that her dorsal convexity is high, the supratip depression is deep, and the nasal base is large. Imagine how much larger the base would appear if the dorsal hump were leveled.

856

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The patient illustrated her postoperative goal using a photograph of this woman, whose nose was shorter with a straighter dorsum, but whose tip and supratip were remarkably similar.

SUMMARY OF THE SURGICAL PLAN 1. Moderate skeletonization over the middle vault, narrow over the bony vault 2. Slight dorsal reduction 3. Retrograde cephalic trim of alar cartilage lateral crura 4. Transfixing incision with a 3 mm trim of the anterior caudal septum and a 2 mm trim from the membranous septum 5. Septoplasty 6. Spreader grafts 7. Layered dorsal grafts 8. No tip grafts 9. No osteotomies

857

PART IV



PRIMARY RHINOPLASTY

This patient’s septal specimen provided a straight dorsal graft, and a second, thinner piece was fixed with an absorbable suture to its cephalic, posterior end. Dorsal reduction and lateral crural modification allowed slight tip rotation, shortening the nose.

Postoperative Analysis

858

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Postoperatively, the middle vault is slightly wider, but tip projection and contour have changed only minimally. The radix is slightly higher, but the dorsum and supratip are level, ending in a slight supratip depression that mimics the patient’s preoperative goal. Postoperative airflow increased 1.9 times over preoperative values.

859

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY TWO

This young woman represents a more extreme variant: her skin is thinner, her alar cartilages are more convex and prominent, her middle vault is tighter, and her nose is longer, but her bridge still undulates. In addition to the dorsal graft needed to smooth bridge contour, the alar cartilages will be treated by a modest trim of the lateral crura and a vertical interruption of the domes, using crushed cartilage to reshape the tip and minimize the visibility of the lateral genua edges. An alternative would be lateral crural resection and replacement or transposition, but that is a riskier strategy when the cartilages are strong and the skin is thin, because postoperative deformation is much more likely.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization of the upper cartilaginous vault, limited over the bony vault 2. Reduction of the bony and cartilaginous dorsum 3. Transfixing incision with 3 mm trim of caudal septum and overlying mucosa 4. Delivery of alar cartilages through infracartilaginous incisions; 2 mm cephalic trim and 3 mm vertical wedge removed at each lateral genu 5. Septoplasty 6. Spreader grafts 7. Dorsal graft 8. Crushed cartilage tip grafts

860

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The primary septum yielded suffici t cartilage for a dorsal graft. Reduction of the dorsum, upper lateral cartilages, and caudal septum shorten the nose. It is important to resist the temptation to reduce the alar cartilages excessively, recognizing that soft tissue contraction will increase the effect that the surgeon sees on the table. Because tip grafts, not columellar struts, re-create projection, and because no permanent sutures have been placed, the tip is balanced on the alar cartilage arches.

861

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Postoperatively, there is confluence among the upper, middle, and lower nasal thirds after 31⁄2 years. The upper third maintains its preoperative width but seems slightly wider because the dorsum has been reduced, the middle third has been opened by spreader grafts, and the lower third has been narrowed by reduction of the alar cartilage arch. The entire nose is slightly shorter, but the nasal base remains unscarred. NOTE: Although interrupting the arch narrowed the alar cartilage arch, there is only

a modest change in tip lobular width. It is important to remember that tip lobular width is not only cartilage width but also skin width. For the tip to narrow significantly, both cartilage and skin components must have the ability to tighten. Skin contraction is always finite, even when the soft tissue cover is thin.

862

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The dorsum is straight, the tip is adequately projecting, and the sidewalls are confluent but supported. The columella remains narrow. Crushed cartilage tip grafts are not visible, even under this patient’s thin skin.

863

PART IV



PRIMARY RHINOPLASTY

STRAIGHT DORSUM A

B

Original preoperative

Preoperative

D

C

Preoperative

Preoperative

This patient’s aquiline, straight dorsum was reduced, and her columella was resected, thickening her delicate skin, and costing contour and function. The smooth preoperative columellar contour was replaced by the knobby discontinuity visible in B and C. Maxillary augmentation, nasal shortening, tip and columellar grafts, and revision of the columellar scar provided improvement (D), but the beauty of the original contours cannot be restored. 864

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Comparing inferior views before and after columellar resection, the surgical changes are not flattering. Although carefully performed open rhinoplasties can yield very good or even excellent scars, columellar resections never do. The columella, already thickened by its central strut, develops discontinuities and deformities that are impossible to correct, because tissue is missing.

Even more interesting are the changes that have taken place on the frontal and inferior views. In an effort to reduce a large nasal base, made apparently larger by the dorsal resection, one of her surgeons resected a portion of the columella, along with the alar bases.

865

PART IV



PRIMARY RHINOPLASTY

Here are other unhappy examples. In each case, the surgeon was trying to reduce a straight dorsum with a disproportionate nasal base. Nasal base reduction by direct excision should be filed with other well-intentioned techniques that succeed only on paper. It does not work. An alternative, less destructive strategy is to use the principles outlined previously: 1. Ignore the false assumptions of reduction rhinoplasty, recognizing instead that soft tissue contractility is limited, not infinite, and that the nasal regions are interrelated, rather than independent. 2. Employ the principles of balance and proportion whenever reduction alone is not suffici t. 3. Maximize function. 4. Respect the patient’s aesthetic. In particular, recognize that a straight dorsum tests a surgeon’s ability to do less of everything, which requires mastery of techniques that allow small, incremental changes and a light touch.

866

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

PATIENT STUDY ONE A

B

C

There is nothing strikingly wrong with this patient’s nose. At most, it only has a little too much of everything: dorsal height, width, and length. But the patient had a very definite idea of what she wanted: a nose resembling her sister’s (C, right). Achieving that goal within the patient’s tissue limits meant small reductions in overall nasal size but more tip contour—increasing tip angularity without increasing projection.

867

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. Rasping of bony vault 3. Trim of cartilaginous dorsum 4. Retrograde reduction of alar cartilage lateral crura (2 mm) 5. Transfixing incision with resection of caudal septum and mucosa 6. Septoplasty 7. Spreader grafts 8. Radix graft 9. Multiple crushed tip grafts 10. Bilateral osteotomies

Postoperative Analysis

Two years later, the nose is narrower, and the middle vault remains stable and supported, despite dorsal resection. The nasal base is unscarred and the tip lobule is slightly narrower, but the external valves remain supported.

868

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

The dorsum is slightly lower but straight, and the tip remains projecting but narrower and more defined. Her result more closely resembles the familial appearance that the patient wished to share.

This is an operation measured in millimeters. It is surprising how such small resections and augmentations can alter contour. The dorsum is now slightly lower and the tip is more projecting, the radix graft has altered the balance between dorsal length and nasal base size, and the combination of lateral crural reduction, tip grafting, and elevation of the caudal and membranous septa has added delicacy to the nasal base.

869

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY TWO

The straight nose seems simple, because none of its regional deformities are very remarkable. However, that is exactly what makes this type of nose so treacherous. The diagnosis must be precise, and individual maneuvers must be carried out sufficiently but not in excess, because the space between “too little” and “too much” is tight. Here, the patient’s goals were a lower dorsum and a narrower, more projecting tip. Notice the radix position (slightly low) and the tip contour (blunt). The patient’s lateral crura are malpositioned. Her nostrils are small relative to her tip lobular size.

870

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

SUMMARY OF THE SURGICAL PLAN 1. Resection and replacement of alar cartilage lateral crura 2. Resection of medial crural footplates through short overlying incisions 3. Slight dorsal reduction, not opening cartilaginous roof 4. No transfixing incision 5. Septoplasty 6. Single-layer radix graft 7. Multiple tip grafts with buttress 8. Bilateral osteotomies

Postoperative Analysis

The patient is shown 5 years postoperatively. Dorsal reduction and osteotomies have narrowed the upper nose, and spreader grafts were unnecessary because the cartilaginous roof was not opened.

871

PART IV



PRIMARY RHINOPLASTY

The dorsum is still straight, but its relationship to the tip has changed, in concert with the patient’s wishes.

The 5-year, postoperative oblique view shows the change in nasal balance that has occurred with radix and tip grafting, particularly from the left side, where the preoperative inadequate tip projection is more obvious. Without augmentation, more refinement could not have been obtained beneath this soft tissue cover, and without elevating the radix, the postoperative nose would have been unbalanced.

872

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

PATIENT STUDY THREE

This young man had sustained previous trauma that caused the left nasal bone to protrude through the skin. It was subsequently removed by his first treating physician. There was a high septal deviation toward the right, and the caudal septum protruded from the right side of the columella. Although the dorsum is straight on the lateral view, the right oblique draws the low radix/inadequate tip projection combination into relief.

873

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Relocate the caudal septum 2. Minimal skeletonization 3. Slight dorsal trim 4. Septoplasty 5. Asymmetrical spreader grafts, thicker on left 6. Lateral wall graft over left bony vault depression 7. Thin radix graft 8. Two crushed tip grafts 9. Bilateral osteotomies

Despite previous trauma, the septal specimen supplied suffici t cartilage. Notice that there is asymmetry in spreader graft thickness to compensate for the high septal deviation, with the left much thicker than the right. A thin radix graft has altered the nasofacial angle, and tip grafts have brought the tip above the septal angle.

874

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Postoperative Analysis

Postoperatively, the nose is symmetrical, the sidewalls are smooth, and the lateral wall graft has filled the depression left by the excised nasal bone. The resected caudal septum supports the columella as a free graft and remains midline.

875

PART IV



PRIMARY RHINOPLASTY

Without a columellar strut, tip projection has been increased, and lobular contour appears normal.

The oblique views now match for this previously asymmetrical nose. The nasofacial angle has improved. Notice that all surface markings remain identifiable (the bony vault edges and the lateral crural contours).

876

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

M iddle Vault Problems NARROW MIDDLE VAULT/NARROW NOSE A narrow nose or narrow middle vault indicates a nose already in jeopardy. A suboptimal airway almost certainly exists, and dorsal resection will incapacitate the internal valves and can reduce nasal airflow up to 50%, according to our rhinomanometric measurements. It is worth making this diagnosis preoperatively.

PATIENT STUDY ONE

Although patients’ eyes are drawn to the height of their dorsa and the width of their tips, the surgeon should look elsewhere. Consider how disproportionately narrow the middle third is and its implication for the patient’s airway. Without a basis for comparison, such patients may not be aware of their preoperative obstructions, but symptoms can often be elicited. Observation frequently shows a patient who mouth-breathes through the initial interview, and sidewall support with a cottontipped applicator during inspiration brings immediate improvement. The surgeon must not forget the consequences of dorsal reduction without also stabilizing the middle vault. In this patient the dorsum is high, the radix is low, the tip is inadequately projecting, and the cephalically rotated lateral crura have abandoned the external valves and left them flat and unsupported.

877

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Resection and relocation of alar cartilage lateral crura 2. Limited skeletonization 3. Dorsal reduction 4. Transfixing incision; shortening of the caudal and membranous septum 5. Septoplasty 6. Spreader grafts 7. Radix grafts 8. Multiple tip grafts

Postoperative Analysis

Three years after surgery, the nose is symmetrical and the sidewalls are smooth. The nose progressively widens from top to bottom, without the preoperative hourglass shape that constricted the airway. Postoperative airflow increased 12.9 times over preoperative measurements.

878

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Despite tip grafting, the higher radix has favorably altered nasal base size, and the overall appearance has created an integrated nose, with each third fitting the adjacent one and the whole.

The combination of a lower dorsum and a repositioned lateral crura has produced oval, stable nostril openings.

879

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY TWO

A narrow nose can coexist with a low or high dorsum. When it accompanies a low dorsum, short nasal bones are usually present, as in this patient. The shorter the nasal bones are, the relatively longer the upper lateral cartilages are. Like a sail without a batten, the long expanse of upper lateral cartilage is frequently unstable, unsupported by a high, broad dorsum or long, sturdy nasal bones. When the lateral crura are cephalically rotated, even the external valves function poorly. This patient flares her nostrils to support her airways. Notice that the cephalic end of the middle vault hollow indicates that the bony arch extends only 20% of the distance from the radix to the tip.

880

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

SUMMARY OF THE SURGICAL PLAN 1. Resect and replace alar cartilage lateral crura 2. Minimal skeletonization 3. Rasp bony vault for graft adherence 4. Septoplasty 5. Bilateral spreader grafts, single layer dorsal graft, thicker at root 6. Tip grafts 7. Bilateral alar wedge resections, removing 3 mm of external skin and 2 mm of vestibular skin

A

B

Each lateral crus was dissected free from its external and vestibular skin and resected at the lateral genu (A), crushed, trimmed, and replaced along the alar rim in an orthotopic position (B). A septal cartilage graft is another alternative, but using the patient’s lateral crura spares more donor material.

881

PART IV



PRIMARY RHINOPLASTY

The septum yielded suffici t material for a nice dorsal graft. No other nasal skeleton was resected. Spreader grafts and a thin dorsal graft were fashioned. If the septum had provided less material, the dorsal graft alone would probably have provided suffici t internal valvular support and functional improvement, but both spreader and dorsal grafts provide width and stability.

Silhouettes dramatize the effect of tip reduction and skeletal rearrangement. Notice that no contraction is required for the surface effect to appear.

882

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Postoperative Analysis

One-year postoperative views show smooth, continuous dorsal lines. The middle vault is slightly wider.

The dorsum is now straight, ending in a defined point of maximum projection. The inadequate tip projection often associated with alar cartilage malposition has been corrected by tip grafts, using neither a columellar strut nor sutures. The thin dorsal graft has raised the radix slightly and diminished apparent nasal base size. The base is slightly narrower, the patient no longer flares her nostrils, and the nostril sills are smooth. Postoperative airflow increased 4.6 times over preoperative values. 883

PART IV



PRIMARY RHINOPLASTY

WIDE NOSE

Like thick skin, wide noses dramatize the error of False Assumption Number One: nasal soft tissues do not have an infinite ability to contract to the shape of any underlying skeleton. Skeletal reduction, even accompanied by alar base resections, only creates soft tissue distortion, not a smaller nose. Because human beings often seem to want the opposite of what they have, most patients with wide noses and/or thick skin describe or bring photographs of noses that are narrow and angular. If these patients are not to be disappointed, surgeons must channel these goals into results that can actually be achieved: even if the postoperative tip is not narrower, would a more angular tip be acceptable? Even if the postoperative dorsum is not narrower, would a straight dorsum be acceptable? If surgeon and patient can agree on essentials and find practical common ground, it is safe to proceed. Some patients, however, cannot abandon an ideal but surgically impossible objective, in which case these consultations can be long and unsuccessful.

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PATIENT STUDY ONE

As this delightful young woman noted, “My nose spoils my image.” Although the bony vault seems wide, it is still appropriate for the nasal base width; although the base seems wide, the tip lobule consumes most of its transverse dimension. This patient’s frontal contours demonstrate nicely how many rhinoplasty decisions must be based on the relationship of one nasal part to another, even more than on the relationships of nasal parts to other ideal measurements or to the face as a whole. In practical terms, making a nose that fits the face translates to making the best possible nasal contours. The surgeon can really do no more than that.

SUMMARY OF THE SURGICAL PLAN 1. Maxillary augmentation, greater in the perialar areas 2. Minimal skeletonization and no transfixing incision 3. Dorsal reduction 4. Resection and replacement of the alar cartilage lateral crura 5. Septoplasty 6. Bilateral spreader grafts, with convexities toward the right for a high septal deviation to the left 7. Harvest ear cartilage 8. Radix graft 9. Tip grafts of ear cartilage (insufficient septal cartilage) 10. Columellar grafts of ear cartilage 11. No osteotomy

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Dorsal reduction, lateral crural relocation, and maxillary augmentation have removed the deformities and repositioned the upper lip. However, the tip lobular skin remains soft and unsupported, and if left alone, the skin would retract to a supratip deformity.

Spreader, dorsal, tip, and columellar grafts support the skin sleeve in a new shape. Dorsal reduction, maxillary augmentation, and columellar grafts have shortened the nose. The nose seems smaller.

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Postoperative Analysis

Without osteotomies, but with lateral crural repositioning and dorsal grafting, the nose seems narrower and shorter. The cephalically rotated lateral crura are now orthotopic. Lateral crural repositioning and tip grafting have altered the nostril axis. Geometric mean postoperative airflow has increased 2.6 times over preoperative values.

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The oblique view is smooth and symmetrical. Lateral crural repositioning has ablated the alar wall hollows. Despite greater tip projection, the dorsal graft has maintained nasal balance, maxillary augmentation has moved the upper lip forward slightly (which is even more apparent on the frontal view), and columellar grafts have provided additional caudal displacement without widening the columella. These grafts extend the length of the columella only, and are not struts.

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PATIENT STUDY TWO

The deformity seen here is less common, and it cannot be treated by dorsal resection, because the dorsum is already at the proper height. Instead, the surgeon must think in three dimensions and narrow the shoulders of the bony and upper cartilaginous vaults without narrowing the dorsum, and then reestablish lateral wall position with spreader grafts.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. Rasping bony vault shoulders, lowering bony sidewalls to allow 2 mm medial movement with osteotomies 3. Trim upper lateral cartilages to allow similar movement 4. Septoplasty 5. Spreader grafts 6. Crushed cartilage tip grafts 7. Bilateral osteotomies

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PRIMARY RHINOPLASTY

A

Resection allows narrowing

B

Spreader grafts control sidewall position

C

This is the single circumstance in which I will separate the upper lateral cartilages from the dorsal septal edge, to facilitate technical reduction of the upper lateral cartilages without touching the dorsal septal edge (A). My finger and the scissors denote the space created between the sidewalls and the dorsum in B. The oblique view shows the expected middle vault collapse (C). Notice the relatively short bony vault. Septoplasty cleared the airway and provided material for spreader and tip grafts.

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Postoperatively, the bony and upper cartilaginous vaults are narrower, but spreader grafts have established the position of the middle third and internal valves, preserving function. Without them, the intraoperative inverted-V deformity would have become permanent. Crushed tip grafts have lifted the point of maximum tip projection slightly, but the profile line is essentially unaltered, as the patient wished. Wide noses with thick skin are rarely discussed among surgeons, because they are so difficult to treat using conventional methods. Absolute skeletal reduction in all areas would yield supratip deformity, because the tissues cannot change their dimensions. The surface effect of complex skeletal maneuvers is blunted or lost.

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However, some limited improvements can be offered if they will meet the patient’s stated and unstated goals. Tip grafts improve contour. Dorsal reduction and/or rearrangement can improve shape and balance. These changes can be subtle or unacceptable to some prospective patients. I always show a series of postoperative results, including patients whose noses changed only modestly, and try to gauge a new patient’s reaction. If he or she cannot accept the limited improvement that I can offer, it is better for me not to operate.

T ip Problems INADEQUATE TIP PROJECTION Inadequate tip projection ranks high among concepts that rhinoplasty surgeons must fully grasp, and for which they must have a dependable and reliable corrective technique. Even though inadequate tip projection is one of four common anatomic variants that must be diagnosed preoperatively to avoid an adverse result (see Chapter 5), many rhinoplasty surgeons have their own unique definitions of what tip projection is, how to define whether tip projection is adequate, inadequate, or excessive, and therefore how to correct each of these subtypes. It is also easy to confuse excessive tip projection with a large nasal base, a distinction that I have made earlier (see Chapters 1, 2, and 7). If the diagnosis is inaccurate, the correction will be unsuccessful. Adequate tip projection must be adequate relative to something—in this case the nasal dorsum. Unless the alar cartilages are strong enough to support the tip independent of dorsal height, the patient cannot have a straight profile. Any tip that projects to or beyond the level of the anterior septal angle is adequately projecting, and any tip that does not project to the level of the anterior septal angle is inadequately projecting. The tip lobular/septal angle relationship is independent of nasal base size (instead reflecting skin volume and distribution), and therefore is applicable to any nose. Tip projection denotes cartilage strength, not skin volume—a concept that may seem obvious but that becomes diffused or lost if the surgeon adds parameters such as the distance from the upper lip to the tip-defining point, the proportion of the nasal base in front of the anterior facial plane, or the ratio of base dimension to dorsal length, all of which are really skin volume and distribution estimates.

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But there is an even easier way of defining inadequate tip projection: by learning to recognize what it looks like. The key to much of rhinoplasty is learning to see what is beneath the skin surface—what combination of anatomic shapes has created a particular surface configuration. In this case, the relevant anatomy is middle crural length. Adequate tip projection indicates a middle crus that is long enough to project the tip to the level of the septal angle or beyond (left). When the middle crus is too short, the tip lobule seems to hang from the septal angle, which is inadequate tip projection (right).

Preoperative

Postoperative

Even without a schematic to guide you, the anatomic shape that creates this patient’s tip strength is obvious. The medial, middle, and lateral crura can only have one dimension based on their surface impact. A surgical dissection is not necessary. As you examine each of the preoperative photographs throughout this text, imagine the underlying shape that must exist—the responsible anatomy.

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Inadequate tip projection is common, approximately 40% in primary patients and 80% in secondary patients. Perhaps more than any other single nasal anatomic feature, inadequate tip projection impacts nasal aesthetics and surgical strategy. The surgeon new to rhinoplasty should therefore remember seven points about inadequately projecting tips: 1. Adequate tip projection is essential for a straight postoperative profile. 2. Inadequate tip projection profoundly affects the entire profile line, causing some patients to view their noses as hooked, when the actual problem is tip lobular shape, not nasal length. Shortening the nose does not correct inadequate tip projection. 3. Inadequate tip projection reflects a short middle crus. 4. Adequate tip projection must be adequate relative to something—in this case the septal angle. 5. Tip projection reflects cartilage strength, not skin volume; the treatment for inadequate tip projection therefore depends on skeletal change, not skin thinning or supratip suturing. 6. Inadequate tip projection cannot be rendered adequate by reducing the tip. 7. The surgeon cannot correct inadequate tip projection by a larger dorsal resection. The solution is to set the dorsum at the proper level, and to bring the tip forward by lengthening the middle crural segment.

PATIENT STUDY ONE

This patient’s inadequate tip projection is accompanied by a slightly low radix and significant asymmetry in the middle vault. Previous trauma had injured the septum, causing airway obstruction and upper lip recession. Notice that, on the frontal view, the high septal deviation begins just below the medial canthi, at the caudal end of the bony arch, thus indicating short nasal bones. 894

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SUMMARY OF THE SURGICAL PLAN 1. Maxillary augmentation 2. Resection and replacement of the caudal septum 3. Dorsal reduction 4. Retrograde reduction of alar cartilage lateral crura 5. Septoplasty 6. Thick left spreader graft 7. Onlay to upper cartilaginous vault 8. Thin radix graft 9. Multiple tip grafts 10. Right osteotomy

A sheet of 1 mm Gore-Tex was rolled into an implant, trimmed, and fixed circumferentially with 6-0 nylon sutures. The implant was inserted through an incision in the right nasal floor into a subperiosteal pocket dissected high over the maxillary arch and tight against the piriform aperture. In this nonmobile position with thick soft tissue cover, the implant is comfortable and effective, and it has a very low complication rate (unlike alloplastic nasal augmentation, which I do not perform). Septoplasty cleared the airway and provided excellent building material. However, previous trauma had increased calcification in the septal segments. Accordingly, cartilage was saved for the dorsal and tip grafts. Calcified cartilage or bone can be used for spreader grafts, and the ethmoid makes an excellent lateral wall graft.

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A

B

C

D

Notice the position of the vertical plane of the lip after maxillary augmentation. A radix graft has been fashioned, its edges have been beveled, and the graft has been crushed and contoured to the defect (thickest at the root) (A). The only pieces left for tip grafting are small scraps, none of which form a traditional shield graft (B). However, because the tip lobular pocket is intact, the dissection can be high and limited so that maximum effect can be obtained from the limited material.

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Postoperative Analysis

At 1 year postoperatively, frontal contours are smooth and more symmetrical. There is a slight residual depression in the left cartilaginous vault. Although absolute symmetry would have been better, asymmetries such as these are better left undercorrected than overcorrected: patients accept a familiar asymmetry that has been improved more than a nose that is straighter but much wider.

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The low radix/inadequate tip projection combination is a common one. Dorsal reduction alone would have enlarged apparent nasal base size, and such thick tissues are unlikely to have contracted over a lower dorsum. Without an effective increase in middle crural length (tip grafts), a straight dorsum could not have been achieved. The nose seems shorter even though the nasolabial angle was not altered. Two little augmentations—radix and spreader grafts—have completely altered the relationship of the nasal tip to the dorsum, and the balance between nasal length and nasal base size. That so much could come from so little is part of the magic of rhinoplasty. Throughout this chapter, notice the similarities among the surgical plans for patients with inadequate tip projection. If the dorsum is high, it is reduced, but not with an expectation of seeing a straight profile until tip projection increases. As little as possible is done to alar cartilages—only enough to remove the deformity and maintain or establish external valvular support—and the tip pocket is not violated by other maneuvers, ensuring secure graft placement. Notice also that increasing tip projection always obliges the patient to accept a slightly larger tip lobule, regardless of how the surgeon decides to increase projection. Increases in projection mean equivalent increases in tip lobular size, whether the projection is created by a columellar strut, by tip grafts, or by forcing the alar cartilage arches into new positions with sutures. Nature has only one set of rules,

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and skin sleeve distribution imposes limits on surgeons. My preference for tip grafts rests on its anatomic logic: grafts augment the deficient cartilaginous area, a quality not shared by borrowing cartilage from another deficient area with sutures or by forcing the tip skin forward with pressure from the nasal spine. Because inadequate tip projection is so common and so critical to recognize (see Chapter 5), there are many examples of it throughout this text. All examples of inadequate tip projection share common traits. Once recognized and integrated into your right brain, the pattern and its underlying anatomy are impossible to miss, which is fortunate, because failure to correct this anatomic variant is one of the most common causes of an unfavorable rhinoplasty result. The good news is that the anatomic defect—a short middle crus—is consistent and always responds to augmentation of the deficient cartilaginous segment.

BOX TIP, BALL TIP, AND ALAR CARTILAGE MALPOSITION Boxy and ball nasal tips are widely recognized as aesthetically complex surgical problems, and they have inspired imaginative solutions to correct the deformities they impart. The overwhelming majority of boxy and ball tips, however, have an importance outside the lobule that has been understated in the surgical literature and that eluded me for many years: both tip types represent variants of alar cartilage malposition (cephalic rotation). In fact, both boxy and ball tips occur uncommonly in patients with orthotopic alar cartilages, but instead appear most often as foreshortened variants of alar cartilage malposition. Therefore the major importance of either the boxy or the ball tip is not its cosmetic configuration within the lobule, but rather its functional ramifications outside the lobule at the external nasal valve.

Definition of Terms The terms ball, broad, bulbous, and boxy have been used differently and sometimes interchangeably in the literature. According to most prior usage, ball and bulbous tips should be equivalent. However, neither broad nor bulbous defines the convexity (the ball) nor the angulation (the box) of the lateral crura. The characteristics that distinguish ball and boxy tips from their flatter counterparts are best recognized from inferior views.

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Distinguishing Criteria Distinguishing Criteria for Boxy and Ball Tips

A

Type

Angle of Divergence

Lateral Genu

Lateral Crural Shape

Flat Boxy Ball

60 degrees 90 degrees 60 degrees

Well defined Well defined Poorly defined

Flat Usually convex Usually convex

B

C

The boxy tip (A) imparts a square perimeter to the nasal base, in which there is a wide divergence between the medial crura (often approaching 90 degrees) and a relatively sharp angulation at the lateral genua, creating the corners of the box. Associated lateral crura usually have varying degrees of convexity. The ball tip (B) has a narrower, more ideal angle of divergence (closer to 60 degrees) and lateral crural convexities that often seem to efface the lateral genua entirely. Tips that are not clearly boxy or ball shaped are therefore relatively flat (C), and so have clearly demarcated lateral genua and discrete middle crural segments that create angles of divergence close to 60 degrees. These characteristics apply whether the alar cartilages are adequately or inadequately projecting.

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Association of Lateral Crural Orientation and Tip Contour in 200 Consecutive Rhinoplasty Patients 100 Consecutive Primary Patients Lateral Crural Orientation

Number

Orthotopic Flat Ball tip Boxy tip

32 27 5 0

Malpositioned (cephalically rotated) Flat Ball tip Boxy tip

68 18 31 19

Incidence in Subgroup (%)

84 16 0

100 Consecutive Secondary Patients

Number

13 2 10 1

Incidence in Subgroup (%)

15 77 8

87 26 46 28

24 36 27

28 41 31

This table indicates the relationship between lateral crural orientation and tip contour in 100 primary and 100 secondary consecutive rhinoplasty patients.* Notice several important points: 1. Among the primary rhinoplasty patients, only 32% had orthotopic lateral crura, again dramatizing the prevalence of cephalic rotation (malposition). 2. Within that orthotopic group, the comparative relative frequency of occurrence of the ball tip was only 16%. 3. There were no boxy tips among the primary patients, and the remaining 84% of patients had flat lateral crura. 4. Alar cartilage malposition occurred in 68% of primary patients and 87% of secondary patients. 5. Among these primary and secondary malposition patients, each tip variant occurred at the same relative frequency: The ball tip was the most common in both groups, the boxy tip was second most common, and flat lateral crura were least common.

*Fisher z-tests were performed with a significant difference between independent proportions for each proportion. A 2 ⫻ 6 chi-square for the entire table was 25.8; df ⫽ 5, p ⬍0.0001. A 2 ⫻ 2 chi-square for lateral crural orientation by primary and secondary patients was 10.35, reduced to 9.3 using the Yates correction; df ⫽ 1, p ⬍0.01.

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PRIMARY RHINOPLASTY

Association of Lateral Crural Orientation, Tip Contour, and Projection in 100 Consecutive Primary Rhinoplasty Patients

Lateral Crural Orientation

Incidence in Entire Patient Group (%)

Orthotopic Adequately projecting Flat Boxy or ball Inadequately projecting Flat Boxy or ball

32

Malpositioned (cephalically rotated) Adequately projecting Flat Boxy or ball Inadequately projecting Flat Boxy or ball

68

Incidence in Subgroup* (%)

10 2

31 6

17 3

53 9

7 7

10 10

20 34

29 50

*Upper and lower halves of the columns do not total 100% because of rounding.

This table reflects the association of lateral crural orientation, tip contour, and tip projection among the 100 primary patients only.* Note the following: 1. Inadequate tip projection was significantly more common among patients with malposition than among those with orthotopic lateral crura. 2. Similarly, boxy or ball tips were much more common among primary patients with malposition than among patients with orthotopic lateral crura, regardless of tip projection. 3. The most common configuration in patients with orthotopic lateral crura was flat, inadequately projecting alar cartilage (53%). 4. In contrast, the most common phenotype among patients with malposition was inadequately projecting ball or boxy tip (50%). 5. Adequate tip projection in patients with malposition was relatively uncommon (only 20%), regardless of tip or lateral crural configuration. What does all this mean? First, the data reaffirm that malposition is common, not only in primary patients but especially in secondary patients, which is why malposition qualifies as one of the four anatomic variants that predispose to unfavorable results (see Chapter 5).

*A 2 ⫻ 2 ⫻ 2 chi-square test (crural orientation by projection by contour) gave a value of 21.2; df ⫽ 1, p ⬍0.001.

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The data also indicate that the overwhelming majority of ball and boxy tips are associated with lateral crura that are malpositioned and not orthotopic. Finally, both ball and boxy tip lateral crura (particularly the latter) are foreshortened, as if crural length has been used up in the arch that it forms in the axial plane, relocating the posterior insertion of the crus. Therefore boxy and ball tip lateral crura are both malpositioned and relatively short, increasing the skeletal deficit and its effect on external valvular function. In the cases that follow, notice the posterior alar hollow in the preoperative views and its improvement once the lateral crura have been relocated.

If unrecognized, malposition (in its ball, boxy, or flat incarnations) imparts characteristic secondary deformities. Patients frequently flare their nostrils to stabilize their external valves; in some patients, the soft tissue deficit becomes significant enough to require composite grafts, which not only replace the vestibular skin deficiency but also supply ample alar rim support. Among 100 secondary patients requiring composite grafts, the overwhelming proximate cause of the deformity was a preexisting alar cartilage malposition (80%).

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PRIMARY RHINOPLASTY

BOXY TIP

PATIENT STUDY ONE

This patient illustrates the common association of a boxy tip with inadequate projection. In addition, she has a low radix, a high septal deviation toward the left, and upper lip retrusion (most evident on the frontal view)—a common secondary rhinoplasty characteristic seen also in some primary patients.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation, right side thicker than left 2. Resect and replace lateral crura 3. Minimal skeletonization 4. Transfixing incision 5. Shorten anterior caudal and membranous septa 6. Dorsal reduction 7. Septoplasty 8. Asymmetrical spreader grafts, thicker on right than left 9. Radix graft 10. Tip graft with buttress 11. No osteotomies

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The right lateral crus has been resected and relocated, moving the natural convexity from the tip (where it causes a deformity) to the alar wall (where it converts flat to oval). Skeletal rearrangement has reduced the deformity but rebalanced the nose and increased tip projection. Notice the change in upper lip carriage created by maxillary augmentation.

Postoperative Analysis

Two years postoperatively, the nose is slightly shorter, the sidewalls are confluent and symmetrical, the high septal deviation is camouflaged and straightened by spreader grafts, and the upper lip is more vertical. Resection and replacement of the lateral crura have altered the nostril contour favorably and reduced the bulk of the squared preoperative basal perimeter. 905

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PRIMARY RHINOPLASTY

The profile shows that the radix is slightly higher and the tip now projects slightly beyond the septal angle. The oblique views particularly dramatize the unfavorable preoperative tip shape, reconfigured by lateral crural repositioning and tip grafting. Notice that the preoperative alar hollows have disappeared. Geometric mean postoperative airflow increased 3.6 times in this patient.

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PATIENT STUDY TWO

This patient demonstrates the less common combination of the boxy but adequately projecting tip (represented by only 7% of our series of 100 consecutive primary patients). Typical of so many patients with boxy and ball tips, her skin is thin and her cartilages are stiff and bossed. Her caudal septum protrudes into the left airway. There is a slight dorsal hump, and her low radix position increases apparent nasal base size. Notice that there is a broad angle between her middle crura and the foreshortening that her lateral crural bossing causes.

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PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Relocate caudal septum through hemitransfixing incision 2. Resect and replace lateral crura 3. Moderate skeletonization 4. Resect dorsum 2 mm 5. Trim membranous septum, shortening the nose 6. Septoplasty 7. Bilateral spreader grafts (thicker on left than right) 8. Single-layer radix graft 9. Multiple crushed cartilage tip grafts

A

B

C

After relocating the caudal septum, the lateral crura were dissected free from their external and vestibular skin coverings to rotate them caudally as flaps. In A, note the original, cephalically rotated position (dotted line) and the intended new position (solid line). However, once fully dissected, the lateral crura proved too irregular and distorted for the flap procedure (B); thus each crus was resected, crushed, trimmed, and replaced along its alar rim. After all resections, nasal contours seem improved, but the soft tissues are unsupported; without reequilibration, contraction would yield a supratip deformity (C).

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A



COMMON PROBLEMS IN ANATOMY AND PROPORTION

B

C

Substantial spreader grafts will support the narrow middle third and adjust the high septal deviation (A). A thin radix graft will lift the root slightly (B). Multiple tip grafts will reform the lobule (C).

Postoperative Analysis

Fifteen months postoperatively, the nose is more symmetrical and the sidewalls are smoother. Notice, however, that the strong lateral crura retain a natural convexity, despite crushing. The columella remains narrow, and the caudal septum is now midline.

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PRIMARY RHINOPLASTY

The dorsum is straight and better balanced, and the nasal base retains much of its native shape (in accordance with the patient’s wishes) but seems less massive. The external valves are supported.

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BALL TIP

PATIENT STUDY ONE

Among the boxy, ball, and flat malposition subtypes, the most common is the malpositioned ball tip with inadequate projection (31% in my series). Like the others, the deformity has cosmetic and functional components. Notice the normal angle of divergence of the medial crura (60 degrees), but the poorly defined lateral genu extend into the convex lateral crura. A low radix accentuates the large nasal base, and the small tip lobule (short middle crus) seems to hang from the septal angle.

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PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Resect and replace lateral crura 2. Minimal skeletonization 3. Dorsal reduction 4. Transfixing incision with reduction of nasal spine and caudal septum, and excision of medial crural footplates 5. Septoplasty 6. Spreader grafts 7. Layered radix graft (one longer piece with two additional pieces posteriorly at the cephalic end) 8. Multiple lightly crushed tip grafts with a buttress 9. No osteotomies

A

B

After resection and replacement of the lateral crura, the dorsum is trimmed in anticipation of both radix and tip grafting (which diminish the required dorsal resection). Notice that even this thin resection has opened the cartilaginous roof (A). In configurations such as these, dorsal reduction alters the profile very little (B). The caudal ends of the bony arch and the middle vault hollow were marked preoperatively.

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A

B

A layered radix graft was sized to the defect (A). Compare the appearance after radix grafting (B) to the appearance after dorsal resection (B in the previous figure). Notice how radix elevation has straightened the dorsal line and decreased apparent nasal base size.

A

B

C

Tip grafts have been selected and lightly crushed, but they have been left untrimmed until their necessary length has been determined (A). A small ethmoid buttress lies on the tongue blade center. After buttress placement, the point of maximum projection has been set, but the tip is artificially angular (B). Crushed grafts inserted anterior to the ethmoid buttress soften the contour and further increase projection (C).

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PRIMARY RHINOPLASTY

Postoperative Analysis

Even at 1 month after surgery, the nose has begun to take shape. The lobule has started to narrow, and the profile is straight. Notice the change from the blue card picture: serial intraoperative photographs strengthen a surgeon’s judgment and teach feel.

At 1 year, the tip has narrowed. Without osteotomy, the narrower upper nose now fits the wider nasal base. The external valves are supported.

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COMMON PROBLEMS IN ANATOMY AND PROPORTION

On the profile and oblique views, the nose remains balanced and less bottom heavy. Lateral crural repositioning has ablated the alar wall hollows. Geometric mean postoperative nasal airflow increased 2.5 times over preoperative values.

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PRIMARY RHINOPLASTY

This patient, like the previous one, has thick soft tissues. Lateral crural resection and replacement creates conditions under which the tip lobule can narrow. However, a surgeon cannot force the narrowing—individual soft tissue characteristics prevail. Compare the postoperative results of the previous patient and of this patient, also at 1 year. This patient’s tip was treated in the same way, but although the profile has improved, her tip lobule (now soft and unsupported) has not narrowed. Patients must accept this possibility beforehand so that they do not confuse the uncontrollable for the uncontrolled.

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PATIENT STUDY TWO

This patient’s thinner skin highlights the malposition. The alar walls are unsupported and grooved, and the broad sweep of her cephalic lateral crura overpowers the short middle crural segments. The bony vault, however, is appropriately narrow relative to nasal base width. Characteristically, she wants what she does not have: retroussé and tip projection.

917

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PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Relocate lateral crura 2. Minimal skeletonization 3. Dorsal reduction 4. Transfixing incision with nasal spine, caudal septal, and medial crural footplate reductions 5. Septoplasty 6. Radix graft 7. Asymmetrical spreader grafts, thicker on the left than on the right (high septal deviation to right, masked by malposition) 8. Tip grafts with buttress 9. No osteotomies

NOTE: Retroussé is produced by adequate projection beyond a straight dorsum, not

by thinning or suturing the supratip skin (the upper nasal sutures represent an incidental scar revision).

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COMMON PROBLEMS IN ANATOMY AND PROPORTION

Postoperative Analysis

Twenty months postoperatively, the tip is narrower, more angular, and projecting. Middle crural length is adequate. Even without osteotomy, the narrow bony vault balances nasal base width.

Despite unfavorable soft tissues, the combination of dorsal reduction, radix grafts, and tip grafts have achieved the patient’s aesthetic goals. Spreader grafts and lateral crural repositioning stabilized the airway. Repositioned lateral crura support and reshape the alar rims. Postoperative nasal airflow increased 4 times over preoperative values. 919

PART IV



PRIMARY RHINOPLASTY

Sheen described malposition in 1979, but it has been regarded as an uncommon phenotype. However, malposition is exceedingly common, even among primary patients. Malposition affects alar crease length and alar margin shape and height, and occurs almost universally with cleft lip nasal deformities, as we shall see. The data presented here indicate that the lateral crura of most boxy and ball tips are malpositioned (cephalically rotated) and foreshortened in their axial planes, and provide poor structural support for the external valves. The major importance of ball and box tips is therefore not only the lobular deformity, but also the functional deficit associated with them.

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COMMON PROBLEMS IN ANATOMY AND PROPORTION

KNUCKLED TIP OR NARROW TIP

A subtype of primary deformity has as its most prominent characteristic a narrow tip with knuckles at the lateral genua, which patients characterize as “a witch’s nose.” Commonly associated with this tip configuration are thin skin, short nasal bones, and a disproportionately large nasal base. The dorsum may be straight or high. Tip projection may be adequate or inadequate. A short bony vault increases the proportion of cartilaginous sidewall support, so high septal deviations and valvular incompetence are usually obvious. A

B

The knuckled alar domes are delivered (A), and they are treated by vertical wedge resections through cartilage that spare lining (B). There are surgeons who object to disrupting the alar cartilage arch because it alters tip projection, and this is a valid argument. But trouble only arises when the surgeon does nothing to compensate. If the tip is reconstructed with multiple crushed grafts, projection can be maintained, reduced, or augmented to satisfy the patient’s wishes. 921

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY ONE

Typical of this subtype, short nasal bones support significant septal deviation poorly, leaving concave sidewalls. Although the domes are knuckled, the lateral crura are also concave, and valvular support is poor.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization over middle vault, narrow over bony vault 2. Retrograde reduction of alar cartilage lateral crura with 4 mm resection from domes 3. Submucosal 3 mm trim of caudal ends, upper lateral cartilages 4. Reduction of cartilaginous dorsum only 5. Complete transfixing incision, shortening caudal and membranous septa 6. Septoplasty 7. Asymmetrical spreader grafts, thicker on left than right 8. Upper dorsal graft 9. Multiple crushed tip grafts 10. Columellar grafts 11. No osteotomies

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Postoperative Analysis

Eighteen months postoperatively, the long middle vault remains straighter, guided by the spreader grafts. Slight shortening has resected some of the caudal septal deflection. The tip is less projecting but normally contoured, without projecting edges, and cartilaginous dorsal resection and radix grafting have altered the nasofacial angle, diminishing apparent nasal base size. Geometric mean nasal airflow increased 12 times over preoperative measurements.

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PATIENT STUDY TWO

This patient shares similar characteristics with the previous one, with striking sidewall collapse in a nose doubly handicapped by short nasal bones and malposition. Unlike the previous patient, however, this woman has a high dorsum; but because the radix is similarly low, the same imbalance exists.

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SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization 2. Resect alar cartilage lateral crura, medial to the deformed lateral genua; crush; and replace the long alar rims 3. Dorsal reduction 4. Transfixing incision, shortening caudal and membranous septa 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on left than right 7. Layered radix graft 8. Multiple crushed tip grafts 9. No osteotomies

At the conclusion of the surgery, the upper nose is smaller but the radix is higher and the base is rotated, each of which helps to improve nasal balance.

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Postoperative Analysis

Two years postoperatively, the narrow, knuckled tip has disappeared, and spreader grafts have aligned the walls, softening the depressions at the caudal end of the bony arch. Geometric mean nasal airflow increased 12 times over preoperative measurements, a value that is artifactually high because of abnormally poor preoperative values. Lateral crural repositioning has improved alar wall contour and ablated the hollow, so the patient no longer flares her nostrils to support her airways. Notice that no alar wedge resections were performed. The apparent reduction in nostril size stems from an improvement in alar flare and from the increased tip lobular size (the result of grafting). 926

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P roblems of Length and Balance SHORT NASAL BASE/SHORT NOSE In patients with relative or absolute skin sleeve deficiency, skin expansion is not practical and stretch is limited. However, a surgeon can achieve what is possible by small expansions and reductions and by the sleight of hand that stems from improved balance and proportion.

SHORT NASAL BASE

PATIENT STUDY ONE A

B

C

D

This is a slightly long nose with a tight nasal base and a vertical nasofacial angle. Dorsal reduction and shortening alone will not provide the nasal balance that this patient prefers (D). Her surgeon must move the nasal base forward visually. The following tools are potentially available: 1. Reduce dorsal height, if needed. 2. Increase tip projection. 3. Augment the columella (not as a strut but to increase medial crural strength). 4. Augment the maxillary arch, if needed.

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SUMMARY OF THE SURGICAL PLAN 1. Two-piece maxillary augmentation, widest in perialar areas 2. Limited skeletonization 3. Dorsal reduction 4. Retrograde lateral crural reduction, 2 mm 5. Transfixing incision, shortening the caudal and membranous septa, 3 mm 6. Septoplasty 7. Spreader grafts 8. Thin radix graft 9. Multiple tip grafts with buttress 10. Columellar grafts 11. Bilateral low-to-high osteotomies

A piece of 1 mm Gore-Tex sheeting is rolled to form a tapered implant, split, and placed into a subperiosteal pocket, high over the maxillary arch and tight against the piriform apertures. The implant is placed as the first step, using a no-touch technique (see Chapter 17).

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COMMON PROBLEMS IN ANATOMY AND PROPORTION

B

C

Reduction of the bony vault increases apparent cartilaginous dorsal height (compare A and B). Maxillary augmentation and dorsal resection have moved the nasal base anteriorly (B). The cartilaginous resection is thin, but suffici t to open the roof (C).

A

B

After placing the left spreader graft (A), both internal valves have been reconstructed (B).

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C

A

Septal cartilage is crushed to make a pliable graft (A), which is placed at the radix under direct vision. The dorsal line is thereby straightened (B). Tip grafts are added, completing the reconstruction (C).

Silhouettes demonstrate the change in nasal base position and balance that has occurred.

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Postoperative Analysis

One year postoperatively, the improvement in nasal base projection is evident, even on the frontal view. The subnasale seems less compressed. Any change in postoperative nostril visibility alarms some patients, particularly if they do not anticipate it. The surgeon is wise to obtain explicit consent preoperatively. Notice the effect of maxillary augmentation.

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Tip and columellar grafts have moved the nasal base forward and increased projection. It may have been possible to perform this rhinoplasty without the radix graft, particularly considering the short nasal base. But the combination of a low radix and inadequate tip projection creates the appearance of the nose sliding down the patient’s face; this and the patient’s postoperative goal influenced my surgical plan.

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SHORT NOSE Primary rhinoplasty patients with short noses seem to have too much skeleton for the amount of soft tissue, but the soft tissue is normally elastic. This anatomy must be distinguished from that in secondary cases, in which the skin deficit is the result of direct excision or contraction after skeletal reduction and in which the soft tissues are now often tight and inelastic. The logic of the corrective plan is to reduce skeletal volume where possible in a way that will lengthen the nose or add soft tissue (particularly lining). In addition, augmenting the cephalic and caudal ends of the nose (radix, tip lobule, and columella) creates absolute and relative increases in nasal length by forming a nose that begins higher and ends lower.

PATIENT STUDY ONE

This patient is a tall man with a short nose. The dorsal skeleton pulls his inadequately projecting tip and alar rims cephalad, braced only by the caudal septum. The tendency of dorsal reduction to shorten the nose further must be overcome by dorsal augmentation at the cephalic end and by rotating the nasal base caudally. This is a shape in disequilibrium: a skin sleeve too small to accommodate its skeleton, creating a so-called tension nose characterized by a high dorsum, an obtuse nasolabial angle, and elongated nostrils (not all tension noses are short).

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SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. Minimal reduction of bony dorsum 3. 3 mm reduction of cartilaginous dorsum 4. Transfixing incision; resection of posterior caudal septum with overlying mucosa 5. No modification of tip cartilages 6. Septoplasty 7. Asymmetrical spreader grafts (thicker on right than left) 8. Upper dorsal graft 9. Tip grafts with ethmoid buttress, caudally positioned 10. Bilateral osteotomies 11. Augmentation mentoplasty

A

B

C

D

Dorsal reduction releases skin tension, and caudal septal resection allows the base to rotate inferiorly (B). Septoplasty yielded a specimen that was thin and largely bony. The best piece was selected for the dorsum (C). The dorsal graft and tip grafts draped the skin sleeve cephalad and caudad. Notice that the tip buttress was placed to set the desired angle of rotation, and other grafts added to it forced the tip and columellar skin inferiorly, adding absolute and relative nasal length (D).

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Postoperative Analysis

At 31⁄2 years postoperatively the nose is more symmetrical, corrected by asymmetrical spreader grafts (thicker on the right than the left). Dorsal reduction and caudal rotation of the base have decreased nostril visibility. Tip projection is greater, and the tip lobule is appropriately larger, representing an increase in projection and middle crural length. Dorsal reduction has relieved anteroposterior nostril tension, converting tight slits to ovals.

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P roblems of Volume LARGE BASE/LARGE SKIN SLEEVE Large bases and large skin sleeves are two variations on a theme and so can be considered together. As much as or more than any of the deformities that we have considered in this chapter, large bases and large skin sleeves are right-brain surgical problems, because they share a common characteristic: there is too much skin for the preoperative skeleton. The surgeon has a problem, because skin sleeve contraction is limited (in contradistinction to False Assumption Number One, which states that the nasal soft tissue cover has an infinite ability to contract to the shape of any underlying skeleton). If the rhinoplasty reduces net skeletal volume, but the skin sleeve (already excessive) does not contract suffici tly, the nose will not shorten. Hence the aphorism that “Long noses become long again postoperatively.” The way out of this puzzle is a combination of reduction and augmentation, maintaining support where possible and adding it where needed. In specific terms, the surgeon should alter the structures that will shorten the nose by performing the following steps when indicated: 1. Reduce the dorsum, if possible. 2. Shorten the caudal ends of the upper lateral cartilages submucosally. 3. Reduce lateral crural width, maintaining valvular support. 4. Shorten the caudal and membranous septa. 5. Avoid narrowing the nose by osteotomy. And augment where possible: 1. Radix graft for balance 2. Spreader grafts for middle vault width 3. Tip and columellar grafts for nasal base support 4. Lateral wall grafts for symmetry

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PATIENT STUDY ONE

Paralleling the long nose in this woman is a severe functional problem, signaled by the flared nostrils as she tries to support her airways. Her middle vault is asymmetrically narrow after a high septal deviation to the right, and her caudal septum deflects into the right airway. Her base is long and large, unbalanced by her slightly low radix. Her soft tissues are moderately thick. Aside from the functional correction, the aesthetic key in this nose depends on diminishing apparent nasal base size by improving nasal balance—the necessity of illusion.

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SUMMARY OF THE SURGICAL PLAN 1. Resect and replace lateral crura 2. Resect and replace dislocated caudal septum as free graft 3. Wide skeletonization 4. Shorten membranous and caudal septa through transfixing incision 5. Dorsal reduction, right greater than left 6. Septoplasty 7. Asymmetrical spreader grafts, thicker on the left than right 8. Thin radix graft 9. Multiple crushed cartilage tip grafts, no buttress 10. Columellar grafts 11. No osteotomy

Let your technique-oriented left brain relax, and enjoy the right-brain changes: dorsal reduction and nasal shortening have reduced apparent nasal base size, and the radix graft altered the balance.

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Postoperative Analysis

Preoperative

Preoperative

Postoperative

Postoperative

Postoperative with inspiration

Five years postoperatively, the nose is shorter and the patient no longer flares her nostrils to support her airways. The sidewalls are confluent, and even without osteotomy, the width relationship of the upper and lower nasal thirds is appropriate.

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Lateral crural relocation has altered alar wall contour. The tip is symmetrical, the base is unscarred, and the resected and replaced caudal septum supports the columella without relapse of the curvature.

Repositioned lateral crura have ablated the alar wall hollows. Tip grafts have altered tip contour, columellar grafts support the nasal base, and slight nasal shortening and radix grafts have altered nasal balance. Although no skin contraction has occurred (not possible with this skin sleeve), the nose seems smaller. This is the magic of rhinoplasty. The dorsum is still straight, but the aesthetics improve with better balance. 940

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PATIENT STUDY TWO

This patient is younger, with thinner skin that arguably will contract more. The upper nose is excessively narrow, the large and long base crowds the upper lip, and the skin sleeve is large. A significant reduction will cost the patient contour. The short nasal bones and narrow middle vault signal a poor airway.

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Wide skeletonization, dorsal reduction, submucosal upper lateral cartilage shortening, caudal septal resection, and thin radix and spreader grafts widen and support the new nose and maintain the airway. Postoperatively, dorsal height balances the large base (which seems smaller), and the middle vault is now appropriately wide, bringing the whole frontal view into better proportion. The nose seems to have moved visually cephalad on the patient’s face.

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PATIENT STUDY THREE

In a different variation of the same problem, this older patient has thicker skin, but with the same low radix/large nasal base. She has a narrow middle vault with a high septal deviation toward the left, and dimples marking the wavy lateral crura. The plan is the same: reduce the deformity, stabilize the airway, and support the skin sleeve, with dorsal reduction, nasal shortening, and radix, spreader, lateral, tip, and alar wall grafts. Twenty months after surgery, the symmetry, airway, and nasal shortening remain.

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The long nose has many parallels with the ptotic breast. Both have excess skin relative to underlying support. Unless a surgeon plans to resect skin, the underlying support must be increased, not reduced, to maintain postoperative skin position. But noncontractile skin may lengthen postoperatively, despite the surgeon’s best efforts. Additional secondary shortening or augmentation may improve the result further. As is true in breast surgery, recurrent ptosis may be a problem. Direct skin excision can assist unusual cases (see Chapter 16). The key, however, remains equilibrium: balancing skeletal support to skin sleeve volume. The surgeon who controls the postoperative equilibrium controls the postoperative result.

You may not see much difference between the long nose and the large base patient studies, which do occur along a continuum. The difficulty for most patients, and many surgeons, is not technical but rather conceptual. All of the preoperative noses in this section are large, and the patients know it. Their goals are uniformly smaller noses, but for these patients truly smaller noses come at a price measured in lost function, contour, and proportion. The solution, therefore, is not a philosophical one; that is, it does not depend on whether a surgeon likes large noses or likes small noses. Successful treatment of a long nose/large nasal base requires a strategy that respects what Nature can and cannot do. If thick, large skin sleeves cannot contract, the postoperative plan cannot depend on contraction. During the consultation, these patients’ surgical goals must be reframed from “smaller” to “better function, better shape, and better proportion.” In doing so, most patients achieve what they believe is a smaller nose, because proportion reduces apparent size; but they may have achieved success by an unexpected route. 944

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BIBLIOGRAPHY Adamson PA, McGraw-Wall BL, Morrow TA, et al. Vertical dome division in open rhinoplasty. An update on indications, techniques, and results. Arch Otolaryngol Head Neck Surg 120:373-380, 1994. Adamson PA, Morrow TA. The nasal hinge. Otolaryngol Head Neck Surg 111:219-231, 1994. Adham MN. A new technique for nasal tip cartilage graft in primary rhinoplasty. Plast Reconstr Surg 97:649-655, 1996. Aiach G, Levingnac J, Riu R. La Rhinoplastie Esthétique. Paris: Masson, 1989, pp 84-90. Ali-Salaam P, Kashgarian M, Davila J, et al. Anatomy of the Caucasian alar groove. Plast Reconstr Surg 110:261-266, 2002. Anderson JR. A reasoned approach to nasal base surgery. Arch Otolaryngol 110:349-358, 1984. Arregui JS, Elejalde MV, Regalado J, et al. Dynamic rhinoplasty for the plunging nasal tip: functional unity of the inferior third of the nose. Plast Reconstr Surg 106:1624-1629, 2000. Beekhuis GJ. Nasal tip projection. Eye Ear Nose Throat Mon 51:92-99, 1972. Beekhuis GJ, Colton JJ. Nasal tip support. Arch Otolaryngol Head Neck Surg 112:726-728, 1986. Behmand RA, Ghavami A, Guyuron B. Nasal tip sutures part I: the evolution. Plast Reconstr Surg 112:1125-1129, 2003. Belinfante LS. Nasal tip modification using four distinct methods. J Oral Maxillofac Surg 51:506-516, 1993. Berman WE. Changing the nasal tip: Part III. Ear Nose Throat J 75:71, 1996. Berman WE. Changing the nasal tip: Part IV. Ear Nose Throat J 75:131, 1996. Berman WE. Changing the nasal tip: Part V. Ear Nose Throat J 75:198, 1996. Berman WE. Changing the nasal tip: Part VI. Ear Nose Throat J 75:280, 1996. Bernstein L. A basic technique for surgery of the nasal lobule. Otolaryngol Clin North Am 8:599-613, 1975. Burres S. Tip points: defining the tip. Aesthetic Plast Surg 23:113-118, 1999. Cachay-Velásquez H. Surgical lengthening of the shot columella: division of the depressor septi muscles. Eur Arch Otorhinolaryngol 249:336-339, 1992. Cárdenas JC, Carvajal J, Ruiz A. Securing nasal tip rotation through suspension suture technique. Plast Reconstr Surg 117:1750-1755, 2006. Chait L, Ritz M. A new approach for the refinement of the very broad nasal tip. Br J Plast Surg 44:572574, 1991. Close LD, Schaefer SD, Schultz BA. The over-projecting nasal tip: precise reduction without rotation. Laryngoscope 97:931-936, 1987. Collawn SS, Fix RJ, Moore JR, et al. Nasal cartilage grafts: more than a decade of experience. Plast Reconstr Surg 100:1547-1552, 1997. Constantian MB. Closed rhinoplasty current techniques, theory, and applications. In Mathes SJ, Hentz VR, eds. Plastic Surgery, vol 2, 2nd ed. Philadelphia: Saunders, 2005, pp 517-572. Constantian MB. Elaboration of an alternative, segmental, cartilage-sparing tip graft technique, experience in 405 cases. Plast Reconstr Surg 103:237-253, 1999. Constantian MB. Experience with a three-point method for planning rhinoplasty. Ann Plast Surg 30: 1-12, 1993. Constantian MB. Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plast Reconstr Surg 105:316-331, 2000. Constantian MB. Functional effects of alar cartilage malposition. Ann Plast Surg 30:487-499, 1993. Constantian MB. Grafting the projecting nasal tip. Ann Plast Surg 14:391-402, 1985. Constantian MB. Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation. Plast Reconstr Surg 110:1116-1133, 2002. Constantian MB. Narrow middle vault and unrecognized alar cartilage malposition: the face of secondary rhinoplasty today. Presented at the New England Society of Plastic and Reconstructive Surgeons, Inc. Lenox, MA, June 2004. Constantian MB. Rhinoplasty in the graft-depleted patient. Oper Tech Plast Reconstr Surg 2:67-81, 1995.

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Constantian MB. The boxy tip, the ball tip, and alar cartilage malposition: variations on a theme—a study in 200 consecutive primary and secondary rhinoplasty patients. Plast Reconstr Surg 116:268281, 2005. Constantian MB. The incompetent external nasal valve: pathophysiology and treatment in primary and secondary rhinoplasty. Plast Reconstr Surg 93:919-931, 1994. Constantian MB. The middorsal notch: an intraoperative guide to overresection in secondary rhinoplasty. Plast Reconstr Surg 91:477-484, 1993. Constantian MB. The septal angle: a cardinal point in rhinoplasty. Plast Reconstr Surg 85:187-195, 1990. Constantian MB. The two essential elements for planning tip surgery in primary and secondary rhinoplasty: observations based on review of 100 consecutive patients. Plast Reconstr Surg 114:15711581, 2004. Constantian MB, Clardy RB. The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast Reconstr Surg 98:38-54, 1996. Daniel RK. Rhinoplasty: a simplified, three-stitch open tip suture technique. Part I: Primary rhinoplasty. Plast Reconstr Surg 103:1491-1502, 1999. Daniel RK. Rhinoplasty: a simplified, three-stitch open tip suture technique. Part II: Secondary rhinoplasty. Plast Reconstr Surg 103:1503-1512, 1999. Daniel RK. Rhinoplasty: creating an aesthetic tip. A preliminary report. Plast Reconstr Surg 80:775-783, 1987. Daniel RK. Secondary rhinoplasty following open rhinoplasty. Plast Reconstr Surg 96:1539-1546, 1995. Davidson TM, Murakami WT. Tip suspension suture for superior tip rotation in rhinoplasty. Laryngoscope 93:1076-1080, 1983. Dayan SH, Kempinars JJ. Treatment of the lower third of the nose and dynamic nasal tip ptosis with Botox. Plast Reconstr Surg 115:1784-1785, 2005. de la Fuente A, Martin del Yerro JL. Calibrated nasal tip: review of 100 cases. Aesthetic Plast Surg 18:357-361, 1994. Duarte A, Atilano J, Cuenca R. Apex columellar cartilage graft. Aesthetic Plast Surg 12:217-222, 1988. Ellis DA, McDonald GA. Narrowing of the wide nasal tip. J Otolaryngol 13:55-57, 1984. Fanous N. The “light reflex” tip-plasty—a new theory in tip esthetics and tip correction. J Otolaryngol 10:162-168, 1981. Fanous N. The “light reflex” tip-plasty: surgical application of a new theory in tip esthetics. Laryngoscope 92:310-313, 1982. Farina R, Cury E, Ackel IA. S-shaped nasal wings: rhinopteroplasty. Case reports. Aesthetic Plast Surg 7:177-178, 1983. Farina R, Cury E, Ackel IA. The prominent nasal tip. Aesthetic Plast Surg 8:141-144, 1984. Farkas LG, Kolar JC. Anthropometrics and art in the aesthetics of women’s faces. Clin Plast Surg 14:599616, 1987. Farkas LG, Munro IR. Anthropometric Facial Proportions in Medicine. Springfield, IL: Charles C. Thomas, 1986. Foda HM. Management of the droopy tip: a comparison of three alar cartilage-modifying techniques. Plast Reconstr Surg 112:1408-1417, 2003. Fredricks S. Tripod resection for “Pinocchio” nose deformity. Plast Reconstr Surg 53:531-533, 1974. Friedman WH, Biller HF. Evaluation of nasal tip surgery. Laryngoscope 85:1539-1549, 1975. Garcia-Velasco J, Garcia-Velasco M. Tip graft from the cartilaginous dorsum in rhinoplasty. Aesthetic Plast Surg 10:21-25, 1986. Ghavami A, Janis JE, Guyuron B. Regarding the treatment of dynamic nasal tip ptosis with botulinum toxin A. Plast Reconstr Surg 118:263-264, 2006. Ghilardi C. An approach to nasal tip remodeling. Aesthet Surg J 21:345-348, 2001. Giunta SX. Nasal tip surgery—a simple technique to aid in symmetry. Laryngoscope 94:974-976, 1984. Goldman IB. The importance of the mesial crura in nasal-tip reconstruction. AMA Arch Otolaryngol 65:143-147, 1957. Goode RL, Ross J. Columellar advancement for nasal tip elevation. Laryngoscope 83:1123-1127, 1973. Gruber RP, Friedman GD. Suture algorithm for the broad or bulbous nasal tip. Plast Reconstr Surg 110: 1752-1764, 2002.

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Gruber RP, Grover S. The anatomic tip graft for nasal augmentation. Plast Reconstr Surg 103:1744-1753, 1999. Gruber RP, Nahai F, Bogdan MA, et al. Changing the convexity and concavity of nasal cartilages and cartilage grafts with horizontal mattress sutures: Part I. Experimental results. Plast Reconstr Surg 115:589-594, 2005. Gryskiewicz JM. The “iatrogenic-hanging columella”: preserving columellar contour after tip retroprojection. Plast Reconstr Surg 110:272-277, 2002. Guerrero-Santos J. Cosmetic repair of the acute columellar-lip angle. Plast Reconstr Surg 52:246-249, 1973. Gunter JP. The tripod concept for correcting nasal-tip cartilages. Aesthet Surg J 24:257-260, 2004. Gunter JP, Friedman RM. Lateral crural strut graft: technique in clinical applications in rhinoplasty. Plast Reconstr Surg 99:943-952, 1997. Gunter JP, Rohrich RJ. Correction of the pinched nasal tip with alar spreader grafts. Plast Reconstr Surg 90:821-829, 1992. Gunter JP, Rohrich RJ. External approach for secondary rhinoplasty. Plast Reconstr Surg 80:161-174, 1987. Guyuron B, Behmand RA. Nasal tip sutures part II: the interplays. Plast Reconstr Surg 112:1130-1145, 2003. Guyuron B, Poggi JT, Michelow BJ. The subdomal graft. Plast Reconstr Surg 113:1037-1040, 2004. Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 112:1929-1935, 2003. Hamra ST. Crushed cartilage grafts over alar dome reduction in open rhinoplasty. Plast Reconstr Surg 92:352-356, 1993. Hamra ST. Repositioning the lateral alar crus. Plast Reconstr Surg 92:1244-1253, 1993. Hinderer UT. Relationship between the protrusion of the nasal tip and the dorsum in rhinoplasty. Aesthetic Plast Surg 8:201-212, 1984. Hoefflin M. Geometric sculpturing of the thick nasal tip. Aesthetic Plast Surg 18:247-251, 1994. Hubbard TJ. Exploiting the septum for maximal tip control. Ann Plast Surg 44:173-180, 2000. Ishida LC, Ishida J, Henrique Ishida L, et al. Total reconstruction of the alar cartilages with a partially split septal cartilage graft. Ann Plast Surg 45:481-484, 2000. Janeke JB, Wright WK. Studies on the support of the nasal tip. Arch Otolaryngol 93:458-464, 1971. Johnson CM, Toriumi DM. Open structure rhinoplasty: featured technical points and long term followup. Facial Plast Surg Clin North Am 1:1-22, 1993. Kamer FM, Churukian MM. Shield graft for the nasal tip. Arch Otolaryngol 110:608-610, 1984. Kamer FM, Churukian MM, Hansen L. The nasal bossa: a complication of rhinoplasty. Laryngoscope 96:303-307, 1986. Kridel RW, Konior RJ, Shumrick KA, et al. Advances in nasal tip surgery. The lateral crural steal. Arch Otolaryngol Head Neck Surg 115:1206-1212, 1989. Kuran I, Tümerdem B, Tosun U, et al. Evaluation of the effects of tip-binding sutures and cartilaginous grafts on tip projection and rotation. Plast Reconstr Surg 116:282-288, 2005. Larabee WF Jr. The tripod concept. Arch Otolaryngol Head Neck Surg 115:1168-1169, 1989. Mavili ME, Safak T. Use of umbrella graft for nasal tip support. Aesthetic Plast Surg 17:163-166, 1993. McCollough EG, English JL. A new twist in nasal tip surgery. An alternative to the Goldman tip for the wide or bulbous lobule. Arch Otolaryngol 111:524-529, 1985. McCollough EG, Mangat D. Systematic approach to correction of the nasal tip in rhinoplasty. Arch Otolaryngol 107:12-16, 1981. McKinney P. Management of the bulbous nose. Plast Reconstr Surg 106:906-917, 2000. McKinney P, Stalnecker M. Surgery for the bulbous nasal tip. Ann Plast Surg 11:106-113, 1983. Micheli-Pellegrini V. Archivio Italiano di Otologia, Rinologia e Laringologia, Revista Italiana Di Chirurgia Plastica, 1975. Micheli-Pellegrini V. Cause D’Insuccesso Nella Chirurgia Estetica Del Naso, Revista Italiana Di Chirurgia Plastica, 1974. Micheli-Pellegrini V. LaTecnica Per Correggere la Punta Durante La Rinoplastica, Revista Italiana Di Chirurgia Plastica, 1990.

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Millard DR Jr. Corrective rhinoplasty and augmentation mentoplasty. In Grabb WC, and Smith JR, eds. Plastic Surgery: A Concise Guide to Clinical Practice. Boston: Little Brown, 1968, p 510. Mir y Mir L. Dissection of the medial crura as a standard procedure in rhinoplasty: case studies. Aesthetic Plast Surg 11:203-205, 1987. Mischkowski RA, Kübler AC. Correction of congenital nasal hypoplasia associated with Kallmann syndrome using self-inflating injectable tissue expander pellets. Plast Reconstr Surg 118:1147-1452, 2006. Mittelman H. A more precise technique of tip rhinoplasty with a cartilage-splitting incision. Arch Otolaryngol 107:425-427, 1981. Mocella S, Bianchi N. Double interdomal suture in nasal tip sculpturing. Facial Plast Surg 13:179-196, 1997. Muti E. Treatment of alar cartilages: should the “domes” be interrupted? Aesthetic Plast Surg 17:193198, 1993. Nagel F. Tip surgery and functional rhinoplasty. Facial Plast Surg 11:191-203, 1995. Neu BR. Reduction of nasal tip projection with medial rotation of alar cartilages. Plast Reconstr Surg 108:763-770, 2001. Ortiz-Monasterio F, Olmedo A, Oscoy LO. The use of cartilage grafts in primary aesthetic rhinoplasty. Plast Reconstr Surg 67:597-605, 1981. Papel ID. A graduated method of tip graft fixation in rhinoplasty. Arch Otolaryngol Head Neck Surg 121:623-626, 1995. Papel ID, Mabrie DC. Deprojecting the nasal profile. Otolaryngol Clin North Am 32:65-87, 1999. Parkes ML, Kamer FM, Merrin ML. “Practical suggestions on facial plastic surgery—how I do it.” Modifications of the Fomon technique in the approach to the lower lobule. Laryngoscope 87:1774-1778, 1977. Peck G. The difficult nasal tip. Clin Plast Surg 4:103-110, 1977. Peck GC. The onlay tip graft for nasal tip projection. Plast Reconstr Surg 71:27-39, 1983. Pensler JM. The septal strut for nasal projection following closed rhinoplasty. Aesthet Surg J 26:275279, 2006. Petroff MA, McCollough EG, Hom D, et al. Nasal tip projection. Quantitative changes following rhinoplasty. Arch Otolaryngol Head Neck Surg 117:783-788, 1991. Pitanguy I. Revisiting the dermocartilaginous ligament. Plast Reconstr Surg 107:264-266, 2001. Pitanguy I, Salgado F, Radwanski HN, et al. The surgical importance of the dermocartilaginous ligament of the nose. Plast Reconstr Surg 95:790-794, 1995. Psillakis JM. O papel da crus medial nas rhinoplastias. Folha De Cirurgia Plastica 80:6, 1980. Rafaty FM. Correction of the over-projecting nasal tip by the suture technique. Arch Otolaryngol 103:361-364, 1977. Randall P. The direct approach to the “hanging columella.” Plast Reconstr Surg 53:544-547, 1974. Raspall G, González-Lagunas J. Management of the nasal tip by open rhinoplasty. J Craniomaxillofac Surg 24:145-150, 1996. Rees TD, LaTrenta GS. Aesthetic Plastic Surgery, 2nd ed. Philadelphia: WB Saunders, 1994, pp 159-244. Regalado-Briz A. Aesthetic rhinoplasty with maximum preservation of the alar cartilages: experience with 52 consecutive cases. Plast Reconstr Surg 103:671-680, 1999. Regalado-Briz A. Cephalo-crural suture: a new way to deal with supratip fullness. Aesthet Surg J 25:481488, 2005. Rich JS, Friedman WH, Pearlman SJ. The effects of lower lateral cartilage excision on nasal tip projection. Arch Otolaryngol 117:56-59, 1991. Ricketts RM. Divine proportion in facial esthetics. Clin Plast Surg 9:401-422, 1982. Rohrich RJ, Adams WP Jr. The boxy nasal tip: classification and management based on alar cartilage suturing techniques. Plast Reconstr Surg 107:1849-1863, 2001. Rohrich RJ, Griffi JR. Correction of intrinsic nasal tip asymmetries in primary rhinoplasty. Plast Reconstr Surg 112:1699-1712, 2003. Rohrich RJ, Gunter JP, Adams WP Jr, eds. Graduated approach to tip projection in rhinoplasty. In Dallas Rhinoplasty: Nasal Surgery by the Masters. St Louis: Quality Medical Publishing, 2002, pp 333358.

948

CHAPTER 15



COMMON PROBLEMS IN ANATOMY AND PROPORTION

Rohrich RJ, Gunter JP, Friedman RM. Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 95:795-799, 1995. Rohrich RJ, Janis JE, Kenkel JM. Male rhinoplasty. Plast Reconstr Surg 112:1071-1085, 2003. Rohrich RJ, Muzaff r AR, Gunter JP. Nasal tip blood supply: confirming the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 106:1640-1641, 2000. Rubin FF. Controlled tip sculpting with the morselizer. Arch Otolaryngol 109:160-163, 1983. Safian J. The split-cartilage tip technique of rhinoplasty. Plast Reconstr Surg 45:217-220, 1970. Sheen JH. Achieving more nasal tip projection by use of a small autogenous vomer or septal cartilage graft. A preliminary report. Plast Reconstr Surg 56:35-40, 1975. Sheen JH. Middle crus: The missing link in alar cartilage anatomy. Perspect Plast Surg 5:31-53, 1991. Sheen JH. Tip graft: A 20-year retrospective. Plast Reconstr Surg 91:48-63, 1993. Sheen JH, Sheen AP. Aesthetic Rhinoplasty, 2nd ed. St Louis: CV Mosby, 1987. Smith GA. Tip refinement in upturned noses. Ear Nose Throat J 62:14-23, 1983. Smith RA, Smith ET. A new technique in nasal-tip reduction surgery. Plast Reconstr Surg 108:17981804, 2001. Smith TW. Thoughtful nasal tip surgery. Arch Otolaryngol 97:244-246, 1973. Spina V, Kamakura L, Psillakis J. A new method for correction of the prominent nasal tip. Plast Reconstr Surg 51:416-420, 1973. Tardy ME, Cheng E. Transdomal suture refinement of the nasal tip. Facial Plast Surg 4:317-326, 1987. Tardy ME Jr, Patt BS, Walter MA. Transdomal suture refinement of the nasal tip: long-term outcomes. Facial Plast Surg 9:275-284, 1993. Tasman AJ, Helbig M. Sonography of nasal tip anatomy and surgical tip refinement. Plast Reconstr Surg 105:2573-2579, 2000. Tebbetts JB. Letter to the editor. Plast Reconstr Surg 95:772-773, 1995. Tebbetts JB. Rethinking the logic and techniques of primary tip rhinoplasty: a perspective of the evolution of surgery of the nasal tip. Otolaryngol Clin North Am 32:741-754, 1999. Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new systematic approach. Plast Reconstr Surg 94:61-77, 1994. Uhm KI, Hwang SH, Choi BG. Cleft lip nose correction with onlay calvarial bone graft and suture suspension in Oriental patients. Plast Reconstr Surg 105:499-503, 2000. Vuyk HD. Suture tip plasty. Rhinology 33:30-38, 1995. Webster RC, Davidson TM, Rubin FF, et al. Nasal tip projection changes related to cheeks and lip. Arch Otolaryngol 104:16-21, 1978. Webster RC, White MF, Courtiss EH. Nasal tip correction in rhinoplasty. Plast Reconstr Surg 51:384396, 1973. Williams JE. Pinched nasal tip. Clin Plast Surg 4:41-45, 1977.

949

CHAPTER 16 Exceptions to the U sual Through tattr’d clothes small vices do appear; Robes and furred gowns hide all. . . . WILLIAM SHAKESPEARE King Lear

A few naturalists . . . who have already begun to doubt upon the immutability of species, may be influenced by this volume; but I look with confidence to the future, to young and rising naturalists, who will be able to view both sides of the equation with impartiality. . . . CHARLES DARWIN On the Origin of Species by Means of Natural Selection

They don’t make mirrors like they used to. . . . TALLULAH BANKHEAD

951

PART IV



PRIMARY RHINOPLASTY

T he Traumatized Nose There is no nasal deformity for which prioritization is more important than the traumatized or crooked nose. The traumatized nose is already damaged—its skeleton is deformed and potentially unstable, and its soft tissues are scarred. Scarring of the soft tissues is important for both patients and surgeons to remember, because some soft tissue changes may have become irreversible. Every type of nasal trauma, whether surgically deliberate or accidental, precipitates a wound-healing cascade, part of which involves soft tissue changes. Even if the surgeon could magically replace every bit of cartilage and bone where it ideally belonged, the patient’s soft tissues may be incapable of following those changes. Thus soft tissue deformity might remain even if skeletal deformity does not. But it is worse than that, because only rarely can the surgeon place every skeletal structure where it belongs—the skeleton itself has often undergone irreversible changes. Although surgeons and patients may be acutely aware of the problems associated with correcting septal deviation and overcoming “cartilage memory,” trauma may have created additional abnormal stresses in the upper or lower lateral cartilages, making symmetry difficult to achieve even if those structures were radically mobilized, positioned, and fixed by sutures or wires. Finally, although not always discussed, the more aggressive techniques for septal straightening can be hazardous. Surgeons who fracture, score, or cut the dorsal septal strut, and surgeons who resect the entire septum, divide and reassemble it, and replace it in the midline, have reported impressive results. However, the complications of those techniques are not often described in the same vigorous detail as the successes, but they do occur, even in expert hands, and range from recurrence of the original deformity to complete septal collapse. My own approach to the traumatized crooked nose is based on the principles used in the many cases of nasal asymmetry already described in this book: 1. Remove or reposition deviated or deformed skeletal parts that either obstruct the airway or mar the desired aesthetic result. 2. Clear the airway of septal obstruction. 3. Harvest the needed augmentation materials. 4. Graft to reestablish function, nasal equilibrium, proportion, and symmetry.

952

CHAPTER 16



EXCEPTIONS TO THE USUAL

In planning these surgeries, my priorities are always safety, predictable function, and aesthetics, in that order, even though a patient’s presenting complaint may be only cosmetic. In proposing and explaining my plan to a patient, I demonstrate the deformities that the previous trauma has created and discuss the surgical alternatives. I indicate that I cannot weaken or move every asymmetrical structure, because some of them are supporting the nose. I explain my priorities, and in doing so I reassure patients that, in following them, the chances of septal collapse or other catastrophe are quite remote, that nasal function will be maximized, and that I will try to create the best possible shape, but that some asymmetry will probably remain. Most patients readily understand (and support) the logic of a highly safe operation, even if it leaves residual asymmetry. In that regard, when a concavity must be camouflaged by augmentation, I have learned to undercorrect rather than overcorrect. Patients accept a residual asymmetry to which they have become accustomed over a more symmetrical nose that has now become much wider. Finally, it is important to remember that asymmetrical noses require asymmetrical strategies. When performing analysis and setting a plan, it is easiest to divide the crooked nose into thirds (bony vault, upper cartilaginous vault, and lower cartilaginous vault and caudal septum), as in the table below.

Strategies for Correcting an Asymmetrical Nose Nasal Area

Basic Technique

Ancillary Techniques

Upper third Bony vault

Unilateral osteotomy

Lateral onlay graft (preferably ethmoid) Dorsal onlay graft

Unilateral spreader graft Unequally thick spreader grafts

Lateral onlay graft Dorsal onlay graft

Realign lateral crura Asymmetrical tip grafts

Onlays to lateral crura/alar walls

Resect and replace caudal septum

Columellar grafts for contour

Middle third Upper cartilaginous vault Lower third Lower cartilaginous vault Caudal septum

953

PART IV



PRIMARY RHINOPLASTY

BONY VAULT If the bony vault is shifted, bilateral osteotomies narrow the upper nose but the shift remains. A unilateral osteotomy (on the outfractured side) coupled with an onlay to the depressed side usually works better. Bony vault onlays must be flawless; the unyielding bed is unforgiving. Deformities become obvious, and eyeglasses become uncomfortable. Choose your graft wisely: ethmoid is excellent, ear cartilage (solid or crushed) is not.

UPPER CARTILAGINOUS VAULT A surgeon must remember the functional deficit manifested by sidewalls distorted by septal deviation. Unilateral or asymmetrically thick spreader grafts correct the functional and aesthetic abnormalities. The most common combination for the upper and middle vaults (the middle third) is therefore a unilateral osteotomy (on the outfractured side), combined with a substantial spreader graft for the contralateral collapsed middle vault (adding onlays as needed). Depending on dorsal height, it may also be helpful to place a dorsal onlay graft over the upper and middle thirds to camouflage underlying asymmetries.

LOWER CARTILAGINOUS VAULT AND CAUDAL SEPTUM Realign the lateral crura if they are asymmetrical, place onlay grafts to fill the sidewall depressions and support the external valves, place multiple tip grafts asymmetrically to create a balanced tip, and resect and replace a deflected caudal septum, adding additional onlay columellar grafts for contour. (These techniques are detailed in Chapters 11 and 12.) The exact shape of the nasal skeleton—asymmetrically resected, rotated, supported, or camouflaged—is irrelevant as long as it creates a stable, open airway and an attractive nasal shape. The following cases are presented in order of asymmetry (other cases are presented in Part V, Secondary Rhinoplasty).

954

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY ONE A

C

D

B

E

F

In this young woman, the most striking asymmetry is located in the middle third, accompanying the high septal deviation toward the left. The bony vault is almost midline and the caudal septum is centered. However, notice the position of the lateral crura on the frontal and the oblique views: the left lateral crus is malpositioned (cephalically rotated), whereas the right lateral crus is orthotopic. Notice also the tip lobular configuration imparted by this asymmetry: the left side of the tip is inadequately projecting (C), whereas the right side is adequately projecting (D and E). The patient requested a slightly lower dorsum and symmetrical, adequate tip projection (F). 955

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Slight reduction of cartilaginous dorsum; no reduction of bony vault 3. Retrograde reduction of right orthotopic lateral crus 4. Dissection and relocation of left malpositioned lateral crus as flap 5. Transfixing incision, slight shortening of membranous septum 6. Septoplasty 7. Asymmetrical spreader grafts (a curved, thinner graft on the left with convexity facing toward the right, and a straight, thicker graft on the right) 8. Three crushed tip grafts 9. Columellar graft for contour 10. Left osteotomy

A

B

C

After relocating the left lateral crus and a slight dorsal reduction, the tip was brought into relief (B). Septoplasty yielded excellent building materials (C).

956

CHAPTER 16

D

E



F

EXCEPTIONS TO THE USUAL

G

The curved piece in the upper right of the grid will form a large spreader graft to force the high septal deviation toward the right (D). Tip and columellar grafts added support, symmetry, and contour (E and G).

Postoperative Analysis

Five years after surgery, and without an onlay graft, spreader grafts have realigned the high septal deviation. The left osteotomy has repositioned the bony vault. Slight dorsal reduction and tip grafts have altered the nasal profile slightly, adding tip projection but leaving a straight dorsum. The lateral crura are now symmetrical, confirmed on frontal and oblique views, and the oblique views are now symmetrical.

957

PART IV



PRIMARY RHINOPLASTY

Multiple tip grafts, placed asymmetrically, have augmented the right side more than the left. Geometric mean postoperative airflow increased 12.5 times over preoperative values. The oblique views demonstrate the relative positions of the bony vault, middle vault, and tip better than any others, but they differ when the nose is asymmetrical. Postoperative obliques therefore demonstrate how much symmetry—or residual asymmetry—exists.

958

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY TWO

In this patient, whose tip is symmetrical and adequately projecting, previous sports injuries have displaced the bony and cartilaginous vaults toward the right. Because the bony vault has shifted, the dorsal hump seems higher on the patient’s right compared with his left. Although the caudal septum is not dislocated, the columella is soft and will be supported by an onlay graft.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Bony vault reduction with rasp, deepening high radix 3. Cartilaginous dorsal reduction with knife 4. No modification of alar cartilages 5. Septoplasty 6. Left spreader graft 7. Columellar graft (unsupported caudal septum) 8. Tip grafts 9. Right osteotomy

959

PART IV



PRIMARY RHINOPLASTY

Septoplasty yielded a specimen that was largely calcified and distorted, which is the result of the patient’s previous trauma. Fortunately, not many grafts are required.

A thick left spreader graft was placed. Notice that the middle vault depression was marked before the procedure, denoting the location for an onlay graft. The best remaining piece supports the columella.

960

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

When the septum has been displaced to this degree, it is almost impossible to bring the bony vault to the midline, because the displaced septum blocks movement of the right sidewall. For a young, athletic man who intends to remain highly active in competitive contact sports, I leave a dorsal strut that is 25 to 30 mm wide for future protection. Because the airstream flows along the floor and over the middle turbinate, the dorsal strut does not block airflow. The postoperative dorsum is straight, and the tip is more refined.

961

PART IV



PRIMARY RHINOPLASTY

The oblique views demonstrate greater symmetry, although the right bony vault is still slightly higher than the left, and the left middle vault is slightly more concave than the right. Both airways are now widely patent, and the nose is stable for all of the patient’s future athletic activities.

962

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY THREE A

B

C

D

Unlike the previous patient, this woman’s radix is low and her tip is inadequately projecting. Notice the difference in nasal contour. The base seems disproportionately large. The nose seems to arch downward, particularly in the left oblique view. The caudal septum is deflected into the right airway and therefore must be resected and replaced (B). Notice the asymmetry in the matching oblique views. Finally, notice the axes of the cephalically rotated lateral crura and the alar hollows that they create. Because the malpositioned cartilages are not deforming, they will be left in position, but their functional and cosmetic effects will be corrected.

963

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Reduction of bony and cartilaginous dorsa 3. Resection of dislocated caudal septum and replacement as free graft 4. Retrograde reduction of alar cartilage lateral crura 5. Septoplasty 6. Left unilateral spreader graft 7. Left onlay graft 8. Radix graft 9. Multiple tip grafts 10. Right osteotomy

Notice that after the dorsal and tip resections, the nasal configuration has changed very little. This is typical of the low radix–inadequate tip projection combination. The nose cannot assume a new shape until the radix and tip have been supported. Silhouettes dramatize the effect of dorsal and tip reduction, and radix and tip grafts, on nasal balance. The postoperative nose seems smaller and less bottom heavy.

964

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

Two years postoperatively, the nose remains symmetrical. The unilateral osteotomy has created bony vault symmetry. The left spreader graft and onlay have created middle vault symmetry.

965

PART IV



PRIMARY RHINOPLASTY

Despite significant preoperative asymmetry, the matching postoperative obliques are nearly identical. Tip grafts have lifted the right dome to be symmetrical with the left; the radix graft has reduced apparent nasal base size; and dorsal reduction, left spreader grafts, and onlay grafts have improved middle vault symmetry and camouflaged the high septal deviation. Slight lateral crural reduction, tip grafts, and caudal septal relocation have created nasal base (lower-third) symmetry. Remember that a small size without proportion or contour delicacy is not a victory.

966

CHAPTER 16



EXCEPTIONS TO THE USUAL

A

B

C

As this figure shows, dorsal resection favors a straighter nose. When the deviated nose has a convex bridge (A), the nasal hump is often its most asymmetrical part (B). By reducing bridge height, the surgeon also removes the area of greatest deflection and therefore makes a straighter nose even before performing other maneuvers (C). Conversely, when the nasal dorsum is low and asymmetrical relative to a large nasal base, the surgeon can frequently achieve more symmetry by camouflaging the deflection with a straight dorsal graft or by aligning the anterior septal edge with spreader grafts. The strategy for achieving symmetry therefore depends in part on whether the nasal dorsum is convex or concave, and therefore on the relationship of nasal bridge height to nasal base size. Deflection of the septal angle is another frequent cause of malalignment, particularly of the nasal base. Septal angle resection releases soft tissues of the nasal tip, allowing them to move toward the midline. However, septal angle or dorsal resection sufficient to correct an asymmetry may simultaneously produce a nasal bridge that is now too low and therefore requires augmentation to reestablish postoperative balance and middle vault support. Asymmetrically thick spreader grafts can also align a deflected caudal septum or septal angle.

967

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY FOUR

Some cases of previous trauma present unique problems. This young woman had sustained multiple injuries as a young child. The significant deviation of her bony and upper cartilaginous vaults is obvious. The caudal septum was dislocated, resulting in a retrusive maxillary arch and retracted columella. Her skin is scarred, and the oblique views are grossly different. In this case, significant dorsal reduction is needed just to remove the deformity. The surgeon also can anticipate that a septum that is so scarred, calcified, and crisscrossed with fracture lines is unlikely to yield a good dorsal graft. Spreader grafts cannot align such a crooked nose. The approach, therefore, is to reduce the dorsum enough to decrease the deformity, and then to rebuild the dorsum, tip, columella, and maxillary arch by augmentation. 968

CHAPTER 16



EXCEPTIONS TO THE USUAL

SUMMARY OF THE SURGICAL PLAN 1. Harvest calvarial bone graft 2. Harvest ear cartilage 3. Gore-Tex maxillary augmentation 4. Dorsal reduction 5. Septoplasty to clear the airway 6. Calvarial bone dorsal graft 7. Onlay graft of calvarial bone to left middle vault 8. Ear cartilage caudal support graft 9. Multiple tip grafts

A

B

C

Gore-Tex was rolled into an implant to be placed through an incision in the right nasal floor into a subperiosteal pocket at the base of the piriform aperture. Before insertion, the patient’s eyes were protected with gauze and the nasal base was isolated from the skin with a plastic drape (A). My hands did not touch the patient’s skin before I inserted the implant. Immediately on placement, the upper lip and nasal base moved forward (B and C).

969

PART IV



PRIMARY RHINOPLASTY

B

C

A

Dorsal reduction reduced the deformity, but the nose was small and soft, and the soft tissues were unsupported. The septal specimen can be seen the left side of the grid (A); notice that most of the pieces were distorted or bony. Ear cartilage (right of grid) was used to support the base and tip. A calvarial graft was sized, and its edges were lightly beveled (B). After placement, dorsal length was appropriate. A boot-shaped graft was constructed from ear cartilage to replace the absent caudal septum (destroyed by trauma), according to Sheen’s method (C). This graft was placed through an incision in the membranous septum, replacing the caudal septum to the septal angle. In doing so, the graft moved the nasal base forward and provided normal support and firmness to the columella.

Silhouettes dramatize the changes in nasal proportion and shape that occurred.

970

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

One year postoperatively, the nose remains straight. Although the dorsal skin is laced with scars, the dorsal line is smooth, the tip is adequately projecting, the upper lip is vertical, and the tip is projecting and contoured.

971

PART IV



PRIMARY RHINOPLASTY

The oblique views now match much more closely. Normal tip projection, columellar support, and the restored vertical position of the upper lip combine to reduce the stigmata of previous damage. Geometric mean postoperative airflow increased 3.2 times over preoperative values.

972

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY FIVE

When noses have been significantly traumatized, the deviation may be too significant to camouflage, and the septal skeleton may be too distorted and calcified to form acceptable grafts. Retaining an intact L-shaped septal skeleton, the nose can still be rendered straight by resecting the deformity and placing a camouflaging dorsal graft of septal cartilage (if available), calvarial bone, or rib. The postoperative views are at 31⁄2 years. When treating the traumatized nose, attention must be paid to nasal analysis in thirds, and to evolving a strategy whose order of priorities is always safety, function, and then aesthetics.

973

PART IV



PRIMARY RHINOPLASTY

R hinoplasty in Men Although the diagnostic and technical aspects of rhinoplasty performed on men do not differ from those performed on women, there are other differences. As a rule, men have larger frames, heavier bones, thicker skin, and historically have been more likely to involve themselves in contact sports and in work with high physical demands (though this is less true today). We have already seen that men are judged to be most attractive when they represent their phenotype—that is, when they “look male”: defined jaws, strong foreheads, and larger noses (see Chapter 7). It is also true that men can have turbulent postoperative courses. In one group of 1000 consecutive rhinoplasty patients, men represented 30% of the disruptive or needy patients and 40% of patients with body dysmorphic disorder, even though men only represented 22% of the total population in that study (see Chapter 20). This is not to say that men cannot be very good rhinoplasty patients. However, some generalities almost always apply.

 Men tolerate larger noses than women; that is, shape is more important than size.  Bridge height is important. Most men prefer a straight (or even convex) dorsal line to one that is concave with retroussé.  Men want noses that “look male”—not too short, not too narrow, and not too small.  Secondary patients who have had significant reductions often complain that something is missing, even if they cannot articulate what it is.  Whereas some women say, “I don’t care how well I breathe as long as my nose is pretty,” men expect excellent postoperative airways.

Each of the men on p. 975 brought a photograph to illustrate what he thought was wrong with his nasal contours. Notice that none of the presented noses are small or short; all of them have strong, high bridge contours. The third man, who had already undergone two rhinoplasties, could not easily articulate what was wrong; he just knew that something was missing from his nose. The fourth man, also a secondary patient, wanted to restore the high bridge seen in his high school photograph. In each case, maintaining contour and size (or, for the last two patients, rib graft reconstruction) was necessary to fulfill their conscious and unconscious expectations.

974

CHAPTER 16



EXCEPTIONS TO THE USUAL

975

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY ONE

This is a large man with a large nose and a large skin sleeve. The tip is inadequately projecting and hangs from the septal angle. His nose will not tolerate significant reduction without losing airway or shape. The patient brings with him a typical desired male result: a strong nose with a slightly high dorsum and adequate tip projection. Although the patient’s own nose is significantly larger and could not be reduced to duplicate the size of the nose in his illustration, the contrast provides the opportunity to discuss tip projection, radix height, and nasal balance.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over bony vault, wide skeletonization over upper cartilaginous vault 2. Reduction of bony and cartilaginous dorsa 3. Relocation of alar cartilage lateral crura to strengthen external valves 4. Submucosal shortening of caudal ends, upper lateral cartilages (3 mm) 5. Transfixing incision; reduction of caudal and membranous septa, shortening the nose 6. Septoplasty 7. Asymmetrical spreader grafts (thicker on the left) 8. Upper dorsal graft, thicker at the radix and tapering into the middorsum 9. Multiple tip grafts 10. Right osteotomy

976

FPO 37

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

One year after surgery, the nose is more symmetrical and the base is appropriately wider. The patient no longer flares his nostrils to support his airway. Relocation of the lateral crura has favorably altered nostril contour. The tip no longer hangs from the septal angle. Although the skin remains thick, the nose has not lengthened again, because dorsal support is greater.

977

PART IV



PRIMARY RHINOPLASTY

Preoperative

1 month postoperatively

6 months postoperatively

12 months postoperatively

Notice the changes that occur from the preoperative nose at 1 month, 6 months, and 12 months postoperatively. As edema resolves, the nose lengthens slightly and then stabilizes after 6 months. Nasal balance has changed significantly. The nose is no longer bottom heavy, and postoperative airflow has increased 3.4 times over preoperative measurements.

978

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY TWO

It is obvious that this man cannot breathe easily; notice that the nostrils flare to support his airways. The nasal bones are short, leaving an unsupported hollow that begins approximately 12 mm below the nasal radix, with high septal deviation toward the right (note the light reflex). The lateral crura are convex and malpositioned, leaving defects in the alar walls, parentheses that frame the tip, and unsupported external valves. The dorsum is strong and high, and the tip is blunt and inadequately projecting.

Valvular incompetence is confirmed by watching the patient breathe.

979

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over bony and upper cartilaginous vaults 2. Reduction of bony and cartilaginous dorsa 3. Resection and replacement of alar cartilage lateral crura through infracartilaginous incisions 4. Transfixing incision with trim of membranous septum; no nasal shortening 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on the left 7. Radix graft 8. Tip grafts with buttress 9. No osteotomy

Postoperative Analysis

One year postoperatively, the nose is more symmetrical, the valves are stable, and the patient no longer flares his nostrils.

980

CHAPTER 16



EXCEPTIONS TO THE USUAL

The nose has been rebalanced by the radix graft, reducing the required dorsal resection. Lateral crural relocation has ablated the alar hollows. The tip is adequately projecting and the nostril contour seems proportionately shorter, because tip lobular length has increased slightly. Lateral crural repositioning and tip grafting have favorably altered nostril contour and axis.

981

FPO

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY THREE

This is a tall young man with a left-sided high septal deviation and bilateral airway obstruction. Each nasal third (the bony vault, upper cartilaginous vault, and nasal tip) is asymmetrical. The dorsum is straight, and no net bridge reduction should be performed.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over the bony and upper cartilaginous vaults 2. 2 mm trim of the cartilaginous dorsum 3. Retrograde reduction of lateral crura, 2 mm 4. Resection of ellipse, membranous and caudal septa, posterior third only 5. Septoplasty, leaving 20 mm dorsal and 15 mm caudal struts 6. Asymmetrical spreader grafts, right thicker than left 7. Upper dorsal graft, thicker at radix and tapering distally 8. Crushed tip grafts with ethmoid buttress 9. Left unilateral osteotomy

982

CHAPTER 16



EXCEPTIONS TO THE USUAL

FPO

Postoperative Analysis

Postoperatively, radix and tip grafts have lengthened the dorsal line. Upper nasal augmentation and slight dorsal reduction have reduced the nasofacial angle and decreased base size.

983

FPO

PART IV



PRIMARY RHINOPLASTY

Asymmetrical spreader grafts have corrected the high septal deviation. Use of an ethmoid buttress has established a new angle of tip rotation, and the crushed grafts anterior to it have improved tip symmetry.

984

CHAPTER 16



EXCEPTIONS TO THE USUAL

FPO 47

PATIENT STUDY FOUR

Multiple previous surgeries, including an iliac bone graft, had failed to correct this man’s traumatic deformity. The bone graft had partially absorbed, leaving an irregular remnant along the dorsum. Note also the degree of upper lip retrusion and the sunken subnasale, a common characteristic in secondary patients. Perhaps because of soft tissue thickness, the degree of lip lengthening and retrusion often seems greater in males than in similarly affected females.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Remove old bone graft 3. Harvest rib cartilage 4. Rib cartilage maxillary augmentation 5. Dorsal graft 6. Tip grafts 7. Lateral wall grafts 8. Columellar grafts

985

PART IV



PRIMARY RHINOPLASTY

Rib was harvested and split tangentially. Notice the yellowness of the cartilage, typical of a patient this age. The slices are arranged with the outer rib edges at each end of the grid. Multiple areas of calcification (visible as white spots) prevent rib distortion, even in those strips covered on one surface by perichondrium. One of the rib strips was cut to create a two-piece maxillary augmentation. Independent pieces allow common asymmetries to be individually addressed, and seem to be more comfortable than a single rigid graft.

A

B

C

One of the perichondrially covered slices was trimmed and scored to lessen its distorting forces. It was designed to extend from the radix into the supratip, but not into the tip lobule (B). Once dorsal and tip grafts were placed, contour improved and the nose lengthened (C). Note the change in upper lip position provided by the maxillary augmentation. 986

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

Two years postoperatively, the nasal contours have a smooth and natural appearance—properties gained partially by graft quality and the patient’s thick, soft tissues. The multiple preoperative irregularities are gone, and the dorsum is straight, leveled by the rib graft. Notice that the patient’s preoperative skin was heavily scarred and would have adapted poorly to a simple reduction of the supratip dorsum. His columella and maxillary arch have been braced, moving the nasal base anteriorly. Postoperative airflow increased 2.4 times over preoperative measurements.

987

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY FIVE

Four previous rhinoplasties, including septal and ear cartilage grafts and an alloplastic implant to support the airway, had not corrected the patient’s other problems: convex, cephalically rotated lateral crura, and an imbalance caused by a low, straight dorsum ending in a large, blunt nasal base.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Resect and replace cephalically rotated lateral crura 3. Rib cartilage for: a. Maxillary augmentation b. Dorsal graft c. Caudal support graft d. Tip grafts e. Alar wall grafts

988

CHAPTER 16

B



EXCEPTIONS TO THE USUAL

C

A

Segments of the eighth and ninth ribs were removed for the reconstruction (A). The tip of the ninth rib was used for maxillary augmentation. Sections of the eighth rib were trimmed, scored, and fashioned into a laminate by suturing the periphery with 6-0 nylon interrupted sutures (the knots were buried between the rib slices) (B). Additional slices were trimmed to support the alar walls, patterning their shape according to the deficient areas (C).

After removing the deformity and resupporting with grafts, the effect of rearrangement became visible. Percutaneous sutures coapted the external and vestibular skin after resection of the malpositioned lateral crura.

989

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Three-year postoperative views show a nose that is narrower because of increased dorsal height—osteotomies were not performed. Tip lobular width has diminished after lateral crural replacement. The dorsum remains straight and the tip is supported. The maxillary arch is less retrusive. Both dorsal and alar wall grafts have improved valvular function. Alar wall grafts support the rims. Alar hollows have disappeared.

990

CHAPTER 16



EXCEPTIONS TO THE USUAL

Ethnic Rhinoplasty Beauty is subjective. Throughout this book we have seen patients whose private aesthetics were quite specific, and patients who simply wanted the surgeon to remove the bump and restore the airway. I have shown examples of Asian, Jewish, Italian, Armenian, Scandinavian, Mediterranean, Hispanic, and African noses, discussing their treatment in terms of function and patient aesthetic. So what is ethnic rhinoplasty? The answer is that ethnic rhinoplasty does not differ from any other type of rhinoplasty. Nature’s laws do not change when one crosses borders or changes passports. Middle vaults collapse and unsupported soft tissues contract everywhere in the world. Perhaps even the term ethnic rhinoplasty could be improved, because who is not ethnic? The point that I believe Sheen and Sheen were making when they brought attention to the topic is an important one: for some patients, ethnic background helps determine their aesthetic goals. This determination can work two ways: some patients wish to retain the ethnic characteristics of their noses, and other patients want to lose them. But the surgeon must ask. The principles of forming and performing the surgical plan, however, do not differ. The surgeon trying to correct a low, broad dorsum and a large nasal base covered by thick soft tissue, faces the same imbalances and the same technical challenges whether the patient is of African or eastern European descent. Donor sites may differ (for example, the septum of an African or Asian may be smaller than the septum of a Caucasian, with a higher percentage of ethmoid bone), but if the aesthetic goals are the same, the surgical strategy must be the same. Even though the surgeon must be aware of particular ethnic characteristics, it is the interaction with each patient that sets the plan.

In one sense there is no such thing as ethnic rhinoplasty. Throughout this book, we have seen examples of different ethnic backgrounds in patients with a wide span of surgical objectives. Some patients have wished to retain their ethnicity, and others have not. It is important for a surgeon to determine the importance of ethnicity to the patient so that all changes are intentional and reflect the patient’s aesthetic and ethnic sensibilities.

991

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY ONE

This woman illustrates a number of characteristics typical of the Latino patient: a broad face with a proportionally small nose, medium to thick soft tissues, a short columella, a small tip lobule with soft alar cartilages, an acute nasolabial angle, a retrusive upper lip, and a sharp subnasale. The treatment to produce any desired result is the same for a patient of any ethnicity possessing these characteristics. Patients must individually decide how much change they desire. This particular patient wanted a nose that seemed shorter and straighter, and a narrower tip that “turned up instead of down” (an appearance created by the combination of a low radix, high dorsum, convex supratip, indistinct tip-defining point, acute nasolabial angle, and sharp subnasale).

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Limited skeletonization 3. Reduction of the bony and cartilaginous dorsa 4. Resection and replacement of alar cartilage lateral crura 5. Transfixing incision, shortening membranous septum only 6. Septoplasty 7. Spreader grafts 8. Radix grafts 9. Multiple tip grafts 10. No osteotomy

992

CHAPTER 16

A

B



C

EXCEPTIONS TO THE USUAL

D

After maxillary augmentation and dorsal reduction, the lateral crus is resected and trimmed (A). It is shown here before replacement along the alar rim. After dorsal reduction and maxillary augmentation, a single, solid tip graft was placed (C). Because the graft supports the tip along only one edge, it looks artificial and would not provide a satisfactory long-term result. Notice the change in the vertical plane of the upper lip after maxillary augmentation. With the addition of lightly crushed grafts anterior to the buttress, the lobule became less angular (D).

Compare the blue silhouette here with the postoperative lateral view on p. 995.

993

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

By repositioning the lateral crura (which can widen the base slightly) and even without osteotomy, nasal width is now appropriate for the patient’s face. Maxillary augmentation has corrected the upper lip retrusion and softened the subnasale.

994

CHAPTER 16



EXCEPTIONS TO THE USUAL

The dorsum is now straight, the nose is shortened, and the tip is supported above the septal angle, but the appearance has changed slightly from the blue silhouette as the tip lobule has contracted. Such expected changes can only be learned from sequential intraoperative and postoperative photographs. Maxillary augmentation improved the nasolabial angle. The nasal base remains unscarred, and the tip lobule is slightly narrower.

995

PART IV



PRIMARY RHINOPLASTY

Maintaining bridge height and nasal length is an important surgical goal for many Middle Eastern and Mediterranean patients. Although both of these Jewish women (whose surgeries are detailed in Chapters 8 and 9, respectively) desired more delicate noses and better airways, both were adamant that they wanted to preserve dorsal height. In each case, dorsal contour was maintained but modified, in the first patient by dorsal reduction and a radix graft, and in the second patient by resection of the hump and a long dorsal graft. Notice also that the tip was modified in both cases, increasing refinement and contour. A straight dorsum is not necessary for an elegant nose, but good tip aesthetics are always necessary. A

B

C

In contrast, this woman had undergone a previous rhinoplasty that she believed had cost her ethnic identity: her nose was too short, and the bridge was too low. Her objective (B) was a longer nose with a suggestion of dorsal convexity. This was achieved using multiple dorsal, tip, and composite grafts (C) (see Chapter 2). 996

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY TWO

Maintaining dorsal height and length is just as critical in men as it is in women. This young Egyptian man, on whom I operated 3 years into my practice, had a high radix, a straight dorsum, inadequate tip projection, and a nose that was shifted toward his left from previous trauma. The septum protrudes from the left side of the columella. The soft tissues are moderately thick, and nasal contours are blunt, even at this size. How could I straighten this nose without reducing the dorsum excessively? The answer, I concluded, was to resect the dorsal deformity and camouflage the asymmetry with a dorsal graft.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. Reduction of the bony and cartilaginous dorsa 3. No modification of tip cartilages 4. Hemitransfixing incision with resection and replacement of caudal septum as free graft 5. Septoplasty 6. Dorsal graft 7. Tip graft 8. Left osteotomy

997

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Four years after surgery, the nose is straighter, and the dorsal graft has camouflaged many of the remaining underlying asymmetries. The dorsum is strong and straight, with a suggestion of height over the bony vault. Notice the profound change wrought by a slight change in dorsal height combined with adequate tip projection: although not smaller, the nose seems more refined, slightly shorter (a result of the change in tip lobular shape), and more elegant.

998

CHAPTER 16



EXCEPTIONS TO THE USUAL

The patient’s oblique views now match more closely. A slight depression between the dorsal graft and the tip graft sets the tip apart from the bridge. The supratip depression is not created by thinning the skin or suturing soft tissue to the skeleton, but by adequate dorsal height and tip projection and by separating dorsal and tip supports. An L-shaped framework will not provide the same contour. The base is unscarred, and the nostrils are equally sized.

999

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY THREE

This young Armenian man wanted a shorter nose without a dorsal hump, but retroussé or a highly angular tip would be inappropriate for his face. On the frontal view, the upper lip seems flattened and retrusive, and the lateral crura are convex and cephalically rotated. The lateral view reveals a low radix with an inadequately projecting tip slung from a high dorsum. With the heavier tissues that men have, shortening the nose always requires maintaining support. If dorsal reduction is planned, where can a surgeon add support? This is the time to look for relative low spots or weak areas. The radix is slightly low relative to the large nasal base. The middle crura are weak, reducing tip support. The maxillary arch is slightly retrusive, which allows the nasal base to fall posteriorly and caudally. The skin is moderately thick, so shortening by soft tissue contraction cannot be assumed. This nose must be rebalanced and supported so that it holds its new shape without lengthening again.

1000

CHAPTER 16



EXCEPTIONS TO THE USUAL

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Dorsal reduction 3. Resection and relocation of alar cartilage lateral crura 4. Submucosal shortening upper lateral cartilages, 3 mm 5. Transfixing incision, shortening the caudal and membranous septa 6. Septoplasty 7. Dorsal graft of septal cartilage 8. Multiple tip grafts 9. No osteotomy

Before beginning the rhinoplasty, a piece of 1 mm Gore-Tex sheeting was rolled and placed in a subperiosteal pocket high over the maxillary arch through a short incision in the right nasal floor. In examining the silhouettes, notice that the dorsum is lower and straighter, and it is now separated visually from the tip lobule. The tip is adequately projecting, and the upper lip is more vertical.

1001

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Eight years after surgery, the nose is shorter, more symmetrical, and stable. The widths of the upper nose and the lower nose are appropriate for each other.

1002

CHAPTER 16



EXCEPTIONS TO THE USUAL

The radix is slightly higher, the dorsum is straight, and the tip is differentiated from the dorsum. The upper lip remains vertical, and the base is supported. Resection and replacement of the lateral crura flattened the supratip and ablated the alar hollows. Geometric mean nasal airflow increased 4.2 times over preoperative values.

Before operating on black patients, it is worth remembering how infrequently the neoclassical canons apply not only to Caucasians and Asians, but to those of African heritage in particular (see Chapter 7). Consider these young black women shown preoperatively and postoperatively. Although aesthetic norms theoretically require that the intercanthal distance equal the interalar distance, that rule applies in only 3% of blacks. 1003

PART IV



PRIMARY RHINOPLASTY

The width of the mouth should equal 1.5 times the width of the nose, but in fact, that canon only applies to 1% of the black population. Nasal width should equal 25% of total facial width, but that rule never applies to black patients. Imagine the poor result that would have been created by the surgeon who attempted to narrow this patient’s nose, nasal tip, and nasal base to equal her intercanthal distance or to equal 25% of her total facial width.

The surgeons treating each of these patients were apparently influenced by the neoclassical canons without recognizing their practical limitations. The canons do not apply to most human beings—not even to most Caucasians. The only goals that a surgeon has any realistic chance of achieving are trying to match each patient’s aesthetic goals, preserving or increasing function, and creating noses that appear balanced and attractive unto themselves.

1004

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY FOUR

This young black woman dramatizes the two themes we have just discussed: the impracticality of abstract aesthetics and the importance of the patient’s perception of beauty. Her skin is somewhat thin, her bony vault is slightly narrow, her septal curvature turns to the right. Her low radix and dorsal hump are exaggerated by inadequate tip projection, and her upper lip is retrusive. The patient’s tip lobular width exceeds her intercanthal width. She desires a straight dorsum and an angular, projecting tip.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Minimal skeletonization 3. Dorsal reduction, right more than left 4. 3 mm reduction of alar cartilage lateral crura, retrograde 5. Septoplasty 6. Asymmetrical spreader grafts, left thicker than right 7. Layered radix graft 8. Tip grafts 9. Columellar graft 10. Right unilateral osteotomy 11. No alar wedge resections

1005

PART IV



PRIMARY RHINOPLASTY

Before performing the rest of the rhinoplasty and before touching the skin with my gloved hands, I formed a maxillary augmentation from 1 mm Gore-Tex sheeting. The patient’s septum provided only modest material, but enough for spreader, radix, and tip grafts. Spreader grafts are in the center of the grid, the resected nasal skeleton is to the left, and the rest of the septal specimen is to the right. Notice that half of it is bony.

A

B

C

D

A radix graft was fashioned, crushed, and layered to conform to the defect. The graft is longer than the actual defect and tapers at its distal end to integrate with the nasal skeleton (A). The dorsum was reduced (B), enough to form a straight line after the radix graft placement (C). The remaining cartilage was cut into tip grafts (D). Notice that none of the grafts qualify as a standard shield graft. Shape is not as important as graft substance, pocket position (high in the lobule, to maximize effect), and the use of multiple grafts to avoid asymmetry and to produce a natural lobule.

1006

CHAPTER 16



EXCEPTIONS TO THE USUAL

At the conclusion of the procedure, nasal contour has been significantly altered but function has been preserved. The tip now supports itself independent of dorsal height, and maxillary augmentation has moved the upper lip anteriorly. Columellar grafts (for caudal repositioning, not struts) have strengthened the medial crura.

Postoperative Analysis

The patient is shown preoperatively and at 1 year and 12 years postoperatively (her interval postoperative sequence is shown in Chapter 2). Contours remain stable over time.

1007

PART IV



PRIMARY RHINOPLASTY

Minimal retrograde tip reduction and grafting have altered tip lobular contour significantly, without the variables associated with a more extensive dissection, permanent sutures, or struts. Grafts are smooth and impalpable. The tip remains adequately projecting.

At 12 years, the effect of even small tip graft fragments, placed high in the lobule for maximum effect, is evident. The nasal base is unscarred, and the nostril axis is less horizontal because of increased tip support. Although tip projection has increased, the columella remains narrow. Geometric mean postoperative airflow increased 15.5 times over preoperative values. Imagine the deformity that would have been created by alar wedge resections sufficient to narrow the base to the patient’s intercanthal distance. 1008

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY FIVE

This patient is interested in a result that is “ethnically appropriate,” by which she means a straight dorsum without retroussé, angular tip, or excessive narrowness. She had seen numerous plastic surgeons, some of whom would not operate and others who proposed aggressive nasal base narrowing. This nose is full of traps: balance problems, aesthetic puzzles, and anatomic variants. On the frontal view, the bony vault is narrow, but the nasal base is excessively wide. In addition, the alar walls flare outward like a skirt. The lateral crura are flat but malpositioned, visible only by their internal reflections. The nasal base is large, the tip is flat and inadequately projecting, and the maxillary arch is slightly retrusive, particularly in the perialar areas. The dorsum is high, and the radix is low. Her tissues are thin but unforgiving, and they have a soft, inelastic, “fluffy” quality; they do not easily coapt the skeleton that she has. Augmentation is essential but must be understated, and septal cartilage may be inadequate for long grafts. The alar walls are a problem by themselves. Simulating alar wedge resection with my fingers, I still could not duplicate the shape that I wanted, because the rims still everted. I decided that the best approach would be to relocate the lateral crura, hoping that they would brace and invert the rims, so that alar wedge resections could narrow the base appropriately.

1009

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation (two pieces, right side more than left) 2. Alar cartilage relocation as flap 3. Wide skeletonization 4. Submucosal shortening of caudal ends, upper lateral cartilages 5. Transfixing incision, shortening membranous septum only 6. Slight dorsal reduction 7. Septoplasty 8. Single-layer radix graft 9. Spreader grafts 10. Multiple tip grafts with buttress 11. Alar wedge resection, removing external and vestibular skin

A

B

C

Two Gore-Tex implants were made by rolling 1 mm Gore-Tex sheeting (A). Each implant was fed through the same incision in the right nasal floor and placed so that the widest end determined the amount of perialar augmentation, and the midline overlap determined the degree of central augmentation. Each lateral crus was dissected free from its external and vestibular skin through an incision 3 mm above the rim (B), and the crus was rotated at the lateral genu and fixed by catching the edge of the cartilage in the wound closure. A percutaneous suture coapted the skin and lining for 48 hours. The bony vault was rasped and the cartilaginous dorsum was resected 2 mm (C). 1010

CHAPTER 16



EXCEPTIONS TO THE USUAL

B

A

C

D

E

The septum produced an excellent specimen (A). Spreader grafts were cut and placed to support the narrow middle vault, which had been weakened by dorsal resection (B). The best piece of septal cartilage was trimmed, beveled, and lightly crushed to make a conforming dorsal graft (C). Compare the appearance before and after radix grafting (D and E), and note the change in dorsal contour and apparent nasal base size.

1011

PART IV



PRIMARY RHINOPLASTY

B

A

C

D

The operation was completed by placing tip grafts, both solid (center of grid) and lightly crushed (A). Radix augmentation, nasal shortening, and tip grafting altered the dorsum–tip relationship. Note the change in alar rim contour produced by moving the lateral crura closer to the rims (B and C). From each side, 3 mm of external skin and 2 mm of vestibular skin were removed (D), preserving a medial flap on the nasal floor to avoid notching.

1012

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

Postoperatively, the nose is better balanced and the nasal base deformity has improved. The base is still wide, but it is appropriate for the patient’s face, and the nose is balanced within itself. Maxillary augmentation has improved upper lip retrusion, which can best be seen in the frontal view. Despite tip grafting, radix augmentation has improved nasal balance and reduced apparent nasal base, as has nasal shortening. The tip is in line with the dorsum, and the alar walls remain flat. Preservation of the medial flap and closure without tension have created alar base scars that are almost imperceptible.

1013

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY SIX

This black secondary patient presented a cosmetic quandary that only deepened during her surgical procedure. Two previous rhinoplasties had scarred and thickened her nasal skin and left a supratip deformity. However, the tissues seemed well supported by the remaining skeleton, and the septum was intact; thus the surgical plan appeared straightforward. However, to illustrate her goals, the patient brought photographs of Caucasian women with narrow, thin-skinned noses that were shorter and contained significant retroussé and tip angularity. For this nose, direct skin excision offered the only avenue to absolute reduction; however, based on the condition of her existing scars, I believed that direct skin excision was unwise. With this type of difference between the expected and the practical, surgeon and patient must come to an explicit understanding of what can really be done; and the determined course of action must be capable of satisfying the patient’s goals. We were able to come to such an agreement (a straighter, narrower dorsum with retroussé, if possible), so surgery proceeded.

SUMMARY OF THE SURGICAL PLAN 1. Maxillary augmentation 2. Minimal skeletonization 3. Septoplasty 4. Dorsal graft 5. Tip graft 6. Left lateral wall graft

1014

CHAPTER 16

A



EXCEPTIONS TO THE USUAL

C

B

What could not be accurately palpated was the degree of previous skeletal resection. After skeletonization, a deep upper dorsal defect appeared (A); compare this image to the preoperative lateral image. I proceeded with the septoplasty, which yielded only a thin specimen (notice the translucence of the largest piece in the center of the grid) (B). I inserted a single dorsal graft from that piece (C), but it had almost no effect.

A

B

C

Accordingly, I rolled and fixed ear cartilage circumferentially with 5-0 nylon sutures, filling the undersurface with cartilage scraps according to Sheen’s method (A). The thicker graft elevated the dorsum and produced a surface difference (B). Tip grafts completed the reconstruction (C). 1015

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Six years postoperatively, the dorsum remains straight and narrower because of augmentation. Skin-sleeve volume has not changed. Maxillary augmentation has softened the perialar retrusion without moving the nasal base forward.

1016

CHAPTER 16



EXCEPTIONS TO THE USUAL

Although the nose is still large, its mass has been redistributed cephalad so the nasal base seems less dominating. Tip grafts created a slight degree of retroussé as desired, narrowed the tip lobule, and produced a more angular tip. Geometric mean postoperative airflow increased 2.7 times over preoperative values.

1017

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY SEVEN

This man from southern Asia had undergone a rhinoplasty that not only failed to change his nasal appearance but also created a new airway obstruction. The dorsum was still low, the supratip was still high, and the tip cartilages were soft. The only perceptible change was a new airway obstruction, evident on inspection when the patient flared his nostrils to support his airway. Typical of this racial group is medium-thickness soft tissues, a distally located dorsal convexity, a low radix, a soft tip, and thin tip cartilages. The patient desired a straight dorsum, more tip shape, and a patent airway. As an engineer, he was distressed by the undulations of his nasal sidewalls.

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage 2. Minimal skeletonization 3. Rasping bony vault for graft adherence 4. Septoplasty 5. Spreader grafts 6. Dorsal graft 7. Grafts to alar creases 8. Multiple tip grafts

1018

CHAPTER 16



EXCEPTIONS TO THE USUAL

The entire operation was performed through three short incisions. The first was an intercartilaginous incision carried around the septal angle and provided access for dorsal and spreader grafts. The dorsum was rasped for bony vault adherence.

A

B

Spreader grafts were cut from the septal specimen and placed into each tunnel. Both grafts are visible in B, where the tip of the forceps indicates the caudal septum.

A

B

The best septal piece was beveled on the edges and adjusted to fit the defect, with the thickest end going toward the root (A). Placed through the same intercartilaginous incision, the graft leveled the dorsum (B).

1019

PART IV



PRIMARY RHINOPLASTY

Through separate incisions approximately 3 mm above each alar rim and in separate pockets, trimmed ear cartilage was placed to re-create the lateral crura.

Tip grafts have been placed (see additional illustrations for this patient in Chapter 12). The medial crura are further strengthened by placing a columellar graft. Scissor tips hold open a short, left-sided columella incision so that the graft can slip into place and complete the reconstruction. Silhouettes reveal the rebalancing and alteration of the dorsum-tip relationships. No supratip skeleton was resected.

1020

CHAPTER 16



EXCEPTIONS TO THE USUAL

Postoperative Analysis

Postoperatively, the patient no longer flares his nostrils. The sidewalls are smooth and confluent, and the alar wall creases have softened. The dorsum is now straight, and the tip of the dorsal line and the middle vault are confluent with the upper and lower thirds. The inverted-V deformity and the alar wall shadows have ablated. Alar resections were not performed, but dorsal, alar wall, and tip augmentation have improved the contours. Retroussé would be ethnically inappropriate in this patient.

1021

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY EIGHT

Typical of southern Asian noses is a distal deformity: a hump that begins far caudally, malpositioned alar-cartilage lateral crura, and a convex supratip. Often added to these characteristics is a long nose or, in this patient’s case, a nose that seems longer than it is. Notice in the frontal view that some nostril is visible, yet the combination of a high supratip and poor tip lobular shape exaggerate the patient’s nasal length. Notice also that the columella-labial angle is just less than 90 degrees. Although this nose should be shortened slightly, tip shape creates the most significant visible deformity. The steps involved in a standard reduction rhinoplasty would create a deformity essentially identical to the one seen in the previous patient: collapsed middle vault, deep alar creases and external valvular incompetence from resection of malpositioned lateral crura, supratip deformity, increased tip ptosis, and a new bilateral airway obstruction.

SUMMARY OF THE SURGICAL PLAN 1. Moderate skeletonization over upper cartilaginous vault, none over bony vault 2. Shortening caudal ends, upper lateral cartilages, submucosally 3. Transfixing incision, shorten membranous septum only 4. Relocate malpositioned lateral crura 5. Minimal trim of distal cartilaginous dorsum (not opening roof) 6. Septoplasty 7. Spreader grafts 8. Tip grafts

1022

CHAPTER 16

A

B



EXCEPTIONS TO THE USUAL

C

The patient’s bony vault length measured only 5 mm (marked), leaving a long span of cartilaginous sidewall support. After skeletonization, the middle vault hollow became more obvious (A). Spreader grafts, sized to span the sidewall from the bony arch to the supratip (B), were slipped into submucoperichondrial tunnels. The change in middle vault support was visible externally (C).

The first solid graft placed into the tip created the angle of rotation, but the lobule remained flat and the tip was unnaturally angular. Additional crushed grafts placed anterior to that graft rounded the lobule and completed the reconstruction.

1023

PART IV



PRIMARY RHINOPLASTY

Silhouettes show the effect of slight nasal shortening and tip reconfiguration. No dorsal augmentation was performed.

Postoperative Analysis

Two years after surgery, there is little change in frontal view. Although the lateral crura were resected and their previous bed now feels soft, the patient’s tissues were unable to manifest any significant surface change. Patients should be forewarned of such tissue limitations. Tip lobular contour has improved: the supratip is flat, there is a defined point of tip projection, and the mass of the tip lobule is now caudad, rather than cephalad. The alar walls are slightly convex and supported, the hollows are ablated, and the nose seems shorter even without a significant change in the columella-labial angle. 1024

CHAPTER 16



EXCEPTIONS TO THE USUAL

Similar to blacks, Asians share few of the neoclassical aesthetic canons. Nasal width constitutes 25% of total facial width in 51.5% of Asians (compared with 36.9% of Caucasians and 0% of blacks, as noted by Bashour). The distance between the eyes equals the interalar distance in 35.4% of Asians and 40.8% of Caucasians, but only 3% of African Americans. As a rough generalization, many Asian faces have low nasal dorsa, medium-thickness subcutaneous tissues, retrusive upper lips, bimaxillary protrusion, short nasal septa (predominantly ethmoid), and thin, soft tip cartilages. Overall, the nose tends to be small, and so the Asian nose satisfies some of the neoclassical canons designed for Caucasians as well as or better than some Caucasians. Many Asians dwelling in the United States desire “Americanization,” by which they mean a higher, narrower dorsum and a more angular tip. Because the nose is small, surgeons must be wary of applying techniques slavishly without assessing nasal balance. For example, the low radix, which is helpful in altering nasal proportion in Caucasian noses, has much less relevance in Asian noses, where the base is generally so short that routine placement of the radix at the supratarsal fold or upper lash margin may produce a nasofacial angle that is too vertical. In addition, donor sites are often an issue in Asian rhinoplasty, hence the common use of silicone implants throughout Asia and the United States. The conchae are typically small and deep, virtually never providing grafts of sufficient length for the nasal dorsum. For many years, before I became more comfortable with costal cartilage, I used calvarial bone for these patients. However, calvarial bone only supplies dorsal grafts, and perhaps lateral wall and columellar grafts; conchal cartilage

1025

PART IV



PRIMARY RHINOPLASTY

must still be harvested for the tip, and some alternative must be used for the maxillary arch. Rib grafts serve all of these needs. The following two cases illustrate these issues.

PATIENT STUDY NINE

This young Thai woman wanted a nose that was as narrow and angular as possible. She had a broad, low dorsum, an obtuse nasolabial angle, and bimaxillary protrusion. The alar base was slightly flared, but the nose was not large.

SUMMARY OF THE SURGICAL PLAN 1. Harvest calvarial bone and ear cartilage grafts 2. Maxillary augmentation 3. Limited skeletonization through single cartilage splitting incision (better coverage for the dorsal graft) 4. No transfixing incision 5. Septoplasty 6. Dorsal graft, calvarial bone 7. Lateral wall graft, septal cartilage 8. Columellar graft, calvarial bone 9. Tip grafts, septal cartilage 10. Alar wedge resections, removing external and vestibular skin

1026

CHAPTER 16



EXCEPTIONS TO THE USUAL

B

A

C

In 1988, when this surgery was performed, I was using Proplast (which is no longer available) for maxillary augmentation (A). Although Proplast was successful in many ways, it was a rigid implant, unyielding in the sulcus. Notice the change in the vertical plane of the upper lip after maxillary augmentation (B). The septal and cranial bone harvest is shown in C. Notice that the septal specimen was mostly thin ethmoid with only small cartilage fragments. This is typical of many Asian noses. A

B

C

The calvarial graft was shortened and contoured to fit the defect; notice that it is only 3 cm long, but it is all that was required to fit this short dorsum. Once the dorsal graft was placed, remaining pieces of ethmoid or calvarial bone were used to fill the lateral walls (B) and columella (C). When the dorsum is raised, lateral wall grafts are often necessary to reconstruct the dorsal pyramid, not only for contour but also to diffuse support and therefore camouflage the dorsal graft edges. 1027

PART IV



PRIMARY RHINOPLASTY

Profiles at the beginning and end of the procedure show the transformation. The dorsum is higher, the tip is more angular, and the nasal base is apparently smaller.

Postoperative Analysis A

B

C

At 6 weeks the early postoperative course was benign (A). At 5 months, however, she returned with upper lip swelling (B) and fluctuance in the upper gingivobuccal sulcus (C). The Proplast was removed.

1028

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EXCEPTIONS TO THE USUAL

One year after surgery, the dorsum is straight and smooth. Despite removal of the Proplast, enough scar tissue remains to maintain lip position. The radix is slightly low in absolute terms (it is at the midpupillary level) but appropriately balanced for this nose. The alar base was narrowed, but closure without tension and preservation of the medial flap avoided notching.

1029

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY TEN

This patient presented with an L-shaped implant that threatened extrusion through the tip, and was already exposed intranasally at the septal angle. Notice the strange appearance of the high radix. Because there was no purulence or soft tissue infection, and because I wanted to preserve the space that the implant had created, I resected the distal portion of the implant, leaving just the segment along the dorsum, and closed the wound. Healing was uneventful.

1030

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EXCEPTIONS TO THE USUAL

As healing progressed, the base collapsed proximally as the soft tissues contracted, but dorsal height was preserved. Aside from a crease in the right alar wall and some wound retraction on the left, the soft tissues survived nicely. Notice how nasal balance improved when the implant dropped distally at the radix once the columellar section had been removed. This is the proper height for the patient’s radix. A costal cartilage reconstruction was planned for the dorsum and tip. Alar wedge resections (external skin only) were to be used for composite grafts to correct wound retraction and to gain apparent nasal length (as a delayed, isolated procedure).

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Skeletonization through a single cartilage-splitting incision 3. Removal of dorsal implant 4. Dissection under implant capsule, maintaining good soft tissue cover; rasp bony vault for graft adherence 5. Dorsal laminate of rib cartilage 6. Multiple tip grafts 7. Columellar grafts 8. No delivery of tip cartilages 9. No transfixing incision 10. No osteotomy 11. Alar wedge resection to rim transfer (composite graft) as a secondary procedure

1031

PART IV



PRIMARY RHINOPLASTY

After the silicone implant was removed, notice how the nose shortened and the nasal base apparently enlarged. A laminate was fashioned from cartilage/perichondrial strips, leaving the perichondrial surfaces facing externally and burying the 6-0 nylon knots between the slices. Once the graft was in place, the nasal base apparently became smaller and the nose lengthened once again. Tip grafts completed the reconstruction.

1032

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EXCEPTIONS TO THE USUAL

Postoperative Analysis A

B

C

D

The patient is shown in stages during the reconstruction: with the extruding implant in place (A), after partial implant removal (B), after rib graft reconstruction (C), and after coronally oriented composite grafts to the alar rims (using alar lobules as donor sites) (D). After the final stage, the dorsum is smooth and stable, and the rib graft is impalpable. Cartilage and composite grafts have reconfigured the nasal base, correcting the peculiar deformity conferred by the implant.

1033

PART IV



PRIMARY RHINOPLASTY

These procedures must be performed with appropriate waiting periods, giving sufficient time for the soft tissues to mature and recover from each step. In this case, 3 years occurred between removing a portion of the implant and the definitive rib reconstruction, and it was 8 months between the rib reconstruction and the composite grafts.

The patient is shown 3 years after reconstruction. The deformities caused by the implant are almost imperceptible, except for a slight depression in the right medial alar wall. Her nose is balanced between dorsal height and nasal base size, both aesthetically and appropriately for her ethnic group. Her tip projects above the dorsal line, but there is no exaggerated retroussé or angularity. Her reconstruction was autogenous and should therefore be permanent. Without a strut or open rhinoplasty dissection, the columella remains narrow. Geometric mean airflow increased 2.3 times over preoperative values. 1034

CHAPTER 16



EXCEPTIONS TO THE USUAL

Older Patients Older, of course, is a relative term, like most things in rhinoplasty. Two important considerations for the older patient are (1) how long dissatisfaction with the nose has been present and (2) any particular structural characteristics that may require altering the surgical plan. Older nasal bones are thinner and more brittle, and the bony arch must be able to support eyeglasses. Soft tissues have become atrophic and less elastic, and they tend to wrinkle instead of tighten, making some intraoperative judgments more difficult and contraction to a reduced framework less probable. Cartilages may have become more rigid, and many patients believe that their tips have grown larger with time. Whether this reflects actual cartilaginous growth, elongation or thinning of soft tissues, or even absorption of the bony vault creating a new imbalance is not yet known. Tips that were adequately projecting in prior years begin to hang from the septal angle, causing an apparent curvature in the lower nose. It is therefore wise to inquire how long the patient has been unhappy with his or her nasal shape. For some patients, it has been since their teen years. These patients can undergo more fundamental surgical changes, but exotic alterations (such as too much dorsal reduction, too much retroussé, and excessive narrowing) should be avoided. Alternatively, the patient whose unhappiness with his or her nasal shape is recent may simply be noticing aging changes. The surgeon’s task in these cases is to restore the nose, insofar as possible, to its previous, more youthful appearance.

1035

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY ONE

This woman had noticed that her nose had begun to lengthen and that it seemed to have grown larger at the base. However, the tissues were firm and of excellent quality, suggesting that some contraction was still possible. The lateral crura were malpositioned, and there was a high septal deviation toward the right.

SUMMARY OF THE SURGICAL PLAN 1. Resect and replace alar cartilage lateral crura 2. Wide skeletonization over upper cartilaginous vault, narrow over bony vault 3. Transfixing incision with trim of caudal and membranous septa, shortening the nose 4. Submucosal shortening of upper lateral cartilages retrograde 3 mm 5. Dorsal reduction, slightly greater on the left than the right 6. Septoplasty 7. Asymmetrical spreader grafts, thicker on the right than the left 8. Thin radix graft 9. Multiple crushed cartilage tip grafts 10. No osteotomy

1036

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EXCEPTIONS TO THE USUAL

Postoperative Analysis

Two years postoperatively in the frontal view, there is very little change. The base is rotated slightly, and the right sidewall is now confluent. The nose is shorter in the lateral and oblique views, the radix is slightly higher, and the tip now ends in a defined point of projection. Aging tissues cannot always be relied on to contract around a reduced framework. Although support assists balance and shortening at any age, it is particularly important in older patients to avoid postoperative elongation and disappointment.

1037

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY TWO

This patient was happy with her nasal contour until a recent trauma increased the dorsal convexity and created new frontal asymmetry. She has an undulating bridge with adequate tip projection. The two alternatives for creating a straight profile are dorsal resection alone (which will increase nasal base size), or dorsal resection and replacement with a septal cartilage graft (which will not increase nasal base size). In this patient, resection and replacement is preferable, not only for nasal balance but also because a dorsal graft will help camouflage the frontal asymmetry.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Dorsal reduction 3. Retrograde reduction of the right lateral crus (preoperative asymmetry) 4. No transfixing incision 5. No nasal shortening 6. Septoplasty 7. Asymmetrical spreader grafts, much thicker on the left than the right 8. Onlay graft to the left middle vault 9. Dorsal graft 10. Minimal tip grafts for symmetry

1038

CHAPTER 16



EXCEPTIONS TO THE USUAL

The septum fortunately yielded a perfect dorsal graft that was thicker at one end than the other. The graft edges were contoured and beveled distally to fit the defect. The remaining small cartilage scraps were placed into the superior tip lobule for contour and symmetry.

Postoperative Analysis

The patient is shown 6 months after surgery. The nose is significantly more symmetrical in the frontal view by virtue of the asymmetrical spreader and dorsal grafts. Nasal length has not changed.

1039

PART IV



PRIMARY RHINOPLASTY

The dorsum is now straight and the oblique views are more symmetrical. A few crushed septal cartilage scraps placed high in the tip lobule (see Chapter 12) have improved symmetry without causing significant change in lobular size, tip projection, or nasal base volume. Notice that the patient’s retrusive upper lip carriage has not changed, because neither a transfixing incision nor a caudal septal reduction was performed.

1040

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EXCEPTIONS TO THE USUAL

PATIENT STUDY THREE

This French Canadian grandmother had decided it was time to do something about her lifelong nasal deformity. Length is a problem. The dorsum must be lowered and the base must be rotated, but any skeletal reduction will increase the patient’s relative skin excess.

Accordingly, skin reduction was planned at the radix. The scar was less important in this case, because the patient’s heavy eyeglasses would camouflage it. Much of the caudal septum would be preserved and sleeved between the medial crura as a tongue-in-groove, fixed with absorbable sutures only (see Chapter 11). 1041

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization over upper cartilaginous vault, narrow over bony vault 2. Dorsal reduction 3. Transfixing incision, shortening of caudal septum 2 mm and membranous septum 5 mm; sleeve caudal septum into columella as tongue-in-groove 4. Retrograde reduction of alar cartilage lateral crura, 3 mm 5. Reduction caudal ends, upper lateral cartilages, 4 mm 6. Septoplasty 7. Excision of upper nasal skin 8. Bilateral spreader grafts 9. Radix graft 10. Tip grafts 11. Columellar grafts 12. No osteotomy

A

B

C

D

After dorsal reduction, notice that the nose lengthens (B). This is typical not only of many long noses but also noses in which the hump is located distally. An incision was made as previously marked, extending across the radix, with back cuts along each side to absorb the dog-ears. Notice that, despite a significant dorsal reduction, the bony vault was still intact, and the cephalic part of the bony arch was quite dense (C). The skin resection equilibrated the soft tissue and the skeleton (D).

1042

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EXCEPTIONS TO THE USUAL

Postoperative Analysis

More than 4 years postoperatively, the nose remains shorter. Though the patient is 4 years older, dorsal reduction and nasal shortening have had a rejuvenating effect on her appearance (and her psyche, evidenced by her carrying her chin higher). The shortening has held, assisted by a skin excision and a firm caudal septal repair. Bony vault width and stability remain unchanged. Notice the persistent depressions caused by her heavy eyeglasses.

1043

PART IV



PRIMARY RHINOPLASTY

SECONDARY RHINOPLASTY IN OLDER PATIENTS Secondary rhinoplasty in older patients requires the same precautions as in primary cases regarding anatomic variants, the soft tissue and skeletal changes that occur with aging, and the degree of change that patients expect or can tolerate. However, the surgeon must also cope with lost airway and support and with deficient donor sites.

PATIENT STUDY ONE

This patient had undergone two previous rhinoplasties that had diminished her airway (notice the nostril flare and the narrow middle vault). Lateral crural reduction has allowed the alar rims to retract cephalad. The tip lobule was essentially empty, hanging from the septal angle. This patient is an excellent example of someone with a large nasal base that is nonetheless inadequately projecting, indicating a large lower skin sleeve with deficient skeletal support. Septal cartilage was absent, and so rib cartilage was harvested for the dorsum and all other graft requirements. The septal partition was flaccid, and synechiae bound the septum to the inferior turbinate on one side.

1044

CHAPTER 16



EXCEPTIONS TO THE USUAL

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Minimal skeletonization through single intercartilaginous incision 3. Divide synechiae between inferior turbinate and the septum 4. Thin rib cartilage maxillary augmentation 5. Rib cartilage dorsal graft 6. Rib cartilage lateral wall grafts 7. Rib cartilage alar wall grafts, left thicker than right 8. Multiple crushed tip grafts with solid rib cartilage buttress 9. Right alar wedge resection (lobule only), transferred to left alar rim as composite graft

Postoperative Analysis

Two years postoperatively, the dorsum is straight. The dorsal graft has opened the middle vault, and lateral wall grafts have obscured the edges of the dorsal graft and smoothed the irregularities in the nasal sidewalls. Alar wall grafts have replaced the missing lateral crura. The transfer of the right lobule to the left rim has corrected the rim height asymmetry.

1045

PART IV



PRIMARY RHINOPLASTY

The dorsum is now correctly positioned, and the radix has moved from the lower lash margin to the level of the upper lash margin. The empty tip lobule has been expanded by grafts and now supports the tip above the level of the septal angle. The alar hollows have decreased.

1046

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EXCEPTIONS TO THE USUAL

PATIENT STUDY TWO

Although at first glance the dorsal hump may seem to be the most striking characteristic of this nose, examine also the nasal base. The maxillary arch is retrusive, and the entire base has rolled caudad and posteriorly. Despite strong alar cartilages, a previous septoplasty had included resection of the distal 25% of the septal partition, leaving nothing to support the base. A portion of the septum remained but was distorted. My plan was to reduce the dorsum, rotate the base, and then use the remaining septal and conchal cartilage to re-create caudal support and level the dorsum.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization over upper cartilaginous vault, narrow over bony vault 2. Resection of bony and cartilaginous dorsa 3. Submucosal shortening of upper lateral cartilages, 3 mm 4. Transfixing incision, shortening caudal and membranous septa 5. Delivery of alar cartilages as a bipedicle flap, reducing cephalic margin by 3 mm and resecting a 3 mm vertical wedge from each dome 6. Septoplasty 7. Harvest conchal cartilage 8. Unilateral spreader graft, right 9. Dorsal graft of septal cartilage 10. Ear cartilage graft to membranous septum, replacing caudal septum to the septal angle 11. No osteotomies

1047

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Postoperatively, the rejuvenating effect of a shorter nose is immediately obvious, not only in absolute aesthetic terms but in the patient’s perception of her own attractiveness. The nasal base has been narrowed slightly by the domal resection, but skeletal reduction did not exceed soft tissue contractile limits. The nose is supported by increased middle vault width, maintenance of bridge height, and replacement of the caudal septum. No maxillary augmentation was performed to avoid pushing the large nasal base farther anteriorly. Although some reduction was performed, a great deal of dorsal height and alar cartilage strength was maintained. The middle vault and the caudal septum were augmented, and osteotomy was avoided. Geometric mean nasal airflow increased 2.9 times over preoperative values. 1048

CHAPTER 16



EXCEPTIONS TO THE USUAL

PATIENT STUDY THREE

This patient had undergone four previous rhinoplasties, the last of which, 27 years earlier, had been a silicone dorsal augmentation. Although the silicone implant had been in place for many years, the patient was bothered by its movement and its sensitivity to winter cold.

Photographs of the patient as a teenager and at her wedding show a high dorsum and a projecting tip without retroussé.

1049

PART IV



PRIMARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Minimal skeletonization through right-sided intercartilaginous incision 3. Remove silicone prosthesis 4. Skeletonize dorsum behind prosthetic capsule 5. Rasp bony vault for adherence 6. Rib cartilage dorsal graft 7. Rib cartilage alar wall grafts 8. Multiple tip grafts, placed on caudal side of lobule 9. Bilateral alar wedge resections, removing external and vestibular skin; transfer of alar wedge resection tissue to alar rims as composite grafts

The old silicone prosthesis is shown next to its rib graft replacement, which is longer to facilitate caudal tip rotation. Note the color of the rib graft, highly calcified at this patient’s age and therefore virtually impervious to warping.

1050

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EXCEPTIONS TO THE USUAL

Postoperative Analysis

Three years after surgery, the dorsum remains stable and smooth. The rib graft, unlike the silicone implant, has firmly united to the bony arch. The nasal base is narrower, and the alar rim notches have softened. Because the alar resections were small, their transfer to the rims produced a negligible improvement. More significant changes in alar rim height could have been effected by conchal cartilage/skin composite grafts, which are stiffer than alar lobular skin but would have necessitated another donor site. The patient’s soft tissue laxity, a bonus in this older tertiary rhinoplasty patient, allowed several millimeters of nasal base rotation caudally. Combined with an elevation of the radix by the dorsal graft, the increase in nasal length is noticeable. Geometric mean nasal airflow increased 4.3 times over preoperative measurements. 1051

PART IV



PRIMARY RHINOPLASTY

T hin Skin The soft tissues and skeletons of patients with thin skin treat both patients and surgeons mercilessly. Thin skin reveals every underlying skeletal flaw and tightens around a reduced framework until it reaches its contractile limits, after which the skin begins to thicken and a supratip deformity develops. However, it is not the skin alone that constitutes the problem in these patients—it is the underlying skeleton, particularly the alar cartilages, which are usually strong, convex, and full of internal stresses. Reduced excessively, alar cartilages knuckle. Resected, crushed, and replaced, they may heal unevenly, one bowing more than the other. Interrupted with vertical resections, the ends may curl outward, producing unattractive ridges that frame the tip.

The following points should be kept in mind when treating patients with thin skin:  Give particular care to producing a smooth skeleton.  Preserve enough alar cartilage arch to retain shape and avoid postoperative kinking and knuckling at the domes or elsewhere.  Place spreader grafts to avoid any postoperative middle vault discontinuity, almost always visible in these patients.  Use only softened or crushed cartilage dorsal and tip grafts, which provide support with a lower chance of visible edges.

Malpositioned alar cartilages and other anatomic variants are particularly noticeable in thin-skinned patients and must be treated to produce a normal result.

1052

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EXCEPTIONS TO THE USUAL

PATIENT STUDY ONE

If this patient’s skin were thicker, her malpositioned lateral crura would not be so obvious. Thin skin outlines the caudal end of the bony vault, the contour of the middle vault, the normal declivity between the alar cartilages, the tip of the septal angle, and the extended abnormal position of each lateral crus. The patient’s flared nostrils manifest her poor airway.

SUMMARY OF THE SURGICAL PLAN 1. Resect and reposition alar cartilage lateral crura 2. Dorsal reduction 3. Transfixing incision, with 2 mm trim of caudal and membranous septa 4. Septoplasty 5. Bilateral spreader grafts, thicker on the left than right (preoperative asymmetry) 6. Thin radix graft 7. Multiple crushed cartilage tip grafts 8. Columellar grafts to smooth columellar/lobular contour

1053

PART IV

A



PRIMARY RHINOPLASTY

B

C

Notice that the lateral crural dimensions correspond exactly to what the skin had shown (A). The cartilage was crushed, trimmed, and replaced along the alar rim (B). After repositioning the right lateral crus, the external valve was supported and the rim became normally convex (C). When placed where it belongs, anatomy creates the normal.

A

B

C

D

The resected roof, 2.5 mm thick, shows normal surface markings, with its central depression denoting the fusion line between the upper lateral cartilages and the anterior septal edge (A). Compare the views before (B) and after (C) a single-layer radix graft, and notice the difference in dorsal contour and apparent nasal base size. At the conclusion of the procedure the dorsum was straight, the tip was adequately projecting, and all four valves had been reconstructed (D). 1054

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EXCEPTIONS TO THE USUAL

Postoperative Analysis

Eighteen months postoperatively, the dorsal lines are smooth and continuous. The bony vault is slightly narrower, the middle vault is appropriately wide and confluent with the upper and lower vaults, and the alar cartilages are repositioned, now with normal surface markings. The dorsum is straight, the septal angle is in line with the tip, and the tip itself has been recontoured by multiple soft grafts with edges that do not show. Correction of external valvular support alone doubles airflow in most patients.

1055

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY TWO

This woman’s nose is an asymmetrical version of the previous patient’s, although her narrow, excessively angular tip is more distorted and her septum projects from the right side of the columella, twisting the nasal base first one way and then the other. The entire nose is pencil-thin, and the dorsum is high and unbalanced (with the radix too low and the tip inadequately projecting). This is a tension nose, manifested by slitlike nostrils and a skeleton that seems too large for the skin sleeve that contains it, pulling the upper lip forward from the midface. Dorsal reduction and caudal septal resection will allow the nose to recess posteriorly and release the upper lip. The problem here is not the upper lip musculature or an overactive or short depressor septi muscle. The problem is a skin sleeve that cannot cover the skeleton beneath it. When the skeleton is recontoured, the soft tissues will correct themselves.

1056

CHAPTER 16



EXCEPTIONS TO THE USUAL

SUMMARY OF THE SURGICAL PLAN 1. Resect and relocate malpositioned lateral crura 2. Minimal skeletonization over dorsum 3. Reduction of bony and cartilaginous vaults 4. Transfixing incision 5. Shorten caudal and membranous septa, 3 mm 6. Asymmetrical spreader grafts, thicker on right than left 7. Thin, layered radix graft 8. Multiple crushed cartilage tip grafts 9. No osteotomy

A

B

C

D

Compare the patient’s appearance at the beginning of the case to her appearance after bony vault resection alone (A and B). Bony vault reduction further decreased the low radix, creating the illusion of an even larger nasal base. The tip rotated cephalad, raising the nostril rim and producing a relatively low caudal septum. After completing the dorsal reduction, the caudal septum required a compensatory adjustment (C). After dorsal, tip, and caudal septal reductions, notice the new upper lip position: the distortion self-corrected without any direct modification of the lip itself. A layered radix graft was used to improve nasal proportion (D).

1057

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

Eighteen months postoperatively, nasal contours are smooth and more symmetrical. Spreader grafts have improved the high septal deviation, but the patient’s rigid, posttraumatic cartilage has resisted complete correction. Dorsal and caudal septal reductions have allowed the entire nose to recess so that it no longer dominates the patient’s midface. Her upper lip contour is normal, without distortion at the subnasale. The radix is slightly higher, continuing into a straight dorsum and ending in a tip that is slightly higher but less severely narrow, according to the patient’s wishes. The oblique views match more completely. Notice also the apparent diminution in nostril length (although no alar wedge resections were performed), which is the result of a better nostril-lobular proportion.

1058

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EXCEPTIONS TO THE USUAL

T hick Skin The problem for surgeons treating patients with either thin skin or thick skin is that the surface cover does nothing to help. Thin skin shows everything; thick skin shows nothing. It was not so long ago that patients with thick skin were summarily rejected for rhinoplasty, because previous experience had shown that results for these patients were uniformly poor. And the results were poor when rhinoplasty was only a reduction operation, because nasal soft tissues do not have an infinite capacity to conform to the shape of any reduced skeleton (in contrast to False Assumption Number One [see Chapter 2]). Thick skin does not move much.

If thick soft tissues can move at all, they collapse and obstruct the airway when underlying support decreases.

1059

PART IV



PRIMARY RHINOPLASTY

Or, if thick skin collapses posteriorly, tip projection decreases and supratip deformity is produced.

1060

CHAPTER 16



EXCEPTIONS TO THE USUAL

When malpositioned lateral crura have created a ball tip, skeletal reduction obstructs the external valves and costs tip shape and projection. The problem may be the skin, but the solution is not the skin. Dermal thinning is never effective.

Several ground rules are helpful when treating the thick-skinned nose:  Thick skin conforms poorly to a reduced framework. Consider it a fixed parameter, not variable.  To the extent that thick skin can contract and conform, it becomes even thicker, causing the nose to lose definition.  The heavier the tissues, the more support is required.  The heavier the tissues, the more substantial the grafts must be to produce a given surface effect.  When the augmented skeleton projects and influences surface contour, the nose appears more refined.

1061

PART IV



PRIMARY RHINOPLASTY

PATIENT STUDY ONE

This young woman had been rejected for surgery by numerous prior physicians, who believed she was untreatable. They were right to assess this nasal configuration as difficult. Adding complexity to the procedure was the patient’s surgical goal as pictured in the magazine photographs: a smaller, narrower nose with a slender, angular tip.

1062

CHAPTER 16



EXCEPTIONS TO THE USUAL

This type of consultation must be a journey into what is possible and what is not. I explained to the patient that the model’s soft tissues and skeleton are entirely different from her own, and that such a transformation is not surgically possible by methods that I know. I then showed her photographs of thick-skinned patients with similar problems, explaining that these examples demonstrated the limits of what Nature would permit. I explained the logic of augmentation and the restrictions imposed by her tissues. Some patients accept these limitations (as this young woman did) as the best of the available alternatives, even though they must reset their goals. Other patients are not willing to accept them, and they should seek treatment elsewhere. This young woman’s tissues are thick, and her contours are blunt. The dorsum is slightly low relative to the nasal base size, therefore giving room for dorsal augmentation (which should narrow the frontal view). Bony vault width equals base width. The lateral crura are bossed and broad, but the overlying soft tissues do not coapt the lateral crura that she has, indicating that they will not tighten around cartilages that are even smaller. However, modest tip reduction followed by lobular augmentation becomes a rearrangement rather than a reduction, allowing the tip to become more angular without the need to change volume.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over bony and upper cartilaginous vaults 2. Rasp bony vault for graft adherence 3. Reduction of alar cartilage lateral crura through a delivery technique, leaving 8 mm; 3 mm vertical wedge taken from each lateral genu 4. Septoplasty 5. Dorsal graft of septal cartilage 6. Tip grafts 7. Bilateral osteotomies

1063

PART IV

A

D



PRIMARY RHINOPLASTY

B

E

C

F

G

After alar cartilage reduction, dorsal contour changed very little, as expected (B). The best piece of septal cartilage was beveled and trimmed for the dorsum (C), and two firm pieces were selected for the nasal tip (D). After dorsal and tip augmentation, the skeleton has better shape and angularity (E). Silhouette views document the increase in tip projection (F and G). Dorsal height seems unchanged despite augmentation.

1064

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EXCEPTIONS TO THE USUAL

Postoperative Analysis

Two-and-one-half years after surgery, the frontal view is slightly narrower (the result of osteotomies and dorsal grafting), and the tip change is real but modest. Despite lateral crural reduction and dome resection, the tip lobule has only narrowed slightly. Lateral and oblique views show smooth, more angular contours with an apparent reduction in apparent nasal base size. The nose has a nonsurgical appearance. This patient was pleased with her outcome, largely because she had accepted a limited change preoperatively and redefined her goal.

1065

PART IV



PRIMARY RHINOPLASTY

Each of these thick-skinned patients was treated in the same way: by conservatively reducing areas that were excessive and looking for areas that could be augmented and for places where angularity could be increased to provide the illusion of refinement. All patients received minimal dorsal and tip reductions, tip grafts, and either radix or dorsal grafts (depending on the configuration). When tip-grafting patients with thick skin, the firmer the grafts and the fewer their number, the more angularity they will produce (see Chapter 12).

1066

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EXCEPTIONS TO THE USUAL

R hinophyma

Rhinophyma is the perfect setting for a real reduction rhinoplasty mindset. All of the noses pictured here really are too large, distorted by sebaceous and vascular overgrowth, chronic inflammation, exudates, and sometimes grotesque excesses of nasal soft tissue. There is no question that the soft tissue must be reduced, either by tangential excision or direct excision. As the excised surface heals, skin texture changes, sometimes becoming smoother and sometimes becoming scarred, depending on the depth of the excision. Patients must be forewarned of the latter possibility, but few patients object, because the deformity is so significant and so inaccurately associated with middle-aged ethanol abuse.

1067

PART IV



PRIMARY RHINOPLASTY

Three principles can guide the surgeon treating rhinophyma:  Not every nose with rhinophyma was originally small and straight. Before beginning the excision, try to visualize the patient’s real underlying contour, and obtain old photographs if possible. The objective is to reduce the nose but produce as little scarring as possible. An initial shape compromise may be necessary.  Do not assume that every nose was well balanced before it became diseased: some had dorsal humps and low radices, some had inadequate tip projection, and some were already too long. Your patient may need a second rebalancing procedure; skin excision does not correct skeletal abnormalities.  Plan excisions according to the nasal planes and aesthetic units to minimize distracting color and contour discontinuities.

PATIENT STUDY ONE

This physician had noticed a progressive, mild enlargement of his nose over the previous 3 years. His medial cheeks were similarly affected: the rubor and telangiectases of the nose, upper lip, and cheeks indicate acne rosacea.

1068

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EXCEPTIONS TO THE USUAL

I began by outlining the nasal planes and light reflexes so that I would not lose my orientation during surgery. After local anesthesia infiltration, I worked from area to area with a scalpel, changing No. 15 blades frequently. I began with the dorsal reflex, extending down the sidewalls, and then carving the tip lobule. If the tissues permit, I try to narrow the middle vault slightly to show the demarcation of the caudal end of the bony arch and to highlight the point of maximum tip projection and the tip facets, all of which give the illusion of refinement to a thick nose. Notice that the soft triangles were spared to avoid retraction and nostril deformities.

1069

PART IV



PRIMARY RHINOPLASTY

Postoperative Analysis

A

B

C

D

Four days after excision, the wound has the expected amount of exudate, but epithelization has already begun (B). The tissues are protected with petrolatum. At 4 weeks, epithelization is complete and contour is good (C and D).

1070

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EXCEPTIONS TO THE USUAL

At 1 year, the frontal and inferior views show modest but definite changes. Excision has been sufficiently superficial to avoid scarring. The midnose and tip lobule are narrower, and alar rim contour has been preserved. The columella remains narrow.

1071

PART IV



PRIMARY RHINOPLASTY

Dorsal height has been maintained, but the tip lobule is smaller. There is a slight concavity over the middle vault, and skin texture has been preserved. The skin has hypopigmented as expected, but it is confined to aesthetic units.

1072

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EXCEPTIONS TO THE USUAL

PATIENT STUDY TWO

This man has a more severe manifestation of the same disease, with gross enlargement of the alar lobules and extension onto his medial cheeks. The nasal skin is pitted and filled with sebaceous secretions, and there are vascular ulcerations in the right alar lobule. The treatment in this case is the same as the previous case, but visualization is more difficult. By palpation, it is obvious that the dorsum is not straight, and the tip lobule must therefore be sized appropriately for this nose. The same applies to the tip and alar lobules in the frontal view. Disease of this depth requires excision into the upper dermis and middermis, which means that the texture and color of the healed skin will not be normal, but hypopigmented and scarred in some areas. Although patients must be forewarned, I have never seen a patient be discouraged by these possibilities.

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Postoperative Analysis

One year postoperatively, the nose has healed, and the skin is smooth but lightly scarred and hypopigmented. Nevertheless, the excised area blends well with the unoperated nasal skin. The alar walls are normally thin, and the tip lobular width is appropriate for the patient’s frontal aesthetics. General dorsal contour—including the underlying hump—has been preserved, and tip and alar lobular aesthetics have improved.

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PATIENT STUDY THREE

Although this patient’s photographs of himself as a young man show much thinner skin, they do not give information about his profile. His preoperative lateral view reveals a significant imbalance between the upper and lower nose. The surgeon should not assume that beneath a thickened, rhinophymatous exterior lies a straight dorsum with adequate tip projection, because patients with dorsal humps, excessive tip projection, or low radix imbalance can all develop rhinophyma. In this particular case, correction necessitated two stages: shaving in the first stage, followed by skin excision and rebalancing in the second stage.

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The patient had undergone a previous septoplasty but his airway was still obstructed. Although totally obscured by the skin cover, his internal valves were narrow and incompetent.

Three months after the shaving procedure, the dorsum and tip are healed, but some hypertrophic scarring has developed in the patient’s midnose at the site of the most prominent disease. On the lateral view, the supratip convexity is still obvious. The nose remains slightly long, and the upper dorsum is slightly low relative to the nasal base size. A direct transverse excision is planned, which will lower the supratip and shorten the nose; spreader grafts will reconstruct the internal valves. As a necessary compromise, crushed ear cartilage will form a thin radix graft to improve nasal proportion.

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SUMMARY OF THE SURGICAL PLAN 1. Transverse resection of supratip skin 2. Harvest ear cartilage 3. Bilateral spreader grafts 4. Cartilage graft to posterior columella for contour and support 5. Thin, crushed ear cartilage graft to upper dorsum

A transverse skin excision was planned, spanning the area of redundancy. The surgeon must treat all nasal skin excisions with extreme care. Patients who most need them have skin replete with surface bacteria. Suppuration and exudates are common. The skin cannot be resected, sutured, and left covered by tape and plaster for 7 days. Place fine subcuticular sutures so that skin sutures may be removed early. I change the dressings myself daily and begin suture removal at 48 hours. The wound must be kept scrupulously clean. If proper attention is paid, then the scars, although not invisible, reach their potential best.

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Postoperative Analysis

One week following the second procedure, the skin wound has healed primarily. The dorsum is straight, and the nose is slightly shorter.

Fourteen months following the second procedure, nasal contours are smooth. The transverse excision has virtually disappeared within the area of hypertrophic scarring, which itself has matured.

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The tip lobule and nostrils are now shaped normally. Skin excision and the weight removed from the tip have rotated the base cephalad. Slight upper dorsal augmentation, direct shaving, supratip excision, nasal shortening, and columellar grafting have reduced the apparent nasal base size. Disease resection sufficient to create a straight dorsum was not performed; it would have produced a full-thickness defect. Scarring was reduced by the combination of skin reduction and skeletal augmentation. Rhinophyma surgery matches the surgeon’s right brain against disease.

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BIBLIOGRAPHY Anderson JR. Straightening the crooked nose. Trans Am Acad Ophthalmol Otolaryngol 76:938-945, 1972. Baser B, Shahani R, Khanna S, et al. Calvarial bone grafts for augmentation rhinoplasty. J Laryngol Otol 105:1018-1020, 1991. Bashour M. History and current concepts in the analysis of facial attractiveness. Plast Reconstr Surg 118:741-756, 2006. Baum SJ. Nasal projection. Arch Otolaryngol 103:262-267, 1977. Beheri GE. Rhinoplasty in Egyptians. Aesthetic Plast Surg 8:145-150, 1984. Berry RL, Edwards RC, Paxton MC. Nasal augmentation using the mandibular coronoid as an autogenous graft: report of case. J Oral Maxillofac Surg 52:633-638, 1994. Boccieri A, Pascali M. Septal crossbar graft for the correction of the crooked nose. Plast Reconstr Surg 111:629-638, 2003. Boo-Chai K. The management of ala ptosis in Oriental rhinoplasty. Aesthetic Plast Surg 10:17-20, 1986. Brain DJ. The management of the deviated nose. J Laryngol Otol 95:471-486, 1981. Byrd HS, Solomon J, Flood J. Correction of the crooked nose. Plast Reconstr Surg 102:2148-2157, 1998. Cannistrá CN, Guerrieri L, Iannetti G. Deviated nose: technical proposition for prevention of recurrences. Aesthetic Plast Surg 22:206-210, 1998. Celik M, Tuncer S. Nasal reconstruction using both cranial bone and ear cartilage. Plast Reconstr Surg 105:1624-1627, 2000. Cheney ML, Gliklich RE. The use of calvarial bone in nasal reconstruction. Arch Otolaryngol Head Neck Surg 121:643-648, 1995. Clark DP, Hanke CW. Electrosurgical treatment of rhinophyma. J Am Acad Dermatol 22:831-837, 1990. Colton JJ, Beekhuis GJ. Management of nasal fractures. Otolaryngol Clin North Am 19:73-85, 1986. Constantian MB. An algorithm for correcting the asymmetrical nose. Plast Reconstr Surg 83:801-811, 1989. Curnier A, Choudhary S. Rhinophyma: dispelling the myths. Plast Reconstr Surg 114:351-354, 2004. Daniel RK. Hispanic rhinoplasty in the United States, with emphasis on the Mexican American nose. Plast Reconstr Surg 112:244-256; discussion 257-258, 2003. Dingman RO, Natvig P. The deviated nose. Clin Plast Surg 4:145-152, 1977. Ducut EG, Han SK, Kim SB, et al. Factors affecting nostril shape in Asian noses. Plast Reconstr Surg 118:1613-1621, 2006. Ellis DA, Gilbert RW. Analysis and correction of the crooked nose. J Otolaryngol 20:14-18, 1991. Farina R, Cury E, Ackel IA. Traumatic nasal deformities. Aesthetic Plast Surg 7:233-236, 1983. Flowers RS. Nasal augmentation by the intraoral route. Plast Reconstr Surg 54:570-578, 1974. Foda HM. The role of septal surgery in management of the deviated nose. Plast Reconstr Surg 115:406415, 2005. Gilbert JG. Treatment of posttraumatic nasal deformity. N Z Med J 100:713-715, 1987. Gilbert SE. Overlay grafting for lateral nasal wall concavities. Otolaryngol Head Neck Surg 119:385-388, 1998. González-Ulloa M. The fat nose. Aesthetic Plast Surg 8:135-140, 1984. Grimes PE, Hunt SG. Considerations for cosmetic surgery in the black population. Clin Plast Surg 20:27-34, 1993. Gruber R, Kuang A, Kahn D. Asian-American rhinoplasty. Aesthet Surg J 24:423-430, 2004. Gruber RP, Weintraub J, Pomerantz J. Suture technique for the nasal tip. Aesthet Surg J 28:92-100, 2008. Grymer LF, Fogstrup J, Stoksted P. The deflected nose—surgical correction. J Laryngol Otol 96:719-724, 1982. Gurley JM, Pilgram T, Perlyn CA, et al. Long-term outcome of autogenous rib graft nasal reconstruction. Plast Reconstr Surg 108:1895-1905, 2001. Guyuron B. The aging nose. Dermatol Clin 15:659-664, 1997. Guyuron B, Griffin A, Hoefflin S, et al. African-American rhinoplasty. Aesthet Surg J 24:551-560, 2004.

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Hallock GG. Cranial nasal bone grafts. Aesthetic Plast Surg 13:285-289, 1989. Har-El G, Shapshay SM, Bohigian RK, et al. The treatment of rhinophyma. ‘Cold’ vs laser techniques. Arch Otolaryngol Head Neck Surg 119:628-631, 1993. Hodgkinson DJ. The olecranon bone graft for nasal augmentation. Aesthetic Plast Surg 16:129-132, 1992. Jeppesen F. Anterior wedge excision in correcting deflections of the nasal dorsum. Ear Nose Throat J 71:49-58, 1992. Jeppesen F. Anterior wedge excision in deflected nasal dorsum. A pilot study. Rhinology 29:201-212, 1991. Johnson CM Jr, Anderson JR. The deviated nose—its correction. Laryngoscope 87:1680-1684, 1977. Kabaker SS. An adjunctive technique to rhinoplasty of the aging nose. Head Neck Surg 2:276-281, 1980. Kabaker SS. An approach to aesthetic rhinoplasty in the non-Caucasian nose. Arch Otolaryngol 103:461-467, 1977. Kane NP, Kane LA. Open reduction of nasal fractures. J Otolaryngol 7:183-186, 1978. Kilic A. The nasal bone graft for nasal augmentation. Plast Reconstr Surg 108:274-275, 2001. Kline RM Jr, Wolfe SA. Complications associated with the harvesting of cranial bone grafts. Plast Reconstr Surg 95:5-13, 1995. Lawson VG. Management of the twisted nose. J Otolaryngol 7:56-66, 1978. Levine B, Berman WE. Demineralized bone grafts in rhinoplasty. Ear Nose Throat J 74:222-223, 1995. Maniglia AJ. Surgical correction of the traumatized nose. Otolaryngol Clin North Am 16:609-621, 1983. Mann DG, Pillsbury HC III. Correction of the “right hooked” nose. Laryngoscope 91:1562-1564, 1981. Maran AG. The deviated nose and the nasal airway. J R Soc Med 72:848-851, 1979. Martin H. Surgery of the crooked nose. Arch Otolaryngol 92:583-587, 1970. McCurdy JA Jr. Aesthetic rhinoplasty in the non-Caucasian. J Dermatol Surg Oncol 12:38-44, 1986. McKinney P, Shively R. Straightening the twisted nose. Plast Reconstr Surg 64:176-179, 1979. Megumi Y. Augmentation rhinoplasty with soft tissue and cartilage. Aesthetic Plast Surg 12:89-93, 1988. Merkx CA. Treatment of pseudo-arthrosis of the mandibular body by a sliding bonegraft. Arch Chir Neerl 23:273-285, 1971. Orak F, Senyuva C, Bayramicli M, et al. Reversed roof graft for the severely deviated nose. Aesthetic Plast Surg 19:31-36, 1995. Ortiz-Monasterio F, Lopez-Mas J, Araico J. Rhinoplasty in the thick-skinned nose. Br J Plast Surg 27:1924, 1974. Ortiz-Monasterio F, Olmedo A. Rhinoplasty on the mestizo nose. Clin Plast Surg 4:89-102, 1977. Parkes ML, Kamer FM. The mature nose. Laryngoscope 83:157-166, 1973. Parkes ML, Kanodia R. Avulsion of the upper lateral cartilage: diagnosis, surgical anatomy and management. Laryngoscope 91:758-764, 1981. Patterson CN. The aging nose: characteristics and correction. Otolaryngol Clin North Am 13:275-288, 1980. Pirsig W. Wedge resection in rhinosurgery: a review of the literature and long-term results in a hundred cases. Rhinology 26:77-88, 1988. Planas J. The twisted nose. Clin Plast Surg 4:55-67, 1977. Porter JP, Olson KL. Analysis of the African American female nose. Plast Reconstr Surg 111:620-626, 2003. Powell NB, Riley RW. Facial contouring with outer-table calvarial bone. A 4-year experience. Arch Otolaryngol Head Neck Surg 115:1454-1458, 1989. Ramsay SC, Yeates MG, Ho LC. Bone scanning in the early assessment of nasal bone graft viability. J Nucl Med 32:33-36, 1991. Robbins TH. The noselift procedure for rhinoplasty in the older patient. Br J Plast Surg 38:264-266, 1985. Rohrich RJ, Adams WP Jr. Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg 106:266-273, 2000.

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Rohrich RJ, Hollier LH. Rhinoplasty with advancing age: characteristics and management. Clin Plast Surg 23:281-296, 1996. Rohrich RJ, Muzaffar AR. Rhinoplasty in the African-American patient. Plast Reconstr Surg 111:13221339, 2003. Rohrich RJ, Griffin JR, Adams WP Jr. Rhinophyma: review and update. Plast Reconstr Surg 110:860869, 2002. Rohrich RJ, Gunter JP, Deuber MA, et al. The deviated nose: optimizing results using a simplified classification and algorithmic approach. Plast Reconstr Surg 110:1509-1523, 2002. Rohrich RJ, Hollier LH Jr, Janis JE, et al. Rhinoplasty with advancing age. Plast Reconstr Surg 114:19361944, 2004. Romo T III, Jablonski RD. Nasal reconstruction using split calvarial grafts. Otolaryngol Head Neck Surg 107:622-630, 1992. Sheen J, Sheen A. Aesthetic Rhinoplasty, 2nd ed. St Louis: CV Mosby, 1987. Siemssen SO, Siemssen SJ. Sliding osteotomy of the nasal skeleton: a possible method of altering the length of the external nose. Brit J Plast Surg 34:247-248, 1981. Smith HW. Autogenous nasal bone grafts. Ear Nose Throat J 64:122-126, 1985. Staffel JG. Optimizing treatment of nasal fractures. Laryngoscope 112:1709-1719, 2002. Stucker FJ. Non-Caucasian rhinoplasty. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 82:417-422, 1976. Thatte RL, Deshpande SN, Thatte MR. A radical approach in the treatment of the deviated nose. Br J Plast Surg 43:596-602, 1990. Uchida M, Kojima T, Hirase Y. Secondary correction of the bilateral cleft lip nose by excision of the columellar forked flap and nasal remodeling with reverse-U flaps: a preliminary report. Brit J Plast Surg 47:490-494, 1994. Vilar-Sancho B. Rhinoseptoplasty. Aesthetic Plast Surg 8:61-65, 1984. Watanabe K. New ideas to improve the shape of the ala of the Oriental nose. Aesthetic Plast Surg 18:337344, 1994. Wexler MR. Reconstructive surgery of the injured nose. Otolaryngol Clin North Am 8:663-677, 1975. Willemot J. The crooked or twisted nose. Eye Ear Nose Throat Mon 49:412-413, 1970. Won Kim S, Pio Hong J, Kee Min W, et al. Accurate, firm stabilization using external pins: a proposal for closed reduction of unfavorable nasal bone fractures and their simple classification. Plast Reconstr Surg 110:1240-1246, 2002. Wright WK. Surgery of the bony and cartilaginous dorsum. Otolaryngol Clin North Am 8:575-598, 1975.

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PART V Secondary R hinoplasty “What would you say is the earliest sign of civilization?” she asked. . . . “Here is what I believe to be evidence of the earliest true civilization.” High above her head she held a human femur . . . and pointed to a grossly thickened area [of bony union]. “Such signs of healing,” she went on, “are never found among the remains of the earliest, fiercest societies. In their skeletons we find clues of violence. . . . But this healed bone shows that someone must have cared for the injured person—hunted on his behalf, brought him food, served him at personal sacrifice.” MARGARET MEADE Quoted by Paul Brand and Philip Yancey Pain: The Gift Nobody Wants Be well aware, quoth then that Ladie milde, Least suddaine mischief ye too rash provoke. EDMUND SPENSER The Faerie Queene

CHAPTER 17 Theory, P lanning, and Technique And there were gardens bright with sinuous rills, Where blossomed many an incense-bearing tree. . . . But Oh! That deep romantic chasm which slanted Down the green hill athwart a cedern cover! A savage place! As holy and enchanted As e’er beneath a waning moon was haunted By woman wailing for her demon-lover! SAMUEL TAYLOR COLERIDGE Kubla Khan

“I see nobody on the road,” said Alice. “I only wish I had such eyes,” the King remarked in a fretful tone. “To be able to see Nobody! And at that distance too! Why, it’s as much as I can do to see real people, by this light!” LEWIS CARROLL Through the Looking Glass 1087

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P henomenology and Diagnosis in Secondary Rhinoplasty Successful primary rhinoplasty is the key to successful secondary rhinoplasty. Fundamental to both are familiarity with nasal phenomenology, soft tissue response to various skeletal alterations, and the effect of reducing support on the nasal airway. In practice, therefore, diagnosis is not necessarily more difficult in secondary patients than in primary ones if the surgeon understands normal anatomy and what happens as a result of the usual reduction maneuvers or the newer grafting or cartilage suturing techniques. In secondary patients, however, the approach is the reverse of primary rhinoplasty: instead of identifying anatomic traps and modifying the surgical plan accordingly, the surgeon observes the sequelae of failing to recognize those anatomic traps, and must correct the consequences. Primary and secondary rhinoplasty are two sides of the same coin, which creates a unity between the operations. If the surgeon removes or repositions deforming structures, maximizes function and equilibrium, uses incisions and dissection economically, and augments to create balance, contour, and structure, there is really no difference between primary and secondary rhinoplasty except the donor sites. Throughout this textbook, I have included the presurgical photographs of all secondary rhinoplasty patients for whom I have them. I encourage surgeons to obtain such photographs whenever possible. Like the musician who trains his or her ear to recognize a perfect fifth or a Lydian mode, the surgeon who can rapidly identify the structural and functional impact of previous surgery is already halfway toward correcting it. Try your deductive reasoning on the following patients. What has happened to their noses in the interval between the photographs?

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Notice that a dorsal reduction has been performed in this patient (her nose is wider). An inverted-V deformity has developed. The septal curvature has shifted from the left to the right. If the tip cartilages were reduced, the change was either minimal or the soft tissues were thick enough to resist change: nostril rim height is the same and there are no alar hollows. Upper lip plane and length appear unchanged; it is possible that no transfixing incision was made.

In contrast, what seems to have happened here? The dorsum and tip have obviously been reduced: the nose has shortened, the tip has narrowed, and a high septal deviation to the right has appeared. Lateral crural reduction has allowed the alar rims to retract, the right side more than the left. The nose has been shortened at the caudal septum, judging from increases in upper lip length and retrusion. The shadow over the bony vault indicates that a cartilage graft was placed.

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The candid preoperative photograph for this patient shows a low radix and a tip that is barely in line with the septal angle. Postoperatively, both dorsum and tip have evidently been reduced, enlarging apparent nasal base size, decreasing tip projection, and creating a supratip deformity. Although alar cartilage surface markings no longer remain (indicating a sizeable reduction), the patient’s alar rim tissues have not retracted, confirming their substance. This patient’s nose seems to have lengthened since her yearbook picture, her upper lip has also become retrusive, and her middle vault is narrower. Because the bony dorsum appears no lower, it is reasonable to postulate a septal collapse even without examining the patient. Her lateral views confirm our observations.

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Here the effects of reduction are more obvious and devastating. Even without seeing the lateral view, the magnitude of the dorsal resection can be estimated by the relative increase in nasal width and loss of length. Caudal septal damage is signaled by the columellar retraction and increase in upper lip length, and the change in tip lobular shape and alar retraction mark the collapse caused by alar cartilage reduction.

What has happened here? Although the dorsum is narrower, it seems lower. The malpositioned lateral crura have been reduced, allowing the alar rims to retract. The subnasale and superior upper lip seem to have dropped posteriorly, rotating the vermilion outward.

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Because most malpositioned alar cartilages are also inadequately projecting, can you deduce the patient’s profile appearance? In theory, the preoperative dorsum should be slightly higher, the tip inadequately projecting, and the lip more vertical. The postoperative dorsum should be lower, the tip still round, the alar rims higher, and the upper lip more retrusive.

The patient’s lateral view confirms an appearance that was almost completely predictable from the frontal view and a knowledge of common anatomic associations (in this case, inadequate tip projection with alar cartilage malposition).

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A



THEORY, PLANNING, AND TECHNIQUE

B

The most noticeable change in this patient is the nasal base. Dorsal height and middle vault width seem only slightly greater, yet the preoperative lateral crural convexities have disappeared and the alar rims have retracted. Although the patient is smiling in A, her upper lip still seems to have lengthened and become more retrusive in B. The airway has also diminished, indicated by the patient’s involuntary nostril flare to support airflow. Her oblique view therefore should show very little difference in dorsal height but a loss of tip projection, alar wall contour, and upper lip position.

Our speculation matches the patient’s appearance. 1093

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These patients reveal the effects of devastating panchondritis. Their premorbid frontal views show intact dorsa and normal nasal length and upper lip positions. But septal disease has changed everything. The noses have shortened, the middle vaults have collapsed, the columellae have retracted, and the upper lips have lengthened. Nasal width seems to have increased. The tip cartilages, largely sandwiched between the external and vestibular skin, have been affected less (though this is not always the case).

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The oblique views support the speculations that were based on the patients’ frontal appearances. Surgeons discuss the lateral view more often than the frontal view, and they derive more information from it. The frontal view itself is foreshortened, and candid photographs limit detail. Nonetheless, notice how much information about surgical events, airway, remaining anatomy, and soft tissue response can be gathered from only the frontal view—often enough to predict important elements of other views without having seen them. As is true across the field of surgery, success in both primary and secondary rhinoplasty rests on correct diagnosis. Ultimately, it all comes down to anatomy.

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S econdary Rhinoplasty Compared With Primary Rhinoplasty Though primary and secondary rhinoplasty share common anatomy and phenomenology, three distinct differences separate the two: tissue tolerance, donor site depletion, and patient depletion.

TISSUE TOLERANCE The tissues of secondary rhinoplasty patients have undergone irreversible changes; they will not tolerate extensive dissection, thinning procedures, and multiple incisions, and sometimes not even the columellar and tip exposure required for the open approach. Every prior operation alters soft tissue and skeletal characteristics. The skin becomes less pliable, less able to expand, and less tolerant of underlying pressure.

A

B

C

Unyielding soft tissues resist expansion and compress the grafts placed beneath them. A scarred, hypovascular bed increases the incidence of graft absorption, which is uncommon in primary rhinoplasty. Those elements are visible in this cleft patient, whose maxillary arch, dorsum, and tip were reconstructed with rib grafts; in addition, alar rim skin on the left (cleft) side was excised. Compare the result at 7 days (B) with the result at 1 year (C). The patient’s scarred tissues compressed the tip projection obtained, and a portion of the dorsal graft absorbed.

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Surgical planning can be simplified somewhat by remembering that the only important deformities or anatomic variations are those that distort the surface or obstruct the airway. Anatomic facts that can be exposed only by an extensive dissection may be intellectual curiosities, but finding them is not relevant to treatment. Surgical objectives are based instead on internal septal and valvular examination and on inspection and palpation of the nasal surface.

Using the Open Approach for Secondary Rhinoplasty Surgeons who use both the endonasal and open approaches often advocate a closed dissection for primary cases and reserve an open exposure for the most complicated, distorted, anatomically difficult cases. This strategy is exactly backward—in fact, established surgical teaching supports the opposite rationale for secondary surgery in almost all other body areas. The more difficult the case, the more limited the donor material, the more new support is required, the more scarred the soft tissue cover, the more important it is to avoid closure tension, and the more valuable it is to limit dissection, then the greater becomes the advantage of the endonasal approach. Surgeons who perform both open and endonasal rhinoplasty may therefore wish to rethink their strategy, and consider open access for well-vascularized, supple, primary cases and the endonasal approach for scarred and distorted secondary and tertiary patients. Columellar or nasal tip necrosis after secondary open rhinoplasty is almost never reported and rarely discussed, but it does occur, even in expert hands.

DONOR SITE DEPLETION The population of secondary patients is changing. Thirty years ago, many surgeons would not attempt secondary rhinoplasty, and so most patients had undergone just a single endonasal operation and had intact septa. All that has changed, and today most secondary rhinoplasty patients have undergone two or more procedures by their original surgeon or by other surgeons; grafts and sutures have been tried, and donor sites have been exhausted and deformed. Surgeons who expect to perform secondary rhinoplasty must become facile with septal, ear, and rib cartilage, rib, and calvarial bone grafts. Each has its optimal uses.

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PATIENT DEPLETION Paralleling changes in soft tissue and donor sites, the patients themselves are depleted. Having undergone one or more unsuccessful procedures, secondary rhinoplasty patients have a lower tolerance for postoperative problems or disappointments. The surgeon electing to treat such patients must learn the specifics of the operation and perform a biologically sound surgical plan. Often unspoken, but quite common, is a profound sense of guilt felt by the patient—guilt that he or she did not provide enough information to the surgeon, did not ask enough questions, did not do enough research into the surgeon’s qualifications, or did not validate the correctness of the proposed procedure. This guilt, which seems deeper among rhinoplasty patients than others, increases patient anxiety and should be anticipated and recognized.

THE INTERVIEW Secondary rhinoplasty patients are roundly considered to be a demanding and difficult group; but in their defense, there are virtually no other aesthetic operations in which a patient can lose ground after each procedure. Many patients whose rhinoplasties have worsened their external deformities and also created new airway obstructions could justifiably be more disagreeable than they are. It is therefore imperative that the surgeon construct a safe and biologically sound surgical plan, and also that both patient and surgeon have an accurate, explicit understanding of the aesthetic goals and the realities of the surgical problem—that is, what is possible and what is not. The patient must be guided to understand that every rhinoplasty is a compromise between the patient’s aesthetic goals and the limitations that the operated skeleton and soft tissue configuration impose. Each patient’s donor material varies in quantity and character, which determines its usefulness for a specific situation. What the secondary patient fears most and needs least is another unsuccessful result.

HISTORY It is important to determine what the patient was originally trying to accomplish, whether that is still the goal, and whether it is attainable. Examine preoperative photographs. Try to untangle what the previous surgeon has done and what happened thereafter. In this regard, the secondary surgeon has an advantage that the primary surgeon did not: the ability to know preoperatively how this nose responds to surgery. Although most postoperative changes can be predicted, not all can: some soft tissue that appears able to contract will not, and some skeletal techniques work when they should not.

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Inquire about previous trauma (which may alert you to unhealed septal fractures), sinus disease, epistaxis, and chronic rhinitis (which may indicate turbulent airflow or, much more commonly, excessive turbinate resection). Patients are asked to supply previous operative reports if they can, but their value is limited. Surgeons struggling with the operation may not be able to report what they are seeing, and other surgeons exaggerate their functional work for the insurance company audience. I rely more heavily on my own examination.

NASAL EXAMINATION I always examine the internal nose first to avoid being distracted in the discussion of aesthetics. Many patients know that they have bad airways, but in other patients, obstruction has developed more imperceptibly as edema from the first surgery resolved. I palpate the nasal septum to determine how much cartilage and bone can be harvested and, if a previous septoplasty has been performed, how much dorsal and caudal support remains. I examine the nose during quiet and forced inspiration to assess valvular competence, and I look for previously normal anatomy that has now become distorted (for example, malpositioned lateral crura buckled into the airway). I do examine the turbinates, but I am as conservative in treating them in secondary patients as in primary patients, because (1) most turbinate hypertrophy is reactive, not indicative of intrinsic disease, and (2) hypertrophy reflects cystic bony enlargement (not mucosal thickening), which can be treated in most cases by crushing and outfracture. The external examination follows the same pattern as in primary patients. I identify deformities that can be seen or that obstruct the airway, areas of collapse or disequilibrium, soft tissues that require support for shape, and problems of proportion. As in primary patients, the surgical plan is founded on three criteria: (1) skin thickness and distribution, (2) tip lobular shape, and (3) the balance between nasal base size and dorsal height (see Chapter 7).

ASSESSING PATIENT ATTITUDE: THE ANGRY PATIENT The way in which patients recall their previous surgeries forms a continuum, from patients who have poor results and seek any improvement but who like their previous surgeons, to patients with very good results who are desperately unhappy and furious with their previous surgeons.

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The identity of the previous surgeon creates distinct management differences. The surgeon evaluating his or her own unhappy patient has the advantage of knowing the operative circumstances, the characteristics of the donor material, and the patient’s personality, but has the disadvantage of having to manage both the patient’s disappointment and his or her own. These are the circumstances that measure the surgeon’s equanimity and test the degree to which informed consent has been obtained. Alternatively, the surgeon evaluating someone else’s unhappy patient need not overcome disappointment with the current result, but has less information about the original deformity, the patient’s tissue idiosyncrasies and donor material, the procedures themselves, and the patient’s personality. It is here that preoperative photographs and the surgeon’s interviewing skills may have the greatest impact. Patient anger can reflect hostility toward the previous surgeon or only disappointment with an unanticipated outcome. The distinction is an important one. Most surgeons want to help their patients, and most surgeons are doing their best—I try to diffuse patient anger by reminding them of those two facts. Often, a patient’s attitude will then soften, allowing unhappiness with the previous surgeon to fade into the background so that our attention can turn to the rhinoplasty itself. But other patients remain fixed in their anger. Unless I can convert an angry patient’s attitude from one of resentment and revenge to one of disappointment and understanding, I will not operate at that time. Angry patients must also understand the margin of error inherent in human surgery. Some patients become convinced that seeing a surgical specialist or a rhinoplasty subspecialist inoculates them from another suboptimal outcome; Internet hyperbole and posturing have only intensified this belief. Whereas the discussion of functional and aesthetic problems and the techniques required to correct them may be similar in primary and secondary rhinoplasty, the donor sites and the chances of perfection differ. The criteria for accepting a patient for surgery remain the same (see Chapter 20): 1. Can I see the deformity? 2. Can I fix it? 3. Can I manage the patient? 4. If there is a complication, will the patient remain controlled and cooperate with treatment? 5. Does the patient accept the margin of error inherent in surgery?

1100

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THEORY, PLANNING, AND TECHNIQUE

There are also secondary patients who should not have another operation, but it is hard for a surgeon to withhold care that he or she can provide. Ultimately, the difficulty of the deformity (not necessarily its size) must be weighed against the patient’s attitude toward it. The patient must seem able to tolerate another imperfect result. For my part, I try to remember that I am not Lochinvar and I am too old to be a Boy Scout. When there is a danger of exceeding a patient’s tissue or emotional tolerance, I have learned to step aside. Some patients return years later with new and more acceptable attitudes and tolerance for imperfect results. Some patients find other surgeons. The decision to operate is one of the most personal decisions that a surgeon can make, and it is an individual one that depends on the surgeon’s own skill with a particular problem and his or her unique personality.

SUMMARY: PLANNING GUIDELINES SPECIFIC TO SECONDARY RHINOPLASTY Identify the surgical conditions: 1. Which of the four critical anatomic variants are present and uncorrected? 2. What are the functional deficits? 3. What are the soft tissue conditions (stiffness, pliability, scarring, thickness) that will affect the surgical plan? 4. What are the visible deformities? 5. Imagine the correct balance: what areas need augmentation for shape, proportion, function, or stability? 6. Are the tissues suffici tly healed to permit the necessary dissection and augmentation? 7. What donor sites will be needed? 8. How can incisions and dissections be limited? The skeletal and soft tissue deformities and the quality and availability of building materials have been predetermined and are unique to each patient. They are beyond the surgeon’s control. Secondary rhinoplasty tests the surgeon’s ability to overcome those obstacles, minimize mental errors, and apply complex surgical techniques. Secondary rhinoplasty is a test like no other.

1101

PART V



SECONDARY RHINOPLASTY

A pplicable Techniques ALAR BASE FLAPS A

B

C

Though most patients and surgeons conceive alar base width as either normal or wide, the base can also be too narrow. Narrow bases occur less commonly in primary rhinoplasty (A). Much more frequent is medial displacement of the base on the cleft side after lip repair (B) or after alar wedge resections in tertiary rhinoplasty (C). Neoclassical aesthetic standards dictate that alar base width should equal intercanthal distance, an axiom that is true in only 40.8% of the Caucasian population, 3% of the African American population, and 35.4% of the Chinese population, according to the study by Bashour. When the alar base is properly positioned, nostril or vestibular stenosis can be improved by composite grafts, using either the alar lobule or the ear as a donor site. In some circumstances, however, two simultaneous deformities exist: both nostril stenosis and malposition of the alar base. The alar base may be malpositioned in any direction. In these situations, composite grafting will enlarge the nostril but cannot correct the alar base displacement. In 1931, Joseph described an inferiorly based flap that he transposed into the nasal floor to correct stenosis. Burget and Menick have employed the same flap elegantly in complex nasal reconstructions. Although my limited experience with the Joseph flap has been good, the transposition pivot point normally creates a dog-ear that may require secondary revision. The following is my modification of the flap, designed as a crescentic island on subcutaneous and musculocutaneous perforators.* *While preparing my 1997 manuscript on this technique, I discovered that an identical flap had been described by Meyer in 1988.

1102

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THEORY, PLANNING, AND TECHNIQUE

PATIENT STUDY ONE

This tertiary rhinoplasty patient has an alar base that has been narrowed to bony vault width. Note also the difference in bony vault and upper cartilaginous vault widths that dorsal reduction has produced.

The flap should be designed as a crescent adjacent to the alar base (illustrated here in another patient). The medial flap edge must lie just lateral to the alar crease to avoid destroying this important landmark. The flap must be wide enough to correct the nostril stenosis, although 3 to 4 mm is all that is usually necessary. The lateral flap edge is incised at the appropriate position of the alar base on the cheek, or in cases of asymmetry, matches the lateral edge of the alar lobule on the normal side.

1103

PART V



SECONDARY RHINOPLASTY

A

B

C

D

The flap is elevated as an island based on subcutaneous and musculocutaneous perforators (A and B) and on branches of the angular artery, which can be seen entering the flap base and should be protected if possible (C: tip of scissors). Although it may at first seem more logical to transpose the flap so that its cephalic tip on the cheek becomes the posterior tip in the nasal floor, it is usually easier to rotate the flap into the defect (D). Undermine the pedicle widely enough so that the flap transposition will not distort the donor site or cause tension on the repair, but be careful not to devascularize it. The flap normally rotates clockwise on the patient’s left side and counterclockwise on the patient’s right side.

1104

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THEORY, PLANNING, AND TECHNIQUE

E

F

G

By reopening the nostril at the site of the previous alar resection (or the greatest tissue deficit) and freeing the displaced alar base, the surgeon can inset the flap into the nostril sill and floor (E and F). In G, the intranasal closure is complete. Closure of the donor site simultaneously corrects nostril stenosis and alar base malposition.

1105

PART V

A



SECONDARY RHINOPLASTY

B

A surprisingly small flap can make a significant difference. In another patient, notice the nasal floor width created by this 3.5 mm wide flap. Flap length should be suffici t to span the length of the sagittal stenosis in the nasal floor, but must not extend beyond the alar crease. Overcorrection is not necessary. Here are two other technical points. First, because these patients have a relative tissue deficit, the cheek flap inset at the alar crease should be as tension free as possible so that the alar base does not drift laterally later. The cheek area to be undermined is the outer line drawn on the patient’s right side in A. Place deep sutures from the cheek flap to the muscle and subcutaneous tissue beneath the nasal floor so that the skin edges lie together gently before closure.

A

B

C

Second, it is important to create a declivity, not a flat surface, at the alar crease. Recall that the alar lobule curves posteromedially to meet the flatter cheek surface— the lobule does not meet the cheek surface edge-on. To help create this effect, it is often helpful to deepithelialize a 1 mm edge on the alar lobular side (B) and place inverting skin sutures to re-create this normal structure. Notice the magnitude of change produced on the patient’s right side (C) from the 3 mm flap outlined at the beginning of the sequence. Preoperatively, the right nostril was smaller than the left.

1106

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THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

Eighteen months after the transposition flap, the nostril remains patent and the alar base width remains appropriate. A calvarial bone dorsal graft and conchal cartilage tip grafts were also performed in this patient.

1107

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO

Although the patient’s dorsum is straight and his nose is well balanced in the lateral view, three rhinoplasties have narrowed the base excessively. Note the hypertrophy of the alar base scars, signifying excessive closure tension. The patient’s columella is thick and his Class III malocclusion exaggerates his upper lip position. His septum and both ears have been previously harvested.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib graft 2. Rib cartilage maxillary augmentation, greater in the perialar areas, less in the midline 3. Columellar grafts 4. Tip grafts 5. Bilateral alar base flaps

1108

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THEORY, PLANNING, AND TECHNIQUE

The patient’s harvested rib shows the yellow, calcified appearance typical at this age. Notice the dimensions of the planned alar base flap, which will be set into the site of the previous alar base resection.

Postoperative Analysis

One year after surgery, the relatively small flaps have produced a significant change in alar base and nasolabial fold aesthetics. The scars have not hypertrophied, perialar maxillary augmentation has softened the upper lip depressions, and the repositioned bases have favorably altered alar rim contour.

1109

PART V

A

E

B

F



SECONDARY RHINOPLASTY

C

D

G

The alar base scars are not objectionable, and the columellar and tip grafts have helped rotate the nasal base and differentiate the tip lobule from the dorsum (B and D). However, the extraordinary tension on the closure has widened the base slightly and effaced the alar creases on inferior view (F). Comparing the postoperative appearance to the patient’s midfacial contours as a young man (G), nostril length and nasal base contour have been partially restored.

1110

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

The survival of alar base flaps has been uniformly complete in more than 70 patients. None of the flaps—whether unilateral or bilateral, performed as a separate procedure (Patient Study One) or simultaneous with other reconstructions (Patient Study Two)—have been lost. Even in patients whose donor tissue has been burned or scarred by previous procedures, survival has been uncomplicated. However, remember that all these reconstructions were performed endonasally. The safety of this procedure simultaneous with open rhinoplasty has not been established. In this regard, the work of Rohrich et al (1995) that identified a dual blood supply to the nasal tip is germane. The lateral nasal vessels consistently appear 2 to 3 mm cephalad to the alar groove; the columellar artery (present in 68.2% of their dissections) can be divided during an open rhinoplasty, because the lateral nasal arteries (present in 100% of their specimens) adequately profuse the nasal tip. The authors of the work caution that previous alar base incisions or alar base excisions that extend more than 2 mm above the alar groove may damage the lateral nasal arteries. Because the alar base flaps described here are similarly perfused by the lateral nasal arteries, and because the flaps must be widely mobilized to rotate adequately, the surgeon who prefers open rhinoplasty should proceed with extreme caution; it may be unwise to perform an alar base flap simultaneously with open rhinoplasty. Even when using the endonasal approach, a surgeon should carefully limit the dissection in secondary and tertiary patients and make other access incisions precisely and only with specific indications. Further applications of the alar base flap can be found in the section on cleft rhinoplasty in Chapter 19.

1111

PART V



SECONDARY RHINOPLASTY

CAUDAL SUPPORT GRAFT

When the caudal septum is modified—even modestly, as we have seen in previous chapters—the subnasale can sharpen and the upper lip lengthens. When more of the septum is involved (for example, after septal collapse or surgical removal of the distal septum), the entire nasal base drops inferiorly and the nose lengthens. Maxillary arch retrusion alone can be corrected by maxillary augmentation. Loss of nasal base support, however, requires something more extensive that cannot easily be corrected by dorsal or tip modification alone. The most powerful solution is replacement of what is missing: the caudal septum and septal angle.

1112

CHAPTER 17

A

B



THEORY, PLANNING, AND TECHNIQUE

C

When rib cartilage is harvested for the rest of the reconstruction, a flat graft taken from the center of the rib works very well, provided it is large enough (A). However, when rib is not being harvested or if the rib is unusually calcified or distorted, the concha can be folded to create an excellent replacement for the distal septum (B and C). Here I use the method of Sheen and Sheen. The concha can be folded along either axis to suit the defect. Folding the graft and securing its shape with 5-0 nylon sutures increases its rigidity and therefore its strength. It is important that the portion being fitted into the columella be thin enough to avoid widening this delicate structure. The graft is placed through a short incision in the membranous septum on one side, just posterior to the columella, through which scissors dissection separates the membranous septal flaps (already empty from the septal collapse or resection). The portion of the graft that replaces the distal dorsal septum and septal angle slides in first, at which time the graft rotates either clockwise (for lefthanded surgeons) or counterclockwise (for right-handed surgeons) until the tip of the caudal end can slip into place and slide into the posterior columella. It is important that the dissection not be too wide (particularly posteroinferiorly), because the graft would float in the pocket and not provide proper anterior projection.

1113

PART V



SECONDARY RHINOPLASTY

These patients illustrate the power of the technique and the importance of proper nasal base position. Each patient is shown at the beginning of the surgery (left) and after dorsal reduction, maxillary augmentation, and placement of the caudal support ear cartilage grafts shown on p. 1113 (center). Notice the effects of maxillary augmentation and caudal support grafts: the upper lips have become vertical, the subnasales have become less sharp, the bases have rotated anterosuperiorly, and the columellae have become more evident. Dorsal and tip grafts were added to complete the reconstructions (right).

1114

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

In these patients dorsal grafts were added as onlays and were not cantilevered. No columellar struts were used. Their upper lip positions were created by maxillary augmentation, and the nasal base rotations were achieved by replacing the missing caudal septa.

1115

PART V



SECONDARY RHINOPLASTY

MAXILLARY AUGMENTATION Because upper lip carriage and contour are affected by rhinoplasty, correction of any resulting deformities should be part of the reconstruction.

Not only facial clefts but trauma, cocaine, and especially rhinoplasty all affect upper lip position and contour. A retrusive upper lip occurs commonly with a long nose; in fact, it is uncommon to see a long nose with a full subnasale and strong upper jaw. The association of a lengthened upper lip and sharp subnasale after septal injury or chondritis should make the surgeon skeptical of the argument that only changes in the nasal spine, depressor septi muscle, or frenulum can alter surface contours. The common thread in each of these cases is the caudal septum. 1116

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THEORY, PLANNING, AND TECHNIQUE

Treatment of maxillary retrusion is most easily and effectively performed at the maxillary arch, not the caudal septum. In fact, caudal septal replacement alone does not move the lip forward very far. I make the decision to perform maxillary augmentation and/or caudal septal replacement independently, based on upper lip position and whether the columella is supported. Either area may be treated independently, or both may be treated together.

Technique: Autogenous Augmentation Although donor cartilage from septum, ear, rib, or calvarium will augment the maxillary arch, rib is most commonly used in practice. Neither septum nor ear cartilage is available in suffici t quantity to justify their use where other donor sites will suffi . I have occasionally used ear cartilage to augment the maxillary arch in cleft patients (where alloplastics are always unwise), but rib cartilage is used much more often.

Although the tip of the tenth rib forms a very good single-unit maxillary augmentation, I more commonly augment the arch with a two-piece graft, for two reasons. First, in many patients, the perialar areas, not the midline, are the deepest, so the graft must be wider laterally. Second, a two-piece augmentation allows more normal lip movement and feels less like a rigid bar, which can annoy some patients.

1117

PART V

A

B



SECONDARY RHINOPLASTY

C

The donor rib is cut into sections of appropriate length, depending on the depth of the defect. Exact shape is not important, but the edges should be contoured to avoid palpability either laterally or in the midline. The lateral ends of the grafts determine the amount of perialar augmentation, and the degree of midline overlap controls the position of the central lip. In this patient, each segment measures approximately 2.5 cm (A). Their approximate final position is shown in B. Grafts are placed through a 5 mm incision of the right nasal floor (C).

A

B

C

After incising down to the nasal spine, a Joseph elevator strips the periosteum in the desired area. Dissection must be kept high across the maxillary arch, and tight against the piriform aperture. Some caution is necessary here: there is less resistance to dissection toward the sulcus, and so it is easy to make the pocket too low, in which case the augmentation will be visible and palpable intraorally and annoy the patient. In B, my right thumb indicates the position of the elevator tip. After dissecting on one side, I use the elevator to strip the periosteum in the other direction (C).

1118

CHAPTER 17

A

B



THEORY, PLANNING, AND TECHNIQUE

C

If necessary, I follow the Joseph elevator with a broad Cottle elevator, ensuring the proper pocket width (A). Retracting the wound edge, the first graft is slipped into the pocket, widest and first (B), followed by the opposite graft (C).

A

B

C

The tip of the second graft is folded over the nasal spine (A). Graft position is checked by palpation and by noting the degree of midline overlap (B). The correction is 1:1. If it seems excessive, the medial ends can be trimmed until there is little (or no) overlap, or additional slices of rib can be placed anterior to bring the midline forward. The wound is closed with fine, absorbable sutures (C).

1119

PART V



SECONDARY RHINOPLASTY

Technique: Alloplastic Augmentation A

B

C

D

In a similar manner, 1 mm Gore-Tex sheeting can be rolled into a single implant or split into a two-piece implant. The material is supplied in 7.5 cm square pieces. While my scrub nurse holds the material under tension, I begin at one corner and roll the implant tightly until the proper central width has been achieved, which varies from patient to patient (A and B). The implant is then trimmed and rolled to the correct shape (C). The implant must be wide enough to provide the proper surface effect, remembering that excessive width will distort upper lip movement or impinge on the labiogingival sulcus (D).

1120

CHAPTER 17

A



THEORY, PLANNING, AND TECHNIQUE

B

C

D

E

The implant is secured with penetrating and circumferential 6-0 nylon sutures (A and B), and is trimmed at each end. Sutures are added until it is bound snugly. The implant should extend just to the alar creases but not beyond them (C), and it can be curved to fit the maxillary arch (D). Notice also that a folded gauze pad protects the patient’s eyes and that sterile adhesive drape isolates the nose. I perform the maxillary augmentation before any of the other rhinoplasty procedures, and without touching the skin with my gloved hand. While the bed is prepared, the implant is soaked in an antibiotic solution (E).

1121

PART V



SECONDARY RHINOPLASTY

A Cottle elevator broadens the pocket, and the implant is retrieved from the antibiotic solution.

A

B

C

D

With a small curved retractor holding the pocket open, I slip the implant inside up to its midpoint (A), after which the retractor picks up the other side and I tuck in the implant completely (B). I can confirm symmetrical placement by palpation and by checking the position of the circumferential sutures (C). I then slide over the implant with bayonet forceps to each of its ends to ensure that the tips have not folded over and that they lie flat (D).

1122

CHAPTER 17

A

B



THEORY, PLANNING, AND TECHNIQUE

C

I check inside the sulcus to confirm that the implant is neither visible nor palpable (A). The wound is then closed securely, with deep sutures opposing the entire depth of the wound on each side, including muscle (B), and a second layer of skin closure of fine, absorbable sutures (C).

If the greater deficiency is in the perialar areas than in the midline, or if the maxillary arch is asymmetrical (which is often the case), the rolled implant can be split in the midline and the edges tapered, after which it can be placed as previously demonstrated for autogenous rib.

1123

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY ONE

After two rhinoplasties, this patient’s left high septal deviation remains. Her nose shows signs typical of a reduction disequilibrium: a low radix, a persistent dorsal hump, a blunt and poorly projecting asymmetrical tip, and a left nostril that is smaller than the right and displaced more medially. The caudal septum had been resected to the septal angle, producing a depression above the tip and a flaccid and unsupported columella.

1124

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

The patient’s desired goal is impossible to achieve except at the metalevel. This is an opportunity to show the patient the differences in radix height and tip projection— the ingredients necessary for a straight profile and good nasal balance.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Limited skeletonization over bony and upper cartilaginous vaults 3. Dorsal reduction, left greater than right (preoperative asymmetry) 4. Septoplasty 5. Harvest composite and caudal support grafts (then change gloves) 6. Asymmetrical spreader grafts, left greater than right 7. Caudal support graft 8. Radix graft 9. Multiple tip grafts with buttress 10. Bone grafts to external valves 11. Axially oriented composite graft along left alar rim and floor to correct vestibular stenosis

1125

PART V



SECONDARY RHINOPLASTY

The right concha was harvested, preserving the skin on a portion of the cymba conchae (to be used for the composite graft); the rest will form the caudal support graft.

A

B

C

D

After maxillary augmentation and dorsal reduction, the boot-shaped caudal support graft was slipped into the caudal septum to replace the missing cartilage and correct the columellar retraction (B). Compare the result after only these steps with the preoperative view (C with A), and notice the change in upper lip position, columellar visibility, and nasal base projection. Dorsal, spreader, and tip grafts completed the reconstruction (D).

1126

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THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

Fourteen months postoperatively, the nose is more symmetrical. Spreader grafts have aligned the high septal deviation, and radix and tip augmentation have supported the soft tissues and created tip contour. The left alar base has moved farther laterally. An axial composite graft, with its skin island in the vestibular floor and its cartilage ring running across the floor and around the left alar wall, has opened the smaller nostril on that side and supported the flatter left rim. Geometric mean nasal airflow increased 3.5 times over preoperative values.

1127

PART V

Preoperative

2 months postoperatively



SECONDARY RHINOPLASTY

1 week postoperatively

6 months postoperatively

14 months postoperatively

Slight dorsal reduction, and radix and tip grafts have improved nasal balance, reduced apparent nasal base size, and created adequate tip projection. The maxillary augmentation has corrected the vertical position of the upper lip, and the caudal support graft has replaced the resected caudal septum and septal angle. As the postoperative months progress, the nose lengthens and edema reduces, but the dorsal, tip, and upper lip positions remain stable.

1128

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

In the oblique views, many of the patient’s preoperative goals have been realized. The dorsum is straight, the tip is adequately projecting, and the nose is more proportional. The tip is more angular, with a point of maximum projection and a flat supratip. The sharpness and retrusion of the subnasale have been softened. To avoid creating excessive fullness, the surgeon must use caution in performing maxillary augmentation in patients with a lip configuration such as this. In this patient, a two-piece maxillary augmentation was placed, putting most of the correction in the perialar areas and less in the midline.

1129

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO

After three rhinoplasties, this patient lost tip projection and airway (notice the narrow middle vault), and her upper lip appears flat and retrusive. In addition to maxillary augmentation, alar wedge resections will be performed, recycling the excised lobular skin as coronally oriented composite grafts.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Minimal skeletonization 3. Rasp bony vault for graft adherence 4. Transfix, shortening membranous septum 2 mm anteriorly 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on right than left 7. Thin radix graft 8. Crushed cartilage tip grafts 9. Bilateral alar wedge resections, right greater than left 10. Alar rim to lobule transfers, right greater than left 11. Four-lid blepharoplasty with lateral retinacular canthopexy

1130

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THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

Two years later, the nose is slightly shorter on the frontal view, the middle vault is confluent with the bony vault instead of concave, and tip lobular support has appeared, with highlights demarcating the tip from the dorsum. The perialar creases have softened, and the upper lip appears less flat and retrusive. Alar wedge resections, removing both external and vestibular skin, have narrowed the base slightly, and the 3 mm wide grafts placed into short vestibular alar rim incisions have reduced the preoperative notches.

1131

PART V



SECONDARY RHINOPLASTY

The profile is altered mostly by changes in nasal base position—the product of maxillary augmentation and tip grafts. Notice that the combination of tip grafting and small alar wedge resections has reduced apparent nostril size. The dorsum retains essentially all of its preoperative height, although radix and tip grafts have flattened the dorsal convexity. The columella remains narrow and unscarred, and although the alar wedge resection scars are visible on the inferior view, the floors remain smooth and unnotched. Geometric mean postoperative airflow increased 10 times over preoperative values.

1132

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

CALVARIAL BONE GRAFT

I used calvarial bone grafts for dorsal nasal reconstruction exactly 50 times before changing to rib cartilage for most cases. I never had a bad experience with calvarial bone except for the first one that I performed, which absorbed in the supratip. That one bad experience was a technical error: without the proper equipment, I used a high-speed, electric-driven drill designed for orthopedic surgery, which undoubtedly overheated the graft. After switching to an electric drill to harvest the graft at low speed under a constant, cooling water stream, absorption became negligible, even in patients followed for more than a decade.

1133

PART V



SECONDARY RHINOPLASTY

Calvarial bone forms a smooth, straight, reliable dorsal graft. However, contouring calvarial bone for lateral wall grafts is tedious, and its survival when not in contact with an underlying bony bed is uncertain. Bone grafts do not work well in the tip, so another donor site must be harvested. To save time, I used alloplastics for maxillary augmentation, but that meant that three different materials were needed for a single reconstruction. It is for that reason that I now prefer rib graft reconstructions for most patients in whom septum is not available and conchal cartilage will not suffi . Calvarial bone does have its place, particularly in adolescents and young adults whose white, elastic rib is likely to deform, or in other patients in whom their surgeons prefer calvarial bone.

Technique

A calvarial bone graft may be harvested from either the superior or posterior parietal area, preferably on the patient’s nondominant side. It is important to be far enough laterally to avoid the sagittal sinus. An incision is made perpendicular to the hair follicles and straight down through the pericranium to the bone. The surgeon then places the self-retaining retractor and tries to visualize the best location for graft harvesting.

1134

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

A 2 mm cutting burr, running at low speed under a constant stream of water, outlines the graft, and then deepens the cuts through the outer table until bleeding indicates that the diploic space has been reached. As the surgeon cuts, holding the drill almost parallel to the surface of the parietal bone, he or she can gauge the substance of the bone and feel when resistance decreases, indicating the diploic space. Using an angled chisel, the surgeon should begin harvesting laterally by taking a partial-thickness piece of bone and working toward the main graft. Removing a lateral piece allows the surgeon to angle the osteotome parallel to the diploic space, so that the main graft can be removed without fracturing it and without penetrating the inner table. It is extremely important that the surgeon maintain the angle of the chisel parallel to the surface plane of the skull, and remove the graft patiently and gently without twisting the osteotome, which might otherwise penetrate the inner table. In the patient shown here, the harvested grafts were unusually long.

Once the main graft and the side graft have been removed, any bleeding points are controlled with bone wax. The lateral graft is placed in the deeper portion of the defect to minimize palpable irregularities in the skull, and the wound is closed with a few interrupted 2-0 chromic sutures, passing through all layers, and finished with 4-0 chromic sutures. The sutures should not be tied tightly to avoid postoperative alopecia, which has been very rare in my experience.

1135

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY ONE

Two previous surgeries in this patient have created changes from his original preoperative nose that can be interpreted based on reduction and disequilibrium. Dorsal and tip reduction narrowed the middle nasal third, revealing a high septal deviation toward the right. Alar cartilage reduction allowed the tip lobule to contract posteriorly, producing a supratip deformity. The upper lip has lengthened and become retrusive. Septal cartilage was unavailable.

SUMMARY OF THE SURGICAL PLAN 1. Harvest calvarial bone and ear cartilage 2. Gore-Tex maxillary augmentation 3. Minimal skeletonization over dorsum 4. Rasp bony vault for graft adherence 5. Calvarial bone dorsal graft 6. Bilateral calvarial bone lateral wall grafts, thicker on left than right 7. Ear cartilage tip grafts

1136

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

Seven-year postoperative views demonstrate what calvarial bone does so well: produce a straight, smooth dorsum in a patient who only needed a thin dorsal graft for a shallow defect. Maxillary augmentation has corrected the upper lip retrusion.

1137

PART V



SECONDARY RHINOPLASTY

The dorsum remains straight, the upper lip is vertical, and the tip is adequately projecting. The dorsal graft edges are smooth and nonpalpable. Geometric mean nasal airflow increased 5.4 times over preoperative values.

1138

CHAPTER 17



THEORY, PLANNING, AND TECHNIQUE

Comparing the patient’s original appearance to his preoperative nose, the volume loss is evident. Tip reduction had allowed the alar creases to deepen, and the patient flared his nostrils to support his airway. Postoperatively, the dorsum is straighter and higher, and the alar walls remain supported by bone grafts. Nostril size seems smaller, partially because flare has diminished and because grafts have increased lobular size. No alar wedge resections were performed. The patient returned to ask for a further increase in dorsal height to restore his preoperative nasal volume; however, because the skin sleeve had permanently contracted, further augmentations were not possible.

1139

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO

When nasal soft tissues are able to contract until they have nowhere else to go, the result is supratip deformity: the shape of unsupported nasal skin. This patient has a small, tight skin sleeve with no visible underlying skeletal landmarks: the middle vault is soft, the supratip is thick, the alar walls are flat and deeply grooved, the columella is unsupported, and the dorsum is low; only palpation of the bony vault offers any resistance.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Harvest calvarial bone and ear cartilage 3. Minimal skeletonization over bony and upper cartilaginous vaults 4. Rasp bony vault for graft adherence, deepen radix 5. Calvarial bone dorsal graft 6. Ear cartilage tip grafts with calvarial bone buttress 7. Ear cartilage alar walls grafts 8. Ear cartilage columellar grafts

1140

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A

B



THEORY, PLANNING, AND TECHNIQUE

C

D

Compare the appearance at the beginning of the surgery with the appearance after maxillary augmentation alone (A and B). The nasal base has moved forward. After dorsal graft placement, the base rotates caudally (D).

Solid ear cartilage tip grafts with a calvarial bone buttress (top of tongue blade) were used to complete the reconstruction. These tip grafts, which became visible, were revisited 2 years later (see Chapter 14). Silhouettes reveal the changes in nasal base size and dorsal contour that have taken place.

1141

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Ten years postoperatively, the dorsum remains smooth. Revised tip grafts are no longer visible. The upper lip retrusion has been corrected.

1142

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THEORY, PLANNING, AND TECHNIQUE

Alar wall grafts have filled the preoperative hollows and reconstructed the lateral crura. Each graft was placed in a separate pocket, combining incisions where possible: a cartilage-splitting incision was made on one side for access to the dorsum and placement of one alar wall graft; and short, vestibular skin incisions for the tip, opposite alar wall, and columella were also made. Dissection was kept to a minimum. In tertiary patients whose skin is tight and heavily scarred, the surgeon should treat the tissues as he or she would treat irradiated skin. When exposure is wider than necessary, rough, or aggressive, tissue loss can occur.

1143

PART V



SECONDARY RHINOPLASTY

SKIN EXCISION The caudal transverse excision and the cephalic transverse excision have both been discussed in Chapter 16. But there are times when a longitudinal excision is necessary, even though it is always a compromise. Although I have seen scars in Dr. Sheen’s patients that I would not have known were there unless the patients told me, I have rarely attained a scar like that on one of my own patients. I avoid external excisions if I possibly can, and I spend a great deal of time discussing and illustrating the resulting scars with prospective patients.

PATIENT STUDY ONE

If all noses were shaped like this one, rhinoplasty as an operation would have disappeared long ago. This nose is virtually impossible to reduce successfully. The dorsum is straight, the tip is barely in line with the septal angle, and the tissues are moderately thick. Any disruption of this tenuous equilibrium should cause soft tissue distortion. Patients with such noses usually want the same shape in a smaller size; however, these patients must be guided to understand that such a goal is impossible. Even a conservative rhinoplasty changes each view for the worse. The middle vault becomes narrower, the alar walls collapse and groove, and the tip apparently increases in size and loses shape.

1144

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THEORY, PLANNING, AND TECHNIQUE

Dorsal and tip grafts, combined with a midline excision extending through the supratip to the point of greatest projection, have improved nasal balance and differentiated the dorsum from the supratip. The nasal base seems smaller because of direct excision and because of the dorsal grafts. The nose, however, remains large.

A

B

C

The patient is shown preoperatively (A), and at 2 months (B) and 2 years after surgery (C). The scar, although faint, is still visible.

1145

PART V

A

B



SECONDARY RHINOPLASTY

C

If skin excisions could always be performed on patients with fine, elastic skin, the scars would be much better, but most such patients do not require excision. This patient illustrates this principal. A midline excision was performed for excess soft tissue resulting from the involution of a cavernous hemangioma. The patient is shown preoperatively (A), and at 7 months (B) and 13 years after surgery (C). The scar is barely visible. Coarser-skinned patients often have opportunistic bacteria in their large pores, producing maceration and epidermolysis if sutures remain too long. Dressings should be changed daily by the surgeon, the wounds should be cleansed and dried, and the sutures should be removed early. Even with such precautions, scars are frequently suboptimal.

1146

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THEORY, PLANNING, AND TECHNIQUE

PATIENT STUDY TWO

Paralleling the first patient in this subsection, this patient has a nose that is very difficult to reduce successfully. The tissues are thick and soft, the cartilages are bulky, and tip projection is barely adequate. The skin sleeve is long and loose, and the vertical plane of the lip inclines backward. Reduction will only increase apparent nasal bulk and length, and decrease the airway.

And that is exactly what happened. On the frontal view, the nose has lost what definition it had. The internal valves, not visible from the surface, have become incompetent. The columella has retracted and the upper lip has sunken posteriorly. On the lateral view, nasal length has increased and the subnasale has sharpened. From below, alar wedge resections have decreased nostril size and worsened the nostril-lobular ratio, accompanying a tip that has become rounder and less defined, although more symmetrical. 1147

PART V



SECONDARY RHINOPLASTY

Restoring the airway involves two components: stabilizing the internal valves and increasing nostril size. The latter will also improve the nostril-lobular ratio and reduce apparent tip lobular volume. To shorten the nose, her surgeon must employ all of the strengthening mechanisms possible: maxillary augmentation, columellar augmentation (not as a strut but to increase soft tissue rigidity), and tip grafts. Because of the large skin sleeve volume, radix grafting would only improve nasal proportion modestly.

SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Gore-Tex maxillary augmentation, two pieces, right thicker than left (preoperative asymmetry) 2. Wide skeletonization over upper cartilaginous vault, limited over bony vault 3. Rasp bony vault for graft adherence 4. Shorten caudal ends, upper lateral cartilages, submucosally 5. Harvest composite grafts (change gloves afterward) 6. Septoplasty 7. Bilateral spreader grafts 8. Upper dorsal graft 9. Multiple tip grafts with buttress 10. Columellar grafts 11. Bilateral axial composite grafts, placing the skin islands in the nostril floors, with cartilage components augmenting the medial floors and alar walls

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (1 YEAR LATER) 1. Revise columellar scar, excise supratip skin 2. Excise left alar rim skin

1148

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THEORY, PLANNING, AND TECHNIQUE

A

B

C

D

E

F

Mark the nasal midline and then the excision area, noting any soft tissue asymmetries. When the deformity is unilateral, place the scar along one of the dorsal reflections instead of the midline. It takes surprisingly little excision to affect the desired outcome, so the surgeon can decrease the chance of overcorrection by incising in the midline and confirming the amount of excision by overlapping the edges. In the patient in A through D, the excision measured only 4 mm at its widest point (which corresponded to the area of greatest supratip depression). When the tip lobule also must be narrowed, the excision design changes to two skewed diamonds lying end to end (E). Their tips should meet at the point of maximum tip projection, which will be accentuated by wound closure.

1149

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SECONDARY RHINOPLASTY

Postoperative Analysis

A

B

C

D

After the first surgery (B), the nose is shorter, the upper lip is more vertical, tip projection is adequate, and nasal balance is slightly improved. The supratip is still high and soft; it is not possible to augment this nose suffici tly to redrape all of the excess skin. At 1 week (C) and 1 year after the second stage (D), the nose has narrowed slightly on the frontal view, and the tip lobule is differentiated from the dorsum better.

1150

CHAPTER 17

A

B



THEORY, PLANNING, AND TECHNIQUE

C

Excision of supratip skin has decreased bulk in the lower third of the nose (compare B and C). However, the degree of change between the patient’s original appearance (A) and the finished product (C) is soberingly small, and this is still a large nose.

Geometric mean nasal airflow increased 13 times over preoperative values, which is unusually high, because the effects of both valvular and vestibular stenosis were treated. Axial composite grafts have recontoured the alar walls and widened the floors, improving the nostril-lobular ratio. The skin islands were inset exactly at the sites of the previous alar wedge resections.

1151

PART V



SECONDARY RHINOPLASTY

COMPOSITE GRAFTS Composite cartilage and skin grafts from the ear can supply lining in the coronal, axial, or sagittal planes, and they can restore alar rim height, increase external valvular support, and enlarge the airway. However, even more important than understanding how to use these grafts is recognizing the cause of the deformities, because we create most of them.

A

B

C

When the alar cartilages are reduced, the alar rims lose support (B). Not all alar rims retract as a result, but if the resection is significant enough or if the soft tissues are thin, the remaining cartilage can no longer brace the alar rim in its preoperative position. Like a burn scar contracture developing, the lining shortens, pulling the rim cephalad with it. In the process, vestibular stenosis may occur. Even if lining has not been resected, external valvular incompetence reflects insuffici t underlying support. Composite grafts correct both the lining and skeletal deficiencies (C).

1152

CHAPTER 17

A



THEORY, PLANNING, AND TECHNIQUE

B

The pathophysiology worsens when the lateral crura are malpositioned. Malpositioned lateral crura are positioned so far from the rims that even unoperated patients may have arching nostril contours and external valvular incompetence (A).* In a thin-skinned patient, lateral crural reduction suffici t to reduce a cosmetic deformity disrupts this fragile equilibrium and the rim retracts farther, producing a real lining deficit and valvular incompetence, in addition to the external deformity (B). Therefore it is important to make the diagnosis of malposition preoperatively so that functional and aesthetic problems may be corrected together and so that a new obstruction does not develop.

*In my first review of external valvular incompetence, 61% of the primary patients had alar cartilage malposition.

1153

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SECONDARY RHINOPLASTY

Causes of Nostril Deformities in 100 Consecutive Secondary Rhinoplasty Patients Treated by Composite Graft Reconstruction Cause

Number of Patients (%)

Previous rhinoplasty: Normal alar cartilage anatomy Previous rhinoplasty: Alar cartilage malposition Congenital deformity Trauma Tumor

50 33 7 6 4

A review of 100 consecutive patients on whom I had performed composite grafts indicated that the cause of the nostril deformity was a previous cosmetic rhinoplasty in 83%. Not surprisingly, 33 of the 83 patients (39.7%) had a previous alar cartilage malposition, based on their original preoperative photographs.

Composite Graft Use in 100 Consecutive Secondary Rhinoplasty Patients Principal Indication

Alar notching or asymmetry in rim height Insuffici t nasal length External valvular incompetence Nostril/vestibular stenosis Combined vestibular stenosis and lateral alar wall collapse

Number of Patients (%)

43 28 14 11 4

Composite grafts serve a variety of functions. The obvious function is reducing alar rim height and restoring a more normal nostril appearance, but the cartilaginous component not only prevents contraction of the skin island but also braces the external valve, correcting valvular incompetence. Used in addition to dorsally and caudally placed tip grafts, composite grafts can provide the illusion of greater nasal length. In addition, when oriented axially or sagittally, composite grafts will correct a nostril or vestibular stenosis.

1154

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THEORY, PLANNING, AND TECHNIQUE

Harvesting Technique

Before infiltration, the length of the defect is marked on the external skin, approximately opposite the site of the planned vestibular incision. The markings are then transferred to the ear. Any portion of the concha may be used, but the posterior wall should always be spared to avoid deforming the ear. I usually select the donor area based on the shape of the defect, previous scars or harvested areas, or locations that will be the least conspicuous. Local anesthesia is used to infiltrate the periphery of the graft, being careful not to separate the skin from the underlying cartilage.

1155

PART V



SECONDARY RHINOPLASTY

The graft is incised through skin and cartilage around its periphery and resected from the bed, protecting the underlying skin. In most patients, bilateral grafts are used, so the single piece will be split obliquely to provide two grafts of maximum width.

1156

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THEORY, PLANNING, AND TECHNIQUE

If additional cartilage is needed, a Cottle elevator or scissors can be used to dissect the rest of the concha through the same incision, still sparing the posterior wall. The entire harvest is shown.

Visually marking the size of the defect or using a pattern, I cut and defat a fullthickness skin graft from the retroauricular skin.

1157

PART V



SECONDARY RHINOPLASTY

The donor site is closed in layers, using horizontal mattress sutures. The closure should lie exactly in the postauricular sulcus.

The full-thickness graft is transferred to the anterior defect and sutured in place with 6-0 chromic sutures. Basting sutures are added if necessary to coapt the anterior and posterior surfaces. I pass 3-0 nylon sutures through the ear and around a gauze bolster, which is placed in the sulcus to protect the postauricular and retroauricular skin.

1158

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THEORY, PLANNING, AND TECHNIQUE

The external canal is filled with saline solution and suctioned, removing any residual preparation solution or blood to prevent external otitis. Half-inch petrolatum gauze is fed into the defect, and the sutures are tied over it. The sutures should be tied purposefully but not tight, because underlying skin necrosis is possible with excessive pressure. The dressing remains in place for 1 week.

1159

PART V



SECONDARY RHINOPLASTY

Insetting Composite Grafts in a Coronal Orientation

A

B

The composite graft as it comes from the ear is always too thick. Thin the cartilaginous component as much as possible without cutting through it. Usually only a shim is necessary, because more than that will broaden the alar wall (A). At this point, the graft is split obliquely to provide two pieces of maximum width and length. If the degree of alar retraction is asymmetrical, the graft must be split accordingly (B).

A

B

C

An incision is made opposite the external marking, 3 or more millimeters away from the alar rim. If the incision is made too close to the rim, the graft edge will be visible (A). Dissect back toward the rim for approximately 2 mm to free the edge for attachment (B); doing so allows the caudal suture line to lie flatter. The upper cephalic edge is dissected enough to free the tissues and release the contracture, but only as far as necessary (C).

1160

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A



THEORY, PLANNING, AND TECHNIQUE

B

C

D

E

The caudal edge is inset first, suturing the widest point in the graft to the highest part of the defect (A and B). Then the rest of the caudal edge is inset. The surgeon uses a double hook to pull down on the alar rim until it reaches proper height, so that the required graft thickness can be assessed. It is important not to trim excess graft until this point, because, like releasing a burn scar contracture, more is often needed than might be anticipated (C). The cephalic edge is then inset (D and E). The right composite graft has already been placed in this series.

1161

PART V



SECONDARY RHINOPLASTY

After graft inset, I place a percutaneous suture through the graft center and out the external skin to hold the graft snugly against its bed and prevent any blood accumulation early in the postoperative period. The percutaneous suture is always removed at 24-48 hours. Both composite grafts are shown.

1162

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THEORY, PLANNING, AND TECHNIQUE

The composite graft correction is 1:1. In this patient, the dorsum and caudal septum were also reduced, and radix and tip grafts were added.

The Alar Lobule as a Donor Site Occasionally, secondary patients require alar wedge resections, which can be recycled as composite grafts to correct alar retraction or vestibular stenosis.

In this patient with asymmetrical alar bases, the right base will be used as a lobule for the left rim. Approximately 3 mm of external skin and 1 mm of vestibular skin will be removed. The inferior incision is made first, adjacent to the alar crease to avoid destroying this landmark. The No. 11 blade is rotated counterclockwise as it approaches and crosses the nasal floor to preserve a medial flap.

1163

PART V

A



SECONDARY RHINOPLASTY

B

C

D

E

The superior incision is made, removing only a small wedge of tissue. Closure begins at the vestibular side of the rim and is completed. Inset of the caudal end graft is performed first (D), and then along its superior surface (E).

1164

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THEORY, PLANNING, AND TECHNIQUE

Donor Site Problems

In a review of 100 of my own patients, donor site complications occurred in three patients, but with larger patient numbers, the complication rate is approximately 5%. Most patients with ear donor sites have imperceptible scars.

1165

PART V

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 L

A

B



SECONDARY RHINOPLASTY

C

D

Graft imperfections vary from atrophic skin changes (A) to raised graft edges—the most common complication (B and C). I have only seen one keloid in several hundred composite graft patients (D).

Postoperative Care I place routine rhinoplasty packs for 1 week. At that time, the skin islands should be obviously pink and healthy. Patients are instructed to apply petrolatum ointment twice daily for 1 more week to prevent desiccation. When stenosis has been significant, I splint the airway with short sections of lubricated endotracheal tubing (usually 6 to 8 Fr), starting 2 to 3 days later, when the lining is not too fragile or tender to place them. The tubing only needs to be long enough to stay in place (less than 25 mm) but the diameter must be large enough to exert some pressure without being painful. Increasing sizes can be used as the sidewall softens. Tubes are worn at night for 2 to 6 months, depending on the severity of the preoperative condition. Tubes are routinely used when correcting stenosis— that is, when axial or sagittal grafts are used—but are less often needed for alar retraction, unless postoperative swelling has thickened the rims.

1166

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THEORY, PLANNING, AND TECHNIQUE

PATIENT STUDY ONE COMPOSITE GRAFTS IN A CORONAL ORIENTATION

This patient’s photographs appeared earlier in this section. Additional original preoperative views confirm that the patient had all four critical anatomic variants: low radix, inadequate tip projection, narrow middle vault, and alar cartilage malposition (see Chapter 5). Despite the presence of a columellar strut (visible at the left side of the nasal tip), dorsal and alar cartilage reduction have created internal and external valvular incompetence and supratip deformity. No septal cartilage was available.

1167

PART V



SECONDARY RHINOPLASTY

Skin Cartilage

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Explore right tip, resect strut 3. Minimal skeletonization over dorsum, rasp bony vault for graft adherence 4. Transfixing incision, elevating caudal and membranous septa without shortening nose 5. Harvest calvarial bone 6. Harvest ear cartilage 7. Calvarial bone dorsal graft 8. Solid and crushed tip grafts 9. Bilateral composite grafts

1168

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THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

Fourteen months after surgery, the dorsal graft has expanded the middle vault and provided confluence between the upper and middle vaults. The alar rims remain stable, and the nasal base side walls are smooth, without notches.

1169

PART V



SECONDARY RHINOPLASTY

The dorsum is now straight, the supratip is flat, and the tip is adequately projecting. The combination of columellar elevation and alar rim reduction has improved basal relationships, and maxillary augmentation has corrected the vertical position of the upper lip.

Comparing the patient’s original preoperative nose with her nose after secondary rhinoplasty, an alternative original plan would have been slight caudal septal and dorsal reduction with radix, spreader, and tip grafts.

1170

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THEORY, PLANNING, AND TECHNIQUE

PATIENT STUDY TWO COMPOSITE GRAFTS IN AN AXIAL ORIENTATION

One rhinoplasty created a supratip deformity in this young man, but alar base resections had increased apparent tip lobular width. The nostrils were small and notched at the sites of the previous excisions. No septal cartilage was available.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Harvest composite grafts 3. Minimal skeletonization over bony and upper cartilaginous vaults 4. Rasp bony vault for graft adherence 5. Trim supratip 6. Dorsal graft of rib cartilage 7. Multiple tip grafts 8. Bilateral axial composite grafts

1171

PART V



SECONDARY RHINOPLASTY

Skin Cartilage

The graft is harvested in the same fashion as for coronal placement. Although less skin will be required for nostril correction, it is better to denude only the tips of the graft and leave a large central island until the size of the recipient defect can be established, because it may be larger than anticipated.

Here, the right side has already been corrected. The skin island required is often only 3 to 4 mm wide. Just as an extra millimeter of alar wedge resection can suddenly create a notch in the nostril floor, only a few millimeters of correction can relieve a notch.

1172

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THEORY, PLANNING, AND TECHNIQUE

The complete technique is detailed here in a different patient with a unilateral deformity. A 2 cm graft has been harvested, and the skin island will measure 5 mm (as inked).

The floor is incised to re-create the defect at the point of greatest deficiency, which is usually the site of the previous scar.

1173

PART V

A

C



SECONDARY RHINOPLASTY

B

D

E

Scissors are used to separate the external and vestibular skin for a short distance medially along the floor (A), and then laterally around the rim with counterpressure from the opposite hand (B). Once the defect size has been established, the tips of the grafts are denuded of skin (C). The graft first is slipped into the columella (D), and the lateral end of the graft is slid into the alar wall (E).

The skin island is fixed to the defect edges with 6-0 chromic sutures. If the tissues are particularly tight or a wider graft is needed, the floor can be split sagittally, with axial anterior and posterior extensions that form an H (rotated 90 degrees), into which the skin island will fit.

1174

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THEORY, PLANNING, AND TECHNIQUE

A

B

C

This technique corrects a vestibular stenosis when the alar base is properly positioned, and particularly when a flaccid or flat alar wall accompanies the floor deficiency (A). In this patient, a 5 mm skin island has increased internal nostril diameter by 30% (compare B and C). The blue cover marks the K-wire used to stabilize a rib graft used in this short nose. If the alar base is medially displaced, an alar base flap is preferable. The surgeon can determine the need for one technique or another preoperatively by pushing the alar wall laterally with an intranasal cottontipped applicator. If the alar wall and base move easily into the correct position, a composite graft will be suffici t; if not, the soft tissue deficit is more severe and an alar base flap will be necessary.

1175

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

One year postoperatively, the nasal bases remain stable in their lateralized positions. The skin islands are not visible externally. The right alar wedge scar has remodeled after the decrease in skin tension, but the left side could still benefit from revision. Dorsal and tip grafts have redraped the soft tissues and corrected the supratip deformity.

1176

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THEORY, PLANNING, AND TECHNIQUE

Composite Grafts in a Sagittal Orientation

Skin

Cartilage

Less commonly, such as after trauma or in secondary cleft rhinoplasty, a soft tissue defect extends deeper into the airway. In these cases a sagittally oriented composite graft makes a significant improvement. Incise the nasal floor at the site of the previous alar resection, if there has been one, or at the point of greatest deficiency. Cut and gently spread only as deep as the thickness of the composite graft (usually about 3 mm), so that the defect will support the graft and the postoperative floor will be level. After the size of the defect is certain, the graft is harvested in the same fashion as for coronal placement. For this orientation, the cartilaginous component should not be thinned: all of its heft will be needed to minimize the chance of recurrent stenosis. Inset the skin island with fine, absorbable sutures, and remember to use airway splints after removing the packing.

Composite Grafts Used Externally Skin and composite grafts do not have the color and texture match advantages that local or regional flaps have, but neither do they create new facial scars. Though the color match is never perfect, composite grafts provide a good reconstructive alternative in selected cases.

1177

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY ONE

This teenage girl suffered a dog bite a few days before these photographs were taken. With a full-thickness defect of this size, a nasolabial flap is not large enough, and a forehead flap, the best of the alternatives, is a staged procedure that would add an additional facial scar. We agreed to try a composite graft and to use the forehead flap for definitive repair if a composite graft result proved unsatisfactory.

A

B

Intraoperatively, the wound edges were freshened, and the lining was advanced by freeing it from the undersurfaces of the upper and lower lateral cartilages (A). The lining was then closed in a V-Y fashion, reducing the size of the defect to match the normal side, bracing the vestibular side along the alar rim with ear cartilage (B). 1178

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THEORY, PLANNING, AND TECHNIQUE

C

A

B

The composite graft was removed from the junction at the superior and transverse portions of the helix, removing retroauricular skin to fit the surface defect. The donor site was closed primarily along the back of the ear and by helical advancement flaps along the auricular edge. In A and B, the rim with its contained cartilage is inferior and the retroauricular skin is superior.

The graft was sutured into position along its intranasal side first and then externally, coapting the skin graft portion to its advancement flap bed with fine nylon sutures (removed at 48 hours). Graft take was complete.

1179

PART V



SECONDARY RHINOPLASTY

Fourteen months postoperatively, skin contour has improved and the alar rim, although not perfectly smooth, shows only minor imperfections. Fear has disappeared from the patient’s eyes. Inferiorly, the tip lobule is symmetrical, and the nostril rim is continuous. The patient has no other visible donor scars. Forehead flap donor scars are usually excellent, but in younger patients I prefer a one-stage correction that does not introduce new facial scars as long as the result will be suffici t.

1180

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THEORY, PLANNING, AND TECHNIQUE

PATIENT STUDY TWO

This man had undergone excision of a rhinophyma that resulted in a tight, contracted tip lobule and hypertrophic scarring. The middle vault was narrow and deviated toward the right, and airway obstruction was present.

1181

PART V



SECONDARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Harvest composite graft 2. Limited skeletonization, narrow over bony vault 3. Rasp bony vault 4. Septoplasty 5. Spreader grafts—right thicker than left 6. Multiple tip grafts with buttress and crushed cartilage overlay 7. Release external contracture right alar wall 8. Composite graft right alar wall 9. Alar rim and sidewall bilateral osteotomies

Based on the shape of the defect after release of the alar wall contracture, a composite graft was harvested and sutured into position, with its upper border aimed at simulating the cephalic margin of the normal lateral crus. Take was complete.

1182

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THEORY, PLANNING, AND TECHNIQUE

Postoperative Analysis

Two years postoperatively, alar base contours have improved. The right lower nose, although thicker than the left, no longer has a distracting asymmetry.

1183

PART V



SECONDARY RHINOPLASTY

The dorsum is straighter, and the tip is more projecting. The right alar rim has returned to its normal height, and an appropriate lateral crural convexity contours the surface. From below, nostril size has returned to normal, although the alar wall is too thick. The patient declined revision.

1184

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THEORY, PLANNING, AND TECHNIQUE

Tip grafting in such patients is treacherous, particularly using an underlying buttress, because the tissues are scarred and unyielding. However, I needed the buttress to set the angle of tip rotation, which has improved; soft grafts placed anterior to the buttress formed the lobule itself. All grafts were placed without tension, and the wound was closed without tension. Despite that, the tip developed a worrisome blush on the evening of surgery, which resolved in 24 hours. Nasal circulation is never inviolable.

D onor Site Depletion As more and more surgeons become familiar with varying autogenous donor sites, a group of secondary rhinoplasty patients is emerging with donor site depletion, a term that I coined in 1995. These patients have already had septoplasty or harvesting of one or more auricular, calvarial, iliac, or rib grafts. Some patients limit surgeons further by prohibiting donor sites that are painful (rib or iliac crest) or frightening (calvarium). Even primary rhinoplasty patients may have donor site depletion if the septum is bony and yields minimal useable cartilage (a circumstance that is more likely to occur in non-Caucasians or with posttraumatic noses). The surgeon faced with these patients must be familiar with techniques that allow acceptable functional and aesthetic results with suboptimal or minimal graft material. It is here that the endonasal approach becomes especially helpful, because dissection can be limited and surface changes can be assessed accurately. Even scraps of leftover cartilage, none of which qualify as traditional tip grafts, can nevertheless reconstruct a lobule if pocket dissection is kept small and high so that even limited donor material can produce its maximal effect. Another advantage of the endonasal approach is a decreased requirement for the grafts themselves. Because the columellar skin is never dissected from the medial crura, columellar struts are not necessary. Resection and replacement of alar cartilage lateral crura become an anatomic substitute for supporting alar or sidewall grafts. Crushed cartilage can be used in ways and places that would be difficult, if not impossible, through the open approach.

1185

PART V



SECONDARY RHINOPLASTY

Technical Guidelines in Graft-Depleted Patients 1. Internal valvular reconstruction can be accomplished using either spreader grafts or dorsal grafts with equal functional effects. Geometric mean nasal airflow typically doubles with either graft type. 2. External valvular reconstruction can be accomplished by relocating malpositioned lateral crura, by using battens of cartilage or bone that span the area of rim collapse, or by composite skin/conchal cartilage grafts. Mean nasal airflow typically doubles with external valvular reconstruction alone by any of these methods. 3. Tip reconstruction may be accomplished by selective grafting of the skeletally deficient lobular parts using small, crushed grafts in limited pockets. 4. Thick skin limits the amount of reduction that can be performed successfully, because soft tissue contraction occurs only modestly, thickens the skin further, and creates increasingly blunt contours. The surgeon is wiser to plan a strategy that includes appropriate augmentation for balance, shape, or valvular support so that skeletal volume is redistributed rather than reduced. 5. Single-unit dorsal grafts are still needed for substantial bridge defects in thin-skinned patients. Not all patients can be treated with minimal donor material. 6. Multiple staggered grafts can form a smooth dorsum in patients with adequately thick soft tissue cover.

BIBLIOGRAPHY Aiach G, Monaghan P. Treatment of over-reduction of the nose and subsequent deformities. Br J Oral Maxillofac Surg 33:250-261, 1995. Bashour M. History and current concepts in the analysis of facial attractiveness. Plast Reconstr Surg 118:741-756, 2006. Brand P, Yancey P. Pain: The Gift Nobody Wants. New York: Harper Collins, 1993, pp 274-275. Brown JB, Cannon B. Composite free grafts of two surfaces of skin and cartilage from the ear. Ann Surg 124:1101-1107,1946. Burget GC, Menick FJ. Aesthetic Reconstruction of the Nose, 2nd ed. St Louis: Mosby–Year Book, 1994. Byrd HS, Salomon J, Flood J. Correction of the crooked nose. Plast Reconstr Surg 102:2148-2157, 1998. Constantian MB. An alar base flap to correct nostril and vestibular stenosis and alar base malposition in rhinoplasty. Plast Reconstr Surg 101:1666-1674, 1998. Constantian MB. Functional effects of alar cartilage malposition. Ann Plast Surg 30:487-499, 1993. Constantian MB. Indications and use of composite grafts in 100 consecutive secondary and tertiary rhinoplasty patients: introduction of the axial orientation. Plast Reconstr Surg 110:1116-1133, 2002. Constantian MB. Rhinoplasty in the graft-depleted patient. Oper Tech Plast Reconstr Surg 2:67-81, 1995. Daniel RK. Rhinoplasty: a simplified, three-stitch open tip suture technique. Part II: secondary rhinoplasty. Plast Reconstr Surg 103:1503-1512, 1999. Daniel RK. Secondary rhinoplasty following open rhinoplasty. Plast Reconstr Surg 96:1539-1546, 1995. Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 105:2229-2241, 2000. Gruber RP, Tabbal N, Sheen JH, et al. Panel discussion: treatment of complex nasal deformities. Aesthet Surg J 19:475-482, 1999. Hilton L. Secondary rhinoplasty corrects bad “nose job.” Cosmetic Surg Times 3(1), 2000.

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Hodgkinson DJ. Cranial bone grafts for dorsal nasal augmentation. Plast Reconstr Surg 104:1570-1571, 1999. Jackson IT. Long-term follow-up of cranial bone graft and dorsal nasal augmentation. Plast Reconstr Surg 104:882, 1999. Jackson IT, Choi HY, Clay R, et al. Long-term follow-up of cranial bone graft in dorsal nasal augmentation. Plast Reconstr Surg 102:1869-1873, 1998. Jackson LE, Koch RJ. Controversies in the management of inferior turbinate hypertrophy: a comprehensive review. Plast Reconstr Surg 103:300-312, 1999. James SE, Kelly MH. Cartilage recycling in rhinoplasty: polydioxanone foil as an absorbable biomechanical scaffold. Plast Reconstr Surg 122:254-260, 2008. Joseph J. Nasenplastik un Sontstige Gesichteplastik. Leipzig: Hertag von Curt Katbitzsch, 1931, p 205. Juri J. Secondary rhinoplasties for men. Clin Plast Surg 18:763-773, 1991. Kerth JD, Bytell DE. Revision in unsuccessful rhinoplasty. Otolaryngol Clin North Am 7:65-74, 1974. Mazzola RF, Felisati G. Secondary rhinoplasty: analysis of the deformity and guidelines for management. Facial Plast Surg 13:163-177, 1997. Meyer R. Secondary and Functional Rhinoplasty: The Difficult Nose. Orlando, FL: Grune and Stratton, 1988, p 297. Millard DR. Secondary corrective rhinoplasty. Plast Reconstr Surg 44:545-557, 1969. Muenker R. The bilateral conchal cartilage graft: a new technique in augmentation rhinoplasty. Aesthetic Plast Surg 8:37-42, 1984. O’Connor GB, McGregor MW. Secondary rhinoplasties: their cause and prevention. Plast Reconstr Surg (1946) 15:404-410, 1955. Pardina AJ, Vaca JF. Evaluation of the different methods used in the treatment of rhinoplastic sequelae. Aesthetic Plast Surg 7:237-239, 1983. Peck GC Jr, Michelson LN, Peck GC. The external shaving technique in aesthetic rhinoplasty. Plast Reconstr Surg 97:33-39, 1996. Peck GC, Michelson L, Segal J, et al. An 18-year experience with the umbrella graft in rhinoplasty. Plast Reconstr Surg 102:2158-2165, 1998. Pensler J, McCarthy JG. The calvarial donor site: an anatomic study in cadavers. Plast Reconstr Surg 75:648-651, 1985. Pitanguy I, Calixto CA, Caldeira AML. Analise critica e evolucao da rinoplastia secundaria. Revista Bras Cir 74:40-54, 1984. Pollet J, Weikel AM. Revision rhinoplasty. Clin Plast Surg 4:47-53, 1977. Rees TD. Current concepts of rhinoplasty. Clin Plast Surg 4:131-144, 1977. Rees TD, Krupp S, Wood-Smith D. Secondary rhinoplasty. Plast Reconstr Surg 46:332-340, 1970. Rohrich RJ, Gunter JP, Friedman RM. Nasal tip blood supply: an anatomic study validating the safety of the transcolumellar incision in rhinoplasty. Plast Reconstr Surg 95:795-799, 1995. Rohrich RJ, Krueger JK, Adams WP Jr, et al. Rationale for submucous resection of hypertrophied inferior turbinates in rhinoplasty: an evolution. Plast Reconstr Surg 108:536-544, 2001. Sheen JH. A change in the site for cranial bone harvesting. Prospect Plast Surg 4:48-57, 1990. Sheen JH. A new look at supratip deformity. Ann Plast Surg 3:498-504, 1979. Sheen JH. Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg 105:1820-1852, 2000. Sheen JH, Sheen A. Aesthetic Rhinoplasty, 2nd ed. St Louis: CV Mosby, 1987. Stucker FJ, Smith TE Jr. The nasal bony dorsum and cartilaginous vault. Pitfalls in management. Arch Otolaryngol 102:695-698, 1976. Szalay L. Early secondary corrections after septorhinoplasty. Aesthetic Plast Surg 20:429-432, 1996. Thomas JR, Tardy ME Jr. Complications of rhinoplasty. Ear Nose Throat J 65:19-34, 1986. Trussler AP. Revision rhinoplasty. Plast Reconstr Surg 122:309-310, 2008. Webster RC. Revisional rhinoplasty. Otolaryngol Clin North Am 8:753-782, 1975.

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CHAPTER 18 Regional Deformities And there is a Catskill eagle in some souls that can alike dive down into the blackest gorges, and soar out of them again and become invisible in the sunny spaces. . . . Even in his lowest swoop the mountain eagle is still higher than the other birds upon the plain, even though they soar. HERMAN MELVILLE Moby Dick

Our ignorance of the laws of variation is profound. . . . But whenever we have the means of instituting a comparison, the same laws appear to have acted. CHARLES DARWIN On the Origin of Species by Means of Natural Selection

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P

rimary and secondary rhinoplasty both operate under the same natural laws. A surgeon seeing a primary deformity assesses the potential for reduction/disequilibrium, whereas a secondary surgeon sees the results of that disequilibrium. In concept and technique, therefore, there is very little difference between primary and secondary rhinoplasty except the donor sites. But primary rhinoplasty and secondary rhinoplasty are not the same operations. In secondary rhinoplasty, the tissues have suffered and the patients have suffered. Decisions of dissection need to be planned carefully, placing safety first. Most patients have much more anxiety than they did before the primary surgery, because they now know that rhinoplasty is not always simple, and that a good result is not always guaranteed. Some patients are frantic for cosmetic improvement. Most have airway obstructions. Some are angry with their previous physicians, others have lost family support, and almost all have the spoken or unspoken fear that the next operation may also fail. Some patients still seek the same unrealistic goals that they did before the primary surgery, others hope for less, and some only want to breathe well again. The surgeon must manage these goals and develop a plan with the patient that is corrective but not too bold, and enough but not too much. I follow Sheen and Sheen’s tenets for secondary rhinoplasty: 1. Establish realistic patient expectations. Both patient and surgeon must understand why the original goals were not met. If they were never achievable, better goals must be set. 2. Defer surgery until final resolution of tissues. A surgeon must control all possible variables, and if augmentation will be performed, the tissues must be pliable enough to permit it. 3. Have a well-defined aesthetic concept. 4. Make a proper diagnosis. To this I would add that the surgeon must identify which of the anatomic variants were (and still are) present and what problems have been caused by failing to treat them. 5. Limit the dissection. This is critical, particularly for surgeons who like the wider dissection of open rhinoplasty. Treat tertiary skin as if it had been irradiated. 6. Use only autogenous material. Autografts provide the patient’s best chance for a lifetime nasal reconstruction.

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To Sheen and Sheen’s six criteria, I would add two more, asking the following questions: 7. Can I see the deformity and can I personally fix it? These questions eliminate delusional patients and match the surgeon’s individual experience and skill against the severity of the deformity and the patient’s expectations. 8. Does the patient accept the margin of error inherent in surgery? These last two criteria will have different answers among patients and surgeons, but if all criteria are satisfactorily met, the surgeon begins at a good place. These two criteria are discussed further in Chapters 17 and 20.

D orsal Deformities As I have emphasized from the beginning of this book, Nature’s rhinoplasty rules are consistent, whether the operation is done open or closed, and whether the building material is rib cartilage, septum, ear cartilage, or calvarial bone. Unless we acknowledge that principle, the operation makes no sense. If the surgeon resects enough dorsum to open the cartilaginous roof, the middle third will always narrow. Dorsal resection affects nasal balance, apparent nasal base size, bony width, middle vault width, columellar position, and nostril contour. The degree of change, and how much it shows from the surface, depends on how aggressive the surgeon is and how capable the soft tissues are of responding. But the same things always happen. Therefore as you examine these patient examples, I hope that you are able to recognize patterns of nasal response and patterns of deformity, so that secondary nasal shapes become familiar, instantly triggering recognition of the surgical interventions that caused them. Taken backward one step, those secondary patterns teach the surgeon to see the predisposing deformities in the primary nose.

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PATIENT STUDY ONE

A single open rhinoplasty has converted a high dorsum and alar cartilage malposition to a nose with an obstructed airway. There is a high septal deviation to the right. Despite a distorting columellar strut, tip contour remains suboptimal.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization to the radix through a single intercartilaginous incision 2. Transfix, resect columellar strut, trim caudal and membranous septa 3. Rasp dorsum for graft adherence 4. Harvest rib cartilage 5. Rib cartilage graft to nasal dorsum 6. Alar wall grafts 7. Left lateral wall graft 8. Tip graft

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A 33 mm dorsal graft, covered with perichondrium on its anterior surface, was carved and placed, immediately correcting the dorsal defect and decreasing apparent nasal base size. The strut was resected, and the columella elevated. Smooth K-wires, to be removed at 7 days, immobilized the dorsal graft against an asymmetrical underlying platform.

Slices of rib were used to cover the left lateral wall depression and contour the tip (two grafts were placed), which completed the reconstruction.

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Postoperative Analysis

Postoperatively, the dorsal graft has narrowed the nose (no osteotomies were performed) but widened the middle third, correcting the internal valvular incompetence and ablating the inverted-V deformity. The major configurational change has been the conversion of a concave dorsal line to one that is straight. Notice that retroussé, which many patients identify as a desirable “curved” or “scooped” dorsal line, is not concave but straight; retroussé occurs when the tip projects beyond the septal angle. Therefore the profile appears more normal when it is straight, without a middorsal notch, and tip projection is adequate. As usual, a higher dorsum creates an apparently smaller nasal base, despite tip grafts. Columellar contour has improved after strut removal, and alar wall grafts have rounded the rims.

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PATIENT STUDY TWO

A single conservative rhinoplasty left this patient with a movable piece along the dorsum that she thought was a prosthesis. In addition, she had bilateral airway obstruction and a blunt tip. Her upper lip had fallen posteriorly, creating the appearance of Class III malocclusion, which she did not actually have. Her goals were a stable bridge, a vertical upper lip, an improved airway, and a more angular tip.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Remove dorsal implant 3. Two-piece maxillary augmentation, left thicker than right (preoperative asymmetry) 4. Rib cartilage dorsal graft 5. Multiple crushed cartilage tip grafts 6. Columellar grafts behind depressed scar

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A

B



SECONDARY RHINOPLASTY

C

The supposed implant turned out to be the resected cartilaginous roof hiding a significant defect (B), and covering a high septal deviation toward the patient’s left (C).

The tip of the ninth rib was trimmed and split to make a two-piece maxillary augmentation, thicker on the patient’s left than right because of preoperative asymmetry. A more proximal section of the ninth rib was trimmed and beveled for a dorsal graft; sufficient calcifications remained to prevent it from curling, even though periosteum remained on the surface. Once in place, the dorsum became straight, and the nasal base seemed to diminish in size.

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Slices of rib were crushed and used for the tip. Only two of the three slices shown were actually inserted, increasing projection and narrowing the tip slightly.

Postoperative Analysis

One year postoperatively, the dorsum is smooth and seems narrower, simply because it is slightly higher. No osteotomies were performed. Tip grafts have narrowed the tip lobule (no alar cartilage resection). Maxillary augmentation has improved upper lip position, correcting the retrusion in the subnasale and laterally.

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SECONDARY RHINOPLASTY

The vertical position of the upper lip has improved. The dorsum is now straight, ending in a tip that projects to the septal angle. The radix is slightly higher and the supratip is slightly lower, because of a redistribution of dorsal support. Notice that the dorsal graft placed was thickest in the upper third, tapering to a thin edge at the supratip. Despite a high septal deviation to the patient’s left that created asymmetrical preoperative obliques, the postoperative obliques match more closely. Tip augmentation has altered tip lobular shape slightly, and increased columellar support helps smooth the scar. Although I had planned to perform a linear scar revision as a secondary office procedure, the patient later decided against it.

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PATIENT STUDY THREE A VARIATION ON RIB GRAFT DONOR SITE

Four previous rhinoplasties created an irregular dorsum, a supratip deformity, alar retraction, and airway obstruction. One ear had already been harvested, and no septal cartilage remained. Simultaneously with the rhinoplasty and revision of a previous breast augmentation, a slice of sixth rib will be harvested for the patient’s dorsum.

SUMMARY OF THE SURGICAL PLAN 1. Harvest composite graft 2. Harvest sixth rib graft through previous inframammary incision 3. Minimal skeletonization over dorsum 4. Rasp bony vault for graft adherence 5. Excise ellipse of membranous septum without shortening nose 6. Right spreader graft 7. Rib cartilage dorsal graft 8. Tip grafts 9. Bilateral composite grafts, right greater than left (preoperative asymmetry)

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A



SECONDARY RHINOPLASTY

B

Taken tangentially with a No. 10 blade on a long knife handle, either the fifth or sixth rib (depending on patient anatomy) between the origins of the pectoralis major and minor muscles can supply an excellent dorsal graft that is 3 to 4 cm long. Perichondrium is always preserved to create a smooth surface cover (A). In this patient, the yellowed undersurface indicates calcifications typical of her age (B).

The graft was further thinned and scored on its surface to decrease perichondrial spring; the dorsum straightens once it is placed. A percutaneous suture marks the location of the left composite graft.

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Postoperative Analysis

Two years postoperatively, the patient’s dorsum remains straight, and nasal base aesthetics have been improved by columellar resection and composite grafts. Tip grafts have formed a better angle of rotation and created a columellar/lobular break. The oblique views match more closely, and the tip lobule now projects to the level of the septal angle.

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SECONDARY RHINOPLASTY

PATIENT STUDY FOUR

This patient underwent a primary rhinoplasty for airway obstruction that also involved a dorsal reduction. Some months later, noticing that the dorsum was so broad, her surgeon repeated his osteotomies. Most striking is the depth of the dorsal defect.

Comparison against the patient’s original preoperative view illustrates the magnitude of the changes. Both the bony vault and the nasal base have widened, and the upper lip has become noticeably retrusive. The middle vault is narrower but flat. The nose has shortened and lost projection, and the entire midface seems to have become retrusive. 1202

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SUMMARY OF THE SURGICAL PLAN 1. Harvest eighth and ninth ribs 2. Moderate skeletonization over upper cartilaginous vault, limited skeletonization over bony vault 3. Rasp bony vault for adherence 4. Rib graft maxillary augmentation (single unit) 5. Rib cartilage dorsal graft 6. Rib cartilage lateral wall grafts 7. Columellar grafts 8. Multiple tip grafts

One goal for this patient is an increase in midfacial projection. A dorsal graft will improve dorsal and middle vault position, but cannot increase tip projection. Tip grafts improve tip projection but cannot correct maxillary retrusion. This patient is another example of the global effects of resecting only one nasal area (the dorsum), and illustrates how many secondary procedures are required to compensate for it.

The ninth rib was carved to provide significant maxillary augmentation to reach from one alar base to the other. It was notched at its midpoint to fit over the nasal spine. The graft measured 35 by 8 mm at its midpoint. This is unusually large, but the supple, unscarred labiogingival sulcus would provide adequate cover in this patient. The graft was placed through a short incision in the right nasal floor to reposition the nasal base. Placing the maxillary graft first allowed the size of the dorsal graft to be more accurately assessed. 1203

PART V



SECONDARY RHINOPLASTY

A Foley catheter was inserted into the skeletonized dorsum, and the balloon was gently inflated to expand the tight middle vault skin. Notice the difference in lip position created by the maxillary augmentation.

A

B

C

The dorsal graft was 3 cm long by almost 10 mm deep and heavily calcified (A). After skeletonization, the soft tissues collapsed into the defect even further (B). This is what the primary surgeon saw at the conclusion of his operation. The lateral skin markings indicate the location of rib cartilage slivers used to fill out the sidewalls and camouflage the graft edges—such additional sidewall grafts are often necessary with large dorsal grafts.

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Postoperative Analysis

Preoperative

1 week postoperatively

6 months postoperatively

18 months postoperatively

All of the planned corrections are evident at 7 days after surgery. The nose lengthens slightly as edema resolves during the postoperative months, but the correction remains. At 18 months postoperatively, the dorsum remains straight, and the graft edges are not visible. Grafts must be large enough to provide the desired surface change; the soft tissues do not contract to reveal them.

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SECONDARY RHINOPLASTY

Comparing the postoperative views with the patient’s original photo, many of the previous landmarks have reappeared. However, because the soft tissues have thickened irreversibly from contraction, not all nuances are recoverable. Mean postoperative airflow increased 4.2 times over preoperative values. The tip is symmetrical, and the nasal base is unscarred. Columellar grafts provide support and camouflage the intercrural groove.

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M iddle Vault Problems PATIENT STUDY ONE If the surgeon plans only a reduction operation, the success of the entire procedure depends on the validity of two assumptions that we have already seen to be false (see Chapter 2): the reality is that soft tissues do not have an infinite ability to contract, and the nasal regions are functionally and structurally interdependent.

This young woman illustrates both of those principles. Before her first rhinoplasty, she had a low radix, a high dorsum, and inadequate tip projection. Dorsal and tip reduction have not only created a smaller version of her preoperative nose, but they also disrupted the continuity of the bony and upper cartilaginous vaults, creating an obvious inverted-V deformity and impairing her airway at the middle vault. Her reduced lateral crural remnants have buckled medially, creating alar hollows and obstructing the airways internally at the external valves. Based on our rhinomanometric data, her airflow is probably only 25% of what she originally had.

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SECONDARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization over middle vault, narrow over bony vault 2. Trim cartilaginous dorsum 3. Resect and relocate alar cartilage lateral crura 4. Elevate posterior membranous septum to lengthen nose 5. Septoplasty 6. Upper dorsal graft 7. Bilateral spreader grafts, right thicker than left 8. Tip grafts 9. Anterior columellar grafts 10. Posterior columellar graft

Postoperative Analysis

The resected and replaced lateral crura, reversed so that the convexities faced laterally, have ablated the alar hollows and created normal alar wall contours. Spreader grafts have opened the middle vault, and the radix graft combined with the dorsal resection has smoothed the dorsal plane.

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One-year oblique views show a reorganization of the dorsal line: the upper nose is larger and the lower nose is smaller, altering nasal balance and reducing apparent nasal base size. The posterior membranous septal resection has softened the subnasale, and multiple crushed tip grafts have increased projection to the level of the septal angle. The alar wall hollows have disappeared. Geometric mean nasal airflow increased 7 times over preoperative values.

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SECONDARY RHINOPLASTY

PATIENT STUDY TWO

In this patient’s first rhinoplasty, the surgeon recognized the low radix and grafted it correctly; but the graft was slightly short, and the substance of the graft proved too rigid for the thin radix soft tissues. Without spreader grafts, the middle vault narrowed. Only a small amount of septal cartilage remained. Inspiration collapsed the sidewalls caudal to the bony arch at the internal and external valves.

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REGIONAL DEFORMITIES

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization 2. Rasp radix, removing old graft 3. Harvest ear cartilage 4. Resect medial crural footplates through short membranous septal incisions; no transfixing incision 5. Septoplasty 6. Asymmetrical spreader grafts, thicker on right than left (preoperative high septal deviation toward the left) 7. Radix graft, longer than the original to blend with the dorsal resection, with a second short piece sutured to its posterosuperior surface 8. Bilateral alar wall grafts (crushed ear cartilage) 9. Multiple crushed tip grafts

A new dorsal graft and tip grafts created subtle but real profile changes.

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SECONDARY RHINOPLASTY

Postoperative Analysis

On the frontal view, the middle vault is slightly wider but symmetrical. The alar walls are normally convex, and the columella is narrow and unscarred. Mean postoperative airflow increased 8.4 times over preoperative values. The alar walls have become slightly more convex and support the airway. Multiple tip grafts have improved symmetry, but their distributed forces decrease the chance of visibility.

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The dorsum is now straight, but the radix remains augmented, as the original surgeon had correctly intended. The good news about grafting is that most problems are technical and under the surgeon’s control and that imperfect results can be corrected—even in places as troublesome as the radix.

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PART V

!

SECONDARY RHINOPLASTY

PATIENT STUDY THREE

Three previous surgeries have created a straight dorsum, but the nasofacial angle is too vertical, the radix is too high, and the tip is inadequately projecting. The patient’s thick soft tissues hide incompetence at the internal and external valves. Septal cartilage was unavailable, but because no dorsal graft was needed, the entire reconstruction could be performed with ear cartilage.

SUMMARY OF THE SURGICAL PLAN 1. Harvest conchal cartilage 2. Relocate lateral crural remnants 3. Moderate skeletonization over middle vault, narrow over bony vault 4. Rasp dorsum; reduce radix with angled chisel 5. Ear cartilage alar wall grafts 6. Right osteotomy 7. Spreader grafts (attempted but not possible) 8. Multiple crushed ear cartilage tip grafts

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REGIONAL DEFORMITIES

Ear cartilage was thinned and contoured to replace the missing lateral crura. A combination of dorsal reduction and tip grafting altered the nasofacial angle and differentiated the tip from the supratip and dorsum.

Postoperative Analysis

Four years postoperatively, the dorsum remains slightly wider because it is lower. The alar walls are better supported, and the patient no longer flares his nostrils, but some asymmetry persists. Geometric mean nasal airflow increased 5.3 times over preoperative values.

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SECONDARY RHINOPLASTY

The nasofacial angle is less acute, and the tip projects beyond the septal angle. Repeatedly scarred soft tissues cannot always respond to augmentation; and in this case, the patient’s flatter, more-scarred right tip did not expand as well as the left tip. The tip lobule remains twisted to the left; this is a soft tissue, not only a skeletal, difference.

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REGIONAL DEFORMITIES

PATIENT STUDY FOUR

Reduction of this low, straight dorsum with inadequate tip projection has produced a more unbalanced version of the same nose: lower in its midpoint and collapsed in the middle third, with a high septal deviation twisting the tip toward the right. A mild supratip convexity has become a more significant supratip deformity. Only a small amount of septal cartilage was available. The patient’s prior open rhinoplasty and columellar strut had failed to provide adequate tip projection, because the middle crus, deficient preoperatively, remained deficient. Only a small amount of septal cartilage remained.

SUMMARY OF THE SURGICAL PLAN 1. Harvest calvarial bone graft 2. Minimal skeletonization over bony vault and upper cartilaginous vaults; rasp bony vault for graft adherence 3. Remove columellar strut 4. Calvarial bone dorsal graft 5. Calvarial bone lateral wall graft, thicker on right than left 6. Limited septoplasty 7. Septal cartilage tip grafts 8. Septal cartilage graft to right columella

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SECONDARY RHINOPLASTY

An outer-table calvarial graft was harvested and minimally beveled on its edges; too much thinning favors absorption. The radiograph is a 3-year postoperative view of another patient in whom a calvarial bone was used for the dorsum and the columella; both grafts are easily visible. (The patient had returned, because trauma had fractured the dorsal graft at its midpoint.)

Compare the dorsal contour before and after placement of the dorsal graft alone. Solid and crushed tip grafts completed treatment of the supratip deformity.

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Postoperative Analysis

Two years postoperatively, the dorsal graft remains smooth, with its edges invisible. The middle vault has opened, pulled upward and laterally by the dorsal graft (exactly the reverse of what occurs with dorsal resection). The left-sided high septal deviation has been hidden. Inferior views confirm the new middle vault symmetry. The right-sided columellar graft has smoothed columellar contour. Geometric mean nasal airflow increased 4.3 times over preoperative values.

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SECONDARY RHINOPLASTY

N asal Base Problems

In some patients, the entire nasal base is disorganized: the tip is asymmetrical, the columella is lower on one side than the other, the alar rims are different heights, and the alar bases are asymmetrically positioned. Each component must be addressed separately. In this patient, spreader grafts align the middle third, tip grafts create symmetry and projection, and columellar resection and an alar base flap reduce notching from a previous wedge resection and reposition the alar base laterally. But, most problems are not so complex.

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PATIENT STUDY ONE

Although this patient was happy with her dorsal height and overall nasal configuration, she believed that her previous rhinoplasty had lengthened her upper lip and distorted her tip, leaving convex, malpositioned lateral crura that were too prominent. She preferred more angular tip projection. However, her medium-thickness soft tissues would not permit significant nasal base reductions, and her soft tissues could not be expected to contract significantly; thus only conservative changes were possible.

SUMMARY OF THE SURGICAL PLAN 1. Two-piece Gore-Tex maxillary augmentation 2. Resect and replace alar cartilage lateral crura 3. Minimal rasping of bony vault 4. Harvest ear cartilage (available septum previously resected) 5. Thin spreader grafts, right greater than left 6. Multiple tip grafts with buttress 7. Alar wall graft

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SECONDARY RHINOPLASTY

Postoperative Analysis

Resection and replacement of the alar cartilage lateral crura have softened the knuckles left by the previous reduction, which had allowed the cartilages to kink at the lateral genua. Because the patient was satisfied with her dorsal height, the dorsum was not reduced, but spreader grafts have rendered the middle vault more symmetrical. Maxillary augmentation has softened the subnasale. Tip grafts demarcate the tip lobule from the dorsum. Dorsal height is essentially unchanged, but the supratip is now flat, ending in a tip that projects beyond the septal angle. Even though no transfixing incision was made, the nose seems slightly shorter because of the change in tip lobular configuration. Geometric mean nasal airflow increased 6.4 times over preoperative values. 1222

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REGIONAL DEFORMITIES

PATIENT STUDY TWO

After three rhinoplasties, this man liked everything about his nose except the flatness of his nasal base. Septum was unavailable, but one ear remained unharvested. This is not a difficult correction if performed endonasally. The surgeon makes the usual infracartilaginous access incision for the tip lobule, but fills only its caudal side, watching surface changes as the augmentation proceeds. Then, through an incision on the vestibular side of the columella, a separate pocket can be developed anterior to the medial crura and filled with softened cartilage, once again watching surface changes as successive grafts are added.

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SECONDARY RHINOPLASTY

Postoperative Analysis

Four years postoperatively, the dorsum remains unchanged, but the patient’s tip lobule and columella have been filled with autogenous grafts. The base is now proportionate to the upper nose, because new middle and medial alar cartilage segments have been simulated using only multiple softened grafts in limited pockets. This much expansion cannot always be undertaken in one procedure. The surgeon must be mindful of tip circulation and skin tension. In this patient’s case, I was greatly aided because no other procedures, which may have altered nasal circulation, were simultaneously required.

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REGIONAL DEFORMITIES

PATIENT STUDY THREE

This man’s interesting psychological history is more fully described in Chapter 20. He came to me many years after a successful secondary rhinoplasty by another surgeon to inquire about nasal base changes. He thought that his nostrils were too visible, and he wondered if his nose could be lengthened further and whether the inadequate tip projection of his original nose could be better re-created.

SUMMARY OF THE SURGICAL PLAN 1. Harvest composite grafts and ear cartilage for tip grafts 2. Bilateral composite grafts, coronal orientation, right greater than left 3. Multiple crushed cartilage tip grafts, placed caudally

1225

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SECONDARY RHINOPLASTY

Postoperative Analysis

Three years postoperatively, the alar rims are lower and more symmetrical. The tip lobule is slightly broader and fuller inferiorly. Grafts that were deliberately placed caudally in the tip lobule and anterior columella have increased both real and apparent nasal length.

1226

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REGIONAL DEFORMITIES

By further distributing the forces created by the prior tip grafts, the tip has become more blunt and apparently less projecting. Tip and nasal base contours more closely resemble the patient’s original preoperative nose.

1227

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY FOUR

Highlighted by thin skin, this patient’s tip is distorted by malpositioned lateral crural remnants and by a long middle crural segment, worse on her left than her right. The middle vault is narrow and asymmetrical, shifted toward her right; the dorsum is straight, but the nasofacial angle is too vertical. Although I considered maxillary augmentation to help increase nasal base projection, the patient’s overjet and bimaxillary protrusion did not favor additional augmentation in that area.

SUMMARY OF THE SURGICAL PLAN 1. Resect lateral crural remnants; replace if possible 2. Moderate skeletonization over upper cartilaginous vault 3. Transfixing incision, shorten caudal septum 4. Resect middle crura through infracartilaginous incision 5. Slight rasping of bony vault shoulders 6. Septoplasty 7. Asymmetrical spreader grafts, thicker on right than left 8. Harvest ear cartilage 9. Alar wall grafts of ear cartilage 10. Multiple tip grafts 11. Columellar grafts 12. Bilateral osteotomies

1228

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REGIONAL DEFORMITIES

A

B

C

D

The malpositioned lateral crural remnants were first dissected free with the intent of repositioning them (B), but they were so distorted that they were removed and set aside to be used for the tip (C). Conchal cartilage grafts were shaped into lateral crura, thinning the cartilage and beveling the edges to avoid thickening the alar sidewalls (D).

1229

PART V

A

B



SECONDARY RHINOPLASTY

C

After the right lateral crus was replaced, notice the normalization of lateral nostril contour (A). After placement of both alar wall grafts, the nostrils became oval and more symmetrical (B). Frontal appearance improved after bilateral resection of the distorted middle and lateral crura and after ear cartilage alar wall grafts (C).

A

B

C

Multiple solid and crushed grafts have been prepared. A solid tip graft is placed first to establish the angle of rotation (B). After crushed grafts are placed anterior to the buttress to reform the lobule and after additional grafts contour the columella, the nasal base has been re-created (C).

1230

CHAPTER 18



REGIONAL DEFORMITIES

Silhouettes indicate the changes produced by a slight dorsal reduction and by rotation and projection of the nasal base.

Postoperative Analysis

Eighteen months after surgery, the patient’s nasal base distortion has improved, but is not perfect. Her middle vault is more symmetrical, and her alar cartilage deformity has been reduced by resecting the deforming parts and placing tip and alar wall grafts.

1231

PART V



SECONDARY RHINOPLASTY

The nasal base shows better projection, and the tip no longer hangs from the septal angle. But some asymmetries remain, and the flat, tight tip lobule continues to insist on an angle of rotation that is too vertical.

1232

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REGIONAL DEFORMITIES

PATIENT STUDY FIVE

Although this woman has a high septal deviation toward her right, her primary deformities reside in the nasal base. The lateral crura are malpositioned: the left side is orthotopic, whereas the right side is malpositioned, carrying with it the right alar rim. Alar cartilage reduction in a previous rhinoplasty has flattened the malpositioned sidewall and decreased nostril size. The tip is adequately projecting, but the dorsum is slightly low relative to nasal base size, and the tip lobule itself is blunt.

SUMMARY OF THE SURGICAL PLAN 1. Harvest composite graft 2. Resect and relocate right lateral crus 3. Minimal skeletonization over dorsum 4. Rasp bony vault for graft adherence 5. Septoplasty 6. Right spreader graft 7. Thin dorsal graft 8. Crushed cartilage tip grafts 9. Axially oriented composite graft to open the right vestibular stenosis

1233

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Sixteen months postoperatively, the nose is straighter, the alar walls are evenly supported, and nostril height is therefore equal.

1234

CHAPTER 18



REGIONAL DEFORMITIES

The axially oriented composite graft on the right, in which the skin island replaces the nasal floor deficiency, and the cartilaginous ring supports the sidewall and extends toward the columella, has opened the right nostril. The dorsum is slightly higher, the tip is better contoured, and the right alar wall is no longer hollow. Tip grafts have created a defined point of maximum projection. Multiple grafts distribute tip forces and decrease the chances of postoperative visibility. Geometric mean nasal airflow increased 10 times over preoperative measurements.

1235

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SECONDARY RHINOPLASTY

BIBLIOGRAPHY Adham MN. A new technique for nasal tip cartilage graft in primary rhinoplasty. Plast Reconstr Surg 97:649-655, 1996. Burget GC. Aesthetic reconstruction of the nose. In Mathes SJ, ed. Plastic Surgery, 2nd ed. Philadelphia: Elsevier, 2006. Calvert JW, Brenner K, DaCosta-Iyer M, et al. Histological analysis of human diced cartilage grafts. Plast Reconstr Surg 118:230-236, 2006. Camirand A, Doucet J, Harris J. Nose surgery: how to prevent a middle vault collapse—a review of 50 patients 3 to 21 years after surgery. Plast Reconstr Surg 114:527-534, 2004. Clark MP, Greenfield B, Hunt N, et al. Function of the nasal muscles in normal subjects assessed by dynamic MRI and EMG: its relevance to rhinoplasty surgery. Plast Reconstr Surg 101:1945-1955, 1998. Daniel RK. Rhinoplasty: creating an aesthetic tip. A preliminary report. Plast Reconstr Surg 80:775-783, 1987. Gruber RP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99:943-952, 1997. Gruber RP, Kryger G, Chang D. The intercartilaginous graft for actual and potential alar retraction. Plast Reconstr Surg 121:288e-296e, 2008. Gruber RP, Pardun J, Wall S. Grafting the nasal dorsum with tandem ear cartilage. Plast Reconstr Surg 112:1120-1122, 2003. Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 100:161-169, 1997. Gunter JP, Friedman RM. Lateral crural strut graft: technique and clinical applications in rhinoplasty. Plast Reconstr Surg 99:943-952, 1997. Gunter JP, Landecker A, Cochran CS. Frequently used grafts in rhinoplasty: nomenclature and analysis. Plast Reconstr Surg 118:14e-29e, 2006. Gunter JP, Rohrich RJ, Friedman RM. Classification and correction of alar-columellar discrepancies in rhinoplasty. Plast Reconstr Surg 97:643-648, 1996. Guyuron B. Alar rim deformities. Plast Reconstr Surg 107:856-863, 2001. Guyuron B, Michelow BJ, Englebardt C. Upper lateral splay graft. Plast Reconstr Surg 102:2169-2177, 1998. Jung DH, Choi SH, Moon HJ, et al. A cadaveric analysis of the ideal costal cartilage graft for Asian rhinoplasty. Plast Reconstr Surg 114:545-550, 2004. Marin VP, Landecker A, Gunter JP. Harvesting rib cartilage grafts for secondary rhinoplasty. Plast Reconstr Surg 121:1442-1448, 2008. Mowlavi A, Masouem S, Kalkanis J, et al. Septal cartilage defined: implications for nasal dynamics and rhinoplasty. Plast Reconstr Surg 117:2171-2174, 2006. Neu BR. A problem-oriented and segmental open approach to alar cartilage losses and alar length discrepancies. Plast Reconstr Surg 109:768-779, 2002. Peck GC Jr, Michelson L, Segal J, et al. An 18-year experience with the umbrella graft in rhinoplasty. Plast Reconstr Surg 102:2158-2165, 1998. Rohrich R. An 18-year experience with the umbrella graft in rhinoplasty: discussion. Plast Reconstr Surg 102:2166-2168, 1998. Rohrich R, Hollier LH Jr, Janis JE, et al. Rhinoplasty with advancing age. Plast Reconstr Surg 114:19361944, 2004. Rohrich RJ, Muzaffar AR, Janis JE. Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty. Plast Reconstr Surg 114:1298-1308, 2004. Sen C, Iscen D. Use of the spring graft for prevention of midvault complications in rhinoplasty. Plast Reconstr Surg 119:332-336, 2007. Seyhan A. Method for middle vault reconstruction in primary rhinoplasty: upper lateral cartilage bending. Plast Reconstr Surg 100:1941-1943, 1997. Sheen JH. Rhinoplasty: personal evolution and milestones. Plast Reconstr Surg 105:1820-1852, 2000. Smith RA, Smith ET. A new technique in nasal-tip reduction surgery. Plast Reconstr Surg 108:17981804, 2001.

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CHAPTER 19 Generalized D eformities As natural selection acts solely by accumulating slight, successive, variable variations, it can produce no great or sudden modification, it can act by very short and slow steps. Hence the canon of “Natura non facit saltum” [Nature does not jump]. CHARLES DARWIN, On the Origin of Species by Means of Natural Selection

. . . In your next breath, you are taking in 3 ⫻ 1019 [inert argon atoms]. . . . By the end of the year, the 3 ⫻ 1019 argon atoms [in that single breath] . . . will be smoothly distributed throughout all the free air of the earth. . . . The first little gasp of every baby born on earth a year ago contained argon atoms that you have since breathed. . . . Argon atoms are here from the conversations at the Last Supper . . . from the recitations of the classic poets . . . from the battle cries at Waterloo. . . . This story of argon . . . associates us intimately with the past and the future. HARLOW SHAPLEY Beyond the Observatory 1237

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SECONDARY RHINOPLASTY

A

ny division of deformities into regional or generalized is naturally somewhat arbitrary, but since the beginning of this text I have pressed the argument that different nasal areas are functionally and structurally interdependent, not independent. It is partly the failure to recognize such interdependence that has made rhinoplasty difficult for so many surgeons. Most secondary rhinoplasty patients are understandably upset, in varying degrees, that they even need additional operations. In previous years, before the appearance of Internet chat rooms that allow patients to exchange their unhappy stories, many secondary patients believed that imperfect rhinoplasty results were uncommon, and that they had been almost uniquely unlucky. I believe it is important that every patient, before consenting to surgery, understand the pathophysiology of his or her surgical problem and the logic of the proposed plan and to prefer it to alternatives that he or she may have heard or read. The most difficult problems are created by patients whose original goals were unrealistic, but who cannot be convinced of that even in the face of repeated disappointments. A surgeon should never perform an operation that he or she does not personally endorse. “I didn’t think that another reduction was going to work, but the patient pushed and pushed and so I went ahead…” creates an impossible predicament. We are dealing with Nature’s laws, not the surgeon’s. The outcome does not depend on the open or closed approach, or whether the surgeon uses septal, rib, or ear cartilage; it depends on biologic behavior. Success only occurs when patient and surgeon share a common goal and have a realistic way of achieving it. I am guided by the patient’s history, by what the previous surgeons did and why (if I can determine that), and by the patient’s behavior and ability to withstand another operation and, in particular, to tolerate an imperfect result. Multiple previous operations do not necessarily signify a psychological disorder. It is my belief that a person who has self-esteem cannot have body dysmorphic disorder. Body dysmorphic disorder is largely an affliction of patients without self esteem who seek internal acceptance by external means (such as through improved appearance).

1238

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GENERALIZED DEFORMITIES



What is more common, and much more gratifying, is the boost in self confidence and self acceptance that most patients achieve through successful plastic surgery of any kind, including rhinoplasty. You can observe this fact throughout this book simply by looking at the patients’ eyes. Rhinoplasty is indeed brain surgery.

S upratip Deformity A

B

C

Supratip deformity describes the shape of an end-stage nose. When the nasal skeleton has been reduced by trauma, injury, congenital anomaly, or surgical resection beyond the capacity of the soft tissues to adapt, the skin sleeve assumes a characteristic shape containing some or all of the following features (C): low and narrow dorsum, collapsed middle vault, mid-dorsal notch, disproportionately large nasal base, round and shapeless tip lobule, retracted columella, arched alar rims, sharp subnasale, and retrusive upper lip. Depending on the patient’s skin characteristics and the degree of skeletal change, some deformities may not occur. For example, patients with thin skin develop retracted alar rims more commonly than those with thicker skin, which can retain its position even without skeletal support. Because supratip deformity only occurs when the soft tissues have reached their contractile limits, patients and surgeons must accept the fact that the postoperative nose cannot be made smaller unless skin is resected. This reality may present a conceptual problem for patients who believe that their noses have only become larger after every operation. Augmentation can correct the deformity but will not produce a smaller nose—it can only redistribute and support the skin sleeve. But augmentation is better than more reduction, which will accomplish nothing at all.

1239

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY ONE

Two previous operations collapsed this patient’s middle vault, hollowed her alar walls, and produced a round, blunt tip. As dorsal reduction shortened the nose, her columella became relatively too low, and lateral crural reduction allowed the alar rims to arch higher. Her nasal base is wide, relative to the tip lobule and the upper nose.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over middle vault, narrow over bony vault 2. Rasp bony vault for graft adherence 3. Transfixing incision, elevating caudal and membranous septa without shortening the nose 4. Septoplasty 5. Asymmetrical spreader grafts, thicker on right than left 6. Dorsal graft 7. Bilateral alar wall grafts 8. Multiple tip grafts with buttress 9. Bilateral alar wedge resections, removing 3 mm of external skin and 2 mm of vestibular skin

1240

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GENERALIZED DEFORMITIES

Septoplasty yielded adequate material for the reconstruction. The two pieces at the bottom of the image were used for spreader grafts. The straightest and most uniform piece (top) was used for the dorsal graft.

A

B

Intraoperatively, remnants of the malpositioned lateral crura were identified, and these were resected and replaced along the alar rims, providing alar wall support and decreasing the need for two additional grafts. Notice the percutaneous sutures coapting the external and vestibular skin (B). Following dorsal graft placement, the nasal base seems smaller.

1241

PART V



SECONDARY RHINOPLASTY

C

D

E

Crushed cartilage tip grafts (C) were placed anterior to an ethmoid buttress, which itself stabilized the angle of rotation in the new tip lobule (D). After the crushed grafts were placed and alar wedge resections were performed, the reconstruction was complete (E).

1242

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GENERALIZED DEFORMITIES

Postoperative Analysis

One year postoperatively, the upper and lower noses fit more appropriately. Spreader grafts and dorsal grafts have slightly widened and straightened the upper and middle vaults, lateral crural relocation has corrected the alar hollows, and alar wedge resections have narrowed the base. The thin dorsal graft has filled the dorsal concavity, and tip grafts have recreated a new middle crus and defined the point of greatest tip projection. Geometric mean nasal airflow increased 2.7 times over preoperative values. Alar wall grafts and alar wedge resections have reduced the excessive alar rim arch, and alar wedge resection and tip grafts have improved the tip lobular/nostril length ratio. The patient’s skin is sufficiently thin, however, to show not only every preoperative break in the dorsal line and every missing cartilage segment, but also minor irregularities in the postoperative contour. 1243

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO Among the four critical anatomic variants discussed in Chapter 5, inadequate tip projection most often precedes supratip deformity. Inadequate tip projection cannot be rendered adequate by reduction alone, and any combination of dorsal and tip reduction produces a tip that still seems to hang from the septal angle. If skeletal reduction exceeds soft tissue contraction, supratip deformity develops.

This patient has the same anatomic characteristics as the previous patient, but her soft tissues are thicker. Her alar walls bear the marks of a prior lateral crural malposition. The dorsum is low, the tip is blunt, and the supratip is high. Soft tissues hide middle vault width, but internal valvular incompetence is almost always present following dorsal resection. The alar lobules are heavy, and the base is slightly wide relative to tip lobular width and upper nasal width.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over bony and upper cartilaginous vaults through a single intercartilaginous incision 2. Septoplasty 3. Dorsal graft 4. Alar wall grafts 5. Multiple tip grafts 6. Bilateral alar wedge resections, removing both external and vestibular skin

1244

CHAPTER 19



GENERALIZED DEFORMITIES

A

B

C

D

After skeletonizing the dorsum, the supratip flattens (B). As when releasing a burn scar contracture, the soft tissues redistribute. This is the reassuring shape that the first surgeon saw at the conclusion of his operation, but the soft tissues are soft and unsupported. This case was performed in 1990; today I would use a solid dorsal graft, not crushed, for better support under thick soft tissues that are unlikely to show any edges. Tip grafts precede alar resections, which conclude the operation.

1245

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Three years postoperatively, frontal aesthetics have improved. The tip appears differentiated from the dorsum, and grafts have softened the deep alar wall creases. Although the dorsum is higher and tip projection is greater, the overall effect is that of nasal reduction.

1246

CHAPTER 19



GENERALIZED DEFORMITIES

Conservative alar wedge resections, preserving a medial flap, have produced a smooth sill. Alar floor width has decreased. Geometric mean nasal airflow increased 3.8 times over preoperative values.

Matching oblique views once again demonstrate that the delicacy of nasal contour is much less a product of skin thickness than it is of the character, volume, and proportion of the skeleton that shapes it. Although no dorsal or tip tissue was resected, the nose seems smaller. This is a right-brain observation, which is why rhinoplasty is such a right-brain operation.

1247

PART V



SECONDARY RHINOPLASTY

Before 1975, dorsal and tip grafts were not used to treat supratip deformity. Supratip deformity was interpreted as evidence of insufficient resection, so additional reduction became the standard solution. Sheen’s earliest presentations and publications in 1975 were met with heavy skepticism. But the quality and consistency of his results were unmistakable. Sheen’s epiphany that supratip deformity was not a problem of size, but rather of support and proportion, turned the previous conception on its head. And so dorsal and tip grafts redrape the supratip convexity in two directions, cephalad and caudad respectively, to create the dorsal height and tip projection that otherwise may have never existed in a patient.

PATIENT STUDY THREE

This young Syrian man had undergone a primary rhinoplasty that yielded a supratip deformity. The alar walls bear the footprints of a previous malposition. The supratip is compressible, indicating that it is only possible to offer the patient better nasal shape and function, not a smaller nose. Further soft tissue contraction cannot occur. Previous cartilage septal resection had recessed the vertical position of the upper lip. Septal cartilage was unavailable. A relatively short, asymmetrical defect such as this, beneath a thick soft tissue cover, presents the best circumstance for a rolled ear cartilage graft, particularly in a younger patient whose rib cartilage is likely to be undependable.

1248

CHAPTER 19



GENERALIZED DEFORMITIES

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Limited skeletonization through a single intercartilaginous incision 3. Reduce cephalic margin, malpositioned lateral crura 4. Rasp bony vault for graft adherence 5. Dorsal graft rolled ear cartilage 6. Ear cartilage tip grafts

B

C

D

A

Gore-Tex sheeting was rolled into a maxillary augmentation thickest in the midline. The tapered implant must bridge the perialar areas, and in this case it measured 7 mm at its midpoint (A). Following maxillary augmentation, the vertical position of the lip was corrected (B). A rolled ear cartilage graft was fabricated (C). The beauty of this graft depends partly on the size and shape of the patient’s ear, which the surgeon of course cannot control. This dorsal graft had a natural convexity toward the right, which matched the relative concavity in the patient’s nasal dorsum (compare with the preoperative frontal view, p. 1248). Once dorsal and tip grafts redistributed the supratip excess cephalad and caudad, respectively, a small depression appeared in the supratip. This defect was filled with the remaining scrap of ear cartilage, placed beneath the caudal end of the dorsal graft (D). I make this type of final adjustment commonly; the defect is easy to see and correct endonasally because the soft tissues have never been disconnected, so their resting tension has not been altered. It seems paradoxical that a supratip that was too high can actually require augmentation, but this attests to overresection of the anterior septum, despite which the patient developed a supratip deformity. 1249

PART V



SECONDARY RHINOPLASTY

As the tissues became supported, the supratip skin redraped and flattened. The dorsal and tip soft tissues must not be compressible or the deformity will recur. In less experienced hands, insufficient augmentation is more common than excessive augmentation, but either is possible. The surgeon should be able to see and feel the expected result at the conclusion of the procedure.

Postoperative Analysis

Dorsal grafting has narrowed the nose on the frontal view (no osteotomies were performed). The slight dorsal graft asymmetry has corrected the right-to-left asymmetry in the bony and upper cartilaginous vaults. Tip grafts demarcate the tip lobule from the dorsum. Maxillary augmentation has altered the vertical position of the upper lip, most obvious from the subnasale across to the perialar areas. Repositioning the lip has appropriately reduced the amount of visible upper lip vermilion. 1250

CHAPTER 19



GENERALIZED DEFORMITIES

From below, the effect of the dorsal graft on the collapsed middle vault is obvious. Despite the lack of osteotomies, the bony vault appears narrower, because the dorsum has drawn the soft tissues anteriorly. The patient’s columella remains unscarred. Fortunately, the patient’s original surgery was endonasal: the incidence of lateral or central columellar discontinuities is high in thicker skin when the open approach has been used, and the deformities are difficult to correct. The dorsum is now straight, the supratip is flat, and the tip grafts have created a normal angle of rotation, separating the tip lobule from the dorsum. Ear cartilage has formed a straight dorsum with a slight convexity, appropriate for the patient’s ethnic background. The thinner upper nasal skin, however, shows the edges of the rolled dorsal graft. Although they occur on the lateral edges of the dorsal plane and are not particularly distracting, a rib graft may have produced a smoother result. The patient declined revision. 1251

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY FOUR

Not all supratip deformities are compressible. In this patient and the next one, the supratip septum seems too high. But in all likelihood it was not too high at the conclusion of the first operation. It is a common misconception that surgeons underresect the anterior septum, but this would be an unusual omission: excessive reduction is much more common, particularly if the preoperative tip was inadequately projecting.

1252

CHAPTER 19



GENERALIZED DEFORMITIES

Two things occur postoperatively: the nasal skin contracts, and inadequate tip projection recurs. As the skin envelope reduces, the new sleeve becomes smaller than the original. But the thinner upper nasal skin shrinks more; and when the tip returns to its preoperative position (weakened further by alar cartilage reduction), the supratip septum becomes the highest point in the dorsal line. That is evidently what occurred here, and what has often led surgeons to conclude that the best treatment for supratip deformity was further resection. If the preoperative radix was already low, a high supratip becomes even more likely. Although the outcome of reduction in this patient with inadequate tip projection can be predicted, the pathophysiology is still interesting. Dorsal reduction has rotated the tip cephalad, pulling the alar rims with it—producing a nose that seems shorter but a columella (pinned down by the caudal septum) that now appears lower. The middle vault is narrower, revealing a high septal deviation toward the left. Lateral crural reduction has flattened the alar sidewalls, producing depressions above the rims. A columellar strut had been placed endonasally, but tip projection remains inadequate.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization to root 2. Reduce cartilaginous dorsum, deepen radix 3. Transfix, elevate caudal septum without shortening nose and remove columellar strut 4. Resect medial crural footplates 5. Septoplasty 6. Harvest ear cartilage 7. Asymmetrical spreader grafts, thicker on left than right (preoperative asymmetry) 8. Upper dorsal graft 9. Tip graft 10. Bilateral alar wall grafts

1253

PART V



SECONDARY RHINOPLASTY

Even after resecting the columellar strut and elevating the caudal septum, the dorsum still began at the level of the lower lash margin. Septal cartilage formed a dorsal graft. A close-up shows a lightly crushed graft, beveled edges, and a distal end tapered to a thin edge. Such fine points are necessary to avoid graft visibility or palpability.

Alar wall grafts were formed from normally convex conchal cartilage, perfect for this purpose, and placed through vestibular incisions exactly in the proper location for lateral crura. Tip grafts completed the reconstruction. 1254

CHAPTER 19



GENERALIZED DEFORMITIES

Postoperative Analysis

Postoperatively, spreader grafts have straightened the middle vault, and alar wall grafts have created more normal contours. Resection of the strut, caudal septum, and medial crural footplates has reduced columellar width.

1255

PART V



SECONDARY RHINOPLASTY

Although the postoperative nose appears shorter, this is an artifact of the change in columellar and tip lobular shape (notice that the frontal view does not show more nostril). The alar walls have a normal convexity; removing the columellar strut and adding tip grafts has created adequate projection.

1256

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GENERALIZED DEFORMITIES

PATIENT STUDY FIVE

This patient’s very thin skin brings each skeletal part into relief. The caudal end of the bony arch demarcates the mid dorsal notch, the central point of the inverted-V deformity, and the cephalic end of the supratip convexity. Below it, the remaining anterior septum protrudes above the tip. Dorsal reduction has allowed the tip to rotate cephalad, producing a columella that is relatively too low; and the reduction of malpositioned lateral crura has allowed the alar rims to arch, creating nostrils that are too visible on the frontal views. There is a high septal deviation toward the left. Only some septal cartilage remains. The most difficult decision here is what to do with the knuckled lateral genua. If I resect and replace them, can the tip lobule narrow? Should it narrow, or is tip width correct but the upper nose too narrow? Some of these are aesthetic questions and some are strategic. If the lateral crura are resected and replaced, they may not heal symmetrically (particularly true of strong cartilages), and all postoperative asymmetries are likely to be visible. Because of the patient’s facial width, I elected to leave the lateral genua where they were and work around them, minimizing the chance of postoperative problems.

1257

PART V



SECONDARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization over the bony and upper cartilaginous vaults 2. Rasp bony vault for graft adherence 3. Trim cartilaginous dorsum 4. Transfixing incision, shortening caudal and membranous septa, without shortening nose 5. Septoplasty 6. Harvest ear cartilage 7. Asymmetrical spreader grafts, right thicker than left 8. Single layer upper dorsal graft 9. Bilateral lateral wall grafts 10. Ear cartilage tip grafts with ethmoid buttress 11. Bilateral alar wedge resections, removing external and vestibular skin

Postoperative Analysis

Postoperatively, the middle vault has been expanded, and its asymmetry has been corrected with asymmetrical spreader grafts and onlay grafts. Columellar elevation and alar wedge resections have reduced the gangly appearance of the nasal base, diminishing its apparent size, so that the upper and lower noses fit each other more acceptably. The lateral crura remain undisturbed and symmetrical, but columellar elevation has reduced nostril visibility. Secondary composite grafts are always an option if the patient wishes to reduce alar rim height further. 1258

CHAPTER 19



GENERALIZED DEFORMITIES

The dorsum is now straight, ending in a tip that projects to the level of the septal angle. The ethmoid buttress has reduced the angle of tip lobular rotation from 80 degrees to a more normal 60 degrees. On the oblique view, the nose is more symmetrical and the supratip has flattened. The caudal edges of the bony vault and the inverted-V deformity are no longer visible, functionally corrected by the spreader grafts and further smoothed by lateral wall grafts placed in specific pockets. Despite an increase in tip projection, the nasal base seems smaller.

A

B

C

D

One of the more impressive changes in patients with supratip deformity is their altered nasal balance. The postoperative radix begins at the level of the supratarsal fold (the upper limit of normal). Tip grafts increase the distance from the anterior point of the nostril to the most projecting point of the tip. These changes alter the nasofacial angle, appearing to bring the nasal base closer to the face (B), or farther away (D), depending on the need. 1259

PART V



SECONDARY RHINOPLASTY

This is the magic that is almost unique to rhinoplasty, and that most patients (and even some surgeons) need to see to believe.

T hick Skin and Thin Skin PATIENT STUDY ONE

Three previous rhinoplasties have thickened this Latino woman’s skin and enlarged her nasal base. Dorsal reduction has reduced her airways, and alar wedge resections have decreased nostril size, adding apparent width to the tip lobule. A previously placed tip graft improved contour but added to the dorsum/base imbalance. The patient wanted to restore her airway, and would consent to any maneuvers that might make the nose seem narrower and more delicate from the frontal view. This is a difficult strategic problem. Any augmentation will enlarge this nose, yet airway and balance cannot be restored without adding structure. A dorsal graft would decrease frontal width and straighten the dorsal line, but it would also produce a real increase in nasal volume. Composite grafts, placed axially so that the skin island widens the nasal floor, would widen the nasal base slightly but improve nostril/tip lobular proportion (see Chapter 17).

1260

CHAPTER 19



GENERALIZED DEFORMITIES

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage and conchal composite graft 2. Rib cartilage maxillary augmentation, greater on right than left (preoperative asymmetry) 3. Bony vault rasping for graft adherence 4. Rib cartilage dorsal graft 5. Reduction of previous tip grafts and new anterior lobular fill 6. Bilateral axial composite grafts to nostrils 7. Columellar scar revision

Costal cartilage was harvested and sliced. Notice that thinner pieces with attached perichondrium distort the most (toward the perichondrial side). The dorsal graft was fashioned from an appropriate segment, leaving perichondrium attached; the cephalic end was beveled. Notice the yellowish rib color, indicating calcifications that decrease the chance of warpage.

1261

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Postoperatively, the dorsal graft has narrowed the bony and upper cartilaginous vaults. Axial composite grafts have widened the nasal base slightly, apparently narrowing the patient’s tip lobule. The maxillary arch has become less retrusive, particularly in the perialar areas. The columellar scar unfortunately remains.

1262

CHAPTER 19



GENERALIZED DEFORMITIES

Although the nose is not smaller, the dorsum is now straight and the angle of tip lobular rotation has improved. The position of the radix has not moved.

1263

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO

This woman’s asymmetries present similar problems as the previous patient’s, but her soft tissues are troublesome in a different way. In a prior surgery, a graft had been placed over the left side of the bony vault to smooth a depression, but irregularities remained. The airway was compromised at the middle vault, and the septal partition rotated toward the patient’s right. Dorsal contour was good except for the irregularity at the bony vault and an old scar that crossed the upper dorsum. Notice the flat nasofrontal angle associated with a blunted supraorbital ridge: Patients with this type of configuration are unlikely to obtain radixes of appropriate postoperative depth, regardless of what is done to the nasal skeleton. Her tip is asymmetrical, the right side flatter than the left. Previous septoplasty had left a small amount of useable cartilage; I was hoping for one straight piece to be used for a new dorsal roof.

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GENERALIZED DEFORMITIES

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization 2. Removal of the prior dorsal graft 3. Trim the right membranous septum through a hemitransfixing incision 4. Septoplasty 5. Bilateral spreader grafts 6. Onlay graft to left middle vault 7. Crushed cartilage dorsal graft to form new roof 8. Left alar wall graft 9. Crushed tip graft (scraps)

A

B

C

Septoplasty provided a small amount of cartilage and bone for the reconstruction (A). The sturdiest pieces were fashioned into spreader grafts, putting nasal symmetry and airway correction first. An additional crushed piece was placed over the left upper cartilaginous vault for symmetry (B), and a thin piece smoothed the upper dorsum. The remaining scraps, none of which qualified as a traditional tip graft, were placed into a small pocket high in the tip lobule to maximize their effect (C).

1265

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SECONDARY RHINOPLASTY

Postoperative Analysis

One year postoperatively, spreader grafts and a left onlay have improved symmetry; but a meager septal specimen limited the upper dorsal correction. The airway is widely patent; and the tip is more projecting and symmetrical, despite minimal tip graft material.

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GENERALIZED DEFORMITIES

PATIENT STUDY THREE

This secondary patient’s nose demonstrates the ravages of both thin skin and strong cartilages. A prior dorsal resection collapsed the middle vault, demarcating it from the upper and lower thirds. The narrowed alar cartilages have collapsed medially, closing off the airways and deforming the alar walls. The domes have knuckled. The remaining septal partition has shifted toward the patient’s right.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization over bony and upper cartilaginous vaults 2. Resect the knuckles at the alar domes 3. Septoplasty 4. Harvest ear cartilage for spreader and alar wall grafts 5. Asymmetrical spreader grafts, thicker on left than right 6. Thin upper dorsal graft 7. Bilateral alar wall grafts (conchal cartilage) 8. Multiple crushed tip grafts 9. Columellar graft for contour

1267

PART V

A



SECONDARY RHINOPLASTY

B

C

Harvested ear cartilage was split to provide spreader grafts (A) and contoured to replace the lateral crura (B). The natural convexity and elasticity of the conchal cartilage make it an excellent lateral crural replacement. Septal cartilage was crushed and placed into the tip, columella, and dorsum (C).

1268

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GENERALIZED DEFORMITIES

Postoperative Analysis

Fifteen months postoperatively, the patient’s middle vault is stable, the external valves are supported, and the preoperative alar hollows have been leveled by ear cartilage grafts. The knobby tip deformity has disappeared, recontoured with multiple grafts. The tip remains projecting, but the dorsal discontinuity has improved. Nasal anatomy appears normal, though it has been created by selective, segmental augmentation with septal and ear cartilage. What is critical is not skeletal anatomy, but rather surface anatomy, because that is what the patient sees. Exact skeletal shape is irrelevant, except as it affects surface contour or the airway.

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SECONDARY RHINOPLASTY

S eptal Collapse The effects of septal collapse are always devastating, and reflect, perhaps better than any other single deformity, the interrelationships among nasal parts and the magnitude of facial change that injury to a single central nasal structure can produce.

The shape of this patient’s nose does not reflect a cocaine-induced polychondritis; it is the result of nasal surgery. Septal resection has allowed the nasal tip to rotate cephalad and has demarcated the caudal edges of the bony vault. The remaining deflected septal partition turns the nasal tip toward the right.

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GENERALIZED DEFORMITIES

This woman’s upper lip has lengthened and fallen posteriorly, and her subnasale has sharpened. Resecting malpositioned lateral crura compounds airway obstruction by rendering the external valves incompetent.

1271

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SECONDARY RHINOPLASTY

When the septum is deviated preoperatively, collapse worsens the asymmetry. The nose may shorten or lengthen depending on dorsal contour and skin characteristics, but the middle vault always narrows, and the airway always suffers.

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GENERALIZED DEFORMITIES

The deformity occurs along a spectrum, but it is important to recognize the more subtle variations. In my experience, a break in the middorsal line (sometimes only a small notch) accompanied by a change in upper lip position are usually two of the earliest signs of septal injury.

Even Michelangelo’s later-life self portrait (reflecting the septal collapse sustained during a fight) accurately shows his own dorsal discontinuity and inverted-V deformity.

1273

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY ONE

This patient’s nasal appearance is deceptive, but history and a previous photograph provide the necessary information. She had undergone three prior surgeries. The first was a reduction rhinoplasty and septoplasty, but the surgeon performed two additional grafts to the dorsum, the second of which was ear cartilage, to correct a supratip depression. The patient developed an airway obstruction after the first surgery, uncorrected by the revisions. Her original goal was a nose with the same shape but smaller and narrower—probably unobtainable. Notice that nasal length has increased, tip projection has decreased, and her upper lip has lost its vertical position.

1274

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GENERALIZED DEFORMITIES

Thicker soft tissues do not reveal the same details as thinner ones, but the changes in lip carriage, tip projection, and upper dorsal height are obvious, although camouflaged by the onlay ear cartilage graft. The lateral crural remnants are malpositioned and bossed, broadening the nasal tip. Because some anterior septal support remained, a cantilevered dorsal graft was not necessary.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Maxillary augmentation 3. Limited skeletonization over nasal dorsum 4. Rasp bony vault 5. Remove old ear cartilage graft 6. Resect and replace lateral crural remnants 7. Rib cartilage dorsal graft 8. Rib cartilage caudal support graft 9. Multiple tip grafts

A

B

To reduce the number of incisions and ensure good coverage over the dorsal graft, the dorsum was skeletonized through the same infracartilaginous incision used to relocate the malpositioned lateral crura. The old ear cartilage graft was dissected free and removed, revealing the supratip septal depression (A). The tip of the tenth rib was trimmed and beveled to form a single-piece maxillary augmentation, and was placed into the subperiosteal pocket high over the maxillary arch through a short incision in the nasal floor (B). 1275

PART V

A



SECONDARY RHINOPLASTY

B

D

C

E

A section of split ninth rib produced a perfect dorsal graft, even containing the correct convexity to match an underlying skeletal asymmetry (B). Another graft, cut from the center of the rib and therefore unlikely to distort, was sized to replace the caudal septum, and was slipped into a pocket dissected between the membranous septal flaps, rounding the anterior corners before insertion. Notice its yellow, partially calcified center, typical of this patient’s age (C; shown before trimming). Thin strips of lightly crushed rib cartilage were rough-cut for tip grafts (D), which were then inserted to conclude the reconstruction (E).

1276

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GENERALIZED DEFORMITIES

Postoperative Analysis

Three years postoperatively, nasal contours are smooth. The rib graft is not palpable. Lateral crural repositioning has normalized alar wall contours. Nostril shape has been improved by correcting dorsal height and tip projection. The columellar scar remains. The dorsum is straight, smooth, and symmetrical, ending in a tip that projects to the dorsal line and approximates the patient’s preoperative contours. Notice also that no transfixing incision was made nor was any intranasal soft tissue resected: nasal shortening was produced by better maxillary, caudal septal, and tip support. Geometric mean nasal airflow increased 2.1 times over preoperative values.

1277

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO

A septoplasty intended to correct airway obstruction collapsed the nose, giving this young woman most of the expected sequelae: increased nasal length, an apparent increase in bony vault height, a supratip depression, retracted columella, decreased tip projection, a sharpened subnasale, and a retrusive upper lip. The remaining septum curved toward the patient’s left.

SUMMARY OF THE SURGICAL PLAN 1. Harvest calvarial bone for dorsal, caudal septal, and maxillary augmentation 2. Harvest ear cartilage for tip grafts 3. Limited skeletonization through a right-sided intercartilaginous incision 4. Rasp bony vault to level dorsum 5. No modification of tip cartilages 6. Calvarial bone maxillary augmentation 7. Calvarial bone dorsal graft 8. Calvarial bone caudal support graft 9. Ear cartilage tip grafts

1278

CHAPTER 19

A

C



GENERALIZED DEFORMITIES

B

D

E

The bony vault was rasped to level the dorsum, bringing the tip into greater relief (B). The preliminary calvarial bone graft will be shortened before placement (C). A small section of calvarial bone was used to support the columella (D). Tip grafts completed the reconstruction (E).

1279

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

This operation was performed in 1988. Four-and-a-half-year postoperative views show a continuous dorsum, a bony vault that appears narrower, and a middle vault that is no longer collapsed. Upper lip position has improved. Were I performing this case today, I would have added a right lateral wall graft to camouflage the leftsided high septal deviation. Each of the augmentations has played a part in improving nasal base projection and altering nostril contours.

1280

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GENERALIZED DEFORMITIES

The dorsum remains straight, without any evidence of graft absorption. As seen with the previous patient, restorating underlying support corrects the nasal lengthening that septal collapse produces. Despite the patient’s delicate skin, no underlying graft contours are visible. More than four years after surgery, the reconstruction is stable and successfully recreates the patient’s premorbid nasal contours.

1281

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY THREE

This is a patient whom I misdiagnosed. Thirty years after primary rhinoplasty and limited septoplasty, she sought correction of her airway obstruction and nasal asymmetry. The septal partition was severely twisted internally, obstructing the left airway anteriorly and the right airway posteriorly. The dorsum was stable but distorted toward the left. The reduced, malpositioned lateral crura had retracted her alar rims, and her retrusive upper lip seemed identical to what I had observed so many times in other secondary patients. A basal cell carcinoma resection over the right middle vault had left a depressed scar.

SUMMARY OF THE SURGICAL PLAN 1. Gore-Tex maxillary augmentation 2. Dorsal reduction 3. Resection and replacement of alar cartilage lateral crura 4. Septoplasty 5. Right unilateral spreader graft 6. Onlay over right middle vault 7. Tip grafts

1282

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GENERALIZED DEFORMITIES

As soon as surgery began, something felt wrong. When I began to rasp the bony vault, the nose felt unstable. There seemed to be too many moving parts. Immediately I presumed an old septal fracture, probably through ethmoid and therefore supported only by a weak fibrous union, even after 30 years. I was faced with two equally unappealing options. The first was to abandon the airway correction (the patient’s primary concern) and treat only the external deformity with onlay and tip grafts. The second was to proceed with the septoplasty, leaving a particularly wide dorsal strut, undissected from its mucoperichondrial attachments, and hope to maintain stability. I chose the latter course. As the septoplasty proceeded, the dorsal strut became more unstable, and began to settle posteriorly, disconnecting at its ethmoid attachments and producing a saddle nose, despite undissected 25 mm dorsal and 20 mm caudal struts. I completed the septoplasty, which yielded only small amounts of cartilage but several useful strips of flat ethmoid. I harvested ear cartilage for the tip and right sidewall and placed fine, transcutaneous K wires through the nasal bones and dorsal strut (see Gunter et al, 2006). I then smoothed the dorsal line with ethmoid grafts and reconstructed the tip as planned. Half of the wires were removed at 4 weeks, the rest at 6 weeks.

1283

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Two years postoperatively, nasal contours remain stable and smooth; and maxillary augmentation has corrected vertical position of the upper lip, most impressively on the frontal view (as is so often the case). The width provided by the onlay grafts and dorsal reduction has improved frontal aesthetics, and repositioned lateral crura support the alar rims. The right nasal scars remain slightly depressed. Geometric mean nasal airflow has improved 12.0 times over preoperative values.

1284

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GENERALIZED DEFORMITIES

Although this nose is small, it remains balanced; and despite multiple onlay grafts, no disturbing discontinuities are evident. The deepened radix has improved the nasofacial angle. To my knowledge, in the past 30 years I have produced two septal fractures. This was one of them. The other was in a secondary patient in whom I tried to harvest a thin strip from an already-reduced dorsal strut, narrowing its width to less than 10 mm. Although this patient’s preoperative appearance could be explained through traditional secondary rhinoplasty pathophysiology, the supratip depression and increased nasal length from her original preoperative photographs might have alerted me to the possibility of septal collapse. Today they would.

1285

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY FOUR

This patient suffered a septal collapse as a result of an infected hematoma following septoplasty and developed many of the signature deformities.

A

B

C

The primary difference in her treatment was a need to cantilever the graft by wire fixation at the bony vault after resecting the roof with an osteotome (B).

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GENERALIZED DEFORMITIES

Three years postoperatively, the dorsum remained reasonably straight and stable. Upper lip retrusion and columellar retraction were corrected, and nasal base projection was restored. I published this patient’s results after her 3-year follow-up (Constantian, 2001), but her story was not yet over. This patient illustrates the importance of long-term follow-up and the occasional unpredictability of rib grafts in younger patients.

1287

PART V



SECONDARY RHINOPLASTY

The patient returned 10 years after her first operation, asking to be checked because she sensed that something had changed. Indeed it had. The dorsal graft had warped in all three dimensions, twisting toward her right on the frontal view, bowing anteriorly over the bony vault and buckling into the supratip. In doing so, it elevated the right nostril by distorting the soft tissues above the rim. In addition, the tip lobule had flattened, the tip graft having been partially absorbed. Only the maxillary augmentation had held. Although I had placed an axial, threaded 0.9 mm Kirschner wire to stabilize the dorsal graft (see Gunter et al, 1997), the exceptional forces in the distorting rib had actually pulled the rib away from the wire, which was now palpable subcutaneously.

1288

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GENERALIZED DEFORMITIES

Reasoning that I was 10 years more experienced with rib and the patient was 10 years older (therefore presumably providing more rigid rib cartilage), I reoperated. The new graft was fashioned from the eighth rib, placed through a distal, cartilagesplitting incision to ensure good mucosal cover, fixed at its cephalic end with two smooth K-wires to prevent lateral displacement, and camouflaged at its edges with thin shavings of rib cartilage.

On the day of splint removal the nose was symmetrical, with the contour I had hoped. A few shavings of rib cartilage had been used to expand the anterior lobule, and rounded the tip nicely.

1289

PART V



SECONDARY RHINOPLASTY

Within 6 weeks the new dorsal graft began to distort. By 10 months (shown here), the graft had curled anteriorly at both ends, lifting the radix and the supratip, and curved once again toward the patient’s right. Interestingly, none of the other grafts had distorted.

A

B

C

D

Twelve months later, the dorsal graft was removed through the same unilateral cartilage splitting incision and was found to be distorted as expected (A). Concluding that rib cartilage was unreliable in this patient, I used rib bone instead, trimmed to fit and lightly beveled where necessary (B). The patient is shown at the beginning and end of the correction (C and D).

1290

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GENERALIZED DEFORMITIES

Postoperative Analysis

The patient is shown 2 years following her third surgery and 13 years following her first. The dorsal graft has remained midline and straight. Overall nasal balance is good. The upper rib correction has not regressed, and none of the sidewall or tip grafts have become visible. But the future behavior of this patient’s unpredictable rib remains unknown. Fortunately, the patient has maintained her equanimity through it all.

1291

PART V



SECONDARY RHINOPLASTY

P roblems of Length and Balance A

B

C

D

Whether reduction rhinoplasty shortens or lengthens the nose depends on several factors, chief of which are the shape of the preoperative nose (particularly the location of any dorsal convexity) and soft tissue thickness. Noses with medium or thick soft tissues and noses in which the dorsal convexity begins at the midpoint or more distally usually lengthen (A and B). If they are only reduced, long noses become longer as postoperative edema resolves. In contrast, noses with straight bridges, those in which the dorsal convexity begins high, and those with thinner, tighter skin sleeves usually shorten (C and D). Accompanying the lengthening or shortening are the other typical sequelae of dorsal reduction, the most important of which is loss of internal valvular competence. The response of the alar rims to lateral crural reduction also depends on skin thickness: thicker soft tissues respond less or not at all (although a postoperative alar hollow develops), whereas thinner skin retracts cephalad and may require corrective composite grafts to add lining. Similarly, the degree to which augmentation can shorten or lengthen a nose depends on skeletal and soft tissue factors. As we saw in the section on Septal Collapse, support shortens long noses.

1292

CHAPTER 19

A

B



GENERALIZED DEFORMITIES

C

D

Lengthening is more difficult. A tight, contracted skin sleeve (A) only accepts limited expansion safely. A surgeon can augment the dorsum, place caudally-positioned tip grafts, and fill the columella, but soft tissue capacity constrains the results (B). If the soft tissue is slightly more lax (C) and a long dorsal graft can be placed (in this case, rib cartilage), the tip lobule will often rotate more completely (D).

For this tertiary patient, dorsal, tip, and columellar grafts provided only modest improvement. After five other rhinoplasties, her soft tissues had undergone irreversible changes (including the development of unusual grooves along the alar walls) that responded only to a limited degree.

1293

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SECONDARY RHINOPLASTY

PATIENT STUDY ONE

Two previous rhinoplasties and a septoplasty have left his patient with an asymmetrical nose and airway obstruction. The reduction has widened her nose, her middle vault has collapsed, and the septal remnant twists toward her right. Because of her age and the shallowness of the dorsal defect, I wanted to avoid rib cartilage. If I could obtain one piece from the septum adequate for the dorsum, I could perform the rest of the reconstruction with ear cartilage.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization over middle vault and dorsum 2. Rasp bony vault for adherence 3. Septoplasty 4. Harvest ear cartilage 5. Asymmetrical ear cartilage spreader grafts, left thicker than right, right graft convexity facing toward left 6. Septal cartilage dorsal graft to cephalic end 7. Ethmoid grafts to left bony vault 8. Crushed cartilage grafts to left lateral wall 9. Bilateral alar wall grafts 10. Crushed tip grafts

1294

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GENERALIZED DEFORMITIES

Postoperative Analysis

Five years postoperatively, the nose looks slightly longer because dorsal and tip grafts have established dorsal length, and alar wall grafts have decreased nostril visibility. Spreader grafts have opened the middle vault, and lateral grafts have improved symmetry.

1295

PART V



SECONDARY RHINOPLASTY

Although the caudal septum remains untouched, notice that the columella has become less visible because of anteroposterior tension provided by the tip grafts.

1296

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GENERALIZED DEFORMITIES

PATIENT STUDY TWO

A prior rhinoplasty compromised this patient’s airway at the internal and external valves, the latter already weakened by alar cartilage malposition (notice the alar creases and retracted rims). He believed that his lower nose was too large. There was a high septal deviation toward the right, and the lateral genua had knuckled.

SUMMARY OF THE SURGICAL PLAN 1. Resect lateral genua knuckles 2. Limited skeletonization over bony and upper cartilaginous vaults 3. Rasp bony vault for adherence 4. Transfixing incision, elevating caudal and membranous septa without shortening nose 5. Harvest rib cartilage (septum unavailable) 6. Harvest composite grafts 7. Rib cartilage dorsal graft 8. Rib cartilage tip grafts 9. Left lateral wall graft 10. Bilateral, coronally oriented composite grafts

1297

PART V



SECONDARY RHINOPLASTY

The case was performed in 1997. Were I doing it today, I would not resect the knuckles; this is unnecessary dissection of structures that were not excessively projecting and would have been camouflaged by the tip grafts. Knuckle resection decreased tip projection and increased the complexity of the judgment calls required.

Postoperative Analysis

Two years postoperatively, the nose is straight, the tip is symmetrical, and alar retraction has been diminished by the composite grafts. Geometric mean nasal airflow has increased 5.1 times over preoperative values.

1298

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GENERALIZED DEFORMITIES

The change in dorsal height and columellar position has reduced apparent nasal base size. Tip projection has not changed but grafts have altered lobular contour. The cartilaginous components of the composite grafts have corrected the alar hollows.

1299

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY THREE

Two previous rhinoplasties created a very narrow nose from a narrow nose, and converted a narrow middle vault and alar cartilage malposition to subtotal airway obstruction with retracted nostrils. Although the patient’s profile seems good, imagine, based on the frontal view, what is missing from the inferior tip lobule and the columella. Only a portion of the septum remains. To avoid a rib cartilage dorsal graft, which would be overkill for such a small defect, the surgeon needs to obtain one nice strip from the septum. Ear cartilage can supply all rhinoplasty needs in most patients (spreader grafts, alar wall grafts, tip grafts, columellar grafts, and composite grafts), but ear cartilage cannot form a thin, long straight dorsal graft that is unlikely to be visible under thin soft tissues.

1300

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GENERALIZED DEFORMITIES

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage for cartilage and composite grafts 2. Minimal skeletonization through single intercartilaginous incision 3. Resect posterior caudal septum 4. Trim knuckled left genu 5. Septoplasty 6. Asymmetrical ear cartilage spreader grafts, right thicker than left 7. Single layer septal cartilage dorsal graft 8. Crushed cartilage tip grafts 9. Crushed columellar grafts 10. Bilateral coronal composite grafts, left slightly wider than right 11. Right alar wedge resection, removing external skin only

The septum yielded one serviceable piece for the dorsum (top center of grid). The harvested composite graft (skin covering only a portion of the resected cartilage, bottom left of grid) was split to form two pieces, trimmed to the appropriate size, and its cartilaginous component thinned. Comparative photographs from the beginning and the end of the procedure show apparent nasal base rotation and less nostril visibility, largely the result of the caudal septal resection, composite graft, and caudally positioned tip and columellar grafts.

1301

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Three years postoperatively, the nose has retained the length achieved at surgery. Lengthening the nose is not magical. Only so much can be gained by rotating the tip and raising the dorsum. If there is a true lining deficit, it must be replaced. Alar wall grafts will not stretch contracted skin several millimeters to correct a defect of this magnitude.

1302

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GENERALIZED DEFORMITIES

Comparing the lateral views, it should be more obvious now how much of the inferior tip lobule and columella were missing, reconstructed by feeding crushed grafts into separate pockets through vestibular skin incisions, and taking care that the grafts all laid flat and produced no surface irregularities. The postoperative nose is appropriately wider, and the length created by filling the tip lobule and columella can be appreciated best from the oblique view. The cartilaginous components of the composite grafts have created natural convexities in the alar sidewalls. Geometric mean postoperative nasal airflow increased 4.5 times over preoperative values.

1303

PART V



SECONDARY RHINOPLASTY

R econstruction in Patients With Prostheses

I have never regretted the philosophical decision that I made when I first went into practice to never use nasal prostheses. There are surgeons who do not agree with me, and I am familiar with their argument, because it is echoed by each of the papers that promotes the use of particular implants or nonautogenous material (such as irradiated homograft), correctly citing the problems associated with autogenous materials (such as pain, morbidity, and imperfect predictability). The surgeon who uses a silicone implant knows exactly how the implant will behave intraoperatively—information that the surgeon harvesting rib does not have.

Autogenous materials do involve more pain and recovery for patients and more uncertainty for surgeons, but autografts do not fail in the same ways that alloplastics do. With good surgical technique, infection and extrusion virtually never occur. Instead, suboptimal results from autogenous reconstructions are generally limited to imperfect cosmetic results, which the surgeon can largely (but not completely) avoid. 1304

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GENERALIZED DEFORMITIES

Some implants placed without tension in primary patients with thick soft tissues can survive for many years. However, many of the patients in whom one would most like to use implants are least suited for them: patients who have undergone multiple prior surgeries, those whose septal and ear cartilage have already been harvested, and others who are understandably exhausted after many failed operations and want only simple solutions. I sympathize with these patients, but they deserve operations that have the greatest chance of long-term success.

The nasal tissues of these tertiary patients are stiff, scarred, and hypovascular, which is one of the worst possible situations for placing implants, especially under tension. Particularly bad are L-shaped implants, designed to increase tip projection, which put their greatest stresses at the nasal tip.

Once implants extrude or are removed, the tip skin may be permanently thinned and damaged from dermal erosion. No one knows the real long-term implant fail-

1305

PART V



SECONDARY RHINOPLASTY

ure rate, the percentage of implants that ultimately extrude, or the number removed because the cosmetic reconstructions were unacceptable. Nasal prostheses are unquestionably easy to use. A young surgeon’s first silicone implant will work, whereas his or her first rib graft may not. But these implants are only easy on the day the surgeon puts them in. Autogenous grafts are the patient’s best chance of a lifetime result.

PATIENT STUDY ONE

This young Latino man had undergone a reduction rhinoplasty, after which a dorsal silicone implant had been placed to correct an overresection. His frontal view shows the stigmata of previous alar cartilage malposition, recognizable by the creases that used to demarcate the caudal edges of the lower lateral cartilages, and by the nostril retraction.

1306

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GENERALIZED DEFORMITIES

Here is our proof. The patient was able to supply a photograph of his nose prior to any surgery, showing the rotated lateral crural position. He also supplied a photograph of his nose between the first and second procedures (showing a supratip deformity), with an ink overlay tracing what he wanted to accomplish: a higher dorsum with more tip projection and a flatter supratip. The patient instinctively understood skin limitations and the fact that the improvement required augmentation, not further reduction. If the skin could have contracted further, he would not have developed a supratip deformity. Fortunately, septal cartilage was available.

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage for composite grafts 2. Limited skeletonization through a single intercartilaginous incision 3. Enter silicone capsule on its posterior surface, maintaining as thick a soft tissue cover as possible; remove silicone implant 4. Elevate nasal periosteum, rasp bony vault for graft adherence 5. Transfixing incision, resect an ellipse of membranous septum without shortening nose 6. Septoplasty 7. Layered dorsal graft 8. Tip grafts 9. Coronally-oriented composite grafts

1307

PART V



SECONDARY RHINOPLASTY

A

B

C

D

After the implant was removed (B), the nose revealed the same balance alterations seen after any large dorsal reduction: a notch developed at the mid-point of the bridge, the supratip became higher, and the nasal base appeared larger (C). Following dorsal and tip grafts, the nose became straight, with a slight convexity over the bony vault, respecting the patient’s aesthetic goal (D).

1308

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GENERALIZED DEFORMITIES

A

B

C

D

The harvested composite graft was cut to size and placed where preoperative skin markings indicated the greatest deficiency (A). After the right graft was placed (B), the depression in the right alar wall disappeared and rim height dropped (C). After both composite grafts were placed, the nostrils became more symmetrical and the alar hollows disappeared (D).

1309

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Two and a half years later, the abnormalities of the preoperative nose have decreased. The nasal sidewalls show a gradual, confluent divergence instead of narrow, parallel edges. The alar creases have diminished, and nostril height has improved. The lobulated preoperative inferior view has been softened by composite grafts. The donor ear shows negligible changes from the harvest in the cymba conchae.

1310

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GENERALIZED DEFORMITIES

FPO 104

The oblique and lateral views indicate symmetry and separation of the dorsum from the supratip. Columellar elevation and nostril height reduction reduce nostril visibility. The reconstruction is now autogenous and has supplied tip projection not created by the silicone implant. The patient’s aesthetic goals have been met. This part of rhinoplasty is not magic. Most careful surgeons can produce these same results if they understand nasal phenomenology and attend to technical details.

1311

PART V



SECONDARY RHINOPLASTY

PATIENT STUDY TWO

This patient had undergone two rhinoplasties, the first of which reduced his nose, the second of which inserted homograft cartilage. In fairness to the homograft, it had been present for 15 years, but was too small, too short, and too mobile, and it did not correct the patient’s airway obstruction. An original preoperative view shows malposition. Septal cartilage was unavailable.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Minimal skeletonization beneath implant, removing old implant 3. Rasp bony vaults for graft adherence 4. Two-piece rib cartilage maxillary augmentation 5. Resect ellipse of caudal and membranous septa without shortening nose 6. Rib cartilage dorsal graft 7. Rib cartilage alar wall grafts 8. Right sided lateral wall graft 9. Tip grafts 10. Right alar wedge resection, removing 3 mm of external skin and 2 mm of vestibular skin

1312

CHAPTER 19



GENERALIZED DEFORMITIES

A dorsal graft was fashioned (right of grid), and the homograft was removed (left of grid). Compare lateral views at the beginning of the procedure and following implant removal, and notice the change in apparent nasal base size. The caudal septum was also adjusted.

The tip of the ninth rib, with its own nice intrinsic curve, was carved to make a single unit maxillary augmentation, and the carved rib graft was placed into the dorsum, immediately decreasing apparent nasal base size and providing a smooth contour. A left unilateral composite graft was added 12 months later as an isolated procedure.

1313

PART V



SECONDARY RHINOPLASTY

Postoperative Analysis

Two years postoperatively, the dorsum remains smooth and straight. The rib graft is not palpable and has fully integrated with the bony arch. The discontinuities created by the narrow, asymmetrical homograft have been corrected. Alar wall grafts have modified the hollows created by resection of malpositioned lateral crura. A right alar wedge resection has improved nasal base symmetry, and tip grafts have diminished the cleft in the patient’s tip.

1314

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GENERALIZED DEFORMITIES

Because the tip and alar wall grafts distribute tip forces, the lateral genua are not as prominent. Geometric mean nasal airflow increased 2.1 times over preoperative values. Maxillary augmentation has improved upper lip position, and the dorsal and tip grafts form an integrated profile without discontinuities, resembling the patient’s unoperated nasal shape. The alar wall grafts have filled the hollows and created a normal convexity. Rib is particularly well suited for this purpose, because a shaving of the rib surface naturally produces a curl toward the perichondrial side, which can be used to the patient’s advantage. The operating surgeon should always remember that every implant was inserted for a reason. The surgical plan must include adequate arrangements for a reconstruction that cannot be fully planned until the implant has been removed.

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Cleft Lip Nasal Deformity If there is a most unsolved area of rhinoplasty, it is the cleft lip nasal deformity. Our imperfect progress so far has two causes. First, knowledge is still increasing about cleft deformities and how they change as a child grows. Second, the technical aspects of cleft rhinoplasty must deal with not only deficient or abnormal anatomy and soft tissue changes, but inherently asymmetrical ones (except in bilateral clefts). Like surgery in hands with rheumatoid arthritis, the results (at least my results) are always imperfect. There is always more to do, more to offer the patient, more techniques that might overcome the abnormalities that biology has produced.

What makes a cleft deformity noticeable? Both of the results shown here are imperfect—works in progress. But there is improvement. Is the change created by a better upper lip contour after maxillary augmentation? Or by a change in nasal tip position? Or by a straighter dorsum? Or by better nostril or alar base position? Or is it the change in the patient’s eyes, where the sense of deformity seems to have diminished? Many surgeons have described elements of the abnormal anatomy that characterizes the cleft lip nasal deformity, which include any or all of the following: the nasal tip and caudal septum deviate away from the cleft side; the septal convexity bows toward the cleft side, obstructing the ipsilateral airway; the left alar dome is depressed; and there is a vestibular web in the cleft side nostril, running from its apex to the pyriform aperture, roughly along the cephalic margin of the alar cartilage.

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The cleft side alar rim buckles medially; there is an absent alar/facial groove on the cleft side; and the cleft alar base is laterally displaced. The maxilla on the cleft side is hypoplastic; and the medial crus on the cleft side is positioned inferiorly to its normal mate, abutting a widened nasal floor. The bilateral deformity is characterized by a short columella, an inadequately projecting tip sometimes notched in the midline, lateral displacement of both domes and lateral crura away from the septum, flattened alar rims, flared alar bases, and bilateral maxillary hypoplasia. To these I would add that the lateral crura on the cleft sides of unilateral and bilateral deformities are cephalically rotated and behave exactly like malpositioned lateral crura in noncleft noses.

However, most rhinoplasty surgeons see patients with clefts years after the initial repair has been performed, and often after a number of additional surgeries. Frequently complicating the original anatomy (or those elements that remain uncorrected) are nostril stenosis on the cleft side, inadequate tip projection, columellar scars with or without previous forked flaps or other columellar lengthening procedures, residual malpositioned lateral crural remnants, persistent vestibular webs on the cleft side, untreated maxillary hypoplasia, and other causes of airway obstruction or nasal deformity that may have resulted from earlier treatments (such as supratip deformity, internal or external valvular incompetence, or residual septal deviation). With few exceptions, my approach to these patients follows my approach to other tertiary rhinoplasty deformities, remembering that the deformities are usually asymmetrical, that the soft tissues are scarred, and that there are skeletal and soft tissue deficiencies on the cleft side. The phenomenology and logic, however, remain the same.

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PATIENT STUDY ONE

This patient’s two prior surgeries had not corrected her airway obstruction from internal and external valvular incompetence. The septum had been previously harvested. The patient was satisfied with her external lip repair but consented to treatment of the modest whistle deformity. She thought that her tip was too flat, her nose too short, and her nostrils too visible.

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SUMMARY OF THE SURGICAL PLAN 1. Revise lip with V-Y mucosal advancement 2. Harvest composite graft and ear cartilage 3. Resect lateral crural remnants through the same vestibular incisions planned for the composite grafts 4. Minimal skeletonization to root 5. Rasp radix; bilateral ear cartilage spreader grafts, thicker on right than left 6. Bilateral coronal composite grafts 7. Columellar grafts 8. Tip grafts

Ear cartilage spreader grafts were placed, the radix reduced, and the tip expanded. The goal was to create a less vertical nasofacial angle.

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Postoperative Analysis

Three years postoperatively, the nostrils remain more symmetrical. Resection of the deformed lateral crural remnants and composite grafting have diminished the asymmetrical alar creases, and asymmetrical ear cartilage spreader grafts have widened the middle vault slightly. Geometric mean nasal airflow increased 4.1 times over preoperative values.

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Grafts have separated the tip lobule from the dorsum and displaced the columella caudally. However, the deeper radix obtained during surgery did not persist postoperatively, which is not unusual. When the supraorbital forehead is flat, a change in radix depth is difficult to maintain.

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PATIENT STUDY TWO

After three nasal corrections (including the repair in infancy) this patient still had valve-related airway obstruction and left-sided nostril stenosis. Only a small amount of septal cartilage was available. She declined lip revision.

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage 2. Minimal skeletonization through single intercartilaginous incision 3. Minimal rasping and trim of nasal dorsum 4. Septoplasty 5. Maxillary augmentation (vomer and ear cartilage scraps only) 6. Tip grafts 7. Columellar grafts 8. Left lateral wall graft 9. Left alar base flap

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Because the patient’s donor materials were limited to a small amount of septal cartilage and one unused ear, the residual building materials not needed for other areas were used for maxillary augmentation. These were insufficient for the job, but rib cartilage was not warranted and alloplastics are always contraindicated under a scarred gingivobuccal sulcus.

Postoperative Analysis

One year following surgery, the nose remains more symmetrical.

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Lateral and oblique views show a modestly improved upper lip carriage, with better tip and columellar position. The left alar crease remains appropriately deep, although slightly flatter when compared to the normal side. Because the left alar base was displaced medially, an alar base flap repositioned the base and opened the stenotic nostril. It is important to recreate an alar crease by advancing the cheek, so that a flattened contour does not develop.

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PATIENT STUDY THREE

Besides repair of her bilateral cleft lip in infancy, this young woman had undergone two columellar lengthening procedures using a forked flap and cartilage strut. Despite columellar lengthening, the patient’s tip lobule remains small, and the nasal base has taken on a gangly, unnatural appearance. It is too wide from the front, and the nostrils are large, triangular, and notched laterally. The columella is symmetrical but scarred and too narrow at its posterior end. In terms of overall nasal balance, the dorsum is straight but too low in relation to a relatively large nasal base, and the tip is undefined.

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SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Ear cartilage maxillary augmentation 2. Resect posterior columella 3. Alar wedge resections, removing 3 mm of external skin and 2 mm of vestibular skin

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (6 MONTHS LATER) 1. Revise lip repair 2. Harvest ear cartilage 3. Additional maxillary augmentation 4. Additional columellar grafts

SUMMARY OF THE SURGICAL PLAN: THIRD STAGE (1 YEAR LATER) 1. Limited skeletonization over dorsum 2. Rasp the bony vault for graft adherence 3. Septoplasty 4. Harvest ear cartilage (limited donor material from previous septoplasty) 5. Dorsal graft 6. Additional columellar grafts 7. Tip grafts, solid and crushed

A

B

C

The needed columellar resection is often disarmingly small. My preoperative plan can be seen in A. 1326

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Postoperative Analysis

Three and a quarter years after the final procedure, frontal balance has improved. Although scar maturation is slow during the teenage years, lip contour is better, the whistle deformity has been improved by mucosal advancement, and the left Cupid’s bow notch has been corrected. The philtral column, however, is not symmetrical, but the patient declined further surgery. Alar rim excisions have improved nostril contour; and the combination of the dorsal graft and alar base resections has brought the frontal view into better balance by narrowing the upper and lower noses, respectively. The nasal base shows an overall improvement, though covered with objectionable scars, some of which are from me. Nostril size has decreased and tip lobular size has increased; nostril contour is more normal, but could benefit from further revision. The lower lip scar is the vestige of an Abbé flap performed by the previous surgeon. 1327

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Autogenous maxillary augmentation (using ear cartilage) has improved the vertical position of the upper lip. The columella is no longer retracted. Tip grafts have improved contour, and the dorsal graft has improved the balance between nasal base size and bridge height.

On the oblique views, the improvement in balance is perhaps more obvious. A slightly higher dorsum and grafted tip have corrected the profile. Recall the size of the columellar resection, which was less than 3 mm and could not by itself have caused the improvement in nasal balance. Columellar and alar wedge resections merely corrected the view from below; dorsal and tip grafts improved the relationships among the dorsum, middle vault, and nasal base on all other views. Despite a reduction in nostril size, geometric mean nasal airflow increased 4.8 times over preoperative values, indicating the combined effect of septoplasty and the dorsal graft, which strengthened the internal valves. 1328

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PATIENT STUDY FOUR

Despite the frontonasal dysplasia spectrum with a right unilateral cleft lip and palate, the family remained uninterested in correcting the patient’s mild hypertelorism, which caused no visual disturbance. His speech was good. Nevertheless, the nose was broad, the dorsum bifid, the tip undefined, and the nostrils asymmetrical.

Cleft side

Normal side

Notice that the lateral crural axes are not symmetrical: the normal (left) side is orthotopic (its axis points toward the lateral canthus), but the cleft (right) side is cephalically rotated, (its axis points toward the medial canthus). 1329

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SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Harvest rib cartilage 2. Rib cartilage maxillary augmentation 3. Midline skin excision 4. Rib cartilage dorsal graft, placed through midline incision 5. Columellar grafts 6. Tip grafts

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (1 YEAR LATER) 1. Composite graft, left nostril 2. Excise skin, right rim 3. Revise lip

A

B

C

Rib cartilage was carved into a single piece maxillary augmentation, its limbs deliberately asymmetrical to compensate for maxillary hypoplasia on the cleft side. Notice the midline mark and planned middorsal excision (A). The dorsum was split and the malpositioned right lateral crus rotated into proper position, symmetrical with the left side (B). The rib graft was carved, sized, and placed into the dorsal defect, where it was immobilized with fine absorbable sutures (C).

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The patient is shown at the beginning of the procedure and following the dorsal graft. Notice that the skin has been coapted to the thinned underlying soft tissue with basting sutures, advancing the skin medially under very gentle tension. The basting sutures were removed in 24 hours. Although the dorsum is straight, tip projection is still inadequate, common in many clefts. Tip grafts complete the reconstruction. No cast was placed. During the following year, a large composite graft was added to the left side, the right nostril rim was excised, and lip revision was performed.

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Postoperative Analysis

Seven years postoperatively, the dorsum remains straight and midline.

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The nasal base is less asymmetrical. Excision of nostril skin on the right and the left composite graft have improved symmetry, but the dorsal and tip scars are still suboptimal. A second composite graft would improve left alar rim height, but the patient has declined further surgery. The amorphous nasal shape has improved with dorsal, tip, and columellar grafts. Although disparate preoperatively, the postoperative oblique views match more closely. Geometric mean nasal airflow increased 4.1 times over preoperative values.

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PATIENT STUDY FIVE Aside from the lip scars and frequent whistle deformities, I have often thought that the maxillary hypoplasia and flat tip make a cleft deformity most obvious. Other surgeons may disagree, but two of my primary goals in patients with clefts are to improve both vertical lip position and tip projection.

Like so many patients with clefts who are treated in their teens, this man had already undergone several surgeries, including a septoplasty that failed to clear an airway obstructed at the internal valves. His dorsum was straight, but his maxillary arch was characteristically retrusive, his tip was inadequately projecting, and nasal base projection was poor. The unsupported base seemed to drip off the dorsum. Although the cleft nostril was not stenotic, the floor was depressed, and the normal right alar rim was higher than the left.

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SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Harvest rib cartilage 2. Rib cartilage maxillary augmentation, thicker on the left than right (preoperative asymmetry) 3. Moderate skeletonization over bony and upper cartilaginous vaults 4. Retrograde reduction of left lateral crus 5. Rib cartilage spreader grafts 6. Rib cartilage dorsal graft 7. Rib cartilage left middle vault onlay 8. Rib cartilage caudal support graft 9. Tip grafts 10. Left lateral wall graft 11. Excision left alar rim

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (1 YEAR LATER) 1. Harvest rib bone 2. Harvest composite graft 3. Revise lip 4. Dorsal graft, rib bone 5. Coronal composite graft, right nostril 6. Right osteotomy

SUMMARY OF THE SURGICAL PLAN: THIRD STAGE (1 YEAR LATER) 1. Left alar wedge resection 2. Repeat right composite graft (partial loss) using left alar wedge as graft 3. Revision of left alar rim

Unfortunately, the dorsal graft distorted, as detailed in Chapter 14. One year later, that graft was removed and replaced with tenth rib bone, the lip was revised, and a right composite graft and right osteotomy were performed. Small revisions were done the following year.

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Postoperative Analysis

Three years after the first stage, the dorsum remains smooth, symmetrical, and straight, and the bone graft edges are not palpable. Maxillary augmentation, columellar grafts, and tip grafts have rotated the nasal base cephalad, and have improved the nasal base/upper lip complex, reducing the cleft stigma.

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The oblique views match more evenly. The combination of left alar wedge resection, left nostril rim excision, and right coronal composite graft have improved nostril symmetry, but multiple attempts to correct the left nostril have produced a lining that is thick and almost stenotic. Despite that, geometric mean nasal airflow increased 2.5 times over preoperative values.

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D eformities Resulting From Previous Open Rhinoplasty Open rhinoplasty is an operation nearly without complications. I know this because there are almost no papers on the subject. One of the larger open rhinoplasty series indicates no complications. Another series notes an occasional hypertrophic scar, but says that other complications were “comparable to those seen after the endonasal approach.” In several series reviewing successes, the incidence of suboptimal scars was listed at 1% to 3%, with rare exceptions: Daniel’s report (1995) of 22 patients indicated a 9% rate of objectionable scars, and a group of 50 patients was reported to have a 44% rate of unsatisfactory scars (Bafaqueeh and Al-Qattan, 1998). However, the columellar scar that results from open rhinoplasty is not the real issue. Every surgeon needs access. My objection to the open approach is not the exposure that it provides, but rather the exposure that it does not provide—one that reveals the proportion, contour, and nuance of the nasal surface, which is what the patient sees. The putative advantages of the open approach—wider exposure, and the ability to fix grafts, set columellar struts, and place sutures—become liabilities when the result is not what the surgeon had intended. Although I have seen many very good open rhinoplasty results from my colleagues and in the literature, no one knows how often suboptimal results occur, even in the best hands, or how they compare to those seen in patients treated endonasally. Are there differences in surgical outcome? Does the access route chosen by the surgeon place patients at risk for particular postoperative consequences? To answer some of these questions, I performed a review of 100 consecutive secondary or tertiary rhinoplasty patients (66 women and 34 men) on whom I operated between 1997 and 1998 (Constantian, 2002). Their mean age was 35 years (range, 14-68 years). Of these patients, 64 had previously undergone only endonasal rhinoplasty (45 women and 19 men), and 36 had undergone one or more open rhinoplasties (21 woman and 15 men). Most of the open rhinoplasty patients had undergone only open procedures; at the very least, the most recent rhinoplasties had been performed through the open approach. There was no significant difference in the proportion of men to women among those patients who had undergone either rhinoplasty approach (chi square ⫽ 1.47; df ⫽ 1; p ⬎0.05). At the time the survey was conducted, the popularity of the open approach had been increasing progressively for several years. In 1996 and 1997, 21% and 23% of my secondary and tertiary patients had previously undergone open rhinoplasty, re-

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spectively; by 2000, the number was 50%; and currently it is more than 80% (with a higher proportion from United States surgeons relative to those patients undergoing surgery overseas).* There were provocative differences between the two patient groups. Open rhinoplasty patients had undergone more previous operations (3.1, versus 1.2 for closed rhinoplasty patients) and had a larger number of presenting complaints (5.8, versus 2.6 for closed rhinoplasty patients).

Relative Frequency of Presenting Complaints in 100 Consecutive Secondary Rhinoplasty Candidates After Closed or Open Approaches Presenting Complaint

Previous Closed Approach

Previous Open Approach

Airway obstruction (internal valve) Alar distortion Bridge too low Tip too blunt Nose asymmetrical Airway obstruction (external valve) Tip too narrow Nose too short Nose too long Bridge too high Nose too narrow Columella wider Columellar scar Hard struts

42%

64%

16% 50% 33% 27% 11%

64% 64% 61% 50% 50%

28% 14% 20%* 17%* 8% 0% 0% 0%

47% 39% 3% 11% 31% 36% 25% 19%

*Higher incidence following closed approach.

The nature and rank order of complaints differed in each of the groups. Although both patient groups complained of bridges that were too low, airway obstruction at the internal valves, tips that were too blunt, or postoperative asymmetry, patients previously treated by open rhinoplasty also frequently complained of nostril and alar distortion, airway obstruction at the external valves, noses that were too short or too narrow, or unacceptably wide columellae. Of all complaints presented in both groups, only excessively long noses and bridges that remained too high were more common in previously treated closed rhinoplasty patients. *A Z test comparing the difference between proportions for independent samples indicated significant prevalence for most presenting complaints individually and as a whole.

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Surgical Problems More Frequent After Open or Closed Rhinoplasty (100 Consecutive Secondary Patients) Surgical Problem

Relative Occurrence (Times More Frequent)

More Frequent After Open Rhinoplasty Excessive columellar width Hard columellar strut Excessively narrow tip External valvular obstruction Chronic rhinitis Alar/nostril distortion Excessively narrow nose

36 19 11 4.5 4.5 4.0 3.9

More Frequent After Closed Rhinoplasty Nose excessively long Bridge too high

6.7 1.5

With those two exceptions, patients previously treated by the open approach voiced more complaints in every other category than their closed rhinoplasty counterparts. Complaints related to the columella ranged from 19% to 36%. Interestingly, the columellar scar, widely assumed by open rhinoplasty critics to be its major drawback, troubled only 25% of the open rhinoplasty patients.

The complaints registered by these two groups of patients are not difficult to interpret. When a surgeon resects a dorsum like the one Monet has caricatured here, a skin sleeve that cannot contract will often lengthen, accounting for the “nose excessively long” complaint, as well as complaints traceable to internal valvular incompetence. When tip reduction decreases tip support (or when inadequate tip projection existed before rhinoplasty) the tip hangs further, creating a patient belief that the bridge is now too high (when in fact the tip is too low).

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Unlike the closed group, however, alar distortion, external valvular obstruction, and a too-narrow tip ranked high among previous open rhinoplasty patients.

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A

B

C

D

E

F

Columellar struts, which are very easy to place, can create their own deformities: columellae that are too wide with displaced medial footplates (B and D), or columellae that are overrotated and broad (F and H).

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Interestingly, despite the size and substance of their columellar struts, notice that each of these patients still has inadequate tip projection. Adequate tip projection results from adequate middle crural length, not from direct pressure transmitted from the maxilla or medial crural extensions.

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The columellar scar was a relatively infrequent complaint among the open rhinoplasty patients (ranking eleventh out of 15 complaints), but it was distressing to 25% of the patients in this group. Particularly unfortunate deformities can occur when the surgeon resects a portion of the columella, leaving incongruous surfaces with missing normal tissue. Such resections are performed in an effort to reduce large nasal bases or decrease tip projection; but the procedure rests on an anatomic misdiagnosis and creates a deformity for which I currently know no adequate correction.

1344

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The most severe deformities occur after multiple surgeries, compounded by aggressive dissection, devascularization, deliberate resection, and inadvertent tissue loss. It is here that the concept of using the open approach in a tertiary reconstruction can be most dangerous. Much safer are techniques that allow improvement with limited dissection, limited danger for the patient, and limited access. As should be apparent from inspection alone, the investing nasal tissue is not inviolable. Comparisons of my review with any previous studies are obviously difficult and must be approached cautiously. However, one report of revisionary surgery on 22 previous open rhinoplasty patients does document related deformities (Daniel, 1995). In that report, nasal base problems occurred with similar frequency to my study (columellar scar: 18%, nostril asymmetry: 27%, excessive infratip lobular fullness: 18%, or distorted nostril apices: 27%). Only 9% of the patients in that study objected to their columellar scars, which contrasts with the 25% in my group.

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Although none of this data should be over-interpreted, the divergent spectrum of deformities between closed and open results suggests a correlation with the different approaches. Both groups complained of airway obstruction at the internal valves, an overresected bridge, loss of tip contour from alar cartilage resection, or nasal asymmetry. However, the open rhinoplasty patients were more likely to complain of deformities and functional impairments related to the structures most easily accessed by a transcolumellar incision (such as complaints of alar and nostril distortion or external valvular obstruction) or to techniques that can be performed more readily or aggressively through it (such as complaints of rigid columellar struts, wide columellae, or objectionable scars). Some techniques that would be difficult or impossible using the endonasal approach are of course provided by open rhinoplasty access: columellar resection, or directly suturing the upper or lower lateral cartilages to each other or to the nasal bones for valvular stability. Open rhinoplasty is not merely a different access route—it is a different operation. Surgeons who prefer the open technique must acknowledge not only the advantages that it affords but the restrictions that it imposes on nasal circulation, accurate surface study, interpretation of dynamic intraoperative changes, and right brain analysis. Despite the volume and enthusiasm of the relevant literature, open rhinoplasty has its own unique catalog of unintended consequences. No one knows the prevalence of these results, even in expert hands. It is not my aim here to criticize any operating surgeons. When a similar set of preoperative conditions produces the same unintended consequences by different surgeons, the inescapable conclusion is that we are dealing with an error-prone situation, rather than with careless or inept individuals. A surgeon who prefers the open approach should perform it with eyes open to the limitations that it imposes, and be prepared to minimize the potential for the nasal base deformities that are easier to create through the access, exposure, and techniques advocated for this approach. The surgeon revising open rhinoplasty results must remember the tip suturing or strut techniques that previous surgeons may have used. Tip sutures are only reversible on the day they are placed; once healed, the deformed structures often require repositioning or resection and reconstruction.

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A

B

C

It is true that the open approach affords a surgeon an opportunity to place and secure a columellar strut and determine the angle of tip rotation; but because the strut is not an anatomic correction, it can also broaden and distort the columella and create excessive tip rotation (compare A and B). Resecting the strut, thinning the columella, and grafting the tip corrects this deformity (C).

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PATIENT STUDY ONE

Thick skin creates additional complexity for surgeons performing open rhinoplasty. Although the same can be said for endonasal surgeons, the wider dissection of the open approach, the columellar struts used, and the difficulty of producing a beautiful columellar scar in heavier tissues place thicker-skinned patients at special risk. This patient’s preoperative nose was not especially wide, but two rhinoplasties, reducing dorsal height and tip projection, have allowed the soft tissues to thicken so that surface landmarks have become invisible. The columellar strut has distorted the angle of rotation, raising it to 80 degrees; and relative nasal base size, very difficult to assess during open rhinoplasty, has increased. Dorsal reduction uncovered a high septal deviation toward the right. No septal cartilage was available.

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage 2. Minimal skeletonization 3. Dissect and remove columellar strut 4. Bilateral ear cartilage spreader grafts, thinner on the right (with a convexity toward the left), thicker on the left 5. Tip grafts 6. Thin crushed graft to supratip

1348

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Postoperative Analysis

Even 18 months postoperatively, there is very little difference on the frontal view, although the distortion produced by the strut has diminished. Heavy soft tissues hide the airway improvement created by spreader grafts. Pliable ear cartilage will not straighten a high septal deviation as vigorously as stiffer septal or rib cartilage, but the functional improvement is the same. Strut resection and tip grafts have altered the angle of rotation. Rebalancing a nose like this is difficult, because dorsal grafting is not possible; as always, the surgeon is limited by the volume and distribution of the preoperative skin sleeve.

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PATIENT STUDY TWO

This patient’s columellar scar was good, and was located at the junction of the columella and upper lip; but the external valvular and alar wall deformities typify most common adverse open rhinoplasty results. Despite the columellar strut, supratip deformity was present.

SUMMARY OF THE SURGICAL PLAN 1. Minimal skeletonization over bony and upper cartilaginous vaults 2. Rasp dorsum for graft adherence 3. Resect and relocate malpositioned lateral crura 4. Transfix, resect ellipse of posterior membranous septum, remove columellar strut 5. Septoplasty 6. Dorsal graft 7. Tip grafts

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A



GENERALIZED DEFORMITIES

B

The malpositioned lateral crura were recovered through vestibular skin incisions placed 3 mm above the rims. They were resected at the lateral genua (A), crushed, and replaced (B).

Yellow and blue card photographs show the contour change created only by redraping the soft tissues cephalad and caudad. Dorsal and tip reduction create supratip deformity; dorsal and tip grafts correct it.

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Postoperative Analysis

Three years later, the supratip deformity remains corrected. Adequate tip projection is present. The airway has been improved by the dorsal graft (internal valves) and the repositioned lateral crura (external valves). In combination with the septoplasty, geometric mean nasal airflow increased 13.4 times over preoperative values, an unusually high response because of the patient’s significant preoperative obstruction. However, she was unhappy because her postoperative nose remained wider than it had been. She did not see the preoperative tip and alar walls as pinched and collapsed, but rather as narrow. Although she liked her postoperative profile, her new alar wall contour improvement, and her better airway, none of this overcame her dissatisfaction with the postoperative frontal width. 1352

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Aside from patient selection issues, one other point must be made. Maximally contracted skin can only redistribute itself—it cannot shrink. Although the alar wall grafts may have bowed postoperatively, some of the patient’s postoperative width is attributable to this redistribution, for which I know no acceptable alternative.

PATIENT STUDY THREE

Thick skin may obscure underlying skeletal deformities, but the deformities are nonetheless present. Dorsal and tip reduction have created supratip deformity in this patient; inadequate tip projection remains, despite a columellar strut; and collapse of the internal valves now outlines a high septal deviation toward the patient’s left. Only a small amount of septal cartilage was available. 1353

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SECONDARY RHINOPLASTY

SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage (change gloves) 2. Two-piece Gore-Tex maxillary augmentation 3. Limited skeletonization over bony and upper cartilaginous vaults 4. Resect columellar strut 5. Trim supratip septum 6. Septoplasty 7. Asymmetrical spreader grafts (thicker on right than left) 8. Dorsal graft 9. Tip grafts 10. Excise columellar edges

Postoperative Analysis

Three years postoperatively, the nose remains more symmetrical. The patient’s columella has been narrowed by strut removal and excision of subcutaneous scar and soft tissue at the columellar edges. Geometric mean postoperative airflow increased 4.1 times over preoperative values.

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On the lateral view, the dorsum is straight, the radix begins at the right level, and the nose looks less bottom-heavy, even though tip projection has increased. When absolute reduction is not possible, balance and proportion are the surgeon’s best allies.

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SECONDARY RHINOPLASTY

A

B

Columellar thinning is shown here in another patient who previously underwent open rhinoplasty. She had a unilateral deformity and a notch at the left soft triangle (to be filled with a composite graft). After removing the columellar strut, I drew a dotted line symmetrical with the opposite columellar contour (A), and incised along this line (B).

A

B

The membranous septal flap was elevated, but no tissue had yet been removed (A). Excess soft tissue was removed from beneath the membranous septal flap (B). In many patients reduction is produced by thinning and rearrangement rather than skin excision.

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Once thinned, the membranous septal flap redundancy was conservatively sized, and absorbable transfixing sutures closed the dead space. Fine nylon sutures repaired the wound.

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PATIENT STUDY FOUR

This is a difficult nose because it is so unbalanced and because skeletal distortions, produced by a strut and cartilage suturing, have created knuckles and asymmetries that have attenuated the skin sleeve. There is a high septal deviation toward the right, with tip asymmetry in that direction. The internal valves are compromised, the supratip septum is high, but the lower nasal skin is distended. The bony vault is wide. The best alternative is to reduce the deformity and rebalance, trying to decrease apparent nasal base size by shortening the nose and maintaining dorsal height.

SUMMARY OF THE SURGICAL PLAN 1. Wide skeletonization over upper cartilaginous vault, narrow over bony vault 2. Rasp bony vault for graft adherence; trim anterior septal edge 3. Shorten caudal ends upper lateral cartilages submucosally 4. Transfix, shorten caudal and membranous septa 5. Deliver middle crura through vestibular incisions; resect knuckles 6. Septoplasty 7. Asymmetrical spreader grafts, thicker on left than right 8. Upper dorsal graft 9. Crushed cartilage tip grafts 10. Bilateral osteotomies

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Postoperative Analysis

Twenty-two months postoperatively the nose is more symmetrical, and the tip deformities have disappeared. Notice the expression in the patient’s eyes. Unfortunately, this is still a bottom-heavy nose. Although only two crushed grafts were used for the tip, the tissues have been sufficiently stiffened by previous surgery to limit their ability to contract further. The dorsum, however, is straight and the angle of tip rotation has improved. Apparent nasal base size has diminished slightly, assisted by nasal shortening, dorsal elevation, and a change in tip lobular contour.

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PATIENT STUDY FIVE

After three rhinoplasties, this patient’s two concerns were her nostril shape and the rigidity of her lower nose. She recognized that her alar walls had uneven contours, and was unhappy that each nostril was shaped differently.

A radiograph shows why the nose was so rigid. Dorsal and columellar grafts fixed to one another and to the facial skeleton are as uncompromising as an L-shaped silicone strut. Although such constructions create stability and can produce very good cosmetic results, they are nonanatomic solutions and do trouble some patients. The normal tip moves independently of the bony and upper cartilaginous vaults, a fact that is related to its anatomic investiture between the external and vestibular skin. As such, the alar cartilages float like a cap anterior to the remaining nasal skeleton, which explains why the nose shortens when the dorsum is reduced and lengthens when it is raised (see Chapter 1).

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SUMMARY OF THE SURGICAL PLAN 1. Harvest ear cartilage 2. Resect columellar strut and maxillary wire 3. Shorten lateral crural grafts 4. Trim caudal end, dorsal graft 5. Alar wall grafts (to simulate lateral crura) 6. Tip grafts 7. Columellar grafts

A

B

C

D

The wire was exposed through a short intraoral incision and pulled forward out of the maxilla after the columellar strut had been cut. As expected, very little immediate change in tip projection occurred (B), but the tip lobule and columella were now soft. The lateral crural grafts were cut short so that they no longer extended so far posteriorly and now floated in the alar soft tissues, enough to support the rims but no longer braced against the pyriform aperture edges. Crushed ear cartilage was used for the tip and columella, and to create the surface markings of the missing lateral crura (C).

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Postoperative Analysis

Postoperatively, the severity of the dorsal lines has been diminished, partly by releasing the soft tissues from the dorsal, columellar, and lateral crural struts, and partly by grafting the tip to form a discrete, independent lobule. The alar rims have become more symmetrical, no longer tethered by long lateral crural grafts. The columellar/lobular angle is softer, and the tip is slightly less angular and now projects beyond the septal angle. The alar walls are smooth and slightly convex.

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Of all the open rhinoplasty examples in this section, this was certainly the best preoperative result. Contour lines were smooth, the airway was open, and the columellar scar was very good. Yet the mechanisms used to support the nose created an artifactual rigidity and contour that this patient could not accept.

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Complex Deformities By using the phrase complex deformities, I mean to indicate anything out of the ordinary: unusual patient requests, combinations of donor sites, or deformities limited by cutaneous scars and multiple surgeries. The management principles, however, do not change. Identify the visible deformity, the airway obstruction, and the important anatomic variants and their sequelae. Select the best donor sites. Remove or reposition the deforming structures. Augment to restore function, to improve contour, and also to create proper proportion.

PATIENT STUDY ONE Body image is a personal issue. I do not believe that a surgeon must decide whether a patient’s goal is justifiable, whether it seems right to the surgeon, or whether the surgeon would want the same goal for himself or herself. What is important is whether the goal is achievable for the surgeon who is going to provide the result, and whether the surgeon believes that the patient will be happy with the result.

This gentleman had undergone airway surgery, and at the last minute agreed to small external changes. The result upset him greatly. Not only was his airway newly diminished, but he was disconcerted by the reduced nasal size. He could not accept the straight, narrow dorsum or the tapered tip, and wanted as much of his preoperative appearance restored as possible.

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In these circumstances, it is important for the surgeon to explain that the skin sleeve itself has also changed, and therefore restoration of exact nasal dimensions is not possible. Yet a great deal can be done. Fortunately for this man, his septum was untouched.

SUMMARY OF THE SURGICAL PLAN 1. Limited skeletonization over bony and upper cartilaginous vaults 2. Rasp bony vault for graft adherence 3. Septoplasty 4. Asymmetrical spreader grafts (right thicker than left) 5. Layered dorsal graft, placed deliberately low to produce a notch at the radix 6. Tip grafts placed caudally (to produce inadequate tip projection) 7. Columellar grafts 8. Alar wall grafts

The patient’s septum provided ample cartilage for a layered dorsal graft to rebuild his preoperative convexity.

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Postoperative Analysis

One year postoperatively, the nose is broader, higher, and longer. Restoration of internal valvular competence has substantially increased airflow. Layered dorsal grafts reconstructed the patient’s considerable preoperative arch, fortunately aided by the capacity of the remaining nasal skin to accommodate them.

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Augmenting the caudal tip lobule and columella has increased nasal length slightly and recreated the bow of the preoperative columella. There is a subtle but real expression change in the patient’s eyes.

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PATIENT STUDY TWO A

B

C

D

The personal photographs that this young woman supplied trace the evolution of her deformity. As a teenager, malpositioned lateral crura are easily visible (A). Following the first rhinoplasty, dorsal and tip reduction collapsed the sidewalls (B). An additional surgery produced the preoperative appearance with notched alar rims and almost no ability to breathe through the nose (C). The patient’s thin skin had contracted, producing a tight supratip deformity (D).

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SUMMARY OF THE SURGICAL PLAN 1. Harvest calvarial bone 2. Harvest composite grafts 3. Harvest conchal cartilage 4. Gore-Tex maxillary augmentation 5. Minimal skeletonization over bony and upper cartilaginous vaults 6. Dorsal graft of calvarial bone 7. Lateral wall calvarial grafts 8. Alar wall calvarial grafts 9. Conchal cartilage tip grafts with calvarial buttress 10. Conchal cartilage grafts to anterior columella 11. Bilateral composite grafts, coronal orientation

A longer dorsal graft than usual has been created to recover maximum nasal length. Silhouettes dramatize the intraoperative changes achieved.

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Postoperative Analysis

Seven years postoperatively, the dorsum remains smooth and symmetrical. Composite grafts have recreated the alar walls and corrected the retraction. Multiple tip grafts form a smooth lobule. The columella has been displaced caudally and occupies a more normal position, although a notch remains at the previous scar site.

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A combination of dorsal grafting and augmenting the caudal sides of the tip and columella has increased apparent nasal length, even in this tight skin sleeve. Geometric mean nasal airflow increased 3.8 times over preoperative values.

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PATIENT STUDY THREE

The combination of a childhood hemangioma and previous trauma has distorted this patient’s nose. There is a high septal deviation toward the right, the dorsum is slightly low, the supratip is high, the soft tissues are thick, and the right alar base is malpositioned. Previous surgeons had thinned the right medial cheek and upper lip, improving contour but effacing the nasolabial fold. Previous alar base scars are apparent. The correction will be performed in stages

SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Thin soft tissues, right sidewall; place percutaneous sutures 2. Right alar base flap, repositioning base cephalad 3. Excise right alar rim skin

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (6 MONTHS AFTER THE FIRST STAGE) 1. Minimal skeletonization over bony and upper cartilaginous vaults 2. Harvest ear cartilage 3. Septoplasty 4. Asymmetrical spreader grafts, left thicker than right (preoperative asymmetry) 5. Layered upper dorsal graft 6. Tip grafts 7. Columellar grafts 8. Revise right alar crease scars

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FPO 191

Postoperative Analysis

Five years postoperatively, the alar bases remain symmetrical. Some hypertrophy has occurred at the cephalic end of my right nasolabial fold scar revision. Dorsal and spreader grafts have aligned the upper nose; the right sidewall remains flat following thinning procedures. Tip grafts separate the tip lobule from the dorsum. The right alar crease is reasonably well defined, but when soft tissue deficits are present, this landmark often becomes effaced as time passes. Dorsal and tip grafts have flattened the supratip and added nasal length. Geometric mean nasal airflow increased 4.0 times over preoperative values.

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PATIENT STUDY FOUR A

B

C

This patient’s desire to have a slightly smaller nose in the same shape started a cascade of unhappy experiences. She was treated by multiple experts and underwent septal surgery and rib grafts, and then sought treatment from Dr. Sheen (B). He placed new rib grafts (C), then referred her to me when he retired.

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A number of problems remained. The patient thought that her nose was still too short. The alar rims were high, notched, and uneven. The deficit produced by alar wedge resections had created hypertrophic scars. Dorsal asymmetries remained, with the left supratip lower than the right. Repeated open rhinoplasties had left a notched columellar scar; nostril diameter was uneven, the left side was stenotic, and the columellar base pulled toward the patient’s left. No septal cartilage was available. Fortunately, parts of both conchae remained.

SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Crushed ear cartilage grafts to left upper vault, adjacent to dorsal graft 2. Coronal composite grafts to alar rims 3. Tip grafts to caudal lobule and columella

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (1 YEAR LATER) 1. Axial composite graft left nostril 2. Revise columellar scar; crushed ear cartilage grafts to columella

SUMMARY OF THE SURGICAL PLAN: THIRD STAGE (1 YEAR LATER) 1. Revise old alar wedge resection scars

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Postoperative Analysis

Five years postoperatively, alar retraction has decreased. When tension was reduced at the alar bases, the patient’s scar hypertrophy self-corrected. The vestibular stenosis has improved, although the columella still veers toward her left. The nose seems longer and more symmetrical.

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Crushed ear cartilage grafts must be used cautiously. Uncrushed ear cartilage is not flat. Even crushed, it retains asymmetrical stresses on its two surfaces, and can deform postoperatively, bowing the grafted area outward, providing a bonus augmentation that the surgeon and patient do not want. These grafts must be crushed sufficiently (remembering to protect their survival), trimmed to fit, and placed accurately. Slight undercorrection is often wise.

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PATIENT STUDY FIVE

A severe motor vehicle accident followed by three rhinoplasties (the last of which included a rib graft) had left this patient with a distorted nasal base, airway obstruction, and a nose that she believed was too short. The rib dorsal graft had shifted toward her left. Her maxillary arch remained retrusive, and her tip blunt.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Two piece maxillary augmentation, thicker on left than right 3. Minimal skeletonization over bony and upper cartilaginous vaults 4. Remove old rib graft 5. Rasp dorsum for graft adherence 6. Rib cartilage dorsal graft 7. Right lateral wall graft 8. Multiple tip grafts 9. Columellar grafts 10. Composite graft from right alar lobule to left nasal floor

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A

B



GENERALIZED DEFORMITIES

C

Once the old rib graft was removed, the nose shortened (compare A and B). A thicker, longer rib graft was prepared and placed, which immediately regained nasal length, reduced apparent nasal base size, and created internal valvular competence (C).

Shavings of rib cartilage were used for the nasal tip and columella. They increased real and apparent nasal length.

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Postoperative Analysis

A

C

B

D

E

At 28 months postoperatively, the nose remains more symmetrical. The dorsal graft has added real length. The upper lip retrusion has improved. Inferior views reveal that the improvements seen in the left nasal floor at two months (D), produced by a composite graft taken from the alar lobule, have diminished by 50% at 2 years. A skin/cartilage composite graft from the ear may have produced a longerlasting result, but the patient declined further surgery.

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Of all the techniques for increasing nasal length, the most predictable is a significant dorsal graft—and the effect can be further augmented by also filling the undersides of the tip lobule and columella. However, the length achieved always depends on the pliability of the investing nasal skin and lining.

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PATIENT STUDY SIX

Four previous rhinoplasties had left this patient with a grossly distorted nose and a diminished airway. The patient’s septum had been resected. Previous surgeons, in haste to revise early, had perforated the dorsal skin, leaving a nearly circumferential scar that encircled the tip lobule. The alar walls were flaccid, and the combination of the constricting scar and lack of support had allowed the nasal base to collapse toward the patient’s left.

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SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Limited skeletonization through a single cartilage-splitting incision 3. Trim dorsum of residual cartilage and scar 4. Rib cartilage dorsal graft 5. Fillet left alar wall through vestibular incision, releasing contracture 6. Left alar wall grafts 7. Right-sided lateral wall graft 8. Tip grafts 9. Columellar grafts

The patient’s rib cartilage was typically rigid for his age. However, the underlying skeleton was so irregular, and the dermis was damaged so unevenly that the graft had to be contoured so that its center was thinner than either its cephalic or caudal ends. A second layer was added in the supratip. Only the proximal and distal ends of the graft were covered by perichondrium. Once in place, notice that the tension supplied by the dorsal graft seemed to smooth even the cutaneous scars. As I dissected the left alar sidewall, the contracture unfurled, and the tip rotated toward the midline. An alar wall graft stabilized the correction.

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Postoperative Analysis

Postoperatively, the nose remains stable and symmetrical. Airflow has improved significantly. The rigidity supplied by mature costal cartilage worked in the patient’s favor. Almost more interesting than any of the other configurational changes is the improvement in the cutaneous scars, visible even early in his postoperative course, and a reminder that the dynamic equilibrium of many scars can be modified by stress. Although this man had held a high level executive position for 20 years with his deformity, his eyes show a gratifying change in expression.

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PATIENT STUDY SEVEN

This woman’s fraternal twin sister did not share her congenital anomaly. When I first saw the patient, she had undergone three surgeries, and septal cartilage was unavailable. Her airway was significantly compromised. Her original alar rim asymmetry persisted, and the columella had been broadened with a strut and was crisscrossed by scars.

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SUMMARY OF THE SURGICAL PLAN: FIRST STAGE 1. Harvest rib cartilage 2. Single stage maxillary augmentation 3. Harvest composite graft 4. Limited skeletonization through a single cartilage-splitting incision 5. Rasp bony vault; remove old septal cartilage graft from supratip 6. Rib cartilage dorsal graft 7. Right composite graft, coronal orientation 8. Excise left alar rim 9. Tip graft 10. Columellar grafts

SUMMARY OF THE SURGICAL PLAN: SECOND STAGE (1 YEAR AFTER FIRST STAGE) 1. Harvest ear cartilage 2. Remove and reposition dorsal graft 3. Thin and contour left alar wall 4. Augment tip further 5. Thin columella 6. Graft right lateral wall

The dorsal graft was carved to fit the asymmetrical defect.

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The combination of dorsal grafts, tip grafts, maxillary augmentation, and columellar augmentation altered the nasal profile dramatically. The patient’s dorsal graft shifted toward the right after the first procedure and was repositioned during the second stage. When the underlying bony platform is asymmetrical or the nose is extremely short (so that the tight skin sleeve might displace the dorsal graft proximally), I immobilize the dorsal graft with one or two 0.7 mm smooth Kirschner wires, which are removed at 7 days. Further immobilization has not been necessary.

Postoperative Analysis

Ten years postoperatively, the nose remains symmetrical and straight. The left alar rim excision and the right composite graft have improved nostril symmetry. 1388

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The columella has narrowed, but remains too wide. Geometric mean nasal airflow increased 5.1 times over preoperative values. The dorsal line is straight, with adequate tip projection and a good relationship of the columella to the alar rim. This patient’s preoperative tip lobule was small and tight, but the combination of her age and staged surgery allowed me to achieve normal projection. It is important not to press the tissues too far: not every reconstruction can be performed in a single session, particularly when tip or columellar augmentations are required beneath tight, scarred tertiary tissues.

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PATIENT STUDY EIGHT

This woman had undergone five rhinoplasties that used all available septal and ear cartilage. Her dorsal strut had collapsed, producing a soft supratip and a nose held distally only by a small ear cartilage graft in the supratip. A large septal perforation left only 12 mm of intact vestibular lining above the columella. Her maxillary arch was retrusive. The tissues were rigid with scars.

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This patient’s reconstruction must be staged, and the surgeon must be careful not to raise patient expectations too high. My goal in the first procedure was only to restore the airway and a stable nasal dorsum. I anticipated that two additional procedures would be needed, each separated by at least 1 year. Incisions must be planned cautiously, because this patient cannot afford another unsuccessful procedure or further soft tissue loss. The entire operation will be done through four short incisions.

SUMMARY OF THE SURGICAL PLAN 1. Harvest rib cartilage 2. Maxillary augmentation 3. Excise ear cartilage grafts in supratip through vestibular incision, left 4. Dorsal graft, placed through transverse incision at nasal radix, immobilized with two 1.6 mm by 6 mm self-tapping screws 5. Left alar wall graft 6. Caudal support graft 7. Tip graft

Postoperative Analysis

These images were taken 7 months after the successful first stage. The airway correction is complete. The dorsum and alar rims are stable. 1391

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Her maxillary retrusion has been corrected, her caudal septum is braced, and her tip contour has improved. No soft tissue was lost. Limited access, limited dissection, and autogenous augmentation provided this patient’s best chance for a lifetime solution. However, her nostrils remain asymmetrical: the right side requires a composite graft if one can be harvested without deforming the remaining ear. Her heavily scarred tip skin, still pink after expansion, needs time to recover. The columella will never expand normally under the transverse scars. As healing proceeds, more problems may develop. Adequate long-term follow-up is required. Yet something else indefinable has happened here, seen in the patient’s eyes, that may exceed the importance of all her other reconstructions. The magic never stops. 1392

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BIBLIOGRAPHY Adams WP Jr, Rohrich RJ, Gunter J, et al. The rate of warping in irradiated and nonirradiated homograft rib cartilage: a controlled comparison and clinical implications. Plast Reconstr Surg 103:265-270, 1999. Adams WP Jr, Rohrich RJ, Hollier LH, et al. Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty. Plast Reconstr Surg 103:255-261, 1999. Adamson PA, McGraw-Wall BL, Morrow TA, et al. Vertical dome division in open rhinoplasty. Arch Otolaryngol Head Neck Surg 120:373, 1994. Adamson PA, Smith O, Tropper GJ. Incisional and scar analysis in open (external) rhinoplasty. Arch Otolaryngol Head Neck Surg 116:671, 1990. Agarwal R, Bhatnagar SK, Pandey SD, et al. Nasal sill augmentation in adult incomplete cleft lip nose deformity using superiorly based turn over orbicularis oris muscle flap: an anatomic approach. Plast Reconstr Surg 102:1350-1357, 1998. Ahuja RB. Primary definitive nasal correction in patients presenting for late unilateral cleft lip patients. Plast Reconstr Surg 110:17-24, 2002. Ahuja RB. Radical correction of secondary nasal deformity in unilateral cleft lip patients presenting late. Plast Reconstr Surg 108:1127-1135, 2001. Bafaqeeh SA, Al-Qattan MM. Open rhinoplasty: columellar scar analysis in an Arabian population. Plast Reconstr Surg 102:1226-1228, 1998. Baran CN, Tiftikcioglu YP, Baran NK. The use of alloplastic materials in secondary rhinoplasties: 32 years experience. Plast Reconstr Surg 116:1502, 2005. Bassichis BA, Thomas JR. Foreign-body inclusion cyst presenting on the lateral nasal sidewall 1 year after rhinoplasty. Arch Facial Plast Surg 5:530-532, 2003. Becker H. Nasal augmentation with calcium hydroxylapatite in a carrier-based gel. Plast Reconstr Surg 121:2142-2147, 2008. Beekhuis GJ. Silastic alar-columellar prosthesis in conjunction with rhinoplasty. Arch Otolaryngol 108:429-432, 1982. Bejar I, Farkas LG, Messner AH, et al. Nasal growth after external septoplasty in children. Arch Otolaryngol Head Neck Surg 122:816-821, 1996. Berghaus A, Mulch G, Handrock M. Porous polyethylene and Proplast: their behavior in a bony implant bed. Arch Otorhinolaryngol 240:115-123, 1984. Berman WE. Balancing the nasal tip height with a potential pollybeak. Ear Nose Throat J 73:854, 1994. Bikhazi NB, Chow AW, Maas CS. Nasal reconstruction using a combination of alloplastic materials and autogenous tissues: a surgical alternative. Laryngoscope 107:1086-1093, 1997. Boccieri A, Pascali M. Open rhinoplasty without transcolumellar incision. Plast Reconstr Surg 97:321326, 1996. Botti G. Thick skin and cosmetic surgery of the nasal tip: how to avoid the cutaneous polly beak. Aesth Plast Surg 20:421-427, 1996. Bradley JP, Kawamoto HK, Taub P. Correction of warfarin-induced nasal hypoplasia. Plast Reconstr Surg 111:1680-1687, 2003. Bravo FG, Schwarze HP. Closed-open rhinoplasty with extended lip dissection: a new concept and classification of rhinoplasty. Plast Reconstr Surg 122:944-950, 2008. Burgess LP, Everton DM, Quilligan JJ, et al. Complications of the external (combination) rhinoplasty approach. Arch Otolaryngol Head Neck Surg 112:1064-1068, 1986. Byrd S, Andochick S, Copit S, et al. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 100:999-1010, 1997. Byrd S, Salomon J. Primary correction of the unilateral cleft nasal deformity. Plast Reconstr Surg 106:1276-1286, 2000. Chait LA. The “C” costal cartilage graft in reconstruction of the unilateral cleft lip nose. Br J Plast Surg 34:169-172, 1981. Chang Y, Chen Y, Noordhoff MS. One-stage salvage of fractured nasal prosthesis with immediate calvarial bone grafting. Aesth Plast Surg 12:235-237, 1988.

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Cho BC. Correction of unilateral cleft lip nasal deformity in preschool and school-aged children with refined reverse-u incision and v-y plasty: long-term follow-up results. Plast Reconstr Surg 119:267275, 2007. Clark MP, Greenfield B, Hunt N, et al. Function of the nasal muscles in normal subjects assessed by dynamic MRI and EMG: its relevance to rhinoplasty surgery. Plast Reconstr Surg 101:1945-1955, 1998. Cochran S, Landecker A. Prevention and management of rhinoplasty complications. Plast Reconstr Surg 122:60e-67e, 2008. Cole RR, Myer CM III, Bratcher GO. Congenital absence of the nose: a case report. Int J Pediatr Otorhinolaryngol 17:171-177, 1989. Collawn SS, Fix RJ, Moore JR, et al. Nasal cartilage grafts: more than a decade of experience. Plast Reconstr Surg 100:1547-1552, 1997. Collis NM, Litherland J, Enion D, et al. Magnetic resonance imaging and explanation investigation of long-term silicone gel implant integrity. Plast Reconstr Surg 120:1401-1406, 2007. Colton JJ, Beekhuis GJ. Use of Mersilene mesh in nasal augmentation. Facial Plast Surg 8:149-156, 1992. Conrad K, Gillman G. A 6-year experience with the use of expanded polytetrafluoroethylene in rhinoplasty. Plast Reconstr Surg 101:1675-1683, 1998. Conrad K, Torgerson C, Gillman G. Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg 10:224-231, 2008. Conrad K, Yoskovitch A. The use of fibrin glue in the correction of pollybeak deformity: a preliminary report. Arch Facial Plast Surg 5:522-527, 2003. Constantian MB. Differing characteristics in 100 consecutive secondary rhinoplasty patients following closed versus open surgical approaches. Plast Reconstr Surg 109:2097, 2002. Constantian MB. Secondary rhinoplasty. In Goldwyn RM, Cohen MN, eds. The Unfavorable Result in Plastic Surgery. Philadelphia: Lippincott Williams & Wilkins, 2001, p 943. Cook TA, Wang TD, Brownrigg PJ, et al. Significant premaxillary augmentation. Arch Otolaryngol Head Neck Surg 116:1197-1201, 1990. Crysdale WS, Walker PJ. External septorhinoplasty in children: patient selection and surgical technique. J Otolaryngol 23:28, 1994. Cussons PD, Murison MSC, Fernandez AEL, et al. A panel based assessment of early versus no nasal correction of the cleft lip nose. Br J Plast Surg 46:7-12, 1993. Daniel RK. A 6-year experience with the use of expanded polytetrafluoroethylene in rhinoplasty. Plast Reconstr Surg 101:1684, 1998. Daniel RK. Rhinoplasty: septal saddle nose deformity and composite reconstruction. Plast Reconstr Surg 119:1029-1043, 2007. Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty. Plast Reconstr Surg 103:1491-1502, 1999. Daniel RK. Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part II: secondary rhinoplasty. Plast Reconstr Surg 103:1503-1512, 1999. Daniel RK. Secondary rhinoplasty following open rhinoplasty. Plast Reconstr Surg 96:1539, 1995. Davis PK. Cleft lip nose tip deformity: a tutorial dissertation. Br J Plast Surg 36:200-203, 1983. Davis PK, Jones SM. The complications of silastic implants: experience with 137 consecutive cases. Br J Plast Surg 24:405, 1971. Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 102:1230-1237, 1998. Drake-Lee AB, Bickerton RC, Milford C. Wegener’s granulomatosis and nasal deformity. Br J Clin Pract 42:348-350, 1988. Duffy FJ, Rossi RM, Pribaz JJ. Reconstruction of Wegener’s nasal deformity using bilateral facial artery musculomucosal flaps. Plast Reconstr Surg 101:1330, 1998. Durante BJ, Porubsky ES. Reducing columella scarring in open septorhinoplasty. Laryngoscope 96:810, 1986. Egyedi P, Müller H. Correction of the kinked nostril rim. J Max Fac Surg 14:289-290, 1986. Elsahy NI. Prevention of parrot’s beak deformity after reduction rhinoplasty. Acta Chir Plast 19:63-69, 1977.

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Erlich MA, Pathiscar A. Nasal dorsal augmentation with silicone implants. Facial Plast Surg 19:325, 2003. Fanous N, Samaha M, Yosikovitch A. Dacron implants in rhinoplasty: a review of 136 cases of tip and dorsum implants. Arch Facial Plast Surg 4:149, 2002. Fisher DM, Mann RJ. A model for the cleft lip nasal deformity. Plast Reconstr Surg 101:1448, 1998. Flemming I. Rhinoplasty in children. Otolaryngol Clin North Am 10:33-40, 1977. Fodor PB. Aesthetic rhinoplasty in early adolescence. Aesth Plast Surg 12:207-216, 1988. Fodor PB, Lemperie G, Biewener A. External skin excision in the sebaceous nose and supratip deformity. Plast Reconstr Surg 91:1180, 1993. Fortunato G, Marini E, Valdinucci F, et al. Long-term results of hydroxyapatite-fibrin glue implantation in plastic and reconstructive craniofacial surgery. J Craniomaxillofac Surg 25:124-135, 1997. Fujimori R, Haritz Y. Elongation of the nostril and columella using an island flap. Br J Plast Surg 35:171176, 1982. Furlow LT. Flaps for cleft lip and palate surgery. Clin Plast Surg 17:633-644, 1990. Giunta SX. Premaxillary augmentation in Asian rhinoplasty. Facial Plast Surg Clin North Am 4:93-102, 1996. Godin MS, Waldman SR, Johnson CM Jr. Nasal augmentation using Gore-Tex: a 10-year experience. Arch Facial Plast Surg 1:118-121, 1999. Godin MS, Waldman SR, Johnson CM Jr. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. Arch Otolaryngol Head Neck Surg 121:1131-1136, 1995. Goodman WS, Charbonneau PA. External approach to rhinoplasty. Laryngoscope 84:2195, 1974. Goodman WS, Zorn MLT. The unilateral cleft lip nose. J Otolaryngol 11:198-203, 1982. Gorney M. Centripetal rotation-advancement for bilateral cleft lip nasal deformities. Ann Acad Med Singapore 12:331-336, 1983. Goto M. Augmentation rhinoplasty by the sandbag method that uses a dermal bag containing hydroxyapatite granules. Japan J Plast Reconstr Surg 35:645-649, 1992. Gruber RP. Open rhinoplasty. Clin Plast Surg 15:95, 1988. Gruber RP. Primary open rhinoplasty. In Gruber RP, Peck GC, eds. Rhinoplasty: State of the Art. St Louis: Mosby, 1992, pp 61-87. Gryskiewicz JM. Visible scars from percutaneous osteotomies. Plast Reconstr Surg 116:1771-1775, 2005. Gryskiewicz JM. Waste not, want not: the use of AlloDerm in secondary rhinoplasty. Plast Reconstr Surg 116:1999-2004, 2005. Gryskiewicz JM, Rohrich RJ, Reagan BJ. The use of AlloDerm for the correction of nasal contour deformities. Plast Reconstr Surg 107:561, 2001. Gubisch W, Reichert H, Widmaier W. Six years’ experience with free septum replantation in cleft nasal correction. J Craniomaxillofac Surg 17:31-33, 1989. Guerrerosantos J, Trabanino C, Guerrerosantos F. Multifragmented cartilage wrapped with fascia in augmentation rhinoplasty. Plast Reconstr Surg 117:804-812, 2006. Gunter JP. The merits of the open approach in rhinoplasty. Plast Reconstr Surg 99:863-867, 1997. Gunter JP. Secondary rhinoplasty: the open approach. In Daniel RK, ed. Aesthetic Plastic Surgery: Rhinoplasty. Boston: Little Brown, 1993. Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 100:161-169, 1997. Gunter JP, Cochran CS. Management of intraoperative fractures of the nasal septal “L-strut”: percutaneous Kirschner wire fixation. Plast Reconstr Surg 117:395-402, 2006. Gunter JP, Rohrich R. External approach for secondary rhinoplasty. Plast Reconstr Surg 80:161-173, 1987. Guyuron B, Afrooz PN. Correction of cocaine-related nasal defects. Plast Reconstr Surg 121:1015, 2008. Guyuron B, DeLuca L, Lash R. Supratip deformity: a closer look. Plast Reconstr Surg 105:1140-1151, 2000. Ham KS, Chung SC, Lee SH. Complications of oriental augmentation rhinoplasty. Ann Acad Med Singapore 12:460-462, 1983. Hansono MM, Kridel RWH, Pastorek NJ, et al. Correction of the soft tissue pollybeak using triamcinolone injection. Arch Facial Plast Surg 4:26-30, 2002.

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Harashina T. Asymmetric incision for open rhinoplasty in cleft lip nasal deformity. Plast Reconstr Surg 105:805, 2000. Herbst A. Extrusion of an expanded polytetrafluoroethylene implant after rhinoplasty. Plast Reconstr Surg 104:295-296, 1999. Hernandez-Zendejas G. The history of augmentation rhinoplasty: implant and design. Plast Reconstr Surg 103:1802-1803, 1999. Hiraga Y. Complications of augmentation rhinoplasty in the Japanese. Ann Plast Surg 4:495, 1980. Hobar PC. Cleft lip II: secondary deformities. Sel Read Plast Surg 7:22, 1994. Holmstrom H, Luzi F. Open rhinoplasty without transcolumellar incision. Plast Reconstr Surg 97:321326, 1996. Ishida J, Ishida LC, Ishida LH, et al. Treatment of the nasal hump with preservation of the cartilaginous framework. Plast Reconstr Surg 103:1729-1733, 1999. Jackson IT. AlloDerm used in rhinoplasty. Plast Reconstr Surg 108:1828, 2001. Jackson IT, Yavuzer R. AlloDerm for dorsal nasal irregularities. Plast Reconstr Surg 107:553-558, 2001. Johnson CM, Toriumi DM. Open Structure Rhinoplasty. Philadelphia: Saunders, 1990. Jugo SB. Total septal reconstruction through decortication (external) approach in children. Arch Otolaryngol Head Neck Surg 113:173, 1987. Jung DH, Kim BR, Choi JY, et al. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases. Plast Reconstr Surg 120:1997, 2007. Juraha LZG. Experience with alternative material for nasal augmentation. Aesth Plast Surg 16:133-140, 1992. Koh KS, Eom JS. Asymmetric incision for open rhinoplasty in cleft lip nasal deformity. Plast Reconstr Surg 103:1835-1838, 1999. Koh KS, Kim EK. Management of unilateral cleft lip nose deformity, with retracted ala of the noncleft side. Plast Reconstr Surg 118:723, 2006. Kornblut AD, Wolff SM, DeFries HP, et al. Wegener’s granulomatosis. Laryngoscope 90:1453, 1980. Krzysztof C, Torgerson CS, Gillman GS. Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg 10:224-231, 2008. Krzysztof C, Yoshovitch A. The use of fibrin glue in the correction of pollybeak deformity: a preliminary report. Arch Facial Plast Surg 5:522-527, 2003. Lam SM, Kim YK. Augmentation rhinoplasty of the Asian nose with the bird silicone implant. Ann Plast Surg 51:249, 2003. Lee Y, Han S. Use of a temporoparietal fascia-covered silastic implant in nose reconstruction after foreign body removal. Plast Reconstr Surg 104:500-505, 1999. Lefkovitz G. Nasal reconstruction with irradiated homograft costal cartilage. Plast Reconstr Surg 113:1291-1292, 2004. Lewis JD. Depressed nasal fractures: a comparison of the prosthetic values of paraffin, bone, cartilage and celluloid, with report of cases corrected with celluloid implants by the author’s method. Ann Otol Rhinol Laryngol 32:321, 1923. Liou EJ, Subramanian M, Chen PKT. Progressive changes of columella length and nasal growth after nasoalveolar molding in bilateral cleft patients: a three year follow-up study. Plast Reconstr Surg 119:642, 2007. Lipshutz HA. A clinical evaluation of subdermal and subcutaneous silicone implants. Plast Reconstr Surg 37:249, 1966. Liu ES, Kridel RWH. Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing. Plast Reconstr Surg 112:282-287, 2003. Lo L, Kane AA, Chen Y. Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbé flap revisited. Plast Reconstr Surg 112:1219-1227, 2003. Lohuis PJ, Watts SJ, Vuyk HD. Augmentation of the nasal dorsum using Gore-Tex: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci 26:214, 2001. Losee JE, Kirschner RE, Whitaker LA, et al. Congenital nasal anomalies: a classification scheme. Plast Reconstr Surg 113:676, 2004.

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Losken A, Burstein FD, Williams JK. Congenital nasal pyriform aperture stenosis: diagnosis and treatment. Plast Reconstr Surg 109:1506, 2002. Lovice DB, Mingrone MD, Toriumi DM. Grafts and implants in rhinoplasty and nasal reconstruction. Otolaryngol North Am 32:113, 1999. Maas CS, Gnepp DR, Bumpous J. Expanded polytetrafluoroethylene (Gore-Tex soft-tissue patch) in facial augmentation. Arch Otolaryngol Head Neck Surg 119:1008, 1993. Matsuya T, Lida S, Kogo M. Secondary rhinoplasty using flying-bird and vestibular tornado incisions for unilateral cleft lip patients. Plast Reconstr Surg 112:390-395, 2003. McCurdy JA Jr. The Asian nose: augmentation rhinoplasty with L-shaped silicone implants. Facial Plast Surg 18:245, 2002. Mendelsohn M, Dunlop G. Gore-Tex augmentation grafting in rhinoplasty: is it safe? J Otolaryngol 27:337-341, 1998. Menick F. Anatomic reconstruction of the nasal tip cartilages in secondary and reconstructive rhinoplasty. Plast Reconstr Surg 104:2187-2198, 1999. Millard DR, Mejia FA. Reconstruction of the nose damaged by cocaine. Plast Reconstr Surg 107:419424, 2001. Morehead JM, Holt GR. Soft-tissue response to synthetic biomaterials. Otolaryngol Clin North Am 27:195, 1994. Nagasaot MJ, Yasuda S, Ogata H, et al. An anatomical study of the three dimensional structure of the nasal septum in patients with alveolar clefts and alveolar-palatal clefts. Plast Reconstr Surg 121:2074, 2008. Neel HB III. Implants of Gore-Tex. Arch Otolaryngol 109:427, 1983. Niechajev I. Porous polyethylene implants for nasal reconstruction: clinical and histologic studies. Aesth Plast Surg 23:395, 1999. Ortiz-Monasterio F, Olmedo A. Corrective rhinoplasty before puberty: a long-term follow-up. Plast Reconstr Surg 68:381, 1981. Owsley TG, Taylor CO. The use of Gore-Tex for nasal augmentation: a retrospective analysis of 106 patients. Plast Reconstr Surg 94:241-242, 1994. Padovan IF. External approach in rhinoplasty (de-cortication). In Conley J, Dickinson JT, eds. Plastic and Reconstructive Surgery of the Face and Neck. Stuttgart: Thieme Verlag, 1972, pp 143-146. Padovan IF, Jugo SR. Complications of external rhinoplasty. Ear Nose Throat J 70:454, 1991. Pak MW, Chan ESY, van Hasselt CA. Late complications of nasal augmentation using silicone implants. J Laryngol Otol 112:1074-1077, 1998. Paulus GW, Bormioli P, Steinhäuser EW. Vertical transection of the alar cartilages in unilateral cleft noses. Int J Oral Maxillofac Surg 15:225-232, 1986. Peled ZM, Warren AG, Johnson P, et al. The use of alloplastic materials in rhinoplasty surgery: a metaanalysis. Plast Reconstr Surg 121:85e-92e, 2008. Pigott RW. Alar leapfrog. Clin Plast Surg 12:643, 1985. Queen TA, Palmer FR III. Gore-Tex for nasal augmentation: a recent series and a review of the literature. Ann Otol Rhinol Laryngol 104:850, 1995. Raghavan U, Jones NS. The complications of giant titanium implants in nasal reconstruction. J Plast Reconstr Aesth Surg 59:74, 2006. Raspall G, González-Lagunas J. Management of the nasal tip by open rhinoplasty. J Craniomaxillofac Surg 24:145, 1996. Raszewski R, Guyuron B, Lash RH, et al. A severe fibrotic reaction after cosmetic liquid silicone injection. J Craniomaxillofac Surg, 18:225-228, 1990. Reese BR, Koltai PJ, Parnes SM, et al. The external rhinoplasty approach for rhinologic surgery. Ear Nose Throat J 71:408, 1972. Regnault P. Nasal augmentation in the problem nose. Aesth Plast Surg 11:1-5, 1987. Rethi A. Raccourcissement du nez trop long. Rev Chir Plast 2:85, 1934. Roe JO. The correction of angular deformities of the nose by a subcutaneous operation. Med Rec 40:57, 1891. Roe JO. The deformity termed “pug nose” and its correction, by a simple operation. Med Rec 31:621, 1887.

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Romo T III, Choe KS, Sclafani AP. Cleft lip nasal reconstruction using porous high-density polyethylene. Arch Facial Plast Surg 5:175-179, 2003. Romo T III, Rizk SS, Suh GD. Mucous cyst formation after rhinoplasty. Arch Facial Plast Surg 1:208211, 1999. Romo T III, Sclafani AP, Sabini P. Use of porous high-density polyethylene in revision rhinoplasty and in the platyrrhine nose. Aesthetic Plast Surg 22:211, 1998. Rothstein SG, Jacobs JB. The use of Gore-Tex implants in nasal augmentation operations. Entechnology Sept:40-45, 1989. Sachs ME. Enbucrilate as cartilage adhesive in augmentation rhinoplasty. Arch Otolaryngol 111:389393, 1985. Sachs ME. Tissue clay. Arch Otolaryngol 113:289-291, 1987. Salyer KE. Primary correction of the nasal deformity associated with cleft lip. In Cohen M, ed. Mastery of Plastic and Reconstructive Surgery. New York: Little Brown, 1994, pp 581-594. Schubert W, Gear AJ, Lee C, et al. Incorporation of titanium mesh in orbital and midface reconstruction. Plast Reconstr Surg 110:1022-1030, 2002. Sclafani AP, Thomas JR, Cox AJ, et al. Clinical and histologic response of subcutaneous expanded polytetrafluoroethylene (Gore-Tex) and porous high-density polyethylene (Medpor) implants to acute and early infection. Arch Otolaryngol Head Neck Surg 123:328, 1997. Shapley H. Beyond the Observatory. New York: Charles Scribner, 1967. Shaw RB, Kahn DM. Aging of the mid-face bony elements: a three dimensional computed tomographic study. Plast Reconstr Surg 119:675, 2007. Sheen JH. Achieving more nasal tip projection by use of small autogenous vomer or septal cartilage grafts: a preliminary report. Plast Reconstr Surg 56:35-40, 1975. Sheen JH. Closed versus open rhinoplasty: and the debate goes on. Plast Reconstr Surg 99:859-862, 1997. Sheen JH. A new look at supratip deformity. Ann Plast Surg 3:498, 1979. Sheen JH. Secondary rhinoplasty. Plast Reconstr Surg 56:137, 1975. Sheen JH. Secondary rhinoplasty surgery. In Millard DR Jr. ed. Symposium on Corrective Rhinoplasty. St. Louis: CV Mosby, 1976. Shiba A, Hatoko M, Okazaki T, et al. A case of human adjuvant disease after augmentation rhinoplasty. Aesth Plast Surg 23:175-178, 1999. Shirakabe Y, Shirakabe T, Kishimoto T. The classification of complications after augmentation rhinoplasty. Aesth Plast Surg 9:185-192, 1985. Shirakabe Y, Suzuki Y, Lam SM. A systematic approach to rhinoplasty of the Japanese nose: a thirty-year experience. Aesthetic Plast Surg 27:221-231, 2003. Slupchynskyj O, Gieniusz M. Rhinoplasty in African American patients. Arch Facial Plast Surg 10:232236, 2008. Sood VP. Septoplasty in children. Indian J Otolaryngol 37:87, 1985. Stal S, Hollier L. Correction of secondary deformities of the cleft lip nose. Plast Reconstr Surg 109:13861393, 2002. Stoll W. A 5 year experience with open septorhinoplasty. Larygorhinootolgie 70:171, 1991. Stoll W. Complications following implantation or transplantation in rhinoplasty. Facial Plast Surg 13:4550, 1997. Strauch B, Erhard HA, Baum T. Use of irradiated cartilage in rhinoplasty of the non-Caucasian nose. Aesthet Surg J 24:324-330, 2004. Strauch B, Wallach SG. Reconstruction with irradiated homograft costal cartilage. Plast Reconstr Surg 111:2405-2411, 2003. Stucker FJ. Autoalloplast. Arch Otolaryngol 108:130, 1982. Stucker FJ. Nasal augmentation using Gore-Tex: a 10 year experience. Arch Facial Plast Surg 1:122, 1999. Stucker FJ, Bryarly RC, Shockley WW. Management of nasal trauma in children. Arch Otolaryngol 110:190-192, 1984. Taylor P, Kaakedjian G. Preliminary studies on the use of nail as a material for reconstructive or cosmetic surgery. Plast Reconstr Surg 101:1276-1279, 2005.

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Tebbetts JB. Open rhinoplasty: more than an incisional approach. In Daniel RK, ed. Aesthetic Plastic Surgery: Rhinoplasty. Boston: Little Brown, 1993. Tebbetts JB. Shaping and positioning the nasal tip without structural disruption: a new, systematic approach. Plast Reconstr Surg 94:61, 1994. Teichgraeber JF, Riley WB, Russo RC. External rhinoplasty: indications for use. Br J Plast Surg 45:47, 1992. Tessier P. Anatomical classification of facial, craniofacial, and latero-facial clefts. J Maxillofac Surg 4:69, 1976. Tham C, Lai YL, Weng CJ, et al. Silicone augmentation rhinoplasty in an oriental population. Ann Plast Surg 54:1, 2005. Tobin HA. Extruded nasal implant. Otolaryngol Head Neck Surg 109:552-553, 1993. Toriumi DM, Mueller RA, Grosch T, et al. Vascular anatomy of the nose and the external rhinoplasty approach. Arch Otolaryngol Head Neck Surg 122:24, 1996. Triglia J, Cannoni M, Pech A. Septorhinoplasty in children: benefit of the external approach. J Otolaryngol 190:274-278, 1990. Trybus M. The harpoon-shaped nasal implant. Ear Nose Throat J 68:878-881, 1989. Tucker K. A new look at supratip deformity. Plast Reconstr Surg 66:655, 1980. Turegun M, Sengezer M, Guler M. Reconstruction of saddle nose deformities using porous polyethylene implants. Aesthetic Plast Surg 22:38, 1998. Uhm K, Hwang SH, Choi BG. Cleft lip nose correction with onlay calvarial bone graft and suture suspension in oriental patients. Plast Reconstr Surg 105:499-503, 2000. Uysal A, Ozbek S, Ozcan M. Comparison of the biological activities of high-density porous polyethylene implants and oxidized regenerated cellulose-wrapped diced cartilage grafts. Plast Reconstr Surg 112:540-546, 2003. Van Beek A, Hatfield A, Schnepf E. Cleft rhinoplasty. Plast Reconstr Surg 114:57e-69e, 2004. Velidedeoğlu H, Demir Z, Sahin Ű, et al. Block and Surgicel-wrapped diced solvent-preserved costal cartilage homograft application for nasal augmentation. Plast Reconstr Surg 115:2081, 2005. Vilar-Sancho B. An old story: an ivory nasal implant. Aesth Plast Surg 11:157, 1987. Vuyk HD, Adamson PA. Biomaterials in rhinoplasty. Clin Otolaryngol Allied Sci 23:209, 1998. Vuyk HD, Kalter PO. Open septorhinoplasty: experiences in 200 patients. Rhinology 31:175, 1993. Waldman SR. Gore-Tex for augmentation of the nasal dorsum: a preliminary report. Ann Plast Surg 26:520, 1991. Walker PJ, Crysdale WS, Farkas LG. External septorhinoplasty in children. Arch Otolaryngol Head Neck Surg 119:984-988, 1993. Wang TD, Madorsky SJ. Secondary rhinoplasty in nasal deformity associated with the unilateral cleft lip. Arch Facial Plast Surg 1:40-45, 1999. Webster RC, Hamdan US, Gaunt JM, et al. Rhinoplastic revisions with injectable silicone. Arch Otolaryngol Head Neck Surg 112:269-276, 1986. Wolfe SA. A pastiche for the cleft lip nose. Plast Reconstr Surg 114:1-9, 2004. Wong GB, Burvin R, Mulliken JB. Resorbable internal splint: an adjunct to primary correction of unilateral cleft lip-nasal deformity. Plast Reconstr Surg 110:385, 2002. Wright WK, Kridel RWH. External septorhinoplasty: a tool for teaching and for improved results. Laryngoscope 91:945, 1981. Yanaga H, Yanaga K, Imai K, et al. Clinical application of cultured autologous human auricular chondrocytes with autologous serum for craniofacial or nasal augmentation and repair. Plast Reconstr Surg 117:2019-2030, 2006. Yaremchuk MJ. Facial skeletal reconstruction using porous polyethylene implants. Plast Reconstr Surg 111:1818-1827, 2003. Zeng Y, Wu W, Yu H, et al. Silicone implant in augmentation rhinoplasty. Ann Plast Surg 49:495, 2002. Zhanqiang L. Carving Gore-Tex reinforced sheets for augmentation rhinoplasty in Chinese patients. Plast Reconstr Surg 117:326-328, 2006.

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CHAPTER 20 U nhappy P atients and Those W ith B ody D ysmorphic D isorder

A doctor does not treat typhoid fever, but treats the man with typhoid fever, and it is the man with his peculiarities—his body idiosyncrasies— that we have to consider. SIR WILLIAM OSLER, speaking of treating Walt Whitman

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T

his chapter is about unhappy patients, most of whom were mine—if not initially, at least eventually. I have lectured and given courses on this topic for many years, but I have never written about it for several reasons: (1) I did not believe I knew enough, (2) I had not yet begun to put the problem together, and (3) a paper about unhappy patients that has no illustrations loses some of its teaching focus for surgeons. Even after 30 years in practice, I do not yet feel qualified to make a diagnosis of body dysmorphic disorder (BDD). I am not a psychiatrist and would not qualify as an expert witness on this subject. Two of the 10 patients in this chapter were diagnosed with BDD by a psychiatrist. I do not know whether any of the others had BDD, and I do not allege that they did. There may be some surgeons who believe these patients did have BDD; there may be some who think these patients had another psychiatric disorder; or some may even take the patients’ side and agree that they were justified in their unhappiness. It is not my intent to criticize these patients for their responses to my work but rather to recount their histories, surgical procedures, and reactions so that readers might learn from them and develop their own perspectives and philosophies for handling unhappy patients.

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T he Problem for Surgeons My personal introduction to BDD and unhappy surgical patients was very direct. I operated on three such persons in short succession without being aware of the possibility of BDD beforehand. A little background will put the histories of these three patients into better context. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) lists three criteria that must be met to establish a diagnosis of BDD: 1. There must be a preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the patient’s concern must be markedly excessive. 2. The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 3. The preoccupation must not be better accounted for by another mental disorder. Unfortunately, psychiatrists see a different population of patients than surgeons do—that is, they see persons who (for the most part) have an established or suspected diagnosis and who have agreed to be treated (this latter characteristic is particularly critical, as we shall see). Furthermore, as clear as the DSM-IV-TR criteria may seem, they are not easily applied to many rhinoplasty patients. Who decides what constitutes a deformity and therefore whether it is imagined—the surgeon, the patient, or the psychiatrist? Who defines aesthetic standards? For example, if a deformity is subtle but real, should the desire to have it corrected be an indication of BDD? Also, who decides what is “significant distress”? If the patient has had six rhinoplasties, resulting in an increasingly deformed nose and an impaired airway, thereby creating a patient who is frustrated by failure and angry about wasted time and money, how much distress is too much? Plastic surgeons need a different context and a different set of management principles for treating such patients. In plastic surgery practices, the DSM-IV-TR criteria become less absolute.

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Finally, what makes patients satisfied or dissatisfied with their surgical results, or even with their own lives? What inner forces influence patients to want further revisions, or alternatively, to decide that enough is enough? Why are some patients happy when they ought not to be, whereas others are unhappy when they should be happy? How is it possible for a surgeon to know what life events have occurred? What unknown changes color the lives of our patients, for better or worse, before we change their appearances? The unhappiness that my three initial unhappy patients experienced and the inevitable turbulence it caused throughout their postoperative courses and in my practice sent me straight to the literature. At that time (1996), the syndrome known as BDD was being recognized with increasing frequency. But the mental health literature, although moderately extensive, had only limited value for the plastic surgeon, who treats a broader, less definable demographic. These patients often include fastidious and perfectionistic secondary rhinoplasty patients, who may have added anger, frustration, and anxiety to the mix. How would you characterize the rhinoplasty patient who has also undergone breast augmentation with reoperation for capsular contracture, blepharoplasty, and face lift? Is this individual fastidious, narcissistic, a cosmetic surgery addict, or a person with some variant of BDD? Does it matter whether this patient is 35 or 55 years old? These questions are not answered by the DSM-IV-TR criteria. What determines how many procedures a patient should undergo? Which patients are more normal: those who are delighted with imperfect results or those who are dissatisfied with postsurgical flaws? Does it matter? In the past decade significant BDD research has appeared, and the percentage of secondary rhinoplasty patients in my practice has grown to almost 70%. Both have guided me toward the answers to some of these questions.

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UNHAPPY PATIENTS AND THOSE WITH B ODY DYSMORPHIC DISORDER

THE INITIAL TRIO The following three patients introduced me to intensely unhappy surgical patients and to BDD; together they circumscribe many characteristics of the BDD spectrum.

Patient One

This woman was a teacher in her 60s whose goal was a functional airway and a modest dorsal hump reduction that nevertheless preserved its convexity. The patient’s anatomic problems included a low radix, inadequate tip projection, a slightly narrow middle vault, and alar cartilage malposition.

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Notice the effect of her narrow middle vault and alar cartilage malposition on sidewall stability during inspiration.

Silhouettes outline the changes following lateral crural relocation; slight dorsal reduction; and radix, spreader, and tip grafts. The dorsum was straight, the tip was above the dorsal line, and the airway was supported at both the internal and external valves. The nose looks smaller because of the rearrangement. I did not expect the patient’s lax tissues to retain this shape, however. Eventually the tip would drop, thereby restoring some of the preoperative dorsal height.

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Preoperative

4 weeks postoperatively

The patient was pleased for approximately 2 weeks, at which time she called and asked to be seen. Crying and agitated, she demanded an immediate revision, because she believed that her nose had been overshortened and the tip pointed toward the ceiling. My explanation that any shortening was temporary and artifactual did not convince her. The patient resigned from her teaching position and became a recluse, remaining in her home and refusing to see friends or family. “If I return to teaching,” she said, “my students will be stunned.” “Everyone will ask me, ‘What have you done to your nose?’” Her behavior is not uncommon among persons with BDD. In several series, 25% to 30% of patients have become housebound (see Phillips, 2005).

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6 weeks postoperatively

7 months postoperatively

Note the evolving changes as the months passed—progressive narrowing and lengthening. Alar rim contours remained stable, as did middle vault stability. None of the grafts were visible, and most of the dorsal hump progressively returned, just as the patient desired.

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Hoping to reassure her, I sent comparable preoperative and postoperative photographs. She returned them, covered with careful measurements, to prove what she saw instead.

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I continued to see her frequently for the first postoperative year. She repeatedly refused psychiatric counseling, which was offered as only a temporary measure until she was more emotionally equilibrated. Shortly before her 4-month follow-up visit, she sent the following letter: I told you that I wanted my nose shortened by “a hair”—perhaps 1⁄8 inch, perhaps only inch or 1⁄64 inch. . . .

1⁄ 32

I never in my wildest imagination expected (nor did you ever suggest) that my nose would be this pointy, short, and turned up. This nose is a mockery of my long . . . face. It’s like someone else’s nose has been plucked off and put on my face. . . . I am brokenhearted and devastated [by this] sawed-off, turned-up snout. . . . How could you have done this to me—and why? I feel so terribly betrayed. . . . I am living (barely) for the day when you will make this right. . . .

At the 1-year postoperative visit, all grafts were smooth and invisible. The airway was widely patent. Airflow had increased three times over preoperative measurements. However, my reassurances were once again ineffective. The patient had resumed teaching and was seeing her family again but maintained that her nose was still dramatically overshortened and that her nasolabial angle was almost a straight line toward the ceiling. She demanded corrective surgery. I did not confront her with a diagnosis of BDD. I was not positive that she had it. Because I was fearful of precipitating another similar outburst, I refused to reoperate. The patient left my offic angry. I do not know if she has undergone subsequent surgery. This patient demonstrates that even primary rhinoplasty patients can show signs of BDD. Higher education does not protect against dissatisfaction with surgery. Often it is difficult to refer unhappy patients for psychiatric treatment; and the response to the surgeon may not be disappointment but rather victim anger. Notice the patient’s words, “I feel so terribly betrayed” [italics mine].

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Patient Two

My second unhappy patient was a 44-year-old woman seeking a tertiary rhinoplasty. Aside from airway obstruction, only a series of skeletal irregularities supported the patient’s thin skin. No septal cartilage remained.

Reduction of tip projection and the increase in dorsal height completely rebalanced the nose; the sharp edges and undulating bridge were corrected.

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The reconstructed nose was smooth and balanced without surface distortions. Geometric mean airflow had doubled. Initially the patient was happy with the result. Two months after surgery, however, her husband called, imploring me to revise my poor outcome. He reported that his wife had become reclusive and that my surgery had disrupted the entire family’s life. I continued to see the patient at regular intervals throughout the first postoperative year. She slowly resumed her presurgery activities.

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Her disappointment with the result was confined entirely to a contour irregularity of the left alar wall (circled), the result of a minor distortion in the underlying graft. Throughout the first year, the patient remained angry and unhappy, criticizing the result and my technique. Believing that it was my obligation to make any necessary correction, I told her the revision would be a simple adjustment of that single graft. However, by the twelfth postoperative month, I had decided that revision was unwise. “But you told me you could fix the bump!” she exclaimed. “I can,” I replied, “but I won’t.” I explained that the first surgery had so disequilibrated her that I did not want to risk another similar postoperative course. I meant it. I do not know if she has undergone another surgery.

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Similar to the first patient, and whether or not she suffered from it, this patient demonstrates some of the hallmarks of BDD: a minor defect provokes disproportionate distress; education is no immunity against BDD; a demanding personality may mask signs that suggest BDD; and victim anger may be a clue to the disease. Finally, even the patient’s husband believed that the cure was surgical and not psychiatric. My experience has been that a mental health diagnosis is unthinkable to most of these families, despite significant evidence to the contrary.

Patient Three

This 40-year-old autobody mechanic sought tertiary rhinoplasty to decrease the size of his lower nose and reduce tip angularity. The patient had a sophisticated grasp of nasal aesthetics, balance, and contour, an understanding that I attributed to his profession. One previous surgery had reduced the nose, and another surgeon had added tip grafts. I explained that the size of his lower nose was partly attributable to tip cartilage distortion and excessive projection and partly to nasal length; accordingly, reducing the tip projection and increasing dorsal height would diminish the apparent size of the nasal base.

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No septal cartilage was available, so I removed his previous tip grafts. Then, taking cartilage from the one remaining (untouched) ear, I placed a circumferentially wrapped, rolled ear cartilage graft. The scraps of remaining cartilage were fed into a separate pocket in the tip.

This is nasal shortening in reverse: as the dorsum goes higher, the nasal base rotates caudally because of increased anterior pressure on the dorsal skin. Caudally placed tip grafts only help to force the skin further downward so that there is a relative and absolute increase in nasal length.

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Unlike the previous two patients, this man was not happy for even 2 weeks. When I removed his splint, he looked in the mirror and said, “You have destroyed my face.” During that visit and subsequent ones, I was unable to reassure him, even with comparative photographs and a lengthy review of our preoperative plan. He closed his business (36% of BDD patients are unemployed and unable to work; Phillips, 1996), his alcohol intake increased, and he became unable to work or leave his home. At his 1-year visit, he returned to my offic with his son and ex-wife, armed with desperate appeals for a surgical solution. My attempt to refer him for psychiatric treatment was unsuccessful. Eventually, the patient tried to use a razor to reduce the dorsal height, but he succeeded only in lacerating himself. After treatment in the emergency room, he was ad-

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mitted to the psychiatric unit and later referred to a psychiatrist with special expertise in BDD. The patient continued to request more surgery, but I did not reoperate. This episode demonstrates the more extreme variant of BDD. The common characteristics, in my experience, are as follows: 1. The entire family believes that the patient’s distress reflects the need for surgery. 2. The response to postoperative emotional pain in these unhappy patients may be addiction. 3. Some patients with BDD will inflict injury on themselves to correct their perceived deformities (45% to 71% of affected patients have suicidal ideation, and 24% to 28% attempt suicide; Veale et al, 1996; Phillips et al, 2005). It is important to note that none of these patients fulfilled the DSM-IV-TR criteria for BDD preoperatively. None had unusual distress about their deformities. In all cases the deformities, as the patients saw and described them, seemed accurate and appropriate. All of the patients were pleasant preoperatively; all saw examples of my treatment results for similar deformities, and all agreed to my surgical plan in detail. Their presenting deformities were neither trivial nor imagined. These patients exhibited no signs of obsessive behavior or distress in daily functioning: all were active and productive in their work. For these reasons, the usual screening methods and checklists suggested for making a diagnosis of BDD would not have applied here. Nevertheless, the patients’ postoperative signs of distress were indeed real, significant, and debilitating, but the treatment they presumably needed, according to these patients and their families, was entirely surgical. It is also sobering to wonder to what degree surgery can precipitate BDD in patients who are predisposed but not previously affl ted.

SUMMARY OF BODY DYSMORPHIC DISORDER CHARACTERISTICS IN THE LITERATURE BDD is not a new disorder. It is the term currently used for a disease that was previously called dysmorphophobia in Eastern European, German, and Russian psychiatric literature. Freud described a patient he called “The Wolf Man,” whose behavior included the obsessive and mirror-checking traits of the disease. Having previously treated the patient for “compulsive neurosis,” Freud later commented that the patient “neglected his daily life and work because he was engrossed, to the exclusion of all else, in the state of his nose. . . . His life was centered on the little mirror in his pocket, and his fate depended on what it revealed or was about to reveal” (Hay, 1970). Based on its similarity to obsessive-compulsive disorder (OCD), BDD has been characterized as part of that spectrum (Richter et al, 2004). However, there are ways in which BDD fits that conceptualization and ways in which it does not. The pri-

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mary similarities between BDD and OCD are their responses to pharmacotherapy and cognitive behavioral therapy. However, patients with BDD are notorious for their poor insight (between 35% and 40% are delusional; Phillips, 2004). Also, the intensity with which BDD patients experience their perceived flaws is uncharacteristic of OCD. There is evidence that BDD is a heritable disorder, which is particularly relevant to the histories of some rhinoplasty patients, as we shall see. Eight percent of patients with BDD have a family member with BDD, which is four to eight times the prevalence in the general population (Bienvenue et al, 2000). Patients with BDD appear to have abnormal perceptual and emotional information-processing capabilities and deficits in memory organization (Hanes, 1998). Interestingly, the brains of patients with BDD emphasize negative words and interfere with the processing of positive words, making these patients more hypersensitive to criticism and therefore less amenable to reassurance by the surgeon (Buhlmann et al, 2002). Similarly, patients with BDD are much more likely than control subjects or patients with OCD to interpret others’ descriptive or neutral comments as criticism (Buhlmann et al, 2002). Patients with BDD are therefore much more sensitive than control subjects to teasing and are more likely to misidentify facial expressions as angry or contemptuous. Even more important, BDD patients imagine distortions in their own faces when judging computerized images (Yaryura-Tobias et al, 2002). This characteristic has encouraging implications for surgeons who may try to screen patients for BDD by using computer-imaging software. Characteristically, BDD has its onset in childhood or adolescence, most commonly between the ages of 12 and 14 years. Although the disease usually arises in the early teen years, the diagnosis is often delayed for an average of 11 years after its onset. As many as one third of patients with BDD also have an eating disorder (Ruffolo et al, 2006). It should not be surprising to plastic surgeons that the disease is as common in men as in women, because male rhinoplasty patients are so widely believed to be troublesome. Particularly troublesome for surgeons is the delusional variant seen in some patients with BDD. At least 35% to 40% of patients have no insight into their disease. Nearly all patients with BDD try to cope with their disease by adopting behaviors designed to diminish the anxiety they feel—for example, camouflaging a perceived defect with makeup, hair, or their hands; constantly comparing the area of the body they consider “defective” to that of other individuals; frequently checking the mirror; excessive grooming; and a continuous need for reassurance. The literature indicates a prevalence of 3% to 15% in surgical practices. In my own practice the prevalence is 0.5% of primary rhinoplasty patients and 4% (operated) to 12% (interviewees) of secondary patients.

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There are significant comorbidities: 76% of those with BDD also have major depressive disorder; 37% have social anxiety disorder; 32% have OCD; and 25% to 35% have an eating disorder and associated substance abuse and impulse control disorder (Hadley et al, 2006). Particularly relevant is the fact that, across all cultures, the most common area of the body for which BDD patients seek surgical treatment is the nose (45%; Phillips, 2005). Unfortunately, as my own earlier patients and subsequent cases indicate, surgery is almost always ineffective, and many patients with occult disease exhibit full-blown BDD postoperatively. Most studies show a surgical dissatisfaction rate of 80% to 90% in patients with BDD. Furthermore, not all unhappy patients go away quietly. In a 2002 survey, 40% of plastic surgeons stated that a patient with BDD had threatened them physically or with legal action (Sarwer, 2002). In one prominent New York case, a patient with BDD sued her plastic surgeon, asserting that, despite undergoing successful previous operations performed by him, she was unable to give informed consent because of the cognitive distortion produced by her disease (Leonardo, 2001). Several unhappy plastic surgery patients have murdered their physicians; however, it has not been established whether the patients’ psychopathology in these cases was BDD.

THE PROBLEM FOR PLASTIC SURGEONS In reviewing these data, the most pressing question continues to be whether to operate. How does the surgeon decide? All of us who treat cosmetic surgery patients see those who are anxious, depressed, or significantly distressed by a rather minor flaw. But there are other considerations. Secondary rhinoplasty patients who have already spent a significant amount of money and emotional energy to achieve a certain result, who may have had one undesirable outcome after another, who may have exhausted family support (after all, how many operations can you have on your nose?), and who may be, justifiably or unjustifiably, angry at the previous surgeon or surgeons, do not all have BDD. Many can be helped by a proper diagnosis and skillful, compassionate surgery. As important as the psychiatric literature is, all plastic surgeons must develop their own individual criteria for accepting or rejecting patients, and these criteria should reflect each surgeon’s safe zone. A number of surgeons have observed that one key factor may not be simply the size of the defect but rather the patient’s response to it (Gorney, 2006). Therapists using cognitive-behavioral therapy to treat patients with BDD note the black-and-white, all-or-nothing thought patterns of these patients. The challenge for therapists, and for surgeons, is not necessarily to change the patient’s belief but rather its significance. For better or worse, it is the patient’s reality that really counts.

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HOW THE SIGNS AND SYMPTOMS OF BODY DYSMORPHIC DISORDER HAVE MANIFESTED THEMSELVES IN MY RHINOPLASTY PRACTICE Most of the characteristics of BDD that are identified in the psychiatric literature are found in the following case studies.

Patient Four A

B

C

The first photograph shown here was taken before this patient had any surgery (A). The second image is from when I saw her after she had undergone several rhinoplasties (B). Her nose was symmetrical, the contour was smooth, and the airway was wide open. But the patient complained that her nose was crooked. The crookedness was so significant, she said, that others constantly noticed it; even her fiancé had left her because of the asymmetry. When I asked her to demonstrate the correction that she would like, she pushed her nose to the side (C).

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Patient Five A

B

This woman demonstrated a similar dissatisfaction. She appears as she did when I saw her in consultation (A), and demonstrating the correction that she wanted me to produce (B). The patients’ realities in these cases are at the heart of the decision to operate and constitute my first criterion: I must see what the patient sees.

Patient Six A

B

C

D

This patient had undergone 10 previous rhinoplasties. I was going to be surgeon number eight. He was agreeable and calm when he saw me, and he appeared as he did in photo A; he requested a change that he had drawn on a photo (B). Believing

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that the request was reasonable and that I could achieve it, I reduced and re-created a new dorsum with rib cartilage (C). However, as he had done when he first saw me, the patient wore a small adhesive bandage to hide the deformity (D)—no longer the original deformity, but rather the one he believed I had produced. The sense of deformity can be a lifelong affl tion.

Patient Seven A

B

C

Photo A shows the patient’s nose before several rhinoplasties (B and C). She presented with a supratip deformity, despite having undergone a homograft dorsal implant, and requested restoration of her original appearance. Because no septal cartilage was available, I augmented the dorsum, tip, and lateral walls with rib cartilage.

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During the first few postoperative weeks, the patient was happy. But soon she began to contact me requesting her “next surgery.” She traveled a great distance from her home to see me several times, on occasion distraught to the point of tears. The nose was too large and much too wide, she believed, and she wanted the same shape in a smaller size. “The same nose in a smaller size” is a common but often impossible request. Particularly in patients undergoing secondary or tertiary rhinoplasty, where the soft tissues have already contracted maximally, the skin sleeve is a fixed rather than a variable parameter. Thus a straight nose in only one size is possible. Less augmentation would leave a residual supratip deformity, and more augmentation would simply make the nose larger and risk graft visibility. To convince the patient that we had achieved her goals of autogenous reconstruction, correction of the supratip deformity, and a restoration that resembled her presurgical appearance, I sent her a series of comparative photographs.

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The patient returned the photographs with a four-page analysis of all aesthetic problems.

The short excerpts that follow illustrate the crossover to OCD. Now, we have a trapeze [sic] ABEF on top of a rectangle EFCD . . . The most protruding point seems to lie along EF rather than along CD. . . . [and] is closer to an ideal vertical tangent. . . . The distance between points O and N is now approximately 1.1 cm (it was 1.0 cm), and between points P and Q is now 1.2 cm (it was 1.1 cm). . . . The tip lobule is 1 cm in photo 5 and 1.2 cm in photo 6. . . . In fact, in some light the nose appears divided into two parts; the part above EF and the part below. . . . I’d like to keep the new columella, but it is now not compatible with the tip lobule. . . . The nostrils seem to have stretched horizontally. . . . I am ready to come and see you personally. . . . I am absolutely confident that you are the best person to help me with my nose. . . .

This patient provides one example of the emotional perfectionism of some dissatisfied patients. However, insight is not the issue here. It is a failure of the patient to fully appreciate the margin of error inherent in surgery (the most important of all criteria in the surgeon’s decision to operate). Notice for each of these patients that the surgeon’s ability to correct the deformity does not guarantee a satisfied patient. 1426

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T he Link to Relational Trauma Patients with BDD are obviously troubled, but where does the problem begin? This question, I believe, has received too little attention in the literature. My current answer reflects observations of the effects of trauma in dysfunctional families and the experiences of some of my patients.* Relational trauma and its lifelong aftershocks circumscribe many features relevant to our discussion of patients with BDD and the spectrum of affective and behavioral dysfunction in which BDD is only a single point.

Trauma, Core Issues, Addictions, and Relational Problems Nurturing parents raise their children to understand five concepts (core issues) that form the basis for mature adult behavior: (1) their vulnerabilities, (2) their strengths and weaknesses, (3) their dependency, and (4) the importance of moderation. But most of all, nurturing parents teach their children that (5) they are valuable—that they are neither less than nor better than others but are precious simply because they are alive. Their value does not need to be earned. When dysfunction in a family causes relational trauma or abuse of any kind, the core issues develop differently. The child may learn distorted self-esteem, develop poor boundaries, have an imperfect sense of reality, and struggle with self-reliance or living in moderation. We all know patients who display the extremes of these types of dysfunctional upbringing. At one end of the spectrum are arrogant, resentful, self-important patients who are rude to offic and hospital personnel and want to dictate the operative procedure. At the other end are passive, hypersensitive, indecisive, dependent patients whose neediness places special burdens on both surgeon and staff. Although dysfunctional behavior appears along a spectrum, the extremes are easiest to identify as the love (or relational) addict and the love (or relational) avoidant. Love addicts, in particular, have a special capacity to create fantasies that significantly complicate the surgeon-patient relationship and may contribute to the unhappiness and emotional intensity felt by patients with BDD.

*My ideas have been heavily influenced by the model elaborated by Pia Mellody, to whom I am grateful for her interest and comments on my thesis.

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R elational Addiction Both love addicts and love avoidants are subsets of individuals known as codependents, a term that itself is more broadly used to indicate immaturity caused by childhood trauma. Codependents suffer from five primary, or core, symptoms: 1. Difficulty experiencing an appropriate level of self-esteem 2. Difficulty protecting themselves by setting proper boundaries 3. Difficulty defining their reality; in other words, knowing who they are 4. Difficulty with self-care 5. Difficulty living in moderation As a result, codependents interpret the behaviors of others inaccurately, which in turn impairs their relationships. However, the primary problem of codependents is their relationship with themselves. As a result, secondary symptoms develop that directly interfere with a healthy surgeon-patient relationship. These include the following: 1. Negative control. Codependents either try to control others or allow others to control them. 2. Resentment as a form of self-protection. From this resentment develops victim anger, as already seen in patients one, two, and five. This resentment may generate not only anger but also desire for revenge. 3. Impaired spirituality. Codependents improperly view others with godlike powers through hate, fear, or worship or may attempt to be another’s higher power. 4. Addictions and mental or physical illness. 5. Difficulty with intimacy (healthy, close relationships). As a subcategory of codependency, love (or relational) addicts share three common traits that directly affect their ability to establish and maintain a healthy surgeonpatient relationship: 1. Love addicts assign a disproportionate amount of time and attention to the person to whom they are addicted, often obsessively. 2. Love addicts have unrealistic expectations for unconditional positive approval from the person to whom they are addicted. 3. Love addicts are unable to value or care for themselves in that relationship.

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It is not difficult to imagine what problems these personal characteristics can create in marriages or other intimate relationships, but imagine also what problems they can create when the love addict is a patient. Love addicts commonly rate their surgeons as superior to (or more powerful than) themselves. In fact, patients who assign more power to a surgeon than he or she truly possesses will always expect a more flawless surgical result than is ever possible. Beyond the surgical result, love addicts can expect the other party (the surgeon, in this situation) to rescue them from their own unhappiness, protect them from pain, and nurture them—exactly what they never received from their parents. Thus the surgeon becomes the savior, and the object of an addiction that is no different from an addiction to alcohol, gambling, drugs, sex, or work. However, the surgeon, who has now become the love addict’s drug, can never fulfill these impossible expectations, and so the patient experiences repeated disappointments. When the patient experiences enough pain, he or she may move to another surgeon, begin the cycle again, and only suffer subsequent disappointments. The toxicity of the patient’s disappointment fuels victim anger, complaints to medical boards, or retaliation against what the patient believes is a deliberate failure to nurture and rescue, which is what the patient expected.

T he Physician Component In the midst of this bewildering morality play, the surgeon plays a primary role. Trained and disciplined as we are, our behavior only fuels the flames. Matching the patient’s sense of low self-esteem is the surgeon’s (perceived or real) high selfesteem. Matching the patient’s boundaryless vulnerability is the surgeon’s apparent unflagging strength and invulnerability. Matching the patient’s physical (nasal) and psychological sense of imperfection is the surgeon’s apparently needless and wantless perfection.

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A nd So the Play Begins We have our protagonist. The patient, wounded through improper parenting into a painful reality of shame and inadequacy (or superiority), the specter of which has followed the patient into adulthood camouflaged, copes with greater or lesser success through years of adaptation. Just as the child adapted to survive in a dysfunctional family unit, he or she has adapted to survive in life. The variations of this compensatory behavior are as limitless as the human personality. Examples of these behaviors include the successful executive who nevertheless swamps the surgeon’s offic with fussy, worried telephone calls about each step of the preoperative and postoperative care; or the charming, voluble, cooperative, and grateful woman who has no questions about the surgical procedure but who nevertheless remains dismally dissatisfied with every one of her numerous previous cosmetic operations. My first clue to adaptations of the wounded child is usually a sense of discomforting incongruence—that is, the demeanor of worried indecision does not match that of the successful executive; neither does the unhappiness with previous results match the charming, unquestioning persona of the patient in front of me. I try not to brush aside bewilderment in these circumstances. A patient drawn to surgery to increase his or her sense of self-worth seeks a surgeonpatient relationship that simulates the unconditional, positive regard that the patient wanted from his or her parents as a child but may not have received. The attention, the careful instructions, and the solicitousness of the staff, which appears to be merely competent care to a conscientious surgeon, may look like the behavior of loving parents to a patient who has seemed to adapt but, in reality, has no idea of his or her self-worth. The entire experience is intensified by expectations of improvement after surgery. Similar to Sleeping Beauty waking to new happiness with her prince, the love-addicted patient expects to wake up from anesthesia to a transformed life. As noted earlier, love addicts can neglect self-care when they enter into an addictive relationship. As surgeons we see these manifestations in a different setting, such as when an apparently self-suffici t, competent patient deteriorates after surgery and becomes passive, excessively needy, and childlike. For example, I treated one tertiary rhinoplasty patient whose preoperative complaints were well circumscribed and achievable but who, after surgery, had difficulty expressing herself in moderation and difficulty containing her anger.

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Patient Eight

This primary rhinoplasty patient requested the following conservative changes: reduce the hump, but do not create a pinched tip, retroussé, or tip angularity. Silhouettes dramatize the rearrangement. The patient’s sister came with her when the dressings were removed and remarked, with apparent annoyance, “I told her she should never have gone through this.”

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1 month postoperatively

18 months postoperatively

Notice, as you compare the preoperative, 1-month postoperative, and 18-month postoperative photographs, that things change only as they should. The nose progressively narrows, but the middle vault remains stable. Frontal symmetry and balance have improved. In the lateral views, the nose appears smaller where it was reduced, but (despite tip grafting that has brought the tip above the septal angle) the lower nose does not appear larger because it is off et by the radix graft. As the edema resolves, contours improve but remain stable.

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The patient was almost immediately unhappy. It was futile to reassure her that the swelling would be transient. She was inconsolable. She wrote a letter pleading for revision. Although my staff and I had spent many hours trying to reassure her, her response was not disappointment but rather victim anger. The following are excerpts from our correspondence (italics are mine): I have a few more questions [based on what I have read on the Internet]. . . . I am wondering if [the osteotomy] was made suffici tly thin enough? If this wasn’t made thin enough, then it seems I could wait forever and still not have the look I was hoping to achieve. . . . If this is the case, then the mental distress of having to wait another 6 months for more surgery and then having to go through another year of swelling is almost more than I can bear. . . . I know that you don’t consider me an attractive person. My sister told me that at this point my looks are ruined—that my nose is way too wide and I am missing a certain more feminine look I had before. You may not agree, but I have not heard one positive comment from anyone: friends, family, co-workers, or even casual acquaintances. . . . It is now the start of the seventh month with no change. . . . Doctors on the Internet say that their patients do not swell and are happy right away. . . . I just expected to feel more attractive, not less so. . . . Why did you use a spreader graft in my nose when, according to the attached articles, it is not generally recommended for nasal refinement? I feel, at this point, that it is cruel to continue making me walk around looking like this. Why do people on the Extreme Makeover shows have noses that look so good and are hardly swollen after 6 weeks to 4 months when their noses were worse than mine to begin with? I have lost hope, 18 months after surgery, that my nose is going to turn into something I can live with. Nothing has changed—it is larger than ever. I cannot tolerate any more remarks such as: “why is your nose so large after you had rhinoplasty?” “why did you have it made so wide?” “when are you going to do something about it?” “how can you walk around like that?” “I would be so disappointed if I were you,” etc. . . . It is the extreme width from the front view that is very disturbing to me. . . . I am relying on you for compassion and help. . . . I just wanted to thank you for effectively ruining my life. Each plastic surgeon I have seen has admitted that my nose is too wide but that I should go back to you because you are such a “professional” and would be able to fix it, and you certainly would not want an unhappy patient. Well, as we know, you don’t care if I am unhappy or not. . . .

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You have made my nose wider and bigger than any woman I know. I feel, literally, like a freak. I am having a hard time even leaving the house each morning. Now, let’s see— what kind of drug would help that problem? How many years of counseling will help with having an oversized nose that I actually paid for? A better profile doesn’t make up for having what my brother-in-law calls a “clown” nose. Why you have turned against me and abandoned me when I am in need of help, I just cannot understand. If you don’t believe the comments I am hearing, I can get sworn affidavits. I think you are just stubbornly refusing to acknowledge that this look has not worked out for me. . . .

Throughout these excerpts, notice the patient appears to be mind reading (“I know that you don’t consider me an attractive person”), an unusual remark to make to one’s surgeon. Recall the patient’s victim anger (“I feel, at this point, that it is cruel to continue making me walk around looking like this”), alternating with desperation, and her inability to nurture herself (“I have lost hope at this point”). Finally, notice that the patient believes that the relationship is deteriorating (because I will not agree to schedule another surgery), the patient’s seductive pleas (“I know, with your expertise, that something can be done about it. . . . I am relying on you for compassion and help”). At last, the patients’ victim anger resurfaces (“I just wanted to thank you for effectively ruining my life. . . . You don’t care if I am happy or not. . . . I feel, literally, like a freak”), and she states her real distress (“Why you have turned against me and abandoned me when I am in need of help, I just cannot understand”). I did not manage this case expertly. I was responding in a logical manner, answering questions about spreader grafts, and explaining osteotomies when I might have been more successful if I had addressed her pain and fear. Unfortunately, the patient’s solution is more surgery (as we have seen in each of the preceding patients). This is one of the characteristics that distinguishes surgical patients from psychiatric patients. In the latter, a diagnosis of BDD has already been made and the patient has accepted it. I speculate that many patients with love-addicted personalities see their surgeons as nine-foot-tall, bulletproof saviors who will “rescue” them from their inadequacies and, through the miracle of surgical intervention, will fix what is wrong in these patients’ lives. When this does not occur, these patients become angry. As in patient one, the reaction is not disappointment but rather victim anger: “How could you have done this to me, and why? . . . I feel so terribly betrayed.”

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Evidence From a Patient’s Story Patient Nine A

B

C

The history of this patient from 2001 was my first clue to the link between relational trauma and BDD. The above photographs show the patient’s preoperative appearance (A), his appearance when he first consulted me, requesting a reduction of nostril visibility (B), and 4 years postoperatively after conchal skin/cartilage composite grafts (C). At the beginning of his interview, the patient explained that he had previously been diagnosed as having BDD. He had been treated and believed he had recovered. I sought confirmation from his therapist, who concurred. After his surgery, through which he was an excellent patient, I asked, “If I write you a letter with a series of questions, will you describe for me what it was like being inside BDD?” He agreed, and the following is his fascinating letter, printed in its entirety. The sections with the greatest relevance to the etiologic factors of BDD are in italics.

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Here are some thoughts that I hope touch on some of the questions you asked me to answer about my experiences with BDD. Before the First Surgery: Summer of 1978 I was an extremely shy, self-conscious, and unconfident child and adolescent. I could barely get two words out in history class without becoming tongue-tied, blushing, and my voice becoming quivery. I felt OK about the way I looked. I wished I wasn’t so thin and scrawny, but I didn’t dwell on it. I didn’t think about my nose at all. It was my stepfather who convinced me that something was wrong with the way I looked. Looking back on it, he spent a lot of time and creativity trying to convince me that my nose looked weird. I suppose he didn’t feel too good about himself—he was a 50-year-old parking lot attendant with, probably not coincidentally, a large “Greek” nose that had a bump on it. My mother, my brothers, and I are all 100% Jewish. It took years for him to convince me that something was wrong with my nose. He said to me, “Your nose droops. I’m going to call you ‘droopy nose’ from now on,” doing his best imitation of a 7-year-old. I looked in the mirror, turning my head from side to side, but everything looked OK to me. I was mostly angry just for the very idea that my stepfather was trying to upset me. One day, he pointed out my brother’s nose to me. “Look,” he said. “It looks kind of chopped off at the end.” I looked closely at my brother’s nose apart from his face for probably the first time in my life. My stepfather was right; my brother’s nose looked different from what most people think a nose should look. I’d never noticed it before. The harassment from my stepfather continued through the years. “Your nose goes down straight like this,” he said, while tracing his finger through the air, “and then . . . it droops. I don’t know; it looks funny.” My stepfather also described my nose as if it were in the process of getting worse. “It’s starting to droop. It’s turning into a [family name] nose.” My biological father was mentally ill, so I found this frightening. Finally, the summer before my senior year in high school, I submitted two photographs taken by my stepfather with the express purpose of showing me what was wrong with my nose. My stepfather struggled to find the perfect angle to capture the flaw of my nose. And I let him do it. That year, which was kind of a lonely one for me, I got dumped by my first girlfriend, among other things, and I would take out the photographs whenever I felt in a down mood. I noticed my nose looked a little flat at the end, but that it was at 90 degrees in profile (which I felt was good). With a pen, I drew in my own tip graft to make my nose look like an average nose. One day, I got angry and scribbled through the tip of my nose angrily. It’s clear in retrospect that my generalized self-hatred had transferred to my nose. I remember the following “conversation” with my stepfather: ME:

Other people have noses like mine. No they don’t.

HIM:

The battle was over. I believed my stepfather.

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I started looking at my nose in the mirror with a second mirror so I could scrutinize my nose in profile. I’d work myself into a state of agitation at how my nose “drooped.” After 10 minutes or so, I would stop. I don’t believe I thought about my nose too much when I was out in public, but the little I did, I found to be painful. “Why not change the thing I hated about myself?” I thought. I thought by changing my nose, I would stop thinking about it for even a second, and free my mind from this obstacle. My stepfather and mother were against surgery, but I was convinced there was something wrong with my nose. I didn’t give too much detailed instruction to [the doctor]. “I don’t like the way it droops. I just want a slight change. Don’t make me look like a pig.” I had seen two of my classmates’ “nose jobs” and didn’t like their unnatural look. I thought that if I told [the doctor] to be conservative, he would be and everything would be OK. I had grown up with the TV shows Medical Center and Marcus Welby, MD, and in those shows doctors were gods and never made mistakes. After Primary Surgery: 1978-1982 I didn’t like the way I looked after surgery, but I wasn’t horrified. I hoped that I had broken even—that my nose had looked weird before the surgery, and now it looked weird still, but at least I had actively tried to change something I didn’t like about myself. My stepfather’s reaction: “It still looks weird.” My brother’s reaction: “It still looks Jewish.” I had a goal in mind when I went to college: to become a doctor myself. I focused on that goal as much as I could and tried to forget about my nose. On my first day at the University of Massachusetts, I bumped into a high school acquaintance who lived in my dorm: “I hate nose jobs,” she said, apropos of nothing—other than seeing my nose, that is. I was an erratic student: some days I’d study all day, and the next day I’d skip all my classes. I had around a 3.5 GPA after 2 years, and I worried all the time about my future, to the point of waking up with my heart pounding. Occasionally I would use two mirrors to look at myself in profile, vacillating back and forth about whether my nose looked OK. I don’t remember looking at it too closely from the front. In the summer of 1980, my brother committed suicide. I blamed myself for not being more involved in my brother’s life and concentrating on my pre-med obsession instead. I felt I didn’t cry enough, I felt numb. I hated myself so much, and considered myself an uncaring person. I lost my ambition to be a doctor, reasoning that if I couldn’t help or care about my brother, how could I care about strangers. I switched majors from premed to psychology, then English. As my life lost meaning, I started to get obsessed with my nose for the first time. I felt sure that it looked operated on and strange, and I started to avoid socializing. I asked all my friends, old and new, about whether they had noticed anything weird looking about my nose. No one said they did. I had very nice friends as roommates, and they kept me from being totally isolated. Unfortunately, I can’t remember how long it took to grow into an obsession. I think it was a fairly short period of time. I remember wanting to drown myself when I went on an outing to the beach with my friends; that’s how bad I felt about how I looked. I felt my nose looked shapeless, short, and snubby in profile, but I don’t remember thinking much about how my nostrils looked from the front.

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Hope came when a psychologist I was seeing suggested that I go to a medical library to find out more about my nose. I saw an article by one surgeon about something called a “supratip deformity.” I felt very happy that there was a name and a solution for my problem. I had a feeling that this surgeon was a maverick, a man who cared about quality in what I had started to feel was a pretty sloppy and careless profession. He was my only hope, so perhaps I built him up in my mind. But he was so busy in those days that I think it took me 6 months just to get an appointment and another 3 to have the surgery. I stayed pretty isolated before surgery, and I was still very self-conscious about my nose, but I think I might have taken a class or two and was somewhat relaxed and hopeful before surgery. I signed up for a summer class at UCLA so that I could hang around Los Angeles for awhile after surgery. Surgery: 1982 It was quite an experience going to another city for the surgery. I stayed at a house for out-of-town patients, and got to know a few people who were in the same boat as I was, and I didn’t feel so isolated. I have fond memories of the woman who owned the house; among her kindnesses, she served us fresh-squeezed orange juice, even after we had had our surgeries and couldn’t appreciate it. I remember catching a glimpse of myself after the bandages were removed and noticing a lot of nostril show for the first time. I quelled that thought and walked around UCLA fairly happy, even with my glasses taped to my forehead, because I knew that my profile looked better. I had gone to the best doctor in the world: What else could I do? It was time to forget about my nose. I pretty much did. I struggled to finish college and find a new purpose in life now that my dream of being a doctor was over. Every day I would wake up and think about my brother, and what an asshole I was. I tried desperately to feel some grief and a connection to him. I went to a psychiatrist with the goal of learning how to cry about my brother, and to feel less like an evil person who had somehow caused him to kill himself. I somewhat succeeded in my goal of grieving the loss of my brother. I cried a lot, but it was difficult for me. Every time I cried, I thought I was breaking through to a more real and passionate and compassionate life. I read a book by Noam Chomsky called Turning the Tide and became wildly political. This book changed my whole view of the world. The book was about the U.S. government supporting the brutal Salvadoran government, and the counterrevolutionaries in Nicaragua. I had a found a new obsession, a purpose to life. I would stop moaning about things I should have done for my brother, but couldn’t do anything about now, and become a Central America activist. I imagined my brother as a Nicaraguan or Salvadoran peasant whom I would save. I worked really hard trying to do that for a few years, from 1986 to 1988. My guilt about my brother was transferred to these political issues. I don’t remember looking at my nose at all, or thinking much about it.

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1988-1992 My inheritance from my father ran out. The Central America issue was fading from the news. With no money, I moved back to my parents’ house. I felt like a complete failure. With my new political beliefs, I didn’t want to work in the corporate world. I felt a sense of dissatisfaction with the political world, a lack of a sense of accomplishment or of developing my skills. Could I really hand out fliers for the rest of my life? I signed up for computer science classes at the University of Massachusetts in Boston. I had no car and practically no friends in my old hometown. I tried to concentrate on my classes, but I felt a sense of guilt about abandoning the Central America issue. I had become very sensitive to the fact that there was a huge amount of suffering in the world and I was doing very little to help alleviate it. I wasn’t doing well in my computer science classes. In this maelstrom of negative feeling, my nose obsession grew to its greatest level ever. It began in January 1992, perhaps related to a medical experiment I had signed up for: $1200 to be a guinea pig for a blood pressure medication. Somewhere between January and June of 1992, I developed a full-blown obsession with how my nostrils looked from the front. My nose looked “suspended” up above where it should be. I tried to pull my nose down. I pushed my nostril sills up. My nostrils looked very round, noticeable, and unnatural to me, which they hadn’t before, except right after surgery, and I had quickly forgotten about it. I wrote to my surgeon, hiding my great distress. By this time I was looking at my nose for hours at a time, arguing with myself. “If it’s so obvious to me, why isn’t it obvious to everyone else? Why didn’t I think or notice it much in the last 10 years when it looks so obvious now?” I would walk around the house looking at my nose in various lighting, trying to see when the nostril problem was most noticeable. The surgeon wrote back to me and said “further improvement was possible,” but I had no money. I begged my brother Michael and my parents for money, but they wouldn’t give it to me. I was currently working for $7.50 an hour, and I had a sense of hopelessness about raising the money. Looking back on it, I don’t know why. Why couldn’t I have gotten a second or even a third job if I was so desperate for “further improvement”? I felt totally helpless, and I went the mental health route instead. 1992-1996: A Trip Through the Mental Hell-th System Various medications were tried, mixed with others, and abandoned. My nose obsession continued. I grew suicidal because I couldn’t stop thinking about how deformed my nose looked to me and, I imagined, to others. Some medications made me sick, some made me confused. My life was out of control as I looked for a magic pill. I was in and out of hospitals. In 1996 I remember being so confused that I spent a whole night trying to figure out how to put on my t-shirt. I failed. I went into a 10-day coma from what afterward doctors said was serotonin poisoning. I was released from the hospital a month later. I was in the blackest mood of my life, and I stayed in bed sleeping as much as possible. I went back into the hospital. I got electroshock therapy and was released in, I think, October 1996. I went to a group home to live, because my mother couldn’t stand the stress anymore. I spent my days in treatment chatting with other nuts. At first the ECT made me so confused I didn’t know who I was or what my problems were. A lot of the negative energy was removed from my nose. I started to think that my problem was

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not my nose, but that I was 36 years old and didn’t know how to support myself financially, and that I’d never had a girlfriend, and that I would be in this awful situation for the rest of my life unless I worked to change it. I forgot about the poor people of El Salvador, Nicaragua, and everywhere. I thought, “My life sucks almost as bad as theirs does, I had better do something about helping myself before I can help them.” I got a job delivering newspapers early in the morning. Then I got a job as a substitute teacher. I sold my brother’s vintage guitar for $2000 and moved out of the group home and into a nice apartment near the ocean. I got my first real girlfriend at age 37. I got certified as a teacher and got my first real job as a math teacher at 38. I still didn’t like my nose: the nostrils, the idea that I even got that first nose job in the first place, but instead of carrying the obsession with myself all day, the last thing I said to myself as I left the mirror was, “That’s not your real problem.” And I was able to forget about it as I went about my business. In 2000, I got married. In 2001 my marriage wasn’t going well, and my stepfather died. My work as a teacher at an alternative school was a strain, because I was still shy and not a strict-enough disciplinarian. I went to Portugal with my wife and felt guilty because the whole time I was thinking about how I was going to tell her I wanted a separation. My wife spoke Portuguese and we were staying with her brother there, and I was totally dependent on her. In this context I developed nose consciousness for the first time since being released from the hospital in 1996. I got in contact with my surgeon again, and then you. Now, let me read your questions again to make sure I touched on them in my “nose biography”: Q: Are there stages to developing BDD? A: In my experience, there are different levels of BDD, but the onset is fairly abrupt. Level 0: Lack of nose consciousness. Level 1: Nose consciousness in private moments; dissatisfaction, mostly forgotten in public. Level 2: On the brink. Carrying nose consciousness around while in public, fighting it off with varying degrees of success, struggling, wasting time in front of the mirror. Level 3: Over the edge. Full-blown obsession, spending several hours in front of the mirror, difficulty thinking of anything else. Q: Were all my perceptions distorted, or just my body image, or just my nose? A: Just my nose. Q: Did I view my surgeon’s surgery differently [when BDD developed]? Was it no longer successful in my eyes? A: Since I didn’t notice my nostril visibility before the surgery, I wondered whether in fixing my supratip deformity, my surgeon inadvertently created the nostril visibility problem. I knew my surgeon was regarded as the best rhinoplasty surgeon in the world, so I figured the nostrils were probably a preexisting problem that I had not noticed before. I wondered why my surgeon did not fix the nostril problem at

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the same time as the supratip problem. At the same time that I developed BDD with regard to my nostrils, I was grateful that my surgeon had done such a nice job on my profile. At the same time, I wished that my nose was longer, but I knew that shortening of my nose had occurred in the first operation, and my surgeon was probably unable to do anything to correct that. As far as my profile went, even with BDD, I thought my surgeon did a great job with what he had to work with, but I figured that the material just wasn’t there. Q: How did my friends and associates view this period? Did anyone understand? A: My friends were very supportive for long periods, although many gave up on me because I was sick for a very long time. Overall, I think my friends were probably more understanding than I would have expected them to be. Q: How easy was it to find a psychiatrist who understood this problem? A: I didn’t really find anyone who I felt helped me, but I don’t think there is really any way to help someone with BDD, other than hit-or-miss methods. ECT helped me, I guess, but I worry that I may have sustained brain damage in the process, because I am definitely more forgetful than I was in the past, but it may be because of age. Q: [What are the] clues for a surgeon to make the diagnosis of BDD? A: Honest patients will tell you if they have BDD, or if they don’t know about BDD. If they answer questions posed to them honestly about how much they think about their appearance and if they believe their obsession is negatively affecting their lives, the surgeon will be able to determine whether or not these persons have BDD. I can see reading over what I wrote, that I wrote mostly about my life, to give a context in which BDD developed. Not surprisingly, when my life is not going well, I have a tendency to develop BDD. I may take another shot at this, with a greater focus on the questions you specifically asked, but I am afraid if I don’t send what I have written so far, you won’t get anything. I hope what I have written is of some use to you, and perhaps other doctors and patients, in understanding BDD.

If I needed evidence that some patients with BDD come from dysfunctional families, this was it. His letter told a compelling story of systematic child abuse by his stepfather. He describes the early attention the stepfather brought to his nose, his initial resistance to the stepfather’s beliefs, and his ultimate growing obsession with his perceived nasal deformity once the stepfather’s view prevailed. This patient had an epiphany, completed his education, created a family, and became a school teacher. Many patients are not that fortunate and spend years pursuing a dizzying array of operations that are never successful.

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N arcissism in the Classical Sense: A Factor in Body Dysmorphic Disorder Surgeons have a tendency to label patients with BDD, and many other difficult patients, as narcissistic. The DSM-IV-TR defines narcissistic personality disorder as a preoccupation with an exaggerated sense of self-importance, brilliance, or beauty. But who was Narcissus? Ovid’s Metamorphoses notes that Narcissus was the son of the nymph Liriope. Anxious to know if her son would live to see a ripe old age, she consulted the seer Tiresias. The prophet answered, “If he never knows himself.” Seeing his reflection in a pool of water, Narcissus was engulfed by the beauty of his own image. “He fell in love with an image without reality, and he mistook for reality what was only an image. Narcissus was held spellbound by himself and lay there motionless . . . gazing into his own eyes . . . the beauty of his face, the rosy glow on his snow-white skin, and he admired all that he saw. . . . Foolishly he longed for himself. . . . So Narcissus, pining with love, wasted away and was gradually consumed by the fire of love buried within him. . . . Narcissus laid his weary head upon the green grass as death closed the eyes that wondered at the beauty of the sight that held them.” Narcissus, filled with “such chill pride,” was unable to establish an authentic relationship, and instead became captivated and eventually destroyed by the illusory beauty of his own reflection. In I Don’t Want to Talk About It, therapist Terrence Real agrees with the Renaissance philosopher, Marsilio Ficinio, that Narcissus suffered not from an overabundance of self-love but rather from a deficiency of it. The myth of Narcissus is a parable about the absence of self-esteem. Rather than an internal sense of preciousness and value instilled by his parents, Narcissus formed his sense of himself entirely from the external: his beautiful appearance. In this way, he is no different from the man who only believes that he has self-worth when he earns more money than I do, or drives a bigger car, or performs more rhinoplasties. Like anyone addicted to reflected glory, Narcissus cannot break free, even at the cost of his own life. As such, Narcissus is not self-obsessed; rather he is imageobsessed.

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Put some of your unhappy patients in this context. I believe that many of the patients who seek one cosmetic procedure after another or one rhinoplasty touchup after another, who are never quite happy but never quite able to articulate why, are searching for a sense of self-worth that surgery cannot provide. The operation is irrelevant. These patients see themselves as imperfect and worthless because their noses are not perfect. They unconsciously believe that once the surgical correction is made, an internal sense of self-worth will appear. This, it seems to me, is narcissism in the classical sense, and it explains not only why the surgery is not helpful but why entire families concur that the problem is surgical and not psychological. It is not uncommon for families to share the same mistaken beliefs about selfesteem, because parenting values continue from generation to generation unless someone breaks the pattern. Traditional socialization teaches young women that self-worth depends on appearance, whereas it teaches young men that self-worth depends on performance. In each case the filter is external, and so something internal is always missing.

Patient Ten This young woman underwent rhinoplasty when she was a college student; at that time I had been in practice for only 2 years.

Preoperative

10 years postoperatively

A very bright young woman, she went on to practice law and then abandoned it to help her husband in his business. She suffered chronically from clinical depression that did not respond to a change in careers.

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7 years postoperatively

10 years after the initial surgery

Periodically she would call to ask about revisions, an idea that I always discouraged despite the fact that she had received advice about “easy touch-ups” from other surgeons. Some 20 years after her rhinoplasty, she committed suicide. Nothing external in this woman’s life apparently created a suffici t sense of self-worth. I have listened to the histories of many unhappy patients and others treated for BDD; virtually every one used the words, “I was never quite good enough,” or “I always felt that there was something wrong with me.” “I must have surgery,” one patient confided, “because inside I am fundamentally flawed.”

T he Incidence of Body Dysmorphic Disorder in Private Practice Some years ago I reviewed the records of 50 consecutive primary rhinoplasty patients and 75 consecutive secondary rhinoplasty patients whom I had seen in consultation, in addition to 200 consecutive secondary patients on whom I had performed rhinoplasty. My staff and I looked for the following primary and secondary personality traits as we saw them: normal, depressed, demanding, perfectionistic, undiagnosed but real surgical problem, functional problem, minimal defect, and, finally, no insight. This last trait is notoriously characteristic of patients with BDD.

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Primary and Secondary Personality Characteristics of 200 Consecutive Operated Secondary Rhinoplasty Patients Personality Trait

Number

Percent*

Primary Characteristics Unremarkable Undiagnosed surgical pathology Perfectionistic Functional airway pathology Depressed Demanding Minimal defect No insight

81 51 25 18 9 8 8 0

41 26 13 9 5 4 4 0

Secondary Characteristics Functional airway pathology Depressed Demanding Perfectionistic Undiagnosed surgical pathology Minimal defect No insight Unremarkable

103 48 30 27 21 15 7 2

52 24 15 14 11 8 4 1

*Percentages may exceed 100 because numbers were rounded off.

Personality Characteristics of 325 Rhinoplasty Patients

Personality Trait

Unremarkable Undiagnosed surgical pathology Perfectionistic Functional airway pathology Depressed Demanding Minimal defect No insight

50 Primary Rhinoplasty Patients Seen in Consultation (%)

75 Secondary Rhinoplasty Patients Seen in Consultation (%)

200 Secondary Rhinoplasty Patients (%)

50 16 10 14 0 8 0 2

7 36 19 7 4 11 5 12

41 26 13 9 5 4 4 4

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We rated our patients according to their most prominent primary and secondary personality characteristics. For example, if a patient had a functional problem but was also depressed, each characteristic was listed according to its dominance. When both primary and secondary traits were pooled, 61% of secondary rhinoplasty patients had functional problems that justified their unhappiness, and 37% had an undiagnosed pathologic condition that was treatable and directly related to their chief complaints. However, 29% of these patients were depressed, 27% were perfectionistic, 19% were demanding, and 4% had apparent BDD that I did not perceive before surgery. As expected, secondary rhinoplasty patients as a whole were more demanding and perfectionistic and had more minimal defects than primary rhinoplasty patients. They also had more undiagnosed deformities (but fewer functional problems, surprisingly). Although 12% of secondary rhinoplasty patients seen in consultation had no insight into their BDD, most were eliminated before surgery. Four percent of the operated secondary rhinoplasty patients later showed signs of BDD. Finally, even the primary rhinoplasty patients are not a “safe” group: 2% had no insight and therefore saw something I did not. So what was my rationale for operating on that 4%? Examining their records, in each case I made a diagnosis of perfectionism, depression, or a functional problem that I believed justified the surgery. In focusing on the surgical deformity, I overlooked the BDD.

A Survey of 1000 Consecutive Rhinoplasty Patients Some patients may have BDD, but equally troublesome are those who are disruptive and consume unusual amounts of staff and surgeon time. How common are they? To determine this, I reviewed the records of 1000 consecutive rhinoplasty patients: 78% women and 22% men, 35% primary and 65% secondary rhinoplasty patients, which was my consistent demographic over the years. Patients were rated for their impact on the practice (that is, the level of disruption they caused) and on their insight.

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Of 1000 patients, 9.1% were taxing, disruptive, narcissistic, or needy, and 2.5% had no insight into their behavior; thus 11.6% were deemed difficult patients. Within the 11.6% who were labeled difficult, men were disproportionately represented: among the disruptive or needy patients, 30% were men, and of those with BDD, 40% were men. However, men represented only 22% of the total population. Other surgeons have made the same observation (Gorney, 2006). As was identified in the survey, even primary rhinoplasty patients can be disruptive or have BDD. Of all the disruptive or needy patients, 6.5% were primary rhinoplasty patients; of all the patients with no insight (or BDD), 5% were primary rhinoplasty patients. According to these data, therefore, if you perform only primary rhinoplasty, your chances of having a patient with BDD are 0.5%. If you also perform secondary rhinoplasty and your practice composition and diagnostic skills resemble mine, your chances are 4.5% of encountering a patient with BDD. However, 11.6% of your rhinoplasty patients will require extra time from you and your staff.

P utting It All Together My current thesis is this: The degree of difficulty that patients demonstrate to surgeons and staff is partly related to their narcissism in the true sense of the word. Their self-worth is not internal but rather dependent on appearance. The conversion to BDD, in many cases, is related to childhood trauma. There is recent corroborating evidence to support my theory (Didie et al, 2006). The particularly troublesome subset of these difficult patients is the love addicts, as defined by Pia Mellody (1992): those unfortunate persons whose childhood experiences have engendered poorly functioning adults who cannot value themselves; who have poorer protective capacities (boundaries); who have distorted senses of reality (“My nose is abnormal; therefore I am worthless”); who have difficulty with self-care (particularly during the postoperative course) as well as with living and behaving moderately. In surgical situations, love addicts see the surgeon as a rescuer and therefore place unrealistic expectations not only on the surgeon but also on the effect that rhinoplasty will have on their lives. Preoperatively and postoperatively, these patients may experience an emotional high. As one patient told me, “I am never as happy as when I am recovering from cosmetic surgery.” However, when the “rescue” does not occur, the fantasy transforms into victim anger and fear of abandonment, not just by the patient but by the plastic surgeon as well. The patient may plan how to entice the surgeon to operate again and reestablish the relationship,

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leave and find another surgeon, begin a secondary addiction (just as one of these patients did to alcohol), or think of ways to retaliate, through the medical boards, the Internet, destruction of personal property, or even bodily harm. Many of these patients demonstrate and recount significant relational trauma and self-esteem issues that lead them to multiple surgeries, endless revisions, unhappiness with the result, anger against the surgeon, a sense of betrayal, and sometimes a desire to “get even”—hence the importance of recognizing language and behavior that connote victim anger.

W ho, Then, Are the Surgical Candidates? Determining who are candidates for surgery is, of course, the critical question. Although screening surveys have proved useful in some dermatologic practices, I have not had the same experience in my practice. Even those developed by experts are too easily discovered by the patients: for my own practice, the questions are too transparent, and many patients will not admit that their distress level is as high as it feels, because they are seeking surgery, not psychiatric treatment, and therefore will not risk disqualifying themselves. However, there is a bigger issue: a decision to operate cannot rest simply on the size of the deformity—that is, if the deformity is large, surgery is always indicated, but if it is “slight” (in DSM-IV-TR language), surgery is not indicated. Not every patient unhappy with prior surgery has BDD and, conversely, some patients who may have BDD seem reasonable, even charming, but are still not candidates for surgery. Therefore I believe it is most useful to use criteria that extend beyond the patients’ level of distress and even the magnitude of their deformities. Any decision to operate must reflect both the surgical problem and the rapport between patient and surgeon. Independent of the magnitude of the deformity or the emotions that may be felt by the patient or the surgeon are the answers to the following five questions: 1. Can I see the deformity? This question eliminates delusional patients, or patients whose problem shows only in “certain lights and certain mirrors in my house” and may be a clue to the patient for whom the nose has become a physical manifestation of an internal imperfection. 2. Can I fix it? This criterion will vary from surgeon to surgeon and must be based on operative experience and ease in correcting specific problems. 3. Can I manage the patient? A patient who is unacceptably nervous, impossible to examine, or unwilling to comply with preoperative and postoperative instructions is a poor candidate, even if all other conditions are met.

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4. If there is a complication, will the patient remain controlled and cooperate with treatment? No patient enjoys a complication, but there are those who, although disappointed, quietly understand and will await the proper time for revision. There are others who become hysterical, angry, disruptive, or accusatory and want an immediate correction. Most surgeons can sense with accuracy which patients fall into which groups. I know from experience that the personal stress of operating on the latter group and anticipating the outcome if something goes wrong is agonizing. More than that, patients whose emotions are poorly controlled are in no position to withstand the additional trauma of surgery. 5. Does the patient accept the margin of error inherent in surgery? In dealing with patients with BDD, perfectionists, or those biased by a previous negative surgical experience, this is the most important criterion. Some patients (and even some surgeons) have unrealistic views concerning the degree to which any surgeon can control wound healing; the quality and availability of building materials, the patient’s immune competence, or myriad other factors, currently known and unknown, that influence surgical outcomes. Even more important, a patient’s willingness to accept the imperfection that is inherent in surgery is a willingness to accept the imperfection that is inherent in being human. Finally, acceptance of postoperative imperfection indicates recognition that surgeons themselves are not perfect. This last recognition flies in the face of one of the strongest beliefs held by love addicts: that there is, somewhere out there, a savior who can correct what is wrong in the patient’s life and create self-esteem. Failure to accept the fifth criterion is an absolute contraindication to elective aesthetic surgery, in my opinion. Unless I can answer “yes” to each of these questions, I will not operate.

Conclusion BDD is a troublesome disease. Because patients and their families are generally unaware of the disordered thought processes associated with it, BDD is extremely difficult to treat once surgery has been performed. BDD is common enough that every plastic surgeon will encounter it. My experience has generated the hypothesis that BDD is the result of narcissism, compounded in many instances by childhood trauma or abuse, which correlates with the increased incidence in other family members. Does the degree of childhood trauma correlate with the severity of symptoms of BDD? At present, I do not know. But I do believe that you cannot have BDD if you have self-esteem.

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However, BDD is only one end of the spectrum. There are other difficult patients who are still not surgical candidates, even though they do not meet the criteria for BDD. Ultimately the decision to operate is a personal one between the patient and the surgeon. It depends on the ability of the surgeon to make the diagnosis, his or her comfort with its correction, and the personality characteristics of the individual patient and surgeon. To that end, there is no substitute for taking the time needed during the initial patient interview, because rhinoplasty is brain surgery.

BIBLIOGRAPHY Allen F, Pincus HA, First MB (Chair, Vice-Chair, Editor). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), 4th ed. (text revision). Washington, DC: American Psychiatric Association, July 2000. Andreasen NC. Dysmorphophobia: symptom or disease? Am J Psychiatry 134:673-676, 1977. Bernstein DP, Fink L. Childhood Trauma Questionnaire: A Retrospective Self-Report (CTQ). San Antonio: Harcourt Assessment, 1998. Bernstein DP, Fink L, Handelsman L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 151:1132-1136, 1994. Bienvenu OJ, Samuels JF, Riddle MA, et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry 48:287-293, 2000. Book HE. Psychiatric assessment for rhinoplasty. Arch Otolaryngol 94:51-55, 1971. Borah G. Psychological complications in 281 plastic surgery practices. Plast Reconstr Surg 104:12411246, 1999. Brown J, Cohen P, Johnson JG, et al. Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. J Am Acad Child Adolesc Psychiatry 38:1490-1496, 1999. Brunswick RM. A supplement to Freud’s “History of an Infantile Neurosis.” Int J Psychoanal 9:439-476, 1928. Buhlmann U, Wilhelm S, McNally RJ, et al. Interpretive biases for ambiguous information in body dysmorphic disorder. CNS Spectr 7:435-443, 2002. Byram V, Wagner HL, Waller G. Sexual abuse and body image distortion. Child Abuse Neglect 19:507510, 1995. Carter LS. Katharine Phillips ’87: shedding light on BDD. Dartmouth Med, Spring 2001, pp 60-64. Castello JR. Body dysmorphic disorder and aesthetic surgery: case report. Aesthetic Plast Surg 22:329331, 1998. Clarkson P, Stafford-Clark D. Role of the plastic surgeon and psychiatrist in the surgery of appearance. Br J Med 2:1768-1771, 1960. Cole RP, Shakespeare V, Shakespeare P, et al. Measuring outcome in low-priority plastic surgery patients using Quality of Life indices. Br J Plast Surg 47:117-121, 1994. Constantian MB. Closed rhinoplasty: current techniques, theory, and applications. In Mathes SJ, Hentz VR, eds. Plastic Surgery, vol 2, 2nd ed. Philadelphia: Elsevier, 2006, p 565. Constantian MB. Relationship between patient and surgeon. In Goldwyn RM, Cohen MN, eds. The Unfavorable Result in Plastic Surgery, 3rd ed. Lippincott Williams & Wilkins, 2001, p 940. Crerand CE, Franklin ME, Sarwer DB. Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg 118:167e-180e, 2006. Crisp AH. Dysmorphophobia and the search for cosmetic surgery. Br Med J 282:1099-1100, 1981.

1450

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Davis J, Petretic-Jackson PA, Ting L. Intimacy dysfunction and trauma symptomatology: long-term correlates of different types of child abuse. J Trauma Stress 14:63-79, 2001. Deckersbach T, Savage CR, Phillips KA, et al. Characteristics of memory dysfunction in body dysmorphic disorder. J Int Neuropsychol Soc 6:673-681, 2000. Didie ER, Tortolani CC, Pope CG, et al. Childhood abuse and neglect in body dysmorphic disorder. Child Abuse Negl 30:1105-1115, 2006. Dinis PB. Psychosocial consequences of nasal aesthetic and functional surgery: a controlled prospective study in an ENT setting. Rhinology 36:32-36, 1998. Doheny K. Cosmetic surgeries don’t always end in a smile. Los Angeles Times, August 21, 1998. Drapeau M, Peny JC. Childhood trauma and adult interpersonal functioning: a study using the core conflictural relationship theme method. Child Abuse Negl 28:1049-1066, 2004. Dufresne RG. A screening questionnaire for body dysmorphic disorder in a cosmetic dermatologic surgery practice. Dermatol Surg 27:457-462, 2001. Edgerton MT. Plastic surgery and psychotherapy in the treatment of 100 psychologically disturbed patients. Plast Reconstr Surg 88:594-608, 1991. Evans E, Hawton K, Rodham K. Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse Negl 29:45-58, 2005. Ficino M. Commentary on Plato’s symposium on love (translated by Jayne S). Dallas TX, Spring, 1985. Gipson M, Connoly FH. The incidence of schizophrenia and sincere psychological disorders in patients 10 years after cosmetic rhinoplasty. Br J Plast Surg 28:155-159, 1975. Glasgold AI. Psychological effects of rhinoplasty. J Med Soc N J 81:187-189, 1984. Goin JM, Goin MK. Changing the Body: Psychological Effects of Plastic Surgery. Baltimore: Williams & Wilkins, 1981. Goin MK. Psychological understanding and management of rhinoplasty patients. Clin Plast Surg 4:3-7, 1977. Goldwyn RM. Beyond Appearance: Reflections of a Plastic Surgeon. New York: Dodd, Mead, 1986. Goldwyn RM. The dissatisfied patient. In Goldwyn RM, Cohen MN. The Unfavorable Result in Plastic Surgery, 3rd ed. Philadelphia: Lippincott, 2001, pp 8-13. Goldwyn RM. The Patient and the Plastic Surgeon, 2nd ed. Boston: Little Brown, 1991. Goldwyn RM. Why we fail. In Goldwyn RM, Cohen MN, eds. The Unfavorable Result in Plastic Surgery, 3rd ed. Philadelphia: Lippincott, 2001, pp 3-7. Gorney M. Professional and Legal Considerations in Cosmetic Surgery. In Sarwer DB, Pruzinsky T, Cash TF, et al, eds. Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery. Philadelphia: Lippincott, 2006, pp 315-327. Groves JE. Taking care of the hateful patient. N Engl J Med 298:883-887, 1978. Guggenheim FG. Body dysmorphic disorder. In Sadock BJ, Sadock VA, eds. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, vol 1, 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2000, pp 1527-1531. Guyuron B. Patient satisfaction following rhinoplasty. Aesthetic Plast Surg 20:153-157, 1996. Hadley SJ, Kim S, Priday L, et al. Pharmacologic treatment of body dysmorphic disorder. Prim Psychiatry 13:61-69, 2006. Hanes KR. Neuropsychological performance in body dysmorphic disorder. J Int Neuropsychol Soc 4:167-171, 1998. Haraldsson PO. Psychosocial impact of cosmetic rhinoplasty. Aesthetic Plast Surg 23:170-174, 1999. Harris D. The benefits and hazards of cosmetic surgery. Br J Hosp Med 41:543-545, 1989. Hauptfuhrer F. Face to face with a nose? Asks Desmond Morris—look closely, it may be telling you something. People 25:57-61, 1986. Hay GG. Psychiatric aspects of cosmetic nasal operations. Br J Psychiat 116:85-97, 1970. Haybashi K, Miyachi H, Nakakita N, et al. Importance of a psychiatric approach in cosmetic surgery. Aesthet Surg J 27:398-401, 2007. Hinderer UT. Dr. Vazquez Anon’s last lesson. Aesthetic Plast Surg 2:375-382, 1978. Hodgkinson DJ. Identifying the body-dysmorphic patient in aesthetic surgery. Aesthetic Plast Surg 29:503-509, 2005.

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Hollander E. Body dysmorphic disorder. Psychiatr Ann 223:359-364, 1993. Hollander E, Allen A. Beauty is in the eye of the beholder: new insights in imagined ugliness. Prim Psychiatry 13:37-38, 2006. Honigman RJ. A review of psychological outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg 113:1229-1237, 2004. Ishigooka J, Iwao M, Suzuki M, et al. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin Neurosci 52:283-287, 1998. Jakubietz M, Jakubietz RJ, Klose DF, et al. Body dysmorphic disorder: diagnosis and approach. Plast Reconstr Surg 119:1924-1930, 2007. Josephson SC. Obsessive-compulsive disorder, body dysmorphic disorder and hypochondriasis: three variations on a theme. CNS Spectr 1:24-31, 1996. Kaplan HI. Somatoform disorders. In Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry/VI, 6th ed. Baltimore: Williams & Wilkins, 1995, p 1268. Kearney-Cooke A, Striegel-Moore RH. Treatment of childhood sexual abuse in anorexia nervosa and bulimia nervosa: a feminist psychodynamic approach. Int J Eat Disord 15:305-319, 1994. Klassen A, Jenkinson C, Fitzpatrick R, et al. Patients’ health-related quality of life before and after aesthetic surgery. Br J Plast Surg 433-438, 1996. Knorr NJ. Feminine loss of identify in rhinoplasty. Arch Otolaryngol 96:11-15, 1972. Kurtz RM. Sex differences and variations in body attitudes. J Consult Clin Psychol 33:625-629, 1969. Last U, Moses S, Mahler D. Mental health correlates of valid perception of nasal deformity in female applicants for aesthetic rhinoplasty. Aesthetic Plast Surg 7:77-80, 1983. Leonardo J. New York’s highest court dismisses BDD case. Plast Surg News July:1-9, 2001. Macgregor FC. Facial disfigurement: problems and management of social interaction and implications for mental health. Aesthetic Plast Surg 14:249-257, 1990. Mancini C, Van-Ameringen M, Macmillan H. Relationship of childhood sexual and physical abuse to anxiety disorders. J Nerv Ment Dis 183:309-314, 1995. Marcus P. Psychological aspects of cosmetic rhinoplasty. Br J Plast Surg 37:313-318, 1984. Marcus P. Some preliminary psychological observations on narcissism, the cosmetic rhinoplasty patient and the plastic surgeon. Aust N Z J Surg 54:543-547, 1984. McElroy SL, Phillips KA, Keck PE Jr, et al. Body dysmorphic disorder: does it have a psychotic subtype? J Clin Psychiatry 54:389-395, 1993. Mellody P, Freundlich LS. The Intimacy Factor: The Ground Rules for Overcoming the Obstacles to Truth, Respect, and Lasting Love. New York: HarperCollins, 2003. Mellody P, Miller AW, Miller JK. Facing Love Addiction: Giving Yourself the Power to Change the Way You Love. New York: HarperCollins, 1992. Moses S. After aesthetic rhinoplasty: new looks and psychological outlooks on postsurgical satisfaction. Aesthetic Plast Surg 8:213-217, 1984. Muhlbauer W, Wood DL, Home C. The Thersites complex in plastic surgical patients. Plast Reconstr Surg 107:319-326, 2001. Newell R. Attitude change and behaviour therapy in body dysmorphic disorder: two case reports. Behav Cogn Psychother 22:163-169, 1994. Ovid’s Metamorphosis II: Echo and Narcissus (translated by Hendricks RA). In Hendricks Rhoda A. Classical Gods and Heroes: Myths as Told by the Ancient Authors. New York: William Morrow, 1974, p 339. Phillips KA. Body dysmorphic disorder: diagnosis and treatment of imagined ugliness. J Clin Psychiatry 57(Suppl 8):61-65, 1996. Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry 148:11381149, 1991. Phillips KA. Body dysmorphic disorder. In Oldham JM, Riba MB, eds. Review of Psychiatry Series, No 20. Somatoform and Factitious Disorders. Arlington, VA: American Psychiatric Publishing, 2001. Phillips KA. The Broken Mirror—Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press, 2005. Phillips KA. Letter to the editor. Am J Psychiatry 149:577-578, 1992.

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Phillips KA. Letter to the editor. Am J Psychiatry 149:719, 1992. Phillips KA. Psychosis in body dysmorphic disorder. J Psychiatr Res 38:63-72, 2004. Phillips KA, Coles M, Menard W, et al. Suicidal ideation and attempts in body dysmorphic disorder. J Clin Psychiatry 66:717-725, 2005. Phillips KA, Diaz SF. Gender differences in body dysmorphic disorder. J Nerv Ment Dis 185:570-577, 1997. Phillips KA, Dufresne RG. Body dysmorphic disorder: a guide for dermatologists and cosmetic surgeons. Am J Clin Dermatol 4:235-243, 2000. Phillips KA, Grant J, Siniscalchi J, et al. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 42:504-510, 2001. Phillips KA, Kim JM, Hudson JI. Body image disturbance in body dysmorphic disorder and eating disorders—obsessions or delusions? Psychiatr Clin North Am 18:317-334, 1995. Phillips KA, McElroy SL. Insight, overvalued ideation and delusional thinking in body dysmorphic disorder: theoretical and treatment implications. J Nerv Ment Dis 181:699-702, 1993. Phillips KA, McElroy SL, Keck PE Jr, et al. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 150:302-308, 1993. Phillips KA, McElroy SL, Keck PE Jr, et al. A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacol Bull 30:179-186, 1994. Powley KR. Brochure for Neysa Jane Body Dysmorphic Disorder Fund. Real T. I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression. New York: Scribner, 1997, p 43. Richter MA, Tharmalingam S, Burroughs E, et al. A preliminary genetic investigation of the relationship between body dysmorphic disorder and OCD. Neuropsychopharmacology 29(Suppl 1):S200, 2004. Robin AA. Reshaping the psyche: the concurrent improvement in appearance and mental state after rhinoplasty. Br J Plast Surg 152:539-543, 1988. Rosen JC. Development of the body dysmorphic disorder examination. Behav Res Ther 34:755-766, 1996. Roth RS, Lowery JC, Davis J, et al. Psychological factors predict patient satisfaction with postmastectomy reconstruction. Plast Reconstr Surg 119:2008-2015; discussion 2016-2017, 2007. Ruffolo JS, Philips KA, Menard W, et al. Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance. Int J Eat Disord 39:11-19, 2006. Ruhlmann U, McNally RJ, Wilhelm S, et al. Selective processing of emotional information in body dysmorphic disorder. J Anxiety Disord 16:289-298, 2002. Sarwer DB. Awareness and identification of body dysmorphic disorder by aesthetic surgeons: results of a survey of American Society of Aesthetic Plastic Surgery members. Aesthet Surg J 22:531-535, 2002. Sarwer DB. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg 101:1644-1649, 1998. Sarwer DB. Female college students and cosmetic surgery: an investigation of experiences, attitudes and body image. Plast Reconstr Surg 115:931, 2004. Sarwer DB. Mental health histories & psychiatric medication usage among persons who sought cosmetic surgery. Plast Reconstr Surg 114:1927-1935, 2004. Savage CR, Deckersbach T, Wilhelm S, et al. Strategic processing and episodic memory impairment in obsessive compulsive disorder. Neuropsychology 14:141-151, 2000. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl 20:709-723, 1996. Slator R. Are rhinoplasty patients potentially mad? Br J Plast Surg 45:307-310, 1992. Slator R. Rhinoplasty patients revisited. Br J Plast Surg 46:327-331, 1993. Slaughter JR, Sun AM. In pursuit of perfection: a primary care physician’s guide to body dysmorphic disorder. Am Fam Physician 60:1738-1742, 1999. Smith TW. The selection of patients for rhinoplasty. Arch Otolaryngol 94:56-58, 1971. Stewart EJ. Assessment of patient’s benefit from rhinoplasty. Rhinology 34:57-59, 1996.

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Stroomer JWG. The effects of computer simulated facial plastic surgery on social perception by others. Clin Otolaryngol 23:141-147, 1998. Terino E. Psychology of the aesthetic patient: the value of personality profile testing. Facial Plast Surg Clin North Am 16:165-171, 2008. Thomas CS. Appearance, body image and distress in facial dysmorphophobia. Acta Psychiatr Scand 92:231-236, 1995. Thomas JR. Analysis of patient response to preoperative computerized video imaging. Arch Otolaryngol Head Neck Surg 115:793-796, 1989. Tobin HA. The less-than-satisfactory rhinoplasty: comparison of patient and surgeon satisfaction. Otolaryngol Head Neck Surg 94:86-95, 1986. Veale D. Outcome of cosmetic surgery and “DIY” surgery in patients with body dysmorphic disorder. Psychiatr Bull 24:218-221, 2000. Veale D, Boocock A, Gournay K, et al. Body dysmorphic disorder: a survey of fifty cases. Br J Psychiatry 169:196-201, 1996. Vilar-Sancho B. Present and future of rhinoplasty: an editorial. Aesthetic Plast Surg 9:181-184, 1985. Waller G, Hamilton K, Rose N, et al. Sexual abuse and body image distortion in the eating disorders. Br J Psychiatry 32:350-352, 1993. Wenninger K, Heiman J. Relating body image to psychological and sexual functioning in child sexual abuse survivors. J Trauma Stress 11:543-562, 1998. Wright MR. How to recognize and control the problem patient. J Dermatol Surg Oncol 10:389-395, 1984. Wright MR. The male aesthetic patient. Arch Otolaryngol Head Neck Surg 113:724-727, 1987. Wright MR. Management of patient dissatisfaction with results of cosmetic procedures. Arch Otolaryngol 106:466-471, 1980. Yaryura-Tobias JA, Neziroglu F, Torres-Gallegos M. Neuroanatomical correlates and somatosensorial disturbances in body dysmorphic disorder. CNS Spectr 7:432-434, 2002.

1454

INDEX A Aesthetics frontal view, 292-293 history-taking about, 320-326 inferior view, 297-299 lateral view, 295-296 male, 359-365 oblique view, 294 theoretical, 280-286 African-heritage patients; see also Black patients perpendicular plate of ethmoid in, 16 retention of characteristics, 360 Airflow dynamics, 135 geometric mean, 146 internal valvular incompetence and, 72 nasolabial angle effects on, 47 Airstream, 136 Airway nostril flaring to support, 143 postsurgical improvements in, 134 restoration, 1148-1151 size determinants, 138 study of, 145-150, 157 surgical effects on, 137-138, 151-156 surgical techniques for correcting septoplasty; see Septoplasty spreader graft tunnels, 516-519 Airway obstruction case studies, 176-177 causes description, 137 excessive nasal length, 757 lateral nasal wall movement, 157 nasal valves, 752-754 osteotomy, 758 overshortening, 756 septal deviation, 158 tip support loss, 754-755 turbinates, 345, 758

creation of, 134 iatrogenic, 752-754 internal valve collapse, 141 nose blowing with, 175 postoperative, 752-758 sites of, 149 Alar base flaps, 1102-1111 Alar bases, 1372-1373 Alar cartilages anatomy, 9, 29-44, 80-81 arches, 695, 862 axial rotation, 30 cephalic edge, 7 crushed, 761 domes, 7, 921 dorsum height effects on, 67 external valvular competence and, 139 knuckling, 499 lateral crus; see Lateral crus malposition case studies, 195, 198-207, 10911092 characteristics, 245 definition, 191 importance, 189 incidence, 192, 244 narrow middle vault and, 178-179 medial crus; see Medial crus middle crus; see Middle crus reduction, 311, 1064, 1152 surgical treatment, 498-503 tip projection and, 89, 358 Alar hollows, 201 Alar rims adjustment, 1226 cleft side, 1317 columella and, 67 loss of support, 1152 thin skin and, 1239 Alar wall description, 15 stabilization, 168-170

Alar wall grafts case study, 1143 conchal cartilage, 212 positioning, 362 Alar wedge external and vestibular excess, 544-547 external excess, 542-543 overresection, 547-548 resection, 540-541, 1247 subtypes, 542-548 Allergies, 819 Alloplastics description, 820 maxillary augmentation using, 11201123 Anatomic variants alar cartilage malposition; see Alar cartilages, malposition case studies, 232-250 defining, 188-189, 404-407 illustration, 190 importance, 189 inadequate tip projection; see Tip projection, inadequate incidence, 192, 211, 244 low radix; see Radix, low narrow middle vault; see Middle vault, narrow Anatomy overview, 4-5 questions regarding, 465 simplicity, 4 skin, 12-14 Anesthesia general, 470 local, 472-478 Angle of divergence, 34 Angle of rotation, 35, 37 Angry patients, 1099-1101 Anterior mask rhinomanometry, 146 Antibiotics, 557 Anxious patients, 381, 469

I-1

INDEX

Apicis nasi, 14-15 Armenian patients, 1000-1003 Artifacts dorsal resection, 483-484 skeletonization, 479-483, 686 Asian patients perpendicular plate of ethmoid in, 16 radix in, 228 rhinoplasty considerations, 1018-1026 upper lip carriage in, 50 Asymmetry, 46 Aufricht retractor, 488, 551 Autogenous maxillary augmentation, 1117-1119 Averageness, 289 B Bacterial infection, 816 Ball tip case studies, 911-920 definition, 34, 41 lateral crura malpositioning and, 167 Basal plane, 5-6 Base; see Nasal base Bayonets, 468 Benzoine contact allergies, 819 Bipedicle flap dissection of lateral crus with arch interruption, 506 surgical technique for, 504-506 Bipedicle flaps, 430 Black patients case studies, 1003-1004, 1005-1008, 1014-1017 neoclassical canons in, 287 upper lip carriage in, 50 Blue sheet, 383-388 Body dysmorphic disorder age of onset, 1419 case studies, 1405-1418, 1421-1426 characteristics, 1418-1420 comorbidities, 1420 delusional variant in, 1419 description, 1403-1404 emotional perfectionism, 1426 heritability, 1419 incidence, 1444-1446 key factors in determining, 1420 obsessive-compulsive disorder and, 1418-1420, 1426 patient’s perspective on, 1436-1441 prevalence, 1419 relational trauma and, 1427-1429 self-esteem and, 1238 summary, 1449 surgical dissatisfaction rate and, 1420 traits of patients with, 1444-1446 Body image, 319-320, 1364

I-2

Bony vault anatomy, 15-16, 74-77 examination, 347 irregularities in, 758 midface three-dimensionality and, 7576 narrow, 16 reduction of, 485 tip grafts and, 851 in traumatized crooked nose, 954 upper lateral cartilage position and, 74 width, 74-75, 367 Boxy tip case studies, 904-910 definition, 34, 899-900 inadequate tip projection and, 904910 lateral crura malpositioning and, 167 malpositioning, 903 Buttress, tip grafts with, 676-677, 913, 1184 C Calvarial bone grafts, 820, 1027, 11331143, 1218 Cartilage; see Alar cartilages; Upper lateral cartilages; specific cartilage Cartilaginous roof dissection, 159 resection, middle vault and, 28, 70, 194 spreader grafts in, 159 Caucasian patients neoclassical canons in, 287, 1004 upper lip carriage in, 50 Caudal septum deflection, 528-531 midline, 718 surgical adjustments, 491-496 Caudal support graft, 1112-1115 Cavernous hemangioma, 1146 Chinese patients, 287 Circulatory problems, 810-811 Cleft lip, 228, 782, 920, 1316-1337 Closed approach, 55 Cocaine-soaked cotton, 476 Codependents, 1428 Columella alar rim and, 67 augmentation, 704-706 discontinuity, 375 examination, 347 local anesthesia, 474 loss, 810 dorsal reduction and, 66, 675 resection, 865, 1201 retraction, 706 superior tip lobule and, 698-703 thinning, 1356

Columella-lobular junction, 35 Columellar grafts, 555-556, 932 Columellar scar, 1338, 1340, 1344-1346, 1350 Columellar struts correction of deformity created by, 720-725, 1342-1344, 1347-1348 description, 706 Complex deformities, 1364-1391 Complications airway obstruction, 752-758 alar cartilages, 761 allergies, 819 calvarial bone grafts, 820 circulatory problems, 810-811 coping with, 1449 damaged dermis, 769-771 dorsum, 759-760 excessive nose length, 757 frontal asymmetry, 760 graft absorption, 798-803 graft–soft tissue match, 763-768 hemorrhage, 815 hyperpigmentation, 821 infection, 816-818 lacrimal duct injury, 819-820 middle vault, 758-759 overshortening, 756 pink tip, 814 radix grafts, 790-791 red tip, 812-813 rhinitis, 809 septum collapse, 808-809 perforation, 804-806 synechiae, 807 tip grafts, 792-797 tip support loss, 754-755 Composite grafts from alar lobule, 1163-1164 axial orientation, 1171-1176 case studies, 369, 373, 1178-1184 coronal orientation, 1160-1163, 11671170 donor sites alar lobule, 1163-1164 problems in, 1165-1166 external use of, 1177 functions, 1154 harvesting, 203, 373, 1155-1159 indications for, 1154 in men, 1181-1184 postoperative care, 1166 sagittal orientation, 1177 secondary rhinoplasty and, 11521184 Computer imaging, 380 Concha bullosa, 174

INDEX

Conchae, 1025 Conchal cartilage grafts; see also Ear cartilage dorsal grafts alar wall, 212 case studies, 591-599 characteristics, 582 costal cartilage versus, 600 harvesting anterior approach, 583-587 complications during, 584 description, 203, 1157 incisions, 584 posterior approach, 587-589 insertion preparation for, 590 trimming, 236 Consultation blue sheets, 383-388 body image, 319-320 closing, 388 details, 342 overview, 318-319 patient’s goals, 319 photographs from patients, 326-341 plan discussions; see Surgical plan risk discussions, 381 Controlling patients, 381-382 Cooperation, 347-348 Costal cartilage grafts case studies, 617-621 description, 600; see also Rib cartilage grafts harvesting, 1261 Cottle dorsal scissors, 489 Cottle maneuver, 344 Cottle periosteal elevator, 483, 585, 1119, 1122 Cotton packs, 476-477 Crooked nose, traumatized approaches to, 952-953 bony vault, 954 case studies, 955-974 lower cartilaginous vault, 954 strategies for, 953 upper cartilaginous vault, 954 Cymba conchae, 203 D Depressor septi, 14-15 Dermis, 769-771 Diagnosis for primary rhinoplasty, 256-264 for secondary rhinoplasty, 10881095 Difficult patients, 382 Dilator naris, 14-15 Disruptive patients, 1446-1447 Distress, 1403 Donor sites, for grafts, 411-412

Dorsal grafts case studies, 154, 197, 203, 361, 372, 374, 377, 652-664 ear cartilage; see Ear cartilage dorsal grafts harvesting, 203, 377, 401, 602, 861, 1204 imbalances corrected with, 652-664 indications for, 634-639, 652-664 insufficient augmentation, 788-789 internal nasal valve and, 148, 163165 layered, 651 middorsal notch treated with, 73 nasal length affected by, 10 nasal narrowing using, 1194 nasal tip affected by, 10 onlay use, 1115 overshortened nose and, 756 postoperative problems, 772-789 radix grafts and, 648 rib, 610-612 supratip deformity and, 197, 375, 672 technique for, 649-652 visibility, 780-784 Dorsal height alar cartilage and, 67 increasing, 369 internal valvular competence and, 139 nasal base and, 408 nasal length and, 10-11, 633, 648 rib cartilage grafts and, 76 Dorsal hump, 491, 828, 845, 1022, 1047 Dorsal line case studies, 1209, 1362 description, 7 ear cartilage graft and, 205 middle crural length and, 36 nasal base and, 18 radix changes and, 20 shortening, 20 Dorsal plane, 5-6 Dorsal reduction case studies, 211, 303, 332, 898, 1253 columellar position and, 66 destabilization after, 409-410 false assumptions about, 56-63, 60 frontal balance and, 293 internal valvular incompetence and, 1292 inverted-V deformity and, 1089 lateral crural modification, 858 low radix and, 358 middle vault and collapse, 194 resection, 25 nasal base size and, 312 nasal length and, 10, 66-68, 241, 272

osteotomy and, 871 septal grafts and, 222 sequelae, 1091 shortening of nose after, 241, 272, 367, 425 surgical technique, 483-491 tip reduction and, 691 Dorsal resection, 483-491, 855, 1191 Dorsum augmentation septal grafts for, 261 tip grafts for, 227, 663 contour, 78-80, 340 convex, 78-80 deformities, 1191-1206 high, 256 low, 846-850, 1217; see also Radix, low nasal base size and, 313 skeletonization, 1245 straight, 91, 864-876 supratip, 88-89 tip and, 66-69 E Ear cartilage dorsal grafts; see also Conchal cartilage grafts description, 163, 411, 793, 1016 dorsal line smoothing, 205 harvesting site, 207 instruments for, 469 middle vault deformities and, 12141216 Ear cartilage tip grafts, 1141 Egyptian patients, 997-999 Elevators, 468 Emotional perfectionism, 1426 Endonasal approach advantages, 697, 722, 1185 description, 54-55, 265-268 secondary rhinoplasty indications for, 1185 Ethmoid buttress, 913 Ethnic characteristics restoration, 638 retention, 321, 340, 360, 400, 996 Ethnic rhinoplasty, 991-1034 Armenian patient, 1000-1003 black patients, 1003-1004, 1005-1008, 1014-1017 definition, 991 Egyptian patient, 997-999 Jewish patients, 996 Latino patients, 992-995, 1260 Middle Eastern patients, 996 southern Asia patients, 1018-1026 surgical plan considerations, 991 Thailand patients, 1026-1029

I-3

INDEX

Examination external, 346-347 intranasal, 342-346 nasal valves, 342-344 septum, 344-345 turbinates, 345-346 External examination, 346-347, 1099 External nasal valve anatomy, 138 collapse description, 43 examination for, 343-344 examination, 342-344 incompetence, 44 alar cartilages’ effect on, 139 case studies, 166-173 Cottle maneuver, 344 in graft-depleted patients, 1186 lateral crus cephalic rotation and, 142 reconstruction, 148-149, 161 stability, 47 Eye protection, 470 F Facial analysis neoclassical canons, 287-289 rhinoplasty applications, 290-291 Facial attractiveness, 289 Facial telangiectasias, 812 False Assumptions, 56-63 Family controlling types, 382 reassuring, 469 risks discussed with, 381 Feedback, 423 Fentanyl, 470 Filler grafts, 697 Forceps, 468, 523 Frazier suction, 520 Frontal asymmetry, 760 Frontal view aesthetics, 292-293 photography, 270 Frontonasal dysplasia, 1329-1333 G General anesthesia, 470 Golden Ratio, 289 Grafts absorption, 798-803 adherence over, 762 alar wall; see Alar wall grafts autografts, 622 calvarial bone, 820, 1027, 1133-1143, 1218 columellar, 555-556, 932

I-4

composite; see Composite grafts conchal cartilage; see Conchal cartilage grafts crushing, 643-644 donor sites, 411-412 dorsal; see Dorsal grafts lateral crural, 511 logic, 568 postoperative problems, 772-803 prioritizing specimens, 622-623 requirements for, 410-411 soft tissue match, 763-768 spreader; see Spreader grafts thinning, 762 tip; see Tip grafts visibility, 780-784 Guarantees, 382 H Handedness, 110 Harvesting composite grafts, 203, 373, 1155-1159 conchal cartilage grafts anterior approach, 583-587 complications during, 584 description, 203, 1157 incisions, 584 posterior approach, 587-589 dorsal grafts, 203, 377, 401, 602, 861 ear cartilage dorsal grafts, 207 rib cartilage grafts, 601-610, 989, 1113 septal cartilage grafts, 332, 339, 377, 426, 568-569 Hemangioma, 1372 Hemorrhage, 815 Hemostasis, 586, 606-607 Heuristic learning, 422 Hinge, 15, 30 Hispanic patients, 50; see also Latino patients History aesthetics, 320-326 rhinology, 320 secondary rhinoplasty, 1098-1099 Hooked nose, 39-40, 227 Hooks, 468 Hyperpigmentation, 821 I Implants L-shaped, 69, 1305 reconstruction in patients with, 13041315 silicone, 1025 Inadequate tip projection; see Tip projection, inadequate

Incisions access, 413 description, 478 inframammary, 602 intercartilaginous, 402, 480, 498, 550, 649, 810 Killian, 158, 518-519 rib cartilage graft harvesting, 601-610 skeletonizing, 480 transfixing, 491-496, 529, 655 Infection, 816-818 Inferior turbinates, 345 Inferior view, 297-299 Inframammary incisions, 602 Inspiration nasal sidewall movement, 140 presurgical evaluation, 140 Inspired air heating, 135-136 relative humidity, 135 speed, 140 Instruments, 467-469 Interalar width, 288 Intercanthal width, 281 Intercartilaginous incision, 402, 480, 498, 550, 649, 810 Internal nasal valve air speed through, 136 anatomy, 24, 138 collapse airflow and, 141 examination, 343-344 dorsal height and, 139 examination, 342-344 incompetence after dorsal reduction, 1292 Cottle maneuver, 344 description, 72 dorsal grafting and, 163-165, 664 in graft-depleted patients, 1186 predisposition for, 754 short nasal bones and, 141, 159 spreader grafts for, 625 narrowing, 25 obstruction, 28 reconstruction, 161 shape, 24 stability, 159 Interview, 1098 Intraoperative photography, 272-277, 424 Inverted-V deformity case studies, 195, 198, 428, 1089, 1194, 1259 illustration, 70, 74 as middorsal notch, 72 Isoflurane, 470

INDEX

J Jewish patients, 996 Joseph elevator, 1118-1119 Joseph scissors, 495, 530, 609, 669, 705 Judgment, surgical, 422-423 K Keystone area, 20-21 Killian incision, 158, 518-519 Killian septal forceps, 523 Knife, 468 Knuckled tip, 218, 921-926, 1222 L Lacrimal duct injury, 819-820 Lagophthalmos, 470 Laryngeal mask airway, 470 Lateral crus anatomy, 24, 41 axis, 41-44 bipedicle flap dissection with arch interruption, 506 technique for, 504-506 cephalic rotation definition, 191 description, 43-44, 142-143, 160, 167 concave, 41 convex, 41 dissection, 881 flat, 41 function, 499 graft, 511 malpositioned case studies, 168-173, 410, 762, 831, 1153, 1228-1229, 1233, 1241, 1351 presentation, 515 relocation, 790 resection and replacement, 507-512 rotating as flaps, 513-516 normal width, 81 orthotopic, 515 relocation, 450, 458-459, 940 repositioning, 199, 405, 879, 888, 915, 926 resection, 7 retrograde dissection, 503-504 splinting of deficient area, 506 surgical treatment, 503 tip contour and, 901-902 undulating, 41, 44 as valve, 42-43 width, 81, 513 Lateral light reflex, 8, 16 Lateral nasal wall airstream and, 136 movement, 157

Lateral plane, 5-6 Lateral view aesthetics, 295-296 photography, 271 Latino patients, 992-995, 1260; see also Hispanic patients Left brain cultivation of, 109 deception by, 121-131 nasal characteristics affected by, 124 open rhinoplasty and, 109 Levator labii superioris alaeque nasi, 1415 Light reflexes, 5-8 Limen nasi, 138 Lip cleft, 228, 782, 920, 1316-1337 upper ethnically appropriate carriage, 5051 lengthening of, 1271 nasal base and, 45 retrusion, 985, 1116 Local anesthesia, 472-478 Long nose, 944; see also Nasal length case studies, 93-99 options for, 92 Love addicts, 1427-1430, 1447-1448 Lower cartilaginous vault, 954 Low radix; see Radix, low L-shaped implants, 69, 1305 M Maxillary arch, 475 Maxillary augmentation alloplastic, 1120-1123 autogenous, 1117-1119, 1328 case studies, 212, 354, 412, 1124-1132 Maxillary retrusion, 85, 1117 Medial crus anatomy, 31-33 excess, 499 function, 31, 499 grafts augmentation uses, 31 length, 38 retraction, 31 rib graft for support, 500-501 short, 32 Men aesthetics in, 359-365 composite grafts in, 1181-1184 postoperative course in, 974 rhinophyma in, 1067-1080, 1181-1184 rhinoplasty in, 974-990, 1018-1026 supratip deformity in, 1248-1251 Methicillin-resistant Staphylococcus aureus, 817-818

Middle crus excess, 499 function, 499 length alar cartilage structure and, 29 dorsal contour and, 35 lobular height and, 38 nasal length and, 39 tip grafts and, 35, 39 tip projection and, 33, 35 long, 36 resection, 502 short illustration, 35 tip grafts and, 39-40 Middle Eastern patients, 996 Middle turbinates examination, 345 polypoid degeneration, 174 Middle vault cephalic end, 880 collapse airflow effects, 72 cartilaginous roof resection and, 28, 70 description, 832 dorsal resection and, 194 functional effects, 72 skin thickness and, 26 spreader grafts to prevent, 71 deformities, 1207-1219 depression, 451 dorsal components, 70-72 examination, 347 lateral components, 70-72 narrow after cartilaginous roof resection, 194 airway obstruction and, 176 alar cartilage malposition and, 178179 case studies, 194-200, 428, 441-449, 877-883, 1207-1219 characteristics, 245 criteria for, 191 description, 28, 160, 188-189 dorsal grafting for, 598 incidence, 192, 244 spreader grafts for, 196, 219 resection during dorsal reduction, 25 widening, 407 Middorsal line, 1273 Middorsal notch anatomy, 72-73 case studies, 195, 367, 758 Midface bony vault and, 75 projection increases, 1203

I-5

INDEX

Midpupillary level, 221, 256 Millard’s rotation-advancement cheiloplasty, 255-256 Mucoperichondrial flaps, 522 Musculature, 14-15 Musculus apicis nasi, 14-15 Musculus depressor septi, 14-15 Musculus dilator naris, 14-15 Musculus levator labii superioris alaeque nasi, 14-15 Musculus nasalis pars alaris, 14-15 Musculus nasalis pars transversa, 14-15 Musculus zygomaticus minor, 14-15 N Narcissism/narcissistic personality disorder, 1442-1443, 1447 Narrow tip, 921-926 Nasal base anatomy, 83-85 in Asians, 228 bridge height and, 312-313 caudal rotation, 745 contours, 45 deformities, 1220-1235 dorsal height and, 408 dorsal line and, 18 dorsal reduction and, 312 flatness, 1223 large, 641, 936-944 maxillary retrusion and, 85 narrow, 281 radix and, 296, 642 rotation, 1110 secondary rhinoplasty for, 1093 septal loss and, 84 short, 927-932 surgical adjustments, 491-496 tip projection and, 86, 88, 295 upper lip and, 45 Nasal bones length description, 21-22, 24 internal nasal valve stability and, 141, 159 in older patients, 1035 upper lateral cartilage avulsion, 28 Nasal bridge nasal base and, 312-313 straight, 326 undulating, 856-863 Nasalis pars alaris, 14-15 Nasalis pars transversa, 14-15 Nasal length alteration, 756-757 case studies, 275, 1292-1303, 1293 dorsal height and, 10-11, 633, 648

I-6

dorsal reduction and, 66-68, 241, 272 excessive, 757 increasing case study, 99-103 spreader grafts for, 633 middle crural length and, 39 tip projection and, 92 Nasal planes, 5-8 Nasal retractors, 467 Nasal root, 119 Nasal shortening after dorsal reduction, 241, 272, 367, 425 case studies, 93-99, 1297-1299 options for, 92, 496 Nasal sidewalls collapse, 234, 343 dorsal resection and, 484 local anesthesia, 473 movement, 139-140 stiffness after airway correction, 150 Nasal skeleton false assumptions and, 60-61 functions, 63 Nasal specula, 467 Nasal spine resection, 496 subnasale shaping by, 51 Nasal wall lateral, 15 movement, 138 Nasofacial angle, 855, 1214 Nasolabial angle acute, 47 obtuse, 47 Neoclassical canons, 287-289, 1003, 1025 Neoteny, 289 Nose air conditioning by, 135 blood flow, 136 crooked; see Crooked nose, traumatized dynamic nature, 56 equilibrium, 63-65 external examination, 346-347 facial width and, 1004 inner layer, 9 interrelationships, 56, 61 muscles, 14-15 narrow, 353, 877-883 outer layer, 9 overshortening, 756 patient complaints about, 56 physiology, 135-145 regions of, 61 respiratory resistance, 135 rigidity, 1360

short, 933-935 shortening; see Nasal shortening skin of, 12-14 soft tissue contractility, 57-60 structural layers, 9 tension, 933 wide, 884-892 Nose blowing, 175 Nostril(s) composite grafts and, 207 deformities, 1154 diameter, 49 flaring, 143, 155, 193, 343, 654, 937 size, 541 tip lobule and, 48, 297, 540 O Oblique view aesthetics, 294 photography, 271 Obsessive-compulsive disorder, 14181420, 1426 Older patients anatomic characteristics, 1035 primary rhinoplasty, 1035-1043 rhinophyma, 1067-1080, 1181-1184 secondary rhinoplasty, 1044-1051 Onlay grafts, 954 Open approach advantages, 266, 1346 complications, 1338-1340 deformities from, 1338-1364 description, 54 disadvantages, 267, 1346 left-brain dominance of, 109 principles, 499 for secondary rhinoplasty, 1097 Operative order, 466-467 Osteotomes, 468 Osteotomy airway obstruction and, 758 exceptions to, 539 indications for, 535, 831 intranasal, 538 repeat, 1202 technical details, 535-539 Overshortening, 756 P Packing, 557-562 Panchondritis, 1094-1095 Partial inferior turbinectomy, 534 Patients aesthetic goals, 349-358 age, 349 angry, 1099-1101, 1433-1434 anxious, 381, 469

INDEX

asking questions, 329 body dysmorphic disorder; see Body dysmorphic disorder controlling types, 381-382 cooperation, 347-348 difficult, 382 discussions with, 337 disruptive, 1446-1447 expectations, 1190 goals deformity relative to, 392-403 description, 319, 349-358 photographs supplied by, 326-341 positioning, 470 postoperative anxiety, 736 rapport with, 347-348 risks discussed with, 381 selection criteria for, 348 as surgical candidates, 1448-1449 unhappy, 821-822 Peck graft, 699 Perichondrial strips, 616, 619 Perpendicular plate of ethmoid, 16 Phenomenology, 351, 1088-1095 Phenylephrine, 815 Phi, 289 Photography consent for, 269 documentation uses, 268 facial expressions during, 270 frontal views, 270 inferior view, 271 intraoperative, 272-277, 424 lateral view, 271 oblique view, 271 office procedure for, 269-270 overview, 268-269 from patients, 326-341 Pink tip, 814 Plan; see Surgical plan Planning parameters overview, 300 skin thickness and distribution, 300307 tip lobular contour, 308-312 Positioning patients, 470 Postoperative complications; see Complications Postoperative period changes in, 738-743 difficulty for patients, 736 early changes, 744-747 first visit, 737-738 instructions, 737 sequences description, 425 skeletal changes, 425-428

skin sleeves, 436-441 soft tissue changes, 429-436 tissue limits, 449-461 value, 736 Preoperative envelope, 415-416 Preoperative examination; see Examination Propofol, 470 Prostheses, reconstruction in patients with, 1304-1315 R Radix anatomy, 16, 18-20 in Asians, 228 graft preparation, 485 high, 20, 216, 851-855 ideal, 18 local anesthesia and, 472 low case studies, 195, 201-232, 441-449, 449-461, 836-845, 1090 characteristics, 245 description, 18, 20, 188-189 dorsal reduction and, 358 inadequate tip projection and, 208232 incidence, 192, 211, 244, 845 skin thickness evaluations, 226 at midpupillary level, 221, 256 nasal base and, 296, 642 Radix grafts case studies, 264, 304, 405, 460, 640648, 1006 crushed, 643-644 defect shape and, 644-646 donor materials, 643 dorsal grafts and, 648 illustration, 623 indications for, 634-639 layered, 838, 913 in men, 981 nasal base size reduced by, 241 nasal length affected by, 11 postoperative problems, 790-791 prevalence, 648 principles, 643-648 shortness, 646-648 sizing, 646-648 technique for, 551-553 width, 646-648 Rapport, 347-348 Rasps, 467 Red tip, 812-813 Reduction rhinoplasty, 255; see also Dorsal reduction Refinement, 4-5

Relational trauma, 1427-1429 Retractors, 467, 488 Retroussé, 326, 349, 918, 974, 1017 Revisions, 383 Rhinitis, 175, 346, 809 Rhinology history, 320 Rhinophyma, 1067-1080, 1181-1184 Rhinoplasty assumptions regarding, 54 candidates for, 1448-1449 difficulties associated with, 55-56, 254-277, 318, 464 disequilibrium after, 63 goals, 45, 280, 290, 392 in men, 974-990 uniqueness, 465-466 Rib cartilage grafts banking, 608-609 case studies, 153, 362, 368, 617-621 crushing, 613 donor scars for, 602-608 donor sites, 609-610, 1199-1206 dorsal grafts, 610-612 dorsum elevation using, 76 harvesting, 601-610, 989, 1113, 1193 indications for, 616-617 instruments for, 468 maxillary augmentation uses, 412 medial crural support using, 500-501 modification methods, 612-613 ninth rib, 604 principles, 600-601 split rib technique, 616 stresses, 601 techniques, 613-617 tenth rib, 604 Right brain cognitive shift to, 110-118 developmental slowing, 123 learning to access, 110-118 rhinoplasty strategy and, 118-120 theory regarding, 108-110 Risks, 381 Rongeurs, 468 Rotation-advancement cheiloplasty, 256 S Saddle nose, 62, 665, 847 Scissors, 468, 489 Scooped profile, 349 Secondary rhinoplasty alar base flaps, 1102-1111 calvarial bone graft, 1133-1143 caudal support graft, 1112-1115 composite grafts; see Composite grafts diagnosis in, 1088-1095 donor site depletion, 1097, 1185

I-7

INDEX

Secondary rhinoplasty—cont’d endonasal approach for, 1185 history-taking for, 1098-1099 interview before, 1098 maxillary augmentation; see Maxillary augmentation nasal examination before, 1099 nostril deformities, 1154 in older patients, 1044-1051 open approach for, 1097 patient attitude assessments before, 1099-1101 phenomenology in, 1088-1095 planning guidelines for, 1101 primary rhinoplasty versus, 1096-1101 skin excision, 1144-1151 tissue tolerance, 1096-1097 Segmental method, 698-703 Self-esteem, 1238, 1427 Septal angle, 1112 spreader grafts and, 633 tip projection and, 90, 209, 1216 Septal cartilage grafts case studies, 100, 226, 260-261, 377, 395, 568-581 caudal, 222 crushing, 670, 1040 harvesting, 332, 339, 377, 426, 568 as spreader grafts, 628-629 Septal deviation airway obstruction caused by, 137, 158 examination for, 344 high, 550, 760, 1058, 1124, 1192, 1233, 1358 postoperative, 1272 Septal scissors, 468 Septoplasty, 355, 843 airway clearance and, 895 caudal septal deflection, 528-531 indications for, 518 Killian incision for, 518-519 mucosal tears during, 527 spreader graft tunnels before, 519 technical elements, 519-528 Septum anatomy, 82, 158 asymmetrical edge, 633 caudal deflection, 528-531 surgical adjustments, 491-496 collapse, 62, 84, 808, 1270-1291 deformities, 393 dorsal border resection, 487-488 examination, 344-345 height losses, 82 nasal base affected by, 84

I-8

palpation, 344, 476 perforation, 804-805 racial differences, 569 tip positioning and, 69 Sexual dimorphism, 289, 359 Short nasal base, 927-932 Short nose, 933-935; see also Nasal length Silhouette images, 119 Silicone implants, 1025 Simulator, 422 Sinus headaches, 175 Skeleton, postoperative changes in, 425428 Skeletonization, 479-483, 686, 1245 Skin anatomy, 12-14 contraction, 226, 284, 300 excision in secondary rhinoplasty, 1144-1151 middle vault collapse and, 26 texture changes in, 58 thick, 14, 916, 1059-1066, 1260-1269, 1353 thickness case studies, 916, 1059-1066 contraction, 300 description, 833 internal valvular competence and, 141 low radix and, 226 nasal shape relative to, 408 planning affected by, 300-307 thin, 13, 797, 1052-1058, 1239, 12601269 Skin sleeve case studies, 436-441 contraction, 57, 63 description, 54, 291 graft supports for, 886 large, 936-944 limitations, 460 thickness, 216 volume, 291 Soft tissue contractility, 57-60, 220, 284, 464 examination, 347 in older patients, 1035 postoperative changes, 429-436 thickness, 916, 1292 Southern Asia patients, 1018-1026 Splint, 562 Spreader grafts asymmetrical, 984 in cartilaginous roof, 159, 172, 194 case studies, 219, 224, 304, 356, 374, 431, 439, 460, 624-633, 774

creation, 624-633 illustration, 273, 623 indications for, 625 internal nasal valves supported by, 148 length, 633 materials used as, 630 middle vault indications case studies, 219, 224 concavity realignment, 71 narrow middle vault, 196 widening, 407 nasal lengthening using, 633 septal angle and, 633 septal cartilage as, 628-629 technique for, 548-550 thickness, 874 Spreader graft tunnels, 516-519 Staff, 382 Staging, 414 Straight dorsum, 91, 864-876 Subcuticular sutures, 1078 Submucoperichondrial dissection, 626 Subnasale, 51, 1112, 1222 Suction-assisted lipectomy, 258 Suction catheter, 559-560 Supraorbital ridge continuity, 16-17 Supratip deformity case studies, 160-161, 197, 201, 206, 375, 776, 1240-1260, 1352 cephalad redraping, 378 definition, 1239 description, 57 dorsal grafts for, 197, 375, 672 historical approaches to, 1248 inadequate tip projection and, 1244 in men, 1248-1251 postoperative, 665 Supratip dorsum, 88-89 Surface planes, 5-8 Surgeon-patient relationship, 822 Surgery candidates for, 1448-1449 caudal septum, 491-496 dorsal resection, 483-491 eye protection during, 470 general anesthesia, 470 incisions; see Incisions instruments, 467-469 local anesthesia, 472-478 markings before, 472 nasal base adjustments, 491-496 operative order, 466-467 positioning, 470 preparing patient, 469-470 skeletonization, 479-483 surgeon’s preparation table, 471-472

INDEX

transfixing incision, 491-496 upper lateral cartilage shortening, 496-498 Surgical judgment, 422-423 Surgical plan access incisions, 413 aesthetic goals, 349-358 anatomic variants, 404-407 constructing, 414 deformity relative to patient’s goals, 392-403 destabilization by reduction phase, 409-410 discussion and agreement on, 348 ethnic considerations, 991 explaining, 366-379 formulating, 349-358, 392-414 functional deficits, 409 grafts donor sites, 411-412 requirements, 410-411 incisions, 413 male aesthetics, 359-365 nasal shape relative to surface parameters, 408 order of the operation, 414 staging, 414 Symmetry, 289 Synechiae, 807 T Tape contact allergies, 819 Teaching postoperative sequences; see Postoperative period, sequences sequential intraoperative photographs and, 424 Telangiectasias, 812 Tennison-Randall triangular flap, 256 Tension nose, 933 Thailand patients, 1026-1029 Theoretical aesthetics, 280-286 Thick skin, 14, 916, 1059-1066, 1353; see also Skin, thickness Thin skin, 13, 797, 1052-1057, 1239 Tip aesthetics, 308 alar rim–columella relationship and, 67 angle of rotation and, 37 angularity, 667 asymmetrical, 1264 ball case studies, 911-920 definition, 34, 41 lateral crura malpositioning and, 167

blunt, 302 boxy case studies, 904-910 definition, 34, 899-900 inadequate tip projection and, 904910 lateral crura malpositioning and, 167 malpositioning, 903 dorsal grafting effects on, 11 dorsum and, relationship between, 66-69 examination, 347 ideal, 33 knuckled, 218, 921-926, 1222 lobular shape, 33 local anesthesia and, 474 loss of support, 754-755 narrow, 921-926 pink, 814 reconstruction options, in graftdepleted patients, 1186 red, 812-813 reduction, 60, 847 symmetry, 667 Tip-defining point, 311 Tip grafts absorption, 335 bony vault and, 851 with buttress, 676-677, 1184 case studies, 680-696 complications, 726-728 crushed, 333, 335, 396, 402, 502, 623, 702, 838, 863, 891, 1242 dorsal augmentation with, 227, 663 ear cartilage, 1141 ethmoid buttresses, 667 illustration, 623 indications for, 91, 197, 204, 212-213 lobular contour affected by, 38, 656 middle crural lengthening through, 35, 39 nasal balance alterations using, 685689 overcorrection, 679, 714-719 overprojection using, 712-713 postoperative problems, 792-797 rib cartilage, 368 secondary, 459 short nasal base and, 932 with solid cartilage, 672-675 technique for, 554-555, 664-672, 678679 tip contour and, 940 tip lobular size and, 297 trimming, 262, 274

type change produced using, 690-692 visibility, 726-728, 797 vomer buttresses, 667 Tip lobule asymmetry, 46 augmentation, 456, 1371 best possible, 48-49 columellar strut–induced deformity, 720-725 contour, 308-312, 656, 693-696, 901902 contracted, 204 inferior augmentation, 704-706 middle crural length and, 36 narrowing, 282 nasal shape relative to, 408 nostril and, balance between, 48, 297, 540 poorly shaped, 309 ratio for, 48-49 shape, 257 superior, 698-703 tip graft effects on, 297 well-shaped, 310 Tip projection adequate, 89, 892 alar cartilages and, 89, 358 cartilage strength and, 892 case studies, 275, 357 definition, 86, 89 determinants, 29, 33 inadequate boxy tip and, 904-910 case studies, 208-232, 441-449, 449461, 892-899 characteristics, 245 description, 36, 86 importance, 189 incidence, 192, 211, 244, 894 lobular fill for, 708-711 low dorsum and, 1217 low radix and, 208-232 supratip deformity and, 1244 tip grafts for, 197 increases in, 357, 407 L-shaped implants and, 69 middle crural length and, 35 nasal base size and, 86, 88, 295 nasal length affected by, 92 overprojection and tip grafts, 712-713 septal angle and, 90, 209, 1216 septal sutures and, 69 skin thickness and, 1060 supratip dorsum and, 88-89 tip contour and, 902 traits, 899

I-9

INDEX

Tip suturing, 1346 Transfixing incision, 491-496, 529, 655 Transposition flap, 1107 Transverse reflex, 7-8 Traumatized crooked nose approaches to, 952-953 bony vault, 954 case studies, 955-974 lower cartilaginous vault, 954 strategies for, 953 upper cartilaginous vault, 954 Turbinates anatomy, 174 crushing, 174, 346, 533-534 enlargement, 532 examination, 345-346, 1099 functions, 345 obstruction, 174 outfracture, 533-534 Turbinectomy airway obstruction and, 758 description, 149, 157, 346 partial inferior, 534 philosophy, 532

I-10

rhinitis after, 175 technique, 534 U Undulating nasal bridge, 856-863 Unhappy patients; see also Body dysmorphic disorder case studies, 1405-1418, 1431-1441 description, 821-822 as narcissists, 1442-1444 Upper cartilaginous vault anatomy, 15, 22-24, 70-72 roof, 27 short nasal bones and, 21-22 in traumatized crooked nose, 954 Upper lateral cartilages air inspiration through, 25 anatomy, 22 aponeurosis of, 24 avulsion from nasal bones, 28 bony vault effect on, 74 caudal margin, 24 destabilizing, 409 fusing to cartilaginous septum, 23

separation, 487, 890 shortening, 429, 496-498 sutures to, for tip positioning, 69 as valves, 24-27 Upper lip ethnically appropriate carriage, 50-51 lengthening, 1271 nasal base and, 45 retrusion, 985, 1116 V Valves; see External nasal valve; Internal nasal valve Vasomotor rhinitis, 175 Venturi effect, 140 Vomerectomy, 526 W Wegener’s granulomatosis, 84 Wide nose, 884-892 Z Zygomaticus minor, 14-15

Introduction The Politics of Entertainment War on Trump War on America Immigration War on White People Film and Television Liaison Offices Climate Change Sports “News” Late-Night Comedy Shows Award Shows Feminism The LGBT Agenda Sexual Deviants Crimes Inspired by Hollywood Conclusion Copyright Info

Introduction A lot of people say, “I don’t follow politics,” but the reality is that pop culture is politics. It’s woven into the fabric of movies, television shows, music—and now even professional sports. Just as art imitates life, life imitates art, and what is often seen as mere “entertainment” actually functions as a container to deliver carefully crafted pieces of propaganda intended to influence the audience as much as it is to entertain them. Millions of people practically worship celebrities and blindly follow their lead, imitating characters’ hair styles, the way they dress, and even their attitudes and behaviors. People subconsciously absorb ideas and actions they see in the media and regurgitate them as part of their own personalities. While many celebrities engage in political activism as a hobby during their off time, the more subtle power of Hollywood is using entertainment itself to influence. The ability to influence is a tool, and tools can do great things for humanity, but in the wrong hands easily turn into weapons. In the 1980s, The Cosby Show brought a nice upper middle class Black family into the homes of millions of Americans, depicting the husband as a doctor and the wife as a lawyer, changing the way many looked at the possibility of Black people achieving higher education and making a better life for themselves. 1 For Generation X kids who grew up during this time period we watched He-Man and GI Joe cartoons which always taught a valuable lesson, either through the plotline, or a brief PSA at the end. “So now you know, and knowing is half the battle!” Shows like Family Ties and Growing Pains often tackled serious issues kids and families sometimes faced, and as cheesy as those shows may seem today, by the end of the episode there was an obvious moral to the story that undoubtedly, however subtle, affected millions of people in a positive way. And while there are still plenty of nice family shows on television today, they are surrounded by landmines consisting of the most degenerate characters and perverted plots one could imagine—shows so vile just a

generation ago it would have been unthinkable that major networks would air such content. A strategic and relentless campaign by LGBT activists has saturated television shows, movies, and even commercials with gay, lesbian, and transgender characters which is the sole reason they have become normalized in the minds of the masses. Despite denying there was a “gay agenda,” you’ll see that well-funded and highly organized groups have been lobbying Hollywood studios to promote and celebrate such characters. 2 America went from having one television per household in the 1950s —prominently placed in the family room—to children as young as seven or eight years old carrying their own TV around in their pocket and being able to watch practically anything they want with virtually no adult supervision. 3

So not only has there been a stunning drop in the moral quality of content in recent years, the safeguards to prevent children from consuming it have all but vanished as well. Joshua Meyrowitz, professor of Media Studies at the University of New Hampshire, points out, “Television dilutes the innocence of childhood and the authority of adults by undermining the system of information control that supported them. Television bypasses the year-by-year slices of knowledge given to children. It presents the same general experiences to adults and to children of all ages. Children may not understand everything that they see on television, but they are exposed to many aspects of adult life from which their parents (and traditional children’s books) would have once shielded them.” 4 He continues, “Television and its visitors take children across the globe before parents even give them permission to cross the street.” 5 How true is that?! And he said this in a book I’ve had since college—a book published back in 1995 when the Internet was just in its infancy, and a decade before social media would begin to wrap its tentacles around an entire generation of children. Today, kids have access to unlimited adult content in the palm of their hand thanks to YouTube, Netflix, Snapchat and the rest. Parents don’t know what to do, and trying to shield children from inappropriate content in today’s online age would require living like the Amish. Pandora’s Box has been opened. Meanwhile, celebrities continue to speak out of both sides of their mouths—saying entertainment inspires, encourages, and teaches viewers

about life, while at the same time denying that it can influence anyone in a negative way. About 100 years ago a British film industry paper called Bioscope once wrote that movies were the Christian church’s “legitimate competitor in moulding the character of the nation.” 6 Since then, the Church has lost out, and it’s no longer a question of which institution has more influence. The majority of people don’t even realize what has happened. Professional hypnotherapist Dr. Rachel Copelan warned, “Most people drift into a common, everyday trance when they gaze into the light of the TV tube. Indirect hypnosis manipulates the minds of millions of unsuspecting viewers every day. Surreptitiously, subliminal persuasion leaves its mark upon the collective subconscious. Ideas implanted by commercials affect the health and behavior of all of us. We eat, drink, dress, and make love based on what we see and hear. Television has the power to lull the mind into a state of exaggerated suggestibility, opening it up to behavior control from the outside.” 7 Singer Miley Cyrus popularized “twerking” in 2013, a form of “dance” (if you can call it that) where girls rapidly shake their butt—an act that was instantly mimicked by millions of teens who now regularly post twerking videos on TikTok and Snapchat, etc. In the early 2000s we saw the “Jackass Effect”—where kids got hurt imitating the stunts they saw Johnny Knoxville and his friends doing on the popular MTV series. 8 A college football-themed film in 1993 called The Program had a scene edited out when it was later released on DVD because at one point several of the players decided to lay down in the middle of a busy highway at night to show how “brave” they were. Of course, several groups of teenagers imitated the scene which resulted in at least one death and numerous others getting seriously injured when they were struck by a car. 9 Edward Bernays, the man who is credited with being the father of public relations, was a 20th century genius who knew how to manipulate the media in order to shape public opinion around virtually any issue. He was hired by advertising agencies and even the U.S. government to deploy his methods for a variety of aims. 10 He’s the man responsible for diamond engagement rings being the cultural standard and even convinced women that smoking cigarettes was an act of defiance against the patriarchy. 11 The De Beers diamond monopoly and the tobacco industry paid him well for his ingenuity, and because of his knowledge of psychology and

mass media he was able to play the public like a fiddle through a series of cleverly crafted press releases and ad campaigns. In his 1928 book Propaganda , he admitted, “our minds are molded, our tastes formed, our ideas suggested, largely by men we have never heard of...in almost every act of our lives whether in the sphere of politics or business in our social conduct or our ethical thinking, we are dominated by the relatively small number of persons who understand the mental processes and social patterns of the masses. It is they who pull the wires that control the public mind, who harness old social forces and contrive new ways to bind and guide the world.” 12 He even went so far as to say that those in control of the media “constitute an invisible government which is the true ruling power of our country.” 13 Entertainment rules America. Charlie Sheen made it into the Guinness Book of World Records as the person to reach 1 million Twitter followers the fastest once joining. 14 Ellen DeGeneres set a world record for the most retweeted tweet after she posted a selfie taken with a group of other celebrities at the 2014 Oscars. 15 Music videos get more views than political speeches, and celebrities make more money while they sleep than police officers or fire fighters do risking their lives to keep their communities safe. The majority of media today functions as a modern-day equivalent of the “bread and circuses” of ancient Rome, where people were pacified by games and food at the Colosseum, so they weren’t paying attention to the collapsing empire around them. Karl Marx famously said that religion was the “opiate of the masses,” but really its entertainment. It’s television sitcoms, sports, and anything that streams. It’s the trending list on Twitter and the viral hashtags on Instagram. Entertainment is such a powerful medium for influencing people’s behavior that for several years the CIA actually secretly recruited and directed popular rappers in Cuba to write and perform “protest songs” denouncing their Communist leader Raul Castro in order to foment civil unrest and erode support for his regime. 16 It may seem like the plot out of a movie, but declassified documents obtained by the Associated Press years later show that’s exactly what they did. 17 The CIA had a budget of millions of dollars for this program and used a front company (which is commonplace) named Creative Associates International in order to conceal their activities. 18 They literally created a

talent agency to mold the music and careers of artists they thought could be used to influence Cubans to rise up against Raul Castro. 19 Similar operations have been run in America. Shortly after President Trump’s inauguration, the DJ Moby, who was fairly popular in the early 2000s, revealed that he had been in contact with “active and former CIA agents” who “confirmed” to him that Russia was “blackmailing” Trump and said they needed his help to get the word out. “So they passed on some information to me and they said, like, ‘Look, you have more of a social media following than any of us do, can you please post some of these things just in a way that…sort of put it out there.’” 20 Deep State operatives reaching out to celebrities hoping to use them to smear Donald Trump—and that’s just the tip of the iceberg. In this book you’ll learn in detail how the Hollywood elite are using their media conglomerates to wage a war on President Trump and his supporters, and not just by celebrities “speaking out,” but by incorporating countless anti-Trump themes into their projects. You’ll see who is behind the coordinated effort to promote climate change hysteria, how the entertainment industry was instrumental in getting the public to accept gay “marriage,” and how they are waging a war against traditional family values, American culture, and even against God Himself. The late Andrew Breitbart famously said that politics is downstream from culture, meaning if you want to change the laws in a country, you have to first change the culture. This saying became known as the Breitbart Doctrine because it captures the essence of power, propaganda, and politics and explains how many once fringe ideas and behaviors are now legally protected and any business, school, or landlord that dares to disagree can now be punished with the full force of the courts. Within these pages you’ll also learn that liberal Hollywood has some interesting bedfellows when it comes to promoting war, and you’ll be shocked to find that the U.S. government often works hand in hand with major studios to produce what essentially amounts to propaganda films; and why there has been an explosion in plots promoting mass immigration, abortion, and socialism. Not even sports coverage is immune from being turned into another mouthpiece for their agenda as the Left is now pulling out all of the stops hoping to succeed in their “cultural revolution.” Let’s now pull back the

curtain and take a look around behind the scenes of Hollywood Propaganda .

The Politics of Entertainment Television commercials try to sell you a product or a service despite the fact that most of the time the content of the commercials has nothing to do at all with what they’re actually selling. Celebrities drink a soda and react as if it gives them an orgasm. “Ahhh! Pepsi, the choice of a new generation” they say with a huge fake smile. Samuel L. Jackson shouts “What’s in your wallet!” as if it’s a punchline from a sitcom while he’s simply promoting a credit card. Ads for insurance featuring a caveman and a gecko are passed off as if they’re

characters from a recurring comedy series, and the list goes on. But it’s not just products or services that companies try to sell us through entertainment. It’s ideas. Hollywood propaganda is carefully woven into movies and TV shows with the intent of influencing the audience rather than merely entertain them. Sometimes the central plot serves as the propaganda which is coated in a thin layer of entertainment, but the writers and producers know, and often openly admit, what their true intentions are. Film critic James Combs wrote, “The term propaganda comes from the Latin propagare , denoting the ability to produce and spread fertile messages that, once sown, will germinate in large human cultures,” adding, “Removed from its pejorative connotation, propaganda may be viewed objectively as a form of communication that has practical and influential consequences,” and can “sway relevant groups of people in order to achieve their purposes.” 21 In the late 1980s a man named Jay Winsten, who worked as an associate dean at Harvard’s School of Public Health, launched a campaign to convince Hollywood producers to include messages about the dangers of drunk driving in TV shows along with the importance of using designated drivers. 22 It was called the Harvard Alcohol Project and soon the term “designated driver” was being used in shows like Cheers , L.A. Law , The Cosby Show , and countless others, catapulting it into the public lexicon. 23 Before the 1980s there wasn’t much of a social stigma against driving drunk, but with a persistent propaganda campaign from groups like the Harvard Alcohol Project and MADD [Mothers Against Drunk Driving], the country as a whole began thinking differently about the issue. More recently, special interest groups use their power to promote abortion, the gay agenda, Obamacare, climate change hysteria, and literally every one of their social justice crusades in the same way. But in these cases, instead of raising awareness for a public good, like stigmatizing drunk driving, they’re using their influence to push fringe political ideas into the mainstream and convince the masses to accept the most flagrant violations of morality and decency.

Social Impact Entertainment Today there are over 100 organizations dedicated to using entertainment to further political and social causes, and there’s even an Orwellian term for the propaganda they create—“Social Impact Entertainment.” In 2014 UCLA opened the Skoll Center for Social Impact Entertainment (SIE) which boasts to be “the first of its kind dedicated solely to advancing the power of entertainment and performing arts to inspire social change.” 24 The department is committed to “exploring innovative approaches to curricular development for the emerging field of social impact entertainment, but also provide students and faculty with workshops, lectures, distinguished visiting artists programs and unique opportunities to focus their scholarly and creative work in this arena.” 25 “It will launch research initiatives that explore the development of a new field in social impact entertainment research and practice; inspire students and faculty to use the power of story to make a difference and inspire social change; galvanize the public to action to foster positive social change; develop meaningful partnerships between the public and private sectors to create new models to drive social change; and engage local, national and global communities about how the industry impacts global society through film, television, animation, digital media and theater.” 26 In 2019 they released a report titled “The State of SIE” [Social Impact Entertainment] where they said, “Given the magnitude of today’s challenges—climate change, economic inequality, forced migrations and any number of other problems—it’s easy for people to get discouraged about their capacity to make a difference in the world. But as the case studies in this report reveal, SIE can play a critical role in catalyzing significant change.” 27 The report cited Al Gore’s documentary An Inconvenient Truth , which it said, “helped shift global opinions on climate change, one of the most contentious issues of our time, and mobilized a new generation of pioneering environmental activists.” 28

It appears that the Skoll Center for Social Impact grew out of another UCLA program which had the same goals called the Global Media Center for Social Impact (GMI) which was founded a year earlier in 2013. Sandra de Castro Buffington, who was the director of the program, said, “Topics that have been traditionally taboo are showing up on series television and they’re being discussed, especially via social media, and because of this they don’t seem so controversial anymore. When something goes from being taboo to being openly discussed, it’s a predictor of mass behavior change.” 29 An industry publication called Cinema of Change noted, “[The Global Media Center for Social Impact] provides the entertainment industry with free, on-demand access to leading experts and cutting-edge resources on topics such as health, immigration, racial justice, America’s prison crisis, the environment, LGBT/gender equality, learning and attention issues, youth sexuality, reproductive health and rights and more. From script reviews and writers’ room consultations to off-site visits and special events, GMI facilitates experiences for industry professionals that inspire them to create stories that entertain, engage, and empower viewers to make change on issues that matter to them.” 30 Their website, GMImpact.org is now defunct, and it appears they morphed into UCLA’s Skoll Center for Social Impact in 2014, which was created with a $10 million dollar donation by billionaire Jeffrey Skoll, who made his money as the first president of e-Bay.

The Center for Media & Social Impact A similar SIE organization is located in Washington D.C. at American University called the Center for Media & Social Impact (CMSI). They describe themselves as “an innovation lab and research center that creates, studies and showcases media for social impact. Focusing on independent, documentary, entertainment, and public media, the Center bridges boundaries between scholars, producers and communication practitioners across media production, media impact and effects, public policy and audience engagement. The Center

produces resources for the field and academic research; convenes conferences and events; and works collaboratively to understand and design media that matter.” 31 They receive funding through various grants and list some of those contributors on their website, including Bill Gates, the Rockefeller Foundation, the Ford Foundation, the National Endowment for the Arts, and Univision. In 2019 the Center for Media & Social Impact launched “Comedy Think Tanks” which aims to use comedy to promote social justice issues. The following year they released a report titled Comedy and Racial Justice in the Climate Crisis that “analyzes the value and importance of comedy for local public mobilization in climate change.” 32 The report highlights “the unique potential of social justice comedy” and suggests it be used as a “mobilization strategy, and as disruptive creative expression inserted into a broader cultural conversation about climate change, centering communities of color and low-income people who are ‘hit first and worst’ by climate disasters.” 33 It concludes, “Through the open-minded experience of co-creating with comedy professionals, social justice organizations can embrace the innovation and creativity that comedy can provide. Comedy can cut through cultural clutter, and it also entertains and invites feelings of play. This kind of light is needed in the climate movement, which can feel too complicated and difficult to engage disparate groups and communities beyond a stream of fatiguing outrage or clinical statistics.” 34

Propper Daley Propper Daley is another “social impact agency” which was founded by Greg Propper and Mark Daley, who are close associates to Hillary Clinton. Before helping start the agency, Greg Propper actually worked for the Clinton Foundation, and when Hillary was running for president in 2016, Propper Daley helped organized fundraisers for her,

bringing together stars like Leonardo DiCaprio, Tobey Maguire and others under the same roof. 35 Previously they had organized meetings with writers from TV shows like Parks and Recreation , How I Met Your Mother , and Glee , to sit down with Chelsea Clinton to discuss how they could help promote some of the Clinton Foundation’s initiatives. 36 Patti Miller, who worked for the foundation, admitted the meeting aimed to “bring together a cross section of the industry, with leading television comedy writers, hoping they can help us reach our audience with creative, funny content.” 37 In March 2019 Propper Daley held a private invite-only conference with 400 writers, producers and executives to discuss how they could use their positions to “think differently or with more nuance about certain characters or storylines and hopefully create a more empathetic public.” 38 In other words, to lobby them to include more pro-gay and transgender storylines, and promote mass immigration, abortion, and other Leftist causes through their work.

GLAAD GLAAD [the Gay and Lesbian Alliance Against Defamation] has been aggressively lobbying Hollywood for years to include gay and transgender characters in television series and films. One of their current aims is to pressure studios to include gay characters in 20% of films by the year 2021 and 50% of all films by the year 2024. 39 Each year they release their Studio Responsibility Index , a report where they track their progress and complain that mainstream entertainment isn’t gay enough. They even have what they call the “GLAAD Media Institute” that has drawn up a “roadmap for Hollywood to grow LGBTQ inclusion in film.” 40 Their 2018 Studio Responsibility Index says, “With wildly successful films like Wonder Woman and Black Panther proving that audiences want to see diverse stories that haven’t been told before, there is simply no reason for major studios to have such low scores…At a time when the entertainment industry is holding much needed discussions about inclusion,

now is the time to ensure the industry takes meaningful action and incorporates LGBTQ stories and creators as among priorities areas for growing diversity.” 41 It goes on, “Studios must do better to include more LGBTQ characters, and construct those stories in a way that is directly tied to the film’s plot…Far too often LGBTQ characters and stories are relegated to subtext, and it is left up to the audience to interpret or read into a character as being LGBTQ. Audiences may not realize they are seeing an LGBTQ character unless they have outside knowledge of a real figure, have consumed source material for an adaptation, or have read external press confirmations. This is not enough…Our stories deserve to be seen on screen just as much as everyone else’s, not hidden away or left to guess work, but boldly and fully shown.” 42 It’s really an open secret in Hollywood, but few people outside the industry are familiar with the intense (and very successful) lobbying efforts the organization engages in. Entertainment Weekly recently admitted that “GLAAD is changing Hollywood’s LGBTQ narrative—one script at a time,” and CEO Sarah Kate Ellis confirmed that as far back at the mid1980s, “we realized we needed Hollywood to be telling our stories to humanize LGBTQ people. So we opened a chapter very quickly in Los Angeles, in Hollywood, and really the main focus was lobbying Hollywood to tell our stories.” 43 I’ll cover this topic in more detail in “The LGBT Agenda” chapter because it’s one of the Left’s most aggressive efforts, and in the last few years they have successfully caused an influx of LGBT characters in major television series, and even convinced Disney and Sesame Street to get on board with their plans. 44

United Nations The United Nations has a special program called the Creative Community Outreach Initiative to lobby producers and celebrities to help them promote various agendas as well. In 2009 they convinced producers of NBC’s Law and Order: Special Victims Unit to make an episode about child soldiers who were brainwashed by the Lord’s Resistance Army in Uganda. 45 The U.N. also convinced ABC’s Ugly Betty

to incorporate the use of mosquito nets over beds to prevent the spread of malaria in Africa by having the lead character promote the (real) Nothing But Nets program which works to donate bed nets to people there. 46 The United Nations has even launched a campaign called “The Unstereotype Alliance” which has been backed by consumer product giants Procter & Gamble and Unilever, along with the Big Tech companies like Google, Facebook and others to promote “social justice” through advertising campaigns for unrelated products. 47 “Advertising is a reflection of culture and sometimes can be ahead of the curve and help effect change. We are proud to be a founding member of this UN sponsored initiative to ‘unstereotype’ through the power and breadth of our messaging. We are all in,” said a Microsoft executive. 48 It used to be that commercials promoted the benefits of their products and did their best to avoid getting political because Republicans and Democrats both drink beer, eat hamburgers, and buy cars; and companies didn’t want to ostracize half of their potential customers by supporting any polarizing causes. But since the liberal pathogen has caused a zombie-like apocalypse in America recently, many large corporations have decided to take up the banner of “social justice,” and when lobbyists from the “Unstereotype” campaign make demands, companies often oblige. This goes far beyond companies trying to be environmentally friendly, introducing recyclable packaging, or highlighting how they’re using renewable energy to power their factories. Nobody could really disagree with those practices. I’m talking about companies that actually now insult half of their potential customers in the hopes of gaining the unwavering support of a smaller segment of society because of their “woke” campaigns. They don’t even see it as insulting people, they’re just so arrogant that they feel they need to “educate” people about social justice causes, or think they need to virtue signal about how much “they care” by jumping on the bandwagon. The Unstereotype Alliance has boasted of “smashing” gender roles in commercials so now they don’t depict cleaning as “women’s work,” and regularly feature interracial and homosexual couples to give them more “visibility.” 49

Promoting Obamacare When President Obama was trying to get Obamacare passed into law, his administration was aided by a chorus of enthusiastic celebrities who used their voice to support the bill, but behind the scenes strings were being pulled to encourage them to speak up, and Hollywood studios were actually lobbied to include pro Obamacare messages in the plots of popular TV shows. 50 One such lobbyist group called Hollywood, Health & Society works with studios to promote health based initiatives and were paid $500,000 to convince them to incorporate “the need for Obamacare” into storylines of network TV shows 51 An executive with the organization said, “Our experience has shown that the public gets just as much, if not more, information about current events and important issues from their favorite television shows and characters as they do from the news media…This grant will allow us to ensure that industry practitioners have up-to-date, relevant facts on health care reform to integrate into their storylines and projects.” 52 Hollywood, Health & Society has become the one-stop-shop for organizations that want to have their messages covertly inserted into entertainment. Executive Kate Folb, admitted, “There was a time when there were so many organizations lobbying the entertainment industry on just their one issue, that it was just too much. They were all calling the same writers and trying to get meetings with the same shows. What happened was the industry stopped taking all of those calls because they became so overwhelmed. That’s part of the reason HH&S came into being: to help writers get what they need and keep them from getting overwhelmed with requests to include certain messages in their shows.” 53 Another PR firm called Ogilvy Public Relations Worldwide was paid $900,000 to pitch Obamacare plots to major networks. They even tried to get major networks to shoot a reality show about “the trials and tribulations of families living without medical coverage.” 54 “I’d like to see 10 of the major TV shows, or telenovelas, have people talking about ‘that health insurance thing,’” said Peter V. Lee, the California

Health Benefit Exchange’s executive director, which hired the PR firm. “There are good story lines here.” 55 President Obama brought a bunch of actors and producers to the White House to ask them for their help promoting Obamacare, and soon they started happily doing so. 56 In October 2013, Jennifer Hudson starred in a Funny or Die skit designed to promote Obamacare where she played a Washington D.C. “fixer” or a “scandal manager” in a parody of ABC’s series Scandal. The “funny part” was that everyone who tried to hire her to fix their problems (like a college student without any health insurance, and a guy who was changing insurance companies but was worried they were going to drop him because of preexisting conditions), learned that there was no problem at all because of Obamacare. 57 It was a pathetic attempt at humor and to do such a lame skit under the Funny or Die banner made it even more sad, but they wanted to do their part to help the cause. President Obama also appeared on Zach Galifianakis’ Funny or Die skit “Between Two Ferns” for a scripted interview meant to be funny but was just another stunt to promote Obamacare. It worked, however, and when the segment was posted online it became the number one source of traffic to the new HealthCare.gov website. 58 The White House Entertainment Advisory Council admitted, “This is a perfect example of a great partnership with Funny or Die stepping up in a big way. The site has a very robust traffic base of young men and women who are on the edge of the cultural zeitgeist. It has an organic reach, and now the traditional media will be talking about it for days.” 59 Under the Obama administration all of Hollywood was more than willing to support anything the White House wanted, but once Donald Trump took over the Oval Office everything changed as I will detail in the next chapter, the “War on Trump.”

Abortion Planned Parenthood is America’s largest abortion factory and most people have no idea they also have a special Arts & Entertainment Engagement department that reaches out to television studios and “feeds” them plot points they would like included in shows. 60 Few people outside of the

industry know such a department exists and most would probably have a hard time believing it, but it does. And for eight years now they’ve been hosting an annual “Sex, Politics, Film, & TV Reception” at the Sundance Film Festival to “celebrate” films and television shows that promote abortion. 61 Little press coverage has been given to Planned Parenthood’s Arts & Entertainment Engagement department, but The Washington Post did mention their work once, saying, “For nearly 50 years, it has been legal to have an abortion in America yet stubbornly taboo to show one on television or film. But both those things are now changing.” 62 The article went on to admit the existence of the abortion A&E department and list some of their “successes.” I’ll cover their activities in more detail in the “War on America” chapter, but for now you should at least know that such an apparatus exists and has been working behind the scenes for years. Easy abortions cause many women to ignore the use of simple precautions to reduce the risk of pregnancy, and by softening the social stigma that has historically been associated with abortions, many young girls now see them as a regular part of life.

War on Trump It’s obvious that the “news” media has been waging a disinformation war against President Trump since the day he won the 2016 election—something I chronicled in my previous book The True Story of Fake News . But the entertainment industry has also dedicated much of their creative efforts to continuously casting him and everything he does in a negative light by weaving antiTrump narratives into the plot lines of countless television dramas and sitcoms to ensure as many people as possible are inundated with the message. Stephen Colbert went so far as to produce an entire

animated series for HBO called Our Cartoon President which is dedicated to mocking him. Before becoming President, the media used to love Donald Trump. For decades he was a symbol of wealth and success, and throughout the 1980s and 90s made cameos in dozens of TV shows and movies like The Fresh Prince of Bel-Air , Spin City , WrestleMania , Home Alone 2 , Zoolander , and more. But all that changed after winning the 2016 election, when the Liberal Media Industrial Complex launched a war against him hoping to derail his administration and prevent him from cleaning up the corruption in Washington D.C. and bringing the government gravy train to a halt. ABC’s sitcom Black-ish revolves around an African American family and the issues they face as a Black middle-class family in America today, and shortly after the 2016 election there was an episode about how “terrified” everyone was about Trump’s victory and what it would mean for Black people. 63 For his entire professional life Donald Trump has been a friend of the Black community and had been given awards for all he did. 64 Every leader in the Black community from Jesse Jackson and Al Sharpton to Muhammad Ali had sung praises of him for decades, but now the media started gaslighting that he was a racist, hoping to get Black people to turn against him. 65 In an episode of The Simpsons , Lisa is seen reading To Kill a Mockingbird while seated on the couch next to Homer, when he tells her, “Now just remember, it’s set in the South a long time ago. The terrible racism you’re reading about is now everywhere .” 66 Homer and Lisa then head off to the local mall and pass a TV news crew which is interviewing a group of men, one wearing a red hat. “Kent Brockman here interviewing three blue-collar men who voted for Trump. How do you feel now?” the reporter asks them. One of the men replies, “Please stop interviewing us,” as if he’s ashamed he voted for President Trump and realized he made a big mistake.

In an episode of the revived Murphy Brown series, a character (who is a reporter) was depicted as being attacked by rabid Trump supporters because of their hatred for the media. 67 While promoting the show Candice Bergen (who plays Murphy Brown) said Donald Trump winning the 2016 election was the motivation to revive it. 68 The original series which aired from 1988-1998 depicted Murphy Brown as an investigative journalist and news anchor, so producers thought with Trump’s war on the media raging they could bring the show back and have Murphy Brown working to “expose” him. Rolling Stone noted, “The season premiere climaxes with Murphy swapping insults with President Trump during a live broadcast (him via Twitter, her glaring at the camera). The second episode has her lecturing Sarah Huckabee Sanders about the fundamental dishonesty of her press briefings, while the third sees her verbally dismantling a barely-disguised version of Steve Bannon.” 69 Literally the entire reason for bringing the show back was to use the angle of Trump vs the media, with Murphy Brown and other reporters being the underdogs and the “victims” of President Trump’s attacks. When NBC brought back Will & Grace in 2017 after initially ending the series in 2006, one new episode depicted a character walking into a cake shop because she’s hosting a birthday party for the president and wants a cake that says Make America Great Again on it. While ordering the cake she makes a comment about how she’ll be serving White Russians, a reference to the Democrats’ obsession that the Trump campaign “conspired” with Russians to “steal” the 2016 election, adding, “But you don’t need to know the guest list.” 70 The baker then refused to bake the cake saying that the phrase “Make America Great Again” is racist. 71 Vice News had a whole series called The Hunt for the Trump Tapes starring comedian Tom Arnold where he traveled around the world looking for the rumored “Trump pee tape” or a supposed recording of him saying the n-word. And just like the shows about people searching for Bigfoot that are somehow able to be drawn out for an hour each week despite never finding a shred of evidence, The Hunt for the Trump Tapes finally ended without uncovering a thing. 72 Even the X-Files has included anti-Trump messages. The series, which originally ran from 1993-2002 was revived in 2016 for a few more seasons and in January 2018 the season premiere kicked off with the “Cigarette

Smoking Man” narrating footage of President Trump’s inauguration which then cuts to a montage of clips including Vladimir Putin, people at voting booths, a KKK rally, and police confronting Black Lives Matter protesters while he continues to talk about the state of the country. 73 Robert Mueller is also depicted as the head of the FBI in the series, but “the bureau’s not in good standing with the White House.” In one episode Scully tells Mulder “Sometimes I think the world is going to hell and we’re the only two people who can save it,” to which he responds, “The world is going to hell, Scully. And the president is working to bring down the FBI along with it.” 74 After an assassination attempt on Mulder he later discovers the perpetrator is a Russian contractor with a special security clearance given to him by “the Executive branch” of our government, insinuating the President was trying to have him killed. 75 But the anti-Trump snides in sitcoms and dramas get much darker than just obsessing about how “terrible” President Trump is, or promoting the conspiracy theory that he’s a Russian agent. They’re openly calling for violence against his supporters, and want him to be assassinated.

Endorsing Violence The CBS legal drama The Good Fight posted a trailer on their official Twitter account which showed one of the main characters ranting about how “some speech” deserves “enforcement” and that it’s time to physically attack American citizens “unprovoked” who are engaging in speech that social justice warriors perceive as “racist.” 76 To the Left, supporting the border wall is considered “racist” and all Trump voters are Nazis and they want us all to be silenced, jailed, or dead. The Good Fight clip also referred to Alt-Right leader Richard Spencer getting sucker punched while giving an interview in Washington D.C. and insinuated that anyone wearing a MAGA hat in public should face the same fate. The show’s Twitter account also posted a picture showing a list of words stacked on top of each other reading, “Assassinate,” “President,” and “Trump.” 77 In one episode a character was arrested for participating in a

riot, and during his court appearance when he was talking with his lawyer he told her that the judge was a Trump appointee and so he is “fucked.” She advises him not to say anything radical, and he responds in a quiet voice, “Oh, like ‘we need to assassinate the president?” Later, when they’re back at his house she says to him, “Tell me what you said today in court was a joke” to which he responds, “Why? You don’t believe in regime change?” “You’re discussing a crime with your lawyer,” she responds and then takes his pistol and unloads it. He looks at her, disappointed, and says, “This won’t slow us down.” 78 In another episode one of the lead characters (Diane) goes on a rant about needing to get rid of President Trump and when she proposes spreading fake news about him, some of her colleagues push back thinking she’s gone too far. She then responds, “I have a Smith & Wesson 64 [handgun] in my desk, and I’m this close to taking to the streets.” 79 The series even depicted the lawyers obtaining the fabled “Trump golden showers video” after getting a flash drive sent to them by a Russian woman who claimed to have been one of the prostitutes in the video. The Daily Beast , a garbage online outlet and waste of cyberspace, was happy that such a grotesque plot line was aired on network television, saying, “It allows the show to channel our collective anxieties and outrage better than most other series that grapple with our new political reality.” 80 Amazon produced a show for their Prime streaming service titled Hunters which is about a “diverse” group of vigilantes led by Al Pacino who go around assassinating people they think are closet “Nazis” working in the United States to revive the Third Reich. In one of the trailers posted online a “Nazi” could be seen wearing a red baseball cap with some white writing on it, looking almost identical to a Make America Great Again hat. 81

“The best revenge, is revenge,” says Al Pacino’s character, who tells the vigilantes they “have to find them before they find us.” The series could easily incite (and perhaps has incited) vigilantes to go out and attack supposed “Nazis” (meaning ordinary Trump supporters). The Left thinks free speech is “hate speech” and “hate speech” is “violence,” so they justify physically attacking Trump supporters unprovoked because Antifa believes they’re fighting actual Nazis.

The executive producer of Hunters is Jordan Peele, the Black director behind Get Out who has an axe to grind with White people, so it’s not surprising he would be involved with a series that fetishizes torturing and killing them. The Left always accuse others of exactly what they’re guilty of themselves. It’s a form psychological projection, as well as a gaslighting technique. They are so detached from reality that they lack the ability of introspection and can’t see that they are the violent ones, while claiming that it’s President Trump and his supporters. They’re acting like fascists, while accusing President Trump of being one. They are the racists, spewing hatred of White people every day while claiming White people are conspiring to uphold the “systemic White supremacist system” in the United States simply because they exist. Alec Baldwin says, “the near moral collapse of this country falls squarely in the lap of Trump’s supporters,” when in reality they are the immoral degenerates destroying the foundations of our Republic. 82 Law and Order: SVU aired an episode about a character based on an amalgamation of Ann Coulter and Millie Weaver who was sexually assaulted by a suspected Antifa member, but because of her political views some of the police investigating the attack wrestled with sympathizing with her. The episode was titled “Info Wars.” At the end, the final twist was the attacker might not have been Antifa after all, but one of her own supporters (depicted as a vile White supremacist) because he got upset with her after she had turned down his advances the night before when they met at a bar. The “moral” of the story was Antifa are just peaceful protesters fighting against right-wing extremists, and while the victim was worried about them, thinking they were responsible for her assault, it was her own supporters who are the violent ones. The series usually depicts White men as the criminals, often rapists, and avoids storylines about illegal aliens being the perpetrators or Latino gangs involved in sex trafficking even though the show is supposedly often inspired by actual events. And it is extra careful not to include very many Black people as perpetrators out of the usual concerns of supposedly perpetuating “stereotypes” about Black men and crime. Actress Jessica Chastain once posted a link on Twitter to a Time magazine article denouncing Antifa, the Left’s terrorist foot soldiers, adding

“If we resort to violence as a way to combat hate, we become what we are fighting,” but then later posted a video tearfully apologizing after being barraged by social justice warriors saying that she was helping “Nazis” (meaning Trump supporters) by denouncing the increasing violence being waged against them. “I’m making a video because my heart is very heavy,” the apology began. “I’ve learned so much the past few days about the trauma many people are experiencing in our country. I’ve had the opportunity to listen, more than to speak. And [dramatic pause] it’s really hard for me to express my feelings, my thoughts, in 140 characters on Twitter so here’s my first video. I wanted you guys to know that I hear you. I want you to know that I’m committed to creating transformative social change. That I’m committed to dismantling systems of oppression. I share in the sadness of what is happening in the country. I hear you and you may never have met me, but I love you.” 83 She literally cried and apologized for denouncing violence against Trump supporters! Teen Vogue magazine declared “Antifa grows out of a larger revolutionary politics that aspires toward creating a better world, but the primary motivation is to stop racists from organizing.” 84 A better world? If Donald Trump wins reelection, Antifa may feel they have no other option to stop him than to become overt terrorists like the Weather Underground or the Symbionese Liberation Army since every attempt from the last four years to demonize him and remove him through impeachment and the ballot box have failed. Daily Show host Trevor Noah, who is from South Africa, says that Trump’s demeanor and style is like “many African dictators” or those from the Middle East. 85 And virtually every celebrity with a talk show from the old bags on The View to Stephen Colbert and Jimmy Kimmel regularly paint the president as such. 86 While everyone is familiar with Trump Derangement Syndrome—the irrational hatred and fear of President Trump, for the first time in modern history the chorus of Hollywood celebrities crossed the line far beyond their usual criticisms and hatred of a Republican president into openly calling for him to be assassinated. Madonna famously said she “thought an awful lot about blowing up the White House.” 87 Comedian Kathy Griffin did a photo shoot showing her holding Trump’s bloody decapitated head which looked like an ISIS

beheading. Griffin also said she wanted to beat down Donald Trump’s then 11-year-old son Barron. 88 At one of their shows in Mexico, Guns N’ Roses brought a Donald Trump piñata on stage and invited their fans to beat on it. 89 At a Green Day concert in Oakland, California singer Billie Joe Armstrong shouted “Kill Donald Trump!” in the middle of a song. 90 Rapper Snoop Dogg “shot” Trump in the head in one of his music videos. 91 Marylin Manson “beheaded” him with a large knife in one of his. 92 Rapper Big Sean did a freestyle about murdering Donald Trump with an ice pick on a popular hip hop radio show. 93 All with no consequences whatsoever. Actor Adam Pally, who starred in a time traveling comedy series called Making History , told TMZ that if time travel were possible he would go back and kill Donald Trump. 94 Johnny Depp went even further saying someone should assassinate him right now. “When was the last time an actor assassinated a president?” he asked a crowd. “It’s been awhile, and maybe it’s time,” he concluded, referring to John Wilkes Booth (who was an actor) killing Abraham Lincoln. 95 He faced no consequences whatsoever. He wasn’t dropped by his management company, none of his movies were pulled from the streaming services; nothing! Before she dropped out of the 2020 Presidential race, Kamala Harris joked with Ellen DeGeneres about killing Trump if she was stuck in an elevator with him. 96 Robert De Niro has said numerous times that he wants to punch President Trump in the face. Jim Carrey said he had a dream of murdering him with a golf club, and now draws pictures almost daily and posts them on his Twitter account depicting Trump and those in his administration as madmen hell-bent on destroying the earth. Mickey Rourke said that he wants to beat him with a baseball bat. 97 After the Iranian government put an $80 million bounty on President Trump’s head, comedian George Lopez responded on Instagram saying, “We’ll do it for half.” 98 While hosting Saturday Night Live , comedian John Mulaney urged people to assassinate President Trump like Julius Caesar. “It is a Leap Year, as I said. Leap Year began in 45 B.C. under Julius Caesar. This is true, he started the Leap Year in order to correct the calendar and we still do it to this day,” he began. 99 “Another thing that happened under Julius Caesar, he

was such a powerful maniac that all the senators grabbed knives and they stabbed him to death. That would be an interesting thing if we brought that back now.” 100 The atmosphere the media has created in the Trump era, where publicly wishing for his death has become commonplace, has incited numerous unhinged lunatics to attempt to storm the White House and Trump’s Mar-a-Lago resort in Florida where he often goes on holidays. 101 Yet with the exception of Kathy Griffin getting dropped by CNN as cohost of their New Year’s Eve coverage, none of the celebrities calling for his assassination have faced any consequences. Not legally or professionally. Imagine the outrage if anyone even remotely suggested that Barack Obama should be assassinated, or hung for treason. Their career would have been over by the end of the day and their “terrorist threats” would have dominated the news cycle for an entire week.

The 25th Amendment Fantasies As you likely know, every few months throughout the Trump Administration the mainstream media repeats the same news cycle about the “possibility” that President Trump may be removed from office by enacting the 25th Amendment, which allows the expulsion of a president if the majority of his cabinet agree he is mentally unfit for office, which would result in the Vice President taking over. Such pipe dreams have been fueled by gossip columnists like Michael Wolff in his tabloid trash books that are hailed by the media for his supposed “anonymous sources” inside the White House who say this possibility is “being discussed” every day. 102 The Left’s desperate hope that the 25th Amendment could end their Trump nightmare has caused the issue to get written into the plots of various political dramas on television, allowing those with Trump Derangement Syndrome to have the emotional satisfaction for a fleeting moment that it has actually happened. These plot lines also serve to plant seeds in people’s minds hoping they’ll grow and increase discussions and pressure about actually doing a such thing to President Trump.

The Showtime series Homeland , a spy thriller about the Department of Homeland Security investigating terrorist threats against the United States, is just one of numerous shows to include this plot point. “I am here to relieve you of your command,” says the character playing the Vice President to a flabbergasted now former President standing in the Oval office as he is informed of the decision. 103 Before President Trump, such a topic was never addressed in any political drama or thriller. The 25th Amendment was an obscure provision few people ever heard of, but it’s included in the Constitution just in case the President becomes mentally incapacitated. Democrats, however, hoped to use it as a weapon. CBS’s political drama Madam Secretary did the same thing. “I’ve talked to White House Counsel and the attorney general, and though there is a ‘fog of law’ surrounding Section 4 of the 25th Amendment, because it’s never been invoked, they assured me that if the heads of the executive departments plus the vice president vote by simple majority, the president will be removed from office, and Vice President Hurst will become the acting president.…If ever there were a time to set aside politics and do what’s best for the country, this is it,” says the White House Chief of Staff. 104

After the Cabinet voted in favor of removing the President by enacting the 25th Amendment, he addressed the nation to announce that he would be stepping down and thanked them for putting their country first! “I thank the brave cabinet secretaries who voted to invoke the 25th Amendment. They are all true American heroes and patriots. They put their country ahead of their personal relationship with me. That’s what separates us from dictatorships and oligarchies. Without people of such courage, our democracy would be lost, and they will forever have my gratitude. And because of them, I have never felt more proud to be an American.” 105 Kiefer Sutherland’s Designated Survivor series on ABC also aired a 25th Amendment fantasy, where his vice president plotted to invoke the power hoping to have him removed as President after notes about his therapy sessions were leaked to the public, causing concerns about his mental stability as he tried to cope with the death of his wife. 106 Michael J. Fox guest-starred as the prosecutor for the Cabinet, which ultimately failed in removing Sutherland, but succeeded in making an entire

episode about the 25th Amendment, which was the whole point in the first place. Even The CW’s superhero series Supergirl , a derivative of the Superman franchise that focuses on Superman’s cousin, also aired an episode where Kara (aka Supergirl, who, like Clark Kent works as a reporter) published an exposé on the President conspiring with arch villain Lex Luther, resulting in the cabinet invoking the 25th Amendment to have him removed. As the characters are watching a news broadcast about the situation, one turns to Kara, congratulating her, saying, “Talk about the power of the press.” 107 She replies, “These have been some dark days. And I’ll admit, there were some times where I thought we would never get out of it, but we didn’t give up, and we kept chipping away, until we brought the truth to light. Can you believe the Fourth Estate saved the day?” 108 The “Fourth Estate” refers to the news media, which functions as an unofficial fourth branch of government that is supposed to help keep political power in check.

Are There Any Conservative Celebrities? Sometimes people may wonder “why are there so few conservative celebrities?” The answer is that there may not be as few as it appears because they keep quiet about their politics knowing that if they were vocal about their beliefs it would virtually end their career. Being a conservative in Hollywood has always been difficult but in the Age of Trump, it has never been more dangerous. There are a few rare exceptions like conservative comedians Dennis Miller, Larry the Cable Guy, and Jeff Foxworthy, but they are allowed to exist because they have a niche market, and only as long as they don’t come out too hard against the Left. They won’t do jokes about gays, transgenders, Black crime, or other topics they know will cause them to be canceled. They have to stay in their lane. There are some Republican actors like Jon Voight, and Dean Cain who are public about their beliefs but open conservatives in Hollywood are mostly lower-level actors who make a good living, but aren’t A-listers.

Those who want to be megastars know what needs to be done, and what must not be done—or said publicly. James Woods says that after he was asked at a Hollywood Foreign Press Association junket (the organization that runs the Golden Globe awards) if he would support Hillary Clinton for president, he was blacklisted from Hollywood for saying no. 109 After President Trump became elected Woods began tweeting support for him, and his tweets became increasingly political. He was later dropped by his talent agent who gave him no other reason than, “I don’t want to represent you anymore.” 110 Woods is now basically retired but still enjoys tweeting his disgust for liberals on a regular basis. Kanye West says it took him a year to “have the confidence” to publicly support Trump and wear a MAGA hat. He would later say that wearing the hat “represented overcoming fear and doing what you felt no matter what anyone said.” 111 When Kanye was the musical guest on Saturday Night Live for the season premiere in 2018 he wore his MAGA hat on stage for his performance, and afterwards he started ranting about how the staff and producers were not happy about it. “They said, ‘don’t go out there with that hat on.’ They bullied me backstage. They bullied me! And then they say I’m in a sunken place.” He then went on to say that ninety percent of news is liberal, “So it’s easy to make it seem like it’s so one-sided.” 112 He got a lot of backlash and was even called a White supremacist, but he is a big enough star to weather the storm and eccentric enough for many to dismiss his political views as him just “being Kanye.” But there is no tolerance for ordinary actors or actresses just starting their career. Mean Girls was a movie and is now a play on Broadway, and one of the stars (Laura Leigh Turner) made headlines because someone snooping around her Twitter account noticed that she was following various popular conservatives, including President Trump and Sean Hannity. 113 She then un-followed Trump hoping to avoid any more negative attention. Something similar happened to a contestant on The Bachelorette in the 2018 season when it was discovered that the frontrunner had “liked” various Instagram posts that made fun of feminists and illegal aliens. After making headlines for his “egregious behavior” he deleted his account so more wouldn’t be uncovered and issued a lengthy and pathetic apology. 114

Because of the increasing persecution of conservative celebrities, actor Gary Sinise founded a “secret society” of sorts called the Friends of Abe in 2004 to function as a support group and networking organization for conservatives in the entertainment industry. “Abe” refers to Abraham Lincoln, and at one time the group supposedly had around 2000 members, including Kevin Sorbo, Jon Voight, Scott Baio, and Kelsey Grammer. They used to meet once a month and would host guest speakers like conservative pundits as well as Republican politicians. When the organization filed for a 501(c)(3) tax exempt status in 2011, the Obama-controlled IRS demanded a list of their members in order to process their application which is not a requirement for a group to be granted a non-profit status. 115 It was during this same time that the IRS was later found to have discriminated against over 400 different conservative groups, especially if they had “Tea Party” in their name. 116 After getting some negative press for trying to find out the names of everyone associated with Friends of Abe, the IRS reluctantly approved them as a 501(c)(3). It is said that they disbanded in 2017 over divisions about President Trump, but there are rumors that a new “Friends of Abe” may have formed, possibly under a different name. 117 Being a conservative in Hollywood has always been difficult, but in our modern age with political correctness run amok and Thought Police ready to destroy anyone’s career for having the “wrong” opinion, it has caused most conservatives in the entertainment industry to stay hiding in the closet. It’s not just Donald Trump that Hollywood is waging war on—it’s what he represents. He’s a nationalist, not a globalist. He puts America First, and unlike most other recent presidents won’t surrender our sovereignty to the United Nations. But Hollywood isn’t just trying to destroy him and his supporters. They’re waging war on the entire country, our culture, our history, and our families.

Author’s Note: Please take a moment to rate and review this book on Amazon.com, or wherever you purchased it from if you’re reading the ebook, to let others know what you think. This also helps to offset the trolls who keep giving my books fake one-star reviews when they haven’t even read them. Almost all of the one-star reviews on Amazon for my last three books, “The Liberal Media Industrial Complex,” “The True Story of Fake News,” and “Liberalism: Find a Cure” are from NON-verified purchases which is a clear indication they are fraudulent, hence me adding this note. It’s just more proof that liberals are losers and can’t play fair, so if you could help me combat them as soon as possible since you actually bought this book, that would be great! Thank you!

War on America Since the Leftists are trying to overthrow the United States of America and replace our Republic with a socialist dictatorship they are heavily promoting illegal immigration, demonizing the police, and are relentlessly attacking American culture, customs, symbols, and holidays. This is all obvious today, but back in the late 1940s and early 50s there were widespread concerns about communists and communist sympathizers working in Hollywood who may use their positions to do just that. Numerous individuals were blacklisted and basically banned from working in the industry to prevent them from spreading anti-American

sentiments. In 1947, ten writers and directors refused to testify about their suspected communist ties or sympathies before the House Un-American Activities Committee, likely because they didn’t want to incriminate themselves. The communist purge back then was widely criticized as an overreaction and a witch hunt (often referred to as McCarthyism), but it’s obvious—the seeds of Marxism have taken root in Hollywood and now, as Tim Allen said, being a conservative in that town today is like being a Jew in 1930s Germany. 118 Orson Bean, who was a popular gameshow host in the 1960s, later noted, “Sitcoms and movies today hate old-fashioned values. There’s more anti-American propaganda today than the Soviets could have ever worked into our culture through their covert party members who were writing screenplays.” 119 A former KGB Agent named Yuri Bezmenov who defected to Canada in the 1970s would later give a series of interviews and lectures in the United States detailing how the Soviet Union was working to undermine the United States as part of their long term goal to end our reign as the world’s premier superpower. He described the process as “ideological subversion” which was comprised of four different parts: Demoralization, Destabilization, Crisis, and Normalization. 120 He said the Marxists knew it would take an entire generation to accomplish, but were patiently and persistently working towards the goal. “What [ideological subversion] basically means is: to change the perception of reality of every American to such an extent that despite [an] abundance of information, no one is able to come to sensible conclusions in the interest of defending themselves, their families, their community, and their country,” he explained. 121 Basically, the communists planned to cause cultural chaos by encouraging Americans to embrace socially toxic ideas they knew would ultimately lead to self-destruction down the road. It’s obvious that each phase of the Ideological Subversion plan has been successful. Hollywood has warped the minds of tens of millions of people causing irreversible damage, brainwashing them into believing that America is an evil country built entirely on the backs of slaves while the greedy 1% control all the wealth, so why bother trying to earn an honest living.

They’ve destabilized the nuclear family causing a sociological crisis like the world has never seen, with the majority of children now being raised by single parents; they’ve normalized the most unhealthy sexual behaviors and lifestyles anyone could imagine; and recently we’ve been faced with numerous crises from the coronavirus pandemic to the ongoing racial conflicts from Black Lives Matter. All of which have thrown America into a tailspin. The ongoing attacks on American culture are stunningly similar to the “Cultural Revolution” in China which was launched by communist dictator (and mass murderer) Mao Zedong in the 1960s to purge any remaining elements of capitalism from the country along with anything else that may be an obstacle to his power. The Communist Party claimed that although the capitalists had been overthrown they were “still trying to use the old ideas, culture, customs, and habits of the exploiting classes to corrupt the masses, capture their minds, and stage a comeback.” 122 To solidify his power Mao Zedong had his Red Guards (a network of student groups) violently target what were called the “Four Olds”— meaning old customs, old culture, old habits, and old ideas; in order to “transform education, literature and art, and all other parts of the superstructure that do not correspond to the socialist economic base, so as to facilitate the consolidation and development of the socialist system.” 123 This is exactly what the social justice warriors of today are doing in the United States by targeting gender norms, the nuclear family, American holidays, our history, capitalism, and free speech.

Socialism’s Emergence in America Bernie Sanders popularized socialism perhaps more than anyone else in a generation, and now an increasing number of wealthy celebrities have taken up the cause. Mark Ruffalo was one of the first to endorse Sanders’ presidential campaign. The Avengers star is worth over $30 million dollars and earned $6 million playing the Hulk in just one of the many Avengers films but he thinks “It’s time for an economic revolution,” and claims, “Capitalism today is

failing us, killing us, and robbing from our children’s future.” 124

John Cusack also endorsed Bernie Sanders and at one of his rallies said we need to end “predatory capitalism,” which basically means forgive all debt and offer everyone free stuff paid for by those of us who work hard and save our money. 125 It’s our fault that others frivolously spend their money on things they don’t need instead of saving it or investing it, and now they feel they deserve ours. Jim Carrey, Britney Spears, and others are also encouraging Americans to “say yes to socialism.” 126 The Democratic candidates for president in 2020 were in a competition to see who could offer voters more free stuff: Free health care, free college, forgiving all student loans, reparations for Black people and gays, and more. Recently we’ve started seeing blatant anti-capitalism and pro-socialism themes in major movies and television shows which is exactly what Joseph McCarthy was worried communist sympathizers would do. Such messages seem to have been glossed over in 2019’s Joker by most viewers who were captivated by Joaquin Phoenix’s disturbing performance, but they were actually at the core of the movement the Joker would come to lead. “Kill The Rich—A New Movement?” is the headline on a tabloid the Joker had in his apartment as civil unrest erupted in Gotham. “Fuck the rich! Fuck Thomas Wayne! That’s what this whole fucking thing is about! Fuck the whole system!” screams one protester. A reporter asks Mr. Wayne (Batman’s father) about the “groundswell of anti-rich sentiments,” adding, “It’s almost as if our city’s less fortunate residents are taking the side of the killer.” “What kind of coward would do something that cold-blooded?” he responds, speaking of Arthur Fleck killing three men who assaulted him on the subway, sparking his transformation into Joker. “Someone who hides behind a mask. Someone who’s envious of those more fortunate than themselves.” At the very end when the Joker is a guest on a popular late-night talk show, he begins the interview saying, “It’s been a rough few weeks Murray…ever since I killed those three Wall Street guys.”

“Okay, I’m waiting for the punchline,” Murray (Robert De Niro) responds. “There is no punchline. It’s not a joke.” He goes on to rant about how awful society is and how nobody is civil anymore. “Do you think men like (billionaire) Thomas Wayne ever think what it’s like to be someone like me? To be somebody but themselves? They don’t!” He continues ranting and gloats about the riots on the streets and the police officers who have been harmed and then shoots Murray in the face live on the air. The Joker is hailed as a hero by the mobs gathering in the streets for fighting back against the system. Throughout the riots some people are seen holding signs that say “Resist”—the same signs anti-Trump “Resistance” activists often use at their protests. The hacking thriller Mr. Robot has been praised for its anti-capitalism themes. The main character “Elliot” wants to cause “the single biggest incident of wealth redistribution in history,” by deleting all financial records of credit card debt and mortgages. 127 The Atlantic said, “for the most part the show plays like an Occupy Wall Street fever dream.” 128 Another critic called it, “the anti-capitalist TV show we’ve been waiting for,” and praised it because it, “makes socialism a vibrant force again in popular culture.” 129 Justin Timberlake stars in the 2011 film In Time about a future world where people are genetically programmed to stop aging at 25, and then die a year later if they can’t afford to buy any more “time.” Their remaining lifespan counts down on a timer implanted in their arm which shows how much longer they have to live. The rich people are able to afford more “time” and can live for hundreds of years, but the poor people can’t, and have to borrow “time” at high rates of interest. So Justin Timberlake decides to steal a whole bunch of “time” and distribute it to the poor people in order to “crash the system.” 130 The Netflix series The Society is about a small town where all the adults mysteriously disappear, leaving a group of high schoolers stuck in what appears to be a parallel universe to fend for themselves while they struggle to build a new “society” in order to survive on their own. After some of the kids decide to raid the local hardware store for supplies, fighting with each other as they scramble to take what they can, it results in a town meeting where the natural leader (the new “mayor,” who was student body president in their previous world) tells everyone they’re

going to take inventory on all the food and other resources in the town and begin eating meals communally in the school cafeteria to ration it. A group of the jocks are later shown laying around reflecting on what they had done to the hardware store and discussing the emerging government. One of them begins, “I’ve been thinking—what if we didn’t, like, take stuff? Like food or whatever. Wouldn’t be the worst thing in the world, right? Sharing. It could be like socialism. There’s no “I” in team, right?” Another says it “kind of worked” in China because “everything’s made in China.” “Well. Socialism it is,” they conclude. 131 But sharing food and work responsibilities angers some of the rich kids from the town (the “haves”) who don’t want to give up their property to others (the “have nots”) or work at what they see as jobs that are beneath them, so a power struggle ensues and the “haves” organize a coup, seizing political power of the town proving how “ruthless” rich people are and the lengths they’ll go to maintain their lifestyle at the “expense” of others. In season two of Amazon Prime’s Jack Ryan series, the cause for Venezuela’s economic and humanitarian crisis isn’t said to be from socialism failing the country, but because the president is a “nationalist.” The president’s opponent however, is “running against him on a social justice platform and on the strength of, in my humble opinion, just not being an asshole,” explains Jack Ryan. 132 The Foundation for Economic Freedom denounced the series, pointing out that, “By making the villain of Jack Ryan a nationalist, the writers take a not-so-subtle jab at US President Donald Trump, whose ‘America First’ slogan has been described as nationalism ‘that betrays America’s values.’” 133

The growing pro-socialist messages woven into the plots of TV series and movies caused the Orange County Register to ask, “Why does Hollywood smear capitalism, promote socialism?” 134 The answer is clear— the Marxists embedded in Hollywood are using their positions in the industry just as the Red Scare of the 1940s and 50s had feared. In February 2020 a “Netflix for the Left” was launched called Means TV by a group of socialist film makers who helped produce campaign ads for Alexandria Ocasio-Cortez’s 2018 election to Congress. 135 It’s an “anticapitalist” subscription service that streams documentaries, news shows,

and even cartoons and comedies in order to “create the cultural foundation and need to build socialism in the U.S.” 136 It is an admittedly Marxist service that aims to incite people to rise up and “seize the means of production.” 137

Black Lives Matter Riots of 2020 After a man named George Floyd, who was high on fentanyl and methamphetamine, 138 died while in police custody in Minneapolis, it kicked off nationwide riots and looting that went on for over a week. 139 They started locally in Minneapolis, Minnesota, where the Black community looted and burned businesses and even took over the local police station and burnt that down too. 140 The riots and looting quickly spread to other cities across the country largely due to the mainstream media fanning the flames of racial tensions by reporting half-truths and gaslighting, giving gullible people the impression that African Americans are being systematically hunted by police and around every corner Black people minding their own business are confronted by “White supremacists.” Celebrities were more than happy to pour gasoline on the fire, and many of them announced that they were donating money to bail out the rioters. Justin Timberlake, Chrissy Teigen, Steve Carell, Seth Rogan and many more declared that they were on the side of the mob and were helping to fund them. Others, including John Legend, Lizzo, Natalie Portman, Common, and more all signed a petition supporting the new anti-police agenda calling for police departments to be defunded and shut down. 141 Just days later the Los Angeles mayor announced that he was cutting $100 to $150 million dollars from the LAPD budget and diverting the money to communities of color. 142 New York City mayor Bill de Blasio followed suit saying he too was cutting the NYPD budget by one billion dollars to defund the police. 143 This just days after iconic stores like Macy’s on Fifth Avenue had been looted because police were too busy dealing with rioters in other parts of the city. “We don’t want no more police,” one protest leader told

Minneapolis mayor Jacob Frey before the mob ran him out of an event for not supporting the cause. 144 Defunding and disbanding police departments as part the Black Lives Matter “revolution” certainly wasn’t enough to satisfy the angry mob, so soon they began calling for all TV shows and movies about cops to be canceled. The Washington Post led the charge with the headline “Shut down all police movies and TV shows—Now,” and just a few days later the popular “Cops” reality show was pulled from TV because it “glorified police.” 145 It had been on air for 33 seasons, beginning in 1989. Another popular cop reality show, Live PD, was also canceled. 146 These unscripted series show the dangers police officers face firsthand, but since they humanize them, the Marxists wanted the shows banned. And all this happened within two weeks of Black Lives Matter resurging. They even targeted Paw Patrol , a cartoon for kids about dogs who work a variety of jobs like a dalmatian firefighter, a bulldog construction worker, and a German shepherd police officer. 147 The Left doesn’t want children to have any positive depiction of police so they can more easily indoctrinate them into their nihilist cult and the “ACAB” (All Cops Are Bastards) ideology. It’s a miracle Will Smith and Martin Lawrence didn’t apologize for starring in the action comedy Bad Boys since it makes cops seem funny and cool. Apple Music even disabled the search feature for a day, called Blackout Tuesday, to help raise “awareness” for Black Lives Matter—as if we all hadn’t been hearing enough about them on the news and social media. Instead of letting people find the music they wanted to listen to, Apple replaced the Browse feature with a special curated playlist containing Black power music, including NWA’s infamous “Fuck the Police.” 148 They continued marching in the streets for months claiming the United States is inherently racist against Black people and that they are being oppressed by “systemic racism” that keeps them from succeeding in life. This, while every major social media platform coddles them and even gives Black people special privileges and perks. 149 The terms of service forbidding “hate speech,” harassment, and inciting violence are rarely enforced when such violations are made by non-White users. During the 2020 Riots countless major corporations including Facebook, Twitter, Google, Amazon, Disney, McDonalds, Starbucks, Bank

of America and many others released statements declaring their support for the Black Lives Matter movement and donated hundreds of thousands, or even millions of dollars each to Black communities and causes. 150 Cable networks, including the Discovery Channel and the Disney Channel were airing Black Lives Matter PSAs, 151 and several video games including Call of Duty and FIFA 20 (soccer) added a “Black Lives Matter” message every-time the games were booted. 152 Black Lives Matter is not about “ending racism” or “helping” Black people—it’s a front for a neo-Marxist movement attempting to overthrow the United States government and uproot our Constitutional Republic. 153 One of their original online manifestos (which has since been toned down a bit) read, “Black people will never achieve liberation under the current racialized capitalist system…The White supremacist, imperialistic, patriarchal systems needs not reform but radical transformation…We must remake the current U.S. political system in order to create a real democracy where Black people and all marginalized people can effectively exercise full political power.” 154 One of the original “founders” of the movement, Patrisse Cullors, openly admits she’s a Marxist and her “intellectual influences” are Karl Marx, Vladimir Lenin, and Mao Zedong. 155 Other Black Lives Matter leaders like Yusra Khogali have written that White people are “subhuman” and are “genetic defects.” 156 They are also calling for a universal basic income [UBI], universal healthcare, reparations for slavery, the release of “all political prisoners” meaning Black people incarcerated for committing any crime, and want “a radical and sustainable redistribution of wealth.” 157 Such extremist ideas had been festering on the fringes of the Black power movement since the 1960s but now they have the unwavering support of virtually every celebrity and the entire Hollywood machine has been recalibrated to promote their cause.

Christianity Under Attack In order to destroy America, the conspirators are determined to eradicate faith in God and dismantle organized Christianity. Attacking Jesus and Christianity is a sacrament in Hollywood because the far-Left

hates Jesus and everything He stands for. It’s not an overstatement to say that many in key positions of power in the entertainment industry (and politics) are Satanists who will someday openly embrace Lucifer as the rebel angel kicked out of Heaven for defying God. “I’m glad the Jews killed Christ,” ranted comedian Sarah Silverman in one of her comedy specials. “Good. I’d fucking do it again!” she declares, as her audience agrees in laughter. 158 While accepting an Emmy Award one year Kathy Griffin said, “A lot of people come up here and they thank Jesus for this award. I want you to know that no one had less to do with this award than Jesus. He didn’t help me a bit…so all I can say is suck it Jesus! This award is my god now!” 159 I’m not saying people shouldn’t be able to make fun of Christians, but no mainstream celebrity would dare make such insults or jokes about Muhammad because Muslims (and Jews) are vigorously protected against any criticism or mockery and only wonderful things can be said about them. Even a slightly edgy joke ignites a barrage of attacks with cries of “Islamophobia” or “anti-Semitism” and gears start moving in the wellfunded and massive smear machines like the ADL and the SPLC which quickly move to destroy the person’s career before they can utter another word. Hating Christians is almost as necessary as believing in climate change if you’re going to be a mainstream Hollywood celebrity. There are very few open Christians in Hollywood, most of them are has-beens like Kevin Sorbo and Kirk Cameron who have been basically blacklisted since being open about their faith. Kevin Sorbo was banned from Comicon because he’s a conservative and “pals with Sean Hannity.” 160 He and other Christian actors are stuck doing low budget films that get little attention. They’re allowed to exist (for now) as long as they never point out the Bible’s teachings on homosexuality. Only watered down and generic Christian messages are allowed to be said. After Guardians of the Galaxy star Chris Pratt appeared on The Late Show with Stephen Colbert and happened to discuss his “spirituality,” many

online began attacking him for being a Christian and attending a church. Actress Ellen Page (a lesbian) from the X-Men and Inception tweeted, “If you are a famous actor and you belong to an organization that hates a certain group of people, don’t be surprised if someone simply wonders why it’s not addressed. Being anti LGBTQ is wrong, there aren’t two sides. The damage it causes is severe. Full stop.” 161 Singer Ellie Goulding threatened to back out of her scheduled performance at the 2019 Thanksgiving NFL halftime show if the Salvation Army didn’t pledge to donate money to LGBT causes. She got the idea after her Instagram comments were flooded with complaints from her fans because the Salvation Army was sponsoring the game to announce their annual Red Kettle Campaign (bell ringers) fundraiser for the homeless. 162 Since the Salvation Army is a Christian charity, Goulding’s fans freaked out, accusing them of being “homophobic” and “transphobic.” They quickly bowed to the pressure and “disavowed” any anti-LGBT beliefs, which basically means they’re disavowing the Bible because even the New Testament denounces homosexuality in Romans 1:26-27 and 1st Corinthians 6:9-10. Many critics claim that only the Old Testament does, but the Book of Romans makes it clear that just because Jesus came to offer salvation doesn’t mean God’s law regarding homosexuality changed. The Salvation Army also removed a “position statement” from their website that had made it clear “Scripture forbids sexual intimacy between members of the same sex,” and replaced it with one saying “We embrace people regardless of race, gender, ethnicity, sexual orientation, or gender identity.” 163 One of the world’s largest Christian charities whose very name “The Salvation Army” refers to the salvation of Christ, cowardly bowed down to the Leftist activists out of fear they would be branded “homophobic.” Christians are easy targets since they’re much more passive than Jews and Muslims when attacked, and Hollywood loves to stereotype them as a bunch of superstitious bigots who don’t know how to have fun. In the rare case that there is a movie favorable to Christianity that gets widespread distribution, that too is attacked. Passion of the Christ was deemed “anti-Semitic” because it depicts the story of Jesus’ arrest, sham trial, and crucifixion. 164 It was the most popular film about the events to be made and wasn’t a straight to DVD release like

most others. With Mel Gibson behind it, the film became a huge success, which caused a tremendous backlash. The ADL [Anti-Defamation League] denounced the film, saying it “continues its unambiguous portrayal of Jews as being responsible for the death of Jesus. There is no question in this film about who is responsible. At every single opportunity, Mr. Gibson’s film reinforces the notion that the Jewish authorities and the Jewish mob are the ones ultimately responsible for the Crucifixion.” 165 That’s because that’s what happened! Technically, the Romans did it, but at the behest of the Jewish leadership in Jerusalem at the time. The Bible makes it very clear what led to Jesus being crucified. Pontius Pilate is quoted in Matthew 27:24 saying, “I am innocent of this man’s blood,” and “It is your responsibility!” meaning the Jewish Pharisees. They were the ones who conspired to have Jesus arrested and killed for “blasphemy” and being a “false” messiah. Pontius Pilate even offered to release Jesus, but the crowd demanded he release Barabbas instead, another man who was being detained for insurrection against Rome, and for murder. 166 A critic for the New York Daily News called The Passion of the Christ , “the most virulently anti-Semitic movie made since the German propaganda films of the Second World War.” 167 Many others angrily denounced the film when it came out in 2004. Some in the media even blamed it for a supposed “upsurge” in anti-Semitic hate crimes. 168 When the History Channel miniseries The Bible was released in 2013, the same cries of “anti-Semitism” rang out. 169 The New York Times opinion editor Bari Weiss went so far as to say that it’s a “conspiracy theory” that Jews killed Jesus. 170 Even though most Christmas movies aren’t overtly Christian and instead focus of the importance of families reuniting and spending time together, that doesn’t mean they’re not going to come under attack. As the war on western culture continues, the Marxists have set their sights on Christmas too. Online liberal cesspool Salon.com ran a headline reading “Hallmark movies are fascist propaganda,” and complained they promote “heteronormative whiteness” because there aren’t enough LGBT characters or people of color in them. 171 “Hallmark movies, with their emphasis on returning home and the pleasures of the small, domestic life, also send a not-at-all subtle signal of

disdain for cosmopolitanism and curiosity about the larger world,” Salon said, “which is exactly the sort of attitude that helps breed the kind of defensive White nationalism that we see growing in strength in the Donald Trump era.” 172 The article went on to say that because the Hallmark Channel airs so many Christmas movies, it is promoting, “a set of patriarchal and authoritarian values that are more about White evangelicals defining themselves as an ethnic group, and not about a genuine feeling of spirituality…The very fact that they’re presented as harmless fluff makes it all the more insidious, the way they work to enforce very narrow, White, heteronormative, sexist, provincial ideas of what constitutes ‘normal.’” 173 The article wasn’t satire. Salon.com has a deep-seated hatred of Christianity, conservatives and families, and is another cog in the Cultural Marxist machine working to destroy the United States. Comedian Whitney Cummings was reported to the Human Resources department of a major Hollywood studio after she wished the crew of a TV show she was working on “Merry Christmas” when they wrapped up for the year. She made the revelation while speaking with Conan O’Brian the following December. “Last year, I was working on a TV show, [and] got in trouble with Human Resources for saying ‘Merry Christmas’ to an intern,” she began. 174 Conan asked her if she was being serious and she said it was a true story, elaborating, “I was leaving, like on the 18th or whatever…and I was like, ‘Bye guys, Merry Christmas.’” When she returned from vacation after New Year’s she was called to HR and scolded. She joked, “I don’t even care how your Christmas was. It was just a formality. It’s what you say when you leave.” 175 Conan O’Brien then replied, “In these times we’re in, that could trigger someone or offend them if it’s not their holiday.” 176 She didn’t say which network it was, but she’s been involved with some major shows like NBC’s Whitney (where she played the main character), as well as the CBS sitcom 2 Broke Girls, which she created and was a writer for. While today it may seem impossible that Christmas movies may become a thing of the past, nobody could have ever guessed that reruns of the classic Dukes of Hazzard would get banned after the Confederate flag was deemed a “hate symbol” in 2015, or that Aunt Jemima pancake syrup,

Eskimo Pie ice cream bars, and Uncle Ben’s Rice would be deemed “racially insensitive” and pulled from production a few years later. 177 Once someone reminds liberals that the word Christmas is derived from Christ’s Mass and that it is actually a commemoration of the birth of Jesus, they may finally go over the edge and deem Christmas just as offensive as Columbus Day or the Fourth of July. And with the Muslim and Sikh populations increasing in the United States, the American standard of Christmas music playing in shopping malls and retail stores all month long every December may one day come to an end because it’s not “inclusive” and leaves non-Christians feeling “ostracized.”

Glorifying Satanism Since the Hollywood elite hate God and everything that is normal and good, it would only make sense that they have embraced Satan as their symbolic (or literal) master. The Church of Satan is an organization started by Anton LaVey in the 1960s which gained popularity among a few celebrities at the time like Sammy Davis Jr. and Jayne Mansfield. The “church” was really just Anton LaVey’s house, but he was a showman, so in the late 1960s and early 70s he was able to get some media attention for openly embracing satanism and engaging in various theatrical rituals and stunts (like serving an amputated leg for dinner that one of the members stole from a hospital he worked at). 178 While the group’s 15 minutes of fame soon faded away, satanism in Hollywood didn’t. Rock stars and heavy metal bands in the 1980s and 90s continued to promote satanism through their music. Marilyn Manson, the self-described “anti-Christ superstar,” would often tear out pages from the Bible on stage as part of his shows. Of course he would never do that to a Quran because radical Muslims would put out a fatwa calling for him to be executed, not to mention he would be denounced as “Islamophobic,” but attacking Christians gets one hailed as a hero in Hollywood.

In the early 2010s we began to see an explosion of pop stars promoting a new brand of satanism, in the form of the Illuminati. The original Illuminati was a secret society founded in Bavaria, Germany in the late 1700s by a law professor at the University of Ingolstadt named Adam Weishaupt. While the Founding Fathers in America openly declared their views and goals to gain independence from the King of England, the Illuminati sought secrecy and subversion to escape the grasp of the Monarch in Germany. After many of the members were discovered, rounded up and arrested, it was said the secret society was no more, but rumors have persisted for over two hundred years that they survived and continued on. The group’s original plans—many of which had been discovered by seizing their letters of correspondence—detailed how the organization was structured to avoid collapsing if any of its cells were discovered. Some trace their symbols, slogans, and activities to the Skull & Bones secret society founded in 1832, and later to the Bohemian Grove, and the Bilderberg Group. 179 Aside from being a mafia of sorts, consisting of powerful politicians, bankers, and businessmen—many people believe that these “Illuminati” members are privy to ancient philosophical secrets about the history of mankind and the “true” nature of divine forces. Concerns and conspiracy theories about the Illuminati were mostly contained on the fringes of the Internet until the early 2010s when allegations of celebrity Illuminati involvement went viral through YouTube videos and social media postings. 180 Many rappers and pop stars began incorporating Illuminati symbols into their music videos and hinting that they were somehow a part of it. None of these musicians were members of Skull & Bones or attending the Bohemian Grove, but by promoting the Illuminati and satanism as cool, they laid the foundation for the widespread acceptance of satanism—or Luciferianism as it is also called. Those who follow this secret doctrine believe that the God who created the world (and all living things) was actually a lower level god called the Demiurge (Jehovah), who essentially enslaved mankind through our very creation, either through malevolence or ignorance of its own lack of abilities; and so Satan/Lucifer, the “supreme” being of the Universe from this point of view, decided to enter the Demiurge’s creation to “save” mankind by convincing Adam and Eve to eat from the tree of the knowledge of good and evil, giving them consciousness. 181 This strange

belief that Satan is the savior, and God (the creator) is evil, is found at the core of most occult fraternities and secret societies. 182 Such esoteric ideas had remained mostly hidden from public view for thousands of years, but now a large number of Hollywood celebrities seemed to be embracing the idea that Satan/Lucifer is good, and giving a wink and a nod that they too know the Illuminati secret. 183 While the Illuminati fad in pop culture has passed, the open embrace of this idea—that Satan/Lucifer is actually the “savior”—will no doubt return someday and catch on like wildfire among the high priests of pop culture. A-list celebrities will declare that Satan is “king” and countless people will blindly follow their lead as they always do. Bible prophecy predicts that one day a counterfeit Christ (the Antichrist) will declare that he is “God” and the ruler of the earth, and such proclamation will be welcomed by billions of people. And thanks to the massive cultural shifts that are taking place, the path is being paved for the widespread acceptance of the “secret doctrine” that Satan/Lucifer is really the “good” God and here to “save” mankind from the inept or malevolent creator who made a flawed world.

Abortion Because liberals celebrate hedonism, debauchery, and tend to live in the moment without any concern for the consequences, unwanted pregnancies are a common occurrence. And instead of accepting responsibility for their actions, they usually decide to kill the baby and have its remains vacuumed out of the womb, seeing such barbarism as no different than getting a wart removed. But they’re upset that such a procedure has a negative stigma for so many people, so the Hollywood propaganda machine has been working behind the scenes to change that. It’s not enough for abortion activists to hope that writers will decide on their own to include pro-abortion messages in their scripts, so Planned Parenthood took it upon themselves to create their own entertainment liaison who lobbies studios to insert such themes on their behalf.

A woman named Caren Spruch is the current director of the Arts & Entertainment Engagement department at Planned Parenthood, and the Washington Post calls her their “secret weapon,” admitting, “She encourages screenwriters to tell stories about abortion and works as a script doctor for those who do.” 184 Spruch said that Planned Parenthood has advised studios on over 150 different movies and television shows since 2014. Their first project was a “comedy” called Obvious Child which is about a girl who has a one-night stand with some random guy after breaking up with her boyfriend and later finds out she’s pregnant and gets an abortion on Valentine’s Day. 185 One of the many shows Planned Parenthood’s entertainment liaison office helped “advise” is the Hulu series Shrill , which shows the lead character (Aidy Bryant) getting pregnant and deciding to have an abortion “before it becomes illegal.” After killing the baby she tells her roommate she’s glad she “got out of a huge fucking mess” and, “I feel very fucking powerful right now. And I just feel like I need to go out [and party].” 186 A sociologist at the University of California, San Francisco wants more comedies about abortion to help destigmatize it. “The purpose of including an abortion plot line is simply to make jokes about abortion, recognizing that such satire is valuable for some people as both a means and an end,” said Gretchen Sisson, PhD. 187 She continued, “This should not be surprising: comedy has often been used as a subversive way of challenging predominant social structures,” and she thinks abortion is “intuitive new ground for comedy to address.” 188 NBC’s Parenthood included an episode where a character (played by Skyler Day) visited a Planned Parenthood clinic to get an abortion despite her boyfriend’s wishes she keep the baby and the two “start a life” together. “If I have this baby, my life is over” she told him, and proceeded to kill the child. Depicting characters getting an abortion was rare back in 2013 for network television, and the episode was celebrated for “bravely” tackling the topic. 189 The Huffington Post praised the episode as well, noting “Amy’s mind was made up and there was nothing Drew could do to stop her.” 190 Melanie Roussell Newman, who works as Planned Parenthood’s senior vice president of communications and culture, admitted, “We’ve seen pop culture change views around LGBTQ issues, for example, and pop culture

has the power to challenge abortion stigma, too.” 191 Yes, that’s a real job position—they have a “communications and culture department” (as well as their Arts & Entertainment Engagement office). One Planned Parenthood affiliate even said that there should be a cartoon where a Disney princess gets an abortion. 192 Many people believed the statement to be an Internet hoax, but it is real, and they later explained, “Planned Parenthood believes that pop culture—television shows, music, movies—has a critical role to play in educating the public and sparking meaningful conversations around sexual and reproductive health issues and policies, including abortion.” 193 Another organization called the Center for Reproductive Rights was recently formed to promote abortion through entertainment. 194 Chairwoman Elizabeth Banks said her goal is to make abortion stigma-free and wants girls getting one to be seen as symbolic of “liberty itself.” 195 Comedian Michelle Wolf had a short-lived show on Netflix where she once did a segment titled “Salute to Abortions” which consisted of her being joined on stage by a marching band as she shouted to the audience, “It doesn’t have to be a big deal, it’s actually a great deal! It’s about $300 dollars. That’s like six movie tickets.” The segment ended with her declaring, “God bless abortions, and God bless America!” 196 She later revealed that she herself had gotten one and it made her feel “very powerful” and “like God.” 197 Actress Lena Dunham once admitted she wished she had gotten an abortion so should could “better understand” other women who have had them. 198 When actress “Busy Philipps” was at a pro-abortion rally in March 2020 she stood at the podium and screamed (literally screamed ) about how glad she was to have gotten one when she was a teenager since it allowed her to become a star. “Soon I would be driving my hybrid [car] to my beautiful fucking home…and I have all of this! All of it! Because I was allowed bodily autonomy at fifteen!” 199 “I will not be shamed into being quiet. We will not be shamed into being quiet. Never again! I will never stop talking about my abortion or my periods or my experiences in childbirth, my episiotomies, my yeast infections, or my ovulation that lines up with the moon!” 200 After seeing her unhinged rant, one might think it was someone playing a character and

doing a parody sketch of a pro-abortion activist, but she really meant it and screamed it at the top of her lungs. She was happy to sacrifice her baby for fame and fortune.

Bowing to China It’s interesting to note that Hollywood is increasingly bowing to China’s cultural standards in order to maintain distribution channels there. The Communist government has strict rules about which films are allowed to be seen in China, and in hopes of pleasing them, various plots are changed and scenes altered before they are put into production. When the trailer for the Top Gun sequel was released, some eagle-eyed fans noticed that a Taiwanese flag patch which had been sown onto Tom Cruise’s jacket along with a few other country’s flags where his father had flown missions, was now missing. 201 Taiwan has been in an ongoing dispute with China trying to become an independent country, but China still claims the island as their territory and in another apparent attempt to appease the Chinese government, Top Gun producers removed the Taiwanese flag from Cruise’s jacket because it simply being there symbolized Taiwan was not part of China, but their own country. DC Comics also censored a promotional image for a Batman comic that was posted on their Instagram and Twitter accounts after some people in China interpreted it as supporting Hong Kong in their struggle for independence. The picture showed Batman throwing a Molotov cocktail with the caption “the future is young.” 202 Protests by separatists had been growing in Hong Kong, and mostly involved college age people using social media to organize, and some read too much into the Batman picture thinking it supported them, so DC Comics deleted it so it wouldn’t cause any issues with their distribution there. The 2015 film Pixels starring Adam Sandler and Kevin James about aliens in the form of popular video game characters invading planet earth was altered so China wouldn’t get offended. While waging war against our planet—in one scene an Arkanoid paddle, similar to Breakout, was supposed to destroy part of the Great Wall of China since in the game

players bounce a ball against bricks to break them apart, but the censors changed that scene to depict the object destroying the Taj Mahal in India instead. 203 The zombie action movie World War Z was based on a book that described the virus outbreak turning people into zombies starting in China, which is ultimately nuked, leaving Lhasa, Tibet the largest remaining city in the world. But for the film, producers changed the location of the outbreak to Korea and of course China wasn’t nuked because they had nothing to do with it. Apparently the Chinese government has banned the distribution of any films featuring zombies, and the Hollywood Reporter noted that a sequel was in the works for World War Z but later canceled because Paramount wouldn’t be able to distribute the film internationally there. 204 The Chinese market is huge, and if studios are pitched a film they know won’t be allowed in China, they’re often inclined to pass on making it altogether. “You’re not going to see something that’s like Seven Years in Tibet anymore,” said Larry Shinagawa, a college professor at Hawaii’s Tokai International College. 205 The 1997 film which stars Brad Pitt takes place in the 1940s and 1950s when Tibet was struggling for independence from China, but that’s too offensive to the Chinese these days and similar films may hurt distribution deals for other, unrelated projects. Richard Gere’s Red Corner (1997) was perhaps the last major film critical of Communist China to be made. In it, Gere plays a businessman who is framed for the murder of a Chinese general’s daughter while on a trip there, and soon realizes how corrupt their legal system is. In First Man (2018), a biopic about Neal Armstrong and the Apollo 11 landing on the moon, the film didn’t show one of the most iconic scenes in history—Neal Armstrong and Buzz Aldrin planting the American flag on the moon once they arrived. When viewers noticed this strange omission Ryan Gosling, who played Armstrong, defended its absence saying landing on the moon was a “human achievement” not an American one. 206 Others had their suspicions the scene wasn’t depicted to avoid making the film too American in hopes it could be distributed in China. It doesn’t make any sense that a movie about one of America’s greatest achievements wouldn’t proudly show the historic scene of the American flag being victoriously planted in the ground on the moon after we won the Space Race.

Ryan Gosling and the producers couldn’t admit to the public the real reason for omitting the scene, because it would shock filmgoers across the country and perhaps cause people to boycott the movie for downplaying our own greatness in attempts to make more money through distribution in China. Hollywood stays very quiet about the lengths they go to in hopes of achieving that. Even the NBA has sold out to China. When the general manager of the Houston Rockets basketball team tweeted support for Hong Kong in the midst of growing protests there hoping to gain their independence, it sparked an enormous problem for the NBA because their games are broadcast in China since they are surprisingly very popular there. Adding to the problem was Chinese native Yao Ming (the 7-foot 6-inch star) had played for the Houston Rockets before retiring. Stars like James Harden praised China saying “We apologize. You know, we love China.” 207 LeBron James said the coach “wasn’t educated” about the situation and that his tweet “harmed” people financially and could have “physically” harmed them as well. 208 Despite celebrity athletes always supporting “good causes” and denouncing racism, police shootings, and human rights abuses around the world, none of them were saying a word about how China treated their citizens or that one million Muslims have been locked up in re-education camps there. 209

Immigration To say that the United States is being invaded by illegal immigrants is an understatement, but we’re now living in a period of time where certain facts are considered to be “hate speech” and the liberal media gaslights their audience trying to get them to deny their own lying eyes. Over 20 million illegal aliens have breached our border and are currently living 210 in the United States,

most of which drain financial and social resources which they don’t even pay into—but to admit the extent of the illegal alien problem is strictly forbidden. In fact, the term

“illegal alien” is now considered 211 “hate speech.” In 2019 almost 400,000 anchor babies were born in the United States from illegal alien mothers. In 48 of the 50 states there were more babies born by illegal alien mothers than ones who were born by women who are U.S. citizens. 212 Flooding the United States with immigrants from third world countries is a primary objective of the globalists because it erodes patriotism, our cultural heritage, and hastens their planned economic collapse which they look to seize upon in order to launch their socialist revolution. During the early Democratic presidential debates for the 2020 election, every single Democrat candidate on stage raised their hand when asked if they support giving free healthcare to illegal aliens. 213 There are even reports of Mexicans waiting (and hoping) for Donald Trump to lose his re-election bid in November 2020, who plan to then illegally enter the U.S. because they feel their chances of getting in and being able to stay will be almost assured. 214 The more illegals the better for Democrats, who hope to one day grant them all amnesty and make them U.S. citizens (and their new voter base), destroying any chances of Republicans winning a national election again for generations. So aside from the Democrat Party and the mainstream “news” media calling for a nonstop influx of immigrants to bring this about, Hollywood is helping as much as they can as well. Often brief pro-illegal immigration messages will be inserted into the dialogue of a show or a character will comment how “terrible” President Trump’s immigration policies are, but now we’re even seeing entire television series dedicated to promoting illegal immigration and demonizing anyone who wants to secure the border. We all know Hollywood loves to reboot old shows from decades ago, from Hawaii Five-0 and Murphy Brown to MacGyver , hoping to cash-in on the nostalgia original fans had for the series. One of those reboots was Party of Five , which originally aired in the 1990s and was about a family

of five kids (ages one to twenty-four) who had to fend for themselves after both of their parents were killed in a car accident by a drunk driver. But in 2020, it was rebooted to depict a Mexican family whose parents got deported because of President Trump’s crackdown on illegal aliens! The five kids (who are anchor babies because they were born in the U.S.) are then left here to fend for themselves. 215 The show was canceled after just one season. 216 In 2017, the New York Times expressed their frustration that there weren’t enough illegal aliens in starring roles or television shows that focus on them and their struggles, so they called on studios to green-light more series about “Dreamers”—the millions of illegal aliens smuggled into the United States by their parents that President Obama gave amnesty to. 217 Producers listened, and soon plots about “innocent” illegal aliens being persecuted would become a common occurrence.

ICE Are the New Bogymen After Roseanne Barr’s character was killed off and the series renamed The Connors due to her infamous “offensive tweet” about Obama administration official Valerie Jarrett, her daughter “Becky” in the show got knocked up by an illegal alien who worked as a busboy at the same Mexican restaurant she waitressed at. He later called her one day to let her know that he got caught up in an ICE (Immigration and Custom Enforcement) raid and she breaks down in tears out of fear that now the baby is going to have to grow up without a father because he’s being deported. 218 NBC’s sitcom Superstore featured ICE agents coming to the fictional retail giant “Cloud 9” (the “superstore” at the center of the show) to arrest an illegal immigrant who works there in the season finale. Her fellow employees tried to help her escape the agents. 219 Netflix’s female prison drama Orange is the New Black also featured ICE agents as the bad guys who arrested a major character just when she was about to be released from prison for an unrelated crime, leaving her

boyfriend waiting outside with a bouquet of flowers devastated that he wasn’t getting reunited with her. 220 In an episode of the CW’s Two Sentences Horror Story, a Latino nanny fends off would-be robbers trying to break into the family’s home that she works for, but when the heroic nanny makes the news, ICE agents discovered she was undocumented and soon paid her a visit, thus the horrifying twist at the end. 221 Charisse L’Pree Corsbie-Massay, a professor at the Newhouse School of Public Communications at Syracuse University, says, “ICE has emerged as a villain in popular discourse, and now we’re seeing that on screen. But these ICE agents are one-off characters with no lines and no names. They’re just representations of ICE, the faceless government entity. Their only role is to play the villain to our characters.” 222 Pamela Rutledge, the director of the Media Psychology Research Center, said, “Making ICE agents as bad guys exacerbates the political fission surrounding the immigration issues…Whether you agree or disagree with current policies, it is important to understand how fiction can inform beliefs on current issues where most people have little actual experience.” 223

During the Trump administration we’ve seen more open border messages being sprinkled into shows than ever before. In Showtime’s Shameless one character (Frank Gallagher) played by William H. Macy, announces he’s having a keg party at his house and is charging people 10 bucks at the door to get in, and adds that unlike this “piece of shit country,” his “border” turns away no one. 224 Pop singer Kesha released a song and music video dedicated to DACA illegal aliens (Dreamers) called “Hymn” where she sings, “Even the stars and the moon don’t shine quite like we do. Dreamers searchin’ for the truth. After all we’ve been through, no, we won’t stand and salute [the flag].” 225 The medical drama Grey’s Anatomy had an episode about an illegal immigrant who reluctantly takes her daughter to the hospital to finally get healthcare she’s been neglecting out of fear that she would get deported. Lobbying agency Hollywood, Health & Society convinced the writers to include that plot point to highlight the concerns illegal aliens have about getting deported if they go to a hospital. 226 Even the rebooted Twilight Zone on CBS featured an episode where “welcoming illegal immigrants” was the “moral of the story” at the end. An

upper middle class woman’s housekeeper is detained by ICE and scheduled to be deported, and despite working for the family for over a decade, the family’s friends seem fairly callous about her situation. “These people know the risks when they come here,” a neighbor says. 227 The homeowner herself, Eve, is later revealed to be an illegal immigrant as well—from another dimension, who came to ours thirty years ago to live among humans on earth after fleeing terrible living conditions on her own planet. In the end, she is also detained and hauled off screaming, now facing deportation herself, back to where she came from. The episode concludes with narrator Jordan Peele giving the “moral” of the story, saying, “We are all immigrants from somewhere, be it another city, another country, or another dimension. As a child, Eve Martin escaped to what should have been a better world. A world where the skies are blue. But now those skies have darkened, and the land below them is a place she is no longer welcome. For Eve Martin, there’s no passport to be stamped for passage out of the Twilight Zone.” 228

Other Attempts There were reports that Jane the Virgin star Gina Rodriguez was hoping to produce a TV series about a college student who found out they were an undocumented immigrant, and reportedly had a pilot episode made for the CW network, but so far it hasn’t been picked up. 229 Then CBS reportedly bought the rights and hoped they could get the show to air under the working title of Rafa the Great . 230 Gina Rodriquez is also trying to get another show called Have Mercy produced, which is about a Latina doctor who immigrates to Miami but is unable to practice medicine in the United States for whatever reason (probably because the medical school she went to is considered substandard), and so she decides to open an illegal clinic run out of her apartment to help her Latino neighbors. 231 CBS shot a pilot episode for In the Country We Love , based on Diane Guerreros’s memoir of having her parents deported back to Columbia when

she was a teenager, but it doesn’t appear to have been picked up. 232 Probably because it’s too similar to the Party of Five reboot. Another planned series called Casa (Spanish for Home) was shopped around which is about a family of immigrants who have to fend for themselves after their parents are deported. 233 It’s unknown if the idea was dropped because it’s identical to the Party of Five reboot, or if the series was just rebranded as that. It’s likely numerous different scripts about the same premise floated around Hollywood before one of them finally got picked up since it’s such a predictable plot, and several different writers probably thought it was the next big idea. DACA dramas are becoming “TV’s new obsession” in the United States. 234 Even Apple TV, which has recently joined the television production business, produced an immigration series called Little America about a 12-year-old boy from India whose parents were deported, and he is left to run his father’s hotel. Each episode tries to “go beyond the headlines to look at the funny, romantic, heartfelt, inspiring and unexpected lives of immigrants in America, at a time when their stories are more relevant than ever.” 235 In 2019 Netflix released a documentary titled After the Raid which follows the lives of several people in a small town in Tennessee after ICE officers conducted a roundup of illegal aliens there in order to guilt trip White people into feeling bad for the “Latino families” that were “broken up.” 236 Netflix is also producing a documentary series about illegal aliens with singer/actress Selena Gomez called Living Undocumented , which follows around eight families that are at risk of being deported. Gomez told the Hollywood Reporter that, “I chose to produce this series, Living Undocumented , because over the past few years, the word ‘immigrant’ has seemingly become a negative word. My hope is that the series can shed light on what it’s like to live in this country as an undocumented immigrant firsthand, from the courageous people who have chosen to share their stories.” 237 Executive producer Aaron Saidman said, “Living Undocumented is designed to illuminate one of the most important issues of our time. But rather than discussing this issue with only statistics and policy debates, we wanted viewers to hear directly from the immigrants themselves, in their own words, with all the power and emotion that these stories reflect.” 238

It’s not just TV shows. For years feature length films have been subtly promoting immigration. District 9 put a unique spin on an alien invasion story by depicting the aliens arriving to earth, not to kill us and conquer our planet, but apparently in a desperate search of a new home. The friendly aliens were malnourished and weak from their long journey and presumably came here looking for help, only to be mistreated by humans and forced to live in a slum called “District 9” that serves as a giant internment camp surrounded by barbed wire and armed guards. In the end, the lead “immigration” official who had previously harassed and abused the aliens is turned into one himself after being exposed to a DNA-mutating agent, and is forced to live in District 9 as one of them. The entire film was a cheesy allegory about racial segregation and xenophobia. 239 In Machete (2010), Danny Trejo plays an illegal immigrant and vigilante living in Texas who is seen as a folk hero for killing a bunch of evil White people trying to stop illegal immigration. The film’s catchphrase is “We didn’t cross the border, the border crossed us.” The White people are depicted as stupid or evil and at one point Robert DeNiro’s character, who is part of a volunteer border patrol group, even murders a Mexican kid after they catch him trying to cross the border. “Welcome to America,” he says, just before pulling the trigger. Danny Trejo then kills all the White “devils.” When some people denounced the film for seemingly encouraging anti-White violence, the Southern Poverty Law Center stepped in to defend it, calling it, “an argument for comprehensive immigration reform,” 240 meaning an argument for open borders since the bad guys in the film (aside from the Mexican drug cartel) were White people who didn’t want illegal aliens crossing the border into the United States. Elysium is a 2013 science fiction action film starring Matt Damon about a futuristic society where most of the inhabitants of earth live in extreme poverty and lack basic healthcare, while a small elite group live in luxury on a space station (called Elysium) that orbits the planet. Those not authorized to land on Elysium are deemed illegal immigrants and are “deported” or even have their aircraft shot down before reaching it. 241 Matt Damon’s best friends’ daughter has leukemia and is in need a medical treatment, so he helps smuggle her to the space station to save her, despite the elite’s best efforts to stop him.

A film critic from Variety wrote that Elysium was, “one of the more openly socialist political agendas of any Hollywood movie in memory, beating the drum loudly not just for universal healthcare, but for open borders, unconditional amnesty, and the abolition of class distinctions as well.” 242 Entertainment Weekly critic Sean Smith said, “If you are a member of the 1 percent (referring to the Occupy Wall Street movement which was occurring at the time the film was released), Elysium is a horror movie. For everyone else, it’s one step shy of a call to arms.” 243

Mexican Drug Cartels Are Good Action films need “bad guys,” and for generations those bad guys have often been Mexican or Colombian drug cartels, but now those kinds of plots have been deemed xenophobic and racist out of concerns that they cast Latinos in a negative light. When the trailer dropped for Sylvester Stallone’s latest Rambo film (Last Blood ) it showed the iconic character fighting against a Mexican drug cartel and liberals immediately called it “xenophobic” and “antiMexican” propaganda. 244 Rambo’s adopted niece, who is of Mexican descent, runs away to Mexico hoping to find her birth mother, but is kidnapped by the cartel and forced into prostitution, but leave it to liberals to defend sex trafficking and get upset because an iconic American film hero hunts down and kills the traffickers! The Daily Beast said the film was “designed to prove the president’s claim that we need to Build That Wall,” and that “Rambo has gone full MAGA.” 245 One reviewer called it “deeply xenophobic” and said that the film “should be end of line for the character.” 246 Another critic called it a “hyper-violent xenophobic revenge fantasy” and said “It’s all a setup for Last Blood to live out every assault rifle owner’s worst fears and most insane fantasies about Mexico. The only way it could be more transparent is if Stallone had growled ‘I. Am. The Wall!’ in his best Judge Dredd voice.”

Some idiot even called it a “radicalizing recruitment video,” for right wing extremists. 248 On Rotten Tomatoes it got only a 27% positive rating from critics, while 85% of viewers gave it a thumbs up—a disparity often seen on Rotten Tomatoes where critics now trash politically incorrect comedy specials and movies that are well-received by viewers. In 2018, Sicario: Day of the Soldado was released starring Josh Brolin and Benicio del Toro who battle drug cartels in the stereotypical fashion, and it too set off a wave of crying critics, one saying “it doubles down on violent fantasies about another Mexican-American War,” and “feels like a piece of state-sanctioned propaganda, a MAGA-sploitation thriller that does not see humanity in our neighbors.” 249 Jennifer Garner starred in a film called Peppermint (2018) in which her husband and daughter are murdered by a drug cartel, so she becomes a vigilante hunting and killing them. The New Yorker called the movie “racist” and “ignorant.” 250 Another critic said it was “irresponsible” to make movies where the bad guys are Mexican drug cartels anymore because they “portray Latinos as animals.” 251 NBC News said the film “is a poorly written blockbuster filled with racist stereotypes. Hollywood should know better.” 252 Until the Trump era, nobody thought that films about fighting Mexican drug cartels were problematic, but because of the hyper-vigilant Twitter outrage mobs that organize harassment campaigns hoping to stomp out any opposing ideas, the entire plot point may be all but abandoned by studios out of fear that their movies will be poorly reviewed by critics who deem them “racist.” 247

The Immigration Endgame Pat Buchanon warned in his 2002 book The Death of the West that, “Uncontrolled immigration threatens to deconstruct the nation we grew up in and convert America into a conglomeration of peoples with almost nothing in common—not history, heroes, language, culture, faith, or ancestors.” 253

He goes on, “Millions have no desire to learn English or become citizens. America is not their home; Mexico is; and they wish to remain proud Mexicans. They have come here to work. Rather than assimilate, they create Little Tijuanas in U.S. cities, just as Cubans have created a Little Havana in Miami…With their own radio and TV stations, newspapers, films, and magazines, the Mexican Americans are creating an Hispanic culture separate and apart from America’s larger culture. They are becoming a nation within a nation.” 254 Many Latinos actually want to create a new country in the Southwest called Aztlan that would include California, Arizona, New Mexico, Texas, and other states in the region. 255 The name refers to a mythical homeland of the Aztecs which Chicanos (Mexicans) want to restore. Mario Obledo, the president of the League of United Latin American Citizens, said, “California is going to be a Mexican State. We are going to control all the institutions. If people don’t like it, they should leave.” 256 Never mind that if California was still part of Mexico the water wouldn’t be safe to drink. On college campuses in the Southwest various Chicano student groups exist to further the cause, including MEChA (the Chicano Student Movement of Aztlan) and La Raza (recently renamed to UnidosUS). These groups (and others) are really acting as agents of a foreign government, which means they should have to register with the Department of Justice as such, but it’s doubtful any members of La Raza, MEChA, or any other proillegal alien activist groups have. For the globalists plan for the New World Order to be complete, first large regions of the various continents must be merged into unions that act as the governing bodies for those countries, and then their different currencies merged into a single unit as well. The European Union (EU) and their common currency (the Euro) is the model for the rest of the world. Plans to merge the United States, Canada, and Mexico into the “North American Union” (NAU) which would use a new common currency (called the Amero), have been drafted, and the schemers are waiting for the day they can force their agenda through. 257 Similar regional mergers, such as the Asian Union, the Middle Eastern Union, and the African Union, are also in the plan, which would each have their own common currency as well. And once they are all formed, the final step would be to merge all of those regional unions into a single global

governing system along with each of their respective currencies, ultimately forming a one world government and a single digital global currency.

War on White People Despite Hollywood’s insistence on wanting to end all bigotry and promote “tolerance” for everything; there is a growing anti-White sentiment where White people are regularly demonized, ostracized, and blamed for all the problems in the world. At the same time, Hollywood does everything they can to portray Blacks and Latinos as perpetual victims of “whiteness” whose lives have been ruined for generations because of “White privilege.” According to Hollywood, Black people never do anything wrong, or if they do it’s a result of the circumstances in their life which

put them in that position because of “systematic” and “institutional racism” at the hands of White people. John Langley, the creator of the reality show COPS, admitted he purposefully didn’t allow many segments which involved police confrontations with Black suspects, and instead aired more where White people were being detained and arrested because he didn’t want to promote the “stereotype” that Black people tend to be criminals. 258 Never mind Department of Justice statistics which show that Black people make up approximately 13% of the population in the United States, but are responsible for close to 50% of the total murders. 259 Just pointing out statistics like that is considered to be racist, and the ADL considers 13/50 a “numeric hate symbol.” 260 “Diversity” is a code word meaning less White people, and in recent years Hollywood has been obsessed with what liberals believe are too many White people starring in films and TV shows. In 2015 after the Academy Award nominees were announced, the hashtag #OscarsSoWhite went viral from people complaining that there weren’t any Black people nominated for Best Actor or Best Actress that year. 261 In their minds Black people are the best , and it must have been because of “racism” that none happened to be nominated for those spots that year. From that point on their foot was in the door, and each year after that there would be more scrutiny over how many “people of color” were nominated and which actors won, and how many White people starred in TV shows and films. Every time nominees were mentioned, media reports would flood the Internet about the “lack of diversity” and how “problematic” it was. 262 “Why do snubs for women and people of color keep happening?” they would ask every time half of the nominees weren’t Black or Latino. 263 Fans of Jenifer Lopez were so upset that she wasn’t nominated for Best Actress

for her role as a stripper in Hustlers they took to Twitter (as usual) to complain about it, demanding “Justice for J. Lo.” 264 In the film she plays one of a group of strippers who drug and then defraud rich men who come into their club, running up their credit cards. Not exactly Oscar material, but she must have gotten “snubbed” because she’s Latino! Others were equally upset that Jamie Foxx (Just Mercy ), Lupita Nyong’o (Us ), Awkwafina (The Farewell ), and Eddie Murphy (Dolemite Is My Name ) weren’t nominated for anything either one year. All because of “racism,” not that they had mediocre performances or others who happened to be White made more of an impact. When Toy Story 4 was nominated for Best Animated Feature at the Golden Globes, some lunatics voiced their concerns that none of the toys in the franchise were Black! 265 Keep in mind that Woody, Bow Peep, and Buzz Light Year are the only “human” toys. The rest are ones like Mr. Potato Head, a dog, a pig, a dinosaur, etc. The Hollywood Reporter complained about the “near-absence of people of color,” despite two toys being voiced by the Black comedy duo Jordan Peele and Keegan-Michael Key, but that’s not good enough. Their review went on to complain that not only are each of the lead toys Caucasian, but a new character (Forky) is a “very white fork.” 266 The toy is homemade, created out of a plastic spork, some stick-on googly eyes, and has pipe cleaners for arms. It’s a spork, it doesn’t have a race, but the lunatic film reviewer saw it as another “Caucasian” toy because it’s white, which most plastic utensils are. The reviewer was also upset because, “in many ways [Toy Story 4’s] worldview seems like an Eisenhower-era fantasy, a vision of America that might have come from the most die-hard reactionary: lovely if you’re wealthy and White, but alarming if you’re Black or brown or gay or a member of any other minority—in other words, more than half the U.S. population.” 267 There weren’t enough Black people in Joker to please some critics either, even though Joaquin Phoenix’s character starts dating a neighbor of his who is a single Black mother. Time magazine complained that her character had too small of a role, saying, “In Joker, Black women are visible but they are not seen,” whatever the hell that means. 268 The review went on to complain about the roles other Black people had in the film such as the Joker’s social worker. She doesn’t really listen to

his problems and is just going through the motions, thus missing another opportunity to possibly steer him away from ultimately becoming a psychotic killer. That’s casting a Black person in a negative light, and “racist.” Another Black character, a random woman on a bus, scolds him to stop “bothering” her son when all he was doing was being nice to the kid, and that’s perpetuating “racism” too by furthering the “angry Black woman” stereotype. The 2019 film Little Women, which is based on a novel written in 1868 about four young girls living during the Civil War and coming of age, is also “too White.” A writer for Teen Vogue , a Marxist publication dedicated to perverting the minds of teen girls, wrote that when old literary classics are made into films, they need to “better incorporate diversity.” 269 Another critic said that it “romanticizes White privilege” and that “casual racism is merely the start of its problems.” They concluded that “Little Women is, indeed, rooted in the advantages of bourgeois White womanhood.” 270 We can’t have films anymore where the story just so happens to be about people who are White, because that’s not “diverse” enough. The Hollywood Reporter complained that Christmas movies on the Hallmark Channel don’t have enough Black people in them and “struggles to give diversity a home for the holidays.” 271 Their complaint begins with a snarky, “While other networks are viewing the holidays with an eye toward inclusion, Hallmark is delivering the dream of a white Christmas, just like the one’s audiences used to know,” and then notes, “Of the network’s record 24 original holiday movies this season, four of them have Black leads,” but “that’s down from last year, when five of its 21 original holiday movies had Black leads.” 272 Others have complained about Hallmark movies being “too White” as well. 273 In my previous book Liberalism: Find a Cure I detailed how many on the Left are upset that Santa Claus is White, and are now calling him a symbol of “White supremacy.” 274 Some are so determined to destroy Santa’s image that publishing giant Harper Collins released a book called Santa’s Husband which depicts him as a homosexual “married” to a Black man. CNN gleefully gave the author airtime to promote the book when it came out. 275 Director Tim Burton, the man behind Edward Scissorhands (1990), Beetlejuice (1988), and The Nightmare Before Christmas (1993) angered

the Diversity Police because he didn’t cast a “diverse group of characters” in his movie Miss Peregrine’s Home for Peculiar Children (2016) since Samuel L. Jackson was the only Black person in it. He began trending on Twitter from so many “woke” people calling him a racist. 276 Actor Jonah Hill said that “real change” in the industry will come only when White men no longer run the studios and streaming companies. 277 While celebrities obsessively complain about too many White people being in positions of power in Hollywood and starring in too many shows (and winning too many awards); none of them would ever commit the cardinal sin of the entertainment industry by asking about Jewish influence in Hollywood. 278 Everyone knows that would kill their career overnight no matter how earnestly or tactfully it was brought up, but complaining about too many White men having positions of power in the industry has become a rallying cry for social justice warriors. There are numerous specials on Comedy Central and Netflix which feature Black and Latino comedians whose entire act is basically making fun of White people, which is fine—and sometimes funny, but we all know the double standard. Few White comedians will dare make jokes about Blacks or Latinos. Jokes about Asians used to be acceptable, but those too would be career suicide today. Blacks and Latinos can “joke” about how they “hate White people” or complain about “the problem with White people” and often their distain is obvious, and their “jokes” are just thinly veiled racism—but that’s just fine. Black sitcoms often include subplots about how the families are living in a hostile country and White people around every corner hate them. 279 An entire episode of ABC’s sitcom Black-ish was about how “America hates Black people” with a lead character telling members of her family that repeatedly throughout the show. 280

90’s Sitcoms Now “Too White” Since “diversity” dominates these days, many classic shows from the past are now seen in hindsight as “racist” because there are “too many” White people in them. Beverly Hills 90210 , Seinfeld , Home Improvement ,

Everybody Loves Raymond , Growing Pains , Family Ties , Cheers , Frasier , Full House , Dawson’s Creek , Friends , and more all “lack diversity.” 281 Even with the rash of revivals and reboots, critics are upset that many of the shows’ racial makeup remained the same. The Hollywood Reporter complained about the “blinding whiteness of nostalgia TV.” 282 In the return of Roseanne , however, producers ensured there was some “diversity” by depicting her son D.J. as having married a Black woman and has a Black daughter with her. 283 Friends star David Schwimmer would later suggest that his show be rebooted with an all-Black or Asian group of friends. He went on to virtue signal that, “I campaigned for years to have Ross [his character] date women of color. One of the first girlfriends I had on the show was an Asian American woman, and later I dated African American women. That was a very conscious push on my part.” 284 These days White people are considered racist if they prefer dating only White people. 285 No other race faces the same pressures for personal relationships and families to become more “racially diverse”—only White people. And despite David Schwimmer’s hopes for a “Black Friends” reboot, that show has already been made—and before Friends. It was called Living Single , and Friends was basically an all-White reboot of that show, but there will never be enough “diversity” in sitcoms and feature films. No matter how many shows feature an all-Black cast, or star Black characters, the Left will never be satisfied. There were plenty of Black sitcoms in the 1990s, like The Fresh Prince of Bel-Air , Family Matters , A Different World , Martin , Roc , Hangin’ with Mr. Cooper , The Hughleys , The Wayans Bros , The Cosby Show , and many more. All with Black stars and few, if any, White actors involved, but God forbid sitcoms exist with a White-only cast! Of course Black-only shows were made long before the 90s, and continue to be made today—like Empire , Power , Black-ish , Grown-ish , and many others, and nobody complains that there aren’t any White lead actors or threaten to boycott those shows for not being “diverse” enough.

Not Enough Mexicans The mayor of Los Angeles, Eric Garcetti, wants to double the number of Latinos in TV shows

and movies within the next ten years, and launched a project called “LA Collab” in order to “connect Latinx talent, executives, and creators to opportunities in the entertainment industry.” 286 Latinx , if you’re wondering, is the new politically correct gender neutral term for Latino , since even that is problematic these days, but that’s a topic for a whole other book. 287 Los Angeles County contains 4.9 million Hispanics and now there are at least 60 million of them living in the United States (20 million of which are illegal aliens), so Hollywood is doing everything they can to cater to them. For example, Jimmy Kimmel’s little sidekick Guillermo—who speaks broken English—is paid $500,000 dollars a year to stand off to the side of the stage and laugh at his jokes and chime in once in a while with his catch phrase, “That’s right Jimmy!” Before becoming a fixture on air for the show he worked as a security guard in the parking lot of ABC Studios making $8.00 an hour. 288 There have also been a flood of TV shows starring Latinos in recent years, including the Magnum PI reboot, but there will never be enough to satisfy the social justice warriors. Every show and movie must have a “diverse” cast (meaning fewer White people). Every popular series must have a Black, Asian, and Latino equivalent. Soon there will probably be growing calls for Arab versions of hit shows, since those of Middle Eastern descent will clamor about being “under-represented” in American entertainment. And after that it will be the Indians (or Native Americans, or Indigenous people, or whatever politically correct term they’re calling themselves these days), and then probably the Eskimos. We’re sliding down a slippery slope of stupidity with no end.

Obsessed with White Sins of the Past The one kind of movie Hollywood loves to make more than crime thrillers or actionadventures are ones that highlight how “racist” White people are. “Historical dramas” about how awful White people are

and how the films “reflect what’s still happening today” come out every year. Some of them are Black revenge fantasies like Django Unchained. Actor Jamie Foxx even bragged about killing a bunch of White people in the film when he was a featured guest on Saturday Night Live , saying, “I get to kill all the White people, how great is that?” 289 The film incited some Black people to vent their fantasies of killing White people themselves, flooding Twitter with their hatred in tweets like, “Django got me wanting to kill White people!” and “After watching Django, all I wanna do is shoot White people.” 290 Of course, you can’t tell disgruntled Blacks who hate America to “go back to Africa,” because that would be “racist.” Everything is “racist” to liberals. Black people’s obsession with racism of the past can be seen in the obvious double standard of demanding White people not be “allowed” to say “the n-word” even while singing along to popular rap songs. Kendrick Lamar brought a fan on stage to perform one of his songs with him in 2018, but stopped the show mid-performance because the girl (who was White) rapped along to the original lyrics which included the word “nigga” in the hook. After about 30 seconds he told the DJ to stop the music and started staring at the girl. “Am I not cool enough for you, bro?” she asks, thinking that her rapping wasn’t good enough. He went on to tell her the “rules” and said she had to bleep that word. She apologized, and then they started again. 291 When Latino actress Gina Rodriguez sang a few lines from a rap song that included “nigga” in the lyrics (as most rap songs do) and posted it on her Instagram, Blacks (and SJW Whites) freaked out so bad she became the top trend on Twitter. 292 She then apologized. The same thing happened when a star of the Bachelorette was singing along to a rap song on Instagram Live. 293 Most Black people get more upset when a White person says the word than they do when gang bangers end up killing an innocent kid in their neighborhood with a stray bullet. As Black radio host Jessie Lee Peterson points out, “They’re not [actually] offended! They pretend to be in order to scare White folks and shake ‘em down for stuff.” 294 Imagine if White people demanded that

Black people weren’t allowed to use certain words! Democrats in Congress would hold hearings and pass a resolution denouncing such outrageous word policing and it would be a national scandal, but the word “nigga” mustn’t be uttered out loud by White people, because it’s their word.

On the Lookout for Racism Many Black people (and White SJWs) are so hyper-sensitive and obsessed with racism that they hallucinate and often see it where none exists. For example, Roseanne Barr was fired from her hit TV show within just a few hours after making a joke about Valerie Jarrett, a former advisor to Barack Obama, when she tweeted that Valerie looked like a character from the Planet of the Apes movies; and if you saw a side by side photo of her and that character, you would know why Rosanne said that. But it turns out that Valerie Jarett is half Black, although you would never guess from looking at her. Rosanne later explained, “I thought the bitch was White!” which most people did. 295 Her show was number one on ABC, but the network immediately fired her and then continued the show, calling it The Conners after killing off her character with an opioid overdose from pain pills she was taking for knee pain. 296 Of course Rosanne is not a racist, and in the 1990s the original series promoted a lot of liberal propaganda, but once someone starts trending on Twitter after getting the attention of the perpetually offended online activists, most companies feel they need to appease the mob by firing the person even if they didn’t do anything wrong. Hollywood’s dogma is so rigid that if anyone dares doubt that all Trump supporters are racist they will be denounced for “supporting White supremacy,” as a star of Queer Eye for the Straight Guy realized when he simply said that “not all Republicans are racist.” 297 Jonathan Van Ness trended on Twitter from so many people attacking him for simply stating what should be obvious, but defending conservatives in any way is seen as a major transgression.

Sometimes when popular novels are made into movies, the studios feel the need to add some racism to “remind” the audience how terrible White people are. When Tom Clancy’s bestselling book The Sum of All Fears was turned into a film starring Morgan Freeman and Ben Affleck, the plot was changed from Palestinian terrorists trying to dupe the United States and Russia into a nuclear war because of the United States’ support for Israel, to a story about White supremacists trying to trick the two super powers into a nuclear war so they could build a Whites only Europe. 298 The movie was so different from the book that when Tom Clancy introduced himself on the DVD commentary he said he was the person who “wrote the book they ignored.” 299

Actors Denounce “White Privilege” If White celebrities don’t regularly denounce their own “White privilege” and falsely claim that their success is due to the color of their skin, then they may become a suspected White supremacist themselves, and aren’t seen as an ally of the Black community. Chelsea Handler even hosted a Netflix show called “Hello, Privilege, It’s Me, Chelsea” which examined “White privilege” and followed her around as she traveled across the country endlessly apologizing for being White and talking with other people about how terrible White people have made America. 300 Jon Stewart even issued an apology for having too many White people on the staff of The Daily Show when he was the host. 301 He hadn’t even been the host for five years and nobody was concerned about it, but he too was “sorry” and began doing various interviews to give his two cents about how America needs more “diversity.” He also called for Black people to be paid reparations. 302 When Netflix released a trailer for a forthcoming series about the crimes of serial killer Ted Bundy (played by Zac Efron), people were shocked how it glamorized him and made Bundy seem like a rock star instead of a monster. 303 Pushing back against the criticism, Zac Efron said the film highlights Ted Bundy’s “White privilege” and he believed the only reason Bundy got away with his crimes for so long was because he was a “clean-cut White dude.” 304

After the Black Lives Matter riots in the summer of 2020 the media became even more obsessed with demonizing White people, and there was an endless flood of celebrities apologizing for their “White privilege” and even producing PSAs about how sorry they are and how they “take responsibility.” 305 Poor Jimmy Fallon looked like he was being held at gunpoint when he interviewed the author of “White Fragility,” a book about how White people have ruined America for Black people. He had her on The Tonight Show to lecture the audience about White people’s “inevitable and often unaware racist assumptions and behaviors,” and called White people “aholes” because we make life “miserable” for Black people. 306 He went along with the agenda so well that he sat there agreeing with everything she said, even when she said that he was a racist but didn’t even know it. “When I’m talking about the racism that I have, the racism that you have, it’s the result of living in a society in which racism is the foundation. We all absorb it,” she said. “There’s no way we could exempt ourselves from it.” 307 There’s no way White people can’t be racist she says! The title of the segment posted on the Tonight Show YouTube channel is “Dr. Robin DiAngelo Wants White People to Stop Saying They’re Not Racist,” because she thinks we all are! 308

Watchmen When the Watchmen comic book was turned into a television series on HBO, of all the villains that the superheroes could have been fighting, the producers decided to have them tackle the “problems brought about by White supremacist forces.” 309 The series creator said, “In a traditional superhero movie, the bad guys are fighting the aliens and when they beat the aliens, the aliens go back to their planet and everybody wins. There’s no defeating White supremacy. It’s not going anywhere, but it felt like it was a pretty formidable foe.” 310

The HBO series kicked off depicting the Tulsa Race Riot of 1921, where mobs of Blacks and Whites fought and killed each other after a Black man was arrested for assaulting a White woman and a group of armed Black men came to the jail out of concern that the man had been lynched, which wasn’t true. The series started with this to set the stage that “not much” has changed in the United Sates, and Black people are still supposedly being lynched on a regular basis. The show revolves around a modern day fictional White supremacist group in Tulsa, Oklahoma called the Seventh Kavalry, who “wage war” against the local police because the city has decided to pay reparations to Black people. In order to protect themselves from the White supremacists, police hide their identities by wearing masks and costumes. The original Watchmen comic book series and the 2009 movie depicted the superheroes fighting crime at the height of the Cold War between the United States and the Soviet Union. Obviously many fans were disappointed in the HBO series turning the vigilantes into social justice warriors and force-feeding more identity politics to the audience, but critics were eager to defend the show. Vox said, “Some Watchmen fans are mad that HBO’s version is political. But Watchmen has always been political.” 311

Others blamed “right-wing trolls” who gave it negative reviews online. 312

CBS’s Supernatural Drama “Evil” CBS has a drama which is a cheap knockoff of the X-Files called Evil where a “skeptical” forensic psychologist (who’s Black) works with a Catholic priest to investigate supposed supernatural events. And in one episode the skeptic investigates a case of a girl who was pronounced legally dead, but later “came back to life” once her body was moved to the morgue. After concluding his investigation he figured out that the “resurrected” girl did not experience a miracle, but was the victim of racism because she’s Black! Once he cracked the case, he heads to the office of a senior official at the hospital with two stacks of medical records, saying, “Turned out to be

hyperinflation [of the lungs], and undiagnosed COPD…But it wasn’t the paramedics fault.” That’s when he drops the files on the man’s desk. “What are those?” he asks. “The emergency life-saving efforts of this hospital over the last year. A hundred and seventy-six in all,” he replies, looking smug. “Okay.” “These are your Caucasian patients” he says, placing his hand on one of the stacks. “Did you know that on average during a code your doctors perform fifty-eight minutes of chest compressions and rescue breathing on Caucasian patients? “No. I didn’t.” “And these are your African American patients. Your doctors on average perform chest compressions and rescue breathing twenty-three minutes on them. Patients like Naomi Clark” (the Black girl who supposedly died and came back to life). “It is the stated position of this hospital that it does not distinguish on the basis of race,” the hospital executive responds. “Naomi Clark came back to life in the morgue because your E.R. staff called her time of death thirty minutes earlier than if she were White. That’s why this wasn’t a miracle. It was implicit racism,” he concludes. “I think you should get out of here,” the executive responds. Talk about running out of ideas! Who could come up with such a ridiculous plot? And that was the big climax of the episode!

BlacKkKlansman BlacKkKlansman (2018) directed by Spike Lee was based on a true story about a Black detective in Colorado who investigates the Ku Klux Klan in the 1970s. His partner, who is White, goes undercover and infiltrates the KKK while the Black detective is the brains behind the operation. There’s a scene where David Duke (played by Topher Grace from That ‘70s Show ) is making a toast to a group of people and talks about how great it is to be a White man in America and part of the “real America” and then says “I want to thank you so much for never putting your country

second. America first!” he declares as he holds up a glass of champagne. “America first!” he repeats, to cheers from the crowd. 313 That phrase, as you know, was popularized by President Trump, and that scene was included in the film as another attempt to tie David Duke to Donald Trump, even though Trump has denounced David Duke numerous times over the last few decades. 314 During an interview about the film, Topher Grace said, “This is the first script when I read it that’s really of the Trump Administration.” 315 Of course, it’s not. It’s about a Black detective and his partner investigating a local chapter of the KKK for allegedly conspiring to bomb a civil rights rally, but Spike Lee decided to use the 50-year-old story to try and tie the events to President Trump.

“Cracka” In a series called CRACKA, a neo-Nazi is sent to a parallel universe that takes place in the 1800s where Whites are the slaves and Black people are in control of America. “Cracka,” being an insult that angry Blacks love to call White people, a ghettoized derivative of “cracker.” In the trailer, before the Nazi is transported back in time to the alternate reality, he and his friends attack a random Black man and his car is shown to have a “Trump 2020” bumper sticker on it. The series slogan is “You stole our freedom, now we steal yours.” It isn’t meant to put Whites in the shoes of Blacks to make them reflect on the injustices of the past, instead CRACKA is a Black revenge fantasy. Posts on the series official Facebook page are filled with anti-White rhetoric like “You’re in our world now!” 316 The trailer was released on Juneteenth (June 19th) the date that commemorates the freeing of the slaves, and before the comments were turned off many viewers were expressing their excitement about watching White people “get what they deserve.” Trayvon Martin’s mom endorsed the series saying, “I applaud the bravery and vision for the creation of CRACKA .” 317

Magical Negroes and White Saviors Since most liberals see racism everywhere, they’re not even happy when films depict a Black person possessing a unique quality that is used to help others who happen to be White. That is what they call employing the “magical negro” trope. Spike Lee went off on The Legend of Bagger Vance because Will Smith’s character comes to help Matt Damon win a golf tournament that takes place in Georgia in the 1930s. “Blacks are getting lynched left and right, and [Bagger Vance is] more concerned about improving Matt Damon’s golf swing!... I gotta sit down; I get mad just thinking about it. They’re still doing the same old thing ... recycling the noble savage and the happy slave,” he said. 318 Whoopi Goldberg’s character in Ghost has been criticized as a “magical negro” (by Black people) because she helps the spirt of Patrick Swayze communicate with his widow after he dies. 319 Michael Clarke Duncan’s character in The Green Mile also upset some Black people because he has the power to heal sickness and disease and ends up using his ability on several White people who worked at a prison he was being held in, despite being on death row for a crime he didn’t commit. 320 It seems some Black people hate Whites so bad that they can’t stand to see a Black person do anything nice to them. No good deed goes unpunished, as the saying goes, and when well-meaning Hollywood studios produce films of White people helping minorities, that too is criticized as being a racist trope called the “White savior narrative.” In Finding Forester , Sean Connery’s character is a reclusive but wellknown writer who crosses paths with a Black teen who plays basketball in the courts across the street from his apartment. Connery learns the kid has a gift for writing that he helps encourage, and later the boy is accused of plagiarism because his teacher doesn’t think he has the ability to write as good as he does, but Connery vouches for him in a surprise appearance at the school preventing him from failing the class.

In The Blind Side (2009) Sandra Bullock is considered a White savior for taking in a Black homeless kid named Big Mike who becomes a football star thanks to her help. One critic said the Blind Side , “peddles the most insidious kind of racism, one in which whiteys are virtuous saviors, coming to the rescue of Blacks who become superfluous in narratives that are supposed to be about them.” 321 Others attacked the film because they felt it depicted Sandra Bullock saving Big Mike from inner-city Black people who were all “poor and violent.” 322 Apparently they would have been happier if she just left him to waste away in the ghetto. White people are often damned if they do, and damned if they don’t. Other popular films liberals got upset about because they feature “White saviors” are Dangerous Minds (because a White teacher helps educate Black and Latino students in a poverty stricken part of the city), and even Gran Torino because Clint Eastwood helps his Asian neighbors fight against a Black gang in Detroit. 323 Cool Runnings , a film about a Jamaican bobsled team, was attacked because the Jamaicans wouldn’t have made it to the Olympics without the “White savior” (John Candy) their trainer. 324 Even Avatar has been accused of this since a White character using a remote control avatar of an alien body helps the alien race save their planet from human invaders looking to take their natural resources. 325 In the 1980s Diff’rent Strokes was a popular sitcom about a rich White man living in Manhattan who adopts two Black orphans from Harlem. At the time the series covered a lot of serious issues like racism, drug use, and even child molestation. But today some see it as another example of a “White savior” plot. One online magazine even included Diff’rent Strokes on its “50 Most Racist TV Shows” list, writing sarcastically, “Save us, Mr. White Man! Come rescue us from Harlem and let us come live with you in yo’ giant Park Avenue mansion where our po’ deceased mama onced worked her fingers to the bone cleaning up after yo’ wrinkled White ass! We’s cute, Mista Drummond, we ain’t gwine start no trouble.” 326

MTV’s Anti-White Agenda In 2015, MTV aired a documentary titled “White People” that was hosted by a homosexual illegal

alien named Jose Antonio Vargas who traveled around America shaming White people about their “privilege” and lecturing them for not being concerned enough about minorities. 327 The following year MTV News released a video with “New Year’s resolutions for White guys” because we’re all such terrible people we need to be educated by Blacks and Latinos on how we can be better. “Try to recognize that America was never ‘great’ for anyone who wasn’t a White guy,” begins one presenter. 328 “Nobody who has Black friends says that they have Black friends, and just because you have Black friends doesn’t mean you’re not racist. You can be racist with Black friends,” says another. “Look, guys, we know nobody’s perfect, but honestly, you can do a little better in 2017.” They surprisingly deleted the video due to the backlash but their obsession with “White privilege” continues. MTV produced a YouTube show called “Decoded” where the host uncovered White people’s hidden “racism” that she sees around every corner, including decoding “microaggressions” and “the problem with White beauty standards.” The usual complaints about Halloween costumes being “cultural appropriation” (and thus offensive) have also been covered. Each week for several years beginning in 2015 the show would release a new episode where the host found more problems to blame on White people or ways White people are supposedly being racist.

White Replacement in Media Recently another obsession we’ve seen in Hollywood is remaking popular movies or sequels and replacing the main character (if they happen to be White) with a Black actor in the name of “diversity.” It’s actually considered to be a “White supremacist conspiracy theory” to talk about White populations being “replaced” through mass immigration, but that is exactly what Hollywood has been

doing to various characters in order to stamp out “whiteness.” 329

Generation Xers remember the musical Annie being about the curly redhead orphan, but when it was remade in 2014, Annie was Black with an afro. When the live-action remake of The Little Mermaid was announced, it was also revealed that the red-headed mermaid Ariel would be played by a Black actress instead. 330 When a reboot of Buffy the Vampire Slayer was announced the show cast an African-American actress as Buffy, who was originally played by Sarah Michelle Gueller in the 1990s series. 331 Two years later the show still hadn’t made it to air, which likely means the pilot was so horrible it didn’t get picked up. But due to the low standards of what is considered “entertainment” today, that may change if they rework the script or decide to just dump it on Netflix or Hulu. Activists also began pushing for James Bond to be played by a Black man, and it was later announced that a Black woman would play Agent 007, taking over Bond’s famous codename. 332 In 2010 when The Karate Kid reboot was released it starred Jaden Smith, Will Smith’s son, who is of course Black. In 2018, Spider-Man: Into the Spider-Verse depicted the kid who becomes Spider Man as biracial— being half Black, half Latino. 333 There are growing calls to depict Superman as Black in future films as well. 334 In the 2015 remake of Fantastic Four, Johnny Storm (the human torch character) who is White in the first two films (as well as in the comics) was played by Michael B. Jordan, a Black man. 335 This, despite being depicted as the brother of a fellow “Fantastic Four” member, Sue Storm, who is White. Samuel L. Jackson plays Nick Fury in The Avengers series even though the character is White in the comics. In the late 1990s a made for TV movie titled Nick Fury: Agent of S.H.I.E.L.D . aired on FOX where the character was true to the comic depiction (played by David Hasselhoff), but when Marvel launched their Avengers film series they chose Samuel L. Jackson for more “diversity.” Another comic book superhero called Domino was turned Black when she made an appearance in Deadpool 2 .

After the original actress who played Batwoman in The CW television series didn’t renew her contract, she was replaced by a Black girl. 336 ABC announced plans to reboot The Wonder Years , a hit coming-of-age comedydrama about a typical kid growing up in suburban America in the late 1960s, only this time…you guessed it—the family is Black. 337 For Black History Month (February) in 2020, Barnes & Noble planned to release special editions of various literary classics like The Wizard of Oz , Romeo and Juliet , and Alice in Wonderland with new covers depicting the lead characters as African Americans. They called it the Diverse Editions program, but canceled their plan after critics complained that it was “literary blackface” and said they should have just promoted actual books written by people of color instead of doing something so dumb. 338 When Harry Potter was turned into a play, a Black actress was chosen to play the character Hermione Granger, who is described as White in the books, and was played by Emma Watson in the films. Writer J.K. Rowling later denied that she wrote the character as White, but in the books she is specifically described as such. 339 Other films are being remade with modern day “Black” versions, like Steel Magnolias , originally released in 1989 about a group of women and how they cope with the death of one of their friends, and then remade in 2012 starring all Black women. The romantic comedy About Last Night (1986), about couples entering into committed relationships for the first time in their lives, was remade in 2014 starring an all-Black cast. And there have been others, including Cinderella , Death at a Funeral , and more. 340 Remaking a “Black” version of a film is quite different than changing a well-established character like Orphan Annie or the Little Mermaid, but when race-swapping happens to Black characters, it’s denounced as “whitewashing.”

How About Entertainment For Whites? Once Whites are a minority in the United States (estimated to occur in 2045), will it then be okay to have a White Entertainment Channel like Black people have BET [Black Entertainment Television]? Will White people be able to have a Miss White USA pageant since Blacks, Latinos,

and Asians have their own beauty pageants for their race? Once Whites become a minority in America can we have White students clubs on college campuses just like the Black, Asian and Latino student organizations? Will it be okay for a White person to say that they are proud to be White? No, it won’t. The special interest groups for Blacks and Latinos will get unhinged and scream that “White supremacy” is trying to resurrect itself and loads of “White allies” will join in on the chorus denouncing their fellow White people to show solidarity with people of color. “White people had their turn,” they’ll say, and don’t deserve to be proud of their race or culture because they enslaved Black people 400 years ago. “We ended White supremacy and must ensure it never returns,” they’ll say. White people must forever bow down to the new Latino/Black/Asian majority and live the rest of their lives in servitude to the new ruling class to atone for the sins of our White ancestors, they will demand. Of course Black people ignore the fact that virtually all countries in the ancient world had slaves. Maybe we should point out that the Egyptians (Africans) enslaved the Jews. And that Black Muslim tribes in Africa actually sold other Africans to the European slave traders who brought them to North America. 341 Africa is also the world’s leader in modern-day slavery, where millions of people remain trapped in forced labor. 342 When the question is raised about a White counterpart to BET or White-only shows and movies, the knee jerk reaction is to always claim that the majority of mainstream entertainment is produced for White people. But with forced diversity being injected into almost every single television show, movie, and even commercials which all do their best to have an equal number of White, Black, Asian, and Latino characters, the claim that White people have entertainment that is a reflection of our own family, community, and culture is rapidly becoming null and void. Since most “White” homogeneous entertainment has been “diversified” and turned into a heterogenous multicultural mishmash, this just adds to the justification that such shows should be created and maintained. But just pointing out these issues is enough to get one tarred and feathered as a “neo-Nazi,” then deplatformed from social media, and “White nationalist” added to the first sentence of their Wikipedia page. 343

Film and Television Liaison Offices Most people think that propaganda films were just something produced by Nazi Germany or perhaps are still made by communist regimes in North Korea or China, but the truth is the United States is the world’s biggest producer of such material. For example, during World War II our government commissioned a series of documentary films called Why We Fight which were designed to encourage Americans to support the war. Animated segments of the films were produced by Walt 344 Disney Studios.

Disney actually produced various cartoons throughout World War II featuring Donald Duck for this same purpose. One such film titled The Spirit of ’43 encouraged Americans to file and pay their income taxes in order to help fund the war effort. “Taxes...To Defeat the Axis” was the film’s tagline which was commissioned by the U.S. Treasury Secretary at the time. 345 The title, “Spirt of ’43 ” was a play off the old patriotic sentiment from the American Revolutionary war which was captured by the slogan “The Spirit of ’76.” Another Disney war propaganda film from the era was Der Fuehrer’s Face (originally titled Donald Duck in Nutzi Land ), which encouraged Americans to buy war bonds to help fund World War II. In the film Donald Duck has a nightmare where he is forced to work at a munitions factory in Nazi Germany, but then wakes up in “home sweet home” and has a renewed love for America. 346 Donald Duck also starred in a short anti-Japanese propaganda film during World War II, where he parachuted into a Pacific island jungle to “wipe out” a Japanese airfield. 347 While it’s simple to make the case that these films were for a good cause, the point is that propaganda is more pervasive than people realize, and the avenues used to reach the masses aiming to persuade them are so vast that even popular cartoon characters are employed. Most people think war propaganda films disguised as innocent entertainment is just something from the World War II era, but the practice continued—and so did the sophistication. During the height of the Cold War in the 1980s the film Red Dawn (starring Patrick Swayze and Charlie Sheen) depicted the Soviet Union invading the United States only to be confronted by a group of high school kids who form a militia called “the Wolverines” (named after their school’s mascot) and help fight off the communists, saving their town. It was remade in 2012 with North Korea being the invaders this time, who just so happened to be in the crosshairs of the Department of Defense which considered them part of the “axis of evil.” Hollywood didn’t just think this would be a neat plotline, the film (and many others) was actually produced with the help of the Department of Defense. An open secret in Hollywood, but something rarely ever mentioned because it would spoil the “fun,” is that the U.S. government works hand in hand with writers and directors to craft blockbuster propaganda films that reinforce American foreign policy objectives. 348

During the War on Terror in the early to mid 2000s, millions of Americans were subjected to pro-torture propaganda through Kiefer Sutherland’s popular series 24 which began airing just two months after the September 11th attacks in 2001. Torturing suspected terrorists or people detained who were believed to have information about Al Qaeda was a hot topic of debate at the time, and Kiefer Sutherland was on national television with a new episode each week to show Americans that torturing the “bad guys” was “necessary” to save the world. 349 Over a decade later the popular entertainment industry publication Variety would admit that “Liberal Hollywood carried water for torture.” 350 The article pointed out, “Not only has torture become more frequent since the Sept. 11 terror attacks, but the acceptance of those depictions in entertainment has been cited as a point of reference—and even an endorsement of the tactics.” 351 Zero Dark Thirty , the 2013 dramatization depicting the hunt for Osama Bin Laden, falsely depicted torture as the reason information was obtained that led to the location of his compound after years of the terror leader eluding U.S. forces. Torturing detainees had nothing to do with discovering his hideout, but the film essentially rewrote history in the minds of millions who saw it and believe it tells the real story of how it unfolded. 352

When he was Secretary of Defense, Leon Panetta gave classified details about the raid to the producers to help them make the film. 353 Zero Dark Thirty later received several Oscar nominations. Most movie lovers have no idea that many big budget blockbuster films are produced with the direct help and oversight of the United States government. How else do you think the Hollywood studios get access to aircraft carriers, F-16 jets, tanks, and other sophisticated military equipment? They can’t just rent those kinds of things from a prop house. They get them from the government. The stars will never talk about this when doing the talk show circuit promoting their films. It’s kind of a trade secret really, but in the industry it’s widely known that various departments of the government have what are called entertainment liaison offices which work with producers and screenwriters to get them the equipment they want. Of course there is a price for this. It’s not monetary though—it comes in the form of script approval.

The U.S. Army isn’t going to lend a bunch of tanks to a producer for a film showing the dark side of war, or one that questions the WMD hoax that was used to justify invading Iraq in 2003, for example. Movies must always celebrate war and glorify it, and never doubt the reasons for starting one. Such deals have been made for films like Zero Dark Thirty, Red Dawn, Top Gun , American Sniper , and hundreds of others. Some have called this form of entertainment “government-subsidized propaganda.” 354 Freedom of Information requests revealed that the Department of Defense has been involved in over 800 films and television shows between 1911 and 2017, many of them since 2001 because of the War on Terror that started shortly after the 9/11 attacks. 355 It’s not just the Army, Navy, Marines, and Air Force, however. The CIA has their own Entertainment Liaison Office and has also been involved in the production of dozens of different films and television shows since at least 1947. 356 These entertainment liaison offices also include agreements that get active duty military personnel to be extras in movies when a scene calls for a large number of uniformed troops. That way the director gets their shot of hundreds of soldiers on the battlefield, but also saves the money they would have had to pay all the extras to be there. Mark Wahlberg plays a Navy SEAL deployed in Afghanistan in Lone Survivor , which is based on a true story derived from Marcus Luttrell’s biography about his experiences there in 2005, and thanks to the Department of Defense Entertainment Liaison Office the film was shot in New Mexico on Kirtland Air Force Base. 357 That way the studio didn’t have to recreate an entire military base, they were able to use a real one. Fortune magazine calls this “Hollywood’s Military Complex” and explained, “Even in an age of special effects, it’s exponentially cheaper to film on actual military ships with real military advisers. Despite action sequences and an A-list lead, Captain Phillips cost about $55 million to make (compared with a visual effects fest like Gravity , which cost about $100 million). The fulcrum of Hollywood’s unlikely partnership is Phil Strub, a former film school student and Navy videographer, now the entertainment liaison at the Department of Defense.” 358 Fortune goes on to say, “Scripts of movies helmed by Michael Bay, Ridley Scott, and Steven Spielberg are regularly sent to an ascetic office at the Pentagon in hopes of procuring military cooperation. If he [Phil Strub] signs off, the filmmakers stand to access the most awesome arsenal in the

world, and in turn, the image and message of the American armed forces get projected before a global audience.” 359 An official who works in the Department of Defense’s Entertainment Liaison Office confirmed they maintain control over the scripts, saying, “We make sure the Department and facilities and people are portrayed in the most accurate and positive light possible.” 360 That’s a nice way of saying, if anything in the film paints the government or war in a bad light, you’re not getting your equipment. Before an agreement is made to allow the use of government equipment (and locations), the Entertainment Liaison Office carefully reviews a script and then raises any possible concerns with the producer; and if they’re willing to change certain dialog or plot points then the government will give them basically anything they need as long as the movie will serve as an infomercial for the military. They can be quite picky even about the smallest detail. For example, in the original script of Hulk , the laboratory which caused Dr. Banner’s condition was a government lab, but documents obtained by a Freedom of Information Request show that the Department of Defense requested it be just a “lab” and not associated with the government at all. 361 The Army Times admitted that “filmmakers can ask the Pentagon for assistance on their projects, from consultation on uniforms and military procedures to use of real military aircraft and equipment.” 362 Or as Phil Strub, who was the head of Department of Defense’s Entertainment Liaison Office for almost thirty years put it, “The relationship between Hollywood and the Pentagon has been described as a mutual exploitation. We’re after military portrayal, and they’re after our equipment.” 363 Sure these films are entertaining and dramatic, but they’ll only tell half the story about why a conflict actually started, and what the costs will be. They also serve a secondary purpose by encouraging people to join the military because war is painted as exciting and glorious and always for a just cause, never because of misinformation or lies (as in the case of the War in Iraq). “We want these movies to help us in terms of recruitment and retention,” admitted the Department of Defense. 364 The original Top Gun starring Tom Cruise was said to have spiked enrollment in the Air Force to record levels. They even called it the “Top Gun Effect” and in some cities Air Force recruiters literally set up tables outside movie theaters. 365

Katy Perry’s music video “Part of Me” was actually shot at Camp Pendleton, a massive Marine base in San Diego, California, thanks to help from the Entertainment Liaison Office. 366 In the video she finds out her boyfriend is cheating on her and doesn’t know what to do with her life, so she ends up joining the Marines. The entire rest of the music video is literally a recruitment commercial, showing her dressed in uniform completing basic training, shooting an M-16, and riding in an Amphibious Assault Vehicle. The video also includes actual Marines as extras, marching alongside her and storming a beach with helicopters flying overhead—all provided by Camp Pendleton. Even the creators of the popular “Call of Duty” video game series consult with the Department of Defense’s Entertainment Liaison Office in order to get access to advisors in hopes of creating more realistic video games. 367 While the government enthusiastically helps produce movies, TV shows, and music videos that will reinforce their preferred narratives, big budget anti-war films or those which depict some of the horrors of war like Platoon (1986), Apocalypse Now (1979), and Full Metal Jacket (1987) have to go without any of this assistance. Sometimes the studios have to actually rent military vehicles and equipment from foreign governments and film outside of the United States to get their projects made. When Platoon came out, Oliver Stone, who wrote and directed the film, said, “I hope people go to see what the war was really like. That’s the statement. And once you see it, you have to think about it for yourself. Think about what you think about war. Think about what it really is, as opposed to the fantasy comic book stuff of Top Gun.” 368 He also said that the main character (played by Charlie Sheen) was actually based on his own experience of being in Vietnam, and how at first he wanted to do his “patriotic duty” for his country, but after seeing the horrors of the war first hand and later learning about the lies that got us there, he began to resent the U.S. government for what they had done. During the Iraq and Afghanistan wars in the early 2000s, George. W. Bush issued a ban on any photos and video of the coffins being unloaded from airplanes after soldiers’ remains were brought back to the United States. 369 It was widely known that support for the Vietnam War dramatically dropped when people began seeing footage of the tens of thousands of coffins returning, not to mention pictures of wounded soldiers,

and so the Bush Administration did everything they could trying to prevent a similar situation by censoring the details of the casualties in Iraq and Afghanistan. It wasn’t just George W. Bush and the neocons’ policies that caused needless death and destruction because of our involvement in the Middle East, however. Barack Obama became known as the “Drone King” for using the newly popular remote-control aircraft which ended up killing a stunning number of innocent civilians while the American mainstream media provided him cover by barely, if ever, mentioning it. 370 First Lady Michelle Obama played her part to help promote the Military Industrial Complex during the Obama administration. She actually appeared at the Oscars in 2013 via satellite to announce the winner of Best Picture which was given to Argo , a movie about the CIA covertly working with Hollywood movie producers so their agents could pose as film makers working on a science fiction movie in order to infiltrate Iran so they could rescue American hostages being held there. 371 That same year Homeland won Golden Globe awards for the Best Actress (Claire Danes), Best Actor (Damian Lewis), and Best TV Drama for their Showtime series depicting a returning veteran secretly siding with Al Qaeda. 372 This narrative parroted a report released by the Department of Homeland Security a few years earlier that warned returning veterans should be considered possible domestic terrorists out of concerns they may join right-wing extremist organizations after supposedly having a difficult time re-integrating into their communities. 373 The real reason for the report, which angered veterans groups when it was made public, may have been concerns that many soldiers were disgruntled with the U.S. government after learning that the reason for starting the War in Iraq (the “weapons of mass destruction” Saddam Hussein supposedly had), turned out to be a lie. In March 2012 a 30-minute documentary titled Kony 2012 was posted to YouTube and immediately went viral. The film promoted a campaign to capture or kill the African warlord Joseph Kony, leader of the Lord’s Resistance Army. Kony 2012 was the first YouTube video ever to get one million “likes” and was called the most viral video ever at the time. 374 Celebrities from Justin Bieber to Kim Kardashian helped spread it through their social media accounts and a few weeks later the U.S. Senate

passed a resolution condemning Joseph Kony and agreed to send troops from the African Union to help find him. 375 The film’s surprising popularity was no accident. It was produced by a charity called “Invisible Children” which used a high-power public relations firm called Sunshine Sachs Associates to promote it. That PR firm was co-founded by a man named Ken Sunshine who has close ties with Barack Obama. Many people became suspicious of Kony 2012 immediately since the video seemed to come out of nowhere and went viral so quickly. In hindsight it appears it was a carefully crafted propaganda campaign to promote the United States getting involved in another conflict halfway around the world. 376 The Military Industrial Complex had been eager to become more invested in the fight against Joseph Kony and the Lord’s Resistance Army, but since they weren’t a threat to the United States and had no direct connections to us, drumming up support to go after him would have been impossible. But thanks to the viral Kony 2012 video, everyone was talking about him, and despite living in a country few Americans could even find on a map (Uganda), he became public enemy number one.

The CIA In Hollywood In the 1990s the CIA appointed a man named Chase Brandon as a their liaison to Hollywood, and he began helping the agency produce dozens of films and television shows for major studios and television networks, including documentaries on the History Channel. 377 Chase Brandon retired in 2007 and was replaced by a man named Paul Barry who continues with the task. 378 Former CIA officer Bob Baer said, “All these people that run studios—they go to Washington, they hang around with senators, they hang around with CIA directors, and everybody’s on board.” 379 Just a few weeks after the 9/11 attacks CBS launched a new series about the CIA called The Agency , which was shot on location at the actual

CIA headquarters, and largely focused on the hunt for Osama Bin Laden and how the CIA was tirelessly working to keep America safe. The director of The Recruit (2003) a spy thriller starring Al Pacino and Colin Farrell, was invited to visit the CIA’s headquarters in Langley, Virginia so he could “understand how the space worked and looked.” 380 He wasn’t just brought there for a tour, the CIA’s Entertainment Liaison Office was involved in the production of the film to make sure it didn’t cast the CIA as a whole in a negative light, only Al Pacino’s character who is a corrupt agent and is eventually discovered. Over a decade later, The Atlantic would publish a story titled, “How the CIA Hoodwinked Hollywood” which explained, “The agency has established a very active spin machine in the heart of the entertainment capital, which works strenuously to make sure the cloak-and-dagger world is presented in heroic terms. Since the mid-1990s, but especially after 9/11, American screenwriters, directors, and producers have traded positive portrayal of the spy profession in film or television projects for special access and favors at CIA headquarters.” 381 Robert DeNiro played a retired CIA officer in Meet the Parents who famously hooks Ben Stiller up to a lie detector as part of his over-protective antics to determine if Stiller can be trusted to marry his daughter. Apparently the original script included a brief scene showing “torture manuals” on DeNiro’s book shelf once Stiller stumbled across his secret office in the basement and learned of his future father in law’s true identity, but the CIA told the studio not to include them on the shelf since they would cast the Agency in a negative light. 382 Not all films about the CIA show them in a positive light, however. Those movies have to be made without the help of any government agency. Matt Damon stars in The Bourne Identity (2002) which is loosely based on the CIA’s very real mind control experiments called MK-ULTRA. 383 Needless to say the CIA would rather sweep that under the rug and didn’t provide any assistance in its production. Syriana (2005) starring George Clooney focuses on the CIA’s involvement in the Middle East where they engage in numerous shady activities behind the scenes in order to maintain control of major fields in the region—another film they prefer would have never been made. Spy Game (2001), starring Robert Redford and Brad Pitt shows the CIA turning their back on one of their operatives in order to avoid

jeopardizing a trade deal that is about to be signed between the United States and China. The Agency wouldn’t have anything to do with that film because it showed senior management in an “insensitive light” 384 when in reality it showed the complexities of international relations and the difficult and sometimes coldblooded decisions that are made behind the scenes to maintain American superiority in the world. In his book Operation Hollywood: How the Pentagon Shapes and Censors Movies , David Robb concludes, “No society is free that allows its military to control the arts. In America, it is not only unconscionable, it is also unconstitutional.” 385 He’s certainly not alone in thinking that. Many legal experts believe that entertainment liaison offices actually violate the First Amendment because they only help producers whose films portray the U.S. government, the military, and various other agencies, in a favorable light. This kind of selective help is equivalent to the government refusing to allow certain groups from reserving local town hall venues because of what those groups or their leaders believe. Constitutional Law professor Irwin Chemerinsky, who teaches at the University of Southern California argues, “The government cannot favor some speech due to its viewpoint and disfavor others because of its viewpoint. The court has said that when the government is giving financial benefits, it can’t decide who to give to, or not give to, based on the viewpoint expressed.” 386 He and others say this one-sided favoritism is no different that if the government gave one particular religious group material support or financial favors while denying those same benefits to others. 387

Some Actors Are Real CIA Assets Aside from the CIA aiding in the production of various films and television shows, their involvement in the entertainment industry goes much further and sounds like something right out of a movie. A former CIA officer named John Rizzo wrote a memoir called Company Man: Thirty Years of Crisis and Controversy in the CIA , where he admitted the agency regularly works with production companies that allow CIA operatives to work undercover as

members of film crews when a film is being shot on location in a foreign country. 388 “Among businesses in general, the CIA has long had a special relationship with the entertainment industry, devoting considerable attention to fostering relationships with Hollywood movers and shakers—studio executives, producers, directors, and big-name actors,” Rizzo explains. 389 He also said that some celebrities have been enlisted as CIA assets through the agency’s National Resources Division, which recruits foreign students studying in America, business people here on work visas, and even foreign diplomats the Agency wants to become spies for the United States when they return to their home countries. Once initiated, the celebrities are used to relay information to the CIA about foreign leaders they meet since they’ll often speak more candidly with a celebrity than with diplomats or reporters due to being star struck and letting their guard down. 390 “These are people who have made a lot of money basically making stuff up. A lot of them, at least the smarter and more self-aware ones, realize that what they do makes them ridiculously rich but is also ephemeral and meaningless in the larger scheme of things,” Rizzo says. “So they’re receptive to helping the CIA in any way they can, probably in equal parts because they are sincerely patriotic and because it gives them a taste of reallife intrigue and excitement.” 391 In his book he also says that a major film star once approached the CIA himself, wanting to work with them, “just out of his patriotic duty,” after the actor learned that another major studio had a relationship with the agency. Rizzo says the actor asked his handler for $50,000 of cocaine for his services, which the agency allegedly refused. 392 When Ben Affleck was promoting his film Argo (2012), which is based on the true story of the CIA working undercover with a film studio to infiltrate Iran to rescue American hostages under the guise of shooting a movie there, he was asked by a reporter if he thought there were any actors working as CIA operatives in Hollywood today. “I think there are probably quite a few. Yes, I think probably Hollywood is full of CIA agents and we

just don’t know it, and I wouldn’t be surprised at all to discover that this was extremely common,” he responded. 393 Knowing what happened with the Iranian hostage rescue and working on other films that are overseen by the CIA’s Entertainment Liaison Office, Ben Affleck would certainly be in a position to know. He also starred in The Sum of All Fears (2002) where he played a CIA analyst, another film that was produced with the help of Chase Brandon, the agency’s entertainment liaison at the time. 394 Affleck’s (now ex) wife Jennifer Garner also played a CIA agent in ABC’s action thriller Alias, which the Central Intelligence Agency consulted on, so he is obviously very familiar with how close the agency works with Hollywood.

The FBI and Hollywood The FBI has their hand in Hollywood too. On their website they admit, “If you are a writer, author, or producer who wants to feature the FBI, we may be able to work with you to create an accurate portrayal of the Bureau. We’ve been doing it since the 1930s.” 395 They call this office the Investigative Publicity and Public Affairs Unit (IPPAU), and they work with “domestic and international screenwriters, producers, authors, and other industry personnel associated with TV programs, documentaries, made-for-TV movies, books, and motion pictures.” 396 J. Edgar Hoover, the infamously corrupt founding father of the FBI (and its director for almost 50 years), used his position to bully Hollywood studios into dropping certain actors from projects and got scripts changed that would have shown the agency in a negative light. John Wayne was chosen to be the narrator for a television series called “The FBI” for the ABC network in the 1960s, but because of his connections to the right-wing John Birch Society, Hoover “vetoed” John Wayne’s involvement and had ABC remove him from the project “in order

to prevent any possible criticism of the Bureau by using someone with known John Birch Society connections.” 397 J. Edgar Hoover also used his position to target anti-Vietnam war musicians like Jimmy Hendrix, Janis Joplin, and especially John Lennon, who he was concerned threatened President Nixon’s chances of getting reelected, so Hoover tried to have him deported back to England because he was once arrested for possession of marijuana. 398

Operation Mockingbird In the news industry, intelligence agencies enjoy similar influence and have deeply embedded operatives and developed covert relationships for decades. In the 1970s a Congressional hearing uncovered a secret program called Operation Mockingbird which involved the CIA infiltrating television news networks, newspapers, and magazines, and paying off reporters and editors to do the agency’s bidding. 399 At the time there were widespread concerns that the CIA was involved in numerous corrupt and illegal activities, including spying on American citizens and assassinating foreign leaders, so Congress investigated the agency and happened to learn of their secret dealings with the media. At one point during the hearing William Colby, the head of the CIA then, was asked if the agency had operatives working for any television networks. He refused to answer the question and said that it’s something he would rather “get into” in an “executive session,” meaning behind closed doors with just a small number of senators authorized to have access to classified information. 400 The former president of CBS, Sig Mickelson, was later asked if he thought despite Operation Mockingbird being uncovered, was the CIA still engaged in the same type of operations. “Yeah, I would think probably, for a reporter it would probably continue today, but because of all the revelations of the period of the 1970s, it seems to me a reporter has to be a lot more circumspect when doing it now or he runs the risk of at least being

looked at with considerable disfavor by the public. I think you’ve got to be much more careful about it.” 401 Anyone who followed the “Russiagate” scandal and the conspiracy to bring down the Trump administration by claiming he’s a secret Russian agent, knows in their gut that various intelligence agencies (the “Deep State”) continue to work closely with the mainstream media in order to push their agenda. I cover Operation Mockingbird in detail in my previous book, The True Story of Fake News , which I encourage you to order from Amazon or download the e-book from any of the major e-book stores if you’re interested in learning more about the subject. Decades have gone by since the name “Operation Mockingbird” has been mentioned on national television, and when you learn just how deep the CIA burrowed their way into the various news networks, it’s chilling, especially in light of their ruthless and relentless war on President Trump.

Climate Change Many of Hollywood’s concerns about the environment, specifically global warming (or “climate change” as they have rebranded it) aren’t really about keeping our air clean, preserving delicate ecosystems, or developing green energy, but instead is just a smokescreen to hide their true intentions. Obviously we should take care of the environment, not litter, recycle, and be good stewards of the earth, but the fanatical doomsday warnings about global warming are designed to mobilize people to accept exorbitant carbon taxes and embrace the implementation of enormous new socialist programs. 402 Alexandria Ocasio-Cortez’s senior aide and puppet master admitted, “The interesting thing about the Green New Deal is it wasn’t originally a climate thing at all…Do you guys think of it as a climate thing? Because we really think of it as a how-do-you-change-the-entire-economy thing.” 403 Ocasio-Cortez said the plan was aiming for “a new national social, industrial and economic mobilization on a scale not seen since World War II and the New Deal,” in order to “provide unprecedented levels of prosperity and economic security for all people of the United States.” 404

Celebrities have always been “tree huggers” and concerned about the environment—which is a good cause, but their hysterical rhetoric about what humans are doing to the planet is getting increasingly radical to the point that they are literally claiming the human race will soon go extinct if we don’t listen to them, and any day now when we peer outside the windows of our homes it will be as if we’re looking at a scene from a disaster movie. Because of all the “end of the world” fear mongering about climate change, some children are getting what is called “eco-anxiety” which child psychologists describe as “a form of anxiety about where the world is heading when it comes to climate change.” 405 This is what caused Greta Thunberg, the teenage climate change activist from Sweden, to begin skipping school thinking she was helping save the world. Once she caught the eye of the climate change lobby, they adopted her as their spokesperson and threw the weight of their massive propaganda machine behind her to propel her to international stardom as a child prodigy who is trying to save the planet. Time magazine even put her on the cover for their 2019 Person of the Year issue. 406 Recently there have been increasing calls for geoengineering, something that was said to be conspiracy theory just a few years ago. 407 Some scientists want to spray little particles of glitter into the atmosphere to block out some of the sun’s rays hoping that will keep the earth slightly cooler to offset the supposed “global warming” that’s happening. Meanwhile geoengineering advocates ignore the law of unintended consequences, and nobody knows what kind of environmental disasters doing such a thing would cause. Like everything liberals do, their claims of “living green” are rife with hypocrisy. Just one trip on their private jet spews more pollution into the air than several months’ worth of daily commutes on the freeway in a car. 408 Just one of Al Gore’s homes uses more than 20 times the amount of energy as an average home, costing an estimated $30,000 a year in utilities for the gas and electricity. 409 Arnold Schwarzenegger said fossil fuel executives should be sued for “first degree murder” because their industry is “killing” the planet. 410 Arnold apparently forgot that he was the first civilian to buy a Hummer in 1992 when the extra-large gas guzzling military vehicle became commercially available. It famously got about 10 miles a gallon. 411

Recently Hollywood has been inserting messages about global warming hysteria into almost everything. During the Miss Universe 2019 pageant one of the contestants was asked, “Are leaders of today doing enough to protect future generations from climate change?” Steve Harvey, the host, then rolled his eyes as soon as he was done reading the question off the card. 412 Hollywood, Health & Society (the organization that helped inject storylines about Obamacare into TV shows) also lobbies Hollywood studios about climate change. They specifically have been focusing on comedy shows because as Lizz Winstead, a writer for The Daily Show points out, “Comedians have become trusted as people who observe the world and talk about it truthfully. Because they’re not beholden to anyone, they can call bullshit when they see it.” 413 That may have been true before “Cancel Culture,” but that’s a whole other topic. The organization’s website openly states, “Hollywood, Health & Society assists with research, providing a range of information from experts for storylines on topics, from rising seas to melting glaciers, the increase of extreme weather to the spread of infectious diseases, from the Arctic to L.A.” 414 But they’re certainly not the only ones lobbying Hollywood to warn viewers about the issue. In 2011 the Secretary General of the United Nations traveled to Hollywood during Oscar week in order to encourage industry insiders to make more films about climate change. 415 The U.N. famously recruits celebrities like Angelina Jolie and George Clooney as “ambassadors” to further their agendas since so many people view celebrities as experts in everything. Knowing that few people watch documentary films, the U.N. focused on getting the issues incorporated into television series and movies. Ban Ki-moon, the Secretary General of the U.N. at the time, told attendees, “Animate these stories. Set them to music! Give them life! Together we can have a blockbuster impact on the world.” 416 Another speaker at the event said, “There’s a huge gap between what governments can do, given political constraints, and what they should do. That’s where you come in…We need you to make it sexy and cool to bring about the energy revolution that has to happen.” 417 Executives working for the FOX television network (not to be confused with Fox News) once openly admitted the network uses their shows to promote concerns about global warming. Chairman Gary Newman

admitted in a promotional video the company put out years ago to brag about their efforts that, “We want to set an example in our industry and other industries that no matter what the size of your carbon footprint is, you can make a difference...The biggest thing we have done is inserting messages about the environment into some of our content.” 418 The Simpsons , King of the Hill , Family Guy , 24 , and many other FOX shows have all included warnings about climate change, sometimes very brief, but they are there. For example, in a scene from Family Guy when a character is looking around at a car dealership he asks “what kind of jerk would drive one of those?” when he comes across a Hummer. Another FOX television executive, Dana Walden, said, “the most powerful way that we could communicate the commitment on behalf of our company was to change the practices within the production as well as work in a message about global warming, about environmental changes, and about empowering people to take responsibility.” 419 The most infamous global warming propaganda is Al Gore’s “documentary” An Inconvenient Truth which helped jump start global warming hysteria. Devastated by losing the 2000 election to George W. Bush, Al Gore found meaning in his life traveling around the world giving his doomsday predictions to anyone who would listen. But documentary films don’t have the same impact that big budget action movies do. Jesse Bryant, who organizes an environmental film festival at Yale University, said, “It’s great to publish academic journals on the issues but the real breakthrough is when pop culture stories are hinted towards this cliff that we are all heading off.” 420

The Film that Started it All? Kevin Costner’s Waterworld was perhaps the first major film used to promote fears of global warming. Released in 1995 the story takes place around the year 2500 when the polar ice caps have melted and the entire earth is covered with water, forcing citizens to live on boats. At the time, it was the most expensive film ever made, costing around 175 million dollars, and turned out to be an epic flop. 421

An interesting spin on the climate change hysteria was The Day After Tomorrow (2004) which, unlike Waterworld , depicted the earth freezing from climate change. It’s based on a crazy “non-fiction” book titled The Coming Global Superstorm written in 1999 by UFO buff Art Bell and another guy named Whitley Strieber. Dennis Quaid plays a climatologist who realizes that the melting of the polar ice caps has disrupted the ocean currents and caused an enormous polar vortex which drops the earth’s temperature below freezing. Soon dozens of feet of snow fall everywhere from the disruptive weather patterns, trapping everyone inside. There’s even a scene where the vice president, who looks like Dick Cheney, was chastised for not listening to scientists earlier about the looming disaster global warming would cause. 422 The film was widely mocked as ridiculous and had the opposite effect that was intended. Instead of raising awareness for the “dangers” of climate change, The Day After Tomorrow became a prime example of how absurd those fears were. Vanity Fair is upset that there aren’t more films about climate change, saying, “Fifteen years after The Day After Tomorrow, movies about climate change remain rare, and never as serious as the problem itself.” 423 The article recommended that the next Fast & Furious film depict the gang driving electric vehicles instead of ones with “gas-guzzling” combustion engines to “set an example.” At the bottom of the article it has a note that reads, “This story is part of Covering Climate Now, a global collaboration of more than 220 news outlets to strengthen coverage of the climate story.” 424

Perhaps the writer got the idea of Fast & Furious using electric vehicles from Pixar’s animated film Cars 2 , which casts Big Oil as the bad guy, conspiring to prevent an alternative (more environmentally friendly) fuel from catching on. 425 A 2012 film called Beasts of the Southern Wild depicts planet earth on the verge of a climate catastrophe that ends up ultimately flooding a bayou village and causing dangerous prehistoric beasts which were frozen in the polar ice caps to become free and roam the earth again when they melt. Snowpiercer (2013) starring Chris Evans is about a future where climate change made the earth freeze over due to a failed attempt by scientists trying to use geoengineering to stop it, so the humans who remain have to live on a train that constantly travels around the world non-stop.

Why do they have to live on a train, and not in a building with a furnace to keep them warm, you ask? Because that would defeat the point of the movie about the train being an allegory for “classism” and the hierarchy of society separating the rich from the poor. The upper class members live in the cars closest to the engine, in luxury, while the poor masses are stuck living in the cars at the end of the train, in poverty. 426 One science blog said the “Frozen earth in ‘Snowpiercer’ is a grim (and possible) future for our warming planet.” 427 Others liked that it wasn’t just another “climate change dystopia film” but was what they called the first geoengineering dystopia film. 428 It seems some who are concerned about climate change also doubt that geoengineering could solve the problem and think hopes of geoengineering (like spraying glitter in the atmosphere to block some of the sun’s rays) are only addressing the symptoms, and not the cause of global warming. In May 2020 the TNT television network aired a reboot of the film as a television series which is said to take place in the year 2021. The 2014 science fiction film Interstellar revolved around the human race having to find another planet to live on because of dust storms and crop failures, and while not mentioning the words “climate change,” many saw the subtle message it was trying to make. Green Peace noted, “Interstellar has the potential to play a positive role in the climate movement. It can urge those who already see the impact of climate change to take activist action. And for others who have up to now have ignored the science, they may think again.” 429 But the message was too subtle for some critics. The Atlantic complained that “climate change” is never explicitly mentioned in the film, and instead of trying to solve the “mistakes” humans have made on earth that “caused” the planet’s destruction, the characters instead decided to abandon earth and try to start over somewhere else. 430 They were upset that the space opera aspects of the film and the issues of time travel overshadowed concerns about why Matthew McConaughey and his crew had to leave the earth in the first place. It’s interesting to point out that both Jeff Bezos and Elon Musk have aerospace companies and want to colonize other planets out of fear that, because of climate change and “limited resources,” earth may become uninhabitable in the future. 431

In Downsizing (2017) Matt Damon and Kristen Wiig play a couple who plan to undergo a new scientific shrinking procedure similar to Honey I Shrunk the Kids , but this time on purpose, along with thousands of other people in order to all live in miniature communities so they will use a much smaller amount of earth’s natural resources. By “downsizing” they also reduce the amount of pollution they create, and help slow climate change. Another “benefit” is that by living in the miniaturized communities everything costs less since building materials and food go much further, making ordinary middle class people wealthy in their new life. But only 3% of the population opts for “downsizing,” meaning it has little effect on saving the earth from overpopulation. In the end the people who didn’t succumb to the procedure are said to be on the verge of all dying from global warming, but the miniature “downsized” people were all safe in an underground bunker, and they will be the ones to repopulate the earth once the climate calamity finally ends. In Geostorm (2017) special weather-controlling satellites are put in space to save the planet from all the climate change we’ve caused, only to get sabotaged and turned into weapons of mass destruction. 432 Despite the film’s over the top special effects showing major cities around the world being completely destroyed, climate change alarmists felt it was a good try regardless since it helped raise awareness for the “ecological tipping point” they fear we are approaching and were glad that climate change had been a common theme in several movies that year. 433 Ethan Hawke stars in First Reformed (2017) where he plays a minister struggling with his faith after his son died in the War in Iraq because he encouraged him to enlist in the military as part of the “family tradition.” The earth is on the verge of being uninhabitable because of climate change, and at one point a woman calls him to ask if he will counsel her boyfriend out of concern for his environmental extremist views. The woman later finds a suicide vest her boyfriend made that he planned to use to fight back against the industrialists who ruined the planet. Hawke takes it but agrees not to call the police, hoping he can talk some sense into the man and avoid getting him in trouble. The minister then researches climate change for himself, starts to agree with the man’s extremist views, and begins planning to use the suicide vest himself to kill a wealthy factory owner and others who aren’t good stewards of the earth.

Writer and director Paul Schrader said the film reflects his own “despair” over the “climate crisis.” 434 Equally corny was the 2018 version of The Predator where a key part of the plot was when the humans figured out why the creatures had returned to the earth after the incident depicted in the original film. The aliens, it turns out, were worried that climate change was going to make humans extinct soon, so the creatures came to earth to collect our DNA for their own genetic experiments before it was no longer available! “How long before climate change renders this planet unlivable? Two generations? One?” asks a federal agent trying to kill the creatures. Then it suddenly dawns on the lead scientist, played by Olivia Munn. “That’s why their visits are increasing. They’re trying to snap up all of our best DNA before we’re gone.” 435 That’s literally the reason given in the film as to why they returned to earth! Climate change was going to kill us! HBO’s Years and Years aired an entire episode focusing on the issue. The series follows a political family over the course of 15 years, with each episode taking place in a different time period, and one in the year 2025 depicts the north pole as having melted because of global warming. A lead character (Edith Lyons) says, “We keep saying, ‘you’ve got ten more years to sort out climate change, you’ve got ten more years to sort out flooding, you’ve got ten more years to sort out the rain forest.’ We’ve been saying that for 30 years. It’s too late. We’ve run out of time. Everyone knows it.” 436 The show goes on to warn that most people will soon starve from floods destroying crops and those who survive will have to live in small huts and only have their memories of what life was like before the climate catastrophe. Aquaman (2018) starring Jason Momoa depicted the King of Atlantis “Orm” starting a war with humans because of the decades of pollution we have been dumping into the ocean. Despite its pro-environmental message, some critics were upset that the words “global warming” were never actually explicitly mentioned in the film. “Aquaman shows, with unfortunate clarity, that the superhero film genre is ill-equipped to take on serious subjects,” said one critic. “Superhero stories love to imagine the end of the world, but don’t have much to offer in the face of actual global catastrophes.” 437

“Aquaman” Jason Momoa took the role very seriously however. When actor Chris Pratt posted a picture on his Instagram showing himself after a workout, he got “called out” by Momoa for drinking from a “single-use” plastic water bottle. Pratt then apologized. 438 Even if you recycle your plastic water bottle, that’s not environmentally friendly enough, so now the extremists are shaming people who don’t drink out of re-usable water bottles instead. In the Marvel superhero film Venom , the villain who is using his personal space exploration company to search for other inhabitable planets because “overpopulation and climate change” are going to make earth “uninhabitable” in just “literally” one more generation. 439 It’s by accident that one of their probes discovers an alien symbiotic lifeform that is brought back to earth, creating the “Venom” superhero by merging with a man’s DNA.

“Thanos Did Nothing Wrong” Fighting climate change often involves reducing the earth’s population, since the more people there are living on the planet, the larger our supposed accumulative carbon footprint is, and it’s under this rationale that some environmentalists sided with Avengers villain Thanos in his quest to kill half of all life in the Universe. In the movies, that’s his goal once he obtains all of the “Infinity Stones” which would grant him supernatural power, and some critics began arguing that instead of being a psychotic villain, Thanos “did nothing wrong.” The saying “Thanos did nothing wrong” had become a popular Internet meme from nihilist fans who sided with him, but some on the Left took it seriously thinking that it would help save the earth. Forbes magazine asked “Is Thanos right about overpopulation? His rationale seems to make sense if we consider our own planet. Since the Industrial Revolution, the world population has grown rapidly. The figure is currently over 7.6 billion and is projected to reach 10 billion in 2050… Fewer people ought to mean more food and less hunger, and might lower the risk of an epidemic when overcrowding enables the spread of disease. Human activity is driving a loss of biodiversity, with about 25% of animals

and plants now threatened with extinction, so halving the population would help other species. As a consequence, you could conclude that by eliminating 50% of all humans, Thanos did the Earth a huge favor.” 440 Their review concluded, “you could indeed argue that Thanos did nothing wrong—and in the long run, the villain might have actually saved the world.” 441

Population Control The idea of dramatically reducing the earth’s population in order to “save” it is actually something that environmental extremists have been promoting for decades. Back in the late 1960s, Stanford University professor Paul R. Ehrlich published a book titled The Population Bomb, which warned that within the next ten years society would collapse from massive famines because there were too many people on the planet using too many resources. 442 Despite the book being wildly inaccurate and over 50 years later the predictions laughable, many activists are still warning that we need to immediately reduce the population to save the planet. 443 Some celebrities like Miley Cyrus have even said they’re not going to have children because of climate change. 444 Alexandria Ocasio-Cortez has also said she too isn’t sure whether or not she wants to have kids for the same reason. 445 Many others are blaming couples who have children for contributing to the “problem.” 446 With Transhumanism appearing to be on the horizon which promises to extend our lifespan by hundreds of years (or indefinitely), 447 proponents are becoming increasingly concerned that this will cause the earth’s natural resources to become even more rapidly depleted because if people are able to quadruple their lifespan, that also means they’ll end up using four times as much energy, food, and other natural resources as well. 448 The mysterious Georgia Guidestones monument located in the small town of Elberton, Georgia, was erected in 1980 to declare the “need” for such actions. The 19-foot-tall monument consists of four slabs of granite

planted into the ground with 10 “commandments” engraved on each side, written in eight different languages. 449 The first of the ten “commandments” is to reduce the planet’s population down to 500 million, an over 90% reduction from its current 7.5 billion. The “Guidestones” were commissioned and paid for by an unknown man using the pseudonym R.C. Christian who said he represented a group that wanted the monument built to send the world a message. 450

Sports “News” Unlike politics and religion, sports is supposed to be the one universal activity that people can enjoy or discuss without the usual controversies associated with the human condition. One would expect that sports news shows and networks would be the last place you’d hear about politics, let alone be subjected to political propaganda, but unfortunately that’s not true these days. In the past, sports and politics would occasionally intersect but usually only when a star athlete joined a political cause and their involvement was part of a human-interest story. It was usually void of much controversy because often their activities weren’t divisive or controversial, but instead humanitarian in nature. But recently many sports writers, websites, and television networks have become liberal propaganda outlets, promoting left wing causes and putting athletes on pedestals who become token symbols of the liberal agenda. The entire NBA and NFL endorse the Black Lives Matter movement and have turned Colin Kaepernick, the former San Francisco 49ers player who refused to stand during the National Anthem before games, into a hero for starting the trend. When the 2020 NBA season began after a long delay from the COVID-19 pandemic, many of the players wore special jerseys with “social justice” messages printed on them in place of their last names on the back. 451

The league had worked with Nike to make the “Black Lives Matter” jerseys. This was in response to the protests (and riots) that spread across the country that summer when it became mandatory for sports leagues to condemn White people for “systemically” ruining Black people’s lives. Several basketball stadiums even painted “Black Lives Matter” on the courts. 452 The NFL also kicked off the 2020 season with the “Black National Anthem” being performed at the start of each game during week one in order to help “raise awareness” of “systemic racism” in America. 453 The

“Black National Anthem” is a song titled “Lift Ev’ry Voice And Sing” that many Black people consider to be “their” national anthem, instead of the Star Spangled Banner. Even NASCAR became political in 2020 when they banned drivers and fans from displaying any Confederate flags at the races just two days after the league’s only (half) Black driver Bubba Wallace made the demand. 454

Then a week and a half later someone allegedly hung a “noose” in his garage at the Talladega Superspeedway in Alabama right before a big race. Bubba became a hero overnight from the media endlessly reporting that a “racist” NASCAR fan upset at him for getting the Confederate flag banned must have snuck into his garage and hung the “noose” for revenge. At the race the next day Bubba was given a parade as he rolled out onto the track to show how the entire league supported him for being so “brave” for what he had gone through. 455 Only, as I’m sure you know, the “noose” turned out to be the handle on the end of the rope which is used to pull open the garage doors at the track. 456 But Bubba had become a star overnight and was a NASCAR hero for standing up against the imaginary “hate crime” that 15 FBI agents wasted their time investigating. 457 After Amazon obtained the naming rights to Seattle’s NHL arena, formerly called Key Arena, they changed the name to Climate Pledge Arena to “raise awareness” for climate change, so now fans can’t watch a hockey game in Seattle without the constant reminder to be on the lookout for global warming. 458 Not even the Super Bowl Halftime shows are safe from becoming avenues to deliver political messages with musical guests sometimes incorporating “social justice” propaganda into their performances. 459 Sportswriter Bryan Curtis noted, “There was a time when filling your column with liberal ideas on race, class, gender, and labor policy got you dubbed a ‘sociologist.’ These days, such views are more likely to get you a job.” 460 Sports broadcaster Jason Whitlock said, “ESPN and most of the mainstream media have lurched farther left. That’s a complaint from middle America and, in my opinion, objective America. ESPN’s own ombudsman acknowledged ESPN’s hardcore progressive slant.” 461 Speaking about Fox Sports 1, a competitor to ESPN, he said, “I think we’re the alternative for sports fans who respect and like traditional sports values. I think we’re the alternative for mainstream sports fans, Little

League coaches, athletes, sports moms and dads. I think we’re the alternative for people who want to hear authentic conversation and debate rather than words crafted for Twitter applause. I think we’re the alternative for middle America, blue-collar sports fans. I think we’re the alternative for people who don’t think every misspoken word is a fireable offense. ESPN caters to the elite, safe-space crowd. We cater to the people who love to tailgate and knock down a six-pack.” 462 Michael Brendan Dougherty, editor of The Slurve baseball newsletter, wrote, “It’s also true that conservative ideas tend to be slower off the block. Because they are defenders of tradition, conservatives’ arguments often strike liberals as either an unreflective devotion to the way things are (or were), or as being too subtle to be credible.” 463 For the 2015 season the NBA teamed up with Sheryl Sandberg, a radical feminist and top executive at Facebook, to promote her “Lean In” campaign which nagged men to, “take more responsibility for housework and child care,” and said they need to “do their fair share of daily chores.” 464

The campaign aired commercials on TV during basketball games which used NBA players like LeBron James and Stephen Curry to lecture men to help out more around the house with laundry and other chores. 465 In 2015 ESPN gave Caitlyn Jenner the Arthur Ashe Courage Award, choosing “her” over others—including double amputee Noah Galloway, who is an Iraq War veteran—and despite missing one arm and one leg became a competitive distance runner, CrossFit athlete, and won third place on Dancing With the Stars . 466 Caitlyn Jenner was also chosen over fellow nominee Lauren Hill, a college basketball player who lost her fight with a brain tumor. 467 Surprisingly, veteran sports broadcaster Bob Costas admitted choosing Caitlyn Jenner was a “crass exploitation play,” saying, “In the broad world of sports, I’m pretty sure they could’ve found someone—and this is not anything against Caitlyn Jenner—who was much closer actively involved in sports, who would’ve been deserving of what that award represents.” 468 Caitlyn Jenner hadn’t played competitive sports since the 1980s (when “she” was Bruce). Sports Illustrated also put “her” on the cover at the age of 66 wearing the gold metal “she” won at the 1976 Olympics as Bruce, forty years earlier. 469 Not long after this, ESPN fired baseball analyst Curt Schilling because he posted a meme on his personal Facebook page criticizing new

transgender bathroom laws which allow biological males to use women’s bathrooms, locker rooms, and showers. 470 The meme simply consisted of a man dressed as a woman with the caption, “Let him in to the restroom with your daughter or else you’re a narrow minded, judgmental, unloving, racist bigot, who needs to die!” ESPN’s President John Skipper was asked if the “perceived political shift” in sports becoming political was a “conscious decision” by the network. He responded, “It is accurate that the Walt Disney Company and ESPN are committed to diversity and inclusion. These are long-standing values that drive fundamental fairness while providing us with the widest possible pool of talent to create the smartest and most creative staff. We do not view this as a political stance but as a human stance. We do not think tolerance is the domain of a particular political philosophy.” 471 One conservative employee at ESPN revealed, “If you’re a Republican or conservative, you feel the need to talk in whispers. There’s even a fear of putting Fox News on a TV [in the office].” 472 Speaking shortly after the 2016 Presidential election, ESPN’s public editor Jim Brady said, “As it turns out, ESPN is far from immune from the political fever that has afflicted so much of the country over the past year. Internally, there’s a feeling among many staffers—both liberal and conservative—that the company’s perceived move leftward has had a stifling effect on discourse inside the company and has affected its publicfacing products. Consumers have sensed that same leftward movement, alienating some.” 473 Sportscaster Joe Buck is uncomfortable with sports recently becoming political, saying, “Unless I’m completely wrong, and I know in this case I’m not, nobody’s tuning into the 49ers-Cowboys game to hear my political opinions, whether it’s about Trump, or Kaepernick or Flint, Michigan. That’s not why they’re watching a football game. It’s misplaced. I hear guys doing it at times. It seems self-serving. Like they want to inject themselves into the conversation. Wait for a talk show. Go on Bill Maher’s show. Bill O’Reilly. Whoever. I think people watch these games to get away from that stuff. I think you risk alienating and upsetting a lot of people when you start going down that rabbit hole.” 474

NFL Promotes “Social Justice”

Shortly into the 2017 season, NFL players and owners issued a joint statement saying they held an important meeting to, “discuss plans to utilize our platform to promote equality and effectuate positive change. We agreed that these are common issues and pledged to meet again to continue this work together.” 475 Then Roger Goodell, NFL Commissioner, sent a letter to the Senate Judiciary Committee encouraging them to pass the Sentencing Reform and Corrections Act of 2017, which would reduce the prison sentences for drug offenders. A few months later the NFL announced the creation of their new “Inspire Change” initiative which involves giving millions of dollars in grants to “social justice” causes, including “helping schools implement more comprehensive African-American history education programs.” 476 The NFL also started becoming concerned that the tradition of using beautiful women as cheerleaders was “sexist,” so for the 2018 season they introduced male “cheerleaders” for the first time. The Los Angeles Rams and the New Orleans Saints were the first two teams to add them, and they’re not there to help the girls perform stunts by tossing them into the air and catching them. They dance with the girls and do all the same routines on the sidelines, even holding pom-poms. 477 Instead of being denounced as stupid or weird, they were hailed by the liberal media for “making history.” 478

Nike also decided to get into politics recently. In September 2018 the sportswear giant put out a new ad featuring Colin Kaepernick to celebrate the 30th anniversary of the company’s “Just Do It” campaign. While it was a polarizing choice, pushing half of their potential customers away who despise Kaepernick for his anti-American and anti-police activism, Nike’s revenue increased over the previous year’s quarter. 479 Under their new business model they don’t care how many of their previous customers will never buy a Nike product again because with Kaepernick as their new poster boy the company’s focus is now on the fanatics who will buy Nike gear even more because it reflects their social justice warrior identity. 480 As everyone knows, Black people dominate the NBA and NFL—and other sports like long distance running; but NBC Sports president Pete Bevacqua is worried that too many White people play golf. “Golf hasn’t had the best history,” he says. “Golf needs more diversity. How do you get more minorities playing the game, how do you get more women playing the

game? I think all of golf understands that, whether it’s the LPGA, the PGA Tour, the USGA, the PGA of America, Augusta National.” 481 Imagine a sports broadcaster saying there’s too many Black people in the NBA, or that it needs more “racial diversity!” They would be fired within the hour, but as I detailed in the “War on White People” chapter, the liberal media has no problem with anti-White racism, and in fact encourages it. Jemele Hill (a proud Black woman) who was co-host of SportsCenter, called President Trump a “White supremacist” in 2017 without any repercussions from the network. 482 Such an outrageous comment from the host of ESPN’s flagship show drew criticism from White House Press Secretary Sarah Huckabee Sanders and even President Trump himself. Many had become accustomed to hearing such slander from CNN and MSNBC panelists, but coming from an ESPN host took things to a new level of depravity.

“Pride Night” All major sports leagues now host an annual “Pride Night” where they celebrate LGBT people, decorate their stadiums with rainbows, and bring special guests to the games from the gay (and transgender) community. To make sure everything is gay enough they even have gay men’s choirs sing the national anthem. 483 Today, most—if not all—NBA teams now host one each year, but it’s not just the NBA. The NFL launched their own annual “Pride Night” as well, to “heighten sensitivity to the LGBTQ community” and show their “commitment to an inclusive environment in which all employees are welcome.” 484 As of 2018, every major league baseball team except one hosted an annual Pride Night. 485 The following year the one hold out (the Yankees) gave in and held their first “Legacy of Pride” night and even awarded scholarships to various LGBT students. 486 Even the NHL has an annual Pride Night, where they too decorate the stadiums in rainbow colors and players even use hockey sticks wrapped in rainbow colored tape to show support for the LGBT community. 487 You

can’t even go to a hockey game these days without LGBT propaganda being shoved in your face.

The Super Bowl Since the Super Bowl is the most-watched event on television every year, the NFL and their sponsors can’t pass up the opportunity to spread liberal propaganda to as many people as possible. Lately we’ve been seeing an increasing amount of Super Bowl commercials pushing a political agenda, from Audi using a car commercial to complain about the (non-existent) “gender pay gap” to a lumber company denouncing President Trump’s plan to build a wall on the U.S. / Mexico border. 488 The NFL has also reportedly refused to air pro Second Amendment commercials. 489 Even the Halftime show, which might be the last place one would expect to push a political agenda, isn’t immune. In 2016, Beyonce was the featured artist and turned her performance into a dedication to the Black Panthers and Black Lives Matter. 490 The following year, with tensions still high from the recent Presidential election, Lady Gaga also used the spotlight to promote a political agenda, although a lot more subtle than Beyonce the year before. Many people missed it, but it was there, and it was undeniable if you knew what to look for. 491 Gaga gave a shoutout to the anti-Trump protesters who were (at the time) out protesting the new president’s temporary travel ban from seven countries which had been identified as hotbeds of terrorism. 492

When Jennifer Lopez and Shakira performed in a sex-charged halftime show that included stripper poles, booty shaking, and crotch-grabbing; they also depicted “kids in cages” as a way to denounce President Trump’s immigration policy of detaining people who cross illegally into our country. 493

Both Jennifer Lopez and Shakira are of Latin descent, and at one point during their performance they started singing in Spanish to cater to the tens

of millions of non-assimilating immigrants who are occupying areas in American cities. After the New England Patriots visited the White House following their 2017 Super Bowl win, the New York Times tweeted out two side by side photos, one showing when the Patriots visited the White House in 2015 when Barack Obama was president, and the other from the current visit, giving the impression that far fewer players showed up because they didn’t want to have anything to do with President Trump. 494 The official Patriots Twitter account then issued a statement saying, “These photos lack context. Facts: In 2015, over 40 football staff were on the stairs. In 2017, they were seated on the South Lawn.” 495 Countless other people called out the New York Times for their fake news, and of course President Trump took to Twitter to denounce them as well. 496 The next day the New York Times sports editor Jason Stallman apologized, saying, “Bad tweet by me. Terrible tweet. I wish I could say it’s complicated, but no, this one is pretty straightforward: I’m an idiot. It was my idea, it was my execution, it was my blunder. I made a decision in about four minutes that clearly warranted much more time. Once we learned more, we tried to fix everything as much as possible as swiftly as possible and as transparently as possible. Of course, at that point the damage was done. I just needed to own it.” 497 But that wasn’t the only politicizing of the Patriot’s White House visit. Rob Gronkowski, who played tight end, interrupted Sean Spicer’s press briefing that day asking if he needed any help [arguing with the fake news] in a hilarious stunt that had Spicer and the press corps laughing, but ESPN’s Max Kellerman didn’t think it was funny at all. “When the press corps is cracking up at a press secretary because of an athlete’s presence there, so he’s lending something to the proceedings, the athlete is, and the press corps is, you know, they’re having a rollicking good time…that’s a very bad thing. That’s an unhealthy thing to have happened,” he complained on air. 498 Kellerman went on to say that Gronkowski’s prank “normalized” Sean Spicer, who he insists worked for an “authoritarian” administration. 499

Layoffs Many people were growing tired of politics being intertwined with sports coverage, especially when the issues

weren’t even remotely related, and polls began showing it was causing some viewers to tune out. 500 In April 2017 ESPN laid off about 100 people, including several on-air personalities, and six months later laid off another 150 people. 501 This was after ESPN had reportedly lost an average of 15,000 subscribers a day in October alone, totaling an estimated decline of 465,000 for the month. 502 In the fiscal year of 2018 they lost two million subscribers. 503 While some of the loss can be ascribed to cord-cutters ditching cable in favor of streaming services, a significant portion was due to fans becoming sick of the players protesting during the national anthem. 504

In October 2019 the sports news website Deadspin sent out a memo to their editors and staff telling them to stick to sports and stop covering politics since the website had steadily drifted into regularly complaining about President Trump. The memo said in part, “Deadspin will write only about sports and that which is relevant to sports in some way.” 505 The editor-in-chief then decided to plaster the entire website with political and pop culture news in protest, and was immediately fired. He unironically tweeted, “I’ve just been fired from Deadspin for not sticking to sports.” 506 Members of the staff then quit en masse to show solidarity with the editor, and to also protest the new “stick to sports” policy. 507 Yes, people who worked for a sports website quit when management told them to write about sports! Sports are supposed to be an outlet for people to get away from the stress and responsibilities we face during the work week. And the last thing most sports fans want is to have politics brought up when they’re trying to enjoy their favorite game, but unfortunately “stick to sports” is no longer the motto for most sports entertainment outlets. While playing sports is a great way for kids and adults to stay physically fit and learn about working together with others, the artificial importance placed on professional sports entertainment largely serves as a type of bread and circus distraction, diverting people’s attention and energy away from important problems in society.

Instead, the focus is put on concerns about whose team is going to win, and which players are injured or may get traded, and other trivial and meaningless controversies which, when you boil them down, do nothing other than serve to keep people pacified with things that lack any real importance whatsoever. George Orwell summed this phenomenon up in his prophetic novel Nineteen Eighty-Four when he wrote, “films, football, beer, and above all, gambling filled up the horizon of [people’s] minds. To keep them in control was not difficult.” 508

Author’s Note: If you haven’t already, please take a moment to rate and review this book on Amazon.com, Kindle, Google Play, iBooks, or wherever you bought it from, to let other potential readers know how valuable this information is. Almost all of the one-star reviews on Amazon for my last three books “The Liberal Media Industrial Complex,” “The True Story of Fake News,” and “Liberalism: Find a Cure” are from NON-verified purchases which shows the “reviewers” probably didn’t even read them, and just hate me. So if you could help me offset their fake one-star reviews by leaving a real one yourself since you actually read the book, that would help a lot! Thank you!

Late-Night Comedy Shows For decades the late-night talk shows were something Americans could watch at the end of the day to get a few laughs about current events, celebrity stupidity, or from other theatrics. Viewers couldn’t tell Johnny Carson’s politics because he was an equal opportunity offender. The same was true for Jay Leno and David Letterman who were staples of late-night TV for a generation. Starting the evening following Donald Trump’s victory over Hillary Clinton in 2016, late night TV stopped being funny. In fact, the hosts were visibly distraught when they took to the air, speaking in a somber tone as if we had just experienced a national tragedy. They tried to pull themselves together over the following days and weeks, but late-night television was never the same.

Today Jimmy Kimmel, Stephen Colbert, and Jimmy Fallon aren’t merely “entertainers.” They are stealth propagandists; whose political messages go down easier than those from “news” outlets because it’s covered in comedy. Their agenda is no longer to make people laugh, it’s to get them to cheer on the liberal agenda and mock conservatives. New York Magazine embraced comedy’s new mission and asked, “How Funny Does Comedy Need to Be?” noticing that it wasn’t very funny anymore. “Like post-rock, post-comedy uses the elements of comedy (be it stand-up, sitcom, or film) but without the goal of creating the traditional comedic result—laughter—instead focusing on tone, emotional impact, storytelling, and formal experimentation. The goal of being ‘funny’ is optional for some or for the entirety of the piece.” 509 Comedy without comedy? At least they’re honest enough to admit the shows aren’t funny anymore. When Supreme Court Justice Anthony Kennedy announced he was retiring, opening the door for President Trump to nominate a second judge to the court, the official Comedy Central Twitter account tweeted sarcastically “Thanks, Justice Kennedy,” along with a graphic that read “Supremely Fucked.” 510 Comedy Central’s Jim Jefferies went so far as to deceptively edit an interview with a man named Avi Yemini who is opposed to Muslims mass emigrating to European countries, but unbeknown to Comedy Central, Yemini secretly recorded the entire interview and posted it on YouTube to show how manipulated the footage was for the segment when it aired and demonstrated how many of his statements were completely taken out of context. He then sued them for defamation. 511 Some hosts like HBO’s John Oliver are steeped in guilt because they mocked the idea of Donald Trump becoming president. When guest hosting the Daily Show, John Oliver responded to a news clip reporting Trump was considering running in 2016 by saying, “Do it. Do it! I will personally write you a campaign check now!” because he thought it would make for some great material and didn’t think for a moment Trump had a chance to actually win. Now John Oliver lives in misery every day of his life. In an interview five years after he was fired from NBC as host of the Tonight Show, Jay Leno was asked how much different the late-night comedy shows are in the Trump era. “Do you miss being on the show, or is it such a different time that it would be hard to do?” Al Roker asked him.

“No, it’s different. I don’t miss it,” he replied, going on to say during his time hosting he didn’t want people to know his politics, so he tried to hit both sides equally. 512 “Because, you know, the theory when we did the show was you just watch the news, we’ll make fun of the news, and get your mind off the news. Well, now people just want to be on the news all the time. You just have one subject that’s the same topic every night, which makes it—makes it very hard. I mean, all the comics, Jimmy and Colbert and everybody else, it’s tough when that’s the only topic out there.” 513 Leno noted that the comedy on late-night TV is now “one-sided” and “all very serious” and that “I’d just like to see a bit of civility come back to it, you know?” 514 Saturday Night Live alumni Rob Schneider noted today, “Much latenight comedy is less about being funny and more about indoctrination by comedic imposition. People aren’t really laughing at it as much as cheering on the rhetoric.” 515

Jimmy Kimmel Jimmy Kimmel is largely credited with killing the Republicans’ plan to repeal Obamacare after he spent several nights ranting (and crying) about it on his show in 2017, claiming it would prevent poor people from getting healthcare. He even used his newborn son Billy as a prop since he was born with a congenital heart defect and claimed that if Obamacare was repealed then other children with similar life-threatening conditions would die. But Kimmel wasn’t coming up with his Obamacare material on his own. The Daily Beast admitted, “Kimmel and his team were in touch with health care officials, charities and advocacy groups,” as well as Senator Chuck Schumer who, “provided technical guidance and info about the bill, as well as stats from various think tanks and experts on the effects of [it].” 516

CNN asked, “Did Jimmy Kimmel kill the health care bill?” after Senator John McCain [who cast the deciding vote] said he wouldn’t support the repeal. “Kimmel’s critique [of the Republican plan] inspired intense

coverage and analyses, pundits debated Kimmel’s expertise on the subject while others told him to stay in his lane, and the comedian found himself again at the center of the health care fight.” 517 Kimmel’s propaganda efforts have extended far beyond healthcare. He has used children in skits about how “disastrous” global warming is. 518 He calls CPAC the largest gathering of “anti-vaxxers” and “very angry White people.” 519 And he even called for Supreme Court Justice Brett Kavanaugh to be castrated. 520 Kimmel says, “It just so happens that almost every talk show host is a liberal and that’s because it requires a level of intelligence.” 521 He has also admitted that sharing his political views “has cost me commercially” but neither he nor ABC care, because it’s “for a good cause.” 522

Stephen Colbert Stephen Colbert took over The Late Show from David Letterman in 2015 and ever since has turned the nightly monologue into an anti-Trump editorial, but his audience enjoys it, even his pathetic Donald Trump impression which should be enough for anyone with any taste in comedy to change the channel. He plays a big role, however, in politics. Practically all the Democrat candidates running for president in 2020 appeared on his show: Bernie Sanders, Kamala Harris, Julian Castro, Beto O’Rourke, Elizabeth Warren, Corey Booker, etc. CNN admitted that, “Aides for several of the mosttalked-about contenders confirmed that they view Colbert as a crucial stop on the presidential roadshow,” and one campaign official who spoke off the record said, “We strategize about Stephen a lot.” 523 New York senator Kirsten Gillibrand announced she was running for President in 2020 on his show. 524 She had coordinated with them and then Stephen shamelessly had her on to awkwardly ask if she had anything to announce, and then she revealed the “big” news. Congressman Eric Swalwell also officially announced he was running for president in 2020 on Colbert’s show. 525 His campaign soon embarrassingly ended with him

begging people on Twitter to donate “just one dollar” in hopes he could stay in a little bit longer.

Jimmy Fallon Poor Jimmy Fallon tried not to become a rabid anti-Trump ranter out of concerns he would ostracize half his viewers, but was reportedly pressured by NBC to stop being so soft on Trump. 526 Industry-wide Fallon was shunned and denounced after his 2016 interview with then-candidate Donald Trump because he didn’t use the opportunity to tear into him, and instead had a fun interview like he does with all of his guests. Trump even famously let Jimmy mess up his hair to prove it was real, but the liberal media was furious and claimed Fallon had “humanized” him. 527

He was shut out of the Emmys that year in what many speculated was retaliation for “helping” Trump. 528 Fallon later apologized for being too friendly and said that people “have a right to be mad.” 529 Despite trying to not have a show tainted with an obvious political agenda like Stephen Colbert and Jimmy Kimmel, Fallon soon bent to the will of his producers and started focusing more on the president and other social justice issues. He even had anti-gun activist David Hogg and his sister on the show to rail against the NRA and Florida Senator Marco Rubio for not supporting radical anti-gun laws. 530 Fallon had the kids recount their experience during the Parkland school shooting, because what could be a more appropriate topic for a late night comedy show than talking about a mass shooting at a school?

Saturday Night Live Once a staple of American comedy, Saturday Night Live has been on a slow and continuous decline, perhaps in part to an increasing number of options for viewers with the growth of cable TV and more recently streaming

services and other online entertainment; but the show’s parodies of presidential politics still bring in viewers and the sketches make headlines. More importantly than that, Saturday Night Live has been responsible for significantly altering how tens of millions of people view certain politicians. One critic noted, “The series has also shown a deft ability to define politicians’ personas—for better or worse. For some, Chevy Chase’s exaggerated version of President Gerald Ford or Dana Carvey’s over-the-top President George H.W. Bush are more familiar than the politicians’ actual legacies. And sketches spoofing the likes of Michael Dukakis and Sarah Palin have had a much longer shelf life than the real-life versions’ political careers.” 531 University of Tennessee professor and blogger Glenn Reynolds admitted, “Personally, I think that Chevy Chase cost Ford the 1976 election. Well, part of it, anyway.” 532 Decades later Chase admitted, “[M]y leanings were Democratic and I wanted [Jimmy] Carter in and I wanted [Ford] out, and I figured look, we’re reaching millions of people every weekend, why not do it.” 533 During the 2000 presidential campaign Darrell Hammond’s character of Al Gore was devastating, accentuating his dull personality to the point that the real Al Gore reminded people of Hammond’s character. SNL’s portrayal of a George W. Bush vs Al Gore debate showed him repeatedly referring to his “lock box” and haunted Gore for the remainder of the campaign. Will Ferrell’s impression of a bumbling George W. Bush is what really launched him to stardom. In 2008 Tina Fey’s portrayal of Sarah Palin stuck like glue and many political analysts credit SNL with permanently tarnishing her image in the minds of millions of voters. 534 While the show and its cast have always leaned Left, once they came down with Trump Derangement Syndrome their sickness began showing its symptoms in their skits. In 2018 they sung a special rendition of Mariah Carey’s “All I want for Christmas Is You” conveying their wishes to have Robert Mueller throw President Trump in prison. 535 And their anti-Trump obsession has caused them to sink so low that they actually endorsed assassinating him.

Cast member Michael Ché began, “Maybe I just don’t understand politics well, because when they said Trump was gettin’ impeached, I immediately thought, ‘Great! Trump’s fired! Let’s get drunk!’ But they’re like ‘no, he’s just being impeached, but he ain’t exactly impeached yet, it’s still gonna take another year or so.” 536 The punchline was, “You know, I’ll bet somebody explained how long impeachment took to John Wilkes Booth, and he was like ‘Okay, well where’s he at right now?’” 537 Jokes about assassinating a current President, or any President even after they’ve left office, have always been out of bounds, especially for any show on network television, but Saturday Night Live decided to go there. SNL alumni Norm McDonald has trashed the show’s obsessive antiTrump agenda, such as framing his 2016 election victory as if it was the end of the world. “I was like, what the fuck are we getting through? That a man was duly elected president? What are you, crazy? …I can get through anything. I got through my own father’s death. You think I can’t get through a man getting elected president of the United States?” 538 McDonald made it clear that he is certainly no fan of President Trump, but says they’re “playing into Trump’s hands.” 539 He said he doesn’t even do political jokes because he hates politics and mostly just watches sports. Pondering how comedy shows have gotten so partisan these days he said, “I wonder when it happened. Maybe with Jon Stewart. But it happened at some point that talk show hosts had to be political pundits.” 540

The Good Old Days In a 1984 interview with Barbara Walters, late night legend Johnny Carson was asked if there were things in the world that bothered him and caused him to want to use his platform (then host of The Tonight Show on NBC) to raise awareness for them. He responded, “I think one of the dangers if you are a comedian, which basically I am, is that if you start to take yourself too seriously and start to comment on social issues, your sense of humor suffers somewhere.” 541

“I’ve seen other people, whose names I won’t mention, who do humor, and then somewhere along the line they start to want to make their views known. I try to do it humorously. Some critics over the years have said that our show doesn’t have great sociological value, it’s not controversial, it’s not deep,” defending the show saying it’s just to entertain people and make them laugh. 542 He was asked a few years earlier by Mike Wallace on 60 Minutes about why he never gets political. “Do you get sensitive about that fact that people say ‘he’ll never take a serious controversy?” 543 Carson responded, “Well, I have an answer to that. Now tell me that last time that Jack Benny, Red Skelton, any comedian, used his show to do serious issues. That’s not what I’m there for. Can’t they see that? Why do they think that just because you have a Tonight Show that you should deal in serious issues? That’s a danger. That’s a real danger. Once you start that, you start to get that self-important feeling that what you say has great import, and strangely enough, you could use that show as a forum, you could sway people, and I don’t think you should as an entertainer.” 544

Hate Crime Charges for Jokes? Although mainstream shows have lost their edge and turned into social justice cesspools, some stand-up comedians are trying to save freedom of speech by carrying on the tradition of George Carlin, Lenny Bruce, and others who stood up for the right to offend people with thin skin, but comedy is under attack by the Thought Police who want people arrested for telling jokes. The London Independent published a piece titled, “As a comedy aficionado, I’m appalled at disgusting ‘jokes’ creeping back into the industry” where the columnist complained, “Comedians, crying ‘free speech’ isn’t good enough—hate crime laws should apply to all of us.” 545 She complained about what she called “Alt-Right comedy” naming YouTubers PewDiePie and Sargon of Akkod as supposedly having “persuaded some comedians that there is money to be made from belittling social justice.” 546 The writer then whined about Ricky Gervais’ Netflix special Humanity where he “deadnamed” Caitlyn Jenner (liberalspeak for calling a

transgender person by their legal name or birth name), and complained about Dave Chappelle cracking some jokes about transgender people too, saying, “I would go so far as to argue that some of the jokes I have heard on the comedy circuit of late constitute actual hate speech.” 547 Chappelle’s 2019 Netflix special Sticks & Stones upset a lot of liberals since they have no sense of humor and he kept the edge he once had for his Comedy Central sketch series in the early 2000s. Vice News told their moronic readers that “You can definitely skip Dave Chappelle’s new Netflix special Sticks & Stones ” because he “doubles down on misogyny and transphobia.” 548 The critics at Rotten Tomatoes, the popular entertainment rating website, gave it an approval rating of just 35% while the average audience rating is at 99%. 549 Matt Stone, co-creator of South Park, said that the reason so many critics trashed it was because they were afraid to say it was actually funny. “When I read TV reviews or cultural reviews, I think of someone in prison, writing. I think about somebody writing a hostage note. This is not what they think. This is what they have to do to keep their job in a social media world.” 550 Tim Allen has said that today he couldn’t do his old act from the ‘90s because it would be deemed too “sexist” since much of it was about the dynamics between men and women. 551 His hit show Last Man Standing was canceled by ABC after he appeared on the Jimmy Kimmel show and joked about how being a conservative in Hollywood these days is like being a Jew in 1930s Germany because of the persecution they face. 552 ABC claimed it was canceled because the show wasn’t performing as well as they wanted, but it was actually the network’s second most watched comedy, and the third most watched show on the entire network. 553 It was later picked up by FOX where it instantly became the highest rated show on its night. 554 Many European countries have much stricter “hate speech” laws than the United States, and it’s a model the Left wants to implement here, starting by amending or repealing the First Amendment to allow criminal charges for people who say things that hurt others feelings or are “divisive” and “not inclusive.” 555 Scottish comedian “Count Dankula” was famously arrested and convicted for hate speech after he posted a video on YouTube

showing that he trained his girlfriend’s dog to do a “Nazi salute” as a joke to upset her. 556 There is no doubt that Leftists would love to have political commentators like me arrested for jokes (or even sarcastic statements) about Black people, illegal aliens, gays, and transgenders. Comedy, which was once seen as the last bastion of free speech, is increasingly coming under attack by intolerant liberals who aim to use the mechanisms of government to silence people if the social media companies won’t.

Award Shows Award shows aren’t just for awards. They themselves are elaborate propaganda campaigns whose winners are often chosen, not because of their extraordinary talent, but because certain songs, movies, and TV shows promote agendas the social engineers want to encourage. Movies that fail miserably at the box office are still awarded if the Hollywood elite want to highlight their “powerful” message. In recent years the award shows have veered further left than most people could imagine, and it’s impossible to make it through one now without getting browbeat by nauseating messages about “diversity,” antiWhite bigotry, and gender bending. For example, the 2018 Emmys began with Kate McKinnon (a lesbian) and Kenan Thompson (a Black man) saying, “Tonight is the celebration of the hard work and the talent of everyone in this room,” begins Kate. “That’s right,” continues Kenan.

“We’re also celebrating the fact that this year’s Emmy Awards has the most diverse group of nominees in Emmy history.” It seemed like they may have been setting up a joke for a second, but they were really being serious. A few more celebrities then came out on stage and literally began to sing a song celebrating the “diversity” of the nominees. Halfway through their little musical number Ricky Martin entered the stage, saying, “You haven’t solved it. This song is way too White!” and then the music changed to salsa music and they all started dancing again. At that point Saturday Night Live’s Andy Sandberg joined the group and sings, “What about me? Is there any room in this song for a straight White guy like me?” “You can’t be a part of this,” he is told. “Sounds good, have fun you guys,” he replies, and then walks off stage. White people should be shunned was the message. Get rid of them. If you took a drink every time someone said “diversity” during the show you would have died of alcohol poisoning. When Jimmy Kimmel took to the stage to present he began, “We are delighted this year to have such a diverse collection of talented supporting actress nominees.” 557 Another presenter, Emilia Clarke (best known for starring in HBO’s Game of Thrones ), also had to make note of the wonderful “diversity,” saying, “Tonight, we are happy to announce that the comedy writing category, once dominated by White male nerds now boasts more female and diverse nerds than ever before.” 558 But there were still too many White people winning awards despite the “diverse” group of nominees that night, so in protest when James Corden was presenting he told the audience at home to get #EmmysSoWhite trending on Twitter, which they did. 559 And we can’t have an award show these days without it including a celebration of drag queens, so RuPaul was given the Emmy for his crossdressing competition, RuPaul’s Drag Race . 560 The Golden Globes are basically the Oscars and Emmys combined, meaning both movies and television shows are given awards. The event is put on by the Hollywood Foreign Press Association which is an organization consisting of foreign media outlets and reporters who cover American entertainment outside the United States.

It’s the typical superficial award show with celebrities who think they can save the world by giving a shout out to various causes, but once Donald Trump became president it was obligatory for at least one of the winners to denounce him while accepting their award. Meryl Streep was the first at the 2017 Golden Globes, held just two months after the 2016 election, where she gave an overly dramatic speech about how he’s ruining the country for immigrants. 561 The following year feminism was the theme of the night with host Seth Meyers beginning the show by saying, “People in this room worked really hard to get here, but it’s clearer now than ever before that the women had to work even harder. So thank you for all the amazing work that you’ve all done, and you continue to do. I look forward to you leading us into whatever comes next. So thank you so much for letting me say that.” 562 His cucking didn’t stop there. After his monologue he expressed concerns that the first presenters were going to be two White men. “Now to present our first awards, please don’t be two White dudes, please don’t be two White dudes. Oh, thank God! It’s Gal Gadot and Dwayne Johnson everybody.” 563 The very first award of the night went to a man named Ramy Youssef who won Best Actor in a Comedy Series. As soon as he took the stage he said, “Look, I know you guys haven’t seen my show,” and then the entire audience laughed. “Everyone’s like ‘is this an editor?’” he continued. 564 He was only half joking because nobody there, and hardly anyone watching at home, knew who he was. His show Ramy streamed on Hulu and was a comedy about a Muslim family from Egypt who had just moved to New Jersey. He was given the Golden Globe as a form of affirmative action to demonstrate how “woke” Hollywood is by celebrating a Muslim comedy, not because it was the funniest show, but simply for the sake of “diversity,” and he knew it. When Jessica Chastain announced the winner for Best Actress that year, she began sarcastically, “I’m so happy to announce that the winner of this category will also receive the 23 percent of her salary that went missing in the wage gap.” Chris Hemsworth, who stood there alongside her virtue signaling, added, “It’s true. That’s correct.” 565 When presenting the nominees for Best Actor, Geena Davis also made a sarcastic comment about the supposed wage gap, saying, “These five nominees have agreed to give half of their salary back, so that the women

could make more than them.” 566 But the White male bashing didn’t end there. When Natalie Portman announced the winner for Best Director, she went off script, saying “And here are the all-male nominees,” clearly upset that no women were nominated that year because of “sexism.” 567 At the end of the night Oprah Winfrey was given the Cecil B. de Mille Award for her “contributions” to the entertainment industry, where she gave a tearful acceptance speech causing liberals to become ecstatic and filled with hope that she would run for president in 2020 against Donald Trump. NBC’s official Twitter account even tweeted a picture of her and said, “Nothing but respect for OUR future president.” 568 The New Yorker ran the headline, “Oprah Leads a Decisive Feminist Takeover.” 569 At the 2020 Golden Globes, Ellen DeGeneres was given an “Award for Excellence” for all she has done to advance the LGBT agenda. 570 The dinner which takes place before the show was an all vegan meal that year to help “raise awareness about climate change.” 571 When Joaquin Phoenix won the Best Actor award for his performance in Joker, he began his acceptance speech thanking the Hollywood Foreign Press for “recognizing and acknowledging the link between animal agriculture and climate change.” Adding, “It’s a very bold move making tonight plant-based and it really sends a powerful message,” referencing the vegan dinner. 572 While Sacha Baron Cohen was presenting he took the opportunity to rip into Mark Zuckerberg for not cracking down on free speech enough on Facebook, sarcastically describing him as a “naive misguided child who spreads Nazi propaganda.” 573 Just two months earlier Cohen gave a speech to the Jewish ADL where he aggressively called for the major social media companies to increase censorship, claiming that they’re still allowing people to post “hate speech.” 574 Then during her acceptance speech for Best Actress in a Limited Series, Michelle Williams (who was visibly pregnant), admitted she once killed her other baby in an abortion and was glad that she did because if she had the kid it would have prevented her from becoming a successful actress. 575

The audience cheered her “bravery” for admitting what she had done.

The Biggest Night in Hollywood The “biggest night in Hollywood” is the Academy Awards where the Oscars are

handed out, and for many years celebrities have spewed political nonsense—often about saving the environment or some issue in a third world country, but in the Trump-era, everything is about Trump. At the 2017 Oscars, held just one month after President Trump’s inauguration, host Jimmy Kimmel called him a racist and insinuated that the entire world now hates America. “I want to say thank you to President Trump,” he said sarcastically. “I mean, remember last year when it seemed like the Oscars were racist?” referring to the “Oscars so White” controversy. 576

In 2018 Call Me by Your Name was nominated for “Best Picture” which is based on the true story of a 24-year-old man seducing a 17-yearold boy. Hollywood calls that a great “love story.” 577 As the Oscars kicked off that year host Jimmy Kimmel gave a shoutout to the actor who played the boy, Timothee Chalamet, saying he is “the star of a small but powerful story, Call Me By Your Name, which did not make a lot of money, in fact, of the nine best picture nominees, only two of them made more than 100 million dollars. But that’s not the point. We don’t make films like Call Me By Your Name for money. We make them to upset Mike Pence.” 578 (Vice President Mike Pence is a devoted Christian who doesn’t support same sex “marriage.”) Then came more White guilt as Black films, Black actors, and Black writers were touted as being the best. At one point Jimmy Kimmel mentioned that the new Black power film Black Panther wouldn’t be included in that year’s awards because it just came out, and then expressed his disappointment that there aren’t more Black superheroes. “It’s weird that so many superheroes are White because that’s what they were in the comics, right? People say, ‘Well Superman is White. He’s always been White. You know what else Superman has been? Not real!” 579 Apparently it’s racist now that Superman is always White in the movies, because he’s White in the comics! Then two Black women (Tiffany Haddish and Maya Rudolph) came out to present and Maya began, “We are so happy to be here, but a little

nervous too, because a few years ago people were saying that the Oscars were so White, and since then some real progress has been made.” 580 Tiffany Haddish, who has a voice scratchier than Axl Rose then chimed in, agreeing. “Mmhmm. When we came out together we know some of you were thinking, ‘are the Oscars too Black now?’” Maya Rudolph replies, “Don’t worry. There’s so many more White people to come tonight.” “Mhhhmmm. So many! We just came from backstage and there are tons of them back there! And not just movie stars. There are White people walking about with headsets. White people with clipboards. I’m personally not a fan of White people with clip boards because I’m always wondering ‘what are they writing down about me?’” 581 The message was clear. There were still too many White people around, despite the recent strides in “diversity.” Best documentary that year went to Icarus , a movie about the Russian doping scandal at the Olympics to fan the flames of the hysteria at the time about Russia supposedly helping Donald Trump win the 2016 election. Then there was more pro-immigration propaganda. Lupita Nyong’o (who is from Kenya) and Kumail Nanjiani (who is from Pakistan) presented an award, but not before saying they’re not just actors, they’re also immigrants, “and like everyone in this room and everyone watching at home, we are dreamers. We grew up dreaming of one day working in the movies. Dreams are the foundation of Hollywood, and dreams are the foundation of America…To all the Dreamers out there, we stand with you,” they said, to a resounding applause, referring to the millions of illegal immigrants Barack Obama granted amnesty to with his “Dream Act” executive order. “Now the nominees for achievement in production design.” 582 Rapper Common and singer Andra Day performed their social justice anthem “Stand Up for Something” with Common beginning, “We put up monuments for the feminists. Tell the NRA they’re in God’s way… Sentiments of love for the people from Africa, Haiti, and Puerto Rico.” 583 Later while Andra Day sung, Common continued injecting his two cents with statements like, “We stand up for the Dreamers. We stand up for immigrants.” The eight-year-old Syrian refugee, Bana al-Abed, who (supposedly) began tweeting photos of civil war-torn Syria in 2016, was brought on stage during their performance. 584 Of course eight-year-olds

don’t tweet, but the girl was used as a propaganda tool to promote U.S. intervention in the country by making her a symbol of the civil war there, but that’s a whole other story. 585 Planned Parenthood CEO Cecile Richards was also on stage, along with a total of ten social justice activists invited up there during the performance because they all “Stand Up for Something.” 586 Mexican film maker Guillermo del Toro won the Academy Award for Best Picture that year for The Shape of Water , a movie about a woman who falls in love with a fish-man (and literally gets naked and has sex with it). Probably Hollywood’s way of taking baby steps on the path to giving an Oscar to a film about bestiality. Guillermo del Toro also won for Best Director and when he took to the stage he began, “I am an immigrant like, like my compadres, Alfonso and Alejandro, like Gael [García Bernaland] Salma [Hayek], and like many of you. And in the last 25 years, I’ve been living in a country all of our own. Part of it is here. Part of it is in Europe. Part of it is everywhere, because I think the greatest thing the industry does is erase the line in the sand,” [meaning borders]. 587 The 2019 Oscars were just more of the same. At the beginning of the show Maya Rudolph announced, “Just a quick update for everybody in case you’re confused. There is no host tonight. There won’t be a popular movie category, and Mexico is not paying for the wall.” 588 Kevin Hart had originally been scheduled to host, but he was canceled after snowflakes dug up some of his past jokes and tweets about not wanting his son to be gay, so like many others, he became a victim of the “cancel culture.” 589 Black Panther was nominated for “Best Picture” simply because it was the first Black superhero movie. Spike Lee won the Academy Award that year for Best Adapted Screenplay for BlacKkKlansman , and during his acceptance speech said that the 2020 election is “just around the corner” and told everyone to “mobilize” and “do the right thing” by voting Donald Trump out of office. 590 Within just a few minutes of the 2020 Academy Awards show starting, Chris Rock was complaining that not enough Black people were nominated, but the show certainly made up for it that year with presenters. At one point a guy came on stage to announce, “The Academy would like to acknowledge that tonight we have gathered on the ancestral lands of the

Tongva, the Tataviam and the Chumash” [Native American tribes] to apologize for White people “stealing” their land. 591 To kick off the show, singer/rapper Janelle Monae changed the lyrics in one line of her song to say “It’s time to come alive, cuz the Oscars, it’s so White,” marking the sixth year in a row the “Oscars so White” complaint was made. 592 No amount of “diversity” could make them happy. Hair Love won Best Short film for a 7-minute-long animation about a Black father learning to do his daughter’s hair. Usually the winner for this category isn’t included in the show, but because the film celebrated Black people and their “hair” the producers made a special exception this year. When accepting the award the director encouraged people to support the Crown Act, which was pending legislation that would ban employers and schools from “discriminating” against people for their hairstyles, for example, if a business didn’t want their employees to wear dreadlocks, or have an afro that sticks out two feet. 593 A Netflix show called American Factory that Barack and Michelle Obama’s production company made won the Oscar for best documentary in 2020, and when accepting the award, the director quoted straight from the Communist Manifesto, saying “workers of the world unite.” 594 When Joaquin Phoenix won the Oscar for Best Actor in Joker he rattled off as many social justice buzzwords as he could, saying, “Whether we’re talking about gender inequality or racism or queer rights or indigenous rights or animal rights, we’re talking about the fight against injustice,” and then went on to complain about cow rights and people using milk in our cereal and coffee in the morning. 595 After the Black Lives Matter riots of 2020 caused a surge of Black supremacist sentiments to spread across the country and endless virtue signaling by corporations and schools about how they were going to work much harder to “support the Black community,” the Oscars announced that they were changing the criteria for films to be considered for the awards, adding a “diversity requirement.” 596 So now it doesn’t matter how good a film is, if there isn’t a Black person, a Latino, or a queer as part of the main plot, then it may get passed over in favor of another film with more “diversity.”

The Grammys The Grammys used to be mostly just about the music, but now the event browbeats the audience about how there are too many White people in the United States and endlessly praises LGBT people for being “amazing.” The Grammys have even openly celebrated Satanism. In 2014, Katy Perry performed her song “Dark Horse” in a ceremony that depicted her as a witch and made headlines across the country from people saying the performance looked like a satanic ritual. 597 She did it as a collaboration with a group called Three Six Mafia—get it—three sixes “666”—the “Satanic Mafia.” A few years earlier in 2012 Nicki Minaj had done a similar “satanic ritual” for her performance of her song “Roman Holiday.” 598 (A “Roman holiday” means to get pleasure from someone else’s pain or misfortune.) The Grammys is supposed to be a celebration of music, but they can’t make it through a show without expressing their love for the LGBT agenda. Katy Perry performed her lesbian-themed single “I Kissed a Girl” in 2009 shortly after she burst onto the music scene thanks to that song. A few years later Lady Gaga performed her “gay rights” anthem “Born This Way” during the show. 599 And now every year there are shoutouts to the “LGBT community” and how “awesome” they are. In 2014 Macklemore & Ryan Lewis won a Grammy for Best New Artist and Best Rap Album as a reward for producing a “gay rights” anthem called “Same Love” which promoted gay “marriage.” 600 When they performed at the Grammys that year thirty-three gay couples were married on stage as part of the show. 601 At the time, gay “marriage” still wasn’t legal in all fifty states, and the issue was awaiting a ruling by the Supreme Court. That same year Irish musician Hozier’s debut single “Take Me To Church” was nominated for Song of the Year because it denounced Christianity, particularly the Catholic Church’s views on homosexuality. The music video for the song was a gay anthem depicting two homosexuals being persecuted by an angry mob. It was made for just $500 and posted to YouTube when the band was still virtually unheard of, but music executives in Hollywood discovered the video and turned Hozier into a star that year because they wanted a new “gay rights” anthem to promote.

To kick off the 2017 Grammys, Jennifer Lopez said it was a really tough time in our nation’s history since it was just a few weeks after Donald Trump was inaugurated as president. Sounding like she was about to breakdown and cry she said, “It is about the music, the words, and the voices. How they move us and inspire us and touch all of our lives. At this particular point in history our voices are needed more than ever.” 602 There was no question what “point in history” she was talking about. Hollywood and the talking heads in the news media were still in shock that Hillary had lost. James Corden even performed a rap song at the start of the show which included lyrics about his fear of what Donald Trump was going to do to the country. 603 Busta Rhymes later trashed President Trump on stage, calling him “President Agent Orange.” He was joined by another group “A Tribe Called Quest” who made their entrance to the stage by breaking through a wall constructed of foam blocks. At one point Busta said that President Trump was “perpetuating evil” throughout the United States. 604 The following year the Grammys were hosted by James Corden who began the show saying “This year, we don’t just have the most diverse group of nominees in Grammys history, we also have, for the second year in a row, the least diverse host in Grammys history,” referring to himself being a straight, White male, with blonde hair and blue eyes. 605 Then rapper Kendrick Lamar got on stage and performed an anti-cop, pro-Black Lives Matter song. Halfway through his performance the lights dimmed and the camera cut to Dave Chappelle, who said, “I just wanted to remind the audience that the only thing more frightening than watching a Black man being honest in America, is being an honest Black man in America.” 606 Later Hillary Clinton made an appearance via a video which showed her reading the anti-Trump book Fire and Fury that was all the rage at the time. 607 The following year in 2019, they brought Michelle Obama on stage during the opening segment to talk about how much music means to her and how it keeps her going in tough times. 608 Childish Gambino won the award for Song of the Year and Album of the Year for his racist, anti-White, anti-police diatribe “This is America,” marking the first time that a rapper had won both awards. 609 When the nominees were announced a month or so earlier, he and other rappers complained that there weren’t enough Black artists being nominated, so it

looks like the Recording Academy tried to make it up to him by crowning him the night’s big winner. At the 2020 Grammys, host Alicia Keys started the show playing a piano melody while doing a spoken word performance mentioning the various artists who were nominated and tossed in a line celebrating President Trump getting impeached. 610 Broadway theater performer Billy Porter then took to the stage (dressed like a woman) and introduced the Jonas Brothers who performed a song, but not without first giving a wink and a nod to the “gender fluid” and “gender non-conforming” people. “Ladies, gentlemen, and those who have yet to make up their minds…” he said, before introducing the group. 611 Singer John Legend also gave a non-verbal shout-out to the gender “nonbinary” people by wearing a “dress/suit.” Ellen DeGeneres introduced a performance by “country rapper” Lil Nas X, and after mentioning some of his accolades added, “And he’s done it all by being true to himself. Unwavering in the face of prejudice, he told the world that he was gay, and overnight he became an inspiration and a role model for millions of young people around the world.” 612 Michelle Obama was then given a Grammy for “Best Spoken Word Album” for the audio book version of her memoir Becoming . 613 There was also a performance by a Spanish singer who goes by the name of “Rosalia” who sung a few songs in Spanish to pander to the tens of millions of nonassimilating Mexicans and other Latinos who have invaded the United States. The American Music Awards and the Billboard Music Awards are just more of the same. Taylor Swift even “broke her political silence” at the 2018 AMAs to encourage her fans to vote Democrat in the upcoming midterm elections. 614 For her entire career she stayed out of politics completely, but the pressure was building for her to denounce the Trump administration, so she eventually did.

MTV Awards The most degenerate of award shows can be found on MTV. Their annual Movie Awards and VMAs (Video Music Awards) are geared for kids, which makes them even more disturbing. The only time anyone really tunes in to MTV

anymore is for these award shows once a year since music videos are all released on YouTube now, and it’s been a decades-long running joke that MTV (which stands for Music Television) doesn’t play any music anymore because the network mostly consists of teen dramas. MTV’s VMAs gave birth to Miley Cyrus with her 2013 performance where she introduced “twerking” to the world, a form of “dance” she popularized which simply consists of shaking one’s butt in a rapid motion, although that’s just the beginning of MTV’s degeneracy. They have unique awards compared to other shows, for things like the Best Villain and Best Fight, and even the Best Kiss. And in 2017, the Best Kiss award went to two men for a “gay coming-of-age” film called Moonlight . 615 The following year in 2018, it was given to two men again, one of them (Keiynan Lonsdale) identifying as a “pansexual” (meaning someone who will have sex with a person of any gender, including trans people). Their movie was another teenage gay “romantic comedy” called Love, Simon. While accepting his “Best Kiss” award the pansexual told the audience, “You can live your dreams and wear dresses.” 616 In 2017 the MTV Movie Awards announced it was going to be a “genderless” award ceremony, meaning they weren’t giving different awards for best actor or best actress because that was “sexist” and “divisive.” They boasted that it was the first “gender-neutral” awards show in history. 617 To emphasize their idiotic idea, the first presenter of the evening was a real life “gender non-binary” person named Asia Kate Dillon who nobody has ever heard of. Her “preferred pronouns” are “they” and “them,” and of course she has a shaved head. The Wikipedia entry for Asia Kate Dillon reads, “Dillon was born in Ithaca, New York. They were assigned female at birth, but identifies as nonbinary. Dillon explained around 2015, they began removing gendered pronouns from their biography, and auditioning for the part of Mason helped them understand their gender identity. Dillon identifies as pansexual, stating they are attracted to multiple genders.” 618

It’s confusing because using the pronoun “they” to refer to one person is usually grammatically incorrect, but even the Merriam Webster dictionary has caved in to the craziness and recently updated the “rules” for grammar to accommodate gender non-binary or non-conforming people and their “preferred pronouns.” 619 Emma Watson won the first award that night for the live-action remake of Beauty and the Beast and made sure to start off her acceptance speech by praising how great of an idea it was to go “genderless,” saying, “Firstly, I feel I have to say something about the award itself. The first acting award in history that doesn’t separate nominees based on their sex says something about how we perceive the human experience. MTV’s move to create a genderless award for acting will mean something different to everyone, but to me, it indicates that acting is about the ability to put yourself in someone else’s shoes. And that doesn’t need to be separated into two different categories.” 620 This was all part of the show. She was just reciting the script that MTV’s producers had given her to emphasize the “historic” genderless theme of the night. Everything in Hollywood is fake, even the award shows. When Vin Diesel was given the Generation Award, he made sure to go along with the social justice agenda and said the only reason that the Fast & Furious series was a success is because the younger generation is accepting of multiculturalism. “Most importantly, I got to thank a generation that was willing to accept this multicultural franchise where it didn’t matter what color your skin was or what country you were from, when you’re family, you’re family.” 621 Multiculturalism had nothing to do with the franchises’ success. It’s an action movie series about cars , and a lot of people love car movies, and the chase scenes and action sequences are amazing, but the Hollywood elite never miss an opportunity to sing praises of their precious “diversity.” In 2018, rapper “Logic” wore a t-shirt that said “F*ck the Wall” and dozens of Mexican immigrants were brought out on stage during his performance who had shirts on that read “We Are All Human Beings.” 622 The previous year a “descendent” of Robert E. Lee, the Confederate Army general, was brought on stage to denounce racism. “We have made my ancestor an idol of White supremacy, racism, and hate,” he began. “As a pastor, it is my moral duty to speak out against racism, America’s original

sin.” 623 The man was the great-great-great-great (four “greats”) nephew of Robert E. Lee. He went on to tell the audience, “Today, I call on all us with privilege and power to answer God’s call to confront racism and White supremacy head on. We can find inspiration in the Black Lives Matter movement, the women who marched in the Women’s March in January, and especially Heather Heyer, who died fighting for her beliefs in Charlottesville.” 624 Then Heather Heyer’s mother was brought on stage, whose daughter was killed during the infamous 2017 Unite the Right rally in Charlottesville, to announce the winner of the “Best Fight Against the System” award. All the nominees had music videos denouncing racism, anti-immigrant sentiments, and promoted “diversity.” While opening the show in 2019, Taylor Swift had the words “Equality Act” projected on the stage in giant letters under a rainbow. 625 The Equality Act is a proposed bill by Democrats that would amend the Civil Rights Act and mandate someone’s gender identity be legally recognized no matter which one of the 58 different “genders” they claim to be. 626 It would also severely restrict the religious freedom of individuals and groups who don’t accept the positions of LGBT extremists. The following year the Supreme Court ruled on similar legislation, declaring that business owners can’t fire employees for being gay or transgender, nor refuse to hire them. 627

Feminism The Left has a saying that “representation matters,” which means the more on-screen depictions of certain kinds of characters, lifestyles, and behaviors, the more the general public warms up to accepting those kinds of things in real life. And part of paving the path to what they hope will be a woman President of the United States someday involves producing a variety of shows focusing on a female character who holds that position. In the years preceding Hillary Clinton’s long-expected attempt at a presidential bid there were almost a dozen television shows that had a woman president as the central part of the plot. Geena Davis starred in Commander in Chief , a short-lived series from 2005 to 2006 where she was originally the Vice President, but then had to takeover after the president died of a brain aneurysm. In FOX’s thriller 24, the show had a female

president for two seasons in 2008-2010. Julia Louis-Dreyfus ascended to the presidency in her series Veep after the president resigned, leaving her in charge. And that was just the beginning. State of Affairs, which aired for just one season on NBC, depicted a Black woman as the president, and CBS’s political drama Madam Secretary revolved around a female Secretary of State (obviously modeled after Hillary Clinton), and at the end of the fifth season the character decided to run for President and won. The following season (which was its last) the series focused on the new female president but kept the name Madam Secretary . But Hollywood’s feminist propaganda goes far beyond hoping to normalize the idea of a woman president. Liberals are obsessed with uprooting the traditional gender roles of men as providers and protectors, and women as nurturers and caretakers. They are determined to “empower women” at any cost and embrace the disastrous effects on family dynamics and society as a whole that their radical agenda is causing. “The future is female” is their mantra, showing they have no concern for equality, but instead have a thirst for power and want to dominate instead of cooperate. They despise traditional families and gender roles, and are on a mission to undermine the very foundational relationships of human society. To feminists, being a stay at home mom is slavery. Women cooking for their family is “oppression” under the Patriarchy, and men are all scumbags; but having unprotected sex with an endless line of them while avoiding any committed long-term relationships is the ideal life. That’s what Hollywood wants women to believe. Their latest plan to promote “women empowerment” is hijacking popular franchises and then completely changing the major characters and turning good old-fashioned action films into social justice warrior propaganda. Not just swapping male characters for females, or adding strong female leads, but by also portraying men as inept and incompetent losers who always need to be rescued from their own stupidity. When the Star Wars series was revised in 2015 with The Force Awakens , it diverted from the usual storyline featuring male leads (Luke Skywalker in the original trilogy and Anakin Skywalker in the prequels) to a totally new character invented by JJ. Abrams named Rey, a female loner.

A female Yoda-type of creature named Maz first starts teaching Rey about the force once she happens to discover Luke Skywalker’s old lightsaber lying around. And throughout the film Rey keeps proving to everyone that a girl can do amazing things like pilot a ship, and even fix one with her ingenuity, saving the Millennium Falcon from exploding. After there was an electrical overload and Han Solo didn’t know what to do, Rey saved the day. For extra diversity the new Star Wars teased a possible interracial romance between Rey and Finn (the Black former stormtrooper). 628

In the next film, Star Wars: The Last Jedi (2017), all women are in charge of the Resistance (the good guys), giving the orders to subservient and bumbling men. The tension keeps building between Poe Dameron and Vice Admiral Holdo (his superior) with them butting heads numerous times and Poe facing repeated snarky comments from her. The Last Jedi was hailed as “the most triumphantly feminist Star Wars movie yet,” because of this odd storyline. 629 And critics hailed it for “awakening the feminist force in little girls everywhere.” 630 At one point Poe and the other men take over the ship at gunpoint, tired of the perceived inability of the women to lead the mission. They committed mutiny only to later learn that Vice Admiral Holdo had a great plan but they just didn’t know it, and now Poe had put everyone at risk. The women save everyone though, and he’s sorry for ever doubting them. Even the Star Wars spinoff Rogue One starred a woman. NBC News noted that, “Not only is Rogue One continuing The Force Awakens trend of putting a young woman in the center of the action, but it appears to provide prominent roles for African-American, Latino and Asian actors as well—a relatively new development in the Star Wars universe.” 631 They loved the “diversity.” George Lucas, the creator of Star Wars , sold the rights to Disney in 2012 and later said he felt “betrayed” after the entertainment giant decided to “go in another direction” from his original ideas. 632 He once referred to the films as his “kids” and said that he regretfully sold them into slavery. 633 In 2015, a new installment of Mad Max was released titled Mad Max: Fury Road , but instead of starring Mad Max it starred Charlize Therone’s character “Imerator Furiosa.” It was declared the “feminist picture of the year.” 634 And instead of Max being a hero like the previous films, he was depicted as an idiot who had to be repeatedly rescued by women.

In Disney-Pixar’s animated Incredibles 2 , a “superhero mom” named Elastigirl (Mrs. Incredible) is chosen for a secret mission over her husband, who led the superhero family in the first film, because he has the tendency to cause unnecessary “collateral damage” and the superhero organization felt they needed to change the image of superheroes in the public’s mind. She then leaves her husband at home to watch the kids while she takes off on her mission. When she calls to check on how things are going, the husband is depicted as being in over his head and not able to handle taking care of the kids and running the house. The London Guardian called the film a “feminist triumph.” 635 Bustle , an online women’s magazine, wrote, “In a time when conversations about representation are more prevalent than ever, showing the diversification of familial roles is definitely fitting. Though not entirely out of the ordinary, seeing a father—especially one as domineering as Mr. Incredible—taking on more of a domestic role will definitely serve as a comedic relief for some, but will also, hopefully, contribute to larger conversations surrounding familial structures and their many forms.” 636 Their glowing review continued, “The responsibilities of family life should be divvied up amongst its members, and gender shouldn’t play a determining factor in who takes on whichever task. In this way, The Incredibles 2 is adding some much-needed perspective to conversations surrounding family dynamics and female empowerment. But, though extremely relevant and important to discuss today, true progressiveness will be measured once conversations about strong female leads and diverse familial structures are no longer needed.” 637 Birds of Prey is a spin-off from Suicide Squad , a film based on DC Comics’ characters, focusing on Harley Quinn (played by Margot Robbie) who just broke up with her boyfriend the Joker and must survive as a supervillain in Gotham City with no man to protect her. Some critics called the character’s portrayal in Suicide Squad sexist and misogynistic, so for the spin-off producers decided to atone for their “sins” by making Birds of Prey a hyper-feminist film where all of the bad guys aren’t just criminal masterminds, but misogynists who treat women poorly and deserve to be punished. 638 Ewan McGregor, who plays the crime lord Black Mask, said, “What interested me with Birds of Prey is that it’s a feminist film. It is very finely written. There is in the script a real look on misogyny, and I think we need

that. We need to be more aware of how we behave with the opposite sex. We need to be taught to change. Misogynists in movies are often extreme: they rape, they beat women ... and it is legitimate to represent people like that, because they exist and they are obviously the worst. But in the Birds of Prey dialogues, there is always a hint of everyday misogyny, of those things you say as a man you do not even realize, mansplaining ... and it’s in the script in a very subtle way. I found that brilliant.” 639 Salon.com raved, “Harley Quinn is back to take down the patriarchy, and this revolution brings scrunchies.” 640 Another critic loved that it was about “women’s emancipation,” because the character proved she could be a supervillain on her own without a boyfriend. 641 Like most “woke” movies, the film bombed its opening weekend, so the producers changed the title to Harley Quinn: Birds of Prey , hoping to spark people’s interest because the character had become a breakout star from Suicide Squad. The film was still a huge loss for the studio, but Hollywood can’t take a hint. They’ll keep making feminist propaganda pieces and have their favorite critics try to sell them to viewers no matter how much they suck and how poor they perform at the box office.

Gender Swaps In 2016 a new Ghostbusters film was released, but instead of starring Bill Murray and the gang it featured four women as the Ghostbusters. At the end of the movie the girls shoot the giant evil ghost in the crotch with their proton packs to finally destroy him. Actress Leslie Jones, who was one of the Ghostbusters, quit Twitter and said she cried because she was getting “harassed” by people who hated the film. 642 It completely bombed at the box office and cost the studio an estimated $125 million dollars in losses. 643 A few years later when it was announced that a new Ghostbusters was in the works that would continue the original series and “hand the movie back to the fans,” the director Jason Reitman was called a “sexist” because that meant it wouldn’t be another feminist empowerment film. 644

In the 2019 film Terminator: Dark Fate , John Connor, the future leader of the “Resistance” against the machines, is killed in the first few minutes, making all of the previous films completely pointless since the primary mission was to ensure that he lives so he can grow up to lead the war against the machines. Then Sarah Connor, along with the help of another “good” time-traveling Terminator (who is an “enhanced” cyborg woman) help another girl evade a new advanced “bad” Terminator which is on a mission to kill her before she becomes a threat to the machines in the future. “If you’re at all enlightened, she’ll play like gangbusters,” director Tim Miller said, speaking of the “good” female cyborg. “If you’re a closet misogynist, she’ll scare the fuck out of you, because she’s tough and strong but very feminine. We did not trade certain gender traits for others; she’s just very strong, and that frightens some dudes. You can see online the responses to some of the early shit that’s out there, trolls on the internet. I don’t give a fuck.” 645 The film bombed, reportedly losing 100 million dollars, 646 and the Hollywood Reporter said the studio had no future plans for any other Terminator movies. 647 Ocean’s Eleven was a popular heist film that originally starred the Rat Pack in 1960 and was remade in 2001 featuring an ensemble cast led by George Clooney. The reboot, which did very well, was followed up with two sequels, (Ocean’s Twelve , and Ocean’s Thirteen ) but then in 2018 the gender swap mania infected the franchise and Ocean’s 8 was released, reenvisioning the professional burglars as a group of all women, led by Sandra Bullock. As I’m sure you expected, the film bombed, and the actresses blamed bad reviews on men of course, saying they were due to a “lack of diversity” among the critics. 648 In 2019, a crime drama called The Kitchen was released as an allwoman gangster film starring Melissa McCarthy because someone thought it would be a good idea to make such a ridiculous movie. It wasn’t even a comedy, which made it even more absurd. The title refers to Hell’s Kitchen, a neighborhood on the West Side of Midtown Manhattan where the women “gangsters” live. The plot revolves around them collecting protection money from local businesses and running the neighborhood as part of the Irish mafia. It was a complete bomb and lost the studio tens of millions of dollars which should come as no surprise. 649

Disney announced they were going to reboot the 1990s Doogie Howser M.D. series about a teenage genius who becomes a doctor which originally starred Neil Patrick Harris, but the remake will star a 16-year-old girl as the child doctor. 650 Disney is also producing an all-female version of Pirates of the Caribbean that will star Margot Robbie. 651 Steven Spielberg said that his iconic character Indiana Jones should take “a different form” and be played by a woman named “Indiana Joan.” 652

Vin Diesel even said that an all-female version of Fast & Furious was in the works. 653 In 2017 when the film Dunkirk was released, which depicts the historic Dunkirk evacuation during World War II when Allied soldiers pulled out of the Dunkirk harbor in France, liberals were upset that the film didn’t gender-swap some characters to make it more “diverse.” 654 Of course that wouldn’t have been historically accurate, or made any sense because women were not on the battlefield, but that didn’t stop the snowflakes from complaining about the soldiers being all men.

The Institute on Gender in Media In 2004 actress Geena Davis started a non-profit research organization to study “gender representation” in media. The “Institute” on Gender in Media is obsessed with monitoring the number of women vs men in TV shows and movies and tracking what percentage of them have speaking roles and how many of them have power. Their website says, “we’re the only organization working collaboratively within the entertainment industry to engage, educate and influence the creation of gender balanced onscreen portrayals, reducing harmful stereotypes and creating an abundance of unique and intersectional female characters in entertainment targeting children 11 and under.” 655 Another pointless project the “Institute on Gender in Media” has been working on is a computer program that checks scripts for “gender bias” language to make sure they’re “inclusive.” Not only does the software scan scripts for words and phrases like fireman , postman , and mankind ; but it also produces a report on the percentage of characters who are “people of

color” and even LGBTQ so the writers and producers can make sure their projects are “diverse” enough. 656

Television Commercials Turn Feminist For many years feminists have been upset about the way cleaning products are marketed, so recently there are an increasing number of commercials for laundry detergent, vacuums, and mops depicting men using the products. Creating “gender equality” in commercials for cleaning products has even been called “the final feminist frontier.” 657 Some companies are even promoting feminism in their commercials even when their products have nothing to do with gender at all. For example, some morons in the marketing department at Anheuser-Busch thought it would be a good idea for Bud Light to promote the supposed “wage gap” in an incredibly unfunny ad featuring Amy Schumer and Seth Rogan. It begins with Schumer saying, “Bud Light party here, to discuss equal pay.” Seth Rogen goes on to complain that “Women don’t get paid as much as men and that is wrong!” The two banter back and forth about women supposedly having to pay more for cars, dry cleaning and shampoo, but “Bud Light proudly supports equal pay. That’s why Bud Light costs the same, no matter if you’re a dude or a lady,” explains Schumer. Forbes magazine called the commercial “unusual” and the writer wondered, “So why did Bud Light choose to make what might be the first civil-rights-inflected beer ad…Are they targeting Hillary voters? Are they simultaneously making fun of ‘equal pay’ claims by subverting the meaning of the term to be about a non-problem—what men and women pay for beer? Or are they trying to thread the needle with comedy to speak to both audiences?” 658 Their beer sales soon declined, and they pulled the ad. 659 When journalists started inquiring about the company’s own business practices regarding “equal pay” they declined to reveal how many women work for

the company or how their salaries compare to those of their male counterparts. 660 Bud Light even took the video off YouTube trying to distance themselves from the mess they created. In 2018 Burger King launched an ad campaign to “raise awareness” about “gender inequality.” Using a hidden camera in one of their restaurants they served what they called “Chick Fries” (which were just thin chicken strips or “chicken fries”) to customers, but when women ordered them, they were served the chicken strips in a pink box and were told they had been charged a few dollars more than men “for the pink box.” 661 When some of them got upset and started arguing with the cashier (who was an actor) about how they shouldn’t have to pay more just because the box is pink for women, the cashier began lecturing them about how women’s razors supposedly cost more than men’s “just because they’re pink” and asked them why they didn’t complain about that too. Why not just promote their chicken fries and say they taste great and are on sale you may be wondering? That’s what a normal person would do, but we’re talking about people who have become infected with the liberal pathogen. The Audi car company aired a Super Bowl commercial showing a group of kids racing in a pine box derby, while focusing on the only girl in the group. As the race begins her dad is the narrator, musing aloud wondering how he was going to teach her about sexism. “What do I tell my daughter? Do I tell her grandpa is worth more than her grandma? That her dad is worth more than her mom? Do I tell her that despite her education, her drive, her skills, her intelligence, she will automatically be valued as less than every man she meets?” 662 She then wins the race, beating the boys, and it concludes with him saying, “Or maybe I’ll be able to tell her something different,” and then the words “Audi of America is committed to equal pay for equal work,” and “Progress is for everyone,” are shown on the screen. 663 The “Secret” women’s deodorant brand aired a Super Bowl-themed commercial showing a kicker kick the winning field goal at the end of a game and then when “he” takes off “his” helmet the crowd realizes it was a woman and goes silent, but after a moment of surprise they begin cheering even more and then the catchphrase “Let’s Kick Inequality” is shown on the screen. 664 Companies often use their big Super Bowl commercials to really promote the liberal agenda instead of their product. The “Unstereotype

Alliance” campaign launched by the United Nations notes, “Advertising is a particularly powerful driver to change perceptions and impact social norms,” and says they are “excited to partner with the foremost industry shapers in this Alliance to challenge and advance the ways women are represented in this field.” 665 It’s impossible to escape liberal propaganda, even when viewing commercials for cars and deodorant! Jared jewelers even released a commercial encouraging women to propose to their boyfriends with the tagline “Dare to ask him.” 666 One ad shows a woman drop down on one knee holding the ring, and then as she slides the ring on his finger the camera cuts to their friends seated at a nearby dinner table all celebrating his acceptance, having witnessed her pop the question.

Fat is “Beautiful” No fat jokes (or “fat shaming” as they’re called now) are allowed anymore, because they’re considered “bullying” and “hate speech” so liberals have been promoting “body positivity” which is a more politically correct term for the “fat acceptance movement” in which morbidly obese women are said to be “beautiful” by those who pity them. Despite becoming obese later in her career, Amy Schumer was reportedly in talks to play Barbie in a live-action film based on the doll—in what some people thought was a joke, but it turned out to be true. 667 She was then pulled from the project, probably due to the ridicule she was receiving or after producers realized the movie would be a complete flop because of their idiotic idea. 668 Lena Dunham is another token fat ugly girl in Hollywood who is always promoted as a feminist icon. 669 Dunham has posted pictures on her Instagram over the years celebrating her weight gain, once posting a beforeand-after photo showing her of average weight in the past next to a current photo of her 24-pounds heavier (weighing in at 162 pounds). 670 The post got almost 500,000 likes from people who were proud of her for being happy that she was obese. A year later she posted a picture of her lying in bed wearing lingerie, noting that “I weigh the most I ever have,” and saying she’s the “happiest I’ve ever been.” 671

By accepting obesity as “normal” and banning criticism of obesity as “fat shaming” people are only contributing to the problem. It would be like claiming you were “bullying” people by declaring opioid use is dangerous and something that should be shunned and avoided. Singer Lizzo, best known for being the 300 pound Black girl who likes bouncing around on stage during her performances, was hailed as “brave” and “beautiful” after she posted a semi-nude photo of herself on Instagram. 672

During the coronavirus pandemic of 2020 she posted a picture of herself wearing a face mask and matching bikini, and one tabloid reported that it was a balance of “safety with sex appeal.” 673 Hollywood’s new affinity for fat women is causing some older TV shows and movies to come under scrutiny. As part of the storyline in Friends , Monica (Courtney Cox) was depicted as severely obese when she was younger, but then ended up losing a bunch of weight and became hot. In flashbacks, Courtney would wear a fat suit and a prosthetic chin playing her old self, but now Entertainment Weekly calls “Fat Monica” the “ghost that continues to haunt Friends 25 years later,” and complains that the show used her to get “cheap laughs in the laziest ways possible.” 674 Shallow Hal and The Nutty Professor have since been deemed the most “fat-phobic” movies of all time for their use of fat suits. 675 It probably won’t be long now until the practice of actors wearing fat suits for comedic effect will be banned industry wide, and the those kinds of characters will be deemed just as offensive as someone wearing “blackface” which used to be a staple of comedy with people like Jimmy Kimmel, Jimmy Fallon, Howard Stern, Dan Aykroyd, Robert Downey Jr. and many others once doing skits as a Black person. Most have recently apologized for what were actually hilarious characters after old clips circulated on Twitter with people denouncing them for being “racist.” Feminists even got upset when Pixar’s Wall-E came out, which depicts a dystopian future where the earth is evacuated because it has turned into a trash heap from all the garbage humans were creating. The online outlet Slate was upset that the movie “goes out of its way to equate obesity with environmental collapse.” 676 They complained, “It plays off the easy analogy between obesity and ecological catastrophe, pushing the notion that Western culture has sickened both our bodies and our planet with the same

disease of affluence. According to this lazy logic, a fat body stands in for a distended culture: We gain weight and the Earth suffers.” 677 The London Telegraph noted that fat pride groups, “believe the film propagates anti-obesity hysteria comparable with the quest for the perfect body by the eugenics movement in Nazi Germany.” 678 Yep, Wall-E is Nazi propaganda to these lunatics! Since the Left is so concerned with “global warming” and people’s “carbon footprint,” you’d think they would start calling out fat people for using triple or quadruple the natural resources as the average person, but that would hurt people’s feelings—so instead they’re trying to convince trendy social justice warriors to eat bugs because the cow farts from beefproducing cattle are supposedly destroying the planet. 679 In 2019, Victoria’s Secret hired a plus-size model named Ali TateCutler in order to be “more inclusive.” 680 And what a surprise—later that year they canceled their annual fashion show, citing declining sales and ratings! That same year they had also celebrated hiring their first transgender model in the name of “diversity” so it’s no wonder the Victoria’s Secret brand had become less appealing to so many people. 681 The move came after lunatics on Twitter kept complaining they were “discriminating” against transgender people by having only (actual) women as models. 682 Abercrombie & Fitch also decided to be “more inclusive” by distancing themselves from their well-established brand of flawless models in their catalogs and have now embraced the “body positivity” movement by using “plus-sized” (fat) models and LGBTQ people in their ads. 683 The Sports Illustrated Swimsuit Edition has also featured a “plus size” (fat) model on the cover recently, but she doesn’t attribute her success to the fat acceptance movement. She believes it’s because of White privilege! “I know I’m on this pedestal because of White privilege,” she says. “To not see Black or Latina women as famous in my industry [meaning the plus size model industry] is crazy! I have to talk about it. I want to give those women kudos because they are the ones who paved the way for me,” she said. 684 The glass is always half empty with social justice warriors. Even when things are good, they’re not good enough, and when a fat woman has a successful modeling career she can’t be happy about that either, because she’s worried that her success is due to “White privilege.”

There are also calls for the NFL to start using plus-sized cheerleaders, and the league is under fire from feminists because the cheerleaders must abide by various strict rules, including maintaining their “ideal weight.” There are even calls to ban cheerleaders altogether because it’s “demeaning to women.” 685 In 2016 toy maker Mattel released a “curvy” Barbie to celebrate “body diversity.” An executive at the company said, “These new dolls (are) more reflective of the world girls see around them—the variety in body type, skin tones and style allows girls to find a doll that speaks to them.” 686 Sofie Hagen, a fat “comedian” who got triggered by billboards warning about the link between obesity and cancer, is also hoping Disney will soon feature a princess in one of their cartoons who is fat. She tweeted, “I cannot stress how much we need a fat Disney princess. We need it now. Shut up. We fucking do.” 687 (No, she’s not joking, and on a side note, she blocked me on Twitter for laughing at her). Feminists are often fat, ugly, angry women, as you know, so the AMC television network aired a dark comedy series called Dietland where a morbidly obese woman fed up with “society’s beauty standards” decides to start killing men who contribute to the “objectification of women,” like fashion photographers. It was basically a fat chick revenge fantasy. Only in Hollywood would someone come up with the idea of the protagonist being a fat woman who kills people who hurt her feelings!

The Four Waves Feminism is like an old tool that has outlived its usefulness, but instead of discarding it and appreciating what it accomplished during the time it was needed, feminists have continued trying to “advance” the movement in our modern era. Feminism has gone through four different phases, or waves as they’re called, since its first incarnation in the early 1900s when women banded together to demand the right to vote (women’s suffrage). In the 1960s and 70s the second wave rose up to fight against the lack of women in political positions, and they were very successful in popularizing birth control pills

and legalizing abortion, but for some power-hungry feminists there was more work to be done to dismantle “the Patriarchy.” They continued pushing forward in the 1990s (the third wave) where they worked to get more women into leadership positions in the government and corporations, often simultaneously complaining about men continuing to “objectify women” while doing everything they could to artificially boost their sex appeal and use it to their advantage in every possible situation. Then came the fourth wave of feminism which is completely unrecognizable from the first two waves which actually had a legitimate purpose and goals. Around 2012, not coincidentally coinciding with social media becoming a fixture of most peoples’ lives, the fourth wave of feminism hit the Internet like a tsunami of insanity. Through social media, crazies from across the country were able to connect with each other and affirm one another’s bizarre ideas about their abnormal lifestyles and celebrate their mental illnesses. They now come up with new “causes” to fight for online like “free-bleeding” (not wearing tampons or pads during their period) in order to “raise awareness” for periods (as if we’re not already painfully aware of them), and “smashing the scale” (celebrating obesity). The most radical feminists (the ones with blue or purple hair) eventually turn into cat ladies. Single, childless, alone, and filled with regret and hate. As their looks fade, so does their ability to attract new mates, thus leading them to the inevitable downward spiral of despair which is then used as fuel to reaffirm their beliefs that men have ruined the world and their lives.

The LGBT Agenda Gays are only approximately one or maybe one and a half percent of the 688 population.

But because of the bombardment of LGBT propaganda, many Americans falsely believe ten or even twenty percent of people are homosexual. 689

And liberals want everyone to think that there is no more of a difference between someone who is straight or gay than there is between someone who is lefthanded or right-handed. Homosexuality used to be officially classified as a mental illness by the American Psychiatric Association until 1973 when they gave in to

intense pressure by LGBT groups and had it removed from their Diagnostic and Statistical Manual (DSM). 690 Now they just call it a “sexual orientation.” Gays used to deny there was a “gay agenda” and claimed that they weren’t promoting homosexuality; all they wanted was to not be “attacked” or “discriminated against”—but those claims, like almost everything that comes out of liberals’ mouths, turned out to be a massive lie. Today it’s not even about LGBT “rights” to them, it’s about LGBT privilege . They get extra rights. They’re special . And any criticism about their behavior or lifestyle is deemed “hate speech” and “harassment” no matter how mild or reasonable. These days anyone who doesn’t celebrate them is considered an enemy. You must put them on a pedestal and marvel at their “awesome” sexuality, or you’re a Nazi! The reason gays and transgenders went from being widely viewed as strange, to being “privileged” and “special” people over the course of a single generation is the result of a massive propaganda campaign the likes of which the world had never seen. In 1987 Gay Community News , a popular LGBT publication at the time, admitted the “gay revolution” would require the use of entertainment in order to be achieved, saying, “We shall sodomize your songs, emblems of your feeble masculinity, of your shallow dreams and vulgar lies. We shall seduce them [children] in your schools…in your youth groups, in your movie theater bathrooms…wherever men are men together. Your sons will become our minions and do our bidding. They will be recast in our image. They will come to crave and adore us.” 691 In 1989 two gay activists published a book titled After the Ball: How America Will Conquer its Fear and Hatred of Gays in the 90s which detailed their goals to have Hollywood produce propaganda that portrayed gays as “victims of circumstance and oppression, not as aggressive challengers.” Their idea was that, “Gays must be portrayed as victims in need of protection so that straights will be inclined by reflex, to assume the role of protector.” 692 Their plan worked perfectly, as Joe Biden admitted when giving a speech for Jewish American Heritage Month, where he said, “It wasn’t anything we legislatively did. It was ‘Will and Grace,’ it was the social media. Literally. That’s what changed peoples’ attitudes. That’s why I was so certain that the vast majority of people would embrace and rapidly

embrace [gay marriage]. Think behind all that, I bet you 85 percent of those changes, whether it’s in Hollywood or social media are a consequence of Jewish leaders in the industry. The influence is immense, the influence is immense.” 693 All gays wanted was to be able to get “married” they said, but within just a few short years after the Supreme Court ruling made it legal nationwide (in 2015) we saw the proliferation of dozens of different “genders,” pre-teen child drag queens and “Drag Queen Story Hour” events popping up at public libraries across the country. In numerous cases the drag queens who were reading books to children at the events have been found to be convicted pedophiles. 694 What a surprise! An LGBT website called Pink News ran a headline titled, “Republican Lawmakers Want to Make Child Drag Shows Illegal,” expressing their anger that a U.S. Representative proposed a bill that would prohibit anyone under the age of eighteen from participating in drag shows. 695 And now LGBT activists harass Christian owned businesses like Chick-Fil-A for not supporting gay “marriage.” 696 I put gay “marriage” in quotes when referring to gay “marriage” because a marriage is between a man and a woman—I don’t care what the Supreme Court says, and I refuse to acknowledge it. Chick-Fil-A restaurants have been banned from opening in airports and on college campuses, and new locations often face boycotts wherever they are. How much longer until the LGBT extremists start trying to run churches out of town and harass parishioners as they come to worship on Sundays?

Ellen DeGeneres, the Trailblazer Ellen DeGeneres is considered a pioneer in the television industry for normalizing gay people after her sitcom Ellen decided to depict her character as a lesbian when she came out in real life in 1997. Will and Grace then picked up the baton in 1998 with a sitcom about a woman (Debra Messing) and her gay roommate. “Will and Grace was the first time you saw characters on television that made gay normal, you wanted to be friends with them,” said Lance Bass from the boy band NSYNC. 697

Sean Hayes, the actor who played Will’s boyfriend on Will and Grace, said, “The best feeling I get is when people come up and say thank you for all you do for the gay community and thank you for playing that part and that show and you feel so fortunate to have been part of something so great.” 698 Since then, the world has been flooded with countless shows and movies where homosexuality is at the center of the plot. Films like Brokeback Mountain (2005) about two gay cowboys; Milk (2008) about Harvey Milk, the first openly gay politician to be elected to public office; Call Me by Your Name (2017) about an adult male who falls in “love” with a teenage boy; and many others which have been made for the sole purpose of promoting “gay rights” no matter how little success they’ll have commercially. But that’s not enough. They want gays and transgenders in every TV show and movie. In 2018, a transgender “woman” was included in the Miss Universe Pageant, a move, as you expect by now, was praised as a “historic first.” 699 Two years later Sports Illustrated included a transgender “woman” in their famous swimsuit edition. 700 And throughout this chapter you’ll see they’re trying to “gay up” everything from Star Wars to Sesame Street. When producers of the HBO vampire series True Blood decided they wanted to depict a character as bisexual and have him do soft-core porn sex scenes with other men (since it’s HBO and shows regularly include nudity), the actor Luke Grimes, who played the character, quit the show. 701 He was immediately denounced by the media and his castmates as “homophobic.” 702

NBC launched a sitcom in the Spring of 2019 called Abby’ s about a bisexual woman who runs a bar—a move that was celebrated as the first sitcom on network television to feature a bisexual as the lead character. For extra diversity she is also a Cuban-American, and the show was promoted as a “multicultural comedy.” 703 It was canceled after just one season. Congresswoman Alexandria Ocasio-Cortez was recently a guest host on RuPaul’s Drag Race , a reality show where drag queens compete to see who is the “best.” When the drag queens thanked her for being so “brave” for standing up against Republicans, she responded by lavishing praise on them for being on the forefront of changing the culture and the laws. “People think Congress and government is all about leading people, but ultimately, a lot of our politics is about following the public will. And the

people who change the way people think are artists and drag queens.” 704 She went on to call the contestants “patriots” and gushed about how proud she was of them.

Gay Superheroes In 2011 Marvel released Captain America: The First Avenger which was a huge success, and when a sequel was released in 2014 (Captain America: Winter Soldier ), many liberals were upset that Captain America and his best friend Bucky weren’t in a gay relationship together. Vanity Fair gave the film great reviews, but said it had one “flaw,” writing, “So while Marvel was likely never going to make the homoerotic subtext of Cap and Bucky into text, would it really have hurt to keep their relationship more ambiguous?” 705 It went on, “As if to put the nail in the coffin of speculation, Bucky and Cap paused for a moment in the middle of snowy Siberia to reminisce about their days chasing skirts in pre-War Brooklyn. It’s a sweet, human bonding moment but one that also bristles with heterosexual virility. If Disney isn’t inclined to give audiences a gay superhero, couldn’t they have at least left us the dream of Bucky and Cap?” 706 The critic was literally upset they reminisced about chasing women in the previous film, which normal guys do, but LGBT extremists were projecting their own thoughts onto the characters and hoping that they would be just like them. When the much-anticipated Black Panther film came out in 2018, the first superhero film starring a Black man, some people were upset because it didn’t include any gay characters. 707 GLAAD, the gay lobbying organization, was upset after the first Wonder Woman film was released because there weren’t any gay or lesbian characters, saying “On screen, record-breaking films like Black Panther and Wonder Woman prove that not only does inclusion make for great stories— inclusion is good for the bottom line. It is time for lesbian, gay, bisexual, transgender, and queer (LGBTQ) stories to be included in this conversation and this movement.” 708

Wonder Woman was turned into a bisexual later in the comics, and the LGBT extremists clamored for her to be explicitly bisexual in Wonder Woman 1984 , the sequel to the 2017 film. When the trailer was released, Gal Gadot (Wonder Woman), teased that it may involve a potential romance between her and the villain, “The Cheetah” played by Barbara Ann Minerva. 709 The Eternals includes a gay superhero named Phastos and is Marvel’s first film to feature an on-screen gay kiss which takes place between him and his “husband.” 710 As soon as the new year rang in for 2020, the president of Marvel Studios announced that the franchise would also be introducing a transgender character. 711 Marvel’s Thor: Love and Thunder (scheduled to be released in February 2022) will feature a lesbian superhero called Valkyrie. 712 And the trend continues. The CW television network’s Batwoman series depicts the superhero as a lesbian. 713 In the first season she was played by actress Ruby Rose, who is herself a lesbian in real life, and throughout much of the series “Kate Kane” (the character whose alter ego is Batwoman) makes it abundantly clear she’s “very gay.” In one episode after a college student tearfully tells Batwoman that her parents hate her because they found out she’s gay, Batwoman “outs” herself and is then shown on the cover of CatCo (a fictional magazine in the DC Comics universe) with the headline “Batwoman Reveals Herself as a Lesbian.” 714 It was hailed as a “historic reveal” and celebrated that the character is now an “openly gay superhero.” 715 Even back in the late 1990s, director Joel Schumacher (who is gay) tried to depict Batman and Robin as gay. When asked about the seemingly gay innuendo between Batman (played by George Clooney) and Robin (played by Chris O’Donnell) in the 1997 Batman & Robin , O’Donnell admitted, “going back and looking and seeing some of the pictures, it was very unusual.” 716 George Clooney later said he played a “gay” Batman. 717 In 2012, DC Comics relaunched the Green Lantern as a gay man. 718 A few years after that they also decided to turn Catwoman into a bisexual. 719 There are growing calls to depict Spider-Man as gay now too. The character has been played by numerous actors over the years in various incarnations, and now one of them (Tom Holland) who currently portrays the character, is lobbying Marvel Studios to depict Spider-Man as gay or bisexual. 720

Sources close to the franchise say the character will be depicted as bisexual or have a boyfriend in a future film. 721 Andrew Garfield, who played the character in The Amazing Spider-Man (2012), said, “Why can’t we discover that Peter is exploring his sexuality? It’s hardly even groundbreaking!…So why can’t he be gay? Why can’t he be into boys?” 722

Star Wars Isn’t Gay Enough When the new Star Wars film The Force Awakens was about to be released in 2015, activists said they wanted Luke Skywalker to be gay. Mark Hamill who plays the character said fans kept asking him, “Could Luke be gay?” and instead of telling them they’re insane, he gave them hope, saying, “If you think Luke is gay, of course he is. You should not be ashamed of it.” 723 If you’re a fan of the franchise you may recall that before Luke learned of his true identity (and that of his twin sister) both he and Han Solo had a crush on Princess Leia. After Star Wars: The Last Jedi was released in 2017, LGBT extremists were upset that characters Finn and Poe weren’t in a gay relationship. BuzzFeed wasn’t happy either because they hoped the two men might have a “romance” as part of the plot. 724 Oscar Issac who plays Poe Dameron, “expressed regret that the ‘natural chemistry’ between Poe and Finn in The Force Awakens was not explored in an overtly romantic way in ‘Star Wars: The Last Jedi’—and wouldn’t be in ‘The Rise of Skywalker.’” 725 “Personally,” he said, “I kind of hoped and wished that maybe that would’ve been taken further in the other films, but I don’t have control. It seemed like a natural progression, but sadly enough it’s a time when people are too afraid, I think, of… I don’t know what.” 726 John Boyega, who plays Finn (the Black former Stormtrooper), agreed, saying, “They’ve always had a quite loving and open relationship in which it wouldn’t be too weird if it went beyond it.” 727 LGBT websites seized the news with one declaring, “Oscar Isaac wishes Star Wars’ Poe and Finn were in a gay relationship but ‘people are too afraid.’” 728

Trying to appease the criticism, director J.J. Abrams included a scene showing two lesbians kissing at the end when everyone was celebrating that the First Order had been defeated. It was hailed as “making history” for the first same-sex kiss in a Star Wars movie, but that wasn’t good enough— nothing ever is. 729 Just a few years ago all they wanted was for gay “marriage” to be legal, they said. And now they’re furious that leading male characters in Star Wars aren’t having sex with each other. They just want to be “accepted” for who they are, they said, and then once they were, they began demanding everyone embrace them and celebrate them. But it’s not just gays and lesbians. Now it’s transgenders too, and the “gender nonconforming” people, and even child drag queens.

Disney Goes Gay Even what was once the most family friendly entertainment brand in the world has gone gay, and is adding an increasing number of LGBT characters and storylines. In 2014 the Disney Channel’s most popular comedy at the time, Good Luck Charlie, included a lesbian couple in the show. 730 They tried to make it funny by depicting two parents confused about the name of the mother of their daughter’s friend. Each one of them had met the “mom,” but one thought her name was Susan, and the other swore it was Cheryl. Then there’s a knock on the door and they open it to reveal their daughter’s friend has two “moms.” The media celebrated Disney for being “brave” and said it was “about time,” and once the LGBT foot was in the door activists started pressuring the network to include a gay teenager in one of their shows. 731 The following year on the Disney-Owned ABC Family Channel [which has since been renamed “Freeform”] they included a gay kiss in a show called The Fosters between two thirteen-year-old boys. 732 The executive producer Peter Paige (who is a homosexual) was proud to have depicted the “youngest same-sex kiss in US television history.” 733 When Disney’s Beauty and the Beast was made into a live-action film in 2017, it included a brief scene of a same-sex couple dancing, which was

hailed as the “first exclusively gay moment” in a Disney movie. 734 That same year they included a “male princess” in their animated series Star vs. The Forces of Evil . 735 The Huffington Post called it a “beautiful message” for kids. 736 The show also depicted Disney’s “first same-sex cartoon kiss,” another move which thrilled the liberal media. 737 Toy Story 4 (2019) had a brief scene where a child is dropped off at school by “two moms,” something that LGBT activists were happy about. “It’s a small scene, sure, and it’s certainly not the major representation that queer people have been waiting for, but it’s still important,” wrote the Gay Times . 738 In Disney’s The Jungle Cruise (2020) starring Dwayne Johnson, one of the characters (played by Jack Whitehall) comes out as gay, which is the first-ever openly gay character to have a role in a Disney movie. 739 Disney then announced that a character in an upcoming animated movie called Onward would be a lesbian. “It’s been a long wait, but a Disney heroine finally has a girlfriend,” gloated Yahoo News when it was revealed that Officer Specter, which is voiced by a lesbian actress named Lena Waithe, would also be a lesbian in the movie. 740 The idea was praised as “making history” for being the first LGBTQ character in a Disney animation film, but as expected, critics complained that the character only appears in one scene. Then a few months later Disney released an animated film on their streaming service Disney+ called Out about a kid who was nervous about moving in with his boyfriend because he hasn’t told his parents that he’s gay. The parents then come to find that his roommate is actually his boyfriend, but instead of being horrified, to his surprise, they’re happy for him. It was hailed as Disney/Pixar’s “first gay main character.” 741 Then they introduced their first bisexual character who stars in another animated series on Disney+ called The Owl House . 742 The character, a 14-year-old girl, had previously been interested in boys, but after the show’s creator, Dana Terrace (who is bisexual herself), lobbied the network to turn the character bisexual just like her, they complied. 743 Soon they’ll probably make Mickey Mouse or Donald Duck gay.

More Gay Characters for Kids Ever since 2017, Sesame Street’s official social media accounts have been posting annual “Happy Pride Month” messages along with pictures of rainbows and various characters from the show celebrating it. 744 In 2018 a former writer for Sesame Street claimed that Bert and Ernie are gay. 745 That man himself is a homosexual (what a surprise) and really just wished they were gay. The next day the show’s producer issued a statement rebuking the former writer’s claim, saying, “As we have always said, Bert and Ernie are best friends. They were created to teach preschoolers that people can be good friends with those who are very different from themselves. Even though they are identified as male characters and possess many human traits and characteristics (as most Sesame Street Muppets do), they remain puppets, and do not have a sexual orientation.” 746 But PBS would soon cave in to the gay agenda completely. The following year (in 2019) their cartoon Arthur included a gay “wedding” in the season premiere where they revealed that one of the teachers in the show, Mr. Ratburn, is gay. The episode is titled “Mr. Ratburn and the Special Someone” and his students all attend the wedding expecting he’s going to marry another character in the show, Patty, but it’s revealed that she’s actually his sister, and then his new “husband” is introduced to everyone. 747 The year after that (in 2020) PBS included a lesbian couple in their animated series Clifford the Big Red Dog , based on the popular children’s book series that follows the adventures of an 8-year-old and her dog. 748 The official Twitter account for Nickelodeon and the Cartoon Network now post messages celebrating “Pride Month,” as well as “International Transgender Visibility Day,” which is another made-up “holiday” by the Left used to promote transgenderism. 749

Old Comedies “Transphobic”

Mrs. Doubtfire , a 1993 comedy starring Robin Williams, has come under attack recently for being “transphobic” after it was revealed that a musical adaptation would hit the stage at a theater in Seattle, and then later on Broadway. In the film, Robin Williams loses custody of his kids after a divorce and in order to remain in their lives poses as an elderly woman who successfully applies for a job working as the kids’ nanny. It was well-received at the time, but the culture has shifted so far Left that when word of the musical was announced, activists started a petition on Change.org calling for it to be canceled because the plot uses “tired, transphobic tropes” and “strengthens the assumptions and misjudgments that continue to harm trans women in implicit, pervasive ways.” 750 Jim Carrey’s 1994 comedy Ace Ventura: Pet Detective has now been deemed “transphobic” because the pet thief who kidnapped the Miami Dolphins’ mascot is found to be a transsexual, now living as a woman. When Jim Carrey realizes this, he runs to the bathroom and starts vomiting, burns his clothes, and jumps in the shower, because earlier in the film “she” came onto him and they made out. 751 Silence of the Lambs (1991) is also now considered “transphobic” since the serial killer Jodie Foster is trying to hunt down (Buffalo Bill) has gender dysphoria. As part of the plot he murders women so he can make a “woman suit” out of their skin to complete his “transformation.” Variety magazine recently denounced the film for “depicting the criminal’s transgender identification as part of his mental illness.” 752 GLAAD complained that the killer is “a walking, talking gay stereotype.” 753 What’s next? Older classics like Some Like it Hot or Tootsie ?, or more modern shows like Tyler Perry’s “Madea” character or Martin Lawrence’s “Shanaynay?” Jimmy Fallon also used to have a regular segment on the Tonight Show called “Ew” where he would dress up as a woman, but he hasn’t done it in quite some time, and it probably won’t be much longer until he apologizes for it. Soon it will probably be considered a slur to call a transgender person “transgender,” and making any distinction between them being born the opposite sex from which they currently identify will be considered an invasion of their privacy, much like releasing someone’s medical records. To call a transgender “woman” a “transgender woman” will be considered “dehumanizing” and “hateful,” and no distinctions will be allowed.

LGBTQ extremists claim people are “assigned” a gender at birth, much like they are given a name—and maintain that the “assignment” of one’s gender is just as arbitrary and is used to confine the “gender expression” of people to correspond with their biological sex. They won’t say that a transgender “woman” was born a male, they say “she” was “assigned” the male gender at birth, as if it was just a coin toss. The animated comedy series Family Guy announced in early 2019 that they were going to stop making jokes about gay people and transgenders. The series, which has been on air for over 20-years, is known for its no holds barred comedy about typically taboo subjects, but now offending LGBTQ people is too much even for them. The executive producers said, “Some of the things we felt comfortable saying and joking about back then [earlier in the series], we now understand is not acceptable…The climate is different, the culture is different and our views are different.” 754

Drag Queen Story Hour and “Drag Kids” One of the three strikes on Alex Jones’ YouTube channel that led to him being banned from the platform was a rant about a local drag queen festival that included children giving dollar bills to the drag queens as they engaged in simulated strip teases. He called it a “freak show” and an “abomination” in a segment for his show and YouTube considered that to be “hate speech.” 755 In my previous book The Liberal Media Industrial Complex I detail the “unpersoning” of Alex Jones and the censorship of conservatives on social media, which I encourage you to read if you haven’t already so you can grasp just how big the ramifications are for speaking out against this degeneracy. At one of the Drag Queen Story Hour events in New York, a drag queen asked the children, “Who wants to be a drag queen when they grow up?” 756 At another, one of them taught the children how to “twerk,” asking them, “Does anybody in this room know how to twerk?” Nobody spoke up, and the drag queen continues, “All you need to do is you just need to stand with your feet sort of shoulder-width apart like so…and then you crouch down in this sort of position, so you’re bum’s sticking out. And then you

just move your bum up and down like that [as he does it]. And that’s twerking.” 757 Equally disturbing is the recent phenomena of young pre-teen boys being dressed in drag by their parents and paraded around at drag queen festivals in hopes they’ll become social media stars. One such “drag kid” who goes by the name “Desmond is Amazing” was even featured on Good Morning America . 758 “Desmond is Amazing” certainly isn’t one of a kind. Other child drag queens like “E! the Dragnificent” and “Lactacia” (who started doing drag at eight-years-old) are building up their social media followings, all trying to be the next YouTube or TikTok star. 759 YouTube even hosts a documentary film called Drag Kids which follows a group of pre-teen kids as they travel around the country participating in child drag shows. 760 The documentary’s purpose isn’t to raise the alarm about this horrific practice, it’s to show how “cool” the kids are. Netflix has a reality series called AJ and the Queen where a 10-yearold child travels across the country with RuPaul as he performs drag shows in gay bars. The sexual things the drag queens say about the child are too disgusting to include here because they’ll make you physically ill as they did me when I first read about it. 761 Another Netflix original series called Dancing Queen follows the life of a drag queen who teaches dance lessons to kids. 762 In 2015, TLC premiered I Am Jazz , a reality show following the life of Jazz Jennings, a transgender teenager, who at the time was one of the youngest people in the world to identify as transgender. “Jazz Jennings” is a pseudonym, and unlike every other public figure on the planet who uses one, “her” birth name is not allowed to be mentioned on Wikipedia because of the special protections given to transgender people. Similarly, “Lavern” Cox’s birth name (Roderick) is not allowed to be mentioned either. In fact, simply mentioning a transgender person’s birth name or legal name is considered a violation of the terms of service on Facebook and Twitter. 763 TLC was originally called “The Learning Channel” and aired educational programming about science, history, and nature, but slowly morphed into another reality TV network (just like the History Channel has), and now instead of featuring anything remotely educational, TLC is

known for mind-numbing trash like Here Comes Honey Boo Boo , and Toddlers & Tiaras .

Celebrities Raising Kids Trans Celebrities love to adopt children from Africa as a novelty and to show how much they “care” about Black people, and since transgenderism has become the coolest new fad in Hollywood, many celebrities seem to be inspired to raise their kids as the opposite gender to defy cultural norms. Charlize Theron adopted two Black kids, one boy and one girl, and then later was spotted around town with the kids both wearing dresses and now insists she has “two beautiful daughters.” 764 Brad Pitt and Angelina Jolie (who are now divorced) adopted several children, but their first biological child was daughter Shiloh who they started dressing in boy’s clothes, causing many to speculate whether she is a tomboy or actually identifies as a boy. 765 Megan Fox (now divorced from Brian Austin Green) dresses her sixyear-old son in girls’ clothes. “He likes to wear dresses sometimes and I send him to a really liberal, hippy school, but even there—here in California—he still has little boys going, ‘Boys don’t wear dresses’ or ‘Boys don’t wear pink.’ And so, we’re going through that now, where I’m trying to teach him to be confident, no matter what anyone else says.” 766 Megan and her son were once spotted by paparazzi when he was dressed up as Elsa from Disney’s Frozen. 767 Singer Adele also dresses her son up as Disney princesses, which the liberal media has hailed as “a triumph for us believers in gender-neutral parenting.” 768 Actor Liev Schreiber brought his eight-year-old son to Comic-Con dressed as Harley Quinn, the Joker’s girlfriend from Suicide Squad . 769 When Mario Lopez appeared on Candace Owen’s podcast and the subject of parents raising their children transgender came up, he said he didn’t think it was right to be deciding that a 3-year-old kid should start

being treated as the opposite gender. 770 But he was immediately attacked for being “transphobic” and soon apologized. That wasn’t enough, however. The LGBT fascists demanded that he become an “advocate” for transgender kids.

Commercials Go Gay It’s not just movies and television shows that have been filled with LGBT people, now even many commercials feature them as well. Homosexual couples are now regularly included in commercials for major brands from IKEA and Chevrolet, to Target and Tide laundry detergent. 771 Each time another one jumps on the bandwagon, their allies in the media always write an article about it celebrating how “great” it is, encouraging more. 772 For example, Campbell’s Soup created a commercial in 2015 showing two gay “dads” feeding “their son” because the company wanted to show the “diverse mix” of American families. The Huffington Post said it, “will melt your heart.” 773 In 2017, the Dove soap company released an ad featuring “real moms” with their babies and praised the “diversity” in how each of them were raising their children, saying there was “no one right way.” Included with the “moms” was a transgender woman who is the biological father of one of the babies, along with the actual mother who gave birth to the poor child. “We are both his biological parents,” the transgender says. “You get people that are like, ‘What do you mean you’re the mom?’ We’re like, ‘Yep! We’re both gonna be moms.’” 774 Gillette razors released a commercial in 2019 featuring a transgender “boy” being taught how to shave by “his” dad for the first time as part of their campaign to “redefine masculinity.” 775 Starbucks released a commercial in support of people’s “preferred pronouns” showing a teenage girl with a butch haircut named Jemma who appears to be uncomfortable every time someone says her name as she goes about her day until she walks into a Starbucks and is asked what it is so the barista can write it on the cup, which is customary.

She proudly answers “James” and is revealed to be transitioning to a boy. The commercial was part of Starbuck’s announcement that they were partnering with a charity that supports transgender children. 776 Coca-Cola’s 2018 Super Bowl ad featured a lesbian and a “nonbinary” person. 777 In another commercial for Diet Coke released the following year a blue-haired woman drives around in an Uber picking up all kinds of different people while enjoying her Diet Coke all night. At one point her passengers are shown to be two gay men, one White and one Black for extra “diversity,” who are kissing in the back seat. The camera then cuts back to the driver who has a big smile on her face. 778 Smirnoff vodka now features transgender actress Lavern Cox in their commercials. 779 Other alcohol brands like Absolut, Effen, Bud Light, and Barefoot Wine, all release special edition “Gay Pride” bottles for the month of June every year featuring rainbows on them. 780 Most major food brands now release special “Pride” themed packages for gay pride month each year, and on social media change their avatars to pictures that include rainbows. All major retailers celebrate it too, from Walmart and Target, to Kohl’s and Old Navy. All tweeting about it and posting on Facebook and Instagram how important LGBT people are to them and issuing press releases alerting the media how they’re going to be “celebrating Pride month.” 781 Sprite even released a commercial for “Pride” month in 2019 showing a bunch of transgender people transitioning; including a man having makeup put on him by another transgender “woman,” and a girl engaging in “breast binding” with her friend as they joyfully wrap her breasts tightly to her chest so she can “pass” as a male. 782

Gay Sexual Predators Swept Under the Rug In the “Me Too” era, Harvey Weinstein has become the symbol of sexual degeneracy in Hollywood, but most of the women who accused him of sexual “assault” willingly had sex with him in order to further their own careers, and they weren’t forcibly raped. Years later they just jumped on the bandwagon to cash-in once they saw the opportunity, and in hindsight regretted they had sex with such a pig for a chance to be a star.

That’s not to say he didn’t make some of them feel extremely uncomfortable by blatantly propositioning them for sex—and he’s undoubtedly a sexual predator—but powerful men using the “casting couch” to entice women into having sex with them isn’t Hollywood’s dirtiest secret. One of the things nobody wants to talk about (aside from the industry’s pedophilia problem which is actually the biggest secret and covered in the next chapter) is the fact that gay men are basically allowed to sexually harass (and assault) other men with impunity because daring to say that a gay man has done anything sexually inappropriate amounts to blasphemy. Surprisingly, actor Terry Crews developed the courage to come forward in 2017 to admit that he was once sexually assaulted by his agent, who grabbed his genitals while making sexual advances toward him. 783 James Van Der Beek, star of the teen drama Dawson’s Creek , later came forward as well to reveal that he was sexually harassed (and groped) by “older, powerful men” in Hollywood. 784 Others including Brendan Fraser, Bill & Ted’s Excellent Adventure star Alex Winter, and Star Trek: Discovery actor Anthony Rapp, have also come forward with allegations of being sexually harassed by gay men in Hollywood. 785 Their stories were just a blip on the radar however, and then the issue was swept under the rug. Undoubtedly the same thing has happened to many others who are afraid to come forward out of embarrassment or because they don’t want to make waves out of fear it may derail their career. In fact, after Terry Crews revealed he was assaulted, others in the entertainment industry including D.L Hughley and 50 Cent mocked him. 786 During a 2011 interview, Rapper Fat Joe admitted that he believes a “gay mafia” controls the music industry, saying, “The hip hop industry is most likely owned by gays. I happen to think there’s a gay mafia in hip hop. Not rappers—the editorial presidents of magazines, the [program directors] at radio stations, the people who give you awards at award shows. This is a fuckin’ gay mafia, my man, and they are in power.” 787 It’s not just in the entertainment industry that gay sexual predators are mostly ignored. The same thing is happening in the U.S. military, especially after Barack Obama lifted the ban on them enrolling. 788 According to the Department of Defense statistics, more men than women are victims of

sexual assault in the military. 789 You won’t hear that on the news because it’s another uncomfortable fact that shows the liberal agenda is severely flawed. When gay couples adopt small children and molest them, those stories are just reported in local outlets and never make the national news. 790 Few people want to even comment on such abuse out of concerns they’ll be branded “homophobic.” Reports of gay couples sexually abusing their adopted or foster children can be found around the world. 791 In some cases the couples force the children into sex trafficking and sell them to other pedophiles. 792 But just mentioning those cases is enough to anger LGBT activists who may then target you to be “canceled.” Same sex couples adopting children was the real issue at hand regarding legalizing gay “marriage,” but very few conservatives or even Christians dared talk about it. When gays are allowed to adopt children it’s no longer about what “two consenting adults” are doing “in the privacy of their own bedroom,” it’s about an innocent third party, and no child should be held prisoner in such an environment. Like many gay people, CNN’s Anderson Cooper became a father (at the age of 52) after he bought an egg from a fertility clinic and then hired a surrogate—and had the egg artificially inseminated with his sperm. 793 The woman carried the child to term and then turned it over to Anderson Cooper to be raised by him and his boyfriend. The kid will most likely never know his mother due to privacy shields regarding egg donors, nor even have the surrogate in his life either, and instead will be raised by two homosexual men in their fifties, only to someday have to be told the horrible truth about how he came to exist.

What Causes It? In 2019, a massive study conducted by over 30 organizations including Harvard and Cambridge Universities was released after scientists analyzed the DNA of almost 500,000 people and ruled out any supposed “gay gene” that caused people to be born homosexual. 794 They cited “the environment” for being 75% responsible for people’s sexual preference. 795

“Obviously, there are environmental causes of sexual orientation. We knew that before this study,” said Michael Bailey, a psychologist at Northwestern University who has researched the causes of sexual preferences. 796 The same may be true of transgenderism as well. In other words, if an infant boy not yet knowing the difference between men and women, sees mommy putting on makeup—and for a moment wants to be like mommy and do what she does—and if the mother doesn’t teach him the distinctions between boys and girls, he’ll obviously grow up extremely confused and have a difficult time knowing which behaviors are normal for a man and which are not. The boy might start “identifying” with the mother if he is not brought up to understand the biological and sociological differences between boys and girls, possibly leading to gender dysphoria and transgenderism later in life. Some psychologists believe that “Rapid Onset Gender Dysphoria” is a form of social contagion or mass psychosis sparked by teens being bombarded with depictions of transgender people on social media portrayed in a positive light, and as a result see themselves as transgender in order to be a part of this “in” group of “cool” people as a coping mechanism for other underlying psychological disorders. 797 YouTube as a company promotes and glorifies transgender YouTubers like “Gigi Gorgeous” as well as gender-bending male makeup artists like Jeffrey Star and James Charles who identify as men but wear women’s makeup and clothes, which is fueling this phenomenon. They have created an extremely confusing environment for children, who as you know, are so impressionable they can be convinced that a fat bearded man in a red suit flies around the country every Christmas to bring them presents. Today, with so many of them being raised by social media personalities instead of their parents they have no idea what kinds of behaviors are conducive or detrimental to a happy, fulfilling life. Freud believed homosexuality is a mental disorder that develops from a disruption in the Oedipal phase of children’s psychosexual development. 798

It’s possible that it could also be a birth defect resulting in a certain region of the brain being wired backwards, so to speak, during gestation while the fetus is developing. 799 Transgender people could be born with the brain of the opposite sex due to the same reason. If, as some scientists believe, prenatal abnormalities in the womb due to a hormone imbalance or other external forces are causing these issues,

then scientists just admitting that homosexuality and transgenderism are birth defects is considered “hate speech” today. 800 To admit that they have a “defect” would be to admit that they’re not normal—and that’s “hateful.” Searching for a cure that would prevent the prenatal changes to a fetus that cause such things is tantamount to eugenics, and equally opposed by the liberal ideologues. Another theory is that homosexuality arose as a maladaptive behavior due to a mutation in the gene pool as a result of the decline of the pressures of natural selection, because in our modern age humans don’t have to complete for mates to pass on their genes as if it were a life or death situation for the species since there are already billions of us, often crammed in large cities literally living on top of one another. Today large groups of “free-riders” exist because of economic abundance, modern conveniences, and social safety nets, so the urge to become financially successful and physically fit in hopes of attracting a beautiful female mate is drastically diminished for many males. Conversely, because of our economic abundant society, many females don’t feel the need to attract a male to provide protection and resources for them like our ancestors did for tens of thousands of years, since modern society offers those luxuries instead. This would explain the explosion of florescent-haired lesbians and socially dysfunctional people who identify as dozens of different genders whose sole purpose in life seems to be ruining it for everyone else. Under this school of thought, because the evolutionary pressures for men and women to find mates have been lifted, many are no longer conforming to the social framework and norms our species has known since the beginning of time, and their behaviors are “mutating.” But instead of being content as “free-riders” whose survival is protected through modernday conveniences and social programs, these changes are causing the rise of what some scientists call “spiteful mutants” who hold hostile views towards those who are normal (i.e. people who continue heterosexual traditions, behaviors, and gender roles; and those who work hard in their careers and take care of their health). 801 The end result of these “spiteful mutants,” according to the theory, is the collapse of the social structure of the entire group of organisms (humans in this case) because the non-affected group (heterosexual and cis gender people) who do not suffer from the same mutations are still severely

impacted due to the disruption of the entire social fabric of the species by those with the mutation. 802 People who are molested as children tend to later become child molesters themselves. So it appears that pedophilia may in some cases be a psychological condition that is induced from an experience rather than something someone is born with. 803 The same may be true of homosexuality and gender-bending. Is it a birth defect, or a psychological disorder exacerbated by the celebration of sexual deviancy and other abnormal lifestyles in the media and on the Internet? Just asking this question is considered “hate speech,” and few scientists will dare risk their career by publicly doubting the new liberal orthodoxy regarding gender identity and sexuality. Once a crazy idea takes hold in a culture it becomes reinforced through social policing, and anyone who begins to doubt the practice is ostracized, reprimanded, or in some cases physically punished. Others who may quietly have the same concerns about the current practice are thus afraid to voice those concerns, which helps to maintain the hegemony, no matter how irrational, abusive, or dangerous it is. Imagine living in Central America and speaking up when your fellow villagers were getting ready to cut out someone’s beating heart to appease the Aztec “gods,” or telling the tribal elders in Africa that slicing your bottom lip and stretching it out by sticking a large plate in there is ridiculous. It’s extremely difficult to break cultural traditions once they have taken root.

“Homophobia” is a Hoax Anyone who doesn’t celebrate this onslaught of homosexuality, bisexuality, and gender-bending is branded “homophobic,” “transphobic,” or a basic “hateful bigot,” but those are just more lies from the Left. A phobia is an irrational fear of something. 804 People who are sick of seeing drag queens and homosexuals celebrated in the media aren’t afraid of them, they’re repulsed by them. The same way normal people are when they hear their parents or grandparents talking about having sex with each other. What

they do behind closed doors in the privacy of their own home is their business, but the rest of us don’t want to hear about it, much less see depictions of it. Unfortunately, today you can’t avoid having gender benders and other LGBT people shoved in your face every time your turn on the TV or scroll through a news feed on social media. And you must not criticize them. You must celebrate them, or you are a “Nazi!” A few years before this cultural Marxism infected the country, comedian Adam Carolla joked that he believed in the future, kids would get bullied for not being gay. 805 It’s sad how right he was.

Sexual Deviants In the 1950s sitcom I Love Lucy, the couple Ricky and Lucy had to each sleep in their own twin bed for a few seasons because the network was concerned about the show being “too sexual” if they were seen lying in the same bed together. Back then it was considered too suggestive to depict a couple in bed on network television even if they were 806 married.

The Brady Bunch (1969-1974) didn’t even have a toilet in the bathroom of their house because executives thought it would be too disgusting to show one on TV during scenes when the

cast was brushing their teeth or 807 doing their hair. Fast forward a few decades and Charlie Sheen would become Hollywood’s darling and the highest paid sitcom actor in history. 808 An HIV-infected scumbag who smoked crack and regularly used hookers became the industry’s favorite star! Hollywood once celebrated wholesome characters and families but now embraces the biggest degenerates as creative “geniuses” who can’t help being a little “eccentric.” The media raved over Fifty Shades of Grey , the sadomasochistic film series based on the bestselling novel, and “The Weeknd” performed a song from the soundtrack at the 2016 Grammys as they attempted to mainstream this once-fringe lifestyle. Target even sold 50 Shades of Grey sex toys. 809 Skip Chasey, the vice president of Endeavor (formerly known as the William Morris Endeavor) one of the largest management firms in Hollywood, accidentally killed a man in his sex dungeon in 2017, but no charges were filed, not even for negligent homicide. 810 He also kept his job at the agency. 811 Lady Gaga tried to revive R. Kelly’s career at the 2014 American Music Awards by doing a live performance with him, despite the allegations of him being a child predator making headlines for well over a decade at the time. 812 She also put him in her video “Do What You Want” which was directed by the infamous Terry Richardson, who has been accused of sexually exploiting models for years. 813 Then a couple years later at the 2016 Grammys, she performed her song “Till It Happens To You” and was hailed as a hero for “raising awareness” about sexual assault and everyone forgot that just a few years earlier she single-handedly put R. Kelly back in the spotlight. 814 Ellen DeGeneres once introduced two little girls aged six and eight to rapper Nicki Minaj because she was their favorite pop star. 815 Ellen had Nicki surprise them on stage live on her show and the audience couldn’t have been any happier. No adult should be letting their children listen to

Nicki Minaj’s music because it’s filled with sexually explicit and vulgar lyrics, but that didn’t stop Ellen DeGeneres from introducing the adult entertainer to the little girls. Perversion apparently runs in Nicki Minaj’s family because her 25year-old brother was convicted of raping an 11-year-old and sentenced to 25 years in prison. 816 Hulk Hogan’s infamous sex tape was the result of him sleeping with his best friend’s wife (with his permission) as he hung out in another room of the house after inviting Hulk over to have his way with her. At one point during the escapade the husband even came into the bedroom to see how they were doing. 817 Celebrities often have dysfunctional lifestyles, becoming jaded and numb from overindulgence due to an endless supply of money and an inner circle of yes men who will never doubt their desires out of fear that they may be cut off from the cash cow they have attached themselves to. Their carnal appetite can never be satisfied, causing them to obsessively try to fill the emptiness in their souls with worldly pleasures. Instead of the media acknowledging these kinds of decisions lead to a disastrous downward spiral, they are celebrated and encouraged. HGTV’s popular series House Hunters follows a couple around town as they search for a new home, and they make sure to regularly include LGBT couples in the show for “diversity,” but that wasn’t enough so they recently included a “throuple,” a group of three people in a polyamorous relationship. “The past four years, I have been living in Lori and Brian’s house, so buying a house together as a ‘throuple’ will signify our next big step as a family of five rather than all four of them plus me,” said one of the three. 818 The “throuple” is also raising two children because for some reason child protective services doesn’t think the kids are in a toxic and abusive household. Imagine trying to explain to the children who the third person is that’s living with them. Democrat Congresswoman Katie Hill was also in such a relationship before she resigned when it was revealed the third wheel was one of her staffers. 819 In ABC’s sitcom Single Parents they introduced a “throuple” that consists of two men and a woman, one of whom is a public school teacher. 820

When they explain their “relationship” to their friends, instead of being

taken aback by the weirdness, one of them gets excited and pulls out her phone to download the same app the “throuple” used to find each other. We’re even seeing incest promoted on network television and in films. 821

Nick Cassavetes, the director of The Notebook, endorsed incest while promoting his film Yellow (2012) which features the main character having an incestious relationship with her brother, saying, “If you’re not having kids—who gives a damn? Love who you want. Isn’t that what we say? Gay marriage—love who you want?…you’re not hurting anybody, except every single person who freaks out because you’re in love with one another.” 822 Other films like Close My Eyes (1991), The Cement Garden (1993), Lovers of the Arctic Circle (1998), Delta (2008), Beautiful Kate (2009), and Illegitimate (2016) all have incest as the central plot. Some websites have even compiled lists of what they call the “20 Best Incest Movies of All Time,” 823 and the “13 Steamiest Incestuous Relationships In Film.” 824 Actress Mackenzie Phillips, best known for her role in American Graffiti and more recently working on the Disney Channel’s So Weird, wrote in her memoir that when she was 19-years-old she began having sex with her biological father and continued the incestuous relationship for ten years until she was almost thirty! She described the relationship as “consensual” and once had an abortion after becoming pregnant because she figured he was the father. 825 In recent years we have been seeing more stories approving of people engaging in incest. 826 Cosmopolitan magazine published a story about how “great” it was with the headline, “Girl describes what it was like to have sex with her dad.” In the article the woman is quoted as saying, “The sexual intensity was nothing like I’d ever felt before. It was like being loved by a parent you never had, and the partner you always wanted, at once.” 827 They did a similar article about a brother and sister who were separated at birth but entered into a sexual relationship with each other when they were reunited as adults. 828 Scientists believe that when parents are reunited with their adult children after giving them up for adoption when they were born, they sometimes develop a strong sexual attraction for each other, called GSA (Genetic Sexual Attraction). 829 The same phenomena can happen to adult siblings when they meet for the first time. 830

Soon liberals will likely welcome incest into the LGBT community and declare it no more abnormal than homosexuality. In fact, there are already a growing number of blogs, Tumblr accounts, and YouTube videos dedicated to legalizing “consensual incest.” 831 As everyone knows, it’s common for Hollywood-types to date people a decade or two younger than them, but some in the industry like partners so young it’s utterly disgusting, and in some cases illegal. Billionaire music mogul David Geffen has a well-known reputation of dating men who are over 40 years younger than him. 832 When he was in his seventies he was “dating” a 20-year-old former college football player. 833 The famous pianist Liberace had a 16-year-old boyfriend when he was fifty-seven years old. 834 75-year-old actress Holland Taylor, who played Charlie Sheen’s mother on Two and a Half Men, has a 35-year old girlfriend. 835 David Bowie is alleged to have had sex with a 14-year-old groupie at the height of his career. 836 Jerry Seinfeld dated a 17-year-old when he was thirty-nine years old. 837 And these are just a few of the most well-known instances. Writer, director, and actor Woody Allen is considered a “treasure of the cinema” (having won four Academy Awards and nominated 24 times), but nobody in the industry seems to care that he began a sexual relationship with his girlfriend Mia Farrow’s adopted 21-year-old daughter when he was fifty-six. 838 Such people would be shunned in most professions, but for decades Hollywood has welcomed those who engage in the most bizarre behaviors and nothing is too taboo. The “MeToo” movement really originated in Hollywood from actresses who finally grew tired of the predatory environment that was pervasive in the industry. A long list of big-named actors have been accused of sexual harassment and other predatory behavior as the “MeToo” movement gained momentum in 2017. But it seems everyone in the industry was very well aware of what was happening and who the perpetrators were. It took the fall of Harvey Weinstein to finally open the floodgates and admit the entertainment industry had a massive sexual predator problem. But sleazebags in Hollywood who prey on young actresses are just the tip of the deviance iceberg that runs rampant in the industry. And even worse, what they’re doing is being exported to the rest of society.

Celebrity Selfies Selfies are a symptom of our narcissistic culture, with people obsessing over posting pretty pictures of themselves on social media in order to feel validated. It’s a sickness that has infected large portions of our society and celebrities like Rihanna, Miley Cyrus, and Kim Kardashian have normalized posting nude pictures online, something that just a few years ago would have been unthinkable for most girls. 839 Some experts have even said that celebrities like Kim Kardashian are making children vulnerable to predators online because so many of them mimic their scantily clad selfies in hopes of attracting the attention of complete strangers who “like” and comment on their posts. 840 Kim even had her 4-year-old daughter (at the time) take a topless photo of her and posted it on Instagram. 841 You could see little North (her daughter) in a mirror holding the phone, taking the picture. Kim Kardashian even captioned it “By North.” Teaching 4-year-old girls to take topless photos and post them online—that’s Hollywood today. Kim Kardashian, perhaps more than any other celebrity has normalized sex tapes. Without hers being “leaked” in 2007 showing her with her then-boyfriend pop singer Ray J, she would be just another spoiled rich girl in Los Angeles, but her sex tape made her a star. The same thing with Paris Hilton’s. When her sex tape was leaked in 2003 she became a star overnight only to be later overshadowed by Kim Kardashian as the “queen” of pop culture. Some wannabe reality stars have even leaked their own sex tapes hoping to follow in these footsteps thinking they too will become famous.

Mainstreaming of Porn People who regularly watch porn have their brains physically altered through the creation of new neural pathways, causing them to become less aroused by actual women during real sexual encounters over time. 842

These neurological changes are similar to the tolerance level of drug addicts which cause them to need more of the drug to achieve the same high they once got the longer they use it. People who develop porn habits often find themselves in need of more hardcore porn to get aroused, even leading them to watch bizarre fetish videos hoping to get off since they don’t experience enough gratification from “regular” porn, let alone actual sexual partners. 843 The Internet has mainstreamed porn since people had to once drive to seedy adult video stores to get VHS tapes of it, but now millions of videos are just a few clicks away. Twitter even allows porn stars (and aspiring porn “actresses”) to have accounts where they can post sexually explicit content in their feed which can easily be accessed by children. 844 A site called PornHub is basically YouTube for porn, where anyone can upload hardcore pornographic videos and they are then instantly published for the world to see. Due to the lack of oversight that traditional pornography producers follow, like verifying the identity, age, and consent of the parties involved, PornHub has hosted numerous videos of underage girls and even rape videos, including one of a 14-year-old girl from Ohio who was kidnapped and gang raped while being recorded by the assailants. 845

The video was uploaded to PornHub several times with titles like “Teen Crying and Getting Slapped Around,” “Teen Getting Destroyed,” and “Passed out Teen.” One upload had over 400,000 views. 846 The victim later emailed the website, explaining she was raped (which was clear by the video and the titles) but the video remained online. A 30-year-old man in Florida uploaded over 50 different videos of him sexually abusing a 15-year-old girl after she went missing before he was finally arrested. 847 Breitbart pointed out, “Pornhub apparently has no idea whatsoever who is uploading content. Pornhub also has no idea and apparently doesn’t bother to verify the age of the performers in the videos, or if they consented to have sex, to be filmed, or to have the video commercialized and made public.” 848 There’s now a social media company called OnlyFans that caters to girls who want to start selling their own amateur nude photos and porn

videos. OnlyFans is basically like Instagram, but people have to pay a monthly fee to see what others are posting, and the website has no rules about nudity other than the users have to supposedly be 18 years old. When unemployment levels skyrocketed because of the stay-at-home orders during the Coronavirus Pandemic of 2020, many young girls flocked to OnlyFans hoping to make some easy money. Once they’re signed up they use Instagram and Twitter to promote their accounts by leaving the link to their OnlyFans page in their bio and then post content using trending hashtags hoping to get guys’ attention and drive traffic there. Previously if a girl wanted to get into porn she would have to go to work for a company that had the infrastructure to host the videos and charge customers’ credit cards, but now OnlyFans has given the ability to anyone to become a “porn star” within just a few minutes. It’s well known that many aspiring actresses who move to Los Angeles hoping to become stars end up working in porn out of desperation to pay their bills (or to afford their drug habits). Some even resort to prostitution. Teen Vogue magazine even published an article in 2019 titled “Sex Work is Real Work,” encouraging girls to become prostitutes and demanding that it become legalized around the world. 849 Many psychologists are warning that porn and video game addiction is actually causing a masculinity crisis among young men. A study by researchers at Stanford University looked into how excessive gaming and use of pornography is causing many young men to be extremely isolated and preventing them from developing the social skills needed to form relationships with girls, which only fuels more isolation. 850

Pedophiles in Hollywood Sexual harassment and pornography aren’t Hollywood’s worst problems however, as child actor Corey Feldman said, “the number one problem in Hollywood was, is, and always will be, pedophilia. That’s the biggest problem for children in this industry…It’s the big secret.” 851 He made the claim in 2011 on ABC’s Nightlight, but his concerns largely fell on deaf ears.

A few years later in 2013 when he was a guest on The View the topic came up again. “I’m saying there are people that were the people that did this to both me and Corey [Haim] that are still working, they’re still out there, and that are some of the richest most powerful people in this business. And they do not want me saying what I am saying right now,” he told the hosts. 852 Barbara Walters responded, “Are you saying that they are pedophiles and that they are still in this business?” “Yes,” Corey replied, going on to warn parents who are thinking about getting their children involved in acting. “You’re damaging an entire industry,” Barbara responds, looking disappointed in him. Feldman said that his best friend Corey Haim, who he costarred with in numerous movies, told him that Charlie Sheen raped Haim in 1986 on the set of a movie (Lucas ) they were filming together. 853 Sheen allegedly told Haim, “it was perfectly normal for older men and younger boys in the business” and “it was what all the guys do.” 854 Sheen denies the allegation. “It’s all connected to a bigger, darker power,” Feldman later said. “I don’t know how high up the chain that power goes, but I know that it probably is outside of the film industry too. It’s probably in government; it’s probably throughout the world in different dark aspects.” 855 Elijah Wood, who was a child actor in various films before hitting it big by playing Frodo in the Lord of the Rings trilogy, once made some comments during an interview about the issue, saying, “Clearly something major was going on in Hollywood. It was all organized. There are a lot of vipers in this industry, people who only have their own interests in mind. There is darkness in the underbelly. What bums me about these situations is that the victims can’t speak as loudly as the people in power. That’s the tragedy of attempting to reveal what is happening to innocent people: they can be squashed, but their lives have been irreparably damaged.” 856 He later “clarified” his statements, claiming that his interview was supposed to be about his latest film but “became about something else entirely” and said he had “no first-hand experience or observation of the topic” and that he just heard about such things from a documentary he had seen (most likely An Open Secret , which had come out a year earlier). 857

An Open Secret In 2014, a film maker named Amy Berg investigated Corey Feldman’s claims of pedophiles in Hollywood in a documentary titled An Open Secret . Previously she had been nominated for an Oscar for another documentary she made called Deliver Us From Evil about sexual abuse in the Catholic Church, so it was a subject she was quite familiar with. An Open Secret alleges that pedophile producers have held parties where they enticed young child actors with drugs and alcohol in order to take advantage of them. 858 It details the alleged activities surrounding an Internet media company called Digital Entertainment Network that was founded in the late-1990s by Marc Collins-Rector [a convicted sex offender], and his boyfriend Chad Shackley. 859 The company is alleged to have held pool parties at their 12,000-square foot mansion that were used to entice underage teenage boys into having sex with adult men. 860 Leonardo DiCaprio’s former talent agent was convicted of molesting a 13-year-old boy in 2005 and sentenced to eight years in prison. 861 The Los Angeles county deputy district attorney said, “People like this are predators who prey on little kids who want to be the next Justin Bieber—and they’re told, ‘That’s what’s done, this is all normal in the industry.’” 862 The Los Angeles Times noted that, “At least a dozen child molestation and child pornography prosecutions since [the year] 2000 have involved actors, managers, production assistants and others in the entertainment industry.” 863

One of those was a talent agent named Martin Weiss who managed kids that had roles on Nickelodeon, the Disney Channel, and in numerous films like Parenthood and The Muppets Movie. He was charged with several counts of child molestation and faced up to 80-years in prison, but was given just one. 864 Director Bryan Singer, whose credits include X-Men, Superman Returns, Valkyrie , and many others, has been accused by numerous men who say he made sexual advances towards them when they were boys. 865 Singer, who denies the allegations, has also claimed journalists who were investigating him were just “homophobic.” 866

Singer is also alleged to have been in attendance at some of the parties held by the Digital Entertainment Network, and is well known in Hollywood for hosting his own pool parties filled with what many have described as “kids.” 867 He has been followed by sexual predator accusations for decades. As far back as 1997 several child actors accused him of asking them to film a nude scene when they were working on one of his movies, yet his career has continued almost unscathed. 868 Infamous pedophile Jeffrey Epstein also had numerous ties with Hollywood A-listers, some of which had flown on his private jet to his island in the Caribbean, dubbed “Pedo Island.” 869 Epstein operated with impunity for years and is believed by many to have worked as an intelligence operative for Mossad (Israel’s CIA) to get dirt on powerful people, including many politicians, so they could be blackmailed. 870 For decades Hollywood hasn’t seemed to care about child abuse, and in fact many defend it and give awards to the abusers. Director Roman Polanski fled the United States in the 1970s after he was convicted of drugging and raping a 13-year-old girl, but continued to make films in Europe where he could avoid being extradited by U.S. authorities. 871 Not only did he continue to make films, but Hollywood continued to give him awards. In 2002 he was given the Oscar for Best Director for his film The Pianist. When he was announced as the winner, the audience gave him a roaring applause and a standing ovation by many, including Martin Scorsese and Meryl Streep. 872 Harrison Ford, who was presenting the winner that year, looked out at the crowd astonished, knowing very well why Polanski wasn’t there to accept his award. After the applause died down he said, “The Academy congratulates Roman Polanski, and accepts this award on his behalf.” 873 Not only did his peers give him a standing ovation at the Oscars, but many in Hollywood defend Polanski, still to this day. Whoopi Goldberg said that things were “different” in the 1970s, and it wasn’t “rape-rape” and thinks Polanski should be left alone and not extradited to the United States to serve the prison time he has been avoiding for over 40 years. 874 In an interview on the Howard Stern Show director Quentin Tarantino defended Polanski. Howard interrupted him, saying, “Wait a minute. If you

have sex with a 13-year-old girl and you’re a grown man, you know that that’s wrong.” 875 Howard’s cohost Robin Quivers was stunned and pointed out that Polanski had also given her alcohol and Quaaludes to which Tarantino responded, “She wanted to have it…And by the way, we’re talking about America’s morals, not talking about the morals in Europe and everything… Look, she was down with this.” 876 In 2009, Harvey Weinstein wrote an op-ed in The Independent titled “Polanski has served his time and must be freed.” 877 Over one hundred Hollywood celebrities and directors including Natalie Portman, Penelope Cruz, David Lynch, and Martin Scorsese, signed a petition that year to show their support for Polanski, demanding his release after he was taken into custody in Switzerland since he was facing extradition back to the U.S. 878 Switzerland later decided against extraditing him and let him go free. Virtually an entire industry rallied behind a man who drugged and raped a 13-year-old girl and then fled the country to avoid going to prison. That’s Hollywood! After a documentary called Leaving Neverland investigated some of the allegations surrounding Michael Jackson, singer Barbra Streisand said she believed boys were molested by Jackson, but, “they were thrilled to be there” and “his sexual needs were his sexual needs,” adding, “They [the alleged victims] both married and they both have children, so it didn’t kill them.” 879 In 2017, Stephen King’s It was remade into a feature film due to the wildly popular TV miniseries in 1990, but what people who hadn’t read the 1987 novel don’t know is that Stephen King depicted the kids all having an orgy after they finally defeated the “It” creature in the sewer. Out of the blue Beverly Marsh, the only girl in the group, tells the boys “I have an idea,” and then they all got naked and she has sex with all six of them. 880 In the book she’s depicted as eleven-years-old (and twelve in the 1990 TV miniseries). Once the boys are all done having sex with her, they magically remember which way to go in order to get out of the sewer and finally escape. Stephen King literally wrote an entire scene about an elevenyear-old girl getting gang banged and nobody seems to care. 881 Actress Annette O’Toole, who played Beverly Marsh in the 1990 television version, was upset that the orgy scene wasn’t allowed in the film. “This was their greatest attachment to one another—she thought they were

all going to die, and this was a gift she was giving to each one of them, and I thought it was the most beautiful, generous love-filled gift, and it tied them all together in such an amazing way.” 882 In 2017 after Kevin Spacey was accused of trying to engage in a sexual relationship with a 14-year-old child actor back in 1986, he announced for the first time that he was gay. That deflected much of the media criticism away from the allegations and he was celebrated for his “emotional” admission. ABC News ran a story with the headline, “‘I choose now to live as a gay man,’ Kevin Spacey comes out in emotional tweet,” but later changed it due to the backlash from people who on social media were shocked ABC sanitized the story with such a pleasant headline. 883 The CEO of entertainment giant Allied Artists, Kim Richards, said of Spacey, “If true, acting on impulse while inebriated speaks to overindulgence, not predatory behavior. You’re good & decent, deserving forgiveness.” 884 Years earlier Seth McFarlane’s Family Guy animated comedy series included a brief scene of a character (Stewie) running naked through a shopping mall screaming “Help! I’ve escaped from Kevin Spacey’s basement!” 885 McFarlane had previously called out Harvey Weinstein in 2013, years before the MeToo movement and the widespread reports about Weinstein. When he read off the names of the nominees for Best Supporting Actress for the Oscars, he followed up by saying, “Congratulations, you five ladies no longer have to pretend to be attracted to Harvey Weinstein.” 886

McFarlane knew of the rumors about Weinstein but at the time outsiders just though it was a joke. Many wondered if he also heard rumors about Kevin Spacey’s secrets as well, resulting in him adding the bizarre scene in Family Guy . Others came forward with similar allegations as well. Spacey was soon fired from his Netflix series House of Cards , and went into hiding. But on Christmas Eve of 2019 he posted a bizarre video on YouTube speaking in the tone of his evil House of Cards character Frank Underwood while sitting in front of a fireplace. “You didn’t really think I was going to miss the opportunity to wish you a Merry Christmas, did you?” he began. “I know what you’re thinking, ‘Can he be serious?’ I’m dead serious. The next time someone does something you don’t like, you can go on the attack. But

you can also hold your fire and do the unexpected. You can…kill them with kindness.” 887 He smiled menacingly at the camera and the video ends. Even more disturbing is that one of his accusers had died just a few months earlier. 888 He seemed to be alluding that he had killed him. The very next day, on Christmas, another one of his accusers died from a purported suicide. 889 That person’s estate then dropped the lawsuit against Spacey which had been pending.

Crimes Inspired by Hollywood While it’s not entirely accurate to say that violence depicted in movies causes real world violence, it can be said that sometimes it’s a catalyst, and in numerous cases mass murderers, bombings, bank robberies, and other crimes have been inspired by popular movies. Extensive news coverage of mass shootings is actually correlated with more mass shootings because it seems to plant the seeds in other 890 lunatics’ minds.

The same is true of news reports about suicide,

a phenomenon called suicide 891 contagion. The FBI and Department of Homeland Security were concerned that Joker (2019) may inspire mass shootings at theaters, so police presence was increased during the film’s opening weekend and some even inserted undercover agents inside as a precaution. 892 The fears arose from a lunatic dressed as the Joker opening fire inside a theater during a showing of The Dark Knight Rises in 2012, killing a dozen people and injuring many more. The New York Post reported that, “It’s reasonable to ask if ‘Joker’ will inspire would-be killers.” 893 Some of the victims’ families of The Dark Knight Rises shooting wrote a letter to Warner Brothers, the studio that produced Joker , expressing their concern that the movie gave the character a “sympathetic origin story.” 894 It’s not a typical superhero film, nor is it cartoonish in any way like many of the previous Batman movies. Instead, Joker is a depressing “character study” showing a man descend into madness and morph into a mass murderer, but because a portion of the population are severely mentally ill, many saw the Joker as a hero. The 1976 film Taxi Driver starring Robert De Niro (which was largely the inspiration for Joker ) is said to have triggered John Hinckley Jr.’s murderous fantasy that resulted in him attempting to assassinate President Ronald Reagan in 1981. In Taxi Driver, Robert De Niro’s character plots the assassination of a presidential candidate he becomes fixated on, which gave John Hinkley Jr. the idea to do the same thing to Ronald Reagan. He later shot Reagan outside the Washington Hilton Hotel. 895 In the 1995 film Basketball Diaries starring Leonardo DiCaprio, his character has a dream sequence where he walks into his high school wearing a black trench coat and starts blowing away his fellow classmates with a shotgun. Three years later in 1998, two students in Colorado carried out the infamous Columbine High School shooting, causing the very name “Columbine” to become synonymous with a school shooting.

The killers wore black trench coats on the day of the massacre just like Leonardo DiCaprio. Some parents of the victims filed lawsuits against the producers of The Basketball Diaries for inspiring the attack. The Columbine massacre itself has inspired dozens of copycats from more unhinged high school students who see the killers as heroes. 896 Oliver Stone’s 1994 black comedy Natural Born Killers is believed to have inspired over a dozen copycat murders and mass shootings by teenagers in the 1990s and early 2000s. 897 In the film, a murderous couple (Mickey and Mallory) go on a drug-fueled killing spree and become television news sensations. Oliver Stone says he meant the film to be a critique of how the media sensationalizes violence and murders, but some unhinged viewers actually saw Mickey and Mallory as true heroes and wanted to become famous mass murderers just like them. After actor Robin Williams committed suicide in 2014, researchers believed it caused suicide rates to spike almost 10% from copycats. “Although we cannot determine with certainty that these deaths are attributable to the death of Robin Williams, we found both a rapid increase in suicides in August 2014, and specifically suffocation suicides, that paralleled the time and method of Williams’ death,” said a report compiled by researchers at Columbia University. 898 NBC News admitted, “It has been known for decades that media reports about suicides, especially celebrity suicides, lead to an increase of suicide deaths.” 899 The Netflix teen drama 13 Reasons Why is about a girl who commits suicide after being bullied and gossiped about at her high school. She left behind a box of cassette tapes where she recorded the “13 reasons why” she killed herself, which forms the basis of the show, and many researchers believe that the series actually increased the rate of teenage suicide. 900 Studies show that suicide is “contagious” and the more widely it is portrayed in the media, the more people get inspired to follow the same path in hopes of putting an end to their own personal struggles. 901 At the University of Illinois, a student was arrested for sexually assaulting a woman he tied up in his dorm room in order to re-create a scene from Fifty Shades of Grey , the popular sadomasochism film based on the bestselling novel. 902 The lead actor in the film, Jamie Dornan, later admitted that he feared a crazy obsessed fan would actually murder him like John Lennon. 903

Ben Affleck’s 2010 film The Town was the admitted inspiration behind a pair of Brooklyn crooks who, like the characters in the film, dressed up as cops to rob a local check-cashing business. 904 Another robbery at a bank in Chicago is also believed to have been inspired by The Town , where the perpetrators copied a different scene from the film in which the characters dressed as nuns for their disguise when they robbed one of the banks. 905 A teenager in New York City was inspired by Fight Club to bomb a Starbucks which thankfully didn’t cause any injuries because it was closed. 906

In the 1999 film, the underground fight club started by Brad Pitt and Edward Norton escalates into a terrorist organization with the launch of “Project Mayhem,” beginning with a series of attacks on symbols of corporate America. One of those attacks was on a “corporate piece of art” consisting of a gigantic metal ball which is knocked off its foundation and rolls into a nearby coffee shop, clearly designed to look like a Starbucks, destroying it. There is also speculation that a serial bomber in Austin, Texas who ultimately blew himself up after being pulled over by police may have been inspired by a recent television series about Ted Kaczynski, the “Unabomber.” 907 The perpetrator had sent five package bombs in the Austin area, killing two people and injuring five others during a three week period in March 2018. On Halloween night in 2018 police in France arrested over 100 masked people for rioting and threatening locals after word spread through social media calling for a “Purge,” referring to the 2013 horror film of the same name which depicts the American government allowing all crimes, including murder, to be perfectly legal for one night a year. 908 Similar “Purge” threats have gone viral through social media in the United States claiming such uprisings would occur in various communities on specific dates, thankfully turning out to be hoaxes posted by troublesome teenagers. 909 But the inspiration for the threats of indiscriminate killing for “fun” were obviously inspired by the film. Following the 1996 release of Scream there were also numerous murders and attempted murders by people inspired by the teen slasher film, several of which actually involved the famous Ghostface mask that the killer used in the movie. 910 Two days after watching Interview with the Vampire when it first came out in 1994, a man told his girlfriend “I’m going to kill you and drink your blood,” and proceeded to stab her seven times

and did indeed drink her blood. She miraculously survived, and when he was arrested the “vampire” admitted to police he was inspired by the film starring Tom Cruise and Brad Pitt. 911

Rap Videos Nothing promotes violence and crime more than rap music. Listeners internalize the lyrics which are presented from a first-person perspective, putting them in the proverbial driver’s seat of countless drive-by shootings and other mayhem which is portrayed as exciting and fun. It would be impossible to know how many seeds have been planted in the minds of thugs who become accustomed to crime and whose music choices reflect back to them a distorted world where they are a hero for the lifestyle they chose. Many former gang members have admitted that the music helped to “brainwash” them. 912 And numerous studies have connected rap music to real world violence. 913 It’s common for rappers to include a line in their songs about doing a “187 on a cop,” which is a police code for murder. Countless rappers from Snoop Dogg and NWA, to Eminem and Tekashi 6ix9ine have entire songs about murdering people. Just two weeks after the Sandy Hook Elementary School massacre, where twenty children and six adults were gunned down by 20-year-old lunatic Adam Lanza, stunning the entire country, a popular rapper who goes by “The Game” released a song titled “Dead People” which is about him stalking and murdering people for fun. 914 A 17-year-old acting out the music video “Bustin’ At ‘Em” from rapper Waka Flocka Flame accidentally shot and killed his friend while he was waving a gun around. 915 The lyrics go “Shoot first ask questions last. That’s how these so called gangstas last. Bitch I’m bustin’ at ‘em (shooting). Ain’t no talkin’ homie I’m just bustin’ at ‘em. Bitch I’m bustin’ at ‘em.” In the music video Waka Flocka Flame and his thug friends are waving guns around shooting them in all directions the entire time. After a man in Hawaii shot and killed his landlord, he claimed he was possessed by rapper Jay Z and said that he should be the one who goes to prison. 916 In a certain sense the man was possessed by Jay Z, since the

rapper’s murderous lyrics filled his head. In his mind he just did what he thought Jay Z would have done. Jay Z has called for George Zimmerman, the man who shot Trayvon Martin in self-defense, to be killed, and has numerous songs about murdering people. 917 Thousands of years ago philosophers like Plato, Aristotle, and Socrates understood the influence that music has on its listeners. Aristotle recognized that music can even shape people’s character, saying, “Music directly represents the passions of the soul. If one listens to the wrong kind of music, he will become the wrong kind of person.” 918

Bobo Doll Experiment A famous study conducted in the early 1960s known as the Bobo Doll Experiment demonstrated how children often mimic violent behaviors they see others engaging in. Researchers monitored the children in a playroom filled with a variety of toys including a bobo doll, a sort of inflatable punching bag with a weighted bottom that stands on the ground—and when punched, returns to its upright position. Even though the bobo doll was in the room and available for the children to play with, they mostly ignored it at first, but after witnessing an adult punching the toy, they began doing the same thing, imitating their actions shortly after they had left the room. 919 The experiment clearly demonstrates the fundamentals of social learning theory and observational learning because the children’s behavior immediately changed from simply witnessing the adults interact with the doll in a “violent” manner, or as the saying goes—monkey see, monkey do. And just like children mimicked the actions they saw against the bobo doll, they also mimic behaviors they see in the media. A Senate Committee was formed in 1999 to investigate the influence of media violence on children and concluded that one of the primary catalysts of youth violence is media violence. 920 The word cause may be too strong of a word, and to more accurately describe the relationship between viewing violence and engaging in violent

acts, media effects researchers often use the word prime , instead—meaning viewing violence primes people to potentially act out similar behaviors. 921 One popular textbook, The Fundamentals of Media Effects , explains, “Media message content triggers concepts, thoughts, learning, or knowledge acquired in the past that are related to the message content. In this way, message content is connected, associated, or reinforced by related thoughts and concepts that it brings to mind.” 922 There are numerous variables that function as catalysts for priming aggressive or violent behaviors in viewers, such as the extent they identify with a character engaging in violence, the consequences the character faces for such behavior, and the perceived justification for it, or meaning of the violence. 923 Media mogul Ted Turner knew this, as do most people with common sense. Best known for founding CNN in 1980, he once noted, “You know that everything we’re exposed to, influences us…those violent films influence us, and the TV programs we see influence us. The weaker your family is, the more they influence you. The problems with families in our societies are catastrophic, but when you put violent programs before people who haven’t had a lot of love in their lives, who are angry anyway, it is like pouring gasoline on the fire.” 924

Author’s Note: Once you finish this book, please take a moment to rate and review it on Amazon.com, or wherever you purchased it from if you’re reading the e-book, to let others know what you think. This also helps to offset the trolls who keep giving my books fake one-star reviews when they haven’t even read them. Trolls often target books on Amazon written by people they don’t like and flood them with fake one-star reviews in order to tank the ratings and hope to dissuade people from reading them. It’s a dirty tactic they’ve used on my other books. If you look close, you can see that practically none of the one-star reviews are from actual verified purchases which is a clear indication they are fraudulent. Also, please spread the word about this book by posting a link to the Amazon listing on your social media accounts, or order a few extra copies for family and friends. I don’t have a large publisher behind me to promote the book since I self published it; all I have is word of mouth, social media, and you. Thank you!

Conclusion There’s a famous quote attributed to Eleanor Roosevelt that says, “Great minds discuss ideas; average minds discuss events; small minds discuss people.” The moronic masses are concerned about who their favorite celebrities are dating, which rappers are having a new beef, or the latest actor found to have said something “racist” years (or decades) ago, while life is passing them by. It’s a circus, and as media analyst Neil Postman noted, people are amusing themselves to death. 925

Everything is backwards and upside down in Los Angeles, even the city’s name. “Los Angeles” is Spanish for the City of Angels, when it’s really a city of demons. Hollywood is the “city of dreams” they say, but it’s really the city of broken dreams. Cute girls from across the country move to LA thinking they’re going to be the next Kim Kardashian or Jennifer Lawrence only to realize that they’re just one of tens of thousands of other girls equally as beautiful who are all competing for the same prize. After a string of dead end auditions or maybe landing a few bit parts in b-movies that are never released in theaters, most girls eventually give up or turn to drugs hoping to numb the increasing depression they feel from not seeing their dreams materialize as they are faced with the harsh reality of the entertainment industry. The supposed sunny blue skies of Los Angeles are filled with toxic smog from the overcrowded freeways. Many of the people driving fancy cars and renting nice houses are often living paycheck to paycheck and have no money saved for retirement and spend most of what they earn trying to portray an image of a person they’re not, living further beyond their means every day. Almost everything is fake in Los Angeles. The LA River is made of concrete. The city’s basketball team is called the Lakers, but most of the lakes are man-made. Most people think the Hollywood Walk of Fame is a beautiful place symbolic of the glitz and glam they see on the award shows, but in reality it’s a dirty street filled with homeless people and beggars. Los Angeles is widely considered to be one of the loneliest cities in America because so many people living there have few (or no) close friends they can confide in or trust. Many residents don’t even make eye contact with their neighbors when out to check the mail, they just ignore them and pretend they don’t exist. It’s a strange and sad city. Unfortunately, much of our country is now afflicted with the same kinds of sentiments. The American empire will most likely collapse someday just as ancient Rome did. The United States has too much debt, there is no sense of community throughout much of the country anymore, national pride has been undermined by floods of immigrants who won’t assimilate and are openly hostile to our culture, customs, and history—and now even many millions of native-born Americans hate our country as a result of the Marxist indoctrination they’ve been inundated with.

Open hatred of America by enemies within has never been more widespread, and they are determined to overthrow our Republic and put an end to our Constitutionally protected freedoms. Child drag queens are being celebrated by major media outlets, celebrities are bragging about their abortions, work ethic is dwindling, calls for socialism are spreading, and people can’t decide which one of the fiftyeight different “genders” they are. The angry and ignorant masses want to seize financial assets through force from those who have worked hard and saved their money for decades instead of steadily pissing it away on things they don’t need. But we do need entertainment (in moderation). It’s important to relax your mind at the end of the day or get a little distracted after a long week, so what should we do? What can you show your kids without having them indoctrinated with the idiocy and enemy propaganda that surrounds us? Fortunately, there are limitless choices of quality entertainment if you just take the time to look. There are science shows, cooking shows, how-to videos, and plenty of family friendly entertainment available—not to mention good old-fashioned books like the one in your hands. Aside from quality non-fiction books that can educate while they entertain, there are also countless literarily classics that will take your mind on a journey to faraway lands, all from the comfort of your own home. But it’s critical to do a regular digital detox, especially on the weekends, and tune out the endless distractions competing for your attention on television and smartphones. Spend time with family and friends, having face to face interactions, not artificial ones by “liking” their Facebook posts or communicating through social media. It’s important to limit social media consumption because by design it’s addictive due to the endless feedback and dopamine boosts people get from “likes” retweets, comments, and follows. Stories on social media are hard to resist because they personalize incidents that happen across the country in cities and states you’ll never step foot in, but the viral videos and photos open a window to an artificial world you have no business being in. It’s also dangerous because lies spread through social media at the speed of light, racking up tens of thousands of retweets and “shares” within minutes. By censoring opposing voices, manipulating trending topics, and major celebrities constantly jumping on the bandwagon for liberal causes,

the Big Tech companies create the false appearance of a consensus around issues. Many are afraid to stand up against it out of concern they may catch the attention of the angry online mobs who will harass them, dox them, and do everything in their power to destroy them. All of this leads many to wonder—what is wrong with liberals? Why do they always seem like they have no sense of right and wrong, almost like they have no soul? Researchers at Virginia Tech discovered that people can be identified as either liberal or conservative by a simple fMRI (Functional MRI) scan of their brain. They found that when they show people images of disgusting things like a dead animal or food covered with maggots, they could predict with a 95% accuracy rate whether the person was a liberal or a conservative based solely on brain scans which showed how people’s brain activity reacted to seeing such things. 926 How is this possible? What they found was that the brains of liberals don’t show the same signals of being disgusted when shown the disgusting images. It was a discovery made by accident, but it has an enormous significance. What it means is, the further Left someone is on the political spectrum, the higher their tolerance is for abnormal (and horrifying) things. It makes perfect sense when put into perspective. They’re the ones who accept and embrace the most bizarre, unhealthy, and disgusting behaviors and lifestyles. So when shown images of disgusting things, their brain scans show little reaction, when a normal person should be repulsed. The researchers who conducted the experiments appear to be afraid to explain why liberals aren’t disgusted by disgusting things, but the answer is clear. The Bible calls this the reprobate mind. 927 The Bible also predicted, “There will be terrible times in the last days. People will be lovers of themselves, lovers of money, boastful, proud, abusive, disobedient to their parents, ungrateful, unholy, without love, unforgiving, slanderous, without self-control, brutal, not lovers of the good, treacherous, rash, conceited, lovers of pleasure rather than lovers of God— having a form of godliness but denying its power. Have nothing to do with such people.” 928 The fact that you read this book shows where your heart and mind is, and while we may be a minority, there are many millions of us who see the principalities and powers that oppose us and refuse to go along with their

agenda or submit to their demands. We know the truth, and the truth has set us free!

Copyright Info

Hollywood Propaganda © 2020 by Mark Dice

All Rights Reserved

Published by Mark Dice San Diego, CA No part of the text within this book may be reproduced or transmitted in any form and by any means, graphic, electronic, or mechanical, including photocopying, recording, taping, or by any information storage retrieval system, without the written permission of the author. Visit www.MarkDice.com E-book ISBN: 978-1-943591-10-7

Cover images licensed from iStockPhoto

Cover design by Mark Dice

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The Los Angeles Times “‘The Cosby Show’ Was Profound, Influential--and Indispensable” by Bobby Crawford (May 11th 1992) 2 Bloomberg

“Why Stop at 10%? Advocates Push for Even More LGBT Characters on TV” by Jeff Green (November 8th 2019) 3

The Guardian “Most children own mobile phone by age of seven, study finds” (January 29th 2020)

4 Questioning

the Media - Chapter 3, the Mediating Communication - What Happens? page 43 by Joshua Meyrowitz 5

Questioning the Media - Chapter 3, the Mediating Communication - What Happens? page 44 by Joshua Meyrowitz 6

History of British Film (Volume 4): The History of the British Film 1918 - 1929 - edited by Rachael Low 7

Dr. Rachel Copelan - How to Hypnotize Yourself And Others page 3

8

New York Times “Boy, 13, Is Critically Burned After Imitating Stunt on MTV” by Sherri Day (January 29th 2001) 9

The New York Times “Disney Plans to Omit Film Scene After Teen-Ager Dies Imitating It” by The Associated Press (October 20th 1993) 10

Encyclopedia Britannica online edition entry “Edward Bernays: American publicist” (July 20th 1998) 11

New York Times “Edward Bernays, 'Father of Public Relations' And Leader in Opinion Making, Dies at 103” (March 10th 1995) Bernays, Edward – Propaganda page 37-38 (Ig Publishing 2005)

12

Ibid.

13

14

CBS News “Charlie Sheen Sets Guinness World Record: Fastest to a million Twitter followers” by Crimesider Staff (March 4th 2011) 15

USA Today “Ellen DeGeneres nabs most retweeted tweet of the year” by Alison Maxwell (December 10th 2014) 16

Billboard “How the U.S. Government Infiltrated Cuba’s Hip-Hop Scene to Spark Change” via Associated Press (December 11th 2014) 17

Reuters “U.S. defends program to fund anti-government hip-hop music in Cuba” by David Adams (December 11th 2014)

18

CBS News “U.S. infiltrated Cuba’s hip-hop scene to spark change” (December 11th 2014)

19 The

Guardia n “US agency infiltrated Cuban hip-hop scene to spark youth unrest” by Matthew Weaver (December 10th 2014) 20

Pitchfork “Moby Says CIA Agents Asked Him to Spread the Word About Trump and Russia” by Noah Yoo (January 12th 2018) 21 Film

Propaganda and American Politics: An Analysis and Filmography by James Combs and Sara T. Combs page 6 (Routledge 2013) 22

New York Observer “Hooray for Hollywood: How Charities Influence Your Favorite TV Shows” by Anne Easton (October 28th 2015) 23

The Washington Post “This Harvard professor used TV sitcoms to fight drunk driving. Can he do the same for distracted driving?” by Fredrick Kunkie (April 26th 2017) 24

UCLA’s official Theater, Film & Television department website. http://www.tft.ucla.edu/skollcenter-for-social-impact-entertainment/ 25

Ibid.

26

Ibid.

27

https://thestateofsie.com/the-state-of-social-impact-entertainment-sie-report-introduction-peterbisanz/ 28

Ibid.

29

New York Observer “Hooray for Hollywood: How Charities Influence Your Favorite TV Shows” by Anne Easton (October 28th 2015) 30

https://www.cinemaofchange.com/directory/listing/the-global-media-center-for-social-impact.

31

https://cmsimpact.org/about-us/ (August 2020)

32

Comedy for Racial Justice in the Climate Crisis by Caty Borum Chattoo page 5 (August 2020)

33

Ibid.

34

Comedy for Racial Justice in the Climate Crisis by Caty Borum Chattoo page 19 (August 2020).

35

Hollywood Reporter “Hillary Clinton Woos Young Hollywood Democrats at Fundraisers in L.A.” by Tina Daunt (June 19th 2015) 36

Hollywood Reporter “Chelsea Clinton to Meet With Network TV Writers on Saturday” by Tina Daunt (June 13th 2014)

37

Ibid.

38 Forbes

“The Power Of Purpose: How Propper Daley Is Driving ‘Unreasonable Conversations’” by Afdhel Aziz (March 12th 2019) 39

GLAAD.org “2018 Studio Responsibility Index” by Megan Townsend (May 22nd 2018)

40 Ibid. 41

Ibid.

42

Ibid.

43

Entertainment Weekly “How GLAAD is changing Hollywood’s LGBTQ narrative — one script at a time” by Gerrad Hall (May 23rd 2020) 44

The Advocate “Sesame Street Celebrates LGBTQ+ Pride With Rainbow Muppet Message” by Daniel Reynolds (June 12th 2020) 45

CNN “U.N. hosts filming of ‘Law & Order: SVU’ episode” by Richard Roth and Even Buxbaum (March 30th 2009) 46

TV Guide “Ugly Betty Teams with United Nations to Fight Malaria” by Adam Bryant (October 9th 2009) 47

AdAge “The UN Believes Ads Can Turn the Tide in Long-Losing War for Gender Equality” by Jack Neff (June 23rd 2017) 48

Unilever Press Release “Launch of Unstereotype Alliance set to eradicate outdated stereotypes in advertising” (June 20th 2017) 49

Unilever.com “12 Unilever Ads That Smash Stereotypes” (January 8th 2019)

50

New York Post “Is there ObamaCare ‘propaganda’ on our favorite shows?” by Kyle Smith (October 19th 2013) 51

The Washington Times “TV propaganda? $500K grant to sneak pro-Obamacare messages in shows” by Cheryl Chumley (October 11th 2013) 52

The New York Post “Is there ObamaCare ‘propaganda’ on our favorite shows?” by Kyle Smith (October 19th 2013) 53

New York Observer “Hooray for Hollywood: How Charities Influence Your Favorite TV Shows” by Anne Easton (October 28th 2015) 54

The New York Times “California Tries to Guide the Way on Health Law” by Abby Goodnough (September 14th 2012)

55

Ibid.

56 The

Los Angeles Times “Obama looks to Hollywood to help promote his healthcare law” by Maeve Reston (September 20th 2013) 57

The Hollywood Reporter “Jennifer Hudson Pitches Obamacare in Will Ferrell's Funny or Die Clip” by Paul Bond (September 30th 2013) 58 USA

Today “Healthcare.gov gets traffic boost after Obama’s ‘Funny or Die’ video” by Jolie Lee (March 12th 2014) 59

Hollywood Reporter “ObamaCare Website Traffic Spikes After President’s ‘Funny or Die’ Interview” by Tina Daunt (March 11th 2014) 60

National Catholic Register “Planned Parenthood ‘Secret Weapon’ Script Doctor Feeds Abortion Line to Hollywood” by Lauretta Brown (September 23rd 2019) 61

PlannedParenthood.org “Planned Parenthood Hosts 8th Annual Sex, Politics, Film, & TV Reception at Sundance Film Festival” Press Release (January 27th 2020) 62

The Washington Post “Planned Parenthood’s Secret Weapon” by Nora Caplain-Bricker (September 23rd 2019) 63

Black-ish (Season 3, episode titled “Lemons”) first aired January 11th 2017

64

Snopes “Did Donald Trump Receive an Ellis Island Award in 1986?” Rating: True by Dan Evon (September 5th 2016) 65

Patheos “FLASHBACK: Jesse Jackson Praises Donald Trump for ‘Lifetime of Service’ to Blacks” by Martin English (January 16th 2018) 66

The Simpsons (Season 30, episode 9, title “Daddicus Finch”)

67

Newsbusters “Reporter Beaten at Trump Rally on ‘Murphy Brown,’ Attacked by ‘Sea of Red Hats’” by Karen Townsend (November 29th 2018) 68

CBS This Morning “Trump’s election motivated ‘Murphy Brown’ reboot, Candice Bergen says” by Jessica Kegu (September 26th 2018) 69

Rolling Stone ‘Murphy Brown’ Review: A Crusty Comeback” by Alan Sepinwall (September 25th 2018) 70

News Busters “Will & Grace Won’t Bake MAGA Cake: Conservatives are ‘Terrible People’ with ‘Horrible Beliefs’” by Dawn Slusher (March 16th 2018) 71

Ibid.

72

Vulture “The Hunt for the Trump Tapes Doesn’t Seem Likely to Uncover Much” by Jen Chaney (September 14th 2018) 73 The

Verge “In a post-truth environment, The X-Files has gotten political” by Samantha Nelson (February 9th 2018) 74

Ibid.

75 Newsbusters

“‘The X-Files’ Wants to Believe in Trump-Russia Conspiracy” by Lindsay Kornick (January 10th 2018) 76

RedState “Is CBS Inciting Violence In The Latest Episode Of ‘The Good Fight’” by Jennifer Van Laar (April 13th 2019) 77

The Wrap “CBS All Access’ ‘The Good Fight’ Deletes Tweet with List of Words That Included ‘Assassinate’ and ‘Trump’” by Sean Burch (April 16th 2019) 78

Newsbusters “‘The Good Fight’ Character: ‘We Need to Assassinate the President’ by Callista Ring (April 22nd 2018) 79

Ibid.

80

The Daily Beast “‘The Good Fight’ Imagines a Trump ‘Pee Tape’ as Impeachment Heads to Network TV” by Kevin Fallon (April 30th 2018) 81

Summit News “New Amazon Show Features White People Wearing Red MAGA-Style Hats Being Hunted As ‘Nazis’” by Paul Joseph Watson (November 25th 2019) 82

Washington Times “Alec Baldwin sees ‘near moral collapse’ in America, blames it on Trump ‘supporters’” by Jessica Chasmar (January 14th 2020) 83

Hollywood Reporter “Jessica Chastain Clarifies Comments About Non-Violent Protests” by THR Staff (September 1st 2017) 84

https://twitter.com/TeenVogue/status/1250159551111929862

85

Breitbart “Trevor Noah: Trump’s ‘Demeanor,’ ‘Style’ Is Like ‘Many African Dictators’” by Pam Key (July 10th 2018) 86

Newsbusters “‘View’ Attacks ‘Menace’ ‘Dictator’ Trump for Acosta Heckling” by Kristine Marsh (August 1st 2018) 87

Washington Post “Madonna says she’s thought about ‘blowing up the White House’” by Coby Itkowitz (January 21st 2017) 88

Washington Examiner “Kathy Griffin said in 2016 she wanted to ‘beat down’ Donald and Barron Trump” by Leah DePiero (June 2nd 2017)

89

Time “Watch Guns N’ Roses Invite Mexican Fans Onstage to Smash a Donald Trump Piñata” by Tessa Berenson (December 2nd 2016) 90 Multiple

people recorded video of the incident and posted it on YouTube the next day, although it went unnoticed by major media outlets unlike most of the other incidents of celebrities making similar threatening statements. 91

The Hill “Snoop Dogg shoots clown dressed as Trump in latest music video” by Judy Kurtz (March 13th 2017) 92 Metro

UK “Donald Trump brutally beheaded in new Marilyn Manson video” by Ann Lee (November 8th 2016) 93

Rolling Stone “Hear Big Sean Threaten Donald Trump in New Freestyle” by Daniel Kreps (February 3rd 2017) 94

TMZ “‘Making History’ Star Adam Pally ‘I’d Have to Kill Trump or Hitler’.. If Time Travel Existed” (March 16th 2017) 95

NBC News “Johnny Depp: ‘When Was the Last Time an Actor Assassinated a President?’” (June 23rd 2017) 96

San Francisco Chronicle “Sen. Kamala Harris ruffles feathers with ‘Trump death joke’ on ‘Ellen’ show” by Michelle Robertson (April 5th 2018) 97

Toronto Sun “Mickey Rourke goes on vicious anti-Trump rant” (April 7th 2016)

98

Newsweek “Comedian George Lopez Under Fire for Instagram Joke About $80-Million Bounty for Trump's Head” by Tufayel Ahmed (January 6th 2020) 99

Mediaite “SNL: John Mulaney Jokes That Senators Should Stab Trump Like Julius Caesar” by Sarah Rumpf (March 1st 2020) 100

Ibid.

101

CNBC “Trump’s Mar-a-Lago security breach: Officials shoot Connecticut woman’s SUV after she crashes through checkpoints” by Dan Mangan, Mike Calia, and Yelena Dzhanova (January 31st 2020) 102

Newsweek “Michael Wolff Says Trump's White House Is 'That Bad' The 25th Amendment Mentioned Every Day” by Harriet Sinclair (January 7th 2018) 103

Newsbusters “‘Homeland’ Invokes 25th Amendment on ‘Unconstitutional’ President” by Lindsay Kornick (April 16th 2018) 104

Newsbusters “‘American Heroes’ Invoke 25th Amendment, Remove ‘Unfit’ President in Liberal Fantasy Show” by Lindsay Kornick (January 15th 2018)

105

Ibid.

106 RealClear

Politics “ABC’s ‘Designated Survivor’ Uses 25th Amendment To Remove President” by Ian Schwartz (April 16th 2018) 107

IMDB “Super Girl” (Episode: The Quest for Peace) 2019

108 Ibid. 109

USA Today “James Woods: I was ‘blacklisted’ like Brendan Fraser but for my conservative politics” by Maria Puente (February 23rd 2018) 110

CBS News “James Woods dropped by ‘liberal’ agent on Fourth of July” by Andrea Park (July 5th 2018) 111

NME “Kanye West says speaking out about Trump support ‘represented overcoming fear’” by Rhian Daly (August 10th 2018) 112

New York Times “Kanye West Ends ‘S.N.L.’ With Speech About Trump and Bullying” by Joe Coscarelli (September 30th 2018) 113

The Daily Dot “‘Mean Girls’ Broadway actress called out for following right-wing Twitter accounts” by Esther Bell (February 11th 2020) 114

Variety “‘Bachelorette’ Frontrunner Apologizes for Controversial Instagram Likes” by Ellis Clopton (May 31st 2018) 115

Variety “Hollywood Conservative Group Grapples With IRS Scrutiny As It Seeks Tax-Exempt Status” by Ted Johnson (January 22nd 2014) 116

Reuters “Justice Department settles with conservative groups over IRS scrutiny” by Brendan O’Brien (October 26th 2017) 117

The Guardian “Club for Hollywood Republicans locked in dispute – caused in part by Trump” by Rory Carroll (June 13th 2017) 118

The Hollywood Reporter “Tim Allen Compares Being Conservative in Hollywood to 1930s Germany” by Arlene Washington (March 19th 2017) 119

Newsweek “The Hollywood Blacklist Then And Now: The Late Actor Orson Bean On AntiAmerican ‘Propaganda’" by Paul Bond (February 29th 2020) 120

Epoch Times “How Soviet Russia Conducted ‘Ideological Subversion’ in Western Nations” by Michael Wing (January 29th 2020) 121

BigThink “34 years ago, a KGB defector chillingly predicted modern America” by Paul Ratner (July 18th 2018)

122

The Communist Party’s “Decision Concerning the Great Proletarian Cultural Revolution” also known as the Sixteen Points (August 8th 1966) 123 Ibid. 124

Fox News “Actor Mark Ruffalo attacks capitalism for ‘failing us’ in tweet, but boasts 7-figure net worth” by Melissa Robert (December 3rd 2019) 125 Fox

News “John Cusack at Bernie Sanders rally: World has 10-12-year window to stop climate change, ‘predatory capitalism’” by Bradford Betz (January 19th 2020) 126

Washington Post “Jim Carrey tells Democrats: ‘We have to say yes to socialism’” by Amy B. Wang (September 10th 2018) 127

Los Angeles Times “TV Preview: Wealth disparity, hackers and cyber threats in ‘Mr. Robot’” by Alan Everly (May 29th 2015) 128

The Atlantic “Whose Side Is Mr. Robot On, Anyway?” by Spencer Kornhaber (August 6th 2015)

129

InTheseTimes “Mr. Robot Is the Anti-Capitalist TV Show We’ve Been Waiting For” by Brian Cook (August 4th 2015) 130

Reuters “Dopey socialist parable ‘In Time’ a slick, fun ride” by Alonso Duralde (October 27th 2011) 131

The New Yorker “‘The Society,’ Reviewed: A Teen Dystopia, but with, Like, Socialism” by Doreen St. Felix (May 22nd 2019) 132

Jack Ryan Season 2 Episode One on Amazon Prime

133

Foundation for Economic Freedom “‘Jack Ryan’ Gets 4 Pinocchios on Venezuela” by Jon Miltmore (January 15th 2020) 134

Orange County Register “Why does Hollywood smear capitalism, promote socialism?” by John Stossel (December 4th 2019) 135

USA Today “‘Radicalized’ couple behind viral AOC ad launches pro-socialism, Netflix-like service” by JC Reindl via Detroit Free Press (April 13th 2019) 136

Deadline Detroit “‘Netflix For The Left’: Socialist Streaming Service Launches In Detroit” (February 25th 2020) 137

HuffPost “The Couple Behind The Viral AOC Ad Plans A Streaming Channel For Socialists” by Christopher Wilson (May 17th 2019) 138

Newsweek “George Floyd Was on Fentanyl, Medical Examiner Says, As Experts Dispute Cause of Death” by Daniel Villarreal (June 2nd 2020)

139

Fox News “Rioting, looting linked to George Floyd protests leaves trail of destruction across American cities” by Greg Norman (June 1st 2020) 140 Fox

News “Minneapolis Third Precinct police station set on fire after rioters break in” by Dom Calicchio (May 28th 2020) 141

Rolling Stone “John Legend, Common, the Weeknd, Lizzo Sign Open Letter to Defund the Police” by Jon Blistein (June 2nd 2020) 142 NPR

“Amid Protests Against Police Violence LA Mayor Eric Garcetti Announces Cuts To LAPD” by Vanessa Romo (June 3rd 2020) 143

CBS News “De Blasio seeks to cut $1 billion from NYPD budget” (June 29th 2020)

144

New York Times “For Mayor Jacob Frey of Minneapolis, a Stinging Rebuke” by Michael Levenson (June 7th 2020) 145

New York Times “‘Cops,’ Long-Running Reality Show That Glorified Police, Is Canceled” by Nicole Sperling (June 9th 2020) 146

Entertainment Weekly “Live PD host slams cancellation: ‘There’s an overreaction going on’” by James Hibberd (June 11th 2020) 147

New York Times “The Protests Come for ‘Paw Patrol’” by Amanda Hess (June 10th 2020)

148

Rolling Stone “What Music’s Tech Companies Are Doing on Blackout Tuesday” by Ethan Millman (June 2nd 2020) 149

TubeFilter “YouTube Hosts Inaugural #YouTubeBlack Event To Support Creators Of Color” by Geoff Weiss (April 11th 2016) 150

CNET “These are the major brands donating to the Black Lives Matter movement” by Mercey Livingston (June 16th 2020) 151

Fox 23 “Disney releases video showing support for Black Lives Matter movement” by Katlyn Brieskorn (June 14th 2020) 152

CNN “‘Call of Duty’ games now display a Black Lives Matter message” by Steve Dent (June 5th 2020) 153

The Telegraph “Make no mistake – BLM is a radical neo-Marxist political movement” by Alexandra Phillips (June 12th 2020) 154

Breitbart “Black Lives Matter Anti-Cop Protests Part of Agenda Seeking Socialist Revolution” by Joshua Klein (June 12th 2020)

155

Time “Black Lives Matter Co-Founder Patrisse Cullors on Her Memoir, Her Life and What’s Next for the Movement” by Aric Jenkins (February 26th 2018) 156 The

Blaze “Toronto Black Lives Matter co-founder says white people are ‘genetic defects’” by Tre Goins-Phillips (February 13th 2017) 157

Breitbart “Black Lives Matter Anti-Cop Protests Part of Agenda Seeking Socialist Revolution” by Joshua Klein (June 12th 2020) 158 Sarah

Silverman in her 2005 show “Jesus is Magic.” Clips of the segment are currently available on YouTube and elsewhere online if you search for “Sarah Silverman Says I Would Kill Christ Again” 159

Reuters “Kathy Griffin’s Jesus remark cut from Emmy show” (September 11th 2007)

160

Daily Caller “Daily Caller: Comic Convention Bans Christian Conservative Actor Kevin Sorbo For Friendship With Hannity” by Ian Miles Cheong January 14th 2018) 161

NBC News “Ellen Page doubles down on criticism of celebs who attend anti-gay churches” via Variety (February 11th 2019) 162

Dallas News “Ellie Goulding threatens to cancel her Cowboys Thanksgiving halftime show over Salvation Army concerns” by Dan Dinger (November 12th 2019) 163

USA Today “Ellie Goulding threatens to quit Thanksgiving NFL game; Salvation Army says she’s a go” by Charles Trepany (November 13th 2019) 164

The Telegraph “Mel Gibson’s film on Christ condemned as anti-Semitic” June 29th 2003)

165

ADL.org “ADL and Mel Gibson’s ‘The Passion of the Christ’” (January 2nd 2013)

166

Luke 23:19

167

The New York Daily News “The Passion of the Christ” by Jami Bernard (February 24th 2004)

168

The Guardian “Mel’s Passion blamed for rise in anti-semitic attacks” (March 16th 2005)

169

The Guardian “History Channel’s The Bible series is worse than reality TV” by Alan Nyuhas (March 25th 2013) 170

Real Time with Bill Maher “Bari Weiss: How to Fight Anti-Semitism” Segment posted on the show’s official YouTube channel (September 13th 2019) 171

Salon.com “Hallmark movies are fascist propaganda” by Amanda Marcotte (December 25th 2019) 172

Ibid.

173

Ibid.

174 Breitbart

“Whitney Cummings Says She Was Reported to HR for Saying ‘Merry Christmas’” by David NG (December 20th 2019) 175

Ibid.

176 Ibid. 177

Wall Street Journal “Aunt Jemima and Uncle Ben’s, Rooted in Racist Imagery, to Change” by Annie Gasparro and Micah Maidenberg (June 17th 2020) 178

The Secret Life of a Satanist: The Authorized Biography of Anton LaVey by Blanche Barton page 78 (Feral House 1992) 179

See my previous book, Inside the Illuminati (2014)

180

The Daily Beast “How the Illuminati Stole the Mind, Soul, and Body of Hip-Hop” by Rob Brotherton (January 2nd 2016) 181

Manly P. Hall wrote, “The serpent is true to the principle of wisdom, for it tempts man to the knowledge of himself. Therefore the knowledge of self resulted from man’s disobedience to the Demiurgus, Jehovah.” — The Secret Teachings of All Ages page 272 (Tarcher/Penguin 2003) 182

Aleister Crowley wrote “This serpent, Satan, is not the enemy of Man, be He who made Gods of our race, knowing Good and Evil; He bade ‘Know Thyself!’ and taught Initiation. He is ‘the Devil’ of the book of Thoth, and His emblem is Baphomet, and Androgyne who is the hieroglyph of arcane perfection.” — Magick: In Theory and Practice page 193 183

Rolling Stone “Katy Perry: I Want to Join the Illuminati!” (August 1st 2014)

184

Washington Post “Planned Parenthood’s Secret Weapon” by Nora Caplan-Bricker (September 23rd 2019). 185

Ibid.

186

Newsbusters “Hulu Character Feels ‘Really, Really Good,’ ‘Very F**king Powerful’ After Abortion” by Rebecca Downs (March 18th 2019) 187

Campus Reform “Sociologist calls for more abortion-based comedy” by Toni Airaksinen (January 2nd 2018) 188

Ibid.

189

Salon “‘Parenthood’ bravely tackles abortion” by Willa Paskin (January 9th 2013)

190

HuffPost “‘Parenthood’: Dramatic Episode Tackles Teen Pregnancy And Abortion” (January 9th 2013) 191 PlannedParenthood.org

“Planned Parenthood Announces New Senior Hires” Press Release

(January 11th 2019) 192

USA Today “Planned Parenthood called for Disney princess ‘who’s had an abortion’ in nowdeleted tweet” by Josh Hafner (March 27th 2018) 193 WNEP

16 ABC “Planned Parenthood Keystone: ‘We need a Disney princess who’s had an abortion’” by WNEP Staff (March 27th 2018) 194

Hollywood Reporter “Elizabeth Banks to Lead Center for Reproductive Rights Creative Council” by Lindsay Weinberg (October 29th 2019) 195

Washington Times “Elizabeth Banks: Abortion can be stigma-free, seen as ‘liberty itself’ with the right storytellers” by Douglas Ernst (March 5th 2020) 196

Netflix “The Break with Michelle Wolf” (June 2018)

197

Washington Examiner “‘I am God’: Comedian says abortion empowered her and encourages others to get one” by Spencer Neale (December 18th 2019) 198

New York Magazine “Lena Dunham: ‘I Still Haven’t Had an Abortion, But I Wish I Had’” by Gabriella Paiella (December 20th 2016) 199

Townhall “Actress Busy Philipps Screams She's Proud of Her Abortion at 15-Years-Old Because It Helped Her Career” by Julio Rosas (March 5th 2020) 200

Ibid.

201

Hollywood Reporter “‘Top Gun: Maverick’ Trailer Sparks Controversy as Fans Notice Taiwanese Flag Missing From Tom Cruise’s Jacket” by Patrick Brzeski (July 22nd 2019) 202

Hollywood Reporter “DC Comics Faces Backlash for Deleting ‘Batman’ Artwork That Caused Controversy in China” by Abid Rahman (November 28th 2019) 203

The Big Think “The silent Chinese propaganda in Hollywood films” by Scotty Hendricks (December 10th 2018) 204

Hollywood Reporter “Zombie Films at Cannes: What’s Up With All the Undead?” by Tatiana Siegel (May 18th 2019) 205

The New York Times “How China is Writing Its Own Script” by Amy Qin and Audrey Carlsen (November 18th 2018)

206

CNN “Ryan Gosling defends ‘First Man’ amid American flag controversy” by Sandra Gonzalez (August 31st 2018) 207 ESPN

“James Harden apologizes as controversy grows: ‘We love China’” (October 6th 2019)

208

ABC News “LeBron James says general manager who tweeted in support of Hong Kong protesters ‘wasn’t educated’ on the issue” by Meghan Keneally (October 15th 2019) 209 New

York Times “In China’s Crackdown on Muslims, Children Have Not Been Spared” by Amy Quin (December 28th 2019) 210

The Hill “Yale, MIT study: 22 million, not 11 million, undocumented immigrants in US” by Rafael Bernal (September 21st 2018) 211

CBS News “New York City’s anti-discrimination policy warns against terms like ‘illegal alien’” by Christopher Brito (October 1st 2019) 212

Breitbart “Nearly 400K Anchor Babies Born in 2019, Exceeding U.S. Births in 48 States” by John Binder (January 5th 2020) 213

CNN “Democrats want to offer health care to undocumented immigrants. Here’s what that means” by Tami Luhby (September 11th 2019) 214

Washington Times “Illegal immigrants lying in wait for Trump to lose election” by Stephen Dinan (January 17th 2020) 215

NPR “In ‘Party Of Five’ Reboot, Deportation Separates The Family” by Michael Martin (January 11th 2020) 216

Hollywood Reporter “‘Party of Five’ Reboot Canceled at Freeform” by Lesley Goldberg (April 17th 2020) 217

The New York Times “Hollywood’s Diversity Problem and Undocumented Immigrants” by Monica Castillo (October 20th 2017) 218

NewsBusters “‘Roseanne’ Spinoff: Illegal Immigrants ‘Just Trying to Have a Better Life’” by Dawn Slusher (January 23rd 2019) 219

Vulture “America Ferrera Says Superstore Season Four ICE Raid Could Shape the Show for Years” by Jordan Crucchiola (July 19th 2019) 220

The Hollywood Reporter “‘OITNB’ Star Opens Up About Tackling ‘Dangerous’ Immigration Storyline” by Jackie Strause (August 1st 2018) 221

Newsbusters “New CW Anthology Advises Illegal Immigrants To ‘Hide’” by Lindsay Kornick (August 15th 2019)

222

Daily Beast “ICE Agents Are Television’s Newest Bogeymen, From Netflix’s ‘Orange is the New Black’ to NBC’s ‘Superstore’” 223 Ibid. 224

Breitbart “Showtime’s ‘Shameless’: America Is a ‘Piece of Shit Country’” by Alana Mastrangelo (November 25th 2019) 225 Rolling

Stone “Watch Kesha Celebrate DACA Dreamers in Moving ‘Hymn’ Video” by Jon Blistein (May 31st 2018) 226

New York Observer “Hooray for Hollywood: How Charities Influence Your Favorite TV Shows” by Anne Easton (October 28th 2015) 227

Newsbusters “‘The Twilight Zone’ Defends Illegal Immigration: ‘We Are All Immigrants From Somewhere’” by Lindsay Kornick (May 16th 2019) 228

Ibid.

229

Vulture “Why You Could Be Seeing a Lot of Immigrant Stories on TV This Fall” by Maria Elena Fernandez (January 23rd 2018) 230

Hollywood Reporter “‘Jane the Virgin,’ ‘Vida’ Writers Talk Onscreen Representation” by Jenna Marotta (October 3rd 2018) 231

Variety “Gina Rodriguez Developing Pair of Latino Series at CBS, CW” by Joe Otterson (September 6th 2017) 232

Variety “Immigration Projects Take Center Stage at Broadcast Networks” by Joe Otterson (September 8th 2017) 233

Washington Post “TV dramas and sitcoms are suddenly all about immigration” by Travis M. Andrews (October 13th 2017) 234

The Guardian “‘Daca dramas’: How immigration become US TV’s new obsession” by Lanre Bakare (September 13th 2017) 235

Deadline.com “‘Little America’ Immigrant Anthology Series In Works At Apple From ‘The Big Sick’ Writers, Lee Eisenberg & Alan Yang” by Nellie Andreeva (February 8th 2018) 236

The Daily Beast “How an ICE Immigration Raid Tore Apart a Small Midwest Town” by Nick Schager (December 20th 2019) 237

Hollywood Reporter “Selena Gomez-Produced ‘Living Undocumented’ Docuseries a Go at Netflix” by Rick Porter (September 17th 2019) 238

Ibid.

239

The Guardian “District 9: South Africa and apartheid come to the movies” by David Smith (August 20th 2009) 240 SPLCenter.org

“Does Robert Rodriquez’s ‘Machete’ Advocate ‘Race War?’” by Alexander Zaitchik (September 10th 2010) 241

Philadelphia Inquirer “‘Elysium’ - the rich above, the slums below” by Steven Rae (August 8th 2013) 242 Variety

“Film Review: ‘Elysium’” by Scott Foundas (August 1st 2013)

243

Entertainment Weekly “‘Elysium’: Future Shock” by Sean Smith (July 26th 2013)

244

Worcester Telegram & Gazette “Movie review: Xenophobic ‘Rambo: Last Blood’ should be end of the line for character” by Katie Walsh (September 19th 2019) 245

Daily Beast “‘Rambo: Last Blood’ is a Trumpian, Anti-Mexican Nightmare” by Nick Schager (September 20th 2019) 246

The Spokesman-Review “Deeply Xenophomic, lazy ‘Rambo: Last Blood’ should be end of line for character.” by Katie Walsh via Tribune News Service (September 19th 2019) 247

Uproxx “‘Rambo: Last Blood’ Is A Rollicking Good Time Of Hyper-Violent Xenophobic Revenge Fantasies” by Vince Mancini (September 18th 2019) 248

The Playlist.net “‘Rambo: Last Blood’: Sylvester Stallone Leads A Manic MAGA Fever Dream & Radicalizing Recruitment Video [Review]” by Charles Barfield (September 21st 2019) 249

Indiwire “‘Sicario: Day of Soldado’ Doubles Down on Mexican Stereotypes and Violent MAGA Fantasies — Opinion” by Monica Castillo (June 29th 2018) 250

The New Yorker “‘PEPPERMINT,’ REVIEWED: JENNIFER GARNER STARS IN AN IGNORANT, RACIST DRUG-TRADE REVENGE FILM” by Richard Brody (September 7th 2018) 251

Latino Rebels “‘Liberal’ Hollywood Is Reinforcing Trump’s Hate” by Alejandro Diaz (July 25th 2018) 252

NBC News “‘Sicario: Day of Soldado’ is a poorly written blockbuster filled with racist stereotypes. Hollywood should know better.” by Ani Bundel (July 1st 2018) 253

The Death of the West: How Dying Populations and Immigrant Invasions Imperil Our Country and Civilization by Patrick J. Buchanon page 3 (2002 Thomas Dunne Books) 254

The Death of the West: How Dying Populations and Immigrant Invasions Imperil Our Country and Civilization by Patrick J. Buchanon pages 125-126 (2002 Thomas Dunne Books)

255

Los Angeles Times “Vision That Inspires Some and Scares Others: Aztlan” by David Kelly (July 7th 2006) 256 FrontPageMag.com

“Expressions of Ethnic Animosity” by James Lubinskas (November 24,

1999) 257

“Building a North American Community” report by the Council on Foreign Relations (2005)

258 The

Hollywood Reporter “TV Executives Admit in Taped Interviews That Hollywood Pushes a Liberal Agenda” by Paul Bond (June 1st 2001) 259

U.S. Department of Justice “Homicide Trends in the United States, 1980-2008” by Alexia Cooper and Erica L. Smith (November 2011) 260

ADL.org “Hate on Display™ Hate Symbols Database”

261

CBS News “#OscarsSoWhite: Academy Awards slammed for lack of diversity” by John Blackstone (January 14th 2016) 262

Fortune “These Oscar Best Picture nominees are ‘problematic’—but will that matter?” by Paula Bernstein (January 16th 2020) 263

USA Today “Oscar nominations 2020: Why do snubs for women and people of color keep happening?” by Andrea Mandell (January 13th 2020) 264

NBC Los Angeles “Fans Link J.Lo ‘Hustlers’ Snub to Oscars Diversity Problem” (January 13th 2020) 265

The Hollywood Reporter “The Whiteness of ‘Toy Story 4’” by Stephen Galloway (January 3rd 2020) 266

Ibid.

267

Ibid.

268

Time “In Joker , Black Women Are Visible But They Are Not Seen” by Beandrea July (October 11th 2019) 269

Teen Vogue “‘Little Women,’ Laurie, and the Argument for Racebent Casting” by Natalie De Vera Obedos (December 23rd 2019) 270

National Review “Greta Gerwig’s Little Women Romanticizes White Privilege” by Armond White (December 27th 2019) 271

Hollywood Reporter “Hallmark Channel Struggles to Give Diversity a Home for the Holidays” by Lesley Goldberg (November 27th 2019)

272

Ibid.

273 IBTimes

“Why Are Hallmark Movie Casts So White? We Asked The CEO” by Rachael Ellenbogen (December 21st 2017) 274

Mediaite “Touré Says There’s Already a Benevolent Black Man Who Gives Gifts to Kids: Obama” by Noah Rothman (December 16th 2013) 275 CNS

News “Harper, CNN Promote Gay ‘Married’ Santa Claus” by Michael W. Chapman (December 20th 2017) 276

USA Today “Tim Burton’s diversity comments blew up Twitter” by Carley Mallenbaum (September 29th 2016) 277

Breitbart “Jonah Hill: ‘Real Change’ in Film Will Come When Women, Minorities Run Studios and Streaming Companies” by Warner Todd Huston (January 31st 2020) 278

Newsweek “CNN’s Rick Sanchez Fired After Implying Jews Run the Media” by David A. Graham (October 1st 2010) 279

Newsbusters “‘Blackish’ Does Episode on Teaching Black Kids ‘America Hates You’” by Amelia Hamilton (January 16th 2018) 280

Ibid.

281

Complex.com “The 50 Most Racist TV Shows of All Time” (June 3rd 2013)

282

The Hollywood Reporter “Critic’s Notebook: The Blinding Whiteness of Nostalgia TV” by Inkoo Kang (March 28th 2018) 283

Inquisitr “Roseanne Barr Explains Why She Wanted The Conners To Have A Black Grandchild On The ‘Roseanne’ Revival” by Victoria Miller (February 21st 2018) 284

The Guardian “David Schwimmer: ‘I’m very aware of my privilege as a heterosexual white male’” by David Smith (January 27th 2020) 285

Slate “Is It Racist to Date Only People of Your Own Race? Yes.” by Reihan Salam (April 22nd 2014) 286

CNN “Los Angeles mayor wants to double Latino representation in Hollywood in the next 10 years” by Christina Maxouris (January 20th 2020) 287

See my previous book, Liberalism: Find a Cure (2018)

288

Parade “Guillermo’s Job Before Becoming Jimmy Kimmel’s Sidekick” by Walter Scott (April 12th 2014)

289

Washington Examiner “Jamie Foxx: It’s ‘great’ to ‘kill all the white people’” by Kelsey Osterman (December 9th 2012) 290 VLADTV

“‘Django Unchained’ Viewers Tweet Desire To ‘Kill White People’” by John S (January 9th 2013) 291

BBC “Kendrick Lamar stops white fan using N-word on stage at concert” (May 22nd 2018)

292 CNN

“Actress Gina Rodriguez comes under fire over her use of the n-word” by Faith Karimi (October 19th 2019) 293

NBC News “‘Bachelorette’ star Hannah Brown apologizes for using the N-word” by Janelle Griffith (May 19th 2020) 294

https://twitter.com/jlptalk/status/1262490953094295552

295

Vanity Fair “Roseanne Barr Screams About Valerie Jarrett: ‘I Thought the Bitch Was White!’” by Laura Bradley (July 20th 2018) 296

The Washington Post “Roseanne’s character overdosed on opioids and left ‘The Conners’ behind. It’s better this way.” by Hank Stuever (October 16th 2018) 297

The Wrap “‘Queer Eye’ Star Jonathan Van Ness Under Fire After Saying ‘Not All Republicans Are Racist’” by Jon Levine (August 16th 2018) 298

Carolina Journal “‘The Sum of All Fears’ Falls Victim to Political Correctness” by Hans Marc Hurd (August 6th 2002) 299

IGN “The Sum of All Fears: The Jack Ryan prequel hits DVD. Our full review” by Jeremy Conrad (December 13th 2018) 300

Mashable “Chelsea Handler talks about facing up to her own white privilege” by Rachel Thompson (September 10th 2019) 301

Rolling Stone “Jon Stewart Talks Lack of Staff Diversity During his ‘Daily Show’ Tenure” by Jon Blistein (June 24th 2020) 302

Esquire “Jon Stewart: America Can Only Have Equality When Black People Are Given What’s Been Taken From Them” by Justin Kirkland (June 25th 2020) 303

Insider “Zac Efron’s portrayal of serial killer Ted Bundy is being accused of romanticizing the brutal murderer” by Jacob Shamsian (January 28th 2019) 304

Fox News “Zac Efron says white privilege allowed Ted Bundy to kill people for so long before being captured” by Jessica Napoli and Tyler McCarthy (May 3rd 2019)

305

Los Angeles Times “White celebrities partner with NAACP to ‘take responsibility’ for racism” by Christi Carras (June 11th 2020) 306 The

Tonight Show Starring Jimmy Fallon “Dr. Robin DiAngelo Wants White People to Stop Saying They’re Not Racist” segment posted on the show’s official YouTube channel (June 17th 2020) 307

Ibid.

308 Mashable

“‘White Fragility’ author Robin DiAngelo explains why white people shouldn’t say they’re ‘not racist’” by Sam Haysom (June 18th 2020) 309

IndieWire “‘Watchmen’: Damon Lindelof Shares How The New HBO Adaptation Deals with White Supremacy” by Steve Greene (July 24th 2019) 310

Ibid.

311

Vox “Some Watchmen fans are mad that HBO’s version is political. But Watchmen has always been political” by Alex Abad-Santos (October 24th 2019) 312

Esquire “The Right-Wing Troll Backlash Against HBO’s Watchmen Is Hilariously Stupid” by Matt Miller (October 24th 2019) 313

The Hollywood Reporter “Watch Topher Grace Embody KKK Leader David Duke in ‘BlacKkKlansman’” by Evan Real (August 1st 2018) 314

The American Spectator “Trump Denounced a ‘White Supremacist Loser’ — 19 Years Ago” by Jeffrey Lord (March 19th 2019) 315

Interview with BlackTreeTV’s YouTube Channel “Topher Grace says finding the human side of David Duke was a challenge in BlacKkKlansman” (August 16th 2018) 316

https://www.facebook.com/crackatv/photos/a.119499679798117/119499656464786

317

CrackaWorld.com - the film’s official website (July 2020)

318

Yale Bulletin & Calendar “Director Spike Lee slams ‘same old’ black stereotypes in today’s films” Volume 29, Number 21 (March 2nd 2001) 319

Salon.com “The offensive movie cliche that won’t die” by Matt Zoller Zeitz (September 14th 2010) 320

NPR “‘Magical Negro’ Carries The Weight Of History” by Mary Louise Kelly (February 11th 2019) 321

Dallas Observer “The Blind Side: What Would Black People Do Without Nice White Folks?” by Melissa Anderson (November 19th 2009)

322

Ranker “Quietly Racist Things You Probably Missed In ‘The Blind Side’” by Evan Lambert (July 13th 2020) 323 RacismReview.com

“‘Gran Torino,’ White Masculinity & Racism” (January 17th 2009)

324

Slate.com “Cool Runnings Was Not Good, and It Is Definitely Not a ‘Cult Classic’” by Justin Peters (February 16th 2014) 325 Gizmodo

“When Will White People Stop Making Movies Like ‘Avatar’?” by Annalee Newitz (December 18th 2009) 326

Complex “The 50 Most Racist TV Shows of All Time” (June 3rd 2013)

327

Vulture “MTV’s New Documentary Wants to Make White People Very Uncomfortable” by Dee Lockett (July 8th 2015) 328

RealClearPolitics “‘MTV News’ Deletes YouTube Video Telling ‘White Guys’ What They Could Do Better In 2017 After Backlash” by Tim Hains (December 20th 2016) 329

The College Fix “Stanford University course to study ‘abolishing whiteness’” by Matthew Stein (August 11th 2017) 330

The Hill “Disney network defends casting black actress in ‘Little Mermaid’ after backlash” by Rachel Frazin (July 9th 2019) 331

CNN “‘Buffy the Vampire Slayer’ reboot to feature African-American lead” by Chloe Melas (July 23rd 2018) 332

The Guardian “Bond’s number is up: black female actor ‘is the new 007’” by Steph Harmon (July 15th 2019) 333

NBC News “In Marvel’s ‘Spider-Verse,’ Spider-Man’s mom is alive and Puerto Rican” by Arturo Conde (December 13th 2018) 334

Forbes “Science Says Superman Should Be Black” by JV Chamary (March 31st 2016)

335

The Guardian “Fantastic Four film-makers respond to criticism of decision to cast black actor” by Ben Child (June 4th 2015) 336

NBC News “‘Batwoman’ casts Black, bisexual actress Javicia Leslie to play superhero” by Tim Fitzsimons (July 9th 2020) 337

Variety “‘Wonder Years’ Reboot With Black Family in the Works at ABC, Lee Daniels to Produce” by Joe Otterson (July 8th 2020) 338

NPR “Author L.L. McKinney: Barnes & Noble ‘Diverse Editions’ Are ‘Literary Blackface’” by Audie Cornish (February 6th 2020)

339

Harry Potter and the Prisoner of Azkaban by J.K Rowling

340 BuzzFeed

“10 Classic Remakes That Gave Minority Actors The Spotlight” by Doriean Stevenson (March 28th 2014) 341 Wall Street Journal “When the Slave Traders Were African: Those whose ancestors sold slaves to Europeans now struggle to come to terms with a painful legacy” by Adaobi Tricia Nwaubani (September 20, 2019) 342

Reuters “West African slavery lives on, 400 years after transatlantic trade began” by Angela Ukomadu (August 7th 2019) 343

See my previous book The Liberal Media Industrial Complex (2019)

344

PBS “The War” series directed and produced by Ken Burns and Lynn Novick in the “At Home” episode 345

Time “The U.S. Government Used Disney Cartoons to Convince Americans That Paying Taxes Is a Privilege” by Oliva B. Waxman (April 16th 2018) 346

Der Fuehrer’s Face (1942) produced by Walt Disney

347

Commando Duck (1944) produced by Walt Disney

348

Operation Hollywood: How the Pentagon Shapes and Censors the Movies by David Robb (2004 Prometheus Books) 349

Variety “The ‘24’ Effect: How ‘Liberal Hollywood’ Carried Water For Torture” by Brian Lowry (December 14th 2014) 350

Ibid.

351

Ibid.

352

Washington Post “‘Zero Dark Thirty’ waterboarding depictions not accurate, senators say” by Ed O’Keefe and Ann Hornaday (December 19th 2012) 353

The Atlantic “Secret Report: Panetta Gave bin Laden Raid Details to ‘Zero Dark Thirty’ Makers” by Philip Bump (June 5th 2013) 354

Washington Post “25 years later, how ‘Top Gun’ made America love war” by David Sirota (August 26th 2011) 355

The Independent “Washington DC’s role behind the scenes in Hollywood goes deeper than you think” by Matthew Alford (September 3rd 2017) 356

Ibid.

357

Universal Studios “Lone Survivor Production Notes”

358 Fortune

Magazine “Hollywood’s military complex” by Soo Youn (December 19, 2013)

359

Ibid.

360 Wired

Magazine “CIA Pitches Scripts to Hollywood” by Mark Riffee (September 9th 2011)

361

The Independent “Washington DC’s role behind the scenes in Hollywood goes deeper than you think” by Matthew Alford (September 3rd 2017). 362

Army Times “The Pentagon’s Hollywood Liaison” by Hope Hodge (July 1 2013)

363

Business Insider “One Man In The Department Of Defense Controls All Of Hollywood’s Access To The Military” by Aly Weisman (March 5th 2014) 364

Wired Magazine “CIA Pitches Scripts to Hollywood” by Mark Riffee (September 9th 2011)

365

Los Angeles Times “‘Top Gun’ Boosting Service Sign-ups” by Mark Evje (July 5, 1986)

366

San Diego Union Tribune “Marines say Katy Perry video is good publicity” by Jeanette Steele (March 22nd 2012) 367

Newsweek “‘Call of Duty’ Creators Collaborated with Pentagon Adviser in Upcoming Videogame” by Madeline Grant (August 28th 2014) 368

Oliver Stone in CNN’s “The Movies” documentary series - Episode 1: The Eighties

369

CBS News “Pentagon Defends Photo Ban” (April 23rd 2004)

370

Bureau of Investigative Journalism “Obama’s covert drone war in numbers: ten times more strikes than Bush” by Jessica Purkiss and Jack Serle (January 7th 2017) 371

USA Today “Michelle Obama presents Oscar to ‘Argo’” (February 25th 2013)

372

Hollywood Reporter “Golden Globes 2013: Complete List of Winners” (January 13th 2013)

373

CBS News “DHS’ Domestic Terror Warning Angers GOP” (April 16th 2009)

374

Time “Top 10 Everything of 2012” - Top 10 Viral Videos

375

ABC News “Senate Resolution Condemns Uganda’s Joseph Kony” by Sunien Miller (March 21st 2012) 376

Reason “Kony 2012’s Old-Fashioned War Propaganda” by Tate Watkins (March 14th 2012)

377

The Guardian “The caring, sharing CIA: Central Intelligence gets a makeover” by John Patterson (October 4, 2001) 378 PR

Week “Barry named CIA Entertainment Liaison” (June 5, 2007)

379

The Guardian “An Offer They Couldn’t Refuse” by Matthew Alford and Robbie Graham (November 13th 2008) 380 Cinema

Review Magazine “The Recruit: About the Production”

381

The Atlantic “How the CIA Hoodwinked Hollywood” by Nicholas Schou (July 14th 2016)

382

The Independent “Washington DC’s role behind the scenes in Hollywood goes deeper than you think” by Matthew Alford (September 3rd 2017) 383

Time Magazine “CIA Mind-Control Experiments” by Nate Rawlings (August 6th 2010)

384

The Guardian “The caring, sharing CIA: Central Intelligence gets a makeover” by John Patterson (October 4, 2001) 385

Robb, David - Operation Hollywood: How the Pentagon Shapes and Censors Movies page 365 (2004 Prometheus Books) 386

Robb, David - Operation Hollywood: How the Pentagon Shapes and Censors the Movies page 47-48 (2004 Prometheus Books) 387

Chemerinsky also points to the 1995 U.S. Supreme Court case Rosenberger v. the University of Virginia. 388

Los Angeles Times “Hollywood figures spied for CIA, book asserts” by Ken Dilanian (January 10th 2014) 389

John Rizzo - Company Man: Thirty Years of Crisis and Controversy in the CIA page 63 (2014 Scribner) 390

Ibid.

391

John Rizzo - Company Man: Thirty Years of Crisis and Controversy in the CIA page 64 (2014 Scribner) 392

Ibid.

393

YouTube - Interview with The Guardian “Ben Affleck on Argo: Probably Hollywood is full of CIA Agents” (November 8the 2012) 394

Los Angeles Times “The CIA Spins Itself” by Patrick Goldstein (September 29th 2001)

395

https://www.fbi.gov/about/faqs/how-can-screenwriters-authors-and-producers-seekingauthenticity-work-with-the-fbi396 Ibid. 397

John Wayne: American by Randy Roberts page 569 (1995 Free Press)

398 CBS

News “The U.S. vs. John Lennon” by Jon Wiener (September 15th 2006)

399

Final Report of the Select Committee to Study Government Operations With Respect to Intelligence Activities. April 1976. 400

Church Committee Hearings (1975) testimony by William Colby

401

Sig Mickleson in a clip widely available on YouTube about the CIA and the news

402

CNBC “A carbon tax is ‘single most powerful’ way to combat climate change, IMF says” by Emma Newburger (October 10th 2019) 403

Washington Post “AOC’s Chief of Change” by David Montgomery (July 10th 2019)

404

Politico “‘Green New Deal’ lands in the Capitol” by Zack Colman and Anthony Adragna (February 7, 2019) 405

Daily Mail “The devastating rise of ‘eco-anxiety’: Psychologist says school kids are being damaged by the climate change debate” by Zoe Zaczek (September 25th 2019) 406

Time magazine “Greta Thunberg: TIME’s Person of the Year 2019” by Edward Felsenthal (December 11th 2019) 407

CNBC “This Bill Gates-funded chemical cloud could help stop global warming” by Katie Schoolov (September 7th 2019) 408

The Independent “How Bad are Private Jets for the Environment?” by Helen Coffey (August 20th 2019) 409

ABC News “This Bill Gates-funded chemical cloud could help stop global warming” by Jake Taper (February 27th 2007) 410

Politico “Schwarzenegger to Sue Big Oil for ‘First Degree Murder’” by Edward-Isaac Dovere (March 12th 2018) 411

History.com “The Origins of the Hummer”

412

Fox News “Steve Harvey brings drama to ‘Miss Universe’ with eye roll before contestant claims ‘the planet is dying’” by Melissa Roberto (December 9th 2019)

413

New York Observer “Hooray for Hollywood: How Charities Influence Your Favorite TV Shows” by Anne Easton (October 28th 2015) 414 HollywoodHealthAndSociety.org

“Climate Change Resources”

415

The Los Angeles Times “U.N. leader asks Hollywood for help in fight against global climate change” by Margot Roosevelt (February 27th 2011) 416 Ibid. 417

Ibid.

418

Promotional video for News Corp (2006)

419

Ibid.

420

Ibid.

421

Time “Top 10 Disappointing Blockbusters” (August 24th 2009)

422

Pittsburgh Post-Gazette “‘The Day After Tomorrow’ falls far short of its goal” by Tony Norman (May 27th 2004) 423

Vanity Fair “When Will Hollywood Actually Tackle Climate Change?” By Richard Lawson (September 19th 2019) 424

Ibid.

425

The Wall Street Journal “In ‘Cars 2,’ John Lasseter Says Big Oil is the ‘Uber Bad Guy’” by Ethan Smith (June 20th 2011) 426

USA Today “Stylish ‘Snowpiercer’ takes a cold look at class divisions” by Claudia Puig (June 26th 2014) 427

LiveScience.com “Frozen earth in ‘Snowpiercer’ is a grim (and possible) future for our warming planet” by Mindy Weisberger (October 11th 2019) 428

Earth Island Journal “In Review: Snowpiercer” by Jason Mark (July 19th 2019)

429

GreenPeace.org “No, Interstellar doesn’t mention climate change but it could still do the problem a lot of good” by Brian Johnson (November 12th 2014) 430

The Atlantic “Interstellar: Good Space Film, Bad Climate-Change Parable” by Noah Gittell (November 15th 2014) 431

CNBC “Jeff Bezos: Forget Mars, humans will live in these free-floating space pod colonies” by Catherine Clifford (March 8th 2019)

432

Variety “New ‘Geostorm’ Trailer: Gerard Butler Attempts to Save the World From Climate Change Disaster” by Dave McNary (July 6th 2017) 433 The

Guardian “Is climate change Hollywood's new supervillain?” by Greme Virtue (October 19th

2017) 434

Variety “Paul Schrader on How ‘First Reformed’ Reflects His Own Despair Over Climate Crisis” by Ted Johnson (May 19th 2018) 435 Screen

Rant “The Predator: Ultimate Predator Origins, Hybrid DNA & Abilities Explained” by Hannah Shaw-Williams (September 14th 2018) 436

NewsBusters “Futuristic HBO Drama Lambasts Trump, Pence, ‘Old Men In Power Forever’” by Rebecca Downs (July 1st 2019) 437

NBC News “DC Comics ‘Aquaman’ raises questions about environmentalism” by Noah Berlatsky (December 21st 2018) 438

The Hill “Chris Pratt apologizes for posing with single use plastic bottle” by Justine Coleman (December 4th 2019) 439

Yale Climate Connections “Superheroes and aliens: Climate change in the movies in 2018 - with a preview of 2019” by Michael Svoboda (March 21st 2019) 440

Forbes “The Science Of ‘Avengers: Endgame’ Proves Thanos Did Nothing Wrong” by JV Chamary (May 7th 2019) 441

Ibid.

442

Smithsonian Magazine “The Book That Incited a Worldwide Fear of Overpopulation” by Charles C. Mann (January 2018) 443

The Guardian “Climate crisis: 11,000 scientists warn of ‘untold suffering’” by Damian Carrington (November 5th 2019) 444

Washington Times “Miley Cyrus: ‘I refuse’ to have kids until climate change resolved” by Jessica Chasmar (July 12th 2019) 445

Newsweek “Alexandria Ocasio-Cortez Asks: Is It Still OK to Have Kids in Face of Climate Change?” by Nicole Goodkind (February 25th 2019) 446

BBC “The couples rethinking kids because of climate change” by Ted Scheinman (October 1st 2019) 447

Newsweek “Silicon Valley Is Trying to Make Humans Immortal—and Finding Some Success” by Betsy Isaacson (March 5th 2015)

448

The New Bioethics: A Multidisciplinary Journal of Biotechnology and the Body “Transhumanism: How Far Is Too Far?” by Joel Thompson pages 165-182 (July 6th 2017) 449 The

Elberton Star “The Georgia Guidestones: tourist attraction or cult message?” by Gary Jones (April 21st 2012) 450

The man published a little-known book in 1986 titled Common Sense Renewed where he admits that he represented a group. In it, he also says that leather-bound copies were sent to all members of Congress. At the time of this writing in July 2020, one is for sale on E-bay, and listed for $3,500. I own a paperback version which was later published in a small quantity. 451 ESPN

“‘Equality’ tops list of NBA players’ most popular social justice jersey messages (July 8th

2020) 452

CBS News “NBA reportedly plans to paint ‘Black Lives Matter’ on courts when season resumes” by Christopher Brito (June 30th 2020) 453

USA Today “NFL will play Black national anthem ‘Lift Every Voice and Sing’ before each Week 1 game” by Mike Jones (July 2nd 2020) 454

New York Times “Bubba Wallace Wants NASCAR to Ban the Confederate Flag” by Maria Cramer (June 9th 2020) 455

NBC Sports “NASCAR drivers push Bubba Wallace’s car in act of solidarity after noose found in his garage” via Associated Press (June 22nd 2020) 456

Boston Globe “FBI says noose in Bubba Wallace’s stall was garage door-pull rope, not a hate crime” by Jenna Fryer via Associated Press (June 23rd 2020) 457

USA Today “FBI announces noose found in Bubba Wallace's garage had been there since 2019; no federal crime committed” by Michelle R. Martinelli (June 23rd 2020) 458

Seattle Times “Amazon buys naming rights to KeyArena, will call it Climate Pledge Arena” by Geoff Baker (June 25th 2020) 459

CNN “Beyonce gets political at Super Bowl, pays tribute to ‘Black Lives Matter’” by Deena Zeru (February 9th 2016) 460

The Ringer “Sportswriting Has Become a Liberal Profession — Here’s How It Happened” by Bryan Curtis (February 16th 2017) 461

SportingNews.com “Jason Whitlock sounds off on ‘liberal’ sports media, whether Bill Simmons should return to ESPN” by Michael McCarthy (April 12th 2017) 462

Ibid.

463

The Week “The arrogant thinking of liberal sports writers” by Michael Brendan Dougherty (February 21st 2017) 464 Associated

Press “Facebook exec, NBA team up to get men to ‘lean in’ for women” by Michael Liedtke (March 5th 2015) 465

NBA.com “NBA and WNBA Partner with LeanIn.Org to encourage men to support equality at home and at work” (March 5th 2015) 466 National

Review “Yes, ESPN Did Pick Caitlyn Jenner Ahead of Iraq War Vet and Amputee Noah Galloway for the ESPY Courage Award” by David French (June 3rd 2015) 467

New York Daily News “Twitter users call for ESPN to give Arthur Ashe Courage Award to Lauren Hill, not Caitlyn Jenner, at ESPYs” by Bernie Augustine (June 2nd 2015) 468

The Washington Post “Bob Costas: Caitlyn Jenner’s ESPYs courage award is ‘crass exploitation play’” by Cindy Boren (June 10th 2015) 469

ABC News “Caitlyn Jenner Appears on Sports Illustrated Cover 40 Years After Victory” by Ricki Harris (June 28th 2016) 470

New York Times “Curt Schilling, ESPN Analyst, Is Fired Over Offensive Social Media Post” by Richard Sandomir (April 20th 2016) 471

ESPN.com “Inside and out, ESPN dealing with changing political dynamics” by Jim Brady (December 1st 2016) 472

Ibid.

473

Ibid.

474

Sporting News “Fox’s Joe Buck says announcers should stick to sports” by Michael McCarthy (April 18th 2017) 475

NFL.com “Players, owners meet to discuss social issues in N.Y.” (October 17th 2017)

476

Sports Illustrated “NFL Announces ‘Inspire Change’ Initiative, Will Boost African-American History Education in Schools” by Jenny Vrentas (January 11th 2019) 477

USA Today “Los Angeles Rams’ male cheerleaders make NFL history” by Steve Gardner (March 28th 2018) 478

Los Angeles Times “Rams’ male cheerleaders make NFL history at Super Bowl” by Bill Plaschke (January 30th 2019) 479

Time “Despite Outrage, Nike Sales Increased 31% After Kaepernick Ad” by Gina Martinez (September 10th 2018)

480

ABC News “Why the sneaker game is becoming more political: 'It’s not just good business but a net positive for the world’” by Deena Zaru (December 22nd 2018) 481 Hollywood

Reporter “NBC Sports President: 2020 Will Be ‘Uniquely Combustible’ as Olympics, Conventions Collide” by Marisa Guthrie (December 16th 2019) 482

USA Today “ESPN’s Jemele Hill stands by comments calling President Trump white supremacist” by Steve Gardner (February 21st 2018) 483 NBA.com

“Los Angeles Lakers to Hold Second Annual Pride Night” (September 24th 2019)

484

USA Today “NFL launches LGBT initiative, NFL Pride” by Scott Gleeson (August 18th 2017)

485

NBC News “Yankees set to be only MLB team not to host LGBTQ Pride Night” by Kit Ramgopal (July 5th 2018) 486

USA Today “New York Yankees, the only team without a Pride Night, announce LGBT initiative for 2019” by Scott Gleeson (September 21st 2018) 487

NHL “Washington Capitals To Host Pride Night Jan. 7” (January 7th 2020)

488

Fortune “This Will Probably Be the Super Bowl’s Most Controversial Commercial” by Tom Huddleston Jr. (February 3rd 2017) 489

Breitbart “NFL Bans Super Bowl Gun Commercial” (December 2nd 2013)

490

CNN “Beyonce gets political at Super Bowl, pays tribute to ‘Black Lives Matter’” by Deena Zaru (February 9th 2016) 491

Vanity Fair “Lady Gaga Made an Edgy Political Statement You Might Have Missed at the Super Bowl” by Joanna Robinson (February 5th 2017) 492

CNN “How the Trump administration chose the 7 countries in the immigration executive order” by Kyle Blaine and Julia Horowitz (January 30th 2017) 493

CBS News “‘Kids in cages’ help J-Lo make powerful statement at Super Bowl halftime show” by Christopher Brito (February 3rd 2020) 494

USA Today “The truth behind the New York Times’ Patriots photo that went viral on social media” by Luke Kerr-Dineen (April 20th 2017) 495

CBS Boston “Patriots Hit Back At New York Times Over White House Tweet” (April 20th 2017)

496

Fox News “Trump Blasts NY Times for ‘Big Lie’ About Patriots’ Visit to White House” (April 20th 2017)

497

The Washington Times “New York Times sports editor takes sole blame for Patriots tweet that elicited Trump response” by Cindy Boren (April 20th 2017) 498 Breitbart

“ESPN’s Kellerman: Gronkowski Popping Into WH Press Briefing Normalizes Sean Spicer — Patriots Should’ve Boycotted Trip” by Trend Baker (April 20th 2017) . 499

Ibid.

500 Washington

Times “Hollywood stars, athletes driving away viewers with political activists poll finds” by Valerie Richardson (March 21st 2018) 501

Los Angeles Times “ESPN laying off 150 employees in another round of cuts” by Daniel Miller (November 29th 2017) 502

Media Research Center “ESPN Lost 15,000 Subscribers a Day In October” by Nick Kangadis (October 31st 2017) 503

Variety “ESPN Loses 2 Million Subscribers in Fiscal 2018” by Cynthia Littleton (November 21st 2018) 504

New York Post “Anthem protests biggest reason for NFL’s falling ratings: study” by Richard Morgan (February 2018) 505

USA Today “Order from management to ‘stick to sports’ has Deadspin site in open revolt” via Associated Press (October 30th 2019) 506

Fox News “Top Deadspin editor says he was fired after refusing to ‘stick to sports’” by Joseph A. Wulfsohn (October 29th 2019) 507

NPR “After Days Of Resignations, The Last Of The Deadspin Staff Has Quit” by Brakkton Booker (November 1st 2019) 508

Orwell, George - Nineteen Eighty-Four page 63 (1983 Plume)

509

New York Magazine “How Funny Does Comedy Need to Be?” by Jesse David Fox (September 4th 2018) 510

https://twitter.com/comedycentral/status/1012049409503358982

511

ReclaimTheNet.org “Avi Yemini files lawsuit against Jim Jeffries and Viacom after deceptively edited Comedy Central video” by Didi Rankovic (February 19th 2020) 512

Today Show “Jay Leno Talks Cholesterol, Comedy And Life After Late-Night” (March 12th 2019) 513

Ibid.

514

Ibid.

515 Fox

News “Alec Baldwin says Rob Schneider ‘has a point’ in criticism of ‘SNL’ Trump impersonation” by Jennifer Earl (April 30th 2018) 516

The Daily Beast “Jimmy Kimmel Got a Hand From Chuck Schumer in His Fight Against Obamacare Repeal” by Asawin Suebsaeng, Lachian Markay, and Sam Stein (September 23rd 2017) 517 CNN

“Did Jimmy Kimmel kill the health care bill?” by Frank Pallotta (September 22nd 2017)

518

Mediaite “Jimmy Kimmel Enlists Little Children to Explain ‘Global Warming’ and Climate Change to Trump” by Tommy christopher (January 30th 2019 519

Newsbusters “Kimmel: CPAC Is ‘Largest Gathering’ of Anti-Vaxxers Led by a ‘Dementia’Stricken Trump” (March 5th 2019) 520

Newsweek “Jimmy Kimmel Suggests Cutting Off Brett Kavanaugh’s ‘Pesky Penis’ if He’s Confirmed to Supreme Court” by Janice Williams (September 25th 2018) 521

Town Hall “Jimmy Kimmel: ‘Almost Every Talk Show Host Is Liberal’ Because ‘It Requires a Certain Level of Intelligence’” by Timothy Meads (February 4th 2018) 522

Daily Caller “Jimmy Kimmel: Sharing political views ‘has cost me commercially’” by Justin Caruso (March 13th 2018) 523

CNN “Welcome to the Stephen Colbert primary” by Brian Stelter (January 14th 2019)

524

Vanity Fair “Kirsten Gillibrand Just Announced Her Presidential Bid on The Late Show” by Laura Bradley (January 16th 2019) 525

Rolling Stone “California Democrat Eric Swalwell Announces 2020 Presidential Run on ‘Colbert’” by Ryan Reed (April 8th 2019) 526

New York Post “Fallon forced to change ‘Tonight Show’ amid Colbert ratings wins” by Carlos Greer (March 7th 2017) 527

Washington Post “Jimmy Fallon says people ‘have a right to be mad’ at his friendly hair-tousling of Trump” by Travis M. Andrews (May 18th 2017) 528

Decider.com “Did Donald Trump Cost Jimmy Fallon His Emmy Nomination?” by Joe Reid (July 13th 2017) 529

Washington Post “Jimmy Fallon says people ‘have a right to be mad’ at his friendly hair-tousling of Trump” by Travis M. Andrews (May 18th 2017) 530

The Hollywood Reporter “Parkland Survivors David Hogg and Lauren Hogg Recall Mass Shooting and Call for Change” by Katherine Schaffstall (June 20th 2018)

531

NBC “How ‘Saturday Night Live’ Has Shaped American Politics” by Adam Howard (September 30th 2016) 532 PJ

Media “‘The President’s Watching. Let’s Make Him Cringe And Squirm.’” by Ed Driscoll (December 26th 2006) 533

CNN “Chevy Chase: I wanted Carter to win” (November 3rd 2008)

534 Boston

Globe “How Tina Fey destroyed Sarah Palin” by Kevin Lewis (March 3rd 2012)

535

Newsbusters “All ‘SNL’ Wants for Christmas Is for Mueller to Lock Up Trump, ‘Only Other Option Is a Coup’” by Nicholas Fondacaro (December 2nd 2018) 536

Breitbart “SNL ‘Weekend Update’: Impeachment Process Was Too Slow for John Wilkes Booth” by David Ng (September 30th 2019) 537

Ibid.

538

The Daily Beast “Norm Macdonald Sounds Off on SNL: ‘I Think They’re Playing Into Trump’s Hands’” by Matt Wilstein (July 27th 2017) 539

Ibid.

540

Ibid

541

Barbara Walters interviews Johnny Carson (1984)

542

Ibid.

543

Rolling Stone “Flashback: ‘60 Minutes’ Profiles Johnny Carson in 1979” by Patrick Toyle (June 23rd 2015) 544

Ibid.

545

The Independent “As a comedy aficionado, I’m appalled at disgusting ‘jokes’ creeping back into the industry” by Liam Evans (February 26th 2019) 546

Ibid.

547

Ibid.

548

Vice “You Can Definitely Skip Dave Chappelle’s New Netflix Special ‘Sticks & Stones’” by Taylor Horsking (August 26th 2019) 549

Rotten Tomatoes “Dave Chappelle: Sticks & Stones” Critics Consensus (as of February 2020)

550

RedState “‘South Park’ Co-Creator Matt Stone Knows Why Critics Trashed Dave Chappelle’s New Special: to ‘Keep Their Jobs’” by Alex Parker (September 13th 2019) 551 Fox

News “Tim Allen decries ‘thought police,’ political correctness in comedy” by Sam Dorman (November 26th 2019) 552

The Wrap “Did Tim Allen’s Nazi Germany Joke Help Kill ‘Last Man Standing’?” by Tony Maglio and Ryan Gajewski (May 10th 2017) 553 Deadline

“Tim Allen Comedy ‘Last Man Standing’ Canceled By ABC After 6 Seasons” by Nellie Andreeva (May 10th 2017) 554

Deadline “Friday Ratings: Fox’s ‘Last Man Standing’ Returns To The Top” by Bruce Haring (March 16th 2019) 555

The Washington Post “America Needs Hate a Speech Law” by Richard Stengel (October 29th 2019) 556

BBC “Man guilty of hate crime for filming pug’s ‘Nazi salutes’” (March 20th 2018)

557

Jimmy Kimmel and Tracy Morgan present Outstanding Supporting Actress in a Comedy Series at 2018 Emmys 558

Orange Country Register “Emmys 2018: Here’s how diversity in Hollywood was handled on the awards show” by Angela Ratzlaff (September 17th 2018) 559

Boston Herald “Focus on Hollywood’s diversity at Emmy Awards” by Mark Perigard (September 18th 2018) 560

Hollywood Reporter “Emmys: ‘RuPaul’s Drag Race’ Wins Best Reality Competition Program” by Allison Crist (September 17th 2018) 561

Washington Post “Meryl Streep called out Donald Trump at the Golden Globes. He responded by calling her ‘over-rated.’” by Elahe Izadi and Amy B Wang (January 9th 2017) 562

Yahoo “Golden Globes 2018: The 5 most memorable lines from Seth Meyers’s monologue” by Ethan Alter (January 7th 2018) 563

New York Times “Seth Meyers’s Golden Globes Opening Monologue: Transcript” by Giovanni Russonello (January 7th 2018) 564

Entertainment Tonight “Ramy Youssef Jokes ‘I Know You Guys Haven’t Seen My Show’ After First Golden Globe Win” by Myeisha Essex (January 5th 2020) 565

Esquire “The Best, Worst, and Most Empowering Moments of the 2018 Golden Globes” by Jake Kring-Schreifels (January 8th 2018)

566

Hollywood Reporter “Golden Globes: ‘Thelma & Louise’ Stars Susan Sarandon, Geena Davis Reunite Onstage” by Meena Jang (January 7th 2018) 567 USA

Today “Natalie Portman savages the Golden Globes’ ‘all-male nominees’ for best director” by Maeve McDermott (January 7th 2018) 568

Entertainment Weekly “NBC apologizes for tweet calling Oprah ‘our future president’” by David Canfield (January 8th 2018) 569 The

New Yorker “The 2018 Golden Globes: Oprah Leads a Decisive Feminist Takeover” by Michael Schulman (January 8th 2018) 570

Los Angeles Times “Ellen DeGeneres accepts Carol Burnett Award at Golden Globes” by Greg Braxton (January 5th 2020) 571

NBC News “Golden Globes will serve plant-based meal at awards ceremony to raise environmental awareness” via Associated Press (January 3rd 2020) 572

Variety “Joaquin Phoenix Made the Golden Globes Go Vegan” by Meg Zukin and Ramin Setoodeh (January 5th 2020) 573

Business Insider “Sacha Baron Cohen satirically described Facebook CEO Mark Zuckerberg as a ‘naive, misguided child who spreads Nazi propaganda’” by Isobel Asher Hamilton (January 6th 2020) 574

Washington Post “‘Your product is defective’: Sacha Baron Cohen slams Facebook for allowing hate speech” by Katie Shepherd (November 22nd 2019) 575

Hollywood Reporter “Michelle Williams Delivers Empowering Acceptance Speech on Women’s Rights at Golden Globes” by Katherine Schaffstall (January 5th 2020) 576

New York Times “Jimmy Kimmel’s Oscars Opening Monologue” by Giovanni Russonello (February 26th 2017) 577

Tampa Bay Times “Coming-of-age love story ‘Call Me By Your Name’ is a rare treasure” by Steve Persall (January 11th 2018) 578

The Hill “Kimmel: We make films like ‘Call Me By Your Name’ to upset Mike Pence” by Morgan Gstalter (March 4th 2018) 579

Jimmy Kimmel at 2018 Oscars

580

Slate “Tiffany Haddish and Maya Rudolph Reassure America That The Oscars Are Still Pretty White” by Rachel Withers (March 4th 2018) 581

Ibid.

582

ABC News “Lupita Nyong’o, Kumail Nanjiani at the Oscars: ‘To all the Dreamers ... we stand with you’” by Emily Shapiro (March 4th 2018) 583 Vibe

“Oscars 2018: Andra Day and Common Celebrate Unsung Heroes During ‘Stand Up For Something’ Performance” by Christine Imarenzor (March 4th 2018) 584

Washington Post “Syrian refugee girl gets star treatment at the Oscars” by Christina Barron (March 5th 2018) 585 NBC

News “Aleppo Twitter Star Bana al-Abed Asks Trump to ‘Save’ Syria’s Children” by Mark Hanrahan and Ammar Cheikh Omar (January 25th 2017) 586

Variety “Here Are the 10 Activists Who Shared the Oscars Stage With Common and Andra Day” by Shirley Halperin (March 4th 2018) 587

USA Today “Mexico had great night at the Oscars. President Trump still tweeted smear” by Maria Puente (March 5th 2018) 588

The Hill “Maya Rudolph hits Trump at Oscars: ‘Mexico is not paying for the wall’” by Judy Kurtz (February 24th 2019) 589

Washington Post “Trending: Kevin Hart is out as Oscars host” by Briana R. Ellison (December 9th 2018) 590

Hollywood Reporter “Oscars: Read Spike Lee’s Powerful Political Acceptance Speech” by Jasmyne Bell (February 24th 2019) 591

The Hill “The Oscars acknowledged the indigenous land Hollywood sits on” by Anagha Srikanth (February 10th 2020) 592

Newsweek “Janelle Monae’s Oscars Performance Channels Mr. Rogers, Calls Out Lack of Diversity in Opening Number” by Samuel Spencer (February 10th 2020) 593

Washington Post “Oscar-winning ‘Hair Love’ director calls attention to efforts to ban race-based hair discrimination” by Jenna McGregor (February 10th 2020) 594

New York Post “Karl Marx gets shoutout during Barack Obama-produced film’s 2020 Oscars speech” by Tamar Lapin (February 9th 2020) 595

The Hill “Joaquin Phoenix makes impassioned plea for animal rights in Oscars speech” by Judy Kurtz (February 9th 2020) 596

The New York Times “The Oscars Will Add a Diversity Requirement for Eligibility” by Nicole Sperling (June 12th 2020) 597

Christianity Today “Katy Perry satanic performance of ‘Dark Horse’ at Grammys called demonic glorification by Glenn Beck” by Serena McGill (January 29th 2014)

598

Wall Street Journal “Nicki Minaj Defends ‘Roman Holiday’ Grammy Performance” by Lyneka Little (February 4th 2012) 599 MTV

“Lady Gaga Emerges from Egg to Perform ‘Born this Way’ at the Grammys (Jocelyn Vena (February 13th 2011) 600

New York Times “Stars Align for Gay Marriage Anthem” by James McKinnley Jr. (June 30th 2013) 601 The

Hollywood Reporter “Grammys: Macklemore and Madonna Perform ‘Same Love’ As 33 Couples Wed Live on Air” by Debbie Emery (January 26th 2014) 602

W Magazine “2017 Grammys: Jennifer Lopez Made a Moving Political Statement at the Award Ceremony” by Lynsey Eidell (February 12th 2017) 603

Hollywood Reporter “Grammys: Read the Lyrics of James Corden’s Opening Rap Number” by Lexy Perez (February 12th 2017) 604

The Hollywood Reporter “Grammys: Busta Rhymes Refers to Trump as ‘President Agent Orange’ During A Tribe Called Quest Performance” by Ryan Parker (February 12th 2017) 605

People Magazine “James Corden Jokes in Opening Monologue About Being the ‘Least Diverse Host in Grammys History’” by Jeff Nelson (January 28th 2018) 606

Mediaite “Dave Chappelle Interrupts Kendrick Lamar’s Grammy Performance With Joke About Race in America” by Rachel Dicker (January 28th 2018) 607

Politico “Hillary Clinton reads from ‘Fire and Fury’ at Grammys” by Brent D. Griffiths (January 28th 2018) 608

Vanity Fair “Michelle Obama Made a Surprise Visit to the 2019 Grammys” by Erin Vanderhoof (February 11th 2019) 609

Billboard “Childish Gambino’s ‘This Is America’ Becomes First Rap Song to Win Record of the Year Grammy” by Tatiana Cirisano (February 11th 2019) 610

Newsweek “Alicia Keys References Trump’s Impeachment, Tells President to ‘Get Out’ and Cardi B to Enter Politics at Grammys” by Christian Zhao (January 26th 2020) 611

MRCtv.org “Billy Porter ‘Ladies and Gentleman and Those Who Have Yet To Make Up Their Minds’” by Rachel Peterson (January 27th 2020) 612

Hollywood Reporter “An Epic Performance and 2 Wins: Lil Nas X’s Big Night at the Grammys” by Evan Real (January 26th 2020) 613

Hollywood Reporter “Grammys: Michelle Obama Wins Best Spoken Word Album for ‘Becoming’” by Katie Kilkenny (January 26th 2020)

614

ABC News “Taylor Swift breaks her political silence, endorses Democrats in passionate post on midterm elections” by Deena Zaru (October 8th 2018) 615 Time

“Moonlight Stars Dedicate MTV Best Kiss Award to ‘Those Who Feel Like the Misfits’” by Megan McCluskey (May 8th 2017) 616

MTV “Love, Simon’s Keiynan Lonsdale Accepts Best Kiss Award with a Magical Speech” by Crytal Bell (June 18th 2018) 617 Variety

“The MTV Movie & TV Awards: A New Gender Revolution?” by Owen Gleiberman (May 7th 2017) 618

https://en.wikipedia.org/wiki/Asia_Kate_Dillon

619

Time “‘Social Forces Change Language.’ Merriam-Webster Adds Gender-Neutral Pronouns to Dictionary” by Suyin Haynes (September 17th 2019) 620

Washington Post “Emma Watson takes first major gender-neutral movie award” by Travis M. Andrews (May 8th 2017) 621

Entertainment Weekly “Vin Diesel pays tribute to Paul Walker as Fast & Furious wins MTV Generation Award” by Derek Lawrence (May 7th 2017) 622

Variety “VMAs 2018: Logic Wears ‘F— the Wall’ Shirt in Bold Statement on Immigration” by Rachel Yang (August 20th 2018) 623

The Daily Beast “MTV VMAs Unite Heather Heyer’s Mom and Robert E. Lee’s Descendant Against Racism” by Matt Wilstein (August 28th 2017) 624

Ibid.

625

The Hollywood Reporter “Taylor Swift Promotes Equality Act During 2019 VMAs Performance” by Katherine Schaffstall (August 26th 2019) 626

Forbes “What Is The Equality Act And What Will Happen If It Becomes A Law?” by Eric Bachman (May 30th 2019) 627

The Hill “Workers can’t be fired for being gay or transgender, Supreme Court rules” by Harper Neidig (June 15th 2020) 628

Digital Spy “How Star Wars: Episode VIII could break Hollywood’s final taboo” by Al Horner (December 23rd 2015) 629

The Guardian “A Force for good: why the Last Jedi is the most triumphantly feminist Star Wars movie yet” by Anna Smith (December 18th 2017)

630

The Guardian “Star Wars is a game-changer, awakening the feminist force in little girls everywhere” (December 29th 2015) 631 NBC

News “‘Rogue One: A Star Wars Story’ Diversity a Selling Point” by Adam Howard (August 13th 2016) 632

NME “George Lucas ‘felt betrayed’ by Disney’s plans for ‘Star Wars’ sequel trilogy” by Sam Moore (September 24th 2019) 633 Business

Insider “George Lucas says he sold ‘Star Wars’ to ‘white slavers’” by Jason Guerrasio (December 31st 2015) 634

New York Post “Why ‘Mad Max: Fury Road’ is the feminist picture of the year” by Kyle Smith (May 14th 2015) 635

The Guardian “How Incredibles 2 goes to work for the feminist superhero” by Anna Smith (June 28th 2018) 636

Bustle “‘Incredibles 2’ Has A Feminist Message That Couldn’t Be More Timely” by Ashley Rey (June 6th 2018) 637

Ibid.

638

Metro UK “Bird Of Prey’s Ewan McGregor is proud to be part of the ‘feminist film that tackled misogyny’” by Zara Woodcock (January 30th 2020) 639

CinemaBlend.com “Ewan Mcgregor Calls Birds Of Prey A ‘Feminist Film’” by Corey Chichizola (October 10th 2019) 640

Salon.com “‘Birds of Prey’ is a fantabulous, feminist grenade” by Mary Elizabeth Williams (February 8th 2020) 641

Digital Spy “Birds of Prety does feminism in a way Endgame never could” by Gabriella Geisinger (June 2nd 2020) 642

ABC News “‘Ghostbusters’ Star Leslie Jones Quits Twitter After Online Harassment” by Luchina Fisher and Brian McBride (June 20th 2016) 643

Forbes “‘Ghostbusters’ Brand Crosses The (Revenue) Streams For Halloween” by Simon Thompson (July 17th 2019) 644

Fox News “‘Ghostbusters’ reboot director faces sexism accusations for saying he’s handing the film ‘back to the fans’” by Joseph A. Wulfsohn (February 21st 2019) 645

IndieWire “Tim Miller Says ‘Terminator: Dark Fate’ Will ‘Scare the F*ck’ Out of Misogynistic Internet Trolls” by Zack Sharf (July 10th 2019)

646

Variety “Box Office Bomb: ‘Terminator: Dark Fate’ Could Lose Over $100 Million” by Rebecca Rubin (November 3rd 2019) 647 Hollywood

Reporter “‘Terminator: Dark Fate’ Puts Franchise on Ice, Faces $120M-Plus Loss” by Pamela McClintock (November 3rd 2019) 648

IndieWire “Sandra Bullock and Cate Blanchett Second Brie Larson in Championing More Diversity Among Film Critics” by Jenna Marotta (June 15th 2018) 649 Deadline

“‘Hobbs’ Hauls $25M; ‘Scary Stories’ Frighten ‘Dora’; ‘Kitchen’ Sinks Melissa McCarthy & Tiffany Haddish To Career B.O. Lows – Sunday Final” by Anthony D’Alessandro (August 11th 2019) 650

Hollywood Reporter “‘Doogie Howser’ Reboot in the Works at Disney+” by Rick Porter (April 8th 2020) 651

Entertainment Weekly “Margot Robbie set to star in new Pirates of the Caribbean movie” by Nick Romano (June 26th 2020) 652

The Sun “INDIANA JOANS - Ready Player One director Steven Spielberg says it’s time for a woman to play Indiana Jones” (by Grant Rollins (April 3rd 2018) 653

Entertainment Weekly “Vin Diesel says a female Fast & Furious spin-off is coming, so here are some we’d love to see” by Derek Lawrence (January 24th 2019) 654

Washington Times “‘Dunkirk’ review in USA Today warns ‘no lead actors of color’ in WWIIinspired film” by Douglas Ernst (July 19th 2017) 655

https://seejane.org/about-us/

656

Hollywood Reporter “Geena Davis Unveils Partnership With Disney to ‘Spellcheck’ Scripts for Gender Bias (by Patrick Brzeski (October 10th 2019) 657

The New Republic “Cleaning: The Final Feminist Frontier” by Jessica Grose (March 18th 2013)

658

Forbes “What Amy Schumer And Bud Light Have To Say About Marketplace Inequality” by Ian Ayres (August 15th 2016) 659

New York Post “Bud Light abruptly pulls Amy Schumer, Seth Rogen ads” via Fox News (November 1st 2016) 660

CNBC “The big problem with Bud Light’s new commercial” by Sarah Whitten (June 30th 2016)

661

ABC News “Burger King raises awareness of the pink tax with ‘Chick Fries’ that cost $1.40 more” (July 28th 2018)

662

Wall Street Journal “Audi’s Super Bowl Ad on Gender Pay Gap Faces Criticism” by Alexandra Bruell (February 2nd 2017) 663 Ibid. 664

Men’s Health “Secret Deodorant’s Super Bowl Ad Contains a Powerful Message About Gender Equality” by Philip Ellis (January 31st 2020) 665 UnstereotypeAlliance.org

“About the Unstereotype Alliance”

666

The Federalist “In Flight of Idiocy, Diamond Ad Tells Women to Propose to Men (by David Marcus (November 19th 2018) 667

US Weekly “Amy Schumer Is Reportedly in Talks to Star in Live-Action Barbie Movie” by Stephanie Webber (December 2nd 2016) 668

Variety “Amy Schumer Drops Out of ‘Barbie’ Movie” by Justin Kroll (March 23rd 2017)

669

Time Magazine’s 2013 List of Most Influential People

670

Breitbart “Lena Dunham Celebrates Gaining 24 Pounds” by Ben Kew (July 11th 2018)

671

Breitbart “Lena Dunham Posts Lingerie Photo to Celebrate Weighing ‘The Most I Ever Have’” by Justin Caruso (February 27th 2019) 672

ET Online “Lizzo Poses Fully Nude in Racy Instagram Photos and Video” by Paige Gawley (December 2nd 2019) 673

Page Six “Lizzo’s bikini and matching face mask balance safety with sex appeal” by Elana Fishman (May 25th 2020) 674

Entertainment Weekly “‘Fat Monica’ is the ghost that continues to haunt Friends 25 years later” by Clarkisha Kent (September 4th 2019) 675

The Revelist “The 8 most fat-phobic movies in Hollywood, ranked by awfulness” by Lauren Gordon (October 3rd 2016) 676

Slate “Fat-E: The new Pixar movie goes out of its way to equate obesity with environmental collapse” by Daniel Engber (July 10th 2008) 677

Ibid.

678

The Telegraph “WALL-E's ‘fattist’ satire angers fat pride groups” by Tim Shipman and Rowena Mason (July 12th 2008) 679

CNN “The food that can feed, and maybe save, the planet: Bugs” by Sandee LaMotte (October 25th 2019)

680

USA Today “Victoria’s Secret just got its first plus-sized model: ‘It felt surreal’” by Rasha Ali (October 8th 2019) 681 The

New York Times “Victoria’s Secret Casts First Openly Transgender Woman as a Model” by Christine Hauser (August 5th 2019) 682

Los Angeles Times “Valentina Sampaio makes history as first transgender Victoria’s Secret model” by Christi Carras (August 5th 2019) 683 New

York Post “Abercrombie tries to redeem its body-shaming past with inclusive ad campaign” by Melkorka Licea (February 6th 2020) 684

The Cut “Now, This Is a Supermodel. Ashley Graham isn’t a sample size. Which is exactly why she’s become the face of a movement” by Jada Yuan (August 6th 2017) 685

USA Today “NFL cheerleading is demeaning to women. It’s time to end this nonsense” by Tom Krattenmaker (August 9th 2018) 686

New York Daily News “Mattel remakes Barbie dolls to include a curvy body type” by Nicole Lyn Pesce (January 28th 2016) 687

https://twitter.com/sofiehagen/status/903706367646687232

688

The Atlantic “Americans Have No Idea How Few Gay People There Are” by Garance FrankeRuta May 31st 2012) 689

Gallup “Americans Still Greatly Overestimate U.S. Gay Population” by Justin McCarthy (June 27th 2019) 690

Psychology Today “When Homosexuality Stopped Being a Mental Disorder” by Neel Burton (September 18th 2015) 691

Gay Community News “Gay Revolutionary” by Michael Swift (February 15th 1987)

692

After the Ball: How America Will Conquer its Fear and Hatred of Gays in the 90s by Marshall Kirk and Hunter Madsen (1989 Doubleday) 693

Washington Post “Biden: Jewish leaders helped gay marriage succeed” by Rachel Weiner (May 22nd 2013) 694

Newsweek “Sex Offender Busted as Drag Queen Who Read Books To Children in City Library” by Scott McDonald (March 16th 2019) 695

Pink News “Republican Lawmakers Want to Make Child Drag Shows Illegal” by PinkNews Staff Writer (April 22nd 2019)

696

New York Times “Chick-fil-A Thrust Back Into Spotlight on Gay Rights” by Kim Severson (July 25th 2012) 697 In

CNN’s “The Nineties” miniseries in episode 1 “The One About TV Part 2”

698

Ibid.

699 NBC

News “In a first, transgender woman competes in Miss Universe competition” by Tim Frizsimons (December 17th 2018) 700

CNN “Valentina Sampaio becomes Sports Illustrated's first trans model” by Kiely Westhoff (July 13th 2020) 701

BuzzFeed “Luke Grimes Left ‘True Blood’ Because He Refused To Play Gay” by Louis Peitzman (June 25th 2015) 702

New York Daily News “‘True Blood’ star Nelsan Ellis on Luke Grimes quitting show because he didn't want to play gay: ‘I’m over him’” by Kirthana Ramisetti (July 24th 2014) 703

NBC News “‘Abby’s,’ 2nd network sitcom with a bisexual lead, premieres” by Gwen Aviles (March 28th 2019) 704

Washington Examiner “AOC backs drag queen ‘patriots’ to ‘push society forward’” by Spencer Neale (April 11th 2020) 705

Vanity Fair “Is this the one flaw in the otherwise great Captain America: Civil War?” by Joanna Robinson (May 9th 2016) 706

Ibid.

707

The Washington Times “‘Black Panther’ packed with action, diversity -- but no gays” by Bradford Richardson (February 20th 2018) 708

Washington Times “GLAAD report condemns Hollywood for decline in LGBT representation on big screen” by Bradford Richardson (May 23rd 2018) 709

The Daily Mail “‘The sexual tension is always there’: Gal Gadot teases potential romance between her character and Kristen Wiig’s villain Cheetah in Wonder Woman 1984” by Roxy Simons (May 30th 2020) 710

Entertainment Weekly “The Eternals will feature Marvel’s first onscreen LGBTQ kiss: ‘It’s a beautiful, very moving kiss’” by Sydney Bucksbaum (February 15th 2020) 711

NBC News “Transgender character coming to Marvel Cinematic Universe, studio president suggests” by Gwen Aviles (January 2nd 2020)

712

NBC News “Tessa Thompson’s Valkyrie to become Marvel Studios’ first LGBTQ superhero” by Alexander Kacala (July 22nd 2019) 713 The

Hollywood Reporter “Ruby Rose to Play Lesbian Superhero Batwoman for The CW” by Lesley Goldberg (August 7th 2018) 714

Newsweek “‘Batwoman’ Officially Comes Out on the CW Show: Ruby Rose ‘Cried’ While Reading the Script” by Samuel Spencer 1-20-2020) 715 The

Hollywood Reporter “‘Batwoman’ Boss Goes Inside That Historic Reveal”by Shannon O’Connor (January 19th 2020) 716

Shadows of the Bat: The Cinematic Saga of the Dark Knight Part 6-Batman Unbound (2005) Warner Home Video 717

ABC - Barbara Walters Interview (2006)

718

New York Post “DC Comics Green Lantern relaunched as gay superhero” by Dareh Gregorian (June 1st 2012) 719

The Washington Times “Catwoman comes out as bisexual in new DC comic” by Jessica Chasmar (March 1st 2015) 720

The Sun “SASSY SPIDEY Tom Holland hints there will be a gay Spider Man in the next few years” by Carl Greenwood (June 30th 2019) 721

We Got This Covered “Sony Reportedly Wants To Introduce A Bisexual Spider-Man” by Christian Bone (February 11th 2020) 722

Entertainment Weekly “Andrew Garfield on Spider-Man’s sexuality: ‘Why can't he be gay?’” by Sara Vilkomerson (July 10th 2013) 723

Vanity Fair “‘Of Course’ Luke Skywalker Is Gay, Confirms Mark Hamill, Echoing Thousands of Fan-Fiction Prayers” by Charles Bramesco (March 5th 2016) 724

BuzzFeed “Why LGBT Representation Didn’t Make It Into ‘The Last Jedi’” by Adam B. Vary (December 18th 2017) 725

Ibid.

726

Ibid.

727

Ibid.

728

Pink News “Oscar Isaac wishes Star Wars’ Poe and Finn were in a gay relationship but ‘people are too afraid’” by Emma Powys Maurice (December 4th 2019)

729

New York Post “‘Star Wars: The Rise of Skywalker’ has a same-sex kiss – but not the one fans hoped for” by Eric Hegedus (December 19th 2019) 730 E!

News “Disney Channel Introduces Its First Lesbian Couple on Good Luck Charlie” by Alyssa Toomey (January 28th 2014) 731

New York Times “Waiting for Disney’s First Gay Teenager” By KJ Dell’Antonia (February 27, 2014) 732 Breitbart

“ABC Family’s ‘The Fosters’ Airs Youngest-Ever Gay Kiss Between Two 13-Year-Old Boys” by Kipp Jones (March 4th 2015) 733

BuzzFeed “This May Be The Youngest Ever Same-Sex Kiss On US TV” by Lane Sainty (March 2nd 2005) 734

The Guardian “Beauty and the Beast to feature first ‘exclusively gay moment’ in a Disney movie” by Catherine Shoard (March 1st 2017) 735

Entertainment Weekly “Disney XD gets a male princess in Star vs. the Forces of Evil” by Nick Romano (November 22nd 2017) 736

Huffington Post “Disney Sends Beautiful Message With First ‘Boy Princess,’ Complete With Chest Hair” by Noah Michelson (November 22nd 2017) 737

Teen Vogue “Disney Just Aired its First Same-Sex Cartoon Kiss” by Brittney McNamara (February 27th 2017) 738

Gay Times “Toy Story 4 has a small but important moment of LGBTQ representation” by Daniel Megarry (June 26th 2019) 739

Newsweek “Comedian Jack Whitehall to Play Disney’s First-Ever Openly Gay Character in ‘Jungle Cruise’ by Dory Jackson (August 13th 2018) 740

Yahoo! “‘Onward’ introduces the first LGBTQ character in Disney animation history” by Ethan Alter (February 21st 2020) 741

NBC News “New short film ‘Out’ features Pixar’s first gay main character” by Gwen Aviles (May 22nd 2020) 742

CNN “Disney confirms its first bisexual lead character, who is also multi-cultural” by Adrianne Morales (August 15th 2020) 743

New York Post “‘The Owl House’ becomes Disney’s first show with bisexual lead character “ by Lee Brown (August 16th 2020) 744

Hornet “‘Sesame Street’ Celebrates Pride Month, But How LGBTQ-Friendly Is the Show?” by Daniel Villarreal (June 27th 2017)

745

NBC News “Bert and Ernie are indeed a gay couple, ‘Sesame Street’ writer claims” by Kalhan Rosenblatt (September 18th 2018) 746 The

Washington Post “‘They remain puppets’: ‘Sesame Street,’ once again, shuts down speculation over Bert and Ernie’s sexual orientation” by Elahe Izadi (September 19th 2018) 747

Entertainment Weekly “Arthur season premiere reveals Mr. Ratburn is gay” by Tyler Aquilina (May 13th 2019) 748 CBN

News “‘Clifford the Big Red Dog’ Becomes Second PBS Kid Series to Feature LGBT Character” by Steve Warren (February 28th 2020) 749

The Daily Caller “Kids’ Networks Celebrate Transgender People Through #TransDayOfVisibility” by Mary Margaret Olohan (March 31st 2020) 750

Seattle Times “Does ‘Mrs. Doubtfire’ at The 5th Ave transcend the original’s problematic elements?” by Seattle Times Staff (December 20th 2019) 751

BuzzFeed “25 Years Of Transphobia In Comedy” by Meredith Talusan (February 27th 2016)

752

This quote was included in the original article published by Variety titled “10 Problematic Films That Could Use Warning Labels” by Tim Gray (June 17th 2020) but was later removed because it insinuates that transgenderism is a mental illness. The Internet Archive Wayback Machine has the original article saved and can be viewed at https://web.archive.org/web/20200618004648/https://variety.com/2020/film/news/gone-with-thewind-problem-films-forrest-gump-1234640666/ 753

Slate “When Gays Decried Silence of the Lambs , Jonathan Demme Became an Early Student of Modern Backlash” by Jeffrey Bloomer (April 28th 2017) 754

CNN “‘Family Guy’ phasing out gay jokes” by Lisa Respers (January 2019)

755

Politifact “Why Infowars’ Alex Jones was banned from Apple, Facebook, Youtube and Spotify” by Manuela Tobias (August 7th 2018) 756

Associated Press “NY Library Brings Drag Queens to Kids Story Hour” Video posted on official AP Archive YouTube channel (May 21st 2017) 757

Lifesite News “WATCH: Drag queen teaches kids to ‘twerk’ at library story hour” by Calvin Freiburger (August 7th 2019) 758

Media Research Center “Good Morning America Devotes a Whole Segment to a Child Drag Queen” by Ferlon Webster Jr. (November 19th 2018) 759

The Advocate “Meet 8-Year-Old Drag Queen Lactatia” by Neal Boverman (May 6th 2017)

760

HuffPost “Meet The ‘Drag Kids’ Who Want To Slay The World And Then Some” by Curtis M. Wong (October 24th 2019) 761 Newsbusters

“Sick: RuPaul’s New Drag Queen Dramedy Sexualizes 10-Year-Old Child as a ‘Top’” by Elise Ehrhard (January 13th 2020) 762

NPR “‘Dancing Queen’: Alyssa Edwards Doesn't Let Dance Moms Drag Her Down” by Glen Weldon (October 11th 2018) 763 The

Verge “Twitter has banned misgendering or ‘deadnaming’ transgender people” by Adi Robertson (November 27th 2018) 764

E! News “Why Charlize Theron Decided to Speak Out About Raising Two Daughters” by Jess Cohen (December 17th 2019) 765

OK Magazine “Shiloh Jolie-Pitt ‘Only Wears Boys’ Clothes’ After Questioning Gender Identity To Brad & Angelina” (August 4th 2016) 766

Today “Megan Fox opens up about letting her 6-year-old son wear dresses” by Ree Hines (September 20th 2019) 767

Teen Vogue “Megan Fox’s Son Wore a Frozen Dress Again in Spite of Critics” by Alyssa Hardy (October 5th 2017) 768

The Independent “Adele letting her son dress as Disney princess Anna is a triumph for us believers in gender-neutral parenting” by Siobhan Freegard (February 19th 2016) 769

HuffPost “Liev Schreiber’s Son Dressed As Harley Quinn, And the Internet Inevitably Reacted” by Isabelle Khoo (July 25th 2017) 770

NBC News “Mario Lopez’s comments about transgender kids aren’t just dumb. They’re dangerous.” by Chase Strangio (August 1st 2019) 771

LGBTQ Nation “The new normal: Gay couple featured in Tide TV commercial” (December 14th 2014) 772

Huff Post “J.C. Penney and Gap’s Gay-Themed Ads Seek Profit With Progress” by Ron Dicker (May 17th 2012) 773

Huffington Post “This Campbell’s Soup Ad Featuring Gay Dads Will Melt Your Heart” by Curtis M. Wong (10-6-2015) 774

NewsBusters “Dove Ad Features Transgender Mom: ‘No One Right Way’” by Sarah Stites (April 12th 2017) 775

CBS News “New Gillette ad shows dad teaching transgender son how to shave” by Aimee Picchi (May 29th 2019)

776

Daily Caller “Starbucks Partners With Trans Children Charity, Releases Ad On Calling Transgender Youth By Preferred Pronouns” by Marty Margaret Olohan (February 5th 2020) 777 Daily

Beast “Why Coke’s Non-Binary Super Bowl Moment Mattered” by Samantha Allen (February 5th 2018) 778

The commercial is titled “Late-Night Driver” and can be seen on YouTube and elsewhere.

779 Forbes

“Behind The Scenes Of Smirnoff’s New ‘Hang Out From Home For America’ Campaign With Laverne Cox” by Emily Price (April 24th 2020) 780

Newsweek “These 50+ Brands Are Celebrating Pride by Giving Back to the LGBT Community” by Daniel Avery (June 3rd 2019) 781

USA Today “How retailers have turned Pride month into a marketing, sales bonanza” by Verena Dobnik via Associated Press (June 23rd 2019) 782

PJ Media “Creepy New Sprite Commercial Sells Transgenderism and Breast Binding, Not Soda” by Megan Fox (November 18th 2019) 783

The Guardian “Actor Terry Crews: I was sexually assaulted by Hollywood executive” by Gwilym Mumford (October 11th 2017) 784

Vanity Fair “James Van Der Beek Reveals His Own Experience of Sexual Harassment” by Hilary Weaver (October 12th 2017) 785

Vanity Fair “‘I Was Terrified, and I Was Humiliated’: #MeToo’s Male Accusers, One Year Later” by Laura Bradley (October 4th 2018) 786

Newsweek “Terry Crews Threatens to ‘Slap’ D.L. Hughley for Mocking His Sexual Assault Allegation” by Dory Jackson (January 28th 2019) 787

VLADTV “Fat Joe thinks the Gay Mafia Controls Hip-Hop” (November 7th 2011)

788

Washington Times “‘Gay’ rape in military underreported by Pentagon” by Rowan Scarborough (November 3rd 2015) 789

U.S Army S.H.A.R.P (Sexual Harassment / Assault Response & Prevention report “What We Know About Sexual Assault of Military Men” 790

Sky News “Adopted Boy Sexually Abused by Gay Fathers” (July 3rd 2013)

791

The Telegraph “Gay couple arrested for abusing foster children” by Paul Stokes (June 24th 2006)

792

Australian Broadcast Network “Australian paedophile Peter Truong jailed for 30 years in US after trafficking adopted son to Boy Lovers Network” (December 9th 2013)

793

USA Today “Anderson Cooper proudly announces the birth of his son Wyatt: ‘I am a dad. I have a son’” by Cydney Henderson (April 30th 2020) 794 CBS

News “Is there a ‘gay gene’? Major new study says no” by Dennis Thompson (August 29th

2019) 795

The Telegraph “‘Gay gene’ ruled out as huge study shows environment is major factor in homosexuality.” by Sarah Knapton (August 29th 2019) 796 PBS

“There is no ‘gay gene.’ There is no ‘straight gene.’ Sexuality is just complex, study confirms” (August 29th 2019) 797

Psychology Today “Why Is Transgender Identity on the Rise Among Teens?” by Samuel Paul Veissiere Ph.D. (November 28th 2018) 798

Basic Freud: Psychoanalytic Thought for the 21st Century by Michael Kahn, Ph.D page 77 - on the negative resolution of the Oedipus complex (2002 Basic Books) 799

Sci Tech Daily “Homosexuality Might Develop in the Womb Due to Epigenetic Changes” (December 12th 2012) 800

Science Magazine “Homosexuality may be caused by chemical modifications to DNA” by Michael Balter (October 8th 2015) 801

Evolutionary Psychology Science (2017) “Social Epistasis Amplifies the Fitness Costs of Deleterious Mutations, Engendering Rapid Fitness Decline Among Modernized Populations” by Michael A. Woodley, Matthew A Sarraf, Radomir Pestow, and Heitor B.F. Fernandes 802

Of Mice and Men: Empirical Support for the Population-Based Social Epistasis Amplification Model by Matthew Alexander Sarraf and Michael Anthony Woodley (National Institute of Health 2017) 803

The Journal of Offender Rehabilitation “The Genesis of Pedophilia” by J. Paul Fedoraff and Shara Pinkus pages 85-101 (Volume 23, 1996) 804

Dictionary.com definition of “phobia”: a persistent, irrational fear of a specific object, activity, or situation that leads to a compelling desire to avoid it. (2020) 805

Adam Carolla - In 50 Years We’ll All Be Chicks page 12 (Crown Archetype 2012)

806

TVtropes.org “Sleeping Single”

807

Mental Floss “16 Things You Might Not Know About The Brady Bunch” by Kara Kovalchik (February 25th 2016) 808

Forbes “Hollywood’s Highest-Paid TV Actors” by Dorothy Pomerantz (October 11th 2011)

809

CNN “‘Fifty Shades of Grey sex toys hit stores like Target” by Katie Lobosco (February 3rd 2015) 810 Hollywood

Reporter “Death in a Hollywood Sex Dungeon: How a Top Agency Executive’s ‘Mummification’ Ritual Ended in Tragedy” by Seth Abramovitch (June 29th 2018) 811

Page Six “S&M-loving Hollywood exec keeps job after man dies in his sex dungeon” by Richard Johnson (June 29th 2018) 812 New

York Times “R. Kelly’s Two-Decade Trail of Sexual Abuse Accusations” by Jacey Fortin (May 10th 2018) 813

The Guardian “Fashion photographer Terry Richardson accused of sexually exploiting models” by Caroline Davies (March 19th 2010) 814

MTV “Lady Gaga Gives a Lesson On ‘Chemistry’ with R. Kelly in ‘Do What U Want’ Video” by Jocelyn Vena (November 11th 2013) 815

Hollywood Reporter “Nicki Minaj Performs ‘Super Bass’ With YouTube Star Sophia Grace” by Erika Ramirez (October 12th 2011) 816

USA Today “Nicki Minaj’s brother Jelani Maraj sentenced to 25 years to life for raping 11-yearold” by Cydney Henderson (January 27th 2020) 817

New York Post “Husband cheered on Hogan during sex-tape romps with wife” by Kathianne Boniello and Laura Italiano (March 20th 2016) 818

Deadline “HGTV’s House Hunters Breaks New Ground With Its First Throuple Exploration” by Bruce Haring (February 13th 2020) 819

New York Post “Rep. Katie Hill resigns amid snowballing ‘throuple’ scandal” by Marisa Schultz and Kenneth Garger (October 27th 2019) 820

Newsbusters “Now Even Network Sitcoms Have ‘Throuples:’ ABC Comedy on Polyamory: ‘It Just Works!’” by Elise Ehrhard (January 15th 2020) 821

Newsbusters “Gay Psychiatrist on ‘New Amsterdam’ Pushes Incest” by Karen Townsend (February 26th 2020) 822

Fox News “‘The Notebook’ director Nick Cassavetes says of incest: ‘Who gives a damn?’” (September 10th 2012) 823

The Cinemaholic “20 Best Incest Movies of All Time” by Vishnu Warrior (August 16th 2018)

824

Ranker “13 Steamiest Incestuous Relationships In Film” by Roger Nackerman (June 8th 2020)

825

ABC News “Mackenzie Phillips Confesses to 10-Year Consensual Sexual Relationship With Father” by Russell Goldman, Eileen Murphy, and Lindsay Goldwert (September 22nd 2009) 826 Fox

News “North Carolina father-daughter couple arrested for incest after having love child” (February 4th 2018) 827

Cosmopolitan “Girl describes what it was like to have sex with her dad” (February 19th 2015)

828 Cosmopolitan

“This is what it’s like to fall in love with your brother” by Asher Fogle (October

30th 2015) 829

The Guardian “Genetic sexual attraction” (May 16th 2003)

830

The Telegraph “Disgusted by incest? Genetic Sexual Attraction is real and on the rise” by Charlie Gill (September 9th 2016) 831

https://marriage-equality.blogspot.com/p/genetic-sexual-attraction.html

832

Daily Mail “Billionaire David Geffen, 69, splits from toyboy lover 41 years his junior after six years together” by Daniel Bates (February 21st 2012) 833

Daily Mail “David Geffen takes out restraining order against his ’20-year-old former college football player ex after ending affair’” by James Nye (December 29th 2014) 834

Daily Mail “Liberace’s ex-lover who wrote memoir ‘Behind the Candelabra’ is back behind bars after violating his probation and testing positive for meth in random drug test” by Ashley Collman (September 6th 2013) 835

Page Six “Sarah Paulson defends 32-year age gap with girlfriend Holland Taylor” by Francesca Bacardi (May 22nd 2018) 836

The Guardian “‘I wouldn’t want this for anybody’s daughter’: will #MeToo kill off the rock’n’roll groupie?” by Thea De Gallier (March 15th 2018) 837

Seinfeld FAQ: Everything Left to Know About the Show About by Nicholas Nigro Nothing (2015 Applause Theatre and Cinema Books) 838

New York Times “Woody Allen, Mia Farrow, Soon-Yi Previn, Dylan Farrow: A Timeline” by Sopan Deb and Deborah Leiderman (January 31st 2018) 839

Time “Study Finds Most Teens Sext Before They’re 18” by Randye Hoder (July 3rd 2014)

840

Daily Mail “Children ‘at risk of abuse’ because they’re copying Kim’s sexy selfies: Trend for imitating explicit images posted online by celebrities leaves young girls vulnerable to predators, experts warn” by Laura Cox (November 14th 2014)

841

People “Kim Kardashian Posts Topless Photo Taken by Daughter North West” by Brittany Talarico (February 8th 2018) 842 The

Telegraph “How porn is rewiring our brains” by Nisha Lilia Diu (November 15th 2013)

843

Ibid.

844 Vice

“Porn Is Still Allowed On Twitter” by Samantha Cole (November 3rd 2017)

845

BBC “‘I was raped at 14, and the video ended up on a porn site’” by Megha Mohan (February 10th 2020). 846

Ibid.

847

Newsweek “Florida Man Arrested After 58 Porn Videos, Photos Link Him To Missing Underage Teen Girl” by Scott McDonald (October 23rd 2019) 848

Breitbart “Nolte: Pornhub Under Fire for Allegedly Hosting Rape, Child Porn Videos” by John Nolte (February 10th 2020) 849

Teen Vogue “Sex Work is Real Work” by Dr. Tlaleng Mofokeng (April 26th 2019)

850

The Independent “Porn and video game addiction leading to ‘masculinity crisis’, says Stanford psychologist” by Doug Bolton (March 10th 2015) 851

ABC News Nightline “Actor Corey Feldman Says Pedophilia No. 1 Problem for Child Stars, Contributed to Demise of Corey Haim” By Steven Baker and David Wright (August 10, 2011) 852

Fox News “Corey Feldman’s tense Barbara Walters interview recirculates amid Harvey Weinstein scandal” (October 17th 2017) 853

Entertainment Weekly “Corey Feldman accuses Charlie Sheen of sexually abusing Corey Haim in (My) Truth documentary” by Rosy Cordero (March 10th 2020) 854

Ibid.

855

Vanity Fair “Corey Feldman on Abuse Allegations: ‘It’s All Connected to a Bigger, Darker Power’” by Yohana Desta (November 10th 2017) 856

Vanity Fair “Elijah Wood Says Hollywood Has a Pedophilia Problem” by Alex Stedman (May 23rd 2016) 857

CNN “Elijah Wood clarifies comments on pedophilia and Hollywood” by Lisa Respers (May 24th 2016) 858

The Hollywood Reporter “Hollywood Sex Abuse Film Revealed: Explosive Claims, New Figures Named (Exclusive)” by Gregg Kilday (November 12th 2014)

859

The Atlantic “Nobody Is Going to Believe You” by Alex French and Maximillian Potter (March 2019 Issue) 860 The

Hollywood Reporter “Bryan Singer Sex Abuse Case: The Troubling History Behind the Accusations” by Kim Masters and Jonathan Handel (April 30th 2014) 861

Los Angeles Times “Child sexual abuse cases in Hollywood attract attention” by Dawn C. Chmielewski (January 08, 2012) 862 Ibid 863

Ibid

864

Ibid

865

People “Bohemian Rhapsody Director Bryan Singer Accused of Sexually Assaulting Four Underage Boys” by Ale Russian (January 23rd 2019) 866

Variety “Bryan Singer Hit With Fresh Allegations of Sex With Underage Boys” by Gene Maddaus (January 23rd 2019) 867

The Federalist “A Timeline of the Many Sexual Assault Accusations Against Director Bryan Singer” by Paulina Enck (June 25th 2020) 868

Chicago Tribune “Bryan Singer Allegations Part of Upcoming Sex Abuse Documentary” by Ramin Setoodeh (April 18th 2014) 869

New York Magazine “Jeffrey Epstein’s Rolodex: A Guide to His Famous Friends and Acquaintances” by Adam K. Raymond and Matt Stieb (July 10th 2019) 870

Fox News “Jeffrey Epstein’s alleged ‘spy’ ties under fresh scrutiny in new book” by Hollie McKay (June 18th 2020) 871

Daily Mail “French government drops support for director Roman Polanski as he faces extradition to the U.S.” by Peter Allen (October 1st 2009) 872

Snopes “Did Meryl Streep Applaud Roman Polanski at the Academy Awards?” Rating: True (January 9th 2017) 873

CBS News “An Oscar Out Of Reach For Polanski” via the Associated Press (Marcy 24th 2003)

874

The Guardian “Polanski was not guilty of ‘rape-rape’, says Whoopi Goldberg” by MaevKennedy (September 29th 2009) 875

Time “Quentin Tarantino Defends Roman Polanski in Resurfaced Interview: 13-Year-Old Victim ‘Wanted to Have It’ by Cady Lang (February 7th 2018)

876

Ibid.

877 The

Independent “Polanski has served his time and must be freed” by Harvey Weinstein (September 28th 2009) 878

Indy Wire “Over 100 In Film Community Sign Polanski Petition” by Peter Knegt (September 29th 2009) 879 Rolling

Stone “Barbra Streisand Draws Criticism for Stance on Michael Jackson’s ‘Leaving Neverland’ Accusers” by Daniel Kreps (March 23rd 2019) 880

The Independent “It movie: How the book’s infamous orgy scene is handled and why Stephen King wrote the scene” by Jack Shepherd (September 10th 2017) 881

The Telegraph “Why the It movie left out Stephen King’s Losers’ Club sewer orgy” by Adam White (September 8th 2017) 882

SciFiNow Annual “Stephen King’s It: 25th Anniversary” (Vol. 2. 2015) pages 160–163

883

Mediaite “ABC News Changes Headline About Kevin Spacey After Spinning His ‘Emotional’ Coming Out” by Joseph A. Wulfsohn (October 30th 2017) 884

News.com.au “‘Over-indulgence, not predatory behaviour’: Hollywood CEO says Kevin Spacey deserves forgiveness” by Frank Chung (October 31st 2017) 885

Entertainment Weekly “Family Guy producers finally explain origin of 2005 Kevin Spacey joke” by Dan Snierson (January 4th 2018) 886

Hollywood Reporter “Seth MacFarlane Explains 2013 Oscars Jab at ‘Abhorrent, Indefensible’ Harvey Weinstein” by Ashley Lee (October 11th 2017) 887

USA Today “Kevin Spacey posts bizarre video suggesting you ‘kill people with kindness’” by Maria Puente (December 24th 2019) 888

Hollywood Reporter “Kevin Spacey Accuser Dies in Midst of Sexual Assault Lawsuit” by Eriq Gardner (September 18th 2019) 889

CBS News “Kevin Spacey accuser and writer Ari Behn dies by suicide” via Associated Press (December 26th 2019) 890

NBC News “Mass shootings: Experts say violence is contagious, and 24/7 news cycle doesn’t help” by Dennis Romero (August 5th 2019) 891

Time “Suicide Deaths Are Often ‘Contagious.’ This May Help Explain Why” by Jamie Ducharme (April 18th 2019)

892

Washington Post “Undercover police officers in theaters as Warner Bros.’ ‘Joker’ opens” by Steven Zetchik (October 4th 2019) 893 The

New York Post “It’s reasonable to ask if ‘Joker’ will inspire would-be killers” by Sara Stewart (September 24th 2019) 894

NBC News “‘Joker’ backlash: Aurora shooting victims’ families express concerns to Warner Bros.” by Daniel Arkin (September 24th 2019) 895 Washington

Post “Hinckley, Jury Watch ‘Taxi Driver’ Film” by Laura A. Kiernan (May 29th

1982) 896

The Hill “Investigation shows more than 100 copycat shooters inspired by Columbine since 1999” by Rachel Frazin (April 17th 2019) 897

The Guardian “Natural Born Copycats” by Xan Brooks (December 19th 2002)

898

NBC News “Robin Williams’ death followed by rise in suicides” by Maggie Fox (February 7th 2018) 899

Ibid.

900

NPR “Teen Suicide Spiked After Debut Of Netflix’s ‘13 Reasons Why,’ Study Says” by Matthew S. Schwartz (April 30th 2019) 901

New York Times “The Science Behind Suicide Contagion” by Margot Sanger-Katz (August 13th 2014) 902

Time “Fifty Shades of Grey Inspired Student’s Sexual Assault, Prosecutors Say” by Kevin McSpadden (February 24th 2015) 903

New York Daily News “Jamie Dornan says he’s scared of 'Fifty Shades of Grey’ fans: ‘I fear I'll get murdered like John Lennon’” by Kirthana Ramisetti (January 8th 2015) 904

Daily Mail “Revealed: How black robbers copied Ben Affleck film ‘The Town’ by disguising themselves as white cops with latex masks to snatch $200,000 from check-cashing store” (July 31st 2013) 905

ABC News “Thieves Dressed Like Nuns Rob Chicago Bank in Scene out of ‘The Town’” by Russell Goldman (May 31st 2011) 906

NBC New York “Teen Pleads Guilty to ‘Fight Club’-Inspired Starbucks Bombing” by Colleen Long (September 17th 2010) 907

Inside Edition “Was Suspect in Austin Explosions Inspired by Unabomber Miniseries?” (March 20th 2018)

908

Reuters “French police arrest over 100 after Halloween ‘Purge’ night riots” by Michael Roseand Catherine Lagrange (November 1st 2018) 909 USA

Today “Social media ‘Purge’ campaigns spark fear of bloody copycats” by Nindsay Deutsch, Kelsey Pape and Ryan Haarer (August 19th 2014) 910

The Irish Times “Student charged with murder amid concerns in France over violent films” (June 6th 2002) 911 Orlando

Sentinel “Inspired by Vampire Film, Man Stabs His Girlfriend” (November 30th 1994)

912

Chicago Tribune “Ex-gang member talks about rap music’s influence” by Dawn M. Turner (November 5th 2015) 913

NPR “Study: Rap Music Linked to Alcohol, Violence” (May 8th 2006)

914

“Dead People” by The Game on the album “Jesus Piece” (2012)

915

USA Today “Sheriff: Man acting out rap song fatally shoots friend” by J.D. Gallop via Florida Today (January 28th 2015) 916

Hawaii Tribune Herald “Nanawale murder suspect says Jay Z possessed his body” by John Burnett (October 10th 2015) 917

Spin “Jay-Z Asks Why XXXTentacion Died While George Zimmerman Lives on Drake’s ‘Talk Up’” by Israel Daramola (June 29th 2018) 918

A Concise Survey of Music Philosophy by Donald A Hodges page 111 (Routledge 2016)

919

Simple Psychology “Bobo Doll Experiment” by Sean McLeod (February 5th 2014)

920

CHILDREN, VIOLENCE, AND THE MEDIA: A Report for Parents and Policy Makers Senate Committee on the Judiciary, Senator Orrin G. Hatch, Utah, Chairman, Committee on the Judiciary, Prepared by Majority Staff Senate Committee on the Judiciary (September 14, 1999) 921

Fundamentals of Media Effects - Second Edition by Jennings Bryant, Susan Thompson, and Bruce W. Finklea page 74 (Waveland Press Inc. 2013) 922

Fundamentals of Media Effects - Second Edition by Jennings Bryant, Susan Thompson, and Bruce W. Finklea pages 78-81 (Waveland Press Inc. 2013) 923

Fundamentals of Media Effects - Second Edition by Jennings Bryant, Susan Thompson, and Bruce W. Finklea page 79 (Waveland Press Inc. 2013) 924

Los Angeles Times “We’re Listening, Ted” by Jane Hall (April 03, 1994)

925

Amusing Ourselves to Death is the title of his famous book on the media, first released in 1985. The subtitle is “Public Discourse in the Age of Show Business” 926 New

Scientist “Left or right-wing? Brain’s disgust response tells all” by Dan Jones (October 30th

2014) 927

Romans 1:28

928 2

Timothy 3:1-5

Introduction Censorship The Memory Hole The War on Trump The War on Trump Supporters The War on Families TV “News” Internet “News” Sites Wikipedia Google Rise of Social Media Facebook Twitter YouTube The Future of Fake News Conclusion Copyright Info

Introduction Today, “media” doesn’t just mean television, radio, newspapers, and magazines; since all of those industries have been swallowed up by the Internet (convergence as it’s technically called). As you know, people now get most of their news and entertainment online where there is an endless supply of things to click on, scroll through, and stream. People carry TVs in their pockets and wear them on their wrists like the old science fiction films predicted. With the push of a button anyone can watch almost any show, access any newspaper or magazine article, and even send instant feedback

about what they think. Everywhere you go people are constantly glued to their device, consuming an endless stream of “media.” It’s like a madhouse that’s almost impossible to escape. In our current mobile age, trying to keep up with the news is like running on a treadmill that’s getting faster and faster. The longer you’re on it, the more exhausting it gets, leading many to become so fatigued they decide to jump off and quit paying attention altogether. Many have become so stressed out, disgusted, and tired of the “news,” that they basically boycott it and only follow sports or other forms of entertainment, but even there they can’t escape being bombarded by political messages and cries for “social justice.” Those who wish to push political agendas know that movies, music, and TV shows are convenient vehicles to deliver their propaganda to millions under the cloak of “entertainment.” Even some sports coverage on ESPN has become political in recent years, amplifying the messages of athletes involved in fringe causes or ones based on half-truths and out-right lies. 1 Music, movies, and television shows are not just “entertainment.” They shape and influence the culture by manufacturing iconic characters whose beliefs and behaviors are mimicked by millions. While art imitates life, life also imitates art, as President Obama admitted during an appearance via video at the 2015 Grammies where he told the audience, “Tonight, we celebrate artists whose music and message helps shape our culture…Artists have a unique power to change minds and attitudes and get us thinking and talking about what matters.” 2 Celebrities have largely taken over the role that families, the Church, and national traditions used to play in molding and monitoring a society’s attitudes and actions.

As Andrew Breitbart pointed out in his book Righteous Indignation , “Hollywood is more important than Washington. It can’t be overstated how important this message is: pop culture matters. What happens in front of the cameras on a soundstage at the Warner Bros. lot often makes more difference to the fate of America than what happens in the back rooms of the Rayburn House Office Building on Capitol Hill.” 3 He continues, “As it stands, the Frankfurt School-taught Left is fighting the political battle on both the political and the cultural battlefields. Conservatives are fighting it only on the political battlefield. That means that art, humor, song, theater, television, film, dance, are all devices used every day in order to influence the hearts and minds of the American people.” 4 He’s talking about Cultural Marxism, which is the practice of waging a psychological war against America and all of Western civilization by relentlessly attacking every aspect of our culture, symbols, and institutions; hoping to gradually weaken society by subverting its foundations to the point where it becomes so dysfunctional it can be overthrown and replaced by a Marxist State. To accomplish this, the supposed “news” media regularly engages in what’s called Agenda Setting by hyping up certain stories and covering them ad nauseam to create the false impression that those stories are actually important because they’re “what people are talking about.” This provides a false justification for the extensive coverage, creating an artificial feedback loop where they hype up a story as if it’s the talk of the town, and then everyone starts talking about it because they’re inundated by reports about it, so the media keeps reporting on it, claiming that it’s a relevant story because so many people are talking about it.

They carefully choose stories, oftentimes of rare and isolated incidences, and then amplify them hoping to give the impression that there’s an epidemic and use the cherry-picked examples to promote or reinforce liberal ideologies. At the same time they act as gatekeepers, purposefully omitting other (actually important) stories and events which show a side of an issue they’re hoping people don’t hear about, or are trying to downplay the significance of. The Liberal Media Industrial Complex uses their technology to influence rather than inform; to attack instead of educate; to promote certain events while pretending others don’t exist. They always amplify salacious allegations that feed into the one-sided narratives they’re pushing, and then completely ignore the facts when they later come out if they prove the initial reports to be false. They just carry on as if nothing happened and keep repeating the same pattern like clockwork — amplifying the allegation, and then ignoring the outcome. The election of President Trump has resulted in the American mainstream media throwing all objectivity out the window and dedicating their existence to painting him as a mentally deranged dictator who needs to be impeached and imprisoned. They’ve gotten so bold in their attempts to overthrow our Republic that they now regularly engage in gaslighting and continue to repeat easily debunked falsehoods as if they are true, hoping to get people to start doubting their own memory, reasoning, and perception about what is actually going on. This is what gaslighting is. By repeatedly lying with confidence, using misdirection and discounting contrary information, the media causes some people to begin questioning their own version of reality. The term gaslighting originates from an old 1938 play (later made into a movie in 1944) where a central theme of the plot involves a woman’s husband who subjects her to all kinds

of mind games trying to drive her insane, including dimming the gas lamps in their home while convincing her that she’s just imagining it’s getting darker. The media insists that the name George Soros is a code word for antiSemitism, as are “globalists” and “Hollywood liberals.” 5 The constant assertions that anyone who supports building a wall at the US-Mexico border is racist, and anyone who supports President Trump is a white supremacist are ridiculous, but are believed by gullible people who are susceptible to propaganda. Television “news” anchors lie with such assurance and being accompanied by symbols of authority like their fancy studios and graphics, on the surface it appears as if they’re legitimate news broadcasts. The 2016 presidential election proved that the balance of power had shifted from the tight-knit group of mainstream media companies into the hands of everyday Americans who used Facebook, Twitter, and YouTube to spread their messages to others, whether it was a few hundred of their Facebook friends, or an audience of millions if their posts went viral. So in order to regain control of the flow of information, the legacy media conglomerates began working closely with the Silicon Valley titans to rewrite the algorithms so these popular platforms would favor their content above that posted by ordinary people or popular social media personalities. It’s an understatement to say that what’s happening is a conspiracy between various sectors of the media industry which are working together to give traditional outlets the loudest voices online. Mix in Google and YouTube manipulating search results, Wikipedia being the number one source of “encyclopedia” articles, and social media companies systematically censoring prominent conservative accounts under the disguise of combating “hate speech,” and you have a recipe for total

information control. There is a reason that dictators throughout history have aimed to seize their country’s media as one of their top priorities so they can use it to not only further their own aims, but prevent their opposition from using it for theirs. Just two weeks after the shocking loss of Hillary Clinton to Donald Trump in the 2016 election, the war on “fake news” was launched as a smokescreen to suppress the reach of regular users’ social media posts and artificially boost messages from the mainstream media. The Democrats became frantic about supposed “fake news” being shared on Facebook that they claimed had cast Hillary in a false light, and that was the reason they said, why so many people didn’t trust her; and hence, didn’t vote for her. 6 While there were a few viral fake news stories smearing her, all the studies show they had no influence on people’s votes and just reinforced beliefs they already held about her. 7 There were also fake stories about Donald Trump that went viral during the heat of the campaign, but that fact is ignored and the “fake news” problem was framed as an issue that’s only one-sided. In reality, the fake news scare was just an elaborate ruse to drastically alter the way social media functions by pressuring Big Tech companies to emphasize mainstream media outlets in people’s feeds instead of showing organically what should be there based on who they were following and what was being posted. 8 Barack Obama was the first “social media president,” getting elected in 2008 when Facebook was first becoming a central hub in people’s lives. He was the first president to have a Facebook page and a Twitter account, and his senior advisor David Axelrod admitted, “If not for social media, Barack Obama would never have been elected president [because] it gave us the ability to connect to a new generation of voters.” 9

At the time, social media was still kind of a novelty, but a few years later it would permeate most people’s lives when everyone had to have an iPhone and the social media companies released mobile apps so people could “stay connected” wherever they were instead of having to wait until they got home from work or school to open up their laptop to see what’s happening online. But today, getting news online isn’t just a novelty, it’s the norm. A report from the Pew Research Center in 2018 showed that more Americans get their news from posts on social media than from newspapers. 10 Social media now starts revolutions, and overnight a single video clip can turn most of the world against a nation’s leader, or galvanize members of an entire political party to rally behind a cause. Since the barriers to entry are now so low today with anyone being able to start a YouTube channel or create a Facebook page, we are seeing the legacy media frantically trying to stop their industry (and their influence) from slipping through their fingers. Liberals’ favorite tactic today is silencing their opposition under the disguise of combating “hate speech” or stopping “right-wing extremists,” and the ability to censor and manipulate information online rests in the hands of just a few gigantic corporations whose values are completely opposed to middle America and traditional family values. Because of the emergence of social media, billions of people around the world communicate through Facebook, Twitter, and other online platforms which have largely taken the place of sending emails and talking on the phone. As you know, these social media apps can allow anyone’s message to be spread just as far as something broadcast on the national news, or printed on the front page of the New York Times , but because of

this massive redistribution of power, the Liberal Media Industrial Complex is scrambling to put the genie back in the bottle. One doesn’t even have to be a “social media star” to be a victim of the Left’s censorship because average users have their Facebook posts, tweets, Instagram pics, and YouTube videos removed all the time for “violating community standards.” Big Tech’s increasingly sophisticated artificial intelligence systems automatically scan every post for key words they have identified as sexist, racist, homophobic, transphobic, Islamophobic, anti-Semitic, or just generically “hateful” or “offensive;” and has them removed once discovered. Just a handful of these “violations” and your entire account is shut down for good and everything you’ve ever posted there deleted. Nothing is out of the reach of their AI, and anything can be deleted at any moment by the nameless and faceless moderators, leaving the victims with no recourse or appeal. Total control of information is what they want, and they have hijacked the technology we all use to communicate in our modern age, but thankfully you were able to get this powerful tool into your hands before they could stop it — an old fashioned book! I commend you for picking one up and tuning out the noise relentlessly trying to make its way to your ears, and turning away from the millions of tweets, Facebook posts, and video clips all competing for your attention. In the coming pages we’ll do a deep dive into each of the major social media platforms and I’ll detail their algorithm manipulation, double standards, liberal bias, and censorship. We’ll also dissect the media’s war on President Trump, their mission to destroy our culture by undermining traditional family values, and we’ll look at the future of fake news.

While scrolling through tweets and Facebook posts is often like junk food for the brain, reading a book is a healthy and nourishing four-course meal in comparison. Sure, junk food is fine in moderation, but if it’s all you eat then you’re going to be very unhealthy. And the difference between reading through social media feeds (or watching the news) and reading a book is about the same as the difference between a good steak and eating a burger at McDonalds. One is quick, cheap, and poor quality; while the other is expensive, time consuming to make, and healthy to eat. And since we’re dealing with a very important subject, it’s best to do this right. So let’s begin by taking a look behind the curtain of the monolithic Liberal Media Industrial Complex and start dismantling it piece by piece.

Censorship There are several classic books that highlight the dangers of censorship and depict tyrannical governments that use their endless power to snuff out any opposition in hopes of maintaining their control over society. George Orwell’s Nineteen Eighty-Four , which was first published in 1949, and Fahrenheit 451 , published in 1953, are two of the most popular examples and weren’t just written for entertainment. They were meant to serve as a warning of what giant bureaucracies could do if their growing power goes unchecked. But today in America, it’s not the government censoring what newspapers print or what airs on the evening news. It’s the Silicon Valley titans — it’s Mark Zuckerberg, Jack Dorsey, and Susan Wojcicki. In the marketplace of ideas they are losing, and so these industry leaders are silencing influential opponents who speak out against the Left’s attempted revolution.

They’re also trying to create a chilling effect by scaring people into not speaking out about certain issues or make us think twice before sharing certain information on social media out of fear we will be socially ostracized, or even fired from our job; so many people are self-censoring themselves in what’s been called the “Spiral of Silence.” 11 The fewer people who speak out about an issue due to fear of repercussions causes others who feel they should say something to be more apprehensive about doing so because nobody else seems to be doing it, which in turn causes even more people to stay silent, causing the false impression that no one seems to be opposed to what’s happening. Thankfully, in the United States (at least today) the First Amendment is still intact, but in places like Canada, 12 Germany, 13 England, 14 Scotland, 15 and other supposedly “free” countries, people are being arrested and charged with “hate speech” crimes for posting things on their social media accounts that are critical of the “Islamization of Europe” from the mass influx of Muslim refugees and for voicing opposition to the LGBT agenda. 16

But while Americans are still technically free to say these things without getting arrested, there are other serious consequences since we’re living in an online world where most people rely on a handful of apps to communicate with others. Back in 1997, Harvard Law professor Larry Lessig wrote an article for Wired magazine titled “Tyranny in the Infrastructure” warning that, “Laws affect the pace of technological change, but the structures of software can do even more to curtail freedom. In the long run the shackles built by programmers could well constrain us more.” 17

In his book Cyber Ethics: Morality and Law in Cyberspace , Richard A. Spinello expanded on this concern saying, “This notion that private code

can be a more potent constraining force than public law has significant implications. The use of code as a surrogate for law may mean that certain public goods or moral values once protected by law will now be ignored or compromised by those who develop or utilize this code.” 18 We’re seeing the very principle of free speech under attack like never before, with the Liberal Media Industrial Complex even claiming that freedom of speech is “dangerous” and saying that conservatives have “weaponized” the First Amendment. 19 There have always been restrictions on the First Amendment, for example you can’t yell fire in a crowded theater, and you can’t threaten to murder someone or encourage acts of terrorism; but today just insulting a person who believes there are 58 different gender identities or pointing out certain facts and statistics is considered “hateful” and “dangerous.” Democrat Congressman Ted Lieu from California says he’s frustrated by the fact that the First Amendment is preventing him from silencing conservatives for Thought Crimes, so he’s calling on the Big Tech companies to do it on the government’s behalf. 20 Meanwhile Jerry Nadler, a Democrat Congressman from New York, says it’s just a “conspiracy theory” that the Big Tech companies have a liberal bias and, “The notion that social media companies are filtering out conservative voices is a hoax, a tired narrative of imagined victimhood.” 21 Other Democrat members of Congress, like Jamie Raskin from Maryland, insist that it is an “entirely imaginary narrative that social media companies are biased against conservatives.” 22 Of course CNN repeatedly denies conservatives are being censored and claims that pushback from President Trump is, “exacerbating a longstanding paranoia from conservatives who have for years erroneously accused social media companies of bias and censorship.” 23 It’s just

paranoia that conservatives are being censored, guys! Nothing to worry about! CNN claims, “For years, the conservative media machine has pushed the flimsy narrative that conservatives are unfairly treated by social media companies, which they accuse of bias and censorship. When the claims often fall apart under a light touch of scrutiny, right-wing media outlets continue to advance the narrative, irrespective of the facts.” 24 After years of mounting evidence, Twitter CEO Jack Dorsey finally admitted that even conservatives who work at Twitter, “don’t feel safe to express their opinions at the company” and that “They do feel silenced by just the general swirl of what they perceive to be the broader percentage of leanings within the company.” 25 With each new purge of conservative voices from the social media platforms, more and more people are seeing just how big of a threat these tech giants are to the principles of free speech and the massive implications of their monopoly on communication tools. Donald Trump Jr., who obviously has the president’s ear, has also been very vocal about the increasing censorship on social media, even writing an op-ed about it in The Hill , saying, “Our right to freely engage in public discourse through speech is under sustained attack, necessitating a vigorous defense against the major social media and internet platforms.” 26 In May 2019, the White House set up a new tool on WhiteHouse.gov for people to report instances of social media bias and censorship so the Trump administration could put together more thorough reports of what conservatives are facing online. 27 The page includes a form for users to submit details about which post was taken down, what it said, and which platform removed it. “Social media platforms should advance freedom of speech. Yet too many Americans have seen their accounts suspended,

banned, or fraudulently reported for unclear ‘violations’ of user policies,” the website reads. 28 In subsequent chapters I’ll detail what’s been happening on each of the major social media platforms, but rampant censorship isn’t limited to just Facebook, Twitter, and YouTube.

Music Streaming Services While politicians and news commentators have always had to watch what they say about certain subjects so they don’t get fired, artists have always been seen as the bastions of free speech, and censoring art—no matter how provocative or offensive it is to some people—was always seen as something only a tyrannical government would do. Major music labels and movie studios always stood by their artists and vigorously resisted calls for censorship, championing the freedom of expression whether it was NWA’s “Fuck the Police” or blasphemous anti-Christian films like The Da Vinci Code or Martin Scorsese’s The Last Temptation of Christ. But in August 2017 Spotify, the popular music streaming service, announced they would start censoring songs from “hate bands” including songs they claim “incite violence against race, religion, [or] sexuality.” 29 How will they determine which bands and songs to censor? Whatever the Southern Poverty Law Center tells them to. 30 Not surprising, the SPLC got their tentacles wrapped around Spotify and other streaming services to “help” them keep a lookout for “hateful” content. 31 Other streaming services like Apple and Pandora followed suit, banning supposed “white power” music, while allowing rap music that blatantly calls for the murder of police officers from people like Ice-T, NWA, and Snoop Dogg, who recently depicted himself murdering President Trump in one of his music videos. 32 As you know, it’s common for rappers

to diss “crackers” and “white boys” in their music, but that’s just fine. Hating white people isn’t considered to be racist to the Left. And Jay Z’s albums are okay, despite calling women “bitches” in (literally) 50% of his songs. 33 About a year later Spotify announced another new policy, saying they were going to start banning songs from artists who have engaged in “harmful or hateful conduct” in their personal lives, like domestic violence or sexual abuse. That put songs by R. Kelly and Michael Jackson at risk of not being available anymore. But then just three weeks later they reversed their decision and apologized, saying they don’t want to be the “moral police,” but affirmed that they were still going to be censoring “hate speech.” 34 Guns ‘N Roses song “One in a Million,” which was released on their 1988 album G N’ R Lies, includes a line about “immigrants and faggots” but when the studio released the Guns ’N Roses box set in 2018 they didn’t include that song on the album because it’s been deemed “racist” and “homophobic.” 35 It’s probably only a matter of time before other songs like Aerosmith’s “Dude Looks Like a Lady” will be banned for being “transphobic” as well. Once you give liberals an inch, they demand a mile, and since they smell blood in the water they will continue their quest to eliminate everything they find offensive.

Netflix and Prime Video Even movie streaming services like Netflix and Amazon’s Prime Video are showing signs of liberal bias and censoring “controversial content” that had once been available on the platforms for years. Netflix won’t allow The Red Pill , a popular documentary about the Men’s Rights Movement

produced by Cassie Jaye, to be streamed. Through the course of producing the film she found that claims about the “patriarchy” and supposed “male power” were extremely warped and that many of the burdens men typically bear in society are overlooked and often discounted by feminists. 36 Cassie Jaye herself was a feminist when she started making the film and expected to find the Men’s Rights Movement would be full of misogynists and losers who had no luck with women, but learned they have very legitimate points about gender roles and unfair treatment in child custody cases, and by the end of the film she admitted they weren’t a bunch of women-haters as she had previously thought, and decided that she could no longer call herself a feminist because “feminism is not the road to gender equality.” 37 When the trailer was released on YouTube it reached over a million views in 24 hours and was the number one purchased movie on YouTube (which streams movies on-demand for 4 or 5 dollars) beating Guardians of the Galaxy and Rogue One: A Star Wars Story. 38 But Netflix wouldn’t allow the film to be streamed on their platform because when it was released in selected theaters it had generated some negative publicity from feminists protesting it, calling it “misogynistic propaganda.” 39 In March 2019 Democrat Congressman Adam Schiff sent a letter to Amazon CEO Jeff Bezos pressuring him to censor “anti-vaccination” documentaries from Amazon Prime after seeing a report on CNN claiming that “Anti-vaccination conspiracy theories thrive on Amazon.” 40 Within hours of Schiff sending his letter, the streaming service pulled at least five documentaries including the popular Vaxxed: From Cover-Up to Catastrophe , 41 which had been promoted by Robert De Niro when it first came out because one of his children is autistic which he suspects may have been caused by the MMR vaccines. 42

Others included: We Don’t Vaccinate!;” Shoot ‘Em Up: The Truth About Vaccines , The Greater Good ; and Man Made Epidemic , which investigated the alleged connections between the autism epidemic and the preservative Thimerosal used in vaccines. Many have long suspected a link between Thimerosal and autism, including Robert F. Kennedy Jr., who has tried to bring awareness to the dangers of vaccines for years. 43 CNN then celebrated the censorship with a follow-up story touting, “Anti-vaccine movies disappear from Amazon after CNN Business report.” 44 During a segment on CNN in 2009 Dr. Oz was talking with host Campbell Brown about the H1N1 (swine flu) vaccines, encouraging people to get them, but was put on the spot by the host about her concerns that they may not be safe. He responded, “I’m going to get it, if that helps at all, but I’ll tell you my wife is not going to immunize our kids. Cuz I’ve got four of them and when I go home I’m not Dr. Oz, I’m Mr. Oz.” 45 So he went on television encouraging people to take the vaccine and give it to their children, but admitted that he’s not going to give it to his own children because his wife didn’t think it was safe; and despite him being a famous doctor, he couldn’t convince her otherwise and allowed his children to go unvaccinated. Netflix also censored an episode of comedian Hasan Minhaj’s show, blocking it for customers in Saudi Arabia at the request of the government there because in it he talked about Saudi Arabia’s role in the 9/11 attacks and the murder of Washington Post columnist Jamal Khashoggi at the hands of Saudis. 46 Netflix will not stream the 1980s classic Dukes of Hazzard because that’s too “racist” today. Reruns of the show were pulled from TV Land and other cable networks in 2015 after growing sentiment that the Confederate Flag is a “white supremacist” symbol, and since the Duke boys’ car (The

General Lee) has one painted on the roof, networks now deem the TV show too offensive to air. 47 Other classic TV shows and movies will likely slowly and quietly disappear from the streaming services and cable TV because they’re deemed too “insensitive” for our modern age. Owning DVDs may be the only way to ever see them again. A growing number of activists are upset about Ace Ventura: Pet Detective for what they call its “contempt” for LGBT people because the main suspect in the movie later started living as a woman and after catching him and realizing this, Jim Carrey goes into convulsions vomiting while having flashbacks to when “she” had kissed him earlier in the film. Or other comedies like Mrs. Doubtfire or Tyler Perry’s “Medea” character may be banned for being “transphobic” as well. Or films like Idiocracy , The Breakfast Club , or Bill and Ted’s Excellent Adventure because characters call people fags. Or maybe even The Sand Lot since one boy tells another that he plays baseball like a girl. That’s sexist! In 2018, Barack and Michelle Obama signed a deal with Netflix to produce several documentaries, scripted series, and full-length feature films through a production company they started called Higher Ground. 48 “Touching on issues of race and class, democracy and civil rights, and much more, we believe each of these productions won’t just entertain, but will educate, connect and inspire us all,” said Barack. 49 The couple’s debut documentary American Factory was hailed as their “first big anti-Trump statement of 2020” by Politico, although it didn’t mention him by name “it’s message is clear.” 50 Others called it “lefty propaganda” and an attack on Trump. 51 Netflix has also produced various liberal “comedy” shows called Netflix Originals which have included hosts like skank Chelsea Handler, Michelle Wolf, and other insufferable and non-funny Leftists. Similarly,

Hulu produced a show hosted by Sarah Silverman called “I Love You America” which got canceled after two seasons, calling into question the streaming services ability to tap into the late-night talk show genre. 52 They also produced a documentary following the Congressional campaign of Alexandria Ocasio-Cortez. After Georgia’s controversial “heartbeat” abortion bill was signed by the governor in May 2019 which bans abortions after six weeks into the pregnancy, Netflix announced they may quit using the state as a production location because several of their shows like “Stranger Things” and “Ozark” are shot there. They even vowed to help fight the bill in court. 53 It certainly is strange for a major corporation to take a stance on abortion, but that’s where we’re at.

Amazon Banning Books Banning books was once seen as the ultimate sin, and something only the Nazis would do, but today we’re seeing a growing number of books disappearing down the memory hole in the name of political correctness and stopping “hate speech.” 65% of all books are sold through Amazon and they have a virtual monopoly over the entire industry. 54 They are the reason Borders, Walden Books, and B. Dalton went out of business. Amazon advertises themselves as the world’s largest bookstore where you can find practically any book, new or used, since if they don’t stock it, they (supposedly) allow anyone to list used copies for sale themselves. For over twenty years since Amazon was launched in 1995 they would sell any book new or used, but recently that all changed. In July 2018 a children’s book titled No Dress for Timmy was banned for being “transphobic.” It was written by Shefflorn Ballantyne and is described as, “A story of a little boy who found himself in a perplexing situation where

he was forced to choose between speaking the truth and cheering on a friend who thinks of himself as a girl.” 55 The young protagonist basically wouldn’t support a transgender classmate. After an LGBT advocacy organization called Family Rhetoric discovered it when searching for LGBT-themed children books, they launched a campaign to pressure Amazon to ban the book, which they did. The group later celebrated on their Facebook page saying, “We did it. You did it friends! The link to No Dress for Timmy is not working. Amazon took down the book. It’s gone!” 56 And indeed it is. Amazon banned almost all of pickup artist Roosh V’s books just days after his latest one was released, titled Game: How to Meet, Attract, and Date Attractive Women. 57 They wouldn’t even give him a reason, just that they “violated” their policy and “can’t offer any additional insight or action on this matter.” 58 Roosh had come to the attention of various radical feminist groups who see him as a huge “misogynist” for his views on women and feminism, and they most likely lobbied Amazon to pull his books. Juanita Broaddrick’s book about Bill Clinton allegedly raping her was removed in June 2018, and then later restored. 59 It appears that Amazon keeps testing how far they can push the envelope by gauging the backlash, but not everyone is so lucky to have their books re-listed after media reports denounce the censorship. In August 2018 Amazon banned a book that contained plans to build a 3D printed gun called The Liberator Code Book: An Exercise in Freedom of Speech , which had been listed by the publisher just a few weeks earlier. An Amazon spokesperson said it violated their guidelines. 60 Yet they sell the Anarchist’s Cookbook and other bomb-making manuals (at least at the time this book was first published in November 2019). The Anarchist’s

Cookbook author William Powell later denounced his terrorist manual which he wrote in 1971 when he was just nineteen-years-old. 61 But he does not own the rights to the book; the publisher does (now Ozark Press), which keeps it in print, and which Amazon still sells. 62 The Columbine school shooters, who planted bombs in the school aside from shooting and killing twelve students and one teacher, owned a copy of the Anarchist’s Cookbook and used it to manufacture their bombs. 63 When members of the Black Liberation Army were arrested in the 1970s for murdering several police officers, they had a copy in their possession and are believed to have planted a bomb in a San Francisco church during the funeral of a police officer who died in the line of duty. 64 Thomas Eugene Spinks, who bombed ten abortion clinics in the 1980s, used the Anarchist Cookbook to build his bombs. 65 Many others have used it as well, including Timothy McVeigh, who carried out the 1995 Oklahoma City bombing, and the radical Islamic terrorists who committed the July 2005 bombings on the London public transportation system used the book as their instruction manual too. So No Dress for Timmy is too “transphobic” to be sold, but a literal bomb-making manual used by terrorists in numerous high-profile bombings is okay. Jared Taylor, a leader in the white identitarian [pro-white] community, had several of his books censored from Amazon in February 2019, including White Identity , despite having been sold on the site since 2011. 66 The following month Tommy Robinson’s book Mohammed’s Koran was banned from Amazon just days after Facebook and Instagram banned him (in response to Tommy posting a documentary critical of the BBC on his YouTube channel). 67 His book was deemed “Islamophobic.” 68 Then in March 2019 they banned David Duke’s autobiography My Awakening and another one of his books titled Jewish Supremacism where

he details what he believes is a Jewish supremacist belief system within Judaism. 69 The books had been available on Amazon since they first came out, one in 1998, and the other in 2004, but were removed shortly after a no-name freelance writer “inquired” about why Amazon was selling books written by a “white supremacist.” 70 They’re not just shown as out of stock or unavailable; the entire listings for the books have been deleted, and it appears Amazon is also prohibiting any 3rd party sellers from listing used copies as well. They also banned several books published by the Nation of Islam which were critical of Jews, 71 as well as a few written by Christian pastor Texe Marrs, including Holy Serpent of the Jews , for being “anti-semitic.” 72 This is especially interesting because Amazon still sells Adolf Hitler’s Mein Kampf (for now). 73 After CNN successfully pressured Amazon to censor various popular documentary films from their Prime Video streaming service in March 2019 that question the safety of some vaccines, they went on to lament that Amazon still sold “anti-vaccine” books, saying, “while some anti-vaccine videos are gone from the Prime streaming service, a number of anti-vaccine books were still available for purchase on Amazon.com when CNN Business reviewed search results on Friday afternoon, and some were still being offered for free to Kindle Unlimited subscribers.” 74 Amazon soon banned several “anti-vax” books for promoting what they called “vaccine misinformation.” 75 In July 2019 they banned books by Dr. Joseph Nicolosi, who is best known for advocating conversion therapy for homosexuals. Two of his most popular books on the subject, Healing Homosexuality and A Parent’s Guide to Preventing Homosexuality were taken down after sustained pressure from LGBT activists. 76 Perhaps Amazon will ban some of Sigmund

Freud’s books next because he believed that homosexuality was caused by a disruption in a child’s development due to a dysfunctional relationship with their parents in terms of the role those parents fill in their lives. 77 For several years now Amazon has banned sales of all Confederate flags because they’re considered to be symbols of “white supremacy” these days. 78 They have also banned the sale of various Halloween costumes liberals consider to be offensive, like the “Tranny Granny” costume that’s “transphobic,” 79 a Chinese dress for being “cultural appropriation,” and a “sexy burka” costume for being disrespectful to Islam. In January 2019 Amazon removed dozens of other products that were said to be offensive to Muslims as well. 80 Meanwhile, an album by a band called Marduk titled “Fuck Me Jesus” is allowed, which shows a naked woman using a crucifix as a dildo on the cover. 81 Amazon also sells a song titled “Fuck White People” which has a noose on the album cover. 82 They also stock various black supremacist books that promote hate groups like the Black Hebrew Israelites.

Twitch.TV Twitch.TV (which is owned by Amazon) is a website where people livestream themselves playing video games (I know this seems strange to anyone over 40) and they can have a large number of viewers who enjoy watching them play. Like YouTube livestreams, there is a chat box on Twitch where viewers can post comments and even tip the player. While it’s mostly for video games, sometimes the gamers will talk politics during their streams, and the Thought Police are watching in case they say something “racist,” “sexist,” “homophobic,” etc., etc. One gamer was recently banned from Twitch for simply saying there are only two genders. 83 The email informing her of the ban read, “Your recent behavior

has proven your lack of understanding of what hateful speech is and how it may affect your community on your channel…Several of your statements have been found offensive towards the transgender community, and we don’t tolerate this kind of behavior.” 84 In a YouTube video discussing the ban she said, “I specifically said, it’s okay if a man wants to be a woman, and a woman wants to be a man, you cannot be anything in between,” referring to the odd “gender fluid,” “pan gender,” and the dozens of other “genders” liberals have invented. A popular DJ named Deadmouse (stylized Deadmau5), who also streamed on Twitch for fun was banned for “hate speech” after he called another streamer a dreaded “homophobic slur.” He issued a statement saying, “It was intended to insult a fuckin asshat who was being a fucking asshat…it wasn’t ‘directed at an entire group of people who have a sexual orientation that differs from my own.’ Fuck off with that shit. I know who I am, and I don’t have to fucking sit here and cry and defend my fucking self with the obligatory ‘I’M NOT THAT PERSON, I AM SORRY” reflex… The sane people who knew what it was in the heat of the moment knew the purpose of the statement, and the people that think otherwise, I’m better off not even fucking knowing and they can just keep the fuck clear of me.” 85 It was great to see someone of his celebrity push back against this PC nonsense, but he soon backtracked and issued an apology, along with apologizing for his previous “non-apology” in response to the ban, saying, “I know what I said was wrong, and my hastily composed non-apology was an insult to injury.” 86 Many other Twitch streamers have had their accounts suspended and banned for just uttering what moderators thought were “slurs” out loud in a fit of anger when something went wrong on the game they’re playing when they actually said something that just sounded similar to one. 87 So even

while players are virtually “mass murdering” people in a video game, the Thought Police are carefully monitoring them to make sure their off-thecuff commentary doesn’t happen to offend someone in the LGBTQ community or other “protected group.” One streamer was even given a 30day suspension for calling another player a “mongoloid,” because Twitch considers that “hate speech” too. 88 Like YouTube and Facebook Live, Twitch uses real-time voice recognition systems to analyze what people are saying in order to lookout for any words that are flagged as being inappropriate. Monitoring livestreams using AI is one of the top priorities of the tech companies due to the bad press they get when someone livestreams something completely ridiculous (or criminal) so they are putting enormous resources into being able to detect what is being said in real-time, and even what is being shown so they can take down a stream if their algorithm deems the broadcast includes anything “inappropriate.” Twitch, however, like all the other major platforms turns a blind eye when liberals flagrantly violate their rules. A popular streamer who goes by “Destiny” (real name Steven Kenneth Bonnell II) has explicitly called for violence against conservatives on at least one occasion. When he was asked during a stream, “You genuinely do hate conservatives, don’t you?” he answered, “Very much so. I’ve moved full-on to the political violence level or the real violence level when it comes to conservative people. I feel like they need to be fucking excised from my fucking country. I think they’re demonstrably evil people.” 89 He remains on the platform and his channel is still monetized.

Alex Jones “Unpersoned” One of the scariest aspects of censorship isn’t a few songs, movies, or books disappearing from the Internet, but a person being deleted. An

“Unperson” is a term from George Orwell’s Nineteen Eighty-Four that describes someone whose very existence has been erased from society, and this basically happened to radio talk show host Alex Jones in August 2018. Within the course of just a few days he was banned from YouTube, Facebook, iTunes, the TuneIn radio app, Spotify, Stitcher, Pinterest, and even LinkedIn! Years of archived shows and interviews just disappeared. PayPal also closed his account, preventing his website Infowars.com from accepting payments through the service, 90 and numerous credit card processors also refused to allow him to have an account, making it difficult to accept debit and credit cards for the products he sells. Liberals were thrilled with the actions, including Democrat Senator Chris Murphy from Connecticut who said, “Infowars is the tip of a giant iceberg of hate and lies that uses sites like Facebook and YouTube to tear our nation apart. These companies must do more than take down one website. The survival of our democracy depends on it.” 91 Many conservatives, even those who think Alex Jones is a raving lunatic, were quite concerned about his sudden “disappearance” from the Internet. Even Senator Ted Cruz defended Alex, tweeting, “Am no fan of Jones — among other things he has a habit of repeatedly slandering my Dad by falsely and absurdly accusing him of killing JFK — but who the hell made Facebook the arbiter of political speech? Free speech includes views you disagree with.” 92 Others came to his defense as well, including Bill Maher who said despite Jones telling “lies” about him, “if you’re a liberal, you’re supposed to be for free speech. That’s free speech for the speech you hate. That’s what free speech means. We’re losing the thread of the concepts that are important to this country. You care about the real American shit or you

don’t. And if you do, it goes for every side. I don’t like Alex Jones, but Alex Jones gets to speak. Everybody gets to speak.” 93 The ACLU [American Civil Liberties Union] even warned his ban could set a dangerous precedent and expressed concerns that the pendulum could swing the other way some day, and groups like Black Lives Matter could be shut down under the same pretense. 94 President Trump appeared to reference the unpersoning of Alex Jones which had made national headlines, saying, “I won’t mention any names but when they take certain people off of Twitter or Facebook and they’re making that decision, that is really a dangerous thing because that could be you tomorrow.” 95

Alex Jones Was Just the Beginning Many people who were quite concerned about Alex Jones getting unpersoned overnight were afraid to speak out against it because they didn’t want to appear as if they supported Jones because of some of the outlandish things he has said over the years, but Big Tech coordinating with each other to ban him was just a test case and the beginning of what was to come. The editor in chief of The Verge , one of Vox Media’s online properties, started calling for Fox News to be taken off the air next, saying, “I feel like we should be just as comfortable asking Comcast and Verizon and Charter why they continue to offer Fox News on their networks as we are about Facebook and Alex Jones.” 96 Immediately after Jones was universally deplatformed PBS did a report about it and in that report complained that he had inspired countless “imitators” who “sell merchandise” and then showed a clip of me from one of my YouTube videos promoting my popular t-shirts.

Apple CEO Tim Cook then said it’s a “sin” for social media platforms not to ban people the Left deems “hateful” and “divisive.” He was given the first “Courage Against Hate Award” from the Jewish ADL, and during his acceptance speech said, “We only have one message for those who seek to push hate, division, and violence: You have no place on our platforms. You have no home here.” 97 He went on to say, “and as we showed this year, we won’t give a platform to violent conspiracy theorists on the app store,” referring to banning Alex Jones. “Why? Because it’s the right thing to do,” Cook concluded. 98 Even conservative darling Ben Shapiro is technically in violation of their terms of service for “hate speech” by saying transgenderism is a mental illness. 99 They could drop the hammer on anyone at anytime for things they’ve said years ago, and even “off platform,” meaning things said in interviews or speeches that didn’t even directly involve social media. Just voting for Donald Trump is considered “hate speech” by the Silicon Valley titans, and it won’t be long now before they include negative tone of voice, contorted facial expressions or even supposed “code words” and “dog whistles” into their terms of service as things that are not allowed. For example, if someone is reporting on a new television commercial featuring two gay men who are raising a child they adopted and react with a disgusted look on their face, or a sarcastic, “I’m sure the child will grow up to be totally normal.” That will likely be a violation of their policies. George Orwell even warned about such things in his classic novel Nineteen Eighty-Four , saying, “to wear an improper expression on your face (to look incredulous when a victory was announced, for example) was itself a punishable offense. There was even a word for it in Newspeak: facecrime, it was called.” 100

They’ll start claiming that certain words or phrases are “code words” for something else just like they’ve done with the “okay” hand sign, and soon nobody will be safe from being smeared as a “white supremacist,” “Islamophobe,” “homophobe,” “xenophobe,” etc. The Left are now engaged in a Maoist-style attempted overthrow of our culture and our country, and are systematically purging influential dissenting voices from social media. Get ready, because this is just the beginning. They don’t just want prominent vocal opponents of the liberal agenda silenced; they want our lives destroyed. Some people believe censorship amplifies extremism by forcing people to descend into the dark corners of the Internet where their ideas aren’t challenged or debunked by onlookers who disagree with them, and so they fester in an echo chamber that fuels and radicalizes them. Censoring someone who’s not calling for violence can also be seen as confirmation that they are being persecuted and cultivate a sense that they feel justified fighting back in a more extreme way. By having their voice taken away for what was perfectly legal speech, they may be compelled to act out in other ways in order to “be heard.” The liberal Establishment is working tirelessly to take down any independent social media personalities who organically gain sizable followings, and if they’re truly independent, meaning not working for a major media outlet then they are extremely vulnerable because they don’t have a legal department behind them that can push back on their behalf. They have developed a formula to take us down. First, a few unscrupulous liberal online outlets like the Huffington Post, BuzzFeed, and Vox label certain conservatives “Alt-Right” or “right-wing extremists” and then the editors at Wikipedia update those people’s pages to claim they are a white

nationalists or neo-Nazis and use those dubious reports as “sources” to solidify the smear. And since Wikipedia is the go-to place for information for most people and one of the top search results on Google, anyone looking those people up from that point on will be presented with information claiming they’re a racist or far-right extremist. Then, even more outlets repeat the false claims, thus generating even more news articles from mainstream sources parroting the smear which are then used to add even more citations to the Wikipedia articles to reinforce their false narrative. These liberal outlets know that most people don’t have the vast resources necessary to sue for defamation, and so they are forever branded a “racist.” Then the self-referencing Wikipedia page is used as the justification to demonetize their YouTube channels and suspend their PayPal accounts to cutoff their revenue streams in order to crush them into silence. In our current political climate, especially as the 2020 election is approaching, I wake up every morning wondering if today will be the day that it happens to me.

What’s Next? How far will this fascism go? Will Visa, MasterCard, or American Express deactivate certain accounts because the banks don’t like what some people say or believe? Will Bank of America and Wells Fargo start closing people’s checking accounts because they don’t like their politics? Some banks are already doing just that. Chase Bank issued a letter to Proud Boys (a pro-Trump men’s fraternity) leader Enrique Tarrio that they would be closing his account and he had until the end of the month to move all his money somewhere else. 101 Then Joe Biggs, a former reporter for Infowars who banks at Chase, got the same notification. Others did as well, including

Martina Markota who works for the conservative news site Rebel Media. 102

After word spread of the shocking move, outraging many veterans groups because Joe Biggs is an Iraq vet, Chase re-activated his account, but wouldn’t give him a reason as to why they had initially banned him. 103 PayPal has already banned Alex Jones, Laura Loomer, Milo Yiannopoulous, Lauren Southern, Tommy Robinson, Gavin McInnes, Roosh V, Faith Goldy, as well as Twitter alternative Gab, and YouTube alternative BitChute because they support free speech and won’t ban users for posting things that hurt others feelings. 104 A senior software engineer at Google recommended the company delete Donald Trump’s G-mail account, and that of everyone working in his administration. He even suggested they “brick” Donald Trump’s cell phone. 105 A “bricked” phone, if you’re not familiar with the term, means one that is completely deactivated and won’t even turn on. So the engineer was literally recommending Google remotely disable Donald Trump’s phone, since they are the owners of the Android operating system which it uses. We only know about this because the proposal was included in a series of documents obtained as part of a lawsuit filed by former Google employee James Damore who was fired after circulating a memo explaining how the company’s obsession with “diversity” is misguided. While the company didn’t authorize those radical actions, who’s to say in the future they (or Apple) won’t ban certain people from using their phones? When you activate a smartphone you “agree” to the terms and conditions, even though hardly anyone actually reads them. Those terms also say the manufacturer can change the terms at any time, so what’s to stop them from adding a clause that says they reserve the right to brick your phone (or computer) if they feel you’re engaging in certain kinds of

behavior or speech that they find objectionable? Perhaps Google didn’t want the publicity and the backlash of sabotaging the President of the United States’ cellphone, but what’s to stop them from doing it to people who aren’t as powerful or well known? How far will the Silicon Valley titans go to stamp out vocal critics of the radical Leftists’ agenda? Will video editing software companies deactivate their software on people’s computers if they don’t like the content people are creating? Will Photoshop not sell their software to artists who are making the “wrong” kind of memes? Or will Microsoft and Apple refuse to license their operating systems on the computers (or smartphones) of political activists, social media personalities, or authors they consider racist, sexist, homophobic, transphobic, Islamophobic, etc.? Or maybe their local ISP [Internet Service Provider] won’t even allow them to have an Internet connection or will start blocking certain websites. 106 What if Priceline or Orbitz decides not to sell you a plane ticket because they refuse to do business with “hateful” people? Or if Enterprise decides they won’t rent you a car. Or a popular gas station chain won’t sell you gas? What if a major grocery store chain decides they won’t sell you any food? If Visa or Mastercard blacklist you, then you won’t even be able to have a debit card. If no banks will allow you to have an account, how can you cash your paycheck? In the Bible, a prophecy in the Book of Revelation says that one day “no man might buy or sell, save he that had the mark, or the name of the beast, or the number of his name,” warning that people who don’t worship the counterfeit Christ will be completely cut off economically from the modern world. It appears we are beginning to see the justifications for such widespread bans by those who control the backbone of the financial system.

Section 230 of the CDA Technically, private companies can ban people from their platforms as long as it’s not because of their race, sex, sexual orientation, age, disability, country of origin, or other legally “protected” class. But political affiliation is not a protected class, and companies could legally ban all Republicans if they wanted to. Laws and regulations are always many years behind innovation, and the framers of the legislation governing our communication infrastructure could have never imagined the emergence of social media, let alone how instrumental of a role it would come to play in our lives. The Telecommunications Act of 1996 was passed by Congress and signed into law by President Clinton in order to overhaul the rules and regulations governing communication systems in response to the development of the Internet. Within the Act was a subsection called the Communications Decency Act, and Section 230 of the law granted immunity to Internet Service Providers, Domain Registrars, and website hosting services so if customers use these services in ways that violate copyright laws (or criminal statutes), the companies themselves are not liable for the legal consequences because they are not deemed publishers, but platforms, and are not responsible what their customers are posting. In other words, if someone posts an episode of The Big Bang Theory television show on their YouTube channel, YouTube is not responsible for that person violating CBS’s copyright (as long as YouTube would promptly remove the infringing video if notified by CBS.) Because YouTube provides a service (i.e. the “platform”) to the public, they can’t necessarily prevent people from using that service to post copyrighted material, so they are given “safe harbor” and are immune from any civil or criminal penalties when their users break the law.

Section 230 of the CDA also granted immunity to Internet Service Providers and interactive websites if third party users post defamatory information about someone, 107 death threats, 108 or even if they sell fake merchandise on eBay, meaning eBay is not responsible, only the person posting the fake listing is. Today, many Big Tech companies are abusing their immunity granted to them by Section 230 of the Communications Decency Act by censoring certain users and posts and deciding themselves what to delete from their platforms, when that content is not violating any laws. They are now acting as publishers, not platforms, because they are making editorial decisions about what will and will not be allowed. If a person posts something that doesn’t violate any laws, then why should the social media companies have the right to take it down if they are in the business of offering a platform for (supposedly) anyone to use? Currently there is a loophole in section 230 that allows for what it calls “Good Samaritan” blocking and screening of “obscene, lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable content.” 109 So they interpret “objectionable” content as being facts or opinions that hurt people’s feelings or undermine the liberal agenda. Further evidence that section 230 of the CDA is outdated and unfair can be seen by the fact that a court ruled that President Trump can’t block people on Twitter after several trolls who he had blocked found a law firm that sued the President on their behalf. 110 The court ruled that Trump can’t block people on social media because it “deprives them of access to official Presidential statements,” and his feeds are considered a “public square.” This begs the question, why is Facebook, Twitter and YouTube allowed to deprive citizens access to that same public square?

If the President of the United States can’t “deprive” someone of access to his statements on social media, why should the tech companies be allowed to do that to ordinary citizens? Facebook and Twitter are basically the modern day equivalent of a telephone, or post office. They’ve become an intimate and crucial part of billions of people’s lives. It’s how friends and families communicate with each other, and share photos and videos. It’s where they send out party invitations and look up old childhood friends or family members they’ve lost touch with. It’s how they get their news and see what the President is saying. Imagine the phone company canceling your service because they didn’t like what you and your friends talked about. That’s essentially what Facebook and other social media platforms are doing today when they suspend people, delete their posts, or ban them completely because of what they say when their statements are not crimes, but just a “controversial,” “divisive,” or “hateful” point of view. The power these mega corporations have over how billions of people on the planet communicate with each other is staggering. And the fact that they are working in concert together to enforce their arbitrary and bias “terms of service” to silence certain people and points of view is beyond horrifying. As George Washington said, “If the freedom of speech is taken away then dumb and silent we may be led, like sheep to the slaughter.” 111 Author’s Note: Please take a moment to rate and review this book on Amazon.com, or wherever you purchased it from if you’re reading the ebook, to let others know what you think. This also helps to offset the trolls who keep giving my books fake one-star reviews when they haven’t even read them.

Almost all of the one-star reviews on Amazon for my last two books “The True Story of Fake News” and “Liberalism: Find a Cure” are from NON-verified purchases which is a clear indication they are fraudulent hence me adding this note. It’s just more proof that liberals are losers and can’t play fair, so if you could help me combat them as soon as possible since you actually bought this book, that would be great! Thank you!

The Memory Hole Censorship encompasses much more than people getting their posts and accounts deleted from social media platforms. It involves the mainstream media self-censoring stories and certain issues as well. They lie by omission and purposefully ignore events and individuals they don’t want to give publicity to, even when what’s happening fully warrants extensive coverage. They spent years chasing after “Russian agents” who are supposedly around every corner trying to infiltrate every aspect of America, while ignoring that the National Security Agency actually considers Israel to be the top espionage threat against the United States. 112 While regularly portraying Muslims and Jews as poor minorities who are constantly persecuted by Islamophobes and anti-Semites, the American media never reports that Christians are actually the most persecuted religion in the world, and are being murdered at such a rate in the Middle East that it is considered to be “near genocide levels” according to human rights groups. 113

When a reporter for Reuters learned that Beto O’Rourke was a member of the infamous Cult of the Dead Cow hacking group when he was a teenager, he promised Beto he wouldn’t reveal that information until after the 2018 midterm election when Beto was running against Ted Cruz for his Senate seat. 114 During the campaign Beto was already being haunted by his past for leaving the scene of an accident he caused while driving drunk, and if word got out that he was also committing computer crimes as well, it certainly wouldn’t have looked good. PBS edited out a part of Finding Your Roots , a documentary series that traces celebrities’ ancestry, after Ben Affleck discovered that his ancestors owned slaves and then pressured the network to cut that part out of the episode, which they did, so it wouldn’t hurt his image. 115 We only know about the censorship because hacked emails from Sony were posted on Wikileaks, including one between Finding Your Roots host Henry Louis Gates Jr. and the CEO of Sony Entertainment discussing Affleck’s request. 116

In our digital world, news outlets can alter an article or a headline after something is published without most people even noticing, covering up falsehoods and mistakes, or even changing the overall message of the story. This often results in an inflammatory article going viral and whipping people into a frenzy, only to later have key points quietly changed in response to the backlash. Sometimes outlets have other reasons for dumping things down the memory hole. For example, the popular New Zealand news website Stuff.co.nz quietly deleted an article about how a local resident had allegedly been “introduced to radical Islam at the Al-Noor mosque in Christchurch,” immediately after a white supremacist walked into the same mosque and livestreamed his mass-murder of 50 Muslims inside. 117 It appears the

website was trying to prevent word from getting out that the attacker appeared to have targeted that particular mosque because it had allegedly been linked to Muslim extremists.

Project Censored Have you heard of Project Censored? Most people have not, which is the ultimate irony because it’s an organization that highlights important under-reported or censored stories that mainstream media buries. Each year they publish a list of the top 25 censored or under-reported stories in America hoping to give them the attention they deserve. “Under-reported” meaning that they may have been mentioned in some mainstream outlets, but weren’t front page stories or didn’t dominate the news cycle for a week as they should have due to their importance. In our fast paced world, if a story isn’t one that happens to get circulated in the news cycle non-stop for a week, it is almost immediately forgotten by most people who are swept up in the next wave of reporting about mass shootings, fires, floods, celebrity gossip, health scares, and political scandals. Project Censored was founded in 1976 at Sonoma State University by a professor who wanted to expose censorship and propaganda in mainstream media. It has been praised by many media analysts around the world. Whistleblower Daniel Ellsberg, who leaked the Pentagon Papers which showed that the Johnson administration lied to the American people and Congress about the reasons for getting involved in the Vietnam War, said Project Censored, “shines light in the dark places of our government that most need exposure.” 118 Even Walter Cronkite, who anchored the CBS Evening News for almost twenty years and who was considered to be “the most trusted man in

America” said, “Project Censored is one of the organizations that we should listen to, to be assured that our newspapers and our broadcasting outlets are practicing thorough and ethical journalism.” 119 The Los Angeles Times once admitted that Project Censored, “offers devastating evidence of the dumbing-down of mainstream news in America” and said their annual book of the top 25 most censored and under-reported stories was, “Required reading for broadcasters, journalists, and well-informed citizens.” 120

New York Times Best Seller List When the New York Times learned the NSA was illegally spying on tens of millions of Americans they sat on the story for over a year and only published it after the reporter who got his story killed by the editors decided to write a book about the spying since the paper couldn’t stop him from publishing that. 121 But that’s not the only censorship the New York Times has engaged in. They even censor books from their prestigious “best seller” list. Ted Cruz’s book A Time for Truth was excluded from their list in 2015 when it qualified to be number three on the list. 122 They claimed it was because most of the sales were from bulk orders, which they say was evidence that an author is ordering their own book to artificially inflate the numbers, but the publisher HarperCollins issued a statement saying they investigated the sales patterns and found no evidence of any such bulk orders. 123 Cruz’s campaign tweeted “The New York Times is lying — they should release their evidence or issue a formal apology.” 124 A few days later, the book was then finally included on the best seller list. 125

Bill O’Reilly’s book Legends & Lies: The Patriots was included on The New York Times best sellers list when it came out in 2016, but was only ranked number six despite being number one on the Wall Street Journal’s best seller list, as well as number one on the Publisher’s Weekly list. At the time the Nielsen organization reported Bill O’Reilly’s book sold 24,348 copies that week, while the number one book on The New York Times best seller list, The Gene , sold only 9,781 copies. 126 The New York Times also omitted a bestselling book about the Philadelphia abortionist Dr. Kermit Gosnell who killed babies that were born alive during his attempted abortions and was found to have kept baby body parts in jars around his office. He was later convicted of three counts of murder and one count of involuntary manslaughter but the liberal media paid little attention to the trial because it cast abortion in such a horrific light. 127 The book’s co-author Ann McElhinney said it is “shocking that the cover-up of the Gosnell story is continuing…It’s clear that this is a blatant fake list in a fake news newspaper…It’s not only an insult to the people who have bought this book, but an insult to the readers of The New York Times who buy the newspaper and think they are getting the truth about book sales across America but instead get false facts disguised as a neutral list.” 128 In October 2018 when Stormy Daniels’ book came out detailing her alleged affair with Donald Trump, the New York Times included it on their top 10 best seller list but not Fox News’ Jeanine Pirro’s book Liars, Leakers, and Liberals , or David Limbaugh’s Jesus is Risen , both of which had actually sold more copies than Stormy’s. 129 In June 2019, CNN’s Jim Acosta released a book about President Trump titled The Enemy of the People: A Dangerous Time to Tell the Truth

In America that didn’t even make it into the top 50 on Amazon’s best seller list and completely dropped off the top 100 list after just two days. But the New York Times placed Acosta’s book at number ten on their “best seller” list, proving once again it’s not an accurate ranking of the week’s bestselling books, but really just a favorites list of the editors. Books are so powerful that today liberals even protest companies which decide to publish certain authors. Simon & Schuster came under tremendous fire when it was revealed they had signed a deal with rightwing provocateur Milo Yiannopolous, causing the publisher to become one of the top trends on Twitter from triggered liberals calling for people to boycott not just Milo’s book (which they weren’t going to read anyway), but every book Simon and Schuster publishes! 130 Hollywood producer Judd Apatow tweeted support of the boycott, saying, “I am in! In these times we can not let hatemongers get rich off of their cruelty. Shame on Simon (and) Schuster.” 131 Former Governor of Vermont Howard Dean tweeted, “This is an embarrassment for [Simon & Schuster] and their owner CBS which is already on record putting their company ahead of the USA.” 132 The publisher eventually canceled their contract with Milo and he later had to self-publish it.

Illegal Immigration The facts about illegal immigration are rarely allowed into the news cycle because the American people would learn just how big of a crisis it is, and the damage illegal aliens are doing to our country. In 2015 over 50% of legal immigrant households received some form of government welfare— including food stamps, housing assistance, school lunch programs, or Medicaid. 133 A 2018 report by the Center for Immigration Studies found that 63% of non-citizens use at least one form of welfare. 134 While the

liberal media loves to report that they’re just coming here to work, the fact is millions of them are sucking off our tax dollars. Many illegal immigrants come infected with diseases as well, including ones that had been previously eradicated from the United States, like measles—resulting in new “mysterious” outbreaks (at places like Disneyland) because the diseases are imported by illegal aliens and those claiming to seek asylum. 135 Just in the last few years there have been thousands of murders committed by illegal aliens. 136 Lives stolen and families shattered by people who should have never been in our country in the first place. Every day there are headlines in local papers about violent illegal aliens (“undocumented workers,” as liberals call them) being arrested, and the stories may get a 15-second sound bite on the local news, but that’s it. The number of drunk driving arrests, thefts, burglaries, rapes, and other crimes they commit on a daily basis is staggering. One study shows that illegal aliens commit crimes at double the rate of native-born citizens. 137 In June 2018 when President Trump met with Angel Families at the White House (people whose family members have been killed by illegal aliens), both MSNBC and CNN abruptly cut their live feed and began talking about how the Trump administration isn’t treating illegal immigrant families who sneak into our country good enough. Ironically, during the meeting a woman who lost her son to an illegal alien drunk driver began telling the president, “The mainstream media does not let you know what is really happening.” 138 Democrats say the flood of illegals entering our country isn’t a national emergency, as President Trump declared, meanwhile in a recent four-month period Border Patrol agents apprehended 136,000 people crossing from Mexico into the U.S. illegally. 139 In February 2019 alone over 66,400

people were arrested trying to cross the border, the most detained in a single month in over ten years. 140 During one live feed on MSNBC when their reporter was down at the border talking about the prototypes for Trump’s proposed new wall, in the background a group of illegal aliens climbed over the current short and inadequate fence that’s only a few feet high, right in the middle of his report. 141 The Left go so far when denying and defending the crimes of illegal aliens that when Donald Trump called MS-13 gang members “animals” the Democrats and their mouthpieces in the media began claiming that he was referring to immigrants in general! “Trump calls immigrants animals” was their new talking point which was repeated for years as a deceptively edited video of his statement continues to circulate as the “proof.” 142 MS-13 is widely considered to be the most sadistic and vicious street gang in the world by law enforcement agencies. 143 Their motto is “rape, control, kill” and they are known for torturing and dismembering people. 144 Democrats all used to support expanding the border wall and were tough on illegal immigration, until Donald Trump became president. 145 You’ve probably seen the video compilations of Chuck Schumer, Hillary Clinton, Barack Obama, and other top Democrats all previously supporting the wall and saying we need to stop the influx of illegals crossing the border —but that has changed. It appears the Democrats don’t support the blue collar working class any more. President Trump has won most of them over to his side, so now the Democrats are hoping to build a new base of future voters consisting of Americans who are too lazy to work and want free handouts from a Socialist government, and 20 million illegal aliens who they are hoping to grant citizenship to.

Transgender Crimes Transgender people have an extremely high rate of mental illness, 146 so it should be expected that they also have a high rate of crime. But because they’re part of a legally “protected class” and liberals see them as having achieved the next phase in human evolution, the media always ignores the dangers they pose to society. While their crimes may be reported briefly in local outlets where they occurred, the national conversation regarding transgender people is always framed as if they are amazing and special people who are being treated unfairly by society because they are different. A 30-year-old transgender “woman” in Wyoming was convicted of raping a ten-year-old girl in a bathroom in 2017 but nobody really heard about this story except for maybe some locals. 147 Another transgender “woman” sexually assaulted a ten-year-old girl in a grocery store bathroom in Scotland but avoided jail and was just given community service. 148 A 52-year-old transgender “woman” was arrested for raping (an actual) woman in 2016 and then once placed in a female jail “she” sexually assaulted four female prisoners within the first few days. 149 This story spread through social media because people found it so disturbing, but some were in denial and thought it was a hoax, causing Snopes to post an article asking “Did a Male Rapist Who Identifies as Female Transfer to a Women’s Jail and Assault Female Inmates?” and rated the claim “True.” 150 In March 2019 a black transgender “woman” in New York was arrested for hate crimes after targeting random white women walking along the sidewalk near subway stations in Harlem and the Upper West Side and spraying them in the face with pepper spray. Police believe 37-year-old

Thomas Herd, a black man who identifies as a woman, was behind almost a dozen other similar attacks in the area. 151 A transgender “woman” in Sydney, Australia was captured on surveillance cameras inside a 7-Eleven walking into the convenience store in January 2019 with an ax, and then randomly smashing two customers in the face after getting upset about a bad Tinder date. 152 In 2015, a 30-year-old man dressed as a woman was arrested for secretly videotaping women in a mall’s bathroom in Virginia. 153 A 37-yearold man in Toronto was arrested after he claimed to be a transgender “woman” and was allowed inside a women’s shelter, where he then assaulted four women. 154 These are just a few of many examples. Aside from ignoring the transgender Peeping Toms, rapes, and hate crimes that transgender “women” commit, the liberal media also ignores the rapes that gay men commit, and try to portray rape as something that only a man does to a woman, but the reality is that gay men raping other men occurs far more frequently than people know, particularly in the U.S. military since Barack Obama lifted the ban on gays being allowed in. 155

Black Crime The liberal media always portrays black people as being “racially profiled” by police and cite figures about black people being arrested at exponentially higher rates than whites as some kind of “proof” that the police are racist, but the reality is that black people per capita commit significantly more violent crimes than whites, so it only makes sense that they would get arrested more! Since liberals don’t know anything about math, when you mention that black men commit murder at approximately ten times the average of whites, they may lookup the statistics and claim that’s not true, but they are only

comparing the total number of murders committed by whites to the total number committed by blacks, and don’t factor in that blacks are only about 14% of the U.S. population. 156 The figures are per capita , meaning the average per person, and since less than 20% of murders in Chicago are actually solved, 157 the number of murders committed by black people is likely much higher than the FBI and Department of Justice records show, which again, reveal that black people commit murder at close to ten times the average of whites. Not twice as many per capita, or three times as many—ten times , or 1000% more murders per capita! Unfortunately many black Americans have embraced the identity of a thug, and see gangster rappers as role models, and view going to jail as a badge of honor. Local TV news in Chicago, Detroit, Milwaukee, and Baltimore cover the day’s murders, stabbings, and robberies for a few minutes each night, and it’s almost the same story the next night, and the night after that, but the black crime problem in America is never addressed as part of our national discussion. Memorial Day weekend of 2016 in Chicago ended with 69 people shot, every one of them from black on black crime. 158 And while the story may have gotten a fifteen second segment on some of the national broadcast news networks, the horrifying weekend was forgotten by the next day. There was no CNN Town Hall special to discuss the violence problem there. No endless panelists brought on air to discuss it with Anderson Cooper or Don Lemon. It’s like it never even happened. The following year 52 people were shot in Chicago over the same holiday weekend. 159 36 people were shot the year after that over Memorial Day weekend. 160 All black victims and black perpetrators. Over the Fourth

of July holiday and Labor Day weekends the same thing happens every year. It’s total carnage in the black communities in Chicago. It’s especially sad that the emergence of the Black Lives Matter movement was built upon a foundation of lies. The list of armed and dangerous perpetrators justly shot and killed by police and then labeled “victims” of “police brutality” is long. In fact, convicted cop killer Assata Shakur, who fled to Cuba which granted her “political asylum,” is considered to be an inspiration for starting the Black Lives Matter movement. 161 She was a member of the domestic terrorist organization the Black Liberation Army which stated their goal was to wage war against the United States government, and they carried out a series of bombings and assassinations of police officers in the 1970s. 162 Many Black Lives Matter supporters carried on the philosophy of the Black Liberation Army and see themselves in a war against police. During their marches they would sometimes chant “What do we want? Dead cops! When do we want them? Now!” 163 In June 2015 two black men were arrested for plotting to blow up a police station in Ferguson, Missouri to get revenge for an officer shooting Michael Brown (after Brown attacked him and tried to take his gun). 164 In July 2016 a black man ambushed a group of police officers during a Black Lives Matter march in Dallas, Texas, killing five of them and injuring nine others. 165 In 2017 when groups of black youth were robbing people of their cellphones at a train station in San Francisco, police refused to release security footage of the crimes “to avoid racial stereotypes.” 166 Debora Allen, who works for the Department of Transportation, gave an interview with the local news and explained the police told her that, “To release these videos would create a high level of racially insensitive commentary toward the district. And in addition it would create a racial bias in the riders against

minorities on the trains.” 167 Police wouldn’t release video footage of the perpetrators because they were concerned it would make black people look bad! The media regularly tries to ignore or downplay most instances of antiwhite hate crimes committed by black people. For example, after a black man walked into a predominately white church in Nashville, Tennessee in 2017 and opened fired, killing one woman and wounding seven others, a judge sealed most of the evidence for almost two years, and then during the trial it was revealed, as many had suspected, that he specifically went there to kill white people. 168 Meanwhile, if you’re concerned about white farmers being murdered in South Africa by the racist mobs of blacks who believe it’s their rightful land, you are called a racist conspiracy theorist for promoting what the Liberal Media Industrial Complex calls the “white genocide conspiracy theory.” 169 In recent years, white farmers in South Africa (called the Boers) have been facing persecution by vicious black gangs who raid their homes and slaughter them to get “revenge” against the “imperialists” who benefited from the Apartheid. 170 And God forbid you point out the anti-white hate crimes that occur in the United States at the hands of disgruntled blacks who blame white people for all of their personal and cultural failures. That’s a guaranteed way to get labeled a “white supremacist.”

Fake Hate Crimes Since a large part of our culture has come to celebrate victimhood instead of personal achievement, we have seen a staggering increase in the number of hate crime hoaxes where mostly black people, gays, Muslims, and Jews report fake hate crimes to the police after vandalizing their own

property with racial slurs, or claim they were physically attacked by some evil white people. The initial reports air on local and national news and go viral on social media, sparking outrage at the “racist” white people and “Trump supporters” who allegedly keep carrying out these attacks. But oftentimes when police get involved and interview the “victim” and gather evidence, the supposed “hate crime” turns out to be a hoax and it’s quietly forgotten about. Just after the 2016 election an 18-year-old Muslim woman in New York claimed that Trump supporters harassed her on the subway, chanting “Trump!” while trying to steal her hijab, but after police launched their investigation she was arrested for making the whole story up in an attempt to distract her father from the fact that she had been out getting drunk with her friends that night. 171 A Muslim student at the University of Texas-Arlington said she was threatened at gunpoint by a group of white men in a pickup truck only to later admit she fabricated the whole story too. 172 Hate crime hoaxes are a specialty in LGBT communities and have been used to further their cause and gain sympathy for years, and in some cases defame a neighbor they’re feuding with. 173 Since LGBT people are treated like an endangered species by the liberal media, every time a claim is made that one of them has been harassed, assaulted, or had their property vandalized with anti-gay “slurs,” the activist media is more than happy to amplify their claims. But when the police discover, as they often do, that the “victim” made the whole thing up, the story is dropped like a hot potato and the media just moves on to cover something else. For example, after a transgender “man” who was a prominent LGBT “rights” activist in Michigan had “his” home burned down, killing five pets, the FBI investigated it as a hate crime and the incident was used as leverage by the “man” to help pass a local ordinance that prohibited the

discrimination of gays, but authorities later arrested “him” for the crime and said the motive was to create publicity to help pass more gay “rights” legislation. 174 It seems every “protected” group engages in these kinds of false flags. A Jewish freshman at George Washington University reported someone had drawn swastikas on her dorm room door, but a security camera actually captured her doing it. 175 At the same school another student posted a swastika on a community bulletin board that belonged to a Jewish fraternity and it was later discovered that the perpetrator, a Jew, was a member of that same fraternity. 176 An African American community center in Seattle was vandalized with racist graffiti including “Nigger Babies” and “Vote Trump,” and as you can guess, an African American was arrested for the crime. 177 A 44-year-old black man in Colorado was arrested after it was discovered he was the one who hung racist flyers outside of a predominantly black church that caused the local community to be understandably outraged. 178 A black man reported that while his car was parked near Kansas State University it had been vandalized by someone painting “Go home nigger boy” on it. A photo of the damage went viral on social media only to later be exposed as another false flag and the man admitted that he defaced his own car and filed a false police report. 179 The FBI was even brought in to help investigate the case, which turned out to be another hoax. The following year a black student at the same school posted a photo of a note on his Twitter account that he claimed had been put on the door of his apartment, reading “Beware Niggers Live Here!!!” But when the police got involved he admitted that he made the note and put it there himself. 180

And of course the most popular hate crime hoax in decades involves actor Jussie Smollett, who claimed that two men wearing MAGA hats attacked him in the streets of Chicago in subzero weather and tied a noose around his neck, poured bleach on him, and yelled “This is MAGA country, nigger.” His story was so absurd that many were skeptical from the start, and as the investigation went on, police discovered he staged the whole thing hoping to become a social justice hero. 181 Aside from a lot of fake hate crimes being fabricated by black people, they also hallucinate that there are hate crimes committed against them. The black mayor of a small South Carolina town called police thinking she was the victim of a hate crime after she found a “yellow, sticky substance” covering her car in March 2019 which was parked in the driveway of her home. She assumed someone had spray-painted it, but police investigated and discovered it was just pollen. 182 Black college students at the University of Mississippi freaked out when someone saw a banana peel hanging over a tree branch outside a cabin at a fraternity’s weekend retreat. It caused such a concern that the retreat was canceled because some black students were afraid it was meant as a warning or to harass them, but it turns out a student who had finished eating the banana hung it on the tree because there were no garbage cans nearby and he didn’t want to just throw it on the ground where someone may end up stepping (or slipping) on it. 183 The list of recent hate crime hoaxes from “protected groups” like gays, lesbians, and black people could fill an entire book. 184 If you want to learn more about the issue there’s a whole chapter in my previous book, The True Story of Fake News which details these kinds of incidents.

Good News Ignored

Aside from burying bad news that will cause audiences to question the liberal narrative of how the world works, the Liberal Media Industrial Complex also ignores good news that undermines the agenda they’re trying to push. If it’s not completely ignored, it might be mentioned for 15 or 30 seconds on the broadcast news or published in newspapers or online articles but won’t be included in the lengthy discussions on cable news or the weekend talk shows like Meet the Press (NBC), Face the Nation (CBS), or This Week (ABC). Good news about President Trump is just a tiny blip on the radar, and then drowned out by the endless whining and moaning about minor issues and pundits’ latest paranoid delusions about what Trump “may do.” Despite reporting that if Donald Trump won the 2016 election the stock market would tank, it has skyrocketed largely in part due to him repealing countless burdensome business regulations and scrapping various awful trade deals previous administrations had gotten us into such as the Trans Pacific Partnership and NAFTA. In the first two years of his presidency the S&P 500 rose 28% 185 The Dow Jones Industrial Average later reached a record high, closing above 27,000 for the first time ever. 186 Black unemployment hit an all-time record low in May 2018 of just 5.9 percent. 187 In Trump’s first two years as president he was able to do more for African American communities than Barack Obama did in eight. Hispanic unemployment has fallen to its lowest level on record, down to 4.8%. 188 The unemployment rate for veterans also fell to an all-time low as well. 189 The average unemployment rate for the country dropped to 3.7% in October 2018, the lowest in almost 50 years. 190 The average American’s salary is also increasing at record rates. 191 President Trump signed the Veterans Affairs Choice program to dramatically speed up the amount of time that it takes U.S. veterans to get

their healthcare claims processed by enabling them to use private doctors and health care facilities instead of just the government-run VA hospitals. 192 The VA, like the DMV, the Post Office, and almost every other government-run program, was a disaster and it had taken months for veterans to see doctors and get the treatment they need. Trump’s reforms were a much-needed and long-overdue upgrade to how our veterans are taken care of. When Trump first took office ISIS controlled about 20,000 square miles of territory in Iraq and Syria, which contained a population of several million people. 193 However a year later they were driven out of their last outpost in Syria, crippling their organization and expelling them from their “Islamic State.” 194 While there are many Muslims in the Middle East who still adhere to the radical Islamic ideology of ISIS, they lost their territory and precious caliphate under President Trump. The ABC Nightly News spent literally 18 seconds on the story the day the Department of Defense announced the news that ISIS’ once planned Islamic State had fallen. 195 The CBS Evening New s spent one minute and twenty three seconds on the event. 196 Admitting that, despite his abrasive style and personality flaws, President Trump’s policies have been great for America is the last thing the Establishment will do. Instead they are trying to misdirect people’s attention and occupy their minds with issues of little significance and artificial controversies they drum up to smear him.

The War on Trump Because politicians on the Left and the Right have been screwing us over for years and using the mechanisms of government to fulfill their own selfish desires for power and wealth, the election of Donald Trump shook

the very foundation of the Washington D.C. Establishment. The lifelong bureaucrats knew the gravy train was going to come to a halt. For decades millions of Americans had felt a businessman, not a politician, would be the only one who could begin to fix the broken system—and the opportunity had finally come. Trump’s arrival to Washington was like parents who came home early from a long vacation, and now the kids (who were running around unsupervised breaking the rules) have to end the party and be held accountable for their actions. In 1988 on Oprah Winfrey’s show he was asked if he would ever run for president and he responded probably not, but added that he wouldn’t rule it out in the future because he was tired of seeing what’s happening in America. 197 And that’s why he thought about running in 2012, but felt his sons needed a few more years of experience before they were ready to take over the family business. In 2016 he felt it was the right time, and the rest is history, but the Establishment immediately struck back because they needed to destroy him before he started cleaning up the mess that decades of corruption had created. He was the ultimate roadblock to their globalist agenda, and longawaited New World Order. They were so upset about Trump’s victory they counterattacked by kicking off the “fake news” scare hoping to regain control of the flow of information. The Big Tech companies then started changing their algorithms and suppressing posts about certain topics and artificially favoring content from “authoritative” [liberal] mainstream sources. Even Tim Berners-Lee, the “founder of the World Wide Web” and the man who basically created HTML, said, “[People] are all stepping back, suddenly horrified after the Trump and Brexit elections, realizing that this web thing that they thought was that cool is actually not necessarily serving humanity very well.” 198

Nonstop Negative Coverage They began fabricating fake stories like the supermarket tabloids that invent scandals based on their own imaginations to smear President Trump and keep him constantly on the defense. “Our source says” and “if true” are littered throughout reports that endlessly speculate about Trump being engaged in a massive conspiracy to steal the election and work as a Russian “Manchurian candidate.” Nothing President Trump does is good in the eyes of the mainstream media. Everything he says is twisted and taken out of context in order to paint him as an incompetent racist who is destroying America. Journalist critic Anthony Brandt once said, “Members of the press sometimes print gossip as truth, disregard the impact they have on people’s lives, and are ready to believe the worst about people because the worst sells…We in the media have much to answer for.” 199 The week President Trump was inaugurated, Democrat operative David Brock, founder of Media Matters, a Leftist “media watchdog group,” launched a new plan to “kick Donald Trump’s ass” which included handing out a 50-page document marked “private and confidential” that outlined how they were going to use their resources to push for impeachment, bog down his administration by continuously filing lawsuits, and use their new proxy “media outlet” Shareblue to attack conservative media personalities and harass their advertisers to pull out. 200 The city of West Hollywood even voted to remove Donald Trump’s star from the Walk of Fame. “Earning a star on the Hollywood Walk of Fame is an honor,” the mayor said. “When one belittles and attacks minorities, immigrants, Muslims, people with disabilities or women — the honor no longer exists.” 201 The city has no problem with accused underage

sexual predator Kevin Spacey having a star, or convicted rapist Bill Cosby, or accused pedophile Michael Jackson. But they were determined to have Trump’s removed. So far, the star remains, since the Walk of Fame is considered a historic landmark and run by the Hollywood Chamber of Commerce which said “as of now” they have no plans to remove it. 202 A Pew Research study found that the media’s coverage of President Trump’s first 60 days in office was three times more negative than that of President Obama. 203 Even NPR admitted, “Compared to other recent presidents, news reports about President Trump have been more focused on his personality than his policy, and are more likely to carry negative assessments of his actions.” 204 Another study from the Media Research Center showed that 89% of the broadcast news reports from President Trump’s first 100 days in office were negative. 205 Newsbusters, a website run by the Media Research Group, declared 2017 “The year the news media went to war against a president.” 206

A poll by Politico showed that 46% of Americans believe the media just makes up fake stories about President Trump. 207 And ethics scholar John Hulteng previously warned, “It may be well that if journalism loses touch with ethical values, it will then cease to be of use to society, and cease to have any real reason for being.” 208 But unfortunately that ship sailed a long time ago.

“He’ll Crash the Economy” Just a few weeks before the 2016 election, CNN reported that, “A Trump win would sink stocks.” 209 Politico said that, “Wall Street is set up for a major crash if Donald Trump shocks the world on Election Day and wins the White House.” 210 CNBC warned that, “it probably won’t be a

pretty picture for stocks if he does.” 211 New York Times economist Paul Krugman wrote a column the day after the 2016 election saying, “So we are very probably looking at a global recession, with no end in sight,” adding that, “a terrible thing has just happened.” 212 Instead, the stock market kept reaching all-time highs, 213 black unemployment soon reached the lowest in history, 214 and countless Americans were getting bonuses and taking more money home each week in their paychecks because of his new tax reforms, 215 but still the liberal media kept nitpicking every little thing he did or said, trying to spin it as if it was the end of the world. People’s tax refunds were technically “lower” under Trump’s new tax code because less money was being taken out of their paychecks; money that would have been returned to them once they filed their taxes at the end of the year. Headlines from NBC News read, “Under new Trump tax code, average refund is 8.4 percent smaller,” and they reported, “Frustrated taxpayers are using the hashtag #GOPTaxScam to vent about their smaller than expected tax refunds.” 216 All the major news outlets piled on with similar reports, but this was only half of the story. The other half would put things into perspective. An executive at the Tax Foundation, a think tank that studies U.S. tax policies, told a New Jersey PBS station, “What the Treasury Department did is they adjusted the amount of taxes that were withheld from your paycheck every time you got paid, say every two or three weeks. And so you actually saw a little bit more in every paycheck in terms of less taxes withheld, but that means your refund at the end of the year might be a bit smaller than you actually expected.” 217 Why would you want to give the government more money than is required each paycheck and then wait until the end of the year to get it

back? Taking less money from each paycheck is much more efficient, but since many people are too dumb to grasp this simple concept the media spun the news about lower refunds as if people were somehow having to pay more taxes to the government, when the complete opposite is true!

“Trump is Hitler” We’ve never seen the American media be so slanderous, vicious, and dangerous when reporting on a president. They sound worse than a raving lunatic you would find standing in the streets ranting about the end of the world. CNN and MSNBC hosts regularly say that President Trump is acting like a dictator and often compare him to Adolf Hitler. Not even in the months and years after the weapons of mass destruction hoax fell apart did the liberal media stoop so low when criticizing President George W. Bush for the disaster that the Iraq War had become. Just two days after Donald Trump was inaugurated, CNN’s Brian Stelter gave the impression that the country had just been hijacked by a dictator. “These are uncomfortable questions, especially these last ones, but it’s time to ask them,” he began. “Do citizens in dictatorships recognize what’s happening right here, right now? Are they looking at the first two days of the Trump administration and saying, ‘that’s what my leader does.’ What should we learn from them today?” 218 Don Lemon opened his broadcast one night by declaring “This is CNN Tonight. I’m Don Lemon. The President of the United States is racist,” 219 and often insinuates the President supports neo-Nazis and could become the next Hitler. 220 In response to Trump’s speech at CPAC 2019 where he highlighted his America First agenda, CNN analyst Sam Vinograd said she felt “sick” after hearing it, because Trump talking about “preserving our heritage” to her,

“sounds a lot like a certain leader that killed members of my family, and about six million other Jews in the 1940s.” 221 Another CNN panelist said that President Trump has radicalized more people than ISIS ever did. 222 The New York Daily News ran a headline reading, “Trump, Not ISIS is America’s Greatest Existential Threat,” and went on to say “This is not some bit of clickbait,” and claimed, “Trump can wreak far more havoc on America, its vaunted institutions and its people than a terror group on the other side of the world.” 223 Keith Olbermann later said that Donald Trump and his family have done more damage to America than Osama Bin Laden and ISIS combined. 224 MSNBC’s Donny Deutsch has said Trump is a dictator on several occasions and people need to hit the streets and start a “revolution” to overthrow him. 225 Fellow MSNBC host Christ Matthews even compares Ivanka Trump and her husband Jered Kushner to Saddam Hussein’s two murderous sons, Uday and Qusay. 226 In his commentary about President Trump’s inauguration speech Matthews said it sounded “Hitlerian.” 227 Just before the 2018 midterms an MSNBC legal analyst hoping the Democrats would take back control of the House and the Senate said, “We’re going to see if this reign—that [Republicans] now have control over all three branches of government—we’re going to see if this reign lasts for 30 days or two years, or a thousand-year Reich.” 228 The “thousand-yearReich” was the Nazi’s name for their planned global empire. In the past, if an unhinged guest on cable news would make such outrageous statements they would never be invited back and the host would apologize for their behavior, but it is a common occurrence in the Trump era to compare him to Hitler, and it’s not just guests who aren’t affiliated with the networks, it’s people on the payroll, from regular contributors, to the hosts themselves!

Calls to Assassinate Trump The endless streams of fake news painting President Trump as a Russian agent or the reincarnation of Hitler have incited countless unhinged whack jobs to publicly make assassination threats against him on social media. 229 There have also been numerous arrests of individuals who have made such threats (and taken specific action towards their goal), but the vast majority of them go unpunished. Just a few weeks before he was elected, a Secret Service agent said she wouldn’t protect Donald Trump if someone tried to assassinate him. 230 After word spread of her treasonous statements she was forced to retire. The New York Times even published several fictional stories by various novelists imagining how the Mueller investigation may end, and one of them depicted President Trump getting assassinated with the help of a Secret Service agent. 231 The anti-Trump mania has even resulted in numerous high-profile celebrities uttering threats of violence or wishing violence against him. Madonna famously declared she “thought an awful lot about blowing up the White House,” but that was just the beginning. Johnny Depp asked an audience, “When was the last time an actor assassinated a president?” answering, “it’s been awhile and maybe it’s time,” referring to John Wilkes Booth (who was an actor) killing Abraham Lincoln. 232 Jim Carrey said he had a dream about killing President Trump with a golf club. 233 Mickey Rourke said he wanted to beat him with a baseball bat. 234 And Robert Di Niro said he wants to “punch him in the face.” 235 Rapper Big Sean did a free style on a popular radio show about how he wanted to “murder Trump.” 236 Snoop Dogg released a rap video depicting himself shooting Donald Trump in the head. 237 Marilyn Manson made a

video titled “Say 10” (a play on words to sound like “Satan”) which depicted him decapitating Donald Trump with a large knife. 238 Green Day singer Billie Joe Armstrong shouted “Kill Donald Trump!” at one point when performing the song “American Idiot” at a concert in Oakland, California. 239 And of course Kathy Griffin posted that infamous photo of herself holding Trump’s bloody decapitated head. 240 Never before have there been so many threats to assassinate a president of the United States, and it’s utterly shocking to see that there have been little to no repercussions for the high profile celebrities who have done so. Previously such reckless and dangerous statements would completely end someone’s career and gotten their movies and music pulled from store shelves and streaming services, but today these celebrities have been mostly immune from any consequences.

The Red Scare The Democrat conspiracy theory that Donald Trump “colluded” with Russians to “steal” the 2016 election caused the greatest case of mass hysteria in America since the Salem witch trials. As you know it completely consumed the news cycle for over two years, and every night the speculation and imagination about “what really happened” got more and more out of control. “Donald Trump now sits at the threshold of impeachment,” MSNBC’s Lawrence O’Donnell once declared with glee. 241 “The worst case scenario that the president is a foreign agent suddenly feels very palpable,” Rachel Maddow concluded one night. 242 He was certainly going to not only be impeached, but led out of the White House in handcuffs for committing “treason” and “undermining our Democracy,” they thought. Those who hadn’t succumbed to the madness were skeptical of these wild allegations from the start, and when the

“bombshell” reports kept turning out to be completely false, the mainstream media became increasingly discredited and desperate. Alan Dershowitz, a rare liberal who still maintained his sanity though all of this, summed it up pretty well when he said that “hope over reality” fueled their delusions. 243 When the Robert Mueller investigation finally cleared Trump and everyone connected to him of conspiring with the Russians in any way, the Democrats and their mouth pieces in the media still couldn’t admit they were wrong (and completely insane), and instead kept concocting new conspiracy theories about a “cover-up.” Since they took control of the House of Representatives in the 2018 midterm election, they kept “investigating” Trump’s business records trying to find “something.” As President Trump once noted, “If it was the goal of Russia to create discord, disruption and chaos within the U.S. then, with all of the Committee Hearings, investigations and party hatred, they have succeeded beyond their wildest dreams. They are laughing their asses off in Moscow.” 244

LGBT “Rights” President Trump supports gay “marriage” unlike every previous Republican president (and all Democrat presidents too, except for Obama when he flip-flopped during his second term). But the media still portrays Trump as anti-gay. At a campaign event before he was elected, Donald Trump held up a big gay pride rainbow flag and waved it around stage after seeing someone in the audience holding it. 245 He even said Caitlyn Jenner can use whatever bathroom “she” wants to in Trump Tower. 246 But the radical LGBT activists are still convinced that he “hates” gay people because the mainstream media ignores his pro-LGBT positions.

After President Trump announced a plan to work with the United Nations to prevent countries from enforcing laws banning homosexuality, Out Magazine , a popular American gay publication, attacked him, publishing a story titled, “Trump’s Plan to Decriminalize Homosexuality Is an Old Racist Tactic,” and claimed, “The Trump administration is set to launch a global campaign to decriminalize homosexuality in dozens of nations where anti-gay laws are still on the books,” which you would think they would be happy about, but they denounced the move, saying, “Rather than actually being about helping queer people around the world, the campaign looks more like another instance of the right using queer people as a pawn to amass power and enact its own agenda.” 247 You can’t make these lunatics happy!

They Sided with North Korea The liberal media hates Trump so bad, they basically sided with North Korea out of spite when President Trump was trying to help broker peace between the North and the South. When he was trying to incentivize Kim Jong Un to dismantle his nuclear program, NBC News complained about it, reporting that, “Trump’s North Korea policy could trigger famine,” because of new sanctions he threatened to put in place if they didn’t comply with the U.S. demands. 248 How else was he supposed to apply pressure to them without launching a full-out war? Applying sanctions to cutoff imports is a basic tactic when dealing with rogue regimes! Comedian Michelle Wolf (who had recently bombed at the White House Correspondents Dinner) polled her Netflix audience, asking them, “Are you sort of hoping we don’t get peace with North Korea so you wouldn’t have to give Trump credit?” and 71% agreed that they didn’t want

peace in North Korea because it would make President Trump look good. 249

When Michael Moore was talking with MSNBC’s Chris Hayes, the cable news host admitted that he was “genuinely rooting for him to handle the Korean situation well,” at which point Michael Moore cut him off and replied, “I don’t know if I agree with that.” A stunned Hayes responded, “You’re not rooting for him to deal with North Korea well?!” Michael Moore continued his explanation with a ridiculous analogy trying to justify his hope that President Trump fails at helping negotiate a peaceful resolution between North and South Korea. 250 The two countries joined together during the 2018 Winter Olympics to form a unified Korean hockey team which was an incredible sign that relations were improving. Kim Jong Un later crossed over the DMZ (demilitarized zone—the border between the North and South) to meet personally with the leader of South Korea, marking the first time leaders of the two countries had met since Korea split apart after World War II. 251 Families have been allowed to reunite with each other for the first time since the separation, and President Trump himself was invited to step over the DMZ where he was greeted by Kim Jong Un in a historic moment giving more hope for peace in the region, but Trump doesn’t get any credit for that, and the media kept claiming his tactics were going to start World War Three.

Trump Derangement Syndrome Conservatives began joking about liberals being afflicted with Trump Derangement Syndrome when it became obvious that they weren’t able to cope with the fact that he is the president, but as time went on many psychologists said they were actually treating patients for what they called

Trump Anxiety Disorder. 252 A therapist at the Washington D.C. Counseling and Psychotherapy Center admitted that they were getting a lot of patients who had anxiety, fear, and hopelessness about the Trump administration. 253 The shock on election night 2016 when Hillary Clinton lost was like nothing the country had ever seen. Reporters couldn’t hold back their horror and Democrats across the country were in tears, but after a week the shock still hadn’t worn off. And then a month went by and they were still in denial that Trump was going to be our next president and were getting increasingly distraught. But the months dragged on, and then it was a year, and then two years since he won the election, and instead of gaining their composure and getting back to business, they continued to get more unhinged with every passing week. When a New York Times reporter was asked about why Hillary Clinton wrote her What Happened book, she responded, “I think that the intention of the book was two things. One, it was to really, I think, just to vent and get it out there because there are so many people like Hillary Clinton who are still writing about this, who are still thinking about this, who are still in therapy frankly, sources that I know who are still really upset about the election.” 254 In therapy! On the one-year anniversary of the 2016 election, anti-Trump protesters gathered in Boston to “scream helplessly at the sky.” 255 Over 4000 people RSVP’d to the event on Facebook which was literally titled, “Scream helplessly at the sky on the anniversary of the election,” and hundreds of them actually showed up and did just that! 256 Rosie O’Donnell later admitted that she had been seeing a therapist and it took her a year to be able to compose herself enough to go out into public again. 257 Chelsea Handler also opened up a few years after the election and admitted she too had been seeing a psychiatrist because she had a “mid-life

identity crisis once Trump won the election.” 258 Model Chrissy Teigen, who’s married to singer John Legend, admitted that she asked her doctor to up her medication because Trump was causing her “crippling anxiety” and had to get a Botox injection in her jaw to relieve tension because she kept grinding her teeth, which she blames Trump for. 259 Since Democrats always project, meaning they imagine others doing what they themselves are doing, they started saying that President Trump was “mentally unfit” for office, and kept floating around the idea that the 25th Amendment could soon be enacted to remove him. But to actually invoke the 25th Amendment and get him removed it would take the vice president, his entire cabinet, and two-thirds of both the House and the Senate to achieve it. Democrats are so delusional that they are regularly accusing the president of being crazy, while being completely unaware of the irony of their own activities. One MSNBC guest even said that President Trump’s strong warnings to North Korea were the result of him having, “profound sexual and masculine insecurities” that “are literally threatening to annihilate the planet.” 260 Shortly before he died, Stephen Hawking warned that since President Trump is not very concerned about man-made global warming he may, “push the Earth over the brink, to become like Venus, with a temperature of 250 degrees, and raining sulfuric acid.” 261 One way liberals regularly vent their hatred of President Trump is by obsessively replying to his tweets, and it’s become a game for them to see who can reply first and whose reply can get the most “likes.” Some Twitter activists, like the odd Krassenstein brothers whose obsession with trolling President Trump’s tweets have become “Twitter famous.” (They were later banned for allegedly using fake accounts to artificially amplify their tweets). 262

As one writer in the London Guardian pointed out, it appears that liberals “worst nightmare” is actually a successful Donald Trump presidency. 263 The mainstream media would have to admit that they were wrong about everything and had been stringing along their audience for years under the false pretense that they were reporting news, when in reality they were just throwing an endless temper tantrum and lost every ounce of their integrity.

The War on Trump Supporters The oldest trick in the Democrats’ playbook is to call Republicans racist. When the Tea Party movement emerged in 2009 as a response to Barack Obama’s massive government expansion and increasing taxes, supporters were smeared as a bunch of old racist white people. The same tactic has been deployed against popular social media personalities today who have built up large followings in recent years and are often smeared as members of the alt-right in attempts to derail their careers and get their accounts shut down. Online media outlets and self-proclaimed journalists on Twitter often call conservatives Nazis and alt-right even if they’re Jewish! Laura Loomer (who is Jewish) has been smeared as a member of the white nationalist “altright” 264 As has Trump advisor Stephen Miller, who is also Jewish. 265 And even Ben Shapiro, a devout Orthodox Jew who wears a yarmulke in every one of his public appearances, is considered to be a member of the alt-right by these morons. 266 Instead of defending conservative Jews smeared by the liberal media, Jonathan Greenblatt, the head of the Jewish ADL [AntiDefamation League], adds fuel to the fire by saying that the words “caravan,” and “open borders” are “literally white supremacist phrases.” 267

Alex Jones has been called an “alt-right” radio host by Forbes magazine, which you would think would be a credible publication. 268 YouTuber Steven Crowder was smeared by Newsweek as becoming popular by “touting an alt-right ideology.” 269 And immediately after Trump won the 2016 election various outlets defamed me with the same smear, even though I had never expressed any support whatsoever for white nationalism and am just an ordinary Constitutional Conservative. Several publications issued retractions or removed my name from such articles after I sent them cease and desist notices. 270 Psychology Today published an article titled, “An Analysis of Trump Supporters Has Identified 5 Key Traits,” and said we have “Authoritarian Personality Syndrome, social dominance orientation, prejudice, lack of intergroup contact (contact with minorities), and relative deprivation.” 271 Actor Rob Reiner (who played “Meathead” in the 1970s show All in the Family ) told MSNBC that “20 to 30 percent” of Trump supporters “are hardcore racists.” 272 And guests on MSNBC and CNN often declare that a huge number of Donald Trump supporters are white nationalists and only support building the wall to “keep the brown people out.” 273 Don’t forget the mainstream media’s vicious smears against Nick Sandmann, the high school student from Covington Catholic who was pestered by an old Native American man who beat a drum in the kid’s face when he and his classmates were visiting Washington D.C. on a school trip. CNN then declared that MAGA hats “have become a potent symbol of racism.” 274 Sandmann then filed lawsuits against the Washington Post, CNN, and NBC for $250 million dollars each for defamation. 275 A reporter that CNN gave their “Journalist of the Year” award to was later fired in disgrace after it was discovered he had fabricated numerous stories including claiming he saw a “Mexicans Keep Out” sign at the city

limit of a small Minnesota town when he was reporting “from Trump country.” 276 The Daily Beast published an article just before the 2019 Super Bowl titled, “Tom Brady’s New England Patriots Are Team MAGA, Whether They Like It or Not,” and declared, “Their star quarterback, coach, and owner all supported Trump,” and then called them “the preferred team of white nationalists.” 277 It went on to attack quarterback Tom Brady because he was pictured previously with a MAGA hat in his locker which the Daily Beast says is, “a symbol of white nationalism in America.” 278 The article concluded that the Patriots “are the official team of American White Nationalism” and “When you root for the Patriots, you are associating yourself with a virulent and revolting strain of politics that seeks to Make America Great Again—which is to say, white, European, Englishspeaking.” 279 It also said the Covington Catholic kids are “entitled little shits being racist.” CNN is so despicable they even sent a reporter to an elderly woman’s home to confront her about sharing something on Facebook that had allegedly been originally posted by a Russian troll farm. 280 She was ambushed while doing yard work in the front of her home and had a microphone stuck in her face and was accused of being a pawn of the Russians. The woman, who is 76-years-old, said after CNN aired the segment confronting her she was relentlessly harassed online and her phone rang off the hook from strangers calling her. 281

Denial of Basic Services An increasing number of reports keep circulating about instances where people wearing red MAGA hats have been kicked out of bars and restaurants for just wearing the hats. After attending a Trump rally in

Richmond, Virginia during the summer of 2016 a family stopped into a local Cook Out burger joint for lunch but were turned away by staff because they were wearing Trump t-shirts and hats. 282 After a man wearing his MAGA hat was kicked out of a bar in New York City, he sued the owner for discrimination, but a judge threw out the lawsuit. 283 A 9-year-old boy in California who is a big fan of the President wanted a Trump birthday cake, but his mother said she couldn’t find a bakery that would make one for him. 284 Gays want bakeries sued into bankruptcy if they refuse to bake a special cake for a gay “wedding” but think it’s okay for them to deny service to Trump supporters. White House Press Secretary Sarah Huckabee and her family were kicked out of a restaurant in Lexington, Virginia after the owner recognized her and made them leave. When word of the incident spread, liberals celebrated it. The Washington Post even ran a headline saying, “Chasing White House officials out of restaurants is the right thing to do.” 285 Congresswoman Maxine Waters then encouraged more harassment, saying, “If you see anybody from that cabinet in a restaurant, in a department store, at a gasoline station, you get out and you create a crowd, and you push back on them, and you tell them they’re not welcome anymore, anywhere.” 286 Soon after this, activist Laura Loomer confronted Maxine Waters in the halls of the Capitol on camera, asking her, “Where can a conservative eat at a restaurant in D.C.? Do you think it’s civil to call for the harassment? Are we supposed to sit at the back of the bus?” 287 Maxine scurried away to a “members only” elevator in shock from getting a taste of her own medicine. The Boston Globe published an op-ed that began describing how one of the writer’s “biggest regrets” of his life was not pissing in political commentator Bill Kristol’s food when he ate at a restaurant the writer

worked at. He went on to urge people to tamper with Trump supporters’ food by doing what he was afraid to do, saying members of the Trump administration “have to eat,” and while the person may lose their job, (tampering with someone’s food is actually a crime) “you’d be serving America,” he said. “And you won’t have any regrets years later.” 288 The Boston Globe actually published this filth, but after a growing backlash changed parts of the op-ed and added a note saying, “A version of this column as originally published did not meet Globe standards and has been changed. The Globe regrets the previous tone of the piece.” 289 Even with the alterations, the title was, “Keep Kirstjen Nielsen unemployed and eating Grubhub over her kitchen sink,” and the overall message of the piece was still that people should run members of the Trump administration out of any restaurant they’re seen in. After growing shock and outrage that a major paper would publish such garbage, the Globe later deleted the article. 290

The Left Encouraging Violence In the Trump era political rhetoric from the Left has sunk to levels never before seen in modern American history. Not only are they insistent on smearing all Trump supporters as racists, but they are encouraging people to physically attack anyone seen wearing a MAGA hat in public. During the 2016 election season many peaceful Trump supporters were assaulted as they were leaving events by rabid protesters who had gathered outside. At a San Jose rally one woman was pelted with eggs and water balloons by an angry mob and others were punched and hit with bottles as they left. 291 After a 16-year-old Trump supporter was assaulted in a Whataburger fast food joint by having a drink thrown on him and had his MAGA stolen, CNN’s Marc Lamont Hill said, “I actually don’t advocate throwing drinks

on people. Not at all. But yes, I think MAGA hats (deliberately) reflect a movement that conjures racism, homophobia, xenophobia, etc. So yes, it’s a little harder to feel sympathy when someone gets Coca Cola thrown on him.” 292 Vox’s Carlos Maza encouraged assaulting right-wing figures as well, and hopes to make them “dread” being in public. 293 Breitbart News compiled a list of violent acts against Trump supporters and detailed mainstream media reporters and pundits who approved of them and counted 639 incidents between September 2015 and November 2018. 294

Just wearing a red MAGA hat in public can put you in danger of getting assaulted by some random lunatic who happens to see it. An MSNBC host even said wearing one is “an invitation for confrontation” and considers them “the modern day version of the Confederate battle flag.” 295 The Huffington Post reported that, “Searching for MAGA symbolism is one of the easiest ways to notice online extremists and members of hate groups.” 296 CNN’s Angela Rye said that MAGA hats are “just as maddening and frustrating and triggering for me to look at as a KKK hood.” 297

An 81-year-old man in New Jersey was attacked inside a grocery store by a 19-year-old teen because the old man was wearing a Make America Great Again Hat. 298 A couple shopping at a Sam’s Club in Kentucky had a gun pulled on them by a man who got triggered after seeing their MAGA hats. 299 A man eating at a restaurant in Massachusetts was assaulted by a woman who spotted him wearing the hat. She was arrested for assault and it turns out was an illegal alien, so a few days after her initial arrest, she was arrested again by ICE. 300 A legal immigrant from Africa living in Maryland was beat down by two other black men because he was spotted walking down the street wearing a MAGA hat. 301

A group of five Asians walking down the street in Washington D.C., all wearing MAGA hats, were harassed by two black men who videotaped themselves stealing two of the hats and posted the video on Twitter to brag about what they had done. The group happened to be North Korean defectors who had escaped the country and proudly wore their MAGA hats because President Trump was making progress facilitating peace between the North and the South. 302 A young woman wearing a red hat reading “Make Bitcoin Great Again” in the style of the MAGA hat was pepper sprayed right in the face by a member of Antifa while she was in the middle of doing a television interview on the campus of UC Berkeley during an event at the school. 303 A man in the back of a pickup truck leaving a Trump rally in Arizona was sucker punched in the head by a protester as the truck pulled away. 304 A customer eating at a Cheesecake Factory in Miami was harassed and threatened by several employees of the restaurant because he was wearing a MAGA hat. 305 When Hillary Clinton was asked about civility returning to America, she endorsed the growing angry mobs saying, “You cannot be civil with a political party that wants to destroy what you stand for, what you care about. That’s why I believe, if we are fortunate enough to win back the House and or the Senate [in the 2018 midterms], that’s when civility can start again.” 306 Barack Obama’s former attorney general Eric Holder went even further saying, “Michelle [Obama] always says, you know, ‘When they go low, we go high.’ No. When they go low, we kick them! That’s what this new Democratic Party is about.” 307 Two days after the 2018 midterm election a fascist mob gathered right outside the home of Fox News host Tucker Carlson and with a bullhorn

shouted, “Tonight you are reminded that the people have a voice. Tonight, we remind you that you are not safe,” adding, “We know where you sleep at night.” 308 Facebook didn’t even suspend the Antifa page that organized the event. 309 The Huffington Post published an op-ed calling for violent resistance against Trump and denounced those on the Left who were saying violence isn’t the answer. It’s titled “Sorry Liberals, A Violent Response To Trump Is As Logical As Any,” and starts off saying “there’s an inherent value in forestalling Trump’s normalization. Violent resistance accomplishes this.” 310

It went on to say, “Assuming anti-Trump protests should be strictly focused on electoral politics and not these broader goals would be a detrimental oversight. Understanding European anti-fascists’ use of violent tactics to shut down large rallies from White Supremacists can be illustrative here. Because while Trump isn’t leading full bore White Supremacist rallies, there is value in making it clear that even his fascismlite has no place in civilized society.” 311 The liberal media has been engaging in what’s called stochastic terrorism, which is when the widespread demonization of an individual or a group incites lone wolf political extremists or members of an extremist group to attack them in what appears to be a random act of violence but was actually inspired by inflammatory rhetoric being aimed at that individual or the group they belong to. In April 2019 the CBS show The Good Fight posted a teaser video on their official Twitter account showing one of the main characters engaging in a diatribe about how “some speech” deserves “enforcement” and that “It’s time” to physically attack American citizens “unprovoked” who are engaging in speech that social justice warriors perceive as “racist.” 312

Anti-White Racism Part of the war on Trump supporters involves painting a large percentage of white people as racists in hopes of preventing more blacks and latinos from joining the Trump train. The Liberal Media Industrial Complex now regularly paints white people as the enemy, blaming “systemic racism” for the problems in black communities, and depicts anyone who wants to stop the flood of illegal aliens into America as members of the KKK. While Martin Luther King wanted everyone to judge their fellow man by the content of their character—not the color of their skin, the Liberal Establishment uses identity politics to pit the different races against each other and are trying to create a culture where white people should be ashamed of being white and atone for their “white privilege” by paying reparations to black people and giving blacks special perks in America just because of their race. Online outlets like Salon.com and BuzzFeed are notorious for their anti-white articles. Salon has posted articles titled, “White men must be stopped; The very future of mankind depends on it,” 313 “10 ways white people are more racist than they realize,” 314 and “White guys are killing us: Toxic, cowardly masculinity, our unhealable national illness,” 315 just to name a few. One of BuzzFeed’s racist articles links to various Power Point presentations with titles like “White People Are a Plague to the Planet,” and “White People are Crazy.” 316 They’ve also published articles titled “17 Foods That White People Have Ruined,” “17 Deplorable Examples of White Privilege,” and “22 Reasons Why Straight White Boys Are Actually The Worst.”

Vice News calls whiteness “toxic” 317 and black publications like The Root regularly attack white people as “useless.” 318 MTV did a whole documentary titled “White People” that depicts the entire race as a group whose very existence is based on oppressing black people and other “people of color.” 319 Hollywood constantly complains about white people with campaigns like the “Oscars are too white” and always cries about how there isn’t enough “diversity” in leading roles. When hosting Saturday Night Live to promote his new movie Django Unchained , actor Jamie Foxx bragged, “I kill all the white people in the movie! How great is that!?” 320 Rapper Jay-Z has been photographed at an NBA game wearing a medallion from the 5% Nation, a black power group that believes white people are the Devil. 321 Many rappers admire Nation of Islam leader Louis Farrakhan who has taught that white people are “the Devil” and “deserve to die.” 322 CNN’s Don Lemon says the biggest terrorist threat in America are white men. 323 The network also claims that, “The Internet is radicalizing white men” and urges Big Tech to censor YouTube videos and change the algorithms even more to hide certain ideas on the Internet. 324 CNN contributors and other cable news pundits go so far as to say blacks can’t be racist and justify their racism against white people as “payback” for slavery in the 1800s. Just pointing out anti-white racism is enough for the Liberal Media Industrial Complex to label you a “white supremacist,” so most people are afraid to talk about it.

Demonizing Black Conservatives While it appears that black people can do no wrong in the eyes of liberals and that all their shortcomings, bad decisions, and crimes are the

fault of white people; there is one thing that black people aren’t allowed to do in America today without severe criticism and backlash—and that’s be conservative. Black conservatives like Larry Elder, David Webb, Sheriff David Clark, Pastor Daryl Scott, Ben Carson, and others are constantly smeared by the media as “traitors” to their race, or “uncle Toms” and “house niggers” who have sold out to white people. After Diamond and Silk appeared at CPAC 2019, CNN’s Oliver Darcey insinuated they were “grifters,” meaning con artists. 325 Rolling Stone magazine called Candace Owens an “Alt-Right Provocateur” once she became a star. 326 After posting a few YouTube videos about being a black conservative she was thrust into the spotlight when Kanye West tweeted about her, jumpstarting her career and turning her into one of the most popular young black conservative women in the country. When Candace spoke at a college in Utah, protesters gathered outside, which is common at her events, but this time they had a huge banner that read “End White Supremacy.” 327 When visiting Philadelphia in August 2018 a group of protesters surrounded the cafe she was eating breakfast at and shouted with a megaphone “fuck white supremacy.” 328 Georgetown University professor and regular MSNBC guest Michael Eric Dyson attacked Kanye West after he met with President Trump in the Oval Office (while wearing his MAGA hat), saying, “This is white supremacy by ventriloquism. A black mouth is moving, but white racist ideals are flowing from Kanye West’s mouth.” 329 He went on to say “Kanye West is engaging in one of the most nefarious practices yet. A black body and brain are the warehouse for the articulation and expression of anti-black sentiment.” 330

The Southern Poverty Law Center actually included the mild-mannered and meek Ben Carson on their “Extremist Watch List,” citing a line in his book America the Beautiful where he affirmed that marriage is between a man and a woman and said Leftists are pushing the United States down the same path that led to the fall of the Roman Empire. 331 They labeled Ben Carson an extremist! Hollywood actress and singer Bette Midler claimed that President Trump was paying black people to come to his rallies after she kept noticing them in attendance. She said they were just props for the background. 332 Liberals don’t want diversity of thought, they want everyone to be lockstep in line with the core tenants of the radical liberal agenda and many of their supporters are so dumb that they believe there are black white supremacists in America today, and have no clue how insane they sound. They are afraid that if 20% of black voters leave the Democrat Party and become Republicans, that would be enough to tip the scales in favor of Republicans in elections for years to come and the Democrat Party’s political power would be gravely diminished. 333

The War on Families Families instill moral values, carry on important cultural traditions, and provide a support network when someone goes through an emotionally or financially difficult time. And when someone is engaging in self-destructive or unscrupulous behaviors, those close to them can often see the warning signs and intervene to help get them back on track. But the Left doesn’t want families to raise, teach, or protect children. They want the government

to do it, along with help from the high priests of Hollywood who are held up as the moral leaders of America. Joshua Meyrowitz, Professor of Media Studies at the University of New Hampshire, points out, “Television dilutes the innocence of childhood and the authority of adults by undermining the system of information control that supported them. Television bypasses the year-by-year slices of knowledge given to children. It presents the same general experiences to adults and to children of all ages. Children may not understand everything that they see on television, but they are exposed to many aspects of adult life from which their parents (and traditional children’s books) would have once shielded them.” 334 He continues, “Television and its visitors take children across the globe before parents even give them permission to cross the street.” 335 He said that back in 1995, when the Internet was just in its infancy, and more than a decade before social media would gain a stranglehold on an entire generation of children who access an abyss of adult content, completely unsupervised, through their own smartphones while alone in their bedrooms. The Left’s war on families is targeting the most vulnerable of our society — children. They are determined to raise the next generation to be as perverted as possible—worse than ancient Rome where it was socially acceptable for adult men to engage in sexual activity with young boys. 336 In fact we’re seeing child drag queens like “Desmond is Amazing” and “Lactacia” being celebrated and featured on major television shows as if they’re heroes. NBC’s Today Show promoted “Desmond is Amazing,” the “drag kid” when he was just 10-years-old, calling him “inspiring.” 337 His parents dress him up in drag and have him perform at drag queen festivals across

the country. 338 He also does simulated strip teases on stage (including at gay bars) where grown men throw dollar bills at him. 339 ABC’s Good Morning America also promotes child drag queens, and host Michael Strahan introduced a segment saying, “Get ready for this trailblazing 11-year-old drag kid who RuPaul is calling the future, and his bravery is inspiring so many.” The kid (Desmond is Amazing) then came out on stage dancing like a stripper to hoots and hollers from the audience. 340

Good Morning America glowingly promoted Kate Hudson when reports circulated she was allegedly raising her child “genderless.” Anchor George Stephanopoulos began the segment saying, “Kate Hudson is opening up about how she’s trying to raise her new baby as ‘genderless,’ apparently that’s an approach more and more Americans are trying.” 341 Co-host Paula Faris went on to say the actress will be raising her 3-monthold daughter “without labels or restrictions” because “she doesn’t want to assume how she’ll identify herself as she’s growing up.” 342 Another co-host, Lara Spencer, chimed in, saying, “That’s a great conversation. It’s just a great conversation,” and then (lesbian) Robin Roberts concluded, “No judgment, no judgment. Whatever you feel is best for your child.” 343 Kate Hudson then released a statement on her Instagram saying, “Dear all my friends, fans and others who read this, recently someone asked me something along the lines of, if having and raising a girl is different from boys. My response was simple. Not really. This whole clickbait tactic of saying I’m raising my daughter to be ‘genderless’ is silly and frankly doesn’t even make sense.” 344 Fringe lunatics had been promoting the idea of raising children “genderless” for some time, and so the media saw an opportunity to give

the bizarre practice a boost by attaching a celebrity’s name to it by twisting around what Kate Hudson meant. But there will come a day when major celebrities embrace the “gender neutral” agenda, and they will be hailed as heroes and held up as models for what other parents should do. The media is increasingly glorifying “theybies,” meaning children whose parents are raising them as gender neutral. 345 These child abusers call their kids “theybies” instead of babies, because they use the gender neutral pronoun “they” to refer to their kids instead of “he” or “she.” NBC News recently recommended, “One way of shielding children from gender stereotypes: Keep their biological sex secret.” 346 The radical Leftists don’t want boys raised as boys, or girls as girls. They want all children to be raised as if there’s no biological difference between males and females at all. They want to completely deconstruct the traditional gender roles and deny the inherent differences between the sexes. They want to invert and pervert everything that’s normal including the most fundamental aspects of being human. Every facet of the family and interpersonal relationships is under attack. CNN has even urged people to “rethink” monogamous relationships and become swingers. “Could opening your relationship to others benefit you and your partner?” they asked. 347 According to CNN, a man’s wife banging other dudes “can be a healthy option for some couples and, executed thoughtfully, can inject relationships with some much-needed novelty and excitement.” The report quotes several “sex therapists” who recommend the practice, saying it “can bring back some of the initial novelty and excitement you felt at the beginning of your relationship.” 348 CNN is disappointed that “non-monogamy still carries a stigma in many circles, so think about how you and your partner will address that concern.” 349

Eradicating families is a Communist tactic and as soon as they seized power in Russia in 1917 the new government started shunning families and promoting “free unions” because families raising children were said to be extensions of the old system. 350 The Left wants everyone to be loyal first and foremost to the Party, not to their family. So they’re doing everything they can to rip them apart. In January 2018, CNN published a story advocating cuckolding as a way to “help” couple’s relationships. For those who aren’t familiar with “cuckolding,” it’s a term that originally referred to a man whose partner had been unfaithful, but has morphed into a kink fantasy that some strange couples carry out where the man watches another guy have sex with his wife or girlfriend. CNN cited a “study” by anti-Christian gay extremist Dan Savage and several others which claims that, “acting on cuckolding fantasies can be a largely positive experience for many couples.” 351 To be clear, this isn’t about swinging, an open relationship, or threesomes; it’s about men watching their wives have sex with another man, and CNN portrays the practice in glowing terms, and says, “Acting on adulterous fantasies may strengthen a relationship, as counterintuitive as it may sound.” 352 People are becoming so inept at how to engage in normal and healthy relationships with others that loneliness is plaguing the younger generations who rely on hook-up apps like Tinder to meet people instead of the “old fashioned way” like at school, parties, through mutual friends, or while engaging in their hobbies. 353 Their communication skills are often so poor that many don’t even have the guts to break up with someone when they feel they’re not compatible, so instead they engage in “ghosting” which means they just abruptly stop returning their calls or texts. 354 More than half of adults aged 18 to 34 don’t have a steady romantic partner. 355

And recently birthrates in the United States have fallen to a 32-year low. 356 For teenagers today it is now considered “normal” to be in a virtual “relationship” with someone online for months and even years and never even meet them face to face! 357 Many Millennials don’t even have a best friend or anyone they feel they can confide in. 358 To fill the void created from lack of intimacy in people’s lives, some are turning to unthinkably bizarre alternatives. The disturbing rise in popularity and acceptance of sex bots, which are just high tech blow up dolls that people are having sex with, seems like something out of a horror movie, but it’s actually happening. 359 While blow up dolls are a common gag gift brought along to bachelor parties, no normal person has ever considered actually having sex with one, but recently expensive “life-like” sex bots are being manufactured and sold to lonely losers who resort to having sex with them since their lives are so dysfunctional they can’t get a date with an actual woman. 360 The sex bot business is already a multi-million dollar a year industry and growing. Companies are even working to build models that incorporate artificial intelligence so they can have conversations with people. 361

Google Upset About Families In leaked documents detailing internal discussions of Google employees, one thread shows the use of the word “family” upset a bunch of them who felt it was homophobic and not inclusive enough because of its connotation as referring to a heterosexual couple with children. After one employee walked out of a company presentation over the use of the word “family,” they posted on an internal message board venting their frustration. 362

“This is a diminishing and disrespectful way to speak. If you mean ‘children,’ say ‘children’; we have a perfectly good word for it. ‘Family friendly’ used as a synonym for ‘kid friendly’ means, to me, ‘you and yours don’t count as a family unless you have children.’ And while kids may often be less aware of it, there are kids without families too, you know.” 363 The complaint went on, “The use of ‘family’ as a synonym for ‘with children’ has a long-standing association with deeply homophobic organizations. This does not mean we should not use the word ‘family’ to refer to families, but it mean we must doggedly insist that family does not imply children…Use the word ‘family’ to mean a loving assemblage of people who may or may not live together and may or may not include people of any particular age. STOP using it to mean ‘children.’ It’s offensive, inappropriate, homophobic, and wrong.” 364 It wasn’t just one lone nut who got triggered because the presentation mentioned Google is trying to make “family friendly” apps and services. The documents show that about 100 other Google employees thumbed up the post, and many responses echoed the same psychotic sentiment. “Thanks for writing this. So much yes,” replied one. “Using the word ‘family’ in this sense bothers me too,” said another. Adding, “It smacks of the ‘family values’ agenda by the right wing, which is absolutely homophobic by its very definition,” and continued, “it’s important that we fix our charged language when we become aware of how exclusionary it actually is. As a straight person in a relationship, I find the term ‘family’ offensive because it excludes me and my boyfriend, having no children of our own.” 365 The replies go on and on, all chastising Google for using the word “family.” Another says, “My family consists of me and several other trans feminine folks, some of whom I’m dating. We’re all supportive of each

other and eventually aspire to live together. Just because we aren’t a heterosexual couple with 2.5 kids, a white picket fence, and a dog doesn’t mean we’re not a family.” 366 Google’s Vice President, Pavni Diwanji, then responded saying, “Hi everyone, I realize what we said at TGIF [the name of the event] might have caused concerns in the way we talked about families. There are families without kids too, and also we needed to be more conscientious about the fact that there is a diverse makeup of parents and families.” 367 He continued, “Please help us get to a better state. Teach us how to talk about it in inclusive way, if you feel like we are not doing it well. As a team we have very inclusive culture, and want to do right in this area. I am adding my team here so we can have open conversation.” 368

Celebrating Unwed Mothers When the number of unwed mothers in America reached more than 50% in 2012, the feminist blog Jezebel celebrated the “milestone” with a headline reading, “The Increase in Single Moms Is Actually a Good Thing,” because the increase in single mothers means fewer women are “relying” on men economically, and feminists view more single moms as a sign of female empowerment. The writer was upset that experts (and ordinary people) were concerned about the growing trend since children born out of wedlock “face greater social and economic obstacles than their peers born into traditional nuclear families.” 369 Liberals never want to hear about the effects of their disastrous decisions, but there’s one thing they like more than single mothers, and that’s women who never become mothers at all. A report from CNBC declared, “Your friends may tell you having kids has made them happier. They’re probably lying.” It went on to say,

“Research shows that parenthood leads to a happiness gap. Maybe that’s because the pleasures of parenthood are outweighed by all the extra responsibilities, housework and, of course, the costs.” 370 The article then broke down the average costs per month of having a child and calculated how much it adds up to by the time the kid is eighteenyears-old in attempts to dissuade people from having children. On her short-lived Netflix show, comedian Michelle Wolf (the woman who looks like Carrot Top that performed at the White House Correspondents Dinner in 2018) did a segment titled “Salute to Abortions” which included a marching band coming out on stage where she then began to chant, “It doesn’t have to be a big deal, it’s actually a great deal! It’s about $300 dollars. That’s like six movie tickets.” She ended her speech saying “God bless abortions, and God bless America!” 371 In the Hulu series Shrill , the lead character (Aidy Bryant) got pregnant and decided to have an abortion “before it becomes illegal,” and after killing the baby she tells her roommate she’s glad she “got out of a huge fucking mess” and now, “I feel very fucking powerful right now. And I just feel like I need to go out [and party].” 372 A YouTube channel called “HiHo Kids” which features videos of young children meeting drag queens, transgender people, a gynecologist, and other individuals no child should be subjected to, even produced a video titled “Kids Meet Someone Who’s Had an Abortion” where the woman tells the children about how happy she was to do it, and that it was “part of God’s plan.” 373 Alabama State Representative John Rogers made a startling declaration during a debate about a proposed state law that would ban most abortions unless the fetus had a “lethal anomaly” or if the pregnancy would put the mother’s life at risk, saying, “Some kids are unwanted, so you kill them

now or you kill them later. You bring them in the world unwanted, unloved, [and then] you send them to the electric chair. So, you kill them now or you kill them later.” 374 He wasn’t being sarcastic, he supports abortion and was arguing against the bill. 375

“Kids Cause Global Warming” Perhaps one reason liberals are big supporters of abortion is because children are increasingly being blamed for causing global warming. The London Guardian declared, “The greatest impact individuals can have in fighting climate change is to have one fewer child, according to a new study that identifies the most effective ways people can cut their carbon emissions.” 376 One of the researchers on the project said, “I don’t have children, but it is a choice I am considering and discussing with my fiancé. Because we care so much about climate change that will certainly be one factor we consider in the decision, but it won’t be the only one.” 377 Other lunatics are so concerned that planet earth is doomed they’re afraid to have children because they don’t want to bring them into the world if it’s going to soon plunge into chaos like a science fiction movie. The New York Times interviewed a 32-year-old woman in a story about this madness who said, “I don’t want to give birth to a kid wondering if it’s going to live in some kind of ‘Mad Max’ dystopia.” 378 “Animals are disappearing. The oceans are full of plastic. The human population is so numerous, the planet may not be able to support it indefinitely. This doesn’t paint a very pretty picture for people bringing home a brand-new baby from the hospital,” said another. 379 Others see it as a “sacrifice” they have to make to save the planet. One woman who wanted to have kids but decided not to, said “it’s hard for me

to justify my wants over what matters and what’s important for everyone.” 380 Alexandria Ocasio-Cortez even said that it’s a “legitimate question” for Millennials and those in Generation Z to ask, “Is it OK to still have children?” because global warming is supposedly going to make their lives miserable. 381

The LGBT Mafia Every time a social media personality, actor, singer, or sports figure “comes out” as gay, liberal media outlets across the Internet all celebrate them as if they’ve accomplished some incredible achievement. President Obama made a habit of calling and “congratulating” professional athletes who decided to come out as gay. 382 When the Supreme Court ruled that gay “marriage” was legal in all fifty states, Obama had the White House lit up in rainbow colors that night to celebrate. 383 The media is also on a mission to ruin the careers of any celebrity who dares voice opposition to gay “marriage” or gay adoption. 384 HGTV famously canceled a television show of the Benham Brothers (not to be confused with the “Property Brothers,” who have a show on the network) after news reports started surfacing that the Benhams were Christians and didn’t support gay “marriage.” 385 Comedian Kevin Hart was scheduled to host the 2019 Oscars until LGBT activists started spreading around one of his old bits about him not wanting his son to grow up to be gay. 386 In 2014 Mozilla CEO Brendan Eich, the creator of the popular Firefox web browser, was forced to resign after LGBT activists discovered that he had donated $1000 of his own money to support Proposition 8 in California which amended the state’s constitution to define marriage as specifically between a man and a woman. 387 A gay man once filed a $70 million dollar lawsuit against a popular

Bible publisher claiming that the anti-gay verses caused him “emotional distress.” 388 Kids in California, Colorado, New Jersey, and Illinois schools are now being forced to learn about “LGBT History Month” and are being taught about the “amazing contributions” LGBT people have made to the country. 389 In the UK, school children are being taught that “all genders” can have periods, not just women, and schools started adding tampon dispensers in the boys bathrooms. 390 Since “Drag Queen Story Hour” is being held at an increasing number of public libraries across the country (where insane parents bring their small children to have drag queens read stories to them about being gay or transgender) the city council in Lafayette City-Parish, Louisiana held a meeting after many (normal) parents were outraged the event was being held in their community. During the meeting a gay man took to the podium to support the event, saying, “I’m here to let you know that this event is something that’s going to be very beautiful and for the children and the people that support it are going to realize that this is going to be the grooming of the next generation.” 391 Others in the meeting gasped since the term “grooming children” refers to a sexual predator attempting to persuade a child into a sexual relationship over time. 392 One drag queen who read to children at the Houston Public Library’s “Drag Queen Storytime” is a registered sex offender who had previously been convicted of aggravated sexual assault against an 8-year-old child. 393 The library failed to do background checks on the drag queens who were given access to the children and the sex offender had only been exposed after a conservative activist organization MassResistance took it upon themselves to investigate the drag queens who were reading to the kids at

the events. 394 Another drag queen reading to children at a library actually taught children how to twerk (jiggle their butts in a sexual way, as popularized by skank Miley Cyrus.) 395 Liberals began complaining that Victoria’s Secret “discriminates” against fat women and transgenders because only beautiful (and actual) women walk the runway in their fashion shows. Online outlet “Mic” complained that they “normalized discrimination” and that, “It doesn’t take a fashion insider to recognize that when it comes to plus-size and transgender women, as well as gender nonconforming people, Victoria’s Secret would rather maintain a closed door policy. Since the brand’s first runway show at the Plaza Hotel in New York City in August 1995, not a single plus-size or out transgender or gender nonconforming person has walked in the show’s 23-year history.” 396 Activists then called it “hateful” when the chief marketing officer dismissed criticism, but Victoria’s Secret official Twitter account soon apologized and released a statement saying, “we absolutely would love to cast a transgender model for the show.” 397 Nine months later they hired their first transgender model. 398 Just like conservative blacks are shunned and smeared by the media, so are conservative gays. Deadspin , a sports blog owned by Univision, published an article titled “Conservative Gays Need to Shut The Fuck Up.” 399 And when Caitlyn Jenner “came out” as a Republican, liberals went nuts and completely denounced “her” as a traitor to the LGBT community despite recently having been celebrated as the most famous transgender person in the world upon announcing “her” transition. “She” received infinitely more hate on social media for being a Republican than “she” did for deciding to identify as a “woman,” and

actually said it was harder to come out as Republican than it was transgender. 400

TV “News” Television news is very different from newspapers and magazines which tend to cover stories in much greater detail and context than a fifteensecond sound bite, and require a reader’s active attention and willingness to follow a story. Television, on the other hand, is a passive medium and relies on a quick pace, flashy graphics, and dramatic music in hopes of gaining an audience’s attention and holding it long enough for the commercial break so they can get paid. TV news only skims along the surface of issues, mentioning a few basic points, and is often just infotainment with no real substance. What the audience sees is a carefully crafted version of a story that the producers and editors want people to see, while leaving out the parts they don’t want. Famed media analyst Neil Postman noted, “Television always recreates the world to some extent in its own image by selecting parts of that world and editing those parts. So a television news show is a kind of symbolic creation and construction made by news directors and camera crews…and stranger still is the fact that commercials may appear anywhere in a news story, before, or after, or in the middle, so that all events are rendered essentially trivial; that is to say all events are treated as a source of public entertainment.” 401 The reason intelligent people listen to talk radio is because radio shows provide long-form interviews and in-depth discussions which explore subjects in detail during a 15 or 20 minute segment, and may even continue the discussion after the commercial break for even longer. In comparison,

the average television news segment on a national evening news broadcast is just 2 minutes and 23 seconds. 402 For local TV news it’s just 41 seconds. 403 Television news is the equivalent of reading the headline of a newspaper article and the first paragraph or two. Aside from the limitations of the television format, the days of Walter Cronkite, “the most trusted man in America” who anchored the CBS Evening News for 19 years, are long gone. After his era was over we got people like Dan Rather who used fake documents in a report about George W. Bush’s service record from when he was in the National Guard. 404 And Brian Williams who fabricated a story about his plane being shot down in Iraq when he was covering the war. 405 Most television “reporters” today aren’t reporters, but are just actors. Everyone knows Hollywood celebrities make millions of dollars a year, but most people don’t think about how much money celebrity “journalists” make. They too are performance artists not much different from a Hollywood actor reading their lines. They know when to sound somber, and when to turn up the energy and display faux outrage to the audience when the teleprompter tells them. Many of them don’t believe half the things they say, they’re just playing a part, and for that they get paid very well. For example, before he was fired from the NBC Nightly News , anchor Brian Williams was making $10 million a year. 406 Dan Rather was making $6 million a year at CBS News. 407 At CNN Anderson Cooper makes $12 million dollars a year and has a net worth of over $100 million. 408 MSNBC morning host Joe Scarborough’s divorce documents show that in 2013 he was making just under $100,000 per week! 409 Matt Lauer was making $25 million a year before he was fired from NBC’s Today Show for sexual misconduct. 410 And when Megyn Kelly was fired from NBC’s morning

lineup she left with a $69 million windfall, the remainder of her contract. 411

To put these figures in perspective, Anderson Cooper’s $12 million a year divided by 52 (weeks in a year) is over $230,000 a week, or over $46,000 per show . He makes more money in one day than many Americans make in an entire year! And for that kind of money, these television personalities will say and do almost anything. Being a cable news contributor is also very lucrative, earning pundits an easy six-figure salary to sit around a table for an hour to give their “analysis” on various issues a few nights a week. They know what the host, producers, and network want, and that’s what they deliver. They’re very careful not to bite the hand that feeds them by daring to point out facts that go against the narrative the show is trying to promote. All of the Big Three broadcast networks (NBC, ABC, and CBS) try to separate themselves from the “cable” shows, but promoting the liberal agenda remains at the core of their existence. That’s not to say they don’t have some value. The major networks are useful to learn about dangerous weather events, product recalls, health scares, etc., and they do cover some events that can’t have political spin put on them and which the general public should be aware of. And it can be important to watch what they are reporting just to be aware of the latest issues they are promoting and see what their current agenda is. They also aren’t without their own major scandals that should cause viewers to remain skeptical about their integrity as “news” networks. CBS once killed a story about the tobacco industry covering up how addictive cigarettes are out of concerns that if they were sued by the tobacco companies for their report it would interfere with the pending sale of the

network to Westinghouse. 412 The incident was later made into a movie called The Insider (1999) staring Al Pacino and Russell Crowe. 413 After allegedly burying a story about Nike using sweatshops to manufacture their clothes out of fears they would lose the company as a sponsor for the 1998 Winter Olympics, CBS reporters wore Nike jackets during their coverage as part of the sponsorship deal in what was widely criticized as a breach of journalistic ethics. 414 CBS News has even digitally inserted advertisements for their own network onto fake billboards during live shots using the same technology sports broadcasts use to display banners behind home plate at baseball games. CBS inserted them onto buildings, water fountains, and even on the back of a horse-drawn carriage during “news” reports. 415 After ABC News interrupted the network’s broadcast for some “breaking news” about the “Russia investigation,” Brian Ross falsely claimed that Michael Flynn had implicated Donald Trump in the “conspiracy,” resulting in the stock market immediately dropping 350 points out of concerns that the President would now be impeached or arrested. 416 General Flynn had made no such allegations and the story was completely false. A few years earlier during their breaking news coverage of the shooting in an Aurora, Colorado movie theater by lunatic James Holmes, anchor George Stephanopoulos said that Brian Ross found something that “might be significant.” He then went on to incorrectly report that the shooter may be a member of the Tea Party because ABC found someone on Facebook with the same name who had the Tea Party listed as one of his interests. 417 It was, of course, the wrong James Holmes. ABC News claimed that then-Attorney General Jeff Sessions delivered a speech to a “hate group” after meeting with the Christian non-profit

organization Alliance Defending Freedom, one of the most powerful Christian rights legal organizations in the country. 418 Basically all Christian groups are seen as “hate groups” to the liberal Establishment, which always cites the Southern Poverty Law Center as the ultimate authority of such things. After Oprah Winfrey accepted an award at the 2018 Golden Globes and gave an “inspiring” speech that caused many to hope she would be running for president, the official NBC Twitter account tweeted out a picture of her with the caption “OUR future president.” 419 In 2015, NBC News launched “NBC BLK” (NBC Black), a new website for “black-oriented issues.” 420 Apparently it just wasn’t enough to cover that kind of news on their main platform, they had to dedicate an entire division to “black news.” The following year they launched “NBC Out,” a website featuring LGBT news, “Out” meaning “out of the closet.” The site has it’s own Twitter account and other social media pages dedicated to using the NBC brand to promote the LGBT agenda 24/7.

Cable News As bad as the Big Three broadcast networks have become in recent years, cable news channels like CNN and MSNBC are much worse. They’ll talk endlessly about the same story on every show, every hour, all day, to ensure maximum saturation hoping their propaganda will reach as many viewers as possible since most people just tune in for an hour or two a day. Fox News, while still following the basic sound bite format of television news, actually does a very good job of presenting a variety of stories and perspectives, whereas CNN and MSNBC mostly have endless panel discussions with each pundit throwing in their two cents when their “research” consists of glancing over a few headlines before the show or

reading the producer’s notes about what the topic is for the day. Barack Obama once said that Fox viewers are living on a different planet than those who watch CNN and MSNBC. 421 Maybe he’s right. Fox viewers are the ones living on planet Earth! The Left is so fearful of Fox News that the Democratic National Committee barred them from hosting any of the twelve Democrat presidential primary debates for the 2020 election, claiming they’re “state run TV” controlled by the Trump White House. 422 God forbid any of the moderators ask the candidates some real questions! MSNBC was started in 1996 and functioned as the liberal counterpart to Fox, whereas CNN was supposedly the middle ground. CNN stands for Cable News Network and they were the first 24-hour news network in the world, started in 1980 by Ted Turner. For over 30 years they would cover news from around the globe and were once—as their trademarked slogan still (falsely) claims—one of the most trusted names in news. When something interesting was happening somewhere in the world, it was live on CNN, but in the Trump era all that changed. They rarely report on news anymore. Instead, all they do is talk about how terrible of a person Donald Trump is. It’s improv theater. The producer gives the panel a topic each night, or each segment, and like a group of actors at an improv show, the panelists pretend to be experts on the issue and put forth their opinions as if they actually know what they’re talking about when in most cases they’re just making it up as they go along. CNN doesn’t air newscasts anymore, they air talk shows filled with endless speculation and theorizing about things they have no idea about. It’s a gossip network. CNN now covers one story—Trump. It’s Trump 24/7 and virtually every minute of airtime is dedicated to complaining about him. What would

once be contained in the grocery store tabloids or frivolous websites with zero editorial ethics now regularly airs on CNN. Gossip about Stormy Daniels and the “pee tape” and endless allegations from anonymous sources about how “corrupt,” “incompetent,” “racist,” fascist,” etc., Trump is, is the only thing they talk about. The network is desperate to prevent blue collar Democrats from supporting Trump and abandoning the Democrat Party, so after a grassroots movement called #WalkAway was started by a gay liberal named Brandon Straka encouraging people to stop voting for Democrats because the party has become insane, CNN branded the movement part of a Russian plot! They reported that despite the #WalkAway campaign being “presented as a grassroots effort by former Democrats who are critical of the party’s alleged intimidation, confrontation and lack of civility and want people to walk away from the party,” they said it has, “been connected to Kremlin-linked Russian bots.” 423 The #WalkAway campaign’s YouTube channel and Facebook page are filled with video testimonials of average Americans from all different backgrounds who give their reasons for why they no longer support the Democrat Party and are encouraging others to “walk away” as well. 424 CNN’s poisonous anti-Trump obsession may have incited several terrorist attacks such as the man who shot up Republicans’ softball practice in June 2017, severely injuring Congressman Steve Scalese, or the person who mailed white powder to Donald Trump Jr.’s apartment, causing an anthrax scare and landing his then-wife in the hospital for testing. CNN’s reckless rhetoric could be the catalyst that helped push any number of mentally unstable viewers over the edge, convincing them that the Trump administration is the reincarnation of the Third Reich.

Meanwhile CNN’s senior “media analyst” Brian Stelter says that Trump’s base is a “hate movement” against the press. “I think what we are increasingly seeing from the president and his aides and his allies is a hate movement against the American press,” Stelter whined. “When you look at the behavior around Jim Acosta and some of the other reporter at these rallies, you really do see a hate movement.” 425 Shortly after the election Stelter declared that Donald Trump becoming president was “a national emergency” and painted him as a dictator who just seized power. 426 In an interview with New York Magazine CNN’s president Jeff Zucker admitted, “The perception of Donald Trump in capitals around the world is shaped, in many ways, by CNN,” warning Trump that, “Continuing to have an adversarial relationship with that network is a mistake.” 427 Even the Washington Post admitted that, “it is hard to escape the perception that Zucker issued a kind of threat.” 428 CNN was instrumental in getting Alex Jones banned from all major social media platforms after they literally lobbied the tech giants to have him removed. Before he was “unpersoned,” when his YouTube channel had just one strike they gleefully reported, “InfoWars’ Main YouTube Channel is Two Strikes Away From Being Banned” 429 A few days later his channel got a second strike, and outlets like Newsweek gloated, “InfoWars is perilously close to a permanent YouTube ban after peddling yet another debunked conspiracy theory.” 430 Dozens of other outlets picked up the story about the second strike, salivating that Infowars was one strike away from permanently being banned. 431 Even before Alex Jones’ YouTube channel was deleted, CNN was organizing an advertiser boycott against all the companies whose ads were appearing before his videos played. CNN reported, “Some of the biggest brands in the U.S. had ads running on the YouTube channels for far-right

website InfoWars and its founder, notorious conspiracy theorist Alex Jones, and they say they had no idea YouTube was allowing their advertising to appear there.” 432 Well, how did they learn their ads were running on Alex’s channel? Because CNN made of list of which ads were running, and then contacted the advertisers to pressure the companies into pulling them! Their story goes on, “CNN has discovered ads on InfoWars’ channels from companies and organizations such as Nike, Acer, 20th Century Fox, Paramount Network, the Mormon Church, Moen, Expedia, Alibaba, HomeAway, the NRA, Honey, Wix and ClassPass.” At the end of their story they admitted, “Many of the brands — including Nike, Moen, Expedia, Acer, ClassPass, Honey, Alibaba and OneFamily — have suspended ads on InfoWars’ channels after being contacted by CNN for comment.” 433 MSNBC is usually not quite as insane as CNN but it’s still almost always off the rails. Donny Deutsch, who is a regular contributor on the Morning Joe show, has challenged President Trump to a fight on air, 434 and their other regular panelists say things like Trump’s name is the “modern day swastika.” 435 They also regularly compared him to a dictator and call him a white supremacist. 436 When President Trump announced that he would be meeting face to face with Kim Jong Un, MSNBC claimed it was to “distract” the media from talking about his alleged affair with Stormy Daniels. 437 The network’s darling is lesbian Rachel Maddow whose monologues are convoluted streams of consciousness rattling off all kinds of social justice warrior buzzwords without ever really making a point. Her show is so fanatical and hyper-partisan that the New York Times banned their reporters from even appearing on it out of concern it will tarnish their credibility. 438

The Intercept’s Glenn Greenwald admitted, “I used to be really good friends with Rachel Maddow [but] I’ve seen her devolution from this really interesting, really smart, independent thinker into this utterly scripted, intellectually dishonest, partisan hack.” 439 MSNBC’s research department is so awful they took seriously a parody Twitter account that listed its location as a city in Russia and tweeted satire about a variety of issues (calling itself Boston Antifa). MSNBC reported that it was more “evidence” that Russian bots were active on Twitter. 440 They also fell for a tweet posted by the popular parody account for North Korea, the “DPRK News Service” which MSNBC cited in a report attacking President Trump. 441 Immediately after Robert Mueller wrapped up his two-year long investigation into the Trump campaign’s alleged “collusion” with the Russians and found none, CNN and MSNBC’s ratings dropped like a stone over night. After stringing along their viewers for two years giving the impression that any day now Mueller would announce he found “proof” Trump was a Russian agent and that his impeachment and imprisonment was imminent, hundreds of thousands of disappointed viewers finally quit tuning in. Following the Mueller nothing burger, Rachel Maddow’s viewership dropped by almost 20%. 442 Anderson Cooper’s prime time show on CNN got only 835,000 viewers, and for weeks couldn’t break a million. 443 Meanwhile Fox News continued to dominate, getting more viewers than MSNBC and CNN combined. 444 Even Newsweek magazine, which is part of the anti-Trump smear machine, reported, “MSNBC’s Rachel Maddow Found Huge Ratings Success Covering Trump and Russia — So What Now?” 445 Election years are always huge ratings boosters for cable news, and the regular viewers

who suffered through two years of endless speculation and listened to countless conspiracy theories about Trump and the Russians obviously aren’t the sharpest tools in the shed. Most have already forgotten all about the massive deception they were victims of and due to their short attention spans and lack of intellectual capacity, these cable news companies will continue on as if they did nothing wrong, and hundreds of thousands of people will still tune in. Normal Americans wonder how anyone could watch them again after the massive fraud the “news” networks had engaged in, but it’s easy to underestimate how many stupid people there are out there. After all, the Jerry Springer Show aired for 27 years and was able to keep audiences coming back every day to watch another group of trailer trash fight with each other about who cheated on who and who the father is of some poor child; and despite how mindless and repetitive the show was, enough people kept tuning in every day for it to stay on air for almost three decades.

Internet “News” Sites Just like the Internet sparked the creation of countless different kinds of businesses selling everything from books to airline tickets, it also gave birth to new “news” companies as well. While the brand name newspapers and television networks eventually began migrating their content online, unknown entrepreneurs threw their hat in the news business as well, creating digital-only magazines and “news” sites like the Huffington Post, BuzzFeed, the Daily Beast, Politico, Axios, Vox, Slate, Vice News, and many others.

Since the barriers to entry are so low, and these companies didn’t need to invest in gigantic printing presses or develop supply chains to deliver their product to readers’ homes every morning, many of them saw the incredible opportunities the Internet opened up. But while most newspapers and magazines require people to buy them, the vast majority of Internet news sites are free to read. All they had to do was get people to click on their articles and the advertisements on the website would fund their operation, so instead of focusing on producing quality content that people would be willing to pay for, they began flooding the Internet with sensational clickbait, throwing all journalistic standards out the window with one goal in mind—drive traffic to the articles, no matter what. The Huffington Post was one of the first “successful” online “news” outlets. It was started in 2005 specializing in clickbait trash and other pop culture nonsense, but due to spamming the Internet with countless articles on anything and everything, they generated a lot of traffic and made a name for themselves as one of the most viewed online “news” outlets. 446 In 2011 they were purchased by AOL for $315 million. 447 When Conan O’Brien was the comedian at the 2013 White House Correspondents Dinner he mocked the Huffington Post for being invited, saying, “All the Washington news media here tonight including the stars of online journalism. I see the Huffington Post has a table, which has me wondering if you’re here, who’s covering Miley Cyrus’s latest nip slip? Who’s assembling today’s top 25 yogurt related tweets? [Or] 7 mistakes you’re making with bacon? That’s a real one, and you should be ashamed of yourselves!” 448 The Huffington Post (later rebranded as HuffPost) being welcomed as part of the Washington press corps marked the beginning of the end of

journalism.

BuzzFeed BuzzFeed is another online abomination which took advantage of the new clickbait business model. The site was created in 2006, and began churning out ridiculously dumb quizzes about pop culture and recycling the same handful of topics over and over again to litter Google’s search results with their spam, often in the form of listicles like: “37 Things White People Need to Stop Ruining in 2018;” “21 Things That Almost All White People Are Guilty Of Saying;” and “33 Things That Almost All White People Are Guilty Of Doing.” They seem to hate white people so much that after the White House announced the National Day for the Victims of Communism a BuzzFeed reporter declared that the phrase “victims of Communism” was a “white nationalist talking point.” 449 Aside from their distain for white people, BuzzFeed also can’t stand heterosexual people (known as normal people to those not infected with the liberal pathogen.) When Star Wars: The Last Jedi was released, despite Disney turning the movie into a feminist propaganda piece, BuzzFeed still wasn’t happy because there were no LGBT characters and suggested that Finn (John Boyega) and Poe Dameron (Oscar Issac) should have had a “romance” as part of the plot. 450 BuzzFeed is perhaps the worst clickbait bottom feeder online and makes the National Enquirer look like a Pulitzer Prize winning publication. Outside of the community of morons who actively visit their website, BuzzFeed is best-known for publishing the fake news story about Donald Trump allegedly being caught on tape with hookers peeing on him in a Russian hotel.

The story about the now-infamous “dossier” had been circling internally at most of the major news outlets but nobody had reported on it because it was so ridiculous and there wasn’t a shred of evidence to back it up, but BuzzFeed decided they would get the “scoop” and ran with it. Then the allegations were all over social media and “Golden Showers” was trending on Twitter which provided cover for other “news” outlets to repeat the story. BuzzFeed often does the dirty work for Democrats by publishing salacious allegations and hyping them up enough to then get amplified by mainstream outlets which hide under the cover of qualifiers like “BuzzFeed reports” and “according to BuzzFeed.” This way, they can give the impression that they’re not making the claims, it’s someone else and they’re just passing it along because “if true” it would be a big story.

Vice News Vice News is another popular online outlet which regularly celebrates the most bizarre sexual perversions and promotes degenerates as modern day heroes. Some of their headlines are literally: “We Interviewed the Zoophilia Advocate Who Had Sex with a Dolphin;” “Ever Fantasized About Ingesting an Animal Through Your Anus?” “How to Make Breakfast With Your Vagina;” “Why Can’t I Consent to Sex with My Brother?” “Dear Straight Guys, It’s Time to Start Putting Things In Your Butt;” “Was Jesus Gay?” “Getting Cocaine Blown Up Your Butt;” and “Should Every Man Be Penetrated At Least Once In His Life?” It should be no surprise that Vice News is also on the forefront of celebrating child drag queens and sexualizing children. 451 Vice’s founder Shane Smith became a billionaire from peddling this kind of cancer. 452 In the early 2010s they regularly made viral videos on interesting topics that other news outlets wouldn’t cover, like traveling to

Columbia to investigate scopolamine (also known as the Devil’s Breath) which allegedly puts people into a chemically induced hypnotic trance where they will do anything they’re told, 453 and visiting Kim Dotcom’s estate in New Zealand and letting him give his side of the story regarding the massive copyright infringement case he’s facing for running the filesharing site Megaupload. 454 But Vice quickly devolved into the most perverted of online outlets. Like all the other large Leftist web-based media outlets, Vice seems to be obsessed with criticizing white people and sees “white supremacists” around every corner. They literally reported that, “Racist and white supremacist ideas have become more visible among the Chinese Canadian right.” 455 So Chinese people living in Canada are white supremacists now? There’s no point in trying to make sense of their insanity. It’s best to just stay away from them so their poisonous propaganda doesn’t enter your view because it will only make you upset. In 2015, Disney invested over $400 million into Vice, but four years later had lost all of their money and wrote it off on their taxes. 456 George Soros came to the rescue in mid-2019 and “invested” another $250 million dollars into the failing media company so they could continue to operate. 457 The “investment” from Soros was really just a donation to help them cover their operating expenses for the next few years so they could keep pumping out their liberal propaganda regardless of how much money it cost them to produce or whether they earned any revenue from it.

Vox Vox is another well-funded online outlet that sees white supremacist boogeymen around every corner, and paints anyone to the right of Karl Marx as an alt-right Nazi. Vox largely functions as an activist organization

working to destroy the careers of conservatives by painting targets on their back and smearing them with labels that are difficult to shake. In 2015 they were given $200 million dollars by NBC to do their dirty work without tarnishing the NBC name. 458 For years Vox has been obsessed with PewDiePie, who held the title of YouTube’s most subscribed channel for six years, and thinks that he is putting out secret white supremacist messages to his viewers. 459 Of course they labeled me one of YouTube’s “most extreme” creators in a video they produced crying about how conservatives were making viral anti-feminist and anti-illegal immigration videos on YouTube. 460 Vox came to most people’s attention in June 2019 when one of their activists (who calls himself a “journalist”) named Carlos Maza tried to get Steven Crowder completely banned from YouTube for calling him a “lispy queer” and an “anchor baby.” Just as gay pride month kicked off, Carlos Maza rallied his fans to pressure YouTube to ban Crowder for “bullying” him and for using “hate speech,” despite Maza often referring to himself as a “queer” and the Q in LGBTQ stands for just that. The little sissy spent an entire weekend ranting on Twitter about how miserable his life was and kept harassing YouTube to ban Crowder for his “homophobic attacks.” YouTube then demonetized Crowder’s entire channel, along with many others the company claimed were posting “offensive” content. More on that in the chapter on YouTube. In case there is any doubt as to whether or not Vox hates the First Amendment, for the 4th of July they published an op-ed titled “3 Reasons the American Revolution Was a Mistake,” which starts off saying, “This July 4, let’s not mince words: American independence in 1776 was a monumental mistake. We should be mourning the fact that we left the United Kingdom, not cheering it.” 461

It goes on to wish we would have remained a British colony because slavery would have supposedly been abolished sooner, fewer Native Americans would have been oppressed, and we would have a parliamentary system of government instead of a separation of powers (the three-branch system, which we currently have). The writer also added his belief that we would have passed a carbon tax, since that’s what happened in Britain, whereas such a proposal has (thankfully) so far failed to get enough support in the United States. The article concluded that, “The main benefit of the revolution to colonists was that it gave more political power to America’s white male minority.” 462 Of course! It’s always the white man’s fault!

The Daily Beast The Daily Beast is another unscrupulous online outlet that often functions as a political activist organization instead of a “news” website and regularly depicts Trump supporters as a bunch of bigots. They like to publish stories that smear rising conservative social media personalities as “far-right” to brand them as “extremists” in attempts to derail their careers before a major network hires them as contributors. It’s their way of trying to kill off the next generation of conservative voices before they become household names. The “far-right” label is often associated with neo-Nazism and by muddying up the search results for peoples’ names with a bunch of salacious articles about them it can cause real damage for current and future employment. Headlines like “Meet Candace Owens, Kanye West’s Toxic Far-Right Consigliere,” 463 and “Mike Cernovich and Jack Posobiec, the Far Right’s Twin Trolls, Taste Their Own Bitter Medicine,” 464 and “ProGun Parkland Teen Kyle Kashuv Apologizes for ‘Inflammatory’ Racial

Comments” are commonly deployed to digitally tar and feather conservatives. 465 The Daily Beast calls YouTube a “radicalization factory” for the “farright” and says that it’s “pulling YouTubers down the rabbit hole of extremism.” 466 Like others of their ilk, they often push for more censorship of right-wing content under the smokescreen of fighting “racism” and “extremism.” Defame, demonetize, and deplatform is their M.O. After a joke video depicting Nancy Pelosi as drunk and slurring her words went viral on Facebook, the Daily Beast doxed the person who allegedly made it, revealing his name, the city he lives in, and what he does for a living. The “reporter” (activist) who cyber-stalked the meme maker had apparently messaged his Facebook friends, including his ex-girlfriend, fishing for information about him. 467

Don’t Fall for Their Tricks If you use social media, the best thing you can do is block these Leftist clickbait accounts, and don’t share their links no matter how outrageous their articles are because these sites often rely on hate-clicks, which means they know people will share the links on their social media accounts with the intention of showing their friends how insane the articles are. Unfortunately trying to “expose” them this way just drives more traffic to their website which is what they want. They don’t care if the people clicking the articles like them or hate them, as long as they get the traffic and thus the ad revenue from it. Oftentimes articles are purposefully inflammatory and designed to get attention because of how outlandish they are, even though the people writing them may not even believe a word of it, but are simply publishing

outrageous things in hopes that people will spread them around so they can get a bunch of hate-clicks from it. So instead of posting links to these outlets, take a screenshot of their headline and post that, along with a summary of the article and your commentary so you’re not driving any more traffic to their websites. Starve them of traffic! Or post an article from a conservative website that is covering what the Leftist sites are reporting instead of giving them any more page views directly. It may be best to just ignore them altogether sometimes and not even mention them so that you don’t inadvertently inspire anyone to visit them out of curiosity. And be sure to bookmark and follow conservative sites like Fox News, Breitbart, the Drudge Report, Daily Caller, the Washington Times, Townhall, The Federalist, Washington Examiner, Newsbusters, PJ Media, Red State, One America News, WorldNetDaily, and National Review.

The End of Print Journalism? In early 2018 the New York Times CEO predicted their print edition may only last another ten years before it becomes economically unsustainable to keep it going. 468 Newspaper circulation has been on a steady decline since the Internet revolution, and many magazines are struggling as well. PC Magazine ceased printing a physical edition in 2009 and is now just a website. Computerworld followed suit in 2014. Teen Vogue magazine and Self did the same thing in 2017. Newsweek , once considered to be one of the staples of the news magazine industry ever since its creation in 1933, even quit issuing a print edition at the end of 2012 due to financial problems. 469 About a year later after it had been bought by another media organization (IBT Media) they re-launched the print edition, but continue to struggle.

Despite having over 3 million Twitter followers, most of Newsweek’s tweets barely get a dozen interactions, leading many people to think they bought millions of fake followers in order to appear popular. 470 In 2018 Newsweek was accused of fraudulently inflating the traffic to their website in order to present advertisers with false numbers, causing numerous online ad vendors to pull their ads. 471 So buying fake Twitter followers surely seems right up their alley. CNN’s president Jeff Zucker complained at an industry conference that his network was having a difficult time monetizing their content online since so many videos are spread through social media with CNN clips being posted to YouTube, Twitter, and Facebook. “In a Google and Facebook world, monetization of digital and mobile continues to be more difficult than we would have expected or liked,” he said. 472 What he means is, there is just too much competition from other websites and YouTube channels, and since there are so many different links being shared on social media, CNN’s web traffic has dramatically dropped and with fewer people actually watching them on cable they’re not getting the revenue from the long blocks of commercials. Because a lot of people use ad blocker plug-ins on their browsers which automatically hide banner ads from websites, the Washington Post recently began blocking people from being able to see their articles if their browser is using an ad blocker, requiring people to turn it off or white list (allow ads on) their site in order to even see what’s on the website at all. 473 The New York Times began limiting people’s ability to read free articles on their website to ten per month by either tracking their IP address or placing cookies on their computer, and later reduced it to just five articles a month. 474 When that number is exceeded, the articles are blacked out and a notice pops up saying you have exceeded the allowed free articles limit and

it encourages you to become a digital subscriber for $4 per month (for the first year) which then automatically changes to $15 a month from then on. The business model of displaying digital ads next to articles on their website just isn’t working anymore because there is too much competition now with countless websites all using the same ad servers.

Mainstream Asking for Donations Things are getting so dire for the major online “news” businesses that some are now asking for donations. At the bottom of every Guardian article now there is a notice that reads, “Since you’re here…we have a small favor to ask. More people are reading the Guardian than ever but advertising revenues across the media are failing fast. And unlike many news organizations, we haven’t put up a paywall — we want to keep our journalism as open as we can. So you can see why we need to ask for your help. The Guardian’s independent, investigative journalism takes a lot of time, money, and hard work to produce. But we do it because we believe our perspective matters — because it might well be your perspective too. If everyone who reads our reporting, who likes it, helps fund it, our future would be much more secure. For as little as $1, you can support the Guardian – and it only takes a minute. Thank you.” 475 In August 2017, BuzzFeed “News” started asking for donations at the bottom of all their articles too. There’s a banner that reads “Play a bigger role in our journalism” encouraging people to donate $5 dollars a month to them which readers get zero benefits for other than being added to a BuzzFeed email list. People who donate $100 get an “exclusive BuzzFeed News tote bag.” 476 Soon we may see major media outlets join Patreon!

Wikipedia Encyclopedia Britannica is the world’s oldest encyclopedia, first published in the late 1700s. For many generations they were the standard in school libraries and some homes if parents decided to spend the $1000 plus dollars for the 32-volume set. But in 2012 the company announced they were no longer going to print the books (after 244 years), and instead Encyclopedia Britannica became an online only edition available for a small yearly subscription fee. 477 Unfortunately in the Internet age where everyone wants everything for free, Encyclopedia Britannica has been largely forgotten and Wikipedia has become the new standard “encyclopedia,” which is both sad and disturbing. Wikipedia is one of the top search results, if not the top search result, for almost anything you Google, and gets 33 billion page views a month. 478 And you probably know that literally anyone can edit almost any article on the site, anonymously, without even registering as an editor. In theory, other editors will watch over new updates and remove or correct them if someone posts incorrect information, but this often results in “edit wars” where people go back and forth posting something and then others change it, and then others change it back, and on and on. So depending on when you read an article on Wikipedia, information could be completely different or even missing entirely. For benign pages about things like plants and animals there may be little controversy about what is said about them, but for pages that are biographies of people, particularly political figures (and even for some products and corporations which have entries on the site) they are usually a battleground between different editors fighting to have the final word in terms of what is (and is not) said about the topic.

Wikipedia is a major part of the Liberal Media Industrial Complex smear machine because it solidifies the liberal consensus about individuals by using careless and defamatory online articles as the “sources” for labeling someone a racist, sexist, homophobe, etc. Once outlets like the HuffPost, Daily Beast, Vox, etc., publish an article making baseless claims about a person, then the Wikipedia editors update that person’s page to paint them in a false light and cite the salacious hit pieces as the source in the footnotes, cementing the allegations in the target’s Wikipedia page. Because public figures have to prove “actual malice” in a defamation case, unlike private citizens, its difficult to win a judgment against “news” outlets for libel because they can easily claim they “thought” what they were writing was accurate, or it’s their opinion that someone is “far-right,” “racist,” “Islamophobic,” etc. Often they’ll sneakily add a weak qualifier about someone they’re smearing by saying they are an individual “who some people call far-right.” Who calls them that? A few random trolls on Twitter, so technically “some people” have called them that and it’s a devious way many of these outlets try to get labels to stick. They also know that suing them can easily cost a plaintiff a million dollars in legal fees, and even if they win a judgment for the defamation, that person will still be on the hook for their own legal costs, which may be much more than the actual judgement awarded to them for the defamation in the first place. For months Wikipedia had a section on Tomi Lahren’s page saying she was considered “White Power Barbie,” because an article in the London Guardian labeled her that simply because she’s a beautiful blonde woman who has had a few viral videos criticizing Black Lives Matter. 479 Wikipedia is such a pit of disinformation and slander that Ron Paul was included on their white supremacist list for three weeks before editors

finally fixed it. 480 Wikipedia even listed the California Republican Party’s ideology as “Nazism” for a period of time. 481 There is even an entire Wikipedia page titled “Racial Views of Donald Trump” which paints him as a huge racist, detailing how he is a “birther” for questioning Barack Obama’s heritage; taking his comments about “fine people” on “both sides” of the Confederate statue controversy out of context, and including a whole long list of supposed “evidence” that he’s a racist because he referred to El Salvador, Haiti and parts of Africa as “shit hole countries” and makes fun of Elizabeth Warren, calling her Pocahontas. In September 2018 a Democrat congressional staffer doxed several Republican Senators including Lindsey Graham by posting their home addresses and phone numbers right on their Wikipedia pages. 482 The perpetrator was later arrested and sentenced to 4 years in prison for computer fraud and sharing restricted private information, showing the seriousness of his crime and that the lack of oversight and editorial control makes Wikipedia the Internet’s equivalent of a wall in a gas station bathroom. Wikipedia editors fiercely protect the Antifa page, and (at the time of this writing) have successfully prevented any references to their violent and terrorist activities. The subsections of the article are “History,” “Ideology and Activities,” and “Notable Activism;” but nothing about their violence at all. 483 These are the scum who wear black masks and look like members of ISIS that show up at events to harass, intimidate, and assault Trump supporters with sticks, bricks, and mace. This is the same group that went to Tucker Carlson’s house, banged on his door, and shouted threats through a megaphone. 484 After Antifa members assaulted Quillette journalist Andy Ngo at an event in Portland, Oregon in June 2019, punching him in the face and

throwing milkshakes on him (causing him to be hospitalized for a brain hemorrhage) word of the incident made national news. 485 President Trump even mentioned the attack but Wikipedia editors decided that it wasn’t “significant” enough to warrant being included on the Antifa page. 486 Wikipedia is also preventing any mention of the terrorist attack on an Immigrations and Customs Enforcement [ICE] facility in Tacoma, Washington, where an Antifa member approached the property armed with a rifle and firebombed the building, resulting in him being shot and killed by police. He had also posted a manifesto online before his attack using language from Alexandria Ocasio-Cortez, claiming the United States was keeping illegal immigrants in “concentration camps.” His manifesto began declaring “I am Antifa.” 487 Congresswomen Alexandria Ocasio-Cortez and Ilhan Omar refused to condemn the attack when specifically asked about it. 488 Others, like Black Lives Matter activist Shaun King, appeared to celebrate it and encouraged people to “liberate” the “concentration camps” by any means necessary because illegal aliens are being “tortured” inside. 489 The FBI reported that Antifa has been engaging in terrorist activities, and members of the Senate, including Ted Cruz of Texas and Bill Cassidy of Louisiana introduced an official resolution deeming them a terrorist organization. 490 But not a word of any of this is included on the Wikipedia page about Antifa. 491 Meanwhile the Wikipedia page for disgraced former FBI agent Peter Strzok says the text messages he and his mistress Lisa Page exchanged speaking of having an “insurance policy” to derail the Trump administration is just a “conspiracy theory” saying, “The revelation of the text messages led Republican congressmen and right wing media to start pushing

conspiracy theories to the effect that Strzok was involved in a secret plot to undermine the Trump presidency.” 492 There have been controversies surrounding certain Wikipedia editors being paid to protect pages of political figures as well as big names in tech and the media. 493 Others, like myself, have no hope of ever having a fair or accurate representation on Wikipedia. Right now my page says that I’m best known for being a “conspiracy theorist” because I wrote a few books about the Illuminati when I was younger with the subtitle of “Facts & Fiction” separating the facts from the fiction, because they are a historical group that became a pop culture phenomena in the early 2010s. It’s an interesting subject I was fascinated with for a period of time, but the Wikipedia editors forever want me branded as “conspiracy theorist” for daring to look into the topic. And while I have had a sizable YouTube audience steadily growing ever since 2006, at the end of the 2016 presidential election my channel exploded. But for years after that (and currently at the time I’m writing this) the editor overlords at Wikipedia won’t allow ANY mention of my YouTube stats on my page, which is standard for professional YouTubers. Several liberal YouTubers whose channels that are much smaller than mine, like that of Kyle Kulinski who runs the Secular Talk channel, and David Pakman have their Wikipedia pages loaded with details about their subscriber counts and viewership and all the news sites which have mentioned them; but not mine. My YouTube subscriber count isn’t allowed to be mentioned at all. 494 Wikipedia gives the impression that my career ended in 2015, when in reality it took off in 2016, and I was the first conservative YouTube channel to reach 1 million subscribers. 495 Despite my 2017 book, The True Story of Fake News, reaching the #15 best seller spot (of all books) on Amazon (and #1 in its category for weeks)

the Wikipedia editors say it’s not “significant” enough to mention on my page! My book which came out the following year, Liberalism: Find a Cure , also hit #15 on Amazon best seller’s list (of all books, not just a certain category) but they still refuse to even mention it! One of the editors who fiercely guards my page wrote on the Talk Page discussion about the edits that, “The books were removed via consensus at some point because there were no reliable sources that mentioned them as being significant.” 496 Another editor writing about why my YouTube subscriber count is not allowed on the page says, “I think there is enough evidence that subscriber counts have been manipulated in the recent past that we should not be including this information in this article.” 497 They also removed (and are preventing any mention of) all the television shows I’ve appeared in, including Secret Societies of Hollywood on the E! channel, America Declassified on the Travel Channel, America’s Book of Secrets on the History Channel, Conspiracy Theory with Jesse Ventura on TruTV, as well as shows on the Sundance Channel and interviews on Fox News. These appearances are all listed on IMDB and other media outlets, but the Wikipedia editors have decided that mentioning them would make me look too popular, so they dumped them down the memory hole and are preventing anyone from adding them back to the page. Larry Sanger, the co-founder of Wikipedia (who is no longer with the organization), chimed in on Twitter when I was complaining about this, saying, “If these idiots don’t like you, then they will ignore their own f’n rules. You’re far from being the first this has happened to. It pisses me off. Arrogant little SOBs.” 498 He now calls Wikipedia “a broken system” and says “Wikipedia has long since decided to turn the other cheek when influential editors make

articles speak with one point of view, when they dismiss unpopular views, or when they utterly fail to do justice to alternative approaches to a topic.” 499

The Washington Times did an article about my “battle” with Wikipedia after I made a YouTube video about it, but instead of fixing the page the editors scrubbed any mention of my education credentials, deleting the fact that I have a bachelor’s degree in Communication. They then added a few lines that I once made “numerous homophobic statements” about a Korean boy band after they played at the American Music Awards. I had simply tweeted a picture of them with the caption, “Meet the Korean lesbian pop group BTS featured at the American Music Awards #AMAs last night.” It was clearly a joke because the band members looked very feminine and had blue hair like a stereotypical lesbian. Teen Vogue magazine wrote an article about my tweet because the group’s teeny bopper fans got upset and started a petition on Change.org urging the band to sue me, and that is the “reliable” source Wikipedia used to add a section to my page branding me “homophobic.” They also added a line about how I had been temporarily suspended from Twitter for making “transphobic” comments (in reality saying there are only two genders.) They’re trying to paint me in the most negative light possible, citing random articles from little-known or garbage websites that happened to mention jokes I’ve made on Twitter, while at the same time preventing any real information about my career, my credentials, and my success from being mentioned at all. Wikipedia founder Jimmy Wales (who now lives in England) got so triggered when President Trump visited the UK in June 2019, he tweeted that he was leaving the country until Trump returned to the United States. 500 He was widely mocked in the replies, including by me, causing him to

block me. (He later unblocked me after people continued to ridicule him over the block.) Google has donated millions of dollars to Wikipedia to help cover their operating expenses, 501 and guess who else has given them millions as well —George Soros. 502 You’d think with all their money they could have just funded the Encyclopedia Britannica and made that free to the world instead of giving it to such a garbage website filled with inaccuracies and biased information, but then the Left’s army of online trolls wouldn’t be able to edit entries about people and political policies they want to control the perception of. Author’s Note: If you haven’t already, please take a moment to rate and review this book on Amazon.com, Kindle, Google Play, iBooks, or wherever you bought it from, to let other potential readers know how valuable this information is. Almost all of the one-star reviews on Amazon for my last two books “The True Story of Fake News” and “Liberalism: Find a Cure” are from NON-verified purchases which shows the “reviewers” probably didn’t even read them and just hate me. So if you could help me offset their fake one-star reviews by leaving a real one yourself since you actually read the book, that would help a lot! Thank you!

Google Google is the most-visited website in the world, and is so popular that “Google” has become a verb meaning to look something up. They dominate not just the search engine industry, but others as well, since a large number

of the most popular mobile apps are also owned by Google (like G-mail, Google Maps, Chrome, Google Play, Google Drive, Google News, etc.). Most people assume Google knows the answers to everything, and think the top search results for what they’re looking for is the correct answer. Studies have shown that over 90% of the time people click on what is served up on page one and rarely even look at page two or beyond. 503 The ranking of search results gives Google an enormous amount of power since each page shows just ten different results out of hundreds of thousands, or millions of possible webpages. They can easily prevent people from finding articles or websites by just dropping them down to page two or three in the results. Google’s ability to surface certain information they want to promote while suppressing what they don’t like by manipulating their algorithm gives them enormous power to artificially boost certain companies, products, or political candidates and causes over others. Speaking of the 2016 election, one Google engineer wrote in internal emails, “This was an election of false equivalencies, and Google, sadly, had a hand in it.” 504 They then suggested manipulating the search results to bury articles from Breitbart and the Daily Caller, saying, “How many times did you see the Election now card with items from opinion blogs (Breitbart, Daily Caller) elevated next to legitimate news organizations? That’s something that can and should be fixed.” 505 “I think we have a responsibility to expose the quality and truthfulness of sources—because not doing so hides real information under loud noises…Beyond that, let’s concentrate on teaching critical thinking. A little bit of that would go a long way. Let’s make sure that we reverse things in four years—demographics will be on our side.” 506

Google insiders also discussed manipulating the search results to counter President Trump’s proposed “Travel Ban” in January 2017 which would have prevented people living in countries with high rates of terrorist activity from entering the United States for a period of time. The Wall Street Journal reported, “Google Workers Discussed Tweaking Search Function to Counter Travel Ban,” 507 and detailed, “Days after the Trump administration instituted a controversial travel ban in January 2017, Google employees discussed ways they might be able to tweak the company’s search-related functions to show users how to contribute to pro-immigration organizations and contact lawmakers and government agencies, according to internal company emails.” 508 Those emails showed that, “employees proposed ways to ‘leverage’ search functions and take steps to counter what they considered to be ‘Islamophobia.’” 509 After they were leaked, Google issued a statement denying that they had actually done it, and said the plan was just a “brainstorm of ideas.” 510 A Google employee who has been leaking information to Breitbart told them, “I know there are efforts to demote anything non-PC, antiCommunist and anti-Islamic terror from search results. To what extent that has been successful, I don’t know.” 511 PJ Media did an examination of the search results for the word “Trump” in the Google News tab and calculated that 96% of the results were from liberal media outlets. 512 Similar informal tests have been done by searching for various other topics, such as when Fox News founder Roger Ailes died people noticed that most search results painted him as a monster, with articles from Rolling Stone declaring he was “one of the worst Americans ever” surfacing at the top, along with others like one from NBC News claiming he “built a kingdom on exploited bias,” and the London Guardian saying he helped “create this nightmare world.”

513 A

study at Northwestern University’s Computational Journalism Lab also found that the majority of search results on Google News were from left-leaning outlets. 514 If you search for the same key words on Google and Bing, or Duck Duck Go, you’ll often notice dramatically different results. On numerous occasions when doing research for this book I have Googled various topics trying to find articles that I had seen in the past so I could use them as the citations and had a difficult time finding many of them on Google, but when I looked on other search engines they were in the top results. Sometimes when I was even searching for an article’s exact title after having copied and pasted it into my notes when I first saw it posted on social media, it wouldn’t show up on the first page of search results on Google. Google even rolled out a new “fact check” widget as part of their supposed fight against “fake news” but after a report from the Daily Caller showed the feature was targeting mostly conservative news sites in attempts to paint their overall reporting as inaccurate or misleading, (while ignoring false stories published by BuzzFeed, the Huffington Post, Vox, Salon, and others) Google shut down the feature saying they “encountered challenges” and admitted they were “unable to deliver the quality” they hoped to provide their users. 515 Google deleted Dr. Patrick Moore from the list of Greenpeace founders after he made headlines for insulting Alexandria Ocasio-Cortez over her ridiculous Green New Deal and praised President Trump. 516 Google often displays what are called “knowledge panels” as the top search results for certain topics, which are small boxes highlighting a few main points about the subject. And prior to his headline-making comments about the moronic Congresswoman, Dr. Patrick Moore was included in the knowledge panel

when someone searched for “Greenpeace founders,” but immediately after insulting her royal highness, Google mysteriously scrubbed him from it. 517 The knowledge panel for the popular pro-life movie Unplanned (2019) listed the genre as “propaganda” when it first came out, instead of “drama,” “action,” or “science fiction” like all other movies are labeled. As usual, after word went viral on social media of this “mistake” Google fixed it. 518 A group at the American Institute for Behavioral Research and Technology concluded a study in April 2018 after looking into how much Google’s search results could influence undecided voters by surfacing negative or positive results about certain issues and candidates and reported that such manipulation could shift the preference of those voters between 20 and 80 percent. 519 The same research team led by search engine expert Dr. Robert Epstein concluded that during the 2018 midterm election, Google had been able to flip three key congressional seats from Republican to Democrat due to the prevalence of pro-Democrat bias in the search results. 520

A former Google employee who worked as a “design ethicist” where he studied the ethics of using technology to persuade people, later warned in a TED talk, “A handful of people, working at a handful of technology companies, through their choices will steer what a billion people are thinking today.” 521 Even Google News has recently changed to prevent people from finding exactly what they are looking for. The “News” tab is used to retrieve only search results from mainstream and brand name news sources, not just any random website like the main Google search page. You used to be able to select specific topics you’re interested in and Google News would show recent stories about those topics all on one page, but in 2017 they changed the layout making it much more difficult to customize your

Google News feed, and now you have to click on each individual topic you’re interested in, making it tedious and cumbersome, thus encouraging users to rely on the Google News home page which contains stories curated by their editors instead of creating a custom feed to see only the topics you want to read about. Then in March 2018 Google announced their “News Initiative” plan promising to give $300 million dollars to various “news” organizations over the next three years, as well as offer them various tools and services in order to help them expand their online presence. 522 They have so much money they’re just giving it away, probably to garbage websites like Vox, the Daily Beast, and HuffPost. The Internet created an even playing field allowing someone on a laptop in their kitchen to create a website (or YouTube channel) which gave them access to the same number of potential readers (or viewers) as brand name newspapers and TV networks, and completely changed the power dynamics in media, since ordinary people could bypass the traditional gatekeepers of editors and producers who decide what gets published on their platforms. But this power shift has caused a massive backlash and we’re seeing the very tech companies which created the infrastructure that empowered the individual now quietly working to tip the scale back in favor of the massive corporations their technology once disrupted.

Champions of “Diversity” Google’s corporate culture is liberal to the core, and one brave conservative employee leaked a video of an internal meeting held just after the 2016 election showing all the senior executives sitting around talking

about how disgusted they were with Donald Trump’s victory and that they’re “sure” most people in the company agree. 523 Google is such a “champion” for “diversity” and “social justice” that there are reportedly tampon dispensers in men’s bathrooms because “some men menstruate.” 524 In August 2017 Google fired engineer James Damore after he wrote and circulated a memo internally titled “Google’s Ideological Echo Chamber” which was critical of the company’s corporate culture and their diversity policies which were aiming to hire more women. Damore pointed out that because of the biological differences between men and women, most women tend to be more interested in social activities than engineering (people rather than things). Google soon fired him for “sexism” for daring to point out well-established facts about the differences between men and women. Various psychologists including Geoffrey Miller, a professor at the University of New Mexico; Jordan Peterson, professor of Psychology at the University of Toronto; Lee Jussim, social psychology professor at Rutgers University; and others publicly defended Damore’s memo as being scientifically sound. Damore then filed a class action lawsuit against Google and is suing them for discrimination against conservatives and white men since their diversity policies are inherently discriminatory because they openly favor women and people of color in the hiring process instead of choosing applicants who are best qualified for the job, regardless of their race or gender. 525

Has Google Committed Treason? Billionaire tech investor and PayPal co-founder Peter Thiel says the FBI and CIA should investigate Google for possibly committing treason because of their “decision to work with the Chinese military and not with

the US military.” 526 Google had been secretly working on a special search engine for China that was compatible with their strict censorship rules and would have linked people’s phone numbers to their searches so the Communist government could monitor what everyone was looking up. 527 The project was only revealed after someone leaked documents to The Intercept in August 2018. Google had already been working with the Communist Chinese government since 2006 on their “Google.cn” (Google China) which allowed officials to blacklist certain search terms, but Dragonfly, the codename of the newer system they were working on, was going to be fully compatible with China’s “social credit score” system which tracks and rates citizens based on their personal activities. 528 Senator Josh Hawley called Google “the most dishonest company to appear before Congress” after one of their executives testified before a Senate Intelligence Committee and was evasive in many of his answers. 529

Creepy Google There are also serious privacy issues with Google for those who use it in the U.S. and other countries around the world. Most people don’t think about it too often, but they’re telling Google more than they tell their spouse or their best friend since people sometimes search for answers about relationship or health problems they are keeping to themselves. Google knows exactly who you are and keeps a log of everything you’ve searched for and what links you’ve clicked on. All of this information is then analyzed and sorted to create detailed profiles of people, their personalities, interests, income, and other data points about them. When asked about the privacy concerns surrounding Google, thenCEO Eric Schmidt responded, “There is what I call the creepy line. The Google policy on a lot of things is to get right up to the creepy line and not

cross it.” 530 They are, however, so creepy, that in the future they want to wire the Internet directly into people’s brains. 531 Google engineer Ray Kurzweil is one of the leading proponents of Transhumanism and hopes to one day upload his brain into the Internet so he can become a god-like “immortal” being. 532 Such megalomaniacal goals seem like science fiction and have been the plot of various films like The Lawnmower Man (1992) and Transcendence (2014), but Kurzweil is serious and has the backing of one of the world’s wealthiest tech companies. Google is also a lead developer of artificial intelligence which an increasing number of tech leaders and scientists worry may quickly get out of control and end up exterminating or enslaving the human race. 533 Other companies, including Elon Musk’s Neuralink, are developing braincomputer interfaces in hopes of enabling humans to merge with AI by turning us all into cyborgs. 534 But these are topics for a whole other book. Google’s former motto was “Don’t be evil,” a phrase that was also included in their official code of conduct, but in April 2018 they quietly removed all references of it, and sadly it seems more every day that is exactly what they are becoming.

Rise of Social Media From the creation of the printing press in 1439 to the telegraph in 1837, to radio in 1895 and television in 1927, each new form of media revolutionized society, but the development of the Internet far surpassed all previous communication technologies, especially since it’s now fully mobile and in our pocket wherever we go. It’s changed almost everything from how we interact with our friends to how we get our news and

entertainment, and people gauge what topics and events are the “most popular” because they’re “trending” on social media. As futurist George Gilder noted, “Computer networks give every hacker the creative potential of a factory tycoon of the industrial era and the communications power of a TV magnate of the broadcasting era.” 535 That’s the capability of what’s been dubbed Internet 2.0, or the two-way communication networks the Internet now enables, instead of just static websites. Comedian Dane Cook was one of the first comics to use social media to promote himself in the early 2000s through MySpace, and many of his early critics called him a better marketer than a comic because they didn’t see his humor as all that funny but couldn’t deny his popularity. “I remember getting ready to play Madison Square Garden,” he recalled to the Hollywood Reporter . “I posted once on MySpace and without spending a dime on any promotion or advertising, we sold out.” 536 Similarly, Tila Tequila became the most popular person on MySpace in 2006 from posting racy photos of herself, taking advantage of the new medium and getting floods of friend requests from lonely losers online who hoped to connect with her. 537 Her popularity on My Space opened the door for her (bisexual) dating show A Shot at Love with Tila Tequila on MTV in 2007, which began her 15 minutes of fame. In the early years of social media most people just saw the technology as something to use for fun, and a way to entertain themselves or reconnect with old friends, but as time went on the true power and ability to influence large numbers of people through it became apparent. One member of the Obama administration called journalists on social media “force multipliers” (a fancy term for propagandists) and admitted, “We have our compadres, I [would] reach out to a couple people, and you

know I wouldn’t want to name them.” These people were “prominent Washington reporters and columnists who [would] often tweet in sync with [Obama’s] messaging.” 538 Obama’s former campaign “mastermind” David Axelrod admitted, “over the last couple of years, there’s been an investment in alternative means of communication: using digital more effectively, going to nontraditional sources, understanding where on each issue your constituencies are going to be found. I think they’ve approached these major foreign-policy challenges as campaign challenges, and they’ve run [social media] campaigns, and those campaigns have been very sophisticated.” 539 Amateur video caught Hillary Clinton collapsing at the 9/11 memorial after her campaign and the mainstream media kept dismissing growing concerns that there was something wrong with her health in the final stretch of the 2016 presidential election. 540 The video first went viral through social media before finally getting covered in the mainstream press because so many people were talking about it. The Washington Post, which had been calling questions about her health “conspiracy theories,” then finally admitted, “Hillary Clinton’s health just became a real issue in the presidential campaign.” 541 A bartender working at a fundraiser held by Mitt Romney in 2012 captured the then-presidential candidate on video talking about how 47% of the country wouldn’t vote for him because they’ll support Obama no matter what since they want free hand outs so he wasn’t going to pay much attention to them. 542 Liberals pretended to be outraged and accused Mitt of not caring about half of the country, particularly lower income folks, and the video proved to be quit damaging to his campaign.

Bloggers were the ones who first debunked the fake documents CBS News anchor Dan Rather claimed were the service records of George W. Bush from his time in the National Guard. 543 Matt Drudge’s Drudge Report website first broke the Monica Lewinsky scandal when other outlets were sitting on the story and refused to cover it. 544 Facebook and Google now account for 25% of all advertising spending, both online and off. 545 Social media has swallowed up the news business, and the power-shift has been revolutionary.

Getting “News” on Social Media We all know kids love their devices, and virtually live their lives on them. An entire generation of children have been raised on them, and get babysat by smartphones since parents use them to keep kids occupied while seated in the shopping cart at the grocery store and even at the dinner table. It’s how they communicate with their friends, listen to music, watch movies, and so it only makes sense that’s where they get their news. A study conducted by Internet security company Anchor Free for the Jack Meyers Knowledge Exchange reported, “When asked to identify their two primary sources of news, the majority of this cohort name Instagram (29 percent), You Tube (22 percent), and Facebook (15 percent) as the media where they are most likely to read/see the news. Fewer than a quarter of young people depend on newspaper or television news, with 8 percent reading national newspapers such as the New York Times, Washington Post, and USA Today, 10 percent watching broadcast and cable network news, and 6 percent exposed regularly to local television news or newspapers…By comparison, a stunning 82 percent of Gen Z and younger millennials include among their primary news sources Reddit, Twitter,

Facebook, YouTube, BuzzFeed, Instagram, Snapchat and their desktop newsfeed.” 546 Media advisor Jack Myers warned, “Without the traditional filters of trusted news organizations and journalists, this new generation of potential voters may be highly susceptible to fake and biased news and may find it difficult to discern fact from fiction. Compounding this reality, Instagram — the #1 source of news for young people — is dependent almost exclusively on visual images, and none of the major social media channels invest meaningfully in original news reporting, nor do they provide usertools for deeper investigative analysis of their content.” 547 Of course it’s not just kids who are increasingly relying on social media for their news, it’s everyone.

Homeland Security Studying Influencers Because so many people are now getting their news from social media and there are millions of ways stories can be planted online and go viral governments around the world are very interested in tracking and studying the flow of information through these new channels of distribution. In 2018 the Department of Homeland Security revealed they were developing systems to monitor the social media feeds of various journalists, bloggers, and social media influencers in order to “identify any and all media coverage related to the Department of Homeland Security or a particular event.” 548 In other words there are very serious national security concerns, as well as issues and events local law enforcement need to monitor on social media because they can easily cause real-world consequences. A report in the Chicago Sun Times notes, they were building a database “to monitor the public activities of media members and influencers” so the

government would have the ability “to create unlimited data tracking, statistical breakdown, and graphical analyses on ad-hoc basis.” 549 They reportedly are tracking 300,000 different accounts to create a realtime information matrix of topics that are being talked about and how they spread. Shortly after the 2016 election I myself was contacted by the United States Special Operations Command which integrates various branches of the U.S. Armed Forces because they wanted to interview me and even send a team of researchers to observe me working so they could learn how my YouTube channel had become so popular in the final stretch of the 2016 election. I declined their request.

Operation Earnest Voice Around 2011 the U.S. government launched a program called Operation Earnest Voice which uses specialized software that allows military personnel to create and manage fake social media profiles of various “people” in order to use them for propaganda purposes. 550 The government claims they’re only doing this on websites outside the United States because technically (until President Obama amended it in 2012) it was a violation of the Smith-Mundt Modernization Act for the military to target our own citizens with propaganda, but it’s hard to believe that such technology isn’t being used by U.S. government agencies in black ops on the major social media platforms to influence the American people. Obviously all countries engage in cyber warfare, and in the 21st century that means flooding social media with bots and trolls to push certain agendas or to disrupt various discussions. The London Guardian surprisingly admitted in 2015 that, “Israel Defense Forces have pioneered state military engagement with social media, with dedicated teams

operating since Operation Cast Lead, its war in Gaza in 2008-9. The IDF is active on 30 platforms – including Twitter, Facebook, YouTube and Instagram – in six languages.” 551 The Chinese government was caught using Twitter trolls and posting propaganda videos on YouTube designed to demonize protesters in Hong Kong in the Summer of 2019 when pro-democracy demonstrations broke out. 552 And everyone knows Russia used social media to cause disruption during the 2016 election by promoting both pro-Trump and anti-Trump content, however its effect has been greatly exaggerated by Democrats, causing a modern day moral panic. It’s rarely reported that the biggest Black Lives Matter page on Facebook, which had over 700,000 followers, was found to be run by a white guy in Australia who was using it to scam people into donating money to him. 553 Another huge Black Lives Matter Facebook page called “Blactivist” (meaning black activist) which had over 360,000 followers was found to be part of Russia’s disinformation campaign against the United States and used the page to incite division and fan the flames of racism. 554 Michael Moore even promoted and attended a protest outside of Trump Tower in New York City that had been organized by the Russians. 555 So to say that Russian meddling in American social media circles was just to support Donald Trump over Hillary Clinton is just plain false.

Social Media Causing Mental Health Problems While social media is a powerful tool, it is hard to control. And it seems with every benefit it brings comes the equivalent of an equal sized detriment. The younger generations are getting lost in a world of isolation and have few real-world friendships or interactions. Social media is being

increasingly linked to mental disorders amongst teens since it has become a fixture in their lives. 556 Feeling the need to share how “great” and “perfect” one’s life is through carefully choreographed Instagram photos or Facebook posts appears to be increasing people’s anxiety and depression. 557 Many people have become literally addicted to their phones, not to mention that social media blew the door wide open for kids to be cyberbullied 24-hours-a-day by their fellow classmates who are now able to harass them when they’re not even at school, and can reach them when they’re supposedly in the safety of their own homes. Teen suicide rates have skyrocketed due to cyber bullying because now kids can never get away from their bullies no matter where they go. 558 One study even found that close to 6% of kids aged 12 through 17 have set up fake social media accounts and cyber bullied themselves so they could get attention for being a “victim.” 559 Many people are also developing “mean world syndrome,” which is a term coined by professor George Gerbner who was the dean of the communication department at the University of Pennsylvania. He was a leading researcher in the effects of mass media and concluded that the more time someone spends consuming mass media, the more distorted their view of how the world actually gets, ultimately leading them to think society is a much more dangerous and “mean” place than it actually is since their perceptions are shaped through the warped representations of the world by the media, which amplifies atrocities, arguments, and divisions. Gerbner’s “mean world syndrome” phenomenon was coined in the age of television, and now that most people are glued to their phones and are consuming an almost nonstop diet of media, one can see how the syndrome has only gotten worse. Spending too much time on social media and being bombarded by the never-ending political conflicts and fear-mongering

about things like global warming, mass shootings, and racism is wreaking havoc on the mental health of millions. Many people are getting so depraved that when they witness a tragedy like a car accident or an assault, instead of helping the victims or calling for help, their first thought is to take pictures so they can post them on social media. 560

No Customer Service Despite the Big Tech companies being an integral part of most people’s lives; unlike almost every other company that offers products or services to the public, there are no customer service phone numbers at Facebook, Twitter, YouTube, or Google. You can’t get anyone on the phone there to talk with them about problems you’ve experienced or the grievances you have with their companies. Despite names like Mark Zuckerberg and Jack Dorsey attached to them, they remain faceless corporations you can’t get in touch with. There’s no local branch you can visit where you can ask to speak with a manager, and instead users are relegated to sending tweets or submitting a “help ticket” from within the apps’ dashboard, and those attempts to get answers often only result in automated responses thanking you for contacting them and saying they’ll try to look into it. The social media giants are actually strangely anti-social. For those of you who read my previous book, The True Story of Fake News: How Mainstream Media Manipulates Millions , you know I dedicated different chapters to Facebook, Twitter, Google, and YouTube, where I detailed their Orwellian manipulation and censorship, but since their underhanded activities have only continued, it is necessary to dedicate

chapters to each of them again in this book to discuss their more recent activities. I’ll keep the overlapping information to a minimum and mostly cover what they’ve been doing since the publication of my previous book because you need to know how far they’re going to regain control of the genie they let out of the bottle.

Facebook For countless millions of people Facebook became the family photo album, their contact list, and even their diary of sorts. First started in 2004 as a social network for college kids, it quickly expanded to become the most popular one in the world used by 2.2 billion monthly active users. 561 Its dominance made founder Mark Zuckerberg the youngest billionaire in history at the age of twenty-three. 562 For those naive enough to fill in all the entry boxes when they first signed up for Facebook, the company knows not only who you’re friends with, who you’re dating or married to (as well as when you break up or get a divorce), but also which TV shows, movies, and music you like, which restaurants and businesses you visit, what cities you travel to, where you work, your birthdate, your personal interests, hobbies, and more. It’s free because you are the product and your personal data is what you are trading in exchange for using Facebook. NSA whistleblower Edward Snowden noted, “Businesses that make money by collecting and selling detailed records of private lives were once plainly described as ‘surveillance companies.’ Their rebranding as ‘social media’ is the most successful deception since the Department of War became the Department of Defense.” 563 Many millennials and Generation Z kids either quit Facebook or never signed up, and prefer Instagram (which is owned by Facebook) and SnapChat because they don’t want be on the same social network as their parents. Despite the endless scandals about abusing users’ personal information, Facebook hasn’t gone the way of MySpace (at least not yet) and remains one of the world’s top social networks.

While people use Facebook for various reasons—like keeping in touch with friends and family, many use it to share news stories and videos about political issues, but it wasn’t until after the 2016 presidential election that Facebook saw this as a problem. As you know, the Democrats largely blamed Facebook for Hillary’s loss, citing the spread of supposed “fake news” about her they claimed had caused people to see her in a negative light and not vote for her. Hillary was supposed to pound the final nails in the coffin of the United States of America, and usher in the New World Order for her globalist puppet masters, but Donald Trump canceled those plans. The war mongering neocons in the Bush administration, followed by the charismatic socialist Barack Obama had set the stage, knocking out most of the legs from under our once-great Republic. But the election of Donald Trump changed everything, and he began to right the ship. The scheming globalists were furious. The very tools that Facebook had proudly created so people could share information with others were now seen as a problem because they disrupted the traditional channels of distribution that were controlled by major media companies. If anyone posted a message, link, photo, or video, that post could be seen by as many people who read the New York Times or watch the NBC Nightly News from other Facebook users simply clicking the “share” button. But all that had to change because the “Russians” had posted “fake news” about Hillary Clinton. Rob Goldman, Vice President of Ads at Facebook, admitted, “The majority of the Russian ad spend happened AFTER the election. We shared that fact, but very few outlets have covered it because it doesn’t align with the main media narrative of Trump and the election.” 564 He was reprimanded for revealing the truth, but Facebook would go on to

completely change the way their platform functioned under the guise of stopping “fake news.” Before Facebook, people used to “bookmark” their favorite websites on their Internet browser, and would use that list to navigate to their news sources, but Facebook (and Twitter) have largely replaced browser bookmarks, and by weaseling their way in between news websites sites and their potential audience, it is Facebook, not the users, who are now in control of what articles people see.

Manipulating Users’ Feeds Most people used to assume—and many probably still do—that if they follow certain accounts on Facebook they’re going to get posts from those pages in their news feeds, but the algorithms detect keywords in posts and identify the source of links and Facebook’s proprietary technology throttles the reach of content they don’t want people to see and often limits the reach so posts only show up in a few people’s news feeds. For example, when Wikileaks first released a batch of hacked DNC emails, Facebook blocked links to them claiming they were “malicious” or “spam.” Only after Wikileaks tweeted about their links being blocked and people began clamoring about it did Facebook fix it. 565 There were even reports that when people tried to share certain links to articles exposing Jussie Smollett’s hate crime hoax they were blocked from posting and a pop-up notified them that, “This post goes against our Community Standards, so no one else can see it.” 566 Facebook even patented technology to shadow ban people so they could prevent certain posts from being seen by others without giving any indication to the person who posted it that such censorship was occurring. The Abstract on their patent explains the process, “[T]he social networking

system may receive a list of proscribed content and block comments containing the proscribed content by reducing the distribution of those comments to other viewing users. However, the social networking system may display the blocked content to the commenting user such that the commenting user is not made aware that his or her comment was blocked, thereby providing fewer incentives to the commenting user to spam the page or attempt to circumvent the social networking system filters.” 567 Facebook has admitted conducting several experiments on users to test how well they could manipulate people by making changes to what they see in their news feeds. 568 In 2010 they toyed with 60 million people’s newsfeeds to see if they could increase voter turnout in the midterm election that year and concluded they were able to get an extra 340,000 people to the polls. 569 On their own website they bragged about a case study which found that, “Facebook as a market research tool and as a platform for ad saturation can be used to change public opinion in any political campaign.” 570 They cited the study as an attempt to court advertisers and to show just how powerful their platform is, hoping to get them to run targeted ads. Hopefully it’s common knowledge now that Facebook was caught suppressing conservative news from appearing in the trending section in 2016 and artificially injecting other topics into the list to give the false impression that certain stories were organically viral from so many people talking about them. 571 After Facebook announced they were changing the algorithm to favor posts from people’s friends over the businesses, brands, and media pages they were following, Donald Trump’s engagement dropped 45%. 572 The Western Journal did a survey and analyzed the engagement of 50 different news pages ranging from the Washington Post to the Daily Caller and found

that after these algorithm changes, conservative outlets averaged a 14% drop in traffic, while liberal media accounts increased by 2%. 573 In June 2019, Tomi Lahren had the “Boosting” feature disabled on her account, which is a way for public figures and brand pages to get their posts to actually show up in the news feeds of the people who follow them by paying Facebook different dollar amounts to allow what they post to be seen by people following the page. 574 For anyone running a professional Facebook page (like mine), whatever we post is severely suppressed and only a small fraction of the people who follow the page will see it unless we “Boost” the post, which is a huge revenue generator for Facebook. Tomi Lahren became famous because her videos went viral on Facebook, but once the Boost feature was disabled she couldn’t even pay Facebook to distribute them in the news feeds of people following her page. 575 A slide from a presentation given to Facebook moderators to teach them what kind of content is inappropriate details what the company says is “destructive behavior” by “trolls” and lists doxing and harassment alongside “toxic meme creation,” and “red-pilling normies to convert them to their worldview,” and also includes an “example video” of Lauren Chen (formerly known as Roaming Millennial), a moderate conservative YouTuber who now works for The Blaze. 576 A “normie” is a slang term meaning a normal person, or in the context of certain Internet subcultures means someone who is not part of the group in question. But Facebook considers that word to be an indicator that the person posting it might be a right-wing “troll.” Things have changed so much since the early days of Facebook that it’s a completely different platform than it was when it first rose to popularity in the late 2000s. They have been getting increasingly less tolerant of different

views and their algorithms can easily hide people’s posts or automatically suspend accounts for posting what they deem to be “hate speech,” which you know is just a code word for something that hurts liberals’ feelings or facts they won’t want people to know about. In August of 2018, a senior manager at Facebook posted on their internal message board a thread titled “We Have a Problem With Political Diversity” that explained, “We are a political monoculture that’s intolerant of different views.” It went on to say, “We claim to welcome all perspectives, but are quick to attack — often in mobs — anyone who presents a view that appears to be in opposition to left-leaning ideology.” 577 That person has probably been fired by now but they were brave enough to point out what is obviously wrong with the corporate culture there. PayPal co-founder and Facebook board member Peter Thiel left Silicon Valley and moved to Los Angeles because he was sick of the Leftist culture that permeates the tech industry in Northern California. 578 Thiel reportedly considered resigning from Facebook’s board over disagreements with Mark Zuckerberg and sold three-quarters of his Facebook stock before leaving Silicon Valley. 579

Helping Mainstream News In July 2018 Facebook announced they were partnering with CNN, ABC, Univision, and other mainstream networks and began paying them to do special livestreams Monday through Friday. 580 Their goal was to, “create a curated news hub of content that would be seen as more credible than many of the random posts cycling through the News Feed.” 581 Anderson Cooper’s Facebook show, called “Full Circle” usually averaged around 1,500 live viewers and lasted a year. 582 CNN now claims they’re going to try streaming the show on their app, CNNgo, instead of Facebook.

Six months after launching the new livestreams Facebook announced they would soon be investing $300 million into various news organizations to help them “boost” their online presence. 583 People like me have to pay Facebook to “Boost” our posts so they actually show up in the news feeds of fans following our pages, while at the same time Facebook is paying hundreds of millions of dollars to mainstream media channels to help them get out their messages! The liberal bias is obvious but goes deeper than most people think. Sheryl Sandberg, Facebook’s Chief Operating Officer, wrote to Hillary Clinton’s campaign manager on June 6th 2015, saying “I still want HRC to win badly. I am still here to help as I can.” 584 Facebook openly plays favorites, for example they have a real name policy, except for transgender people, who can open an account in any name they want. 585 The company even put up a huge Black Lives Matter banner on their campus. 586 They also give out employee bonuses based on how much they’re doing for “social justice.” 587

Facebook Censoring People In October 2018, Facebook deleted over 800 accounts for publishing what they called “political spam” and “sensational political content.” 588 One of the pages belonged to Brian Kolfage, a disabled veteran who lost both his legs and one arm in the Iraq War. After retiring from the military due to his injuries he took over management of a Facebook page called “Right Wing News” and helped it build up a following of over three million people. 589 But Facebook banned the page, destroying Brian Kolfage’s thriving online business, while leaving content farms like BuzzFeed and Vox to continue littering Facebook with their political spam. The day after British activist Tommy Robinson released a documentary on YouTube showing his undercover investigation into the BBC as they were planning to air a hit piece on him, he was banned from Facebook and Instagram (which is owned by Facebook). 590 Because he’s been a vocal opponent of the Islamization of England, he has been branded an “Islamophobe.” After Facebook banned him, activists and “journalists” smelled blood and started pressuring YouTube to ban him too. “His YouTube channel has hundreds of thousands of followers and includes films viewed by millions of people,” complained Damian Collins, a Member of Parliament. 591 He continued, “Far-right groups are exploiting social media to spread their messages of hate, and the YouTube [Up Next] feature helps them by directing viewers to even more of this content once they start to engage with it.” He concluded, “I believe YouTube should also ban Tommy Robinson from their platform.” 592 More on this in the chapter on YouTube. The official Facebook page for Britain First, an anti-immigration organization working to stop the flood of Muslims from the Middle East

into the UK was also banned for “Islamophobia.” Their page had over 2 million followers, showing it isn’t just a fringe group, but they have a large number of supporters in the UK. 593 In April 2019 Facebook (and Instagram) banned Faith Goldy, a conservative Canadian journalist who has been smeared as a white supremacist because she too is critical of the massive influx of nonassimilating Muslims into Europe. 594 The Huffington Post gleefully took credit for persuading Facebook to ban her, posting a story titled, “Facebook Bans Faith Goldy After HuffPost Report On White Nationalism Content.” 595 Facebook said, “Individuals and organizations who spread hate, attack, or call for the exclusion of others on the basis of who they are have no place on our services.” 596 After Comedy Central’s Jim Jeffries recorded an interview with a Jewish political commentator from Australia named Avi Yemini, who is critical of Muslim immigration into Western countries, he was permanently banned from Facebook for “hate speech.” 597 The ban came not necessarily because of his interview on Comedy Central, but because he had secretly recorded the interview himself, and exposed how deceptively edited it was when they aired it. 598 The truth of what Comedy Central had done to him couldn’t be seen, so they banned him. Facebook’s moderators despise any criticism of mass immigration and the effects non-assimilating newcomers have on the countries they come to occupy. After a German historian posted a short essay about Islam’s historic impact on Germany, he was banned for 30 days for “hate speech.” 599 Facebook even deletes accounts of Palestinians at the direction of the Israeli government if they deem the people to be engaging in “incitement” due to their complaints about how the Palestinian people are treated. 600

Facebook took down an event page for an anti-caravan protest that was scheduled to happen when hundreds of migrants from Central America were to make it to the U.S.-Mexico border. 601 It may not be much longer before they consider the term “illegal alien” to be a “racist slur” and a violation of their terms of service in the same way posting the n-word is (if you’re white). Like all the other major social networks, conservatives are at risk of having their pages shut down for “hate speech” for being “non-inclusive.” But it’s not just supposed “extremists” like Tommy Robinson and Faith Goldy. In December 2018, Franklin Graham, son of evangelist Billy Graham, was suspended by Facebook for a post he made almost two years earlier criticizing singer Bruce Springsteen for canceling a concert in North Carolina to protest a proposed bill that would have required people to use the bathroom that corresponds to their biological sex. Graham’s post said in part, “Mr. Springsteen, a nation embracing sin and bowing at the feet of godless secularism and political correctness is not progress,” and urged the state’s legislators to “put the safety of our women and children first!” But a Facebook moderator decided that calling liberals “godless” was a violation of their policy forbidding “dehumanizing language,” so they suspended him. 602 After the incident started making headlines Facebook lifted the ban and said the moderator had made a “mistake” in their decision. Facebook even censored the Declaration of Independence after it was posted by a small newspaper’s page (The Vindicator ), claiming it was “hate speech” because it includes the phrase “merciless Indian Savages.” 603 The paper had posted it a few days before the Fourth of July to celebrate Independence Day. I was suspended in April 2017 for criticizing a Dove Soap commercial that featured “real moms” and their babies because it included a transgender

“woman” who is the biological father of “her” child but identifies as the baby’s “mom.” 604 Facebook considers it “hate speech” to denounce such insanity. Then in January 2019, I was suspended for one week after making a comment about there being a lot of crime in black communities. I appealed it, and it was denied. Residents know the local news begins every night in Chicago, Milwaukee, Detroit, Baltimore, etc, with shootings, stabbings, and robberies which occurred in black ghettos, but those stories are just fifteensecond sound bites on the local news and are then forgotten about by everyone except those directly affected—like the victims’ family and friends. But when a black person is killed by a white man, or the suspect is a white man, then the keyboard warriors amplify the story to the national level as if there’s an epidemic of white men assassinating random black people in America. They denounce “evil” “racist” white people and make ridiculous and hateful generalizations about the entire white race, but that’s allowed on Facebook. You just can’t post certain facts and statistics about black crime in America. The truth is, black men make up only about 7% of the U.S. population, but are responsible for 50% of the total murders. 605 It’s a distressing statistic no one in the mainstream media dares to point out, and if you simply mention this on Facebook, your post may likely be removed and you’ll get issued a suspension for “hate speech.” Black conservative commentator Candace Owens was suspended because of a post saying liberalism is a greater threat to black people in America than white supremacy, and for including some statistics about fatherless homes in the black community. 606 It’s “hate speech” even when black people mention certain uncomfortable facts about their communities.

Leaked documents later revealed that Facebook had labeled her a “hate agent” and was offering employees “extra credit” if they could dig up dirt on her and find any previous statements she’s made or groups she has endorsed that they consider to be objectionable. 607 Facebook sensations Diamond and Silk, two black sisters who support Donald Trump by doing a hilarious routine where one of them rants while the other acts as a “hype girl” by adding cleverly timed one or two word comments to emphasize what the other is saying, have also been censored by Facebook. Their videos became so popular that they were invited to Trump rallies during his 2016 campaign and then later to the White House once he won. Their content is 100% family friendly but Facebook deemed them “unsafe” and suppressed the reach of their page, which at the time had 1.2 million followers. 608 As usual, after the issue started making headlines, Facebook lifted the restrictions on their page and said it was just another “enforcement error.” 609 Facebook also reportedly removed posts and memes by people who were (correctly) referring to the man who shot and killed a police officer in California as an “illegal alien” and a “murderer.” 610 Criticizing illegal aliens, even if they’re murderers, is “hate speech.” A writer for the Gateway Pundit named Lucian Wintrich, who is a gay, referred to himself as a “fag” in a post, and seven months later their AI system detected it and banned him for 30-days for “hate speech” just for using the word. 611 Facebook even blocked President Trump’s social media director Dan Scavino from replying to people in the comments, claiming his posts were “spam.” Shortly after the President tweeted about the restriction, Facebook “fixed” it and said it was just another “error.” 612

Banning “Dangerous Individuals” In May 2019, Facebook (and Instagram) permanently banned Paul Joseph Watson, Milo Yiannopoulos, Laura Loomer, and Nation of Islam leader Louis Farrakhan; labeling them all “dangerous individuals” and “extremists.” 613 What’s especially interesting is that news reports were published about their ban a full hour before they were actually banned, because Facebook had been secretly coordinating with CNN and other outlets but botched the timing of the big announcement. 614 Loomer, Milo, and Watson were banned because they are critical of the Islamization of Europe, so they have all been branded “Islamophobes,” and Facebook decided to throw Louis Farrakhan in the mix as a cover to give the appearance that they weren’t just removing vocal opponents of Islam. The Atlantic initially reported, “Any account that shares Infowars content will see it removed, unless the post is explicitly condemning Infowars [or Alex Jones]. Facebook and Instagram will remove any content containing Infowars videos, radio segments, or articles (again, unless the post is explicitly condemning the content) and Facebook will also remove any groups set up to share Infowars content and events promoting any of the banned extremist figures, according to a company spokesperson.” 615 They later “updated” their article and removed the part about people having to explicitly condemn Alex Jones if they are to post anything about him. At this rate it won’t be long before Facebook bans people who say abortion is murder, citing their policy against “hate speech.” Or if you dare say you don’t believe in gay “marriage,” or call it “marriage” in quotes (because a marriage is between a man and a woman.) That’s “hateful.” If Facebook was around in the 1960s, they would have banned Martin Luther King because what he was saying was “dangerous” to the social

order. The FBI at the time, led by J. Edgar Hoover, considered King to be an enemy of the State and the bureau engaged in all kinds of nefarious activities trying to derail his message. 616 Meanwhile the Palestinian terrorist organization Hamas has an official Facebook page (and Twitter account). 617 So does the Muslim Brotherhood, which is listed as a terrorist organization in multiple countries. 618 They can have Facebook pages, but Alex Jones, Paul Joseph Watson, Tommy Robinson, Milo Yiannopoulos, and Laura Loomer can’t.

Instagram Unlike Facebook and Twitter, Instagram (which is owned by Facebook) is more about photography than news, but people do share political memes and news-related posts there, and in recent years they have enabled users to upload videos, so it too has become a place for vlogs. For years just about the only thing that would get removed by Instagram’s moderators for violations of their terms of service were pictures that included nudity or gory and gratuitous violence, but once the Orwellian era began and the Thought Police are now cracking down on free speech online, censorship on Instagram became common. They have censored a few different memes that I had posted, one of them showed a picture of actor Tobey Maguire from a scene in Spiderman looking at a picture of President Trump giving a speech to the Boy Scouts Jamboree, and then below it showed Tobey wearing “CNN glasses” which caused him to see Adolf Hitler talking with a group of Hitler Youth. The message is clear—anything President Trump does when seen through the lens of CNN is sinister, but that meme violated Instagram’s terms of service.

They also censored a meme I had posted showing a happy white couple with two young children that was captioned, “White people — the only race you can legally discriminate against.” As you know, there is a war on white people being waged by the Left in America today and whites are being blamed for everyone else’s problems, but just pointing out the Left’s open discrimination (and hatred) of white people is a violation of Instagram’s terms of service. As the Jussie Smollett hate crime hoax was unraveling, Instagram took down a Scooby-Doo meme from my account which showed the characters surrounding a “ghost” they had captured after unmasking it to reveal who it really was, and the “ghost” had Jussie’s face photoshopped onto it. Instagram said that was “harassment” and “bullying.” They also took down one of Donald Trump Jr.’s posts about Jussie Smollett’s hoax as well. 619 After conservative commentator Kayleigh McEnany posted a picture on her Instagram of Elizabeth Warren’s newly discovered Texas Bar Registration card showing she listed “American Indian” as her race, that post was removed and Kayleigh was given a notification she had violated Instagram’s terms of service by “bullying” Warren. 620 Instagram has also begun testing new technology to fact-check memes by adding pop-ups that appear next to certain posts they deem “false” and even hiding them so they don’t show up when people are searching for particular hashtags. 621 The Thought Police don’t just patrol social media for what people post, they also keep a lookout for things that people “like.” During the 2018 season of The Bachelorette , one of the frontrunners (who got the “first impression rose”) made headlines after people were combing through his social media accounts and found that he had “liked” several “inflammatory” memes that made fun of illegal aliens, transgender people, and radical

feminists. 622 He literally just clicked the “like” button on a few funny memes making fun of social justice warriors and he was smeared in the press as a xenophobic, transphobic, sexist, and forced to apologize.

What It’s Doing To Our Brains Steve Jobs wouldn’t allow his kids to even use an iPad when they were little, admitting in 2012 (two years after it was released), “Actually we don’t allow the iPad in the home,” in response to an interviewer saying his kids must love it. 623 He knew how addictive they could be and how people, especially children, were vulnerable to being completely consumed by them. Apple CEO Tim Cook doesn’t have kids but says he has placed restrictions on what his nephew can do with technology, and he doesn’t want him using social media. 624 Bill Gates also limited the amount of screen time he allowed his kids to engage in and wouldn’t let them have cellphones until they were 14-yearsold, despite them complaining that other kids in their class were able to have one. 625 But using tablets or smartphones to surf the web or watch videos is one thing. Social media apps opened up a whole new world to waste people’s time and warp their minds. The former president of Facebook, Sean Parker, later admitted the site creates an artificial social-validation feedback loop that is, “exploiting a vulnerability in human psychology” and “literally changes your relationship with society, [and] each other. It probably interferes with productivity in weird ways. God only knows what it’s doing to our children’s brains.” 626 Former Facebook executive Chamath Palihapitiya warned, “The shortterm, dopamine-driven feedback loops we’ve created are destroying how society works,” referring to the validation people get from likes, hearts, and thumbs up on their posts. 627 He also pointed out how “social media” is

making people anti-social, saying it’s harming civil discourse and spreading misinformation and hoaxes that have real world consequences. He mentioned how a hoax about a kidnaping spread through WhatsApp (which is owned by Facebook) in India and led to the lynching of seven innocent men who were killed by a local mob. “That’s what we’re dealing with. And imagine taking that to the extreme, where bad actors can now manipulate large swathes of people to do anything you want. It’s just a really, really bad state of affairs.” He also said his children “aren’t allowed to use that shit.” 628 A Google engineer posted a lengthy thread on his Twitter account about the dangers of Facebook, starting off saying, “The problem with Facebook is not *just* the loss of your privacy and the fact that it can be used as a totalitarian panopticon. The more worrying issue, in my opinion, is its use of digital information consumption as a psychological control vector.” 629 He went on to tweet, “The world is being shaped in large part by two long-time trends: first, our lives are increasingly dematerialized, consisting of consuming and generating information online, both at work and at home. Second, AI is getting ever smarter.” 630 “These two trends overlap at the level of the algorithms that shape our digital content consumption. Opaque social media algorithms get to decide, to an ever-increasing extent, which articles we read, who we keep in touch with, whose opinions we read, whose feedback we get.” 631 “If Facebook gets to decide, over the span of many years, which news you will see (real or fake), whose political status updates you’ll see, and who will see yours, then Facebook is in effect in control of your political beliefs and your worldview.” 632

“This is not quite news, as Facebook has been known to run since at least 2013 a series of experiments in which they were able to successfully control the moods and decisions of unwitting users by tuning their newsfeeds’ contents, as well as prediction user’s future decisions.” 633 “In short, Facebook can simultaneously measure everything about us, and control the information we consume. When you have access to both perception and action, you’re looking at an AI problem. You can start establishing an optimization loop for human behavior. A RL loop.” 634 “A loop in which you observe the current state of your targets and keep tuning what information you feed them, until you start observing the opinions and behaviors you wanted to see.” 635 “The human mind is a static, vulnerable system that will come increasingly under attack from ever-smarter AI algorithms that will simultaneously have a complete view of everything we do and believe, and complete control of the information we consume.” 636 “Importantly, mass population control — in particular political control — arising from placing AI algorithms in charge of our information diet does not necessarily require very advanced AI. You don’t need self-aware, super-intelligent AI for this to be a dire threat.” 637 “We’re looking at a powerful entity that builds fine-grained psychological profiles of over two billion humans, that runs large-scale behavior manipulation experiments, and that aims at developing the best AI technology the world has ever seen. Personally, it really scares me,” he concludes. 638 Even one of Facebook’s co-founders says the company is now “unAmerican” and is calling on the government to break it up. “The most problematic aspect of Facebook’s power is Mark [Zuckerberg’s] unilateral control over speech,” he said in a New York Times op-ed. “There is no

precedent for his ability to monitor, organize and even censor the conversations of two billion people.” 639

Twitter Fake news and idiotic ideas spread faster on Twitter than perhaps any other social media platform. 640 Unlike Facebook status updates which can be rather lengthy, Twitter is designed for short and quick messages (limited to 280 characters) and with the click of the retweet button, a tweet posted from anyone can soon be in front of the eyes of millions of people. It’s a place where people share first and think later, and it’s often a sea of angry people arguing with each other and jumping to conclusions based on out of context statements, photos, or video clips; and quickly spread the falsehoods even further without a second thought. 641 By the time the facts come out, the misinformation has already gone viral and shown up on the trending list—poisoning the opinions of countless others. Few people delete their tweets which fueled fake news fires, and fewer still issue retractions when learning of their mistake. Even in those rare occasions the retractions receive little attention compared to the initial tweets, since they aren’t retweeted thousands of times, not to mention most of the damage has already been done. When there’s a tragic event like a mass shooting, the wannabe sleuths online often end up naming and doxing the wrong suspect, and take someone’s photo from a social media account with the same name as the suspect and spread it around claiming they’re the killer. 642 Who knows what will happen when deepfake videos become more popular and carefully crafted hoax clips are spread through Twitter. The

effects could be devastating beyond measure and it’s something I’ll cover in detail later in the chapter titled “The Future of Fake News.” Spreading misinformation through Twitter isn’t just something that random idiots do online. Many mainstream media journalists regularly engage in the practice, or amplify fake news through retweets. Dave Weigel of the Washington Post tweeted a photo of the audience at a Trump event in Florida that went viral, claiming the event had a ton of empty seats, disputing the President’s statement that people had to be turned away because the stadium was over capacity. People starting calling the President a liar because the “prestigious” Washington Post said otherwise, but Weigel’s photo was taken hours before the event had actually started which is why there were rows of empty seats. 643 Just hours after President Trump was inaugurated, a Time magazine reporter claimed that he removed the bust of Martin Luther King Jr. from the Oval Office, posting a photo of the table where it sat, claiming it was gone, insinuating Trump is such a racist he couldn’t stand to see the face of MLK in his new office and got rid of it on his first day as president. It turns out that someone was just standing in front of it, blocking it from view, and the bust was still there. 644 But countless liberals tweeted their disgust after being duped by an “authoritative” Time magazine reporter who made the claim. There are countless vipers who live online, glued to their phones, and derive a sense of power from the amount of likes and retweets they get. And many function as a volunteer army, ready to attack any target on demand. It’s where liberals harass companies that advertise on Fox News, and where they flood the mentions of anyone who dares speak out against garbage like corporations pandering to gays and transgenders during “Pride” month.

Twitter can suck you in, wasting hours of your time while you argue with idiots about anything and everything since your mentions can easily turn into an endless flow of responses from more and more people as those triggered by your tweets keep sharing them with their followers, rallying others to join in on the dogpile. Twitter is often a dangerous and mind-bending place. As a New York Times columnist wrote after the Covington Catholic debacle, it is, “the epicenter of a nonstop information war, an almost comically undermanaged gladiatorial arena where activists and disinformation artists and politicians and marketers gather to target and influence the wider media world.” 645 An article in The Week went even further, warning that Twitter actually poses a threat to our democracy, saying, “Extreme partisan polarization is combining with the technology of social media, and especially Twitter, to provoke a form of recurrent political madness among members of the country’s cultural and intellectual elite.” 646 It continued, “But too little attention has been paid to what may be the most potent facet of the social media platform: its ability to feed the vanity of its users. There’s always an element of egoism to intellectual and political debate. But Twitter puts every tweeter on a massive stage, with the nastiest put-downs, insults, and provocations often receiving the most applause. That’s a huge psychological incentive to escalate the denunciation of political enemies. The more one expresses outrage at the evils of others, the more one gets to enjoy the adulation of the virtual mob.” 647 The piece concluded (accurately) that, “more and more the venom has been bleeding into the real world, with boycotts, doxings, firings, death threats, and groveling apologies offered to placate mobs wielding digital pitchforks. It increasingly feels like it’s just a matter of time before realworld violence breaks out in response to an online conflagration.” 648

After a Black Lives Matter supporter ambushed a group of police officers during one of the movement’s marches in Dallas, Texas in 2016, a surviving officer sued Twitter and Facebook for allowing the social media networks to radicalize the gunman, saying they were used “as a tool for spreading extremist propaganda.” 649 The shooter’s Facebook profile pic was him making a black power salute and he followed various black supremacist pages. 650 While the tech companies are determined to ban anyone posting support for “white supremacy,” they turn a blind eye to radical black power groups and those who promote their extremist ideologies and anti-white hatred. Twitter is a known safe haven for Antifa, with countless Antifa accounts active, many of which regularly promote violence against conservatives. 651 The launch of Twitter was a carefully crafted campaign involving various celebrities like Oprah Winfrey, Ashton Kutcher, and even CNN, which promoted Twitter’s “Million Followers Contest” in 2009 when the site first appeared on the public’s radar. Now practically every television show and political cause has a hashtag and everyone wants you to “follow” them on Twitter. It’s interesting to note that the CIA actually created “Cuban Twitter” so they could monitor everyone’s online activity in the country and manage the spread of information in order to undermine the government there. 652 It’s not unreasonable to think that the CIA has the same interest and control over Twitter in America (and all other major social media sites) as well. It certainly is odd that Twitter awarded the coveted blue verified checkmark to a supposed eight-year-old Syrian refugee, despite the minimum age to be allowed on Twitter is thirteen. Starting in 2016 “Bana al-Abed” began posting photos of the civil war-torn country, urging people around the world (in English) to help. Her tweets soon began making

headlines, gaining her over 322,000 followers, and she was even invited to the 2018 Academy Awards and brought on stage for a performance by Andra Day and Common for their song “Stand Up for Something.” 653 President Trump had wanted to stop intervening in foreign affairs that didn’t directly affect the United States, and what better way to undermine his efforts than showcase an eight-year-old Syrian girl using social media to beg for help? You should never believe what you see on Twitter. In 2013 the Associated Press account was hacked and tweeted that the White House had been bombed and President Obama was injured. The tweet was also said to have caused the stock market to fall until it was discovered that it was a hoax. 654 A rogue employee even took it upon himself to delete President Trump’s entire account in November 2017. If one low level employee has the administrative control to delete the President’s account, what would stop someone from hijacking the account and posting tweets as the President himself? Even if the false tweets were deleted and exposed within a few minutes, the damage they would inflict on international relations or the economy could be enormous. While Democrats cry about “Russian bots and trolls” manipulating Twitter by tweeting out certain hashtags hoping to boost them into the trending module or mass-“liking” certain tweets to give the appearance that the message is resonating with more people than it actually is; the effect they have is often minimal. One of Twitter’s executives, Nick Pickles, testified at a Congressional hearing that just 49 Russian Twitter accounts were involved in trying to artificially boost support for Brexit [the proposal for England to leave the European Union] and those collective tweets had only been liked 637 times and retweeted just 461 times. 655

While troll farms run by foreign governments or domestic political activist organizations should be a concern, Twitter and the other major tech companies have safeguards in place to detect and prevent most of this inauthentic activity from disrupting the platforms. The biggest threat in this modern information war comes from the tech companies themselves, since they hold the power over what billions of people see and hear, and with small changes to their algorithms can hide or amplify certain issues or events in order to further their own political agendas.

Massive Liberal Bias After years of avoiding the issue, Twitter’s CEO finally admitted “It’s no secret that we are largely left leaning, and we all have biases. That includes me, our board, and our company.” 656 They are so liberal in fact, that Jack Dorsey actually apologized for eating at Chick-Fil-A after he tweeted that he just used Square’s Cash App to buy lunch there, which triggered a flood of angry responses from many of his followers because Chick-Fil-A’s CEO doesn’t support gay “marriage.” 657 Jack Dorsey has been photographed hanging out with Black Lives Matter activist Deray McKesson and the two even did a joint interview together in 2016 at the popular Recode Code Conference. 658 Twitter also hired a woman named Dr. Patricia Rossini to examine “civil discourse” on the platform because everyone knows Twitter has become a nasty place, but an examination of Dr. Rossini’s past tweets reveal that she believes the basic tenets of the Republican Party are hate, racism, and homophobia. 659 The leader of Twitter’s new “task force” on “uncivil discourse,” Rebekah Tromble, thinks that President Trump is a Nazi and has “quintupled down on his commitment to white nationalists.” 660 Democrat Congressman Ted Lieu from California tweeted out a photo of himself and

the party’s new social media star Alexandria Ocasio-Cortez at what he described as a “training session” on Twitter, noting representatives from the company were in attendance helping Democrats learn to be more social media savvy. 661 Twitter also allows people to post pornography, and is an easy place for children to access it. 662 Most porn stars have Twitter accounts which contain a steady stream of hard core pornographic videos and pictures with no effective safeguards to prevent kids from following such accounts and seeing their explicit posts.

What’s Trending Twitter’s “Trending” list is supposed to be the top ten list of the most tweeted about topics or hashtags of the moment, but most users are unaware of the manual curation that is often involved. Topics are regularly artificially boosted to give the appearance that they are “popular” while others are suppressed to prevent people from looking into them further. Oftentimes if something trends on Twitter, it then starts making national headlines. Whether it’s a local issue in a small town that, for whatever reason, goes viral and starts trending, or something stupid that a celebrity said or did—if it trends, it then makes headlines. For over six consecutive months starting in the Spring of 2019 every single Sunday pro-LGBT hashtags like #LGBTangels, #LGBTQsquad, #unitedLGBT, #rainbowLGBT, LGBTQoftwitter, etc. would be on the top ten trending list. 663 The hashtag campaigns are organized by liberal groups likely in coordination with Twitter which then inserts them into the trending list to regularly expose people to selfies of teenagers “coming out” online, in attempt to normalize homosexuality and gender bending.

In his testimony to the Senate Subcommittee on Crime and Terrorism, Twitter’s lawyer admitted the company had censored almost half of all tweets using the hashtag #DNCLeak when Wikileaks first published the hacked emails from the Democratic National Committee, despite their systems only linking 2% of the tweets to supposed Russian troll farms. 664 When you click on the Search tab (the magnifying glass icon) on a mobile device, which you need to do in order to get see the Trending list, first you are taken to a page that contains a featured story (they call a “Moment”) which is always chosen by Twitter that supposedly has something to do with what’s trending, but always attempts to frame the issue in a certain light. In an interview with Rolling Stone, Jack Dorsey admitted, “We can amplify the counter-narrative [to what Trump is saying]. We do have a curation team that looks to find balance. A lot of times when our president tweets, a “Moment” occurs, and we show completely different perspectives.” 665

Shadow Banning In July 2018 conservative Twitter users started noticing that when they looked up top Republican members of Congress in the Twitter Search bar that many of their names were mysteriously missing. Devin Nunes, Matt Gaetz, Jim Jordan, Mark Meadows, John Ratcliffe, Republican Party chair Ronna McDaniel, and many others (including myself) were all shadow banned from the Search box to make it more difficult for people looking us up to find our accounts. Surprisingly the very liberal Vice News did an investigation into the shadow banning “allegations” and admitted, “Twitter is limiting the visibility of prominent Republicans in search results — a technique known

as ‘shadow banning’ — in what it says is a side effect of its attempts to improve the quality of discourse on the platform.” 666 The article went on to detail that prominent Republican members of Congress “no longer appear in the auto-populated drop-down search box on Twitter” and that, “It’s a shift that diminishes their reach on the platform — and it’s the same one being deployed against prominent racists to limit their visibility.” 667 Vice also pointed out that the shadow banning was not implemented on any Democrats they looked up, noting “Democrats are not being ‘shadow banned’ in the same way, according to a VICE News review. [Ronna] McDaniel’s counterpart, Democratic Party chair Tom Perez, and liberal members of Congress — including Reps. Maxine Waters, Joe Kennedy III, Keith Ellison, and Mark Pocan — all continue to appear in drop-down search results. Not a single member of the 78-person Progressive Caucus faces the same situation in Twitter’s search.” 668 Many conservatives began noticing this anomaly but it wasn’t until Florida Congressman Matt Gaetz called out the shadow banning that it began making headlines. 669 Then President Trump tweeted about it and the issue couldn’t be ignored. 670 A reporter for Axios then tweeted that he, “Must admit that when some [Republican] sources have complained about this to me I mocked them to their face as conspiracy theorists. This Vice article makes me rethink that, and response from Twitter is inadequate.” 671 Twitter then released a statement, saying, “We do not shadow ban,” but then in the very next sentence admitted, “You are always able to see the tweets from accounts you follow (although you may have to do more work to find them, like go directly to their profile).” 672 They played with the definition of shadow banning too, defining it as, “deliberately making someone’s content undiscoverable to everyone except the person who

posted it.” That’s why it’s more appropriate to label it shadow suppressing or throttling than to call it a “ban.” Earlier that year an undercover journalist at Project Veritas had spoken with various former and current employees of Twitter including a Content Review Agent who admitted that there were a lot of “unwritten rules” about shadow banning and that “It was never written, it was more said.” 673 A Policy Manager for Twitter’s Trust and Safety council named Olinda Hassan said the company was working on down-ranking “shitty people” so their tweets don’t show up. 674 A former software engineer at Twitter told the undercover journalist, “One strategy is to shadow ban so you have ultimate control. The idea of a shadow ban is that you ban someone but they don’t know they’ve been banned, because they keep posting and no one sees their content. So they just think that no one is engaging with their content, when in reality, no one is seeing it.” 675 Twitter most likely uses shadow throttling (instead of a full shadow ban) to limit the reach of certain users, so some people are able to see and interact with their tweets, but far less than if no such filter was activated on the accounts. Facebook admits they limit the distribution of posts unless users pay to “Boost” the post, so it’s foolish to think Twitter isn’t shadow throttling accounts as well using a filter to limit the reach of people the company has deemed politically problematic. When Twitter CEO Jack Dorsey sat down for a rare interview with CNN in August 2018 he said that the company is considering removing the “like” button from all tweets, and hiding people’s follower counts. 676 A few months later he repeated the same thing, indicating they may get rid of the “like” button “soon.” 677

Hiding the number of “likes” and retweets people’s posts get would make shadow banning certain individuals or tweets about specific topics almost impossible to detect, because without being able to see how many people are clicking “like” on a post, users wouldn’t know if their followers were actually seeing the post at all. People who use Twitter get a feel for how many “likes” an average tweet gets, and if all of a sudden their engagement dropped 95% and went from getting twenty likes per tweet to only one or two, they would notice something was wrong and suspect that people weren’t seeing their tweets. Some have pointed out that certain tweets they have posted appear to them when they’re logged in, but when looking at their feed from a different browser (not logged in) they don’t show up, adding to the concerns that Twitter is shadow banning certain tweets. 678

Censoring Accounts by Suspending Users Twitter CEO Jack Dorsey once said his goal was to have Twitter function as a basic utility, like water. 679 And in their early years, Twitter executives used to call their company the “free speech wing of the free speech party,” but as the culture changed, and the social justice warriors clamored for more censorship, Jack Dorsey said their once unofficial motto about being the free speech wing of the free speech party was actually just “a joke.” 680 While he may have been idealistic when starting the company, he later succumbed to pressure to “reign in” the wild, wild west nature of Twitter and rolled out increasingly strict policies resulting in a number of high profile people being permanently banned for saying things that are commonplace on Twitter.

Milo Yiannopoulos got banned permanently in July 2016 for trolling “comedian” and actress Leslie Jones about how horrible the all-female Ghostbusters remake was. 681 Political operative and unofficial Trump advisor Roger Stone got banned in October 2017 after going off about several CNN hosts including Don Lemon, Jake Tapper, and Ana Navarro for “using an expletive” to describe them and saying they should be “mocked” and “punished” for constantly lying about the President. 682 Tommy Robinson was permanently banned from Twitter for posting facts about crimes committed by Muslims in the UK. 683 Twitter has suspended other people’s accounts for posting facts about black crime statistics in America as well. 684 Jayda Fransen, another vocal critic of Muslim immigration to the UK and founder of “Britain First,” was banned less than one month after President Trump retweeted a few of her videos showing violent Muslim mobs attacking people, which put her on the radar of activist groups who wanted to take her down for spreading “Islamophobia.” 685 Blogger Chuck Johnson was banned for saying he was going to “take out” Black Lives Matter troll DeRay McKesson, meaning expose him and take him out of the game, but Twitter claimed it was a threat of violence. 686 Johnson responded on his blog saying “Twitter doesn’t seem to have a problem with people using their service to coordinate riots [referring to the recent spree of Black Lives Matter riots that had been occurring]. But they do have a problem with the kind of journalism I do.” 687 Supposed “white supremacist” Jared Taylor was also banned, along with the account for his American Renaissance organization as a part of a crack down on “abusive content,” but Taylor doesn’t use slurs or heated rhetoric and seems like a mild-mannered senior citizen who is just pushing back against anti-white racism, and celebrating European culture and

achievements. Despite being called a “white supremacist” he actually says that Jews and Asians on average have higher IQs than white Europeans. 688 Gavin McInnes, founder of the Proud Boys [conservative men’s fraternity], was banned after he was falsely labeled the leader of a “hate group.” He then sued the Southern Poverty Law Center for defamation. 689 Comedian Owen Benjamin was banned after going on a rant about anti-gun activist David Hogg where he said “Don’t you think it’s weird that you are telling grown men how to live when you barely have pubes?” 690 Comedian Anthony Cumia, who was once co-host of the Opie and Anthony show, was banned in June 2017 for “harassing” a writer for The A.V. Club after he called her a “fat old trans looking twat.” 691 YouTuber Sargon of Akkad was banned in August 2017 for posting sarcastic comments that included “racial slurs.” 692 Free speech activist Lindsay Shepherd was banned in July 2019 for “misgendering” a transgender “woman” who sexually harassed her. The “woman” attacked Shepherd, who had just had a baby, saying “At least my pussy is tight and not loose after pushing out a 10 pound baby.” 693 This same “woman,” who goes by the name Jessica Yaniv, has been filing discrimination claims against waxing salons for refusing to do a Brazilian wax on “her” penis. 694 Lindsay Shepherd responded, “This is how men who don’t have functional romantic relationships speak. But…I guess that’s kinda what you are!” At least I have a uterus, you fat ugly man.” 695 Twitter then banned Lindsay Shepherd for calling “Jessica” a man, and not the transgender “woman” who clearly violated Twitter’s policy against sexual harassment. Street artist Sabo, who is like an American version of Banksy, was banned in April 2018 for the generic reason of “abusive behavior.” 696 It’s likely they considered him posting pictures of his street art, which is

technically vandalism, to be a violation of the rules. Many other lesser known conservatives have also been banned but don’t get any media attention because they aren’t public figures with an active fanbase who can alert others about what happened. CNN’s Brian Stelter once tattled to Twitter asking them if President Trump violated their terms of service by “threatening North Korea” in a tweet saying he has a “nuclear button” that is much bigger and more powerful than Jim Jong-Un’s when the two were having a heated war of words about North Korea testing missiles and threatening Japan. 697 The @MAGAphobia account, which documented acts of violence and harassment against Trump supporters, was banned in May 2019 for a reason that was never given. 698 Perhaps it was for “showing graphic violence” since the account posted pictures of victims and videos of them being assaulted. Only mainstream media accounts are allowed to post graphic content so they can carefully choose how to frame certain issues, while ignoring others. Even a parody account called the “Alexandria OcasioCortez Press” was banned, even though it was clearly a parody, and labeled a parody in the account’s bio in accordance with Twitter’s terms of service. 699

Meanwhile, Twitter refused to shut down an account that organized a harassment campaign against senator Jeff Flake after he voted in favor of confirming Brett Kavanaugh to the Supreme Court. The person said, “I am starting a National @DemSocialists working group to follow Jeff Flake around to every restaurant, cafe, store, etc he goes to for the rest of his life and yell at him.” 700 Inciting harassment is supposed to be against Twitter’s terms of service, but moderators usually look the other way when liberals do it.

Comedian Kathy Griffin’s account wasn’t penalized after she called for the doxing of the Covington Catholic kids who went viral for wearing MAGA hats during their trip to the nation’s Capital. 701 When the account @HouseShoes, the verified account of a DJ and hip hop producer tweeted out to his supporters that “I want you to fire on any of these red hat bitches when you see them. On sight,” and “IF WE COULD WIPE THESE FAMILIES OUT WE WOULD BE IN A MUCH BETTER PLACE,” and his account wasn’t suspended. 702 Actor Peter Fonda tweeted rape threats to President Trump’s young son Barron and Twitter let him keep his account. 703

An investigation by Breitbart found dozens of pedophiles using Twitter to openly promote pedophilia. Some of them refer to themselves as MAPs (Minor-Attracted Persons) and others call themselves “anti-contact pedophiles” meaning they’re attracted to children but claim to not act on their desires. 704 One of them tweeted, “MAPs have every right to talk (including, yes, on public blogs) about their fantasies, sexual and romantic, as long as sexually explicit material is hidden from children. It’s not bad or disrespectful to talk about people you think are cute.” 705 Other news outlets have covered the issue of admitted pedophiles being allowed on Twitter as well, and Members of Parliament in England have denounced Twitter for allowing the accounts to remain active, some of them having been operating for years. 706 While Twitter doesn’t seem to have much of a problem with pedophiles openly fantasizing about molesting children, Laura Loomer got permanently banned for criticizing Ilhan Omar, the Muslim congresswoman from Minnesota, after Loomer said she was anti-Semitic and is a member of a religion in which “homosexuals are oppressed” and “women are abused.” 707

Not long after Laura Loomer was banned, the Congresswoman made headlines and was denounced by members of her own party, including Nancy Pelosi, for comments she made about AIPAC [The American Israel Public Affairs Committee], the largest Israeli lobbying organization, after many deemed her criticism anti-Semitic. 708 So Loomer was right about Ilhan Omar, but got banned for being “Islamophobic” and posting “hate speech” about Muslims. Later a video clip surfaced of Ilhan Omar appearing to mock Americans who were fearful of Al-Qaeda in the aftermath of the 9/11 terrorist attacks. 709 A writer named Meghan Murphy, who refuses to accept transgender “women” as real women, was banned for simply referring to a transgender “woman” as a “he” (a violation called “misgendering” someone). 710 A world-renowned expert in gender dysphoria, Dr. Ray Blanchard, was suspended for tweeting that transgenderism was a mental disorder. 711 He didn’t say it to be mean, he said it as part of a thread about the condition, (which up until May 2019 was classified as a mental disorder by the World Health Organization — and still is by many psychiatrists around the world, including the American Psychiatric Association’s DSM-5) but some facts are considered hate speech now. 712 After I tweeted that there are only two genders and insinuated the rest of the 50+ “gender identities” liberals have come up with were mental disorders, I was suspended for that too. My account was also disabled from uploading videos longer than 2 minutes and 20 seconds because they said I had posted “Inappropriate Content,” and I have been banned from running ads on Twitter too. I have also been suspended for calling Kevin Spacey a “Satanic scumbag” and telling him to “burn in Hell” after an actor came forward and claimed Spacey made aggressive sexual advances on him when he was just

14-years-old. 713 My tweet was considered to be “hateful” because he’s a gay man who is above reproach. Actor James Woods’ account was suspended for posting a satirical meme making fun of Democrats, showing three soy boys with the caption, “We’re making a woman’s vote worth more by staying home,” and included the hashtag #LetWomenDecide and #NoMenMidterm. Twitter claimed it was in violation of their policy forbidding posting content that “has the potential to be misleading in a way that could impact an election.” 714 Twitter suspended the account of Austin Petersen who was running for Senate in Missouri in 2018 just one week before the primary. 715 Twitter even banned Republican Senate candidate Marsha Blackburn from running pro-life ads during her campaign because they were deemed “inflammatory” 716 The official account for the anti-abortion movie UnPlanned was briefly suspended by Twitter during the film’s opening weekend in March 2019. 717 As usual, the suspension caused a wave a backlash and Twitter later restored it saying it was another “mistake.” Twitter also suspended a user for calling Maxine Waters a “crazy old lying lunatic in a bad wig.” 718 A recent change to Twitter’s terms of service says they will ban anyone who is “amplifying hate groups” by posting articles about them, or even retweeting other tweets about them. (That only applies to right-wing “hate groups” though. Supporting Antifa, black power groups, and other far-left movements is fine). After a bunch of Huffington Post and BuzzFeed employees got laid off in February 2019, a lot of people mocked them by responding with “Learn to Code” after they posted Dear Diary-style tweets crying about being let go, and so Twitter began suspending accounts for using that phrase or hashtag, claiming it was “abusive behavior.” 719

The saying “Learn to Code” is a reference to news outlets publishing stories encouraging coal miners who are getting laid off as clean energy companies replace their jobs to do just that. Expecting a fifty-year-old coal miner to become a software engineer is insane and shows how out of touch the journalists were who recommended they do just that, so people threw “Learn to Code” back in their faces, but that’s “harassment.” When CEO Jack Dorsey appeared on Joe Rogan’s podcast in February 2019, Joe brought up Alex Jones being banned and pointed out that Twitter was the last major platform to do so after (briefly) allowing him to keep his account in the wake of YouTube, Facebook, iTunes, etc, banning him. When Joe asked, “What did he do on your platform, that you all were in agreement that this is enough?” Jack responded, “Ah, I’m not — I’m not sure what the, what the actual like, ya know, violations were.” 720 (That’s an exact quote.) Alex was banned for telling off CNN’s Oliver Darcy outside of the Jack Dorsey congressional hearing in September 2018, where Jones denounced Oliver for pressuring all the social media companies to get him banned. The confrontation was broadcast live on Twitter via Periscope and so Twitter quickly banned Jones for “harassing” a supposed “journalist.” 721 It’s important to point out that Oliver Darcy was working in the capacity of a journalist at the time, on public property, while he was covering an event about social media; thus confirming everything Alex Jones was saying about the censorship of conservatives. Oliver Darcy later admitted that CNN had “presented Twitter with examples of [violations of Twitter’s terms of service] available on both the InfoWars and Jones account.” 722 In August 2019 a group of Leftists gathered outside Senator Mitch McConnell’s house after sunset to harass him and some of them made

threatening statements saying he should be killed, and when he posted a short video on his Twitter account showing the angry mob and what they were saying, he was suspended and the video removed for allegedly violating their terms of service prohibiting making threats, even though he had just posted evidence of what people were doing to him! 723 His staff appealed the suspension but the appeal was denied. 724 Only after growing outrage and media coverage did Twitter lift his suspension and restore the video. 725 Mitch McConnell is the Senate Majority Leader, the most powerful Senator in the country, yet was censored when he tried to show his fellow Americans that Leftists had surrounded his home to intimidate and threaten him.

Twitter Verification The “verified” checkmark on someone’s social media account is a confirmation that the account actually belongs to that person, and isn’t being run by someone else pretending to be them. Public figures like celebrities and journalists usually get them to prevent imposter accounts from impersonating them, and having a verified account is often seen as a sign that someone is “important” and so every wannabe rapper and blogger wishes to get one, but you have to apply, and Twitter won’t just verify anyone’s account. They have, however, verified numerous Black Lives Matter activists’ accounts whose credentials are basically that they’re anti-police trolls who spend their entire lives on Twitter spewing hatred of police and white people. Virulent racist troll Tariq Nasheed, who accuses almost every white person in America of being a “suspected white supremacist,” has been verified. Other Black Lives Matter trolls like Shaun King and Deray McKesson have also been rewarded with verified accounts.

Twitter also verified Sarah Jeong, a new editorial board member at the New York Times , despite a series of racist tweets about “dumbass fucking white people” and saying she gets “joy” out of being “cruel to old white men.” 726 Twitter also verified loads of fringe LGBT social media personalities, and plenty of pro-feminist and pro-abortion trolls in order to give them more clout online. Meanwhile, popular conservatives like James O’Keefe, Carpe Donktum, Gary Franchi, David Harris Jr., Brandon Tatum, David Horowitz, and others have been denied verification for years. 727 Before they were permanently banned, Tommy Robinson, Laura Loomer, and Milo Yiannopoulos had been unverified . Twitter released a statement saying “Reasons for removal [of verification checkmark] may reflect behaviors on and off Twitter that include: Promoting hate and/or violence against, or directly attacking or threatening other people on the basis of race, ethnicity, national origin, sexual orientation, gender, gender identity, religious affiliation, age, disability, or disease” and even, “Supporting organizations or individuals that promote the above.” 728 Twitter verified the “Parkland kids,” a small group of anti-gun activists who became social media stars over night after a lunatic shot up their high school on Valentine’s Day 2018 in Parkland, Florida. One of them, David Hogg, went on to sic his nearly 500,000 followers onto the advertisers of various Fox News shows, harassing them to pull their ads from the network. 729 Twitter even hosted the Parkland kids for a live Q&A to help them promote their “March For Our Lives” event where they demanded more gun control laws. 730

Never Tweet

There’s a meme that looks like the sign-up page for Twitter but reads “Get fired from your job in ten years” just above the link to open an account, and it’s not that far from the truth. What you say in a tweet can be perfectly fine if it was just said amongst a group of friends, but often our enemies are lurking quietly on Twitter, watching and waiting for one little slip up, and even complete strangers who happen to come across your tweet may feel compelled to enact “revenge” because you said something on the Internet that offended them. People often like to go digging through old tweets of their enemies, hoping to find years or decade-old tweets saying “racist,” “homophobic,” or “sexist” things so they can derail their career. Twitter’s search function allows people to search anyone’s Twitter feed for any keyword or phrase, making this tactic extremely simple. (I advise, if you use Twitter, to consider a “tweet delete” app which allows you to easily search for and delete old tweets which contain certain words or phrases. Or regularly delete your tweets that are older than six months in order to avoid past tweets posted years ago from coming back to haunt you.) Oftentimes when someone becomes famous, people will go nosing around their old tweets typing in keywords like “nigger” and “faggot” into the search to see if they’ve ever tweeted anything with those words in the past so they can retweet them, trying to get the person in trouble. This is exactly what happened right after Kyler Murray won the 2018 Heisman Trophy. A reporter for USA Today took it upon himself to search through his past tweets and found some “homophobic” ones from when he was fifteen-years-old. 731 When Milwaukee Brewers pitcher Josh Hader was chosen to pitch in the 2018 All-Star Game, people dug up some of his old tweets from when he was in high school and it made headlines because he used the “n-word”

in a few tweets. 732 He then apologized and deleted his entire account. The same thing has happened to “Mr. Beast,” a popular YouTuber, and singer Shawn Mendes. 733 The best example of what can happen when you tweet is the disaster that occurred to a woman named Justine Sacco in 2013 who had just 170 followers. When boarding a flight to South Africa she tweeted, “Going to Africa. Hope I don’t get AIDS. Just kidding. I’m white!” and then got on the plane without thinking anything of it. She didn’t say it as a racist insult about the AIDS epidemic there, but meant it as a sarcastic jab at Americans who she said lived in “a bit of a bubble when it comes to what’s going on in the third world,” since she herself was born in South Africa and returning there to visit family. 734 But somebody following her got offended and retweeted it, and then their followers saw it and got triggered and retweeted it, and then she soon began trending from so many people being upset about her tweet even though she was just some random person on Twitter. She and her tweet then became a national news story and she ultimately ended up getting fired from her job. 735 Twitter is often fueled by anger with people venting their political frustrations through tweets like irate sports fans yelling at the TV. For others it’s a narcissistic circus where they derive their self-worth by getting likes and retweets since the immediate engagement can become addicting because their notifications release dopamine similar to getting a small payout from a slot machine at the casino. The instant gratification of getting feedback becomes a deeply engrained habit that’s hard for people to break. Perhaps the only good thing about Twitter is President Trump’s tweets. Previously, to hear what a President had to say, he would have to hold a press conference or give an

interview, but now with Twitter he can fire off his thoughts on anything at any time, day or night, and then the media reports on it—often overreacting to the point of having a meltdown. There have been calls to ban him, and groups have even started petitions and presented them to Twitter with the foolish hope they would shut down his account, but he’s still there. Twitter’s co-founder Evan Williams even said he was sorry for his creation helping Donald Trump get out his message during his campaign in 2016 after Trump told the Financial Times that without it, he didn’t think he would have won. 736 “If it’s true that he wouldn’t be president if it weren’t for Twitter, then yeah, I’m sorry,” Williams said. 737 Trump knows and loves the power of Twitter, but the big question is— will he still tweet after he’s left office? Barack Obama broke the unwritten rule of not criticizing his successor, and it’s been the tradition of former presidents to not inject themselves into matters involving the next administration, but both Barack Obama and George W. Bush have been openly criticizing the Trump administration, so after he leaves office he may not sit by silently, and could regularly criticize the next administration as well, and it will be hard for people to ignore what he’s saying since his Twitter feed has become such a newsmaker. There may be only one way for the Liberal Media Industrial Complex to silence Donald Trump, which is why they are constantly painting him as the reincarnation of Adolf Hitler, and incessantly calling him a fascist dictator, because they are hoping to incite some unhinged lunatic who believes what they say to assassinate him.

YouTube

Most people don’t realize this but YouTube is the second largest search engine in the world, after Google of course, and it’s also part of the same conglomerate since Google bought YouTube in 2006 for 1.6 billion dollars. Later corporate restructuring put both of them under the new umbrella company Alphabet Inc. When referring to YouTube many people consider it a part of Google, but it should be considered its own separate entity, which it technically is, with its own CEO — Susan Wojcicki. For the better part of a decade after YouTube was launched, it was largely seen as just a website for user generated entertainment. It was the place for people to upload funny cat videos and show themselves doing stupid “Internet challenges,” but a small group of people (myself included) knew from YouTube’s beginning that it was a powerful tool that could be used to share news and analysis about current events and other important issues that weren’t being properly addressed by mainstream outlets. It was like having our own public access cable channel where we could do anything we wanted with the potential to reach an audience of millions, and for some of us, that started happening on a regular basis. For over a year after the 2016 election, the mainstream media’s war on “fake news” (in reality a war on independent news and ordinary people using social media to get out their message) focused almost exclusively on Facebook and Twitter since the news giants saw them as being responsible for completely losing their power to control the national narrative surrounding major issues and events. The mainstream media could no longer prevent certain information from becoming widely known and millions of people were spending their time scrolling through Facebook, and Twitter, and watching YouTube videos instead of engaging with the traditional news outlets that had dominated the industry for decades since their creation.

But Donald Trump beating Hillary Clinton was a wakeup call for the Liberal Media Industrial Complex , so they launched a bold new effort under the disguise of fighting “fake news” to completely reshape social media. While they first focused on Facebook and Twitter, eventually they stumbled upon a huge secret that was right in front of their nose for years. People like me were creating YouTube videos on a regular basis covering news and politics and we were getting enormous audiences rivaling or beating cable news. In the run-up to the 2016 election my YouTube channel was averaging around 700,000 viewers a day, about half of what CNN’s primetime shows like Anderson Cooper and Don Lemon get on their best nights. 738 But now the Establishment discovered the “fake news” problem was flourishing on YouTube, they said, and it had to be stopped by changing the algorithm to artificially favor mainstream media channels over videos posted by ordinary YouTubers. In October of 2017, sociologist and technology critic Zeynep Tufekci said, “YouTube is the most overlooked story of 2016,” after realizing there was much more to YouTube than cat videos and pranksters. 739 Traditional media outlets discovered the world of underground news and they were shocked at just how popular we were. Slate pointed out that Twitter and Facebook had been receiving the brunt of criticism about spreading “fake news” but, “Now a series of controversies is forcing YouTube to address its responsibilities more directly and candidly than it has in the past.” 740 Soon YouTube would completely change the way the website had functioned for the previous ten years, and turned it from what was meant to be a place where anyone with an important message could post videos and build an audience, to mostly just another mainstream media site filled with brand name news channels and videos of familiar celebrities.

By mid-2018, as Wired magazine points out, YouTube was “ditching vloggers” in favor of Hollywood celebrities. “YouTube used to be all about young digital influencers who managed to threaten TV with their video blogs. Not anymore. It seems that YouTube is opting for traditional celebrities instead.” 741 Another blogger noticed the changes and ran with the headline, “YouTube is turning away from its creators to become a new MTV,” and noted, “YouTube can’t promise brand safety with volatile creators on the platform — advertisers don’t want to be caught in a firestorm. The only move is to pivot, and YouTube is ready. Hollywood names like Will Smith and Demi Lovato are safe bets. Same with music videos already vetted by major record labels.” 742 YouTube, which for over a decade was a place for independent content creators to upload their videos, even began producing shows themselves. 743 For the better part of ten years since its launch in 2006, Hollywood studios and mainstream celebrities didn’t pay much attention to YouTube. They either were afraid of it because it threatened their monopoly on content distribution, or they were too blind to see how the new technology was revolutionizing media and helping to create new kinds of stars.

Right-Wing Channels Dominating In March of 2018 Vanity Fair warned that right-wing “Dark-Web Trolls” were “taking over YouTube” because so many anti-social justice warrior channels were getting popular. 744 The New York Times then said YouTube was “radicalizing” people to the right, and claimed that if people started watching videos of Donald Trump speeches then YouTube will begin recommending videos of “white supremacist rants” and “Holocaust denials.” 745

The article declared that, “Given its billion or so users, YouTube may be one of the most powerful radicalizing instruments of the 21st century,” and that, “Its algorithm seems to have concluded that people are drawn to content that is more extreme than what they started with — or to incendiary content in general.” 746 The New York Times had previously complained that, “For the New Far Right, YouTube Has Become the New Talk Radio,” saying, “They deplore ‘social justice warriors,’ whom they credit with ruining popular culture, conspiring against the populace and helping to undermine ‘the West.’ They are fixated on the subjects of immigration, Islam and political correctness. They seem at times more animated by President Trump’s opponents than by the man himself, with whom they share many priorities, if not a style.” 747 The Left became determined to paint the Right’s rising stars as radicals, Islamophobes, and far-right extremists hoping to derail the spread of our videos. One Leftist blog called “Right Wing Watch” founded by Jared Holt declared that, “White Supremacy Figured Out How To Become YouTube Famous,” and whined that, “YouTube has served as an alternative media ecosystem apart from the mainstream where any person can contribute to national conversation and reach thousands of people overnight. But the Right’s overt domination of the platform, in addition to political forums on Reddit and 4chan, has created an environment where white nationalists and right-wing extremists can easily inject hateful rhetoric and conspiracy theories into national political discourse.” 748 When BuzzFeed or CNN reported “breaking news” about the Trump administration or when something started trending on Twitter, us YouTubers could quickly publish videos giving another perspective and point out things the mainstream media was ignoring or lying about. Our subscribers

would see the videos, but perhaps more importantly, people searching for information on YouTube about those issues could find our videos, and if they were popular with favorable ratings, those videos would be discovered by people seeking out information on the subject matter. But all that has changed.

“Authoritative Channels” Boosted to the Top For over a decade the top search results on YouTube were the most popular videos associated with the search terms you entered in, regardless of whether the videos were posted by someone who had just opened a YouTube account, a full time YouTuber, or a mainstream media outlet. The algorithm that was originally in place worked very well, because instead of showing the most-viewed videos (which could have generated a large number of views by using misleading titles and thumbnails) YouTube surfaced videos with the most “watch time” up at the top. This means that if people clicked on a video and found that the title and thumbnail were misleading or it wasn’t a quality video, and then decided not to watch it by clicking away rather soon once it began playing, the algorithm would know that it wasn’t what people were searching for because the average amount of time people spent watching the video would be low. But if the video had a high watch time average, the site (accurately) figured that people had found what they were looking for because they kept watching it, and those were the videos that ranked the highest in the search results. All that mattered was that the video was uploaded to YouTube by someone—anyone. If it was good, and people watched it instead of clicking away after a few seconds, it would show up in the top of the search results.

But all that changed in October 2017 when YouTube reconfigured the algorithm to favor videos from mainstream media outlets. 749 They added internal tags on certain channels deeming them “authoritative sources,” and overnight the top search results for most things were now videos from channels like CNN, NBC, Entertainment Tonight, etc. Most of these videos have only a tiny fraction of the views (and watch time) compared to countless other videos about the subject being searched for, but those videos are now buried under pages of content from channels that YouTube has deemed “authoritative” sources. 750 They had manually intervened in the search results previously, but only for certain topics they deemed “extremist” material, like videos supporting ISIS. YouTube had been redirecting search results for these topics to curated videos and playlists they had specifically chosen in order to “confront and debunk violent extremist messages.” 751 But now “the Jigsaw Method” as they call it, was rolled out on a massive scale and incorporated news, current events, and many other topics people regularly search for. “We’re continuing to invest in new features and changes to YouTube search that provide authoritative results when people come to YouTube looking for news,” a YouTube spokesperson said in a statement. 752 “So far this year we have introduced new features that promote verified news sources when a major news event happens. These sources are presented on the YouTube homepage, under ‘Breaking News,’ and featured in search results, with the label ‘Top News.’ Additionally, we’ve been rolling out algorithmic changes to YouTube search during breaking news events. There is still more work to do, but we’re making progress.” 753 Soon it wasn’t just videos from mainstream media channels boosted to the top during “breaking news” events, but almost anything having to do with news at all.

MSNBC’s Chris Hayes rang the alarm about YouTube’s algorithm because he didn’t like the search results for videos about the Federal Reserve. 754 Mother Jones magazine joined in on the criticism, reporting, “If you search for ‘Federal Reserve’ on YouTube, one of the first videos to surface is titled ‘Century of Enslavement.’ Using archival footage and the kind of authoritative male voice heard in countless historical documentaries, the 90-minute video espouses the idea the Federal Reserve was formed in secret by powerful, often Jewish, banking families in the early 20th century, causing America to spiral into debt.” 755 It continued, “The incendiary Federal Reserve video, flagged by MSNBC host Chris Hayes earlier this month, is just one of many examples of how political extremists have mastered YouTube’s algorithms and monetization structure to spread toxic ideas ranging from conspiracy theories to white supremacy. The video ‘Why Social Justice is CANCER,’ for instance, appears after searching for ‘social justice.’ 756 That video was from Lauren Chen (formerly known as Roaming Millennial.) 757 Soon the search results for “Federal Reserve” featured only videos from mainstream media channels, and the documentary Chris Hayes called out (Century of Enslavement: The History of the Federal Reserve— which was the top search result) was nowhere to be seen. I looked all the way through page 25 of the search results and it still didn’t show up. 758 Other videos critical of the Federal Reserve, including one titled “Exposing the Federal Reserve,” which is a high-quality 30-minute cartoon, 759 and “The Federal Reserve Explained in 3 Minutes” also vanished. A whistleblower later revealed to Breitbart that “Federal Reserve” had been added to the secret “Controversial Query Blacklist” file which causes “authoritative content” (i.e. mainstream media channels) to artificially rise

to the top of the search results over other videos that actually qualify organically for those positions. 760 My most-viewed video “Donald Trump’s Funniest Insults and Comebacks,” which has over 11 million views, is now buried on page three of the search results when looking for the exact title. All the top results for “Donald Trump’s Funniest Insults and Comebacks” are videos from CNN, NBC News, ABC News, the Washington Post, HuffPost, etc, most of which are critical of President Trump and have far less views and watch time. My channel had reached one million subscribers in May of 2017, and at the time had more subscribers than MSNBC’s channel, NBC News, CBS News, and even Fox News. 761 And many of my videos far eclipsed theirs in the number of views, but since the algorithm changes my channel virtually stalled in growth while theirs all grew exponentially. In the spring of 2019, YouTube changed the algorithm so when people searched for my own name, the top search results were other people’s videos about me, with mine buried at the bottom of the page. When searching for almost any other YouTuber, however, their most recent videos were featured at the top of the page with a notification highlighting their latest uploads. I had been calling YouTube out about this since I first learned of it in May 2019, thanks to people leaving comments on my videos giving me a heads up, but YouTube wouldn’t respond to me. It was only after an uproar four months later when Steven Crowder became aware that none of his videos were coming up in the search results for his name either, and directed his lawyer to contact them about it while his fans bombarded YouTube with a flood of tweets denouncing them for what they had done. They quickly made some adjustments, partially fixing the problem near the end of September 2019, but didn’t publicly acknowledge the complaints

or that they had reverted the algorithm back to the way it was. But at least my two most recent videos started showing up again at the top of the search results along with those of the other popular conservative channels that had been censored (Steven Crowder, Paul Joseph Watson, The Next News Network, Lauren Chen, and Breitbart News). Shortly after a feminist writer for Slate.com, an online magazine, complained about many of the top search results for “abortion” being prolife videos (including one that showed what a baby looks like in the first trimester—complete with arms, legs, fingers and toes), YouTube quickly changed the algorithm to feature various pro-abortion videos at the top. “I emailed YouTube Friday afternoon asking why anti-abortion videos saturated the search results for ‘abortion,’” she wrote, adding, “By Monday morning…the search results had changed to include a number of news outlets among the top results.” 762 National Review pointed out that YouTube was happy to “airbrush away the reality of abortion,” by artificially boosting pro-abortion videos after her complaint. 763 Now a search for “abortion” brings up videos from Vice News, the BBC, and BuzzFeed. In a leaked document given to Breitbart, one engineer admitted “We have tons of white and blacklists that humans manually curate.” 764 The document also first revealed the existence of the “Controversial Query Blacklist” file that contains a list of search terms that will bring up manually curated videos in the results or ensure the top results are videos from mainstream media channels. 765 The list includes “abortion,” “Federal Reserve,” and even people like anti-gun activist David Hogg, and Congresswoman Maxine Waters. When Captain Marvel was released in March 2019 YouTube changed their algorithm in order to bury videos of people who were giving the movie

negative reviews which were appearing as the top search results. 766 The film’s star Brie Larson had been insulting white men and promoting intersectional feminism on her publicity tour, angering many Marvel fans who took to YouTube to express their thoughts. Those videos, being very popular, surfaced at the top of the search results for “Brie Larson,” but that soon changed. A writer for The Verge posted two side by side screenshots showing the before and after top search results and noted, “This is kind of a fascinating discovery: YouTube seems to have changed the immediate ‘Brie Larson’ search results to News. That pushes up authoritative sources and, in turn, pushes troll or MRA-style [Men’s Rights Activists] video rants pretty far down the page.” 767 She went on to report that, “YouTube recategorized ‘Brie Larson’ as a news-worthy search term. That does one very important job: it makes the search algorithm surface videos from authoritative sources on a subject. Instead of videos from individual creators, YouTube responds with videos from Entertainment Tonight, ABC, CBS, CNN, and other news outlets first.” 768 YouTube has even experimented with disabling some of the search filters to make it impossible to do a more focused search when looking for something specific. In March 2019 they temporarily disabled the ability to filter search results by dates, in order to prevent people from finding recent uploads of the New Zealand mosque massacre which was live-streamed by the shooter and was being uploaded to YouTube by various people who had gotten the footage from the perpetrator’s Facebook page before moderators removed it. 769 This way you couldn’t narrow the search perimeters by the date something was posted which is often the only way to find certain clips now

because they’re buried under countless other videos that are artificially pushed to the top even though they’re not necessarily relevant to the search terms. Luckily this time, disabling the search filters was only temporarily, but who knows what the future holds.

Recommended Videos Playing favorites with mainstream channels and serving their videos up as the top search results no matter how few views or little engagement they have wasn’t good enough though. The Wall Street Journal complained, “YouTube’s algorithm tweaks don’t appear to have changed how YouTube recommends videos on its home page. On the home page, the algorithm provides a personalized feed for each logged-in user largely based on what the user has watched…Repeated tests by the Journal as recently as this week showed the home page often fed far-right or far-left videos to users who watched relatively mainstream news sources, such as Fox News and MSNBC.” 770 Their report continued, “After searching for ‘9/11’ last month, then clicking on a single CNN clip about the attacks, and then returning to the home page, the fifth and sixth recommended videos were about claims the U.S. government carried out the attacks. One, titled ‘Footage Shows Military Plane hitting WTC Tower on 9/11—13 Witnesses React’—had 5.3 million views.” 771 Others had been complaining about “conspiracy videos” too. As you can imagine, CNN piled on the criticism as well, reporting, “YouTube has long faced criticism for allowing misinformation, conspiracy theories and extremist views to spread on its platform, and for recommending such content to users. People who came to the site to watch videos on innocuous

subjects, or to see mainstream news, have been pushed toward increasingly fringe and conspiracist content.” 772 NBC News also complained that, “YouTube search results for A-list celebrities [have been] hijacked by conspiracy theorists” and noted, “YouTube did not respond to a request for comment,” [but] “Some conspiracy videos’ rankings dropped after NBC News reached out for comment.” 773 In January 2019 YouTube issued a public statement saying that they will continue, “taking a closer look at how we can reduce the spread of content that comes close to—but doesn’t quite cross the line of—violating our Community Guidelines. To that end, we’ll begin reducing recommendations of borderline content and content that could misinform users in harmful ways—such as videos promoting a phony miracle cure for a serious illness, claiming the earth is flat, or making blatantly false claims about historic events like 9/11.” 774 It went on to say, “This change relies on a combination of machine learning and real people. We work with human evaluators and experts from all over the United States to help train the machine learning systems that generate recommendations.” 775 YouTube now deciding what is and is not a conspiracy theory has dramatic implications. For example, mainstream media outlets claimed that people who thought “Empire” actor Jussie Smollett faked his “racist and homophobic attack” at the hands of Trump supporters were spreading a “conspiracy theory.” 776 And since such “conspiracy theory” videos are now admittedly buried in the search results and kept out of the Recommended and Up Next sections, YouTube was actively hiding the truth about what actually happened, which later came out. 777

A recent addition to YouTube’s terms of service specifically bans, “Content claiming that specific victims of public violent incidents or their next of kin are actors, or that their experiences are false,” which means that anyone who posted a video or did a livestream saying they thought Jussie Smollett faked the “attack” was in violation of their rules and at risk of having their videos taken down and issued a Community Guidelines strike or even having their entire channel banned if they had previous infractions. 778

For many years about one-third of my total views were from “Suggested” videos, but then in April 2019 I and many other YouTubers noticed a quick and dramatic drop, which is detailed in our Channel Analytics. From that point on my total views from “Suggested” videos dropped to around five percent, a significant drop, most likely because my channel was identified as “borderline” and so my videos don’t show up on people’s homepages anymore or next to similar content.

The “Alternative Influence Network” It wasn’t enough to bury independent content creators’ videos under piles of mainstream media channels when searching for various topics, or preventing our videos from showing up in the “Recommended” section or the “Up Next” sidebar. The Liberal Media Industrial Complex got upset that a bunch of YouTubers were collaborating with each other, and doing interviews with one another. In September 2018 a report from a “research institute” called Data & Society claimed to have identified what they called a network of “far-right” YouTubers who indoctrinate people through their videos by promoting right-wing “extremist” ideologies. “Although YouTube’s recommendation algorithms are partly to blame, the problem is fundamentally linked to the social network of political

influencers on the platform and how, like other YouTube influencers, they invite one another on to their shows,” the report reads. 779 It includes an illustration looking like a collage on the wall of a detective’s office linking together all the connections of an organized crime family and notes, “The graph is a partial representation of collaborative connections within the Alternative Influence Network (AIN)–a network of controversial academics, media pundits, and internet celebrities who use YouTube to promote a range of political positions from mainstream versions of libertarianism and conservatism to overt white nationalism. While collaborations can sometimes consist of debates and disagreements, they more frequently indicate social ties, endorsements, and advertisements for other influencers.” 780 The report basically recommends that YouTube forbid people from interviewing individuals who liberals deem unsavory or who talk about things they consider “offensive” or “hateful” which as you know includes almost everything from illegal immigration to the American flag. “The platform should not only assess what channels say in their content, but also who they host and what their guests say. In a media environment consisting of networked influencers, YouTube must respond with policies that account for influence and amplification.” 781 In an interview about the report, lead researcher Rebecca Lewis explained how most of the focus on “extremism” and “fake news” has been on Facebook and Twitter, but, “We don’t have as clear a picture of what’s happening on YouTube and Google. It is important to bring to the fore some illustrations of the problems that do exist on these platforms. I’m trying to show there are fundamental issues we need to be addressing [regarding the algorithms of] YouTube in the same way we have recognized fundamental issues with Facebook and Twitter.” 782

She went on to say, “I absolutely think reassessing the algorithms is one step that needs to be taken. Assessing what government regulation options are available is absolutely worthwhile, and then thinking about how YouTube monetization structures incentivize certain behaviors is something that needs to be done. It needs to be a multi-pronged solution.” 783 Five months after the Alternative Influence Network report was published a group of “researchers” calling themselves Digital Social Contract did a test to see how YouTube’s “Recommended” videos section changed, and looked at over 80 different channels listed in the report and noted, “For the first two weeks of February [2019], YouTube was recommending videos from at least one of these major alt-right channels on more than one in every thirteen randomly selected videos (7.8%). From February 15th, this number has dropped to less than one in two hundred and fifty (0.4%).” 784 The Digital Social Contract report also highlighted that a video of actress Emma Watson promoting feminism had another video titled “How Feminism Ruined Marriage” queued in the “Up Next” autoplay section right beside it, which they claimed was “an anti-feminist video from an altright channel.” 785 That “alt-right” channel was Ben Shapiro’s, who is a Jew, not an alt-right white nationalist, but instead is often a target of altright figures who hate him because he’s Jewish. 786

Censoring Videos YouTube has always had a policy forbidding certain kinds of content from being uploaded like pornography, graphic violence, animal abuse, or blatant invasions of someone’s privacy; which are very reasonable rules, but after the 2016 election they began removing videos critical of the radical

Leftist agenda, including videos denouncing child drag queens, feminists, and for even reporting on anti-white hate crimes. Those kinds of videos can now easily violate YouTube’s “Community Standards” and result in getting channels issued a strike (and the video taken down), and if a channel gets three strikes within a three month period, the entire channel and all its videos are completely deleted. YouTube’s senior leadership (and overall corporate culture) believes there are 58 different genders, and Christians are just old-fashioned superstitious bigots; so we’re talking about godless liberal Silicon Valley standards, not Midwestern community standards. YouTube also teamed up with the Southern Poverty Law Center, who began searching for videos they recommend be taken down. Soon all kinds of them were being removed under the banner of stopping “hate speech.” 787 I got a strike on a video I uploaded about a black man who opened fire inside a Tennessee church hoping to kill as many white people as possible. 788 The video was appropriately titled “Black Man Shoots Up White Church - Media Ignores Anti-White Hate Crime” and didn’t show any graphic images, but as you probably know by now, reporting on anti-white hate crimes is deemed “racist” by the Left. The liberal media wants people to believe hate crimes are only committed by white people against blacks and don’t want anyone talking about how such attacks are actually a two way street. Black conservative Candace Owens even had a video removed from her channel that was critical of Black Lives Matter because it was deemed “hateful” against black people. 789 A channel called High Impact Vlogs had a video removed and got a Community Guidelines strike for criticizing the parents of Desmond is Amazing, the 11-year-old “drag kid,” after the boy was featured on Good Morning America . 790

YouTube pulled a funny 2018 midterm election ad by a Republican running for governor of Florida in which he showed off his “Deportation Bus,” which he used to promote his campaign, claiming his ad was “hate speech.” 791 They later restored the video after their censorship began making headlines. Tommy Robinson’s entire channel has been “quarantined” with special restrictions that prevent any of his videos from ever showing up in the search results at all. This designation also causes all comments to be disabled on every video, and the view counts censored as well, so people can’t gauge how popular they are in another attempt to suppress his message by hiding the number of people watching his videos. 792 Hunter Avallone, a conservative millennial who makes fun of feminists and other SJWs, had his entire channel deleted in April 2019 for “hate speech” despite not having any current strikes. After a growing outrage about the censorship, YouTube restored his channel and once again claimed it was just a “mistake.” 793 The Prager University channel (stylized PragerU) sued YouTube after they discovered that almost all of their videos were hidden when YouTube was in Restricted Mode, which most schools and public libraries have it set on by default in order to filter out “sensitive content.” 794 Many of my videos are also completely hidden to people who are browsing in Restricted Mode as well, even though my content is family friendly. In December of 2017 YouTube hired 10,000 new human moderators to supposedly remove “extremist” content and videos containing “hate speech,” and soon after they began taking down popular videos and entire channels that hadn’t come anywhere close to actually violating the terms of service. As a result of the new moderators a major purge occurred a few months later in February of 2018. Jerome Corsi’s entire channel was taken

down, Mike Adams’ “Natural News” channel was also removed, and many others. YouTube even began issuing community guideline strikes and removing videos that criticized CNN’s Town Hall on gun control following the Parkland school shooting in Florida. 795 Tim Pool had produced a video where he debunked the conspiracy theories about the shooting, but his video was removed as well. 796 After some channels and videos were restored due to a major outcry about this latest wave of censorship, Gizmodo reported that, “the usual whackos like far-right personality Mark Dice are going wild on Twitter claiming the admission of any mistake at all constitutes victory. Hopefully they’re wrong and YouTube isn’t walking back punishments on people like [Jerome] Corsi, whose prior best hits include a steadfast belief Barack Obama is secretly gay and also some kind of Muslim, though InfoWars claimed yesterday that it got YouTube to revoke one of the two strikes against it.” 797

“YouTube’s New Moderators Mistakenly Pull Right-Wing Channels” was the headline at Bloomberg News. 798 It was just another “mistake,” they said. YouTube deleted the entire channel of a gamer for posting a clip of him playing “Red Dead Redemption 2” which showed him “killing” a feminist NPC (non playable character) by lassoing her and then feeding her to an alligator. 799 The game is a western and takes place in the late 1890s, and the character was just one of the townspeople who was hanging out in the street and happened to be promoting women’s suffrage (right to vote) so he thought it would be funny to feed her to the alligator, which the game allows players to do to any of the “townsfolk.”

Professional gaming is a huge industry where people stream themselves playing various video games, which as you know, often include the main character “killing” a number of other characters in the game, but the YouTube moderators deemed feeding the feminist to the alligator “graphic content that appears to be posted in a shocking, sensational, or disrespectful manner.” After others in the gaming community expressed outrage over YouTube censoring a clip of someone playing a popular game, they restored his channel. 800 After the Covington Catholic incident involving the high school kid in the MAGA hat and the Native American man beating a drum in his face at the National Mall in Washington D.C., a retired Navy SEAL named Don Shipley posted a video about Nathan Phillips, the “Vietnam Veteran” Native American, calling him a fraud because Army records show he was never actually in Vietnam. YouTube soon terminated the Navy SEAL’s channel, claiming he was “harassing” the old man. 801 Infowars host Alex Jones was banned from YouTube in August 2018 in part for his criticism of a drag queen festival where adult drag queens performed simulated strip teases for an “all ages” show which included children in the audience brought there by their degenerate parents. He called it an “abomination” and a “freak show” and so his video was deemed “hate speech” and “transphobic,” resulting in YouTube removing the video and issuing him a community guidelines strike. 802 The deleted video (titled “Shocking ‘Drag Tots’ Cartoon Sparks Outrage”) can be seen on BitChute.com 803 and Infowars.com. 804 YouTube also cited another video of Jones as being “Islamophobic” because he was ranting about the increased crime in Europe due to the influx of Muslim refugees in recent years. 805

He was given his second strike for that video, titled “Learn How Islam Has Already Conquered Europe,” 806 and soon a third (and final) strike for “circumvention” of YouTube’s “enforcement measures” because he had promoted another YouTube channel that had taken the feed of his show from his website and was streaming it on their channel since Jones was under a 90-day live-streaming suspension from the previous strikes. 807 The H3H3 Podcast channel then had their livestream taken down and were issued a community guidelines strike simply for talking about Alex Jones being banned. 808 They are a popular husband and wife duo with over a million subscribers (on their podcast channel) who were actually defending YouTube’s decision to ban Alex Jones, and were repeating some of the crazy things he has said over the years which may have been flagged by the AI voice recognition systems that monitor livestreams. H3H3 co-host Ethan Klein later said, “How can I even sit here now and call Alex Jones a conspiracy theorist when our channel just got [a strike] for even fucking talking about him? I was criticizing him!” 809 After BuzzFeed stumbled across a 14-year-old girl’s channel who does comedy sketches mocking social justice warriors and deriding political correctness, they did what they always do and wrote a hit piece urging people to pressure YouTube to ban her for “hate speech.” 810 The writer of the article (Joseph Bernstein) even labeled her an “extremist.” 811 Before the article came out, “Soph” as she goes by, had over 800,000 subscribers which terrified BuzzFeed that such a young, talented, and popular girl was pushing back against the liberal agenda, but shortly after it was published she got two strikes on her channel for previous videos which had been up for weeks with no problems. 812 The following week her entire channel was completely demonetized, dealing a crushing blow to her chances of turning YouTube into a career. 813

A month and a half later she received her third and final strike for “hate speech” after she posted a video critical of homosexuals, and her entire channel was completely deleted. 814 In June 2019 Project Veritas released a 25-minute report which included an undercover investigation into Google which showed that the head of the Innovation Department said they were doing everything they could to prevent another “Trump situation in 2020” and was bragging about how Google had come up with a new definition of “fairness.” The Project Veritas report also included an interview with a current YouTube employee which was done in a silhouette to protect his identity. He explained how YouTube was actually preventing certain conservative and libertarian channels from having their videos show up in the “Recommended” section, confirming what most of us had already basically known since it was obvious. He also provided Project Veritas with leaked documents detailing their algorithm manipulation. 815 Within hours YouTube deleted the video from Project Veritas’ account, claiming it violated the head of Innovation’s privacy even though it only showed her talking at a restaurant and mentioned who she was. Most privacy violations are for publishing someone’s home address or cell phone number. On CNN’s official YouTube channel they posted the video of their reporter stalking and harassing the old woman in her front yard because she shared someone on Facebook that originated with the Russians. During part of the altercation her full street address, which is posted on the front of her house, was completely visible. 816 How is that not a violation of her privacy and YouTube’s terms of service? In October 2019, the channel Red Ice TV was completely deleted, despite having no current strikes against it. No specific reason was given, just that it had supposedly violated YouTube’s policy prohibiting “hate

speech.” It had over 330,000 subscribers, and for over ten years was run by a husband and wife duo out of Sweden who focus on preserving European culture and exposing anti-white racism, so of course they’ve been smeared by the media as “white supremacists.” They were the most popular Identitarian channel on YouTube. 817 Leftist groups like Media Matters, the Southern Poverty Law Center, and the ADL had been pressuring YouTube to ban the channel for years. 818

No Conservative is Safe Kara Swisher, the co-founder of Recode Media which hosted the historic joint interview with Steve Jobs and Bill Gates, said she wanted to “kill” YouTube CEO Susan Wojcicki after discovering that her 13-year-old son was watching Ben Shapiro’s videos, and claims he is the “gateway drug” to “neo-nazi stuff.” 819 She made the comments while interviewing Susan Wojcicki at the “Lesbians Who Tech” conference in March 2019 (Kara Swisher is a lesbian who must have adopted her poor kid or used a sperm bank). She added that her son is “lost” (meaning he’s not infected with the liberal pathogen) and insinuated that YouTube was responsible. Susan Wojcicki responded, “I have a son too and I get some of these discussions also at the dinner table. I think what you’re describing is — and the way we think about it too — look, there’s a set of content that has to meet the community guidelines. Ben Shapiro is going to meet the community guidelines. I don’t think you’re suggesting that we remove him from the platform. Are you?” Kara Swisher responded, “I would,” and continued, whining “You know, last time I saw you, I was like, ‘Get Alex Jones off that platform,’ and you’re like, ‘Well the community guidelines,’ and then [later] you got

him off.” 820 She then changed the subject and went on to ask Susan if there was enough “diversity” in the company, particularly in management. “Diversity” is a code word for “less straight white men,” because Big Tech is concerned that there are too many of those kinds of people working in Silicon Valley. Ben Shapiro is a huge nerd, he’s not a right-wing extremist or a hateful bigot, and is about as mainstream of a political commentator as you can get, yet Kara Swisher, who holds tremendous power in Silicon Valley and has direct access to all of the major CEOs, is demanding that he be banned from YouTube because she thinks he’s a right-wing extremist, proving that no conservative, no matter how moderate, is safe.

YouTube Gives Millions to Mainstream Media Demonetizing us, censoring our videos, down-ranking them in the search results, and hiding them from the “Recommended” section while boosting mainstream media channels still wasn’t silencing us enough, so YouTube decided to just give $25 million dollars to brand name news channels and provide them with special consulting to help them create more engaging videos and grow their audience on the platform. 821 “We will provide funding across approximately 20 global markets to support news organizations in building sustainable video operations,” they announced in July 2018. “Provided on an application basis to news organizations of all types, these grants will enable our partners to build key capabilities, train staff on video best practices, enhance production facilities and develop formats optimized for online video.” 822 So people like me were able to figure out how to produce quality and engaging videos and built an audience all on our own, but since ordinary YouTubers came to dominate mainstream media, YouTube decided to just

give them everything they need to emulate what we had come to learn through years of innovation and practice. The largest “YouTube news channel” is the Young Turks, which was started by progressive Democrat Cenk Uygur in 2005, and over the years has gotten help from some very wealthy benefactors. In 2014 they got $4 million dollars from an investment firm, 823 and then later got another $20 million in 2017 from former Walt Disney Studios chairman Jeffrey Katzenberg. 824 That’s not a typo—twenty million dollars! It’s interesting that their channel bears the same name as the insurgent group of Muslims who committed genocide against the Armenian people (who were Christians), killing 1.5 million of them between 1914 and 1923 in one of the first modern day genocides. 825 For years Cenk Uygur actually denied the Armenian Genocide until growing pressure caused him to change his position, saying he will refrain from commenting on it because he doesn’t know enough about it. 826 Making things even more bizarre is that the Young Turks cohost Anna Kasperian is Armenian, and works for a “news” organization which appears to be named after the very group which committed genocide against members of her own family. 827 She’s the daughter of Armenian immigrants and actually grew up speaking Armenian as her first language. 828 While YouTube has a policy against allowing “extremist groups” on the platform, they have no problem with a channel that some interpret as paying homage to a group that murdered more than a million Christians. 829 Instead, YouTube CEO Susan Wojcicki enjoys hanging out with them and tweeted a photo of herself sitting down talking with Cenk Uygur at YouTube’s headquarters, thanking him for his time. 830 Young Turks host Hasan Piker even declared that “America deserved 9/11” in response to Congressman Dan Crenshaw doing an interview with

Joe Rogan where he said that Osama Bin Laden attacked the U.S. because of our western values. 831 Piker also appeared to praise Al Qaeda for blinding Crenshaw (a retired Navy SEAL) who lost an eye while serving in Afghanistan in 2012. 832 He then mocked the disabled veteran for having one eye. Hasan Piker is allowed to host a show on the platform, but Alex Jones isn’t. Piker has his own personal YouTube channel as well, that hasn’t been demonetized. In 2016 YouTube launched their “Creators for Change” program where they began funding and coaching various YouTubers to make videos denouncing “hate speech,” “xenophobia,” and “extremism.” 833 These handpicked social justice warriors produce propaganda for the platform and some of them promote the latest degeneracy the Left is trying to convince people is normal. At the end of every year YouTube produces a mashup of what they consider to be the year’s top stars and it’s always a bunch of SJWs and LGBT activists. Their 2018 “Rewind” video, as it’s called, featured drag queens and highlighted Hollywood celebrities like Will Smith and John Oliver over ordinary YouTubers. It got so many thumbs down that overnight it became the most disliked video on YouTube ever . 834 Shortly after that, YouTube announced that they were trying to figure out how to prevent what they called “dislike mobs” from “weaponizing the dislike button” and considered removing it altogether. 835

The Adpocalypse Since I’m an old school YouTuber, I was posting videos for six years before my channel was monetized (at the end of 2012) opening the door for me to become a professional YouTuber. While it has always been difficult to make a living on YouTube because monetized videos only pay a small

fraction of a penny per view, a few years after I started doing it full time, it became almost impossible, especially for smaller channels that aren’t getting five to ten million views a month. In April 2017 after the Wall Street Journal published a report about finding advertisements for major brands appearing on “racist” and “offensive” videos, all hell broke loose. Tons of companies pulled their advertisements from the platform entirely, kicking off what us YouTubers call the “Adpocalypse” (advertising apocalypse). YouTube immediately rolled out some new tools they had been testing to comb through the titles, tags, and descriptions of videos and automatically demonetize (strip advertisements from) ones that were about (or even mentioned ) certain topics. Every video uploaded is now immediately scanned by YouTube’s voice recognition software which creates a transcript of everything that’s said in the video. That transcript is then scanned for keywords that may indicate a video is about a “sensitive” or “controversial” topic and then demonetizes it if certain words or phrases are found. As a result of the Adpocalypse, almost half of all of my videos were demonetized, and from that point on making a living on YouTube became uncertain. News channels like mine were hit the hardest, because news and politics are filled with “divisiveness” and controversial issues that YouTube wanted to shield advertisers from. For people who make cooking videos, or how-to videos about fixing cars, or doing home improvement projects, those kinds of videos aren’t about anything that’s particularly “nonadvertiser friendly” like ones that talk about illegal immigration, climate change, political cover-ups, or exposing fake news. Bloomberg News later reported, “In fact, 96.5% of all of those trying to become YouTubers won’t make enough money off of advertising to crack

the U.S. poverty line.” 836 Their report continued bearing bad news, pointing out that, “Breaking into the top 3% of most-viewed channels could bring in advertising revenue of about $16,800 a year…That’s a bit more than the U.S. federal poverty line of $12,140 for a single person. (The guideline for a two-person household is $16,460.) The top 3% of video creators of all time in [the research group’s] sample attracted more than 1.4 million views per month.” 837 But even for those who never expected to be full-time YouTubers, it was still nice to make a few dollars every month for the time and effort put into creating videos about things they’re passionate about. Despite the loss of income caused by the increased scrutiny, a lot of the more popular YouTuber news channels were still able to get by, or at least kept making videos because it’s about the message not the money, but we all have to pay the bills, so YouTube decided to make people’s lives even harder by demonetizing entire channels instead of just certain videos. In January 2019 Tommy Robinson’s entire channel was demonetized. 838 A few months later in May 2019 Count Dankula was fully demonetized. What’s particularly interesting is that he learned about it from an email from BuzzFeed asking for a statement about it. It appears they had lobbied YouTube to get him demonetized and then reached out to him for a comment immediately after their YouTube source confirmed they had done it. 839 BuzzFeed learned about it before him, which speaks volumes about what’s happening. Sargon of Akkad’s channel was also completely demonetized because of a rape joke he had made three years earlier on Twitter, and—what a “coincidence”—BuzzFeed was the first to break that story as well. 840

Another round of mass demonetization and channel bans occurred in June 2019 (dubbed the Vox Adpocalypse) occurred after a gay activist named Carlos Maza, who works at Vox, ranted nonstop on Twitter for an entire week about conservative comedian Steven Crowder making fun of him. Maza’s rant, which was conveniently timed to coincide with the kickoff of gay pride month for extra leverage, was a rallying call for liberals to pressure YouTube to completely ban Crowder (the most-subscribed conservative channel on YouTube) for “hate speech” because he called Maza a “lispy queer” since he talks with a lisp, and he’s a queer. What do you think the “Q” stands for in LGBTQ? They call themselves queers, but normal people can’t use the word now apparently because the Left is trying to claim that only gay people can say queer , similarly to the double standard most black people have about the n-word. While YouTube didn’t ban Steven Crowder from YouTube, or give him any community guideline strikes to take down any of his videos; they did demonetize his entire channel, not just the “offensive” videos in question, which were probably never even monetized to begin with, thus, preventing him from ever making another dollar from the pre-roll ads you often see before videos start playing. 841 It wasn’t just Steven Crowder’s channel though. Dozens, perhaps hundreds, of others were hit at the same time, some of which were very popular with hundreds of thousands of subscribers. 842 YouTube said this was just the beginning of their latest crackdown, and vowed to purge more “hateful” right-wing channels. The very next week the New York Times ran a front page story titled “The Making of a YouTube Radical” which included a collage of various (mostly) conservative YouTubers who have sizable followings, and told the story about how a lonely loser named Caleb Cain “fell down the YouTube

rabbit hole” and it turned him into a “radical.” How radical? The Times explained that, “He began referring to himself as a ‘tradcon’ — a traditional conservative,” supported “old-fashioned gender norms,” started dating a Christian girl, and “fought with his liberal friends.” 843 “Fought” meaning discussed politics and disagreed with the nonsense they were indoctrinated to believe. The man admits he never thought about doing anything violent and wasn’t even a hateful person, but he was the new poster boy denouncing right-wing YouTubers and the “algorithm.” Other outlets immediately added more fuel to the fire and he was interviewed on CNN where he once again blamed “the algorithm” for “radicalizing” him. 844 He said the conservative YouTubers he used to watch warned of Cultural Marxists who “were trying to destroy Western civilization and install some sort of socialist regime.” 845 That’s exactly what they’re doing of course, but now if you just mention that, you’re considered a right-wing extremist and at risk of having your entire channel demonetized or even deleted. When the White House announced the Social Media Summit and invited dozens of the top conservative social media personalities to meet with President Trump to discuss the issues of censorship and liberal bias, the media freaked out saying that the attendees (which included me, as you probably know) were “trolls,” “conspiracy theorists,” and “extremists.” 846 President Trump addressed us by saying, “So this is a historic day. Never before have so many online journalists and influencers, and that is exactly what you are, you are journalists and you are influencers, come together in this building to discuss the future of social media…Each of you is fulfilling a vital role in our nation. You are challenging the media gatekeepers and the corporate censors to bring the facts straight to the

American people…Together you reach more people than any television broadcast network by far.” 847 I knew once word got out that I was invited to the White House I would have a huge target on my back and just a few days later over 200 of my YouTube videos were demonetized, with about 100 of them manually reviewed by the moderators and deemed “non-advertiser friendly” despite not just being fully monetized for days, months, (and some for years) but many of them had been manually reviewed previously and approved for monetization. YouTube moved the goal post again, and may be looking for a reason to demonetize my whole channel by deeming a “significant portion” of my content “non-advertiser friendly” like they had done to dozens of other channels a month earlier. Many of the videos were of me making fun of CNN hosts, Alexandria Ocasio-Cortez, Beto O’Rourke, and other members of Congress. Apparently it’s okay for Stephen Colbert to do political comedy, but not a conservative YouTuber. In January 2017 YouTube introduced what they call Super Chats, which is a creative way for a viewer to get their question answered by their favorite YouTuber while they’re doing a livestream by tipping them a few bucks. Basically, viewers can choose a dollar amount anywhere from $5 to $500, and their question or comment will be highlighted in color and pinned up at the top of the chat box in order to catch the streamer’s attention since comments in the chat can scroll by the screen so fast they’re impossible to read. In May 2018 BuzzFeed targeted Super Chats, claiming they were fueling racism and began pushing for them to be disabled because someone spent $100 on a Super Chat to post a message that said “WHITE PRIDE WORLD WIDE!” during someone’s livestream. 848 A few months later the

Wall Street Journal (which is responsible for setting off the first Adpocalypse in April 2017) also started complaining about people making money from Super Chats in a report titled, “Hate Speech on Live ‘Super Chats’ Tests YouTube.” 849 Just a few days later, KillStream, which was a free speech variety show that included debates about various issues, was completely banned from YouTube since the Wall Street Journal pointed out some of the viewers had been posting racist messages in their Super Chats. 850 A channel has no control over what viewers put in the comments or Super Chats, but now the media was blaming YouTubers themselves for what their fans (or trolls) were saying. The Liberal Media Industrial Complex is targeting Super Chats because even fairly small channels can earn a significant amount of revenue from them, since fans tossing in $5 and $10 can add up pretty fast, whereas in order to earn the same amount of money from video views alone as they can make in a livestream could take hundreds of thousands or millions of views. Because of the growing demonetization issues those of us on the politics and news side of YouTube have had to move to a more fan-funded business model instead of relying on monetized views. I now rely heavily on fans buying my books, shirts, and supporting me through Patreon and PayPal. By removing the financial incentives for people to make quality videos it was just another way for YouTube to discourage us from spending our time and energy producing news commentary and covering current events and has killed the dreams of one day becoming a full-time YouTuber for many. BuzzFeed reported, “The result of the YouTube crackdown is that prominent right-wing YouTubers are scrambling to find alternatives, setting

up shop on YouTube wannabes, or even building their own video apps. It’s all in preparation for what they see as the inevitable day when YouTube gives them the boot or forbids them from making money on the platform by demonetizing all of their videos.” 851

MCNs Dropping Channels Many YouTubers join what are called Multi-Channel Networks, or MCNs, which are companies that take a percentage of their revenue in exchange for offering consultations on how to improve the performance of videos, grow their audience, and even give them access to “brand deals” or sponsorships like talk radio shows have when the hosts plug various products and services. So even if YouTube’s automated system demonetizes a lot of videos, MCNs can get the channel some sponsors who are okay with their product being promoted there, and that way the YouTuber can still earn a living. But since being a member of an MCN can be a way around demonetization, YouTube decided to order MCNs to drop certain channels, and they had to, because they’re under contract with YouTube, and if they didn’t then YouTube wouldn’t do business with the MCN at all. 852 So first it was just certain videos getting demonetized, then entire channels (including the loss of Super Chats), and then YouTube went even further forcing MCNs to drop certain people so they couldn’t acquire sponsorships for their videos. One person who got kicked out of his network got an email reading, “The team here at Fullscreen is reaching out to let you know that your agreement with Fullscreen, Inc. has been terminated. Due to the nature of your uploads and because your uploads may potentially infringe on the rights of others or potentially violates applicable laws or regulations,

including without limitation YouTube’s Terms of Service and/or YouTube’s Community Guidelines, we feel it is best that we part ways. Thank you for your understanding, and good luck with your YouTube channel.” 853 A friend of mine, Luke Rudkowski, who runs the “We Are Change” YouTube channel was kicked out of his MCN, and when applying to others he was told that he would have to delete several of his videos they deemed inappropriate before they would accept him. The videos in question had been automatically demonetized, but didn’t violate YouTube’s terms of service so they were not deleted. Various MCNs thought they were problematic, however, and could get them in trouble with YouTube for including Luke’s channel in their network because he had posted certain content about various wars, military actions, and social unrest in parts of the world. When a channel reaches 100,000 subscribers YouTube sends them a framed “Silver Play Button” plaque to celebrate their success, and if they reach a million subscribers, they get a gold plated one, but YouTube got upset that so many anti-social justice warrior, pro-free speech, conservative channels were reaching 100,000 subscribers, they started refusing to send out the plaques to certain channels once they reached the milestone because YouTube didn’t want to appear as if they were endorsing their views. 854

Patreon Patreon is a service that allows artists to fund their work by having fans sponsor them with varying amounts of monthly support. While the site was created in 2013, it really took off in April 2017 after the “Adpocalypse” when YouTube rolled out their new guidelines and screening mechanisms to demonetize videos they deem “non-advertiser friendly.”

Most YouTubers joined Patreon as a way to supplement the revenue they were losing from so many videos getting demonetized, and for most of them, especially small to moderate sized ones, Patreon is pretty much a standard part of being a YouTuber since earning money from ads has never been the same in the wake of the Adpocalypse. But since many of them came to rely so heavily on Patreon for their revenue, this became a danger for conservatives who are now at risk of having their Patreon accounts shut down at any time for being “intolerant” of the liberal agenda by not supporting gay “marriage,” or pointing out facts about illegal immigration and crime. The first person to be banned from Patreon that made headlines because it was seen as a political decision was Lauren Southern (banned in July 2017), a Canadian YouTuber who became known for her criticism of multiculturalism and the mass immigration of people from the Middle East into Europe. She once even documented her visit to a doctor where she said she wanted to identify as a man and was given a doctor’s note which she then took to Canada’s “DMV” and got a driver’s license legally declaring she was a “man” just to see how easy it was to get her gender legally changed. 855 Lauren Southern’s ban caused quite a stir online and Patreon’s CEO Jack Conte appeared on Dave Rubin’s “Rubin Report” YouTube channel to respond to the criticism. He said that Lauren wasn’t banned because of what she had been saying about the “Islamization” of Europe, but that she had “put lives at risk” during a stunt she recorded involving refugee boats illegally bringing people across the Mediterranean Sea into Europe. The CEO claimed they have a policy about what he called “manifest observable behavior,” and if a creator does certain things, like commits crimes, then they will be banned, but, “The decision to remove a creator

page has absolutely nothing to do with politics and ideology.” 856 He also claimed that Patreon’s policies about speech (not actions) only focused on what people said on their Patreon page , not on Twitter or anywhere else, and emphasized that Lauren Southern was banned for actions not words, but soon this would be proven to be another lie. 857 December 2018, Sargon of Akkod (who had over 800,000 subscribers at the time) was banned for using a “racial slur” that someone at Patreon discovered he said in an interview months earlier. The context in which it was said was actually while he was denouncing the alt-right, saying they were acting like a bunch of “white niggers,” (trying to use their own insults against them) and so his entire Patreon account was disabled, causing him to lose thousands of dollars a month in income with no recourse. 858 About a year after Lauren Southern was banned from Patreon, her friend and sometimes collaborator Brittany Pettibone was also banned for her support of Generation Identity, a right-wing identitarian movement in Europe working to preserve European culture from Islamization. 859 The two girls have been smeared as “white supremacists” by the liberal media because they celebrate Western European culture and oppose mass migration of Muslim refugees into Europe. Soph’s Patreon was shut down one day after YouTube deleted her channel for the same enigmatic excuse of “hate speech” against homosexuals. 860 Patreon now has a policy against even making “negative generalizations of people based on race [and] sexual orientation,” so if you point out well-documented facts about crime in black communities or the HIV rate among gay men, that would be a violation of their terms of service because it’s seen as casting them in a negative light. Imagine a bank not letting someone cash a check that was written to them because the bank didn’t like what the person was going to do with the

money, or didn’t like the kind of language the person uses when talking with their friends. That’s exactly what Patreon has done here, and it’s beyond Orwellian and is a dangerous precedent that’s likely only going to follow with much worse actions in the near future.  Meanwhile, far-left individuals and groups are allowed on Patreon, including “Revolutionary Left Radio,” a communist podcast which is run by an admitted “militant revolutionary Communist who wants to put every fascist in the world against the wall and violently expropriate the wealth and property of the owning class.” 861 Before a Breitbart article was published highlighting violent Leftists using Patreon, the group’s banner on their Twitter account featured masked militants holding guns. 862 Another Communist account called the “Guillotine Podcast” had over 350 patrons (sponsors) donating monthly. The Patreon page itself said they are working to “inspire insurrection” and notes that they want to fire “massive .44 rounds at the heads of politicians and capitalists.” 863 Milo Yiannopoulos was banned by Patreon one day after he joined in December 2018. They released a statement saying, “Milo Yiannopoulos was removed from Patreon as we don’t allow association with or supporting hate groups on Patreon.” 864 He joined Patreon just days after widely circulated reports said he was $2 million dollars in debt from legal fees, employee salaries he hadn’t been paying, and other expenses he racked up in his ascent to Internet infamy. So in a desperate attempt to try and raise money he joined Patreon, but was immediately denied access. In some cases it’s not necessarily Patreon that wants to ban someone, but Visa or MasterCard, who demands Patreon shut down people’s accounts, or threatens to stop processing payments for Patreon all together which would completely put them out of business overnight. 865

The Future of YouTube For the first ten years of YouTube’s existence it was an even playing field where anyone could upload videos and if people watched them and shared them, their message could be seen by millions of people. The search results were fair, and if you were looking something up the videos you would find were relevant to what you had hoped to find. The only videos that would be deleted were things any reasonable person could agree on, like pornography, animal abuse, calls to violence, etc. People found themselves having great careers when their passion unexpectedly opened the door to huge audiences who shared their views. But the corporate conglomerates didn’t realize how many people would use YouTube to counteract the mainstream media and nobody expected how popular conservative channels would become. So YouTube is scrambling to put the genie back in the bottle, and don’t really care how obvious their liberal bias is, or even how much money they lose doing it. Conservative content must be reigned in or stamped out at any cost. In the early years of YouTube only a few carefully chosen channels were monetized, but in 2012 they opened up the “Partner Program” as it’s called, to anyone, allowing them to monetize their videos no matter how many (or few) subscribers or total views they had. You could start a channel, and immediately begin earning ad revenue from your videos if people watched them, but that has all changed. Now they manually review every channel before it’s allowed in the Partner Program, so their moderators look through the videos and see what kind of content someone is producing, and if they don’t like it, none of the videos on the channel will ever be monetized no matter how popular they are.

Some wonder if YouTube is harming themselves financially with all these new restrictions and the mass demonetization crusade they’ve engaged in, but the fact is there are plenty of other “brand friendly” or proliberal agenda channels that they can get revenue from. After all, being a YouTuber is the number one dream job for most kids today. It’s not being an astronaut, football player, or a movie star; it’s literally being a YouTuber. 866

They’ve also been moving away from the monetized view business model entirely. In 2017 they began offering television packages similar to a cable provider but through an Internet connection, calling it YouTubeTV. It started off in just five U.S. markets, but then in January 2019 they massively expanded to 195 markets, making their service available to 98 percent of U.S. households. 867 They have also been slowly morphing into another Netflix by producing original content like the popular Cobra Kai series which is a spinoff from the 1980s Karate Kid movies and stars Daniel LaRusso (Ralph Macchio) and Johnny Lawrence (William Zabka). They rent a large library of popular movies and TV shows on-demand too, for just a few dollars per stream. As one online media outlet put it, “The golden age of YouTube is over,” and it will never be the same. 868 “The platform was built on the backs of independent creators, but now YouTube is abandoning them for more traditional content.” 869 Countless videos once regularly discovered by curious minds are now lost in limbo. Voices opposing certain aspects of the liberal agenda have been systematically silenced. And Leftist propaganda has been artificially amplified to give the impression that their view is the correct one.

For those of us who have seen the changes made in recent years, as we look back on what YouTube once was, it’s like returning to the location of your favorite dive bar to find that it’s been bulldozed and replaced by a strip mall filled with a bunch of trendy stores you would never step foot in. Author’s Note: Once you finish this book, please take a moment to rate and review it on Amazon.com, or wherever you purchased it from if you’re reading the e-book, to let others know what you think. This also helps to offset the trolls who keep giving my books fake one-star reviews when they haven’t even read them. Almost all of the one-star reviews on Amazon for my last two books “The True Story of Fake News” and “Liberalism: Find a Cure” are from NON-verified purchases which is a clear indication they are fraudulent hence me adding this note. It’s just more proof that liberals are losers and can’t play fair, so if you could help me combat them once you’re finished with this book since you actually bought and read it, I would appreciate it very much! Thank you!

The Future of Fake News Once “fake news” consisted primarily of made-up stories posted on cheap websites nobody had ever heard of, or websites with similar URLs to brand name outlets publishing completely fake articles hoping they’ll go viral through social media and generate a bunch of ad revenue from all the clicks. I’m sure you’re familiar with people making fake screenshots on Photoshop and posting them on social media claiming they came from news articles, text messages, DMs, or someone’s “deleted” tweet, but we’re far

beyond those primitive forms of fake news and are approaching something that was once only found in science fiction films. In Arnold Schwarzenegger’s 1987 film The Running Man , he was an innocent police helicopter pilot who was framed for the massacre of civilians looting a grocery store after an economic collapse, and with the help of some doctored video that aired on national television, the general public thought that he had been caught red handed murdering the people, when in fact he had refused orders to open fire on them. His face was also digitally placed onto the body of someone else at another point in the film to further sell the lie to the public. While deceptively edited video has been a problem and can cast people in a false light and twist their statements or place them out of context, the video tricks we’re now facing are far more sophisticated. They can make almost anyone appear to do or say almost anything—just like what happened to Arnold Schwarzenegger in The Running Man. These fake videos are called “deepfakes” named after the deep learning of artificial intelligence algorithms that are used to create them. This same technology had been used dating back to the 1990s in order to make it appear that Forrest Gump shook hands with President John F. Kennedy, and made John Wayne look like he was handing off a six pack of Coors Light to someone in a commercial even though he had been dead for over ten years. 870

More recently it was used to digitally impose Paul Walker’s face onto another actor’s body to finish Fast and the Furious part 7 after he died in a car accident before the film was done being shot. 871 But unfortunately this technology isn’t just being used for entertainment anymore, and people are starting to realize that in the wrong hands it can pose a tremendous danger.

In April 2018 comedian Jordan Peele released a video showing Barack Obama appearing to warn that, “We’re entering an era in which our enemies can make it look like anyone is saying anything at any point at time — even if they would never say those things.” Obama went on to say, “So, for instance, they could have me say things like…President Trump is a total and complete dip shit.” 872 The video then cut to a split screen showing Obama on one side and Jordan Peele on the other, revealing that he was doing the voice for Obama since he does a pretty good impression, and he was also using real-time face mimicking software in order to match his lips and facial expressions onto a digitally recreated version of Obama. It was a clever PSA to bring this kind of technology to people’s attention, since at the time most people hadn’t heard of deepfakes. Two years earlier, in 2016, researchers at Stanford University posted a video demonstrating their “Face2Face Real-time Face Capture” technology, showing how by using their software and an ordinary webcam they could map a person’s facial expressions onto George W. Bush, Barack Obama, and Donald Trump. 873 This may have been the same software Jordan Peele used for his video. The following year a different group of researchers from the University of Washington created another fake Obama video showing him saying things that he has actually said in the past, but the video was completely synthetic and showed him in a different setting while making the statements. They released a paper explaining how they were able to do it. 874 Deepfakes like this could easily change someone’s reaction to seeing or hearing something, giving a false impression as to how they feel about a certain event or issue; but this is just the tip of the iceberg.

Technology to manipulate video in such ways was once extremely expensive and required teams of people to produce, but today deepfakes can be made by amateurs on their home computers. SnapChat filters and Facebook messenger filters can now overlay different cartoon faces and other effects on someone’s face in real time. In January of 2018 someone took a video of actress Amy Adams singing “I Will Survive” and swapped her face for that of Nicholas Cage’s. 875 Then in January 2019 someone made one by taking a segment of Jennifer Lawrence speaking with reporters backstage after the Golden Globe awards and put Steve Buscemi’s face in place of hers. The video was so bizarre and realistic looking that it became the most viral deepfake video since Jordan Peele’s Obama video, and introduced the term “deepfake” to a much wider audience. 876 A few days later Stephen Colbert had Steve Buscemi on as a guest and asked him if he’d seen the video. He joked that he had “never looked better,” but underneath the laughs appeared to be a concern about what this technology was now capable of. 877 In June 2019 a deepfake of Mark Zuckerberg was posted online showing him giving what looks to be an interview with CBS News, where he says, “Imagine this for a second: One man, with total control of billions of people’s stolen data, all their secrets, their lives, their futures. I owe it all to Spectre. Spectre showed me that whoever controls the data, controls the future.” 878 It was a publicity stunt for a futuristic art and technology exhibit in the UK, but also was meant to serve as a warning for what problems technology may cause in the near future. CBS tried to get the video removed from Facebook because the deepfake was made from an interview Zuckerberg gave to CBS News and “violated their trademark.” 879 Facebook wrestled with whether or not to remove the deepfake videos, but

chose not to take any action, but their existence sparked a difficult conversation, which is what the makers intended. The “Spectre” exhibit also commissioned the creation of a deepfake of Kim Kardashian which looked and sounded extremely realistic, unlike the Zuckerberg one which was an obvious fake. This one looked and sounded just like Kim Kardashian bragging about the power social media companies have over their users’ data, and concluded, “I feel really blessed because I genuinely love the process of manipulating people online for money.” 880 Needless to say, she was not happy about it, and tried to have the video removed by filing copyright complaints against social media accounts that posted it. 881 But these kind of satire videos are the least of celebrities’ concerns.

Deepfake Porn Just like many early Internet entrepreneurs were quick to use the emerging new technology to share porn— allowing people to access it from their home computer instead of having to go out and buy magazines or VHS tapes from some seedy adult video store—one of the early uses of deepfake technology was to make fake porn videos depicting famous celebrities like Gal Gadot (Wonder Woman ), Daisy Ridley (Star Wars ), and Scarlett Johansson (The Horse Whisperer ). Celebrity deepfake porn videos were soon banned by PornHub 882 and Reddit where users were posting clips they had made of their favorite actresses. 883 While most of the videos weren’t being passed off as actual sex tapes, their creation obviously caused concern for those actresses whose likeness is now appearing in realistic-looking porn videos. 884 Another concern is that since the software to create such fakes is widely available online, people could make fake sex tapes of someone in

attempts to extort money from them, threatening to post the fakes online if they don’t pay up. Or scorned ex-lovers or those rejected by women could create deepfakes and post them online in order to “get back” at them. 885

Information Warfare When the Bush administration was planning for the invasion of Iraq in 2003, the CIA reportedly came up with the idea to create a fake video appearing to be Saddam Hussein having sex with a teenage boy. “It would look like it was taken by a hidden camera. Very grainy, like it was a secret videotaping of a sex session,” a CIA official later admitted to the Washington Post . 886 The CIA also reportedly discussed making a fake video appearing as if Osama bin Laden and his lieutenants were sitting around a campfire drinking alcohol and talking about their “conquests with boys” as well, but another former CIA official with knowledge of the plan said, “Saddam playing with boys would have no resonance in the Middle East — nobody cares. Trying to mount such a campaign would show a total misunderstanding of the target. We always mistake our own taboos as universal when, in fact, they are just our taboos.” 887 He was referring to the practice of “bacha bazi” which is an Afghani term meaning “boy play” that refers to sexual relationships between older men and young boys who are from very poor families or orphans and used as sex slaves by wealthy and powerful Afghanis. 888 U.S. soldiers were reportedly told to ignore such abuse because it is part of the culture in regions of the Middle East. 889 This abomination is a whole other issue, but the point is the CIA actually proposed making a deepfake of Saddam Hussein as a pedophile thinking it would incite people to rise up and

overthrow him, because if such a video were real, people in a civilized culture would do just that.

Fake Photos Nvidia, a video graphics card company, has created an AI so powerful that it can automatically change the weather in video footage, making a clip of a car driving down a road on a sunny day appear as if it was actually shot in the middle of winter with a few inches of snow on the ground and the leaves missing from the trees. 890 The same technology can take photos of cats or dogs and change them to make them look like a different breed, and can change people’s facial expressions from happy to sad, or anything in between. 891 Nvidia’s AI can even generate realistic pictures of people who don’t actually exist by taking features from actual photos and combining elements of them together into a composite that is almost impossible to tell that it’s fake. 892 The website ThisPersonDoesNotExist.com uses this technology to display a different fake photo every time you visit it, most of them looking like HD photos of ordinary people. AI can now create 3D models of people just from a few photographs, and while it may be fun to input a character in your favorite video game that looks just like you, the capacity for nefarious abuses of this technology are vast.

Fake Audio In November 2016, Adobe (the creator of Photoshop) demonstrated what they called Adobe Voco, or Photoshop-for-voices, which can generate realistic sounding audio, making it sound like someone is saying something

that they never actually said. The software works by inputing samples of someone’s voice, and then can create fake audio files in that same voice saying whatever is typed onto the screen. 893 Dr. Eddy Borges Rey, a professor at the University of Stirling, said, “It seems that Adobe’s programmers were swept along with the excitement of creating something as innovative as a voice manipulator, and ignored the ethical dilemmas brought up by its potential misuse.” 894 He continues, “Inadvertently, in its quest to create software to manipulate digital media, Adobe has [already] drastically changed the way we engage with evidential material such as photographs. This makes it hard for lawyers, journalists, and other professionals who use digital media as evidence.” 895 Google has created similar software called WaveNet that generates realistic sounding human speech by modeling samples of people actually talking. 896 In May 2019 a group of Machine Learning Engineers released an audio clip they created using their RealTalk technology which sounded like podcaster Joe Rogan talking about investing in a new hockey team made up of chimpanzees. 897 It wasn’t perfect, but if you didn’t know that it was fake before you heard it, you may be fooled into thinking that it’s real. The researchers admitted, “the societal implications for technologies like speech synthesis are massive. And the implications will affect everyone.” 898 “Right now, technical expertise, ingenuity, computing power and data are required to make models like RealTalk perform well. So not just anyone can go out and do it. But in the next few years (or even sooner), we’ll see the technology advance to the point where only a few seconds of audio are needed to create a life-like replica of anyone’s voice on the planet. It’s pretty f*cking scary,” the creators wrote on their blog. 899

They went on to list some of the possible abuses this technology may be used for, “if the technology got into the wrong hands.” These include, “Spam callers impersonating your mother or spouse to obtain personal information. Impersonating someone for the purposes of bullying or harassment. Gaining entrance to high security clearance areas by impersonating a government official,” and “An ‘audio deepfake’ of a politician being used to manipulate election results or cause a social uprising.” 900 They raise some great points. What’s to stop people from creating deepfakes of politicians, CEOs of major corporations, or popular YouTubers, and making them appear as if they’re saying racist, hateful, or violent things, and claiming they got it from a coworker or a “friend” who secretly recorded it, or that the clip was from an old YouTube video once uploaded to someone’s channel that they later deleted?

National Security Concerns In July 2017 researchers at Harvard, who were backed by the U.S. Intelligence Advanced Research Projects Activity (IARPA), published a report titled Artificial Intelligence and National Security where they detailed the growing risk of deepfake forgeries, saying, “The existence of widespread AI forgery capabilities will erode social trust, as previously reliable evidence becomes highly uncertain,” and details some of the horrific possibilities that are right around the corner. 901 The report then quotes part of an article one of the researchers wrote for Wired magazine about these dangers, saying, “Today, when people see a video of a politician taking a bribe, a soldier perpetrating a war crime, or a celebrity starring in a sex tape, viewers can safely assume that the depicted events have actually occurred, provided, of course, that the video is of a

certain quality and not obviously edited. But that world of truth—where seeing is believing—is about to be upended by artificial intelligence technologies.” 902 The article continues, “When tools for producing fake video perform at higher quality than today’s CGI and are simultaneously available to untrained amateurs, these forgeries might comprise a large part of the information ecosystem.” 903 The Artificial Intelligence and National Security report goes on to warn that, “A future where fakes are cheap, widely available, and indistinguishable from reality would reshape the relationship of individuals to truth and evidence. This will have profound implications for domains across journalism, government communications, testimony in criminal justice, and of course national security…In the future, people will be constantly confronted with realistic-looking fakes.” 904 It concludes that, “We will struggle to know what to trust. Using cryptography and secure communication channels, it may still be possible to, in some circumstances, prove the authenticity of evidence. But, the ‘seeing is believing’ aspect of evidence that dominates today—one where the human eye or ear is almost always good enough—will be compromised.” 905 Elon Musk is funding a non-profit organization called OpenAI which is trying to ensure that the creation of artificial intelligence will be “safe,” but they created an AI tool so powerful they won’t release it to the public out of concern that it could create such realistic forgeries and fake news articles that they would be difficult to distinguish from real ones. “Due to our concerns about malicious applications of the technology, we are not releasing the trained model,” the organization wrote on their blog. 906

Others are equally concerned. Sean Gourley, who is the founder and CEO of a company called Primer, which data mines social media posts for U.S. intelligence agencies to track issues of concern and possible threats, warns, “The automation of the generation of fake news is going to make it very effective.” 907 Nothing may be safe from the weaponization of artificial intelligence. A group of researchers at the University of Chicago developed an AI system in 2017 that could write fake Yelp reviews and even though sites like Yelp and Amazon have machine learning algorithms designed to detect fake reviews written by trolls or bots, when they unleashed their Yelp review writer on the site their safeguards had a hard time detecting the fake reviews. 908 Ben Zhoa, one of researchers who worked on the project, said, “We have validated the danger of someone using AI to create fake accounts that are good enough to fool current countermeasures,” and warned, “more powerful hardware and larger data for training means that future AI models will be able to capture all these properties and be truly indistinguishable from human-authored content.” 909 This makes the forged documents purported to be George W. Bush’s service record in the National Guard or the infamous “Steele Trump-Russia Dossier” created by Fusion GPS seem like child’s play. The New York Observer reported that there are already multiple fake “Trump sex tapes” circulating among those working in intelligence agencies and suggested that they were created in order to “muddy the waters” in the event that a “real” Trump sex tape surfaces, which some believe was made by the Kremlin when Trump visited Russia in 2013 for the Miss Universe Pageant, for what the KGB calls “kompromat” or compromising material. 910

Trump has insisted that even before his trip to Russia he was well aware of hidden cameras in hotel rooms there and the government’s attempt to gain blackmail material on high profile individuals like himself, and made sure not to get ensnared in their trap. 911 His bodyguard testified that prior to the trip he and Trump had discussed that the Russians used such tactics and knew not to take the bait. 912 So it’s highly unlikely that a real Trump sex tape exists, but it is likely that Deep State operatives within our own CIA may have manufactured such fakes for the same reason they floated the idea of doing such a thing to Saddam Hussein and Osama bin Laden — to discredit Trump and use it as propaganda to fan the flames of an insurgency hoping to bring him down. As Winston Churchill said, “A lie gets halfway around the world before the truth has a chance to get its pants on.” 913 Nobody is safe from being smeared by deepfakes, whether they’re an ordinary person who has been targeted by a jealous ex-lover, a disgruntled coworker or classmate, or whether they are the President of the United States whose political opponents or a foreign adversary want to bring down. The other side of the coin is that if and when actual damning footage is shot of someone doing or saying something illegal or morally reprehensible, they could easily just claim the footage is fake. Perhaps half of the people would believe them, having reasonable doubt since the technology exists to actually fake it and people may have a motive to do it. We’re clearly not in Kansas anymore and only time will tell just how pervasive and damaging deepfakes will become.

Conclusion

We’re in the middle of a war — an information war. It’s being waged by tyrannical billion dollar tech companies against those of us who use their products and services in ways they hadn’t intended or imagined. They sold us tools thinking they were toys, but we saw the potential this new technology had to enable us to defend the Republic and spread our message across the country with a few clicks of a keyboard or taps on a touchscreen. In the marketplace of ideas, we were winning; so our opponents started cheating, and despite the metaphors this is not a game, this is our life. They don’t want to just silence us online, they want to repeal the First Amendment and arrest us for “hate speech” for disagreeing with them as they aim to overthrow the United States government and replace it with a Communist technocratic super-state that’s a crossbreed between the regimes in George Orwell’s Nineteen Eighty-Four and Aldous Huxley’s Brave New World . Syndicated columnist Joseph Sobran Jr. once stated, “Liberalism is really piecemeal socialism, and socialism always attacks three basic social institutions: religion, the family, and private property. Religion, because it offers a rival authority to the state; the family, because it means a rival loyalty to the state; and property, because it means material independence of the state.” 914 They want to turn Boy Scouts into child drag queens, and are encouraging people to buy sex bots instead of engagement rings. They want people to denounce God and view Christians as the enemy, while the hordes of lazy and entitled degenerates live off the labor of those who get up and go to work every morning. Most people are too distracted to see what’s actually happening and are slowly becoming part of the problem. They know more about the history of their favorite football team than they do of their own country. They’re more familiar with the names and

statistics of the players than they are of the people who are in charge of running the government. Sports entertainment and the latest talent shows on TV are mostly modern day bread and circus events that distract attention and divert energy from things that really matter. Our culture, our economy, and our country is at stake. If America falls, it will never be restored. It will be relegated to the history books like the Roman Empire and other great civilizations that have collapsed. To prevent our planned destruction it’s going to take hard work, vigorous study, and unwavering dedication. You don’t get physically fit by going to the gym once a year. Or once a month, or even once a week! You have to go on a regular basis, and keep going! Isn’t the health of our society just as important as our own physical health? Pay close attention to what you do with your time, your talent, and your money. Get involved in your local community. Get on the school board, or city council, or at least show up once in a while to give them a piece of your mind. Maintain regular face-to-face interactions with your friends and family so you don’t get trapped in the downward spiral of living your life through a screen. Do a regular digital detox on the weekends and holidays, and give yourself time for introspection by stepping away from the endless news cycle and social media feeds to get a bigger perspective of what’s going on and what’s important. Maybe we have been asleep at the wheel. Maybe we took the freedoms and prosperity of living in America for granted while the enemy quietly schemed behind our backs. Well not any more! It’s time to wake up. It’s time to get focused on the long-term goals of what we need to do in order to preserve the freedom of speech, family values, Christian traditions, and our economic security. I hope this book has helped you become more media literate so you can see how the mechanisms

of information distribution function in our modern age and what their effects are. If you found this book valuable in your journey please rate it and write a brief review on Amazon or whatever ebook store you downloaded it from, if that’s where you bought it, and tell your friends and family to checkout this book since I don’t have a major publisher backing me (I self-published this) or their marketing team to promote it. I only have my social media accounts, and you. But that’s all I need. And that’s is exactly why they are so scared of us! Also by Mark Dice: -The True Story of Fake News -Liberalism: Find a Cure -The Illuminati in Hollywood -Inside the Illuminati -The Illuminati: Facts & Fiction -The New World Order: Facts & Fiction -The Resistance Manifesto -Big Brother: The Orwellian Nightmare -The Bilderberg Group: Facts & Fiction -Bohemian Grove: Facts & Fiction Connect with Mark on: Facebook.com/MarkDice Twitter.com/MarkDice Instagram.com/MarkDice YouTube.com/MarkDice MarkDice.com

Copyright Info

The Liberal Media Industrial Complex © 2019 by Mark Dice All Rights Reserved Published by The Resistance Manifesto San Diego, CA No part of the text within this book may be reproduced or transmitted in any form and by any means, graphic, electronic, or mechanical, including photocopying, recording, taping, or by any information storage retrieval system, without the written permission of the author. Visit www.MarkDice.com Cover Design by Jason Bermas E-book ISBN: 978-1-943591-08-4 Cover images licensed from iStockPhoto Logos for Google, Twitter, YouTube, Facebook, CNN, NBC, and the Washington Post are registered trademarks of their respective companies and are used in accordance with fair use statutes and case law. 1 Washington Post “‘Hands up, don’t shoot’ was built on a lie” by Jonathan Capehart (March 16th 2015)

2 NBC News “Obama Promotes #ItsOnUs Campaign At 2015 Grammy Awards (February 8th 2015)

3 Righteous Indignation: Excuse Me While I Save the World! by Andrew Breitbart page 97

4 Righteous Indignation: Excuse Me While I Save the World! by Andrew Breitbart page 132

5 Washington

Post “Conspiracy theories about Soros aren’t just false. They’re anti-Semitic” by Talia Lavin (October 24th 2018)

6 CNBC “Read all about it: The biggest fake news stories of 2016” by Hannah Ritchie (December 30th 2016)

7 The Washington Post “Real research suggests we should stop freaking out over fake news” by Christopher Ingraham (January 24th 2017)

8 Wired “YouTube Debuts Plan to Promote and Fund ‘Authoritative’ News” by Issie Lapowsky (July 9th 2018)

9 David Axelrod interview in CNN’s The 2000s

10 TechCrunch “Pew: Social media for the first time tops newspapers as a news source for US adults” (December 11th 2018)

11 http://www.pewinternet.org/2014/08/26/social-media-and-the-spiral-ofsilence/

12 Huffington Post “Think Canada Allows Freedom of Speech? Think Again” by Tom Kott (December 19, 2012)

13 BBC “Facebook, Google and Twitter agree German hate speech deal” (December 15th 2015)

14 Associated Press “In UK, Twitter, Facebook rants land some in jail” by Jill Lawless (November 12, 2012)



15 Breitbart

“UK Police Arrest Man For ‘Offensive’ Facebook Post About Migrants” by Liam Deacon (February 16th 2016)

16 Daily Caller “Mother Arrested, Spends Seven Hours In Jail For Calling Transgender A Man” by David Krayden (February 10th 2019)

17 Wired “Tyranny in the Infrastructure” by Larry Lessig (June 7th 1997 edition page 96)

18 Cyber Ethics: Morality and Law in Cyberspace Second Edition by Richard A. Spinello page 5

19 New York Times “How conservatives have weaponized the first Amendment” by Adam Liptak (June 30th 2018)

20 Washington Free Beacon “Lieu: ‘I Would Love to Be Able to Regulate the Content of Speech’ but First Amendment Stops Me” by David Rutz (December 12th 2018)

21 Reuters “U.S. Congress spars over social media filtering; companies skip hearing” by David Shepardson (April 26th 2018)

22 Jamie Raskin’s opening statement at House Judiciary Committee hearing on Social Media Filtering the (July 17th 2018)

23 CNN “Trump props up false claim that big tech is out to silence conservatives” by Oliver Darcy (August 24th 2018)



24 Ibid.

25 Recode

“Twitter is so liberal that its conservative employees ‘don’t feel safe to express their opinions,’ says CEO Jack Dorsey” (September 14th 2018)

26 The Hill “Conservatives face a tough fight as Big Tech's censorship expands” by Donald Trump Jr. (March 17th 2019)

27 The Hill “White House launches tool for reporting social media ‘bias’" by Emily Birnbaum (May 15th 2019)

28 https://whitehouse.typeform.com/to/Jti9QH

29 The Independent “Spotify removes white supremacist bands from streaming service” by Roisin O’Connor (August 17th 2017)

30 Reason.com “Spotify Partners with the Southern Poverty Law Center to Purge ‘Hate Content’ from Its Music” by Christian Britschgi (May 14th 2018)

31 Breitbart “Spotify Announces Partnership with Far-Left Groups Including SPLC to Police Platform” by Charlie Nash (May 22nd 2018)

32 Rolling Stone “Watch Snoop Dogg Aim Gun at Clown-Trump in ‘Lavender’ Video” by Ryan Reed (March 13th 2017)

33 Time

“How Many of Jay-Z’s Songs Contain the Word ‘Bitch’?” by Claire Suddath (January 18th 2012)

34 Rolling Stone “Spotify Admits Its R. Kelly Ban Was ‘Rolled Out Wrong’” by Amy X. Wong (May 31st 2018)

35 The Guardian “Guns N' Roses remove song with homophobic and racist language from reissued album” by Ben Beaumont-Thomas (May 8th 2018)

36 Breitbart “Netflix Declines Streaming Hit Documentary ‘The Red Pill’” by Lucas Nolan (May 8th 2017)

37 Evening Standard “Feminist filmmaker Cassie Jaye: women’s rights have gone too far are now silencing men” by Chloe Chaplain (December 1st 2016)

38 Ibid.

39 The Sydney Morning Herald “Melbourne’s Palace Cinemas cancel screenings of MRA documentary ‘The Red Pill’ after petition” by Jenny Noyes (October 25th 2016)

40 CNN “Anti-vaccination conspiracy theories thrive on Amazon” by Jon Sarlin (February 27th 2019)

41 Variety “Amazon Pulls Anti-Vaccination Documentaries From Prime Video After Congressman’s Inquiry to Jeff Bezos” by Todd Spangler (March 1st 2019)



42 Sky

News “De Niro offers $100k reward to media for ‘truth’ about controversial children's vaccine” by Duarte Garrido (February 17th 2017)

43 Rolling Stone “Deadly Immunity” by Robert F. Kennedy Jr. (July 14th 2005)

44 CNN “Anti-vaccine movies disappear from Amazon after CNN Business report” by Jon Sarlin (March 1st 2019)

45 The New Yorker “The Operator: Is the most trusted doctor in America doing more harm than good?” by Michael Specter (January 27th 2013)

46 NBC News “Netflix pulls episode of ‘Patriot Act with Hasan Minhaj’ after Saudi complaint” by Saphora Smith (January 2nd 2019)

47 Vanity Fair “The Dukes of Hazzard Pulled Off TV Following Confederate-Flag Controversy” by Julie Miller (July 1st 2015)

48 The New York Times “The Obamas and Netflix Just Revealed the Shows and Films They’re Working On” by John Koblin (April 30th 2019)

49 Rolling Stone “Barack, Michelle Obama Unveil Initial Slate of Netflix Projects” by Althea Legaspi (April 30th 2019)

50 Politico “The Obamas’ First Big Anti-Trump Statement of 2020” by Ted Johnson (August 20th 2019)

51 Fox

News “Obamas’ debut Netflix documentary slammed as ‘lefty propaganda,’ an attack on Trump” by Brian Flood (August 20th 2019)

52 The Hollywood Reporter “Hulu Cancels ‘I Love You, America With Sarah Silverman’” by Lacey Rose (January 9th 2019)

53 Bloomberg “Netflix Threatens to Leave Georgia If Abortion Law Stands” by Nick Turner (May 28th 2019)

54 TheAtlantic “Amazon Has Basically No Competition Among Online Booksellers” by Polly Mosendez (May 30th 2014)

55 ShefflornBallantyne.com (the author’s website) So far no major media outlets have reported on Amazon banning the book.

56 Family Rhetoric by Amer Leventry on Facebook (July 10th, 2018)

57 RooshV.com “Amazon Has Banned 9 Of My Books Without Explanation (UPDATE)” by Roosh (September 10th 2018)

58 Ibid.

59 PJ Media “Juanita Broaddrick’s Book about Alleged Clinton Rape Disappears from Amazon” by Jeff Reynolds (June 12th 2018)

60 FreeBeacon “Amazon Bans Gun Book” by Stephen Gutowski (August 23rd 2018)

61 The

Guardian “I wrote the Anarchist Cookbook in 1969. Now I see its premise as flawed” by William Powell (December 19th 2013)

62 As of November 2019 when this book was first published.

63 NBC News “After latest shooting, murder manual author calls for book to be taken ‘immediately’ out of print” by Tony Dokoupil (December 17th 2013)

64 Wired “THE ANARCHIST COOKBOOKTURNS 40” by Matthew Honan (January 31st 2011)

65 Newsweek “Sorry About All The Bombs” by Tony Dokoupil (February 20th 2011)

66 American Renaissance Press Release “Amazon Now Banning Books Based on Political Content” (February 27th 2019)

67 The Sun “Amazon stops selling Tommy Robinson’s book on Islam the day after he was booted off Facebook and Instagram – but he can still broadcast on YouTube” by Annabel Murphy (February 27th 2019)

68 Independent “Amazon bans book co-written by Tommy Robinson from their website” (March 7th 2019)

69 The Script “Amazon Removes David Duke's Books After Inquiry By The Script [UPDATED with Amazon response]” (March 18th 2019)

70 https://twitter.com/JerylBier/status/1107675822377316352

71 Nation

of Islam Research Group “Amazon Bans the Secret Relationship Between Blacks & Jews” (March 16th 2019)

72 TexeMarrs.com “Amazon Bans Texe Marr’s Book for ‘Content.’”

73 As of November 2019 when this book was first published.

74 CNN “Anti-vaccine movies disappear from Amazon after CNN Business report” by Jon Sarlin (March 1st 2019)

75 NBC News “Amazon removes books promoting autism cures and vaccine misinformation” by Brandy Zadrozny (March 12th 2019)

76 NBC News “Amazon removes controversial books by ‘father of conversion therapy’’’ by Gwen Aviles (July 3rd 2019)

77 Basic Freud: Psychoanalytic Thought for the 21st Century by Michael Kahn, Ph.D pages 78-79

78 USA Today “Amazon, eBay join other retailers to pull Confederate flag” by Gregg Zoroya and Hadley Malcolm (June 23rd 2015)

79 Fortune “Walmart and Amazon Pull ‘Tranny Granny’ Halloween Costume From Their Sites” by Michelle Toh (October 7th 2016)

80 CNN:

Complaints prompt Amazon to remove products that are offensive to Muslims” by Alaa Essar (January 8th 2019)

81 Newsbusters “Amazon Removes ‘Islamophobic’ Products But Sells ‘F**k Me Jesus’” by Corinne Weaver (January 8th 2019)

82 https://www.amazon.com/Fuck-White-PeopleExplicit/dp/B07HXDG3JL/ref=sr_1_2?ie=UTF8&qid=1543984803&sr=82&keywords=fuck+white+people

83 Newsweek “Streamer HelenaLive Speaks Out After Being Banned From Twitch For Saying ‘There Are Only Two Genders’” by Steven Asarch (February 12th 2019)

84 News.com.au “Gamer reportedly banned from Twitch for claiming there are only two genders” by Nick Whigham (February 7th 2019)

85 Business Insider “deadmau5 accuses Twitch of censorship after being suspended for using homophobic language during a live stream” by Kevin Webb (February 13th 2019)

86 Newsweek “DeadMau5 Apologizes For Homophobic Slur After Twitch Ban” by Steven Asarch (February 14th 2019)

87 The Verge “League of Legends streamer banned from Twitch for slur says he was misheard” by Julia Lee (April 24th 2019)

88 Dexerto.com

“Twitch streamer banned for 30 days for using word he didn't know was offensive” by David Purcell (March 19th 2019)

89 Newsbusters “Still on YouTube: Lefty Who Calls for Violence, Purge of Conservatives” by Alexander Hall (May 31st 2019)

90 Bloomberg “PayPal Is Latest Tech Company to Ban Alex Jones and InfoWars” by Julie Verhag (September 21st 2018)

91 https://twitter.com/ChrisMurphyCT/status/1026580187784404994

92 https://twitter.com/tedcruz/status/1023207746454384642

93 The Hill “Bill Maher criticizes social media bans: ‘Alex Jones gets to speak’” by Jacqueline Thomsen (August 18th 2018)

94 The Hill “ACLU: Alex Jones ban could set dangerous social media precedent” by Megan Keller (August 21st 2018)

95 Reuters “Exclusive: Trump says it is ‘dangerous’ for Twitter, Facebook to ban accounts” by Steve Holland and Jeff Mason (August 20th 2018)

96 http://archive.fo/xb693

97 Washington Times “Apple CEO Tim Cook: Hateful views have ‘no place on our platforms’” by Jessica Chasmar (December 4th 2018)

98 Ibid.



99 https://twitter.com/benshapiro/status/890824543522226178

100 George

Orwell in Nineteen Eighty-Four

101 BigLeaguePolitics

“Chase Bank Shuts Down Proud Boys Leader’s Personal Bank Account” by Waldo Crane (February 8th 2019)

102 Breitbart “Financial blacklisting: Chase bank withdraws service from independent and conservative figures” by Allum Bokhari (February 27th 2019)

103 One America News “Chase Bank suspends account of pro-Trump Iraq vet” (February 20th 2019)

104 Breitbart “PayPal Blacklists Free Speech YouTube Alternative ‘BitChute’” by Charlie Nash (November 14th 2018)

105 Breitbart “Google Lawsuit: Senior Engineer Alon Altman Wanted to Sabotage Trump’s Android Phone, Ban His Gmail Account” by Allum Bokhari (April 19th 2018)

106 Major Internet Service Providers in Australia and New Zealand completely blocked the video sharing site BitChute in March 2019 for supposedly not promptly removing re-uploads of the Christchurch mosque shooting which was originally livestreamed on Facebook.

107 Green v. AOL and Blumenthal v. Drudge and Zeran v. AOL



108 Delfino

v. Agilent Technologies Inc.

109 CDA

Section 230(c)(2)(A) Protection for Screening.

110 New

York Times “White House Unblocks Twitter Users Who Sued Trump, but Appeals Ruling” by Charlie Savage (June 5th 2018)

111 BrainyQuote.com “George Washington Quotes”

112 Newsweek “Israel Flagged as Top Spy Threat to U.S. in New Snowden/NSA Document” by Jeff Stein (August 4th 2014)

113 BBC “Christian persecution ‘at near genocide levels’” (May 3rd 2019)

114 Reuters “Backstory: How Reuters uncovered Beto O'Rourke's teenage hacking days” by Jame Lee (March 15th 2019)

115 New York Times “Citing Ben Affleck’s ‘Improper Influence,’ PBS Suspends ‘Finding Your Roots’” by John Koblin (June 24th 2015)

116 CBS 5 KPIX “WikiLeaked Sony Emails Reveal Ben Affleck Told Producers Not To Reveal His Slave-Owning Ancestor On PBS ‘Roots’ Show” (April 19th 2015)

117 http://archive.is/phtxU

118 ProjectCensored.org

“What Some People Been Saying About Project Censored Over The Past Decades”

119 Ibid.

120 Ibid.

121 The Washington Post “At the Times, a Scoop Deferred” by Paul Farhi (December 17th 2005)

122 The Daily Signal “The New York Times Leaves Ted Cruz’s Book Off Bestseller List” by Kate Scanlon (July 13th 2015)

123 BuzzFeed “HarperCollins Refutes New York Times Claim That Ted Cruz Tried To Game Bestseller List” by McKay Coppins (July 10th 2015)

124 https://twitter.com/TeamTedCruz/status/619585464144519168

125 Mediaite “New York Times Finally Adds Ted Cruz Book to Bestsellers List” by Alex Griswold (July 16th 2015)

126 Fox News “The O’Reilly Factor” (June 8th 2016)

127 Washington Times “Kermit Gosnell’s abortion trial draws little media coverage, much outrage on Twitter” by Douglas Ernst (April 12th 2013)

128 Washington Examiner “NYT snubs top-selling book on abortionist Gosnell” by Paul Bedard (February 2nd 2017)



129 Washington

Examiner “NYT bestseller list ignores ‘Jesus’ for porn star Stormy Daniels” by Paul Bedard (October 12th 2018)

130 Huffington

Post “Critics Threaten Boycotts Of Simon & Schuster Over Milo Yiannopoulos Book Deal” by Claire Fallon (December 30th 2016)

131 https://twitter.com/JuddApatow/status/814658578174935040

132 https://twitter.com/GovHowardDean/status/814969506615455749

133 CNBC “Report: More than half of immigrants on welfare” by Alan Gomez (September 2015)

134 Center for Immigration Studies “63% of Non-Citizen Households Access Welfare Programs” by Steven A. Camarota and Karen Zeigler (December 2nd 2018)

135 Breitbart “Six Diseases Return To US as Migration Advocates Celebrate ‘World Refugee Day’” by Michael Patrick Leahy (June 19th 2016)

136 Breitbart “Fact Check: Yes, Thousands of Americans Have Been Killed by Illegal Aliens” by John Binder (January 8th 2019)

137 Washington Times “Illegals commit crimes at double the rate of nativeborn: Study” by Stephen Dinan (January 26th 2018)

138 Washington

Times “CNN, MSNBC cut away from Trump event with ‘Angel Families’ by S.A. Miller and Stephen Dinan (June 22nd 2018)

139 The Wall Street Journal “Record Immigration Surge at the Border” by Alicia A. Caldwell and Louise Radnofsky (March 5th 2019)

140 Ibid.

141 Town Hall “Ha: Illegal Immigrants Jump Border Fence During MSNBC Report on Trump's Wall” by Leh Barkoukis (October 24th 2017)

142 Politifact “In Context: Donald Trump's comments about immigrants, ‘animals’” by Miriam Valverde (May 17th 2018)

143 Newsweek “MS-13: How an FBI Informant Risked Death to Bring America’s Most Brutal Gang to Justice” by Michele McPhee (June 14th 2018)

144 Fox News “What is MS-13, the violent gang Trump vowed to target?” by Kaitlyn Schallhorn (May 23rd 2018)

145 Washington Post “Trump says Democrats used to be for new border barriers. He’s right” by JM Rieger (January 19th 2019)

146 Medical News Today “Mental health risk higher for transgender youth” by Honor Whiteman (April 16th 2018)

147 Christian

Post “Transgender Woman Convicted of Raping 10-Y-O Girl in Bathroom, Faces Up to 70 Years in Prison” by Leonardo Blair (October 20th 2017)

148 The Sun “Transgender woman, 18, sexually assaulted girl, 10, in female toilets in Morrisons” by Gemma Mullin (March 15th 2019)

149 The Telegraph “Transgender person accused of rape is remanded into female prison and sexually assaults inmates within days” by Martin Evans, Kate McCann, and Olivia Rugard (September 6th 2018)

150 Snopes “Did a Male Rapist Who Identifies as Female Transfer to a Women’s Jail and Assault Female Inmates?”

151 CBS New York “Police Arrest Transgender Woman In Bronx Pepper Spray Attack, Links To More Hate Crimes Being Investigated” (March 9th 2019)

152 BBC “Sydney axe attacks: Woman jailed for wounding 7-Eleven customers” (January 18th 2019)

153 NBC Washington “Man Dressed as Woman Arrested for Spying Into Mall Bathroom Stall, Police Say” (November 17th 2015)

154 Toronto Sun “Predator who claimed to be transgender declared dangerous offender” by Sam Pazzano (February 26th 2014)

155 Washington

Times “Victims of sex assaults in military are mostly men” by Rowan Scarborough (May 20th 2013)

156 U.S. Department of Justice “Homicide Trends in the United States, 1980-2008” by Alexia Cooper and Erica L. Smith (November 2011)

157 USA Today “Chicago police solved fewer than one in six homicides in the first half of 2018” by Aamer Madhani (September 21st 2018)

158 Chicago Tribune “Memorial Day weekend closes with 69 shot in Chicago, many of them on West Side” by Peter Nickeas, Grace Wong, Alexandra Chachkevitch and Joe Mahr (May 31st 2016)

159 Chicago Tribune “52 shot in Chicago over Memorial Day weekend, nearly half on final day” by Peter Nicheas and Elvia Malagon (May 30th 2017)

160 USA Today “36 people shot in Chicago over Memorial Day weekend, marking a reduction in gun violence” by Aamer Madhani (May 29th 2018)

161 Town Hall “Exposing The Black Lives Matter Movement For What It Is: Promotion of Cop Killing” by Katie Pavlich (September 2nd 205)

162 Politico “The Untold Story Behind New York’s Most Brutal Cop Killings” by Bryan Burrough (April 21st 2015)

163 Real Clear Politics “Last Week: NYC Protesters Chant ‘What Do We Want? Dead Cops! When Do We Want It? Now!’” by Tim Hains

(December 22nd 2014)

164 St. Louis Post-Dispatch “Two admit plot to blow up police station, St. Louis County prosecutor and Ferguson police chief” by Robert Patrick (June 2nd 2015)

165 NBC News “Dallas Police ‘Ambush’:12 Officers Shot, 5 Killed During Protest” by F. Brinley Bruton, Alexander Smith, Elizabeth Chuck and Phil Helsel (July 7th 2016)

166 KPIX CBS SF Bay Area “BART Withholding Surveillance Videos Of Crime To Avoid ‘Stereotypes’” by Melissa Caen (June 9th 2017)

167 Ibid.

168 Associated Press “State: Man in church shooting aimed to kill 10 white people” by Jonathan Mattise (May 20th 2019)

169 Newsweek “Organization Candace Owens Represents Shares, Then Deletes, Photo Promoting White Genocide Conspiracy Days After Her Testimony” by Daniel Moritz-Rabson (Aril 12th 2019)

170 Newsweek “A White Farmer is Killed Every Five Days in South Africa and Authorities Do Nothing About it, Activists Say” by Brendan Cole (March 19th 2018)

171 USA Today “NYPD arrest Muslim woman who claimed attack by Trump supporters” by Melanie Eversley (December 14th 2016)



172 Dallas

News “UT-Arlington student admits making up claim that gunman followed her to campus, threatened her” by Matt Peterson (February 13th 2015)

173 ABC News “Lesbian Couple Charged With Staging Hate Crime” by Alyssa Newcomb via Good Morning America (May 19th 2012)

174 Detroit News “Jackson gay rights leader accused of burning down own home” by Francis X. Donnely (February 25th 2019)

175 National Review “George Washington University’s Swastika Problem” by Kevin D. Williamson (April 26th 2015)

176 Daily Caller “Jewish Student Admits Swastika Hoax in Jewish Frat Dorm at George Washington U” by Eric Owens (March 19th 2015)

177 Seattle PD Crime Blotter “Burglary, Bias Crime Investigation at Africatown Center, Arrest Made” by Detective Mark Jamieson (March 26th 2016)

178 CBS Denver “Black Suspect Arrested After Racist Message Discovered Outside Predominately Black Church” (June 30th 2015)

179 The Wichita Eagle “Kansas man said he defaced his own car with racist slurs” by Kaitlyn Alanis (November 6th 2017)

180 The

Witchita Eagle “For second time in two years, racist slur at Kansas State was a hoax, police say” by Jason Tidd (November 8th 2018)

181 Variety “Jussie Smollett Indicted on 16 Counts in Attack Hoax Case” by Gene Maddaus (March 8th 2019)

182 Newsweek “S.C. Mayor Says ‘Yellow Sticky Substance’ on Her Car Was Sprayed by Vandals, Police Say It’s Just Pollen” by M.L. Nestel (March 1st 2019)

183 National Review “Frat Retreat Ends Early after Students ‘Frightened’ by a Banana Peel” by Katherine Timpf “August 31st 2017)

184 Hate Crime Hoax: How the Left is Selling a Fake Race War by Wilfred Reilly (2019)

185 Reuters “Two years in, Trump holds stock market bragging rights” by Noel Randewich (November 5th 2018)

186 NBC News “Dow notches record high, closing above 27,000 for first time” by Lucy Bayly (July 11th 2019)

187 CNBC “Black unemployment rate falls to 5.9%, ties record low hit earlier this year” by Kate Rooney (December 7th 2018)

188 Bloomberg “Black and Hispanic Unemployment in America Reach Record Lows” by Randy Woods (May 4th 2018)

189 Fox

Business “US veteran unemployment rate hits all-time low in 2018” by Brittany De Lea (January 14th 2019)

190 NPR “U.S. Unemployment Rate Drops To 3.7 Percent, Lowest In Nearly 50 Years” by Avie Schneider (October 5th 2018)

191 New York Post “Average US salaries on the rise thanks to booming economy” by John Aidan Byrne (May 18th 2019)

192 USA Today “Trump signs VA law to provide veterans more private health care choices” by Donovan Slack (June 6th 2018)

193 Washington Post “Under Trump, gains against ISIS have ‘dramatically accelerated’” by Karen DeYoung (August 4th 2017)

194 NPR “U.S.-Backed Forces Declare Defeat Of ISIS ‘Caliphate’” by Ruth Sherlock (March 23rd 2019)

195 Newsbusters “ABC Yawns as ISIS Stripped of All Territory, CBS Declares ‘ISIS Is Done’” by Nicholas Fondacaro (March 20th 2019)

196 Ibid.

197 Washington Examiner “Flashback: Trump and Oprah discuss presidential run in 1988 interview” by Melissa Quinn (January 8th 2018)

198 Newsweek: World Wide Web Inventor on 30th Anniversary: People Horrified by Trump Election Realize Web Is Not ‘Serving Humanity’” by

Jason Murdock (March 12th 2019)

199 Quoted in Media/Impact: An Introduction to Mass Media (12th Edition) by Shirley Biagi page 312

200 Washington Free Beacon “David Brock’s Shareblue to Be ‘Nucleus’ of Multi-Platform Anti-Trump Media Entity” by Joe Schoffstall (January 24th 2017)

201 PJ Media “Trump May Lose Star on Walk of Fame, But Kevin Spacey Won’t” by Tom Knighton (August 8th 2018)

202 The Wrap “Why Trump Won’t Lose His Star on the Hollywood Walk of Fame Anytime Soon” by Itay Hod (August 8th 2018)

203 Washington Times “As first 100 days in office approaches, media coverage of Trump is 89% negative: Study” by Jennifer Harper (April 19th 2017)

204 NPR “Study: News Coverage Of Trump More Negative Than For Other Presidents” by Danielle Kurtzleben (October 2nd 2017)

205 NewsBusters “Honeymoon from Hell: The Liberal Media vs. President Trump” by Rich Notes and Mike Ciandella (April 19th 2017)

206 Newsbusters.org “2017: The Year the News Media Went to War Against a President” by Rich Noyes and Mike Ciandella (January 16th 2018)

207 Politico

“Poll: 46 percent think media make up stories about Trump” by Steven Shepard (October 18th 2017)

208 Media/Impact: An Introduction to Mass Media (12th Edition) by Shirley Biagi page 312

209 CNN “A Trump win would sink stocks. What about Clinton?” by Heather Long (October 24th 2016)

210 Politico “Economists: A Trump win would tank the markets” by Ben White (October 21st 2016)

211 CNBC “This is what could happen to the stock market if Donald Trump wins” by Patti Domm (November 2nd 2016)

212 New York Times “Paul Krugman: The Economic Fallout” by Paul Krugman (November 11th 2016)

213 CNBC “S&P 500 and Nasdaq close at record highs after strong GDP report” by Fred Imbert (April 26th 2019)

214 Washington Post “Black unemployment falls to lowest level on record” by Heather Long (January 5th 2018)

215 Money.com “Check Your Paycheck: You Probably Just Got a Surprise Pay Bump” by Katie Reilly (February 2nd 2018)

216 NBC

News “Under new Trump tax code, average refund is 8.4 percent smaller” by Alyssa Newcomb (February 11th 2019)

217 NJTV News “Here’s why your tax refund may be disappointing this year” by Raven Santana (February 18th 2019)

218 CNN’s Brian Stelter (January 22nd 2017)

219 Washington Post “‘This is CNN Tonight. I’m Don Lemon. The president of the United States is racist.’” by Samantha Schmidt (January 12th 2018)

220 RealClear Politics “CNN’s Don Lemon Says Trump Could Become Like Hitler: ‘It Starts With Little Lies’” by Tim Hains (June 19th 2019)

221 Mediaite “CNN Analyst: Trump CPAC Speech Looked Scripted by Putin, ‘Reclaiming Our Heritage’ Talk Sounded Like Hitler” by Josh Feldman (March 2nd 2019)

222 Real Clear Politics “GQ's Julia Ioffe: ‘This President Has Radicalized So Many More People Than ISIS Ever Did’” by Ian Schwartz (October 29th 2018)

223 NY Daily News “Trump, Not ISIS is America’s Greatest Existential Threat” by Gersh Kuntzman (February 17th 2017)

224 Real Clear Politics “Olbermann: Osama Bin Laden Did Less Damage To America Than Donald Trump” by Ian Schwartz (November 4th 2017)

225 Free

Beacon “MSNBC Panel Says Trump Is a ‘Dictator’ Who’s Owned by Putin: ‘We Need a Revolution’” by Paul Crookston (February 2nd 2018)

226 Fox News “Chris Matthews Compares Ivanka, Jared Kushner to Saddam Hussein's Sons” (March 28th 2017)

227 Real Clear Politics “Chris Matthews: Trump's Inauguration Speech Had ‘Hitlerian’ Tone To It” by Ian Schwartz (January 20th 2017)

228 Washington Free Beacon “MSNBC Panelist: Kavanaugh Appointment Supports GOP’s Goal of ‘Thousand-Year Reich’” by Paul Crookston (October 8th 2018)

229 Breitbart “Twitter Explodes with Donald Trump Assassination Fantasies” by Patrick Howley (November 10th 2016)

230 Real Clear Politics “Anti-Trump Secret Service Agent Leaving With Pay, Pension” by Susan Crabtree (March 1st 2019)

231 The Washington Examiner “New York Times publishes fictional story on Trump assassination” by Caitlin Yilek (October 25th 2018)

232 NBC News “Johnny Depp: ‘When Was the Last Time an Actor Assassinated a President?’” (June 23rd 2017)

233 World Net Daily “Jim Carrey defends Griffin: I dreamed of beating Trump with golf club” by Chelsea Schilling (June 1st 2017)

234 Breitbart

“Mickey Rourke: Donald Trump ‘Can S*ck My F**king D*ck,’ Threatens to Beat GOP Candidate With Baseball Bat” by Daniel Nussbaum (April 7th 2016)

235 Associated Press “De Niro: I’d Like to Punch Trump In the Face” (October 8th 2016)

236 Rolling Stone “Hear Big Sean Threaten Donald Trump in New Freestyle” by Daniel Kreps (February 3rd 2017)

237 Rolling Stone “Watch Snoop Dogg Aim Gun at Clown-Trump in ‘Lavender’ Video” by Ryan Reed (March 13th 2017)

238 Independent “Marilyn Manson ‘beheads Donald Trump’ in new music video” by Jack Shepherd (November 8th 2016)

239 Multiple people recorded video of the incident and posted it on YouTube the next day, although it went unnoticed by major media outlets unlike most of the other incidents of celebrities making similar threatening statements.

240 USA Today “Kathy Griffin says she doesn’t regret Trump photo despite backlash, death threats” by Sara M. Moniuszko (March 24th 2019)

241 Newsbusters “MSNBC’s O’Donnell Claims Trump Will Get Impeached for ‘Ignorance’” by Kristine Marsh (May 17th 2017)

242 RealClear Politics “Rachel Maddow: “Worst-Case Scenario That The President Is A Foreign Agent Suddenly Feels Very Palpable” by Tim Hains

(July 22nd 2018)

243 Washington Times “Dershowitz: ‘Hope over reality’ delusion fuels obstruction of justice claims against Trump” by Douglas Ernst (December 4th 2017)

244 https://twitter.com/realDonaldTrump/status/965212168449941505

245 The Washington Times “Donald Trump holds high the flag for gay equality” by Richard Grenell (November 2nd 2016)

246 ABC News “Donald Trump OK With Caitlyn Jenner Using Any Bathroom in His Tower” by Candace Smith and Jessica Hopper (April 21st 2016)

247 Out Magazine “Trump’s Plan to Decriminalize Homosexuality Is an Old Racist Tactic” by Matthew Rodriguez (February 19th 2019)

248 NBC News “Trump’s North Korea policy could trigger famine, experts warn” by Alexander Smith December 9th 2017)

249 Herald Sun “Leftists: Rather War with North Korea Than Peace with Trump” by Andrew Bolt (June 17th 2018)

250 Mediaite “‘I’m Not Rooting for the 6-Year-Old’: Michael Moore Not Sure He Wants Trump to Succeed on North Korea” by Justin Baragona (April 28th 2017)

251 ABC

News “North Korea’s Kim Jong Un crosses DMZ line for historic meeting with South Korea” by Joohe Cho, Hakyung Kate Lee, and Tara Fowler (April 26th 2018)

252 Newsweek “Therapists Coin New Term: Trump Anxiety Disorder” by Emily Zogbi (July 28th 2018)

253 CBC “In a divided U.S., therapists treating anxiety are hearing the same name over and over: Donald Trump” by Matt Kwong (July 28th 2018)

254 Real Clear Politics “New York Times’ Yamiche Alcindor: ‘Sources' ‘Still In Therapy’ Because Clinton Lost” September 14th 2017)

255 Newsweek “Thousands of Americans Will Scream Helplessly at the Sky on Trump’s Election Anniversary” by Chris Riotta (October 23rd 2017)

256 Fox News “Anti-Trump protesters ‘scream helplessly at the sky’ to demonstrate on election anniversary” by Caleb Parke (November 9th 2017)

257 The Daily Caller “Rosie: Trump’s Presidential Victory Made Me ‘Physically Sick,’ Took a Year to Recover” by Benny Johnson (October 19th 2018)

258 CNS News “Trump Win Sent Chelsea Handler to a Psychiatrist: ‘I Just Wanted to F***king Fight People’” (April 8th 2019)

259 The Independent “Chrissy Teigen says Donald Trump’s election victory has damaged her mental health” by Maya Oppenheim (May 4th 2017)



260 Newsbusters

“MSNBC Analyst: Trump’s ‘Profound Sexual and Masculine Insecurities’ Threaten to Kill Us All” by Tim Graham (January 3rd 2018)

261 BBC “Hawking says Trump’s climate stance could damage Earth” by Pallab Ghosh (July 2nd 2017)

262 Variety “Twitter Permanently Bans Anti-Trump Krassenstein Brothers, Who Deny They Broke Platform’s Rules” by Todd Spangler (May 24th 2019)

263 The Guardian “Your worst nightmare: a successful Donald Trump presidency” by David Smith (July 3rd 2017)

264 Vox “Far-right protester interrupts Dorsey hearing. Auctioneer-turnedcongressman drones her out.” by Emily Stewart (September 5th 2018)

265 The Jerusalem Post “Ilhan Omar Defends Calling Stephen Miller a White Nationalist” by Ron Kampeas (April 11th 2019)

266 The Hill “Shapiro rips Economist after it labels him alt-right” by Joe Concha (March 28th 2019)

267 Council on Foreign Relations event “The Rise of Global Anti-Semitism (February 26th 2019)

268 Forbes

“Alex Jones: The Preposterous Poster Boy For Bitcoin” by Billy Bambrough (February 28th 2019)

269 Newsweek “Steven Crowder Incites Homophobic Harassment of Voc Reporter, YouTube Slow to React” by Steven Asarch (May 31st 2019)

270 The Guardian “Former Ku Klux Klan leader and US alt-right hail election result” by Esther Addley (November 9th 2016)

271 Psychology Today “An Analysis of Trump Supporters Has Identified 5 Key Traits” by Bobby Azarian Ph.D (December 31st 2017)

272 Newsbusters “Rob Reiner and Wife Liken ‘Evil’ Trump to Hitler, Supporters Are ‘Hardcore Racists’” by Brad Wilmouth (June 24th 2018)

273 International Journal Review “MSNBC Guest Claims That ‘Everything’ Trump Says Is Racist, Says POTUS ‘Is a White Nationalist’” by Madison Dibble (April 28th 2019)

274 CNN “Why Trump's MAGA hats have become a potent symbol of racism” by Issac Bailey (January 21st 2019)

275 Fox News “Trump supporter, 76, blames ‘fake news’ CNN for threats following reporter ambush” by Brian Flood (February 23rd 2018)

276 Washington Post “A Reporter’s dispatch from Trump country featured a ‘Mexicans Keep Out’ sign. But he made it all up” by Antonia Noori Farzan (December 21st 2018)



277 The

Daily Beast “Tom Brady’s New England Patriots Are Team MAGA, Whether They Like It or Not” by Corbin Smith (February 1st 2019)

278 Ibid.

279 Ibid.

280 Real Clear Politics “CNN Reporter Confronts Trump Supporter: Your Pro-Trump Group Was Infiltrated By Russians” by Ian Schwartz (February 21st 2018)

281 Fox News “Trump supporter, 76, blames ‘fake news’ CNN for threats following reporter ambush” by Brian Flood (February 23rd 2018)

282 Fox News “‘Hell No!’ Cashier refuses to serve Trump backers” by Todd Starnes (June 17th 2016)

283 The Hill “Judge rules bar was allowed to kick out Trump supporter” by Luis Sanchez (April 25th 2018)

284 Washington Times “Bakers refused to make pro-Trump birthday cake for 9-year-old boy: Report” by Bradford Richardson (August 7th 2017)

285 Washington Post “Chasing White House officials out of restaurants is the right thing to do” by Tom Scocca (June 26th 2018)

286 Time

“‘They're Not Welcome Anymore, Anywhere.’ Maxine Waters Tells Supporters to Confront Trump Officials” by Jennifer Calfas (June 25th 2018)

287 Daily Wire “WATCH: Activist Confronts Waters Publicly. Here’s How Waters Responded.” by Hank Berrien (June 26th 2018)

288 RedState “Toxic Masculinity: ‘Journalist’ Writes Boston Globe Column Urging Waiters to Pee, Bleed On Kirstjen Nielsen’s Food” by Sister Toldjah (April 10th 2019)

289 Boston Globe “Keep Kirstjen Nielsen unemployed and eating Grubhub over her kitchen sink” by Luke O’Neil” (April 10th 2019)

290 The Washington Times “A column suggested waiters could ‘tamper’ with Trump officials’ food. Amid backlash, the Boston Globe pulled it” by Allyson Chiu (April 12th 2019)

291 NBC News “Protesters Assault Trump Supporters With Eggs, Bottles, Punches After Rally” by Jacob Rascon and Ali Vitali (June 3rd 2016)

292 https://twitter.com/marclamonthill/status/1014904101988167685

293 https://twitter.com/gaywonk/status/1130862813713502210

294 Breitbart “Rap Sheet: ***639*** Acts of Media-Approved Violence and Harassment Against Trump Supporters” by John Nolte (July 5th 2018)

295 Washington

Times “MSNBC host, Princeton professor discuss MAGA hats as an ‘invitation’ to confrontation” by Douglas Ernst (January 23rd 2019)

296 HuffPost “How Far-Right Extremists Abroad Have Adopted Trump’s Symbols As Their Own” by Nick Robins-Early (April 6th 2019)

297 Washington Free Beacon “CNN Commentator Angela Rye Compares MAGA Hat to KKK Hood: I’m ‘So Triggered’ by the ‘Hatred’ It Represents” by Nic Rowan (January 22nd 2019)

298 NBC New York “Teen Arrested for Attack on 81-Year-Old Man Wearing MAGA Hat: Prosecutors” (February 27th 2019)

299 WTSP “Man accused of pulling gun on couple wearing MAGA hats at Sam's Club” by 10News Staff (February 18th 2019)

300 CBS Boston “Woman Charged With Attacking Falmouth Man Wearing MAGA Hat Taken Into ICE Custody” (February 26th 2019)

301 New York Post “Men accused of beating, robbing African immigrant because of MAGA hat” by Max Jaeger (April 17th 2019)

302 Washington Times “North Korean defectors wearing MAGA hats harassed in D.C.” by Jessica Chasmar (May 6th 2019)

303 ABC7 News “VIDEO: Trump supporter pepper sprayed at Milo protest” by Wayne Freedman (February 1st 2017)



304 Mediaite

“Black Trump Supporter Punched While Fleeing Arizona Melee” by Aidan McLaughlin (August 23rd 2017)

305 USA Today “Cheesecake Factory apologizes to black man reportedly harassed for wearing Trump cap” by Eli Blumenthal (May 15th 2018)

306 USA Today “Hillary Clinton: You ‘cannot be civil’ with Republicans, Democrats need to be ‘tougher’” by William Cummings (October 9th 2018)

307 Washington Post “Eric Holder: ‘When they go low, we kick them. That’s what this new Democratic Party is about.’” by Aaron Blake (October 10th 2018)

308 The Hill “Activists converge on home of Fox’s Tucker Carlson: ‘You are not safe’” by Joe Concha (November 8th 2018)

309 Townhall “Chilling Details: Tucker Carlson's Terrified Wife Hid in the Pantry As Antifa Thugs Damaged Her Home” by Guy Benson (November 8th 2018)

310 Huffington Post “Sorry Liberals, A Violent Response To Trump Is As Logical As Any” by Jesse Benn (June 6th 2016)

311 Ibid.

312 RedState “Is CBS Inciting Violence In The Latest Episode Of ‘The Good Fight’” by Jennifer Van Laar (April 13th 2019)



313 Salon.com

“White men must be stopped: The very future of mankind depends on it” by Frank Joyce (December 22nd 2015)

314 Salon.com “10 ways white people are more racist than they realize” by Kali Holloway (March 5th 2015)

315 Salon “White guys are killing us: Toxic, cowardly masculinity, our unhealable national illness” by Chauncey Devega (December 17th 2015)

316 BuzzFeed “19 School Powerpoint Presentations That Give Zero Fucks” by Hattie Soykan and Rachael Krishna (December 5th 2016)

317 Vice “Want to Heal Yourself from ‘Toxic Whiteness’? This Class Can Help” by Shahirah Majumdar (October 15th 2016)

318 The Root “Polite White People Are Useless” by Damon Young (August 29th 2017)

319 The Independent “MTV’s White People documentary succeeds in making viewers ‘uncomfortable’” by Emily Shackleton (July 23rd 2015)

320 Ebony “Jamie Foxx Defends ‘I Kill All the White People’ Joke” by The Grio (December 14th 2012)

321 New York Post “Jay Z’s bling from ‘whites are devils’ group” by Gary Buiso (April 6th 2014)

322 The

Daily Caller “Seven Louis Farrakhan Quotes on Jews, Gays, and White People” by Peter Hasson (January 26th 2018)

323 The Washington Post “CNN’s Don Lemon doubles down after saying white men are ‘the biggest terror threat in this country’” by LIndsey Bever (November 1st 2018)

324 CNN “The internet is radicalizing white men. Big tech could be doing more” by Alex Koppelman (March 17th 2019)

325 https://twitter.com/oliverdarcy/status/1102248695989325825

326 Rolling Stone “Kanye West Distances Himself From Alt-Right Provocateur” by Brendan Klinkenberg (October 30th 2018)

327 Breitbart “Utah Valley University Students Protest Candace Owens with ‘End White Supremacy’ Sign” by Alana Mastrangelo (March 7th 2019)

328 Front Page Magazine “Antifa, The Real Fascists” by Matthew Vadum (August 10th 2018)

329 Newsbusters “Dyson Slams Kanye West Speech as 'White Supremacy by Ventriloquism’” by Brad Wilmouth (October 11th 2018)

330 Ibid.

331 Washington Times “Slippery Slope with a Disastrous Ending, as Witnessed in the Dramatic Fall of the Roman Empire” by Jessica Chasmar

(February 8th 2015)

332 Los Angeles Times “Bette Midler slammed as racist for tweet about black Trump supporters” by Christie D’Zurilla (July 25th 2019)

333 RealClearPolitics “Could Trump Win 20 Percent of the AfricanAmerican Vote in 2020?” by Victor Davis Hanson (October 18th 2018)

334 Questioning the Media -Mediating Communication - What Happens? by Joshua Meyrowitz page 43

335 Questioning the Media -Mediating Communication - What Happens? by Joshua Meyrowitz page 44

336 The Independent “A Brief Cultural History of Sex” (September 23rd 2008)

337 NBC News “Meet the 10-year-old ‘drag kid’ taking over social media with inspiring message” by June 18th 2018)

338 Newsbusters “Morning Child Abuse. ‘Today’ Features 10-Year-Old Drag Queen” by Rachel Peterson (June 18th 2018)

339 The Daily Wire “11-Year-Old Boy Dressed In Drag Dances At Gay Bar, Gets Dollar Bills Thrown At Him” by Amanda Prestigiacomo (December 17th 2018)

340 Good

Morning America’s YouTube channel “The 11-year-old trailblazing drag kid ‘Desmond is Amazing’” (November 2nd 2018)

341 Newsbusters “GMA: ‘Genderless Babies’ Is ‘Healthy,’ Part of ‘Great Conversation’” by Gabriel Hays (January 24th 2019)

342 Ibid.

343 Ibid.

344 https://www.instagram.com/p/BtL8p9FAtZF/

345 NBC News “‘Boy or girl?’ Parents raising ‘theybies’ let kids decide” by Julie Compton (July 19th 2018)

346 Ibid.

347 CNN “Rethinking Monogamy Today” by Ian Kerner (April 12th 2017)

348 Ibid.

349 Ibid.

350 The Epoch Times “The Failed Soviet Experiment With ‘Free Love’” by Petr Svab (October 5th 2018)

351 CNN “Cuckolding can be positive for some couples, study says” by Ian Kerner (January 25th 2018)



352 Ibid.

353 NBC

News “Despite social media, Generation Z, Millennials report feeling lonely” by Sharon Jayson and Kaiser Health News (March 8th 2019)

354 The Independent “Millennial Dating Trends 2019: All You Need to Know, From Ghosting to Bird Boxing” by Oliva Petter and Sarah Young (February 7th 2019)

355 SFGate “It’s not just you: New data shows more than half of young people in America don’t have a romantic partner” via The Washington Post by Lisa Bronos and Emily Guskin (March 21st 2019)

356 NPR “U.S. Births Fell To A 32-Year Low In 2018; CDC Says Birthrate Is In Record Slump” by Bill Chappell (May 15th 2019)

357 Wall Street Journal “For Teens, Romances Where the Couple Never Meets Are Now Normal” by Christopher Mims (May 18th 2019)

358 New York Daily News “More than 20% of millennials claim to have no friends, poll finds” by Tim Balk (August 3rd 2019)

359 The Telegraph “Sex robots on way for elderly and lonely...but pleasurebots have a dark side, warn experts” by Sarah Knapton (July 5th 2017)

360 Forbes

“Goodbye Loneliness, Hello Sexbots! How Can Robots Transform Human Sex?” by Reenita Das (July 17th 2017)

361 Daily Mail “March of the sexbots: They talk, they make jokes, have ‘customisable’ breasts - the sex robot is no longer a weird fantasy but a troubling reality” by Caroline Graham (October 29th 2017)

362 Daily Caller “‘Disrespectful’: Google Employees Melt Down Over the Word ‘Family’” by Peter Hasson (January 16th 2019)

363 Ibid.

364 Ibid.

365 Ibid

366 Ibid

367 Ibid

368 Ibid

369 Jezebel “The Increase in Single Moms Is Actually a Good Thing” by Hugo Schwyzer (February 22nd 2012)

370 CNBC “You can save half a million dollars if you don’t have kids” by Yoni Blumberg (August 17th 2017)

371 Netflix

“The Break with Michelle Wolf” (June 2018)

372 Newsbusters

“Hulu Character Feels ‘Really, Really Good,’ ‘Very F**king Powerful’ After Abortion” by Rebecca Downs (March 18th 2019)

373 KTSA “Video: “Kids Meet Someone Who’s Had An Abortion” by Jack Riccardi (January 4th 2019)

374 Real Clear Politics “Alabama State Dem Rep. Defends Abortion: ‘You Kill Them Now Or You Kill Them Later’” by Ian Schwartz (May 2nd 2019)

375 CNN “Alabama lawmaker sparks backlash for ‘kill them now or kill them later’ comments over state abortion bill” by Veronica Stracqualursi (May 2nd 2019)

376 The Guardian “Want to fight climate change? Have fewer children” by Damian Carrington (July 12th 2017)

377 Ibid.

378 New York Times “No Children Because of Climate Change? Some People Are Considering It” by Maggie Astor (February 5th 2018)

379 Ibid.

380 Ibid.

381 Fox

5 DC “Rep. Alexandria Ocasio-Cortez: ‘Is it OK to still have children?’” by Fox News (February 26th 2019)

382 CNN “Obama congratulates Michael Sam, first openly gay player drafted by NFL” by Chelsea J. Carter and Ralph Ellis (May 11th 2014)

383 CNN “White House shines rainbow colors to hail same-sex marriage ruling” by Allie Malloy and Karl de Vries (June 30th 2015)

384 CNN “Benham brothers lose HGTV show after ‘anti-gay’ remarks” by Lisa Respers (May 9th 2014)

385 Hollywood Reporter “Benham Brothers, Dumped by HGTV Over AntiGay Remarks, Could Land at ‘Traditional Values’ Network INSP TV” by Paul Bond (May 12th 2014)

386 The New Yorker “Why Kevin Hart Had to Go as Oscars Host” by Michael Schulman (December 7th 2018)

387 Washington Examiner “Mozilla CEO Brendan Eich forced to resign for supporting traditional marriage laws” by Joel Gehrke (April 3rd 2017)

388 Christian Post “Gay Man Files $70M Suit Against Bible Publishers Over ‘Homosexual' Verses” by Elena Garcia (July 10th 2008)

389 US News and World Report “These States Require Schools to Teach LGBT History” by Casey Leins (August 14th 2019)

390 Telegraph

“Boys can have periods too, children to be taught in latest victory for transgender campaigners” by Helena Horton (December 16th 2018)

391 Breitbart “Watch: Drag Queen Admits He’s ‘Grooming Next Generation’ in ‘Story Hours’” by Dr. Susan Berry (November 29th 2018)

392 “Grooming” definition in Cambridge Online Dictionary.

393 Houston Chronicle “Houston Library apologizes after registered sex offender participated in Drag Queen Storytime” by Jasper Scherer (March 16th 2019)

394 Newsweek “Sex Offender Busted as Drag Queen Who Read Books To Children in City Library” by Scott McDonald (March 16th 2019)

395 LifeSiteNews “Drag queen teaches kids to ‘twerk’ at library story hour” by Calvin Freburger (August 7th 2019)

396 Mic “How Victoria’s Secret normalized discrimination” by Evan Ross Katz (November 12th 2018)

397 https://twitter.com/VictoriasSecret/status/1061106626583822338

398 Los Angeles Times “Valentina Sampaio makes history as first transgender Victoria’s Secret model” by Christi Carras (August 5th 2019)

399 Deadspin

“Conservative Gays Need to Shut The Fuck Up” by Lauren Theisen (December 12th 2018)

400 CNBC “Caitlyn Jenner says it was harder to come out as Republican than transgender” by Ivan Levingston (July 20th 2016)

401 Mass Communication: Living in a Media World “Can Television Take Anything Seriously” by Ralph E. Hanson (Seventh Edition 2019)

402 Pew Research Center “Video Length” by Pew Research Center: Journalism and Media Staff (July 16th 2012)

403 Ibid.

404 Washington Post “Dan Rather to Step Down at CBS” by Howard Kurtz (November 24th 2004)

405 Chicago Tribune “NBC removes Brian Williams from ‘Nightly News’” by Tribune Wire (June 18th 2015)

406 Los Angeles Times “Brian Williams’ $10-million salary should buy some honesty” (February 10th 2015)

407 CBS News “Court Tosses Dan Rather’s Lawsuit Vs. CBS” (September 29th 2009)

408 Yahoo Finance “Anderson Cooper Net Worth: His Fortune at Age 51” by Joel Anderson (June 1st 2018)



409 TMZ

“Joe Scarborough Divorce: He Earns $99,000 a Week” (October 11th 2013)

410 Business Insider “Fired ‘Today’ host Matt Lauer’s contract was reportedly worth $25 million a year — here’s how that compares to other top TV show hosts” by Jason Guerrasio (November 29th 2017)

411 Vanity Fair “Megyn Kelly Officially Out at NBC, $69 Million Richer” (January 12th 2019)

412 Los Angeles Times “Tobacco Company Sues Source in Unbroadcast ‘60 Minutes’ Report: Litigation: Brown & Williamson is also seeking to prevent its former employee from testifying” by Jane Hall (November 22nd 1995)

413 New York Times “Film Drama Shines a Harsh Light on ’60 Minutes’ and CBS” by Peter Applebom (July 13th 1999)

414 Los Angeles Times “CBS Woes Go Beyond the Ratings to a Swoosh” by Larry Stewart (February 15th 1998)

415 New York Times “On CBS News, Some of what you see isn’t there” by Alex Kuczynki (January 12th 2000)

416 Washington Post “ABC News apologizes for ‘serious error’ in Trump report and suspends Brian Ross for four weeks” by Amy B Wang (December 3rd 2017)



417 Fox

News “ABC News, Brian Ross apologize for report suggesting shooting suspect tied to Tea Party” (July 20th 2012)

418 ABC News “Jeff Sessions addresses ‘anti-LGBT hate group,’ but DOJ won’t release his remarks” by Pete Madden and Erin Galloway (July 12th 2017)

419 New York Post “NBC slammed for tweet endorsing Oprah as president” by Mark Moore (January 8th 2018)

420 The Wrap “NBCBLK Editor Defends New Black Site: ‘It Was Destined to Be Controversial’” by Alicia Banks (January 22nd 2015)

421 The Hill “Obama: Fox viewers ‘living on a different planet’ than NPR listeners” by Julia Manchester (January 13th 2018)

422 NPR “DNC Bars Fox News From Hosting 2020 Primary Debates” by Jessica Taylor (March 6th 2019)

423 CNN “Russian bots are using #WalkAway to try to wound Dems in midterms” by David A. Love (July 17th 2018)

424 https://www.YouTube.com/WalkAwayCampaign

425 CNN “Trump leading ‘hate movement’ against media” (August 5th 2018)

426 PJ

Media “CNN Anchor Calls Trump’s Election a ‘National Emergency’” by PJ Staff (December 12th 2016)

427 New York Magazine “CNN’s Jeff Zucker on Covering Donald Trump — Past, Present, and Future” by Gabriel Sherman (January 18th 2017)

428 Washington Post “CNN’s president has fired a warning shot at Donald Trump” by Callum Borchers (January 19th 2017)

429 CNN “InfoWars’ main YouTube channel is two strikes away from being banned” by Paul P. Murphy (February 24th 2018)

430 Newsweek “Florida Shooting Conspiracy Theories and Alex Jones, Infowars In Hot Water with YouTube” by Gillian Edevane (February 27th 2018)

431 The Hill “Infowars one strike away from YouTube ban” by Julia Manchester (February 27th 2018)

432 CNN “Advertisers flee InfoWars founder Alex Jones’ YouTube channel” by Paul P. Murphy and Gianluca Mezzofiore (March 3rd 2018)

433 Ibid.

434 Washington Times “Donny Deutsch issues Trump ‘serious’ fight challenge: ‘I’ll meet you in the schoolyard, brother’” by Douglas Ernst (June 30th 2017)

435 Daily

Caller “MSNBC Guest: Trump Name Is The ‘Modern Day Swastika’ [VIDEO]” by Amber Athey (August 7th 2017)

436 Newsbusters “MSNBC: ‘Everyone’ Agrees Trump’s a White Supremacist; Prove You're Not Racist by Voting Democrat” by Kritine Marsh (August 1st 2019)

437 Business Insider “Joe Scarborough and Mika Brzezinski say Trump’s North Korea surprise is a ‘painfully obvious’ distraction from porn star sex scandal” by Eliza Relman (March 9th 2018)

438 The Hill “New York Times reinforces policy prohibiting reporters from appearing on cable shows like Maddow” by Joe Concha (May 31st 2019)

439 The Wrap “Glenn Greenwald Blasts Rachel Maddow: ‘Intellectually Dishonest, Partisan Hack’” by Jon Levine (January 22nd 2018)

440 Skeptic Review “Boston Antifa Explains Parody: Vladivostok, Russia, Geo-Tagging & More” by Gretchin Mullen (November 17th 2017)

441 Mediaite “MSNBC Falls for Parody North Korean Twitter Account Attacking Fox News” by Alex Griswold (August 10th 2015)

442 Associated Press “Maddow, other MSNBC hosts see ratings drop, Fox up” by David Bauder (March 27th 2019)

443 BigLeaguePolitics “Tucker Gets More Viewers Than All of CNN Combined, Fox Early News Beats MSNBC Prime Time” by Tom Pappert

(April 4th 2019)

444 Fox News “Fox News dominates CNN, MSNBC in Wednesday primetime ratings, topping both networks’ combined viewership” (March 28th 2019)

445 Newsweek “MSNBC’s Rachel Maddow Found Huge Ratings Success Covering Trump and Russia — So What Now?” by Tim Marcin (March 25th 2019)

446 eBizMBA “Top 15 Most Popular Political Websites - January 2019”

447 Reuters “AOL to buy The Huffington Post for $315 million” by Anthony Boadle and Jennifer Saba (February 6th 2011)

448 Archive.org “CSPAN April 27th 2013 White House Correspondents Dinner”

449 The Wrap “BuzzFeed Reporter Apologizes for ‘Very Dumb’ Remarks About Communism” by Jon Levine (November 8th 2017)

450 BuzzFeed “Why LGBT Representation Didn’t Make It Into ‘The Last Jedi’” by Adam B. Vary (December 18th 2017)

451 Twitchy “What was that about exploitation? Now VICE Canada is celebrating the next generation of drag queens” by Brett T. (June 6th 2019)

452 Forbes

“Vice Media’s Shane Smith Is Now A Billionaire” by Natalie Robehmed (June 20th 2017)

453 Vice “World’s Scariest Drug (Documentary Exclusive)” on YouTube (May 11th 2012)

454 Vice “Kim Dotcom: The Man Behind Megaupload” on YouTube (January 5th 2014)

455 https://twitter.com/vicecanada/status/1042156417577365505

456 The Hollywood Reporter “Disney Discloses New $353 Million WriteDown on Vice Media Investment” by Natalie Jarvey (May 8th 2019)

457 Variety “Vice Media Gets $250 Million in Debt Funding From George Soros, Other Investors” by Todd Spangler (May 3rd 2019)

458 New York Times “NBCUniversal Invests $200 Million in Vox Media” by Emily Steel (August 12th 2015)

459 Vox “YouTube’s most popular user amplified anti-Semitic rhetoric. Again” by Aja Romano (December 13th 2018)

460 Vox “YouTube’s messy fight with its most extreme creators” (October 19th 2017)

461 Vox “3 Reasons the American Revolution Was a Mistake” by Dylan Matthews (July 3rd 2019)



462 Ibid.

463 Daily

Beast “Meet Candace Owens, Kanye West’s Toxic Far-Right Consigliere” by Amy Zimmerman (May 9th 2018)

464 Daily Beast “Mike Cernovich and Jack Posobiec, the Far Right’s Twin Trolls, Taste Their Own Bitter Medicine” by Lloyd Grove (July 23rd 2018)

465 Daily Beast “Pro-Gun Parkland Teen Kyle Kashuv Apologizes for ‘Inflammatory’ Racial Comments” by Will Sommer (May 23rd 2019)

466 Daily Beast “Inside YouTube’s Far-Right Radicalization Factory” by KellyWeill (September 18th 2018)

467 Fox News “Daily Beast accused of ‘doxxing’ alleged creator of ‘Drunk Pelosi’ video” by Frank Miles (June 2nd 2019)

468 CNBC “New York Times CEO: Print journalism has maybe another 10 years” by Kellie Ell (February 12th 2018)

469 Wall Street Journal “Newsweek Quits Print: After 79 Years, the Title Will Be Digital Only” by Keach Hagey (October 19th 2012)

470 https://twitter.com/DonaldJTrumpJr/status/1116426290817638400

471 The Wall Street Journal “Ad-Tech Firms Blacklist Newsweek Sites, Alleging Website-Traffic Manipulation” by Lara O’Reilly and Lukas I.

Alpert (March 7th 2018)

472 New York Post “Jeff Zucker joins fight to monetize mobile journalism” by Richard Morgan (February 26th 2018)

473 Business Insider “The Washington Post is blocking people with ad blockers from reading its articles” by Max Slater-Robins (September 10th 2015)

474 The Verge “The New York Times cuts free articles limit from 10 to five per month” by Natt Garun (December 1st 2017)

475 https://contribute.theguardian.com/components/epic/inline-payment

476 The Wall Street Journal “BuzzFeed News Asks Readers to Chip In With Donations” by Benjamin Mullin (August 27th 2018)

477 The Guardian “Encyclopedia Britannica halts print publication after 244 years” by Tom McCarthy (March 13th 2012

478 Pew Research Center “Wikipedia at 15: Millions of readers in scores of languages” by Monica Anderson, Paul Hitlin, and Michelle Atkinson (January 14th 2016)

479 The Guardian “The rise of Tomi Lahren, the media star lampooned as ‘white power Barbie’” by Jason Wilson (September 23rd 2016)

480 Zero

Hedge “Wikipedia Listed Ron Paul On ‘White Supremacists’ List For 3 Weeks Before Removing Him” by Tyler Durden (July 26th 2018)

481 CBS News “Google blames Wikipedia for ‘Nazism’ tag on California GOP” (June 1st 2018)

482 Washington Post “Former Democratic aide pleads guilty to ‘doxing’ GOP senators, threatening employee” by Spencer S. Hsu (April 6th 2019)

483 As of the time of this writing in July 2019 although that could change. But since Antifa has been engaged in repeated violent acts for years, that’s something that should have been included on their Wikipedia page long ago.

484 Mediaite “Mob Gathers Outside Tucker Carlson’s Home: ‘We Know Where You Sleep at Night!’” by Joseph A. Wulfsohn (November 7th 2018)

485 The Washington Times “Journalist Andy Ngo beaten up by Antifa activists at Portland protest” by Valerie Richardson (June 29th 2019)

486 Breitbart “Wikipedia Protecting Antifa: Wikipedia Editors Protect Antifa by Censoring Andy Ngo Assault, ICE Attack” by T.D. Adler (July 18th 2019)

487 Fox News “Washington ICE detention center attacker Willem Van Spronsen wrote ‘I am Antifa’ manifesto before assault” by Travis Fedschun (July 15th 2019)

488 NewsBusters.org

“The ‘Squad’ Won’t Condemn Antifa Terrorism....WHERE Are The Media?” by Tim Graham (July 17th 2019)

489 https://twitter.com/shaunking/status/1144944444992450560

490 TownHall “Republicans Craft Resolution Condemning Antifa As A ‘Domestic Terrorist Organization’” by Timothy Meads (July 19th 2019)

491 As of July 2019. Increased pressure could change this, but the fact remains, for months (or perhaps years) Wikipedia editors have vigorously protected the page, scrubbing any references to Antifa’s violence.

492 https://en.wikipedia.org/wiki/Peter_Strzok (Accessed May 2nd 2019)

493 Breitbart “Wikipedia Editors Paid to Protect Political, Tech, and Media Figures” by T.D. Adler (March 26th 2019)

494 As of August 2019, although this could change if I happen to get some favorable media coverage highlighting my subscriber count, but it hasn’t been allowed on my page which has been up since 2007.

495 SocialBlade.com lists the historical YouTube statistics for all channels. Under “Detailed Statistics” it shows my channel reached 1 million subscribers in May 2017, and Paul Joseph Watson followed in August 2017, then PragerU in September 2017, Stephen Crowder in November 2017, and Ben Shapiro’s Daily Wire in October 2018, and Next News Network in February 2019

496 TonyBallioni

23:23, 2 February 2019 (UTC)

497 Barkeep49

17:19, 30 January 2019 (UTC)

498 https://twitter.com/lsanger/status/1096227555466596352

499 150Sec.com

“‘Wikipedia is a broken system,’ says co-founder Larry Sanger” by Sophie Foggin (May 22nd 2019)

500 https://twitter.com/jimmy_wales/status/1135456897899945984

501 Tech Crunch “Google.org donates $2 million to Wikipedia’s parent org” by Megan Rose Dickey (January 22nd 2019)

502 Wikimedia Foundation “George Soros, founder of Open Society Foundations, invests in the future of free and open knowledge” by Kaitlin Thaney (October 18th 2018)

503 Search Engine Watch “No. 1 Position in Google Gets 33% of Search Traffic [Study]” by Jessica Lee (June 20th 2013)

504 The Daily Caller “Exclusive: Google Employees Debated Burying Conservative Media In Search” by Peter Hasson (November 29th 2018)

505 Ibid.

506 Ibid.

507 The

Wall Street Journal “Google Workers Discussed Tweaking Search Function to Counter Travel Ban” by John D. McKinnon and Douglas MacMilan (September 20th 2018)

508 Ibid.

509 Ibid.

510 Fox Business “Google employee discussions on altering search function after travel ban raise bias concerns” by Thomas Barrabi (September 21st 2018)

511 Breitbart “Former Google Employee: ‘There Are Efforts to Demote Anything Non-PC from Search Results’” by Allum Bokhari (August 8th 2017)

512 PJ Media “96 Percent of Google Search Results for ‘Trump’ News Are from Liberal Media Outlets” by Paula Bolyard (August 25th 2018)

513 World Net Daily “Does Google have a liberal bias? Search Results for Roger Ailes Speak Volumes” via Heat Street (May 21st 2017)

514 Washington Times “Handful of ‘left leaning sources’ dominate Google’s ‘top stories’ study finds” by Gabriella Munoz (May 12th 2019)

515 The Daily Caller “Google Suspends Fact Check Project, Rediting The DNCF Investigation with Decision” by Eric Lieberman (January 19th 2018)

516 Daily

Caller “Tech Tyranny!’ Greenpeace Co-Founder Claims Google Scrubbed Him From List of Founders” by Virginia Kruta (March 17th 2019)

517 World Net Daily “Google makes Greenpeace co-founder ‘vanish’” by Art Moore (March 18th 2019)

518 Daily Caller “Google Backs Down After Labeling Pro-Life Movie ‘Propaganda’” by Mary Margaret Olohan (April 12th 2019)

519 Breitbart “EXCLUSIVE — Research: Google Search Manipulation Can Swing Nearly 80 Percent of Undecided Voters” by Allum Bokhari (April 24th 2018)

520 Breitbart “Research: Google Search Bias Flipped Seats for Democrats in Midterms” by Allum Bokhari (March 22nd 2019)

521 TED “How a handful of tech companies control billions of minds every day” (July 26th 2017)

522 Fortune “Google Has Announced a $300 Million Initiative to Support News Organizations” by Eli Meixler (March 21st 2018)

523 CNET “Google’s Sergey Brin calls 2016 election ‘offensive’ in leaked video” by Richard Vieva (September 12th 2018)

524 Breitbart “Rebels of Google: Tampons Kept in Men’s Restrooms Because ‘Some Men Menstruate’” by Lucas Nolan (August 17th 2017)



525 Tech

Crunch “James Damore just filed a class action lawsuit against Google, saying it discriminates against white male conservatives” by Connie Loizos (January 8th 2018)

526 CNET “Trump backs billionaire supporter Peter Thiel’s calls for Google investigation” by Dhara Singh and Sean Keane (July 17th 2019)

527 The Guardian “Google's prototype Chinese search engine links searches to phone numbers” by Noah Smith (September 18th 2018)

528 Forbes “Project Dragonfly And Google’s Threat To Anti-Democratic Processes” by Julian Vigo (October 18th 2018)

529 https://twitter.com/HawleyMO/status/1151287368382656519

530 Washington Post “Eric Schmidt: Google’s Policy Is To ‘Get Right Up To The Creepy Line And Not Cross It’” by Nick Saint (October 1st 2010)

531 CNET “Google boss predicts Google implant will put the Web in your head by 2020” by Richard Trenhold (November 10th 2010)

532 PBS News Hour “Inventor Ray Kurzweil sees immortality in our future” (March 24th 2016)

533 Time “5 Very Smart People Who Think Artificial Intelligence Could Bring the Apocalypse” by Victor Luckerson (December 2nd 2014)

534 Business

Insider “Elon Musk believes AI could turn humans into an endangered species like the mountain gorilla” by Isobel Asher Hamilton (November 26th 2018)

535 Media/Impact: An Introduction to Mass Media (12th Edition) by Shirley Biagi page 176

536 Hollywood Reporter “Bring On the Haters: Dane Cook Is Plotting a Comedy Comeback” by Ryan Parker February 13th 2019)

537 Slate “Tila Tequila for President” by Jonah Weiner (April 11th 2006)

538 New York Times “The Aspiring Novelist Who Became Obama’s Foreign-Policy Guru” by David Samuels (May 5th 2016)

539 Ibid.

540 The Washington Post “Hillary Clinton’s health just became a real issue in the presidential campaign” by Chris Cillizza (September 11th 2016)

541 Ibid.

542 ABC News “The Lesson of Mitt Romney's 47-Percent Video: Be Nice to the Wait Staff?” by Chris Good (March 14th 2013)

543 The Los Angeles Times “No Disputing It: Blogs Are Major Players” by Peter Wallsten (September 12th 2004)

544 Washington

Post “Twenty years ago, the Drudge Report broke the Clinton-Lewinsky scandal” by Annys Shin (January 11th 2018)

545 Business Insider “Google and Facebook dominate digital advertising — and they now account for 25% of all ad sales, online or off” by Caroline Cakebread (December 7th 2017)

546 The Ripon Forum “How Generation Z Gets their News” by Jack Myers (Volume 52, No1 February 2018)

547 Ibid.

548 Chicago Sun Times “Homeland Security to compile database of journalists and ‘media influencers’” by Sun-Times Staff (April 7th 2018

549 Ibid.

550 The Guardian “Revealed: US spy operation that manipulates social media” by Nick Fielding and Ian Cobain (March 17th 2011)

551 The Guardian “British army creates team of Facebook warriors” by Ewan MacAskill (January 31st 2015)

552 Engadget “YouTube pulls hundreds of channels tied to Hong Kong influence campaign” by Richard Lawler (August 23rd 2019)

553 Washington Post “Facebook’s most popular Black Lives Matter page was a scam run by a white Australian, report says” by Amy B Wang (April

10th 2018)

554 CNN “Exclusive: Fake black activist accounts linked to Russian government” by Donie O’Sullivan and Dylan Byers (September 28th 2017)

555 Fox News “Michael Moore participated in anti-Trump rally allegedly organized by Russians” by Gregg Re (February 20th 2018)

556 NBC “Social media linked to rise in mental health disorders in teens survey finds” by Shamard Charles (March 14th 2019)

557 Time “Why Instagram Is the Worst Social Media for Mental Health” by Amanda Macmillan (May 25th 2017)

558 New York Post “Rise in teen suicide connected to social media popularity: study” via Associated Press (November 14th 2017)

559 USA Today “Cyberbullying’s chilling trend: Teens anonymously target themselves online, study finds” by N’dea Yancey-Bragg (November 8th 2017)

560 New York Post “Man fatally stabbed on subway while onlookers post on social media” by Tamar Lapin (January 17th 2018)

561 NBC News “Facebook hits 2.27 billion monthly active users as earnings stabilize” by Jason Abbruzzes (October 30th 2018)

562 Business

Insider “How old 15 self-made billionaires were when they earned their first billion” by Kathleen Elkins (February 17th 2016)

563 https://twitter.com/Snowden/status/975147858096742405

564 https://twitter.com/robjective/status/964680123885613056

565 New York Post “Facebook Admits to blocking Wikileaks links in DNC email hack” by Bruce Golding (July 24th 2016)

566 PJ Media “Censored: Facebook Bans Conservative Articles on Jussie Smollett Hate Hoax” by Tyler O’Neil (February 18th 2019)

567 Gizmodo “Facebook Patents Shadow Banning” by Bryan Menegus (July 16th 2019)

568 The Guardian “Facebook sorry – almost – for secret psychological experiment on users” by Dominic Rushe (October 2nd 2014)

569 UC San Diego News Center “Facebook Boosts Voter Turnout” by Inga Kiderra (September 12th 2012)

570 Facebook.com “Case Study: Reaching Voters with Facebook Ads (Vote No on 8)” (August 16th 2011)

571 Gizmodo “Former Facebook Workers: We Routinely Suppressed Conservative News” by Michael Nunez (May 9th 2016)

572 Breitbart

“EXCLUSIVE: Trump’s Facebook Engagement Declined By 45 Percent Following Algorithm Change” by Allum Bokhari (February 28th 2018)

573 Western Journal “Confirmed: Facebook’s Recent Algorithm Change Is Crushing Conservative Sites, Boosting Liberals” by George Upper and Shaun Hair (March 13th 2018)

574 https://twitter.com/TomiLahren/status/1141129134359269376

575 After filing several complaints with Facebook and publicly calling attention to the feature being disabled, they later restored it and said it was just another “error.”

576 Project Veritas “Facebook Insider Leaks Docs; Explains ‘Deboosting,’ ‘Troll Report,’ & Political Targeting in Video Interview” (February 27th 2019)

577 The New York Times “Dozens at Facebook Unite to Challenge Its ‘Intolerant’ Liberal Culture” by Kate Conger and Sheera Frenkel (August 28th 2018)

578 Fortune “Why Peter Thiel Is Leaving Silicon Valley for L.A.” by Chris Morris (February 15th 2018)

579 Reuters “Peter Thiel sells most of remaining Facebook stake” (November 22nd 2017)

580 Variety

“Facebook Paying for News Shows From ABC News, CNN, Fox News, Univision, Others” by Todd Spangler (June 6th 2018)

581 Advertising Age “Facebook Gets CNN to Bring Anderson Cooper To It’s New Media Venture” by Garett Soan (June 6th 2018)

582 Variety “CNN Is Pulling Anderson Cooper’s Show Off Facebook, Will Launch ‘Go There’ on Social Platform This Summer” by Todd Spangler (June 12th 2019)

583 NBC News “Facebook investing $300 million in local news initiatives” (January 15th 2019)

584 Zero Hedge “Facebook COO Sandberg To John Podesta: ‘I Want Hillary To Win Badly’” by Tyler Durden (March 20th 2018)

585 BBC “Facebook amends ‘real name’ policy after protests” by Dave Lee (December 15th 2015)

586 Fortune “Facebook’s Employee Bonuses Now Hinge on ‘Social’ Progress” by Michael Lev-Ram (February 6th 2019)

587 CNET “Facebook ties employee bonuses to progress on social issues” by Steven Musil and Queenie Wong (February 5th 2019)

588 The Hill “Facebook removes over 800 accounts, pages for political spam” by Ali Breland (October 11th 2018)

589 Breitbart

“Facebook Deletes Disabled Veteran’s Page Without Warning — After Taking $300,000 for Ads” by Lucas Nolan (October 16th 2018)

590 The Guardian “Tommy Robinson banned from Facebook and Instagram” by Alex Hern and Jim Waterson (February 26th 2019)

591 The Independent “Tommy Robinson: YouTube under pressure to join Facebook and Instagram in banning far-right activist” by Tim Wyatt (February 27th 2019)

592 Ibid.

593 BBC “Facebook bans Britain First pages” by Rory Cellan-Jones

594 CNET “Facebook, Instagram ban Faith Goldy as they purge white nationalist groups” by Queenie Wong (April 8th 2019)

595 Huffington Post “Facebook Bans Faith Goldy After HuffPost Report On White Nationalism Content” by Andy Campbell (April 9th 2019)

596 Ibid.

597 Breitbart “Facebook Bans Jewish Veteran After Exposé of Jim Jefferies’ Deceptive Editing” by Lucas Nolan (March 26th 2019)

598 RedState “YouTuber Who Outwitted Comedy Central Drops More Hidden Footage Exposing Their Lies” by Brandon Morse (April 10th 2019)

599 PJ

Media “Facebook Bans German Historian for Saying ‘Islam Is Not Part of German History’” by Tyler O’Neil (April 9th 2018)

600 The Intercept “Facebook Says It Is Deleting Accounts at the Direction of the U.S. and Israeli Government” by Glenn Greenwald (December 30th 2017)

601 Breitbart “Facebook Takes Down Event Page for Anti-Caravan Protest” by Allum Bokhari (April 28th 2018)

602 The Washington Post “Evangelist Franklin Graham claims Facebook ‘is censoring free speech’ after it blocked him” by Michael Brice-Saddle (December 30th 2018)

603 Washington Post “Facebook censored a post for ‘hate speech.’ It was the Declaration of Independence.” by Eli Rosenberg (July 5th 2018)

604 Breitbart “Facebook Suspends YouTuber for Disliking ‘Transgender Mother’ Commercial” (April 14th 2017)

605 U.S. Department of Justice “Homicide Trends in the United States, 1980-2008” by Alexia Cooper and Erica L. Smith (November 2011)

606 Fox News “Facebook temporarily suspends Candace Owens over post about ‘liberal supremacy’” by Christopher Howard (May 17th 2019)

607 Breitbart “EXCLUSIVE: Facebook Includes Candace Owens On ‘Hate Agents’ List” by Allum Bokhari (May 17th 2019)



608 The

Hill “Diamond and Silk slam Facebook after company deems their rhetoric ‘unsafe to the community’” by Joe Concha (April 9th 2018)

609 NPR “Facebook Admits ‘Enforcement Error’ In How It Handled Content From Pro-Trump Duo” by Tim Mak (April 15th 2018)

610 The Western Journal “Facebook Suspends Account for Calling Alleged Cop Killer an ‘Illegal Immigrant’” by Kara Pendleton (December 30th 2018)

611 https://twitter.com/lucianwintrich/status/937391808363016192

612 Fox News “Facebook apologizes to Trump’s social media director for temporarily restricting his account” by Chris Ciaccia (March 19th 2019)

613 CNN “Facebook bans Louis Farrakhan, Milo Yiannopoulos, InfoWars and others from its platforms as ‘dangerous’” by Oliver Darcy (May 3rd 2019)

614 Wired “Facebook Bans Alex Jones, Other Extremists—but Not as Planned” by Paris Martineau (May 2nd 2019)

615 The Atlantic “Instagram and Facebook Ban Far-Right Extremists” by Taylor Lorenz (May 2nd 2019)

616 New York Times “Ex‐Officials Say F.B.I. Harassed Dr. King to Stop His Criticism” by Nicholas M. Horrock (March 9th 1975)



617 https://twitter.com/HamasInfoEn

618 https://twitter.com/Ikhwanweb

619 Daily

Caller “Don Trump Jr. Slams Instagram After Smollett Post Deleted: ‘Why Don’t You Want The Truth Out There?’” by Amber Athey and Katie Jerkovich (February 18th 2019)

620 Washington Times “Instagram deletes Kayleigh McEnany post on Elizabeth Warren, issues ‘bullying’ warning” by Victor Morton (February 6th 2019)

621 The Verge “Facebook is turning its fact-checking partners loose on Instagram” by Jon Porter (May 7th 2019)

622 Hollywood Reporter “‘Bachelorette’ Frontrunner Under Fire for Liking Controversial Social Media Posts” by Jackie Strause (May 29th 2018)

623 Business Insider “Here’s why Steve Jobs never let his kids use an iPad” by Eames Yates (March 4th 2017)

624 Business Insider “Apple CEO Tim Cook: I don’t want my nephew on a social network” by Rob Price (January 19th 2018)

625 SF Gate “Bill Gates didn’t allow his kids to have cell phones until age 14” by Amy Graff (April 21st 2017)

626 The

Guardian “Ex-Facebook president Sean Parker: site made to exploit human ‘vulnerability’” by Olivia Solon (November 9th 2017)

627 The Verge “Former Facebook exec says social media is ripping apart society” by James Vincent (December 11th 2017)

628 Ibid.

629 https://twitter.com/fchollet/status/976563870322999296

630 https://twitter.com/fchollet/status/976564096605679616

631 https://twitter.com/fchollet/status/976564511858597888

632 https://twitter.com/fchollet/status/976565324622344192

633 https://twitter.com/fchollet/status/976565553761476608

634 https://twitter.com/fchollet/status/976565723597176832

635 https://twitter.com/fchollet/status/976567526023872513

636 https://twitter.com/fchollet/status/976568469679357952

637 https://twitter.com/fchollet/status/976568588378152960

638 https://twitter.com/fchollet/status/976569442728525824

639 New

York Times “It’s Time to Break Up Facebook” by Chris Hughes (May 9th 2019)

640 Science Magazine “Fake news spreads faster than true news on Twitter —thanks to people, not bots” by Katie Langin (March 8th 2018)

641 Engaget “Twitter’s fake news problem is getting worse” by Nicole Lee (February 17th 2018)

642 New York Magazine “All the Mistakenly Identified ‘Suspects’ in the Boston Bombing Investigation” by Joe Coscarelli (April 19th 2013)

643 The Hill “Washington Post reporter apologizes for tweet on crowd size at Trump rally” by Julia Manchester (December 9th 2017)

644 Daily Caller “Trump Calls Out Time Magazine For Fake News Story About Removing MLK Bust From Oval Office” by Saagar Enjeti (January 21st 2017)

645 New York Times “Never Tweet” by Farhad Manjoo (January 23rd 2019)

646 The Week “How Twitter could be the death of liberal democracy” by Damon Linker (January 22nd 2019)

647 Ibid.

648 Ibid.

649 CBS

DFW “DART Officer Sues Social Media Giants Over 2016 Downtown Police Ambush” by Andrea Lucia (February 14th 2019)

650 The New York Times “Suspect in Dallas Attack Had Interest in Black Power Groups” by Jonathan Mahler and Julie Turkewitz (July 8th 2016)

651 NewsBusters.org “Twitter Bans Doxxing, But Why Are Antifa Accounts Still Active?” by Corinne Weaver (October 4th 2018)

652 Guardian “US secretly created ‘Cuban Twitter’ to stir unrest and undermine government” via Associated Press (April 3rd 2014)

653 Washington Post “Syrian refugee girl gets star treatment at the Oscars” by Christina Barron (March 5th 2018)

654 Washington Post “Market quavers after fake AP tweet says Obama was hurt in White House explosions” by Dina ElBoghdady (April 13th 2013)

655 Engaget “Twitter says 49 Russian accounts tried to sway Brexit voters” by Mallory Locklear (February 8th 2018)

656 The Washington Post “Inside Facebook and Twitter’s secret meetings with Trump aides and conservative leaders who say tech is biased” by Tony Romm (June 27th 2018)

657 Business Insider “Twitter CEO Jack Dorsey forced to apologize for eating Chick-fil-A during Pride Month” by Hayley Peterson (June 11th 2018)



658 Recode

“Full video: Twitter CEO Jack Dorsey and #BlackLivesMatter activist DeRay McKesson at Code 2016” by Recode Staff (June 8th 2016)

659 https://twitter.com/patyrossini/status/756329790907490304

660 https://twitter.com/RebekahKTromble/status/897792260821090304

661 https://twitter.com/tedlieu/status/1085901851927687168

662 The Sun “TWISTED TWITTER: Channel 4 doc shows kids get unlimited access to porn on social media sites” by Rod McPhee (July 2nd 2019)

663 It started as early as March 3rd 2019, and occurred every Sunday through at least September 1st 2019 when I was finalizing this manuscript to be sent off to the proofreader.

664 LawAndCrime.com “Twitter’s Lawyer Admits Hiding Tweets With ‘#DNCLeak’ And ‘#PodestaEmails’ Hashtags” by Colin Kalmbacher (November 2nd 2017)

665 Rolling Stone “Twitter CEO Jack Dorsey: The Rolling Stone Interview” by Brian Hiatt (January 23rd 2019)

666 Vice News “Twitter appears to have fixed ‘shadow ban’ of prominent Republicans like the RNC chair and Trump Jr.’s spokesman” by Alex Thompson (July 25th 2018)



667 Ibid.

668 Ibid.

669 The

Hill “Republican feels ‘victimized’ by Twitter ‘shadow banning’” by Juliegrace Brufke (July 25th 2018)

670 https://twitter.com/realDonaldTrump/status/1022447980408983552

671 https://twitter.com/jonathanvswan/status/1022175120373309441

672 Twitter official blog “Setting the record straight on shadow banning” by Vijaya Gadde and Kayvon Beykpour (July 26th 2018)

673 Project Veritas “UNDERCOVER VIDEO: Twitter Engineers To ‘Ban a Way of Talking’ Through ‘Shadow Banning,’ Algorithms to Censor Opposing Political Opinions” (January 11th 2018)

674 Ibid.

675 RealClear Politics “‘Project Veritas’ Hidden Camera: Twitter And Reddit Use ‘Shadow Ban’ Algorithms to Censor Political Opinions” by Tim Haines (January 12th 2018)

676 CNN - Interview with Jack Dorsey (August 19th 2018)

677 The

Telegraph “This, he said, is to promote more ‘healthy’ conversations” by Margi Murphy (October 29th 2018)

678 Daily Caller “Twitter Censors ‘The Federalist’ Co-Founder Over Lisa Page Tweet” by Amber Athey (March 18th 2019)

679 SearchEnginLand “Twitter as utility, like running water? That’s the goal, says CEO” by Pamela Parker (February 14th 2011)

680 Breitbart “Twitter CEO Jack Dorsey: Our Free Speech Motto Was a ‘Joke’” by Charlie Nash (October 18th 2018)

681 The Guardian “Milo Yiannopoulos, rightwing writer, permanently banned from Twitter” by Elle Hunt (July 20th 2016)

682 New York Times “Roger Stone Suspended From Twitter After Expletive-Laden Tweets” by Jacey Fortin (October 29th 2017)

683 BBC “Tommy Robinson banned from Twitter” (March 28th 2018)

684 Breitbart “Twitter Is Banning Conservatives for Posting Facts” by Allum Bokhari (May 9th 2018)

685 The Wrap “Twitter Drops ‘Britain First’ Leader and Other Alt-Right Accounts” by Sean Burch (December 18th 2017)

686 Politico “Troll Charles Johnson banned from Twitter” by Dylan Byers (May 26th 2015)



687 Ibid.

688 CNN

Special “State of Hate” (2019) hosted by Fareed Zakaria which includes an interview with Jared Taylor where he says this.

689 NBC News “Proud Boys founder Gavin McInnes sues Southern Poverty Law Center over hate group label” via Associated Press (February 4th 2019)

690 https://twitter.com/kenklippenstein/status/981359404875505669

691 The Laugh Button “Anthony Cumia’s Twitter account suspended, allegedly following a fight with an A.V. Club writer” (July 12th 2017)

692 JRE Clips Channel on YouTube “Twitter Exec Reviews Sargon of Akkad's Ban | JRE Twitter Special” Trust and Safety leader Vijaya Gadde talk with Joe Rogan and Tim Pool about Sargon’s ban (March 5th 2019)

693 Ibid.

694 The Daily Wire “Woman Forced To Close Business After Refusing To Wax Male Genitals Of Transgender Person” by Amanda Prestigiacomo (July 21st 2019)

695 Breitbart “Free Speech Activist Lindsay Shepherd Banned from Twitter for ‘Misgendering’” by Alana Mastrangelo (July 17th 2019)

696 The

Wrap “Right-Wing LA Street Artist Sabo Banned From Twitter” by Sean Burch (April 14 2018)

697 CNS News “CNN: ‘Dangerous’ ‘Fascist’ Trump ‘Threatening’ Our Lives With His WWE Tweet” (July 2nd 2017)

698 Washington Times “Twitter suspends Jack Posobiec’s @MAGAphobia account for tracking violence against Trump supporters” by Douglas Ernst (May 78th 2019)

699 Fox News “Twitter permanently suspends AOC parody account for being misleading” by Sam Dorman (May 7th 2019)

700 https://twitter.com/anastasiakeeley/status/1047930583777779714

701 Fox News “Kathy Griffin calls for doxing student’s identities after viral video at Native American march: ‘Shame them’” by Tyler McCarthy (January 21st 2019)

702 Newsbusters “Twitter Deletes Some Covington Threats, Ignores Others” by Alexander Hall (January 22nd 2019)

703 Politico “White House reports Peter Fonda tweet on Barron Trump to Secret Service” by Christopher Cadelago (June 20th 2018)

704 Breitbart “Twitter Allows Self-Proclaimed Pedophiles to Spread Their Message on Its Platform” by Charlie Nash (December 4th 2018)

705 http://archive.is/T9EUe

706 Daily

Mail “Twitter under fire from MPs and child safety campaigners for failing to block accounts used by paedophiles to discuss their sick cravings” by Abe Hawken (December 11th 2017)

707 NBC News “Laura Loomer banned from Twitter after criticizing Ilhan Omar” by Linda Givetash (November 22nd 2018)

708 Politico “Ilhan Omar apologizes after Pelosi denounces tweet as antiSemitic” by Melanie Zanona and Heather Caygle (February 11th 2019)

709 The Daily Caller “Ilhan Omar Blows Off Al-Qaeda, Mocks Americans For Fearing Them in Recently Surfaced Video” by Virginia Kruta (April 12th 2019)

710 National Review “Journalist Sues Twitter for Banning Her over ‘Women Aren’t Men’ Tweets” by Mairead Mcardle (February 11th 2019)

711 Breitbart “Twitter Blacklists Famed Gender Dysphoria Researcher Ray Blanchard” by Neil Munro (May 13th 2019)

712 Psychiatry.org “What Is Gender Dysphoria?” by the American Psychiatric Association

713 USA Today “Who is Anthony Rapp, the actor who accused Kevin Spacey of sexual harassment?” by Jayme Deerwester (October 30th 2017)

714 Associated

Press “Actor James Woods bashes Twitter after getting locked out” by Amy Forliti (September 2018)

715 Daily Caller “Twitter Issued GOP Candidate Temporary Ban Week Before Election” by Kyle Perisic (July 31st 2018)

716 Politico “Twitter pulls Blackburn Senate ad deemed ‘inflammatory’” by Kevin Robillard (October 9th 2018)

717 Hollywood Reporter “Anti-Abortion Movie’s Twitter Account Briefly Suspended” by Paul Bond and Katie Kilkenny (March 30th 2019)

718 The American Mirror “Twitter suspends user for calling Maxine Waters ‘crazy old lying lunatic in a bad wig’” by Kyle Olson (March 3rd 2018)

719 Daily Caller “Daily Caller editor in chief locked out of account for tweeting ‘learn to code’” by Amber Athey (February 6th 2019)

720 Joe Rogan Experience #1236 - Jack Dorsey (February 1st 2019)

721 NPR “Twitter Bans Alex Jones And InfoWars; Cites Abusive Behavior” by Avie Schneider (September 6th 2018)

722 CNN “Twitter says InfoWars hasn’t ‘violated our rules.’ It looks like that’s not the case” by Oliver Darcy (August 9th 2018)

723 CNBC “Twitter locks Mitch McConnell’s campaign account for tweet violating threats policy” by Marc Rod (August 8th 2019)



724 CBS

News “Twitter suspends Mitch McConnell’s campaign account after posting video of protesters threatening him” by Christopher Brito (August 8th 2019)

725 The Wrap “Twitter Reverses Mitch McConnell Suspension, Says Protest Video ‘Will Be Visible’” by Sean Burch and Lindsey Ellefson (August 9th 2019)

726 Breitbart “Twitter Verifies Sarah Jeong Without Making Her Delete Racist Posts” by Charlie Nash (August 16th 2018)

727 Project Veritas “Why James O’Keefe Isn’t Verified On Twitter” by Laura Loomer (September 1st 2016)

728 Twitter.com “Verified account FAQs

729 SF Gate “Here Are the 27 Advertisers David Hogg Convinced to Dump Laura Ingraham” by Brian Welk (April 13th 2018)

730 The Blaze “Twitter only invites anti-gun Parkland students to Q&A panel. Pro-gun student has perfect response” by Chris Enloe (March 18th 2018)

731 USA Today “Kyler Murray apologizes for homophobic tweets that resurfaced after he won Heisman Trophy” by Scott Gleeson (December 9th 2018)

732 USA

Today “Josh Hader apologizes for racist tweets, claims they ‘don’t reflect any of my beliefs now’” by Gabe Lacques (July 18th 2018)

733 NBC New York “Shawn Mendes Apologizes for Past ‘Racially Insensitive Comments’” by Corinne Heller (August 24th 2019)

734 New York Times Magazine “How One Stupid Tweet Blew Up Justine Sacco’s Life” by Jon Ronson (February 12th 2015)

735 ABC News “Justine Sacco, Fired After Tweet on AIDS in Africa, Issues Apology” by Kami Dimitrova, Shahriar Rahmanzadeh and Jane Lipman (December 22nd 2013)

736 Financial Times “Donald Trump: Without Twitter, I would not be here — FT interview” by Lionel Barber, Demetri Sevastopulo and Gillian Tett (April 2nd 2017)

737 New York Times “‘The Internet is Broken’ @ev Is Trying to Salvage It” by David Streitfeld (May 20th 2017)

738 SocialBlade.com - Detailed Statistics for the Mark Dice YouTube channel October 2016

739 https://twitter.com/zeynep/status/915608049141915648

740 Slate “YouTube Is Realizing It May Be Bad for All of Us” by Will Oremus (March 14th 2018)

741 Wired

“YouTube’s ditching vloggers, old-school celebs are back again” by Chris Stokel-Walker (May 8th 2018)

742 Polygon “YouTube is turning away from its creators to become a new MTV” by Julia Alexander (May 7th 2018)

743 Bloomberg “With 40 New Original Shows, YouTube Targets TV’s Breadbasket” by Lucas Shaw and Mark Bergen (May 4th 2017)

744 Vanity Fair “Why the Right’s Dark-Web Trolls Are Taking Over YouTube” by Maya Kosoff (March 1st 2018)

745 The New York Times “YouTube, the Great Radicalizer” by Zeynep Tufekci (March 10th 2018)

746 Ibid.

747 New York Times “For the New Far Right, YouTube Has Become the new Talk Radio” by John Herrman (August 3rd 2017)

748 Right Wing Watch “White Supremacy Figured Out How To Become YouTube Famous” by Jared Holt (October 2017)

749 USA Today “YouTube alters algorithm after searches for Las Vegas shooting turn up conspiracy theories” by Jessica Guynn (October 5th 2017)

750 Wall Street Journal “YouTube Tweaks Search Results as Las Vegas Conspiracy Theories Rise to Top” by Jack Nicas (October 5th 2017)



751 YouTube

Official Blog “An update on our commitment to fight terror content online” (August 1, 2017)

752 Fortune “YouTube Responds to Criticism After Unverified Texas Shooting Reports Top Search Results” by Tom Huddleston Jr. (November 6th 2017)

753 Ibid.

754 https://twitter.com/chrislhayes/status/1037831504158646272

755 Mother Jones “Political Extremists are using YouTube to monetize their toxic ideas” by Tonya Riley (September 18th 2018)

756 Ibid.

757 “Why Social Justice is CANCER | Identity Politics, Equality & Marxism” by Lauren Chen (July 24th 2017)

758 The video, which is an hour and a half long, is titled “Century of Enslavement: The History of the Federal Reserve” posted by the CorbettReport channel on July 6th 2014 and has nearly 2 million views.

759 While the YouTube video is titled “Exposing the Federal Reserve” the video itself is actually the film “The American Dream” by Tad Lumpkin and Harold Uhl

760 Breitbart

“New Whistleblower Allegation: YouTube Manipulated ‘Federal Reserve’ Search Results In Response to MSNBC Host’s Complaint” by Allum Bokhari (July 30th 2019)

761 SocialBlade.com Detailed Statistics for MSNBC, NBC News, CBS News, and Fox News’ YouTube channels.

762 Slate “YouTube’s Search Results for “Abortion” Show Exactly What Anti-Abortion Activists Want Women to See” by April Glaser (December 21st 2018)

763 National Review “YouTube Changed ‘Abortion’ Search Results after a Slate Writer Complained” by Sanda Desanctis (December 22nd 2018)

764 Breitbart “THE SMOKING GUN: Google Manipulated YouTube Search Results for Abortion, Maxine Waters, David Hogg” by Allum Bokhari (January 16th 2019)

765 Ibid.

766 The Verge “YouTube fought Brie Larson trolls by changing its search algorithm” by Julia Alexander (March 8th 2019)

767 https://twitter.com/loudmouthjulia/status/1103730622281994240

768 The Verge “YouTube fought Brie Larson trolls by changing its search algorithm” by Julia Alexander (March 8th 2019)

769 CNBC

“Facebook, YouTube and Twitter go to extraordinary lengths to take down mosque massacre videos” by Lauren Feiner (March 18th 2019)

770 Wall Street Journal “How YouTube Drives People to the Internet’s Darkest Corners” by Jack Nicas (February 7th 2018)

771 Ibid.

772 CNN “YouTube says it will crack down on recommending conspiracy videos” by Kaya Yurieff (January 25th 2019)

773 NBC “YouTube search results for A-list celebrities hijacked by conspiracy theorists” by Ben Collins (July 30th 2018)

774 YouTube Official Blog (January 25th 2019)

775 Ibid.

776 Mercury News “Is Donald Trump Jr. promoting a Jussie Smollett conspiracy theory?” by Martha Ross (February 1st 2019)

777 NBC News “YouTube announces it will no longer recommend conspiracy videos” by Kalhan Rosenblatt (February 10th 2019)

778 YouTube Help “Harassment and cyberbullying policy”

779 The Guardian “YouTube's ‘alternative influence network’ breeds rightwing radicalisation, report finds” by Olivia Solon (September 18th

2018)

780 The Alternative Influence Network on YouTube by Rebecca Lewis page 10

781 The Alternative Influence Network on YouTube by Rebecca Lewis page 44

782 Mother Jones “Political Extremists Are Using YouTube to Monetize Their Toxic Ideas” by Tonya Riley (September 18th 2018)

783 Ibid.

784 Digital Social Contract “YouTube stops recommending alt-right channels” by Nicolas Suzor (February 27th 2019)

785 Ibid.

786 The Washingtonian “83 Percent of Anti-Semitic Tweets Against Journalists Targeted Just Ten People” by Benjamin Freed (October 19th 2016)

787 Daily Caller “EXCLUSIVE: YouTube Secretly Using Southern Poverty Law Center To Police Videos” by Peter Hasson (February 27th 2018)

788 US News & World Report “State: Man in Church Shooting Aimed to Kill 10 White People” by Associated Press (May 20th 2019)

789 https://twitter.com/RealCandaceO/status/903027170460803072

790 YouTube

“High Impact Vlogs” channel “The Two Videos YouTube Didn’t Want You To See! (December 1st 2018) The original video titled “ABC Just Promoted Something SO DISGUSTING & DISTURBING You Won’t Believe It…Or Will You?” can be seen on BitChute here: https://www.bitchute.com/video/_1uEOgN41CU/ (Published November 26th 2018 on the HighImpactFlix BitChute channel.)

791 Washington Times “Ga. gubernatorial candidate’s ‘Deportation Bus’ ad deemed ‘hate speech,’ removed from YouTube” via Associated Press (May 16th 2018)

792 The Independent “Tommy Robinson’s YouTube videos restricted after internet giant refuses to delete channel” by Lizzie Dearden (April 2nd 2019)

793 Hunter Avvalone YouTube Channel “I Got Banned!” (April 10th 2019)

794 TubeFilter.com “Conservative Organization PragerU Sues YouTube Over Alleged Censorship Of Conservative Voices” by Sam Gutelle (October 24th 2017)

795 Breitbart “YouTube is Shutting Down Conservative Criticism of CNN over Parkland Shooting” by Allum Nokhari and Charlie Nash (February 28th 2018)

796 Gateway Pundit “YouTube Deletes Popular Journalist’s Video Criticizing the Media Over Falling for 4Chan Florida Shooter Hoax” by

Cassandra Fairbanks (February 17th 2018)

797 Gizmodo “YouTube’s New Moderation Team Stumbles Out the Gate” by Tom McKay (February 28th 2018)

798 Bloomberg “YouTube’s New Moderators Mistakenly Pull Right-Wing Channels” by Mark Bergen (February 28th 2018)

799 Variety “YouTuber Temporarily Suspended For Video of Suffragette Killing in ‘Red Dead 2’” by Stefanie Fogel (November 8th 2018)

800 The Verge “YouTube reverses ban for streamer who killed Red Dead 2 feminist” by Patricia Hernandez (November 8th 2018)

801 PJ Media "YouTube Deplatforms Retired Navy SEAL Who Exposed Tribal Elder Nathan Phillips’ Stolen Valor” by Debra Heine (February 26th 2019)

802 Politifact “Why Infowars’ Alex Jones was banned from Apple, Facebook, Youtube and Spotify” by Manuela Tobias (August 7th 2018)

803 https://www.bitchute.com/video/WtAHuu0ycCY/

804 Infowars.com “Watch These Videos YouTube Doesn’t Want You To See” (July 25th 2018)

805 Tech Crunch “Here are the platforms that have banned Infowars so far” by Sarah Wells (August 8th 2018)



806 The

video is still available to watch on Infowars.com, which hosts it and the other videos that led to the YouTube ban here: https://www.infowars.com/watch-these-videos-youtube-doesnt-want-youto-see/

807 Engadget “YouTube removes Alex Jones’ official channel for violating guidelines” by Kris Hold (August 6th 2018)

808 https://twitter.com/h3h3productions/status/1028047008144080896

809 H3 Podcast #77 “Alex Jones Stream Shut Down” (August 11th 2018)

810 BuzzFeed “YouTube’s Newest Far-Right, Foul-Mouthed, Red-Pilling Star Is A 14-Year-Old Girl” by Joseph Bernstein (May 13th 2019)

811 https://twitter.com/Bernstein/status/1128308490047561728

812 ReClaimTheNet.org “YouTube censors 14-year-old creator Soph after BuzzFeed hit piece” by Tom Parker (May 14th 2019)

813 https://twitter.com/sewernugget/status/1131340929720147968

814 ReclaimTheNet.org “YouTube deletes Soph’s channel after her latest video was removed for ‘hate speech’ by Tom Parker (August 1st 2019) The video which caused the strike is titled “Pride & Prejudice” and can be seen on her BitChute channel here: https://www.bitchute.com/video/FNqiV8kL4cc/



815 Project

Veritas “Insider Blows Whistle & Exec Reveals Google Plan to Prevent ‘Trump situation’ in 2020 on Hidden Cam” by Staff (June 24th 2019)

816 CNN’s YouTube Channel “Some Americans unwittingly helped Russian trolls” (February 21st 2018)

817 Identitarianism is a right-wing political ideology whose supporters believe European people are entitled to preserve their own cultures and territories, instead of becoming “melting pots” due to massive immigration from countries of other races.

818 Media Matters “YouTube banned Alex Jones, but it’s letting white supremacist content thrive” by Madeline Peltz and Talia Lavin (November 5th 2018)

819 Recode.net “Full Q&A: YouTube CEO Susan Wojcicki talks about child safety, the Google walkout, and AI on Recode Decode” by Eric Johnson (March 11th 2019)

820 Ibid.

821 AdWeek “The Google News Initiative Is Putting $25 Million Toward Fighting Fake News on YouTube” by David Cohen (July 10th 2018)

822 YouTube official blog “Building a better news experience on YouTube together” (July 9th 2018)



823 Politico

“Buddy Roemer firm invests $4 million in Young Turks Network” by Hadas Gold (April 16th 2014)

824 Business Insider “Progressive media outlet The Young Turks has raised $20 million in venture-capital funding and plans to double its staff” by Maxwell Tani (August 8th 2017)

825 Encyclopedia of Human Rights by David Forsythe page 98 Oxford University Press

826 TYT Network “Rescinding Daily Pennsylvanian Article” by Cenk Uygur (April 22nd 2016)

827 The Young Turks “Germany Acknowledges The Genocide” By Ana Kasperian on official YouTube channel (June 2, 2016) Around 3:20 timestamp in the video.

828 The Young Turks “People Don’t Trust Foreign Accents — Study” via The Young Turks YouTube channel (October 28th 2010) at the :20 mark, Ana explains she grew up speaking only Armenian.

829 Paste “Why Cenk Uygur Is Getting Confronted about the Name ‘The Young Turks,’ and Why It Matters” by Monica Hunter-Hart (January 5th 2017)

830 https://twitter.com/SusanWojcicki/status/890654400192028672

831 Washington

Times “Young Turks host Hasan Piker mocks Dan Crenshaw’s war injury, says ‘America deserved 9/11’” by Jessica Chasmar (August 22nd 2019)

832 Ibid.

833 The Verge “YouTube is investing $5 million in creators who ‘counter hate and promote tolerance’” by Lizzie Plaugic (January 24th 2018)

834 Vox “YouTube’s 2018 ‘Rewind’ is the site’s most disliked video ever. The implications are huge.” by Aja Romano (December 14th 2018)

835 The Verge “YouTube wants ‘dislike mobs’ to stop weaponizing the dislike button” by Julia Alexander (February 1st 2019)

836 Los Angeles Times “Hey, star-struck. Making it on YouTube isn’t easier than making it in on the silver screen” by Chris Stokel-Walker (February 28th 2018)

837 Bloomberg “Success on YouTube still means a life of poverty. 96% won’t crack the poverty line” by Chris Stokel-Walker (February 26th 2018)

838 BuzzFeed “YouTube Says Tommy Robinson Will No Longer Be Able To Make Money From His Videos” by Mark Di Stefano (January 17th 2019)

839 BigLeaguePolitics “Count Dankula Demonetized on YouTube After Buzzfeed Hit Piece” by Tom Pappert (January 18th 2019)



840 BuzzFeed

“YouTube Has Downgraded Carl Benjamin’s Sargon Of Akkad Account After He Talked About Raping A British MP” by Mark Di Stefano (May 10th 2019)

841 Fox News “YouTube ends monetization of conservative commentator Steven Crowder’s channel, several others after left-wing outrage” by Gregg R (June 5th 2019)

842 Just a few of them include Jesse Lee Peterson, Press For Truth, Ford Fischer, Mr. Allsop History, SinatraSays, and many others.

843 New York Times “The Making of a YouTube Radical” by Kevin Roose (June 8th 2019)

844 CNN “It’s YouTube’s time in the hot seat” by Seth Fiegerman (June 11th 2019)

845 CNN “Former alt-right follower calls radicalization a health crisis” posted on their YouTube channel (June 12th 2019)

846 CNN “Trump invites right-wing extremists to White House ‘social media summit’” by Oliver Darcy (July 11th 2019)

847 White House Official Transcript “Remarks by President Trump at the Presidential Social Media Summit” (July 11th 2019)

848 BuzzFeed

“How YouTube’s ‘Super Chat’ System Is Pushing Video Creators Toward More Extreme Content” by Ishmael N. Daro and Craig Silverman (May 17th 2018)

849 Wall Street Journal “Hate Speech on Live ‘Super Chats’ Tests YouTube” by Yoree Koh (November 2nd 2018)

850 WhatsTrending “Killstream is KICKED OFF YouTube For Hate Speech SuperChat” by Alex Firer (November 6th 2018)

851 BuzzFeed “Right-Wing YouTubers Think It’s Only A Matter Of Time Before They Get Kicked Off The Site” by Ishmael N. Daro (April 18th 2018)

852 Polygon “YouTube networks drop thousands of creators as YouTube policy shifts” by Julia Alexander (April 24th 2018)

853 https://twitter.com/ChiefCanuck/status/984921575471251456

854 TubeFilter “YouTube On ‘Play Button’ Awards: “Not All Creators Who Apply Will Receive Awards” by Geoff Weiss (February 6th 2018)

855 YouTube “Lauren Southern Becomes a Man” by Rebel Media (October 3rd 2016)

856 The Rubin Report “Patreon CEO Jack Conte: Lauren Southern, IGD, and Free Speech (Live Interview)” (July 31st 2017)

857 Ibid.

858 Business

Insider “Crowdfunding platform Patreon defends itself from protests by ‘intellectual dark web,’ publishes slur-filled posts from banned YouTuber” by Benjamin Goggin (December 18th 2018)

859 Breitbart “Stripe, PayPal, Patreon: The Right Is Being Banned from Online Fundraising” by Allum Bokhari (July 24th 2018)

860 ReclaimTheNet.org “Patreon suspends Soph’s account one day after YouTube deleted her channel” by Tom Parker (August 2nd 2019)

861 Breitbart “Patreon tolerates calls for violence from leftists while demonetizing conservatives” by Allum Bokhari (December 15th 2018)

862 Ibid.

863 Ibid

864 https://twitter.com/Patreon/status/1070446085787668480

865 Breitbart “Mastercard Forces Patreon to Kick Off Jihad Watch’s Robert Spencer” by Charlie Nash (August 15th 2018)

866 USA Today “Forget astronaut: YouTube is a more intriguing work frontier than space for today’s kids” by Dalvin Brown (July 18th 2019)

867 CNBC

“YouTube’s bet against big cable announces nationwide expansion” by Jillian D’Onfro (January 23rd 2019)

868 The Verge “The golden age of YouTube is over” by Julia Alexander (April 5th 2019)

869 Ibid.

870 Hollywood Reporter “R. Lee Ermey and John Wayne Shared Screen Time Together — Kind of” by Ryan Parker (April 15th 2018)

871 Hollywood Reporter “How ‘Furious 7’ Brought the Late Paul Walker Back to Life” by Carolyn Giardina (December 11th 2015)

872 The Hill “‘Obama’ voiced by Jordan Peele in PSA video warning about fake videos” by Morgan Gstalter (April 17th 2018)

873 Standford.edu “Face2Face: Real-time Face Capture and Reenactment of RGB Videos”

874 UW News “Lip-syncing Obama: New tools turn audio clips into realistic video” by Jennifer Langston (July 11th 2017)

875 Washington Post “Here are the tools that could be used to create the fake news of the future” by Philip Bump (February 12th 2018)

876 Fortune “What Is a Deepfake? Let This Unsettling Video of Jennifer Lawrence With Steve Buscemi’s Face Show You” by Kevin Kelleher

(February 1st 2019)

877 Time “Here’s Steve Buscemi’s Reaction to That Haunting Fake Jennifer Lawrence Mashup Video” by Melissa Locker (February 7th 2019)

878 CNET “Deepfake video of Facebook CEO Mark Zuckerberg posted on Instagram” by Queenie Wong (June 11th 2019)

879 CBS News “CBS News asks Facebook to remove ‘deepfake’ video of Mark Zuckerberg with unauthorized CBSN trademark” by Lex Haris (June 12th 2019)

880 PC Magazine “Facebook Declines to Delete Fake Zuckerberg Video” by Michael Kan (June 11th 2019)

881 Tech Dirt “Kim Kardashian Deep Fake Video Removed By Copyright Claim” by Timothy Geigner (June 19th 2019)

882 The Verge “Pornhub is the latest platform to ban AI-generated ‘deepfakes’ porn” by Adi Robertson (February 6th 2018)

883 CNET “Reddit cracks down on ‘deepfake’ pornography” by Erin Carson (February 7th 2018)

884 Wired “Yes people can put your face on porn, no the law can’t help you” by Emma Grey Ellis (January 1st 26th 2018)

885 Engadget

“AI-powered face swapping has taken a dystopian turn” by Richard Lawler (January 26th 2018)

886 The Washington Post “CIA unit’s wacky idea: Depict Saddam as gay” by Jeff Stein (May 25th 2010)

887 The Telegraph “CIA considered faking Saddam Hussein sex video” by Toby Harnden (May 26th 2010)

888 BBC “The sexually abused dancing boys of Afghanistan” by Rustam Qobil (September 8th 2010)

889 The New York Times “U.S. Soldiers Told to Ignore Sexual Abuse of Boys by Afghan Allies” by Joseph Goldstein (September 20th 2015)

890 The Verge “Nvidia uses AI to make it snow on streets that are always sunny” by James Vincent (December 5th 2017)

891 Ibid.

892 CNET “This website uses AI to generate startling fake human faces” by Jackson Ryan (February 14th 2019)

893 BBC “Adobe Voco ‘Photoshop-for-voice’ causes concern” November 7th 2016)

894 Ibid.

895 Ibid.

896 Medium

“RealTalk: This Speech Synthesis Model Our Engineers Built Recreates a Human Voice Perfectly” by Dessa (May 15th 2019)

897 Ibid.

898 Ibid.

899 Ibid.

900 Ibid.

901 The Belfer Center for Science and International Affairs - Artificial Intelligence and National Security by Greg Allen and Taniel Chan (July 2017) page 30

902 Wired “AI Will Make Forging Anything Entirely Too Easy” by Greg Allen (July 1st 2017)

903 Ibid.

904 The Belfer Center for Science and International Affairs - Artificial Intelligence and National Security by Greg Allen and Taniel Chan (July 2017) page 31

905 Ibid.

906 USA

Today “Too scary? Elon Musk’s OpenAI company won’t release tech that can generate fake news” by Edward C. Baig (February 15th 2019)

907 MIT Technological Review “Fake News 2.0: personalized, optimized, and even harder to stop” by Will Knight (March 27th 2018)

908 Scientific America “Could AI Be the Future of Fake News and Product Reviews?” by Larry Greenemeier (October 16th 2017)

909 Ibid.

910 Observer “Spies Suspect Kremlin Is Pushing Dozens of Fake Trump Sex Tapes” by John R. Schindler (November 9th 2017)

911 New York Post “Russian offered to send prostitutes to Trump’s hotel room” by Mark Moore (November 9th 2017)

912 New York Daily News “Ex-Trump bodyguard testifies Russian operative offered to ‘send five women’ to future President’s hotel room” by Leonard Greene (November 9th 2017)

913 Brainy Quote - Winston Churchill

914 AZQuotes.com - Joseph Sobran Quotes

Insights on Mark Dice's The Bohemian Grove

Contents Insights from Chapter 1 Insights from Chapter 2 Insights from Chapter 3 Insights from Chapter 4 Insights from Chapter 5 Insights from Chapter 6 Insights from Chapter 7 Insights from Chapter 8 Insights from Chapter 9 Insights from Chapter 10 Insights from Chapter 11

Insights from Chapter 1



#1

The Bohemian Club is a club for artists, musicians, and writers that was established in San Francisco in 1872. It soon took a more rural turn, and by the early 1880s, the Bohemian Club was holding weekend campouts in the vast redwood forests around Sonoma County, California.

#2

The 2013 records show that the club took in $10,168,330 in revenue that year. They paid out $3,007,779 in salaries to the staff, and other expenses were listed at $2,971,656, which went to pay for the food, booze, insurance, electricity, building maintenance, etc. Their total expenses for the year were $5,997,272.

#3

The Bohemian Club, a club that hosts the Bohemian Grove, was sued for discrimination in 1978 by the Department of Fair Employment and Housing. The court ruled in favor of the club in 1981, but the feminists did not give up and continued to pursue the case.

#4

The Bohemian Grove, along with men’s country clubs, are able to turn down people of the opposite sex for membership without being sued for discrimination because these clubs are considered private, not public.

Insights from Chapter 2



#1

The Bohemian Grove’s mascot is an owl, or more specifically, the Owl of Minerva, who is the Goddess of wisdom. The Dictionary of Symbols says, In the Egyptian system of hieroglyphs, the owl symbolizes death, night, cold and passivity. It also pertains to the realm of the dead sun, that is, of the sun which has set below the horizon and which is crossing the lake or sea of darkness.

#2

A patron saint is someone who embodies a group’s philosophies or goals, and for the Bohemian Grove this is Saint John of Nepomuk. He was a priest who received the confessionals of the queen of Bohemia in the 1300s, and when pressured by the king to reveal her confessions, he refused and was then killed by the king.

#3

The Bohemian Grove’s motto is Weaving spiders come not here, which is said to mean that members and guests are not supposed to conduct business inside the Grove.

#4

The big secret of the Illuminati is that they believe that Satan is not bad, but came to earth to free mankind from enslavement by the Creator. They believe that God was a tyrant who did not want humans to eat from the Tree of Knowledge of Good and Evil.



#5

The ruling class wants to evolve into Gods, and they believe that through the ancient secret and the emerging science of Transhumanism, they will achieve this.

Insights from Chapter 3



#1

Inside the Bohemian Grove, there are 124 different camps, each managed by a camp captain. Each camp has its own unique name and consists of anywhere from a dozen to one hundred men who work in the same field to provide networking opportunities.

#2

The Bohemian Club and the Bohemian Grove are two of the most exclusive and influential clubs in the world. They have been known to select politicians and other powerful people for their favor.

Insights from Chapter 4



#1

The Bilderberg Group, which has been meeting annually for the past sixty years, is a human sacrifice ritual where an effigy called Care is burned on an altar. The men chant No fire, no fire, no fire. Let it be kindled in the world where Care is nourished on the hates of men, and drive him from this Grove.

#2

The Bohemian Grove, a secretive San Francisco club, is where the ceremony depicted in the photos takes place. It’s one thing to read about the ceremony, or see the photos, but the video leaves you with your head shaking. It seems that some kind of bizarre secret ritual takes place there.

#3

In 2004, National Geographic magazine published a photo taken during a Cremation of Care ritual in 1915. The caption said, To purge himself of worldly concerns, a member of the elite Bohemian Club participated in a 1915 Cremation of Care ceremony.

#4

The Bible describes Molech sacrifices in detail, and explicitly condemns them as evil. It states that anyone from the Israelites or the foreigners who live in Israel who gives one of his children to Molech must be put to death.

#5

The symphonic poem The Isle of the Dead by Russian composer Sergie Vasilyevich Rachmaninoff tells the tale of a ghostly ferryman who transports the dead in his small rowboat, as it moves slowly across the calm dark water. The symphony was inspired by Swiss artist Arnold Böcklin’s famous Isle of the Dead painting.

#6

Presidential advisor David Gergen resigned from the Bohemian Club, three days after saying he would not run around naked at its annual Bohemian Grove encampment, and insisting he would not quit. He also resigned from the Bilderberg Group, the Council on Foreign Relations, and nearly all organizations dedicated to setting up a New World Order.

#7

The anchor for the CBS Evening News from 1962 to 1981, Walter Cronkite, is believed to have recorded the voice for the Owl Shrine that is played over the loudspeakers during part of the Cremation of Care.

Insights from Chapter 5



#1

The Bohemian Grove is a two-week-long annual gathering of the most powerful men in the world. The speakers mainly discuss political, economic, and business trends, and occasionally include information that is not publicly disclosed.

#2

The Bohemian Grove is a camp that members of the elite go to every summer. It is rumored that Bill O’Reilly and Glenn Beck were there as guests or possibly speakers in 2013 because they were both missing from their usual schedules at some point in time.

#3

The camp had four sessions: Jeffrey Toobin on the Supreme Court, David Martin on the Obama administration, Michail Armacost on China, and Arthur Laffer on economics.

#4

The summit was held on July 14-21, 2018. The topics of the talks were as follows: Friday, July 14: Global Financial Warriors by John Taylor, professor of economics at Stanford University. Monday, July 17: Untold Tales from the Cold War by Tom Reed, former Secretary of the Air Force.

#5



The Grove hosts many talks, but for the most part, they keep them secret. The only thing that is announced ahead of time is the speaker.

#6

The program was hosted by Charles Elachi, director of the Jet Propulsion Lab at the California Institute of Technology. The topics were: exploring Mars and searching for life in the universe, the landscape of American politics, the elections and their aftermath, state building, and the unrealized potential of the technological revolution.

#7

The festival had a wide variety of speakers and topics, from Yurek Martin, senior writer at the Financial Times of London, to Donald Rumsfeld, member of Nixon cabinet and future Secretary of Defense in the George W. Bush administration.

Insights from Chapter 6



#1

In 1980, a local resident named Mary Moore founded the Bohemian Grove Action Network with the purpose of infiltrating the Grove by having people obtain summer jobs there or by convincing those who already worked there to steal membership lists, program guides, and other information.

#2

In July of 2000, radio talk show host Alex Jones infiltrated the Bohemian Grove and videotaped the Cremation of Care ritual. He cut a hole in the side of a shoulder bag and mounted a camcorder inside, and sat in the bleachers with the rest of the approximately 1500 members and guests. He was accompanied by his thenproducer Mike Hanson.

#3

The Bohemian Grove, a redwood grove in Sonoma County north of San Francisco, is where the wealthy and well-placed gather every summer to socialize, lecture, and conduct rituals away from public scrutiny.

#4

In January 2002, a 37-year-old man named Richard McCaslin snuck into the Grove wearing a superhero outfit, a bulletproof vest, and armed with a fully loaded MK-1 rifle-shotgun. He was there to expose the ritualistic human sacrifices happening there.



#5

In 2005, Chris Jones, a man in his late thirties, got a job at the Bohemian Grove to gather photos and video evidence of what happens inside. He was able to get photos of some of the camps and elaborate clubhouses, as well as some close-up pictures of the site of the Cremation of Care ritual.

#6

The Bohemian Club, a secret society that’s been operating in California since the United States was founded, has been accused of cutting down some trees to prevent forest fires. However, this isn’t actually illegal.

#7

Guccifer, an anti-Illuminati hacker, accessed the emails of various Clinton, Bush, and Obama administration officials, including George W. Bush’s sister’s email where he found family photos.

Insights from Chapter 7



#1

The Bohemian Grove, which is a resort and campground located near San Francisco, is known for its homosexual activities. In 1989, reporter Philip Weiss snuck into the Grove and wrote a lengthy article about the rampant homosexuality there.

#2

It has been rumored that the Mitchell Brothers O’Farrell Theatre in San Francisco’s Tenderloin district has been a source of strippers and high-class call girls used by the Bohemians.

Insights from Chapter 8



#1

The Bohemian Grove, which is a club for the world’s richest and most powerful men, is also said to have performed a human sacrifice. These rumors involve claims of horrific sadistic acts that involve the sexual abuse of children and the production of snuff films.

#2

Around this same time, the Washington Times ran a front page story detailing a gay prostitution ring operating in Washington D. C. that provided teen call-boys to some very powerful and well-connected men. The article quietly went away, and has been forgotten by most Americans.

#3

The Guardian reported, Two newspaper executives have told the Observer that their publications were issued with D-notices – warnings not to publish intelligence that might damage national security – when they sought to report on allegations of a powerful group of men engaging in child sex abuse in 1984.

#4

The world’s lust for realistic and brutal horror movies shows that millions of people find excitement in watching people getting tortured and murdered. It's not hard to believe that some people would pay money to witness an actual murder in person.



#5

Hunter S. Thompson, a journalist known for his work with the Hells Angels, was also connected to the Bohemian Grove, where he allegedly propositioned a man to shoot a snuff film involving the murder of a child.

#6

Hunter S. Thompson’s former editorial assistant, Nickole Brown, posted an article online in 2005 recounting some of the bizarre behavior she had witnessed while working for him. She said he had thrown her out of the house for refusing to watch a snuff film.

#7

Sex magic is the belief and practice of generating sexual energy and directing it to shape the fabric of reality. It is similar to the Law of Attraction, but with sex. The Knights Templars, who learned about sex magic from the Tantrics of India, practiced it.

#8

Sex magic is not just a myth, and it is not just a fringe element of the occult. It is real, and it is disgusting. It involves taking a woman’s menstrual blood and a man’s semen, and then mixing them together and baking the fluids into cookies or a cake. Then you eat it.

#9

The author Cathy O’Brien, who wrote a book about her experiences with the Illuminati, claims that the Bohemian Grove has a Necrophilia theme room. In reality, only a small fraction of the members could possibly be so evil as to enjoy such things and no informants, guests, members or employees have ever mentioned such a thing.

#10

O’Brien claims that some of her abusers were George H. W. Bush, Ronald Reagan, Gerald Ford, Jimmy Carter, Dick Cheney, and Hillary Clinton, who she said performed oral sex on her on front of Bill. Yet, her CIA handlers decided to let her live to tell about it.

Insights from Chapter 9



#1

I used to try and get on the radio to question the hosts about Bohemian Grove, but every time I would get through to the call screener, they would hang up on me immediately as soon as I told them I had a question about Bohemian Grove.

#2

Bill O’Reilly, the host of the radio show, would take call after call on any topic. He would even hang up on people if their questions were off topic. I could understand if my question was irrelevant, but this was the segment where O’Reilly said, You can ask me whatever you want.

#3

Hannity: You are a kook. You are a nut. You are absolutely out of your mind insane. I’ve never been to the Bohemian Grove, sir. It’s just a great conspiracy.

#4

The Bohemian Grove is a club composed of elitist politicians and journalists who conduct secret meetings to take over the world. They run around naked, and no women are allowed.

#5

On the Savage Nation, I asked Savage about the Bohemian Grove and George W. Bush’s and Bush 41’s membership. He was skeptical at first, but did listen to me. When I told him that senator John DeCamp alleged that there were mock funerals there, he said, Well, that’s what everyone goes to the Bohemian Grove for.

#6

I once called Glenn Beck and asked him about the book The Resistance Manifesto. He replied by saying that I might have just gotten that entire show taken off the air because of me. I was promptly taken off the air.

#7

I was on the phone with Fox News host Tucker Colmes, who was asked about the Bohemian Grove and the Republican elite’s annual mock human sacrifice. He said he didn’t know anything about it, and quickly dropped the call.

#8

The Friday night free for all is where you set the agenda, you run the show, and you determine what we talk about. We cannot keep callers off the air as much as we would like to in some cases.

#9

I have continued to try to get onto the show as a guest. You are a phony and a fraud, and I am not going to put you on the air as a guest. It is not going to happen. That's that guy, anyway.

Insights from Chapter 10



#1

The Belizean Grove, a female-only retreat, was started in 2001 by Susan Stautberg, the president of PartnerCom Corporation, who gathered around 100 influential women to fly down to Belize and meet up every year for three days of balanced fun and bonding.

#2

The Belizean Grove is a all-female club that was founded in 2009 after Sonia Sotomayor was nominated for a position on the Supreme Court by President Barack Obama. It has been revealed that Republicans dug up dirt on Sotomayor and found that she was a member of this club, which supposedly discriminates against men.

Insights from Chapter 11



#1

The film Eyes Wide Shut is based on real events, and it has been suggested that the Bohemian Grove or the Illuminati sex orgies occur at the private parties of the ruling elite. The Killing Kittens club has popped up in recent years to hold Eyes Wide Shut themed parties in rented mansions.

#2

The world of politics and Hollywood is full of sex offenders and deviants, who regularly host secret orgies. It shouldn’t be much of a surprise that Eyes Wide Shut-type parties occur.

#3

South Park is a show that makes fun of pop culture figures, politicians, and religious beliefs. It is often distasteful and crude, but it is still funny. The use of the disclaimer This is what Mormons/ Scientologists believe was included in an episode about the Super Adventure Club, an organization of pedophiles who travel around the world to have sex with young boys.

#4

The man who did the voice for Mr. Burns on The Simpsons, Harry Shearer, wrote and directed a little known film that was a spoof on the Bohemian Grove. Shearer labeled the members of Bohemian Grove white Christians, and didn’t believe their activities were secret.



#5

Shearer is just one example of how many Hollywood actors are extremely wealthy. He was paid $400,000 per episode in 2008, but had to take a pay cut in 2013 to lower production costs of the show or else Fox was going to cancel it.

#6

The Turner Broadcasting Network, which owns the Cartoon Network, airs cartoons aimed at children. But after primetime, when most children are supposed to be in bed, the network changes its format to what they call Adult Swim and airs raunchy cartoons supposedly aimed at adults.

End of Insights. Thank you for reading.

Introduction

It sounds like the plot of a cheesy horror film; a group of the world’s most powerful men gather in a secluded forest once a year where they dress in black robes and perform a strange ceremony looking like a human sacrifice as they discuss their plans for world domination—but in this case it’s not the story in some movie, it’s the story of the Bohemian Grove.

Many people interested in “conspiracy theories” about the Illuminati and the New World Order have heard of the Bohemian Grove and probably know a few things about it, and if you’re one of these people, I promise this book will be packed with information and little-known details that few people have ever heard. It’s a story so bizarre, that many simply can’t believe it.

You are about to learn the hidden history, the strange rituals, and the secrets of one of the world’s most exclusive clubs. I will reveal the identity of their most powerful members and details of the over 100 different subgroups within and what world-changing ideas and events the Bohemian Grove has given birth to. I’ll cover what they call Lakeside Talks which are off the record speeches given by elite politicians and business titans to members in order to give them inside information about the speakers’ area of expertise. I will reveal the secret meaning of their motto, “weaving spiders come not here,” and the name of their patron saint and what he symbolizes. I’ll cover early investigations into the club and the leaks of their membership lists, maps, and year books; I will even reveal their tax returns and financial statements, and show you how we know what we know about this mysterious millionaires men’s retreat.

I will analyze the allegations of prostitutes servicing the members, and the gay orgies that are rumored to occur inside. I’ll also take a close look at the horrific allegations of murders and snuff films some say have occurred

inside the forest at the hands of members; and you’ll see why major talk radio hosts and the mainstream media are afraid to acknowledge the place even exists.

The Bohemian Grove is a 2700-acre redwood forest in northern California located about an hour north of San Francisco in a small town named Monte Rio. It is owned by the Bohemian Club, which is headquartered in San Francisco, and their forest—or “the Grove,” as it is called—serves as a vacation spot for around 1000 of the world’s most wealthy and powerful men who meet there every summer in the middle of July for a “men’s retreat.”

Every summer it’s common for both boys and girls to have retreats in the form of basketball camp or cheerleading camp, where the kids spend a week or so polishing their skills and going through various drills to improve their game. Of course, many Christian churches have annual men’s and women’s retreats which facilitate friendship and camaraderie among their church members, and the events also serve to further the attendees’ education on spiritual matters.

So, similarly, the Superclass, the Establishment, the Ruling Elite, the Illuminati—whatever name you want to call them—have their retreat as well, which serves as a place to rub elbows with other industry leaders and powerful politicians in a private, relaxed, and informal environment.

The annual mid-summer encampment at the Bohemian Grove has been called the “greatest men’s party on earth” by members, who include many presidents, military leaders, famous journalists, and top businessmen who enjoy getting away from their wives and the public eye for a bit to let loose and mingle with other like-minded individuals. The gathering lasts for two weeks from mid-July to the end of the month, with some men coming for a weekend, and others staying for an entire week or longer. The men call each other Bohos or Grovers, and members often bring guests with them, but they must be prescreened and approved beforehand by the club.



The term Bohemian refers to people who live non-traditional lifestyles and people who are adventurers, or vagabonds. Ever since it was started, the club’s logo has been an owl because it symbolizes wisdom since it can “see in the dark.” This is because the elite members view themselves as wise and enlightened beings. A forty-foot tall concrete “owl” shrine was constructed inside the Bohemian forest, and every year since 1929 has been the site of the annual Cremation of Care ceremony, one of the strangest aspects of this elite retreat. This is the ritual which they perform each year to kick off their two week long “encampment.”

The Cremation of Care consists of an elaborate production involving live music and fireworks—and a human sacrifice reenactment where a lifesize effigy of a person is placed on an altar at the base of the giant owl shrine and then burned or “sacrificed.” Critics claim the ritual is a toned down and theatrical version of an ancient human sacrifice to Canaanite Gods or the Devil.

It sounds so bizarre, many people chalk it up to an urban legend or an Internet conspiracy theory, but I’ll prove to you in this book that such a thing does happen, and the “rumors” are in fact true. In the 1980s, and 90s as word slowly spread about this place, occasionally a reporter tried to sneak inside the now highly guarded compound, but (at least at the time I’m writing this in mid-2015) little to nothing has been reported in the mainstream media about this fascinating (and frightening) forest.

In the past, membership lists and program guides would sometimes get stolen and made public by employees, and in the 1980s a group called the Bohemian Grove Action Network dedicated themselves to doing just that. The membership list, one of which I personally have in my possession thanks to a former employee, has included every Republican U.S. President since 1923, many cabinet officials, directors and CEO’s of large corporations and major financial institutions, and top military brass.

Some of these names include George W. Bush, George H. W. Bush, Dick Cheney, Colin Powell, Ronald Reagan, Richard Nixon, Dwight

Eisenhower, Alan Greenspan, Arnold Schwarzenegger, and many other mainly Republican members and guests. No current president attends because their schedule and whereabouts is too closely watched, but before and after they are in office they can be found in the Grove.

Some consider the Bohemian Grove to be like a Skull & Bones club for adults, and see the Cremation of Care ceremony as being similar to the satanic induction ritual that “Bonesmen” are put through in college, only with a few extra zeroes added to the budget. As you may be aware, the Skull & Bones “fraternity” located at Yale University recruits fifteen new seniors each spring to join their club and then grooms them for a possible high-level position in the Eastern Establishment once they graduate. Their initiation rituals are blatantly satanic and involve a simulated human sacrifice as well.1

Many people dismiss Skull & Bones as just a “fraternity” for rich kids, but it is far from a fraternity. In reality it is a senior society, meaning people don’t become a member until their senior year, and the organization is designed as an entryway to America’s Establishment and geared for the students’ post-graduate life. They hold meetings every Thursday and Sunday night during the school year to indoctrinate the new members with the philosophies and tactics of the ruling class—where, by the way, no alcohol is drank, or even allowed inside their clubhouse.2

What kind of a college “fraternity” doesn’t allow alcohol in their clubhouse? One that is very serious about their goals of gaining and maintaining power. If you take the time to study Skull & Bones, you will see beyond a shadow of a doubt, that they are far from a “fraternity,” and are in fact a deadly serious secret society with direct connections to the Bavarian Illuminati in Germany which was started by Adam Weishaupt.

So the “kids” in Skull & Bones conduct a satanic human sacrifice reenactment ritual in college, but then instead of outgrowing this juvenile frat boy “phase,” they become involved in even more elaborate and strange

rituals when they are well established adults and old men at the Bohemian Grove!

Is this where the secret rulers of the world meet to plot the course of planet earth? Is the mainstream media part of a cover-up to blackout any mention of the club? What is the evidence for the allegations made about the Grove? Is this annual gathering the Bilderberg Group’s summer camp? Are they really performing satanic rituals or human sacrifices? You are about to learn the answers to these questions and more, and we take a close look into The Bohemian Grove: Facts & Fiction.





History of the Grove

The Bohemian Club was started in San Francisco in 1872 by artists, musicians, and writers as an excuse for late-night drinking for those who supported Bohemianism which had become quite trendy in the late 19th and early 20th century. These Bohemians celebrated hedonism and overindulgence, and reveled in rebelling against the conservative conventions of the culture. Soon after its formation, businessmen and those with money joined the party and were called “men of use” by the original artistic founders, who called themselves “men of talent.”3 The artists enjoyed having the wealthy newcomers help foot the bill for their increasingly elaborate parties.

What originally began in their San Francisco clubhouse soon took a more rural turn. By the early 1880s, the Bohemian Club was holding weekend campouts during the summer in the vast redwood forests around Sonoma County, California. In 1893 they began renting the location now known as the Bohemian Grove from the Sonoma Lumber Company and later purchased 160-acres of the forest in 1901, later expanding their ownership to the current 2712 acres [over four square miles].

Most men’s clubs meet in Masonic lodges or fancy country clubs, but because of its unique rural atmosphere, the Bohemian Grove soon became a favorite spot where wealthy men could relive their college days of partying like there was no tomorrow. In the 1930s the Bohemian Grove became a favorite of U.S. Presidents as sort of a Camp David in the woods, and this is when word about the Grove began to quiet and the media blackout began. Members and guests enter the campground with the strict understanding that what goes on at the Bohemian Grove stays at the Bohemian Grove, and discussions—whether personal or business related—are all completely “off the record.”



The Grove is not “just a campground.” There are hundreds of structures inside ranging from elaborate clubhouses and sleeping quarters to a massive industrial kitchen and large amphitheaters—all of which is maintained by a rather large staff, not to mention guarded by an expensive security force and local police. As you may imagine maintaining such a luxurious facility is not cheap.

Back in 1887, the entrance fee for joining the club was $100 and the dues were $3.00 a month. By 1930 this had risen to $500 and $15 a month after that. In the 1990s, the initiation fee was $10,000 with $120 a month dues.4 There is a ten to fifteen year waiting list for new applicants, and in order to even be considered for membership two current non-related members must sponsor the prospect, who is then thoroughly screened by a membership committee before being placed on the wait list.

Since few men actually quit the club, most aspiring members literally have to usually wait until someone dies to then take their place. Many of the members are in their sixties and seventies, and a few of them usually pass away each year.

The Bohemian Club is registered with the IRS as a 501(c)7 Social Club, which makes them exempt from federal income tax and possibly state property tax as well. One of the requirements for 501(c) organizations is that their financial records are made available to the public for inspection— if you know where to look. I have been able to obtain these documents and they are quite interesting.

The 2013 records show that the club took in $10,168,330 dollars in revenue that calendar year.5 They paid out $3,007,779 in salaries to the staff, and “other expenses” were listed at $2,971,656, which went to pay for the food, booze, insurance, electricity, building maintenance, etc. Their total expenses for the year were $5,997,272. Total assets are listed at $20,428,708. Yes—twenty million dollars!



The general manager or the chief operating officer, Matthew Oggero was paid $556,897. The executive chef Jean-Marie Rigollet was paid $164,515. The controller Michael Boozing was paid $146,240; the HR director Jennifer Robertson was paid $145,385; the Grove Keeper James Daniel took in $146,874; and the financial director Deena Soulon was paid $222,071.

The forms note, “The compensation of all management employees are reviewed and approved annually by the compensation committee consisting of the president, vice president, and treasurer, who also set the composition benefits for the general manager.”6 Each Bohemian Grove member casts one vote for each position the governing body fills.

The first book dedicated to exposing the Bohemian Grove was published in 1974 titled The Bohemian Grove and other Retreats, written by William Domhoff, a sociologist and professor who taught at the University of California, Santa Cruz. He starts off the book explaining that upper-class retreats are of a major sociological relevance because, “they increase the social cohesiveness of America’s rulers and provide private settings in which business and political problems can be discussed informally and off the record.”7

Domhoff and a handful of other scholars who are familiar with the Grove insist it’s not just a vacation hideaway for the rich and powerful, but instead functions to facilitate the ruling class network and elitist ideologies which affects the entire world.

The book also exposed the Cremation of Care ritual, and starts off the first page saying, “You are one of fifteen hundred men gathered together from all over the country for the annual encampment of the rich and famous at the Bohemian Grove. And you are about to take part in a strange ceremony that has marked every Bohemian Grove gathering since 1880.”8 It goes on to include a full transcript and detailed description of the Cremation of Care, which was a historic revelation at the time, especially since this was back in the 1970s—decades before the Information Age.



Almost ten years after Domhoff’s book came out, ABC News surprisingly aired a segment about the Bohemian Grove in 1981. Somebody, somehow, was able to get a copy of this report from their archives and posted it on YouTube in 2006 where it can be seen today.9 The anchor at the time was Frank Reynolds, who began the segment asking, “What have Herbert Hoover, Art Linkletter, Jack London and Richard Nixon all had in common? Well, they’ve all been members of the exclusive all male, Bohemian Club in California, where every year at this time the elite from around the country get together for two and half weeks of, um, fun and games.”10

The segment then went on to reveal that more than 2000 members and guests spend two weeks camped out in the secluded redwood forest and named Gerald Ford, Henry Kissinger, George H.W. Bush, Ronald Reagan, and Richard Nixon as members, along with executives at Standard Oil and Bank of America. “Privacy is one of the Grove’s most cherished virtues,” the report continues. “Members may not photograph, record, speak or write about activities at the retreat. While many public officials are Grove members, the press is a distinctly unwelcome guest.”

The segment even showed a photograph of the Cremation of Care and included an interview with sociologist William Domhoff who explained, “With the ceremony called the Cremation of Care that begins the two week encampment, where the body of Dull Care—symbolizing woes and concerns—is burned on an altar in front of a big owl statue, when that ceremony ends, they all start to cheer and yell, and hand each other a beer.”11

The segment also pointed out that no women were allowed, not even as employees [at the time], and admitted the atomic bomb was developed by club insiders. The senior ABC News editor must have been on vacation, or the Bohemian Grove became arrogant and didn’t think a major news network would betray the strict editorial control by Establishment insiders which usually prevents such stories from making it to the airwaves.



Since this historic segment over three decades ago, there hasn’t been a single national news organization that has made a peep about the Bohemian Grove—at least as of mid-2015 when I’m writing this book—not even a tabloid news show. Pretty much only alternative news sites, and the local Sonoma County Press Democrat newspaper have ever acknowledged it even exists.

A staff of several hundred people help run the place during the summer encampment, working to cook food and keep up the grounds, most of them local high school kids from nearby towns who have no idea about the identities of the men they are serving. For almost 100 years only men (and teenage boys) were allowed to work inside. But as powerful as the Bohemian Grove is, they were not strong enough to prevent the feminists from crashing their party. In 1978 the club was charged with discrimination by the Department of Fair Employment and Housing for not hiring female employees.12

The club fought the charge and in 1981 a judge dismissed the case, but this was only a temporary victory. The judge’s decision was based on the members’ freedom to associate with who they wanted to associate with and included a statement that since the men “urinate in the open without even the use of rudimentary toilet facilities,” the presence of women would infringe on the men’s right to privacy.

The feminists didn’t give up though and continued to pursue the case. Another judge overruled the previous decision a few months later and ordered the club to begin hiring women.13 The club filed an appeal with the Supreme Court arguing that their freedom to associate was being violated, but the Court found against the Bohemian Grove.

To be clear, the Court didn’t say they had to allow women as members, but did force them to hire women as employees. There is a world of difference between being a member (or guest) and being an employee at the Grove. The employees are mainly contained in the kitchen and dining

area, and do not mingle with the guests in their clubhouses or throughout the grounds.

Despite losing their vigorous battle hoping to prevent women from working at the Grove, the Bohos find it amusing that women now work in the kitchen, “where they belong,” so it really wasn’t much of a victory for the feminists at all, since the “civil rights” victory against their “discrimination” is really just a big joke to the Bohos.

The Unruh Civil Rights Act states, “All persons within the jurisdiction of [California] are free and equal, and no matter what their sex, race, color, religion, ancestry, national origin, or disability are entitled to the full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind whatsoever,” so how is it that the Bohemian Grove is able to legally “discriminate” against women as members?

The Bohemian Grove, along with men’s country clubs—or conversely, all-female organizations like the Girl Scouts, are able to turn down people of the opposite sex for membership without being sued for discrimination because these clubs are considered private, not public. Marcy Frost, an employment attorney at Moss & Barnett, explains, “If you are truly a private club, and not open to the public, the answer is generally, yes, you’re allowed to discriminate on the theory we have a Constitutional right of freedom of association.”14

It’s called the “private club exemption” from civil rights legislation. This issue of “legal discrimination” gets into a gray area when people begin arguing over what is considered a private verses a public club. So, at least for now, membership at the Grove remains exclusively reserved for men, but they now have to include women (and teenage girls) as employees who serve the men.

Back in 2008 when Hillary Clinton was first running for president, Bill Clinton was speaking at a campaign event when a heckler began

shouting at him about the Bohemian Grove. There was a pretty big crowd and security couldn’t immediately make it to the man to throw him out and his repeated interruptions were derailing Bill’s speech, finally causing him to respond.

“The Bohemian Club? Did you say the Bohemian Club? That’s where all those rich Republicans go up and stand naked against redwood trees right? I’ve never been to the Bohemian Club, but you ought to go. It’d be good for you. You’d get some fresh air.”15

His comment about “standing naked against redwood trees” refers to the common practice of members just whipping it out and peeing almost anywhere as if they were teenagers again at summer camp. It’s a fun thing for them to do apparently, and is part of the Bohemian Grove culture. The practice is literally encouraged and visitors have reported repeatedly seeing men everywhere around the club peeing on the side of trees or in some bushes instead of making their way to a bathroom.

Bill Clinton was also right about it being primarily a Republican club. Most, but not all of the members, tend to be Republicans who have historically been more involved with big business than Democrats. With the exception of Bill Clinton’s surprising outburst about this “Republican club,” no Democrats have dared to publicly denounce the Bohemian Grove, afraid of a backlash by their Establishment colleagues in Washington. Like the Bilderberg Group, it appears even mentioning the Bohemian Grove is off limits for most politicians.16

 





Their Symbols, Saint, and Motto

The Owl

The Bohemian Grove’s mascot (and logo) is an owl, or more specifically, the Owl of Minerva (or Athena, the Greek equivalent), who is the Goddess of wisdom. Interestingly this is the same symbol that Adam Weishaupt, founder of the Illuminati, used as his personal emblem as well.17 Within the Bavarian Illuminati in Germany, Weishaupt had also created a level in the hierarchy called the Minervals.18 An owl symbolizes wisdom because it can “see in the dark” which is analogous to being enlightened.

Pictures of owls are often seen in school classrooms standing on top of a small stack of books in order to symbolize knowledge. The National Press Club’s logo contains an owl standing on a book for this reason. Owls are also seen as guardians, and you may often see an owl statue on the top of a building in order to scare away other birds in hopes of preventing them from congregating on the ledge of the roof so they won’t dirty the building’s face with their droppings—or worse, hit passersby on the sidewalk below.

The Dictionary of Symbols by J.E. Cirlot says, “In the Egyptian system of hieroglyphs, the owl symbolizes death, night, cold and passivity. It also pertains to the realm of the dead sun, that is, of the sun which has set below the horizon and which is crossing the lake or sea of darkness.”19

A tiny owl can be found hidden in the design of the American one dollar bill, perched on the upper left corner of the frame that surrounds the

“1” located in the upper right hand corner. This isn’t just a case of people seeing something that looks like an owl popping out of a random pattern; it’s clear someone purposefully included it in the design. Some people also see an owl figure designed into the street layout of Washington D.C., appearing on top of the U.S. Capitol building when looking at the location from overhead or on a map. This one is a bit more ambiguous, but still may have been included on purpose by the Freemason architects who are known for their use of occult symbols.20

There is also a giant 40-foot tall concrete statue of an owl standing inside the Bohemian Grove on the shore of their manmade lake which is the site of the Cremation of Care ritual. Many think the “owl” looks more like a demon with horns actually, and at its feet is a large altar where the life-size human effigy (called “Care”) is “sacrificed” each year to kick-off the encampment.

Many people also believe this “idol” represents Molech, an ancient god from the Middle East that the Canaanite culture used to sacrifice their children to. Before the construction of the owl, there stood a large Buddha statue from 1892 to 1928 that was made of plaster of Paris. More on the Cremation of Care in a later chapter.



The Patron Saint

A patron saint is someone who embodies a group’s philosophies or goals, and for the Bohemian Grove this is a man named Saint John of Nepomuk. He was a priest who received the confessionals of the queen of Bohemia in the 1300s, and when pressured by the king to reveal her confessions after he suspected her of cheating on him, Saint John refused and was then killed by the king.

A large statue of Saint John carved from the trunk of a tree stands inside their forest showing him holding his index finger over his mouth, signifying the nonverbal gesture to keep your mouth shut and be quiet, paralleling Robert De Niro’s motto in Goodfellas that you “never rat on your friends, and always keep your mouth shut.” Their patron saint serves to remind Bohos of their oath of secrecy and that what happens in the Bohemian Grove, stays in the Bohemian Grove.



Weaving Spiders Come Not Here

The motto of the Bohemian Grove is “Weaving spiders come not here,” which is said to mean that members and guests are not supposed to conduct business inside the Grove—“weaving” meaning working, but this explanation is just a cover story for the saying’s true meaning. “Weaving spiders come not here” actually means “don’t dare challenge the members,” (or really, the “Gods,” as they see themselves) and is an allegory that comes from an ancient story in Greek mythology.

According to the tale, a woman weaver named Arachne once disrespected Athena, the Goddess of weaving, by failing to acknowledge that her weaving talent was a gift from the Goddess and not derived from her own power. Arachne even pridefully boasted that she was a better weaver than the Goddess herself. Angered by her lack of respect, Athena then turned Arachne into a spider, subjecting her and her descendants to weave webs forever as a curse for disrespecting the Gods.

The Bohos claim that their saying “weaving spiders come not here” is taken from a Shakespeare play called A Midsummer Night’s Dream, but given the elite’s appreciation for the occult and Greek mythology, not to mention their elitist attitude that they are gods among men, this explanation appears to be simply just a cover story for non-members used as an attempt to defuse the allegations that they conduct business in the Grove, which as you will see later in this book is quite common.

Albert Pike, a favorite philosopher among elite Freemasons, wrote that “Masonry, like all the Religions, all the Mysteries, Hermeticism and Alchemy, conceals its secrets from all except the Adepts and Sages, or the Elect, and uses false explanations and misinterpretations of its symbols to mislead those who deserve only to be misled; to conceal the Truth, which it

[the Mason] calls Light, from them, and to draw them away from it.”21 So it should not come as a surprise to learn that the actual meaning of sayings and symbols by elitist organizations are not what we are told.



The Secret of Satan

When you first hear allegations about the ruling elite, or the Illuminati “worshiping Satan” it is hard for many to believe at first, but once you take a close look at the philosophies of the ruling class and the big secret of occult fraternities, it becomes undeniable that this is what’s happening. Do you think this book just took a turn into “crazy tinfoil hat-wearing conspiracy land?” Stick with me for a moment and let me explain and I’m sure you will soon agree.

Everyone, whether they believe it is literally true or just a myth, is familiar with the story of the Garden of Eden and the serpent temping Adam and Eve into eating the forbidden fruit, causing what is called the Fall of Man or the first sin. Adam and Eve were then banished from Paradise and the entire human race was cursed from that point on.

The big secret, or the “royal secret,” as it is often called, is that many men (and women) involved in secret societies believe that Satan is not bad, but instead came to earth to free Mankind from enslavement at the hands of the Creator, who in their view is seen as a tyrant who wanted to keep humans ignorant, hence forbade them from eating from the Tree of Knowledge of Good and Evil.

The big secret taught within elite secret societies is that Satan the rebel “wanted to help” us poor humans, and risking his own eternal banishment from Heaven, he disobeyed God and encouraged Eve to eat the forbidden fruit to begin mankind’s supposed evolution to Godhood by giving them the power [knowledge] that the Creator supposedly was holding back from them out of selfishness or malevolence.



According to the Bible, Satan claimed Man could “become like God” if they listened to him and disobeyed the Creator, and this is the secret of secrets (arcanum arcanorum) of the Illuminati. In 1854 French occultist Eliphas Levi wrote, “There is indeed a formidable secret, the revelation of which has once already transformed the world, as testified in Egyptian religious tradition…This secret constitutes the fatal Science of Good and Evil, and the consequence of its revelation is death.”22

Manly P. Hall, who is considered to be Freemasonry’s “greatest philosopher,” revealed in his 1928 book The Secret Teachings of All Ages that, “The serpent is true to the principle of wisdom, for it tempts man to the knowledge of himself. Therefore the knowledge of self resulted from man’s disobedience to the Demiurgus, Jehovah [God].”23 Hall also stated that, “Both the sinking of Atlantis and the Biblical story of the ‘fall of man’ signify spiritual involution—a prerequisite to conscious evolution.”24

Helena Blavatsky, who was a major spiritual inspiration for Adolf Hitler, wrote in her 1888 book The Secret Doctrine, that, “Thus Lucifer— the spirit of Intellectual Enlightenment and Freedom of Thought—is metaphorically the guiding beacon, which helps man to find his way through the rocks and sand banks of Life, for Lucifer is the Logos in his highest.”25

Albert Pike, another highly esteemed historical figure of Freemasonry wrote, “Lucifer, the Light-bearer! Strange and mysterious name to give to the Spirit of Darkness! Lucifer, the Son of the Morning! Is it he who bears the Light, and with its splendors intolerable, blinds feeble, sensual, or selfish souls? Doubt it not!”26

Even the infamous Satanist Aleister Crowley admitted this is what he believed was the biggest secret of life, saying, “This serpent, Satan, is not the enemy of Man, be He who made Gods of our race, knowing Good and Evil; He bade ‘Know Thyself!’ and taught Initiation. He is ‘the Devil’ of the book of Thoth, and His emblem is Baphomet, and Androgyne who is the hieroglyph of arcane perfection.”27



Saul Alinsky, the leftist radical who Hillary Clinton wrote her college thesis on, acknowledged Satan in his book Rules for Radicals as the first rebel who stood up to the tyranny he said was imposed by God. According to the scriptures, Satan said, “ye shall be as gods,” if you follow his advice, and this is what the elite are striving for. They believe that through this ancient secret and the emerging science of Transhumanism, that they themselves will “evolve” into Gods as the final phase of human evolution.28

The plan to “conquer death” is being promoted as a real possibility through Transhumanism, which involves modifying our DNA or all together replacing our biological brains and bodies with interchangeable mechanical and silicon based systems.29

This is a topic for a whole other book, which I am currently working on, but this is in short the top priority of the ruling class. If my Transhumanism book is not out at the time you are reading this, there is a section on this topic in my book Inside the Illuminati: Evidence, Objectives, and Methods of Operation if you would like to learn some of the details about this disturbing agenda.

 



The Different Subcamps

Inside the Bohemian Grove there are approximately 124 different groups or camps—each having their own sleeping quarters, kitchen and bar, and each managed by a camp captain who is responsible for overseeing their group.30 Each different camp has its own unique name and consists of anywhere from a dozen to around one hundred men who tend to work in the same field to provide commonality and networking opportunities.

For example, the Hill Billies camp is made up mainly of men in big business, bankers, politicians, and media moguls from the state of Texas. The sign for the Hill Billies’ camp, which the Bush family belongs to, consists of a cloven hoofed and horned Devil figure.31 One of most elite camps is Mandalay, which is comprised of former presidents and other top political figures along with major defense contractors. No seated president ever attends the summer encampment because his schedule and location is so closely monitored that his visitation would bring too much unwanted attention to the Grove, but once they are out of office (and before they are even elected) many make it a priority to be there.

Another elite camp of former presidents and high ranking military personnel and defense contractors is Owls Nest. The Hillside camp is made up of Joint Chiefs of Staff members and other top military brass. Other camp names include the Lost Angels which is where major bankers and media executives belong. Uplifters is made up of corporate executives and international business big wigs. The Rockefeller family and other big oil men have their own camp as well called the Stowaways.

It’s quite obvious that having the Grove broken up into small subgroups which are comprised mainly of men who work in the same field facilitates discussions revolving around areas of overlapping interest. Sociologist Peter Phillips, who was a guest inside the Bohemian Grove on

two occasions and who earned his Ph. D. by writing his doctoral dissertation on it in 1994, wrote, “Sharing a camp together at the Grove gives Bohemian directors of major U.S. policy councils ample opportunity to discuss current affairs and socio-economic policy issues. Watching and listening to reactions to Lakeside Chats by various other Bohemians also gives policy directors an opportunity to evaluate policy concerns from the broad sampling of the American corporate business community encamped at the Grove. In this sense, the Grove serves as an informal evaluatory feedback process to the top socio-economic domestic and foreign policy councils in the United States.”32

Although the club claims the mid-summer encampment is just a vacation, and “weaving spiders come not here,” some major worldchanging programs have admittedly been hatched in the Grove. For example, the Manhattan Project (the plan for the atomic bomb) was admittedly conceived inside the club in 1942.33 Aside from the birth of the atomic bomb, the United Nations was hatched from the inside the club as well.34

Peter Phillips’ dissertation reveals, “One of the foremost political events in which the Bohemian political network played a significant role was the United Nations Conference of International Organization (UNCIO), April 25th to June 26, 1945 in San Francisco. This was the original formation meeting for the United Nations, with delegates from fifty nations. Receptions for UNCIO delegates and key dignitaries were held at the Bohemian Club on May 17, May 29, June 4, and June 5. Towards the end of the U.N. conference the Club invited all delegates to a program at the Grove.”35

It is rumored that Alan Greenspan was chosen to be the Chairman of the Federal Reserve Bank shortly after a meeting in the Grove where insiders came to a consensus that he should be their man. Arnold Schwarzenegger’s successful bid for governor of California in 2003 after a special recall election to replace then-governor Gray Davis was allegedly given the green light by the Establishment following a visit to the Grove as well.36



There is even a picture of Ronald Reagan when he was the Governor of California sitting down with Richard Nixon (who would be elected president the following year), taken in 1967 showing them inside the Bohemian Grove together where they were said to have been coordinating their future political careers.37 Nixon even admitted in his memoirs that the path to his presidency began with his visit to the Bohemian Grove.38

President Dwight Eisenhower’s road to the White House also began in the Bohemian Grove. In 1950, two years before he was elected president, he was a guest during the summer encampment and gave a Lakeside Talk that impressed the Establishment insiders. We know of this because President Richard Nixon openly admitted it in his memoirs!

He wrote, “After Eisenhower’s speech we went back to Cave Man Camp and sat around the campfire appraising it. Everyone liked Eisenhower, but the feeling was that he had a long way to go before he would have the experience, the depth, and the understanding to be President. But it struck me forcibly that Eisenhower’s personality and personal mystique had deeply impressed the skeptical and critical Cave Man audience.”39 Nixon was later chosen as his vice president.

After learning how the geopolitical system really works once inside the Oval Office, apparently Eisenhower’s conscience began bothering him. During his famous presidential farewell address in 1961 when his two terms were up he warned Americans that, “In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.”40

There are also rumors that in the build-up to the 2000 presidential election Bohemian Grove members George Bush Senior, Colin Powell, and other neocons had come to a consensus at the summer encampment that Dick Cheney should be George W. Bush’s running mate as VP.



 





The Cremation of Care Ritual

When you learn the details of the Cremation of Care, or see the photos or the video footage, it becomes clear why the mainstream media has maintained a near complete blackout on this issue for decades. In the age of social media, word about the Bilderberg Group—which meets every spring in a five-star hotel for three days of secret off the record talks—has spread far and wide, so the mainstream media can no longer completely ignore their annual gathering.41 While it may be somewhat simple to paint the Bilderberg Group as just another boring conference—explaining away the Cremation of Care is not so easy.

Basically, it is a human sacrifice ritual—only instead of sacrificing an actual person, they use a life-size effigy consisting of a metal skeletal framework wrapped with paper which is burned on an altar at the base of the 40-foot tall Owl Shrine. Close-up photos taken by a former employee reveal the effigy has two arms and two legs and is the size of an adult. The ritual kicks off the two-week encampment at sunset on the second Saturday of July each year, where a small number of members carry out the ceremony while the majority of others sit on a set of bleachers and watch.

It is conducted by a “High Priest” who wears a silver robe with a red cape. He is accompanied on stage by around two dozen other men who wear long black and red robes, some of whom are holding flaming torches. The High Priest also wears a wireless microphone which broadcasts over a sound system so the audience of around 1000 men can hear him. He begins by saying, “The owl is in his leafy temple; let all within the Grove be reverent before him. Lift up your heads, O ye trees, and be ye lift up, ye ever-living spires. For behold, here is Bohemia’s Shrine and holy are the pillars of this house. Weaving spiders, come not here!”



He continues, “Nay, thou mocking spirit, it is not all a dream. We know thou waitest for us when this our sylvan holiday shall end. And we shall meet and fight thee as of old, and some of us prevail against thee, and some thou shalt destroy…But this, too, we know: year after year, within this happy Grove, our fellowship has banned thee for a space, and thy malevolence that would pursue us here has lost its power beneath these friendly trees. So shall we burn thee once again this night and in the flames that eat thine effigy we’ll read the sign: Midsummer set us free!”

It is a very elaborate ceremony with a live symphony orchestra playing music at certain points for dramatic effect. The effigy is called Care, and the ritual is said to symbolically be the killing of Care, or the ritualistic “casting off their cares” so the men can have a good time at their party. As the ritual reaches its climax and the effigy is set on fire, screaming is played over the sound system, and once it is fully engulfed in flames, fireworks are set off and the crowd cheers in excitement.

The High Priest continues “Oh owl! Prince of all mortal wisdom. Owl of Bohemia, we beseech thee, grant us thy council.” A short song is then sung with lyrics that go: “No fire, no fire, no fire. Let it be kindled in the world where Care is nourished on the hates of men and drive him from this Grove. One flame alone must light this fire, one flame alone must light this fire. A pure, eternal flame, a pure, eternal flame. At last within the lamp of fellowship upon the altar of Bohemia.”

The High Priest then concludes, “Oh, great owl of Bohemia! We thank thee for thy adoration! Be gone detested Care! Be gone! Once more, we banish thee! Be gone, dull Care! Fire shall have its will of thee! Be gone, dull Care and all the winds make merry with thy dust! Hail fellowship’s eternal flame! Once again, midsummer sets us free!”

The first photo of the ceremony to be published came from a flier given to members within the Grove which was stolen by an employee and given to a group of activists called the Bohemian Grove Action Network

which was formed in the 1980s by a woman named Mary Moore who lives nearby in the neighboring town of Occidental.

Radio host and founder of Infowars.com, Alex Jones, snuck into the Bohemian Grove in July of the year 2000, and using a small video camera secretly recorded the entire ceremony and released the footage as part of a documentary film called Dark Secrets: Inside Bohemian Grove. By this time, there had been various photos available online of the ritual and many rumors of its occurrence, but Jones’ footage confirmed once and for all that such a thing did in fact take place. The footage can be viewed on YouTube and is quite shocking.42

A British TV producer named Jon Ronson documented Alex Jones’ infiltration for a segment of his own television series titled Secret Rulers of the World, which then featured some of Jones’ footage. Ronson, initially a skeptic who appeared to mock the “conspiracy theories,” was himself stunned to learn they were true. “As incredible as it sounds, it seems that some kind of bizarre secret ritual witnessed by world leaders really does take place in the forests of Northern California,” he said.43

When Ronson contacted the Grove for a comment on the newly shot footage they gave him a brief statement saying, “The Cremation of Care is a musical and verse pageant heralding a two week midsummer escape from business cares and celebrating nature and good fellowship. As grand scale stage drama it may be a bit overdrawn, but it’s about as innocent as anything could be.”44

It’s one thing to read about the ceremony, or see the photos, but the video leaves you with your head shaking. When I first saw it myself in the early 2000s, I thought it was a ceremony conducted by a small and powerless pagan cult and that Alex Jones was crazy for claiming such high profile people were in attendance, but he was right. I first came across Jones’ footage on a torrent site after searching for videos about the Illuminati. This was before video hosting sites like YouTube, Vimeo, and Dailymotion were created, and bit torrents were the primary way people

shared videos through peer-to-peer file sharing applications like BearShare and Morpheus.

After Jones’ infiltration, the club beefed up security and began using thermal imaging scanners and K-9 police tracker dogs to identify anyone lurking around the grounds who doesn’t belong there. Anyone who attempts to sneak inside will be charged with trespassing.

In 2004, National Geographic magazine published a photo taken during a Cremation of Care ritual in 1915 and included a caption saying, “To purge himself of worldly concerns, a member of the elite Bohemian Club participated in a 1915 Cremation of Care ceremony—complete with candles and a robed and hooded comrade to guide him. This private club of influential men still meets annually north of San Francisco and uses this symbolic ritual to kick off its summer retreat. But today the ceremony involves burning a mummy-like effigy named Care at the foot of the group’s mascot: a 40-foot-tall (12-meter-tall) concrete owl.”45



Molech

In the ancient Middle East, the Canaanites and the Phoenicians would regularly sacrifice their children to a horned god called Molech (sometimes spelled Moloch or Molekh). This horrifying ritual consisted of building a fire at the base of the Molech idol, which had its arms extended out over the fire pit, and then having the village high priest lift up a couple’s first-born infant son and place him into the arms of the beast, resulting in the child burning alive over the flames. Many people believe that this was the inspiration behind the Cremation of Care ritual.

David Icke, a popular British conspiracy theorist best known for his belief that the Illuminati are supposedly “reptilian shape-shifting aliens,” claims, “Today, these elite names are still doing ritual sacrifices of children at Bohemian Grove.”46 Yes, David Icke believes the ritual is a real human sacrifice!

Icke also believes the earth is hollow with ancient civilizations living deep inside it,47 and thinks the moon is a giant spacecraft just like the Death Star in Star Wars he says was built by aliens in order to watch over planet earth.48

The book of Leviticus in the Bible describes Molech sacrifices at length, and specifically denounces it as evil. “Don’t sacrifice your children on the altar fires to the god Molech,” it reads.49 It goes on to give specific instructions as to the punishment for such actions. “The Lord spoke to Moses: You are to say to the Israelites, Any man from the Israelites or from the foreigners who reside in Israel who gives any of his children to Molech must be put to death; the people of the land must pelt him with stones.”50



It continues, “I myself will set my face against that man and cut him off from the midst of his people, because he has given some of his children to Molech and thereby defiled my sanctuary and profaned my holy name.”51



Music During Ceremony

The symphonic poem The Isle of the Dead by Russian composer Sergie Vasilyevich Rachmaninoff tells the tale of a ghostly ferryman who transports the dead in his small rowboat, as it moves slowly across the calm dark water. The symphony was inspired by Swiss artist Arnold Böcklin’s famous Isle of the Dead painting which shows a coffin being transported to the symbolic grave depicted by the dark nothingness off in the distance.

Rachmaninoff’s symphony is played by an actual live orchestra during the beginning of the Cremation of Care ritual as a hooded boatman dressed as Death paddles his rowboat along with the coffin containing Care across the pond in front of the stage where “Molech” stands. Beethoven’s 7th Symphony is played later during the ritual.



David Gergen Confrontation

A top advisor to Presidents Ford, Nixon, Reagan, and Clinton— named David Gergen, who also worked as a CNN contributor, was confronted on camera by Alex Jones on the streets of New York during the 2004 Republican National Convention where Jones walked up to him and asked if he’d ever seen the Cremation of Care ritual.

Gergen, looking visibly uncomfortable, responded, “Frankly I don’t think that’s something I need to talk to you about.”52 When Jones asked him again about the ritual, Gergen snapped, “That’s none of your damn business!” and walked away. The clip can be seen on YouTube. Why was he so defensive? If it’s just an innocent “play” then why not answer such a simple question? Jones didn’t accuse him of worshiping Satan or participating in an actual human sacrifice; he just asked him if he’d been there for the Cremation of Care.

Back in 1993 The Washington Times reported, “Presidential counselor David Gergen resigned yesterday from the all-male Bohemian Club, three days after saying he would not run around naked at its annual Bohemian Grove encampment and insisting he would not quit [as the president’s advisor]. White House spokeswoman Dee Dee Myers announced the resignation along with Mr. Gergen’s departure from 17 other interest groups, charities and public boards ranging from the Trilateral Commission to the Very Special Arts Foundation.”53

He also resigned from the Bilderberg Group, the Council on Foreign Relations, and nearly all organizations dedicated to setting up a New World Order, leading many to think that perhaps he grew a conscience and decided he wasn’t going to have anything to do with such a plan any longer. Perhaps the reason he got so upset about Alex Jones’ question was that he wanted to

let sleeping dogs lie and being put on the spot about the Bohemian Grove freaked him out because he knows they cherish their oath of secrecy and didn’t want to be seen as betraying them.



Walter Cronkite

Walter Cronkite was the anchor for the CBS Evening News from 1962 to 1981, and is widely believed to have recorded the voice for the Owl Shrine that is played over the loudspeakers during part of the Cremation of Care. This is especially interesting when you learn that while accepting the Norman Cousins Global Governance Award in 1999 at a World Federalist Association meeting, Cronkite made a disturbing joke about Satan running the New World Order and seriously suggested countries need to give up their sovereignty and yield their authority to a global government.

During this event Cronkite said, “What Alexander Hamilton wrote about the need for law among the thirteen states applies today to the approximately two hundred sovereignties in our global village, all of which are going to have to be convinced to give up some of that sovereignty to the better greater union, and it’s not going to be easy.”54

He then mentioned Pat Robertson’s 1991 book, The New World Order and how Robertson (creator of The 700 Club) wrote that the construction of the global government is the work of the Devil, at which point Cronkite added, “Well, join me, I’m glad to sit here at the right hand of Satan.”55

 

Author’s Note: Please take a moment to rate and review this book on Amazon.com or wherever you purchased it from to let others know what you think. This also helps to offset the trolls who keep giving my books fake onestar reviews when they haven't even read them. Almost all of the one-star

reviews on my books are from NON-verified purchases which is a clear indication they are fraudulent, hence me adding this note. These fraudulent ratings and reviews could also be part of a larger campaign trying to stop my message from spreading by attempting to tarnish my research through fake and defamatory reviews, so I really need your help to combat this as soon as possible. Thank you!

 

The Lakeside Talks

Every afternoon throughout the two week encampment a Lakeside Chat or Lakeside Talk is given just after lunch at 12:30pm, where a political insider or industry leader gives a thirty-minute speech on his area of expertise. These daily talks are a rare and uncensored look into the minds of the most powerful men in the world. The speeches primarily revolve around political, economic, and business trends, and often include information that is typically not revealed publicly.

A reporter named Philip Weiss working for Spy Magazine successfully snuck inside the Grove in 1989 and witnessed a Lakeside Talk given by General John Chain, who was the Commander of the Strategic Air Command.56 In his speech the General lobbied the audience members to help him get the funding for the Stealth B-2 bomber program which would later end up costing almost 45 billion dollars, yes 45 billion dollars.57

Every decade or so the club produces a limited number of yearbooks called the Annals of the Bohemian Grove, which are given out to members so they can reminisce about their time there. These rare books contain dozens of photos from inside the forest and some include attendees dressed in drag, along with pictures of the Cremation of Care ritual and various Lakeside Talk speakers.

I have personally been able to obtain four different copies of these books, (Volumes V, VII, VIII, and IX) since occasionally they’ll find their way into used bookstores after older Bohemian Grove members die and their book collections are sold at estate sales or donated to thrift stores like Goodwill or the Salvation Army. In one book (volume VII 1987-1996 ) there is a clear photo of George Bush Senior and George W. Bush standing at the podium giving a Lakeside Talk in 1995 where Bush Senior reportedly told the audience that his son would make a great president one day.58



President Nixon revealed in his memoir (published in 1978) that his Lakeside Talk marked the beginning of his road to the White House, writing, “If I were to choose the speech that gave me the most pleasure and satisfaction in my political career, it would be my Lakeside Speech at the Bohemian Grove in July 1967. Because this speech traditionally was off the record it received no publicity at the time. But in many important ways it marked the first milestone on my road to the presidency.”59

While Nixon praised the Bohemian Grove in his memoir as the key to his path to the presidency, privately—as you will see in the next chapter— he denounced the widespread homosexuality he witnessed while he was there.60

Schedules of the Lakeside Talks are handed out to members inside which include who each afternoon’s speaker is and what their topic is. Often one of these schedules have been stolen by an employee and made available on the Internet. In the next few pages you’ll find a list of some of these speakers and their topics so you can get a feel for just how exclusive these talks are, and how the information presented impacts the world.

If the members’ time spent inside the Bohemian Grove is “just a vacation,” then why are there speeches by people like the director of the Central Intelligence Agency, U.S. Army Generals, mainstream media executives, political analysts and talk show hosts, leading economists, and bigwig businessmen? The stolen program guides have revealed for example, in 1981 the Secretary of Defense Casper Weinberger gave a speech titled “Rearming America” where he urged his well-connected audience to pull some strings to increase military spending. In 1991 Dick Cheney, who was Secretary of Defense under George Bush Senior’s presidency, gave a speech titled “Defense Problems of the 21st Century” where he did the same thing.

The Grove may have tightened up security in recent years, because the itineraries for the most recent years are unavailable. Some leaks did indicate

who was speaking there, but the program guide of the complete speakers list and their topic is unavailable from 2012 to 2014. It is rumored that they may have stopped handing out the schedule to members since employees keep stealing them and leaking them to the public, and the club may be securing them under a sheet of glass so they may be viewed but not carried away.

In 2013 the local Press Democrat newspaper did report that four-star U.S. Army General Stanley McChrystal and comedian Conan O’Brien were among the speakers, as well as MSNBC’s Chris Matthews, who also gave a Lakeside Talk back in 2003.61 There were rumors that Bill O’Reilly and Glenn Beck were there as guests or possibly speakers in 2013 because they were both missing from their usual schedules at some point in time while the encampment was in session.

 



Lakeside Talks 2011

Saturday, July 17

“The Supreme Court in the Age of Obama” by Jeffrey Toobin—legal analyst for CNN and The New Yorker.

 

Sunday, July 18

“The Obama Administration at War” by David Martin, national security correspondent for CBS News.

 

Wednesday, July 21

“How Should We Think about China. Partner, Competitor, Threat?” by Michail Armacost, former U.S. Ambassador to Japan and member of the National Security Council who handled East Asian and Chinese affairs.

 

Friday, July 23

“K—12 Education in America” by Joel Klein, Chancellor of the New York City Department of Education.



 

Saturday, July 24

“The Future of News” by Rupert Murdoch, CEO of News Corporation, the parent company of the Fox News Channel.

 

Sunday, July 25

“The Revenge of God: Religion & Violence in the Modern World” by Reza Aslan, professor at the University of California, Riverside.

 

Monday, July 26

“Venture Philanthropy—Andrew Carnegie 2.0” by John Wood, founder of Room to Read, a global non-profit organization that’s focused on literacy and gender equality in education.

 

Tuesday, July 27

“Cultural Diplomacy” by Dr. Gary Smith, executive director of the American Academy in Berlin.

 



Wednesday, July 28

“Defeating IEDs as a Weapon of Strategic Influence by” Thomas Metz, Lt. General, U.S. Army (retired).

 

Thursday, July 29

“The Four Most Important Words in Economics: People Respond to Incentives” by economist Arthur Laffer.

 

Friday, July 30

“To Be Announced” by California Governor Arnold Schwarzenegger.

 

Saturday, July 31

“Why is Mars so Important?” by Michael Malin, planetary geologist. Also “Countdown for America” by David Gergen, former presidential advisor.

 



Lakeside Talks 2006

Friday, July 14

“Global Financial Warriors” by John Taylor, professor of economics at Stanford University.

 

Monday, July 17

“Untold Tales from the Cold War” by Tom Reed, former Secretary of the Air Force.

 

Tuesday, July 18

“Energy, CO2 and Climate Change” by Lynn Orr, director of the Global Climate & Energy Project at Stanford University.

 

Wednesday, July 19

“Gulf Coast Erosion: Consequences for America” by Michail Armacosting, Chairman of Louisiana Governor’s Coastal Restoration and

Conservation Committee.

 

Friday, July 21

“America in the New World” by Fareed Zakaria, editor of Newsweek magazine and CNN host.

 

Tuesday, July 25

“Island Conservation with Guns, Traps & Poison” by Bernie Tershy, research biologist at the Institute of Marine Sciences at the University of California, Santa Cruz.

 

Wednesday, July 26

“The Parallelism & Ultimate Convergence of Science and Religion” by scientist Charles Townes.

 

Thursday, July 27

“Global Urbanization: a Challenge for the Future” by Richard Koshalek, President of the Art Center College of Design in Pasadena.



 

Friday, July 28

“Lessons Learned from War, Assassination, the White House and Hollywood” by Jack Valenti, former president of the Motion Picture Association of America (MPAA).

 

Saturday, July 29

“From Battlefields to Playing Fields: Economics, Energy, and Education” by General Colin Powell (retired), former Secretary of State.



Lakeside Talks 2005

Saturday, July 16

“Of Laughter & Leadership” by David Gergen, public policy professor and former presidential advisor.

 

Sunday, July 17

“To Be Announced” by naturalist Richard Leakey.

 

Monday, July 18

“The Case for Immigration Restriction” by Richard D. Lamb, professor at the University of Colorado and former Colorado Governor.

 

Tuesday, July 19

“Iraqi Medicine: Rip Van Winkle’s Burden” by Bernard S. Alpert, M.D.



 

Wednesday, July 20

“Wealth, Poverty & the Threat to Global Security” by William W. Lewis, director emeritus at the McKinsey Global Institute.

 

Thursday, July 21

“Dark Energy & the Runaway Universe” by Alex Filippano, professor of astronomy at the University of Berkley, California.

 

Friday, July 22

“Unlimited Government” by Chris DeMuth, executive director of the American Enterprise Institute.

 

Saturday, July 23

“To Be Announced” (Name not printed, which usually means someone “important” who doesn’t want to be connected to the Grove publicly).

 



Monday, July 25

“Nuclear Considerations: The Way Ahead” by Albert Konetzni, Vice Admiral, U.S. Navy.

 

Tuesday, July 26

“Peering Into Pandora’s Box: Avian Flu & Beyond” by W. Ian Lipkin, M.D., scientific director at the Northeast Biodefense Center.

 

Friday, July 29

“To Be Announced” by Bill Richardson, Governor of New Mexico.

 

Saturday, July 30

“Hoover Talk” by General Colin Powell, U.S. Army General (retired) and former Secretary of State during the George W. Bush administration.



Lakeside Talks 2004

Friday, July 16

“Exploring Mars & Searching for Life in the Universe” by Charles Elachi, director of the Jet Propulsion Lab at the California Institute of Technology.

 

Saturday, July 17

“The Landscape of American Politics” by David Brooks, New York Times columnist and political commentator.

 

Sunday, July 18

“The Elections & Their Aftermath” by Norman Ornstein, political analyst at the American Enterprise Institute.

 

Monday, July 19

“State Building: What We Do and Don’t Know about Creating Institutions in Developing Countries” by Francis Fukuyama, dean of advanced international studies at John Hopkins University.



 

Tuesday, July 20

“The Internal Life of Planets: A Comparison of Earth, Venus, Mars & the Moon” by Mark Richards, professor of geophysics and dean of physical sciences at the University of California, Berkeley.

 

Thursday July 22

“The Coming Virtual Soldier” by Roger McCarthy, chairman & principal engineer at Exponent Inc.

 

Friday, July 23

“The Long War of the 21st Century” by James Woolsey, Former Director of the CIA.

 

Saturday, July 24

“The Unrealized Potential of the Technological Revolution” by James H. Billington, librarian at the Library of Congress.

 



Monday, July 26

“Remembering Reagan, One Insiders Account” by Kenneth Adelman, author and policy analyst.

 

Wednesday, July 28

“Did the Terrorists Expect the World Trade Towers to Fall?” by Ian Mackinlay, architect.

 

Saturday, July 31

“Politics, Plagues, Prevention & Preparedness” by Vice Admiral Richard Carmona M.D., United States Surgeon General



Lakeside Talks 1997

Friday, July 11

“Rogues, Terrorists and Two Weimars Redux: National Security in the Next Century” by James Woolsey, former Director of the CIA.

 

Saturday, July 12

“Augustine’s Laws and the High Tech Grove” by Norman Augustine, chairman and CEO of Lockheed Martin Inc.

 

Sunday, July 13

Individualism in Western History” by Ken Jowitt , professor of political science at the University of California, Berkley.

 

Monday, July 14

“The Triumph of the Market and the Politics of Affluence” by Christopher DeMuth.



 

Wednesday, July 16

“Heretical Thoughts” by Yurek Martin, senior writer at the Financial Times of London.

 

Thursday, July 17

“The New Economics—Ideas Hatched in the Forest are Worth More Than the Trees” Craig McCaw, Chairman & CEO Eagle River LLC.

 

Friday, July 18

“Cyberspace and Managed Care: Is the Acceleration Manageable, or Do We Throw Momma from the Train?” by Louis W. Sullivan, M.D. Former Secretary Health & Human Services.

 

Saturday, July 19

“Plutonium Today and Tomorrow” by Charles Hollister.

 



Sunday, July 20

“National Security is Going South: Where is the Vision?” by William A. Owens, Admiral USN (retired) Former Vice-Chairman of Joint Chiefs of Staff, Vice Chairman SAIC.

 

Wednesday July 23

“Taxation with Representation” by Kurt Hauser

 

Thursday, July 24

“The Information Superhighway: A Way Upward, or a Toll Road to Nowhere?” by Ervin S. Duggan, President and CEO Public Broadcasting Service (PBS).

 

Friday, July 25

“Church, State and the Constitution” by Antonin Scalia, Justice on the Supreme Court.

 

Saturday, July 26



“Campaign Operative The Best of Times and the Worst of Times” Donald Rumsfeld, member of Nixon cabinet and future Secretary of Defense in the George W. Bush administration.



Infiltrations and Leaks

In 1980 a local resident named Mary Moore founded what she called the Bohemian Grove Action Network with the purpose of infiltrating the Grove by having people obtain summer jobs inside or by convincing those who already worked there to steal membership lists, program guides, and other information in order to expose the Grove.

Mary also organized demonstrations outside the Grove beginning in the 1980s consisting mainly of left-wing hippies who were concerned about the big business, environmentally unfriendly “Republicans” inside. She says, “When powerful people work together, they become even more powerful. The Grove membership is wealthy and becoming more so, while the middle class is steadily becoming poorer. This close-knit group determines whether prices rise or fall (by their control of the banking system, money supply, and markets), and they make money whichever way markets fluctuate.”62

Due to all the attention the Bohemian Grove Action Network was generating, in 1982 a reporter from Time magazine decided to sneak inside but his story was censored by the magazine and never published.63

As I mentioned earlier, a reporter from Spy Magazine named Philip Weiss was able to sneak inside the club in 1989 and published an article titled “Masters of the Universe Go to Camp: Inside Bohemian Grove,” detailing what he had witnessed. Aside from seeing a Lakeside Talk by General John Chain, who urged the audience to pull some strings to get the 45 billion dollars in funding for the B-2 bomber program, Weiss also said the members loved chewing on cigars, drinking beer, and peeing everywhere.



“You know you are inside the Bohemian Grove when you come down a trail in the woods and hear piano music from amid a group of tents and then round a bend to see a man with a beer in one hand and his penis in the other, urinating into the bushes. This is the most gloried-in ritual of the encampment, the freedom of powerful men to pee wherever they like,” he wrote.64

In 1991 a reporter for People magazine named Dirk Mathison was able to sneak inside and wander around for a period of time, but he was eventually spotted and removed from the property. He wrote a story about his experience that was supposed to appear in the August 5, 1991 issue of People magazine, but it never did. The managing editor at the time, Landon Jones, claimed killing the story had nothing to do with executives at Time Warner (People magazine’s parent company) being members.65



Alex Jones from Infowars.com

In July of the year 2000, radio talk show host Alex Jones, founder of Infowars.com, successfully infiltrated the Bohemian Grove and actually videotaped the Cremation of Care ritual and got out with the footage. He cut a hole in the side of a shoulder bag and mounted a camcorder inside, and sat in the bleachers with the rest of the approximately 1500 members and guests and watched the event unfold. He was accompanied by his thenproducer Mike Hanson.

A British journalist named Jon Ronson documented Jones’ and Hanson’s infiltration and included their adventure in an episode of his television series, The Secret Rulers of the World which follows Ronson as he “investigates” the claims of what he called “conspiracy theorists” surrounding the New World Order.

Ronson is a skeptic and appears to make fun of his subjects, seemingly intent to “debunk” their claims, but after Jones and Hanson emerged from the Bohemian Grove with the footage in hand, even Ronson was surprised that the “conspiracy theories” were true. After the two returned back to the hotel with the footage, Ronson questioned them about what they had seen.

[Ronson] Do you think this was unholy?

[Hanson] It’s very strange to me. These people are supposed to be running the world and they’re out there doing this.

[Ronson] You seem freaked out.



[Hanson] I am.

[Jones] These people point their fingers all day and call people extremists or cult members or whatever for their religious beliefs, this was a pagan ceremony and engaging in human sacrifice, a mock human sacrifice…

[Ronson] Aren’t they just saying that for two weeks they don’t need to worry about anything?

[Jones] But they’re burning someone in effigy and as it’s burning they “ahh ohhh nooo!”

[Ronson] But they’re not killing a person.

[Jones] We understand they’re not literally killing a person…

[Ronson] They’re killing something that is symbolic…

[Jones] Wait a minute. You saw it. You’ve got Death on this black boat bringing a pallet with the paper mache person obviously, it’s got the feet and the head and they take it over and burn it.

[Ronson] But wasn’t it just a metaphor?

[Hanson] To me it doesn’t matter. I think they’re sacrificing in the real world too.

[Ronson] Was this the New World Order?

[Hanson] Yes definitely. I looked the New World Order in the face out there.



Shortly after Alex Jones’ posted the footage online, a show called Washington Journal on C-SPAN discussed his infiltration. The show was hosted by Brian Lamb, the director of C-SPAN, who interviewed a “scholarly conspiracy researcher” named Michael Barkun who ridiculed Jones and appeared to be engaging in damage control.

The host states that he heard Alex Jones on Coast to Coast AM talking about his adventure and “he was talking about the Bohemian Grove club as if that’s where it all happens. That’s where all the decisions are made. There are thousands of people who go there, and there is some kind of ceremony and an owl and all that, have you followed this?” Lamb asked Barkun.66

Barkun replies, “Yes I have, even though the show is on past my bedtime, but, Alex Jones has been talking about this for quite a while. The Bohemian Grove, of course, is a privately owned redwood grove, up in Sonoma Country, north of San Francisco, where every summer there is a get together of the wealthy and well placed, all male, who get together for general cavorting, socializing, lecture, symposium and so on, in an atmosphere that is completely removed from public scrutiny. Alex Jones and some others have suggested for a long time that there are all sorts of nefarious rituals that go on, and a matter of fact, and I talk about this incident actually in my book, someone who had listened to the Alex Jones show about this was arrested within the Bohemian Grove, very heavily armed, because he said he was trying to bring attention to what he thought were human sacrifices that were being committed by the elite who attend these gatherings.”67

Barkun was referring to a man named Richard McCaslin who snuck onto the property in January of 2002 with the hopes of exposing the Cremation of Care ritual which he believed involved an actual human sacrifice. More on Richard McCaslin in a moment. Lamb and Barkun didn’t even mention the Cremation of Care ritual, and how it clearly depicts a theatrical human sacrifice, and gave the audience the impression that crazy conspiracy theorists have just invented the idea out of thin air that the club

is burning people alive during their party and the intruder was completely insane for thinking such a thing was happening.



The Phantom Patriot

In January 2002 a 37-year-old man named Richard McCaslin snuck into the Grove while wearing a superhero outfit, a bullet proof vest, and armed with a fully loaded MK-1 rifle-shotgun. Having heard the rumors about what allegedly goes on inside, and having seen Alex Jones’ footage of the Cremation of Care, McCaslin was convinced there were actual human sacrifices being carried out and he intended to expose it.68 Jones never said the ritual was an actual human sacrifice, but many people have, including, as I’ve mentioned earlier—David Icke, the guy who believes the Illuminati are blood-drinking shapeshifting reptilians from another galaxy.69

If you’ll recall, the summer encampment begins the second weekend of July, and since “The Phantom Patriot,” as he called himself, went there in January, not much was going on. After he didn’t find any elite insiders gathering, McCaslin decided to set a building on fire and was apprehended by Bohemian Grove security. He was sentenced to eleven years in prison, a sentence dramatically increased because he was wearing a bullet proof vest in the commission of a crime (felony arson) which is an additional charge in California.70

Richard McCaslin was (and still is) part of the real-life super hero subculture, a small and bizarre group of adult males who like to dress up as “superheroes” and fantasize about being “real” crime fighters.71 Some of these people actually walk the streets of cities in America wearing their costumes and see themselves as neighborhood watchmen.72 After McCaslin was released from prison, he continued wearing his “Phantom Patriot” costume and still believes the Bohemian Grove members are reptilian shape-shifters from another planet.73



In 2011 he was seen protesting outside a business in Davenport, Iowa where President Obama was speaking and accused Obama, the Bush family, and Bill Clinton of being reptilians. A local paper did a story on him where he is quoted saying, “Every American president has British peerage [relation], and royalty has always said they have the right to rule by their bloodline. Their ancestors weren’t human; they were aliens, probably of the reptilian type.”74

Les Claypool, the singer of the rock band Primus, wrote a song titled “Phantom Patriot” for his solo project Of Whales and Woe (2006) which is about McCaslin’s “raid” on the Bohemian Grove. Claypool lives in Occidental, California, a small town right next to the Grove and is obviously aware of the rumors and allegations surrounding the place. Here’s a sample of the lyrics:

Walking through the compound With a formulated plan

There to help his fellow man At this decisive point in time The Bohemians of the Grove Don’t see it quite the same Sensing danger in his game They dub his quest a crime - Phantom Patriot



Chris Jones

In the summer of 2005, a man in his late thirties named Chris Jones [no relation to Alex Jones] got a job at the Bohemian Grove for the sole purpose of infiltrating the club and gathering photos and video evidence of what happens inside. He was able to get photos of some of the camps and elaborate clubhouses, and even some close-up pictures of the site of the Cremation of Care ritual, including the effigy used during the ceremony.

His photos clearly show that the object burned on the altar is in fact a life-size human effigy. It consists of a metal skeleton that’s wrapped with paper. Chris said he was able to inspect the effigy shortly before the Cremation of Care in 2005 and stuck his hand inside the paper wrapping to feel around inside it to see if by any chance there was an actual person, child, or vial of blood inside, but he said it was just paper wrapped around the metal skeletal frame.75 His photos and videos were included in Alex Jones’ 2005 film The Order of Death, a sequel to Dark Secrets: Inside Bohemian Grove which first showed the footage Alex shot in July of 2000.

I have personally met Chris Jones and he showed me the photos and videos on his camera along with some other memorabilia he “kept” (stole) from the club, including a membership list, a program guide, a book of matches, and a trashcan.

When he first turned over his photos and footage to Alex Jones for publication on Infowars.com, Chris called himself “Kyle,” wanting to remain anonymous, but after he was later jailed, he went public with his real name. Chris claims he showed some teenagers in his neighborhood the footage and photos he took, trying to educate them about the Bohemian Grove, but one of them got scared and told their parents Chris showed them a “snuff film” and says this was the start of his legal troubles. He was later

arrested for lewd conduct with a minor for playing strip poker with some boys he was babysitting.76

Some people believe these charges were trumped up as payback for him working to expose the Bohemian Grove and for releasing his never before seen photos and video footage, but the court documents detail what appear to be a history of inappropriate behavior with teens in his neighborhood.77 He claimed he was innocent and said the charges were based on misunderstandings but was found guilty in court and sentenced to three years in the Theo Lacy jail in Orange, California.



More Recent Attempts

In July of 2008 a Vanity Fair reporter named Alex Shoumatoff was arrested for trespassing after sneaking onto the property. Apparently he was working on a story—not about the strange rituals or the Lakeside Talks, no —he was working on a story about the club cutting down some Douglas-fir and diseased oak trees in order to help prevent forest fires—or at least that’s what he said he was doing there.78

Shoumatoff later wrote an article in Vanity Fair titled “Bohemian Tragedy,” where he complained about them cutting down some trees and talked about his arrest. He snuck inside, in his words, “to investigate reports that the Bohemians have been desecrating their own bower. That nothing is sacred with these guys anymore. Everything is fair game. But how could the Bohemian Club, where California’s forest-preservation movement began, be logging its own land, which includes the largest stand of old-growth redwoods in Sonoma County?” he wrote.79

In January of 2011 the History Channel’s Decoded included an episode about the Bohemian Grove and two of the show’s “investigators” paddled down the Russian River in canoes and entered the forest from the riverbank which runs right along the edge of the Grove’s property. They were discovered immediately and arrested for trespassing. This wasn’t even during the summer encampment so they wouldn’t have even found anything very interesting happening inside anyway.

The show didn’t even include any of Alex Jones’ footage of the Cremation of Care because the host, Brad Meltzer, said the History Channel’s lawyers were afraid they would get sued for airing it since it was technically obtained illegally. At the end of the segment, the “investigators” talked about their experience and arrest. One of them said, “I had nine hours

of incarceration to think about this. The more I thought about it, the less I was bothered by the Grove, even though they had just arrested me. I sort of felt like they are allowed to do this, it’s their property, and if they want to continue to have presidents and Saudi princes and military leaders come here, they need to promise those guys that they’ll be safe.”80

Another of the “investigators” concluded, “There’s nothing nefarious going on here. It’s just a bunch of businessmen and a men’s club.”81 Brad Meltzer the host ended the show by saying, “To be clear, this is a great club, and breaking laws isn’t a way to get into it, but a bit more disclosure, a bit more transparency, would go a long way.” Meltzer is also friends with President George Bush Senior, who gave him the idea for the plot of his book The Inner Circle, which is about a secret society that’s been operating in Washington D.C. ever since the United States was founded. This secret society isn’t the Illuminati or any “evil” group with ill intentions—no—it turns out to be a “good” secret society that George Washington started, called the Culper Ring, which Meltzer’s book claims is still in existence today to help “protect” America.

It’s likely the Decoded “investigators” arrests were staged in order to send a warning to viewers not to attempt to sneak in. As someone who’s been involved with a variety of “reality” television shows myself, I can tell you there’s not much reality in them.82 Scenes are staged and shot out of sequence to simplify the production schedule and then edited together to make it appear as if they were shot in chronological order.

In 2013 Colin Powell’s personal email was hacked into by an antiIlluminati hacker who called himself Guccifer. Powell’s email inbox contained some photos of him and his buddies inside the Bohemian Grove, and one of the emails was from News Corp executive Andrew Knight asking Powell to “firmly point out” to British Prime Minister Tony Blair that he should attend the Grove’s summer encampment that coming July and saying, “Tony has not yet got his priorities straight.”83



Guccifer was apprehended the following year and sentenced to seven years in prison.84 This is the same hacker who illegally accessed the emails of various Clinton, Bush, and Obama administration officials, including George W. Bush’s sister’s email where Guccifer found family photos as well as a self-portrait painted by George W. Bush depicting him taking a shower.85

On my YouTube channel there is a playlist of footage that I shot at the front gates of the Bohemian Grove in July of 2012 when I attended the Occupy Bohemian Grove protest, where hundreds of people gathered outside the entrance to raise awareness about the club.86 You can see dozens of police wearing riot gear standing guard in order to prevent the crowd from marching inside. I also captured footage of a K-9 unit patrolling the perimeter of the property, a speech by anti-war activist Cindy Sheehan, and the rather violent arrest of one of the protesters.



Hookers and Homosexuality

San Francisco is basically the gay capital of America, and with the Bohemian Grove located just north of the city, one might expect some of this “gayness” would spread to the Grove, especially since it was founded by artists and “Bohemians.” A Pulitzer Prize winning columnist for The San Francisco Chronicle named Herb Caen wrote about the homosexual activities in the Grove in his gossip column in the 1980s, and informants for the Bohemian Grove Action Network have claimed there has been widespread homosexual behavior inside.

Philip Weiss, who snuck inside in 1989 and wrote a lengthy article in Spy Magazine, said, “Today AIDS has put a damper on the Grove’s River Road pickup scene, which Herb Caen used to write about in his San Francisco Chronicle gossip column. Just the same, a man on his own often gets invited back to camps by gay Bohemians.”87 Weiss went on to say that several men tried to pick him up during his visit there.

According to Mary Moore of the Bohemian Grove Action Network, a man named Don Heimforth, who worked inside the Grove, was the “Deep Throat” (referring to the famed White House informant during the Watergate scandal) of the Bohemian Grove in the 1980s, and claimed a lot of gay men were involved in the club. Heimforth himself was gay and later died of AIDS.88

In 2004 The New York Post reported that a gay porn star named “Chad Savage” was discovered working in the Bohemian Grove, supposedly as a “valet,” which many people believe was just a cover story so he could engage in other kinds of activities— like perhaps “entertaining” the members.89 The Bohemian Grove yearbooks (the Annals) have various pictures of men dressed in drag to entertain each other while inside, and one

can only imagine what kind of weirdness goes on at some of the camps under the cover of darkness.

President Richard Nixon, who in his memoir admitted that the path to his presidency began in the Bohemian Grove, had something else to say about the place as well, which was not so favorable. In 1999 the National Archives released over 400 hours of Oval Office tapes from the 1970s, and on one of them Nixon made a pretty damning statement about the Bohemian Grove.

Nixon, along with John D. Ehrlichman and H. R. Haldeman, were discussing how the media was glorifying homosexuality and how it had been spreading, especially in San Francisco. Nixon went on to say, “The Bohemian Grove—which I attend, from time to time—it is the most faggy goddamned thing you could ever imagine, with that San Francisco crowd. I can’t shake hands with anybody from San Francisco.”90



Prostitution

It’s common knowledge that many wealthy men like buying the pleasures prostitutes provide. Sex scandals and politicians go together like peanut butter and jelly and it seems a new one is uncovered every few months. The trophy wives of many wealthy businessmen and powerful politicians are often twenty or thirty years younger than their husbands, and many of these couples have an unspoken open relationship.

The wives sleep with the pool boy or men they meet at the gym, while their husbands buy prostitutes through elite escort services when they’re away on business. And so, during the “greatest men’s party on earth” at the Bohemian Grove, it would be foolish to think some of these wealthy and power-hungry men could spend a week away from their wives without buying some time with a lady of the night (or a call-boy).

The Northwood Lodge and Resort, which is just a few minutes away from the Bohemian Grove, is the spot where some men slip away to hook up with prostitutes throughout the two-week long encampment. Back in 2001 Counter Punch, an independent investigative news site, wrote, “A few years ago KGO radio, out of San Francisco, had an interesting talk show in which callers with first-hand Grove experience told their tales. A man from Monte Rio said he was only one of several towns-people renting cabins every year to prostitutes traveling from as far as Las Vegas to renew the Bohos’ spiritual fibers.”91

It has also been rumored that the Mitchell Brothers O’Farrell Theatre in the Tenderloin red-light district of San Francisco has been a source of strippers and high-class call girls used by the Bohos. Mike Hanson, who worked as Alex Jones’ cameraman and producer, and who was with Jones when he snuck into the club in July of 2000, later interviewed four dancers

from Mitchell Brothers for his book who claimed that prostitution was the “unofficial” but accepted policy at Bohemian Grove.92

These girls said that the strippers who had been brought inside to perform for the guys were always expect to “perform” in other ways, if you know what I mean. The girls Mike Hanson interviewed said they signed NDAs, non-disclosure agreements, preventing them from reveling information about their experiences inside, or even admitting publicly that they had been there, so they only spoke with him on the condition that he would not reveal their identities.

Hanson’s book, titled Bohemian Grove: Cult of Conspiracy, details his and Jones’ infiltration into the Grove, where he includes his interview with these strippers who were between the ages of twenty-one and twenty-five. They say they were hired for a three-day gig inside the Grove and on the first night they said they performed for a group of around 40 men and then later some of the guys paid the girls for their “company for the night.”93

The second night they said they put on a show for a group of around 100 men, but the girls said they started getting extremely uncomfortable with how degrading some of the men were and got creeped out so they chose to leave before their third show and claimed the men wouldn’t pay them since they had agreed to work for three nights and were breaking their contract.94

Hanson wrote that one stripper/hooker admitted she stole a laptop computer she saw laying around as compensation for not getting paid, and said that after she took it home and turned it on, she found pictures of what appeared to be women and children being violently raped.95 More about these allegations in the next chapter.

 



Allegations of Murder

In the past, when hardly anything was publicly known about the Bohemian Grove, rumors about the Cremation of Care “human sacrifice” ritual led many in the conspiracy community to believe the club was performing an actual human sacrifice every year.

After seeing the photographs and confirming that the world’s richest and most powerful men do in fact meet in a secluded forest and perform what appears on the surface to look like a human sacrifice, it’s understandable how many could come to this conclusion. But even though the details about the Cremation of Care eventually emerged showing it involves an effigy and not an actual person—accusations of murder still persist, and there are even allegations more disturbing than them supposedly “just” burning someone alive on an altar in a ritual sacrifice.

These allegations involve claims of horrific sadistic acts that are said to involve the sexual abuse of children and the production of snuff films (the videotaping of a murder for entertainment). These allegations are so grotesque and nauseating, I don’t even like to talk about them, but I feel they must be addressed and investigated. I warn you, this section will be quite disturbing and graphic, and you may wish you had never read it.

These rumors, which I will detail in a moment, don’t just lurk in the dark depths of the Internet, made by anonymous individuals on obscure websites or forums; but actually come primarily from a former U.S. Senator named John DeCamp. DeCamp was a Nebraska state senator in the 1990s who is also an attorney who represented several children who he claimed were sexually abused inside the Bohemian Grove in the 1980s at the hands of a pedophile ring allegedly operating within one of the camps.96



In 1992 he published a book titled The Franklin Cover-Up, where he claimed that a boy named Paul Bonacci was viciously sexually abused at the hands of a group of men inside the Bohemian Grove. DeCamp alleged the boy was forced to engage in necrophilia (sex with a dead body) and claimed to have witnessed these same men rape a young male child and then murder him during the summer of 1984, on or around July 26th inside the Grove.97

This was before anything about the Bohemian Grove had been posted on the Internet, and really before most people had ever heard of the Internet. Paul Bonacci claimed this abuse occurred in a luxurious Northern California campground in an area that had big trees where men wore black hooded robes and where there was a giant moss-covered owl statue.98 DeCamp says that when he asked Bonacci to guide him to the location of this alleged abuse, he said he led him to the gates of the Bohemian Grove.99

Paul Bonacci wrote in his journal about this alleged abuse right after it was said to have occurred. What he wrote is so horrifying I will not include some of it here because it will make you physically ill. He said that he and another boy he called Nicholas were forced to rape another kid who was then shot and killed immediately afterward, all while being videotaped.100

His journal reads, “After that the men grabbed Nicholas and drug him off screaming. They put me up against a tree and put a gun to my head but fired into the air. I heard another shot from somewhere and then saw the man who killed the boy drag him like a toy. Everything including when the men put the boy in the trunk was filmed. The men took me with them and we went up in a plane. I saw the bag the boy was in. We went over a very thick brush area with a clearing in it. Over the clearing they dropped the boy. One said the men with the hoods would take care of the body for them.”101

More details of Bonacci’s journal are available in DeCamp’s book The Franklin Cover-Up, and are far beyond the most gruesome and grotesque things one could imagine, and involve the alleged gang rape of a child and

necrophilia.102 In the first printing of his book in 1992 Senator DeCamp left out Bonacci’s claims of the giant owl statue and men in hoods because at the time he thought it was too far-fetched for people to believe. DeCamp had never heard of the Bohemian Grove, the Cremation of Care, or the giant owl statue at the time. Only years later did he learn about the details of Bohemian Grove and became convinced that Paul Bonacci was abused there.103

When John DeCamp first told William Colby, head of the CIA, about his investigation, Colby reportedly told him to forget everything he knew and to, “Get as far away from this thing as you can. Forget you ever saw it or know it, heard it or anything else.”104 He said DeCamp was opening a can of worms containing forces too dark for him to handle. Only after saying he couldn’t walk away from his investigation did Colby tell him he better get his story out before someone murdered him to stop it. Colby himself later died in what was called a canoeing accident, although many suspect he was murdered due to the strange circumstances surrounding his death.105

Now before you write John DeCamp off as mentally ill, or a conspiracy theorist, or perpetuating a hoax—you should know that around this same time the Washington Times ran a front page story with the headline, “Homosexual prostitution inquiry ensnares VIPs with Reagan, Bush,” and detailed a shocking story of a gay prostitution ring operating in Washington D.C. that provided teen call-boys to some very powerful and well-connected men.106 The man running the ring was a lobbyist named Craig Spence—who, through his connections—was able to bring several teenage boys who worked for him as prostitutes on a midnight tour of the White House, which was the focus of the Washington Times report.

The article begins, “A homosexual prostitution ring is under investigation by federal and District authorities and includes among its clients key officials of the Reagan and Bush administrations, military officers, congressional aides and U.S. and foreign businessmen with close social ties to Washington's political elite, documents obtained by The Washington Times reveal.”107 The story quietly went away and has long been forgotten by most Americans.



A similar elite pedophile ring was also operating in London at this time (and likely still does today). The Guardian recently reported that major news agencies in England were gagged by the government in the 1980s to prevent them from reporting on powerful members of the British government who were suspected of being involved in an elite pedophile ring there which also murdered children for fun.108

The Guardian reported, “Two newspaper executives have told the Observer that their publications were issued with D-notices—warnings not to publish intelligence that might damage national security—when they sought to report on allegations of a powerful group of men engaging in child sex abuse in 1984. One executive said he had been accosted in his office by 15 uniformed and two non-uniformed police over a dossier on Westminster pedophiles passed to him by the former Labour cabinet minister Barbara Castle.”109

The article continues, “The other said that his newspaper had received a D-notice [similar to a national security letter in America] when a reporter sought to write about a police investigation into Elm Guest House, in southwest London, where a group of high-profile pedophiles was said to have operated and may have killed a child.”110

This is the London Guardian, not the National Enquirer or some random website on the Internet, and this story sounds exactly like the accusations Senator John DeCamp was making about a group operating within the United States at the same time, doesn’t it? Two retired Scotland Yard detectives recently came forward and said that a network of powerful and well-known politicians in the United Kingdom sexually abused and murdered young boys at parties but they were prevented from arresting them because they were part of what are called The Untouchables.111 The detectives actually named names, including Cyril Smith, a popular member of the British Parliament who died in 2010, and who was a serial sex offender who preyed on young boys.112



In 2012 a paparazzi working for TMZ came across Ralph Rieckermann who played bass for the Scorpions, a popular rock band from the 1980s, and asked him if he would be going to any fetish parties while in Germany which are apparently very popular in Berlin. Rieckermann answered, “I don’t go to fetish parties,” but then went on to appear to insinuate that he had been to a “snuff party” one time where people were murdered for the partygoers entertainment. “I went to one, one time—I seen some really bad shit,” he says.113

When the TMZ cameraman asks, “Was it a donkey show?” Rieckermann responds “No, they actually, I think, it’s…they actually killed people there and stuff. They pay up to $100,000 to see people get…” the cameraman completes his sentence, asking “executed?”

Rieckermann responds, “I’m not kidding. I went to another one where literally I saw like…the grossest…I wanted to throw up.” The video, which can be seen on YouTube, then cuts back to the TMZ studio to show reactions from the staff. “He is dead serious. He’s not laughing, there’s not a smile on his face,” one man comments. Another says, “I’m disgusted right now.” Harvey Levin, the founder and managing editor of TMZ looked absolutely horrified, and said, “I’m shocked,” and just shook his head.

Three years later, just days after I myself posted a YouTube video about this story, getting almost 10 times as many views as TMZ’s original interview, Rieckermann posted a video statement on YouTube clarifying what he meant about the “snuff party.” He said that he didn’t personally witness anyone getting killed, but was at a party at someone’s estate where the host showed him some of the bondage/sadomasochism fetish rooms where the owner said he and his friends would murder people for fun at special events.114 Rieckermann emphasizes that he did not witness any murders but appeared to believe what the host told him was true.

It’s not hard to believe that a group of extreme sadomasochists would find enjoyment by having someone murdered at one of their parties. The world’s lust for realistic and brutal horror movies shows that millions of

people find excitement in watching people getting tortured and murdered, and with films like Faces of Death, and certain websites which specialize in collecting gruesome photos and videos of crime scenes and people getting murdered, it’s not that hard to believe that some people would pay money to witness an actual murder in person, or even participate in one themselves.



Hunter S. Thompson

A man closely connected with what Senator John DeCamp called the Franklin Cover-Up (named after the Franklin Community Federal Credit Union in Omaha, Nebraska that was allegedly used to fund a pedophile ring used by high-level U.S. politicians in the late 1980s and early 1990s) has made some startling allegations about Hunter S. Thompson and the Bohemian Grove.

Rusty Nelson, [Russell E. Nelson] who worked as the personal photographer for the man at the center of the scandal, Larry (Lawrence E.) King, alleges that the famous “gonzo” journalist offered him $100,000 in 1988 to produce a snuff film involving the murder of a child.115 Rusty said he turned the offer down.

Paul Bonacci also claimed, and wrote in his journal, that a man named “Hunter Thompson” was inside the Bohemian Grove at the time he was allegedly abused there, and also claimed that Thompson was the man videotaping his abuse.116

Interestingly, Hunter S. Thompson wrote in his book Fear and Loathing in Las Vegas about receiving Adrenochrome from a Satanist, which is supposedly a powerful hallucinogen believed to come from the pineal gland immediately after a person is killed. Adding yet another twist to the story is the fact that Hunter S. Thompson wrote in his 2004 book titled Hey Rube about how organized pedophile rings keep children as sex slaves.

“The autumn months are never a calm time in America,” he wrote. “There is always a rash of kidnapping and abductions of schoolchildren in the football months. Preteens of both sexes are traditionally seized and

grabbed off the streets by gangs of organized perverts who traditionally give them as Christmas gifts to each other to be personal sex slaves and playthings.”117

This writing clearly shows Thompson knew of the dark pedophile ring subculture. Thompson was known for getting personally involved in his stories, as was the case when he lived with the Hells Angels for nearly two years in the 1960s while he chronicled his activities for his book Hells Angels: A Strange and Terrible Saga. And so with Paul Bonacci’s allegations that a “Hunter Thompson” was present during his abuse and videotaping it, and Rusty Nelson claiming Hunter S. Thompson propositioned him to shoot a snuff film, some are led to believe he was involved in even more sinister activities than hanging out with a motorcycle gang.

Hunter S. Thompson was a celebrity during his time and is still considered to be a counterculture antihero by many today. In 1988 during an appearance on The Late Show with David Letterman he appeared to have admitted to once being inside the Bohemian Grove. At the start of the bizarre interview Letterman asked him what he likes to do for fun, to which Thompson answered, “I like to kill.”118 The audience was noticeably uncomfortable, and the clip is available on YouTube—at least at the time I’m writing this.119

In his sometimes hard to understand mumbling Hunter went on to say that he liked the Jesuits because, “they’re smart and mean,” and that he himself had what he called a “neo-religious” world view. George Bush Senior came up during the interview since he was running for president at the time, and Thompson appeared to say, “I went to Hillbilly,”120 which is the name of the Bush family’s camp in the Bohemian Grove.

After his suicide in 2005, Thompson’s former editorial assistant Nickole Brown posted an article online titled In Memory of Hunter S. Thompson: Postcard from Louisville, Kentucky, recounting some of the bizarre behavior she had witnessed while working for him over the years.

“For weeks he played a tape recording of a jack rabbit screaming in a trap,” she wrote. She also said that one time, “he threw me out of the house for refusing to watch a snuff film.”121 As she left, he allegedly called her a coward.

In an interview I conducted over the phone with Nickole Brown on May 20th 2005, she told me she thought he was possibly joking about owning a snuff film, and says she didn’t think much of it after the incident, citing his “unique” character. She also said she couldn’t imagine him being involved in anything like what Paul Bonacci and Rusty Nelson claimed. She believes Hunter was possibly investigating such claims, and may have pretended to be interested in shooting a snuff film as part of his own investigation into the rumors, which she thinks might be the source of these allegations.



Sex Magick

Sex magic is the belief and practice that through various sex acts, people can supposedly generate sexual energy and direct it to metaphysically shape the very fabric of reality. It’s basically like mixing the visualization techniques found in teachings like the “Law of Attraction,” popularized in 2006 by Rhonda Byrne’s The Secret, with sex.

The Knights Templars, who reportedly learned about sex magic from the Tantrics of India, and medieval alchemist Paschal Beverly Randolph, and Satanist Aleister Crowley, all practiced secret sexual rites in what they considered to be the secret to “real” magic. Several fraternal organizations and secret societies such as the Ordo Templi Orientis, and the Chthonic Aurarian Temple also believe in—and continue to practice these kinds of rites.

On the surface, sex magic (often spelled with a “k” on the end, as stylized by Satanist Aleister Crowley) may seem like innocent sexual experimentation or a fun game, but the deeper one looks into the practice, the more bizarre it gets.

Multiple members and former members of the Ordo Templi Orientis, the secret society which uses Aleister Crowley’s Book of the Law as their Bible, have admitted that the 11th degree of their hierarchy is dedicated to homosexual sex magick.122 Former OTO member Jason Miller revealed in his book on sex magick, that, “the OTO’s 11th degree is largely dedicated to the cultivation of sperm in the anus,” and goes on to say that according to Crowley’s diaries, “In some writings the point seems to be to cultivate the sperm alone, but in others it seems to be to combine it with blood that seeps in from tearing in the anus and remnants of feces. In this theory the blood attracts the demons and the sperm brings them to life.”123



Miller goes on to say that a group of sex magic practitioners in Japan called the Tachikawa, supposedly engage in “skull fucking.” Miller wrote, “One of the most infamous rituals they practiced is the empowerment of a human skull as a Honzon, a holy relic with supernatural powers…First the practitioner chooses a particular type of skull, such as the skull of a Shogun or an elder….He then has sex with the skull as well as with a woman. Then they wipe the combined sexual fluids on the skull.”124 Miller’s book is not written to “expose” sex magic as sinister or evil, but instead to teach it, and he is an admirer and true believer of it.

The reason I’m talking about sex magic is because the group of men who allegedly abused Paul Bonacci in the Bohemian Grove were most likely doing so under the belief that they were engaging in some dark form of this kind of “magic.” As a disclaimer I must mention that the Ordo Templi Orientis, along with former member Jason Miller, who I quoted above, do not advocate child abuse, pedophilia, or human sacrifice, but it’s not hard to believe that some rogue members or a splinter group of a fraternity that practices esoteric sex magic have tried to follow in the footsteps of Aleister Crowley—dubbed “the wickedest man alive” in his day—by experimenting with, or incorporating child abuse and pedophilia into their rites.

Even consensual adult sex magic is strange, and the deeper one looks into it, the more disgusting the rituals become. One ritual involves taking a woman’s menstrual blood and a man’s semen and then mixing them together and baking the fluids into cookies or a cake and then eating it, believing that this gives people spiritual power.125 Another involves placing sperm in the womb of a horse, which I can only assume mentally deranged people like Aleister Crowley have attempted through bestiality, which he is widely rumored to have committed in his quest to contact demons and gain spiritual energy.

With passages in Crowley’s Book of the Law such as, “Worship me with fire & blood; worship me with swords and with spears, is the

command…let blood flow to my name. Trample down the Heathen; be upon them, o warrior, I will give you of their flesh to eat! Sacrifice cattle, little and big, after a child,”126 it’s obvious he was a mentally deranged sadist.127

In some parts of Africa today, men believe that raping babies is actually a ‘cure’ for AIDS.128 This belief is not as rare as you may think, and again, this is not something people just believed 500 years ago—it’s what many believe today! Many men in Africa also believe that raping an albino woman is a cure for AIDS as well.129 These beliefs and abuses are well documented by humanitarian groups and are not just an urban legend.130

With such bizarre, brutal, and disgusting “sex magic” beliefs out there, is it really that hard to believe that an inner circle of a secret society of power-hungry megalomaniacs would engage in rape, pedophilia or murder in hopes of gaining some kind of supernatural power?



Cathy O’Brien

In 1995 a woman named Cathy O’Brien published a book titled Trance Formation of America (a play on words for Transformation, using the word “Trance” to refer to a hypnotic trance) where she recounts what she claims is a true story of physical and sexual abuse at the hands of the CIA in their MK-ULTRA mind control program.

In the book, and in her lectures which she gave at conspiracy conferences throughout the 1990s, she claims to have been taken to the Bohemian Grove where she says she worked as a sex slave for the enjoyment (and entrapment) of some of the members. “I was programmed and equipped to function in all rooms at Bohemian Grove in order to compromise specific government targets according to their personal perversions…I do not purport to understand the full function of this political cesspool playground as my perception was limited to my own realm of experience,” she wrote.131

What she means is she allegedly was used to entice high level politicians into having sex with her while they were secretly videotaped for blackmail purposes, which seems pretty reasonable, but her claims soon get so strange, they are simply beyond belief. She wrote, “Slaves of advancing age or with failing programming were sacrificially murdered at random in the wooded grounds of Bohemian Grove, and I felt it was simply a matter of time before it would be me.”132 She went on to say, “Rituals were held at a giant, concrete owl monument on the banks of the Russian River.”133

It gets even stranger. She went on to claim, “The club offered a ‘Necrophilia’ theme room to its members,”134 which she says included, “a triangular glass display centered in a main throughway where I was locked in with various trained animals, including snakes. Members walking by

watched illicit sex acts of bestiality, women with women, mothers with daughters, kids with kids, and any other unlimited perverse visual display.”135

She then says, “No memory of sexual abuse is as horrifying as the conversations overheard in the Underground pertaining to implementing the New World Order. I learned that perpetrators believed that controlling the masses through propaganda mind manipulation did not guarantee there would be a world left to dominate due to environmental and overpopulation problems. The solution being debated was not pollution/population control, but mass genocide of ‘selected undesirables.’”136

So, in her mind, keeping child sex slaves isn’t as bad as talking about their plans for a global government and world domination? The closer you look into the claims of Cathy O’Brien, the more holes you’ll find. No Illuminati member or sadistic Satanist is going to be chatting with his friends about their plans for the New World Order in the middle of sex with a prostitute or sex slave! These conversations happen around a campfire, at lunch, or while sitting around having a few drinks in the casual atmosphere of the Grove.

And her claims that the Bohemian Grove has a huge glass display “centered in a main throughway” where children are abused and women are having sex with animals for the enjoyment of the members is absurd. In reality only a small fraction of the members could possibly be so evil as to enjoy such things and zero informants, guests, members or employees have ever mentioned such a thing. If such abuse does occur, it certainly wouldn’t be put on display for the whole club to see and would be limited to a handful of individuals.

O’Brien claims that some of her abusers were George H.W. Bush, Ronald Reagan, Gerald Ford, Jimmy Carter, Dick Cheney, and Hillary Clinton, who she said performed oral sex on her on front of Bill.137 Yet, for some reason after witnessing all this, her “CIA handlers” decided to let her live to tell about it? Why wouldn’t they have just killed her like she said

they did to all the other supposed sex slaves kept in the Bohemian Grove? Cathy O’Brien appears to be another opportunist who tried (and successfully did) make a bunch of money off the conspiracy community by claiming to be a first-hand witness to the activities inside the Bohemian Grove, as well as a victim of the CIA’s mind control experiments.

Her book, Trance Formation of America, is written in the form a novel and includes long passages of dialog that O’Brien claims to have remembered after she was “deprogrammed” by a man named Mark Phillips who claims to be a former CIA operative who decided to rescue her.138 She claims that as a result of being subjected to the MK-ULTRA mind control program, one of her multiple personalities developed a photographic memory and could supposedly recall every conversation that had occurred in her presence.139

In case you’re not aware, the CIA did conduct (and most likely still is conducting) horrific mind control and brainwashing experiments which began in the 1950s. Declassified documents reveal that these inhumane and illegal experiments involved sleep deprivation, drugging people with LSD and other mind-altering drugs, hypnotism, torture, and murder.140 The existence of these declassified and confirmed experiments is what leads many people believe her claims since they do at least contain a grain of truth.

One of the goals of the MK-ULTRA program was to create mind controlled slaves or Manchurian Candidates, as they were called, who would willingly carry out any order given to them whether it included murdering someone, or putting themselves in harm’s way.141 Through post hypnotic suggestions these orders were designed to be forgotten after they were carried out. Several victims of these experiments have actually been awarded six-figure financial settlements for the abuse they suffered, but Cathy O’Brien is not one of these people.142

She was most likely inspired by John DeCamp’s book The Franklin Cover-Up, which first came out several years before she wrote her book,143

where DeCamp, as I mentioned earlier, claims that numerous children have come forward saying they were sexually abused inside the Bohemian Grove and forced to participate in other sadistic acts.144 John DeCamp’s account of what he says happened to his clients is pretty straight forward, and as farfetched as it may sound to some, the claims appear to be plausible and are centered around a small subgroup within the Bohemian Grove, not the entire club.





 

Author’s Note: Please take a moment to rate and review this book on Amazon.com or wherever you purchased it from to let others know what you think. This also helps to offset the trolls who keep giving my books fake onestar reviews when they haven't even read them. Almost all of the one-star reviews on my books are from NON-verified purchases which is a clear indication they are fraudulent, hence me adding this note. These fraudulent ratings and reviews could also be part of a larger campaign trying to stop my message from spreading by attempting to tarnish my research through fake and defamatory reviews, so I really need your help to combat this as soon as possible. Thank you!

 

Talk Radio Hosts Dodge the Topic

Years ago when I first began investigating this subject, I thought I would test to see if the top call-in talk radio shows in America would dare address the Bohemian Grove, so I decided to start calling the shows trying to get on the air. I soon realized that every time I would get through to the call screener, they would hang up on me immediately as soon as I told them I had a question about Bohemian Grove. “We’re not taking calls on that right now, sorry. Click.”

I soon devised a method to actually get on the air and verbally confront the talk show hosts about this and other Illuminati issues. What I did was feed the call screener a fake question that pertained to one of the top stories of the day, and then they would place my call in the queue to be taken by the host. As soon as the host took the call—instead of asking the question the screener approved—I would fire off a question or comment about the Bohemian Grove.

I got recordings of many of these calls from the shows’ podcasts and posted them on MarkDice.com and on YouTube to show people that hosts like Sean Hannity, Rush Limbaugh, Bill O’Reilly, Glenn Beck, and others wouldn’t dare inform their audience about the activities or allegations surrounding the Bohemian Grove.

Even with the seven-second delay, many times I was able to plant seeds in the minds of the audience before getting hung up on, and sometimes the hosts would argue with me for a few seconds before dropping my call and then telling the listeners I was crazy. On the next few pages are transcripts of just a few of these calls so you can see how they reacted to my questions. Sometimes I had to give the call screener a fake name like “John” because “Mark from San Diego” became a known

problem for many of these shows when I repeatedly called into them week after week during my investigation.



First Call to Bill O’Reilly

[O’Reilly]

“Let’s go to Mark in San Diego, what’s going on Mark?”

 

[Me]

“Can you address the Bohemian Grove club private presidential…” [hung up on by Bill]

 

[O’Reilly]

“You know these guys in San Diego they’re just…the weather’s just too nice there. Now here’s what happens…not everybody…but you go out to the beach and you do all that…and some kind of substance gets in your mind. And Mark just demonstrated it.” [referring to getting stoned]



Second Call to Bill O’Reilly

[O’Reilly]

“Ok, we’ve got an all-skate going on, which means you can ask me anything you want at 1-877-9 No Spin…let’s go to Mark in San Diego, what’s going on Mark?”

 

[Me]

“How do you feel about the private presidential resort the Bohemian Grove…” [Bill interrupts and drops the call]

 

[O’Reilly]

“I don’t know what you’re talking about, and I don’t care.”

 

This was on a Friday when Bill was having what he called an ‘allskate’ in which he took call after call on any topic…or so he said. I could understand getting hung up on if my question was off topic, but this was the segment where O’Reilly said, “You can ask me whatever you want.” This call and others can be heard on my YouTube channel, just look for the Bohemian Grove playlist on YouTube.com/MarkDice.145 Bill O’Reilly quit

his syndicated radio show in 2009 but continued to host the O’Reilly Factor on the Fox News Channel.





First Call to Sean Hannity [Hannity] “Hello.”  

[Me] “The Bohemian Grove, have you been there, do you know about it…”  

[Hannity] “I’m very aware of it, I’ve been invited, I’ve never gone.”  

[Me] “Do you know about the mock human sacrifice ritual, the Cremation…” [Hannity drops call]  

[Hannity] “All right, goodbye. This guy’s nuts.”



Second Call to Sean Hannity

[Hannity]

“Alright, back to our phones. San Diego, Mark on KFMB, how are you?”

 

[Me]

“Good. Let’s talk about the Bohemian Grove and the kickoff of their summer festival in July which is a mock human sacrifice, Sean.” [Hannity drops call]

 

[Hannity]

“You’re out of your mind, you’re a sicko...this guy’s a nutcase.”



Third Call into Sean Hannity’s Show

[Hannity]

“KFMB San Diego, Mark next, Sean Hannity show, Mark, how are you?”

 

[Me]

“Let’s discuss the issue instead of hurling insults and ad hominem attacks…”

 

[Hannity]

“You are a kook. You are a nut. You are absolutely out of your mind insane. I’ve never been to the Bohemian Grove, sir. It’s just a great conspiracy.”

 

[Me]

“You said you were invited, but have you looked up what happens in the Bohemian Grove?”



 

[Hannity starts playing the theme song from the film Psycho in the background]

 

[Hannity]

“I have no idea.”

 

[Me]

“The Cremation of Care?”

 

[Hannity]

“No, I don’t.”

 

[Me]

“Look it up on any search engine Sean, ask your friends.”

 



[Hannity]

(Sarcastically) “What do you think is happening in there?”

 

[Me]

“Well, they I think they’re doing a mock human sacrifice where they burn an effigy of a human, it’s like a paper-mache human body.”

 

[Hannity]

“What Republicans do this, sir?”

 

[Me]

“Well, President Bush is on the membership list…”

 

[Hannity]

“President Bush? He’s burning figures in effigies in the Bohemian Grove, sir?”



 

[Me]

“In front of Molech, the ancient Canaanite deity, while they’re dressed up in black robes and colored robes carrying torches.”

 

[Hannity]

(Sarcastically) “Yeah.”

 

[Me]

“Look at Infowars.com.”

 

[Hannity]

“Hey Mark…”

 

[Me]

“Look it up.”



 

[Hannity]

“You are a nut.”

 

[Me]

“Well, you’re a gatekeeper, trying to avoid the truth.”

 

[Hannity]

“You are a nut. Go seek help. Go get help.” [Hannity drops call]



Call to Rush Limbaugh

When I asked Rush Limbaugh about the club, at first he pretended not to know anything about it, saying he had never been there, but when I pressed him, he made a fairly long sarcastic speech about the place, showing he knew exactly what it was and what goes on there.

 

[Rush]

“Mark, you’re next on the EIB Network, hello.”

 

[Me]

“Since I have you on the line, Rush, have you seen the video of the Bohemian Grove ceremony that Alex Jones produced that’s on Google Video?” [the predecessor to YouTube]

 

[Rush]

“Uhh…No. Been invited to the Bohemian Grove, but I’ve never been there. And I’ve not seen the video.”



 

[Me]

“Do you know about the activities within the Grove, can you talk about that?” [hangs up on me]

 

[Rush]

“No! Cuz I don’t…I’ve never been there. All I know is that it’s a bunch of elitists and power brokers who conduct secret meetings to take over the world and they run around nude. It’s all men, no women are allowed. And they run around and you can find them going to the bathroom on trees and so forth. And they have men come out and make speeches to them and all that.”

 

After his little sarcastic rant, he addresses his producer referring to my call, and says, “He believes it’s the CFR in the woods,” and then moves on as if nothing happened. The CFR (Council on Foreign Relations) is an elitist think tank that masquerades as if it were an ordinary committee in Congress that is composed of prominent politicians and journalists who are given policy recommendations and talking points which are practically viewed as marching orders by the Establishment. See my book The Bilderberg Group: Facts & Fiction to learn more about the CFR which functions as a less secretive sister organization to Bilderberg.

 



Call to Michael Savage

Michael Savage seemed skeptical and pretty shocked at first but did listen to me for a bit before he hung up with disgust after I asked him on air about the ritual for the first time.

 

[Savage]

“Mark in San Diego, you’re on the Savage Nation.”

 

[Me]

“Michael, why has information about the Bohemian Grove and George W. Bush’s and Bush 41’s membership been suppressed and ignored, and why is it laughed at in the mainstream media?”

 

[Savage]

“I don’t know. What is so weird about the Bohemian Grove? It’s a powerful group of men who have a club. I don’t understand. What’s the big secret up there?”



 

[Me]

“You haven’t heard of, or seen the mock human sacrifice video?”

 

[Savage]

“Oh please. Come on. Do you have evidence of this? Is there any evidence you can post about this?”

 

[Me]

“Look it up on Google. Look at Alex Jones’ Infowars” [website muted and not allowed on air].

 

[Savage]

“So everybody who goes to the Bohemian Grove including Henry Kissinger, is what, they’re doing snuff movies up there now?”

 

[Me]



“Well, that’s what senator John DeCamp alleges and his witness back in 1984, but…”

 

[Savage]

“Senator who? Senator who?”

 

[Me]

“Listen Michael, you really need to look into this, I’m surprised that you haven’t.” [Savage drops call]

 

[Savage]

“I have a migraine headache sir, there’s only so much a man can do in one day. My God, now the Bohemian Grove, they’re doing mock funerals. There’s only so much madness a man can listen to until he goes crazy. You know, I’m serious. How much more can I take?”



Call to Glenn Beck

[Beck]

“Let’s go to San Diego, welcome to the Glenn Beck program.”

 

[Me]

“I was wondering if you’ve read the book The Resistance Manifesto. I know you’re a big fan of the Bohemian Grove [sarcasm] and I thought you could expand on the rituals and the mock human sacrifice that goes on there each year.”

 

[Beck]

“Yeah, do me a favor. Don’t ever lie to my phone screener again. I’d answer that question if you would have asked my phone screener that question. Don’t lie to my phone screener. We take you off the air immediately and won’t deal with you. You might have just gotten that whole show that we were going to do on that topic taken out of line. I might not do it now because you pissed me off!”





First Call to Alan Colmes [Colmes] “Let’s go to Mark in Oceanside, California. Hello.”   [Me] “Wondering if you checked out those photos or the video of the mock human sacrifice in the Bohemian Grove…” [Colmes drops call]   [Colmes] “No I have not.”

Second Call to Alan Colmes

[Colmes]

“Mark in San Marcos, California. Hello.”

 

[Me]

“Hey, I was wondering since you’ve heard a little bit about it, and you’ve probably seen the photos and the video clips, I was thinking we could spend a few minutes talking about the Bohemian Grove and the mock human sacrifice that’s done each year by the Republican elite.”

 

[Colmes]

“What about it?”

 

[Me]

“What are your comments on that?”



 

[Colmes]

“I don’t know much about it.”

 

[Me]

“You haven’t checked it out after hearing about this bizarre activity that the Republicans engage in?”

 

[Colmes]

“All right, thank you very much.” [Drops call]



Third Call to Alan Colmes

[Colmes]

“The Friday night free for all is where you set the agenda, you run the show, you determine what we talk about, I do not. We take the calls in the order they arrive, and we cannot keep you off the air as much as we would like to in some cases, if you get through you get on. Mark in San Diego, hello.”

 

[Me]

“Alan, if you type in Bohemian Grove into any search engine, the entire page is full of wonderful links and photos, and I’m sure that you’ve done this…” [Colmes cuts me off]

 

[Colmes]

“That’s very nice. And I’m sure that someday you’ll call me with actually a new topic rather than repeating yourself every single time you call me with the same thing. That will be nice.”



Fourth Call to Alan Colmes

[Colmes]

“Hello.”

 

[Me]

“Let’s spend more than just a few seconds talking about such an important issue like the Bohemian Grove…” [Colmes drops call]

 

[Colmes]

“Well, first of all, you are a problem. You have continued since this show has been on the air to try to get to me to put you on the show as a guest. You’re a phony and you’re a fraud and I’m not going to put you on the air as a guest. Ok? It’s not going to happen! That’s that guy by the way, he has attempted to book himself as a guest on the show, he’s left messages on my voicemail, has emailed me. We’ve talked to him off the air and tried to discern whether or not he was someone we wanted to put on as a guest. We decided not to. During the free for all, if he wants to call up and make his statements he’s welcome to do it. That’s why we do the free for all. And if we decide that someone is not someone we’re not going to put on as a guest, I trust the determination of our producers, that’s why they’re hired to make those decisions.”



 



The Belizean Grove

Apparently some wealthy and well-connected women were jealous of the all-male Bohemian Grove, so they started their own version for women —called the Belizean Grove. Not much is known about this girls’ club, but there are a few pieces of information I have been able to put together. The Belizean Grove was started Super Bowl weekend in 2001 by Susan Stautberg who is the president of PartnerCom Corporation, a company which manages advisory boards around the world for businesses and governments.

In a response to her husband and most other men being preoccupied with the “big game,” Stautberg gathered up a small group of her highpowered girlfriends and flew down to Central America for a women’s weekend. This wasn’t just a vacation; this was also a business trip where the women worked to further their careers and privately plotted their futures.

The group now consists of around 100 of the most influential women in the world who meet up every year in Belize for three days for what is said to be “a balance of fun, substantive programs, and bonding.”146 The group says they are “a constellation of influential women who are key decision makers in the profit, nonprofit and social sectors; who build longterm, mutually beneficial relationships in order to both take charge of their own destinies and help others to do the same.”147

One member, Mary Pearl, who works as the Dean of New York’s Stony Brook University, said, “It’s hard if you’re someone who’s a type ‘A’ personality, who’s achieved a lot and who may be in the public eye—it’s hard to make friends, so it’s just a mutually supportive wonderful experience. We get together just for socializing and also just for intelligent conversation.”148



It is bizarre that these women—most of whom are from the United States, would fly all the way down to Central America for a weekend getaway when they could just meet up locally at a fancy resort or one of their lavish private residences. Some speculate this is so the women can go out and have a night on the town with little chance of bumping into anyone they know or being recognized by someone. Perhaps it’s like a Cougar’s night out, when some of the women pickup younger men and bring them back to their hotel rooms, which if they did in an American city, they would run the risk of being spotted by someone who knew who they were, but when down in Central America, it is extremely unlikely anyone would recognize them.

Belizean Grove members include female executives from major banks, public relations firms, and even women in the U.S. Military. A New York Times article written in 2011 said, “Belizean Grove has connected the top women in technology to the top women in finance, to the top women in media, to the top women in law, to the top women in retail, and so on.”149 It is currently unknown if they engage in any occult rituals like their male counterpart at the Bohemian Grove.

The group was really only discovered in 2009 after Sonia Sotomayor was nominated for a position as a Supreme Court Justice by President Barack Obama. During the vetting process, Republicans digging for dirt on her discovered she was a member of this strange girls’ group. She immediately resigned from the Grove since the American Bar Association forbids a judge from being a member of any organization that “discriminates” against anyone based on sex, race, religion, or national origin; and since it’s an all-female club, this caused a potential hang-up for her getting approved to sit on the Supreme Court.

Founder Susan Stautberg was not happy about the new publicity, and said, “We like to be under the radar screen.”150 In order to join, a woman must be recommended to the Belizean Grove “advisory board” which then decides whether or not to admit her. A few known members are U.S. Army

General Ann E. Dunwoody; former Goldman Sachs executive Ann Kaplan; and General Services Administration Director Lurita Doan. Facebook’s Chief Operating Officer Sheryl Sandberg, a major promotor of the feminist agenda, is a likely member as well.

Before taking over for David Letterman on Late Night, Stephen Colbert hosted the popular Colbert Report on Comedy Central from 2005 to 2014, where he pretended to be a radical right-wing conservative, basically satirizing Fox News’ Bill O’Reilly. In 2009 when Sonia Sotomayor was being considered for a position on the Supreme Court, and the Belizean Grove was first discovered—Colbert joked about it in his monologue. “Now it has come to light that Sotomayor is a member of something called the Belizean Grove, a private organization whose members must be a female professional from the profit, nonprofit, and social sectors,” he began.151

“This is not only more Sotomayor reverse discrimination—it also violates the code of conduct for federal judges which forbids membership in groups that practice invidious discrimination on the basis of sex,” Colbert says, pretending to be outraged.

He goes on to say that Republicans have questioned her membership in this “sexist” club, and that, “There’s only one way for Sotomayor to be a member of a single-sex club and still be confirmed for the Supreme Court, which brings us to Tonight’s Word: Bohemian Grove! As opposed to the Belizean Grove, the Bohemian Grove or Bohemian Club is an all-male, 130-year-old secret society of captains of industry, international power brokers and every Republican president since 1923. Herbert Hoover called it quote ‘the greatest men’s party on earth,’ and Richard Nixon agreed,” he says sarcastically before playing the White House Oval Office tape of Nixon calling it the most faggy God damned thing you could ever imagine.152 “That is really saying something from a guy named tricky dick,” Colbert continues.



“Every year, the Bohemian Club holds a retreat in the Bohemian Grove in northern California where they are rumored to engage in costumed pageantry, simulated human sacrifice and worshiping before a 40-foot stone owl. In 1999 after being denied membership in the Bohemian Grove, a group of women started their own same sex organization—the Belizean Grove.”

He then quotes a statement from Sotomayor denying they discriminate against men, reading “All interested individuals are duly considered by the membership committee [and] to the best of my knowledge, a man has never asked to be considered for membership.”

“Until now!” Colbert says. “Because I hereby demand to be admitted to this ladies’ shadowy cabal. Making me a member is the quickest way to put this controversy to rest…and between you and me, the Bohemian Grove is a total sausage fest. I can’t spend another summer watching Henry Kissinger belly dance around a statue of the tootsie pop owl, so madam I await your invitation.”







Depictions in Television and Film

Eyes Wide Shut

In 1999 Tom Cruise and his then-wife Nicole Kidman stared in Eyes Wide Shut, a bizarre film directed by Stanley Kubrick about a secret society of wealthy men and women in New York City who meet periodically in large mansions to engage in strange ceremonies and masked sex orgies.

Tom Cruise’s character (Dr. Bill Hartford) is told about the parties by a friend of his who is paid to play the piano during the events. Out of curiosity Cruise rents a black robe and a mask from a local costume shop, and attends one of the parties. Once inside he witnesses a group of around 100 men and women conducting some kind of occult ritual while wearing long black robes and venetian masks just before having an orgy.

Tom Cruise is eventually discovered and escorted from the property after being given an ominous threat to remain silent about what he had seen. The following day, one of his wealthy friends reveals that he was in attendance at the ceremonial orgy and warned Cruise, “Do you have any idea how much trouble you got yourself into last night just by going over there? Who do you think those people were? Those were not just some ordinary people. If I told you their names...no, I’m not going to tell you their names...but if I did, I don’t think you’d sleep so well at night.”

As strange as it sounds, the plot of Eyes Wide Shut is based on actual events, and for some, the film brought to mind images of the Bohemian Grove or the rumored Illuminati sex orgies many believe occur at the

private parties of the ruling elite. The Hellfire Club was a sex club in England where members of Europe’s class would have sex orgies back in the eighteenth century.153

The club’s name was a celebration of the Hellfire that sin is said to bring, and their motto was “Do what thou wilt,” the same credo Aleister Crowley would adopt over 100 years later. The Hellfire club was a place where European royalty and wealthy men would get drunk and have group sex with prostitutes or loose women from their social circles. But sex clubs and swinger parties aren’t just a thing of the past. In fact, today, they are more popular than ever.

In recent years a franchise of secretive elite sex clubs called Killing Kittens has popped up in Europe and the United States that hold Eyes Wide Shut themed parties in rented mansions in major cities like London, Los Angeles, and New York. Couples pay $250 per party to participate in masked orgies with other strangers.154 The Killing Kittens club vets all requests and couples must be approved before they are allowed to attend a “Kittens Party.”155 Everyone wears a venetian mask, just like the party in Eyes Wide Shut, and everyone has sex with whoever they want, wherever they want, throughout the mansion right in front of everyone else.

A Christian singer named Jeannie Ortega, who had one of her singles reach the Billboard Top 100, wrote a blog in February of 2015 talking about how a record producer she once worked with said he was invited to an Eyes Wide Shut-type of party that was allegedly thrown by rapper Jay Z. “I was working with him [the producer] on my album and we had a conversation about the abnormal things the entertainment industry is involved in. At the time the word ‘Illuminati’ was not as popular, so we called it more so Freemasonry or something like that. The producer proceeded to share with me his own experiences while on Roc-A Fella while Jay-Z was a part of the company. He said he was once invited to a party where he was given a poker chip and asked to go to the party wearing a black trench coat with nothing else underneath it.” 156



The poker chip was supposedly the entrance pass. The producer, who Ortega did not name, said he did not attend. It’s standard operation procedure to have people sign non-disclosure agreements when attending elite parties so they are legally prevented from talking about them and strict security measures are put in place which enforce a no cell phone policy so no pictures can be taken inside. Are such sex parties thrown by the Hollywood and political elite today like they were in the days of the Hellfire club?

Billionaire Andrew Epstein—a personal friend of Bill Clinton—who also rubs elbows with many political and Hollywood elite, is accused of organizing orgies with underage prostitutes and sex slaves to entertain him and his friends on his luxurious and secluded Virgin Islands estate.157 Epstein is a sex offender, having been convicted of soliciting underage prostitutes in the past as young as fourteen-years-old.158 Court documents also claim that Epstein had the bedrooms in his estate fitted with hidden cameras to videotape his high-powered guests’ encounters with prostitutes so he could allegedly then use the videos to blackmail them.159

With swinger clubs becoming more and more popular, and websites and apps like Adult Friend Finder, a place where couples go to meet other couples and fulfill their strange sexual fetishes—and the well-known sexual deviancy of many powerful politicians and Hollywood elite, it shouldn’t be much of a surprise that Eyes Wide Shut parties occur. It’s likely that at some point in the future these sex magic orgy practitioners will come out of the closet and demand that the world accept their activities as “normal,” much in the same way we saw the gay rights movement grow from a ripple to a tidal wave in the early 21st century.



South Park

Known for its no holds barred lampooning of pop culture figures, politicians, and religious beliefs, South Park tries to be as offensive as possible with their crude and often distasteful “humor.” Occasionally the show ridicules various people and institutions by simply presenting bizarre facts in a humorous way, like they did in their episodes making fun of Mormonism and Scientology. Both of these episodes included a banner on the bottom of the screen that read, “This is actually what Mormons/Scientologists believe,” and it really was what they believe! This disclaimer was used to point out the fact that the show wasn’t making up these foolish beliefs, which made the episodes even more hilarious.

The use of this banner was also included in an episode about what was called the “Super Adventure Club.” This episode, titled “The Return of Chef,” was about an organization of pedophiles who travel around the world to have sex with young boys because they believe that it gives them magical powers. The current leader of the group explains, “Our club offers hope. Do you think we go around the world molesting children because it feels really good? No. Our club has a message and a secret that explains the mysteries of life.”160

The leader continues to explain the history of the “Super Adventure Club,” saying that a man named William P. Phineas, a pedophile who traveled all over the world molesting young boys, discovered a great secret. “But now the most wonderful part. You see, after having sex with all those children, Phineas realized that molesting all those kids had made him immortal. He discovered that children have things called marlocks in their bodies and when an adult has sex with a child, the marlocks implode feeding the adult’s receptor cavity with energy that causes immortality.”161



While this is not funny at all, and only in a morally bankrupt society would such dialogue be allowed to air on a major network like Comedy Central, the plot appears to have been inspired by the teachings of satanic sex magic—which—as I covered earlier in this book, is the belief that certain perverted sexual practices unlock spiritual powers latent in the mind. As I pointed out, Satanist Aleister Crowley believed that though sex magic a person could summon demons that would grant them supernatural power, and some believe that if these rituals involve children, it will enable them to harness “real” black magic forces.

South Park’s creators and writers Trey Parker and Matt Stone must have stumbled across this idea since there are probably whispers in Hollywood about people doing such things. Aleister Crowley is highly revered by many musicians and celebrities today.162 And again, just like the episodes making fun of Mormonism and Scientology, this episode included the note on the bottom of the screen saying, “This is what the Super Adventure Club actually believes.”

How could the writers have possibly come up with such a crazy idea out of the blue, and why would they put a banner at the bottom of the screen saying this is what these people actually believe in the same manner they did in the other episodes about strange religious beliefs if they weren’t in a sense trying to be serious?

The “Super Adventure Club” is possibly a reference to NAMBLA, the North American Man Boy Love Association, a “pedophile rights” group which claims there is nothing wrong with pedophilia, and want society to accept it as “normal” as many have in the case of homosexuality. It wouldn’t be surprising at all to learn that NAMBLA members had incorporated satanic sex magic into their teachings as another way to try to justify their mental illness and child abuse.



Teddy Bears’ Picnic

The man who did the voice for Mr. Burns on The Simpsons for over twenty-five years, Harry Shearer, wrote and directed a little known (and commercial failure) which was a spoof on the Bohemian Grove. Teddy Bears’ Picnic went straight to DVD and was too terrible for any distributer to put it in theaters. The movie was made in 2002; just two years after Alex Jones had infiltrated the Bohemian Grove and videotaped the Cremation of Care ritual, which served as Shearer’s inspiration for his film.

The plot of Teddy Bears’ Picnic involves an exclusive men’s club called Zambezi Glen that meets in the woods for their annual summer party where they get drunk, dress in drag, enjoy peeing on trees, and have sex with prostitutes. An employee of the campground secretly videotapes some of the members’ activities hoping to sell the footage to the media, but is spotted and chased into the woods. The well-connected men of Zambezi Glen then call in the military to track the guy down using helicopters and K9s, and in the process end up accidentally setting the forest on fire.

The Molech statue in the Grove is depicted as a large pelican in Shearer’s film, and club members dress up in Halloween-type witch costumes and conduct a ritual called the “Assassination of Time.” Shearer has admitted to being a guest at the Bohemian Grove and talked about his experience there with British television producer Jon Ronson in an episode of his Secret Rulers of the World series which basically makes fun of New World Order conspiracy theorists.

Being a left-wing Hollywood liberal, Shearer labeled the members of Bohemian Grove “white Christians.” He told Ronson, “You don’t have to be a conspiracy theorist to know that this is a get together of very powerful guys. Whatever it is they’re doing there, whether they’re running the world

or just reliving their adolescence, they’re a self-selected group of powerful white Christian Americans.”163

He then went on to say he likes conspiracy theories because he thinks they’re entertaining, but doesn’t believe they are true. “I love the theories, because I believe that these people are the only real good narrative writers left in the English language. They do write really good compelling narratives, but I just don’t happen to think they’re true.”

In the interview he then goes on to stereotype conspiracy theorists as gun-loving, backwoods hicks who live in the middle of nowhere. “And you can imagine, I’m in New York and they’re keeping me spellbound. Imagine being isolated on a ranch in Montana with nobody except your son, who you’re teaching to shoot a rifle, this would be some amazing stuff coming through the night to you, you know.”164 Apparently Harry Shearer thinks Montana is stuck back in the 1800s.

Ronson asked him if he thought the Bohemian Grove was a secret society, to which Shearer answered, “Yeah but I mean it’s a secret society the way the secret society that I was inducted into at UCLA in my senior year is a secret society. There is a lot of meaningless mumbo jumbo and the main conspiracy is to take it seriously.”

“If you’ve ever been through a secret society in college, you know this stuff. Just add two zeros to the budget and you’re doing what you did when you were eighteen-years-old,” he concluded.

Just to put Shearer’s twenty-five year career with The Simpsons into perspective, from around 1989 up until 1998 he was paid $30,000 per episode, then after the show became a wild success and renegotiating his contract, this jumped to $125,000. His income then jumped again to $250,000 an episode a few years later. In 2008 he was being paid $400,000 per episode, but he and other Simpsons staff had to take a pay cut in 2013 in order to lower production costs of the show or else Fox was going to cancel it, so his pay was reduced to $300,000 per episode.165



So Shearer himself is just as wealthy as some of the Bohemian Grove members, and being part of Hollywood’s elite means he probably has a lot more in common with the men inside the Bohemian Grove than he does with the average American.



Lucy, Daughter of the Devil

The Turner Broadcasting Network (TBN) owns the Cartoon Network —which, as its name suggests—consists of cartoons primarily for kids, but after primetime, when most children are supposed to be in bed, the network changes its format to what they call “Adult Swim” and airs raunchy cartoons supposedly aimed at adults. One such show called Lucy, Daughter of the Devil was a short ten minute CGI comedy about Satan trying to convince his daughter, Lucy, to fulfill her role as the Antichrist.

In 2007 an episode titled “Human Sacrifice” was about a satanic ritual at the Bohemian Grove which was being performed to honor a senator who had been chosen to be elected as the next president. “Chosen to be elected,” meaning the elite members control the elections through fraud and had chosen him to be their next puppet.166

A character named DJ Jesús, who is Jesus Christ—and Lucy’s boyfriend in the show, was chosen as the person to be sacrificed to celebrate the new president being picked. Jesus was lured to the Bohemian Grove under the pretense that he would be DJing a party that will be like the film Eyes Wide Shut and is told that Alan Greenspan (former chairman of the Federal Reserve Bank) will be there.

The Bohemian Grove, as depicted in the cartoon, is clearly modeled after the actual Grove and includes the giant owl statue with the altar at its feet and men wearing hooded robes holding flaming torches—all identical to the real Bohemian Grove. “Half of Washington” is in attendance in the episode and everyone chants “Hail Satan” as the ritual begins. The Devil even boasts that ten presidents have announced their candidacy in the Bohemian Grove as the ceremony begins.



Before he can be killed, DJ Jesús escapes and the episode ends by zooming out to an aerial view showing the location of the incident being in Northern California, where the actual Grove is located.

 



Conclusion

After sixty years of mainstream media blackouts regarding the elusive and secretive Bilderberg Group, it became impossible in the age of social media and smartphones to keep them under wraps any longer. The easily swallowed claims of the Bilderberg Group being “just another business conference,” are now offered up after the decades of denials about their existence and power, but writing off the Bohemian Grove as “just another party” is not so easy.

Most of the public gullibly buy into the claims now that the Bilderberg Group is just a bunch of men in suits getting together for another boring meeting, but trying to explain the Cremation of Care—not to mention the allegations of Satanism and child abuse that hang over the Bohemian Grove—is quite a bit more difficult. The video footage and photos of the annual “human sacrifice” ceremony would be disturbing to most people once they saw it, and no amount of whitewash or spin would remove the suspicions that many have about the Bohemian Grove.

A bunch of guys meeting for a three-day conference in the case of the Bilderberg Group is pretty easy to brush off as something rather normal—a bunch of men gathering in the middle of a secluded forest, dressing up in hooded robes, and engaging in a “human sacrifice” ritual—not so much.

Even setting this aside, it’s clear that the Bohemian Grove serves as an elite consensus-building party, held about a month after the more formal Bilderberg conference which occurs in the late spring each year. If one wants to gain a comprehensive view of the world and the mechanisms of power that work to guide it, then learning about the Bohemian Grove is a critical piece of the puzzle.



As Mary Moore of the Bohemian Grove Action Network once said, “Kiwanis and Rotary clubs in every small town has that same sort of ‘goodold-boy network’ of prominent men in the community getting to know each other through a social club. But when you get to the level of the Bohemian Grove, it’s a very global network, and much more powerful.”167

When the wealthiest and most powerful men in the world, from heads of industry to high ranking government officials and those who work in the intelligence agencies, all meet together to hang out and listen to off the record lectures given by a variety of experts and insiders, it is undeniable that this has a tremendous impact on society as a whole.

At the time I’m finishing writing this in June of 2015, very few books exist on the Bohemian Grove, and most Americans have still never heard of it. The stories are so strange that even when they do, many dismiss them as an Internet urban legend or a conspiracy theory, but you now hold the evidence in your hands.

I hope this book has helped shed some light on this dark subject, and put some of the wild allegations into their proper context so you can understand where they came from and why they spread. If you would like to continue your education on related subjects, I encourage you to checkout some of my previous books, and if it’s not too much to ask, please write a brief (or lengthy) review for this one and rate it on Amazon.com or whatever e-bookstore you downloaded it from to let other potential readers know what you think.

Please pass this book on to someone else now that you have finished it to share the information with them, and thanks again for investing your time and energy into my ten-year-long investigation of The Bohemian Grove: Facts & Fiction.





Further Reading

The Illuminati: Facts & Fiction

Secret societies have both fascinated and frightened people for hundreds of years. Often the infamous Illuminati is mentioned as the core of conspiracies which span the globe. The Illuminati is actually a historical secret society which had goals of revolutions and world domination dating back to the 1770s.

Since then, rumors and conspiracy theories involving the Illuminati continue to spread, sometimes finding their way into popular novels like Dan Brown’s Angels & Demons and Hollywood movies like Lara Croft: Tomb Raider. Some men have even come forward claiming to be former members, offering details of what they allege are the inner workings of the organization. When you sift through all of the information available on the subject, you may be surprised that the truth is stranger than fiction.

In The Illuminati: Facts & Fiction, conspiracy and occult expert Mark Dice separates history from Hollywood and shows why tales of the secret society won’t die.



The New World Order: Facts & Fiction

What is the New World Order? Proponents say that it’s an anticipated new era of global cooperation between diverse nations and cultures aimed at ushering in a utopia providing all the earth's citizens with everything they need.

Detractors claim it’s the systematic take-over by secret societies, quasi-government entities and corporations who are covertly organizing a global socialist all-powerful government which aims to regulate every aspect of citizens’ lives, rendering them a perpetual working-class while the elite leadership lives in luxury.

Conspiracy theory expert Mark Dice looks at the evidence, claims, and conspiracy theories as he takes you down the rabbit hole to The New World Order.

 

Calls for a New World Order World Governed Through Secret Societies Mainstream Media Controlled by the Elite Banking, Money, and Taxes One World Currency Population Reduction One World Religion A Coming Global Dictator Who Will Claim to be God



Illuminati in the Music Industry

Famous pop stars and rappers from Jay-Z and Rick Ross to Rihanna and Christina Aguilera are believed by many to be a part of the infamous Illuminati secret society. These stars allegedly use Illuminati and satanic symbolism in their music videos and on their clothes that goes unnoticed by those not “in the know.”

Since these stars appear in our livings rooms on family friendly mainstream shows like Good Morning America, Ellen, and dozens of others —and are loved by virtually all the kids—they couldn’t possibly have anything to do with the infamous Illuminati or anything “satanic,” could they? Some famous musicians have even publicly denounced the Illuminati in interviews or songs.

Illuminati in the Music Industry takes a close look at some of today’s hottest stars and decodes the secret symbols, song lyrics, and separates the facts from the fiction in this fascinating topic. You may never see your favorite musicians the same way ever again.



Big Brother: The Orwellian Nightmare Come True

In Big Brother, Mark Dice details actual high-tech spy gadgets, mindreading machines, government projects, and emerging artificial intelligence systems that seem as if they came right out of George Orwell’s novel Nineteen Eighty-Four.

Orwell’s famous book was first published in 1949, and tells the story of a nightmarish future where citizens have lost all privacy and are continuously monitored by the omniscient Big Brother surveillance system which keeps them obedient to a totalitarian government.

The novel is eerily prophetic as many of the fictional systems of surveillance described have now become a reality. Mark Dice shows you the scary documentation that Big Brother is watching you, and is more powerful than you could imagine.

 

Orwellian Government Programs Facial Recognition Scanners Mind Reading Machines Neural Interfaces Psychotronic Weapons The Nanny State Artificial Intelligence Cybernetic Organisms



The Resistance Manifesto

The Resistance Manifesto by Mark Dice contains 450 pages of extensively researched and documented information drawing from declassified documents, mainstream news articles, religious texts, and personal interviews. A dark web of evil is exposed like never before, making Bible Prophecy and the New World Order crystal clear.

Learn the most powerful information about the Illuminati, plans for the rise of the Antichrist, the institutions, people, and powers involved, and how you can fight them.

 

“Powerful and compelling. A must read.”

- Alex Jones from Infowars.com

 

“Mark takes you beyond 9/11 into a world of secret societies, mystics, and madmen.”

- Jason Bermas, Producer of Loose Change

“Mark Dice is not a conspiracy theorist, he is a conspiracy realist. This book tells it like it is. I urge every American to read it and pass it on to your friends and relatives. Wake up America!”



- Ted Gunderson, Senior Special Agent in Charge (retired) FBI Los Angeles



Inside the Illuminati

When looking into the existence and alleged activities of the infamous Illuminati secret society, one finds an overwhelming amount of conspiracy theories, hidden history, half-truths and hoaxes.

But how much truth is there to some of these claims? What is the real history of the mysterious group? Do they continue to exist today? What is the evidence? And what are they doing?

After a decade of research sifting through the facts and the fiction, secret society expert Mark Dice will help you navigate through the complex maze from the original documents to rare revelations from elite politicians, bankers and businessmen, as he takes you Inside the Illuminati.

 

Insider Revelations Original Writings Spiritual Beliefs Occult Symbolism Early Evidence Zodiac Club “Ex Members” Communism Seraphic Society The Jesuits The Jasons And more!



The Bilderberg Group: Facts & Fiction

Every spring since 1954, a group of approximately one hundred of the world’s most powerful businessmen, politicians, media moguls, and international royalty meet in secret for several days to discuss the course of the world. Called the Bilderberg Group after the Bilderberg Hotel in Oosterbeck, Holland where their first meeting was held, this off the record annual gathering is said to be where the globalist puppet masters plot and scheme.

Does this group of power elite develop new political, economic, and cultural policies that are then covertly implemented by their underlings? Do they choose who our world leaders will be, including the next president of the United States? Is the Bilderberg Group a shadow government? Are they the Illuminati? Why has the mainstream media had a complete blackout regarding their meetings for decades? Who attends? And who pays for it?

Is this “just another conference?” Or, are the “conspiracy theorists” right? What is the evidence? How were they first discovered? What are they doing? And should the public be concerned? Secret society expert Mark Dice will show you the hidden history, financial records, and some of the insider leaks showing how this small group’s consensus has staggering effects on the political landscape of the world, global economies, wars, and more, as he uncovers The Bilderberg Group: Facts & Fiction.

 

Their History Bilderberg’s Goals Their Discovery Recent Meetings

Members and Guests Actions and Effects Financial Records The Oath of Silence Media Blackouts Exclusive Photos And More!

 



The True Story of Fake News

Is fake news being spread through social media as part of an information war? Are political operatives publishing disinformation to smear the opposition and help their own agendas? Who creates fake news, how does it spread, and can it be stopped?

 

What are the real world effects of fake news stories that go viral? Did it affect the outcome of the 2016 presidential election? Or is ‘fake news’ a fake problem, designed to justify tighter control over the mechanisms of sharing information online to drive audiences back to brand name media outlets because their audiences and influence are dwindling?

Media analyst Mark Dice takes a close look at the fake news phenomenon and the implications of mega-corporations like Facebook, Google, and Twitter becoming the ultimate gatekeepers and distributors of news and information.

You will see the powerful and deceptive methods of manipulation that affect us all, as numerous organizations and political activists cunningly plot to have their stories seen, heard, and believed by as many people as possible.

The depths of lies, distortions, and omissions from traditional mainstream media will shock you; and now they’re colluding with the top tech companies trying to maintain their information monopolies. This is The True Story of Fake News.



 



About the Author

Mark Dice is a media analyst and author who, in an entertaining and educational way, exposes our celebrity-obsessed culture and the role mainstream media and elite secret societies play in shaping our lives.

Mark’s YouTube channel has over 1 million subscribers and more 400 million views. His viral videos have been mentioned on the Fox News Channel, CNN, the Drudge Report, TMZ, the New York Daily News, the Washington Times, and other media outlets around the world.

He has been featured on various television shows including the History Channel’s Decoded and America’s Book of Secrets; Conspiracy Theory with Jesse Ventura, Secret Societies of Hollywood on E! Channel, America Declassified on the Travel Channel, and is a frequent guest on Coast to Coast AM, The Alex Jones Show, and more.

Mark Dice is the author of 11 books, including The Illuminati: Facts & Fiction, Big Brother: The Orwellian Nightmare Come True, The New World Order: Facts & Fiction, Inside the Illuminati, The Bilderberg Group: Facts & Fiction, The Bohemian Grove: Facts & Fiction, and more.

While much of Mark’s work confirms the existence and continued operation of various powerful secret societies, he is also dedicated to debunking conspiracy theories and hoaxes and separating the facts from the fiction; hence the “Facts & Fiction” subtitle for several of his books.

He has a bachelor’s degree in communication from California State University.

 



Connect with Mark on: Facebook.com/MarkDice

Twitter.com/MarkDice.com

YouTube.com/MarkDice

MarkDice.com



1

New York Observer “At Skull and Bones, Bush’s Secret Club Initiates Ream Gore” by Ron Rosenbaum (April 23rd 2001)

2

Robbins, Alexandra - Secrets of the Tomb: Skull and Bones, the Ivy League, and the Hidden Paths of Power page 130

3

Hanson, Mike - Bohemian Grove: Cult of Conspiracy page 25

4

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 27

5

Bohemian Club’s 2013 - 990 Tax Forms - Line 9

6

Bohemian Club’s 2013 Tax Forms 990 Schedule O, Supplemental Information (2013)

7

Domhoff, William - The Bohemian Grove and Other Retreats: A Study in Ruing-Class Cohesiveness Preface

8

Domhoff, William - The Bohemian Grove and Other Retreats: A Study in Ruing-Class Cohesiveness Page 1

9

YouTube: 1981 News Report about Bohemian Grove (posted by user Jaketom3 on December 15th 2006) Other channels have also reposted this video.

10

ABC News - Segment about Bohemian Grove (July 23, 1981)

11

Ibid.

12



The New York Times “Bohemian Club Is Upheld On Refusal to Hire Women” (January 23rd 1981)

13

The New York Times “Bohemian Club Ordered To Begin Hiring Women” (October 17th 1981)

14

CBS WCCO-TV “Good Question: Why Can Some Clubs Discriminate?” by Jason DeRusha (August 20th 2012)

15

YouTube “Bill Clinton gets asked about the Bohemian Grove club that he and other elites attend” (uploaded October 2011)

16

See my book The Bilderberg Group: Facts & Fiction for a complete analysis of the annual Bilderberg meeting and the effects it has had on shaping the world.

17

Barruel, Abbe- Memoirs Illustrating the History of Jacobinism page 582

18

See my previous book Inside the Illuminati: Evidence, Objectives, and Methods of Operation, available in paperback from Amazon.com or e-book from all major e-books stores.

19

Cirlot, J.E. -Dictionary of Symbols p. 236-237

20

Ovason, David - The Secret Architecture of our Nation’s Capital (2002 Harper Perennial)

21

Pike, Albert - Morals and Dogma page 104-105

22

Levi, Eliphas - Transcendental Magic pages 9-10

23

Hall, Manly P. - The Secret Teachings of All Ages page 272

24

Hall, Manly P. - The Secret Teachings of All Ages page 83

25

Blavatsky, Helena - The Secret Doctrine: Volume II page 192



26

Pike, Albert - Morals and Dogma page 321

27

Crowley, Aleister - Magick: In Theory and Practice page 193

28

TechnoCalyps - Part II - Preparing for the Singularity (2008) Documentary by Frank Theys

29

CNET “Google exec: Humans will be hybrids by 2030” by Chris Matyszczyk (June 4th 2015)

30

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 67

31

Shown in Alex Jones’ film Dark Secrets: Inside Bohemian Grove (2000)

32

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 127

33

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 92

34

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 93

35

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 111

36

SFGate “Behind the Count” (July 23rd 2003)

37

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 95



38

Nixon, Richard -RN: The Memoirs of Richard Nixon

39

Nixon, Richard -RN: The Memoirs of Richard Nixon pages 80-81

40

President Dwight Eisenhower’s Farewell Address in 1961

41

Checkout my book The Bilderberg Group: Facts & Fiction if you would like to learn more about this annual meeting of the ruling class.

42

There are many different YouTube channels that have posted clips of Alex Jones’ footage and his entire documentary, just search YouTube and you’ll find them.

43

Jon Ronson’s Secret Rulers of the World: The Satanic Shadowy Elite? episode 4 (at approximately the 32:13 mark)

44

Statement from Bohemian Grove included in“Secret Rulers of the World: The Satanic Shadowy Elite? by Jon Ronson (2001)

45

http://magma.nationalgeographic.com/ngm/bestvintage/photogallery_02.html

46

David Icke in a lecture of his, shown in Jon Ronson’s Secret Rulers of the World: The Satanic Shadowy Elite? Episode 4 (at approximately the 42:44 mark)

47

Icke, David - The Biggest Secret page 250

48

YouTube: David Icke - The TRUTH about the Moon - Interview with David Icke talking about this theory of his.

49

The Bible: Book of Leviticus 18:21



50

The Bible: Book of Leviticus 20:2

51

The Bible: Book of Leviticus 20:4

52

YouTube: Alex Jones asks David Gergen https://www.youtube.com/watch?v=GHFoUZEjuNM

about

Bohemian

Grove

Rituals

53

Washington Times “Gergen quits Bohemian Club and 17 other organizations” by Frank J. Murray (June 11, 1993)

54

YouTube: Walter Cronkite speech at the World Federalist Association receiving the Norman Cousins Global Governance Award

55

Ibid.

56

Spy Magazine “Masters of the Universe Go to Camp: Inside the Bohemian Grove” by Philip Weiss (November 1989) pages 59-79

57

B-2 Bomber: Cost and Operational Issues (Letter Report, 08/14/97, GAO/NSIAD-97-181)

58

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making page 284

59

Nixon, Richard - Memoirs (1978)

60

President Richard M. Nixon on the Watergate tapes in 1971 conversation with John D. Ehrlichman, and H. R. Haldeman made public in 1999 by the National Archives

61

The Press Democrat “Retired Gen. Stanley McChrystal, Conan O'Brien highlight secretive Bohemian Grove gathering” by Guy Kovner (July 12th 2013)



62

Sonoma Country Free Press “Bohemian Grove http://www.sonomacountyfreepress.com/bohos/bohofact.html (now defunct)

Fact

Sheet”

63

FAIR.org “Inside Bohemian Grove: The Story People Magazine Won’t Let You Read” (November 1st 1991)

64

Spy Magazine “Masters of the Universe Go to Camp: Inside the Bohemian Grove” by Philip Weiss (November 1989) pages 59-79

65

FAIR.org “Inside Bohemian Grove: The Story People Magazine Won’t Let You Read” (November 1st 1991)

66

C-SPAN - Washington Journal with guest Michael Barkun (March 12th 2004)

67

Ibid.

68

San Francisco Chronicle “Masked man enters, attacks Bohemian Grove / 'Phantom' expected armed resistance” by Peter Fimrite (January 24th 2002)

69

Jon Ronson’s Secret Rulers of the World: The Satanic Shadowy Elite? Episode 4 (at approximately the 42:44 mark)

70

San Francisco Chronicle “Bohemian Grove commando found guilty” by Kelly St. John (April 17,

2002)

71

Krulos, Tea - Heroes in the Night: Inside the Real Life Superhero Movement (October 2013) Chicago Review Press

72

Chicago Tribune “Costume-clad activists hit Chicago streets to spread altruism” by Geoff Ziezuleqicz (January 18th 2014)



73

Quad City Times “Alcoa protester believes Obama is an alien” by Rashah McChesney (June 29th 2011)

74

Ibid.

75

A personal interview I conduced with Chris Jones in 2006

76

05HF1675 The People of the State of California plaintiff vs Christopher Jones 12/21/67 Defendant c6972092 http://www.fearnotlaw.com/wsnkb/articles/p_v_jones-33569.html

77

Ibid.

78

San Francisco Sentinel “Vanity Fair Editor Arrested at Bohemian Grove” by Pat Murphy (July 2008)

79

Vanity Fair “Bohemian Tragedy” by Alex Shoumatoff (May 2009)

80

History Channel’s Decoded (Season 1 Episode 7) Aired January 13th 2011

81

Ibid.

82

I was included in a different episode of Brad Meltzer’s Decoded, as well as a variety of other shows, some of which were pilots that never got picked up. Check the “About the Author” section of this book for a more complete bio of the shows I’ve been involved with.

83

RT “Guccifer emails link Tony Blair to top-secret Bohemian Grove gathering” (March 25th 2013)

84

Herald Globe “Guccifer indicted in US for Bush family email hack” (June 14th 2014)



85

The Washington Post “Guccifer emails link Tony Blair to top-secret Bohemian Grove gathering” by Caitlin Dewey (January 22nd 2014)

86

www.YouTube.com/MarkDice

87

Spy Magazine “Masters of the Universe Go to Camp: Inside the Bohemian Grove” by Philip Weiss (November 1989) pages 59-79

88

Sonoma West Times & News “Remember When: West County Community Protests” by Frank Robertson (November 22nd 2002)

89New

York Post “Gay Porn Star Serves Moguls” by Richard Johnson with Paula Froelich and Chris

Wilson (July 22, 2004)

90

President Richard M. Nixon on the Watergate tapes in 1971 conversation with John D. Ehrlichman, and H. R. Haldeman made public in 1999 by the National Archives

91

CounterPunch.org “Meet the Secret Rulers of the World: The Truth about the Bohemian Grove” by Alexander Cockburn and Jeffrey St. Clair (June 19th 2001)

92

Hanson, Mike – Bohemian Grove: Cult of Conspiracy page 192

93

Hanson, Mike – Bohemian Grove: Cult of Conspiracy page 194

94

Ibid.

95

Hanson, Mike – Bohemian Grove: Cult of Conspiracy page 195

96

DeCamp, John - The Franklin Cover-Up page 326



97

DeCamp, John - The Franklin Cover-Up page 103

98

DeCamp, John - The Franklin Cover-Up pages 326-327

99

DeCamp, John - The Franklin Cover-Up pages 326-327

100

DeCamp, John - The Franklin Cover-Up page 104

101

DeCamp, John - The Franklin Cover-Up pages 326-327

102

DeCamp, John - The Franklin Cover-Up pages 103-104

103

DeCamp, John - The Franklin Cover-Up pages 326-327

104

The Alex Jones Show - “Alex Jones Interviews John DeCamp, Author of “The Franklin Cover-up”

(July 21, 2004)

105

Pytha Press “Who Murdered the CIA Chief?” by Zalin Grant

106

Washington Times “Homosexual Prostitution Inquiry Ensnares VIPs with Reagan, Bush” by Paul Rodriguez and George Archibald (June 29th 1989)

107

Ibid.

108

Guardian “Media ‘gagged over bid to report MP child sex cases’” by Daniel Boffey (November 22nd 2014)

109

Ibid.



110

Ibid.

111

Mirror “Retired Scotland Yard detectives back up claims that paedo MPs murdered boys at sex orgies” By Keir Mudie, Mark Conrad (November 23rd 2014)

112

BBC “Sir Cyril Smith: Former MP sexually abused boys, police say” (November 27th 2012)

113

TMZ “Scorpions Bassist: Yeah, about those Snuff Parties I Went to…” (posed on the official TMZ YouTube channel on April 21st 2012) https://www.youtube.com/watch?v=1JiQAzZ0tzM

114

YouTube: “Ralph Rieckermann official Statement about TMZ Snuff Party Video Clip” Posted on Ralph Riekermann’s YouTube channel on June 4th 2015

115

Interview with Rusty Nelson on A Closer Look with Michael Corbin (April 12, 2005)

116

DeCamp, John - The Franklin Cover-Up: Child Abuse, Satanism, and Murder in Nebraska page

105

117

Thompson, Hunter S. - Hey Rube: First article titled The New Dumb

118

CBS “Late Night with David Letterman” (1988) (at approximately the 7:12 mark in interview)

119

YouTube: Hunter S. Thompson on David Letterman 1988 https://www.youtube.com/watch? v=B6JnkmFMhoU

120

CBS “Late Night with David Letterman” (1988) (at approximately the 7:12 mark in the interview)

121

Brown, Nickole - In Memory of Hunter S. Thompson: Postcard from Louisville, Kentucky (posted

April 15th 2005) http://www.pw.org/mag/pc_thompson.htm



122

Kraig, Donald Michael - Modern Sex Magick: Secrets of Esoteric Spirituality page 62

123

Miller, Jason - Sex, Sorcery, and Spirt: The Secrets of Erotic Magic page121

124

Ibid.

125

Kraig, Donald Michael - Modern Sex Magick: Secrets of Esoteric Spirituality page 56

126

Crowley, Aleister – The Book of The Law page 40

127

Aleister Crowley: The Wickedest Man in the World (2002) documentary film by Neil Rawles

128

Telegraph “South African men rape babies as 'cure' for Aids” by Jane Flanagan (November 11th 2001)

129

Reuters “Albinos in Tanzania murdered or raped as AIDS ‘cure’” by Fumbuka Ng’Wanakilala (May 5th 2011)

130

Ibid.

131

O’Brien, Cathy - Trance Formation of America page 169

132

O’Brien, Cathy - Trance Formation of America page 170

133

Ibid.

134

O’Brien, Cathy - Trance Formation of America page 170



135

O’Brien, Cathy - Trance Formation of America page 171

136

Ibid.

137

O’Brien, Cathy - Trance Formation of America page 155

138

O’Brien, Cathy - Trance Formation of America page 1

139

O’Brien, Cathy - Trance Formation of America page 117

140

The Guardian “CIA sued over 1950s 'murder' of government scientist plied with LSD” by Karen McVeigh (November 28th 2012)

141

Marks, John D. - The Search for the Manchurian Candidate 1991 Norton Paperback

142

Chicago Tribune “CIA Brainwashing Suit Settled” by Howard Witt (October 5th 1988)

143

The first printing of The Franklin Cover-Up was in 1992, three years before Cathy O’Brien’s book was released.

144

DeCamp, John - The Franklin Cover-Up page 326-327

145

https://www.youtube.com/playlist?list=PLa8S4GilqogR8aZGfDIztCDZD_3ImeKHC

146

New York Times “Sotomayor Defends Ties to Association” by Savage, Charlie and Kirkpatrick, David D (June 15th 2009)



147

CNN.com “Sotomayor resigns from women's club” (June 19th 2009)

148

Politico “Sonia Sotomayor found friends in elite group” by Kenneth Vogel (June 4th 2009)

149

The New York Times “A Club for the Women Atop the Ladder” by Pamela Ryckman (April 2, 2011)

150

Politico “Sonia Sotomayor found friends in elite group” by Kenneth Vogel (June 4th 2009)

151

Comedy Central “The Colbert Report” (June http://thecolbertreport.cc.com/videos/v8qfms/the-word---bohemian-grove

17th

2009)

152

President Richard M. Nixon on the Watergate tapes in 1971 conversation with John D. Ehrlichman, and H. R. Haldeman made public in 1999 by the National Archives

153

The Irish Times “Uncovering the origins of Dublin's Hellfire Club” by David Ryan (August 10th 2012)

154

New York Post “Kate Middleton’s pal hosts the swankiest sex party in NYC” by Dana Schuster (March 10th 2015)

155

New York Post “A night inside the sex club hosted by Kate Middleton’s pal” by Dana Schuster (March 17th 2015

156

BreathCast “Questlove Recounts Illuminati Experience with Jay-Z? Christian Artist Shares Own Experience with the Occult in Music Industry” by Jeannie Ortega (February 17th 2015)

157

Newsweek “Jeffrey Epstein: The Sex Offender Who Mixes With Princes and Premiers” by Catherine Ostler (January 29th 2015)



158

The Guardian “Jeffrey Epstein's donations to young pupils prompts US Virgin Islands review” by Jon Swaine (January 13th 2015)

159

The Mirror “Prince Andrew may have been secretly filmed with underage girl he is alleged to have abused” by Matthew Drake (January 3, 3015)

160

Comedy Central - South Park “The Return of Chef” Season 10 Episode 1 (March 22nd 2006)

161

Ibid.

162

See my previous book Illuminati in the Music Industry.

163

Jon Ronson’s Secret Rulers of the World: The Satanic Shadowy Elite? Episode 4 (at approximately the 42:12 mark)

164

Ibid.

165

The Washington Post “Harry Shearer, voice of Mr. Burns, to leave ‘The Simpsons,’ reports say” by Justin Moyer (May 14th 2015)

166

See Hacking Democracy (2006) produced by HBO

167



SonomaCountyFreePress.org (website now defunct)

Causing Trouble

© 2012 by Mark Dice and The Resistance

All Rights Reserved

Published by The Resistance

San Diego, CA No part of the text within this book may be reproduced or transmitted in any form and by any means, graphic, electronic, or mechanical, including photocopying, recording, taping, or by any information storage retrieval system, without the written permission of the publisher and the author. Visit www.MarkDice.com ISBN: 09673466-9-X

eBook ISBN: 978-1-62346-360-1 Table of Contents Introduction High School College Craziness Middle School Moving to California Looking Back on it All

Introduction Kids always cause trouble when they’re growing up, especially boys, but not like my friends and I. We didn’t steal cars, commit armed robberies, or burn down someone’s house. Our trouble was different. It was more creative. It was more fun. It still landed us in handcuffs, in the newspapers, and for me, ultimately getting kicked out of high school and featured on the evening news. But there was a style to our trouble. It was often misguided creative energy that we didn’t know how to handle in our youth, and would manifest itself in our outrageous schemes, our over-the-top pranks, and a life that was more exciting than something out of a movie. Years later, whenever discussing high school pranks or stupid things people did growing up, I always had the best stories. Always. And not just one epic story that became legendary at the school for years afterward. I had story after story of the craziness. My stories were so entertaining to those listening that occasionally people said I should write a book about them, so I did.

I’ll tell you about every detail: Painting obscenities consisting of 30-foottall letters in the snow on the football field using food coloring mixed with water in a giant weed sprayer; sending hundreds of magazine subscriptions to a teacher and checking the “bill me later” box; replacing the magazines in the school library with old pornos from the 1970s that a friend of mine found in her dad’s basement; sending a fake college rejection letter to a former friend informing him that the school had changed its mind about enrolling him; and that’s just the beginning. Two years after getting thrown out of high school for a prank I orchestrated that got out of hand, I moved to California with one of my best friends and the craziness continued for about a year before I really started to grow up and channel my energy into more positive things. You could say that immediately after moving to California was the lowest point in my life as you will discover in this book. Within two weeks I found myself in jail for a DUI and later helped turn my roommate’s closet into a marijuana growing operation hoping we wouldn’t have to spend money on pot anymore since we smoked it every day. Instead of getting jobs, we started selling fake IDs to people at my college in order to make money because we didn’t want to work since we came to California to become successful and “live the dream.” We were headed on a crash course with complete disaster. I don’t know what it was that caused all of this craziness to manifest itself in my brain and in my life. Maybe it was because I never had cable TV growing up, so instead of mindlessly sitting in front of the television for hours on end, I had to come up with things to do to entertain myself. In the 1990s there was no high-speed Internet yet, there were only dial-up modems that took hours to download even small files. Maybe it was because I lived in Wisconsin, and for six months out of the year the weather was too bad to go outside and I was stuck indoors for months on end, so we had to do something for fun. Maybe it’s genetic, because from what I understand one of my grandfathers was a trouble maker when he was young. Or maybe it’s because my mom wouldn’t let me take karate class. I’m not really sure. My trouble making crew mainly consisted of Fred, Diego, Ken, Rick, as well as Marty and Brent. Fred and Diego are my two best friends and we

have all known each other since the first grade and lived on the same block growing up. Ken and I became good friends in the fifth grade after he moved to the area with his mom and brother, and I met Rick, Marty, and Brent freshman year of high school. This book is 100% true. Everything that is written about here in this book happened just the way it is described and nothing is exaggerated or fabricated. Everyone who knows me and grew up with me is familiar with a lot of these stories since they witnessed them first hand. The names of some of the people involved have been changed to maintain their privacy, since you’ll find a lot of craziness occurred that I’m sure they don’t want to be connected to, even though the statute of limitations is probably passed and nobody can be prosecuted. If anyone has the same name that is used in this book, it is merely a coincidence, and is in no way referring to them. And keeping in line with the typical cliché to avoid any legal problems (both for myself and for you) from people attempting to copy anything that my friends and I did, I insist that you please do not try any of this stuff at home…or anywhere…ever. You’ll have enough fun living vicariously through me just from reading about what we did, so there’s no need for you or your friends to do it too. And before you get all judgmental and think that I’m a completely terrible human being for some of things I’ve done, please read through the entire book before coming to judgment, and remember that it’s tough being a kid.

High

School Fake Pregnancy Test Results Rumors started going around that two particular teachers at our school were having an affair. Mr. Bell and Mrs. Hartnett. One of them was divorced, but the other one we thought was apparently still married (as far as we knew). They also somehow convinced the school board to let them “team teach” a course combining art class and geography in what they called “global

studies.” It was the dumbest class ever, and we didn’t really learn anything and pretty much just drew a bunch of pictures and did childish arts and crafts. I hated Mr. Bell and his dumb class that was probably just an excuse for him to spend more time with Mrs. Hartnett. He was an obese man with a fairly normal looking upper body, and then around his stomach and waist, his body just inflated into a massive blob, making him look like an oversized bowling pin or pear. Anyway, a lot of us students believed that they were having an affair, so I sent an envelope to the school addressed to Mrs. Hartnett with large letters printed on the outside that read, “PREGNANCY TEST RESULTS ENCLOSED. PERSONAL AND CONFIDENTIAL.” As you may know, most teachers have their own little mail slots in the school office and whoever receives the mail has to go through it all and put it in the appropriate slot. The words “PREGNANCY TEST RESULTS ENCLOSED” were so large and noticeable that whoever was separating the mail in the office couldn’t miss it, and I’m sure they couldn’t help but gossip about this strange piece of mail that came in addressed to Mrs. Hartnett, and that was exactly what I wanted. Inside the envelope I put a piece of paper that said “Fuck You” written across it. Not as creative as the outside of the envelope, but hey. Of course, neither she nor Mr. Bell ever mentioned anything about this envelope after she had received it, but it wasn’t the last I would hear about it. Probably six months later, maybe even a year later, my mom—who usually never approved of my antics—came home from grocery shopping one afternoon and told me that she bumped into Mrs. So & So, who worked in the office at the high school, and my mom started smiling excitedly like she had heard some incredibly funny news and went on to tell me that this woman told her about the pregnancy test results letter that Mrs. Hartnett had received and figured it was my doing. She also told my mom that she thought it was hilarious. My mom and I started laughing, and she went on to say that the office lady had figured that it was my handiwork (and she was right). Oh yeah, at some point, Mrs. Hartnett had divorced her husband and that summer married Mr. Bell, and became Mrs. Bell. We were right. They had

been in a relationship, and this was certainly not the end of me tormenting them.

Magazine Subscriptions to Teacher You know how when you pick up a magazine, about 20 subscription cards fall out every time you flip through the pages? You know those little postcards that you put your name and address on and send in to subscribe to the magazine? Well, I noticed that you didn’t have to send any money in with your subscription and you could just check the “bill me later” box and they would start sending you the magazines without having to pay for them right away because they would send you a bill later. It was very generous of them, so I figured Mr. Bell could use some of that generosity. I drove to the mall a few days later and went to the magazine section of the bookstore and started collecting the subscription cards for every magazine on the shelves. Since each magazine has about 5 of these little cards fall out every time you open one, sometimes I collected two or three of the subscription cards for the same magazine. My stack of subscription cards kept growing and growing. I had cards for magazines I never even knew existed. I figured Mr. Bell could use some of this interesting reading material, so I spent an hour or so filling out his name and the school’s address on the cards and marked “bill me later” and dropped them off in the mail and started laughing out loud. I didn’t even have to put stamps on them because the postage was all prepaid by the magazines! It was great! It must have been around 200 different cards. I subscribed him to Good Housekeeping magazine, Time, Newsweek, Cosmo , all the fashion magazines, arts and craft magazines, fitness magazines, celebrity gossip rags, and even Penthouse and Playboy . The stack of cards was over an inch tall by the time I was done collecting them. I could already see what was going to happen. In just a week or two, Mr. Bell’s mailbox at school would be flooded with new magazines, probably 10 or more a day, every day, every week, for who knows how long, all with his name on them. Not only this, but a few weeks later he would also be sent the bill for them all. Even though I wasn’t able to see this with my own

eyes, I knew this would happen and that was satisfaction enough. He would know it was me. Only I would come up with such a devious, yet creative, idea and actually put it in motion. I figured he would never mention that this had happened to him out of embarrassment, and he wouldn’t want to encourage more subscriptions or have it happen to other teachers, but this wasn’t the last I would hear about the magazines. Months later, my mom had to come to the school to have a conference with Mr. Bell, the school principal, the vice principal, the guidance counselor, and myself, because of some other trouble I was causing Mr. Bell which involved me drawing a picture of someone holding a gun and shooting a fat man shaped like a bowling pin that resembled him. (Oh, I popped a bunch of inflatable globes he had hanging from his ceiling, too.) The school was not happy about my drawing (or the globes). The picture didn’t have his name on it, so I didn’t see what the big deal was. During the meeting I said, “Do you think this resembles you, Mr. Bell? What makes you think that?” I was trying to get him to say he was basically a fat blob like the guy in my drawing. He looked like a moron, and instead of my mom being mad at me for her having to come to the school for our big meeting, she was mad at him and thought it was a waste of her time. He wouldn’t even admit that the picture was of him, and he insisted he was just concerned because it was “violent” and even asked if I had any issues with the local bowling alley because the guy in my drawing was a human bowling pin because that was one of our nicknames for him since that was basically the shape of his body. It was during this meeting that Mr. Bell mentioned that he had been getting countless magazines sent to him that he didn’t subscribe to, and he said he had to send a letter to every single one explaining that he had not subscribed to them and asked for his subscriptions to be canceled and the bills voided. The coalition seated across from me asked if I knew anything about it. I’m sure from the look on my face they had their answer, but of course I denied it. They couldn’t prove anything and they knew it. The meeting was a complete waste of my time, and my mom’s, so I had to pay Mr. Bell back.

A few days later I started taking up a collection to enroll Mr. Bell in the “Assholes of America Club” which was something I had found in a magazine somewhere. You could pay something like $30 and enroll someone and the company would send them a T-shirt that says “Official Member of the Assholes of America Club,” along with a membership card with that person’s name printed on it, and a nice letter explaining that someone had enrolled them in the club because they are an asshole. This time, instead of just sending his membership kit to the school where I would not see the look on his face when he opened it, I decided to send it to my parents’ house so I could then place it on his desk before class. When the package came, I brought it to class the next day, and before he arrived, I set the T-shirt, letter, and his membership card on top of his podium where he would be standing in just a few minutes. Some of my friends knew exactly what I was doing and anxiously awaited Mr. Bell’s reaction. I have to give the man a little credit, because instead of flipping out and asking who did this and making a scene, he simply removed it from the podium and put it on the shelf underneath it without saying a word. It was still funny. My plan was almost ruined because my mom usually got the mail every day, so she received the package addressed to Mr. Bell, and opened it up to see what was going on. She hid the shirt and things, and left the empty package sitting on the kitchen table and confronted me about it when I came back from school. She almost wouldn’t give me the stuff because she pretty much knew what I was going to do with it, but I somehow convinced her to turn it over to me so I could bring it to school the next day. I basically threatened to do something even worse to Mr. Bell if she didn’t turn over the goods, so she reluctantly returned them to me. Sometimes I was me who deserved to be in the Assholes of America Club, I know.

The Underwear Check Because I kept messing up the computers at school and causing them to display pictures of girls in bikinis and then freeze up, a policy was implemented where the school made all of us sign an agreement that we

would pay $25 an hour for a computer technician (really just the computer teacher) to repair any damage we caused, or else we couldn’t use the computers anymore. One day instead of doing my usual thing of installing new files on the computers to mess them up or formatting the hard drives, I simply reversed the mouse and the keyboard cables to two different computers—that’s it—and the teacher charged me twenty-five dollars to switch them back! I couldn’t believe it. This was during a computer programming class, and there’s not much I could do just sitting there, so I had to pay the money so I could use the computers again. At first I sat through class for a few days in protest doing nothing, telling the teacher I’m not going to pay, but I soon realized he didn’t care and wasn’t going to budge. At first I thought about bringing in a large box of twenty-five hundred pennies all dumped loose inside, but I came up with an even better idea. I had learned somewhere that a check didn’t need to be written on any official paper like money did, and that you could technically write a check on anything as long is it had your name and account number on it and you signed it, so I decided to write the school a check using my Fruit of the Loom tighty-whities underwear. I stretched the underwear over a square piece of cardboard and used a black magic marker to write in the checking account number and all the details, and the next day I put them in an envelope and handed it to the vice principal and told her it was payment for my “damages” to the computers. A few years later I was trying my hand at some stand-up comedy and a local paper wrote up an article about me that mentioned I would be performing at a certain comedy club one Saturday night, and who did I see in the audience, but Mr. Marvin, the computer teacher whose life I made miserable. I thought it was a coincidence but after my routine he came up to me and handed me a pair of underwear that had “To Mark, from Mr. Marvin” written on them with black magic marker! I couldn’t believe it. He had seen the article in the paper saying I would be performing there and thought he would be funny and try to get me back for the underwear check I gave the school for the trouble I caused in his computer class. I didn’t really think his check was funny, I thought it was creepy, and I left the underwear

laying on one of the tables. We always thought he was gay and this kind of reinforced that idea for me. There was a small office in the back of Mr. Marvin’s classroom that was shared with the science room right next door and we noticed occasionally Mr. Marvin and other teachers would hear the phone ringing and tell the class they would be back in a moment and go into the office to take the call. Well, we got a hold of the phone number, which was written on the side of the phone, and we would occasionally call it from a payphone in the hallway and when another teacher answered it we would say, in the gayest voice possible, something like, “Hey, is Mr. Marvin available? This is his boyfriend and I’m sorry to interrupt him, but I really needed to speak with him for a moment.” Sometimes Mr. Marvin would answer the phone himself and we would make some rude comment and hang up, usually something along the lines of him being gay. He was actually married to a woman and had a son, but we still thought he was a closet homo and he certainly acted like one.

Food Coloring in the Snow You might be familiar with the large weed sprayers that consist of a two or three gallon plastic jug that people fill with weed killer and pump up and carry around their yard to spray weeds with. Well, it was winter time, and there were no weeds, but one night I still came up with a use for the weed sprayer that ultimately led to giant obscenities being painted in the snow on the football field behind the school and on the tennis courts that everyone would see the next morning when they arrived. I bought some food coloring at the local grocery store and filled the weed sprayer up with water and made a late-night visit to the school after it had just snowed. Using my boots I dragged my feet on the ground and drew huge 30-foot-tall letters in the snow, spelling out the word “Fuck” on a large slope facing the school on the edge of the football field. I then took the bright blue water I had mixed up in the weed sprayer using the food coloring and filled in the letters by spraying all around them, turning the snow blue. I wanted to spell out “Fuck You Mr. Mueller” (the name of the

principal) but I soon realized there wasn’t enough water for this, although the effect would still be the same. A simple “Fuck” would still do. The lines making up the word were probably three feet wide and about 30 feet tall. The next morning as I walked from the parking lot to the school entrance, there in the distance, on the side of the pure white, snow-covered football field was a huge “Fuck” in bright blue letters. You couldn’t miss it. It was enormous. The slope it was on was so steep that you could see it as clear as day from the school. The janitors were out there with shovels and rakes trying to move the snow around to cover it up, but the letters were so large that it wasn’t really doing any good. Everyone saw it. There was a large staircase inside the school that almost everyone would walk down to get from the upper level to the lower level, and there in clear view through the windows was a gigantic blue “Fuck” starring you in the face. The principal’s office overlooked the tennis courts on another side of the building, where a slightly smaller “Shit” was spelled out that couldn’t be missed. I didn’t even get called to the principal’s office because Mr. Mueller knew I would just deny I had anything to do with it. A lot of people figured it was me, and when the other students asked me if I did it, my face would light up with a huge grin giving them their answer.

Sidewalk Chalk Sidewalk chalk, if you don’t know, consists of huge sticks of colored chalk that kids use to draw on sidewalks and driveways. The chalk sticks are about the size of a large carrot and come in a variety of colors. While a lot of people use cans of spray paint to put graffiti on buildings, this is vandalism and was crossing the line I had thought, but somehow the idea popped into my head that I should buy some sidewalk chalk and then write a bunch of obscenities all over the outside of the high school. I mean all over the outside. I bought a literal bucket of jumbo sidewalk chalk at Toys “R” Us that contained 20 or 30 different sticks and I rounded up some of my crew and late one night we chalked practically every square foot of the outside of the school on every wall around the entire building. It took more than an hour

to finish and we had a bunch of us out there that night. We drew large pot leaves using the green chalk, we wrote “Fuck You,” “School Sucks,” “Smoke Weed” and just about every other offensive thing we could think of. There were also ten-foot-long penises and derogatory statements about the principal and several of our least favorite teachers written in three-foottall letters. While none of us were artists, we sure did put a lot of detail into our drawings. Let me be clear that this was not on the sidewalks around the school. We did this on the outer walls and it was so noticeable that even people driving by could see our handiwork when we were done. There were no 24 hour security guards, or even any surveillance cameras. This was in the 1990s, remember, in a small town in the middle of nowhere. The next morning, the janitors were out there with sponges and buckets of water washing it all off. It must have taken them hours to clean off our masterpiece, possibly even all day. As clever as this was, the one thing I overlooked was the fact that this was a Friday night and there was no school in the morning so hardly anyone got to see our work. There was a track meet that Saturday, so the track team saw some of it, but it would have been much better if we had done it on a different night so everyone would have seen it in the morning before school. Nobody’s perfect, you know.

Shoes on the Telephone Wires I’m sure you’ve occasionally seen a pair of shoes hanging on some telephone wires above the street, a scene that looks very odd and always makes people wonder why someone would toss them up there and whose shoes they were. I always had to do things a little extreme, so instead of just throwing up an old pair of shoes over some telephone wires, I put the word out at school for people to bring me their old pairs of shoes because I was going to do something cool with them, and everyone knew that meant I was going to do something crazy. Over the next few days people brought me dozens of shoes and I gathered them up in a trash bag at the end of the day and brought them home and tied

the laces together for each pair. A few days later, on a Friday night, my friends and I drove through the town and would pull over on the side of Main Street every few blocks and throw the pairs of Shoes up on the wires right in the middle of the road so they would catch and just dangle there. We did this on almost every single wire that crossed Main Street. I’m talking about 15 pairs in the span of just a few blocks and we were just getting started. After a while we were laughing so hard, as we tried to throw the shoes up to get them to catch on the wires, we were too weak to toss them high enough. It wasn’t even that late at night when we did this, and a lot of times there were cars in the distance approaching as we stood in the middle of the street trying to toss them up. We didn’t care. If a cop saw us, we would have taken off on foot and enjoyed the chase. After we were done filling up the wires on Main Street, we drove over to the other major road that went through town and flung shoes on all those wires, too. These were the only two roads that came into town, and no matter which way people came in or out, they saw the shoes. A lot of shoes. Shoe after shoe after shoe. One pair hanging on practically every single wire that crossed the street. It looked very weird and the entire town couldn’t miss them the next morning. A few days later the shoes were all taken down, a task that must have taken a cherry picker and the entire day. I still had a bunch of shoes that we hadn’t used, so my friends and I went out that same night and put them all back up again! One pair we tossed up was a pair of boots that a girl gave me, and since they didn’t have any laces to tie together, I took a piece of rope and punched a hole in each boot and tied them together so we could still hang them. For some reason someone gave me a large doll when I was collecting the shoes and so I tied a rope around it and tied the other end to a block of wood and we even tossed that up and got it to hang from the wires. We were laughing so hard we could hardly muster the strength to throw some of the pairs high enough to get them to catch and wrap around the wires. It was the middle of winter and absolutely freezing outside and that didn’t make it any easier. This time we would park the car over on a side street and each grab a few pairs of shoes and then walk over to Main Street and spread out and do our thing. We did it again. Both major streets coming

into the town were full of shoes right in the middle of the road. When we were done we couldn’t help but think of the poor city worker who was told to take the shoes down earlier that day, and we envisioned him getting yelled at by his boss because they were still up. “Bob, I thought I told you to take down all of those damn shoes yesterday!” “I did boss.” “Then why are there still 20 pairs hanging over Main Street?” Just imagine their bewilderment. It wasn’t a few days later, or a week later that the shoes went back up. It was later that same day . They must have been pissed . The local paper covered the story and said it was a mystery as to why it was happening and claimed the hanging shoes were dangerous because they distracted drivers and could cause an accident or fall onto a vehicle and break their windshield. Of course, we never really thought about that possibility, because, well, you know, we were dumb kids. I was able to call in and get on the air of a local rock station and told the audience that we were a group called the “Instigators” and that the shoes signified our desire to legalize marijuana. They really had no meaning, but I thought we could encourage others around the area to start tossing up shoes too. We then traveled to the radio station later that night and threw a bunch of shoes on the telephone wires in front of their building. Since our small little town was covered with shoes (again), we decided to branch out and expand the operation to the neighboring cities. I specifically wanted to get shoes in the middle of every major intersection so they would be seen by the most people. This was extremely difficult since there was rarely a time when no cars were stopped at the light at the intersections, so we would just toss them up right in front of the cars stopped at the red light. We didn’t care. Who would have thought that shoes could be so fun?

Donating Pornos to the Library

One of my friends found a large collection of her dad’s pornos from the 1970s in her basement, and she just knew I could put them to good use so she asked me if I wanted them. Of course I did, so she brought them to school the next day so I could donate them to the school library. Pornos from the 1970s, as you can imagine, are very different from today’s pornos. The girls were not exactly the most attractive women, and let’s just say there was plenty of hair down there. Nevertheless, I thought the school library could benefit from having a better selection of magazines, especially some vintage 1970s porn. Most of the current magazines were placed in protective plastic covers which were labeled accordingly, so one afternoon during study hall I went to the library and switched a bunch of that month’s magazines with the pornos and placed them back on the shelves to give people a pleasant surprise (or perhaps unpleasant, because the women were not exactly what I would call attractive according to today’s standards, but you get the picture). I also tore out several pages of some nasty looking pictures and slid them into the trophy cases that adorned the hallways around the school. The trophies were in locked glass cases, but there was a small opening where the two glass panels would overlap each other when they were slid open. I stuck the pages inside the cases through these tiny slits, knowing they would stay there until some janitor was called to unlock the case and take them down. While I was usually very careful when scheming, I made a terrible mistake this time. I had accidentally left one of the pornos in my locker. Within a few hours I was summoned to the principal’s office just as I expected. When I arrived and sat down, I saw a half a dozen of the pornos sitting on Mr. Mueller’s desk. I commented that it looked like he had some good reading material there. He asked me if I knew where the magazines came from, and I told him I thought they were his. He was not amused. He then informed me that he searched my locker and found one of the pornos there. “How do you explain that?” he asked. I had already told him that I didn’t know anything about any old pornos and that I had never seen them before,

so I was caught in a lie. I was busted and he knew it. I was suspended immediately and sent home. Before I was allowed to return to school I had to have a conference with him and my mom. It was very embarrassing. When we went in for the meeting, he had the pornos sitting on his desk and he held one of them up and started flipping through the pages showing my mom exactly what was inside. She was disgusted and so was I because the people were pretty gross. I told Mr. Mueller he had to admit that it was funny, not only that, but it was harmless. He still didn’t find the humor in it and said he was really getting sick of my antics. As my mom and I left his office I told him to enjoy the magazines. I just didn’t know when to stop.

The Disappearing Furniture Most schools and office buildings have a dropped ceiling which consists of the white panels that are about 2 feet wide and 4 feet long that can be lifted up so you can access the lights and plumbing pipes and other things that these panels cover up. A lot of times the actual ceiling is 10 or 20 feet above these panels, and dropped ceilings are a staple of modern buildings. One afternoon in literature class a few of us got to go across the hallway into another room to work as a group on a class project. This room was barely ever used and was pretty much only for student council meetings and test taking. It was full of desks and some small tables and extra books from other classrooms, and somehow we got the idea to remove one of the panels from the dropped ceiling and started putting desks up on top of them. Since I’m tall, I stood on top of a table in the back of the room and Fred would hand me one desk at a time, which I then set on top of the ceiling panels and put the missing panel back in place. When we filled that area of the ceiling, we moved to another part of the room and did the same thing over and over again. Someone was standing watch at the door to make sure that the teacher didn’t pop in to check on us, and for the entire period we put as many desks up in the ceiling as we could. We also put the podium up there; we put the small tables up there; we even took all the books off the shelves and threw them up there too.

Like magic, most everything in the room seemed to disappear, including the garbage can. If you looked carefully you could see many of the ceiling panels were drooping from the weight of the desks and the other furniture pushing down on them. One table was fairly large and heavy, and we worried it would break through the panels while we were still there, but fortunately it held. I can’t imagine what the teachers must have thought the next time they used that room, because almost all of the desks were missing along with the books, the podium, and just about everything else! The stuff was up there for the rest of the year and nobody found out. In another class someone had thrown a desk out the window which landed on a section of the roof below, but in this case, dozens of desks just seemed to disappear into thin air.

A Billboard of Me on the School After the principal realized that detentions didn’t bother me, after a while, he found a punishment that did. He started banning me from attending the school sporting events on Friday nights. This sucked. This was my social life he was messing with here. He had finally found my weakness. Detentions didn’t matter. Not allowing me to use the computers during study hall didn’t deter me from scheming. Even throwing me out of the weight room after school didn’t discourage me, but not allowing me to go to the basketball games on Friday night was like a kick in the balls. I tried to think of a way to convince him that the school needed me at the games because I was the loudest person in the audience and I encouraged school spirit. Me just being there really helped our team. I scanned a picture of myself from the school yearbook and using a computer graphics program I enlarged it to about 5 feet wide and 5 feet tall, and printed it out in sections. It probably took about 50 different pieces of paper, and I taped them all together to make a huge billboard of myself. I then typed up a banner that said, “Let Mark attend the basketball game on Friday night,” and I called Fred and asked him to bring a ladder to school in the back of his truck the next morning so we could put them up. We arrived early and hung my picture over a sign that was above the student entrance that had our school name on it. It was probably fifteen feet up in

the air, and instead of showing the name of the school and our mascot, it was now a gigantic picture of me with a banner below urging people to demand I be allowed to attend the game on Friday. Everyone in the entire school saw it when they arrived that morning since it was above the main entrance in the parking lot. In a perfect moment of synchronicity, I happened to be walking behind the principal in the hallway on my way to first period when the strangest thing happened. Another teacher approached him and said, “Mr. Mueller, there is a gigantic picture of Mark Dice on the side of the school above the entrance that I think you should know about.” I sped up my walk and patted him on the shoulder when I got next to him and said, “Good morning, Mr. Mueller, such a beautiful day, isn’t it?” and gave him the biggest smile. He rolled his eyes and shook his head. I’m sure he didn’t know if I had done it, or if one of my friends did, all he knew was there was a huge picture of me on the side of the school above the entrance. Later on that morning I got called to his office. I pretended I was surprised by the picture and had just found out about it that morning when I got to school. I told him it was clear evidence that the student body wanted me at the game and it was important I go. I pleaded with him to let me attend and he actually changed his mind! I came to the game that Friday wearing a red cape and a sign taped on my chest that said “Spirit Man” (as in school spirit), and I riled up the crowd more than any other game I had been to and everybody had the best time. I even think Mr. Mueller was actually glad that he changed his mind and let me come.

Running for Class President Senior year I decided to run for class president and a few of my friends joined me in the campaign and ran for other positions like vice president, secretary, treasurer, and other offices. We decided to call our group the “Dream Team,” which was named after O.J. Simpson’s team of lawyers who got him off for murder. This struck fear in the heart of the principal and the teachers because the possibility of me being the class president was probably one of the worst things that they could think of for the image of

the school. I would be a complete disgrace to the office, which is exactly why I wanted to win. The only contender running against me who was remotely capable of beating me was the school’s beautiful tennis star who was very popular, but I was sure I could gain more support than her and win. The Dream Team put up posters around the school promoting ourselves, while our opponents did little or no campaigning at all. We were sure victory was ours, but when the election results came in, I did not win. The tennis star beat me. I was shocked. There was no way I could’ve lost. Everyone wanted me, the class clown, to also become the class president just for the fun of it. When the results were announced, the principal said it was a close race, but the tennis star had won senior class president by two votes. Two! I demanded to see evidence of this loss and wanted to witness a recount. Mr. Mueller, the principal, told me that the voting ballots were thrown out! This was ridiculous. That meant there was no real proof that she won. I demanded a new election. He said no, so I typed up a petition the next day and got probably 70% of the senior class to sign it saying that they voted for me and believed there was election fraud and wanted a new one. I presented the petition to the principal and told him that he can’t steal the election from me and deny me my rightful place as class president. He said there would be no revote and I threatened to call the local television station and alert the newspapers of this fraud. He didn’t care, and I let it go. I really should have made a bigger deal out of this. I probably really did win the election and the school screwed me. This just pissed me off and made me want to cause more trouble, and that’s exactly what I did.

The Food Locker There was a locker near mine that didn’t have a number on it, which was weird, and we noticed nobody ever used it. The mysterious unmarked locker was unlocked and when I opened it up one day I realized there was a plumbing pipe going through the middle of it from the floor to the ceiling. For some reason it must have been a design flaw in the building and the pipe wasn’t built inside a wall so they had to cut a hole through the top and

bottom of the locker so it could go through. Instead of having this poor locker sit there all lonely and not get used, I decided to turn it into a trashcan. But not just any trashcan. I put out the word to my friends that they should bring their leftover food from the lunch room and dump it in the locker for fun. After just a few days it started filling up with food scraps and garbage, and you could smell it when you got close to it. I had to put a cardboard retaining wall inside it a few days later to hold the garbage in and prevent it from falling out all over the floor when we opened it to add more because it was stacking up so high. Even though the locker smelled like a dumpster, I thought it would smell worse than it actually did. I thought the stench of rotting food would fill the entire hallway but it was only noticeable when you were close to it. I don’t remember whose lockers were right next to it but I feel really sorry for them. I thought about what I could put in there that would really smell since the rotting food scraps just weren’t stinking enough, and I figured the best thing to do was to pour some beer in there, so one morning I brought a can of beer to school and cracked it open and dumped it in. The beer poured out and filled the bottom of the locker and spilled down below through the cracks underneath and I’m sure spread out underneath the surrounding lockers. It smelled immediately. That whole area of the hallway reeked of beer. When you’re at a party and everybody’s drinking beer, you don’t really notice the smell that much, but apparently when you’re in a nice clean school, the stench of spilled beer can practically fill an entire hallway. The food locker was quickly cleaned out after that and a lock was put on it so we couldn’t put anything else inside.

Going out for Lunch We didn’t have an open campus in high school, which meant we couldn’t leave for lunch. Well, it wasn’t that we couldn’t leave, it was we weren’t supposed to leave. My friends and I had a habit of ditching lunch and smoking weed and then sneaking back into the school, but after a while they realized this was happening and thought they could stop us. They

started locking all the school’s doors from the outside, except for the one right next to the principal’s office, so they could only be opened from the inside once school had started. They thought they were really smart, but I was smarter. What they didn’t realize was that if you folded up a sheet of paper like you were passing a note, you could prop the doors open with it so they wouldn’t latch. All you had to do was set the folded up paper on the ground in such a way that the door would close on it, but it would keep it propped open just enough so it wouldn’t latch and nobody could tell. So once the school started locking the doors, every time we skipped lunch I would just jam one of the doors with a folded up piece of paper and we could easily get back into the school without anybody usually noticing. I say usually , because after a while they did notice because from a few classrooms certain teachers could see us walking back to the school from the parking lot every day through their windows and they realized what we were doing so the vice principal would keep an eye out every day during lunch period trying to bust us. I was too good to be outsmarted by some vice principal and have her ruin my fun and kill my buzz, so I started thinking of a plan. I remembered there were a set of doors in the locker room that led out to the football field which was in the back of the school, and there were no windows back there so no spying teacher or vice principal would be able to see us, so we started parking across the street from the school and then walked along the side of the football field to the locker room doors and then would sneak back inside the building that way, and the fun continued for the rest of the year and we never got caught once. Sometimes if we lost track of time and were running a little late getting back to the school we wouldn’t have the time to park the car a block away and walk across the side of the football field to sneak in through the back door, so we would just park in the teachers’ parking lot and boldly walk in the door right by the principal’s office since it was the only one unlocked from the outside. No teachers or office workers would imagine that any student would have the balls to ditch class and come back in through that door. Sometimes the best place to hide something is right under someone’s nose. We would each walk in the door at about ten second intervals so we

didn’t all walk in at the same time, and occasionally a teacher or someone in the office saw one of us walk in the door, but they never said anything because they always assumed that we must have been coming back from a dentist appointment and had some legitimate reason for coming in late. It’s an interesting phenomenon that if you act like you belong somewhere, you won’t raise any suspicion. If someone less skilled in the art of fighting the system were to attempt returning to school through this door and were spotted, a look of guilt would have flashed upon their face giving them away, but when I walked in the door I just acted like there was nothing unusual happening. One afternoon, a teacher was walking right past the door in the hallway when I came back inside the school and he looked at me and shook his head. He knew exactly who I was and what I was doing and made some comment about how I was just getting back from skipping lunch, but he didn’t get me in trouble. He probably figured it was no use.

Perfect Attendance and the Disappearing Detentions In one of my favorite movies, Ferris Bueller’s Day Off , the main character uses a modem to hack into the school’s computer system to change his attendance record in order to reduce the number of unexcused absences he had accumulated. Even though that film was from the 1980s and things still weren’t very high tech then, my school’s attendance system was even less high tech in the 1990s, which actually worked to our advantage. If a student was absent from class, the teacher would just simply use a pencil to fill in the bubble next to their name on the attendance sheet which would be taken to the office every day. There was a slot on the outside of the classroom doors where the attendance sheets would be put at the end of class or at the end of the day, and someone would come around and gather them all and take them to the office where they would be processed. It doesn’t take a genius to figure out that you could just have one of your friends use a hall pass to come by and take the attendance sheet out of the slots and erase the bubble next to your name when you decided to skip class so your absence wouldn’t be recorded.

The same attendance sheet was used all week so if you did this on Tuesday, the teacher might actually notice the following day when the bubble was mysteriously not filled in anymore, so it was to our advantage to only do this on Fridays, which would be the last day they would receive that same sheet, because on Monday they would have a completely new one. This little scheme worked particularly well when there was a substitute teacher because the following day, when the regular teacher came back, they wouldn’t notice that the attendance bubble had been erased because they were not there and wouldn’t know that the student was gone the day before. Little did the high school know, but we had several Good Samaritans who worked in the office who could occasionally prevent us from having to serve detentions that teachers had written us. These Good Samaritans were students who worked part time for the school as office assistants. When a teacher wrote a detention for a student, they were set in the top tray on the vice principal’s desk at the end of the day where she would see them the next morning when she got a chance. She would then compile the detention list for that day, and put the detentions in the students’ files. Our Good Samaritan students would keep an eye on this tray and whenever a detention with my name on it or any other friends of theirs found its way into that tray, they would simply take them and crumple them up and throw them in the trash before the vice principal had seen them. The teacher who wrote them had no way of knowing that the detentions weren’t actually filed, because they confidently assumed that once the detention was on the vice principal’s desk, it would be taken care of. Well, they were wrong. Our Good Samaritans would always find us at some point throughout the day to let us know that our detention had been thrown away so we could enjoy ourselves after school with everyone else instead of sitting in detention hall. Those of us who knew about this detention tray would always keep a close eye on it whenever we were in the vice principal’s office. Occasionally myself or one of my friends would be sitting in her office after getting in trouble when she would get called out for a moment and we would take that opportunity to look through the tray and could steal the detentions or throw them in her trash can so it was like they never existed at all.

Science Class Every once in a while something will happen in a class that’s so hilarious or outrageous that word about the incident is passed down from one grade to the next year, after year, sort of like ancient folklore that was told to every new generation around campfires thousands of years ago. One of these legendary stories in our school had to do with the science teacher, Mr. Powell, who was locked in a closet by a student a few years earlier. The closet was located at the front of the classroom and had a paddle lock on the outside to prevent students from stealing the toxic chemicals and expensive science equipment kept inside. As you can imagine, one day when Mr. Powell went in the closet to retrieve something, a student ran up, closed the door, and locked it shut. Immediately after that, Mr. Powell took a leave of absence for the rest of the semester. He was said to have never been the same since. While we didn’t lock him in the closet again despite the same paddle lock and latch being used, we did make him cry once and had fun using the Bunsen Burners to melt pens and light things on fire, but nothing too crazy ever happened. Probably the funniest thing I did in Mr. Powell’s class— other than contribute to his emotional breakdown once in a while—was when I scooped a couple of goldfish out of the fish tank in the back of the room and slipped them in the jacket pockets of another student. I don’t know how long it took him to discover them, but it could have been days, and by that time I’m sure the jacket had the stench of rotting fish emanating from it. Surprise! Just for fun sometimes I would set my science book on the table standing on its end with it propped open at a 90° angle so it acted as a barrier blocking Mr. Powell’s view of me, and I would roll joints behind it while he was giving a lecture at the front of the room. A guy who sat behind me, who will remain anonymous, went through a stage when he was snorting coke for a few months and thought he would one-up my joint rolling, so he set up his book as a barricade and cut a line of coke on the table and snorted it right in the middle of class. A few students who were seated in the row behind him saw him cutting up the line and ducking behind his book to snort it, but he didn’t care. Neither did they. That’s high school.

Literature Class For a project in literature class one year, Fred and I made a video depicting the 1955 play Inherit the Wind which we had to read for an assignment. The play is about a man being put on trial for teaching Darwinism in a school in Tennessee when it was against the law to do so because only creationism could be taught. Everyone else in our class were doing serious projects and presentations, but Fred and I decided to use some of my old Legos that had been stored away in my closet to make a video depicting the play. We teamed up with a straight edge kid and before we started filming I met a pot dealer in the parking lot of a local park to score some weed and Fred slammed a six pack of Zima in a matter of minutes. Then we went back to my house to make our video. Fred was so drunk when we got started that he was slurring his lines horribly, and I was so stoned that I couldn’t recite my lines without laughing. Our other group partner thought we were insane. When the time came to show it to our class we were worried that the teacher was going to fail us for doing such a pathetic and childish project, but when we played it she absolutely loved it. Everyone in the class could tell we were wasted by the way we sounded in the video, but Mrs. Boswell didn’t have a clue and loved it. For some reason she thought it was brilliant. She also didn’t catch the F-word being used in the soundtrack playing in the background, although a few students who were fans of Pantera heard it loud and clear. At the end of the video we had set the Legos on fire with a blow torch and Fred started spitting on them with the massive saliva his chewing tobacco was generating. Even though making our video was fun, I hated literature class because of all the dumb old books we had to read, so I wrote a large “Fuck Mrs. Boswell” in one of the books, and after we turned them back in she flipped through the pages and inspected them all and found my graffiti. She literally cried in class and told everyone how upset she was and it ruined her entire week. It wasn’t really Mrs. Boswell that I didn’t like, it was having to read all those dumb books, so I felt kind of bad since she took it personally. She was obviously emotionally unstable.

Underage Drinking In Wisconsin, people like to drink. They drink a lot . The state’s baseball team, the Milwaukee Brewers, refers to beer breweries. That’s right. The baseball team is named after people who brew beer, that’s how much people there love beer. If you drive through downtown Milwaukee, you’ll notice tons of different breweries; Miller, Pabst, Schlitz, Leinenkugels, and more. They’re practically the largest buildings in the city. Milwaukee’s nickname is “Brew City” because of all the breweries. Drinking beer is as much a part of the culture in Wisconsin as sunny weather is in Southern California. This is part of the reason everyone in Wisconsin is so fat. Not just fat, but grossly obese…man are they huge. Some of the most disgustingly fat people in the world live in Wisconsin. It’s so cold there for half of the year, there’s really nothing to do but sit inside and drink, and that’s what everyone does, and that’s what we did growing up. Freshman year of high school I made my first fake ID, and it wasn’t long after that I got my first underage drinking ticket (what a coincidence), which was the first of many to come in the following years. This fake ID was not a fake driver’s license. It was not a fake passport or student ID from a local college either. No, this fake ID was a “boating instructor’s license.” Yeah, a “boating instructor’s license.” Most clerks wouldn’t accept it, but one lady at one particular liquor store apparently thought it was perfectly legitimate (or just appreciated my efforts) and so that’s where we got all our alcohol from, at least for a while. I made the ID from an actual boating license I had, since in order to legally drive a Jet Ski or other boat if you didn’t have your driver’s license, you had to take a class and pass a test to get your boating safety permit. I did this because Fred’s dad lived on a lake and had a couple of Jet Skis he let us use. Anyway, using my computer I modified my boating safety permit, and changed the birth date and added the title of “boating instructor permit.” I told the lady at the liquor store that I taught boating safety classes and I had forgotten my driver’s license at home, but somehow, I had my boating safety instructor permit in my wallet. She probably just admired my creativity so she sold me the beer.

I had only used the ID a few times before getting busted and having it taken away by the cops, but it was fun while it lasted, and it would not be my last fake ID. Basically, a car I was in got pulled over and we had a bunch of booze in the back seat because we were slamming beers and hard liquor on the way to the school football game, and we were all ticketed for underage drinking. For me, since the cops discovered my fake ID because I wasn’t smart enough to stash it under the floor mat after we were pulled over, I got a ticket for not only underage drinking, but also for having a fake ID, and a separate charge for using the fake ID to buy the alcohol (called underage procurement), and then I was given a fourth ticket for possession of alcohol by a minor. I was 15 years old and it was hundreds of dollars in fines. I was pissed! So were my parents when they had to pick me up from the police station. Since I didn’t have my fake ID anymore, I had to come up with a new way to get alcohol, so I just started trying to buy it from everywhere I could at every gas station around town, hoping to find someone who wouldn’t card me. Sometimes I would just stop people outside the gas station and ask them if they would buy us beer if I gave them the money. Surprisingly, a lot of people did (this was Wisconsin, remember). One night in a gas station parking lot some guy sitting in the passenger side of a car started talking to me as I walked past him like he knew who I was. I soon realized that he was confusing me with some friend of his named Gary. The guy was extremely drunk. I immediately noticed a bracelet on his wrist that said “Dennis” so I pretended to be surprised and said, “Dennis! How have you been man, I haven’t seen you in so long!” and continued to talk with him for a minute, all the while he was thinking I was someone else. I was able to fool him pretty well (he was wasted like I said), and a few minutes later I told him I forgot my ID at home and asked him if he could go buy me some beer, and he did. My friends and I luckily found one particular gas station where the Indian who worked there never carded anybody. Word quickly got out about this, and Fridays immediately after school got out we’d drive over there to get our beer for the night and I would often see three or four other people from our school pulling up to the gas station at the same time doing the same thing.

There is a stereotype that Indians and Arabs always own gas stations and “Kwiki Marts” in the Midwest, and it’s kind of true. This particular Arab, or Indian, or whatever he was, had an extra thumb on his right hand and was known as “the guy with the extra thumb who didn’t card anyone.” When he would give me my change, I didn’t want to get touched by his extra thumb so I always had to keep lowering my hand, hoping he would just drop my change into it instead of setting it there, where I would have to feel his extra thumb touching my hand. After a few months of taking advantage of “the guy with the extra thumb who didn’t card anyone” (also known as Habib), we got pulled over with beer in the car, and we threw him under the bus and told the cops he sold it to us without carding us. We were so stupid. We should have just said we got some random stranger to buy the beer for us, but our dumb asses told them the truth. The cops actually let us go because they were friends with one of the kid’s dads who was with us. (Hey, it’s who you know, right?) It was a close call, but they must have warned the guy about selling to underage kids because he started carding everyone from that point on. We knew it wouldn’t last. We didn’t know what to do at first now that our source was dried up and he was asking for ID. We needed beer, so one night I pulled a case out of the refrigerator, slapped the money down on the counter, and when he asked for my driver’s license I said “that’s okay don’t worry about it,” and started heading for the door with the beer tucked under my arm. I knew how much the case of beer cost, including tax, and I had left enough money on the counter to cover it, so it wasn’t like I was stealing the beer. As I continued making my way to the door, the guy ran around the counter and tried wrestling the beer away from me yelling that he was going to call the cops. I didn’t know what his problem was. The money was sitting there on the counter, but he really didn’t want me to have that beer. I broke loose from his grip and ran out of the gas station and jumped in my parents’ minivan where Fred was sitting in the driver’s seat with it still running, and we sped off with the beer. We had anticipated the guy may flip out and try to get our license plate number and call the police, so before I went in we taped a fake license plate on the back of the minivan. It was a novelty plate from the

Back to the Future movie that Fred had gotten at Universal Studios which read “OUTA TIME,” so even if the guy wrote it down, it wasn’t going to do him any good if he gave it to the police. The guy remembered me the next time I went to the station to get some gas, and he started saying something about calling the police and me stealing beer. (I actually paid for it, remember, I left the right amount of money on the counter, so I didn’t “steal” the beer.) I told him I was sorry and that I was just in a big hurry that day and I must not have been able to understand him with his thick foreign accent. I needed a new fake ID, and fast! Drinking and driving in Wisconsin when I was a teenager meant drinking while driving, not just drinking and then later getting into your car and driving home. We called it road tripping. A lot of weekends, if we didn’t have anywhere we could go to drink because no one’s parents were gone that night, we would just get some beer and drive around all night drinking and smoking pot. Looking back, this is extremely stupid, but one night our drinking and driving helped save a man’s car and all of his tools from going up in flames. Not that it justifies our stupidity, but at least something good came out of it! We were driving around out in the country—in the middle of nowhere— when we came across a car on the side of the road with its engine on fire, so we drove to the nearest house about a half mile down the road and got a fire extinguisher and some buckets and we rushed back and put the fire out with the help of water from the drainage ditch on the side of the road. The guy, who was a mechanic, was very thankful since we stopped the fire from spreading to the rest of the car and he said we saved all his tools from being destroyed which were in the trunk. We never imagined our drinking and driving could have helped save a guy’s car from going up in flames which would have ruined his career, but we did. One night we were driving around while drinking in my friend Toby’s truck when it was absolutely freezing outside, which is common in Wisconsin since the weather sucks for most of the year, when a girl got sick from drinking too much and puked inside the truck as we drove down the freeway. I was sitting in the passenger seat, and she was sitting between Toby and I, and she leaned over me and mumbled “open the door” as she

started puking in that direction. I cracked the door open a little bit and at least she was puking in that direction, but she had gotten it all over the door panel, the window, and my leg. We pulled off at the next exit and went to a gas station so we could clean her up and remove the puke splattered on the inside of the truck (and on my jeans). It was disgusting . As if this wasn’t bad enough, it was so cold outside that her puke froze almost instantly on the inside of the window, and we had to use an ice scraper to get it off! One Friday night when we couldn’t find a place to party, a big group of us all met up in an abandoned house and hung out there all night. The house was in great shape, it just happened to be on a plot of land that was going to get turned into some commercial real estate, so they were going to tear it down. The electricity still worked and everything! It was awesome! We had the whole house to ourselves and didn’t even have to clean up the mess! After Ken narrowly avoided an open intoxicant ticket by stashing his open beer in the center console between the two bucket seats in my dad’s car when we got pulled over one night, I had an idea. (The cop found my open beer when he searched me, which I hid in my inside jacket pocket, so I did get an open intoxicant ticket that night, but the cop didn’t give me an underage drinking ticket for some reason. You can’t argue with that at least!) Anyway, the summer after high school graduation I bought my first car, a hideously ugly 1981 AMC Concord, but it did the job, and it was all mine. I bought it with my own money, all $900 dollars’ worth. The car had bucket seats in the front and didn’t have a center console between them, so I went to the junkyard and bought one from an old abandoned junker and installed it in my car and added a special false bottom so I could stash beers and my bag of weed under it, so if my car got searched by the cops after getting pulled over, they wouldn’t find anything. This was a great insurance policy that paid off one night when I got pulled over for speeding and the cop happened to search my car. Just a few minutes earlier we were smoking weed from a small portable water pipe that was now stashed under the false bottom in the console along with a small bag of weed. There was also an empty beer bottle in there from several nights earlier that I forgot to throw away, so I was at risk of getting another open intoxicant ticket, and arrested for possession of marijuana and

drug paraphernalia. Fortunately, the console had served its purpose. The cop searched the car probably because he smelled marijuana, but he never found anything. I was always very proud of my false-bottom console, and knew it would work just fine if bad luck ever fell upon me. In order to reduce any suspicion my car may arouse, I went to the local police station and got a D.A.R.E. To Keep Kids Off Drugs bumper sticker and another one that read Back The Badge which showed support for local police officers and I stuck them prominently on my rear bumper. That way if a cop was behind me when I had a carload of people late on a Friday or Saturday night, they would be less likely to think that we were up to no good. It didn’t look like a teenager’s car with a Bob Marley bumper sticker on the back, it looked like a nice innocent family car that must be coming home from a late dinner at grandma’s. It was also a great inside joke among people who knew me since I was a big pothead, yet I had a D.A.R.E . sticker on my car. I’m pretty sure my stickers prevented me from getting pulled over numerous times, when most likely we were drinking beers or smoking pot. Sometimes when we went to the mall on a Saturday afternoon to mess around we would go to the Taco Bell drive through and order a couple extra-large waters that they gave us for twenty-five cents or something, and we would dump out the water and fill the cups full of beer so we could walk around the mall and still drink. One time we bumped into our friends’ mom and had to talk with her for a minute while we were holding our undercover beers and we tried to keep our distance from her so she wouldn’t smell our breath. We thought about making fake labels to wrap around beer cans to make them look like cans of Pepsi or Mountain Dew so we could drink them in public or when we were driving around so we wouldn’t have to worry about anyone noticing. Did I ever mention that our creativity was usually focused in the wrong direction? You probably figured that out by now. I narrowly escaped another underage drinking ticket when Diego and I turned the power off to a large billboard overlooking the freeway one night. I know this sounds weird, so let me try to explain. We noticed a house had been moved which is a pretty complicated task that involves literally

putting a house on the back of a semi-trailer and driving it to another location. (They really do this sometimes.) We were very curious to see where exactly this house went since we had seen it jacked up a few days earlier as they were preparing to move it. The house was so heavy that we could see the tire tracks pressed in the blacktop from the trailer carrying it. We followed these tracks for several miles down a long winding country road that led us to a new subdivision being built right next to the freeway. We were drinking, of course, and when we got to the subdivision we couldn’t help but notice a billboard off to the side of the road overlooking the freeway. I usually carried a Swiss Army Knife with me and so I pulled it out and used it to unscrew the cover of an electrical panel on the back of the billboard that revealed a simple switch inside. Well, what would you do when confronted with this situation? I would flip the switch to see what would happen, which is exactly what I did, and the lights illuminating the billboard suddenly turned off. It was the difference between night and day. The whole area was now pitch black and you couldn’t even read the sign. Diego and I laughed all the way back to the car and started to drive off when we were faced with the red and blue flashing lights of a squad car. The cop must have happened to been driving down the street and noticed the billboard mysteriously turn off and saw us running away from it back to the car. When I stopped the car and pulled over, the cop turned his spotlight on and yelled for us to put our hands on top of our heads. He walked up to my window with his hand on his gun and asked us what the hell we were doing, so we told him we were just trying to see where the house went when we saw the billboard standing there and just decided to turn it off for fun. He thought we were insane or on drugs, because we were talking about following a house, which didn’t make any sense to him at first. “You wanted to see where the house went?” he asked in a patronizing tone. We tried to explain to him that some workers had moved a house so they could expand the road a few miles back, and we were trying to figure out where they took it. It’s understandable how this would sound insane, since houses don’t usually move.

The cop made me pop the trunk and found nearly a full case of beer sitting back there that we intended to drink that night. He then told me to dump it all out, which was almost a full 24 pack since we had just started drinking. I took a beer out of the case and cracked it open and started pouring out it on the side of the road until it was empty. Glug, glug, glug, glug, glug, glug, glug, glug. I then grabbed another one and did the same thing. I cracked it open and started pouring it out. Glug, glug, glug, glug, glug, glug…it takes probably 10 or 15 seconds to empty a beer just from pouring it out, and the cop got mad at me and started cracking a bunch of them open himself and setting them upside down on the ground one by one so they would all empty out. “Do it like this!” he yelled, as he cracked a few more open doing the same thing. We would’ve been there all night if I had done it my way, pouring out one beer at a time. I didn’t know how he wanted me to pour them out. There were probably around 20 beers still in the case, so I poured the rest of them out like he had shown me. I told him it was alcohol abuse and he should be ashamed of himself for wasting beer and making me do this. Diego and I both got disorderly conduct tickets for turning off the billboard, but the cop surprisingly looked the other way about the beer. The worst part was that the cop didn’t even know we had turned the billboard off until we told him! He had pulled us over because we were leaving the construction site for the new subdivision and apparently there had been some problems with people stealing the workers’ tools a few nights ago so he wanted to see what we were doing there. He said, “What the hell are you doing,” so how were we supposed to know that he didn’t just notice the billboard turning off a few seconds earlier and the whole area going dark? He just wanted to make sure we didn’t steal anything from the construction site, which is why he made me pop the trunk. I’m very embarrassed to admit this, but one of my underage drinking tickets came from two police officers who were riding mountain bikes! It’s pathetic, I know. Fred and I were standing in a parking lot next to my car slamming beers before going into a local festival, when out of nowhere two police officers pulled up on mountain bikes right next to us. We were screwed. We were both holding open beers and were caught red handed.

They gave us both underage drinking tickets, and instead of going home discouraged, Fred and I went into the festival as planned and continued drinking. We figured, since we already got tickets for underage drinking, it would be double jeopardy if they ticketed us again, so we figured there was nothing they could do to us if we got caught a second time. We were stupid of course. In Milwaukee, Wisconsin the biggest party of the summer is called Summerfest, which is a beer and music festival downtown, with the emphasis on beer rather than music. People drink so much at Summerfest that halfway through the night, practically every step you take anywhere on the grounds, you crunch or kick a discarded plastic beer cup. They are littered all over the ground, everywhere. Beer at Summerfest, just like most baseball games and other outdoor festivals, is ridiculously expensive, so we would always get drunk before arriving so we could save money on beer once we got there. We were all under 21, but I had a new fake ID so I could just buy four or five beers at a time and hand them off to my friends and nobody would really notice or care. This is Wisconsin, after all. The ride to Summerfest was often just as fun as the festival itself. We would always leave our car at a Park and Ride and take a shuttle to the fairgrounds, and we would always smuggle beer onto it and slam them on our way. We were the loudest, most intoxicated people on the shuttle. Sometimes we would just throw our empty beer cans out the window right on the freeway. We didn’t care. One time we even smoked a joint when sitting near the back, assuming the smoke would blow out the windows, but the driver smelled it and pulled over on the side of the road and started yelling and screaming at everyone. Oops. As everyone knows, when someone’s parents go away for the weekend and leave the kids home by themselves, the parents are morons, because their kids will probably have dozens of people over drinking large amounts of beer, hard liquor and smoking weed, and doing who knows what else in the house while they’re gone. Any parent with teenagers who leaves them home alone for the weekend and thinks that their kid isn’t going to do anything crazy is completely naïve. This includes my parents. They never left for a vacation that my brother Stew and I weren’t forced to go with

them on, but one summer they left us the whole house all to ourselves. Since it was summer time and there was no school, I threw a party three days in a row, each day getting bigger and bigger, culminating in the sheriff and several deputies showing up on the third night, issuing underage drinking tickets, and giving the town sheriff a personal first-hand look at the inside of my bedroom. The most interesting part about this was that I had went to my neighbor’s house with her to grab some of her parents’ wine coolers, and as we were walking back to my house I couldn’t help but notice several police officers standing in my kitchen! This was not good. I could clearly see them through the kitchen windows from the backyard. They were cops. Tyra and I crouched down behind some bushes and watched. There were about three or four different police officers walking around inside my house. Everyone who didn’t get out and run was screwed, I had thought. As you probably know, when the cops come to an underage drinking party, people run, and most people get away, so I was hoping that most people were able to get out of there and not get busted. I certainly wasn’t going to go walking back in there because I had been drinking and there was a keg of beer in my garage, so Tyra and I just hung out in the backyard and watched. It was very surreal. The weirdest part was actually seeing the sheriff standing in my bedroom. My curtains were open, and I could see him standing there as the other officers searched the house. It wasn’t just an ordinary police officer in my room. It was the head of the police department, Sheriff McDonald. Hanging on my walls were various street signs that I had stolen, including the sign from High Street and Eighth Avenue, along with 69th Drive and a student crossing sign that I painted over to make it look like the student figure was crawling on all fours holding a bottle of booze like the popular poster. After a while, the cops all left and the coast was clear so we went back to the house. Practically everyone had gotten away and the only people busted were my friend Toby and the girl he was making out with in the basement. Obviously there was no place for them to run, and imagine their surprise when they were getting busy on the sofa downstairs, and in walk the cops! Everyone else had gotten away. It was a miracle.

The craziest thing about it was when it was all over, even though the party was at my house and several police officers and the sheriff were able to walk right in through the garage door, and the sheriff found his way to my bedroom , I had gotten off scot-free . It was amazing. They never came back to the house later that night, or even a few days later when my parents were back in town. They never called the house telling my parents what had happened either. They seemed to have forgotten all about it. There was, however, a little blurb in the local paper in the police report section explaining that the police were called to my address because of a report of a noise violation and an underage drinking party. It even said that several people had gotten underage drinking tickets. I hoped my parents didn’t notice this, and I don’t think they did, but the one thing they did notice was that we had vacuumed the house. My brother and I never vacuumed the house. Ever. As far as my mom knew, we didn’t even know how to work the vacuum cleaner, yet she realized that the carpeting had been freshly vacuumed and knew that something was wrong. My parents weren’t really mad. They kind of joked about it and said that we must have been so bored while they were gone that we decided to clean the house for something to do. They were probably just glad that nothing was broken and that I didn’t get thrown in jail while they were gone. They probably just thought it was me and a few friends laying low and couldn’t have imagined what actually happened. When it grew to more than a small group of people, I contained it mainly in the garage and basement because I didn’t want people running all over my parents’ house because I didn’t want any dumb drunk people to accidentally break anything or spill beer all over. I wasn’t stupid. I had been to plenty of parties where the house had been completely trashed because the host let it get out of control. The summer after graduation a friend of mine named Khloe was a passenger in a car that got into an accident on the way home from a party at (name withheld)’s and she was in a coma for several days. We learned of the accident when the police arrived and walked right in the house because the door was unlocked and they claimed they had probable cause to enter the residence because they saw us drinking alcohol through the window. They told us that someone who had left the party got into an accident and

was seriously injured and it didn’t look good. We could tell by the looks on their faces that they were serious. They didn’t tell us who it was, which added to our concern, but they made it clear that the person might not live. It wasn’t until the next day that we learned it was Khloe, who remained in a coma. To make things worse, my older brother Stew had bought the keg for us that night, and if Khloe would have died, then surely there would have been a massive investigation into who bought the beer, and that could have resulted in my brother Stew being charged in connection with manslaughter. (Name withheld)’s parents could have gotten sued too since the party was at their house, even though they were out of town and didn’t know anything about it. Luckily Khloe woke up from her coma after a few days and was okay. The night of the party a lot of people slept over at the house, sleeping on couches and wherever, because they were too freaked out to drive home drunk after learning about what happened. That next morning on my way home was the first time that I had ever worn my seatbelt in my car. I lived out in the country, remember, and there wasn’t a lot of traffic, so I didn’t think it was a big deal. I had gotten my own car that summer finally, (the 1981 AMC Concord) but I didn’t even know if it had seatbelts because they were stuffed under the seat and I was never concerned with wearing one. From that night on, I would always wear my seatbelt whenever I got into a car.

Juicy Lucy’s One of the only fast food restaurants open after midnight near our small little town was one named Juicy Lucy’s, which we made a habit of stopping at when we had the munchies on our way home from a night of partying. One of the things we really liked about Juicy Lucy’s was that there was a seating area in the back of the restaurant where no one could see us so we could screw around, throw food, and openly drink beers at our table that we would bring inside. We also made it a tradition to decorate the windows with ketchup, barbecue sauce, and our leftover chocolate shakes. Practically the entire set of

windows in the back would be splattered with something before we left. Half the time we couldn’t contain our laughter as we walked past the cash registers on our way back out to the car. Sometimes we were so stoned when we first arrived, that we could barely even order our food because we were laughing so hard in anticipation of what was about to occur. One night Rick ordered an extra-large chocolate shake, not to drink, but specifically to throw on the windows. He ordered a Coke or something else to actually drink. As we were getting ready to leave, he took the lid off his cup and flung the ice cream at the window, leaving a chocolate shake trail spanning across multiple different windowpanes that must have been tenfeet-long. One time the manager headed to the back of the restaurant as we left, probably because he recognized us from the last several months and knew we were up to no good back there, and as we were getting into the car, he came running out of the place chasing after us with a mop. We all hopped in the car as fast as we could and took off, and he continued chasing us half-way down the block with that mop still in his hand, probably hoping to beat us with it if he caught up to us. Aside from throwing chocolate shakes on the windows at Juicy Lucy’s, sometimes we liked to throw our half drank sodas at parked cars as we drove by. These were not cans of soda, so they wouldn’t do any real damage to the car like putting a dent in the side of them; we just thought it was funny to see the paper cup smash into the side of the cars and have soda splatter all over them. One summer evening when Fred threw his extra-large soda at the side of a parked car as we drove past it, the cup went right inside the car and splattered on the dashboard because the driver’s side window was rolled down. This wasn’t just an empty soda cup. This was a half full, extra-large cup that probably soaked the entire front seat of the car. We didn’t intend for this to happen, but at the time we couldn’t stop laughing. There was one instance when my friend Toby threw a Gatorade bottle at someone riding their bike on the side of the road and hit them in the back. A few days later we heard from one of our friends that someone they knew was talking about how they were riding their bike down whatever road that was, when some car threw something at them and hit them. What a small world.

You’re Never Too Old to Go Trick-or-Treating Since I could be extremely juvenile and immature, I never really thought I was ever too old to go trick-or-treating. I’m sure most kids stopped when they were in sixth or seventh grade, but senior year Fred and I decided it would be fun to be kids again and go trick-or-treating. I was 6-foot-three inches tall, and certainly didn’t look like a kid who should be trick-ortreating, but I thought it would be fun anyway. I put some black makeup all over my face, got some black leather gloves and a fake knife and went as O.J. Simpson, and since we didn’t have too much time to put costumes together, Fred painted his face black too and decided to go as Johnny Cochran, O.J.’s lawyer. After we put our costumes on we drove around in his truck waiting until trick-or-treating started and tipped back a few beers and smoked some weed, and I can’t tell you how many strange looks we got from people. When trick-or-treating began, we went all over town collecting candy doorto-door, and happened to bump into several honor students who were dressed up too. We were surprised, not only because we weren’t the only immature ones to go out trick-or-treating senior year of high school, but these were honor students, and we never would have imagined that they would be so immature too. When we stopped to talk to them, we realized that they weren’t trick-ortreating for candy, they were part of a program that was trick-or-treating for canned goods to then donate to the Salvation Army or some other charity. Wow did we feel dumb! Of course they weren’t so immature that they would go trick-or-treating like us! There we were, being complete jackasses, drunk, dressed up in blackface, collecting candy from all the houses, and there they were helping the needy. It really highlighted how messed up we were in the head. We were a little embarrassed. They didn’t even think it was funny what we were doing. They looked at us like we were insane. They smelled the beer on our breath too. They were the only people we knew that we had bumped into that night, and I’m sure that they couldn’t help but tell others that they

found us trick-or-treating when we were drunk and dressed up as O.J. Simpson and Johnnie Cochran.

Marijuana Use As you may have gathered, I was a big pothead in high school. I always looked at it as a spiritual experience, not like I was doing drugs. I wasn’t a burn out, I pretty much was considered a prep, but I hung out with everyone. I was friends with the preps, the jocks, the burnouts, the nerds, and the loners. I liked everyone, I just happen to like to smoke a lot of pot, and so did Fred and Rick. Rick had his own car, and he was often the driver for our weekend partying, and since it was his car and not his parents, we didn’t have to worry about it smelling like smoke the next day like I did with my parents’ car. By the time senior year came around the seats in Rick’s car were absolutely covered with countless little burn marks from when the cherry fell off the joints we were passing around and landed on the seat, singeing the fabric. We called them potholes as a play on words, because that’s what they were from. Get it? Duh. We were so clever. If you’ve ever smoked a joint before, you know that sometimes the burning weed can fall off the tip of the joint onto the ground. This is called the cherry, and if you’ve smoked joints in a car, you know that it’s bad news when the cherry falls off because it will most likely burn a small hole in the fabric of the seat (or through your pants). Rick’s car didn’t just have a small hole burned in the seat, it had dozens of them. Actually more than dozens. Seriously, probably more than 100 of them from our years of road tripping and pot smoking. The first day of class senior year I arrived at school a few minutes early and Rick pulled in and parked in the spot next to me and hopped into my parents’ minivan, where we then smoked a bowl before heading into class and beginning our senior year. A few hours later in study hall, the teacher, Mr. Michaels was taking attendance and when he called my name I raised my hand and said “here,” to which he answered, “better be careful what

you’re doing in the parking lot before school,” and then went on to call the next name on his list. I immediately knew what happened, because there was a window just outside his classroom in the hallway that overlooked the school parking lot. He must have been standing there watching in the morning, and saw Rick pull up next to me, hop into the passenger side of my parents’ minivan, and moments later saw plumes of smoke wafting out of the windows. Mr. Michaels was pretty cool, and most teachers would have told the principal, or perhaps even called the police to have me or my vehicle searched to find the weed, but I think Mr. Michaels just wanted me to know that he wasn’t stupid. He lived just four houses away from me too, just around the corner. I did a lot of dumb things involving weed (go figure) but I never got caught with it. While I had tremendous bad luck with underage drinking tickets and other alcohol related charges, I only had two close calls with marijuana, but never got busted. One time I was in a car with a bunch of people at a park smoking a bowl when a cop pulled up. It was late at night and the park was closed, and a car full of four teenagers on a Saturday night is obviously something that should be looked into. I had what I called a “dope bag,” which was a small black bag made of a thick fabric with a zipper on it that I carried my pipe in, rolling papers, and of course, the baggie of weed. I carried all contraband in the dope bag for a good reason. As the cop pulled up and flicked on his lights, I had whoever was holding the pipe at the time pass it back to me and I put it out by wetting my thumb and capping the top of the bowl for a moment, and then put it in the dope bag and then crotched it. If you don’t know what “crotching it” means, I slid the bag down inside of my underwear near my balls and it was held there by my tighty-whitey underwear so if the cop searched us, he would most likely not find it since my pockets would be empty. It’s a good thing I did this, because he searched all of us (he obviously smelled the marijuana smoke that was still lingering in the air), and if the contraband was in my pocket, he would have found it and I would have been arrested for possession of marijuana. The one thing in my pocket,

however, that I forgot about, was a small cap for the pipe that we were smoking. This cap screwed on the top of the bowl and had resin (pot residue) on the threads, and the cop found it when he searched my pockets and asked me what it was. I told him it was a part for my lawnmower which I was fixing earlier that day (a complete lie), and he didn’t think anything of it. It was a close call, but the dope bag worked. You know, I learned in Boy Scouts to “be prepared,” although I’m sure this was not what they had in mind. I remember one time, a friend of mine named Benjamin and I actually smoked a joint inside the school. There was a place underneath a staircase where there was a soda machine, and if you were standing in front of this machine, you couldn’t be seen from anyone in the hallway. We really wanted to get high, but we couldn’t skip class that day without getting an unexcused absence, so we each got a hall pass to go to the bathroom and met by the soda machine and quickly smoked a joint there. There was a door leading to the tennis courts right there that we cracked open and tried to blow the smoke outside so it wouldn’t stink up the hallway, but the breeze really just blew the smoke inside the school, instead of sucking it out the door. The whole hallway quickly smelled like weed, and we later heard that one of the teachers was searching the hallways trying to find out the source of this strange stench. Luckily we sucked down our joint and got out of there pretty quickly. An idea we got from the movie Dazed and Confused involved smoking a joint on the 50-yard-line on the football field, which we did late one night after we carried a five-gallon gas can on the field and poured out “Fuck You” in the grass, killing it in that area, so for the rest of the year there was a huge ten-foot-tall brown Fuck You in the football field. Hey, at least we didn’t light the “Fuck You” on fire, so you gotta cut us some slack! I mean, we thought about it, but came to our senses realizing it might burn more than just some letters in the grass. I remember one day after school I was hanging out with a stoner from the grade ahead of me because I didn’t have any weed so I went to his house with him to smoke a bowl on my way home. There were a couple other people who came with us, and as we were passing it around his mom

walked into the living room! I don’t remember who was holding the bowl at that time, but Gavin didn’t seem to care and neither did his mom. We just kept passing it around and smoking it while he introduced us all to her. As if smoking weed in front of some kid’s mom in her living room wasn’t weird enough, she somehow knew my mom and had worked with her on some community project at one point. “So how’s your mom doing?” she asked. “Oh she’s great,” I responded as I took a hit off the pipe. We continued chatting for a minute about whatever project my mom was doing at the time. This was weird. I was talking with one of my mom’s friends, or at least an acquaintance, while I was smoking weed with her son and a few other guys in her living room. I guess it could’ve been worse, like if she actually cared and busted us, because then she could tell my mom what we were doing, but she was totally cool with it. I was a sophomore or a junior in high school at the time. After I was thrown out of school senior year (a story I’ll get into later), the gym class I was in had a bike riding session where everyone would bring their bike to school and the class would go out riding around town for an hour with the teacher. Since I only lived a mile or so away from the school, they rode past my house one afternoon yelling my name and I heard them through the window, so I hopped on my bike and joined them. I also brought a joint with me, and a few of us smoked it as we were driving around the town, passing it to each other from bike to bike. The gym teacher was at the head of the pack, and all the smoke was blowing behind us, so he didn’t notice. I don’t think he would have cared even if he knew. One time at a basketball game I was talking to him at the concession stand, and he said, “You smell like alcohol, get away from me.” He didn’t tell the cops, which were always there, he didn’t tell the principal, he just wanted me to get away from him. Everybody always liked Mr. Birch. He liked to call people boneheads when they were being stupid. “You bonehead!” he would always yell, and then it would usually echo bouncing off the walls or the ceiling. Gym teachers are always the coolest.

Posting New Traffic Signs Around Town

A lot of kids steal street signs and hang them in their rooms, which of course I did with the Main Street sign, 69th Drive, Eighth Avenue, High Street, and a student crossing sign, but one night we thought it would be funny to move some signs around, instead of just stealing them, so we unbolted a stop sign and decided to put it up somewhere else where there wasn’t even an intersection. We took the stop sign from a small four-way stop in the middle of nowhere on a road that no one used so nobody would blow through the intersection and get into an accident (safety first, you know), and we took it over to Main Street right where it entered the town. We unbolted a speed limit sign, and then put up the stop sign in its place and hid in the corn field along the side of the road to see if cars would stop, and they actually did! There was absolutely no logical reason why a stop sign would be in this spot, and there wasn’t even an intersection or a cross street for another mile, but most cars still obeyed the sign and stopped right there in the middle of the road. The next day some city workers removed the sign. A few weeks later on another night when we were bored, we took down a dead end sign and put it up in the same spot we had put the stop sign. We figured it was fitting, since we hated our small town and thought it was a dead end to life, so the new sign seemed very appropriate. Another time we changed the name of Main Street at the central intersection in the town. We scaled the telephone poll that the street name was posted on, and switched it with another sign. That one was up for weeks before anyone switched it back. I also used a black magic marker to add a bottle of booze to all the student crossing signs around town so they looked like the figures crossing the road were carrying large bottles of alcohol. We also unbolted a handicapped parking sign from the school parking lot that was right by the entrance and moved it to the very back of the parking lot. Of course, it didn’t make any sense for a handicapped spot to be so far away from the door, which is why we moved it, and it stayed there for months before it was moved back. The funniest part was that nobody would ever park there because it was a “handicapped zone” and nobody wanted to get a ticket so that parking spot stayed empty every day.

Climbing the Radio Towers Probably the dumbest thing I’ve ever done (aside from drinking and driving) was when Diego and I decided to climb up a radio tower one night even though we were drinking and it was almost freezing outside. I’m sure you’ve seen these types of towers. They’re usually in clusters of five or more, and they have a series of red flashing lights on them so that airplanes won’t crash into them at night. They’re several hundred feet tall, and out by us, they were often in the middle of a clearing in a farmer’s field somewhere. These towers look pretty tall when you’re driving past them off in the distance, but when you’re standing directly underneath them, they seem to go on forever. We noticed the towers had ladders built into the scaffolding on the outside that led as far up as the eye could see, so we somehow got the idea to climb one. The built-in ladder had a special railing on the side of it that was used to attach a safety harness for workers who would climb them so if they lost their grip they would only fall about 10 feet until the harness would catch and save them. Of course, we didn’t have any safety harness, but we didn’t care. We weren’t drunk, but we had been drinking a little, as usual for a Friday or Saturday night, and it was winter time and so cold outside that we were wearing jackets, hats and gloves. Climbing a ladder while wearing gloves is probably not the smartest thing to do since you’re not as dexterous, and gloves can probably slip off the rung easier than your bare hand would, and climbing a ladder that’s located in the middle of a farmer’s field attached to the side of a radio tower extending hundreds of feet into the air after you’ve been drinking is even dumber. I went up first, and Diego began climbing just a few feet below me. These towers had about four or five different red flashing lights spaced out at equal distances, and when we got to the first light we were so high that we could see for miles. It felt like we were 20 or 30 stories up, but we wanted to get to the very top of the tower, so we kept climbing. After a while, we made it to the second light and stopped for a moment to rest. As we looked down below, the first light was so far beneath us it was just a tiny speck. It

felt like we could see half way across the state we were so high. The landscape was filled with countless tiny illuminated dots from street lights, porch lights, lighted signs on businesses, and headlights from cars on the freeway off in the distance. We couldn’t believe how high up we were, and we actually started to get a little freaked out. We were getting pretty tired from the constant climbing, and we worried that if we went much higher we might not have the strength to get back down, so we rested for a few minutes by the second light and then slowly began our descent. When we reached the ground we breathed a sigh of relief and tipped our heads up, gazing at the sky in awe of the amazing height of the structure we had just climbed. Our forearms were tight and we had a slightly hard time opening and closing our hands from the climb. After we got back in the car and started driving off down the country road that led us to the towers, we looked back at them marveling at their awesomeness and realized that we had only made it up about 2/5 of the way, because there were another three lights above the point where we had reached. We also reflected on how risky that just was, and realized how dumb we were.

Cliff Jumping There was a huge rock quarry in a neighboring city that was filled up with close to 100 feet of water after workers unexpectedly struck an underground spring, so it was turned into a local swimming spot since it obviously couldn’t be mined anymore. There was also a secluded area at “the quarry” where people would go cliff jumping at night, which was very illegal, but during the hot summer nights in Wisconsin this was always a good time. One night when we were out there cliff jumping, a bunch of cops showed up and we all scattered into the surrounding woods to escape. Instead of being satisfied that they stopped us from cliff jumping, the police searched the woods for several hours looking for us in the darkness. There weren’t just one or two cops; there were a half dozen or more who made it their mission to find us that night. They had flashlights of course which gave

away their position, so we could usually tell where they were and we snuck off in the opposite direction. There was an urban legend that if you got busted for cliff jumping you would get a ticket for attempted suicide or reckless endangerment or something, and none of us certainly wanted that. At the very least we would probably get ticketed for trespassing since the quarry was closed and we had snuck in by hopping a fence. If you’ve ever seen the first Rambo movie when Sylvester Stallone is on the run from the police in the middle of a forest somewhere, that’s how we felt. Wisconsin is a very wooded area full of trees, bushes, and weeds, which we were able to disappear into once we saw the cops. It was as if we were escaped inmates from a prison and the police had to find us. They just wouldn’t give up. The police chase was a lot of fun, and I never got caught, but a few of my friends did and were charged with trespassing. The cops left a note on my brother’s car, which was parked at a restaurant across the street, where all cliff jumpers left their cars when they snuck into the quarry late at night. The note said something about how they knew who he was and that he would be hearing from them shortly, but he never did. They were just trying to scare us in order to prevent us from coming back. It didn’t work, and the police chase only made cliff jumping more exciting knowing that at any moment we could be on the run again. That night was also the latest I had ever come home because we were stuck in the woods for several hours evading the police. I didn’t really have a set curfew, but I usually made it home by around 1:00AM, and that night I don’t think my brother and I got home until about 3:00 o’clock in the morning. Our mom was not happy, but at least we didn’t get tickets like some of the others. And since we actually did come home, and weren’t dead or in jail, my mom forgot about it after briefly scolding us the next morning about being out so late.

The Spud Gun No kid with a garage full of tools and any sort of engineering abilities should grow up without building a spud gun, I had thought, so one evening

some friends and I all went to Home Depot and bought the necessary PVC pipes and fittings, along with the lantern flints to fire them. We got enough parts to make three or four different guns and even decorated them with paint so they looked really cool. I painted “Mr. Potato Gun” on the side of mine. After our guns were assembled we went out and bought some Aqua Net hairspray, which is used as the fuel, and got a sack of potatoes and headed out to a clearing in the middle of a farmer’s field to test them out. They worked great! We would just shove a potato down the barrel with an old broom handle and spray some Aqua Net hairspray in the chamber and with one flick of the lantern flint—boom! The potato would shoot out like a cannon ball. There was nothing really to shoot at in the middle of a farmer’s field, so a few days later after school we took mine out in my parents’ minivan to test it in a more urban environment. We didn’t wear any eye protection in case the PVC pipe blew up in our face. No, we just figured it would hold, and thankfully it did. I was driving, Fred was in the passenger seat, and Ken was in the back seat with Mr. Potato Gun as we headed into the neighboring town to have some fun. Ken would load up the gun in the back seat and just like a scene out of The A-Team , he would pull open the sliding door, take aim at a road sign, and fire away. He would then slam the door shut as we drove off laughing. Potato guns are not exactly quiet, and it wouldn’t have been that difficult for someone to get my license plate number after they heard a loud boom and saw what looked like the barrel of a cannon sticking out from the side of the minivan. We didn’t think of this at the time, because, well, you know why. We were dumb kids. We did this for perhaps fifteen minutes or so, and when shooting road signs lost its novelty, we started shooting at parked cars and houses until we broke someone’s window and then figured we should quit and get the heck out of there. The window was from someone’s house that Ken shot and we all heard it shatter. I can’t imagine what the people must have thought, especially if they were home at the time, when all of a sudden one of their windows shattered and when they looked to see what had happened they would find a splattered potato lying in their living room. They probably

thought one of the neighbor kids did it. I don’t think anyone could have imagined it was drive-by shooting with a spud gun. A few nights later we took some of the extra potatoes and shoved them up tailpipes on people’s parked cars because we heard that if you did this, the car wouldn’t start. I’m not sure if this is true or not, but we thought we would give it a try. Instead of just shooting potatoes, I discovered that my spud gun could also be turned into a deadly dart gun. By taking a large 3 or 4 inch nail and wrapping a cardboard cone around the head and hot gluing it in place, the darts could be slid down the barrel of the potato gun and would shoot across the entire distance of my parents’ basement and still stick into a piece of wood or lodge themselves into the wall. I shot one dart almost straight up into the air in my backyard to see how high it would go, and when the dart came down it stuck into the neighbor’s roof. Better than landing on someone’s windshield, which it would have smashed, and certainly better than landing on someone’s head which would have probably killed them instantly. I neglected to think about these dangers at the time. We had occasionally talked about creating a semi-automatic spud gun that could shoot 8 or 10 potatoes, one right after the other, but we never got around to it. I did, however, make a blowgun out of a small PVC pipe and the mouth of a two liter soda bottle that was a lot of fun to shoot at rabbits in my mom’s garden. I also made a miniature dart gun that worked pretty well by attaching a small blowgun to a CO2 powered BB gun. I can thank The A-Team for inspiring those creations. Who says television doesn’t give kids bad ideas? It certainly gave me plenty.

Swiss Army Knife Fun I always liked to carry a Swiss Army Knife with me wherever I went, not as a weapon, but because the knife and other tools came in handy to fix things, open things, and to try all kinds of things I saw on MacGyver . When using the toilet in the bathroom stall at school, I happened to notice that the door and wall panels were connected using brackets fastened with large screws, so after I was done doing my business, I whipped out the handy screwdriver

gadget and I unscrewed the hinges from the door, and was able to prop the door back in place so when the very next person who used the stall would walk up to it and give the door a shove to swing it open, instead of opening, it would completely fall off! As I’m sure you know, bathroom stall doors are very heavy, and are often made of large steel panels and sometimes when I was only 20 or 30 feet away from the bathroom, as I walked back to class, I could hear the door come crashing down to the floor, hitting the toilet on its way down because somebody had went to use the stall. I can’t tell you how loud a bathroom stall door is as it crashes on the floor and bashes against the panels in the stall on its way down. Sometimes using my handy Swiss Army Knife I would remove almost the entire stall itself and set the panels up against the wall. After a while, the school janitor started using one-way tamperproof screws to put them together so once they were tightened, they couldn’t be removed. These screws only had an edge that would catch the screwdriver if you turned them to the right to tighten them, but if you turned the screwdriver left to loosen them, the screwdriver wouldn’t catch, so you couldn’t remove them. It was a good idea on their part. I also liked to turn the water off to all the sinks and unscrew the nozzle and take the screens out of them to use in my marijuana pipes. You have to admit that to your average teenage boy, the idea of people finishing taking a crap and then when they try to turn on the sink, nothing comes out, it is pretty funny. It is disgusting, but it is a little funny. Some of the bathrooms had small plastic trash cans, so occasionally I would cut the bottom out with my knife so when the janitor would pick it up to dump it out, all the discarded paper towels and trash would fall out on the floor. I was an asshole, I know.

Jamming Drinking Fountains A fun and extremely childish (and dangerous) thing that I would occasionally do involved tampering with the drinking fountains so they would spray on the floor, filling half the hallway with water. Most of the

drinking fountains shot out two streams of water that joined together into one, and I noticed that one of the streams was a lot larger than the other, so I would clog it with a spit-ball and then jam a folded up piece of paper into the panel that you would push to turn it on, which would leave it running. Once the large hole was clogged, all the water was forced out the small one which caused it to shoot over the edge of the fountain and onto the floor because of the increased water pressure. I would do this sometimes when I had gotten a hall pass to use the bathroom in the middle of class and on my way back I would jam the fountains and they would go on spraying for 20 minutes or so without anybody noticing, and by that time the hallway was completely full of water. There was really no way to prevent me from doing this and every time I did, I couldn’t help but laugh out loud as I walked back to class and I could hardly keep the smile off of my face when I sat back down in my desk. People sitting around me often knew that I had done something by the look on my face, but they weren’t sure what. After a while the school changed all the fountain heads to ones that only had one stream of water, so my little trick wouldn’t work anymore. Looking back on this, I realize how dangerous it really was because someone could have easily slipped on the thin layer of water on the floor and thrown their back out or broke their arm or even their head. That certainly was not my intention, and thankfully this never happened. Thinking about the negative consequences of my actions was not exactly one of my strong points back then.

A “Kidnapping” Fred, Brent, and I were out shopping one Saturday or Sunday afternoon when we got the idea to pretend to abduct Brent in the parking lot of a store right in front of a bunch of people. He left the store a minute before Fred and I did and as we walked out of the door I yelled “there he is” and we ran over to him, pretended to assault him by throwing fake punches and then threw him in the trunk of my dad’s car and sped off. There were several people about 10 or 15 feet from us when we had done this and nobody said a thing. We had hoped someone would try to stop us, but they just stood

there frozen. Nobody ever yelled at us or yelled for help as it was happening. We didn’t think about it at the time, but someone could have easily written down the license plate number and the cops could have put out an APB for the car, or the police could have shown up to my parents’ house shortly afterwards investigating a reported kidnapping. Thankfully this never happened. Years later I saw an episode of MTV’s Jackass where they staged a kidnapping of Brad Pitt, who was playing along, where a black van pulled up and snatched him in front of a crowd of people, so we weren’t the only jackasses to think of this kind of stunt.

Smashing Mailboxes I think every kid in a small town knows what smashing mailboxes is. I’m sure that kids have been smashing mailboxes for decades, but I think the film Dazed and Confused probably multiplied the instances of this practice immeasurably—at least for my generation. Basically, for fun on occasion we would drive past people’s mailboxes and throw things at them like beer bottles, large rocks, garbage cans or construction barricades, and knock the mailboxes off their stands. In some instances we would just stop the car and get out and kick the mailboxes over when we didn’t have anything to throw at them. We just didn’t do this to one or two mailboxes. We did it to dozens of them, and one night we must have smashed every mailbox on every street in a several mile radius out in the country. It made the newspaper a few days later. This is what kids did before they had the Internet and Facebook to waste all their time on. Our usual method for smashing mailboxes involved the driver pulling the car over near the edge of the road and the person in the passenger seat would sit on the window sill and grab a garbage can that was set out for collection, and then the driver would speed up and pull over close enough to a mailbox so the passenger could hit it with the garbage can (or whatever we were using as projectiles). One night, Fred almost broke his arm and Ken’s passenger door got a large hole poked through it because the construction barricade Fred threw at a

mailbox flipped around after hitting it and smashed into the side of the car and smacked Fred’s arm. Of course Ken’s mom wondered what the heck happened to his car so he made up some story I’m sure she didn’t believe. That put an end to our mailbox smashing spree and we found other things to keep us entertained.

Pouring Salt Water in Vending Machine We heard an urban legend somewhere that if you pour saltwater into the coin slot of a vending machine, it will short out and start dumping free sodas and quarters out of the coin return. The theory was, that since the saltwater is electrically conductive, as it’s flowing inside the machine, once it hit the electrical components it would cause all sorts of problems and short it out, dumping its contents. It seemed like a logical idea, and what kid doesn’t want free sodas and handfuls of free quarters to play arcade games with? We sure did, so one night we thought we would test this theory. We took a cup of water and mixed in several tablespoons of salt and brought it to a soda machine outside the local car wash and poured it into the coin slot. We were ready to run because we feared that the machine would start sparking or blow up, but nothing happened. We thought maybe there wasn’t enough salt in the water, or maybe we didn’t use enough water, so we went back to the house and got a huge pitcher and mixed in a bunch of salt and went back to the machine and tried it again. This time, we even used a paper funnel to make sure as much water as possible went into the coin slot, but still, nothing happened. It looks like we would have to continue paying for our sodas after all. We didn’t think about it at the time, but we probably ran the risk of getting electrocuted just by trying this stupid stunt. Apparently an episode of MacGyver in the early 1990s showed this trick being done, and from doing a little research on the Internet after I wrote the first draft of this story, it looks like the salt water trick actually worked in some machines in the 1980s and early 90s, but eventually the manufacturers changed their designs to prevent this from happening.

Creating an “Earthquake”

We knew one of the neighbor girls was home alone and her parents were out of town for the night, so we thought it would be fun to climb on her roof and start jumping up and down to scare the crap out of her. I knew from when my dad was walking around on our roof cleaning out the gutters, I could hear his every step and it would rattle the house, so I figured jumping up and down would create quite a disturbance—and it did. It shook the whole house and we could hear her and her sister screaming from inside. She said she thought it was an earthquake. I’m surprised the plaster on the ceiling inside the house didn’t crack. That would have been hard to explain to her parents, not to mention hard for me to pay to fix it! We tried the earthquake thing again to a different girl in the neighborhood one other night, and her neighbor saw us climb onto the roof and once we were up there he started screaming at us thinking we were Peeping Toms. “You perverts!” he kept yelling as he ran over carrying a broom. “What do you think you’re doing!” We jumped off the roof and took off running into the corn field behind her house. He ran right after us, just repeating himself over and over again. “You perverts! You perverts!” At least he didn’t think we were trying to break into the house. We lost him in the cornfield, so thankfully we didn’t get beaten by his broom.

Tapping Telephones Another idea I got from watching The A-Team involved opening up the telephone boxes located in the back yards of various neighborhoods, and using an old telephone with alligator clips attached on the wires I was able to clip them onto the telephone terminals inside the box, essentially tapping the telephone of that home. There was approximately one telephone box per 10 or 15 houses, and they were always located in people’s back yards where the property lines met. Inside these boxes were two columns of terminals with each pair connecting to the phone line of a different home. Late one night I brought my make-shift telephone tap and opened up one of the boxes and attached my device to a pair of terminals. To my surprise, I heard a dial tone, and my phone actually worked! It was just like I had seen on TV! In order for me to hear anyone’s conversation, they had to actually be on the phone at that time, but this wasn’t the only cool thing I could do. I

was also able to make long distance telephone calls that would then show up on that person’s bill. We thought it would be funny to call a few 1-900 psychic lines that charge your phone bill a few dollars a minute and mess with the psychics for a while since we didn’t have to pay for it because whoever’s phone line we were tapping into would get the charges on their next bill. We sat in the grass next to the box and laughed thinking how strange it would be when whoever’s phone line we were using got their next bill and there would be a $30 charge to a 1-900 psychic hotline. We also made various prank phone calls, not worrying if the recipients had caller ID, because it wasn’t our parents’ phone number that would appear on the display; it would be the person whose phone we were tapping into. I downloaded instructions one time on how to make a blue box and a black box, which are phone phreaking tools (phone phreaking is a slang term for basically hacking telephones). Back in the day, a black box enabled people to call you from long-distance and have nothing show up on their phone bill, and a blue box enabled you to make long-distance phone calls to anywhere you wanted for free. The blue box was too complicated for us to build at the time, but we did toy around and make the black box, but we’re not sure if it worked because we didn’t know anyone that could call from long distance to test it out. These devices probably wouldn’t have worked anyway because by the 1990s the phone companies were well aware of phone phreaking and had implemented safeguards to prevent people from messing with their system and getting free phone calls. Apple Computer founders Steve Jobs and Steve Wozniak built blue boxes that actually worked back when they were in college in the late 1960’s, something I didn’t learn about until years later when I saw the film Pirates of Silicon Valley .

Video Game Crimes Like most kids, I enjoyed playing video games quite a bit. I had an Atari, then a Nintendo Entertainment System, and later bought the Sega Genesis. My junior year of high school the Sega Saturn came out, which was the

most advanced video game system at the time and instead of using cartridges, the games were on CDs since they could hold more information. The Sega Saturn was a videogame player’s dream come true. It was also $400, which I didn’t have, but I really needed a new video game system because the Genesis was becoming a thing of the past, so I came up with a plan. It was sort of luck at first, which I then turned into a full-blown enterprise. While looking around at a Best Buy electronics store, I just happened to notice that the UPC barcode on the box for the Sega Menacer light gun (for shooting games) was just a sticker. The Menacer was selling for $99.99 at this time, so I peeled the UPC off the box and stuck it over the UPC on the Sega Saturn and carried it up to the counter and bought it. I just saved myself $300. I was amazed. It didn’t feel like I really stole anything since I technically bought it. I just bought it at a discount. A 75% discount. Hey, $100 bucks to a teenager in the 1990s was a lot of money! The cashier didn’t notice anything. They just scanned the barcode and took my money and let me bring my brand new Sega Saturn home with no questions asked. I suddenly saw a whole new world of possibilities. A few days later I went back to the store with Fred and did the same thing and he bought a Sega Saturn for $99.99. The video games themselves were $49.99, and I thought that was too much, so I found some other products that sold for around $10, which also had barcodes that were stickers and I peeled them off and stuck them on the video games I wanted and bought them at a discount too. A few other friends of mine wanted Sega Saturns too but didn’t want to pay $400, so I went back and bought a few more over the next week or two, and then sold them for $200, which was half price from the cost at the store, so I made $100 from each one, and my friends got brand new Sega Saturns for half price. Few products had barcodes that were made of stickers that I could just peel off and put on something else. Most products have the UPC code printed on the package, but I did notice that the information tag for each product that was stuck on the shelf not only listed the price and product information for each item, but they also had the UPC code printed right on them as well. I slid some of these information sheets out of their clear plastic sleeves and

stuck them in my pocket and took them to Office Depot and photocopied them and glued the new UPC onto a mailing label sticker so all I had to do was walk into Best Buy and use my own homemade UPC code to stick on whatever product I wanted. Equally shameful was the fact that we took the scissors, glue, and mailing label stickers off the shelf from Office Depot and used them to make the fake UPCs, and then put everything back on the shelves and only paid for a few 10-cent photocopies. The first thing I bought was a brand new $2000 computer for $75. That’s about a 96% discount. It was a pretty good deal. Since my parents’ bought my first computer, they knew how expensive they were, so I couldn’t just walk into the house carrying a brand new one, so I went to my room, opened the window and pulled out the screen, and Fred came around back with it and handed it to me from outside. Just in case my dad realized the brand was different than the one he had bought me a few years earlier, I cut out the logo from the old computer’s user manual and glued it over the name of the new one. The following week I went to a different Best Buy with one of my homemade UPC stickers and purchased a $1000 scanner for another $75 bucks. I also bought a few more video games and a copy of the Windows 95 operating system, which I paid $10 for. I figured Bill Gates had enough money already. If I didn’t like a video game after getting it home and trying it out, I would shrink wrap it and return it as if it were new. I would tell the store I lost the receipt, and they would give me in-store credit and then I would just trade it for another video game to see if I liked that one. For a while I was taking the old video games to a local hobby store that had a shrink wrapping machine and they would charge me a few dollars to shrink wrap each game. Most of the guys there didn’t care and probably knew what I was doing, but after a while they implemented a new policy, and they wouldn’t shrink wrap my games anymore, so I came up with a way to do it myself by using window insulator kits and a heat gun. A window insulator is a sheet of thin plastic that you put over the windows in your house during the winter that helps to prevent cold air from coming in and saves you money on your heating bill. Once the plastic is in place and

taped around the window frame, you use a hair dryer to heat it and it shrinks tightly around the window so it doesn’t obstruct the view. Just as I figured, it also worked as shrink-wrapping material as well. What clerk is going to imagine that a 17-year-old kid played a video game for a month and then had the thing shrink wrapped in order to return it for a different game? You have to admit, it was a genius idea. The insulator kits had enough plastic to shrink wrap several games and only cost a few dollars. After a while, I started returning empty boxes to the stores and would keep the game. They never opened the box to check to see if it was in there because it looked like it was still factory sealed, so how were they going to know it was missing? They didn’t, well, that is until I returned too many empty video game boxes to one particular Toys “R” Us location and then they must have implemented a new policy to check all video games to make sure that they were actually in the box when someone brought them back. Imagine my surprise when I was returning another game and the clerk opened up the box and found there was no disk inside! There I was, in the middle of Toys “R” Us standing at the customer service counter clearly caught red handed. I could have stayed there and pretended like I was just as surprised as the lady at the counter, but they could have easily called the cops and I didn’t want to deal with that, so I said, “I’ll be right back,” and I walked away and headed for the exit. As soon as I got outside I started running to my car, jumped in and took off. I had just gotten the car a few weeks before and hadn’t received my license plates yet, so I was relieved that even if they had followed me out to the parking lot, they couldn’t have gotten my license plate number since there were no plates on the car! While I was glad that I had gotten away, I was disappointed that I still didn’t have any new video games since I was bored with the ones I had. It’s interesting that while Fred and I were driving around smoking weed and “pulling scams” as we called it, we were usually listening to Eazy-E rap about pretty much the same thing: partying, hustling, screwing the system, and in the words of Eazy-E, just not giving a fuck. It was like we were living the kind of life he was rapping about. We felt like untouchable rock star gangsters.

I continued to push the envelope with my homemade UPCs and traveled to different Best Buy stores in the area because I wanted more computer equipment. I really wanted a laser printer but they were very expensive, so I made another UPC and went to buy one at a discount. This time, the clerk actually realized it was an expensive laser printer but the cash register showed it was only $50. She knew something was wrong and called a manager for a price check. I knew this would turn into a problem so I told her I left my wallet in the car and I would be back in just a second, and I calmly walked out of the store and got in the car and took off. The car wouldn’t start right away and took a few tries before the engine started firing so I could get out of there, which wasn’t very fun. All I needed was a laser printer, and I felt my computer collection would be complete. Imagine the possibilities. The best scanner on the market, a brand new top-of-the-line computer, the newest software, and a laser printer. The possibilities were endless and I really had my heart set on that laser printer so I went to a different Best Buy and tried it again. You have to understand that in the 1990s this type of equipment was not common place in every household. In fact, back when I was a kid, only businesses and schools had laser printers and scanners because they were so expensive. This time the cashier didn’t notice the price was suspiciously low. She didn’t even really look to see what product it was. She just mindlessly scanned the barcode and asked for the amount the cash register showed. I paid $50 cash, and she thanked me for my purchase. “No, thank you,” I said, grinning as I picked up my brand-new laser printer and headed for the door. To my unpleasant surprise, the security system started beeping as soon as I passed the checkpoint on my way out. Apparently one of the security tags had not been neutralized at the cash register. The guy at the security desk asked to see the receipt and I nervously handed it to him, but when he compared the item number on the receipt to the item number on the box, they didn’t match up. The printer had two UPCs printed on the box, one on the front and one on the back, and I had only stuck my fake UPC over one of them which I strategically placed in view of the cashier when I set it on the counter so that would be the one she scanned.

The security guy was confused at first, and the cashier, who was just a few feet away, acknowledged that I had just purchased it 10 seconds earlier. I could see this was not going to go well so I said quietly to Fred, who was standing right there with me, “Go. Just go,” and I darted my eyes at the door. He wasn’t sure what I meant so I took off running, leaving the printer on the guy’s counter and my $50 in cash register and Fred ran out the door right after me. It was too close of a call. It was the second time that trying to get the printer caused a problem, and this time the guy followed us out to the parking lot so we couldn’t go to Fred’s truck because he’d get the license plate number, so we just kept running down the block and had to come back later to get it. We waited about a half hour and then Fred went back to the parking lot to retrieve his truck while I waited down the block. As he was backing out of the parking space he saw the security guy standing right behind the truck and he was writing down the license plate number on a pad of paper! Fred stepped on the gas and almost backed right into the guy, causing him to jump out of the way and then took off and came down the block to pick me up and we got out of there. I then retired from creating my own UPCs. It wasn’t long after this that Best Buy started sticking the security tags over the top of the UPC codes, and they started putting the video games in security cases that had to be unlocked at the register using a special key. So even though we had gotten a bunch of discounted computer hardware, software, and video games from them, I figured we actually helped Best Buy by showing them a major flaw in their operation and prevented other people like us from taking advantage of them on an even larger scale. Thankfully the cops never did show up at Fred’s house. It was a stressful few weeks after that close call. The security guy at Best Buy must not have been able to get the entire license plate number, or the cops didn’t have the resources to investigate a possible theft of a computer printer. Whatever reason it was, we were extremely lucky and it was too close of a call for us to continue our operation. We quit while we were ahead.

Fun at the County Fair In every small hick town around the country, the county fair is one of the highlights of the summer. It’s the place where farmers show off their livestock, kids enjoy rides assembled with duct tape that can fall apart and kill anyone at any time, and people seem to enjoy whatever kind of fried food will get them one step closer to a heart attack—like deep fried Snickers bars or chocolate covered bacon. The county fair is always fun, but when you’re a teenager working for minimum wage, the tickets can be very expensive, especially if you end up going there five different times. Today most county fairs have sophisticated ticketing systems complete with barcode scanners and individually numbered tickets to make sure no one can print up their own counterfeit ones and get in for free. But not our county fair, at least not when I was a kid. The ticket booths sold different color bracelets each day that could easily be faked. Once we found out what color was being used each day, I would simply take colored construction paper, cut it into thin strips, and using a leather punch I poked holes in it around the entire bracelet just like the originals. Then my friends and I taped them on our wrists and would walk past the ticket counter like it was no big deal, flashing them to the ticket taker. It saved us each about $30 in entrance fees over the course of the week and nobody ever noticed. I’m sure in larger cities we wouldn’t have been able to pull this off because the bracelets had barcodes on them that would have to get scanned, but in our small little town in the 1990s, nobody could have imagined that a couple of teenagers would’ve been making fake bracelets so they could get into the fair for free. One year I was able to get access to the microphone for the announcement system that covered the entire fairgrounds and told everyone to “smoke marijuana.” Over the course of that evening, several people I knew asked me if I was the one who said something about smoking marijuana over the loudspeaker. I couldn’t help it. The microphone was sitting right there on the desk at the fair office and no one was around, so how could I pass up

this amazing opportunity to say something stupid to every fairgoer that night?

Making a Fake Report Card One of my older brother’s friends went to a local technical college, but he wasn’t doing so well. He had some deal with his dad where if his grades were to fall below a C then he would have to pay rent, or his dad might even throw him out of the house or something. Since his grades sucked one semester and things weren’t looking good for him, he asked me to make him a fake report card so he could show his dad and not get thrown out of the house. I was honored that he would ask me if I could do such a thing. It was very easy, as you can imagine, but remember this was in 1996 when the only people who new how to use computers were businesses and computer geeks. I just took his original report card to Kinko’s and photocopied the school’s logo onto a blank piece of colored paper and then using a simple word processor, I typed up a fake one and gave him all A’s and B’s. He was very thankful, and I made a quick hundred bucks.

T-shirts My Mom Wouldn’t Wash I always liked to have funny T-shirts, but some of my best ones I could only wear a few times because my mom wouldn’t wash them, and if I threw them in the laundry hamper, they would just stay there laying at the bottom indefinitely. I had a great shirt that was a parody of Wheel of Fortune that showed Vanna White standing by a bunch of letters that spelled out, “G_F_ck Y__rs_lf” and the caption below it said, “Want to buy a vowel?” I thought it was great since I could wear it to school and the teachers and principal couldn’t do anything about it, because technically, it didn’t have any obscenities on it. I had another shirt that showed George Washington with bloodshot eyes, smoking a joint on the front, and on the back had a quote attributed to him that said, “Make the most of the hemp seed, sow it everywhere.” I figured if George Washington wanted people to grow cannabis, then there was really

nothing wrong with it. I had another shirt showing President Bill Clinton smoking a joint which read “Bill doesn’t inhale. He just sucks.” Another one had a mushroom cloud from an atomic bomb printed on the front and read “Made in America. Tested in Japan.” I didn’t know how to do laundry since my mom always took care of this. I would just drop my dirty clothes in the hamper and they would magically appear clean in my closet a few days later, so it took me a while to realize that my favorite shirts were disappearing every time I put them in the hamper because she refused to wash them and she would just leave them sitting in there.

Prom Night My prom date was a very cute, sweet and innocent girl, who didn’t really party, and didn’t smoke weed, but I still liked her because she seemed to be very entertained by all of my antics and trouble making. The teachers knew we would all get drunk before prom, so they spread the rumor that they were going to give us breathalyzers at the door when we arrived. We couldn’t go to prom sober, what fun would that be, we thought, so a bunch of us went out and bought flasks so we could enter the event sober, and then go in the bathroom and slam a few shots and catch a buzz since we would have already made it past the checkpoint. The school had organized a bunch of limos to pick us all up and take us to and from prom, hoping to eliminate people from drinking and driving, but the strange thing was, some of the limo drivers went out and got smashed after they dropped us off at the prom! Our driver could barely stand as he opened the door when we got back in the limo to head home at the end of the event, and he was so drunk that he got lost on the way back to the school and we had to tell him where to go. He was blowing stop signs and swerving all over the road the whole way. It would have been safer if one of us had driven. Another limo carrying some friends of mine actually drove off the road and got stuck in a ditch because the driver was so drunk, and the five or six couples in the back had to all cram into other limos. It made for an exciting ride back to the school.

After the drunk limo drivers dropped us off at our cars in the school parking lot, we all headed to someone’s house for an after party until the early morning hours of the next day. The summer after graduation I started dating an extremely attractive girl who also happened to be very intelligent as well. We were certainly the odd couple no one could have imagined would have hooked up. Me, the class clown who got thrown out of school (a story I’ll get to later), with one of the smartest, most mild mannered girls in our entire class. It was great. She must have liked the excitement of being with a “bad boy.” The best part was, that she didn’t even try to change me! I think she liked my trouble making. One night we snuck into the Sheraton Hotel to use their hot tub and I stopped at a Seven Eleven on the way to buy some dish soap which I dumped in the hot tub to turn it into a bubble bath. The whole thing started overflowing with four feet of soap suds rising from the top, so we got out of there. Not long after this she got an underage drinking ticket because of me since we were at a party when the cops came. I felt really bad at first, but she didn’t seem to care too much. I thought about offering to pay for it, but she came from a successful family, so I figured she could afford it. Besides, I had already paid way too much money in underage drinking tickets as it was.

Decorating the School with Beer Cans Every kid goes toilet papering when they’re young, and it’s a lot of fun and pretty much harmless. Sure it’s annoying for the homeowner to clean up the mess the next day, but you can pretty much spray the hose in the trees and it will fall down and the toilet paper doesn’t cause any real damage. It was because of this easy cleanup that I thought we should decorate the trees at school with something else that would last a little longer. This “something else” was beer cans. A lot of beer cans. For several weeks I saved the beer cans from our parties and late-night drinking binges, and I spent a considerable amount of time in my basement cutting sections of three foot string, and tying one beer can to each end in pairs. I would then feed this string inside one of the empty beer cans and

place the two tops of the cans against each other and I wrapped a piece of tape around them, taping them together so the strings wouldn’t get tangled up with each other. I then put each of these contraptions into two large black plastic garbage bags. The idea was to get on top of the school roof, crack the tape and pull the pairs of cans apart, and then fling them into the large tree in front of the school so they would get caught in the branches. When I say it was a large tree, I mean enormous. The upper level roof of the school was about three stories tall and was just about the same height as the tree. Sometime earlier I had noticed one area of the school that had a poll holding up an awning that I could climb up and access almost any part of the school’s roof. This opened up a whole new world of possibilities, so on the eve of April 1st, we headed up to the school with the bags of beer cans and backpacks full of toilet paper for an April Fools prank that everyone would be talking about. When we got to the school that night, Rick and I scaled the poll and hopped on the roof and another friend of ours stayed on the ground to throw toilet paper rolls into the smaller trees and to get the bushes. Once on the roof we made our way to the upper level and headed for the front of the school by the tree and started flinging the beer cans into it. My invention worked perfectly. The strings would get caught on the branches and tangle up, and the cans would hang there, blowing in the wind. We also threw rolls of toilet paper over the top of the tree and the guy on the ground would pick up the remaining roll and throw it back up into the tree finishing it off. Occasionally a car would drive by and we’d all hit the deck, ducking down on the roof so nobody would see any shadowy figures lurking around up there. The next morning I brought a camera to school so I could get a picture of our handiwork in the daylight. It looked great. Of course, the janitors had been out there since first thing in the morning trying clean it up, but the tree was so large that the hose wouldn’t reach most of the toilet paper dangling from the top and certainly wasn’t going to do anything for the dozens of beer cans tangled in the branches. It looked like the tensile from a Christmas tree and each can sparkled in the sun. You couldn’t drive by without noticing it.

The funniest thing was that there were a bunch of classrooms upstairs that had windows looking out over the front of the school and the tree was directly in front of these windows, so when you were sitting in class—there just 20 feet away outside—you could clearly see dozens of beer cans of Miller Lite, MGD, Icehouse, and others dangling in front of the windows. The school had to get a cherry picker from the city and hoist a worker up to cut down the cans one by one. It took them all day. Of course there was no evidence that I had anything to do with this, even though my proverbial signature was written boldly across it and sparkled in the sun. Well, no evidence yet .

Getting Kicked Out of High School I should have quit while I was ahead, but I always had to push the envelope. The April Fool’s Day prank of filling the school’s tree with beer cans was historic. Every car that drove by the school that day couldn’t help but practically be blinded by the sparkling cans shining in the sun. Most of the toilet paper was dangling from so high up that the hose wouldn’t spray far enough to reach it in order to knock it down. It was awesome. So awesome, in fact, that one week later we decided to toilet paper the tree again. It was Tuesday night April 9, 1996, when my friend Bobby’s parents were out of town, so he threw a huge party because we were on spring break and didn’t have school for the next few days. Ken, Rick, myself and brothers Brendon and Byron, took every roll of toilet paper from Bobby’s house and we ventured off to the school to give an encore performance. It felt like I was having déjà vu, although this time the evening would turn out very differently. As we were doing our decorating, someone from a house across the street had seen us tossing the toilet paper up into the trees and called the police. Two or three cop cars tried to sneak up on us by approaching without their lights or sirens on but we noticed them and scattered. The guys on the roof were able to make it to the ground and four out of the five of us met at the back of the school and continued running east across the football field. Byron was missing because he ran in the opposite direction of everyone else when the cops came. We didn’t know this at the time, but as he was

running away, he was tackled by the guy who lived across the street—the same guy who happened to see us and called the cops. Byron was a starathlete and we were confident that he could outrun any cop so we weren’t worried about him getting caught. More police were arriving and got out of their cars and headed on foot shining their flashlights around looking for us as they came running across the football field in our direction. Immediately behind the football field to the east were countless acres of farmers’ fields that went on for miles, so we took off running. We could see four or five cops off in the distance with the beams of their flashlights bouncing up and down as they ran after us. We had a pretty good head start, and there was no doubt in my mind that we would be able to evade them, but they still kept following us into the middle of nowhere. I was very familiar with these fields because Fred, Diego and I had a childhood fort nearby and I knew how we could get back to town through the fields, so we started heading south and crossed through a small creek by our old fort and continued on into the next farmer’s field. That field led to the edge of town and the house where the party was at was just one block from where this field ended and the neighborhood began. We couldn’t see the cops’ flashlights anymore, and we figured they gave up chasing us because there was no way they could have caught up to us. We were too fast and had way too much of a head start. We all made it back to Bobby’s party in one piece, all except one of us, that is, but we still figured Byron had gotten away and was on his way back to the house and we were home free. There is no adrenaline rush like running from the cops. We weren’t scared. We loved it. The police chase had made my night and it certainly wasn’t the first time I had police chasing after me on foot. Just as we started cracking our celebratory beers back at the party because we successfully evaded the police, several squad cars pulled up to the house. “Cops!” someone yelled. “Lock the doors!” We had dealt with this before and knew that if all the doors were locked then the cops would go away eventually. We weren’t sure if it was a coincidence that they had arrived at the house, or what was going on. We were 100% sure we had lost them in the fields, and there was no way they had followed us back to the

house. No way. I could outrun and outsmart any cop, even if I had been drinking. Perhaps one of the neighbors called them because of the party, we thought, which was a common thing we faced. Whatever they were doing there, we were pretty sure we were safe. After all, they couldn’t come in without a search warrant so we figured they would just leave after a while, and we would be okay like we always were in the past. A few minutes later there were cops storming the house. Somehow they had gotten in. My shoes were covered with mud from running through the fields, so I took them off and hid them in a cabinet under a bathroom sink because I didn’t want to draw any attention to myself and have them figure out I was one of the kids leading them on the chase a few minutes earlier through the muddy fields. I hoped there was no connection between their presence at the party and our stunt at the high school, but I was wrong. Byron had been caught and told them everything. He told them who else was there at the school, and he even told them we were at a party at Bobby’s house right before. It was despicable. He broke the cardinal rule we learned from Good Fellas: Never rat on your friends, and always keep your mouth shut. Byron wasn’t one of my crew. He was an acquaintance, not a friend. If it was one of my crew who got busted, they wouldn’t have told the cops a word, but this pretty boy sung like a canary. He probably told them it was all my idea too. The cops were able to get into the house because one of the emergency contacts listed for the alarm company was Bobby’s uncle, who also had a key to house and gave that key, and full authorization to the police to enter the house. The uncle lived just a few blocks away so it only took the police a few minutes to get the key. Once inside, the cops immediately asked which one was Mark, and I knew I was screwed. They placed me in handcuffs with my hands behind my back and sat me down in the kitchen. “How am I supposed to finish my beer with my hands behind my back?” I asked the one guarding me. He wasn’t amused.

Over a dozen people got underage drinking tickets, and everyone who went up to the high school that night ended up getting charged with felony vandalism because some of the guys on the roof kicked over a few ventilation ducts. I would not be allowed on school property ever again, including graduation. The school board made me sign a contract agreeing never to step foot on school property again, and in return, my homework for the remaining two months of school would be sent home with my friends and I would still be allowed to technically graduate, although I certainly wasn’t allowed to come for the ceremony. They just simply wanted me to go away. I pushed them too far, but this time it wasn’t really my fault. I know what you’re thinking, but it wasn’t. It was the guys who broke the ventilation ducts, which I had no part of. This went against my prankster code of conduct. I was a prankster, not a vandal. I was completely against vandalism (with the exception of smashing mailboxes, which at the time I didn’t really consider vandalism because they could be easily put back up, and who cares if their mailbox has a dent in it? Of course it is vandalism, but when you’re seventeen-years-old you don’t see things too clearly sometimes). I was pretty pissed that the guys had gotten out of control and broke the ventilation ducts. Not only were we all charged with felony vandalism, or in my case, party to felony vandalism, since I wasn’t on the roof at night, but we had to pay $3000 in restitution for the broken ventilation systems. We also had to pay for the city workers to clean up the tree again. I’m 100% convinced that the “estimate” the school had gotten for the ventilation systems was fake. Complete bull. After talking with the guys and finding out what they did on the roof, all they did was kick over three or four of the ventilation duct covers that prevent rain and leaves from getting down into the ventilation ducts. These covers must have cost about $30 each, if that. The school had screwed us. A few days later on the front page of the town paper was the headline “Students suspended for vandalizing school.” It gave all our names and told all about the whole deal. I was the only one who was not allowed back to school since I was the ringleader, and this was the last straw in a long, long list of problems that I

had been causing. I still felt this was extremely unfair, especially since I wasn’t even on the roof that night and I didn’t participate in any of the vandalism, not to mention there was no way the ventilation covers cost almost $3000! The actual “vandals” were back in school, yet I was thrown out. The school board didn’t care. They had it with me and this was their opportunity to cleanse themselves of my perpetual problem causing…or so they thought.

My Final Revenge Against the School Me getting thrown out of school was such BS that I couldn’t just sit by and accept it, so my mind started racing and I came up with an idea to piss off the school even more. One of my favorite films was Ferris Bueller’s Day Off , as I’m sure you can see why, and the movie gave me an idea. I remembered a campaign from the film which resulted in the words, “Save Ferris” being painted on a water tower because the school thought Ferris was deathly ill, when in reality he was playing hooky and having the time of his life. I printed up a bunch of “Save Mark Dice” flyers that explained my unfair punishment from the April 9 incident, and then I listed the school’s phone number and the home phone numbers of all of the school board members. “Call any time and voice your opinion,” the flyers read. I gave them to Fred to bring to school the next day so the students could pass them around and that night we went out and stuck a bunch of them in people’s mailboxes all around town. This was just the beginning of the Save Mark campaign, and the humiliation I would cause the principal and the school, even though I wasn’t even there anymore. They say that there are 5 to 7 major turning points in someone’s life. These are major events that alter the course of the rest of your life from then on. These are things like graduating college, getting married, the unexpected death of someone close to you, things like this. They are events that change your life forever, and without even realizing it, I was on the verge of one of those events. The Save Mark campaign was about to go supernova. All it took was one phone call to a local television station and me telling the news director

about what was happening to me and how I was unfairly kicked out of school. The next day a news crew came to my parents’ house and interviewed me about it. Not only did they interview me, but they tracked down one of the school board members and got her on camera too. I had given the reporter the names and addresses of all the school board members to help them with their story. Imagine this woman’s surprise when she answered the door and it was a news crew asking her about why she threw me out of school! They also interviewed several students right in front of the school to get their take on it. Some of the students had Save Mark flyers taped in the windows of their cars and were posting them around school. This made for great footage for the story, which aired later that evening. It was awesome! There I was on the evening news broadcasting to hundreds of thousands of people in the surrounding cities and towns telling everyone about how the evil school board and principal had it out for me and were denying me the memory of a high school graduation. The segment also mentioned that students were posting flyers around town, in the school, and on their cars showing their support for me. Mrs. Vandyke, the school board member who was interviewed for the segment said that instead of having a large disciplinary file, she insisted that a large box was needed to hold all of my detentions and the evidence of my past pranks and everything I was suspected of participating in over the last four years. I’m sure the pornos I put in the library were in the box, along with Mr. Bell’s Asshole of America shirt, and who knows what else. I was very proud. They didn’t just have a file on me, they had a box . The news segment still didn’t change the school board’s mind, and I still didn’t get to come back to school or attend graduation, but this skyrocketed me to a whole new level of popularity that I could have never even imagined. I must say, and very honestly and humbly, that I was already one of the most infamous students in the school, but now I was on the evening news and this took it to a whole new level. It also taught me the power of the mass media, and how easily someone could get on the news. All television stations, newspapers, and even some magazines have tip lines and ask people to phone in news items that they think are interesting, and

that’s what I did. Years later, I would polish my skill of getting into the news, as you may be familiar with, but this is how it all began. This was how I learned that simply calling the news and pitching a story idea could quite often get them to cover it. This was an amazing revelation that shaped the course of the rest of my life and if I could do it all over again, I wouldn’t have it any other way.

The Aftermath My entire locker was cleaned out and everything in it was sent to my parents’ house. Fred and Diego would bring my homework assignments to and from school for me. The principal, Mr. Mueller, along with the entire school board pleaded with Fred to convince me not to do anything else to retaliate or get even with the school for what they had done to me. The school really worried that their decision to throw me out might put me over the edge and cause me to do something even more dramatic and destructive. They just couldn’t wait for the end of the year fast enough. My appearance on the evening news was somewhat favorable to me, and I’m sure it blew the principal’s mind that it happened. Under our signed agreement I was allowed to technically graduate, so that wasn’t so bad, but it did get pretty boring sitting in my room all day by myself while my friends were at school. Even though I didn’t have to actually go to school anymore, my mom would still wake me up and not let me sleep too late since she said this was supposed to be a punishment, not an excuse for sleeping in, and she wouldn’t let me play video games until after 3:00 when school got out. Most of my homework was pretty easy, but I did pay a girl to write book reports for me for English class to save me the trouble of having to read the dumb books. I would then rewrite them in my handwriting and turn them in. I had applied, and was accepted to a local technical college in the fall, but I didn’t really have any serious plans about the future. I was just looking forward to the summer. I happened to be taking a drafting class when I was thrown out of school, and while doing most of my school work at home was fairly easy,

producing drafting drawings without the help of the teacher was very difficult. This was not a computer aided drafting (CAD) class, this was old school pencil and paper drafting where you would draw three-dimensional objects using only pencils, squares, compasses, and rulers. I didn’t even have any of the proper equipment at home, so how was I supposed to produce the last few drawings required of me for the class? I did have the drafting book, which showed a thumbnail image of the items I was supposed to draw, so using my high resolution computer scanner that I scammed from Best Buy, I scanned the tiny images and enlarged them by 1000% and then taped the printouts onto my window, and then traced them onto the drafting paper. It worked fantastic. There was just enough sunlight shining through the window and I could see each and every line in the diagrams, so I would just trace them onto my paper. A drawing that normally took several hours now only took me ten minutes. Later that summer I was told by a friend of mine in the class that the teacher held up one of my drawings as an example of the kind of work the students should strive for! If you’ve ever taken a drafting class, you know that it’s fairly difficult, and you sometimes draw lines in the wrong place or at the wrong angle and set the point of your compass off-center, and most drawings have a fair amount of erasing that has to be done on them before they are complete. Well, not my drawings. They were practically perfect, and even the teacher took notice of my handiwork, never even imagining how I had done it. He thought I was very gifted. I guess I was gifted, just not in drawing. My gift involved “beating the system,” as they say.

The Dildo Present Since I wasn’t allowed at the graduation ceremony and I couldn’t pull off one last jackass move to humiliate the principal, I decided to have one of my friends do it for me. This final prank would take balls, quite literally. I got a large black dildo and put a sticker on it reading “To Mr. Mueller, from Mark Dice,” and called my friend Brent and asked him if he would give it to Mr. Mueller at the graduation ceremony. He was cool, and thought it was a great idea, so he came on over to pick it up on his way there.

He put the dildo in his back pocket, hiding it under his gown, and when his name was called to walk up and shake the principal’s hand and get his diploma, he reached out like he was going to shake hands and placed the dildo in Mr. Mueller’s right-hand and then snatched the diploma from him and walked off the stage, leaving him holding it in front of the entire audience. Mr. Mueller quickly turned around and set the dildo down on a chair and laid a clipboard on top of it trying to hide it from view. One of my friends’ parents were videotaping the ceremony, and they got this on tape so I was able to watch it later which was pretty cool. I had also given my graduation hat to Rick to throw onstage for me at the end of the ceremony since I couldn’t be there. I had written “Fuck You!” in large letters with black magic marker on the red hat and underneath it wrote, “From Mark Dice.” The school had told the students not to throw their hats in the air, which has been a graduation tradition for who knows how long, and anyone missing their hat at the end of the ceremony would get in trouble they claimed. So my hat would be the only one being thrown that night, and Rick snuck it in under his gown and threw it on stage as one final “up yours” gesture from me to the school. Even though I was not there in person, I wanted them to know I was there in spirit. They just couldn’t escape me. I had also done one other thing trying to throw a wrench in the ceremony that night. A small number of honor students were given a gold rope (called an honor chord) to wear around their neck, signifying they were the smart ones. It had something to do with an extremely high grade point average or something, so the afternoon before graduation I went to the local craft store and bought an entire roll of gold rope that looked practically identical to ones the honor students would be wearing, and cut it into small three-foot sections, the same length as the authentic honor chords, and I gave them to Rick to pass out to everyone before the ceremony, so instead of just a handful of people wearing the honor chords, there were dozens. Certainly not as cool as the dildo or my hat, but it was something.

Fake College Rejection Letter

I was very mad that Byron had gotten caught the night we decorated the school’s tree again, especially since he ratted us all out and got me kicked out of school, so I had to get him back. Instead of doing something criminal like slashing his tires or keying his car, I decided to type up a fake letter from the college that he was going to attend in the fall, informing him that due to a recent evaluation of his criminal record they had decided to revoke his acceptance. This was in 1996, and I didn’t have a color printer at the time so I couldn’t just copy the logo off the school’s website and put it in a Word document and print it out to make an official looking letterhead, so I called the school asking for a packet of information which they sent to me. Once the brochures came, I cut out the school’s logo and brought it to Kinko’s and photocopied it onto a blank piece of paper so it looked like official school letterhead. I also made an envelope with the logo in the upper left corner so it looked nice and official too. I then typed up a professional sounding letter explaining the school’s decision to change its mind about his acceptance. I explained that the school had certain standards for their students and that he had failed to live up to those standards due to the recent vandalism charge from that infamous night at the high school. I knew that when he received the letter it would absolutely crush him. It was already too late to apply to other schools, so what would he do? I included a sentence at the bottom of the letter that said if he wished to appeal the decision, he could call and schedule an appointment to plead his case. The phone number that I listed was a 1-800 number to a phone sex line that I got out of the back of a porno magazine where they advertise such numbers. This particular 1-800 phone sex number was advertised to specialize in anal sex talk and it was a 1-800 number (and not a 1-900 number) because you had to call in and give your credit card number so they could charge you per minute to talk dirty to the girls on the other end of the line. There was a very nasty recording that played before you were asked to enter your credit card number. I will never forget this recording, at least the first sentence, which said “Hey baby. You’ve reached the Back Door Entry, the

hottest anal sex line in the world.” It then went on to say some very nasty things about what you could expect for your $3.99 a minute, or however much it cost to talk to one of the girls. I made up some fake name who I said was the college administrator and then signed a signature in pen at the bottom of the letter and folded it up and put it in the official-looking envelope, put a stamp on it, and dropped it in the mail. Later that summer I bumped into Byron’s brother Brendon at a party and I asked him how his brother liked getting thrown out of college before he even started, and then I laughed. He acknowledged his brother and his parents were freaked out when they first got the letter and then were confused when they called to schedule their appeal and got a recording talking about anal sex. They probably thought they dialed the number wrong at first. Oh, to be a fly on the wall when this happened would have been awesome. One of my very best prank phone calls would also include Byron, and interestingly enough didn’t result from me calling someone, it resulted from someone calling me who had a wrong number. I received a call one afternoon from a woman who thought she had called a bank to see if her loan was approved. Seeing a fun opportunity when she asked if this was Wells Fargo (or whatever bank it was), I said, “Yes it is. This is Bill speaking, how may I help you?” She went on to tell me that she wanted to know the status of her loan application. She sounded like an AfricanAmerican woman, and I told her I was sorry, but the loan officer in charge of her account turned her down because she was black. “Excuse me?” she said. “That’s right, I’m very sorry ma’am, and I’m going to do everything I can to correct this,” I assured her. “But Mrs. Wilson who was in charge of processing your loan doesn’t like black people.” I went on to tell her that of course this was against company policy and said I was going to do everything I could to get that loan approved. I also told her that Mrs. Wilson was under investigation for racism and that we were going to be firing her soon. Mrs. Wilson was Byron’s mom of course, and none of this was true. I told the poor woman on the phone that I was going to give her Mrs. Wilson’s home phone number and I wanted her to call and tell her how

disappointed she was that she would turn down a customer’s loan just because they were black. I assured her that the bank would call her back in a few days with the new results of her loan application, but I stressed that she really should call Mrs. Wilson right now and tell her what a piece of garbage she was, and then I gave her Mrs. Wilson’s home phone number. Just imagine how confused Byron’s mom must have been because not only did this woman have her phone number, but also knew her name! I’m sure Mrs. Wilson tried to say that she didn’t work at the bank and she didn’t have anything to do with loans, but the woman on the phone probably said that she just got off the phone with the bank, and they were the ones that gave her Mrs. Wilson’s phone number! I wish I could have been there to witness this conversation, but it was fun enough just coming up with this story off the top of my head and talking with the woman.

The Weed Cutter The summer after high school graduation (I was allowed to technically graduate, remember) Fred and I got a job on a weed cutter, and I’m sure you don’t have any idea what this is, so I’ll try to explain it to you. In the Midwest, a lot of lakes have problems with weeds growing up from the bottom and tangling in the propellers of boats, so it’s fairly common to have a huge weed cutting boat drive around the lake and cut the weeds. It looks like a floating combine like the ones used for harvesting corn. Fred lived on the lake, and his dad had gotten us the job as the two weed cutters which turned out to be one of the greatest jobs ever. One of us would ride around the lake on the boat cutting the weeds, often for several hours at a stretch, while the other one would sit in a dump truck on the shore just waiting for the weed cutter to fill up and unload. When the weed cutter was full of seaweed, we would drive it ashore and using a series of conveyor belts we would unload the weeds into the back of the dump truck. It was then the truck driver’s job to take the weeds to a nearby dump site and dump them. It was very often several hours between loads, and we would switch off every other load so one of us would drive the dump truck for half the day, while the other one would operate the boat.

Our first day on the job we were out test driving the dump truck when Fred put it in the ditch when making a u-turn. This was an omen of what was going to happen for the rest of the summer. The truck was stuck and wouldn’t move but luckily some guy drove by in a pickup truck and had a tow rope and was able to pull us out and our boss didn’t find out about it. This happened on a country road in the middle of nowhere, so we flagged the guy down for help as he approached us. He was drinking a can of Old Style beer (right in his truck while he was driving) and had the rest of the twelve-pack sitting in the truck bed. This is what happens out in the country in Wisconsin. Our supervisor for the weed cutting project was a retired senile old man named Barney. He was a scatterbrained man probably suffering from the onset of Alzheimer’s disease, and every single time he would address Fred or I, he would call us by the wrong name and then correct himself. If he was addressing me, he would say “Fred, ahh, Mark.” He could never get our names right. Ever! A lot of older grandparents do this. They just keep rattling off the names of the grandkids when talking to one until the right name pops into their head. Barney was no different. Even if he called us by the right name, his brain would still have a glitch and he wasn’t sure if he had used the correct name or not, and he would say something like, “Mark, umm, Fred, ahhh, Mark,” every single time. Nobody in their right mind should have let either of us drive a dump truck. We were 18-years-old and smoked weed constantly. The dump truck was just under a certain weight limit so we didn’t need a special driver’s license to run it. It was a stick shift, and I had never driven a stick shift before, so imagine how fun it was to learn using a dump truck! I’m surprised we didn’t destroy the transmission in the first two weeks. We beat the crap out of that truck. I did get the hang of it pretty quickly though, and soon was able to fly down the road steering with my knee while holding a hamburger in my left hand and a soda in my right. I would set my drink down on top of the shifter to shift and would take bites of my hamburger and puff on joints as I drove down the road like a maniac, never once worrying about getting pulled over.

Little did I realize when I first started that job, that it would be a changing point in my life. I could only smoke so many joints sitting in the dump truck waiting for the boat to come ashore to unload, so I had to do something to keep me busy. I soon learned the amazing power of books. I went to Barnes & Noble and bought a book called the Psychology of Persuasion , and it was amazing. It opened up a whole new world for me. When it was Fred’s turn to sit in the dump truck and wait for the boat, he read the book too, and we would discuss what we had learned after work every night. The second book I bought was Unlimited Power by Anthony Robbins, which changed the course of my life forever, and remains one of my favorite books of all time. Here I was, 18-years-old, in a small little town in Wisconsin, and I had found Anthony Robbins, the biggest self-help and motivational guru in history, and his book began to open my mind up to the true power of my potential. Fred and I felt like Jedis in training. It wasn’t long after reading this book that I began dating a hot new girl who was super smart too, and I also started looking ahead in my life, and began coming up with goals and milestones along my desired path. I had never thought too much about the future. I pretty much just lived for the moment and never really looked ahead in my life more than a week. This was my first coming of age moment. Working on the weed cutter did offer other perks too, other than ample reading time in the dump truck. Since Fred lived on the lake at his dad’s house, after work we could go jet skiing whenever we wanted and his dad would let us take out his speed boat by ourselves. We would fill a cooler full of beer and go out waterskiing until sunset with some girls from the neighborhood and smoke joints on the boat, and felt like we owned the lake. There was a water patrol police officer stationed on the lake, but we never worried about getting pulled over for speeding or reckless driving since we worked on the lake and we became friendly with the officer. His name was Malcolm, and we would drive by him with beers in our hands and wave to him and he would wave back, and he was never suspicious or perhaps never cared about what we were drinking.

One time when we were drinking and waterskiing officer Malcolm approached us and waved us down and we thought he was going to bust us for reckless driving or something. We all had open beers, of course, and there was a bag of weed in the boat, and probably not the legal number of life jackets either. We thought we were screwed, but officer Malcolm just wanted to thank us for doing a good job keeping the lake clean and asked us if we would be sure to keep the area around his dock free of weeds! When we were cutting the weeds by people’s piers, sometimes the homeowner would run out and flag us down and toss us a beer or two trying to bribe us to make sure we really cleaned up the lake in front of their house. They probably never assumed that a couple of 18-year-old kids would be operating the $150,000 weed cutter, and since almost everyone in Wisconsin loves beer, they figured this was a good incentive for us. We weren’t getting drunk on weed cutter, it was just a beer or two once in a while, and usually a Miller Lite or something we’d sweat out after a few minutes working in the sun. At one point during the summer, Fred and I had a contest to see who could go longer without showering. It started one day when Fred happened to mention that he hadn’t showered for a few days since he figured waterskiing in the lake after work kept him clean enough. I remarked that it had been a few days since I had showed too, to which Fred responded, “and I’m not going to shower today either,” as he laughed out loud at his blatant violation of social norms. “I’m not showering today either,” I said chuckling. The next day when we arrived at work I proudly announced, “I didn’t take a shower this morning.” “Me either,” Fred responded. We both grinned and went to work, repeating this same smelly game of chicken, day after day to see who would finally flinch first and give up. I went a week or maybe ten days without showering, and then I gave up after I did some work on my car and got all covered in grease. I also smelled like seaweed and there were pieces of it stuck in my hair and it was getting nasty so I figured it was time.

The lake we worked on was part of a park, and the park ranger was an extremely obese woman who drove around in an electric golf cart that we joked was her heavy duty electric wheel chair because we thought she was too fat to walk. We called her “tons of fun.” She was off on Mondays and Tuesdays and on those days we would always see a county vehicle pull into the parking lot and sit for several hours and nobody would ever get out. We realized the city worker would park there and sleep. People always joke about how county and city workers slack off all the time, and this seemed to be true. One of my friends worked for the county that summer and confirmed this, but his job still wasn’t as fun as ours. Our supervisor, Barney, the senile old man who always wore a hat like Gilligan on Gillian’s Island and always had a look of confusion on his face, would always complain that we never wore our life jackets when operating the weed cutter. I didn’t wear a life jacket because it was going to ruin my tan. He complained about it all the time and would occasionally threaten to fire us if we weren’t wearing them. Barney lived on the lake and would watch us with binoculars, and taking care of the lake was his life’s mission in his retirement. We thought about “accidentally” driving the weed cutter into his boat to poke a hole in it and make it sink, or running into his dock to smash it just for fun. One of the dump sites for the weeds was on a guy’s land who lived on the edge of a farmer’s field, and he let us dump the weeds there so the farmer could use them as mulch in the field. We met this man several times and thought he was extremely bizarre. One afternoon we saw him pulling out of his driveway with a black woman in the passenger seat who we assumed was probably his wife. I don’t mean to sound racist or anything, but a white guy with a black woman is extremely rare, especially in Hickville, Wisconsin, and we were pretty surprised by this. Fred started joking that she was his slave who he kept locked up in the basement, and somehow this idea started becoming something we considered may be true. The guy looked like a complete psycho, and we wondered how in the world he was able to even attract a wife at all, and it was even more strange that he had somehow hooked up with a black woman.

We never saw his wife again, so one day we decided we should sneak into his house and investigate to see if Fred’s delusions had any basis in reality. This was out in the country where most people don’t even lock their doors, so after we dumped a load of weeds we parked the dump truck in his driveway and walked up to his front porch to see if he was home. We came up with some dumb question to ask him about where he wanted us to dump that week’s loads, just in case he was home. We rang the doorbell, and when no one answered we thought this was the perfect opportunity to sneak inside his house and look around. I slowly opened the door, and Fred stood on the porch looking out to see if his car would pull into the driveway. I made it just a few steps into the house, and I just couldn’t do it. This was too weird. We were in insane. What the heck were we doing? We were snooping around some stranger’s house because Fred was delusional and thought he kept a black woman locked up as his prisoner. I turned back and ran out the door and we got in the dump truck and left. The weed cutter was one of the best jobs I’ve ever had. We would show up late, cheat on our timecards, smoke joints and occasionally drink a beer right on the boat. I did the same job the following summer, but Fred decided to work for his dad doing construction so I got Barney to hire my friend Marty as Fred’s replacement but we screwed around so bad that Barney told us he wasn’t going to hire us back again the next year. He really meant it too, so I ended up working at a gas station instead. I blamed Marty because he was horrible at operating the weed cutter and even fell asleep one time while he was driving it and hit a buoy and almost crashed into someone’s dock. Barney our boss had a sign hanging off his mailbox that said, “Barney’s Golden Pond,” a reference to the movie On Golden Pond about some senile old man who lives on a lake or something, so it was very fitting of him. To get our “revenge” against him we later ripped the sign off his mailbox a few nights before I moved to California and brought it with me in the car, and later threw it off the edge of the Hoover Dam.

Ideas Not Carried Out

Chicago 69 Sign While I was able to pull off most of the crazy schemes I had come up with, there were still a few that I just didn’t get around to or logistically were too difficult. People had always talked about stealing the “Chicago 69” sign, which is a large sign on the freeway signifying that Chicago is 69 miles away. While I did steal a 69th Drive street sign, stealing the Chicago 69 sign would have been truly historic since people had talked about it for years, and there was only one. Since most people only talk about doing crazy things, my friends and I decided to go out and actually steal it. We brought a battery powered saw so we could just cut down the posts in a matter of seconds and throw the sign in the back of Fred’s truck. It would have taken too much time to climb the posts and actually unbolt it, since hundreds of cars would have seen us and possibly a cop, so simply cutting the sign down seemed like a much better idea. We parked on a frontage road parallel with the freeway and then walked down the embankment to retrieve our sign. As we approached it we came to realize that the sign was three times larger than we had thought. When you’re driving by on the freeway, it doesn’t look all that big, but when you’re standing directly underneath it, it was huge. It was probably 25 feet long and 8 feet tall, and there was no way it would have even fit in the back of Fred’s truck. We had to abort the mission. At least we had tried.

The 7 Day Plan I had an idea for what we called the seven-day plan, which was a series of seven pranks, one every day of the week right after the other, with some of them being spin-offs of the previous one. For example, we were going to list the principal’s house for sale in the local newspaper saying that it had an in-ground swimming pool and a new roof, and then the next day we were going to have Diggers Hotline come to his house and spray paint all over his yard showing where all the utility lines were buried, and then the following day we were going to have a pool company stop by his house to schedule an estimate for a new swimming pool to be put in his backyard.

We were then going to schedule a roofer to come to his house the next day to give him an estimate for some new shingles. For some reason we were going to put a dead squirrel in a box and leave it on his front door because in the listing for his house we were going to put in the real estate section, we planned on mentioning that there were a lot of squirrels and other wild life on the property. The plan would culminate by taking a mannequin dressed in a school letter jacket and hanging it from its neck by a noose from the school so it looked like a student had killed themselves on the upper level of the school roof. We were hoping this would cause school to be canceled before the police realized it wasn’t really a person. The dummy was also going to be holding a copy of the real estate listing for the principal’s house in its hand. I was thrown out of school before we could put the seven-day plan in motion.

Cementing the School Gate Shut If we would have had a little more money, we would have cemented the gates shut to prevent anyone from having access to the school parking lot just to cause chaos when everyone arrived in the morning for school. We were going to go in the middle of the night and chain them shut and mix a few bags of concrete on the ground around them so by morning it would have hardened enough so the gates couldn’t open and the school would have to make a decision to cancel classes that day or have everyone park in the surrounding neighborhoods. Whatever they decide we thought it would have been hilarious but we never got around to it because nobody wanted to spend the money on the concrete.

Coveting An Arcade Game There was a small outlet mall near us that had a few arcade games in the hallway for people to play and both Fred and I had always wanted an arcade game at home, so we thought about stealing one from the mall. We figured since no one would really have the balls to steal one in the middle of the day, we could probably actually do it quite easily. We discussed making

fake T-shirts with the name of the video game company printed on them and then we were going to use a dolly and just load up the arcade game and roll it out to Fred’s truck. Who would suspect we were stealing it? We would have looked like a couple of repair men. We were also going to print up fake lettering for the side of the truck that spelled out the name of the video game company. That way if anyone saw us wheeling it out of the mall and loading it onto the truck, the door would read “Video Games Unlimited” in large letters (or whatever the company’s name was) so nobody would think anything of it. We were even going to print fake license plates for the truck just in case there were security cameras that got us on tape. The reason we never did this was because of the close call we had scamming video games and computer equipment from Best Buy using our homemade UPCs. Aren’t videogames supposed to keep kids out of trouble ? Not us.

Trying to Tap into the Announcement System at School We really wanted to tap into the announcement system of the school with our own microphone so we could say offensive things like telling the principal to go screw himself and voice our opinions about our least favorite teachers, while the whole school was listening, but we just couldn’t figure out how to do this. We did realize that there was a microphone on the principal’s desk with a large button on it that we figured could accomplish this task, but there was no way that this could be done without getting caught since his secretary or someone else would definitely see us running out of there and it was such a small school that they would probably know who it was or at least be able to identify them the next time they saw that person in the hall. Unfortunately there was no way of tapping into the system without having access to the central unit, which was located in the school office. We also thought about taping into the loudspeakers on the football field, but this also proved too difficult. It seems that sometimes dreams don’t come true.

Dumping Dead Fish in the Ventilation System

We wanted to put stink bombs in the ventilation system of the high school to stink up the entire building so they would have to close it for the day. It was something the Joker in the Batman movies would do so it seemed like a pretty good idea at the time. After thinking about this for a while, instead of just throwing a stink bomb in the intake, we decided it would be much better if we would dump a bucket of dead fish in it instead, because they would provide a continuous supply of stench instead of just one burst of it. We found an unmarked door in the school that had a ladder leading up to a room where all the ventilation ducts came from, but we couldn’t find the intake so we resorted to dropping stink bombs in the hallways instead but it didn’t have the same effect. Years earlier Ken threw a lit smoke bomb into the middle school on the last day of class and dropped another one into a ventilation duct somewhere hoping it would get sucked into the school. Kids and their smoke bombs, I’ll tell ya.

Stealing Dead Cats from Biology Class After the Advanced Biology class got done dissecting a bunch of cats for a project, we thought about going in the school dumpster and taking the bodies and then throwing them all in a teacher’s front yard. We knew from our friends in Advanced Bio that the cats had just gotten thrown out after their dissection experiments were completed, and about a dozen of them with their guts cut open were lying in the dumpster behind the school. We would have actually done this, except nobody wanted to put the dead cats in the trunk of their car so we could drive them over to a teacher’s house because we thought the blood and guts would leak out of the trash bags. We realized how bad these cats must smell, and nobody was willing to risk having the trunk of their car smell like a dead body after we were done.

Hanging a Pot Flag on the Flagpole I took a large piece of white fabric and painted a green pot leaf on it and I was going to hoist it up on the school flagpole one night, but I ended up getting kicked out of school before I could do it. I was planning on going in

the middle of the night and would lower the American flag and replace it with the large pot leaf and hoist it back up to the top and then climb the flagpole and cut the rope so the flag could not be taken down. This was one of the pranks next on my list. I had the pot flag already made and ready to go, but my early departure from school caused me to abort this mission.

Building Our Own Float Senior year we came up with the idea to make our own float for the homecoming parade that would have consisted of a trailer covered in beer cans and a large pot leaf displayed on the top, but we didn’t have enough time to build it. We talked about how it could be done and we found someone with a truck who was willing to pull the float, but the parade was a day or two away when we had come up with the idea. We were going to park the float a block away from the school and then in the middle of the parade just pull up from an adjacent street and join the procession. It was a great idea but unfortunately we didn’t have enough time to build it since homecoming was only a day or two away and we were seniors, so we couldn’t do it the following year. A few people did, however, bring eggs and stink bombs to the homecoming pep rally in the gym and raised a little hell that way. We even discussed setting off a bunch of stink bombs in the gym and then chaining all the doors shut from the outside to lock everyone in there so they couldn’t get out. We were terrible kids.

The Shit Box I always wanted to be an entrepreneur. I wanted to own my own business, invent a new product, or do something on my own so I didn’t have to work for anybody, and of course I dreamed of making millions and retiring at the age of 30. One of the first ideas I came up with was to sell boxes of shit. Literally, boxes of cow manure that I called the Shit Box. Of course, you wouldn’t buy one of these for yourself. The idea was that people would call me and give me the name and address of someone they hate, and I would

send them a box of cow manure along with a nasty letter explaining why someone decided to do this to them. This wasn’t just a wild idea I had, I actually purchased the phone number 1888 Shit Box (744-2269). (I had to get the 888 number because the 1-800 number was already taken, but the 888 number was still toll free.) I then looked into having a 24-hour answering service take the orders and researched what it would take to get a merchant account setup so I could accept credit cards. I even spoke with a sales rep from the local rock station I was planning on advertising the Shit Box on. I also wrote up a thirty second commercial I planned on using. Obviously, you can’t say shit on the radio, so the sales rep said they could just bleep it out, and people would get the idea. My commercial went something like, “Do you hate your boss, a teacher, your principal, or ex-lover? Send them a box of (bleep) in the mail. Call 1888 (bleep) box, and we’ll ship them a box of cow manure anonymously along with a letter telling them that they’re receiving a box of (bleep) because they are a piece of (bleep). That’s 1-888 (bleep) box. 1-888-7442269. Call today.” We even painted up some huge cardboard signs that said, “Send your boss a box of shit. Call 1-888 Shit Box.” We had planned to put them up all over town on telephone poles and on the side of the highway to advertise our new service. I would have done it all to, except I decided to save my money and move to California at the end of the summer. The radio advertising was very expensive and I wasn’t sure if the idea was going to take off or not. You have to admit, in a weird sort of way, it seems like a good idea, and years later I found several other websites that were doing exactly the same thing, so I wasn’t the only crazy one with the idea! Of course it wasn’t the most respectable business model, and sending people boxes of cow manure in the mail certainly wouldn’t get me any awards from the Better Business Bureau, but it still could be considered a legitimate business, and there are certainly worse businesses to be involved in.

College

Craziness

Let the Higher Education Begin Freshman year of college I lived at home with my parents and commuted to school, and the year was rather uneventful because most of my friends had all moved away to different schools and lived in the dorms. Since this was a rather boring time, sophomore year I moved into a three story, fourbedroom house with a group of guys (John, Nick, Bobby and I) and we partied at least three nights a week like there was no tomorrow. Bobby would bring home a bottle of tequila every single Friday night after work for months on end, and within several hours the bottle would be empty and then placed on a narrow 4-inch wide shelf that went around our entire living room half way up the wall. I don’t remember how many bottles of tequila were stacked up there by the end of the year, but I think there were dozens. This was in Wisconsin after all, where everybody drinks like a fish. Throughout the course of that year, we probably had the police come to our house at least a half-dozen times, and every time this happened we would lock the door, turn off the stereo, and they would just leave after a while. We did have one problem, however, that wouldn’t go away…our landlord. Our landlord lived in the house literally right behind us. Our backyard was their front yard, and they were probably less than 75 feet away from us. We knew this would be a problem when we moved in, but we had waited too long to rent a house and the school year was just around the corner, and there were hardly any available houses near campus by this time, so we had to take what we found. When we signed the lease we assured them that we were a bunch of studious young men who didn’t party and got good grades. They soon realized how big of a lie that was.

The Picnic Table My house mates and I were able to scrounge up most of the furniture we needed from our parents’ basements, but there was still one thing missing. We got a couple of old couches from Nick’s parents, John had a nice stereo system and Bobby had a decent sized TV that he brought to the house, and

by the time school started we had just about everything we needed except a kitchen table. None of our parents had an old kitchen table lying around, and we certainly didn’t want to go and buy one, so I came up with a plan. The public park that Fred and I worked at operating the weed cutter was full of picnic benches so we went there in the middle of the night and loaded one in the back of his truck and brought it to my new house. It fit perfectly in our kitchen. Of course this qualified as having stolen property in our house and there was a huge stamp that looked like it was burnt into the wood on the top of it that said “Property of the County Park System,” but we figured since it was a public park paid for by our tax dollars, the table was, in a sense, ours. We didn’t think the park would miss one table since there were plenty of them around and we even thought about bringing it back at the end of the year when we were done with it. We were just borrowing it, we weren’t stealing it. The picnic table was a nice touch in our house. Not only did we use it to eat on, but it also served as entertainment during our parties, which happened practically every week. It became common for people to take pens and magic markers, and draw funny pictures on the tabletop and on the benches where people sat. Sometimes people would take knives out of the drawer and carve things into the table as well. We encouraged this. After just a few months, practically every surface on the thing was covered with graffiti, little cartoon images, and a lot of penises for some reason. People really liked to draw penises on the table. At the end of the school year when we all moved out and went our separate ways, we carried the picnic table across the street and set it in a grassy area next to the apartment complex there and within just an hour or so, we saw some people sitting down at it and enjoying it. I’m sure they were also enjoying the two semester’s worth of artwork that was on it too. I thought about returning it to the park I had taken it from, but that would have been too much work, so abandoning it across the street was good enough.

Don’t Puke in the Flowers On St. Patrick’s Day, Bobby bought a bottle of Everclear which is 90% alcohol (190 proof), and contains a warning on the label specifically stating

not to drink it straight, and insisting that it be highly diluted with a nonalcoholic beverage. We didn’t care about this warning, and poured a couple shots. We all clanged our shot glasses together above our heads, said cheers, and downed the shots. Within seconds John and Nick ran out the front door, leaned over the railing surrounding the front porch, and started puking. I felt a little queasy too, but was able to hold mine down along with Bobby, who outweighed me by 70 or 80 pounds. The only bathroom in the house was upstairs, and there was no way anyone would have been able to hold it down until they ran up there, so luckily the front door was only a few feet away. A little while later as our party began to get in full gear, some other people wanted to take shots to see if they could hold it down, so I took another one with them, my second, their first, and one of them ran out the front door and puked immediately after taking it. The stuff tasted terrible, kind of like gasoline in my mouth, but I still was able to keep my second shot down. Then a little while later, Bobby and I took another shot, my third, and his second, and this time it was my turn to run out the front door and start puking over the railing. Bobby followed right behind me. The ground was covered with several inches of snow, and I could see where the others had puked because their chunky and colored vomit was splattered on the clean white snow that covered the grass and flowers on the ground right next to the porch. It looked nasty. Like someone had spilled rotten fruit salad all over the front of the house. The next day, the four of us sat in the living room on the sofas like a bunch of zombies watching movies. We were practically brain-dead. We realized why the bottle of Everclear said not to drink it straight, after all, just one shot made almost everyone puke immediately. I was very proud that I was able to hold two of them down, and only puked after my third. Our heads were throbbing as we watched movies trying to recover from the night before, when all of a sudden we heard pounding on the front door. This was angry pounding, not pounding like one of our friends was seeing if we were home. Everyone was too dead to even want to get up, but I managed to stagger my way to the door to answer it and realized it was the landlord. This couldn’t

have been good. As soon as I opened the door she started yelling at me saying something about puke and ruining her flowers. I had no idea what she was talking about. She started pointing at the puke stains in the snow from people throwing up on the front porch over the railing and was freaking out that the acid in the puke was going to kill her hibernating flowers and they weren’t going to bloom again in the Spring. There were five or six different enormous puke stains at different points around the front porch where people had thrown up the night before, and it just so happened that her flowers were lying dormant underneath the snow right in that area. I apologized to her and came back inside the house and sat down on the couch with my roommates looking bewildered because they overheard someone all pissed off about flowers after I opened the door and didn’t know who I was talking to or what the heck was going on. I reminded them what happened the night before and where we had all puked, and we all went out to have a look at the puke splatter. There must have been gallons of puke splattered all over the front of the house. It was epic, and just one more reason for the landlord to hate us.

Attack of the Lesbians I’m the kind of guy who likes to be the center of attention, and there’s no better way to get attention than to have a microphone in front of a large crowd of people. There was a stage set up one afternoon in the quad at my college, complete with a set of drums, a keyboard, a bunch of speakers, and of course, the microphone which looked lonely sitting in its stand with nobody using it. The band hadn’t taken the stage yet, and the quad was full of people so I jumped on stage to see if the microphone worked so I could speak to the crowd. I started rapping a parody of an Eminem song that I had written, since I was trying my hand at some comedy at the time which I performed on open mic nights at the Comedy Store, but me hijacking the microphone didn’t really go over that well with the band members, who happened to be a group of butch-looking lesbians.

A couple of them ran up on stage as I was performing my song, and one grabbed me by the arm and the other grabbed the microphone and yanked it out of my hand. I walked off stage not thinking anything of it, when all of a sudden a few more lesbians came up for reinforcements and they all surrounded me, yelling and complaining. Whatever. I turned and started walking away when one of them grabbed onto my forearm with both hands and wouldn’t let go. I peeled her hands loose and continued walking away and she followed me and grabbed me again and wouldn’t let go. She was a manly lesbian, and for some reason thought she would act like a bouncer at a bar or something and detain me. It was very weird. She just wouldn’t let go of my arm. What could I do? I couldn’t give her a shove with my other hand, because even though she was a manly lesbian, she was still a girl. I couldn’t push a girl, even if she did look like a man. I kept walking away and wiggling my arm back and forth trying to break her grip as the other lesbians approached me again. I was able to break free but my watch band broke and it fell to the ground. I didn’t care. I took off speed walking in the other direction before more lesbian reinforcements came and the wannabe bouncer lesbian picked up my watch as I left. While I did lose my watch, I avoided getting further assaulted by the lesbian gang which was quite an awkward situation. A few days later I was approached by a security guard at school and asked to come with him. I wasn’t quite sure what he wanted until I saw some of the lesbians off in the distance talking with a second security guard. I couldn’t believe it. Now they were trying to get me in trouble with campus security for some reason. What was the school going to do for me jumping on stage? It wasn’t like the band was playing and I interrupted their show, they weren’t even up there yet. I went with the security guard to one of the offices, where he then introduced me to the dean. Apparently the crazed lesbian band members thought that the reason I jumped on stage and took over the microphone was because they were lesbians! I don’t know how they could have come to this mentally ill conclusion, especially since I had no idea what band was playing or that they were lesbians, and I certainly didn’t say anything about gay people on the microphone, but somehow in their dysfunctional brains they felt so

persecuted by society for being lesbians, that they saw my jackass stunt as an attack on their sexuality. The dean realized they were insane, and I explained to him how they assaulted me and broke my watch, and then he opened up a drawer and pulled it out and set it on the desk in front of me. He made it clear that he had to “investigate” the possible “hate crime” that was supposedly committed against the lesbian band members so they wouldn’t accuse him of discriminating against them for being gay or something. I picked up my broken watch and went on my way. It’s not every day that you get attacked by an angry gang of lesbians.

Crashing the Wrong Party There was some random Friday night my sophomore year of college where I didn’t really have anything to do, so two friends of mine and I decided to walk around our neighborhood and crash someone’s party. As you probably know, in college towns on practically every block on a Thursday, Friday, or Saturday night, some house is having a huge party with dozens of people, and the hosts certainly only know a fraction of them and don’t really care who’s there since it’s not a small intimate gathering of just a few friends. At a lot of large college parties almost anyone is welcome, and friends always invite friends who invite friends, and it’s not uncommon to have 50 or 80 random people partying at someone’s house. We didn’t know of any particular parties going on that night so we went to take a walk in order to find one. Just a block away from my house we saw a bunch of people standing on a balcony holding red plastic party cups in their hands, so we headed up there to join them. Nobody knew that we didn’t know anyone there, and nobody cared. We hung out for a while, drank a few beers from their keg, and since there weren’t any hot girls there, we ventured off down the block to find another party. It wasn’t long before we found a huge three-story house that we could see through the windows was full of people so we headed up the stairs to the porch, opened the front door and walked right in. I knew immediately that this wasn’t just some random party. This was a jock party. All the guys were

pretty huge, and all the girls looked very tough as well. It turns out this was a rugby party, and everyone there was a member of the guys or girls rugby team and knew everyone else. Most people just thought that we were friends with someone at the party, since they knew we weren’t on the rugby team, and whenever anyone asked who I knew there, I would just drop the name of the person that I had been talking to a few minutes earlier. “Oh, I know Sara over there,” I would say, pointing in the direction of the girl I was just chatting with who I had just met. It was a little awkward at first, but we managed, and thankfully nobody really called our bluff. After a while we thought we should get out of there in case they realized that none of us knew anyone there, so we slowly made our way to the door and took off. Directly across the street were a couple girls standing on the second story balcony and I hollered out to them and chatted them up for a minute, and one of them invited us up and we ended up hanging out there for the rest of the night. It wasn’t even really a party. It was just four or five girls all by themselves. I got one of the girl’s phone numbers, whose name was Sheila, but there was only a week left of school and I was going to be moving back home with my parents for the summer so I could save up some money for my move to California in a few months, so I never ended up calling her, but this night revealed to me that if you make yourself feel like you belong somewhere, and you actually believe that you belong there, then people will react in a way that confirms your beliefs. It’s like a selffulfilling prophecy. The night was an interesting social experiment that went much better than any of us had expected. If you put your mind to it, you can probably party anywhere.

Applause is Contagious You expect people to applaud at the end of a play or a live concert, but it’s not something that usually happens in a movie theater. That is, unless I’m in the audience. It was during the digitally re-mastered re-release of the Star Wars films in 1997 that I learned a powerful lesson about how large crowds of people can easily be manipulated. It was a Friday night and the theater was packed since it was the opening for the re-release.

Rick, Marty and I had been partying on the way to the theater and as many Star Wars fans do, we often joked about “the Force” and using “Jedi mind tricks.” I told Marty that I would show him how the Force worked, and as the curtain opened for the film to begin, I started applauding and cheering in excitement. Practically everyone in the entire theater joined me. I felt a tremendous sense of power surging through my body at that very moment. I had just caused the entire theater to start applauding for the movie. I had accidentally stumbled upon the power of applause a year earlier during the film Independence Day because when the aliens blew up the White House in the movie, I started cheering and applauding and half the theater joined me. Every time we went to see a movie we were usually stoned and drunk, and a lot of the times we would fill our jackets full of as many beers as they would hold and sneak them into the theater so we could drink during the movie. If we brought in bottles of beer, you would often hear the empty ones accidentally get kicked over and clang into the other empty ones that we had set on the ground, and you could hear them rolling down the sloped concrete floor of the theater as they banged into the chairs below. Everybody in the theater knew what was happening. The sound of clanging beer bottles is a very distinct sound. Anyway, when we were seated in the theater to see the re-release of Star Wars I recalled the incident during Independence Day when I caused the theater to erupt in applause when the White House was blown up by the aliens, and I decided to test this power again. Aside from getting people to applaud when the curtains opened, at multiple times throughout the movie I would shout out things like, “You can do it Luke!” and “You’re going down Darth Vader!” and other people in the theater would yell in agreement. It was fascinating. I felt like the entire theater was under my control. At the end of the movie, once again, I started applauding and cheering and the rest of the theater followed suit. As we walked out of the theater that night we could see the look of joy on everyone’s face. None of them had ever been to a movie so exciting and with such a great crowd. Little did they know, but I had caused it all. For

years after that night, Marty and I would reference “the Force,” and talk about how we were becoming Jedi masters.

No Final Exam Please I can’t help but say smart ass comments when they pop into my head, and I especially loved to say things out loud in class that nobody else would have the guts to say because I thrived off getting giggles from my fellow students, but I felt like I was in the Twilight Zone on the last day of class when my smart ass comment took on a literal meaning just seconds later. This was a Group Communication class, and in the beginning of the semester we were divided into small groups which we worked with on various projects for the rest of the semester since the entire class was focused on group dynamics and communication among group members. When our groups were first formed, we each had to name our group and draw a picture that represented us. My group consisted of myself, a guy named Chaz, and three girls. Chaz and I were both alpha males and would later have races to see who could finish our tests first in the classes we had together, and we became friends in a competitive sort of way. Our group name had to reflect our dominating type-A personalities, so we decided to call ourselves the Alpha Bitches. Since there were girls in the group, we couldn’t call ourselves the Alpha Males, so the Alpha Bitches worked just fine. There’s nothing like hearing a college professor say something like “it’s time for the Alpha Bitches to give their presentation.” It was hilarious. We dominated the class for the entire semester. We even gave our final presentation on leadership, and we arrogantly explained to the rest of the class that we chose to teach them about leadership because we were the class leaders. It was a great semester. Getting back to my strange smartass comment eerily becoming true…it was the last day of class and we had all arrived to take the final exam after several days of cramming. The previous week we were given a study guide of possible material that would be included on this exam, which is pretty standard for a final. After everyone got seated that morning and just before

the professor started handing out the tests and wrapping up the semester, I raised my hand and said in a condescending tone of voice, “Dr. Moffitt, instead of taking a typical final exam, I think we should draw another picture of our group to show how we’ve changed and grown over the course of the semester.” The group picture we had drawn earlier that year had been a laughing stock for us. This was a junior level college course, and we were drawing pictures like we were in a middle school art class. We couldn’t believe it. Our group picture assignment at the beginning of the year represented how easy this class was, and what a joke it was to us. My patronizing comment about not taking a final exam and drawing a new picture instead was a thinly veiled insult to the professor indicating the lack of challenge her class provided us. Instead of laughing off my comment, or even being mildly offended by it, she replied saying, “It’s very interesting that you would say that, because that’s exactly what we’re going to do.” The class gasped in surprise. “What?” everyone said in unison. Dr. Moffitt went on to tell us to get into our groups and she handed out a blank sheet of paper to each one and had us draw a new picture of our group. That was our final exam! Nobody could believe it. It felt like I pulled a Jedi mind trick on her. It’s one of the strangest things that has ever happened to me.

How to Crash a College Class Everyone who goes to college is familiar with crashing classes, and many people have tried to crash a class, some successfully, others not so successful. Crashing a class means that you are not able to register for the class because it was filled up, but you still show up there on the first day hoping that if a few people who were registered for the class didn’t show up that day, the professor will drop them and you can take their place on the roster. It’s not uncommon for ten people to try to crash the same class on the first day, but usually there is only room for a few, so the teacher will tell the remaining crashers they’re sorry but there just isn’t any room and they should go try to add another class somewhere else. The remaining would-be crashers then frantically leave the room scrambling to crash another class,

hoping to find a spot somewhere else. I have successfully crashed numerous classes, but for one particular class I was not so lucky and wasn’t one of the handful who got their names pulled out of a hat to be added that day. (That’s seriously how some teachers choose who gets to crash when there aren’t enough open spots.) The other unlucky students whose names weren’t chosen left the classroom, but I stayed sitting at my desk and pretended like I belonged there. I took notes, participated in the discussion, and kept coming the next several weeks as if nothing was wrong. I did the homework, and when the time came for the first quiz, I took that too. I was a model student. The only problem was, my name was not on the roster, and the teacher realized this when he tried to mark my grade for the quiz in his grade book but couldn’t find my name. The next day at class he asked which one was me and I raised my hand and he came over and said that I wasn’t on the roster. “That’s weird,” I said, pretending to be surprised. He then told me to go down to the office and get a late registration form and fill it out so he could sign it and add my name to the official roster. My plan worked perfectly. You know what they say, where there’s a will there’s a way, and all the other crashers from a few weeks earlier just didn’t want to be in that class bad enough, but I did. I had to have that class. My whole schedule would have been messed up if I didn’t have it, and I would have been stuck there an extra semester to get the credits that I needed to transfer to another school. A year or so later I realized that if I couldn’t get added to the roster by crashing the first day of class, then instead of leaving like all the other crashers, I would just stay in my seat anyway and log onto the school’s website every night trying to add the class while there was still open registration, which usually went on for the first two weeks of the semester, because I knew the odds were that someone would hate the class or would have a work conflict and would drop it, and so there would be a spot open in the computer, and I would get it. This worked for me several times and I always got the classes I wanted. Where all of the other crashers lost hope and left when the teacher told them there were no openings, I knew

otherwise, and knew that after the first few days of class someone was going to drop it, and I could get their spot, and that’s exactly what I did.

Most Likely To Succeed? One of my favorite college professors once told me that I was going to be the most famous and successful person to ever graduate from my college. She told me this during a conversation we had in her office my senior year when I showed her a compilation of years’ worth of notes and journals about my adventures in dating and my philosophy on meeting and dating girls. (This would later turn into THE Book on Dating which I published and is available on Amazon.com in paperback or in e-book on Kindle) She thought I was a genius. This was in 2004, before Neil Strauss’ book, The Game was published, and before Mystery (Erik von Markovik) had gotten his Pick-up Artist show on VH1 and when professional dating coaches for men were pretty much nonexistent in the mainstream. Dr. Downey saw the potential, not only in my idea to write a book and become a dating coach, but she saw that I had the personality and drive to actually do something with it. Her endorsement and her assessment of me meant a lot, but a strange turn of events that I can’t really be blamed for would later result in her asking me to please never contact her again. About six months after I graduated I began writing a book about how secret societies pulled the strings in our world and hold the true power in politics, banking and business and how many of these secret societies have occult beliefs and rituals. I’m talking about The Resistance Manifesto , my first book of several on this topic. I won’t get into it here, you can check out my other books for yourself on Amazon.com , Kindle or Nook and I hope you do because it’s a very important subject, but this is what led to Dr. Downey’s complete 180 turn on her views of me. I returned unannounced to her office to consult with her on my new project since my entire world view had changed after learning about the New World Order and the Illuminati. Instead of being excited about my new project and life’s mission, and giving me the guidance and wisdom I had expected, a look of horror immediately came to her face. She informed me

that her father was crazy and thought the government was watching everything he did and had hidden microphones in their house in order to listen to him, and that he blew his brains out when she was a little girl. What can you say to that? She then told me that I was bringing back all kinds of horrific memories for her from her childhood and her father’s suicide, and she asked me to leave and never contact her again. I was devastated. It wasn’t like I had done something wrong, it just so happened that this subject matter touched a nerve with her. I felt really bad for how I had made her feel, and how she had changed her feelings towards me from just a few months earlier. She once thought I would be the most successful student she ever had, but now I was the one that she wished she never met.

The Gas Station You may have noticed that the people who work at gas stations are usually the scum of the earth. They look like they just got out of prison, have done way too many drugs, or are homeless. If the gas station is owned by an Indian or an Arab, that’s a whole other story. I’m talking about the white trash that always seems to work at gas stations. One of the most pathetic jobs I ever had in my life was actually working at a gas station during the summer since I wasn’t allowed to work on the weed cutter anymore. The gas station was located in the heart of Main Street, and it actually turned out to be a pretty cool job because it was a party every single night. It seemed like I was living in the film Clerks . The manager was never there, and I never met the owner, and every night I would come into work about four o’clock in the afternoon and work until closing time at 11pm all by myself. All my friends could see when I was working because my car was parked out front, and everybody would stop in and say hi or hang out for a while. I had an endless supply of beer from the cooler and we would drink right there in the store and even get stoned. We didn’t even bother to go outside to smoke pot, we smoked it right there behind the counter.

I brought in my own stereo so I could listen to CDs, and I would just blast it all night and my friends and I would smoke cigars we had taken off the shelves and pretended like we owned the place. One night I forgot to lock the front door when I left because I was so buzzed, and the manager also informed me that she found empty beer cans strewn around the station and asked me if my friends and I were drinking there the night before, and asked if that was why I had forgotten to lock the door. “Of course not,” I said, “I must’ve just been tired.” I felt really dumb. Any normal person would have fired me immediately, but she soon forgot that it happened, and my partying continued. The layout of this particular gas station was very strange. There was a gigantic pole right next to the cash register that helped support the roof, and I can’t tell you how many times people would turn away from the counter after paying and then smack their head right into it. It was the weirdest place for a poll and every few nights someone would turn around full speed from the counter and smack right into it. The manager realized this was a major liability so she wrapped a foam pad around it to try and prevent anyone from getting seriously injured. Every time someone would turn around and smack their head into the poll I couldn’t help but bust out laughing. Often, I would have a friend or two hanging out with me and we would all bust out laughing at the person and they would just duck their head in shame and walk out. As a joke I printed up a sign that said, “Warning: Pole. May cause serious injury,” and I taped it up over the foam pad. I only worked at the gas station for one summer, but that sign stayed up for probably ten years. I realized this when I happened to pull in there to get some gas when I was visiting my parents and when I went up to the cash register to pay, I saw the sign still attached! Apparently the manager thought it was a good idea to keep it up. The thing I learned about life while working at the gas station was that there are a lot of losers who come to gas stations, not to buy gas, but to buy cigarettes. These same people come to buy one pack of cigarettes at a time, day after day after day. These people could buy a carton of cigarettes from a grocery store for a heck of a lot less than they did if they bought individual packs, but they chose to come to the gas station practically every day and

buy one pack at a time. They probably felt like they were saving money since they were only spending $4 or $5 dollars at a time, instead of dropping $50 bucks or however much a carton cost. The other losers that came to the gas station every day were people who buy lottery tickets. Most of the people who bought scratch-off lottery tickets look like complete bums who had run out of hope in life. Most normal people don’t buy scratch-off lottery tickets, or maybe they’ll buy one or two a year, but the people who buy them every day are some of the dumbest and ugliest people I’ve ever seen in my life. The only thing they had to look forward to in life was winning the lottery. Night after night, they would spend $5 or $20, and almost always lost. Most of them would come back a few days later to do it again, hoping to one day win the jackpot. Half of these people couldn’t even wait to get home to scratch them off, and would do it right there at the counter. Some of them would occasionally win $5 or $10 dollars and then immediately spend it all on more scratch-offs, which were all losers. One of my coworkers worked at two different gas stations. He worked part time at the one I worked at, and he worked part time at another one in the next town. His wife also worked at a gas station just down the street from ours. Rusty was pure white trash and a felon who hung out with the Hells Angels. When he laughed you could hear the air wheezing from his lungs through the tar built up in them from decades of smoking. I bought an ounce of weed from him once, which was OK, but other than that I kept my distance from him.

Middle School Sleeping in the Tent Whenever kids come up with the idea to set up a tent in the backyard and have a bunch of friends over to sleep out there, it’s really just a cover story for being able to sneak out that night and go cause trouble in some form or

another. Sure it’s kind of fun to pretend like you’re camping out in your own backyard when you’re a kid, but what’s more fun is being able to sneak out of the tent and go wreak havoc around town after your parents go to bed. After all, you just can’t sneak out of the house most of the time without your parents noticing, even after they go to bed, because it’s still likely that they will hear the front door of the house opening or closing as you sneak out or return. Some kids, if their room is on the first story of their house, can pull the screen out of their window and sneak out that way (which I did a few times as well), but it’s much less noticeable to simply unzip the tent door and disappear into the night. Every time my friends and I slept in the tent in my backyard, houses around the neighborhood would mysteriously get toilet papered, and dozens of people would have their doorbells rung ten times in a row in the middle of the night. Doorbell ditch, as it is called, is the most fun very late at night when everyone is sleeping and you can stand on their front porch and ring the doorbell repeatedly a dozen times to make sure you wake up the resident, and then run off and duck behind some bushes at the neighbor’s house to watch them answer the door and look around to see what happened. Doorbell ditch is extremely fun when you return to the same house a few minutes later and do it again after the person has gotten back in bed after having been woken up from a good night’s sleep. When we slept in the tent, most of the time I would run an extension cord from my parents’ house out to the tent and I would bring a small television from my room out there so we could play video games all night until my parents went to bed and then we would sneak out. Sometimes in the morning we continued playing video games when we woke up, and I remember one time I was playing Double Dragon II for Nintendo, and I had never been able to win the game, but that morning I systematically beat one level after the other, making it to the final fight, and I delivered the death blow to the boss with a hurricane kick and as he flew back in slow motion, the television suddenly turned off! The picture instantly shrunk down and disappeared into a white dot in the center of the screen as the old picture tube televisions did when you turned them off. I frantically grabbed the power button and clicked it on and off repeatedly, but the television was dead. Even the Nintendo had no power. I had no idea what happened.

Then at that very moment, I heard my mom yelling from the back door that lunch was ready. We had stayed in the tent all morning, and it was approaching noon. She had yelled out earlier to come in for lunch, but I was busy trying to win Double Dragon II . I unzipped the tent and started heading to the house and saw the extension cord that had been plugged in to an external outlet on the side of the house was laying there on the sidewalk unplugged. I picked it up in bewilderment and asked my mom through the screen in the kitchen window if she unplugged it. “I told you lunch was ready,” she answered. “You stupid bitch!” I responded. “Why the hell did you unplug that, I just won Double Dragon II for the first time and I didn’t even get to see the final scene!” I had never called my mom a bitch before. Ever. I was just so angry. The timing had been so horrible. At the very second I killed the final boss, she unplugged the TV. I worked so hard to win that game, and I was so mad. Video games mean the world to teenagers (and even some adults). She didn’t take too kindly to being called a bitch. I was twelve-years-old, and that’s not the kind of language anyone should use with their mother. She was in a bad mood for the rest of the day. I was a terrible kid.

Other Video Game Trouble Since I spent so much money at the arcade playing video games, I tried the old “string on a quarter trick” to see if it would fool the machines so I could play them for free. I drilled a tiny hole into a quarter and tied a thread on to it that I got from my mom’s sewing cabinet, and lowered it slowly into the coin slot waiting for a credit to register on the machine so I could then just pull the quarter back up through the slot or just dangle it at that point and bob it up and down repeatedly so it would continue to add credits to the game so I could play for hours, but this didn’t work. Maybe a few years earlier this little trick worked, but when I was a kid in the 1980s and 90s, the video game companies had apparently figured this out and designed some device that the coin would pass through before the machine would register it, and once it got past this point, there was some lever or something that sprung into place to prevent it from being able to come back up through the slot. Did this stop me from thinking of other tricks to try hoping to play free video games at the arcade? No.

I went through my dad’s shop drawers and found some washers that were the same size and thickness of quarters and brought them to the arcade to see if they would work, but they didn’t. I figured it was because they were made of steel and were magnetic and there must be a sensor that gets tripped whenever a steel coin gets dropped into the slot, so I found some aluminum washers that were the same size as quarters, but they didn’t work either. Perhaps they were not the same weight as a quarter. I’m not sure why they didn’t work, but looking back on it now, I’m sure that the video game companies are a lot smarter than a 14-year-old kid, and I certainly wasn’t the only one who tried to trick the machines like this, so of course there are safeguards built into them to prevent it. You have to give me some credit for trying though. Kids go crazy over video games. My friend Rocky’s older brother would threaten to beat him up if he lost certain video games because he wanted to see what the final levels looked like, or he would have Rocky get to those levels so he could then play them because he wasn’t good enough to get there himself. One time, Rocky’s brother locked us out of the game room while he was playing a certain game because he didn’t want us to see what the final level looked like. We tried to see what was happening through a vent in the wall, and when his brother realized this he came out of the room and went berserk. Rocky grabbed a hammer and threatened to hit him with it in self-defense. Rocky’s mom thought that the Nintendo video game system was bad for the television and wouldn’t let him or his brother play it on the large TV in the family room and made them play it on a smaller one downstairs. For a few hours after school they would play the Nintendo on the big TV upstairs until just before their mom got home from work, and they would put it back downstairs. After all, playing video games on a small TV isn’t as fun. One afternoon his brother was playing Metal Gear on the big TV upstairs and wouldn’t let Rocky or I play, so he went and got his mom’s camera and started taking pictures of his brother sitting in front of the television holding the controller so he had proof he was using the big TV. “I got pictures! I’m telling mom you were using the big TV!” I’m sure they got into a fight after

this. They were always fighting over something, but usually it was video games. Rocky was a tough kid and one time he challenged our principal to a fight saying “I can take you,” when we were in seventh grade. We were both called into Mr. Vought’s office for various reasons and I remember he thought Rocky was my “bodyguard” and believed that the two of us ruled the middle school. Apparently he could see our budding leadership qualities back then. Fred had purchased a console copier out of the back of an electronics magazine which allowed him to copy Sega Genesis games onto 3 ½ inch floppy disks and play them that way. The copier plugged into the slot where you would insert the videogame cartridge and had another slot on top of it were you would then plug the game into, and using a built-in 3 ½ inch floppy disk drive it would copy the games from any cartridge you wanted. Once you copied a game onto a disc, you didn’t need the cartridge anymore because you could play it off the disk from then on. This was a kid’s dream come true! You could borrow any video game from any one of your friends and then copy it and play at whenever you wanted! This was practically unheard of in the early 1990s, and of course this was illegal, but we didn’t care. There was a video store downtown that we could ride our bikes to and we would frequently rent a video game and ride back to Fred’s house, copy it onto a disc and then return to the store 15 minutes later telling the guy that we had accidentally rented the wrong game and he would let us exchange it for a different one. This way we could copy two games for the price of one. The console copier was a lot of fun, but as video games got more sophisticated, the Sega Genesis soon became a relic whose graphics and games didn’t compare to the newer systems, but we definitely got our use out of it, and it paid for itself many times over.

Making Crop Circles People often think it’s a big mystery about where crop circles come from, but I can answer that question with firsthand knowledge. They come from

people like me, because my friends and I made them for fun. They weren’t the most complex crop circles, but they were crop circles, nonetheless. To accomplish this mysterious task, we just brought a rope and a wooden stake out into the middle of a corn field on the edge of our block and pushed the stake in the ground with the rope tied around it and straightened it out as far as it would go and flattened all the corn in the radius of the circle it made. One crop circle just wasn’t good enough, we thought. We really wanted this to get in the news so we decided to make two other ones so the three of them would form a triangle in the middle of the cornfield. We didn’t do this during the middle of the night under the cover of darkness like one may assume. We didn’t really see a reason for this, so we just did it when it was still light out in the early evening. What we didn’t expect was that an airplane flying overhead would happen to see us right in the middle of making our masterpiece. It was a small airplane like a Cessna and it immediately started circling the corn field obviously checking out the bizarre formation in the field. We all ducked down underneath the corn to hide so the pilot hopefully wouldn’t see us. I’m not sure why we thought we should hide, because it’s not like he could really identify us from up there; it must have just been our instincts to hit the deck when someone spotted us when we were doing something wrong. I guess it was because we were worried that he could radio into the police that there were some kids making crop circles and they could be waiting for us when we made our way back to the street. The plane kept circling the field and we figured the pilot had spotted us so we all just took off running. We left our bikes on the edge of the field near the street and as soon as we got to them we hopped on and started to ride off. We never would have imagined that the airplane would start following us all across town. It’s tough to lose an airplane when you’re riding on a street since they can pretty much see everything. We didn’t know what to do. Was he in communication with the police and keeping track of where we were so they could come and surround us? I guess technically we ruined some of the farmer’s crops, so we could get in trouble for that and we were also trespassing on the land. We just kept riding and riding all over town, but the plane kept following us and circling around wherever we went, keeping his eye on us the entire time.

Luckily it was near sunset and about a half hour later it was getting dark so it finally left. What the heck had just happened, we thought. We just got chased by an airplane on our bikes for making crop circles! This corn field was right next to a fort we had built that we would spend a lot of time at in the summer afternoons, and after we made those crop circles, I can’t tell you how many airplanes would fly by that field and circle around for a few minutes taking a second look at our handiwork before going on their way. Our crop circles could have made the evening news for all we knew, or been in the local paper, but our parents must have missed it if they had, because they certainly would have mentioned to us that crop circles had appeared in our small little town if they saw something about it on the news. They probably would have realized who was behind them too. Only a handful of people would even consider doing such a thing, and of course it was us.

Fun with the Paper Towel Dispenser Since I liked to build things when I was growing up, I made a key that would open the paper towel dispenser in the school bathroom. I also made one that would unlock the toilet paper dispensers too and I would regularly steal the rolls of toilet paper so we could go toilet paper people’s houses because we didn’t want to spend money buying the toilet paper ourselves since that money could be spent on candy or video games at the arcade. The paper towel machine held other fun possibilities though. I would pull the lever and dispense ten feet of paper towel and then using a black magic marker I would write obscenities on the towel, and then open the machine up and roll it back inside so that the next few people who would come into the bathroom and pull the lever to get their paper towel to dry their hands would be surprised with a nice “Fuck You” written on it. I also liked to write mean things about the principal, Mr. Vought, like the standard middle school insult, “Mr. Vought Sucks” or “Fuck Mr. Vought.” One day after I got done writing a bunch of trash about Mr. Vought and rolling the paper towel back up into the machine, Mr. Vought himself came walking into the bathroom as I left! I can only imagine the look on his face when he went to dry his hands and as he pulled the lever to dispense the

paper towel, out came a piece that said, “Fuck Mr. Vought.” I laughed all the way back to class just thinking about it. The next time I opened up that paper towel dispenser there was a note taped inside that said the mirror to the left was a two-way mirror and behind it was a video camera and that “you will be hearing from us shortly.” How dumb did they think I was? A two-way mirror and a hidden camera in the bathroom? Yeah right. I wrote “Fuck You” across the entire note with a magic marker and closed up the machine. I thought about taking the roll of paper towel home and feeding it in my printer and printing all sorts of crazy things on the entire roll and then putting it back in the machine so that everyone who dispensed a piece of paper towel would be pleasantly surprised by having their paper towel come out with something like “Fuck Mr. Vought” printed on it, but I soon lost interest in the paper towel machine and made a key that would shut off the lights in the hallways, and had fun with that for a while. I also took an old electrical cord with a plug on the end of it and tied the wires together and brought it to school and would plug it into the wall to short circuit the system which would flip the circuit breaker and knock the power out to the room. Yes, I was an evil genius in the making.

Free Cable TV I never had cable TV growing up, but Fred did for a period of time, and back when we were kids it was very easy to steal cable television. There was no digital cable, digital tuners, or video On Demand, or anything like that. If you ordered cable TV, then the cable guy would go out to the cable box in the back of your neighborhood and then just simply connect the coaxial cable leading to your house into the main feed. There was a special screw on these boxes to keep them locked, but Fred’s older brother made the key in shop class and after Fred’s mom stopped paying for cable TV, we simply opened up the box and re-connected the coaxial cable labeled with his address back into the main feed, and bam, he got free cable. There were also several channel blockers on the coaxial cables that ran to the different houses that subscribed to cable TV, which would filter out channels like HBO and Showtime, unless someone paid for them, so we

removed the channel blockers and Fred got those channels for free as well. Years later at his own apartment, Fred would climb a telephone pole out front and do the same thing and got free cable TV for about ten years. Yeah, ten years! A decade of free cable TV!

Our Own TV Station It was dumb luck and a complete surprise to discover that (old analog) camcorders actually broadcast a weak signal like a miniature television station that could be picked up by a television set. Let me try to explain. Old analog camcorders from the 1980s and 90s used coaxial cables to connect to the television, and not RCA or USB cables like future models, and one time when I reached behind the television to screw in the coaxial cable leading from Fred’s camcorder so we could watch what was on the tape, the picture showed up and we started hearing the audio before it was even connected to the TV. This was weird. I hadn’t even touched the coaxial cable onto the receptacle on the TV, but the tape was already playing on it. It turns out that the camcorder was actually broadcasting a signal and if you placed the male end of the coaxial cable near the female receptacle sticking out of the back of the TV, then the signal would transmit through the air and the camcorder’s tape could be seen playing on the TV. To a couple of fifteen-year-old kids who loved electronics, this was amazing. We then had an idea. There is a device (or at least there was years ago before digital television when all signals were analog) called an antenna booster that people used to increase the strength of the antenna on their television sets for picking up the analogue broadcast channels if they didn’t have cable TV or a satellite dish. These antenna boosters have two coaxial connections on them where you plug one end into the back of the television set and the other end into the antenna itself. It then magnifies whatever signal the antenna picks up, so the channels would show up more clearly on your television set. Fred and I went out and bought an antenna booster and took the coaxial cable coming from the camcorder and screwed it into the booster, and then screwed the output cable into the antenna on the top of Fred’s roof. When

we pressed play on the camcorder, to our amazement, the tape showed up on the television. The antenna booster amplified the output from the camcorder so the signal would shoot through the air so the camcorder didn’t even need to be physically wired into the television set for the tape to play on it. We were basically broadcasting the signal from the camcorder through the airwaves to the television! This worked from the antenna on the top of the house to the TV in the basement, but we wondered just how far the signal was going. Fred had a small portable television, so we set it on channel 3, the channel that televisions needed to be on in order for a camcorder or VCR to play on them, and we went outside and started walking down the block to see how far it would pick up the signal from. It slowly faded out as we got halfway down the block, but we were still amazed. We went out and bought two more antenna boosters and daisy chained them one right into the other to boost the broadcasting power even more. Using the antenna on top of Fred’s roof as a transmitter, we broadcast a signal strong enough to be picked up by all of the neighboring houses on the block. From a little experimentation we realized that our TV broadcast was showing up on numerous stations, not just channel 3 because it was so strong. Our little discovery wouldn’t only broadcast the tape from the camcorder, but if you turned the camera on, our system would broadcast whatever the camera was seeing live! We basically had our own television broadcasting station. We called it, WMAD, since we were as mad as hatters. We set the camera up in the basement with it broadcasting using the large antenna on the roof, and Fred, Diego and I started putting on our own skits and acted crazy like we were on Saturday Night Live . We knew that if any one of the neighbors were channel surfing, they would inevitably come across our station and see us. Sometimes we videotaped our “shows” and played the tape back over and over, hoping that some of the neighbors would see it. I then started calling the neighbors pretending to be someone working at “WMAD” and told them I was wondering if they were picking up our signal since we were measuring the signal strength in their area, and I would ask them to turn on

their TV to whatever channels were airing our show. Yep. They were getting it all right. WMAD was broadcasting to the entire block. One of Fred’s neighbors was a year older than us and he happened to find our show when he was channel surfing, and didn’t quite know what to think. After all, how could you possibly explain that we were on TV? He mentioned this to us the next time he saw us and was very confused about how this was happening. Even though we were having fun with our own new television station, we weren’t satisfied with a potential audience of just several surrounding homes around the block near Fred’s house. We wanted the entire town to get our station. A friend of Fred’s dad was an electrical engineer, and one Saturday afternoon Fred’s dad took us over to the cell phone store he owned so we could talk with him about our project (i.e. WMAD). When we told him what we were doing and said we were interested in building a super powerful antenna booster so the whole town would get our show, he pretty much freaked out. This was the first time I ever heard about the FCC (the Federal Communications Commission), the government agency that is in charge of overseeing all television and radio stations, as well as products that broadcast electrical waves through the air such as walkie-talkies and CB radios. The FCC sells and regulates the licenses that broadcasting stations and other companies have to get in order to ensure that their broadcasts or devices don’t interfere with each other. Fred’s dad’s friend went on to tell us that messing with the FCC was like messing with the FBI, and that broadcasting illegally, which is clearly what we were doing, could result in us getting fines of several hundred thousand dollars for each incident. We had been broadcasting WMAD several times a week for close to a month, and sometimes for hours on end. The man then went on to tell us that if people called the local television stations to complain that the signal wasn’t coming in clearly and said that they were picking up images of a bunch of kids acting stupid instead, then the FCC would surely be investigating this with sophisticated equipment, possibly in vans that would drive around the town in order to detect the source of this interference. Whoops!

This kind of spooked us. Fines of several hundred thousand dollars? Wow. The FCC sounded too much like the FBI. Did this discourage us from wanting to build our amplifier? Not at all. We thought about tapping into one of the neighbors’ antennas and broadcasting from theirs instead of the one on top of Fred’s roof to throw the FCC off so they couldn’t track it back to us. We even thought about building an amplifier and then putting it in a car and driving around town so the FCC wouldn’t know where the signal was coming from. We also talked about how funny it would be to broadcast a porno to the entire town since if we were on the move, the FCC couldn’t track the signal back to Fred’s mom’s house, but we were too young and didn’t quite have the engineering capabilities to build a strong enough antenna booster. We soon pulled the plug on WMAD.

Trying to Kill the Neighbor’s Trees One of my neighbors clearly had an advanced case of obsessive-compulsive disorder which caused him to mow his lawn every few days, whether it needed it or not, and he would sweep the floor in his garage practically every night for what seemed like an hour. We thought he was completely insane. His garage was as clean and sanitary as an operating room in a hospital. Practically every garage I’ve ever seen has tools hanging on the walls, shelves that hold a variety of automobile fluids, cleaning supplies, yard tools and other junk, but Mr. Steven’s garage walls had nothing hanging on them at all accept one weed wacker which he also used compulsively. The only things in his garage were the two family cars, and the lawnmower. It was very strange. He was a nice guy, we just didn’t like him because his constant lawn mowing disturbed our peace and quiet during our lazy summer days. One night my brother had a container full of waste oil after changing the oil in his car, and instead of taking it to the recycling site downtown to properly dispose of it, he walked across the street and dumped it around the base of a tree in Mr. Steven’s front yard. That summer, Mr. Steven’s trees became the disposal site of all waste oil, radiator fluid, transmission fluid, and even some stale gasoline. Stew likes to work on engines, so there was no shortage of toxic waste. Those trees were strong but after a while some of the leaves started to lose their color and wilt long before fall. We thought

for sure all those chemicals getting absorbed by the roots would have killed them all, but Mother Nature is surprisingly resilient and the trees still lived.

Prank Phone Calls Every kid who is normal makes prank phone calls. Some kids are better at them than others, and I was one of the best. I had polished my pranking skills from getting calls from telemarketers at my parents’ house. Instead of just hanging up on them or telling them to remove our number from their calling list like most people did, I would keep them on the phone as long as possible and come up with the craziest stories I could think of. If a telemarketer called and my mom or dad answered the phone, they knew I loved to mess with them, so they would call me over and hand the phone to me and we would all sit around and listen to whatever story I would fabricate at the time. As I’m sure you’re aware, telemarketers usually start their call by saying “How are you doing today Mr. Dice?” and instead of just saying I was fine, sometimes I would pretend to be really sad and tell them I’m not doing very well because my dog had just died. “Oh, I’m sorry to hear that. The reason I’m calling tonight is because…” (I would cut them off) “I really loved that dog. I had him for 15 years. The smartest dog in the world.” “I understand sir. I love animals too. We’re having a special on long distance calling plans this week…” (I’d cut them off again) (Pretending to sniffle) “That dog just loved to steal people’s shoes and run around the house so you’d chase after him, and sometimes he’d even take the Dr. Scholl’s padding out from inside the shoe and start chewing on them. He was such a silly dog.”

“I’m sure he was. Sir, we’re offering a special long distance plan where you can call family and friends for a low price any time after 5pm Monday through Friday…” (cutting them off again) “That’s interesting, because the dog used to like to talk on the phone with grandma and grandpa and we’d hold the phone up to his ear and they’d say things, and he’d bark through the phone back at them. That dog was so smart, I bet we could have taught him how to use the phone himself, and I’ll bet he would have.” It was about at this time that they would hang up, but sometimes they’d stay on the line for five minutes because they didn’t want to be rude. It was great. If a telemarketer called trying to sell newspapers, I told them there was nothing but bad news in there anyway and it wasn’t worth reading, and then I’d start giving them story suggestions about what kinds of things I would like to see in the newspaper instead. If they were calling trying to sell long distance service, I told them that I was going to cancel my phone service soon and become Amish, so I wouldn’t need a phone anymore. Since they were always trying to sell me something, sometimes I tried selling them things and would tell them I was having a rummage sale that coming weekend and started telling them all the nice things they could find. It wasn’t just telemarketers I loved to mess with, of course I would make prank phone calls to my friends’ houses and even random phone numbers around the area. When I couldn’t think of anyone to prank call, I would resort to calling the Hooked on Phonics company which sold reading programs for children whose phone number was 1-800-ABCDEFG. I would often call them and pretend to be a parent inquiring about their reading programs for my child, and would make up crazy stories saying something about how my two-year-old was already reading at an eighth-grade level and had just finished books like Huckleberry Finn and Tom Sawyer , and I was wondering if Hooked on Phonics had any programs to help him advance any further. They were always amazed that my child was so intelligent. Sometimes I would tell them that I was interested in getting a program for my unborn child so I could teach it to them while they were still in the womb under the assumption that they would be able to understand it and

would then have a higher IQ once they were born. The operator never seemed to think it would work, but I insisted that I had read some studies that proved unborn children in the womb could understand people if they spoke to them, and could even start learning to spell. One night I was able to get through to Larry King Live on CNN when the guest was Ron Popeil, the infomercial guy who used to sell the Chicken Rotisserie Grill, the Ronco food dehydrator, and a whole list of other infomercial products, including Hair in a Can which is that weird spraypaint for balding people that enabled them to cover up their bald spot with washable paint. I have always been fascinated by infomercials, and I thought of a great question for Ron Popeil. I gave the phone screener a bogus question asking what kind of advice Ron had for young inventors, and then as soon as my call was live on the air I said that I heard his food dehydrator was good for drying marijuana buds so you could smoke them. The screener hung up on me immediately, but my call made it on air. Instead of realizing it was a prank call and going on to the next caller, Larry King asked him, “Is that true?” to which Popeil answered, “It is true. Yes.” Larry King responded, “It is? Well marijuana may be legal someday, [and] may be able to help people.” The phone call is shown on the official transcript for the show which aired live on April 13, 2001, and if you Google “Ron Popeil Larry King Live Marijuana” you can find it. I had videotaped the broadcast on the VCR and my friends and I watched it over and over again laughing our butts off. The funniest part was this would not be the last I would hear about this phone call. About nine years later, Ron Popeil was being interviewed on CNBC about his infomercial empire and the host mentioned my phone call! My jaw dropped. The host said something about one of the most interesting questions Ron had ever been asked about his products was when he was on Larry King Live in 2001 and a caller asked if the food dehydrator could be used to dry marijuana buds from pot plants! I had never guessed that my one phone call would have been so memorable. Looking back, sales for the food dehydrator probably skyrocketed since people who grew their own marijuana would want one to dry the buds. While I was able to find the

official transcript for my call on CNN’s website, at this time I have not been able to find the video clip on YouTube and the VHS copy I made got taped over eventually.

Soda Guns Every kid in America, and perhaps the world, may know how to make a soda gun, I’m not sure. It’s interesting how kids figure these things out. Somehow we found out if you take a ballpoint pen and position it on the top of a soda can in the small round piece of metal that connects the opening tab to the can itself, you could poke a hole through it by pounding your fist on top of the pen and then if you held the soda in your hand and plugged the hole with your index finger and shook it up, when you let your finger off of the hole, soda shoots out in a stream about 15 feet like a squirt gun. A soda gun is only good for about three or four blasts and wastes half of your soda, but it sure was fun, and we must have covered the floor in study hall with sticky soda on numerous occasions, not to mention leaving people smelling like Pepsi or orange soda. And we wondered why they stopped allowing us to drink soda during study hall!

The Jelly Donut Incident Industrial Arts (shop class) has got to be every guy’s favorite class in school because we get to build things and play with power tools, but Industrial Arts at our school was extremely special because the teacher, Mr. Norton, had a short fuse and just a little screwing around would get him to absolutely flip his lid and start yelling and screaming at the top of his lungs. It was very common for students in the surrounding classrooms to be able to hear him yelling at students, but what do you expect when you take a bunch of seventh and eighth graders and give them access to power tools? Several years earlier a student ground up some Ex-Lax pills and put them in Mr. Norton’s jelly donuts that he had in his desk drawer, and after he ate them you can imagine what happened. This wasn’t just an urban legend, it was something that actually happened, and so ever since that day if you

mentioned anything about jelly donuts in Mr. Norton’s class, you were in big trouble. I happened to know this because one of my older brother’s friends was the guy who put the Ex-Lax in his jelly donuts, but not everyone was familiar with the jelly donut story. The very first day of class we all came in and sat down around the shop tables while Mr. Norton was still standing in the hallway chatting with other teachers, and I thought it would be funny to get someone to ask him if he would like some jelly donuts. The kid’s name was Nolan, and he just happened to be sitting at my table, so he was the one I convinced that if he wanted to get on Mr. Norton’s good side, he should ask him if he wants Nolan to bring in any jelly donuts tomorrow for class because he lets students bring in food once in a while for snack day and he really liked jelly donuts. (There was no such thing as snack day in shop class, of course, but it sounded good.) It wasn’t more than five seconds after the teacher walked into the classroom that Nolan turned around and said, “Hey Mr. Norton, how would you like some jelly donuts?” “Get the hell out of here right now!” Mr. Norton shouted as he grabbed Nolan by the arm and dragged him out of the room and down the hall to the principal’s office. Poor Nolan didn’t know what he did wrong, but my friends and I knew the story, and we knew the one thing you should never, ever mention in shop class, were jelly donuts. This sort of set the pace for the chaos to come the rest of the year. While we were supposed to be building things like lamps, clocks, pen holders, etc, we spent almost as much time destroying things. We especially liked to drill holes in everything, like the cabinets, tables, and people’s text books from other classes. I had to leave to get stitches in my hand once, not from a power tool accident, but because I went to punch Ken in the stomach when we were screwing around and he blocked it while holding a tape measure and it sliced my knuckle open pretty bad. We told the teacher he was just handing it to me and it accidentally cut me. I dripped a trail of blood all the way to the bathroom and my mom had to pick me up and take me to the doctor to get it stitched up. A lot of handheld power tools can be set to stay on so you don’t have to keep the trigger pulled the whole time you’re using them, and so we often

liked to lock the trigger for the belt sander so when Mr. Norton would set it on the table and plug it in, the thing would drive right off the table and crash onto the ground. He would catch on to this little trick and tried to make sure he would check the switch before he plugged it in, but every once in a while he would forget and it would go flying off the table as soon as he plugged it in. Mr. Norton had a bad case of dandruff, which we like to add to by sprinkling saw dust in his hair every chance we got. Poor Mr. Norton. We really put him through a lot. It’s really amazing that he didn’t stab one of us with a screw driver or something for all the trouble we caused him. He was a nice guy and we were all complete punks.

The Crossing Guard We would occasionally torment a poor crossing guard on our way to middle school who was probably volunteering his spare time to help make sure the kids would cross a busy highway safely on their way to and from school. He was an older gentleman, who most likely retired from his job and just wanted to help look out for the students’ safety. It’s a very noble thing to do, but at the time we were not very appreciative of him and occasionally when we were riding our bikes to school, instead of waiting for him to stop the traffic, we would just cross the highway anyway and he would start yelling and screaming at us as we drove off laughing. Yes, this is extremely childish, but when you’re 13-years-old, disobeying a crossing guard and having him yell and scream at you was the highlight of your morning. One afternoon on the way home from school Ken pretended to have an accident on his bike and tipped over in the middle of the highway and just laid there pretending to be unconscious. There was no traffic coming because this was when the crossing guard stood in the middle of the highway with his hand-held stop sign, so there was no danger of any cars driving by and hitting him (we weren’t that dumb). Instead of the crossing guard getting concerned thinking that he had been hurt, the old man grabbed Ken by the jacket with one hand and hit him in the head with his hand-held stop sign that he carried in his other hand. Ken

was able to get away from him but he had an enormous bump on his head from getting hit and he was pissed . He wanted to bring water balloons to school the next day and pelt him as he drove by, and even considered throwing a large rock at him, he was so mad. The bump on his head was the size of a large grape and looked horrible, so you can probably understand his desire for revenge. During the wintertime it was very common for us to hit the crossing guard with snowballs as we drove by. Kids are so dumb.

My Friend’s Mom was our Substitute Teacher The one day I realized that I can accomplish almost anything if I actually applied myself was the day that Diego’s mom was our substitute teacher at our school. Ordinarily I facilitated the personal hell of every substitute teacher that ever came to our school and there were a handful of other students who eagerly joined in. Having a substitute teacher was almost better than going on a field trip. We were truly out of control and there was little that they could do to keep us on task. Most of the subs would never return, probably because we made their lives miserable, but one day our sub was one of my best friends’ moms. Not only was she Diego’s mom, but she was actually pretty cool, and everyone liked her. This was a history class and we had an in-class reading assignment that day and we all had to read through a bunch of crap and then answer questions about it. This sucked. I couldn’t just sit there and do nothing, because not only was the teacher Diego’s mom, but she was also good friends with my mom, and I couldn’t have her tell my mom that I was a screwball, so I actually read through the assignment and answered the questions. Not only did I actually sit there quietly and do the assignment, but I was the first one done! It was really the first time I had ever applied myself in history class, since I really hated it at the time and didn’t see the point of it until many years later, and ironically the History Channel would become my favorite channel to watch on television, but I’ll never forget the day that Diego’s mom was our substitute teacher because that was the day I was the first one to finish the assignment in class, and I got a pretty good grade on it too. It was

amazing. If only I cared this much when our regular teacher was there, I would have got straight A’s.

Joyriding Every teenager dreams of taking their parents’ car out joyriding, especially if it’s a cool car with balls. Diego’s dad’s car was a blue Firebird that looked pretty cool, and one afternoon his parents were gone and had taken their minivan somewhere, so Diego decided to take the Firebird out for a joyride. Of course, Fred and I were there and thought it was a great idea. Not only did we take the car without his dad’s permission, but none of us even had a driver’s license at the time, making it that much more fun. We lived kind of out in the sticks, and so we took the car out onto the country roads to see how fast it could go. Diego spun the tires repeatedly, did brake torques, and would drive in reverse going 15 miles an hour and then slam the car into drive and step on the gas. We even caught air when we used a sharp incline over a particular set of railroad tracks as a ramp. Going probably 80 miles an hour we hit the ramp and our heads all smacked into the ceiling and sparks flew out from the back of the car from the muffler or something scraping on the ground. It’s amazing we didn’t cause the transmission to dropout, blow a tire, or put the car in the ditch from Diego’s insane driving. We actually made it all the way back to the house with ourselves and the car in one piece. Then, as we were pulling back into the garage, Diego’s foot slipped off the brake and onto the gas pedal. The car launched forward after squealing the tires and crashed into a table against the back wall, causing it and everything on it to fall onto the hood of the car. This was bad. Surprisingly, there was only a small dent in the hood, and some slight impressions in the wall from the back legs of the table, so we set everything back up and just hoped his parents wouldn’t notice. Aside from the small dent in the hood and the damage to the wall, we had another problem. The engine was so hot from us speeding around that the fan kept running trying to cool it down. We knew Diego’s parents would arrive back home at any moment, and not only was the fan spinning, but

there was a loud ticking noise coming from the engine too. The neighbors had also seen us pull back into the garage and heard the tires squeal and must have heard the table crashing. They were standing right in their driveway 30 feet away. Just as we had feared, Diego’s dad figured out what happened, but we weren’t sure if it was because the neighbor said that he saw us take the car out (he knew we were all too young to have a driver’s license) or if he noticed the dent in the hood, or the dents in the wall, or if his dad heard the engine’s fan when he got back, or a combination of these factors. However he did it, he figured out what Diego had done. This time it wasn’t my fault. It wasn’t even my idea! I just went along for the ride.

Family Vacations I don’t know of any kid who can sit in the back seat of a car for hour after hour on a family vacation without acting up and pissing off their parents. Maybe today kids can since they have their video games, iPads and wireless Internet, but when I was a kid we pretty much had to just sit there and stare out the window or listen to our Walkman portable cassette tape player. This got boring after a while, but one thing my brother and I found that always entertained us were whoopee cushions. We couldn’t set inflated whoopee cushions on people’s chairs since we were in the car most of the time, so we came up with what we called “drive by farting.” To be effective, drive by farting could only be done in cities or towns where there are people walking on the sidewalks next to the roads. Whenever we passed through these areas, we would roll down the windows and “fart” at people who were walking on the sidewalks. Even my mom and dad couldn’t help laughing sometimes. Some people would literally jump and look over at our car as we drove past them, and some people would start cracking up themselves laughing at what had just happened. Sometimes during long drives when there was no one to fart at with the whoopee cushion, we would raise hell from the backseat and my dad would occasionally threaten to turn the car around and go home. What were they

going to do? Ground us? Maybe when we got home, but not at that moment. Whenever we stayed at the hotels, Stew and I would hang the paintings upside down before we left and we would occasionally dump buckets of ice onto people from our second or third story balcony. When we found someone’s door that had a “do not disturb” sign put out, we would flip it over so it read “needs housekeeping” so they would get woken up first thing in the morning by a maid. We were punks. When we stopped at fast food restaurants for lunch, by the time we left, several chairs would have ketchup packets set under their legs so when someone would sit down they would burst and shoot ketchup all over the floor (and their shoes). Of course we enjoyed pulling the old salt and pepper shaker trick where you would spin a quarter on the table and slam down a salt or pepper shaker on top of it so the quarter would break through the plastic bottom so the next time someone picked it up, all the salt or pepper would fall out of the bottom onto the table. I also had a habit of scratching “Mark Was Here” in the bathroom stalls with my Swiss Army Knife before we left. Little did our parents know, but we left a trail of destruction pretty much everywhere we went.

Grandma and Grandpa’s My grandparents on my dad’s side lived an entire day’s drive away from us, and every summer we would go to visit them for a week or so and this was always the highlight of my summer. Just because I was on vacation didn’t mean I took a break from causing trouble. This was a whole new town (and state) where nobody knew who I was, so they couldn’t call my parents to rat me out for something I had done. One of my dad’s friends had a stepson my age named Noah and while our dads were hanging out and catching up, Noah, my brother and I would go out and do what we did best. Noah lived on a highway, and every summer when we hung out we would tie a bunch of empty aluminum cans onto the two ends of a long piece of fishing line and then string it up across the road so when a car would drive by, the fishing line would get caught on it and the cans would all be dragged behind it as it continued down the road. Just

like a car carrying newlyweds leaving a wedding in the movies, the cans would immediately start clanging and make a bunch of noise as they were drug down the road going forty miles an hour behind the cars. We would hide in the bushes on the side of the road and watch, and most of the time the cars would stop at some point down the road to see what all the noise was. We called it “canning.” The local college in my grandparents’ town opened up their swimming pool to the public during the summer, so we enjoyed going there a few times a week to not only go swimming, but to cause trouble around the college. My grandpa would drop us off for a few hours and leave us, so we were completely unsupervised. Sometimes Noah would come with my brother and I to the pool and we liked to bring our leftovers from lunch and throw it on the steamer in the steam room so it would stink up the place. When we were done swimming and waiting for my grandpa to pick us back up, we liked to take a bunch of metal folding chairs and stack them in the elevator leaning towards the door and press the button to send the elevator to another floor, so when the door opened, all the chairs would fall out. We would stand outside of the elevator and lean all the chairs towards the door and hold them there, and just before the elevator door would close we would quickly pull our arm away so the chairs would all lean up against the door as it closed. That way when the elevator stopped on the next floor and the door opened, there would be nothing supporting the chairs and they would all fall over onto the ground. Imagine if you were the person waiting for the elevator and when the door opened up, a pile of five or six different chairs all fell out and crashed onto the ground. OK, so it might not seem that funny to you, but to us when we were thirteen-years-old it was a great time. We usually went to visit grandma and grandpa around the Fourth of July, and grandpa always bought us bags of fireworks and we enjoyed shooting bottle rockets at passing cars and lighting smoke bombs off in the middle of the road around the neighborhood. Grandma and grandpa’s neighbor was a massively obese woman we called “fatso” and we often enjoyed harassing her with our whoopee cushions from our bedroom window when she would come home from work late at night as she walked from her car to her house.

We could hear her pull up since it was summer time and the windows were open, and from the upstairs bedroom where we slept we would hide behind the curtains and “fart” at her with the whoopee cushions practically every night. Sometimes she would sit outside on her porch with her skinny boyfriend and smoke cigarettes late at night, and we would “fart” at them repeatedly with the whoopee cushions. One night fatso yelled up to my window that she was going to tell my grandpa what I was doing, but I was leaving early the next morning to go back home, so even if she did tell on me, it wouldn’t have mattered. My grandpa would have thought it was hilarious anyway. When we weren’t causing trouble, my brother and I got to enjoy watching cable television. We never had cable TV growing up, but grandma and grandpa had it at their house, so we enjoyed watching as much MTV as we could while we were there. Whenever grandma would see some scantily clad women dancing in the videos she would ask us in a disturbed tone, “What are you’s guys watching?” and I would always answer that we were watching the Disney Channel or Nickelodeon. That’s not a type-o in the last sentence. She would always say “you’s guys” when she meant “you guys.” We always got a kick out of it, and I think she believed me that it was the Disney Channel we were watching. Grandpa Dice was quite a troublemaker himself when he was young and I believe he caused a train to be derailed by setting something on the tracks or messing with the switching station when he was a kid, so he understood our need to cause trouble. He also made sure there was an endless supply of ice cream bars in the freezer that we could eat whenever we wanted. He knew what kids wanted. He was kind of like a kid himself. He was still quite a jokester too, and when we got back from an afternoon of “bumming around” as we called it, and my grandma asked what we did all day, he would say something ridiculous like telling her that he taught me how to drive his car or that we went gambling at the local Indian casino. (I was probably thirteen years old.) Grandma’s response was always the same. “My God!” I think she actually believed him most of the time, or perhaps she just didn’t know what to believe anymore after the decades of his antics.

When my dad was a kid he wanted a BB gun for Christmas one year and my grandma wouldn’t allow it, but my grandpa thought it would be fun to mess with her a little bit so he cut a piece of wood in the shape of a rifle and covered it in wrapping paper and put it under the Christmas tree to make grandma think he had gotten my dad the gun. He sure knew how to have a good time.

Miscellaneous Middle School Madness A few other miscellaneous or minor things we did in middle school include folding ourselves up inside a hide-a-bed (three people at a time was the record with some girls from the neighborhood and it almost broke the sofa), putting a metal plate on Fred’s chest and taping a firecracker to it and putting a sandwich bag full of ketchup over it and lighting the firecracker to make our own blood bag like in the movies so it looked like he got shot. We videotaped this of course. My brother bought some new tires for his car and before he put them on, he spun the old tires right in front of our parents’ house, causing a plume of smoke stinking like burnt rubber to fill our entire block. The smoke was so thick it just lingered in the air and didn’t really disperse for several minutes. This was in the middle of summer when everyone had all of their windows open, so I’m sure a lot of people smelled it from inside their homes (and probably almost choked to death). My brother did a break torque and the car didn’t even move, but the tires kept spinning and spinning, all the while emitting the burnt rubber smoke cloud until eventually one of the tires burst and practically disintegrated. I’m sure the neighbors really loved us. My brother really likes engines and mechanical stuff, and one time he took an old lawn mower and drained the oil out of it and replaced it with water and filled the gas tank with racing fuel and let the lawnmower run until the engine seized up because he wanted to see how long it would take. Growing up, my brother was not as crazy as I was, but he certainly had his moments. One time his jacket got snagged on the mailbox and ripped a huge hole in it as he walked by, so he went up to the house and got a baseball bat and smashed the mailbox repeatedly to teach it a lesson. “The mailbox ripped my jacket” he insisted.

Diego and I spray painted some obscenities on a local bridge one summer afternoon for something to do. It seemed like a good idea, and it wasn’t like we were going to ruin it or anything since it was already covered with graffiti anyway. It was a fun thing to do until we found out that his mom or dad had somehow overheard us talking about it afterwards. They weren’t too happy about that. Usually we were pretty careful about not letting our parents overhear us plot our schemes so this was a surprise to us. Diego just denied it, and said we were talking about spray painting the bridge, but claimed that we never actually did it. Since it was already filled with graffiti, they couldn’t really tell if we had added anything to the artwork or not, but I’m sure they knew we were lying. Before we had starting drinking and partying (which was freshman year in high school), we found a stash of beer at my brother’s friends’ fort nearby that was out in the woods where they would party, and instead of drinking the beer ourselves and getting drunk, we brought the cans back to my house and shook them up and smashed them on the street so they would explode and spray beer all over. It was a lot of fun. Just a few years later if we had found a stash of beer in the woods, we certainly wouldn’t have wasted it like that; we would have gotten drunk. Fred, Diego, and I had our own fort that we frequented during the summers and it was in a fantastic location in the woods along the side of a cornfield that had a small river running beside it. The first time we discovered the location we had to wade through the river in order to get to the other side and our shoes got all wet and covered in mud. There were a bunch of large rocks making up the riverbed, so we started picking them up and throwing them in the middle of the river piling them up so we could walk on them and get to our fort without ruining our shoes. The water wasn’t very deep and before long we had a few stable piles of rocks that we could walk on to get to the other side of the river. Somehow we got the idea that it would be cool to completely dam up the river, so every time we went to the fort we would pile up more stones, slowing the water flow little by little. After a while our dam worked pretty well. It didn’t completely stop the river, but it certainly slowed it down a ton and caused it to rise considerably higher in the area on the backside of our dam.

Later that summer we realized that a local sewage plant relied on the water from the river, and when the water flow was dramatically reduced because of our dam, they must have sent someone out to see what was happening. When we returned to our fort one afternoon we realized that someone had driven a backhoe out there and dug up our entire dam and cleared the river! Fred got a water balloon launcher one summer and we had fun with it but ended up denting the aluminum siding on my neighbor’s house because the water balloons shot out so fast. They were not very happy about it. After we used the launcher to hit an annoying neighbor girl, her dad freaked out because she had a large bruise over her entire back from getting hit so hard by the water balloon. Who would have thought that a seemingly harmless water balloon could cause so much damage? We also liked to shoot golf balls out of the launcher, but we knew better than to shoot them at people so we just shot them up in the air over a corn field down the street to see how high they would go. You’d be surprised how powerful (and dangerous) a water balloon launcher is. In the lunchroom at our middle school there was always someone selling half pint cartons of milk and there was a small metal tray sitting on a table where you would set your 35 cents and then you would grab your own carton out of a crate sitting right next to it. We realized that you could pretend to set your money in the tray and by just tapping the other coins sitting in there it would sound like you dropped yours in there, and then you could just take your milk for free. The person attending the milk counter would even let us pick out our own change from the tray, so if we put in fifty cents and needed to take out a dime and a nickel for the change, we would just do it our self. After a while we would walk up to the counter, tap the tray so it looked like we put in our fifty cents, and would then take out a dime and a nickel for our change, so not only did we get a free milk, but we would make fifteen cents. (Hey, fifteen cents back then could get you a decent sized piece of candy from the store.) We stole the milk really just for the thrill of it rather than not being able to afford it. Our parents could certainly afford the extra 35 cents for a carton of milk, we just liked “beating the system.”

Occasionally we would bring four or five empty milk cartons into the bathroom immediately after lunch before the next period began, and we would stomp on them one right after the other, popping them all. Boom, boom, boom, bam! We’d then calmly walk out of the bathroom and off to class as if nothing happened. We were obviously trying to make people think there were gunshots from inside the school. This was way before the Columbine High School shootings in 1998 and the trend of school shootings had infected America. You know, the good old days. There was a massive food fight in the lunch room one afternoon when for some reason all the teachers had left for a few minutes which turned out to be one of their biggest mistakes. This was not just a food fight between a few different people, this was an epic battle among the several hundred kids in the lunch room. The interesting thing about a food fight is that the more people there are involved makes even more people want to join in and start throwing things. Monkey see, monkey do. Within just a few seconds there was so much food being thrown that no matter where you looked, there were countless pieces of something flying through the air. Probably 80% of the students had thrown something, and most of us kept scooping food up off the table that was thrown our way and tossed it somewhere else in the lunchroom. It was better than any food fight I had seen in the movies. After the teachers returned they absolutely flipped out and told us that an “ice cream social” they were planning the following week would be canceled because of our misbehavior. Whatever. We had more fun having the food fight than we would have had eating ice cream. My mom always packed a Granny Smith apple in my lunch since I really liked them, and on another occasion I convinced a kid to throw it at someone across the room, hoping to start a food fight. Granny Smith apples are extremely dense and heavy for their size, and the apple hit a girl in the head and probably caused a lump it was flying so fast. Unfortunately the incident did not start a food fight. The principal did interrupt me and others at my table, suspecting I had something to do with it, but of course we didn’t know anything about it. During study hall we were able to get a pass to go to the weight room in order to work out, and the greatest part was that we were unsupervised the

entire time because the gym teacher always had a class to teach right next door. It doesn’t take a genius to figure out that since we weren’t allowed to talk in study hall we would all get passes to go to the weight room and just hang out there. It was like our own social club. We wouldn’t even change our clothes or put on workout gear, we would just go hang out there so we could get out of study hall. There was a staircase in the weight room that went upstairs to another room filled with all kinds of ventilation ducts, so we couldn’t help but go up there and explore. Some of the vents were absolutely huge and had small access panels on them, so for a period of time we had fun climbing inside of them hoping they would lead throughout the entire school, but we couldn’t get very far because there were duct covers that blocked us. Periodically Mr. Jenson, the math teacher, would come into the weight room and go upstairs for a few minutes, which we thought was strange. Why would the math teacher need to go up there every day? One afternoon, we found out why. Diego happened to be up there exploring when Mr. Jenson walked in and headed up there and when Diego saw him coming up the stairs he was able to duck down and hide behind some ventilation ducts where he witnessed Mr. Jenson light up a cigarette and have a smoke break. Smoking on school grounds was illegal, and apparently Mr. Jenson couldn’t make it through the day without his nicotine fix, so every afternoon he would go up there to have a smoke. From that day on every once in a while in math class we would make loud comments about how the weight room smelled like smoke, or as Mr. Jenson would walk by our tables we would ask the person next to us in a loud voice, “who smokes in the weight room?” Poor guy was probably just trying to relax for a few minutes from all the stress of having to deal with punks like us, and here we were making it worse.

Moving

To

California

The Ultimate Road Trip My 1981 AMC Concord was packed and ready to go. It was early in the morning in the middle of August 1998, and for the entire summer my dad helped make sure my old car was road worthy for my long trip to California. The original plan was for Fred, Diego, and I to move out west together at the end of the summer, but Diego hung back for a few months and would later join Fred and I in January. We all hated cold weather and after my Spring Break trip to Miami sophomore year of college, I put out the word to my friends that I wanted to leave the cold, miserable state of Wisconsin and head back down south to Florida. Diego’s college roommate Curt was originally from San Diego and both Fred and Diego had stayed with Curt at his parents’ house for a vacation the previous year, so they suggested we move to San Diego instead of Miami since there was no humidity or bugs, so that’s what we decided to do at the end of the summer. We were 20-years-old. We didn’t have any jobs lined up; we didn’t have an apartment rented; we just had a road atlas that I got from the gas station I worked at that summer, along with a bunch of beef jerky and cheese sticks for food along the way. We also had two ounces of weed and a cooler full of beer. That was all we needed to start our new lives as we headed out west California dreaming. Of course our parents strongly advised we not move, but we didn’t care. We had to get out of Wisconsin. Everyone always complained about how much it sucked, so we were going to do something about it and leave. Even all our friends thought we were crazy, but they didn’t have the balls that we had to break free from our small little town and see what else the world had to offer. By the end of the first day on the road we made it to Omaha, Nebraska and decided we would stay there for the night and head on to Denver the next day. We didn’t want to spend any money on a hotel room, so we were going to just sleep in the car somewhere, possibly at a campground. We located a campsite on the map in Omaha, but instead of turning in early and resting up for the long journey ahead, we decided to go drinking in the bars downtown. (We both had fake IDs.)

Fred and I went bar hopping until almost closing time and just before we headed to the campground, we decided to steal the beer mugs we had been drinking out of as souvenirs. We finished our beers and walked out the door, hiding them by our sides from the bartender. A little while later we arrived at the campground but there was no attendant in the office because it was closed, so we stopped the car in the parking lot and decided to sleep there. Fred passed out in the passenger seat, but I couldn’t get comfortable enough to sleep sitting up in the car and I couldn’t recline my seat because the entire backseat was filled with stuff, so I got out and laid on the blacktop right next to the driver’s side door and fell asleep there. The next thing I knew it was six or seven in the morning and a police officer was standing over me asking what the heck we were doing there. I told him we were moving to California and we got there too late to get a camp site because the park was closed so we decided to sleep there. He seemed very understanding and left us alone. A little while later we smoked some weed for breakfast and continued on our journey. That evening we made it to Denver and again went bar hopping downtown. Instead of looking for a campground again, we decided we would hook up with a couple girls at one of the bars and sleep at their place, and that’s exactly what we did. We met two girls at one of the bars and at the end of the night we all went back to one of their places. I slept in one of the girl’s beds with her and we messed around a little bit, but she wouldn’t have sex with me. Contrary to popular belief, not every girl who goes home with a guy from the bar has sex with him that night. I didn’t care, I was just happy to be sleeping in a bed instead of in the car or on the ground. Fred got lucky though, and my girl and I heard him having sex with her friend on the futon out in the living room. The next morning we all went to Denny’s for breakfast and later said goodbye to our new friends and headed for Las Vegas. Since we got a late start getting on the road that morning because we slept late in the comfort of the girls’ beds, we stopped at a campsite in Utah to sleep there. We didn’t even have a tent, so Fred just slept in the car and I slept on the ground again, and we headed for Vegas the next day.

It was the middle of the afternoon when we arrived in Las Vegas extremely excited (and high from all the weed we had been smoking the entire trip). We had some 40-ounce bottles of beer left over in the cooler from the night before, so we poured ourselves some beers into the mugs we had stolen from the bar in Omaha a few nights earlier. We were driving down the famous Las Vegas strip smoking a joint and drinking beer out of our mugs like we owned the place. We even took pictures of each other with the mugs up to our mouths inside the car since we figured no one would believe that we were slamming beers on the Vegas strip, out of beer mugs nonetheless. What kind of a person drinks beer from a glass mug in a car while they’re driving on the strip in downtown Las Vegas? Us, that’s who. We had no fear. Using our fake IDs we went to a club and had a few drinks and then explored the casinos and played a few slots hoping to win some gas money to help pay for our trip. Normal people would have gotten a cheap hotel somewhere at the end of the night to sleep in, but we were far from normal. I only had $3000 to my name, which was all the money I had saved that summer, so spending $50 or $100 on a hotel room was just not in the budget, so at the end of the night we went back to the car which was parked in the lot behind the Pioneer Casino, and we crashed there. The backseat was still full of stuff and my seat wouldn’t recline, and I still couldn’t sleep sitting up, so I took a blanket and a pillow and walked over to a small plot of grass where some trees were growing and slept there. Yes, I slept outside on the grass in the middle of the parking lot of the Pioneer Casino right behind the strip in Las Vegas like a homeless person. Actually, homeless people probably knew better than to sleep right out in the open like that, but I didn’t care. I was wasted and exhausted from being on the road for days. I woke up when the sun rose early in the morning and got back in the car and we took off for the final stretch to California. Just as we were leaving the city of Las Vegas, the brakes on my car failed! The pedal dropped to the floor and lost almost all pressure and to get the car to stop I had to slam on the pedal as hard as I could and hold it down. Driving in the mountainous terrain of Colorado the day before had put so much stress on the brakes that we blew a brake line. We didn’t know this at

the time, so we stopped off at a mechanic shop in the city of Baker, California which is an hour and a half outside of Las Vegas. A strange looking man, perhaps the owner, jacked up the car, pulled off the rear tire and inspected the brakes telling us it would be several days until he could get the parts that we needed to fix them. I told him we didn’t want to wait and that we would take our chances on the road, and then he reached inside the brake drum and purposefully pulled loose the brake pads, the springs and all the other parts holding the brake pads in place, flinging them to the ground. “Oops,” he said. “Don’t think you’re going to be able to drive it like that.” Fred and I looked at each other petrified. This man just sabotaged my car, stranding us literally in the middle of nowhere in the desert. I had a sinking feeling in my stomach. This man knew we were a couple of kids with a piece of crap car filled with our entire belongings with out-of-state plates 2000 miles from home. With the rear passenger side of the car still jacked up in the parking lot, the man went inside his office to order the parts he claimed we needed. This was too creepy. This psycho was trying to screw us, or kill us, or who knows what. We had to get out of there. We picked up the miscellaneous parts from the ground, put the tire back on, lowered the jack, and sped off while he was still inside. While the brakes had basically failed (and one of the rear tires didn’t even have any brake pads anymore), there was still enough pressure to stop the car if I pushed the pedal really hard and gave myself enough breaking distance. There was no way we were going to stay stranded there in the desert for days leaving my car in this psycho’s garage in the middle of nowhere. We called my dad and he told us to cut the break line for that tire and crimp it to minimize the leak so the pressure would be enough to depress the other brake pads. We did this and continued our journey completely spooked from the creepy psycho at the garage who tried to strand us. We arrived in San Diego pretty late at night because the brake problem held us up, and we had planned on sleeping at our friend Curt’s parents’ house and staying there for a few days until we found an apartment, but it was too late in the evening and we didn’t want to wake them up so we drove to Pacific Beach just north of downtown San Diego and Fred slept in the car

again on the side of the road, while I took a blanket out and slept on the beach. I didn’t realize how strange this was until I was awoken in the morning by the lifeguards asking me if I was alright. “Of course I’m all right. I’m in California!” I answered. They informed me that it was illegal to sleep on the beach, but they didn’t give me a ticket. I wouldn’t have cared if they did. We had made it. We were in California and at the very edge of the continent. The dream was coming true. After five days of madness and living off beef jerky and cheese sticks, and smoking probably half an ounce of weed and drinking every night and sleeping in parking lots and some random girl’s apartment, and even with the brakes failing and almost getting stranded in the desert, we had done it. We were ecstatic.

The Unexpected Guests We spent our first morning in California driving around checking out the beach for a little while, and later ventured off to find Curt’s parents’ house. Fred insisted that Curt said we could stay there for as long as we needed until we found an apartment. He and Diego had stayed there a year earlier when visiting him, and Fred said Curt’s parents were totally cool…and rich. Their house was a beautiful multi-million-dollar pad on top of a huge bluff overlooking the ocean. Their backyard literally led to the edge of the bluff with the ocean below. This wasn’t just a house with an ocean view. This house was right on the ocean . It was the most amazing house I had ever seen. We knocked on their huge twelve-foot-tall front door and when Curt’s mom answered she immediately recognized Fred from his previous visit and was extremely surprised to see him again. Fred introduced me and she asked what we were doing in California. “We just moved here,” he said. “Oh, where are you living?” she asked. This is where things started to get uncomfortable. Curt had never told his parents that we were moving to California, so of course he never asked them if we could stay there until we found an apartment. You can imagine the look on his mom’s face when Fred answered, “Curt said we could stay with you.” She probably thought he was joking, but of course he wasn’t. She invited us in and told her husband that

we would be staying with them until we found an apartment. He looked just as puzzled as she did. Talk about imposing on someone! They were really nice about it, and even cooked us dinner that night and we ate it out on the patio overlooking the ocean in their back yard. After they went to bed we kept drinking their beer and wine and enjoyed watching their 60 inch flat screen plasma TV while sitting on their white leather furniture feeling like we owned the place . A 60 inch plasma TV in 1998 was practically unheard of and probably cost about $5,000 dollars. Curt’s parents let me sleep in the guest room upstairs which had an ocean view and its own balcony, and Fred slept downstairs in Curt’s sister’s room because she was off at college. When I got up the next morning Curt’s mom and dad were off to work and we had the whole house to ourselves. Sure we looked for an apartment for a few hours, but then came back to the house to hang out and enjoy the amenities. When Curt’s mom came home from work she found us drinking their beer and watching their big-screen TV like a couple of low lifes. “Did you find an apartment today?” she asked. “Nope, not yet. Nothing we could afford at least.” We hadn’t realized how expensive rent was in California, especially near the beach. Most of the apartments were about twice as expensive as we had thought. After freeloading off Curt’s parents for another five days, we actually did find an apartment, and I had to trade in my ocean view bedroom, the big-screen TV, and a house fully stocked with expensive wine for a completely empty apartment about seven miles away from the beach. It wasn’t what we had planned, but we were in California, so we were still pretty happy. Curt’s parents were glad to get rid of us and wished us well, but little did any of us know at the time, us entering their lives would be one of the worst things that had ever happened to them. More about this later.

Our New Apartment You don’t know how much you take for granted in life until you have nothing. We did have a roof over our head, our clothes, and my old car, but

that’s about it. That, and a computer and the scanner we had scammed from Best Buy several years earlier, and a box of dishes that Fred’s mom bought for us before we left. That’s pretty much it. That’s all we had. No furniture, no mattresses, no TV, no lamps, no decorations, no nothing. Our apartment was nice and had a lot of potential though. It was a spacious two-bedroom place with lofted ceilings and also had a community hot tub and pool. The day we moved in we went to Wal-Mart and each bought an inflatable air mattress to sleep on and two plastic patio chairs so we at least had somewhere to sit. After sunset, we grabbed a 12-pack of beer and went to hang out by the pool. We were immediately approached by a security guard who was sitting at one of the tables asking us who we were. We told him we just moved in and arrived from Wisconsin, and he informed us there was no alcohol allowed at the pool. We offered him a beer and sat down at the table with him and he immediately forgot about this rule and we all tipped back a few cold ones as we told him about our crazy adventures on our trip there. When we got to the part about the brakes failing, as luck would have it, he turned out to be a full time mechanic, only doing the security job part time at night. His name was Jax, and he offered to help me fix them the next day. Everything seemed to be falling right into place. It’s very strange living in a completely empty apartment with only two plastic chairs, and we desperately needed furniture but we hardly had any money so it would have to wait. Lucky for us, just as the universe provided us with a nice place to stay in Colorado with the girls we met at the bar and united us with Jax the security guard/mechanic at our apartment complex our first night there, the universe also began providing us with the furniture we desperately needed, and it was all free. Every few nights when we carried out our bags of empty beer cans to the recycling bins, we would notice sitting right next to the dumpster was some old discarded furniture that people had thrown away after moving out. It was incredible. We first found an old desk so we carried it upstairs and set up the computer on it, and seemingly every time we went to throw away our beer cans we would find something else. We called it the magic dumpster, and it provided almost everything that we needed. Aside from the desk, we

got a kitchen table and chairs, a laundry bin, an oscillating fan, shelves made of cardboard that were designed to hold cartons of cigarettes as a store display, and we even found some old picture frames with artwork in them that we hung on our bare walls. Just when everything seemed to be going our way and our California dreams were beginning to come true, our lives would take a quick detour leading us into a downward spiral to depths we had never imagined.

Getting a DUI About two weeks after I arrived in California to start my new life and pursue my hopes and dreams, my plans hit a large speed bump in the form of a DUI. It was Labor Day weekend and the police were out looking for drunk drivers as they often do on holiday weekends, and my piece of crap 1981 AMC Concord with out-of-state plates probably looked suspicious driving down the road at 1:30 in the morning as Fred and I were coming home from the bar. You can probably guess what happened next. After getting pulled over for “swerving” and failing a breathalyzer I was handcuffed and put in the back of the cop car and taken to the police station. A different cop took Fred to the drunk tank. When I arrived at the police station, the arresting officer emptied my pockets and found my fake ID stuck in my money clip. He was confused at first, because when he had pulled me over and checked my ID, he realized I was only 20-years-old, but the ID he found when he emptied my pockets said I was over 21. When he realized what it was, I told him I really needed it, and asked him if he would let me keep it instead of confiscating it. I told him to please stick it in the bushes next to the front door of the police station and when I got out of jail I would come back and find it. “I just moved here,” I told him. “And I don’t know anybody, and I need that to get into the bars in order to meet some girls,” I explained. I continued to tell him that drinking in Wisconsin is a way of life, and that if he confiscated my fake ID it would be devastating to my social life. “Everybody in Wisconsin drinks,” I said. “I really need that fake ID.” The

cop seemed rather sympathetic and told me he would set it on the top of the rear driver’s side tire on my car which was left abandoned on the side of the road where I had been pulled over. He then gave me a plastic cup and asked me to pee in it for a urine analysis. I had already failed a breathalyzer, but I didn’t want to give them any more evidence against me, so I told him I didn’t have to pee at the moment. He put me in an office with a water cooler and told me to drink a bunch of water so I could pee in a little while. The cop left me there all alone for a few minutes to gulp down some water, when I noticed a sink in the room. This was not a bathroom, and there was no toilet, but there was a sink for whatever reason, and since I really did have to pee (I just told him I didn’t have to go and held it so I wouldn’t have to give him a pee sample), I decided to pee in the sink so I wouldn’t have to give him the sample. Once I relieved myself, I knew it would be hours before I had to pee again, and my blood alcohol level would have dropped significantly by that time, and he probably would just give up on wanting his pee sample after a while. Luckily he didn’t walk in and see me peeing in his sink or I probably would’ve gotten charged with something else, like indecent exposure or something. Just as I thought, not long after this, he gave up on me peeing and a police officer drove me to the county jail. It was probably about 3 AM by now and I was placed in a jail cell with about 15 or 20 other guys, most of which looked like hard-core drug addicts or criminals. I certainly did not belong there, I thought. One guy was lying on the bench having withdrawals from heroin, and some of the other guys were passed out on the concrete floor. I felt like I was in hell. To make things even worse, the toilet was clogged and filled almost to the top with urine and feces, and stunk up the whole jail cell. The guards didn’t seem to care, and I’m sure they thought this was funny. It smelled like we were locked up in a sewer. The prisoners all realized that if anyone flushed the toilet, the rushing water coming in would cause it to overflow, spilling out onto the jailhouse floor, so every time someone was using the toilet people would remind them not to flush it or it would overflow. These suggestions worked for a few hours,

until someone out of habit flushed the toilet when they were done using it. The water started flowing into the toilet bowl, and then the urine and feces soup that had been stewing began overflowing onto the floor. This jail cell was fairly small, probably only 20’ x 20’, and the sewage spilled out half way across the floor. Everyone jumped out of the way and huddled up against the wall on the opposite side of the cell and we all put our shirts over our noses trying to cover up the smell. There on the floor was an enormous puddle of poop, probably five feet wide and ten 10 feet long. We started clamoring for the guards, telling them what happened and they came over and looked, but didn’t care. Hours went by with the sewage still on the floor, and we were still huddled up against one side of the jail cell, and we still had to breathe through our shirts to filter out some of the stench. There were no clocks in this holding cell, and of course my watch was confiscated when I was booked, so I had no idea what time it was. It seemed like time was standing still. Eventually, my turn came to be released late the next morning and I got a ride home from one of my cellmates’ girlfriends, who came to pick him up after he was released. He had also been arrested for drunk driving the night before. When they dropped me off at my apartment, I saw my car in the parking lot and I figured Fred was let go and drove it home using the spare key. A feeling of great disappointment then came over me because I remembered what the police officer had said the night before, when he promised he would put my fake ID on top of the tire where we had abandoned the car. It was great that Fred was not in jail, and it turns out the cops just took him to the drunk tank and released him in the morning without even giving him an underage drinking ticket, and he got a ride from someone back to my car and drove it back to our apartment using the spare key. I explained to him that the cop promised me he was going to put my fake ID on the tire, so we drove back to the road where we had gotten pulled over and parked on the shoulder in the approximate spot. We then started walking up the street with our eyes locked on the ground, hoping to find my fake ID, which would have fallen off the tire as Fred drove away if the officer stuck to his word. This was certainly a long shot. First of all, what are the odds that the same police officer who arrested me for a DUI would actually give me my fake

ID back? This was of course the very fake ID that had led to my arrest, allowing me access to alcohol, so what kind of a cop would actually give that back to a 20-year-old kid so he could drink some more? I had to hope for the best. I had to hope that the cop had actually done this insane, illogical, and illegal thing like he had promised. Without my fake ID our lives would be completely ruined. As we continued walking down the gravel shoulder on the highway with our eyes fixed on the ground, there it was! My fake ID! The police officer actually did what he said! I couldn’t believe it. I bent over and picked it up and let out a shout of joy with my prized possession back in my hand, but my problems were certainly not over. Getting a DUI sucks. Of course it’s dangerous drinking and driving, and a stupid thing to do, so the punishment fits the crime. While the cop did give me my fake ID back, he kept my real one because my license was immediately suspended. Right before moving to California I went to the DMV in Wisconsin and got a duplicate driver’s license just in case I lost my wallet. A few days before my DUI arrest I had applied for a California driver’s license, and when I did, the DMV took my (duplicate) Wisconsin ID and said they would mail me my California one a few days later. So, while the arresting officer had taken my remaining Wisconsin driver’s license, I had a brand-new California driver’s license in the mail on its way to me and I received it a few days later. I still had a driver’s license! Ha ha! I didn’t know if the computer systems from California and Wisconsin communicated with each other, but I had a suspicion that my Wisconsin driver’s license would be suspended in the Wisconsin computers, but the California computers would show that I had a valid California license, so I just kept driving. Most people who get a DUI are supposed to get an occupational permit, which allows you to drive only to and from school or work during specific hours, but I didn’t want to pay for this so I just kept driving like there was nothing wrong and luckily never got pulled over until several years later when my license was valid again. My California license probably was suspended, but I didn’t care, so I still drove as if nothing happened.

I did have another problem, though, because after a few months my Wisconsin license plates expired, and there’s nothing like driving an old beat-up car with expired out-of-state plates to raise suspicion when a cop sees it. Since I was most likely driving with a suspended license (along with my now expired registration), I used Photoshop to make a fake registration tag with the current year on it and glued it on my license plate. As if driving with a suspended license after getting a DUI wasn’t bad enough, I was now driving a car with fake registration stickers on it. I thought it was pretty creative, and luckily I never got pulled over, and the following year I was able to get valid California plates and could drive without getting nervous every time a cop was behind me. Getting the DUI really spooked me, especially being thrown in a jail cell with an overflowing bowl of feces that night. I also had to pay expensive fines, take alcohol education classes once or twice a week for several months, and attend a couple Alcoholics Anonymous meetings. I was not an alcoholic, but this was all part of my punishment by the court. This whole experience actually helped me realize the dangers of drinking and driving. Where I was from, the odds were the only thing you would really hit if you were drunk driving was a cornfield, but in California, there is so much traffic and so many lanes going in different directions and crazy intersections with curvy winding roads that it is very dangerous to drink and drive. Of course it’s dangerous to drink and drive anywhere, even surrounded by a bunch of cornfields, because you could hit an oncoming car or a tree, but we were too dumb to think about this at the time. After this experience I was fairly careful to not drink too much and then drive, and alcohol lost a little bit of its fun for me. Marijuana, on the other hand, had not. I still enjoyed smoking weed on a daily basis.

Where Can I Buy Some Weed Around Here? Our marijuana supply was rapidly dwindling after we arrived in California and we desperately needed to find a regular hookup so we could get more. We figured weed can’t be that hard to find in California, especially the dumpy area where we were living, so we walked around the streets by the beach asking random people if they knew where we could buy some pot.

You may be thinking this is a completely ridiculous thing to do, but we were desperate. It didn’t take long before we found a group of kids our age who said they could help. This was before medical marijuana was legal in California so we couldn’t just go and get a prescription for it and pick some up from the local dispensary. These were certainly not the most clean-cut group of kids, and one of them was carrying a cordless telephone that he was hoping to sell to someone so he would have money for his own weed, and even though these weren’t exactly our type of people, they know a guy who lived just a few blocks away who was the local pot dealer for the neighborhood so they introduced us to him. He seemed like a friendly guy at first and sold us a bag of some pretty decent weed and gave me his number for all of our future transactions. Over the next few months this dude was the most reliable pot dispenser I had ever found. He was always home after five o’clock in the evening and he always had some good weed available for sale. One thing I did notice about the guy was that he and his friends liked to play video games, particularly shoot ‘em up games. I would never hang out at his place for more than ten minutes, and it was always a quick and simple transaction, but it seemed that every night Fred and I stopped over there to score some weed, he and his friends were playing these games. “Shoot them in the fucking head!” he would always yell at the person playing the game. He seemed to have a real obsession with shooting people in the head. I didn’t think anything of it really until one morning before school I was watching the morning news and saw a report that showed his picture and mentioned that he was arrested the night before during a party at his apartment for shooting his girlfriend in the head and killing her. It was very surreal. I didn’t usually watch the news, it just happened to be on that morning. Not only did he just shoot his girlfriend and kill her, but he shot her in the head, just like he was always telling people to do when they were playing video games. It was quite disturbing. I shook off the weirdness and soon found another pot hookup at my community college who wasn’t a psycho.

Stalking Tony Robbins “Stalking” may not be the right word, because we didn’t mean Tony Robbins any harm, we just wanted to meet him and get his autograph in our copies of Unlimited Power . Anthony Robbins, of course, is the worldfamous motivational speaker and self-help guru, and his book, which Fred and I read in the dump truck while working for the weed cutter the summer after high school graduation, changed the course of our lives and opened us up to the world of self-improvement. In Unlimited Power , Tony said that he lived in a castle in Del Mar, California, a beautiful and wealthy beach community in San Diego County. Since we largely credited Tony with giving us the confidence to move to California to pursue our dreams, we wanted to meet him and have him autograph our books, so we set out to Del Mar to find the castle. We just asked random people walking on the street where Tony Robbins’ castle was, and to our surprise, somebody knew and pointed us in the right direction! We parked the car outside and walked up to the front door and both Fred and I had our copies of Unlimited Power in our hands as we anxiously awaited to meet our idol. A construction worker opened the door, and we asked him if Tony was home. He informed us that Tony had sold the castle and now lived in La Jolla, the next city south, so that’s where we went. While finding the “Del Mar Castle” was fairly simple, we wondered how in the world we would find Tony’s house in La Jolla. All we knew was that he lives somewhere in the city. We stopped at a local gas station and asked some people if they knew where Tony Robbins lived. It seems like a crazy thing to do, after all, what were the odds that some random stranger is going to happen to know where he lived? La Jolla is not exactly a small town. Someone told us he probably lived on La Jolla Farms Road, because that’s where all the richest of the rich live. The homes on this street are absolutely incredible. It feels like you’re in Beverly Hills. Most of them are gigantic and have beautiful and immaculate landscaping, and some of them you can’t even see because they’re hidden behind massive gates. Just driving down the street, truly is an incredible experience, especially for two

Midwestern boys who had no money and lived in a dumpy part of San Diego. This was definitely where the richest of the rich lived. We randomly pulled over and parked on the side of the road in front of one of the houses, and walked up to the front door to pretend that we had confused their house with Tony’s house, and acted like we were friends of his. When someone answered the door, I said nonchalantly, “Is Tony around?” “Tony?” the man responded. “Yeah. Tony and Becky” (his wife at the time). “Oh, you have the wrong house,” the man told us. “They live across the street.” “Across the street?” we thought to ourselves. “Thanks,” I said, as we turned in astonishment. What were the odds, we thought. Out of all the houses on this long and winding road, the one that we randomly chose to approach was the one directly across the street from his very house! Things soon got weirder. As we walked over to the house, which was hidden behind a large brown gate, a dark colored Porsche drove up and pulled into the driveway, stopping for a moment as the gate opened. We hurried over and approached the driver’s side and there he was, our hero, Anthony Robbins! I don’t know how he fit into that tiny car, but he did. “Tony!” I said, as we approached, holding our copies of his book. “Hey guys,” he said. “What’s going on?” “We just moved here to follow our dreams thanks to you and your book, and we wanted to meet you and say thanks,” I told him. He extended his hand to shake mine, and when they met, mine practically disappeared as he wrapped his gigantic fingers around it. People often joke that Tony has big teeth, but he also has a big head. The guy’s head was enormous, and so are his hands. He really is a giant.

We talked with him for a minute and then he autographed both of our books and drove off down his driveway, disappearing behind the closing gate. We walked back to my car stunned. We had done it. We just met Tony Robbins. Not only that, but we had somehow telepathically honed in on his exact location. What were the odds? Of all the houses on the street, we randomly chose the one directly across the street from him, and not only that, but as we were walking up to his driveway, he pulled up in his car! Tony’s teachings don’t get too much into the metaphysical, the mystical, or the spiritual, it’s mainly about strategies for creating habits that will ultimately lead you closer to your goals, but he does touch on some esoteric spiritual principles, and Fred and I drove back to our empty apartment with no furniture but two plastic Wal-Mart chairs astonished by what had just occurred. Different spiritual teachers, and even Jesus himself, spoke about the power of belief and said that if you simply believe enough, you can metaphorically move mountains, and that’s what we had done. We wanted to meet Tony Robbins so bad, and were so amped up on our new life in California after having just drove over 2000 miles with no apartment ready, no job lined up, no nothing, just our hopes and dreams of what lies ahead, and our focus was so sharp that we somehow metaphysically altered the course of our own reality causing our paths to cross with our inspiration, Tony Robbins. While I still look back on this in amazement, I must advise you that you should never just show up at the home of your favorite celebrity, ever . This is extremely creepy and if you feel that you “have” to meet them to thank them or to talk to them, then you have some mental problems. You might be saying, “but you did it, Mark.” Yeah, I did, and I was high as hell and out of my mind, and as you’ve figured out by now, I was completely insane.

Using Dish Soap in a Dishwasher How was I supposed to know that you’re not supposed to use dish soap in a dishwasher? This didn’t make any sense. I found this out the hard way after moving to California. My mom always did the dishes when I was growing up, and nobody ever told me the difference between dish soap and dishwasher detergent, and unfortunately I had to find this out on my own.

When I first moved out with John, Nick, and Bobby, in our house in Wisconsin this was never an issue, because we didn’t have a dishwashing machine in the house, but our apartment in California luckily had one, even though I didn’t really know how to use it. One morning I loaded up the dishwasher and turned it on right before leaving for the afternoon because it was loud and I didn’t want to be home when the thing was running. A few hours later I returned home to a flooded kitchen with a foot of soap suds everywhere. Later that afternoon, the maintenance guy came over to see what had happened because the neighbor below had reported a leak was coming through their ceiling. I told him my dishwasher must have broke and it overflowed. He rolled his eyes and immediately knew what happened. He asked if I used dish soap, and I said of course I used soap, how are the dishes going to get clean without any soap? He then informed me that you’re not supposed to use dish soap in the dishwasher, and you’re only supposed to use dishwasher detergent . Seriously, how was I supposed to know about this? Dish soap, dishwasher soap, how am I supposed to know there’s a difference? Luckily I didn’t have to pay for any of the damages. I felt like a complete idiot.

Ruining Thanksgiving Dinner Three months after we moved to California, Thanksgiving came around, the time when friends and families all sit around the dinner table and enjoy a good meal together. It’s the one night of the year when nobody likes to eat dinner at home all alone, and if a person doesn’t have any family in the area, then someone is bound to invite them over to their place. Since we didn’t have any family in the area, Curt’s parents generously invited Fred and I to join them and their friends at their house for Thanksgiving dinner. They would soon regret this. To our surprise, they apparently had forgiven us for showing up on their doorstep unannounced when we first arrived in California and shamefully imposed on them, essentially forcing them to let us stay at their house until we got an apartment. We showed up for Thanksgiving dinner high as hell

after having smoked a bunch of marijuana on the way there, and I’m sure Fred was drunk, and we were in no shape to be socializing with sophisticated adults. Early on at the dinner, Curt’s parents asked us what we thought of California. I spoke up and told them San Diego was fantastic, and I was glad that I moved here, but I really hated Los Angeles and thought it was a complete dump and everyone who lived there were fake, shallow, materialistic, scumbags—especially people in Hollywood who worked in the entertainment industry. I also said that I hoped God would wipe Los Angeles off the face of the earth in a massive earthquake. One of my favorite songs at the time was Aenima by Tool, which is basically about this kind of event and the singer’s hatred of Hollywood. An uncomfortable look crept onto their faces as Curt’s dad then informed me that their friends who were joining us that night, seated just across the table from me, lived in Los Angeles! I could feel the embarrassment rising up from the pit of my stomach. I tried to recover from this historic foot-in-mouth moment by asking them what they did for a living, assuming it was not something in the entertainment industry so I could then say that people in their industry are okay, it’s just the people in the entertainment industry in Los Angeles who I hated, but as it turned out both of them happened to work for Paramount, a major motion picture company. There was no recovering from what I just said. I basically just said they were scum and I hated them and hoped they died. I had pretty much ruined Thanksgiving dinner. There were a few moments of extreme uncomfortableness at the table, and I was so stoned I wasn’t sure if my anxiety was from the weed I was smoking earlier, or from insulting Curt’s parents’ guests, or both. I just started drinking more wine and forgot all about it until as Fred and I were leaving walking back out to the car, Fred started laughing uncontrollably. “You basically said you hoped the Langdon’s friends would die in an earthquake, at Thanksgiving dinner!” he cackled. He said it took all his strength and concentration not to bust out laughing uncontrollably at the table after I said it. We still laugh about it to this day. As bad as this was, it would pale in comparison to what we would later put the Langdon’s

through. Ruining Thanksgiving dinner one year is fairly easy to forgive and forget. What happened to them later because of us is not.

The Wrong Max Just a few weeks after my DUI, Fred was driving my car home from the bar one night and put it in the ditch, ruining the radiator. I had gotten a ride home from a girl I was trying to hook up with that night and left my car with Fred, but he was so drunk he crashed it on his way home. The car had been towed and impounded for being abandoned in the ditch, and we needed a ride to the impound lot on the other side of town to get it. Since we didn’t have any friends, this was extremely difficult. My one beginning friendship was with the kid named Max N, who was in my philosophy class at the local community college, but I didn’t have his phone number. I did know his full name, however, so we looked him up in the phone book, but realized there were pages of listings of people with his name because it was so common. What did we do? We started calling the listings in the phone book one by one. This was in 1998 and most people still had home phones (land lines) back then because cell phones were just starting to take off. Each time someone would answer I said, “Hey, it’s Mark from philosophy class.” The first dozen people I called had no idea what I was talking about, because obviously it was the wrong number, but after a while the person on the other end of the phone acknowledged that he was Max N from philosophy class, but when I said it was me, he didn’t know who I was. Not only did this Max N have the same name as my friend, but he was taking a philosophy class at the same college too! When I realized it wasn’t the same Max N that I knew, I told him why I was calling and explained that Max N was the only person we knew and that we had to go get my car from the tow yard. He was very sympathetic to our situation and offered to give us a ride! I gave him our address and twenty minutes later he came over and picked us up and drove us to the tow yard to get my car. This was amazing. This kid was a complete stranger, but he still offered to help us out. He didn’t even seem like a complete weirdo. He was a normal college kid who felt sorry for our situation and decided to help.

It was over $100 bucks to get the car out of the impound lot and Fred had left his keys in the ignition, but I had my set with me so we unlocked the car, got inside, and sped off. Hey, it was my car, so it wasn’t like I was stealing it or anything. It was still registered in Wisconsin, so how were they going to find us? As we drove home, the radiator leaked completely dry and the car almost overheated. The release valve on the bottom was ripped off, and in order to get the radiator to hold any water, we had to jam a towel inside the hole. Water still leaked out really bad, even with our make-shift plug put in the hole, and the car looked like it was going to overheat and ruin the engine, so we had to stop on the way home to add more water. We pulled into a parking lot somewhere and found an old cup on the ground and used it to scoop up water from a puddle and poured it into the radiator. It needed to be replaced anyway, so we figured how much more damage could some muddy puddle water do to it?

Going to The Late Late Show Fred, Max N, and I got tickets to be in the studio audience at The Late Late Show with Craig Kilborn when he hosted it in 1998, so we drove up to Los Angeles where it was filmed and smoked a big fat blunt on the way and anxiously awaited seeing one of our idols in person. Before we got to the studio we decided that we would do two things during the show. First, when Craig was introduced and the show began, we would applaud and holler like every audience did, but we wouldn’t stop because we wanted to see how long the crowd would go along with us; and second, we decided to start laughing and applaud after the setup for one of his jokes during the monologue, before he even got to the punch line. When the announcer said “Here’s your host…Craig Kilborn,” the audience erupted with applause and whoops and hollers, but just when everyone was starting to quiet down, all three of us would get even louder and kept yelling “yeah, Craig! Whooo!” and we kept applauding, and the audience would all join back in and we were able to keep this going for an abnormally long period of time, leaving a confused look on Craig’s face as he wondered why this was the most excited audience he had ever seen.

After he did a few jokes in his monologue, we all agreed now was the time to laugh at the setup, and so as soon as he finished the setup for his next joke and paused for a second before delivering the punch line, all three of us started laughing and applauding, and others in the audience followed like lemmings. The setup wasn’t even funny because the joke wasn’t finished, but most people still applauded with us! Morons! Like most late night comedy shows, the show was taped in the late afternoon or early evening and then aired later that night, so we were able to watch the show after we got back home. When it got to the part when we applauded at the setup, we realized that because so many people started applauding with us and because of our yelling, you couldn’t even hear the punch line for the joke at all! It was the weirdest thing to watch and Craig looked baffled as he continued on to the next joke, no doubt wondering why people were applauding when his joke wasn’t even finished.

Free Food from Complaining Sometimes I’m very attuned to details, and I noticed that practically every food product you buy at the grocery store has a quality guarantee that says if you are not completely satisfied with the product, you can return it for a full refund or a replacement and they list an 800-number for you to call if you want to complain. I didn’t have much money and what little I had I was spending on weed and beer, so I didn’t really have much left over to buy food—especially good food. Fred and I pretty much ate peanut butter and jelly, romen noodles, and spaghetti with no sauce because the sauce cost too much. We needed to eat, but more importantly, we needed beer and weed, so one afternoon I called the phone number listed on a pizza box and complained to the company about it hoping they would give me a refund. I told them it didn’t look like the picture, which it didn’t, and I was very disappointed. On the box, the pizza looked fantastic with all kinds of cheese and pepperoni spread all over the top, but the actual pizza didn’t look anything like that. The robotic customer service person on the other end of the line read a scripted response off their computer screen telling me, “I’m sorry sir for your dissatisfaction. We are committed to providing a quality product to our customers and you are important to us,” and they told me that they

would like to send me some free coupons for a replacement. I gave them my address and a fake name and they sent me some coupons for free pizzas! Who doesn’t like pizza, especially when it’s free? My plan worked just as I expected. I then went through our kitchen cabinet (what little food we had) and I called all the 800 numbers on every package and complained about them all. I would just tell them I didn’t like it or that it looked better on the package and I was very disappointed. Their response was the same every time. “I’m sorry sir, we are committed to providing a quality product to our customers. We would like to send you some free coupons for reimbursement, bla bla bla.” The only thing we had to eat in the apartment was pretty much peanut butter and pizza, so I took a notepad and pen to the grocery store and started writing down the 1-800 numbers from every different kind of product I had an appetite for. The customer service person always asked for the specific lot number or item number that’s stamped on the particular product when I called to complain, so along with the 800 number I would write down the product name, the size, and the specific item number. I did this for just about everything you can imagine. Bread, meat, cookies, peanut butter, jelly, frozen dinners, milk, cereal, soda, spaghetti sauce, I even started calling and complaining about the beer that we drank, telling the company it tasted stale and they would send me free coupons for beer! That’s right, free. One beer company even sent me a check for seven or eight dollars to compensate me for the six-pack that I said I didn’t like! They certainly didn’t want me switching my brand of beer and lose me as a customer for life, so they sent me some money to keep me happy. The cashiers at the grocery store would always look at me funny when they rang up $250 worth of groceries, including beer, steaks, juice, cereal, and just about everything else in the store, and then I would hand them a large stack of coupons they would have to scan one by one, and the balance would be reduced to zero dollars. They had never seen anything like it and were always surprised. I felt a little weird sometimes, but we were eating like kings without paying a dime. I even got Levi’s to send me a few pairs of free jeans because I called them and complained that mine had worn out.

People always complain that companies have terrible customer service, but I can’t praise the food industry enough. They were more than generous and kept me from starving to death.

Custom Compilations While burning your own CDs filled with your favorite music became commonplace in the 2000’s, in the late 1990s, CD burners were very expensive and few people even knew about MP3s back then; but we did. We were on the cutting edge of technology and were downloading MP3s before anyone heard of Napster, and three years before Apple had released the iPod or iTunes. Fred and I came up with the idea to start a “company” we called Custom Compilations where we would burn people compilation CDs of their favorite songs for only $9.99 — less than the cost of a new CD itself. While the idea of Custom Compilations was genius and ahead of its time, our business practices were a bit unorthodox. We didn’t have the money or the resources to acquire the proper licensing to buy the rights to popular songs (we were only twenty-years-old) so that we could legally make copies by burning them onto CDs, so we decided to download the songs from the Internet for free and then just use them anyway. I made up some nice fliers that explained our service and had a section where people could write in the songs in the order that they wanted them to appear on their CD, and we made a large color sign and brought a table out to the quad at my college and set up a booth trying to promote our idea. We figured people could fill in their desired songs on the order form and then we would go home and download them and burn them onto a CD, and the very next day we would meet them in the quad and they could pay us when we gave them their CD. This idea really was ahead of its time because hardly anyone had CD burners or knew that you could download mp3s of practically any song you wanted, but our “business” was slow to take off and we needed money fast, so we quickly abandoned the idea of Custom Compilations and launched another operation that would become immediately profitable.

Selling Fake IDs Every college kid wants a fake ID so they can buy beer and get into clubs and bars, so we decided to tap this enormous market to help pay for rent and fund our weed habit. I went out and bought the best color printer on the market at the time and a Polaroid camera, and using Photoshop we went to work. (Digital cameras were very expensive back in 1998, so we had to use a Polaroid.) We found a template on the Internet of the driver’s license from Georgia, the only state whose license didn’t have a hologram on it, so we could easily replicate it. Fred and I already had fake IDs, but we needed a sample of our work, so we took my picture with the Polaroid camera and scanned it into the computer and shortly after printed out my new Georgia driver’s license. We bought a laminating machine and small lamination cards from Office Depot, and we assembled my new ID with the precision of a surgeon. It looked pretty good, so I brought it with me to school the next day and in between my classes I would approach random groups of students and ask them if they wanted fake IDs. I would show them the one that we had just made and take a picture of whoever wanted one with the Polaroid camera and wrote down whatever name and birth date they wanted on their ID and scheduled a time for them to meet me the next day where I would exchange their new fake ID for $100 cash. We were very proud of our fake ID business. After all, where could you possibly get a fake ID within 24 hours? The best part was that the students wouldn’t even have to pay us until after we gave them their ID so they knew it wasn’t a scam just to take their money. Business was good. Some days we made $400 or $500 dollars a day. We did this only for about a month or two before we had marijuana-fuelled paranoia that the FBI was going to bust down our door early one morning and raid our apartment. We still had absolutely no furniture at all, except for the two plastic Wal-Mart chairs and a few odds and ends we had found out by the dumpster. We looked like spies, or terrorists. We had a large map of California taped on the wall because we didn’t have the money for decorations, and we each slept on inflatable camping mattresses. Our apartment didn’t look like a

home, it looked like a temporary command center for some kind of illegal operation. Because we were so short on money, when we abandoned the ID operation, we boxed up the expensive color printer and returned it to Circuit City as if it was brand new for what I expected would be a full refund, but what I didn’t realize was that the store had a policy that if you waited more than 14 days to return certain electronics, they would only give you in-store credit. I didn’t want in-store credit, I wanted the money, so I hung out in the store parking lot approaching people who were walking in, and told them that I would buy what they were looking for with my in-store credit slip, if they would then give me the cash. It was embarrassing. We also returned the laminator machine and the Polaroid camera to Office Depot and were able to get a cash refund for them. We had opened each package very carefully and sealed them all back up as if they were brand new. It was reminiscent of the days a few years back when I would return used video games by re-shrink wrapping them. Part of the reason we abandoned the fake ID operation was because if the authorities found out about us and raided our apartment, they would discover something else we would rather keep to ourselves.

Growing Weed Since our biggest monthly expense next to rent was our weed habit, and we didn’t have jobs and our savings were rapidly depleting, we did what any economically fiscal pothead would do, and decided to start growing our own. We didn’t want to sell the weed and be drug dealers; we just didn’t want to spend any more money on it since we smoked it every day. Fred spent an afternoon researching on the Internet how to start an indoor grow room, but we were disappointed to find out that you needed special light bulbs in order to give off enough light for the plants to grow properly. These lights were fairly expensive, at least to us they were, but we thought we would try growing weed anyway, and instead of using the proper lights

we just bought a few three-foot-long florescent fixtures from Home Depot and thought we would try them instead of using the recommended lighting. While I was actually enrolled in college and gone for half the day, Fred had nothing to do and didn’t even have a car since we shared mine, so he spent his afternoons transforming his closet into the grow room. Fred is a genius when it comes to engineering, and if he actually applied himself, he could have put his skills to work in college, but Fred didn’t like college. He did like the idea of unlimited free marijuana though, so he figured out how to mix up the soil and built an adjustable lighting system and meticulously constructed his masterpiece. We saved the seeds from the pot that we were smoking and Fred nursed them like they were his babies until they started sprouting. Within just a few weeks the plants were growing up out of the soil and looked beautiful. There were probably a dozen or more, filling the entire inside of Fred’s closet. He wore the same blue T-shirt every day anyway, so he didn’t really need the closet for his clothes. We anxiously awaited our garden’s maturity so we could sample our homegrown weed and start reducing our expenses. Christmas time was just around the corner and we had gotten plane tickets to fly back to Wisconsin for a week and a half, so we wouldn’t be at our apartment to water the plants or raise the lights, so we gave our only friend Max N the key to our apartment and trusted him with the task. Max liked to smoke a lot of pot too, so we had something in common. Since I wanted to have pot to smoke when I was back in Wisconsin, I brought some with me on the airplane because I didn’t know if I was going to be able to score some once I got back there. Carrying drugs onto an airplane is pretty stupid, especially when this was the first time I had ever flown in my entire life and I didn’t know if they used drug dogs to look for people smuggling drugs or what kind of security measures were in place, so I taped the bag of weed inside my pants just in case any drug dogs smelled it and security made me empty my pockets or searched my carry-on bag. Luckily it was no problem, and I got on the plane just fine carrying about a quarter ounce of pot.

Our original plan when we moved to California was to have myself, Fred, and Diego all move out together at the end of the summer, but Diego decided he would join us a few months later at the end of the year so he could finish the fall semester at college. After Christmas, we all flew back to California for some more adventures, now involving the three of us. Diego didn’t smoke pot, and even though he knew Fred and I had been potheads for years, he was a little uncomfortable with the fact that we were growing it in our apartment. It didn’t really surprise him, he just shook his head at our stupidity. The pot plants grew for the next few months, but because we weren’t using the proper lighting, the buds (the part you smoke) were very thin and practically useless. Our operation had failed. We couldn’t really throw a dozen 5-foot-tall pot plants out in the dumpster because that would be a little difficult to explain to the neighbors, so we cut down the plants one by one and stuck them down the garbage disposal. It ground them up pretty well at first, but the stems on some of the plants were so thick that after a few minutes the garbage disposal got jammed up. We couldn’t call maintenance to come over and fix it, because once the guy took it apart he would realize that it was full of pot leaves, so luckily we were able to fix it ourselves and finished disposing of the evidence. I continued being a pothead for several years after this, and smoked so much over the years that I had a chronic smoker’s cough because of it. I didn’t smoke cigarettes at all, only weed, which is probably 10 times worse for your lungs if it’s not filtered with a water bong, especially if it’s the old, rotten, moldy “Mex” weed shipped in from Mexico in bricks, as opposed to the home grown hydroponics that has become the California standard and widely available at medical marijuana dispensaries and grown in closets by hobbyists. When I finally did quit smoking weed every day a few years later, I joined 24 Hour Fitness and started working out five days a week to get in shape. Every morning in the shower I would cough up some tar and spit on the white shower wall to see how nasty it was. Within several months the tar balls were much smaller, but I could still see black residue in my spit.

For over a year I would still cough up black tar in the morning. A year! And this was with me working out five days a week. I started worrying that I had a tumor or something in my lung that was producing the black stuff I was coughing up because it just kept coming. Finally after a year or so my lungs were clean. I’m not saying I won’t take a bong hit or eat a brownie ever again, but the wake and baking and 24/7 pot smoking had to come to an end.

Working as a Telemarketer One of the first real jobs I got in California was at a shady telemarketing company that promoted timeshares. Fred and I and my new friend Max, who I met at school in a philosophy class, all got hired at the same time. There was a group interview and the company hired a bunch of people, and their lack of standards caused them to hire us. You can probably imagine what a telemarketing company is like, it’s mainly just a huge room full of desks and phones and people making unsolicited phone calls all day to promote whatever crap it is they’re selling. The job was a weekend job only on Saturdays and Sundays for about six hours each day, and the first day on the job we smoked a huge blunt (a cigar filled with marijuana) on the way to work and arrived nice and high. We were all given phone lists of people to call to try and rope in to buy a timeshare, but nobody really seemed to be interested. 99% of the people would hang up on us or yelled at us for calling them. This just wasn’t going to work, so we started making prank phone calls to random people and enjoying ourselves. It was much better than pitching timeshares. The three of us just sat around laughing all day, and it was clear that we were not doing our job. On our break we would go out back and smoke more weed by the dumpster and would come back in reeking of marijuana and just screw around for the rest of our shift. One time the manager came in and started yelling at us, and we all just started laughing uncontrollably at him because we were so high we couldn’t contain ourselves. Right to his face! We all got fired. What a surprise.

Telling My Boss Off Over the Loudspeakers Once I recorded an audio CD of me telling a story about how messed up the furniture store was that I worked at and how incompetent most of my coworkers were. I laid my audio track on top of the creepy theme song for Unsolved Mysteries and burned it onto a CD and brought it to work the next day and put it in the company’s stereo system and set it on repeat. After turning the volume up all the way, I closed down the building and went home for the night while the CD was blasting on repeat inside throughout the entire building—my several minute rant, repeating, over and over again. I was yelling pretty loud in the recording since I was venting months of frustration. It was awesome. The next morning the manager came to work and unlocked the door only to be greeted by my voice yelling over the loudspeakers how pathetic he was and how pathetic the company was. It was a good three minute rant detailing the failures of the company in a shocking and vicious attack set to music which multiplied its effect. They didn’t fire me because they needed me since I was a great salesman, and like I said, pretty much everyone else there was incompetent. The company went bankrupt a few months later. I saw the writing on the wall as clear as day and my CD was an omen for everyone else to hear.

Turning Twenty-One A funny thing happened when I finally did turn twenty-one, after six years of hardcore drinking and partying since freshman year of high school. Fred, Diego and I went to our favorite grocery store to stock up on plenty of beer to celebrate, and the girl at the cash register made a comment about how we must be having a big party because of all the beer we were buying. “Yeah it’s my birthday,” I told her. “How old are you?” she asked. “Twenty-one,” I responded. “Twenty-one?” she said with a puzzled look. I had been buying beer from her regularly for the last four months ever since I moved to California. I was such a frequent customer that we were on a first name basis and she didn’t even bother to card me anymore because she knew who I was. She

looked at me with a strange face after I told her it was my twenty-first birthday. “I was using a fake ID all of this time,” I told her as a grinned. “But I’m twenty-one now.” She just shook her head and rang up my beer. I think she just wanted to sleep with me.

Miscellaneous California Craziness A friend of Diego’s from work named Demetrios invited us over for a party one night that he and his roommates were having and it was a good time until I offended one of his roommates by saying that Mexico was a complete dump. (I think I called it a complete shit hole to be exact.) Have you ever been to Tijuana? It is a complete dump, and when I happened to mention this fact, before I knew it, Demetrios’ roommate was holding a knife to my throat. He was a Mexican and took great offense to me saying that Mexico was a shit hole. I told him I was new to California and that I was a hick from Wisconsin and I didn’t mean anything by it and thankfully he put the knife away and told me I better not say anything bad about Mexico again. The truth hurts sometimes, you know. We didn’t know it at first but Demetrios was a complete scumbag and liked to snort crystal meth and hang out with strippers who also enjoyed doing drugs. One night when Diego was hanging out at his place a couple guys walked in and pulled guns on them and started yelling about the money Demetrios owed them. That was pretty much the end of our friendship with Demetrios. My 1981 AMC Concord was having some problems since it was getting old. The power steering pump was leaking pretty bad, and since power steering fluid was fairly expensive, I just started pouring motor oil in it and the pump would start working again for a week or so and then I would have to add more oil, but after a while even that got too expensive, so I just starting filling the power steering pump with water. It actually worked. (If you don’t know anything about cars, this is a completely asinine thing to do.) If there was no power steering fluid in the unit (or in this case, it was now water) then I could barely turn the steering wheel. I could still drive the car, but it was very difficult to turn, especially when getting into (or backing out of) a parking space. Conventional wisdom would say that doing such a

dumb thing as pouring water into a power steering pump would cause it to rust and seize, but it actually worked fine and I was able to sell the car a few months later before things really started going wrong with it. Diego came running back up to our apartment after taking out the trash one day frantically saying that the dumpster was on fire, and he grabbed a bucket and filled it up with water from the kitchen sink and ran out there and dumped it on the flames, and I grabbed a pitcher from the cabinet and filled it up with water and followed right behind him. We called 911 to tell them what was happening because the flames were getting pretty high. As we waited for a fire truck to arrive, we continued running back and forth from our apartment to the dumpster with buckets of water throwing them on the flames. Luckily we were able to put the fire out. If Diego hadn’t went out there to throw something away and saw the flames, then it would have only taken a few more minutes before they spread, lighting the car port on fire, and then who knows what else. Just as we breathed a sigh of relief we noticed that another dumpster across the parking lot was on fire too! We frantically put the flames out with more buckets of water from our kitchen sink. The fire department didn’t arrive until after we had put the second dumpster fire out. Some idiot in our complex had deliberately set them on fire! I don’t know if they ever found out who did it, but when they tried to raise our rent a few months later I sent the rental agency a nasty letter telling them how we had saved the complex from burning down and they decided to keep our rent the same. Somehow despite my constant pot smoking, my lack of money for the first few years after I moved to California, and living in a crappy apartment in a dumpy part of town seven miles from the beach, I was able to hook up with two out of the three hottest girls at my college. I made only slight progress with my number one choice who was the most beautiful girl on campus, but she had a boyfriend who she had met on vacation in Cancun or the Bahamas or somewhere, and she planned on moving to Tennessee to be with him. She was crazy, and her roommate thought she was crazy, and since she barely knew the guy, I figured I could convince her not to make the foolish move to Tennessee to be with him.

After making it clear I was perusing her, she invited me to come and work out with her at 24 Hour Fitness one afternoon, so I worked out with her and her two friends, but I didn’t get anywhere with her. She was actually the reason I joined 24 Hour Fitness so I could go and workout with her, so at least something good came out of me perusing her, and landing two out of the three hottest girls on campus still isn’t bad.

The Fun Couldn’t Last After Diego moved in with Fred and I in January, he was the voice of reason we had been missing. He had always been the most responsible of the three of us. Where Fred and I fed off each other’s insanity, Diego could see we were out of control. He had gotten a real job at a business nearby, and I was going to a community college looking to transfer to a university in a few semesters, but Fred still held onto the hope that we could come up with some business opportunity so we would not have to get real jobs. While all three of us drank frequently, Fred’s drinking was getting out of control. Since he didn’t go to school or have a car or job, he would just surf the Internet all day at our apartment and drink and smoke weed. When I would arrive home from class in the afternoon, he was already pretty wasted. Even though I was smoking weed every day and wasn’t the most responsible person in the world, I could see that Fred was spiraling out of control. He would pass out on the floor every night at about 6 or 7pm after drinking all day and was just a mess. Since we were all running out of money, we were drinking boxes of Franzia wine since it was so cheap. Franzia is that bargain box wine that everyone makes fun of. We would buy three or four boxes at a time because beer was getting too expensive. I ended up getting a job at a bookstore at the mall, and after a few more months Fred moved back to Wisconsin. His dad offered him a job with his construction company and wanted him to take over the business in a few years when he retired. It seemed like a good gig, and Fred didn’t want to turn it down. Diego and I were both relieved that we did not have Fred in our lives anymore. Even though I had been a large part of the madness and Fred was one of my best friends, even I realized that he and I were going down the wrong path. Even though I still liked to party, I was beginning to

learn how to balance it with being a responsible student and started thinking about my future career. Shortly after Fred moved out, Diego moved in with his girlfriend who he would later marry and I got my own studio apartment and transferred from the community college to a university to get my bachelor’s degree in communication. The most insane chapter of my life was finally over. I would not entirely leave the madness of the past behind me, however. In the coming years it reared its ugly head a few times like the ghost of Christmas past reminding me that I still had some work to do to straighten myself up.

New Year’s Eve 1999 By the end of 1999 Fred had been living back in Wisconsin and working for his dad but came back to San Diego for the historic New Years Eve of 1999 as we left the twentieth century behind us and entered the year 2000. Curt, Diego’s old roommate from freshman year of college, was also in San Diego for winter break and all of us decided to go to downtown San Diego for New Years. Diego had bought a small Ford Ranger truck by this time, and I was too messed up to drive by the time we left for downtown, so Diego decided to drive his truck that night because he was worried if he drove my beat up old car with the out-of-state license plates on it that it may draw suspicion causing him to get pulled over by the cops. I told you he was the smartest out of the three of us. Diego and Curt rode in the cab of the truck, and Fred and I ducked down in the back as we headed downtown since all four of us couldn’t fit up in the front. There’s nothing like laying down in the bed of a truck looking up at the night sky when you’re wasted as you’re flying down the freeway to reinforce the idea that you’re not normal. We ended up going to a bar and grill called Dick’s Last Resort to celebrate the big event. Fred got thrown out within an hour or so for saying something insulting to a bartender because she was too slow in getting him a drink, but he was able to sneak back in without notice. I brought a few pre-rolled joints which we would occasionally smoke outside in the courtyard and we did this a few times without notice, but our luck later ran out.

The four of us were standing around out there smoking a joint (except Diego who didn’t smoke weed) when the bouncer who threw Fred out spotted him and grabbed him, pushing him towards the exit. Another bouncer who came over for backup noticed Curt was holding a lit joint and so he grabbed Curt and threw him out too. Curt had a drink in his hand which spilled on Diego as the bouncer grabbed him, so Diego started swearing at him and so he signaled to another bouncer and he grabbed Diego and literally pushed him out the door too. Three out of four us had just gotten thrown out in a span of about 15 seconds. I then followed after the bouncers as they shoved everyone outside and we decided to call it a night and go home. At least it was after midnight and we had made it to the New Year.

Almost Missing College Graduation Since I didn’t have a high school graduation technically, since I was not allowed at the ceremony, my college graduation was extremely special to both me and my parents. After all, I had never worn a cap and gown before so this was a big occasion. My parents had flown to California from Wisconsin for the ceremony and before I arrived, a bunch of friends and I met at a local bar to tip back some beers and get a nice buzz on to celebrate. An hour later I led the procession to the ceremony, and just as I was pulling into the parking lot, I rear-ended the car ahead of me and both of my airbags blew out. I wasn’t going that fast, but it was still fast enough to trigger the airbags. The plastic flap covering the airbag on my steering wheel practically sliced into the side of my arm as it flew open and I immediately had what looked like road rash covering part of my forearm from it scraping me. The airbags also stunk really bad and were very loud when they deployed. The car I hit had been pulling into the parking lot too, and so I followed it in and parked alongside of them. As we got out of our vehicles and inspected the damage, which was barely noticeable, I was in my cap and gown so they knew I was graduating, but I doubt they had any idea that I had been drinking. I’m sure I was over the legal limit, and I started worrying that the cops were going to come over to investigate and realize I was drunk.

I started to have visions of my parents sitting in the audience waiting for that proud moment when their son finally walked across the stage and got his diploma, but when my name was called, I was nowhere to be seen. I had to get out of there and get into the ceremony before I got arrested. Ever since my DUI years earlier, I had been very careful not to drink and drive, but this was graduation, and the ceremony was only a mile or so away from the bar, so I didn’t think it would matter. I had a few hundred dollars on me and I offered to give it to the driver of the car if they just forgot that this happened, and I told them I had to get going for the ceremony. The guy driving the car wanted to take it in to get an estimate for the stupid little scratch I left on his bumper, so we exchanged information and I told him that I would just pay for it out right if they sent me the bill because I didn’t want my insurance company to get involved. Word spread at the ceremony that night to everyone in my department about the accident, and everyone kept asking me if I was ok. Aside from the scratch on my arm from the airbag, I was fine, but I was a little shaken up and started having flashbacks of my DUI arrest several years earlier. I really had been careful not to drink and drive since my DUI, but like I said, this was graduation, and I was only driving a mile down the road so I didn’t think it would matter. This was almost the last straw that scared me straight once and for all. What would happen two weeks later would make sure I never returned to my reckless and irresponsible ways.

The Bachelor Party We Would Never Forget Diego, who had been living with his girlfriend for some time, was getting married. His relationship with her had helped save him from wasting his life away like Fred and I had been doing when we were all roommates. By this time, Fred had moved back to Wisconsin several years earlier and had a steady girlfriend and a job, and I just graduated college two weeks before the wedding, so it felt like we were all finally growing up. Almost all of the craziness we were involved in was a thing of the past. Normal life awaited us. Family and friends of the bride and groom all flew out to California for the beautiful outdoor wedding. Two days before the big day we had Diego’s

bachelor party, and since he was the first one of us to get married, it had to be epic. Our crew was finally reunited for the first time in years. It was Diego, Fred, John (my college roommate from sophomore year who was involved in the puking in the flowers incident with me), Carl (the guy who wanted to steal the dead cats from the dumpster at school and throw them in a teacher’s yard), Ken (whose car door got a hole punched in it when Fred threw a construction barricade at someone’s mailbox as we drove by), Curt (Diego’s roommate from freshman year, whose parents let Fred and I stay with them when we first arrived in California), Diego’s younger brother (who didn’t really cause any trouble), and myself. We decided to go to downtown San Diego and hit up a club, and we got a stretched Ford Excursion limo for the ride. We would be getting extremely drunk this night, so we wanted to make sure nobody would get a DUI, and who doesn’t like to party in the back of a limo? Before we arrived downtown, we stopped off at a strip club first. On the drive downtown there was a porno playing on the television located at the front of the limo, and we were drinking and batting around a blow up doll that Ken had bought for the party. When we got out of the limo at the strip club we could see the porno playing on the TV through the tinted window. Because the TV was fairly bright and right next to the window, the picture clearly shined through since it was dark outside. We all started laughing, wondering what the cars had thought that were driving next to us on the freeway since they all could see the porno playing though the window. It was turning out to be a great night. We did the strip club thing, and almost got thrown out after Diego did a back flip on stage after the strippers pulled him up there when they learned it was his bachelor party. Fred then commented that, “This is the kind of night that could end up like some fucked up movie.” Little did we know at the time, but he was right. What would transpire later in the evening was even more fucked up than anything we could imagine. After the strip club, we had a good time at On Broadway, a club downtown, and on the way home we enjoyed sticking the blow up doll out the window and yelling at people walking along the streets. The limo dropped Diego off back at his apartment, and a few other guys at their hotels, and Curt, Ken

and I crashed at Curt’s parents’ house since they were out of town. This was the beautiful multimillion dollar place on top of a huge bluff right next to the ocean where Fred and I stayed (freeloaded) for a few days when we first arrived in California. Curt went to bed and Ken and I sat out on the patio furniture near the edge of the bluff admiring the view. It was pretty late and we were wasted from a great party. Ken had his feet sitting on top of the table and was slouched back in his chair, looking like he was about to pass out soon. After a little while I got up to go to bed and told him not to fall asleep out there because it was pretty chilly. I crashed in Curt’s sister’s room since she was out of town with the parents and the next thing I knew the door bell was ringing and it was morning. Early in the morning. Nobody was answering the door and it kept ringing so I got up to see who it was. To my surprise there stood a police officer. “Was there a party here last night?” he asked. “No,” I answered. “We had a bachelor party, but we just took a limo downtown, we didn’t party here,” I added. It was only the three of us, Ken, Curt and myself who came back to Curt’s parents’ house, and we weren’t loud at all, so I didn’t know why the cop had come over. “Somebody fell off the bluff last night,” he said, “and we think it was from a party at one of the houses up here.” I still didn’t know what he was talking about and wondered why he was telling me this. He then went on to tell me that the person who fell off the cliff had died. I was still pretty much drunk, and this was real early in the morning so I wasn’t thinking clearly. I didn’t understand what he was getting at. The cop then asked me to make sure everyone in the house was accounted for, so I opened the guest room door to see if Ken was sleeping in there, but the room was empty. I found Curt upstairs sleeping in another bedroom, and I looked around the house to see where Ken had crashed but I couldn’t find him. I thought maybe some of the other guys had picked him up and went out to breakfast, so I tried calling his cell phone but he didn’t answer. The police officer then started describing what the guy looked like who had fallen off the cliff. It sounded like Ken. “I’m really sorry,” said the police officer, “but I’m pretty sure it was your friend.”

My eyes started welling up with tears as I remembered him sitting out there at the table, which was only 10 or 15 feet from the edge of the cliff. There was no railing at all, just a huge drop-off to the ocean below. I started having flashes of images pop into my mind imagining Ken getting up out of his chair to come inside and stumbling and falling over the cliff. I then had a wave of images flood my mind of the wedding that was scheduled for the very next day. Curt was in such a stupor from the previous night, he wouldn’t wake up. I would shake him and he would just mumble incoherently and groan. I called Fred on his cell who was with his girlfriend at their hotel room and I told him to get back to Curt’s house immediately. Of course he asked why, and I told him I would tell him once he got there, but that he needed to get there ASAP. He could tell by my tone that something was very wrong. What was I going to tell Diego? Ken was one of the groomsmen, and one of our best friends. How could we explain this to Ken’s mom? How could we tell everyone who came for the wedding? Would there still be a wedding? It didn’t even make any sense to us. We were in shock and weren’t sure what happened. Fred cracked a beer and started drinking to relieve the stress. It was probably 7:30am. A bunch more police and firefighters came to the house along with forensics people, and they were able to determine that Ken decided to walk down the bluff to go to the beach and fell to his death at the point where the cliff drops off in a concave cutout from the crashing waves below. With no railing to deter anyone from walking down the back yard toward the beach, and in the fog and in the dark in of night, nobody could see where the hill suddenly drops off. The coroner said alcohol was not a factor and that visual conditions on the horizon where the water meets the sky causes an optical illusion making it difficult for a person to get their bearings straight in the dark because there are no points of reference. As he made his way down the moderately sloped back yard in the fog, he was unable to determine where the cliff dropped off until he already stepped off with one foot, losing his balance, and falling to his death on the hard sand below. The homeowners were really negligent for not having any kind of railing to discourage people from walking down towards the beach there. Pretty much every other house on that bluff had railings. This one had nothing. The

backyard just led to a slope which later dropped off. It was very deceptive and it’s hard for me to describe if you haven’t seen it for yourself. The bottom line is, if there was a fucking railing like there should have been, then this would have never happened. Those dumb fuck negligent homeowners! I decided to call Ken’s brother instead of his mom, since it would be easier to break the news to him. He was a few years older than us and was in my brother’s class. How do you call one of your best friend’s moms and tell her that her son, who just flew out to California for a wedding, died at the bachelor party? Calling Ken’s brother was the most difficult thing I had to do in my life. Shortly after I told Ken’s brother what had happened, Ken’s mom called me to try and piece things together. We weren’t even sure what had happened at this point, so it was very difficult for her to make sense of it. It was hard for all of us to wrap our minds around what had just happened. The next most difficult thing was calling Diego to tell him what happened. After I told him he asked me if I was serious, and when I said I wasn’t joking, he smashed the phone against the wall and rushed over to Curt’s house. After all the forensics investigators were done tracing Ken’s steps down the bluff, they all left and we stood in the back yard dumbfounded. Ken had already picked up his tuxedo from the rental shop, so on my way back to my apartment I brought it with me, unused, still in its plastic to return it. “Why didn’t you need it?” the guy at the store asked. “He’s dead,” I answered. What else could I say. He must have seen the dazed look on my face and knew I was serious. The wedding went on as planned, and surprisingly we had a good time. Ken was always the life of the party, and he certainly wouldn’t want us to get all depressed and have a bad time at the wedding, so we partied it up to celebrate Diego’s wedding and to remember all the good times and trouble we had gotten into with Ken when we were younger. I ended up hooking up with Diego’s cousin, who was single and extremely beautiful, so that really helped me get through the night too. She was a hot blonde who flew in from the Midwest for the wedding and didn’t have a date.

A week or so later we all gathered back in Wisconsin for Ken’s funeral. It was like a class reunion. Almost everyone from our school was there. Ken was pretty popular and everybody loved him, and our whole town was in shock at what had happened. Everyone felt bad for us too, and especially Diego and his wife. The whole thing was so surreal, and it was so messed up, I just didn’t know how to deal with it. I couldn’t get it out of my head. The bachelor party, the bluff, the police, Ken, the funeral, it all just kept swirling around in my brain. This happened around the end of May, and for that entire summer I just smoked as much pot as I could to try and get my mind off it. I didn’t even go to the beach that summer, since Ken had died on the beach; just being there made me think of his dead body lying in the sand. I had loved the beach and went there at least once a week for years, but that summer I didn’t go at all and I was as white as a ghost from not getting any sun. We had done everything we could to be safe that night. None of us drank and drove like in the past. That’s why we got the limo to make sure everyone was safe, but somehow, the night still ended in tragedy. I wondered for a long time what the message was in this tragedy. What was the lesson to be learned? Why would God allow this to happen? I realized that you never know when you’re gonna die, or when the ones you love are going to die. Despite every precaution, when you least expect it, and in the most unanticipated way, someone’s life can be lost. You know they say that shooting stars burn out bright, and Ken certainly was a shooting star. He was the life of the party, a ladies man, everyone’s friend, and an all-around great guy. I was very lucky to be friends with him. He really knew how to get the most out of life and after I was able to shake off my depression, that’s what I started doing.

Looking

Back

On It All

Of course it was extremely juvenile, immature, reckless, disrespectful, dangerous, stupid, rude, foolish, moronic, idiotic and illegal to do some of the things I did growing up, and one may even argue that writing this book is almost just as bad. Regardless of how bad some of the more questionable activities were that I was involved in, you gotta admit that a lot of them were pretty cool, and if they entertained you by just reading about them, just imagine how cool it was for my friends and I to actually do them! Writing this book was really just a trip down memory lane for myself. As I would write down the stories and review them and edit them, they were so clear in my mind it was like they just happened yesterday. And who wouldn’t like to relive their childhood, a time when you had no responsibilities and you didn’t have to worry about things like your job, bills, retirement, scumbag politicians, insurance, your health, and the dozens of other things that can bring you down when you get older. When I was working on this book some people asked me what the point of it was. The point is, it was fun for me. The point is also to entertain you; to bring you back to your own childhood for a few hours; to show how creativity that is not properly channeled can be dangerous and illegal, and also to let parents know that if their kids seem to be crazy and out of control, there is hope for them that they can find a way to use that energy to better themselves, make a decent living, or even change the world in a positive way. In movies and comic books, super heroes and villains could almost always be the same person, but one of them took the wrong path at some point in their life. If Batman took just a slightly different road in life, he could have been a very dangerous criminal mastermind. If the TV serial killer Dexter had a different moral code, he would have ended up killing innocent people instead of killing murderers who slipped through the justice system and had gotten away with their crimes. Great men throughout history like Martin Luther who initiated the Protestant Reformation, the civil rights leader Martin Luther King Jr, founding father Benjamin Franklin, and countless other men and women we see as heroes today, were actually trouble makers who caused trouble for

the right reasons. Trouble making is a talent and a skill that can be used for either good things or bad. I’ll never forget an old guy named Laurence who was a pharmacist at a local pharmacy that I worked at when I was in high school who years later told me, “I always thought one day you’d be famous or in jail.” He said this when I had bumped into him ten years after we worked together. Laurence saw that I had a lot of potential when I was young, but he wasn’t sure how I would use it. You may think that because I worked at a pharmacy when I was in high school, that I would steal all kinds of pain killers because I liked to party, but honestly I never stole a single pill ever. I respected the owner, and I would never do anything to cheat him or steal from him. I did have a conscience and a code of conduct, believe it or not. Popping pain pills never really appealed to me either. I was also a late bloomer. I wasted a lot of time, money, and energy before finally shaping up, and could have gotten into much more trouble than I did if I hadn’t been so lucky not to get busted for the numerous stupid things I had done. In the hilarious film National Lampoon’s Van Wilder , the main character, Van, (played by Ryan Reynolds) has been in college for seven years and still hasn’t graduated yet. Seven. He’s not a loser, in fact, he’s the furthest thing from it, and everyone at his school loves him. At one point he is asked by an adult, “Surely you have a career in mind,” to which he answers, “Not really. I’m still looking for that dare-to-be-great situation.” Later on, Van Wilder loses faith in himself for not finishing college after so long and says he hasn’t accomplished anything and almost drops out before realizing his true potential and his purpose in life which was to inspire others and bring the best out of them. While Van Wilder took seven years to graduate and figure out his purpose, which he had been doing all along without realizing it, I took 8 years (and a summer school session) before the big day came for me. I didn’t finish with a master’s degree or a doctorate, but with a simple bachelors in communication. In my defense, I did attend four different colleges in five years and changed majors twice so a lot of credits didn’t transfer from one school to the next. I had attended three different schools in three years, and then two years later I transferred again

to my fourth and final school. My point is, I was like Van Wilder, and I almost lost hope for myself as he did as the years went on. In the past there was no message behind my madness, but as I grew older and wiser and through the tragedy of Ken’s death, my legal troubles from my DUI and underage drinking, my personal failures and my quest for spiritual understanding and inner peace, I was able to find a new direction in my life. As I started to finally grow up and calm down, all of the trouble in my past began to feel like it wasn’t even me. While some of the things I’m proud of, some of them I’m completely ashamed of too. My only defense is that I was young (under 21 for most of the madness) and I was stoned for probably 80% of it. Luckily I found an outlet for my creative energy in the form of writing books and making YouTube videos about politics and pop culture. I certainly never “grew up” and stopped causing trouble. I just found a worthwhile cause that I could put my creative energy into. A lot of the things I studied in college about mass media and communication were exactly what I needed to understand the world around me and provided fuel for my fire. Your “cause” doesn’t necessarily have to be exposing political corruption or pulling back the curtain of the mainstream media propaganda machine that shapes our culture like I have been doing. You could channel your energy into a skill, a career, a hobby, a relationship, art, education, or any number of other positive things that could be very beneficial for you and others. Just think about how big of trouble makers actor Jim Carey or Apple Computer founder Steve Jobs must have been before they fully developed the ability to channel their energy into something productive or were provided the proper outlet for their creativity and energy. After I grew up and finally started to get my life on the right track, I also realized how smart my dad really was. My brother and I always thought he was old fashioned and out of touch when we were kids, but the older I got, the more I realized how wise he was. He was able to provide a nice house in a good neighborhood in our small little town, my mom was a stay at home mom for our entire lives after leaving her career as a teacher to raise us, and we took a family vacation pretty much every year to somewhere different

around the United States. Don’t think we were some first class jetsetters or something. The family car was a Chrysler K car with vinyl seats and no air conditioning, so some summer vacations were not exactly pleasant at times when the temperature was in the 80s or 90s! We didn’t have that much money and were only average middle class, but the wisdom and frugal decisions allowed my dad to provide for us, and enabled him to retire in his 60s, which not everyone can do. I could only hope to accomplish what he did in life, and create and manage a family like he and my mom did. My mom is equally fantastic and loving. She’s done a lot of volunteer work around the community with various gardening projects and events, and is just a great person. My mom and dad are also fantastic moral examples of what good people are like. None of my trouble making should be blamed on them or their parenting. It was all my fault. Sometimes there’s nothing a parent can do to prevent their kids from doing crazy things no matter how loving, intelligent, or harsh disciplinarians they are. Boys will be boys. Most of the time parents don’t even have a clue what their kids are actually doing and couldn’t stop them anyway if they tried. My parents are the nicest, most loving parents anyone could ever ask for, so maybe I just couldn’t contain myself from the normalcy at home when I had so much energy and so many ideas bouncing around my brain I just wanted to scream. I feel really bad for putting them through everything that I did— from them having to pick me up at the police station, having to come in for conferences with the school principal, not to mention my countless detentions and having to worry what the heck I was up to when I didn’t come home until 2 o’clock in the morning on the weekends. I have since apologized to them and they accepted it and actually said they were glad the way I finally turned out! Looking back on it all, there’s not much that I would actually do differently, believe it or not. I had a lot of fun. I wouldn’t have been so careless with certain things like drinking and driving, and I would have kept the pot smoking under a little more moderation. I certainly spent too much money on marijuana, but perhaps like many others, I needed the self-medicating because of my over-active mind that raced with the possibilities of my future, yet I was stuck in a small town in the middle of nowhere. If I was

more focused on school I could have earned a master’s degree in less time than it took me to get my bachelors, but then again I did attend four different colleges as I tried to figure out what I wanted to study and where. Who attends four different colleges? Well, I did. I know you shouldn’t dwell on the past, and I certainly had a lot of fun, I just wish I was able to bridle my energy sooner than I did. So if you are young and on the same path I was, I warn you. It seems those older than you always try to tell you some great bits of wisdom so you don’t make the same mistakes that they did when they were young, but it seems that the ears of the young never listen to this wisdom and only realize how right their elders were when many years later, they are the elder and having missed the boat they then try to impart that same wisdom onto the youth in their life, which also tends to fall on deaf ears as it did on their ears when they were told so long ago by someone trying to help them in this mysterious cycle of life. Despite most teachers hating me, or just hoping for the day when they wouldn’t have to deal with me anymore after graduation, there was one high school teacher who saw the potential in me and did what he could to help me find an outlet for my chaotic energy. He was my homeroom teacher, Mr. Garett. For whatever reason, he treated me with respect and seemed to take special notice of me by delegating minor tasks to me during homeroom sessions. Instead of feeling like he was poking his nose in my business or trying to keep an eye on me, he was always cool. When I was in a study hall during final period, oftentimes he would write me a pass so I could get out and go use the weight room which helped keep me out of trouble, not to mention, in shape. I couldn’t sit quietly for the final hour of the school day in study hall! I would have gotten a detention every few weeks, so Mr. Garett really saved me some extra aggravation I didn’t need, and I really enjoyed working out, so it was a win/win situation. It’s teachers like Mr. Garett who go the extra mile for the “troubled” or “at risk” kids that most other teachers have written off as bad apples with no future who help kids like me realize that we are not worthless trouble makers destined for jail or a lifetime plagued with problems, we’re often

just kids who need an outlet for the abundant energy surging through our minds and bodies. Well, I hope that you were entertained by my stories, and I hope that you learned something from them too. They say you learn more from others’ mistakes than you do from your own, and if that’s true, then you just got an incredible education! There’s almost 250 pages of mistakes right in your hand, one right after the other! Anyway, may your own trouble making be balanced with a conscience, respectable boundaries, and style! And make sure your trouble is designed to be creative, funny, and thought provoking; never dumb, dangerous, or destructive. Now put this book down and get out there and start Causing Trouble!

Also by Mark Dice: -The Illuminati: Facts & Fiction -The New World Order: Facts & Fiction -The Resistance Manifesto -Big Brother: The Orwellian Nightmare Come True

Connect with Mark on: Facebook.com/MarkDice Twitter.com / MarkDice.com YouTube.com/MarkDice MarkDice.com

Connect with Mark on:

Facebook.com/MarkDice Twitter.com / MarkDice.com YouTube.com/MarkDice MarkDice.com

Introduction

The Illuminati is either called a “conspiracy theory” or a “conspiracy fact,” depending on who you talk to. Those familiar with the Illuminati secret society may tell you that it is a criminal and diabolical network of some of the world’s most wealthy, educated, and elite bankers, businessmen, and politicians, who work behind the scenes to gain and maintain high levels of power, enormous wealth, and wield control over the world. The list of claims that come along with this monstrous conspiracy are vast, and range from the Illuminati being an elite good-old-boy network looking out for their own interests (often at the expense of others and in unscrupulous ways), to claims that they are actually alien beings from another galaxy who masquerade as humans, drink people’s blood to survive, and are working to prepare planet earth for the arrival of the Antichrist who will rule the New World Order as a god, offering those who worship him “eternal life” through transhumanist technology merging man with machine.

In this book I will help you get to the core of the conspiracy by providing you with some of the original evidence proving the existence and activities of this infamous group, dating back to the late 1700s in the state of Bavaria, Germany, and as more and more evidence is piled up, we will slowly move into the present day, proving beyond a reasonable doubt that the Illuminati is still fully operational, and many of the “conspiracy theories” are actually true.

This analysis is a supplement for my previous book, The Illuminati: Facts & Fiction and will continue to investigate and examine the many allegations and conspiracy theories associated with the Illuminati. Since the subject matter is so vast, this second volume was required to continue my analysis of the wide-ranging claims and evidence connected to the “Illuminati conspiracy.” I am dedicated to separating the facts from the fiction, since buried within the mountain of “conspiracy theories” circulated

on this subject, there is a considerable amount of irrefutable evidence that there is indeed a powerful “Illuminati” secret society that is operating today in America and around the world.

There is also a large amount of wild speculation, half-truths, and outright lies about what the Illuminati is doing, who is involved with them, and what evidence is available. Some people dismiss the idea that there is a “conspiracy” at all, and do not even believe such a thing exists, because when an educated and rational person comes across some of the more outrageous (and clearly false) allegations stemming from the Illuminati conspiracy, they just shake their head in disbelief and get the impression that all the allegations and “conspiracy theories” must be false as well; thinking such claims must have come from equally mentally deranged people who purport some of the more far-fetched and fabricated information as “evidence” and “proof.”

In this book I will present to you a rational approach to the idea of an “Illuminati conspiracy” and I will discuss the historical evidence of the original, admittedly real, Bavarian Illuminati and the roots of this secret society that has spawned countless tales of its power and reach. I will also cover many of the affiliated secret societies that were not examined in my previous book and will continue to investigate various people who claim to be actual former members. We will also look at some political elite insiders and see what they have to say about the Illuminati and the idea that a secret society of powerful men is posing a danger to the world and to our freedoms. Skeptics of an Illuminati conspiracy will be very surprised to learn the names of some prominent people throughout history who have made startling statements clearly revealing their conviction that the Illuminati is real and poses a danger to us all.

I don’t like to use the word “conspiracy” because it has a negative connotation that this material is just a “conspiracy theory,” when in fact, I do very little theorizing at all. The terms “conspiracy theory” and “conspiracy theorist” have become a pejorative, which means they have a negative connotation and are used to insult people and shut down the discussion, similar to someone screaming “racist” at someone in attempts to

bypass critical thinking and cause a knee jerk reaction to paint them as such, when in reality they simply have an opposing political ideology on a particular issue. Much to some people’s surprise, many “conspiracies” are actually real, and the dictionary definition of a conspiracy is simply, “an agreement by two or more persons to commit a crime, fraud, or other wrongful act.” People are actually charged with “conspiracy” in criminal courts every day for simply “conspiring” or planning to commit a crime.

Conspiracies happen on a small scale such as when two people conspire to rob a bank, and on a large scale when the leadership of a powerful country fabricates a reason to go to war. Conspiracies are a fact of life. When researchers such as myself point out real, solid, irrefutable evidence that reveals a conspiracy, we are often attacked as “crazy tinfoil hat wearing conspiracy theorists,” because the term causes people to immediately dismiss the claims as a paranoid delusion imagined by someone on the Internet who lives in their mother’s basement. The reality is that actual conspiracy theorists can be found in high positions of power and conspiracy theories are put forth by well-educated people. Let’s not forget that Hillary Clinton publicly claimed that a “vast right wing conspiracy” was fabricating allegations that President Bill Clinton had sexual relations with intern Monica Lewinski.1 Hillary Clinton was being a conspiracy theorist, when in reality her husband Bill was having sexual relations with the intern, and there was no conspiracy trying to bring him down—it was only people reporting on the facts.

The Bush administration put forth a conspiracy theory that Iraq had weapons of mass destruction and were planning to use them on America and our allies, strong-arming the public into invading the country based on this conspiracy theory which was later proven to be 100% false.2 Not only was it false, but to be more accurate, it was actually a lie concocted to justify the invasion and war. As everyone now knows, there were no weapons of mass destruction at all, and Americans had been duped into going to war based on a conspiracy theory constructed by the US government.



Until the twenty-first century, most Americans had never heard of the Illuminati. Dan Brown’s novel Angels & Demons introduced millions of people to the group in 2003 (although his version was far from the truth and more like a purposeful disinformation campaign). And with the rise of the information age and social media, YouTube videos a click away, and countless websites popping up dedicated to the subject, more and more people became interested in this mysterious subject.

The 2004 presidential election in America brought John Kerry and George W. Bush together to face off for the presidency, both of whom are members of the Skull & Bones secret society headquartered at Yale University, which added fuel to this growing fire. I say that they are members, not were members, because Skull & Bones is not just a fraternity like they would have you believe, but is instead a post-graduate organization that gives its members access to one of the most powerful social networks in the world. This is how two Skull & Bones members were able to secure the nominations for both the Republican and Democrat party in the same election, so no matter which one of them won (George W. Bush or John Kerry), it would be a victory for Skull & Bones.

It was around this same time that “9/11 conspiracy theories” were growing, and the cover story for the War in Iraq continued to fall apart. The official story of the September 11th attacks and the expanding “war on terror” just wasn’t adding up. For the first several years after the World Trade Center was destroyed, so-called “9/11 conspiracy theories” were contained to the Internet, but around 2005 and 2006 they boiled over into the mainstream and found many high-profile supporters whose comments about 9/11 being an “inside job” couldn’t be ignored by the mainstream media.3

When people interested in investigating the massive inconsistencies in the official story tried piecing together what really happened that day, it inevitably took many “down the rabbit hole” to discover the various secret societies that all led back to the Illuminati. 9/11 would lead to Skull & Bones, which would lead to the Bilderberg Group, which would lead to the Bohemian Grove, which would lead to the Illuminati and a whole can of

worms that raised many more questions about what the shadowy elite of our world are doing behind the scenes was opened.

When one quiets their mind from the buzz of pop culture and mainstream media and steps back from their self-absorbed lifestyle and looks deeper into world events and the power structure directing society, they begin to see the world very differently. Once someone begins to understand that there is more than meets the eye in our world, and they discover the different branches of elite ruling class networks that all converge under one umbrella, their life is often never the same. People describe it as their awakening to what’s really happening in the world or “going down the rabbit hole,” or having their eyes finally opened.

If one truly wishes to learn about the history of the world, and about the driving force behind major world events, the economy, and even our very culture, then one must look into the Illuminati. At one point in history, in the late 1700s, when the Illuminati was first exposed, most people knew about them and the dangers they posed but as time went on and generations have passed, most people had forgotten about them. Sports entertainment and celebrity news had come to dominate most people’s minds and many had fallen asleep at the wheel thinking everything was just fine.

Just as many people used to doubt and deny that the Italian Mafia even existed, the same is true of the modern Illuminati. Ancient secret societies are admitted by mainstream historians to have existed and were not just social clubs for men looking to keep themselves entertained after work. They had a powerful function, even back then. Manly P. Hall, a very well respected secret society insider, explains, “The esoteric organizations of ancient times were for the most part religious and philosophical. In the medieval world they were philosophical and political. In the modern world, political and social.”4

He goes on to say plainly, “It is beyond question that the secret societies of all ages have exercised a considerable degree of political influence,” and that “a second purpose for secret societies was to create a

mechanism for the perpetuation from generation to generation of policies, principles, or systems of learning, confined to a limited group of selected and initiated persons.”5

For years, FBI director J. Edgar Hoover denied that the La Cosa Nostra or Italian Mafia even existed. Some believe the mob was actually blackmailing Hoover with compromising photos of him and his boyfriend Clyde Tolson, but for whatever reason, even the head of the FBI publicly denied there was any such thing as an organized criminal business network that had police, judges, lawyers, and other public officials on their payroll. All the denials changed in 1957 after a major mafia meeting on a farm in Apalachin, New York (about 200 miles northwest of New York City) was discovered, now known as the Apalachin Meeting.

The property was owned by gangster Joseph Barbara and the suspicious gathering of fancy cars and men in suits got the attention of a state trooper. Police surrounded the property and ended up detaining fiftyeight men, and for the first time there was indisputable evidence that the Italian Mafia did, in fact, exist. Many of the men were suspected or wanted criminals who claimed they were just meeting for a weekend barbecue. Of course police had a decent idea of what was really going on and the Mafia began to be unmasked. Some of the men tried to flee into the nearby woods, but most were apprehended. “Don Vito” Genovese, the leader of the Genovese crime family, had organized the meeting to delegate various gambling, loansharking, and drug trafficking operations.

More shocking revelations were to come a few years later in 1963 when a mobster named Joe Valachi, who worked for Lucky Luciano and the Genovese Crime Family for 30 years, testified before the McClellan Congressional Committee on Organized Crime and revealed in detail many of the Mafia’s operations. Valachi had hoped his testimony would help him avoid a death sentence for murder. His testimony shocked most people who could have never imagined how far-reaching the Mafia was, and how they regularly paid police and judges to look the other way. Joe Valachi’s congressional testimony also introduced the world to the term La Cosa Nostra.



Many people wonder if the Illuminati Mafia actually call themselves “the Illuminati.” I highly doubt it, although perhaps occasionally in jest. The Italian Mafia referred to themselves as La Cosa Nostra, which means “this thing of ours,” or “our thing,” so the Italian Mafia literally had no name. They didn’t call each other up and say “hey we’re having a Mafia meeting tonight, why don’t you stop by?” No. They just said, “we have to do our thing” and they knew what each other meant. While you will learn, the Illuminati did at one time call themselves “the Illuminati,” they have most likely abandoned this term long ago, and have expanded into various front groups to further their aims, and—like the Italian Mafia—speak in a language that is understood by each other, but doesn’t betray its true meaning to outsiders.

Many scholars, reporters, and government officials say that conspiracies “never work” because “it’s too difficult to keep a secret” and point to events like Watergate to justify their claims, but it’s foolish to believe that every major conspiracy which is attempted is botched, or that word of it would leak out somehow. It’s preposterous to assume that every group of conspirators are so foolish that they haven’t planned plausible deniability for their actions to convolute any investigation to the point of confusion if any suspicion is aroused or if any outsiders were to take a closer look into their activities.

The Manhattan Project (the atomic bomb program) began in 1939 and was kept secret for six years until the world witnessed the mushroom cloud rising up from what was the Japanese city of Hiroshima in 1945. The project cost $2 billion dollars (adjusted for inflation, that’s $26 billion in 2014 dollars) and 130,000 people worked on it in several different states,6 making it the largest project in American history, but it was still completed in secret. Lieutenant Leslie Groves of the Army Corps of Engineers who directed the project would later reveal in his book Now It Can Be Told: The True Story of the Manhattan Project, that, “compartmentalization of knowledge, to me, was the very heart of security. My rule was simple and not capable of misinterpretation—each man should know everything he needed to know and do his job and nothing else.”7



By giving different groups of scientists and engineers separate tasks and fabricating cover stories for what they were actually working on, those in the know were able to pull off their plan without any outsiders seeing the big picture. President Harry Truman, who was the Vice President under FDR, only became aware of the program after President Roosevelt’s death in April of 1945, when Truman was then sworn in as his replacement— that’s how well kept the secret was! Not even the vice president knew of this enormous and expensive life-altering plan! Four months after Truman was sworn in as president and let in on the secret, the bomb was dropped on the Japanese city of Hiroshima on August 6, 1945, and then three days later, the second one destroyed Nagasaki.

While enormous secrets can be kept by the political elite, they also sometimes leak out. The political elite often become arrogant because of their power and think they can get away with anything. How else could you explain John Edwards running for president in 2008, when he knew he had a newborn illegitimate child from an affair with his campaign’s photographer while his wife Elizabeth was dying of cancer? The Illuminati see themselves as the Gods of Mount Olympus, as literally having evolved into gods thanks to their occult knowledge, which often leads to arrogance and carelessness, causing some of their secrets to be revealed.

How did this “Illuminati” start, and how did they operate in the past, and more importantly, what are they doing right now? In short, the “priest class”—or what is considered to be the ancient Illuminati—dates back thousands of years to ancient Egypt and Greece, where Man’s unfolding intellect was kept hidden from the general public and reserved for “the elect” or the “sages” in what were called Mystery Schools. These fraternities taught the various sciences and philosophies to the intellectual elite who benefitted tremendously from this knowledge. Many believe that at one time in the ancient past, the Mystery Schools had the best of intentions but were hijacked and taken over by selfish and wicked men who used their superior intellect, not to help mankind, but to take advantage of people, morphing the once noble fraternities into a Gnostic mafia of sorts, keeping the majority of humans in the dark about the true nature of reality.



33rd degree Freemason Manly P. Hall claims, “With the decline of virtue, which has preceded the destruction of every nation of history, the Mysteries became perverted. Sorcery took the place of the divine magic.”8 There is a belief in esoteric circles that God or Gods, or extra-terrestrials, or even Satan, gave an ancient human (or small group of humans) some kind of secret knowledge, allowing him (or them) the ability to activate incredible powers latent in the mind, enabling them to become the first priests and kings. Many occultists believe this power can be traced back to the Atlanteans, the supposed demigods, who—according to the theory—are believed to have literally inhabited the Lost City of Atlantis.

These ideas, fraternities, and philosophies will be examined throughout this book. We’ll look into dozens of interconnecting esoteric circles from the ancient Mystery Schools of the Eleusians and Dionysians to the Gnostics, the Knights Templar, Jesuits, Freemasons, Skull & Bones, Bilderberg Group, Bohemian Grove, the Federal Reserve, and many lesserknown, but critically important, pieces of the puzzle as well.

What are the facts and what is fiction? How did it all start? What is the evidence for the Illuminati’s existence? What are their goals? Are they in communication with alien beings from another galaxy that secretly work with them and guide them in their evil ways? Are they themselves alien beings disguised as humans? You are about to find out as you dive head first Inside the Illuminati.







Early Evidence

When we talk about the Bavarian Illuminati, we’re talking about the group that a man named Adam Weishaupt founded in Bavaria, a southern state in Germany, back in 1776. Specifically he founded it on May 1st 1776, which is called May Day or Walpurgis Night, a date celebrating an old meeting of witches and sorcerers. May Day is also a major Communist holiday that celebrates the “workers of the world.” Almost 200 years after Adam Weishaupt ceremoniously founded the Illuminati on this day, Anton LaVey ritualistically shaved his head and founded the Church of Satan on May 1st 1966 as his way of celebrating this occult holiday.9

The Bavarian Illuminati was basically a reorganization and modernization of the corrupted ancient Mystery Schools. Weishaupt was a lawyer like so many corrupt politicians today, and in 1772 when he was twenty-four-years-old, he became a law professor at Ingolstadt University in Bavaria, Germany. A few years later he became the dean of the law department and began formulating his plan to launch the Illuminati.

He received his inspiration for forming his secret society from both the Rosicrucian manifestos and from the Jesuits (the zealous elite Catholic Society of Jesus founded in 1540). The Rosicrucian manifestos were books that first appeared in 1614 in Germany, and described an “invisible brotherhood” dedicated to the pursuit of knowledge and Hermetic and alchemical magic. No such secret society actually existed, but the Rosicrucian manifestos planted the seeds for such a thing in men’s minds, which was the author’s purpose (although not the tyrannical kind of organization that Adam Weishaupt conceived).

Weishaupt used his position at the university to begin recruiting students and others to join him in his quest to overthrow the ruling monarchs of his day and install a global communist system with him and his inner circle of associates as the new rulers. Originally he called his

group the Perfectabilists, meaning they aimed to “perfect” man by facilitating his “evolution,” but the name Perfectabilists was quickly changed to the Illuminati to fit in with the “enlightenment” theme of the era, since Illuminati is Latin for “the enlightened ones.” While he was growing increasingly successful at expanding his network and influence, it was only a matter of time before his secrets began to slowly leak out.



Original Writings Found

It’s indisputable that original copies of Adam Weishaupt’s writings were discovered and published for all to read. This is fully admitted in mainstream history books and encyclopedias, although few people care to take the time and actually look. Today, well over one hundred original documents are kept at the State Museum in Ingolstadt, Germany, where they are on public display.

Founder, Adam Weishaupt, wrote under the pseudonym “Spartacus” and all other members used pseudonyms as well, although many were identified after their letters were found and some defectors came forward. In 1784, eight years after the Illuminati were formed, a defector named Joseph Utzchneider gave a bunch of documents to Duchess Dowager Maria Anna, warning her of the organization and their goals of overthrowing the government and destroying religion. The Duchess, who was the sister-inlaw of the Duke, handed them over to her brother-in-law Duke Karl Theodore, the leader of Bavaria.

A seemingly farfetched tale regarding the discovery of more original writings involves a story about how an Illuminati member was struck by lightning and killed, and when his body was examined the coroner discovered some documents that had been stuffed in a hidden pocket sewn into his clothes. Adam Weishaupt fled Bavaria in 1785 and headed to a neighboring province when he saw the writing on the wall that authorities were closing in on him. He and his friend Jakob Lanz were riding on horseback on their way to Regensburg when Lanz was struck by lightning and killed.10

While this story is so bizarre, it’s understandable for people to dismiss it as a myth, but multiple historical sources report that this is exactly what

happened.11 But regardless, a treasure trove of documents were also discovered by other means as well.

On October 11th 1786 police searched the home of Xavier von Zwack, located in the city of Landshut (45 miles from Ingolstadt), where they found over two hundred letters including membership lists, symbols, carvings used to fake various wax seals used by princes, nobles, clergymen, and merchants; instructions on counterfeiting, committing suicide, recipes for poison, an abortion tea, invisible ink, and instructions for building an explosive strongbox that would blow up and destroy everything inside if it was opened by someone who didn’t know how to disarm it. One paper listed a method for filling a room full of a deadly gas in case they wanted to kill someone without getting their hands dirty.12 These documents were soon published by the government in a report titled Some Original Works of the Order of the Illuminati [Einige Originalschriften Des Illuminaten Ordens in German].

The following year in 1787 police searched the castle of Baron de Bassus and discovered more papers which were then published as a Supplement of Further Original Works.13 The next year in 1788 Johann Faber published The Genuine Illuminati [Der ächte Illuminati] which revealed the rituals for the Preparation, Novitiate Degree, Minerval Degree, the Minor and Major Illuminati Degrees.

In 1789 a French journalist named Jean-Pierre-Louis de Luchet published a book titled Essay on the Sect of the Illuminists [Essai sur la Secte des Illuminés] which denounced the Illuminati and said they controlled Masonic lodges throughout Europe.

In 1794 Illuminati whistleblower Ludwig Adolf Christian von Grolmann published The Latest Work Of Spartacus and Philo (Weishaupt’s and Baron von Knigge’s code names) [Die Neuesten Arbeiten Des Spartacus Und Philo], exposing the secrets of the Illuminati Dirigens degree (Scottish Knight degree) which appointed men to run Masonic lodges so they could recruit new members from within Freemasonry.



In 1797 a French Jesuit priest named Abbe Barruel published a series of books on the French Revolution because he believed it was the result of the Illuminati, saying, “The third conspiracy, which I am now about to investigate, is that of the atheistical Illuminati, which at my outfit I denominated the conspiracy of the Sophisters of Impiety and anarchy against every religion natural or revealed, not only against kings, but against every government, against all civil society, even against all property whatsoever.”14

Barruel pondered, as others still do today, as to whether Weishaupt was the mastermind behind the conspiracy, or whether he was working with or for someone else. “It is not known, and it would be difficult to discover, whether Weishaupt ever had a master, or whether he is himself the great original of those monstrous doctrines on which he founded his school,” he wrote.15

A man named John Robison, a science professor (called natural philosophy back then), living in Scotland published a lengthy book about the Illuminati in 1798 titled Proofs of a Conspiracy, which was one of the first books written in English about the organization. Before writing his book, he was actually asked to join them, but after looking into the group he realized he didn’t want to have anything to do with them and then decided to write his book hoping to expose them. In Proofs of a Conspiracy, he also included English translations of many of the confiscated Illuminati papers.

Robison wrote that, “A collection of original papers and correspondence was found by searching the house of one Zwack (a member) in 1786. The following year a much larger collection was found at the house of Baron Bassus; and since that time Baron Knigge, the most active member next to Weishaupt, published an account of some of the higher degrees, which had been formed by himself.”16

He warned, “An association has been formed for the express purpose of rooting out all the religious establishments and overturning all the

existing governments of Europe. I have seen this association exerting itself zealously and systematically, till it has become almost irresistible.” He continued, “I have seen that this association still exists, still works in secret, and that not only several appearances among ourselves show that its emissaries are endeavoring to propagate their detestable doctrines among us, but that the association has Lodges in Britain corresponding with the mother Lodge at Munich ever since 1784.”17



Original 5 Members

Adam Weishaupt (codename: Spartacus)

Andreas Sutor

(Erasmus Rotero-damus)

Bauhof or Baubof (Agathon)

Franz Anton von Massenhause (Ajax)

Max Elder von Merz (Tiberius)



Primary Goals

The original top five goals of the Illuminati were: 1) Abolish the Monarchy and replace all governments. 2) Abolish private property and inheritance. 3) Abolish patriotism along with people’s national identity and national pride. 4) Abolish the family, marriage, morality, and then have the government raise and indoctrinate the children. 5) Abolish all religion. These are basically the same goals that would be outlined around seventy years later in the Communist Manifesto (1848) and make up the foundation of communism since Weishaupt no doubt inspired Karl Marx. More on this later.

More modern goals include a universal one world digital currency; a Big Brother Orwellian surveillance state; the elimination of the second Amendment and ending citizens’ gun ownership (leaving only police and military to be armed); implementing an all-powerful nanny state socialist government; all leading up to the unveiling of a “messiah” who will claim to be God and offer people eternal life here on earth, saying he has “restored mankind” to our “pre-fallen” state so we can live forever through the use of cybernetic Transhuman technology on the new “Heaven on earth” he has created.18



Deposition for the Court

In 1785 three former members, Joseph Utzschneider, George Grunberger, and Johann Cosandey wrote out a joint deposition for the court where they provided information about some of the Illuminati’s goals and philosophies that men in the first few degrees were taught. First of all, “The Illuminee who wishes to rise to the highest degree must be free from all religion; for a religionist (as they call every man who has any religion) will never be admitted to the highest degrees.”19

The second principle revealed to the initiates was that the ends justify the means. “The welfare of the Order will be a justification for calumnies [defamatory statements], poisonings, assassinations, perjuries, treasons, rebellions—in short, for all that the prejudices of men lead them to call crimes. One must be more submissive to the Superiors of the Illuminati, than to the sovereigns or magistrates who govern the people; and he that gives the preference to sovereigns or governors of the people is useless to us. Honor, life, and fortune, all are to be sacrificed to the Superiors. The governors of nations are despots when they are not directed by us. They can have no authority over us, who are free men.”20

What they called the Patet Exitus, or the “doctrine of suicide,” was also taught as an honorable way anyone who was caught could escape prosecution and prevent themselves from revealing the Order’s secrets.

Thirdly, the deposition revealed, “The Superiors of the Illuminati are to be looked upon as the most perfect and the most enlightened of men; no doubts are to be entertained even of their infallibility.”21

“It is in these moral and political principles that the Illuminati are educated in the lower degrees; and it is according to the manner in which

they imbibe [assimilate] them and show their devotion to the Order, or are able to second its views, that they are earlier or later admitted to the higher degrees.”22

“In consequence of our acquaintance with this doctrine of the Illuminati, with their conduct, their manners, and their incitements to treason, and being fully convinced of the dangers of the Sect, we the Aulic Counsellor Utzschneider and the Priest Dillis left the Order. The Professor Grünberger, the Priest Cosandey, Renner, and Zaupfer, did the same a week after.”

Their testimony continues, “It [the Illuminati] spread through almost every province under the cloak of Freemasonry; because it sows division and discord between parents and their children, between Princes and their subjects, and among the most sincere friends; because on all important occasions it would install partiality on the seats of justice and in the councils, as it always prefers the welfare of the Order to that of the state, and the interests of its adepts to those of the profane.”23

“Experience had convinced us, that they would soon succeed in perverting all the Bavarian youth. The leading feature in the generality of their adepts were irreligion, depravity of morals, disobedience to their Prince and to their parents, and the neglect of all useful studies. We saw that the fatal consequence of Illuminism would be, to create a general distrust between the prince and his subjects, the father and his children, the minister and his secretaries, and between the different tribunals and councils.”24

“We abandoned, one after the other, this Sect [the Illuminati], which under different names, as we have been informed by several of our former Brethren, has already spread itself in Italy, and particularly at Venice, in Austria, in Holland, in Saxony, on the Rhine, particularly at Frankfort, and even as far as America. The Illuminati meddle as much as possible in state affairs, and excite troubles wherever their Order can be benefited by them.”25



“After we had retired from the Order, the Illuminati calumniated us on all sides in the most infamous manner. Their cabal made us fail in every request we presented; succeeding in rendering us hateful and odious to our superiors, they even carried their calumnies [defamatory statements] so far as to pretend that one of us had committed murder.”26

 





Original Illuminati Structure

The Nursery (Entry Level)

 

Preparatory Literary Essay

Novitiate (Novice)

Minerval (Brethren of Minerva, Academy of Illuminism)

Illuminatus Minor

 

Symbolic Freemasonry

Apprentice

Fellow Craft

Master

Scots Major Illuminatus



Scots Illuminatus Dirigens (Directory)

 

The Mysteries (Higher Level)

Lesser

Presbyter, Priest

Prince or Regent

 

Greater

Magus

Rex or King





The 1st Edict Against the Illuminati

An edict is an act of law issued by a monarchy, (much like an executive order issued by a president today) and on June 22, 1784, Duke Karl Theodore, the Elector of Bavaria [the ruler of the state], issued the first edict against the Illuminati after his sister-in-law Duchess Dowagar Maria Anna was given some documents by an early defector named Joseph Utzschneider, and then passed them onto the Duke.27

The edict reads, in part, “Whereas all communities, societies and associations without approval from a public authority and the confirmation of the Monarch are illegal, prohibited by law, suspect and dangerous things in [and] of themselves. His Electoral Highness [the Duke] has decided not to tolerate them in his State, whatever their designation and interior constitutions, ordering categorically…one and all subjects to withdraw from any association or secret assembly of this kind…those societies [have] drawn the attention of the public and awakened its fears…”28



The 2nd Edict Against the Illuminati

The following year in 1785, Duke Karl Theodore issued a second edict, which was much more threatening and specifically named the Illuminati and Freemasonry as the perpetrators of a conspiracy against the government. In this edict the Duke also announced that if anyone were to come forward and reveal who was involved or specifically which masonic lodges had been infiltrated and were being used in this conspiracy—that informant could remain anonymous and even keep half the money that was confiscated as a result of their confession. The other half [of the money], the edict said, would be given to the poor.

It reads in part, “We [the government]…have been deeply affected and displeased to learn that the various Lodges of so-called Freemasons and Illuminati, who are still in our States, have taken so little heed of our General Prohibition issued on June 22nd of last year against all fraternal societies clandestine and unapproved, as to not only continue to hold meetings in secret, but to raise funds, and to recruit new members, seeking to further increase the already large numbers of adepts.”29

It continues, “We had deemed this society, very much degenerated and of primitive institution, too suspect, both as regards to religious concerns and from a social and political point of view, so that we could no longer tolerate it in our States…we command that all authorities must execute our orders exactly and secretly inform us of any disobedience. We declare that all money and any funds collected illegally [by the lodges] shall be confiscated [and] half will be given to the poor, while the other half will go to the denunciator [informant], even if he is a member of one of those societies, with a promise to keep his name confidential.”30

The edict concludes, “We hope that each of our subjects value enough of our favor and his own honor and happiness so that everywhere we can

count on due obedience to our orders and be excused from having to take more severe measures.”31



The 3rd Edict Against the Illuminati

On August 16, 1787, not long after the castle of Baron de Bassus was searched, where more papers were discovered, the third edict against the Illuminati was issued by the Duke of Bavaria saying the penalty would be death for any Illuminati members discovered meeting or recruiting anyone to join them. “Any so charged and found guilty are to be deprived of their lives by the sword; while those thus recruited are to have their goods confiscated and themselves to be condemned to perpetual banishment from the territories of the Duke. Under the same penalties of confiscation and banishment, the members of the order, no matter under what name or circumstances, regular or irregular, they should gather, are forbidden to assemble as lodges.”32

“As more time passes it is further realized how harmful and dangerous the Order of the Illuminati will be for the State and religion if allowed to flourish here and beyond. It is impossible to predict the deplorable effects that would result for posterity if we stand back, if not handled very seriously while there is still time to forcefully eradicate a disease which is far more daunting than the plague itself.”33

“…for the recruiter he is to be deprived of life by the sword, and for the recruited he will be sentenced to have his property confiscated and banished for life from all States of His Electoral Highness, with a promise of never being allowed to return. Under the same penalties of forfeiture and expulsion, the prohibited Lodges of the Illuminati, under whatever name they may hide and carefully present themselves, in all places, must be subject to rigorous surveillance. Those in lodge attire will be held and treated as if they had attended meetings in secret, in suspect places such as hotels or particular houses, and we will not allow the futile excuse usually given—an honest society of good friends—especially when those present have already been suspected of impiety and Illuminism.”34



The 4th Edict Against the Illuminati

Most mainstream sources (including the often inaccurate and completely unreliable Wikipedia) claim that shortly after the third edict was issued in 1787, the Illuminati were completely irradiated and weren’t much of a concern after that. The problem is—the Duke of Bavaria actually issued a fourth edict a few years later in 1790 saying that the Illuminati was not only still active but were continuing to recruit new members!

On November 15, 1790, the following announcement against the Illuminati was issued by the Duke, saying, “The Elector has learned, partly by the spontaneous confession of some members, party by sound intelligence, that despite the Edicts of July 14, 1784 and August 16th 1785 (and in the same month in 1787), the Illuminati still hold, albeit in smaller numbers, secret meetings through the Electorate, but especially in Munich and the surrounding area; they continue to attract young men to the cause and have maintained a correspondence with [secret] societies and with members in other countries.”35

It goes on, “They continue to attack the State and especially religion, either verbally or through pamphlets…Every speech, every printed book or manuscript against religion and the state must be reported to the authorities or the Elector [Duke] himself, as well as any secret meetings. Those who have remained silent on these issues, having indeed been proven to have possessed information, will be severely punished. The denunciator, even if he was an accessory to the crime, will receive a cash reward along with the other, and his identity will be kept confidential.”36

The fourth edict clearly warns, “Any member who has assisted in a secret meeting, has recruited new members or corresponded with [secret] societies or brothers in other countries, will be mercilessly punished by death. Any civil servant or [those in the] military, any holder of a beneficial

office, a parish priest, etc., must swear that he has not and will never form a part of the sect or they’ll be convicted of perjury and shall be punished accordingly.”37



Taking Over the Government

One of the original Illuminati defectors named Joseph von Utzschneider, who gave a deposition to the court about the Illuminati plans, warned that they planned to “introduce a worldwide moral regime which would be under their control in every country. This council would decide on all matters concerning pardons, appointments and promotions, as well as rejections…This would give it the unlimited right to pronounce final judgment over the honesty and usefulness of an individual.”38

The confiscated correspondence between members confirms this allegation. One of the letters reads, “The Order must possess the power of life and death in consequence of our oath; and with propriety, for the same reason, and by the same right, that any government in the world possesses it —for the Order comes in their place, making them unnecessary. When things cannot be otherwise, and ruin would ensue if the association did not employ this mean, the Order must, as well as public rulers, employ it for the good of mankind; therefore for its own preservation.”39

Many letters clearly revealed their intent to deceive people in order to “insure their happiness.”40 Weishaupt’s megalomaniacal goals of world domination become clear with such statements as, “the Order will, for its own sake, and therefore certainly, place every man in that situation in which he can be most effective. The pupils are convinced that the Order will rule the world. Every member therefore becomes a ruler.”41

“The great strength of our Order lies in its concealment; let it never appear in any place in its own name, but always covered by another name, and another occupation.”42 This has effectively happened with private organizations like the Council on Foreign Relations, the Bilderberg Group, and the Federal Reserve—basically taking over the key power centers in society. It must be pointed out that the Founding Fathers of America wrote

down their grievances with the Monarch in the Declaration of Independence and 56 men signed their names to it and sent it off to the king of England. They didn’t hide their intentions or deceive people hoping to further their aims. They were open and honest about their beliefs, tactics, and goals— unlike Weishaupt and the Illuminati—who used deception and fraud as a standard practice.

Similarly, when theologian Martin Luther opposed the tyrannical control of the Catholic Church over 250 years before Weishaupt, he wrote down his grievances and nailed them on the front door of his local church in 1517. He didn’t lie or deceive anyone about his hopes of breaking the Catholic Church’s stranglehold on society, but fellow German, Adam Weishaupt, was power-hungry himself, and instead of wanting to free society from the tyranny of the Jesuits and the Catholic Church, he wanted to be the tyrant himself.



Inducting New Members

Various venues were used for recruiting new members. Once someone expressed interest to a current member about his desire to overthrow the monarch, that person was “carefully observed in silence,” and if, after consideration by the council, “the Novice” as they were called, were thought to be a possible asset, he would be appointed a mentor and invited to a conference.43

One correspondence between members reads, “I shall therefore press the cultivation of science, especially such sciences as may have an influence on our reception in the world; and may serve to remove obstacles out of the way…Only those who are assuredly proper subjects shall be picked out from among the inferior classes for the higher mysteries…And in particular, every person shall be made a spy on another and on all around him.”44

Once given initial approval by the council, the Novice would be shown “certain portions” of the goals and rules of the Order and was instructed to give a weekly account in writing of his progress in carrying out his directives. At this point he was not allowed to take physical possession of any material and had to read it in the Mentor’s house just to make sure they wouldn’t turn it over to authorities, giving them concrete evidence of the conspiracy.45

High level member Baron Von Knigge would later admit, “As a rule, under the veil of secrecy, dangerous plans and harmful teachings can be accepted just as well as noble intentions and profound knowledge; because not all members themselves are informed of such depraved intentions, which sometimes tend to lie hidden beneath the beautiful facade…because for the most part, unknown superiors lie in ambush and it is unworthy of an intelligence man to work according to a plan, which he does not fully see.”46



Another original correspondence brags, “Nothing can escape our sight; by these means we shall readily discover who are contented, and receive with relish the peculiar state-doctrines and religious opinions that are laid before them; and, at last, the trustworthy alone will be admitted to a participation of the whole maxims and political constitution of the Order… In a council composed of such members we shall labor at the creation of means to drive by degrees the enemies of reason and of humanity out of the world, and to establish a peculiar morality and religion fitted for the great society of mankind.”47

In perhaps the most sinister initiation to the higher levels, a prospect was told they had to show their loyalty to the Illuminati by killing someone who betrayed the Order. The candidate was taken before a man bound and gagged who was said to have betrayed their oaths and then handed a knife and blindfolded before being positioned in front of the supposed traitor who they were then ordered to stab. Once the prospect stabbed the “person” in front of them, the blindfold was removed to reveal that the “traitor” had been swapped with a sheep, and the entire charade was a test of their loyalty.48

If the candidate refused to carry out the “murder” of the supposed “traitor,” then they were told they passed the test anyway but were then never allowed to proceed to a higher level and never trusted with any deeper secrets because they had shown they wouldn’t kill for the Order.



Contingency Plans if Discovered

A lot of people claim that because some Illuminati members were discovered and many of their writings published, that they simply gave up and ceased to exist from that point on, but common sense, the Duke of Bavaria’s 4th Edict, and the Illuminati’s own writings suggests otherwise. Weishaupt wrote, “By this plan we shall direct all mankind. In this manner, and by the simplest means, we shall set all in motion and in flames. The occupations must be so allotted and contrived, that we may, in secret, influence all political transactions…I have considered everything, and so prepared it, that if the Order should this day go to ruin, I shall in a year reestablish it more brilliant than ever.”49

“There must not be a single purpose that ever comes in sight that is ambiguous, and that may betray our aims against religion and the State. One must speak sometimes one way and sometimes another, but so as never to contradict ourselves, and so that, with respect to our true way of thinking, we may be impenetrable.”50

“This can be done in no other way but by secret associations, which will by degrees, and in silence, possess themselves of the government of the States, and make use of those means for this purpose.”51

Shortly after the Illuminati were discovered, and believed by many to have been destroyed, Joseph Willard, President of Harvard University, warned, “There is sufficient evidence that a number of societies of the Illuminati have been established in this land of Gospel light and civil liberty, which were first organized from the grand society, in France. They are doubtless secretly striving to undermine all our ancient institutions, civil and sacred. These societies are closely leagued with those of the same Order in Europe; they have all the same object in view. The enemies of all order are seeking our ruin. Should infidelity generally prevail, our

independence would fall of course. Our republican government would be annihilated.”52

Willard was just one of many Americans, including George Washington, who believed the Illuminati survived the intended purge and continued to work under the cover of Freemasonry and other organizations.



The Eradication of Christianity

Unlike theologian Martin Luther who famously nailed his ninety-five grievances on the door of the Castle Church of Wittenberg, Germany in 1517, thus starting the Protestant Reformation with the hopes of ending the Catholic Church’s hold on power and their corrupt un-Christian practices and perversion of Jesus’ message—Adam Weishaupt didn’t appreciate Christianity at all, and instead wanted it completely destroyed. Despite his strong differences with the Church, Martin Luther still respected Jesus and his teachings and simply wanted to reform the Church, but Weishaupt wanted the Church and Christianity entirely eradicated.

John Robison wrote, “It surely needs little argument now to prove that the Order of Illuminati had for its immediate object the abolishing of Christianity (at least this was the intention of the Founder) with the sole view of overturning the civil government, by introducing universal dissoluteness and profligacy [reckless] manners, and then getting the assistance of the corrupted subjects to oversee the throne. The whole conduct in the preparation and instruction of the Presbyter and Regens [degrees] is directed to this point.”53

Another letter written by Baron von Knigge said, “I have been at unwearied pains to remove the fears of some who imagine that our Superiors want to abolish Christianity; but by and by their prejudices will wear off, and they will be more at their ease.” He goes on to write that he made sure not to let them know that “our General [Weishaupt] holds all Religion to be a lie, and uses even Deism, only to lead men by the nose.”54

Weishaupt explains, “But I assure you this is no small affair; a new religion, and a new state-government, which so happily explain one and all of these symbols, and combines them in one degree, you may think that this

is my chief work; but I have three other degrees, all different, for my class of higher mysteries; in comparison with which this is but child’s play.”55

Weishaupt even boasts, “Who would imagine that I was to be the founder of a new religion,”56 and continues, “We must, first gradually explain away all our preparatory pious frauds. And when persons of discernment find fault, we must desire them to consider the end of all our labor…Second, we must unfold, from history and other writings, the origin and fabrication of all religious lies; and then, third; we give a critical history of the Order.”57

The plan to destroy Christianity can clearly be seen today with the liberal media and the gay mafia pushing homosexuality in everyone’s face and then accusing Christians of “hate speech” and “bigotry” if they simply disagree with gay marriage or homosexual couples adopting children. There is clearly a double standard in the mainstream media in terms of what is considered “hate speech” because when popular musicians or liberal political commentators spew hateful anti-Christian rhetoric on a continuous basis, such vicious attacks are touted as “justifiable payback” for the Inquisition hundreds of years ago. Imagine if major media figures were to make the same vicious statements about Jews as they do Christians. Their careers would be over before the end of the day and they would be forever branded an “anti-Semite” and never work again.

A popular reverend named Jedediah Morse preached a series of sermons between 1798 and 1799 in New England where he warned about the Illuminati’s assault on Christianity in Boston and the surrounding area, saying, “Practically all of the civil and ecclesiastical establishments of Europe have already been shaken to their foundations by this terrible organization; the French Revolution itself is doubtless to be traced to its machinations; the successes of the French armies are to be explained on the same ground. The Jacobins are nothing more nor less than the open manifestation of the hidden system of the Illuminati. The Order has its branches established and its emissaries at work in America. The affiliated Jacobin Societies in America have doubtless had as the object of their establishment the propagation of the principles of the illuminated mother

club in France...I hold it a duty, my brethren, which I owe to God, to the cause of religion, to my country and to you, at this time, to declare to you, thus honestly and faithfully, these truths. My only aim is to awaken you and myself a due attention, at this alarming period, to our dearest interests. As a faithful watchman I would give you warning of your present danger.”58

Regardless of your personal religious beliefs, you must admit that Christians have been (and continue to be) the primary opposition to the Illuminati and the New World Order, (not to mention the coming Mark of the Beast), and are the final obstacle standing between the Illuminati and their remaining goals. Christians have long warned about the “satanic conspiracy” being perpetuated by the Illuminati and have been on the front lines of the culture war being waged by Hollywood, which aims to destroy what little morality remains in society.



Using Feminism to Breakdown Families

Since one of the Illuminati’s original goals was to break up the traditional family unit so children would be raised and indoctrinated by the government, they planned on manipulating women through what would later be known as feminism, encouraging them to rebel against their duties of domestic management and motherhood.

“There is no way of influencing men so powerfully as by means of the women,” the original writings read. “These should therefore be our chief study; we should insinuate ourselves into their good opinion, give them hints of emancipation from the tyranny of public opinion, and of standing up for themselves; it will be an immense relief to their enslaved minds to be freed from any one bond of restraint, and it will fire them the more, and cause them to work for us with zeal, without knowing that they do so; for they will only be indulging their own desire of personal admiration.”59

What this means is they planned on transforming women into selfcentered, narcissistic, pleasure seeking sluts, and promote this behavior under the banner of “freedom,” so instead of raising their children and keeping their families in balance, they would have the government raise their kids while turning against their husbands and disrupt the family unit in hopes of redirecting people’s loyalty and love to the State instead of each other.

In more modern times this same method has been applied to promote the feminist movement in the 1970s through the creation of Ms. Magazine and the push to demonize stay-at-home moms. Kim Kardashian and other skilless skanks are promoted as role models even though they have no real value, and are worthless and talentless false idols advertised by the mainstream media as modern day royalty. The hypocrisy of feminism is astounding. For example, feminists who cry about sexism and the

“culturally programed gender roles” only want to give up the roles society expects of them, while still demanding men to continue following theirs.

Women who whine about “equal rights” still expect men to always pay for dates and buy them expensive gifts. Women who don’t feel it’s their duty to know how to cook still feel men should fix things around the house and diagnose their car problems. And of course, feminist women who proclaim they want to end the gender roles still expect their man to cough up thousands of dollars on a diamond engagement ring when the courtship is on the road to marriage. Feminism is a one-way hypocritical double standard street that not only targets men, but also other women who resist giving in to this cultural Marxism.

Mothers who choose to be stay-at-home moms and raise their own children or who enjoy cooking for their family are labeled “victims” of a “male-dominated ideology.” Feminism pressures women to turn their children over to daycare centers and trade in working around the home for being stuck in a cubicle sitting in front of a computer all day. Feminism has led to an entire generation being raised in single parent homes with many mothers turning to government assistance, costing the taxpayers countless dollars—not to mention tens of millions of children growing up without the guidance and supervision of two parents.

Adam Weishaupt himself was an unfaithful husband who actually impregnated his wife’s sister, which he revealed in one of his correspondences. In hopes of killing the baby to hide his adulterous behavior he gave his sister-in-law an “abortion tea,” and it appears from his letter about the issue that he also repeatedly punched his mistress in the stomach hoping to abort the child.

“I am now in the most embarrassing situation; it robs me of all rest, and makes me unfit for everything. I am in danger of losing at once my honor and my reputation, by which I have long had such influence. What think you—my sister-in-law is with child,” he wrote.



He continues, “We have tried every method in our power to destroy the child; and I hope she is determined on everything—even d –– [believed to mean death]. But alas! Euriphon is, I fear, too timid. Alas! poor woman, thou art now under the disciplina arcani [the Discipline of the Secret] and I see no other expedient [convenient yet immoral way].”60



Using Schools to Indoctrinate the Youth

Tyrants throughout history have known that if they are to effectively maintain their power they must indoctrinate the youth with their brand of propaganda to ensure as the children come of age, they will blindly support the leader and his ideologies. Adolf Hitler used the Nazi Youth program to brainwash children beginning at a young age; the Taliban in Afghanistan banned girls from going to school at all to keep them ignorant; and North Korea’s strict control of their education system are just a few examples of this in our modern era.

“We must win the common people in every corner,” the original Illuminati writings read. “This will be obtained chiefly by means of the schools, and by open, hearty behavior, show, condescension, popularity, and toleration of their prejudices, which we shall at leisure root out and dispel.”61

The indoctrination of students by the public school system is clear today with programs like Common Core and the promotion of the Big Government nanny state and the gay lifestyle while demonizing the second Amendment right to bear arms and belief in God. Being a Christian in public schools is not only frowned upon, but out right ridiculed, and favorably mentioning the word “God” or “Jesus” has basically been banned.62

Charlotte Iserbyt who was the head of policy at the Department of Education during the Reagan administration discovered how tax-exempt foundations were shaping the American education system to eliminate critical thinking and innovation by turning students into zombies who only regurgitate what they’re told. She published her findings in her book The Deliberate Dumbing Down of America. Iserbyt and others assert that Skull & Bones runs the Department of Education, which dictates what is taught to

the kids. Skull & Bones also controls the American Historical Association which dictates the “official” version of American history by carefully crafting an often one-sided and biased view of what really happened.

While the vast majority of students who attend public schools are primarily concerned with the latest teen idol, their favorite professional sports teams, or simply getting drunk and high, children of the elite are taught team building, networking skills, and other tools to prepare them to rapidly advance up the social hierarchy once they enter the “real world.”

Philips Exeter Academy is just one example of a private boarding school which was set up for the children of the elite to prepare them for life in the upper class. The Illuminati has largely funded this school and used it to educate their children and prepare them for their duties later in life. In 1930 Edward Harkness (a member of Skull & Bones’ sister organization Wolf’s Head) donated $5.8 million dollars to the school under the condition that their method of teaching students would change to what he called the Aristotelian method of antiquity.63 Harkness was the second largest shareholder in Rockefeller’s Standard Oil in the early 1900s and was in John D. Rockefeller’s inner circle.

The Rockefeller family has been one of the most powerful Illuminati families for generations and the “Aristotelean method of antiquity” that Edward Harkness paid to implement at Philips Exeter Academy was based on the ideology of the Greek philosopher Aristotle (a student of Plato) who believed that most people were too stupid to govern themselves, and that society should be structured in a way that “philosopher kings” should rule and decide what was best for the people.



Controlling the Media

Weishaupt knew the power of information, and back in his time there was obviously no television, radios or Internet, but there were books, libraries, and reading clubs, and he knew how important it was to control them if he wanted to manage what information reached the minds of the public. In one correspondence he wrote, “By establishing reading societies, and subscription libraries, and taking these under our direction, and supplying them through our labors, we may turn the public mind which way we will.”64 [Which way we will, meaning the direction they desired.]

He goes on to write, “In like manner we must try to obtain an influence in the military academies (this may be of mighty consequence); the printing-houses, booksellers shops, chapters, and in short in all offices which have any effect, either in forming, or in managing, or even in directing the mind of man.”65

Another letter written by a different member identified as Cato [real name Xaver von Zwack] points out, “We get all the literary journals. We take care, by well-timed pieces [articles], to make the citizens and the Princes a little more noticed for certain little slips.”66 What this means is they planned to use the newspapers to attack their enemies. “A little more noticed for certain little slips” means to highlight and reinforce anything officials have said or done that can be used against them.

Author Terry Melanson explains in his excellent book, Pefectibilists, that, “Without having to ascend a series of initiations and meaningless rituals—such as those of Freemasonry and Rosicrucianism—like-minded individuals could gather in reading societies, form an intellectual social circle, and discuss the literature of the Enlightenment and the politics of the day. Those who directed these societies had control of the material being

read and discussed. It became a perfect vehicle to instill radical or subversive views.”67

Today, much of the American mainstream media and other outlets in countries around the world are under the control of the government. In some countries the State-controlled television is clearly evident, but in places like America such control is done more covertly, leading many to believe that it is a “free and independent” press. In 1975 a congressional investigation discovered the CIA had virtually every editor from the major news outlets in their pocket.68 The Church Hearings, as they were called, uncovered the government was spending a billion dollars a year (in 2014 dollars) to secretly pay editors and reporters to work as gatekeepers and propagandists for the establishment.69 The program was dubbed Operation Mockingbird.

Of course, after it was exposed, the CIA claimed to have ended their media manipulation, which is a laughable lie. Even the former President of CBS, Sig Mickeson, admitted that CIA continued to maintain relationships with top media figures, “…but because of all the revelations of the period of the 1970s, it seems to me a reporter has to be a lot more circumspect when doing it now or he runs the risk of at least being looked at with considerable disfavor by the public. I think you’ve got to be much more careful about it.”70 In more recent times, the Operation Mockingbird program has been adapted to social media as well.

President Obama appointed a Harvard Law professor named Cass Sunstein to a cabinet level position in order to set up countless fake social media accounts and “troll” the comments section of news articles, YouTube videos, and Facebook pages in attempts to discredit news stories the White House thought were damaging to the establishment.71 One of Edward Snowden’s leaks revealed that the NSA took things even further by having paid trolls harass and defame people online who the establishment thought were causing too much trouble for the government’s well-controlled narrative in attempts to erode their credibility and fan base.72



The NSA also developed technology to spoof e-mails, SMS messages, inflate or deflate the view count on YouTube videos, adjust the ranking of websites, manipulate the outcome of online polls, or simply shut down someone’s social media presence all together for phony “terms of service” violations.73

For decades both the Pentagon and the CIA have had entire divisions dedicated to working with Hollywood in order to literally help produce major television shows and movies. When studios want access to expensive military equipment like aircraft and tanks or actual Army bases, they approach these government television and film liaisons and if the storyline is seen as portraying a current war or a particular military branch or government agency in a favorable light, then the projects are approved and producers are given access to consultants, equipment, uniforms, military bases, and even given active duty servicemen and women to work as extras.

As Fortune magazine once pointed out in article titled Hollywood’s Military Complex, “Even in an age of special effects, it’s exponentially cheaper to film on actual military ships with real military advisers…The fulcrum of Hollywood’s unlikely partnership is Phil Strub, a former film school student and Navy videographer, now the entertainment liaison at the Department of Defense.”74 Strub is just one of several such men who work full-time with the television and film studios on behalf of the government.

In the 1990s the CIA assigned Chase Brandon to be their liaison to Hollywood in order to establish a mutually beneficial relationship between the entertainment industry and the CIA.75 These government entertainment liaisons maintain script approval and have been known to make dramatic changes to screenplays before they are approved in order to achieve the government’s propaganda goals. The Recruit (2003), The Sum of All Fears (2002), Argo (2012), Lone Survivor (2013), and many, many other popular films and television shows have all been produced with the consent, oversight, and input of the CIA or the Pentagon.76



Infiltration of Freemasonry

Illuminati frontman Adam Weishaupt loved the idea of using existing secret societies to help grow his organization, saying, “Nothing can bring this about but hidden societies. Hidden schools of wisdom are the means which will one day free men from their bonds. These have in all ages been the archives of nature, and of the rights of men; and by them shall human nature be raised from her fallen state.”77

One of the primary vehicles used to conceal and further their agenda was (and still is) Freemasonry. Already an established occult organization in his time, Weishaupt had goals of using the fraternity for his own means, and in July 1782 he infiltrated Freemasonry and introduced what he called Illuminated Freemasonry.78 Using the existing structure of Freemasonry he created factions which were dedicated to his cause and with their ruthlessness and obsession, his supporters quickly took control of the highest levels within lodges across Europe.

In his own words Weishaupt explains the importance of using this preexisting fraternity as the ideal cover, saying, “None is fitter than the three lower degrees of Freemasonry; the public is accustomed to it, expect little from it, and therefore takes little notice of it.”79 “I declare and I challenge all mankind to contradict my declaration, that no man can give any account of the order of Freemasonry, of its origin, of its history, of its object, nor any explanation of its mysteries and symbols, which does not leave the mind in total uncertainty on all these points. Every man is entitled therefore, to give any explanation of the symbols and a system of the doctrine that he can render palatable.”80

Knowing the power of claiming to have possession of a great secret, he knew how men could be manipulated into doing his bidding, hoping to have the great secret someday revealed to them. “Of all the means I know to lead

men, the most effectual is a concealed mystery. The hankering of the mind is irresistible; and if once a man has taken it into his head that there is a mystery in a thing, it is impossible to get it out, either by argument or experience. And then, we can so change notions by merely changing a word.”81

A certificate from an Illuminati infiltrated Freemason lodge in Munich contains a pyramid with the sun over the capstone and the seal on the certificate shows the Owl of Minerva, a symbol of wisdom to the Illuminati, and the mascot of the Bohemian Grove.82

One of the most popular books on the definitions of Freemasonry’s symbols also confirms that Weishaupt successfully infiltrated the fraternity and introduced his plot to the inner circle. The Lexicon of Freemasonry was first published in 1845 by Albert G. Mackey, a 33rd degree Freemason, who was one of the most prominent scholars on the subject of Freemasonry in his day. The book contains an alphabetized list of most Masonic symbols accompanied by a detailed explanation of their esoteric meaning.

In the entry on the Illuminati, Mackey admits, “Weishaupt was a radical in politics, and an infidel in religion; and he organized this association, not more for purposes of aggrandizing himself, than overturning Christianity and the institutions of society. With the view of carrying his objects more completely into effect, he united himself with a lodge of Freemasons in Munich, and attempted to graft his system of Illuminism upon the stock of Freemasonry…Many Freemasons, misled by the construction of his first degrees, were enticed into the order.”83

Popular 20th century occult writer Alice Bailey, who claimed her books were dictated to her by a supernatural entity, wrote that, “There is no dissociation between the One Universal Church, the sacred inner Lodge of all true Masons, and the innermost circles of the esoteric societies…It must not be forgotten that only those souls who are on the Probationary Path or the Path of Discipleship will form the nucleus of the coming new world religion.”84



The role of Freemasonry in the Illuminati will be expanded on later in this book, along with a history of this fascinating fraternity and their transformation from a stonemason trade union to the spiritual secret society it is today.



Connections to Yale’s Skull & Bones

Skull & Bones, the secret society at Yale University, is often said to be simply a fraternity, but it’s far from it. It is actually not only a secret society, but its what’s called a senior society, meaning students aren’t full-fledged members until their senior year. It was the first senior society at the university and the first secret society as well. Students don’t just pledge to join hoping to get chosen like they do at fraternities—instead they are recruited if they are seen as possible valuable servants.

Skull & Bones members are responsible for creating the CIA, the Federal Reserve, the Department of Education, the American Historical Society, and various media monopolies. Skull & Bones doesn’t just have identical symbols, ideologies and goals in common with the Illuminati, there are some other very specific pieces of evidence that show a direct link between the two groups.

William Huntington Russell, one of the two founders of Skull & Bones, was studying abroad in Germany just before he returned to America and founded the organization in 1832 using the same symbols, riddles, initiation practices, and having essentially the same goals as the Bavarian Illuminati.

Of course the very emblem of Skull & Bones or the “Brotherhood of Death,” as they are often called, is a sinister skull and cross bones, identical to the Death’s Dead (totenkopf) pin that Nazis operating the death camps wore during World War II. The skull and cross bones (Jolly Rodger) emblem was also used by the Knights Templar, and was the symbol of pirates due to its intimidating look and was meant to convey that they hold the power over life and death. Many Freemasons have a human skull (real or a replica) on their desk in their office or in the “chamber of reflection” in the Lodge.



In 1876 a group of Yale students broke into the Skull & Bones headquarters to investigate this shady organization and then published a detailed newsletter titled The Fall of Skull and Bones about what they discovered inside. The burglars called themselves “File & Claw,” partly to mock Skull & Bones, but also because they used a file and crow bar to remove several security bars that covered the boarded up windows in the group’s headquarters, a building that looks like, and is called, “the Tomb.” One of the more interesting things they found once inside was a framed card on the wall that read, “From the German Chapter, Presented by Patriarch D.C. Gilman of D. 50.”

I’ll point out again that founder William Huntington Russell was in Germany, the hotbed of Illuminati revolutionaries, and the File & Claw intruders reported an open burial vault inside that contained four human skulls and a plaque written in German reading, “Wer war der Thor, wer Weiser, Bettler oder Kaiser? Ob Arm, ob Reich, im Tode gleich,” which in English says, “Who was the fool, who was the wise man, beggar or king? Whether poor or rich, all is the same in death.” This is extremely interesting when you learn this same cryptic riddle is virtually identical to the one given at the initiation ritual of the Bavarian Illuminati.

In his 1798 book Proofs of a Conspiracy, one of the first books to contain English translation of the confiscated Illuminati writings, John Robison describes the initiation ceremony into the “Regent Degree” of Illuminism, in which the initiate would be placed in front of a skeleton that had a crown and a sword at its feet, and the men were asked whether it was the skeleton of a king, nobleman, or a beggar. No matter their answer, the lodge president would explain, “The character of being a man is the only one that is of importance.”85

This means they don’t believe in an afterlife or a divine judgment by God and is used to instill a Social Darwinistic might is right world view. More on this philosophy and the history of Skull & Bones later.



What Ever Happened to Adam Weishaupt?

Adam Weishaupt’s fate is often forgotten in the wake of the Illuminati since the man himself was overshadowed by the monstrous conspiracy he gave birth to. In 1785 he was fired from his job at Ingolstadt University where he was the head of the law department.86 At this time authorities didn’t know he was involved with the Illuminati (let alone the leader and founder) but soon the Bavarian government began to learn about the Illuminati and tighten the noose in their quest to eliminate them, so Weishaupt later fled Bavaria dressed as a craftsman to avoid detection since authorities were now on the lookout for him. He was given exile in Gotha (a city in the German state of Thuringia, located just north of Bavaria) which was under control of Illuminati sympathizer Duke Ernest II. There he worked as a legal advisor for the Duke’s court until he died in 1830 at the age of 82.

After Weishaupt fled Bavaria to avoid capture, a book printer named J.J.C. Bode would take the lead as the head of the Illuminati, and used his printing shop to continue to spread Enlightenment philosophies throughout Europe. Bode traveled from Germany to France and imported the Illuminati into French masonic lodges which later became instrumental in the French Revolution. After J.J.C. Bode, the leader was Karl Leonard Reinhold, a Freemason who believed Moses incorporated secrets from the Egyptian priesthood into the fraternity.

After Weishaupt’s first wife died, he married her sister (the one who he impregnated while his wife was still alive and tried to kill the baby). He and his new wife had their first son Wilhelm the following year in 1784, who died at the age of eighteen in 1802.

Adam himself died when he was eighty-two and was survived by his second wife, Anna Maria, and six children, two daughters (Nanette and

Charlotte), and his four sons Ernst, Karl, Eduard, and Alfred, who all went on to serve as officers in the military.



French Revolution Connections

There are still whispers that the French Revolution was the work of the Illuminati, specifically the work of “Illuminated Masonic lodges” that were infected with Adam Weishaupt’s revolutionary goals. While many historians argue that the French Revolution was the result of a random and organic uprising of the French people against the oppressive Monarchy, others saw the strings being pulled from behind the scenes by the Illuminati.

While head of the Illuminati, J.J.C. Bode took two trips to Paris not long before the French Revolution, where he introduced the Illuminati to French Freemason lodges under the new name of the Philadelphes. Revolutionary and radical Enlightenment ideologies grew under the cover of various French Masonic lodges, reading societies, and Jacobin clubs, all of which were influential in organizing the French Revolution.

Bode wrote in his journal on June 30, 1787 that he met with French Freemason Charles-Pierre-Paul, marquis de Langes Savalette who would soon be involved with the revolution, and on July 3rd he made an entry about meeting with French Revolution National Assembly member Francois-Antoine Lemoyne Daubermesnil to specifically discuss the Illuminati!87

Historian Charles Porset of the National Scientific Research Center in France confirmed that Bode’s journal was authentic, saying, “the Journal has now been published by a German scholar, Hermann Schuttler, and it confirms in all respects the idea put forward by Rossberg of collusion between the Illuminati and the Philadelphes. Moreover, a ‘secret lodge is then created’—the Lodge of the Philadelphes…The unedited correspondences found in the Kloss archives housed in the Library of Grand Orient of the Netherlands, between Bode, von Busch and the Landgrave of Hesse-Darmstadt, which I’ve published, prove it. ‘We agreed,’ wrote Bode,

‘that for France, we would adopt the name Philadelphes instead of Illuminati.’”88

Another clear piece of evidence linking masonic lodges to the French Revolution is a letter from Duke Philip of Orleans that was sent out to all French Masonic lodges which reads, “all the Lodges are summoned to confederate together, to unite their efforts to maintain the revolution; to gain over it, in all parts, friends, partisans, and protectors; to propagate the flame, to vivify the spirit, to excite zeal and ardor for it, in every state, and by every means in their power.”89

In 1791 a book titled The Veil Withdrawn was published which was one of the first books to connect Freemasonry to the French Revolution. In 1792 a booklet titled The Tomb of Jacues Molay was released by Cadet de Gassicourt that linked the revolution to the Knights Templar. A few years later in 1803 a German man named Johann Starck published Triumph of Philosophy where he too claimed the Illuminati used Masonic lodges as a cover for organizing the French Revolution.





The Thirteen Bloodlines Theory

People sometimes refer to the “Illuminati bloodlines” or the “top thirteen bloodlines of the Illuminati” as the ruling elite within the pyramid of power that controls our world. A dozen or two names are thrown around and said to be Illuminati families who interbreed with each other to retain their wealth and power among the small group of ruling elite. The most common alleged thirteen bloodlines are: Astor, Bundy, Collins, DuPont, Freeman, Kennedy, Li, Onassis, Rockefeller, Rothschild, Russell, Van Duyn, and the Merovingian bloodline.

One of the more popular promoters of this theory is Fritz Springmeier, who in 1999 published Bloodlines of the Illuminati, where he wrote, “The goal of this book is to lay out the historical facts about these elite bloodlines…once one understands these bloodlines, wars between kings no longer appear as wars between elite factions, but often can be recognized as contrived wars created to control the masses of both sides by their greedy Machiavellian masters.”90

Springmeier continues, “The Illuminati themselves decided to elevate 13 bloodlines. The number 13 is extremely important magically, and these 13 occult tribes mock the 13 tribes of Israel (remember the 13th tribe, the Tribe of Joseph was split into Ephraim & Manasseh). This does not mean that only 13 Illuminati bloodlines are powerful. There are other families that have risen to prominence. Further, worldwide there are other families of great oligarchical power who have allied themselves to the Illuminati in the political and economic realms without having to intermarry into the Illuminati.”91

While Fritz’s book appears on the surface to be an impressive analysis of the supposed thirteen bloodlines, it is clear that he bought into several known hoaxes and reprinted them as fact, such as the widely debunked claims of John Todd, a man who in the 1970s claimed to be an Illuminati

“defector” belonging to one of the “Illuminati bloodlines.”92 Springmeier also claims that the Illuminati have been operating a space station on Mars, which he says they began colonizing in the late 1990s.93

A much more credible researcher, Antony Sutton, who was given a Skull & Bones membership list in the early 1980s by the daughter of a member, has a much more accurate and rational approach. In his excellent analysis, America’s Secret Establishment, Sutton has stated that twenty to thirty families have dominated the Skull & Bones society since its creation in 1832 and his book provides a scholarly overview of their activities.

The thirteen bloodlines theory is essentially a more modern version of the ancient “divine right of kings” theory, which was perpetuated for thousands of years, claiming that God ordained families of monarchs and kings to rule. In many cases, as with Egyptian Pharaohs, the Caesars of Rome, and the Chinese Dynasties, kings believed (or at least claimed to believe) that they themselves were Gods or literal descendants of the Gods, which in turn, they thought, gave them the divine right to rule. This is not just an ancient idea. The Nazi’s actually believed that white people were the descendants from the (supposed) God-like inhabitants of the Lost City of Atlantis.

Adolf Hitler and his inner circle of Nazi officers, including Heinrich Himmler, Rudolph Hess, and Joseph Georbels, literally believed that white people (the Aryan race, as they liked to call them) were descendants of Gods that once inhabited the Earth, who supposedly lived in the City of Atlantis. The Nazis thought the myth of the “Lost City” was literal history and when the city allegedly sunk into the sea, according to their beliefs, several of the demigods fled to the Himalayas of Tibet where they were said to have started the Nordic and Aryan races.

According to Nazi philosophy, the Jews, claiming to be “God’s chosen people,” were preventing the Aryans from their “divine right” to rule the earth, and race-mixing was weakening the magical power of the Aryan race. Hitler was largely inspired by Helena Blavatsky’s 1888 book, The Secret

Doctrine, which claims that Satan helped free Man in the Garden of Eden, thus allowing humans to “evolve” into gods ourselves. “Satan will now be shown, in the teaching of the Secret Doctrine, allegorized as Good, and Sacrifice, a God of Wisdom,” the book reads.94 “Blessed and sanctified is the name of the Angel of Havas—Satan,” Blavatsky wrote.95

Mainstream historians focus on the racial aspects of the Nazis quest for power, but often ignore the root of their ideology which was a twisted occult doctrine and literally based on Satanism and the belief that they had divine blood in their veins and were descendants of gods. A German secret society called the Thule Society gave birth to the Nazi party and operated much like the Skull & Bones society does in America, working to groom the country’s future leaders. The Thule Society’s logo was a swastika with a dagger in front of it.

The “most royal candidate” theory is the belief that every presidential election in the United States has been won by the candidate with the most royal blood, thus having the closest ties to the kingship bloodline of Europe.96 Proponents of the theory claim that every U.S. president since George Washington can have their bloodline traced back to European royals, and say at least thirty-three presidents are descendants of Alfred the Great and Charlemagne.97

But this begs the question of why a small group of families would consider themselves to have “royal blood.” What exactly does “royal blood” mean? Well, it means that they believe they are direct descendants of the Gods. People who subscribe to this theory often point to a passage in the Book of Genesis in the Bible as evidence. Genesis 6:1-2 reads, “And it came to pass, when men began to multiply on the face of the earth, and daughters were born unto them, That the sons of God saw the daughters of men that they were fair; and they took them wives of all which they chose.” Genesis 6:4 continues, “There were giants in the earth in those days; and also after that, when the sons of God came in unto the daughters of men, and they bare children to them, the same became mighty men which were of old, men of renown.”



Some Christians and Biblical scholars believe that the “Sons of God” which came and took the daughters of men and had children with them, were an alien race called the Annunaki. Some versions of the Bible clearly say that the Sons of God were “supernatural beings” and clearly refers to some kind of alien creatures who came to earth and mated with human females, creating some kind of alien/human hybrid called the Nephilim.

Some believe that God caused the great flood hoping to destroy these Nephilim creatures and then have Noah, his sons and their wives, later repopulate the earth after they emerged safely from the Ark. According to some beliefs, those supposed hybrid creatures survived and went on to become the first kings and queens, and later evolved into what we refer to as the Illuminati today.

The myth that Jesus Christ secretly had a child with Mary Magdalene was brought into the mainstream through Dan Brown’s 2003 book The Da Vinci Code, which was inspired by the widely debunked Holy Blood, Holy Grail (1982). Dan Brown’s novel was made into a film in 2006 starring Tom Hanks, which carried the idea to a much larger audience who wholeheartedly believed the hoax of the “Jesus bloodline.”

According to the myth, the Knights Templar and Freemasons are the guardians of the Holy Grail, which according to this theory, the Grail refers to the descendants of Jesus and Mary Magdalene, thus the “Holy Grail” is the divine bloodline whose supposed members have to live in secret to protect themselves from being killed by the Catholic Church, which allegedly will do anything to prevent this “secret truth” from being known, because it would undermine their power.

This Jesus bloodline myth may very well be unveiled at some point in time as “evidence” of the Illuminati’s supposed “divine right to rule” by claiming they are the literal descendants of Jesus. It may very well culminate with the appearance of the antichrist who will claim to be the

long awaited messiah of the world and cite his alleged genetic connection to Jesus as evidence that he is the return of Christ.

When looking into the supposed “bloodlines of the Illuminati” you will often come across people talking about “the Reptilians” who believe the Illuminati are literally a group of “shape shifting extraterrestrials” or demonic inter-dimensional entities masquerading as humans in order to work towards enslaving the human race. The “Reptilian” theory is widely ridiculed, although a sizable portion of the population has no doubt that famous politicians and celebrities are “impostors,” only pretending to be human.98 Many of the Reptilian claims are something straight out of the XFiles, the popular paranormal thriller from the 1990s, and are virtually identical to the plot of a 1980s mini series titled V (for visitors).

A British conspiracy theorist named David Icke is largely responsible for spreading this theory, and claims these “Reptillian Illuminati” have to drink human blood, “because they are drinking the person’s life-force and because they need it to exist in this dimension in a human form.”99 More recently Icke seems to have distanced himself from “Reptlillians” and began focusing on the Archons, which refer to supernatural agents of the evil Gnostic creator God, the Demiurge. Icke is also a big proponent that these “Reptillian Illuminati” families have interbred with each other throughout history to maintain their unique bloodline and hide their secret from outsiders.

In ancient times it was fairly easy to control who would marry whom, and keep royal families breeding with other royal families. Most people marry others in the same socioeconomic level because they run in the same circles, attend the same prestigious universities, and grow up in the same wealthy neighborhoods. While the ancient alien/nephilim bloodline theory is interesting on its surface, there is little to no evidence that people from these supposed royal or divine/alien/reptillian families have any significant difference in their DNA from “regular” people, or “commoners” as we are called. In more modern times the regulation of who marries whom through arranged marriages has become nearly impossible to control, so if this

theory were true, then the “alien” DNA would be so widely spread that we would be seeing it pop up in medical reports around the world.

One likely reason for a small number of families rising to power in the ancient past is that they just so happened to be living on fertile land, allowing them to have healthy and strong offspring due to an abundance of food and easily accessible water. As they say in real estate—location, location, location. These issues are explored in detail in the Pulitzer Prize winning book Guns, Germs, and Steel: The Fates of Human Societies (1997), written by Jared Diamond. His research presents the case that a variety of environmental factors, not any genetic or intellectual superiority, has been the reason certain cultures have dominated most others around the world.

I certainly wouldn’t rule out the possibility that some kind of extraterrestrial (or demonic) race is secretly working with the Illuminati leadership and directing them in their affairs, but the subject of aliens is beyond the scope of this book and in most cases the “evidence” of such beings is impossible to verify (at least at this point) or limited to interpretations of ancient art or “video evidence” of unidentified flying objects—most of which are top secret experimental aircraft or hoaxes. Aliens (or demons) working with the Illuminati is one thing—a handful of families interbreeding with each other to keep their “alien family tree” a secret amongst themselves is something totally different.







Affiliated Secret Societies

Secret societies entered popular culture in the 21st century, thanks in part to Dan Brown’s novels and Hollywood films like The Skulls (2000) and National Treasure (2004). As the 2004 United States presidential election approached, it was reported in mainstream news that both George W. Bush and his opponent John Kerry were members of Skull & Bones, the now somewhat well-known secret society based at Yale University. The correct terminology is actually that they “are” members, not that they “were” members, since it’s a lifetime membership starting their senior year of college.

While many people have now heard of Skull & Bones, most falsely believe it’s just an elite fraternity for rich kids, but Skull & Bones differs from a fraternity in several key ways. First of all, nobody “pledges to join” the club hoping to get accepted. Instead they recruit people who are seen as worthy to be members. The club doesn’t do any charity work, which is common with most fraternities, and their entire focus is geared for members’ postgraduate life which is why someone doesn’t become an official member until their senior year, as opposed to rushing a fraternity freshman year like most other college clubs.

While there are countless secret societies on college campuses around the world, Skull & Bones is in a league of their own in terms of their power and influence. While they are perhaps one of the more well-known secret societies (thanks to the Internet), there are certainly other powerful (and dangerous) ones that are lesser known.

There are secret societies of businessmen, politicians, and media moguls, (like the Bilderberg Group and the Allen & Company Sun Valley Conference); there is a secret society of scientists (the Jasons); there’s even a secret society of secretaries (the Seraphic Society), who cater to men in other secret societies. Few people know that there is a secret society of

women modeled after the Bohemian Grove who call themselves the Belizean Grove. Many of these mysterious groups have overlapping members, and at the higher levels work in concert with each other in one giant compartmentalized pyramid-shaped power structure. In this chapter I’ll take you back to the beginning, thousands of years ago, and we’ll slowly move forward in time tracking the evolution of this invisible empire.



Mystery Schools

The first secret societies were called the Mystery Schools, which meant they taught the Ancient Mysteries of life and death. The word “mystic” means one who studied the mysteries, and ancient inquisitive men formed groups or “schools” to study and ponder life’s biggest questions. Certain supposed answers were discovered or myths developed which aimed to help man make sense of his existence here on this planet.

Some see the secret occult knowledge stemming from these Mystery Schools not as evil, but as a tool that can be used for either good or evil, similar to “the Force” in Star Wars. Just as men gather into associations based on common interests like car meets, model airplane clubs and countless other kinds of clubs, men in ancient times who found they had a common interesting pondering the mysteries of life found themselves coming together in these Mystery Schools.

Various Mystery Schools popped up in the ancient world, claiming to, or seeking to, discover the powerful secrets of life, and looking to get in harmony with the divine in order to fully receive the blessings the Universe offers or explain the human condition. While these groups appear to have at one time had the best intensions, many believe they were eventually corrupted and taken over by sinister men who turned the once noble schools into a mafia of madmen who used their superior intellect and social networks to enslave society. Illuminati insider Manly P. Hall explains, "The masses, deprived of their birthright of understanding and groveling in ignorance, eventually became the abject slaves of the spiritual impostors. Superstition universally prevailed and the black magicians completely dominated national affairs, with the result that humanity still suffers from the sophistries [fallacious arguments, especially with the intention of deceiving] of the priestcrafts of Atlantis and Egypt.”100



The esoteric tradition, as it is sometimes called, appears to have begun in Mesopotamia, the oldest human civilization and the first to develop a written language. From there it can be traced to ancient Egypt and the Isis cults (3100 B.C.) and then over to Greece in the Eleusinian Mysteries (1500 BC) involving the Demeter and Persephone cults. During this time the Dionysian Mysteries were practiced in ancient Greece and Rome and included the use of intoxicants and other trance-inducing techniques in attempts to come into a greater understanding of the Mysteries. The Dionysian mysteries were based on Dionysus, one of the Twelve Olympians in Greek mythology, who was the God of wine and ecstasy.

If you keep following the chain, you progress to the Pythagoreans (5 B.C.) and onto other Greek mystery cults like Mithrasim (100 A.D.), then to the Gnostics (1-300 A.D.), to the Knights Templar (1118) and on to the Cathars in the 13th Century, and then to the Jesuits (founded in 1540), continuing to the Rosicrucians (1614), then to Freemasonry (1717) and continuing to the Illuminati (1776); and if you keep moving ahead—when you get to more modern times you’ll see organizations like Skull & Bones (1832), Bohemian Grove (1872), the Federal Reserve Bank (1913), the Council on Foreign Relations (1921), the Bilderberg Group (1954), and so on.

While you may be familiar with some of these major Illuminati organizations, each piece of the puzzle contains countless details and when meticulously assembled, creates a mosaic that reveals a clear and common theme. They are all hierarchical fraternities who use various rituals and pageants to instill in their members that they are a special elite group of masters who know “the truth” that will enable them to become gods among men. In order to preserve their secrets to a select few, initiates often swear blood oaths to never reveal their knowledge to outsiders or those in the lower levels of the hierarchy.



The Knights Templar

At this point in time, many people have heard about the Knights Templar and may be familiar with a little bit of the story surrounding them and the accusations levied against them by the Catholic Church, but few people have taken an extended look into the organization and their activities. While most people believe the accusations of devil worshiping and blasphemous rituals were fabricated by the Catholic Church as an excuse to seize the Templar’s wealth and put them out of commission, you may be very surprised to discover who admits the accusations were actually true.

The Knights Templar name basically means they were the knights of Solomon’s Temple, and were a group of (supposed) Christian knights who volunteered to protect Jerusalem from the Muslims who were trying to seize the land. The Templars were founded in 1118 in France by a man named Hugues de Payens who recruited around nine others, mostly members of his own family, who then offered to protect pilgrims traveling from the coast of the Mediterranean to the Holy Land.

While they were supposedly dedicated “warrior monks” who wanted to supposedly protect the Holy Land, it appears the founders had an ulterior motive, and while the majority of the growing Templar organization may have been wholly dedicated to protecting the Holy Land, the inner circle were busy secretly excavating the site of Solomon’s Temple for treasure and rare artifacts.

Among the most damning allegations made against the Templars was that their inner circle performed satanic homosexual rituals involving a demonic idol called Baphomet. While most people believe these allegations were fabricated by the Catholic Church to demonize the Templars, others have a different view. Eliphas Levi, a popular occultist in the 19th century,

explains, “Did the Templars really adore Baphomet? Did they offer a shameful salutation to the buttocks of the goat of Mendes? What was actually this secret and potent association which imperiled Church and State, and was thus destroyed unheard? Judge nothing lightly; they are guilty of a great crime; they have exposed to profane eyes the sanctuary of antique initiation. They have gathered again and have shared the fruits of the tree of knowledge, so they might become masters of the world.”101

He continues to say, “Yes, in our profane conviction, the Grand Masters of the Order of the Templars worshipped the Baphomet, and caused it to be worshipped by their initiates.”102 In the infamous Satanic Bible, published in 1966 by Anton LaVey (real name Howard Levy), Baphomet is listed as the demon the Knights Templar worshiped.103 So even the Church of Satan’s founder accepts the allegations made against the Templars as true.

Manly P. Hall, a 33rd degree mason best known for his revealing book The Secret Teachings of All Ages, wrote, “The famous hermaphroditic Goat of Mendes was a composite creature formulated to symbolize this astral light. It is identical with Baphomet, the mystic pantheos of those disciples of ceremonial magic, the Templars, who probably obtained it from the Arabians.”104

So, according to Hall and others, it is believed the Templars not only found physical treasure like gold and silver in their executions, but also informational treasure as well, in the form of ancient scrolls where they learned their strange secret doctrine.

Researchers Knight and Lomus, who are certainly not considered “conspiracy theorists,” explained that according to their findings, “Hence it follows that the mysteries of the craft are in reality the mysteries of religion. The Knights were, however, careful not to entrust this important secret to any whose fidelity and discretion had not been fully proved. They therefore invented different degrees to test their candidates, and gave them only symbolical secrets without explanation, to prevent treachery and solely to

enable them to make themselves known to each other. For this purpose it was resolved to use different signs, words and tokens in each degree, by which they would be secured against the Saracens, cowans or intruders.”105

In The History of Magic (published in 1860), Eliphas Levi reveals, “The Templars had two doctrines; one was concealed and reserved to the leaders, being that of Johannism [Gnosticism]; the other was public, being Roman Catholic doctrine. They deceived in this manner the enemies that they hoped to supplant. The Johannism of the adepts was the Kabalah of the Gnostics, but it degenerated speedily into a mystic pantheism carried even to idolatry of Nature and hatred of all revealed dogma…They went even so far as to recognize the pantheistic symbolism of the grand masters of Black Magic, and the better to isolate themselves from obedience to a religion by which they were condemned before, they rendered divine honors to the monstrous idol Baphomet.”106

Lynn Picknett and Clive Prince also confirm the secret doctrine accusations in their book The Templar Revelation, writing, “It is likely that the majority of the Knights Templar were no more than simple Christian solders they appeared to be, but the inner circle was different. The inner circle of the Templars appears to have existed in order to further active research into esoteric and religious matters. Perhaps one of the reasons for their secrecy was the fact that they dealt with the arcane aspects of the Jewish and Islamic worlds. They sought, literally, the secrets of the universe wherever they suspected they might be found, and in the course of their geographic and intellectual wanderings came to tolerate—perhaps even to embrace—some very unorthodox beliefs.”107

These “unorthodox beliefs” appear to have involved what’s called sex magic (often spelled sex magick with a “k” on the end), which is the practice of incorporating various sex acts into secret rituals in the belief that the sexual energy produced is transformed into spiritual power, allegedly enabling participants to activate dormant supernatural abilities. Theodore Reuss [co-founder of the Ordo Templi Orientis] revealed that sex magic was the greatest secret of occult fraternities, saying, “Our order possesses the key which opens up all Masonic and Hermetic secrets, namely, the

teachings of sexual magic, and this teaching explains, without exception, all the secrets of Freemasonry and all systems of religion.”108 He also said that sex magic was the big secret of the Knights Templar.109

In his companion book to The Secret Teachings of All Ages, titled Lectures on Ancient Philosophy, Manly P. Hall again reveals some amazing occult secrets that few people have discovered about the Templars. He wrote, “It was not the physical power of the Templars, but the knowledge which they had brought with them from the East, that the church feared. The Templars had discovered part of the great Arcanum; they had become wise in those mysteries which had been celebrated in Mecca thousands of years before the advent of Mohammed; they had read a few pages from the dread book of the Anthropos, and for this knowledge they were doomed to die.”110

Eliphas Levi writes in agreement, “It was the memory of this scientific and religious absolute, of this doctrine summarized in a word, of this word alternately lost and recovered, which was transmitted to the elect of all antique initiations…it was this same memory handed on to secret associations of Rosicrucians, Illuminati and Freemasons which gave a meaning to their strange rites, to their less or more conventional signs, and a justification above all to their devotion in common, as well as a clue to their power.”111

This “occult power” wasn’t the only thing that led to their downfall. The Templars, with the help of other secrets they likely learned from the rare scrolls they acquired, ultimately became wealthy bankers who issued loans, not only to people, but to governments and monarchs. The Catholic Church wouldn’t allow people to charge interest on money they lent to someone else because it was considered a sin (called usury), but the church looked the other way when the Templars did it, likely because they needed their protective services in the Holy Land.

Through lending money with interest, the Templars had exploited one of the most powerful and mysterious concepts in the world today. The same

tactic is used by the Illuminati banking cartel through their front groups like the Federal Reserve, the World Bank, and the International Monetary Fund. More on the magic of making money and collecting interest on loans later.



The Jesuits

Fast forward a few hundred years and we can see the Catholic Church following the same pattern of the Templars hoarding knowledge, power, and wealth, so insiders can live like kings by taking advantage of the ignorant masses. Ignatius of Loyola founded the Society of Jesus (aka the Jesuits) in 1540, whose members are also known as the “Pope’s Marines” because of their militant support of the Catholic Church. The Jesuits were founded to fight against the Protestant Reformation with hopes of keeping the Catholic Church in power by any means necessary. While supposedly being a Christian group, the Jesuits’ activities have been anything but.

Some believe that Illuminati founder Adam Weishaupt was covertly working for the Jesuits, but his correspondences reveal he deeply despised the Jesuits, although he did adopt their “ends justifies the means” tactics in hopes of replacing them with his own similar kind of tyranny.

A document titled The Secret Instructions of the Jesuits, was published in the early 1600s, allegedly written by a general in the society, and revealed the supposed tactics and “ends justifies the means” code of the Jesuits. The Church claims the documents are a forgery designed to defame the Jesuits, of course, but when one becomes aware of the ruthless and criminal activities Church insiders have engaged in to gain and maintain their power, it doesn’t really matter if they’re a forgery or not, because the tactics of the Jesuits and the Vatican have become widely known.

The Catholic Church’s crimes are legendary, from imprisoning Galileo for (correctly) declaring the earth revolved around the sun, to the Spanish Inquisition where officials tortured and killed anyone who dared disagree with them. And everyone is familiar with their institutional pedophile problem and the generations of cover-ups they have engaged in to protect the perpetrators.



These actions continue to give Christians a bad name with most antiChristian bigots apparently unaware (or willfully ignoring) the millions of non-Catholic Christians (like Protestants, Lutherans, Methodists, Baptists, non-denominational groups, etc.) which were (and still are) appalled by the actions of the Catholic Church who, for centuries, held a monopoly on Christianity, albeit their twisted and un-Biblical brand of it.

Jesuits were responsible for the 1605 Gunpowder Plot in England, which was an assassination attempt where the perpetrators, including Guy Fawkes, tried to blow up the House of Parliament to kill King James and the Protestant aristocracy. Every November 5th, bonfires and fireworks are used to commemorate the failure of the plot, an event that has come to be known as Guy Fawkes Night.

Vatican City in Rome is not just a city, but a completely sovereign country owned and operated by the Catholic Church that was established in 1929 by the Lateran treaty. It is only 110 acres and has a population under a thousand people and has over $8 billion dollars in assets.112 The Pope, of course, is the head, and is protected by his own personal army, the Swiss Guard.

The Popes, Bishops and Priests of the Catholic Church are basically the same as the Pharisees who Jesus denounced over 2000 years ago for their hypocrisy and pride due to their spiritual knowledge. One needs to look no further than the Inquisition or the massive institutional cover-up of countless pedophile priests to see the Catholic Church is corrupt to the core. The Catholic Church also diverts and perverts the teachings of Jesus in numerous ways, such as having people confess their sins to a priest instead of to God himself, as well as having sold indulgences, which, if you don’t know, means that people used to pay money to the church and in return a priest would forgive that person’s sins and tell them they could then get into Heaven. Some indulgences were even sold for sins people would commit in the future. Such a practice was clearly a shameful abuse of power and completely contradictory to the teachings of Jesus.



The Catholic Church basically took the freeing messages of Jesus and packaged them up and then sold them to the public, when Jesus had intended them to be accessible to all for free. This is the same thing the Jewish Pharisees did with Judaism causing Jesus to publicly denounce them. It is for these reasons and more that the Vatican, and specifically the Pope is looked at with suspicion regarding the New World Order and is believed by some to one day be the false prophet spoken about in the Bible.

According to Biblical prophecy, the counterfeit Christ (the Antichrist) will be a political figure and the leader of the world, who will be accompanied by the false prophet, a global religious leader that will (wrongfully) confirm to the world that the messiah has arrived when the Antichrist announces he is God. Since the Catholic Church is trying to reinstate itself as the only Christian authority in the world, many see the Pope as a prime candidate for this false prophet.

In 2007 Pope Benedict proclaimed that the Catholic Church was the only place that can offer salvation and held the only key to Heaven.113 He didn’t mean Christianity is the only path to salvation, which is a primary tenant of the faith. He meant specifically that the Catholic Church was the only way to God and that all other Christian denominations were basically leading people astray and were not “true” churches.114

This is the same Pope who, when he was still a Cardinal (then named Cardinal Ratzinger), was in charge of covering up the extensive pedophile priest network which has been operating within (or perhaps in charge of) the Catholic Church for generations.115 A 69-page document typed in Latin and taken from the Vatican’s Secret Archives bearing the seal of Pope John XXIII, was sent to every Bishop in the world in 1962 and contained detailed instructions and policies regarding keeping allegations of sexual abuse a secret.

The title of the documents in Latin, Crimine solicitationies, translates to “Instruction on proceeding in cases of solicitation” and was basically

identical to an earlier set of instructions issued in 1922.116 The documents were confirmed authentic by the Roman Catholic Church in England and Wales.117

Bishops were instructed to deal with child abuse allegations “in the most secretive way” and were reminded of their commitment to “perpetual silence” for what the documents called the “secret of the Holy Office.”118 They go on to say, “The oath of keeping the secret must be given in these cases also by the accusers or those denouncing the priest and the witnesses.”119 Anyone who speaks of the “secret of the Holy Office” or who admits publicly that any victims have come forward were threatened with excommunication.

All complaints about sexual abuse were stored in the Secret Archives of the Vatican. Daniel Shea, a lawyer for abused children said, “It proves there was an international conspiracy by the Church to hush up sexual abuse issues. It is a devious attempt to conceal criminal conduct and is a blueprint for deception and concealment.”120

Another attorney for abused children, Richard Scorer, said, “We always suspected that the Catholic Church systematically covered up abuse and tried to silence victims. This document appears to prove it. Threatening excommunication to anybody who speaks out shows the lengths the most senior figures in the Vatican were prepared to go to prevent the information getting out to the public domain.”121

This leads to the dark road of what is called sex magic, which is the most sinister secret of Satanism and is covered in the chapter titled Spiritual Beliefs. The leader of the Jesuits is officially called the “Superior General,” often nicknamed the “Black Pope,” and is believed by many to be the actual leader of the Catholic Church who wields his power from behind the scenes.



The Rosicrucians

The Rosicrucians are an interesting secret society-type of group, because the “group” started off as a hoax, really, which then inspired people to actually form such a group (or factions) based on the teachings of the mysterious Rosicrucian Manifestos, the first of which was published in Germany in 1614. Two other manifestos later appeared, one the following year in 1615, and another the year after that, said to have come from a secret brotherhood that made up an Invisible College which was preparing to reveal themselves to the world.

There are various theories as to who the author or authors of these mysterious books were. Many believe they were written by Johann Valentin Andrea, a German Lutheran theologian who was allegedly hoping they would help break the Catholic Church’s stranglehold on power.

Whoever wrote the manifestos chose to release them under the pseudonym Christian Rosencreutz as a symbol for the work because the name translates to Rosy Cross—a rose having been an alchemical symbol of heavenly perfection and paradise. The first manifesto tells a story of how “Christian Rosencreutz” went on a journey to the Middle East to study the occult and the ancient mysteries. The books are said to contain hidden meanings and esoteric knowledge which could only be revealed to a select few.

In the texts, “Christian Rosencreutz” wrote about a future utopia where people of different religions would all worship the same God in their own style while having tolerance for all other views. Of course, the Catholic Church condemned the manifestos and anyone who supported them.



The books also forecasted a coming age of enlightenment resulting from the revelation of ancient Hermetic secrets. Some believe surviving Knights Templars were behind the mysterious manifestos, and some also credit Rosicrucianism for changing stone mason guilds into the philosophical Freemasonry we are familiar with today.

Rosicrucian researcher Christopher McIntosh wrote, “It has often been suggested that the Hiramic legend in Masonry might be linked with the legend of Christian Rosenkreuz and his tomb…It is not impossible, therefore, that an impulse of a Rosicrucian nature (using the word “Rosicrucian” in its widest sense) was responsible for the transformation of operative into speculative Masonry.”122 The transformation from “operative” masonry to “speculative masonry” means changing from a mere stone mason trade union to the philosophical and spiritual form of Freemasonry that exists today. The 18th degree of Scottish Rite Freemasonry is called the Knight of the Rose-Croix (Rose Cross), clearly showing a connection between the two groups.

The Mormon Church, or the Church of Latter Day Saints, as they prefer to be called, contains several parallels with Rosicrucianism. First, both stem from books said to have been “discovered” or mysteriously appeared, which cleverly mix occult myths and rituals with Christian philosophy. Mormonism founder Joseph Smith Jr. most likely knew of the Christian Rosencreutz legend (which was two hundred years old in his time) when he concocted his tale of “finding” a supposed ancient text himself. Since Joseph Smith was a Freemason, he certainly would have been familiar with the Legend of Enoch, which claims that the true name of God was carved into a golden delta (triangle), and hidden before the great flood so that it would be preserved (and discovered) by a future generation.

These myths of ancient “lost and found” divine texts speaking of past cultures and mystical secrets were the inspiration for The Book of Mormon which Joseph Smith claimed to have “found” written on a stack of Golden Plates in the 1820s, which of course aren’t in a museum somewhere because he said an angel took them back to heaven for safe keeping! Smith was a Freemason who mixed Masonic mythology with Christianity to create

Mormonism which he claimed “restored” the lost secrets from the ancient past with his “discovery” (fabrication) of the Book of Mormon, again, which he magically “translated” from “Golden Plates” that are nowhere to be found.

The name “R. C. Christian” appeared in 1980 surrounding the creation of an enormous and mysterious occult monument in the small town of Elberton, Georgia—a structure known as the Georgia Guidestones. The name was chosen as a pseudonym by the individual who designed and paid for this bizarre monument. “R.C. Christian,” obviously standing for Rose Cross Christian, and the Brotherhood of the Rose Cross, which was a popular calling card of early Rosicrucians. The Georgia Guidestones monument stands nineteen feet tall and displays ten different commandments in eight different languages as the New World Order’s ten commandments. The first of which is to maintain the human population under 500 million people. The monument is said to be the “Guidestones to an age of reason” and has several astrological markings in the design, including a hole in line with the North Star.

It wasn’t just Mormonism founder Joseph Smith and the man behind the Georgia Guidestones who received inspiration from the Rosicrucians, but also the early founders of Freemasonry and even the father of the Illuminati, Adam Weishaupt. Many Rosicrucians in his time actually denounced Weishaupt and the Illuminati for taking what they considered to be a noble concept of an enlightened brotherhood, and turned it into a mechanism to exercise his own tyrannical goals.



Freemasonry

Often said to be just a men’s club of old guys who want to get away from their wives much like the Moose Lodge or Knights of Columbus— Freemasonry is quite a bit different from most men’s clubs and is actually often included when talking about the grand “Illuminati conspiracy.” What most people don’t know, and what high level masons have openly admitted, is that there is a secret society within this secret society.

Manly P. Hall, considered one of Freemasonry’s greatest philosophers, openly admitted that, “Freemasonry is a fraternity within a fraternity—an outer organization concealing an inner brotherhood of the elect…the visible society is a splendid camaraderie of ‘free and accepted’ men enjoined to devote themselves to ethical, educational, fraternal, patriotic, and humanitarian concerns. The invisible society is a secret most august [respected and impressive] fraternity whose members are dedicated to the service of a mysterious arcanum arcanorum [secret of secrets.]”123

You’ll sometimes hear people say that their grandfather was a “master mason” and dismiss any talk of a “conspiracy” because all grandpa did was engage in cheesy rituals and attend boring meetings. A “master mason” sounds quite impressive if you don’t know much about masonry. George Washington was a master mason and a considerable number of the Founding Fathers of America were masons, so they can’t be that bad, right? Out of the fifty-six signers of the Declaration of Independence, eight of them were confirmed to be Freemasons and at least sixteen U.S. presidents have also been masons, including James Madison, James Monroe, Andrew Jackson, James Polk, Theodore Roosevelt, William Howard Taft, Franklin D. Roosevelt, Harry Truman, Lyndon B. Johnson, and Gerald Ford.

While sounding like an impressive title, a master mason is only the 3rd level (or degree) of a 33 level hierarchy. The first degree is called entered

apprentice, the second is fellow craft, and the third is a master mason; but there are thirty-three degrees in the Scottish Rite. A rite is “a formal or ceremonial act or procedure prescribed or customary in religious or other solemn use.”124

The Scottish Rite is the most popular brand of Masonry and within the higher levels each degree is given a mysterious sounding name like Secret Master (4th Degree), Knight of the Rose-Croix (18th degree) and Grand Pontiff (19th degree). In the 32nd degree (the second highest level), the initiate is called a Sublime Knight Commander of the Royal Secret or Master of the Royal Secret.

The “Scottish Rite” actually started in France and was based on legends that originated from Scotland that were told by Scotts who fled to France in the late 1700s when the British Isles were having problems. Regardless of where the name originated, Scottish Rite Freemasonry is the most popular esoteric hierarchy of the fraternity.

The 33rd degree of the Scottish Rite is the highest level and is awarded by invitation only. Each of the degrees represents the different vertebrate in the human spine and symbolize the member’s ascent in their quest for Enlightenment within the fraternity. On top of the 33rd vertebrate of the spine sits the skull, which holds the brain, so the 33rd degree signifies that the initiate has become fully enlightened with the secret gnosis (knowledge) of the ancient mysteries.

Freemasonry evolved out of stone masonry, whose ancient tradesmen used a series of secret handshakes and code words to identify each other and their level of skill. Over time, various philosophies started arising out of those trade unions and used popular stone mason tools as symbols to represented various aspects of their philosophy. As their theology grew, the stonemasons morphed from what was called operative masonry (meaning men who worked with stones) to speculative masonry, which refers to the philosophical and spiritual Freemasons today.



While the operative (or stone masons) built cathedrals out of stone, the speculative (or Freemasons) built their intellect. The term “Freemason” likely comes from freestone masonry. Freestone is a softer stone used for cathedral faces that is intricately carved by higher skilled masons and is used as a metaphor to describe the development of a man’s character and abilities. Some say that “free” means they are free from ignorance or free from the chains of darkness that once enslaved them.

Evidence indicates that the Knights Templar either assimilated with Freemasonry or directly created it. Most American’s came to hear about Freemasonry as a result of Dan Brown’s 2003 novel The Da Vinci Code, and then in the following few years the History Channel, Discovery, National Geographic and other networks produced shows looking into this fascinating group. The 2004 film National Treasure starring Nicholas Cage capitalized on the hype, and portrayed them as the secret guardians of America.

It officially came into its modern form in 1717 with the creation of the Grand Lodge of England and has been shrouded in mystery ever since. Much of the controversy surrounding Masonry stems from allegations that the higher-level members worship satan and that they deceive lower level members about its purpose. “Anti-Masons” don’t just come up with these allegations out of thin air though; they often point to Masonic texts written by highly revered Masons as their evidence.

The “Bible of Freemasonry,” a book titled Morals and Dogma, written by Albert Pike in 1871 explains Masonic philosophy and is read primarily only by dedicated Freemasons. Part of this philosophy, Pike explains, is, “Masonry, like all the Religions, all the Mysteries, Hermeticism and Alchemy, conceals [emphasis in original] its secrets from all except the Adepts and Sages, or the Elect, and uses false explanations and misinterpretations of its symbols to mislead those who deserve only to be misled; to conceal the Truth, which it [the Mason] calls Light, from them, and to draw them away from it.”125



He reaffirms this deception later in the book, saying, ”The Blue Degrees are but the court or portico (porch) of the Temple. Part of the symbols are displayed there to the initiate, but he is intentionally misled by false interpretations. It is not intended that he shall understand them; but it is intended that he shall imagine that he understands them…their true explication [explanation and understanding] is reserved for the Adepts, the Princes of Masonry [those of the 32nd and 33rd Degrees].”126

Pike even makes several statements appearing to support the Devil, saying, “Satan is not a black god, but negation of God ... this is not a Person, but a Force, created for good, but which may represent evil. It is the instrument of Liberty or Free Will. They [Freemasons] represent this Force...under the mythological and horned form of the God Pan; thence came the he-goat of the Sabbat, brother of the Ancient Serpent, and the Light-bearer.”127

Later in the book he wrote, “Lucifer, the Light-bearer! Strange and mysterious name to give to the Spirit of Darkness! Lucifer, the Son of the Morning! Is it he who bears the Light, and with its splendors intolerable, blinds feeble, sensual, or selfish souls? Doubt it not!”128

I have personally spoken with a 32nd degree Mason who is a friend of a friend, and at first he dodged my insinuations that he worshiped Lucifer, but I pressed him and he started praising Lucifer and criticizing Christians saying they were morbid for worshiping a dead man hanging on a cross, and that they were judgmental and intolerant of other religions.

Satanist Aleister Crowley seems to agree that there is some great mystical secret held by the inner circle when he said, “Although I was admitted to the thirty-third and last degree of Freemasonry so long ago as 1900, it was not until the summer of 1912 that my suspicion was confirmed. I speak of my belief that behind the frivolities and convivialities of our greatest institution [Freemasonry] lay in truth a secret.”129



In his book autobiography The Confessions of Aleister Crowley, he wrote, “…for Freemasonry asserts that every man is himself the living, slain and re-arisen Christ in his own person. It is true that not one mason in ten thousand in England is aware of this fact; but he has only to remember his ‘raising’ to realize the fundamental truth of the statement.”130

Albert Pike was a lawyer who became a Confederate General in the Army, fighting against the northern colonies during the Civil War trying to ensure slavery was kept in place. He is believed to have been the leader of the Knights of the Golden Circle, a secret society of Confederates that included notorious outlaw Jesse James and John Wilkes Booth, the man who assassinated President Lincoln. The Lincoln assassination was not the action of a lone gunman, but was part of a larger plot hatched by the Knights of the Golden Circle with hopes of securing a victory for the south. John Wilkes Booth and other Knights of the Golden Circle planned to assassinate the vice president and the secretary of state that same night, thus eliminating three of the top officials in the United States government, hoping that would ensure the Confederates could take over.

Aside from being a key member of the KGC, it is rumored that Albert Pike founded the KKK as well, which isn’t far-fetched at all, considering it’s obvious he was a racist who saw black people as slaves. When African Americans first wanted to become part of the Masonic fraternity, Pike wrote, “I took my obligations to white men, not to Negroes. When I have to accept Negroes as brothers or leave Masonry, I shall leave it.”131

Pike owned the Daily Appeal, a newspaper in Tennessee, where on April 16, 1868 he published an editorial saying, “The disenfranchised people of the South...can find no protection for property, liberty or life, except in secret association...We would unite every white man in the South, who is opposed to negro suffrage [the right to vote], into one great Order of Southern Brotherhood, with an organization complete, active, vigorous, in which a few should execute the concentrated will of all, and whose very existence should be concealed from all but its members.”132



A larger than life statue of Albert Pike stands in Judiciary Square in Washington D.C. alongside Abraham Lincoln, and Pike’s body is kept in a tomb inside the Masonic headquarters in Washington D.C., a building called the House of the Temple, which is the home of the “Supreme Council” of Freemasonry.

Theosophist teacher and occult writer Alice Bailey, who claimed her books were dictated to her telepathically by an entity she called the Master of Wisdom, wrote that, “The Masonic Movement when it can be divorced from politics and social ends and from its present paralyzing condition of inertia, will meet the need of those who can, and should wield power. It is the custodian of the law; it is the home of the Mysteries and the seat of initiation. It holds its symbolism the ritual of Deity, and the way of salvation is pictorially preserved in its work. The methods of Deity are demonstrated in its temples, and under the All-seeing Eye the work can go forward. It is a far more occult organization than can be realized, and is intended to be the training school for the coming advanced occultists. In its ceremonials lies hid the wielding of the forces connected with the growth and life of the kingdoms of nature and the unfoldment of the divine aspects in man.”133

Many Muslims are against Freemasonry partly because one of Freemasonry’s ultimate goals is to rebuild the Temple of Solomon on its original site in Jerusalem, where the Al-Aqsa Mosque currently stands. This spot is claimed by both Muslims and Jews as their religion’s holy place, and a primary aim of both Palestinians and Jews is to once and for all claim this spot as their own.

Muslims are also critical of Freemasonry’s secretive nature. Sheikh Ahmad Kutty, a prominent Muslim scholar at the Islamic Institute of Toronto, explains, “As far as I know, Freemasonry is a secret organization whose beliefs and practices are totally kept confidential except from those who are initiated into it. They have levels of secrets which are not divulged to those who are at lower levels. A Muslim should never fall prey or give allegiance to something which cannot be scrutinized by the firm criteria of the Quran and the Sunnah. Whoever joins Freemasonry is like a person who

writes a blank check; by doing so he agrees to give allegiance blindly to an authority to comply with their wishes no matter what they are.”134

In 1998 a law was enacted in Britain ordering police, judges, and other government employees in the UK to reveal whether they were Freemasons after it was believed a Masonic Mafia was operating within the government.135 Ten years later the law was reversed but the controversy continued. A secret Metropolitan Police report written in 2002 and leaked to the press in 2014 reveals that an internal investigation by Scotland Yard, the police agency of London, discovered that an organized criminal network of Freemasons largely controlled the police department.136 The investigation, called Operation Tiberius, found that the Metropolitan Police were infested with corrupt Freemasons who used their position within the department to engage in organized crime, destroy evidence, and recruit other corrupt officers.137

While Freemasonry is primarily a men’s organization, there is a woman’s branch called the Eastern Star, whose logo is literally an upside down pentagram. There is even a branch for young girls called Job’s Daughters (or Rainbow Girls) and one for boys called the DeMolays— named after Jacques de Molay, the last Grand Master of the Knights Templar. President Bill Clinton was a DeMolay as a child, which many believe served as a prep school to groom him to later take his place as an Illuminati insider.

As noted earlier, it’s important to highlight that in 1782 Adam Weishaupt successfully infiltrated Freemasonry at the Congress of Wilhelmsbad, Germany, which was the largest, most important Masonic gathering of the eighteenth century.138 There he assigned men to oversee the implementation of “Illuminated Masonry” and recruit new supporters from Masonic lodges throughout Europe who would work on behalf of the Illuminati.



Skull & Bones Society

Even if you’re familiar with Skull & Bones and some of the allegations about them (many of which are true, by the way), the deeper you look into this group, the more apparent it becomes that they are anything but an ordinary college fraternity. Since it has already been touched upon earlier in this book, I won’t repeat most of what has already been covered, but I will add a few more pieces to the puzzle that most people are not familiar with so you can get a more complete picture of them.

Skull & Bones was the FIRST secret society at Yale and the first senior society—meaning someone doesn’t become a member until their senior year at Yale. There were fraternities at Yale, but Skull & Bones started a new chapter in the school’s history in 1832 when they created the first secret society, soon to be followed by Scroll & Key and then later Wolf’s Head, which are the top three senior (and secret) societies. The three clubs even hold regular “inter-council meetings” several times a year to coordinate their activities.

Each year fifteen new members are recruited (or “tapped,” as they say) to join. They are chosen during the last few weeks of the semester their Junior year in order to prepare them to replace the outgoing seniors who lead them through the elaborate and satanic initiation ceremony where they are given a new name (Long Devil, Machiavelli, Baal, Beelzebub are just a few examples).139 During part of the initiation, they lay in a coffin and give a detailed history of their sexual experiences up to that point in a ritual called Connubial Bliss.

Members consider the world “their realm” and call outsiders “Barbarians.” Once initiated the men (and now some women) are considered “bonesmen” or Knights of Eulogia, which is Greek for “Knights of the Blessing.” They even hold a special Skull & Bones wedding

ceremony when one of their members gets married to initiate the new wife into the “Bones Family.” Behind every corrupt man, there’s usually a woman willing to look the other way. They also own a 40-acre island located on the St. Lawrence River in Alexandria Bay, called Dear Island, which is used as a private vacation spot for “bonesmen” and their families.

After the summer, when the new school year begins, and the new initiates are then seniors, they meet every Thursday and Sunday night for a fancy dinner (often steak and lobster) that is followed up with what are called “sessions” which include various lectures and debates. It is believed that they eat using Adolf Hitler’s silverware that a “bonesmen” somehow obtained. Skull & Bones has its own collection of books in its library located in the Tomb [headquarters] to help new members learn the ways of the world. There is even a “Bones Bible” and other black books kept in the clubhouse library. They operate as a 5013c organization under the Russell Trust Association (or RTA Incorporated) and their 2012 filings with the IRS (which must be available for “public review” if you know just where to look and how to get them) shows they spent $469,000 dollars that year on “personal development” for their members.140

No alcohol is allowed inside the Skull & Bones Tomb clubhouse, that’s how serious they are. This is not a party. Taking over the world is serious business. Another difference between Skull & Bones and ordinary fraternities is that frats usually do community service and help with local fundraisers, but this strange group only looks out for themselves. In fact, the men (and now women) who are recruited into Skull & Bones are never engineers or mathematicians, because these careers hold little power compared to those in business, banking, media, politics, and law, which are the dominant careers of the members.

By now I’m sure you’re familiar that the most famous member is President George W. Bush, but what most people don’t know is that his family has a long history with the group. Aside from his father George Herbert Walker Bush being a member, Prescott Bush, George W.’s grandfather was a member, as well as his uncles Jonathan Bush, John

Walker, and his other uncle George Herbert Walker III. So was his greatuncle George Herbert Walker Junior, and his cousin Ray Walker.141

After George W. Bush became president in January 2001, he appointed several of his fellow bonesmen to various high level positions within the government. For example, he nominated William H. Donaldson (Bones 1953) as chairman of the Securities and Exchange Commission; Edward McNally (Bones 1979) was given a position in the Department of Homeland Security.142 Robert D. McCallum was appointed to Assistant Attorney General; Roy Austin was made the ambassadorship to Trinidad and Tobago; Victor Ashe was given a spot on the board of directors of Fannie Mae (the Federal National Mortgage Association), America’s biggest home mortgage financier, and so on.143

The list of Skull & Bones members who have risen to the pinnacles of power is long. Co-founder Alfonzo Taft became the head of the Department of War, which was the name of the Department of Defense until the government changed the name in true Orwellian double-speak fashion. Alfonzo Taft’s son, William Taft became President of the United States. Pierre Jay was the first chairman of the New York Federal Reserve Bank; Winston Lord became chairman of the Council on Foreign Relations. Percy Rockefeller was on the board of Brown Brothers Harriman & Company, which was had its assets seized in 1942 under the Trading with the Enemy Act after it was discovered the firm was helping fund Adolf Hitler.144 John Kerry, who ran for president against George W. Bush in the 2004 election, later became Secretary of State under President Obama.

The list of key power players in government just goes on and on. Raymond Price (1951) was a speechwriter for Presidents Nixon, Ford, and Bush. Christopher Taylor Buckley (1975) was the chief speechwriter for George H. W. Bush when he was the Vice President. Austan Goolsbee (1991) became President Barack Obama’s chief economic advisor, etc., etc. It’s interesting to also point out that the father of American football, Walter Camp, was a boneseman. Football, as you may know, serves as a modern day bread and circus distraction for the majority of Americans, channeling their energy and aggression into watching a bunch of men chasing after a

ball instead of paying attention to important social issues. This is all part of the plan because it keeps most people out of the way so the elite can carry out their agenda.

Skull & Bones members created the American Historical Association, the American Psychological Association, the American Chemical Society; and the American Economic Association. The atomic bomb was basically a Skull & Bones project involving William Averell Harriman, Governor of New York (class of 1913), Henry Stimson, Secretary of War (class of 1888), Robert Lovett, Secretary of Defense (class of 1918), McGeorge Bundy, U.S. Intelligence Officer (class of 1940) and George L. Harrison, advisor to the Secretary of War and President of the New York Federal Reserve Bank (class of 1909).

I guess it shouldn’t be surprising that an organization whose symbols and themes revolve around death would ultimately be responsible for creating the most deadly weapon in the history of mankind. The group’s obsession with death is extremely disturbing and all the death symbolism is meant to serve as a continuous reminder of their own mortality, and since they don’t believe in an afterlife, they are urged to become gods on earth during their short time here by any means necessary.

We often think of the society “ruling the world” in terms of politicians and business, but they have also dominated the faculty of Yale University as well. Some reports claim that four out of five faculty members between 1865 and 1916 were bonesmen.145 In 1873, a student newspaper called The Iconoclast, published an article denouncing Skull & Bones control of Yale. “Out of every class Skull and Bones takes its men...They have obtained control of Yale. It’s business is performed by them. Money paid to the college must pass into their hands, and be subject to their will....It is Yale College against Skull and Bones!”146

Aside from being accused of dominating the faculty at Yale and power positions in politics and business, they are often accused of worshiping Satan and conducting extraordinary disturbing rituals. The group’s favorite

number, 322, possibly holds a secret satanic meaning. Many people believe the number 322 is a reference to the Book of Genesis chapter 3 verse 22 which talks about Adam and Eve eating the Forbidden Fruit from the Tree of Knowledge of Good and Evil and employing this number is seen as a reference to the Luciferian doctrine or the satanic secret.

In 2001, a reporter named Ron Rosenbaum from the New York Observer used a night vision camera to videotape the initiation ritual from the ledge of an adjacent building that overlooked the courtyard of the Skull & Bones clubhouse. The footage shows initiates kneeling down and kissing a skull, and then appearing to take a knife and slit the throat of a naked woman who was being held down by other members.147

People were also heard chanting a strange mantra, “The hangman equals death, the Devil equals death, death equals death!” The hangman likely refers to Jesus hanging on the cross and the mantra appears to convey the same meaning as the riddle of the four human skulls when they are asked which one is the wise man, the beggar, the king, and the fool. The answer given is that it doesn’t matter to them because “all is the same in death.”

Rosenbaum was not sure what to make of this behavior and asked, “Is that the secret they’ve been covering up ever since the society was founded in 1832, the offshoot of a German secret society: devil worship? A fulfillment of the paranoid fantasies of the fundamentalist right, who believe the Eastern establishment is a front for satanic conspiracy.”148



Scroll and Key Society

The Scroll & Key society is a another secret society at Yale University, created in 1842, ten years after Skull & Bones, and was the second secret society at the school composed of seniors. Just like Skull & Bones, Scroll & Key recruits fifteen new students at the end of their junior year who they see as having the potential and willingness to further the organization’s goals. Scroll & Key is considered one of the “Big Three” senior societies at Yale—the other two being, of course, Skull & Bones, along with Wolf’s Head.

Fareed Zakaria, a CNN commentator on foreign affairs, was initiated as a member of Scroll & Key when he attended the university in 1986. Fareed went onto to attend Bilderberg meetings (in 1993 and 2009), and became a member of the Council on Foreign Relations as well. He didn’t just join the CFR, he actually was the managing editor of their publication Foreign Affairs which serves up their political propaganda on a platter for the members.

Fareed once argued that the Constitution is outdated and should be “fixed” to remove the Second Amendment in order to “modernize the Constitution for the 21st Century.”149

Other notable members include Ari Shapiro (class of 2000) who became the White House Correspondent for National Public Radio (NPR); James Stillman Rockefeller (class of 1924) who was the President and Chairman of the First National City Bank of New York; Cornelius Vanderbilt III of the wealthy Vanderbilt dynasty (class of 1895); and Huntington D. Sheldon (class of 1925) worked for the CIA as the Director of the Office of Current Intelligence.



The Scroll & Key society operate under the legal entity called the Kingsley Trust Association which creates a shield of privacy to protect them from people searching for information using the name “Scroll & Key” and according to their 2012 IRS filings, which must be made available for public inspection, they have over $9 million dollars in assets and spent $650,000 dollars that year.150



Wolfs Head

Wolf’s Head is the third of the “Big Three” senior secret societies at Yale and was founded in 1884, partly to counter the dominance of Skull & Bones over student affairs. They too recruit fifteen new upcoming seniors for membership and are now part of the larger network consisting of Skull & Bones and Scroll & Key.

The club’s logo is a wolf’s head on an inverted Egyptian hieroglyph called an ankh, which is often called the Egyptian Cross and said to symbolize “the key of life.” Wolf’s Head built its own Egyptian themed “tomb” headquarters in 1924 thanks to a donation from one of their members, Edward Harkness, who went on to become John D. Rockefeller’s right hand man. Harkness himself was listed by Forbes magazine as the 6th richest man in the world during his life.

The club holds meetings every Thursday and Sunday night where the men (and since 1992 some women) prepare themselves for life after college, when their real work begins.

One of their most well-known members was Erastus Corning, who went on to become the Mayor of Albany, New York for more than 40 years! Another prominent members was Paul Moore Jr. who later became a bishop of the New York Episcopal Church and one of the best known clergy. After his death his daughter revealed that Moore was bisexual and had a history of homosexual affairs.151 She detailed her father’s double life in her book The Bishop’s Daughter: A Memoir. While the Bush crime family has been active in Skull & Bones for generations, they also have a hand in Wolf’s Head. President George H. W. Bush’s younger brother William Henry Trotter “Bucky” Bush (born July 14, 1938) was inducted in 1960.



The business name of Wolf’s Head is the Phelps Association, and according to their 2013 IRS filings, which must be made public since they are registered as a 501c3 tax exempt foundation, the organization holds over $6 million dollars in assets and spent over $373,000 dollars on their members that year alone.152 Wolf’s Head members were responsible for the formation of the Yale Political Union which is the center for politically minded students at the University.



Communism

Communism is most often promoted as a political philosophy to allegedly help the average worker (proletariat) fight against the “oppressive” business owners (bourgeoisie), but it’s actually a conspiracy controlled by the elite who have used Communism as a mechanism to encourage the creation of an all-powerful super state that they themselves are in control of.

As Gary Allen puts it, author of None Dare Call it Conspiracy, “Communism is not a movement of the downtrodden masses but is a movement created, manipulated and used by power-seeking billionaires in order to gain control over the world…first by establishing socialist governments in the various nations and then consolidating them all through a ‘Great Merger,’ into an all-powerful world, socialist super-state probably under the auspices of the United Nations.”153

The Communist Manifesto, written by Karl Marx and his often overlooked coauthor Frederich Engles, was first published in 1848, and is widely believed to have sparked the Communist Revolution in Russia in 1917 and spreading to other countries such as North Korea in 1948, China in 1949, and a few years later moving to Cuba in 1953—but what most people overlook is that Karl Marx was really just a secretary who wrote the book outlining the Communist philosophy for a secret society called the Communist League.

The manifesto itself reads, “The Communist League (formerly called the League of Just Men)…which could of course only be a secret one… commissioned the undersigned [Karl Marx and Friedrich Engels], at the Congress held in London in November 1847, to draw up for publication a detailed theoretical and practical program of the Party. Such was the origin

of the following Manifesto, the manuscript of which traveled to London to be printed, a few weeks before the February Revolution.”154

The California Senate Investigating Committee on Education in 1953 stated, “So-called modern Communism is apparently the same hypocritical and deadly world conspiracy to destroy civilization that was founded by the secret order of the Illuminati in Bavaria on May 1, 1776, and that raised its hoary head in our colonies here at critical periods before the adoption of our Federal Constitution.”155

The report goes on to say, “The recognition of May 1, 1776, as the founding date of this world revolution conspiracy is not difficult to understand, when it is realized that May Day is frequently celebrated, even in recent times, by rioting and bloodshed on a world-wide scale.”156

“It was not until 1847 or 1848, that the Communist conspirators, who had theretofore operated in secret, came out in the open with the Manifesto of the Communist Party, by Karl Marx and Friedrich Engels, boldly proclaiming against practically everything upon which civilization is based —God, religion, the family, individual liberty, and so forth—the concluding paragraph of the manifesto reading: ‘Communists scorn to hide their views and aims. They openly declare that their purpose can only be achieved by the forcible overthrow of the whole extant social order. Let the ruling classes tremble at the prospect of a Communist revolution. Proletarians have nothing to lose but their chains. They have a world to win.’”157

“In issuing this manifesto the Communist conspirators evidently believe the time had arrived when, with the aid of ignorant victims, a worldwide take-over could be accomplished; but there were not enough ignorant victims then, and the expected coup failed.”158

“The Communist conspirators thereupon conceived the plan, for the future, of supplementing the long-established secret conspiracy, in existence since May 1, 1776, with an unremitting publish campaign for victims among the ignorant of all nations. And, in an attempt to hide from view the

underlying hypocritical conspiracy existing since May 1, 1776, it was decided that, in such public campaign, the manifesto of 1848 should be heralded as the founding date of communism, and Karl Marx falsely proclaimed as its author.”159

New Age guru Benjamin Crème, who is looking forward to the arrival of the Antichrist, thinking he will turn earth into a heavenly paradise, admitted, “Marx was indeed a member of the Hierarchy, of a certain degree. Looking at the effect of his work over the years—that could only have been the work of a disciple of some degree, an initiate of some level—first to have the vision, and secondly to have the capacity to embody that vision so that the work could spread.”160

While Christians are often said to have killed the most number of people in the name of God, the reality is that Communists have been responsible for the greatest genocides in the world, killing in the name of the State (their government), in countries like China and North Korea. Over 30 million were killed in the Chinese Communist Revolution lead by Mao Zedong, and Joseph Stalin killed over 3 million in Russia in the name of Communism.161 Massive numbers have also been killed in Vietnam and North Korea by Communist revolutionaries. Belief in any God other than the government is forbidden, because it reduces people’s allegiance to the State. The government is God in Communist countries.

At the heart of Communism is an enormous all-powerful government that controls every aspect of people’s lives—from the schools, to their jobs, to healthcare and banking; with a small group of elite bureaucrats living lives of luxury at the express of the working class. This is, of course, one of the primary goals of the Illuminati, who are promoting the idea as a utopian paradise.



Bohemian Grove

Because the Bohemian Grove has become fairly well-known in terms of the Illuminati conspiracy, many people may think they know all about it, but in most cases their knowledge is limited to only a few basic facts. Because of its extraordinarily bizarre rituals and elite membership list causing widespread rumors, most people who have done a brief investigation into the Illuminati are probably familiar with the basics of the Bohemian Grove, but for those who wish to scratch beyond the surface of this subject, there is certainly a lot to be learned.

As you may have heard, it’s a 2700 acre privately owned redwood forest in Northern California located about an hour north of San Francisco in a small town named Monte Rio and serves as a vacation spot for elite men every summer in mid-July, where around 1000 of the world’s most powerful men gather for a “men’s retreat” inside the Grove which is kicked off by the infamous Cremation of Care ritual, the human sacrifice-depicting ceremony, where a life-size effigy of a person is burned on an altar at the base of a 40-foot tall demon-looking statue. It’s sort of the Camp David of California (with some Satanism mixed in) and was created back in 1872.

The term Bohemian refers to people who live non-traditional lifestyles and people who are adventurers, or vagabonds. The club’s annual midsummer encampment is called the “greatest men’s party on earth” by members, who include many former presidents, military leaders, famous journalists, and top businessmen.

The Bohemian Grove’s mascot (and logo) is the Owl of Minerva, the same symbol that Adam Weishaupt used as his emblem.162 Within the original Illuminati there was a level in the hierarchy called the Minerals and the owl symbolizes wisdom because it can “see in the dark” which is analogous to being enlightened.



Out of curiosity, in the past, occasionally a reporter would try to sneak inside the now highly guarded compound, and some have been successful, yet little has been reported in major publications. Membership lists and program guides have sometimes been stolen and published by employees, and in the 1980s a group called the Bohemian Grove Action Network dedicated themselves to doing just that.

The “patron saint” of the Bohemian Grove is Saint John of Nepomuk and a large statue of him stands inside the grounds with him holding his index finger over his mouth, signifying secrecy and reminding members to keep their mouths shut. A patron saint is someone who embodies a group’s philosophies or goals. John of Nepomuk received the confessionals of the queen of Bohemia in the 1300s and when pressured by the king to reveal her confessions after he suspected her of cheating on him, Saint John refused and was killed by the king. Paralleling Robert De Niro’s gangster gospel in Goodfellas that you “never rat on your friends, and always keep your mouth shut,” the Illuminati cherish the power of secrecy and remind all Bohos (the name members are often referred to) of this with the statue of John of Nepomuk standing prominently in their forest.

A presidential advisor to Presidents Ford, Nixon, Regan, and Clinton, named David Gergen, who also worked as a CNN contributor, was confronted on camera by Alex Jones from Infowars.com on the streets of New York during the 2004 Republican National Convention when Jones stuck a microphone in his face and asked if he’d ever seen the Cremation of Care ritual.

Gergen, looking visibly uncomfortable, responded, “Frankly I don’t think that’s something I need to talk to you about.”163 When Jones asked him again about the ritual, Gergen snapped, “That’s none of your damn business!” and walked away.164 The clip can be seen on YouTube.

One of their popular sayings is that “weaving spiders come not here,” which is said to mean that the Grove is not a place for conducting business

or working, hence “weaving,” but this explanation is just a cover story for the saying’s true meaning. It actually means “don’t dare challenge the members,” (or really, the “Gods,” as they see themselves) and comes from the ancient story in Greek mythology of Arachne, a woman weaver who disrespected Athena, the Goddess of weaving, by failing to acknowledge that the woman’s skills came from the Goddess and not from her own power. Athena then turned her into a spider as punishment, dooming her and her descendants to weave webs forever, since out of her own ignorance she thought she was better than the “Gods.”

The club is divided into about 124 different camps inside the grounds, each one having anywhere from a dozen to 125 men. Each individual camp has its own sleeping quarters, kitchen and bar, and each one has a captain who is responsible for managing their territory.165 Each camp has a different name and tends to contain members who work in the same field. For example, the Hill Billies camp is comprised of mainly men in big business, bankers, politicians, and media moguls from Texas. The sign for Hill Billies’ camp, which the Bush family belongs to, consists of a cloven hoofed horned Devil figure.

The Mandalay camp is made of mainly political figures such as former presidents and defense contractors. Owls Nest is another elite camp of former presidents, high ranking military personnel and defense contractors. Other camp names include the Lost Angels (banking and media), Stowaway (Rockefeller family members and other big oil men), and Hillside (military men including Joint Chiefs of Staff members), just to name a few. No seated president ever attends because his schedule and location is so closely monitored that his visitation would bring too much unwanted attention to the club, but once they are out of office (and before they are even elected) many are fixtures at the encampment.

Sociologist Peter Phillips, who earned his Ph. D. by writing his doctoral dissertation on the Grove in 1994, wrote, “Sharing a camp together at the Grove gives Bohemian directors of major U.S. policy councils ample opportunity to discuss current affairs and socio-economic policy issues. Watching and listening to reactions to Lakeside Chats by various other

Bohemians also gives policy directors an opportunity to evaluate policy concerns from the broad sampling of the American corporate business community encamped at the Grove. In this sense, the Grove serves as an informal evaluatory feedback process to the top socio-economic domestic and foreign policy councils in the United States.”166

The midsummer encampment, as their annual gathering is called, lasts for two weeks from mid-July to the end of the month, with some members and guests coming for a weekend, and others staying for several days or even an entire week or longer. Every afternoon during the two weeks a “Lakeside Chat” is given at 12:30pm, just after lunch, where a political insider or industry leader gives a 30-minute talk on his area of expertise.

It has been rumored that Alan Greenspan was chosen to be nominated as Chairman of the Federal Reserve after a meeting in the Grove, and Arnold Schwarzenegger’s successful bid for governor of California was allegedly given the green light by insiders at the Grove as well. There’s even a famous picture taken in 1967 showing Ronald Reagan (then Governor of California) and Richard Nixon, who would be elected president the following year, sitting next to each other, where they are said to have been coordinating their political careers.167

Despite claiming the Grove is just a vacation spot and no work is conducted during the encampment, the Manhattan Project (the plan for the atomic bomb) was actually hatched inside the club.168 Aside from the atomic bomb being born in the Bohemian Grove, the United Nations was hatched from the club as well.169 Peter Phillips reveals, “One of the foremost political events in which the Bohemian political network played a significant role was the United Nations Conference of International Organization (UNCIO), April 25th to June 26, 1945, in San Francisco. This was the original formation meeting for the United Nations, with delegates from fifty nations. Receptions for UNCIO delegates and key dignitaries were held at the Bohemian Club on May 17, May 29, June 4, and June 5. Towards the end of the U.N. conference the Club invited all delegates to a program at the Grove.”170



The club has limited number of rare yearbooks that are occasionally printed for members, called the Annals of the Bohemian Grove, that contain photos of attendees dressed in drag, along with pictures of the Cremation of Care ritual so men can reminisce about their time there. I have been able to obtain several copies of these books since every once in a while they’ll find their way into the public after older members die and their book collections are sold at estate sales or donated to charity. In one Annal there is a photo of George Bush Senior and George W. Bush standing at the podium giving a Lakeside talk in 1995 where Bush Senior reportedly told the audience that his son would make a great president one day.171

The first book dedicated to exposing the Bohemian Grove was published in 1974 titled The Bohemian Grove and other Retreats, written by William Domhoff, a sociologist and professor who taught at the University of California, Santa Cruz.

The preface to his book explains that upper-class retreats are of a major sociological relevance, because “they increase the social cohesiveness of America’s rulers and provide private settings in which business and political problems can be discussed informally and off the record.”172

The book continues on page one saying, “You are one of fifteen hundred men gathered together from all over the country for the annual encampment of the rich and famous at the Bohemian Grove. And you are about to take part in a strange ceremony that has marked every Bohemian Grove gathering since 1880.”173 He goes on to include a transcript and detailed description of the Cremation of Care, which was a historic revelation, especially considering this was back in the 1970s before the Information Age.

Twenty-five years later, in the year 2000, Alex Jones from Infowars would sneak inside and capture the first ever video footage of the ritual. While it’s one thing to read about the ceremony, actually seeing it leaves you with your head shaking and confirms many of the supposed “rumors”

are true. Jones’ footage is authentic, and after his infiltration they beefed up security and began using thermal imaging scanners and K-9 police tracker dogs to identify anyone lurking around the grounds who doesn’t belong there.

The most disturbing allegations about the Bohemian Grove don’t just lurk in the dark depths of the Internet, but actually come largely from a former U.S. Senator named John DeCamp. The allegations are so horrific and graphic, I don’t even like to talk about them because they involve claims of sadistic child abuse, human sacrifice, and snuff films, said to have occurred there in the 1980s. If you are interested in learning about John DeCamp’s allegations, you can check out his book The Franklin Cover-up, but I warn you, it is extremely disturbing and you may wish you had never heard of them.



Belizean Grove

When talking about secret societies or the Illuminati, most people often think of a group of men, since they have been the dominant sex throughout history, but powerful female secret societies, although rare, do exist. The Belizean Grove is a group of around 100 influential women from politics, media, and high ranking women in the military, that was created as a female version of the Bohemian Grove! It was founded on Super Bowl Weekend in 2001 by Susan Stautberg while her husband and most men were preoccupied with football, since she obviously had something else in mind.

The Belizean Grove, while inspired by the Bohemian Grove, is named after the country of Belize in Central America where the women meet every year for three days of private off-the-record talks, which is said to be “a balance of fun, substantive programs and bonding.”174 It certainly is strange that some of the world’s most powerful women would fly down to Central America for a weekend when they could simply meet locally at one of their lavish private residences. Perhaps this is so they can go out to the bars without the risk of being recognized by the locals so they can engage in extramarital affairs with younger men willing to bed a cougar. Since such behavior would run them the risk of getting caught or recognized if they did it in a major American city, perhaps the long distance ladies night was designed to facilitate such activities.

While high level female executives from major banks, public relations firms, and even the U.S. Military, all belong to the Belezian Grove, perhaps the group’s most famous member is Supreme Court Justice Sonia Sotomayor, who was nominated by Barack Obama to sit as a justice on the court. During the vetting process it was uncovered that she was a member of this strange girls group, causing her to resign since the American Bar Association forbids a judge to be a member of any organization that

“discriminates” against anyone based on sex, race, religion or national origin.

If it had not been for Republicans digging for dirt on Sonia Sotomayer hoping to derail her appointment to the Supreme Court, we likely would still be unaware of the Belizean Grove’s existence. Founder Susan Stautberg was not happy about the new publicity, and said, “we like to be under the radar screen.”

The group says they are “a constellation of influential women who are key decision makers in the profit, nonprofit and social sectors; who build long-term, mutually beneficial relationships in order to both take charge of their own destinies and help others to do the same.”

One member, Mary Pearl, dean of New York’s Stony Brook University, said, “It’s hard if you’re someone who’s a type ‘A’ personality, who’s achieved a lot and who may be in the public eye—it’s hard to make friends, so it’s just a mutually supportive wonderful experience. We get together just for socializing and also just for intelligent conversation.”175

In order to join, a member must recommend a woman to the Belizean Grove “advisory board” that then decide whether or not to admit them to the club. A few known members are Army General Ann E. Dunwoody, former Goldman Sachs executive Ann Kaplan, and General Services Administration Director Lurita Doan. Facebook’s Chief Operating Officer Sheryl Sandberg is a likely member as well.

A New York Times article written in 2011 said, “Belizean Grove has connected the top women in technology to the top women in finance, to the top women in media, to the top women in law, to the top women in retail, and so on.”176 It is currently unknown if the group conducts any bizarre rituals like their male counterpart at the Bohemian Grove, and at the time of this writing little else is known about the Belizean Grove.



Seraphic Society

Would you believe there’s a secret society of elite secretaries? I’m not kidding. Known as the Seraphic Society, this strange group was founded in 1940 in New York to supply, “leaders in industry, and social, civic, philanthropic, professional and other important enterprises” with trustworthy secretaries.”177 The most powerful CEOs in America get their secretaries from the Seraphic Society, which is named after the Seraphim, the highest order of angels in Heaven, because the society considers their secretaries angels who protect Gods.

David Rockefeller, Steve Forbes, CEOs from Meryl Lynch, Goldman Sachs, Chase Manhattan Bank, Sony, and many other Fortune 500 companies all use the Seraphic Society to provide them with “trustworthy” secretaries. A Fortune magazine article in 2009 even admitted that the Federal Reserve Bank of New York and the Council on Foreign Relations use this “secretarial Skull and Bones” society.178

When journalist John Glassie of the New York Times was working on an article about the group in 1998, he was told by the Saraphic president at the time, who asked not to be identified, that “We’re very quiet, very lowkey,” and “It’s very touchy.”179

One “Angel” who was willing to speak with the reporter on the condition of anonymity told him, “Some people would love to be members but they just don’t fit the qualifications, and that’s what keeps this organization so special…You can’t just say you want to join.”180

With many high-powered CEOs of international banks being essentially organized crime bosses, they can’t just hire any secretary to deal with their shady affairs. The Seraphic Society can provide them with

women they know will not have any second thoughts or misgivings about the kind of work their boss is involved in, and who will be compensated very well for their cooperation. The saying goes that behind every great man is a great woman, and the same is true that behind every corrupt man, is a woman who’s willing to look the other way.

Secretaries for rich and powerful, or “administrative assistants,” as they are often called, don’t just deal with their boss’s work schedule, but are also closely intertwined with their personal lives as well. Personal assistants often get to know the intimate details of their boss’s lives and are trusted to manage what are called P & C’s or personal and confidentials, which may range from doing their personal shopping, to even arranging the delivery of drugs or hookers.



The Ordo Templi Orientis

Ordo Templi Orientis (Latin for Order of the Temple of the East or Order of Oriental Templars, often abbreviated to O.T.O.) is a secret society (or “fraternal order” as they say) founded between 1895 and 1906 in Germany or Austria (their exact original is unverified) whose spiritual teachings are based on the philosophy of Aleister Crowley and uses his Book of the Law as it’s Bible. The O.T.O. was inspired by Freemasonry and its founders concocted nine different levels (or degrees) for initiates that each supposedly reveal new spiritual teachings. These degrees were later expanded to thirteen.

Aleister Crowley claimed a demon who possessed his wife while they were in Egypt dictated his Book of the Law to him in 1904, commanding him to obey the entity’s ruthless social darwinistic rules such as, “Compassion is the vice of kings: stamp down the wretched and the weak: this is the law of the strong, this is our law and the joy of the world.”181 The demon, whose words Crowley wrote down in what would later be published as The Book of the Law, also commands readers to “Worship me with fire & blood; worship me with swords and with spears, is the command…let blood flow to my name. Trample down the Heathen; be upon them, o warrior, I will give you of their flesh to eat! Sacrifice cattle, little and big, after a child.”182

It continues, “Damn them who pity! Kill and torture; spare not; be upon them! The best blood is of the moon, monthly, then the fresh blood of a child.”183 The demonic entity voicing its instructions finally said, “I am in a secret fourfold word, the blasphemy against all gods of men. Curse them! Curse them! Curse them! With my Hawk’s head I peck at the eyes of Jesus as he hangs upon the cross.”184



While anyone can pick up a copy of Crowley’s book and read his teachings which make up the core of the O.T.O., many believe the organization’s best kept secrets are only communicated orally, and involve what is called sex magic (often spelled sex magick, with a “k” on the end), which is the belief that through certain sexual practices, one can reach a level of enlightenment that is unattainable by any other means.

“Dr. Israel Regardie [Crowley’s personal secretary] believed that certain sex magick techniques could be used by advanced students to incarnate ‘spiritual’ energies on the physical place, as well as making important shifts in the orientation of the Psyche and the Universe. In other words, if these methods were used properly, couples could bring into the world ‘divine’ forces in the children they generated, who could influence the future of the race.”185

“The realization that man’s emotional, physical and sexual energies are food for the ‘gods’ can create great personal turmoil at first, however when one begins to joyously participate in the spiritual feeding frenzy, one is ‘elevated perpendicularly to infinity.’”186

Crowley revealed in his autobiography that, “the O.T.O. is in possession of one supreme secret. The whole of its system at the time when I became an initiate of the Sanctuary of the Gnosis was directed towards communicating to its members, by progressively plain hints, this allimportant instruction. I personally believe that if this secret, which is a scientific secret, were perfectly understood, as it is not even by me after more than twelve years’ [of] almost constant study and experiment, there would be nothing which the human imagination can conceive that could not be realized in practice…I make these remarks with absolute confidence, for even the insignificant approaches that I have been able to make towards the sanctuaries of this secret have shown me that the relations between phenomena are infinitely more complex than the wildest philosophers have ever imagined, and that the old proverb ‘where there’s a will there’s a way’ needs no caveat.”187



What he’s talking about is his belief that through various sexual practices, heterosexual and homosexual, he believed one could “super charge” in a sense, his ability to “manifest” things into his life that he wanted. Crowley was a bisexual, heroin addict, who ate human feces and reportedly had sex with animals in his quest for enlightenment, yet he is still seen as an idol by rebellious teenagers and many mainstream musicians have paid homage to him.

The fact that the Ordo Templi Orientis bases its teachings on such a perverted and wicked man casts a dark cloud of suspicion over the entire organization. Little is known about the membership and current activities of the OTO but many suspect their secret sex magic rituals have attracted some very powerful men from Hollywood’s elite. Others believe that high level Illuminati members engage in homosexual Enochian sex magic rituals inside the Bohemian Grove every summer in attempts to activate latent metaphysical power allegedly hidden deep inside the brain.



Jekyll Island Meeting

The infamous Federal Reserve, the privately owned banking cartel that is in control of America’s currency and financial system, was born out of a secret meeting held by a handful of banking elite on a secluded island off the coast of Georgia in 1910. Under the cover story of going on a hunting trip, a small group of men met on Jekyll Island for a week and a half to draft what would later be passed into law through a clever and sneaky tactic of voting on their plan on December 23rd 1913, the eve of Christmas Eve, while almost every congressman was at home with their families for Christmas, thus slipping the Federal Reserve Act into law.

While the Federal Reserve sounds like a department of the United States government, it is actually a conglomerate of privately owned banks who dictate America’s monetary policy, and as the saying goes, “those with the gold make the rules.” Just as the elite Illuminati have secretly maneuvered themselves to control both major political parties in the American government, along with the world’s resources, infrastructure, and media though their business monopolies; of course they planned (and successfully accomplished) to take over the financial system as well, and are now in charge of printing the money.

The Jekyll Island meeting included executives from the major banks, such as Rockefeller family associate Frank A. Vanderlip, who was president of the National City Bank of New York; Henry Davison of J.P. Morgan Company; Charles D. Norton, president of the First National Bank of New York; Paul Warburg of Kuhn, Loeb, & Co; and Colonel Edward House, one of the founding members of the Council on Foreign Relations. The plan they put together would then be presented to Senator Nelson Aldrich, whose daughter was married to John D. Rockefeller Jr., who then presented it to Congress where it became known as the Aldrich Plan.



Paul Warburg later admitted, “The matter of a uniform discount rate [interest rate] was discussed and settled at Jekyll Island.”188 Frank Vanderlip, who worked for the Rockefellers and attended the Jekyll Island meeting, would later admit in his autobiography that, “Discovery, we knew, simply must not happen, or else all our time and effort would be wasted. If it were to be exposed publicly that our particular group had gotten together and written a banking bill, that bill would have no chance whatever of passage by Congress.”189

Congressman Ron Paul wrote in his book End the Fed, “A secret meeting was convened at the coastal Georgia resort called the Jekyll Island Club, co-owned by J. P. Morgan himself. The press said it was a duckhunting expedition. Those who attended took elaborate steps to preserve their secrecy, but history recorded precisely who was there: John D. Rockefeller’s man in the senate, Nelson Aldrich, Morgan senior partner Henry Davison, German émigré and central banking advocate Paul Warburg, National City Bank vice president Frank Vanderlip, and NMC staffer A. Piatt Andrew, who was also Assistant Secretary of the Treasury to President Taft.”190

William Greider, author of the New York Times bestseller Secrets of the Temple: How the Federal Reserve Runs the Country, mostly dismisses what he calls “conspiracy-minded” accusations, but does admit that, “their suspicions were poetically accurate—the bankers met secretly because they knew that any proposal identified as Wall Street’s bill would be doomed in the Democratic House of Representatives.”191

Those who own the banking system have a tremendous amount of power in their hands because those who control the issuance of currency have the ability to create money out of nothing, declare it’s legal tender, and then loan it out to people (or the government) and then collect interest on the money they lend out. It’s the perfect scam because instead of earning their money by building something, delivering packages, raising livestock, or any number of other ways people earn a living, the banksters have cleverly positioned themselves into the place where they take in a massive amount of money for basically doing nothing other than acting as the self-

proclaimed sole authority on money itself. Once you can wrap your mind around what it means to “create money out of nothing and loan it out at interest,” you can realize just how monumental their scam is.

The President of the Bank of England and the second richest man in Britain in the 1920s, Sir Josiah Stamp, is reported to have revealed that, “The modern banking system manufactures money out of nothing. The process is perhaps the most astounding piece of sleight of hand that was every invented. Banking was conceived in inequity and born in sin… Bankers own the Earth. Take it away from them but leave them the power to create money, and with a flick of a pen, they will create enough money to buy it back again…Take this great power away from them and all great fortunes like mine will disappear, for then this would be a better and happier world to live in….But if you want to continue to be the slaves of bankers and pay the cost of your own slavery, then let bankers continue to create money and control credit.”192

In 1816 Thomas Jefferson wrote to his longtime friend John Taylor thanking him for sending copy of his book An Inquiry into the Principles and Policy of the Government of the United States (1814). Jefferson concluded his letter saying, “And I sincerely believe, with you, that banking establishments are more dangerous than standing armies; and that the principle of spending money to be paid by posterity [future generations], under the name of funding, is but swindling futurity [the future] on a large scale.”193

Abraham Lincoln reported believed that instead of private banks having this power, “The government should create, issue and circulate all the currency and credit needed to satisfy the spending power of the government and the buying power of consumers.....The privilege of creating and issuing money is not only the supreme prerogative of Government, but it is the Government’s greatest creative opportunity.”194

He goes on to say, “By the adoption of these principles, the long-felt want for a uniform medium will be satisfied. The taxpayers will be saved

immense sums of interest, discounts and exchanges. The financing of all public enterprises, the maintenance of stable government and ordered progress, and the conduct of the Treasury will become matters of practical administration. The people can and will be furnished with a currency as safe as their own government. Money will cease to be the master and become the servant of humanity.”

The Federal Reserve Bank is working with other central banks around the world to incrementally introduce regional currencies in different areas of the world by merging several currencies into one. Taking America off the gold standard in 1972, and continuing to run up the national debt is the bankers plan to inflate the United States Dollar to the point of worthlessness, forcing it to be replaced with a new regional currency or even bypassing that step and moving right to a global currency. The saying goes that the love of money is the root of all evil, and that root leads directly to the Federal Reserve banksters and the global financial mafia.

World-renowned economist John Maynard Keynes (whose philosophies are known as Keynesian economics) wrote in his book The Economic Consequences of the Peace, that, “Lenin is said to have declared that the best way to destroy the capitalist system was to debauch the currency. By a continuing process of inflation, governments can confiscate, secretly and unobserved, an important part of wealth of their citizens. There is no subtler, no surer means of overturning the existing basis of society than to debauch the currency. The process engages all the hidden forces of economic law on the side of destruction, and does it in a manner which not one man in a million is able to diagnose.”195

In the Bible it is written in John 2:15 that Jesus not only denounced the money changers at the Temple, but he actually tipped over their tables and used a whip to chase them away. “So he made a whip out of cords, and drove all from the temple courts, both sheep and cattle; he scattered the coins of the money changers and overturned their tables.”



In the 2000 years since then, the corrupt money changers and tax collectors have only grown more powerful through their sneaky tactics, and have continued to systematically turn most people into peasants or debt slaves. “The rich ruleth over the poor, and the borrower is servant to the lender,” reads Proverbs 22:7.



The Zodiac Club

J.P. Morgan Jr., the infamous Illuminati money master (and one of the men instrumental in the creation of the Federal Reserve Bank which was conceived during the secret meeting on Jekyll Island), was also a major figure in another financial secret society called the Zodiac Club.196 Not much is known about this intimate secret society, but a few details were uncovered in the archives of the Morgan library in New York.197

What is known about the Zodiac Club is that it was created in 1868 and is made up of twelve men, no more and no less, who each represent one of the twelve signs of the Zodiac and meet about a half dozen times every year for dinner to discuss their financial interests and cultural issues.

Their dinners are black tie events that are held in New York City on the last Saturday of every month between November and May at homes of the members. Dinner is provided by a fancy catering service and unlike the enormous undertaking to organize the Bilderberg Group meeting or the annual Bohemian Grove retreat; the Zodiac Club’s small gathering has largely stayed under the radar and has received little press attention.

One interesting factoid reported is that during prohibition, when alcohol was illegal to produce or consume, the Zodiac Club continued to enjoy drinking by either brewing their own alcohol or using their connections to obtain it. Of course, when do the elite ever follow the law anyway?

A member usually only leaves the club when they die or resign due to old age or health problems. Once someone steps down then a replacement is chosen only after they are unanimously approved by rest of the current group.



What little information that’s known about the Zodiac Club was only discovered in 2013 after a reporter for The Gathamist, a blog focusing on events and culture in New York City, took a tour of the Morgan Library where she noticed a strange arrangement of astrological signs painted on the ceiling. After asking about them, the curator admitted that he thought it was some kind of “Morgan Code” and then searched the library for any books or documents containing the word “Zodiac.”198 It was only then that the Zodiac Club’s minutes and several menus from some of their past dinners were discovered.

“I made an appointment to see the material myself. Expecting to find handwritten notes, I was instead handed a striking seafoam green book with an intricate monogram embossed in gold,” wrote art historian Danielle Oteri on The Gathamist blog.199

Oteri’s article explains, “The volumes were richly illustrated with photographs of the members and the special menus from their dinners. Only a hundred copies were printed (by Charles Scribner & Sons, the letters designed by Tiffany & Co.) and they were distributed among Zodiac Club members and their heirs for a sum of $4,800 (the equivalent of around $100,000 today). The two volumes cover the club from its genesis in 1868 up until 1928.”200

Of the few who have heard of the Zodiac Club, some believe that J.P. Morgan founded it, but apparently it was created by Edward Elmer Potter, a Major General for the Union Army during the Civil War. A book titled America’s Secret Aristocracy was published in 1987 by historian Stephen Birmingham that discussed the group and even mentioned the names of several men who he reported as being members, including real estate mogul Robert G. Goelet, who’s related to Astors and Vanderbilts; Robert S. Pirie, who was president of Rothschild Inc.; and Pittsburgh steel magnet Howard Phipps Jr. were among those identified.



Other than this little known book, and Danielle Oteri’s article in The Gathamist, virtually nothing has been printed about this intimate group of the Eastern Establishment.



Council on Foreign Relations

While not exactly a secret society, the Council on Foreign Relations is a society with secrets, and while sounding like an ordinary committee in Congress, the CFR is actually a private organization whose foreign policy recommendations are practically marching orders for the many elite politicians who belong to it. The “council” was founded in 1921 in Manhattan by Colonel Edward Mandell House, who was Woodrow Wilson’s chief advisor, along with Paul Warburg, who was at the Jekyll Island meeting held to create the Federal Reserve Bank, Elihu Root, who was the Secretary of War under both President McKinley and Roosevelt, and a handful of other insiders who then received funding for their venture from the Rockefeller family.

The Council on Foreign Relations was a major force behind the push to launch the War in Iraq which was based on the fraud (a conspiracy theory really) that Saddam Hussein was close to building nuclear weapons so he could supposedly attack the United States and our allies—claims that the world would come to learn were completely false.

At a press conference celebrating their newly opened Washington D.C. office, Hillary Clinton said, “I am delighted to be here in these new headquarters. I have been often to, I guess, the ‘mother ship’ in New York City, but it’s good to have an outpost of the Council right here down the street from the State Department. We get a lot of advice from the Council, so this will mean I won’t have as far to go to be told what we should be doing."201

Aside from most high-powered politicians being members of the council, many mainstream journalists are members as well, and use their positions to promote the agenda of the CFR. Antony Sutton, author of America’s Secret Establishment points out, “Most CFR members are not

involved in a conspiracy and have no knowledge of any conspiracy… however, there is a group within the Council of Foreign Relations which belongs to a secret society, sworn to secrecy, and which more or less controls the CFR. CFR meetings are used for their own purposes, ie., to push out their own ideas, to weigh up people who might be useful, to use meetings as a forum for discussion.”202

The CFR has been the driving force and inspiration behind much of America’s foreign policy and operates as a consensus building and lobbying firm to persuade politicians to carry out their directives. The prominent politicians and journalists then pass the propaganda they are fed into the mainstream.

Richard Haas, who has been the president of the CFR for over ten years, appeared on Bill Maher’s HBO show Real Time in 2010 to promote his book, War of Necessity, War of Choice, and as soon as the interview began Maher started off by joking, “OK, as we discussed last time, you are the president of the Council on Foreign Relations, which secretly controls the world I believe.”203 Haas sat there grinning ear to ear and nodded his head in agreement as the audience laughed.

Robert Pastor, who was once the Chairman of the Council on Foreign Relations, wrote a book in 2001 titled Toward a North American Community, where he said, “In the long term, the amero is in the best interests of all three countries,”204 referring to the United States, Canada, and Mexico, which the Illuminati want to merge into a regional union modeled after the European Union that they plan to call the American Union. The “amero” he mentioned is the proposed new regional currency the Illuminati would like the North American Union to Implement.

The Illuminati’s ultimate plan regarding currency is to first establish regional unions and currencies around the world and then merge all of them into one unified global currency (potentially called the Phoenix) which will be a digital electronic currency. Once physical currency like cash and coins have been eliminated or made nearly impossible to use, the unified

electronic currency will be the global standard controlled by the World Bank and its affiliates.

This is the fulfillment of the mysterious “Mark of the Beast” prophecy written about over 2000 years ago in the Bible’s Book of Revelation, which warned “And he causeth all, both small and great, rich and poor, free and bond, to receive a mark in their right hand, or in their foreheads: And that no man might buy or sell, save he that had the mark, or the name of the beast, or the number of his name...and his number is Six hundred & sixtysix.” (Revelation 13:15-18)

As I’m sure you are aware, cash is slowly being phased out and even using it is now seen as suspicious because it can’t be easily traced, and keeps one’s purchasing history private. The “convenience” of a cashless society is one of the top goals of the Illuminati, and the Council on Foreign Relations is one of the front groups working to make that happen.



The Jasons

We think of most secret societies as political or spiritual associations, but one founded in 1960 is comprised of elite scientists. They are called The Jasons, a name that refers to Jason and the Argonauts from Greek mythology who ventured out to obtain the “golden fleece” (a piece of fabric woven from golden hair) which is symbolic of authority and kingship.

The Jasons, or sometimes referred to as JASON, is a small group of 30 to 60 of the world’s top physicists, biologists, mathematicians, and computer scientists who advise the U.S. Government in their area of expertise. These men are from academia and private business who do not work directly for the government, but instead serve as advisors who are reportedly paid $850 a day from a budget of $3.5 million a year.205 Many members are university professors who work a full time job during the school year, but in the summer months spend their time working on classified projects for the Department of Defense, the Department of Energy, and other government agencies.

The Jasons were responsible for a 1982 report that served as the foundation for the growing barrage of global warming propaganda titled The Long Term Impact of Atmospheric Carbon Dioxide on Climate. They are believed to have been involved with various missile defense programs (Star Wars or HAARP), and gave their analysis contemplating America’s possible use of tactical nuclear weapons against the Vietcong during the Vietnam war.206

The JASONS are technically a 501C3 tax exempt nonprofit organization run through the MITRE Corporation in McLean, Virginia, and were only discovered when the Pentagon Papers were published by Daniel Elsberg in 1971 after Elsberg, a military analyst working for the RAND Corporation, photocopied seven thousand pages of government documents

and leaked them to the press after discovering the extent that the Johnson administration lied to Congress and the public about the Vietnam War. Very little has been reported on them, and at the time I’m writing this there is currently only one book published dedicated to the group—The Jasons: The Secret History of Science’s Postwar Elite (2006) by Ann Finkbeiner.

When researching her book, Finkbeiner reached out to members asking for interviews, including the director, who responded with an e-mail saying, “Frankly, we could not identify an up-side for our organization, but could identify potential downsides to such a book.”207

The reason they are paid as part time contractors and kept outside the bureaucracy of the Department of Defense is because the government feels if they were actual full time employees, their advice would be biased because they would have a vested interest in pushing for certain programs or for advising against others. After all, what government employee is going to actually report to their boss that their own job is unnecessary?

Ann Finkbeiner explains in her book, “A government wanting scientists’ advice on, say the feasibility of a particular system of missile defense could ask scientists who are nearest—that is, who are in the defense industry or on the Defense Department’s various advisory committees. But those scientists like the national lab scientists, would have something political or financial to gain or lose and might hedge their advice accordingly. Disinterested advice comes best from independent scientists, like those on PSAC, outside the government and outside industry—that is from scientists employed in academia whose livelihoods will not depend on the advice they give.”208

The original JASONS were former Manhattan Project physicists who just so happened to hold a major meeting in the Bohemian Grove! Peter Philips, who earned his Ph.D. in sociology after writing his dissertation on the Bohemian Grove, had this to say about the subject: “The atom bomb made this particular meeting at the Grove world famous, but it was not an isolated case of business and government planning through Bohemian club

facilities. This was but one in a long series of historical business-related activities done in the context of a Bohemian corporate family network. The Club takes pride in this event, and members often tell new guests this story while at the Grove.”209

“[Ernest] Lawrence’s use of the Grove’s river clubhouse for a Manhattan Project planning meeting in September of 1942 is well documented.”210 Lawrence would later join the board of directors of Monsanto and worked as a consultant to General Electric.211 The JASONS continue to receive funding from the Department of Defense through DARPA [the Defense Advanced Research Projects Agency] as well as money from other agencies who sometimes attempt to hide the paper trail through various means.

DARPA is responsible for building neural interface systems they plan to wire directly into people’s brains, and they’re behind a whole list of some of the creepiest high tech Orwellian cybernetic devices you could imagine.



The Bilderberg Group

Every Spring since 1954 a group of around one hundred of the world’s most powerful politicians, businessmen, bankers, media executives, and international royalty have been holding a secret three-day long meeting in an evacuated hotel that’s surrounded by armed guards. Once inside the members and invited guests engage in intense off-the-record talks about the top issues facing the world. It’s called the Bilderberg Group, or the Bilderberg meeting, named after the Bilderberg Hotel in Oosterbeck, Holland, the site of their first gathering organized by Prince Bernhard of the Netherlands. Attendees agree not to discuss publicly who was in attendance or what specifically was discussed, and most of them have denied any knowledge of the Bilderberg Group at all.

For over sixty years there has been an almost complete blackout in the mainstream media about the meetings, yielding to the Bilderberg Group’s wishes that they keep them out of the press. For decades, news of the infamous Bilderberg Group spread in Patriot circles, in underground newsletters and websites, until the advent of YouTube and social media finally forced some major mainstream media outlets to admit that Bilderberg is real and some very powerful people attend. Here’s a brief history of how the meetings were first discovered and how news of the group began to spread.

In 1957 a Pulitzer Prize winning columnist named Westbrook Pegler who wrote for Scripps Howard News Service, the Chicago Tribune, and other papers, published the first article on the Bilderberg Group—although he did not know their name at the time—his report marked the beginning of the unraveling of one of the most interesting conspiracies of all time.

In his 1957 article, Westbrook Pegler wrote, “Something very mysterious is going on when a strange assortment of 67 self-qualified,

polyglot designers and arbiters of the economic and political fate of our western world go into a secret huddle on an island of Brunswick, GA and not a word gets into the popular press beyond a little routine AP story. These gumshoe super state architects and monetary schemers were drawn from all NATO countries. The fact of this weird conclave as spooky as any midnight meeting of the Klux in a piney wood, was bound to get known to the world eventually.”212

He continues to explain how he first learned of this meeting, saying, “I got my first word of it from a reader who happened onto St. Simon Island, Brunswick, [Georgia] on her way to West Palm Beach. She wrote that the hotel on St. Simon was almost deserted, but that when she commented on this, the clerk said the place had been alive with mysterious characters a few days earlier and with Secret Service and FBI too.”

While not yet having the group’s name, Westbrook did connect them with the same gang who met on Jekyll Island to formulate the plans for the Federal Reserve. He said, “Senator Aldrich of Rhode Island, called this one into being. He was the father of Winthrop Aldrich. There have been many excited versions of that ancient hoe-down on Jekyll Island, but relatively few have ever heard of it at all.”

After Westbrook Pegler began criticizing executives of the powerful Hearst Corporation that owned and controlled almost 30 different newspapers in America, he was fired. Hearst newspapers literally created “yellow journalism” which refers to sensationalistic headlines and careless reporting with a disregard for the facts in order to sell more newspapers.

A man named Willis Carto read Westbrook Pegler’s article and it motivated him to begin investigating and tracking the Bilderberg Group himself. In June of 1958 Willis Carto founded Liberty Lobby that published a newsletter titled Liberty Lowdown that included articles exposing the Bilderberg Group. He would later begin publishing a newspaper called The Spotlight.



Over two decades later, Jim Tucker learned of this elusive group from Carto and would become the world’s foremost expert on them. Tucker explained, “Had it not been for Willis A. Carto, who hired me as editor of The Spotlight and then put me on the tack of Bilderberg, I would probablyalmost assuredly-never heard of the word ‘Bilderberg.’ Having had the opportunity, through Carto’s good offices as founder of Liberty Lobby, publisher of The Spotlight, to begin what ultimately proved to be a generation of world-wide Bilderberg-hunting, I was able to bring news about Bilderberg to literally millions of folks who would like myself have otherwise remained in the dark about these globalist schemers.”213

Tucker tracked the Bilderberg Group from 1975 until his death in 2013 at the age of 78. His book, titled Jim Tucker’s Bilderberg Diary contains decades of information about where the Bilderbergers met, who was in attendance and what was discussed. Tucker had somehow gained the support of an insider who would leak information to him every year about the location and date of the meeting, as well as attendee lists and other information.

It’s foolish to claim there hasn’t been a secret arrangement between the Bilderberg Group and the American mainstream media to keep them out of the press. When over 100 of the world’s most influential politicians, media owners, banking executives, and business elite fly half way around the world to meet for three days in a closed down five star hotel that’s surrounded by armed guards, you can’t say it’s not newsworthy. And you certainly can’t say it’s not interesting. For years, if anyone called into any of the major talk shows like Rush Limbauh, Sean Hannity, Glenn Beck and others, and told the call screener they wanted to ask about the Bilderberg Group, the call would never be put through. “We’re not taking calls on that right now, sorry. Click.” If the person calling gave the call screener a bogus question and happened to be put on air and then asked about the Bilderbergers, they would be ridiculed and the call would be dropped immediately (something that’s happened to me many times).

After decades of news blackouts, more recently because social media has helped expose Bilderberg, some outlets have reluctantly (and briefly)

mentioned the event in attempts to avoid looking like they were covering it up.

In 1991 an Arkansas newspaper published an article reporting that Bill Clinton was attending the Bilderberg meeting. This of course was before people were using the Internet to spread news and at a time when one local newspaper’s report would rarely be seen by anyone outside its limited circulation area. The article stated, “Private sponsors picked up the tab for Gov. Bill Clinton’s recent trips to Germany and the Soviet Union—a journey he made without staff aids, spokesman said Thursday. Mike Gauldin, the governor’s spokesman, said the Bilderberg Conference paid for Clinton’s trip to Germany and a Washington DC philanthropist paid for the Soviet Union visit.”214

In the 1970s a Democratic U.S. representative from Louisiana named John R. Rarick caught wind of the meetings and became suspicious and wanted to know if taxpayers were paying for American officials to attend the secret meeting. Rarick typed up a ten-page statement and actually entered it into the official Congressional Record. “Mr. Speaker, on several occasions during recent months, I called the attention of our colleagues to activities of the Bilderbergers—an elite international group comprised of high government officials, international financiers, businessmen, and opinion-makers…” the statement begins.

“This exclusive international aristocracy holds highly secret meetings annually or more often in various countries. The limited information available about what transpires at these meetings reveals that they discuss matters of vital importance which affect the lives of all citizens. Presidential Advisor Henry Kissinger, who made a secret visit to Peking from July 9 to July 11, 1971, and arranged for a presidential visit to Red China, was reported to be in attendance at the most recent Bilderberg meeting held in Woodstock, Vermont, April 23 to April 25, 1971. The two points reportedly discussed at the Woodstock meeting were, ‘the contribution of business in dealing with current problems of social instability’ and ‘the possibility of a change of the American role in the world and its consequences.’”



“Following these secret discussions, which are certainly not in keeping with the Western political tradition of ‘open covenants openly arrived at,’ the participants returned to their respective countries with the general public left uninformed, notwithstanding the attendance of some news media representatives, of any of the recommendations and plans agreed upon as a result of the discussions—or for that matter even the occurrence of the meeting itself.”215

President Dwight D. Eisenhower, best known for warning the world about the Military Industrial Complex in his 1961 farewell address, wrote a memo to his assistant in 1955 about that year’s Bilderberg meeting which took place in Barbizon, France. While Eisenhower didn’t mention them by name, it’s pretty obvious who he’s talking about in the memo when he says, “I understand next week Prince Bernhard is having a meeting at Barbizon, continuing his exploration looking toward improving European and American relations. If personally you can fit such a trip into your schedule, I suggest you find the money and go to France.”216

I have been able to obtain several recent years of Bilderberg’s IRS filings since they are registered as a 501c3 “charitable foundation,” certain financial information must be made available for public inspection, if you know where to look.217 I discovered they operate under the business entity “American Friends of Bilderberg” and the documents show that in 2008 they received $645,000 in contributions to fund their annual meeting, with money coming from Goldman Sachs ($25,000), Microsoft ($75,000), Henry Kissinger ($20,000), David Rockefeller ($50,000) and others. The 2009 returns show the Washington Post newspaper donated $25,000.218

Under the “Summary of Direct Charitable Activities,” the forms list the organization’s goals as “Organizing & sponsoring conferences which study & discuss significant problems of the western alliance [and] collaborating on the Bilderberg meetings held in Europe & North America.”



The expenses on the 2008 and 2012 documents are listed as approximately $900,000 per year, which covers renting out the entire hotel for three days, paying the private security forces and compensating local police for the extra man-hours, and for paying the travel expenses of members and attendees.

The documents list James Johnson as the treasurer, who is also the chairman of Perseus LLC, a merchant bank and private equity fund management company based in Washington D.C. with offices in New York and an associated advisory firm in Munich, Germany. Perseus is a leading figure in Greek Mythology and is the one who beheaded Medusa.

Johnson was once the Chairman of the Executive Committee at Fannie Mae; and before that he was a managing director at Lehman Brothers. He’s also on the Board of Directors for Goldman Sachs and a member of the Council on Foreign Relations.

I have personally been to the offices of Perseus in Washington D.C. seeking a comment on the documents, and as soon as I mentioned “Bilderberg,” James Johnson’s secretary said they have no comment and slammed the door. The person listed on the forms as the accountant is Robert T. Foldes of Leon D. Alpern & Company and when I called them, the secretary confirmed they handle the taxes for American Friends of Bilderberg but declined to give me any further information.

Documents leaked from the 1955 Bilderberg meeting show they were planning the European Union and a central currency back in the 1950s, decades before the EU was formed and their new Euro currency introduced. The documents are marked “Personal and strictly confidential,” and “Not for publication either in whole or in part.” Two years later, in 1957, the European Union started to take shape with the creation of the European Economic Community (EEC), which merged the markets of six European countries: France, Germany, Italy, Belgium, the Netherlands and Luxembourg. This later grew into the European Union in 1993 containing 28 nation states: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech

Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom.

Most of their plan has been accomplished, and while they will continue to play themselves off as just an ordinary business conference, the decades of denials and media blackouts prove the Bilderberg Group has been deceptive from their inception and the inside sources who have leaked their plans over the years prove the power they wield. Most often, what’s talked about or agreed upon inside Bilderberg soon mysteriously finds its way into becoming law. It clearly appears that wars, economic booms and busts, and controversial new legislation are often traced back to this small group of around 100 men.

While politicians love to point the finger at their rivals and place all the country’s ills on the opposing party, most politicians (at least at the time I’m writing this) haven’t even uttered the word Bilderberg. Congressman Ron Paul, one of the rare honest politicians, was once asked about the Bilderberg Group by a fan at a book signing who videotaped the interaction and posted it on YouTube. “Did you hear about that recent Bilderberg Group meeting in Chantilly, Virginia?” the person asked. Ron Paul responded, “Yeah, recently there was one and there were some reports on it—I didn’t read a whole lot about it but they certainly were there.”219

The cameraman then asked what he thought they were doing there, and Paul responded, “Well, they probably get together and talk about how they’re going to control the banking systems of the world and natural resources—and we get together and talk about how we’re going to get our freedom back. So we have our own things to talk about too.”

Ron Paul didn’t play dumb and didn’t ridicule the man’s question— instead he answered it quite frankly, which is surprising for a politician, particularly when it comes to talking about the Bilderberg Group. Ron Paul was (and still may be, depending on what happens after this book is

published) the only politician (at the time) to have ever even uttered the word “Bilderberg.”

When Hillary Clinton was campaigning for president hoping to secure the election in 2008, someone asked her about the Bilderberg Group at an event in New Hampshire and posted the video on YouTube. “What’s going on at the Bilderberg meeting and what are you guys talking about up there?” She cackled, “Ha ha ha, I have no idea what you’re talking about.” The man responded, “Why are they such top secret meetings?” To which she answered (looking like a kid with their hand caught in the cookie jar), “Sir, I have no idea what you’re talking about.”220

She has no idea what he’s talking about? How could one of the most powerful and politically connected women in the world possibly not know about them? It’s ridiculous to claim that she isn’t intimately aware of the Bilderberg Group and obviously she was playing dumb to uphold their secrecy policy. Hilary wrote her college thesis on Saul Alinsky, the leftist extremist who dedicated his book Rules for Radicals to Lucifer, and adored his subversive tactics to further the Big Government agenda.

Because of social media and independent blogs and YouTube channels gaining so much popularity in the early 2000’s, Bilderberg’s secrecy has been blown, and they, (along with their accessories to the cover-up in the mainstream media) have been forced to break their silence on the group and finally, beginning in around the year 2012, some mainstream outlets began to briefly touch on the meeting to try to give the impression they weren’t obviously blacking them out in a desperate attempt to maintain their fading facade of credibility.

Almost every article or brief TV news segment mentions how “conspiracy theorists” think the group is up to no good, while glossing over the fact that for over a half century they conveniently ignored the meetings or how the top radio hosts like Sean Hannity, Glenn Beck and others actually ridiculed any caller who even brought it up.



When hosting his popular show on the Fox News Channel, Glenn Beck once claimed that talking about the Bilderberg Group was going down a “tin foil hat road,” and said he didn’t care about the Bilderberg Group, and then compared them to a toy company. “The Bilderbergers had their meeting, I don’t really know much about these people, and I don’t really care. I know probably more about the Build a Bear people in the malls, and I know those people are brainwashing our kids with teddy bears. I don’t know what kind of secret meetings they have to get our kids into the bear industry, but I don’t like it. If the Bilderberg’s are half as evil as the teddy bear people, look out.”221

Beck then went on to say that those inside the Bilderberg meeting were probably talking about how to help the world.







Spiritual Beliefs

It is often said that the Illuminati are “satanic” or Luciferian, which seems unbelievable to someone new to this material because it’s so far outside of most people’s realm of understanding that such claims are often met with skepticism, disbelief, or outright ridicule. But when one takes a closer look and understands just what Satanism and Luciferianism is, such claims not only seem reasonable, but they are undeniable. First we must look at the story of Adam and Eve to begin to understand this.

While Christians, Jews, and many others believe that the first humans disobeyed God in the Garden of Eden by following the advice of Satan, the Illuminati (and every occult association, fraternity, or secret society) believes that Satan actually saved Adam and Eve from enslavement to God, who they say was holding back Mankind’s true potential and keeping Adam and Eve imprisoned in ignorance.

Many religions have an esoteric and an exoteric doctrine, one interpretation for the masses, and another doctrine with deeper or different interpretations for the scholars or religious insiders, often called “adepts” or “the elect.” In Judaism this “second” doctrine is called the Midrash, which goes “beyond” the “simple” and “legal” interpretations of the Torah (the Old Testament) and gives an “expanded view” of the Bible’s stories.

Remember that Albert Pike said, “Masonry, like all the Religions, all the Mysteries, Hermeticism and Alchemy, conceals [emphasis in original] its secrets from all except the Adepts and Sages, or the Elect, and uses false explanations and misinterpretations of its symbols to mislead those who deserve only to be misled; to conceal the Truth, which it [the Mason] calls Light, from them, and to draw them away from it.”222



In his book, The Wisdom of the Knowing Ones, Manly P. Hall explains, “all of these religions had been divided into two sections, one of which was for the public and the other essentially an esoteric or mystical tradition for a few who were willing to consecrate their lives through a process of internal enlightenment. For the many there was obedience to the forms and letters of religious law. For the few there was an insight into the deeper meanings of these things by means of which orthodoxies were transformed into great spiritual systems.”223



Lucifer and Satan

The biggest secret of the Illuminati is that they believe Satan is good, because in their view he is the “superior God,” and this secret has endowed them with tremendous power. Helena Blavatsky in her 1888 book The Secret Doctrine, explains, “Thus Lucifer—the spirit of Intellectual Enlightenment and Freedom of Thought—is metaphorically the guiding beacon, which helps man to find his way through the rocks and sand banks of Life, for Lucifer is the Logos in his highest.”224

She continues, “Lucifer is divine and terrestrial light, the ‘Holy Ghost’ and ‘Satan,’ at one and the same time, visible space being truly filled with differentiated breath invisibly; and the Astral Light, the manifested efforts of two who are one, guided and attracted by ourselves, is the karma of humanity, both a personal and impersonal entity…The Fall was the result of man’s knowledge, for his ‘eyes were opened.’ Indeed, he was taught wisdom and the hidden knowledge by the ‘Fallen Angel’…And now it stand proven that Satan, or the Red Fiery Dragon, the “lord of Phosphorus” (brimstone was a theological improvement), and Lucifer, or ‘Light-Bearer,’ is in us: it is our Mind—our tempter and Redeemer, our intelligent liberator and Savior from pure animalism…Without this quickening spirit, or human Mind or soul, there would be no difference between man and beast.”225

Satanist Aleister Crowley said, “This serpent, Satan, is not the enemy of Man, be He who made Gods of our race, knowing Good and Evil; He bade ‘Know Thyself’ and taught initiation. He is ‘the Devil’ of the book of Thoth, and His emblem is Baphomet, and Androgyne who is the hieroglyph of arcane perfection.”226

The Secret Doctrine states, “For no one, not even the greatest living adept, would be permitted to, or could—even if he would—give out

promiscuously, to a mocking, unbelieving world, that which has been so effectually concealed from it for long aeons and ages.”227

Such views can also be considered Gnosticism, which is a philosophical belief that a lower level evil god called the Demiurge created humans as slaves and in order to be free from the enslavement they must be given the secret knowledge (gnosis) from a higher level God (Satan). Manly P. Hall explains, “Gnostics never looked to salvation from sin (original or other), but rather they desired release from unconsciousness and incomprehension, whereby they meant primarily ignorance of spiritual realities. Salvation, (or liberation) is a potential present in every man and woman, and it is not vicarious but individual. The great Messengers of the Light come to stimulate this potential and they do not by their death but by their lives.”228

Those who believe they have discovered this “secret to life” often keep it contained within occult fraternities, hoping to keep the vast majority of people ignorant of their supposed “truth” so they can keep others from becoming “enlightened” so they can more easily take advantage of them. This sort of spiritual supremacism often leads to Social Darwinism, which is the philosophy of the survival of the fittest. These people have no concern for their fellow man, but are narcissistic, megalomaniacs who view themselves as Gods as a result of Satan’s secret. This superiority complex is conveyed by the “do what thou wilt” philosophy that Aleister Crowley and Church of Satan founder Anton LaVey preached, which means “do whatever you want” because you are your own God.

In his authorized biography The Secret Life of a Satanist, it was revealed that Anton LaVey wasn’t concerned if Satanism inspired people to commit mass murder. It reads, “Anton LaVey maintains that he isn’t really concerned about accusations of people killing other people in the name of Satan. He swears that each time he reads of a new killing spree, his only reaction is, ‘What, 22 people? Is that all?...There will undoubtedly be more Satanically-motivated murders and crimes in the sense that The Satanic Bible tells you ‘You don’t have to take any more shit.’”229



LaVey also admired a homosexual serial killer from the early 1900s named Carl Panzram, who killed at least twenty-two people, and who claimed to have raped one thousand men. “The only way I would like to ‘help’ the great majority of people is the same way Carl Panzram ‘reformed’ people who tried to reform him. It would be most merciful to help them by relieving them of the life they seem to hate so much. People should be happy I’m not a humanitarian—or I’d probably be the most diabolical mass murderer the world has ever known,” LaVey said.230

Richard Ramirez, the “Night Stalker” serial killer from Los Angeles, and Charles Manson were both interested in Satanism. Ramirez famously drew a satanic pentagram on the palm of his hand during his trial and would shout “Hail Satan!” to television cameras and reporters.

Because Satanists do not believe in an afterlife or an all-knowing, allpowerful God, they are not concerned with any kind of divine retribution for their actions, and are thus motivated even more to ruthlessly take advantage of others since they believe in the “survival of the fittest” and that “might is right” and that they themselves are Gods.

This “royal secret” of Satanism will likely one day soon be revealed to the world after having been practiced in secret for thousands of years. The Illuminati and the counterfeit (anti)Christ will likely openly reveal Satanism as the new World Religion and claim it had to be kept a secret all these years until the New World Order was complete. Anyone who denounces this antichrist or the new World Religion will be targeted for termination and will be blamed for trying to stop the completion of “heaven on earth.”



Double Speak

The Illuminati often use “double speak” to conceal their real agenda and present powerful propaganda to the masses who often blindly accept it as the truth without a second thought. The general public have been so dumbed down, they will believe anything their favorite political party tells them and are easily mislead by language and rhetoric that is meant to disguise the speaker’s true intentions. For example, the Department of Defense is really the Department of War, and that’s what it used to be called until the government changed its name in 1949.

The Patriot Act, the bill signed into law shortly after the September 11th attacks on the World Trade Center in 2001, was actually an assault on the Bill of Rights and anything but patriotic, but the term Patriot Act was designed to make the new laws sound as American as the Fourth of July. President Bush declared a “War on Terror” when really it was a “War of Terror.” President Obama said that raising the debt ceiling wouldn’t increase our country’s debt, when that’s clearly exactly what it does, but because the masses have become zombies who react to keywords or neuro linguistic programming language patterns, most people accept statements from presidents as truth without thinking twice.

In some of my viral YouTube videos I’ve asked people to sign petitions supporting legislation that nobody in their right mind would even consider agreeing to, but because I prefaced the question with “would you support Obama…” countless people signed the fake petitions because their blind support for the president caused them to shut off their brain and not even listen to what I was actually asking them to support.



The Hegelian Dialectic

Because the elite Illuminati are social Darwinist Satanists, they often employ what’s called the Hegelian Dialectic, which allows them to roll out their diabolical plans with little opposition. What this entails is creating a problem on purpose through covert means so the government can then present their solution, which is a plan they had waiting in the wings but were unable to implement without the proper crisis which was needed to justify their desired actions.

The Hegelian Dialectic consists of a thesis, an antithesis, and a synthesis, or a problem, a reaction, and a solution. This is the basic structure of a false flag operation which is a military strategy where a government commits a terrorist act while making it appear as if it came from their political enemy—or they allow a terrorist attack to occur when they could have easily stopped it—because the success of the event serves as a pretext (a reason) to carry out actions that previously would have been widely unacceptable by the public, but after the attack occurs, much of the public actually demands that a reaction occur, all the while unaware that behind the scenes the entire operation was planned to get that exact support which was lacking before the attack occurred.

Just three days after the 9/11 attacks, the co-chair of the Council on Foreign Relations stated, “There is a chance for the President of the United States to use the disaster to carry out what his father—a phrase his father used I think only once, and it hasn’t been used since— and that is a New World Order.”231

This attack was precisely the “New Pearl Harbor” event discussed in the Project for the New American Century think tank’s own Rebuilding America’s Defenses report published in September of 2000. From this Illuminati front group came the very plan explaining their need for a

“catalyzing event—a new Pearl Harbor”232 which would be used to set the stage for America to carry out the Illuminati’s agenda by invading the Middle East to complete the New World Order.

In 1962, a false flag attack plan was drawn up by top U.S. military officials who wanted to commit various acts of terror in Washington D.C. and in Miami that would be made to appear as if Cuba had done them, in order to generate public support for an invasion of Cuba. Operation Northwoods, as it was called, plainly stated, “We could develop a Communist Cuban terror campaign in the Miami area, in other Florida cities, and even in Washington…The terror campaign could be pointed at Cuban refugees seeking haven in the United States…Hijacking attempts against civil aircraft surface craft should appear to continue as harassing measures condoned by the government of Cuba.”

When confronted with such damning evidence, most people immediately dismiss it as a “conspiracy theory” but the Operation Northwoods documents have been declassified and are 100% authentic. The plan was even reported on ABC News in 2001 on their website where the article reads, “In the early 1960s, America’s top military leaders reportedly drafted plans to kill innocent people and commit acts of terrorism in U.S. cities to create public support for a war against Cuba.”233

For people still skeptical about the September 11th inside job, all they need to do is read the Northwoods documents and understand that plans like this have actually been put on paper, and approved by the Joint Chiefs of Staff (the heads of all U.S. military branches). Similar attacks have been carried out in the past by governments throughout history such as Operation Gladio throughout Europe, the Gleiwitz incident and the Reichstag fire in Germany, the Gulf of Tonkin incident in Vietnam, and others.

Henry Kissinger has been intimately involved with nearly every major organization or front group that is behind the push for a New World Order and was originally named the Chairman of the 9/11 Commission by President Bush, which was set up to (pretend to) investigate the terrorist

attacks on September 11th 2001. Kissinger resigned from the commission after family members of 9/11 victims discovered his business ties with the Bin Ladens.234 In an interview on CNBC in February 2009, Kissinger was asked about the problems the Obama administration was facing regarding the ongoing “War on Terror” and the economic meltdown, where he responded that Obama, “can give new impetus to American foreign policy partly because the reception of him is so extraordinary around the world. His task will be to develop an overall strategy for America in this period when, really, a New World Order can be created. It’s a great opportunity, it isn’t just a crisis.”

President Obama’s Chief of Staff Rahm Emanual made a startling statement after the economic crash of 2008, when he said, “You never let a serious crisis go to waste. And what I mean by that it’s an opportunity to do things you think you could not do before.”235

Since we’re talking about power-mad megalomaniac Satanists here, it shouldn’t come as a surprise that these men would orchestrate terror attacks in order to gain more power and further their political agendas. And it’s certainly not a surprise that most of these men have ties to occult cabals like Skull & Bones, Freemasonry, or the Bohemian Grove—all of which are incubators for corruption and keepers of the great “secret of secrets.”



Sex Magic

As I mentioned in a previous section of this book, sex magic (sometimes stylized sex magick with a “k” on the end) is the belief that through secret sexual intercourse rituals one can achieve altered states of consciousness which activate dormant metaphysical powers locked inside the mind, supposedly enabling the practitioners to harness God-like manifestation abilities in what has been described as a conscious, living lucid dream. As strange as this idea may be, it isn’t necessarily a crime for two consenting adults to engage in bizarre sex acts, but unfortunately there are some very disgusting and horrific types of sex magic that are beyond evil, and I caution you—what you are about to read is extremely disturbing.

In parts of Africa many men believe if they rape an albino woman it will give them magical power.236 “There is a belief that if you have [sexual] relations with a girl with albinism, you will cure AIDS. So there are many girls with albinism who are being raped in [Africa] because of this belief,” warned Peter Ash, founder of human rights group Under The Same Sun.237

The London Telegraph reported in 2001 that some South African men rape babies believing it is a ‘cure’ for AIDS.238 More than 67,000 cases of rape and sexual assault against children were reported in the year 2000 in South Africa alone.239

In 2013 the singer of a popular heavy metal band in the United Kingdom called Lost Prophets was sentenced to thirty-five years in prison for thirteen child sex offenses including sexually abusing babies in black magic rituals.240 Several women were also sent to prison for willingly giving him their small children so he could use them for this exact purpose.



The singer, Ian Watkins, was apparently a fan of Aleister Crowley, as many musicians are—who wrote in his book Magick: In Theory and Practice that people can obtain satanic power by murdering children. In the chapter on blood sacrifices Crowley wrote, “For the highest spiritual working one must accordingly choose that victim which contains the greatest and purest force. A male child of perfect innocence and high intelligence is the most satisfactory and suitable victim.”241

In 2014 it was revealed that a group of Aleister Crowley fans were abusing children in an England suburb by doing Satanic sex rituals.242 A woman named Jacqueline Marling even turned her daughter over to the cult and forced her to participate in sex magic rituals beginning when she was just seven years old.243

Such insane and evil sex magic practices aren’t just contained to primitive tribes in Africa or twisted rock stars or Aleister Crowley fans. It appears to be one of the deepest and darkest secrets of the Illuminati as well. Apparently in some sects within the Illuminati, initiates believe this kind of child abuse can “super charge” their “metaphysical powers” enabling them to conjure into their life whatever they wish, in a perverted version of the “Law of Attraction,” the philosophy popularized by the DVD The Secret in 2006.

In the 1990s a Republican Nebraska State Senator named John DeCamp published a book titled The Franklin Cover-Up where he alleged children were taken into the Bohemian Grove and ritualistically raped and murdered in black magic rituals at the hands of some of the members in the 1980s.244 DeCamp, who was an attorney, said he personally interviewed several children from orphanages who allegedly identified the Bohemian Grove as the location of this supposed abuse.245

Former CIA director Bill Colby is said to have warned DeCamp that he was looking into something so dark he should walk away and “Get as far away from this thing as you can. Forget you ever saw it or know it, heard it or anything else.”246 Colby later died in what was called a canoeing

accident, but many suspect he was murdered because of the strange circumstances surrounding his death and his conversations with DeCamp about sex magic. There were no witnesses to his death and he drown after mysteriously going canoeing by himself.

In 1989 the Washington Times printed a front-page headline reading, “Homosexual Prostitution Inquiry Ensnares VIPs with Reagan and Bush,” after it was discovered that a high-powered lobbyist named Craig Spence was operating a pedophile prostitution ring in the Washington D.C. area that catered to elite clients.247 Spence turned up dead a few months after the article was published from an alleged suicide. Whispers of elite pedophile rings have alleged for decades that high-powered politicians and businessmen engage in child abuse for fun or part of secret society rituals. This same dark cloud has hung over the heads of Catholic priests for many decades.

A major star at the BBC in England [the British Broadcasting Corporation] named Jimmy Savile reportedly abused hundreds of children, some as young as two-years-old, and even had sex with dead bodies, according the Washington Post and other mainstream media outlets.248 Such news leads many to believe this kind of activity is part of an organized network of powerful perpetrators, not just separate incidences.

It’s unknown how common these kinds of sex magic rituals are within the Illuminati or other Aleister Crowley-inspired groups, and when one tries to understand why anyone would even consider doing such a thing it challenges the mind to come up with an answer. These perpetrators obviously aren’t just sick psychopaths living in an abandoned cabin in the woods. These are successful men (and possibly women) who are addicted to power and wealth and fuel their ego with all of the finest pleasures of this world, often becoming so jaded and desensitized they are eventually unable to find excitement or pleasure in anything normal.

Since these acts of sexual abuse are the worst thing anyone could possibly do to another human being, these acts of ultimate evil are believed

to cause some kind of hormones to be released into the blood which give the perpetrators a kind of satanic adrenaline rush that magnifies their supposed ability to alter reality metaphysically by their thoughts, thus being the most potent “supernatural steroid” in the world. There is no doubt why sex magic is considered the deepest and darkest secret of the Illuminati, and any human being with a soul can agree that sex offenders of all kinds must be eradicated from the earth.



Transhumanism

One of the ultimate goals of the Illuminati is to become Gods themselves in what they believe is the final stage of their evolution or “transcendence.” This branch of science is called Transhumanism— meaning supporters hope to transition from a human into a totally new species or transcend into a “God.”249 This isn’t just a lofty science fiction pipe dream of a few megalomaniacs with God complexes, this is a very real plan being pursued by some very wealthy and powerful people. Billionaire Peter Thiel, the cofounder of PayPal and early investor in Facebook, believes scientists will soon “cure death” enabling him and other billionaires to live forever. “You can accept [death], you can deny it or you can fight it. I think our society is dominated by people who are into denial or acceptance, and I prefer to fight it.”250

The most popular “guru” of Transhumanism (sometimes symbolized as H+) is Google engineer Ray Kurzweil who believes by the year 2045 he and other elite will achieve immortality through cybernetic enhancements that transform them into literal supercomputing cyborgs who are physically wired into the Internet at all times—or even replacing their biological brains and bodies entirely with “more efficient” silicone computers and mechanical bodies in order to “transcend.” Kurzweil predicts, “As you go out to the 2040s, now the bulk of our thinking is out in the cloud. The biological portion of our brain didn’t go away but the nonbiological portion will be much more powerful. And it will be uploaded automatically the way we back up everything now that’s digital.”251

In 2013 Google created Calico, a life extension and anti-aging biotech company to help them pursue Kurzweil’s dream of beating death, and many other companies are pouring billions of dollars into transhumanist technology and working non-stop hoping to soon unlock immortality.



Transhumanist philosopher Zoltan Istvan, who believes that teaching children about the Bible should be banned and that the government should regulate who is allowed to have children, writes, “The transhumanist age— where radical science and technology will revolutionize the human being and experience—will eventually bring us indefinite lifespans, cyborgization, cloning, and even ectogenesis, where people use artificial wombs outside of their bodies to raise fetuses…Breeding controls and measures make more sense when you consider that some leading life extensionist scientists believe we will conquer human mortality in the next 20 years.”252

These “breeding controls” also seem to align with the Georgia Guidestones, the 19-foot-tall granite monument calling for a world population reduction down to 500 million people in order to preserve the earth’s natural resources. The idea is, if the life extension technology will extend people’s lives by hundreds of years or more, the elite feel they need to save the planet’s resources for themselves, because as CNN founder Ted Turner says, “There’s too many people…too many people are using too much stuff, if there were less people, they’d be using less stuff.”253

The mysterious man behind the strange structure made a reference to transhumanism in a little known book he published shortly after the stones were erected in 1980. “We suggest that scholars throughout the world begin now to establish new bases upon which later generations can develop a totally new universal language for men and machines. It will be adapted to our speech mechanism and to the language faculties and patterns impressed in our nervous systems. Its spoken and printed forms will be capable of accurate interchange by electromechanical means,” wrote R.C. Christian, an admitted pseudonym.254

On the inside cover of the book, titled Common Sense Renewed, it says the first two printings were sent to several thousand political leaders and “shapers of public opinion” around the world. Aside from admitting he represented the unnamed group responsible for the creation of the Georgia Guidestones, the author says part of their purpose is that, “The hearts of our

human family must be touched and warmed to welcome a global rule by reason.”255

May I remind you that several of the “guides,” or commandments as many people call them, aside from reducing to human population down to 500 million (which is more than a 90% reduction from 2014 levels) suggest creating a global government, a global universal language, and the last of the ten “guides,” engraved in eight different languages on the faces of the stones, warns people to not be a “cancer on the earth.”

The elite’s insane dreams of becoming God get even more horrifying the closer you look into them. Richard Seed, a leading geneticist and Transhumanist promoter, said, “God made man in his own image. God intended for man to become one with God. We are going to become one with God. We are going to have almost as much knowledge and almost as much power as God. Cloning and the reprogramming of DNA is the first serious step in becoming one with God.”256

Regarding the resistance to such plans, he ominously responded, “We are going to become Gods, period. If you don’t like it, get off. You don’t have to contribute, you don’t have to participate, but if you are going to interfere with me becoming a God, you’re going to have trouble. There’ll be warfare.”257

Illuminati Transhumanists believe what Satan told Adam and Eve in the Garden of Eden will soon come to pass—that they will become allknowing, all-powerful, immortal Gods who will rule planet earth forever and ever. This New Age philosophy falls in line with their Social Darwinist “survival of the fittest” mentally, and while history is filled with a long list of men who have believed they themselves were Gods—from the ancient pharaohs in Ancient Egypt to Adolf Hitler—today the elite, and much of the general public, anxiously await the Singularity and believe they will soon achieve their Luciferian transition into a God, just as Satan promised mankind so long ago.





Symbolism

A picture is worth a thousand words, as the cliché goes, because pictures contain so much information someone could speak for hours trying to describe every detail but still couldn’t convey everything one encapsulated. Symbols reach deep into the psyche and the soul, and consciously and unconsciously convey meanings and evoke emotional responses. We live in a world full of symbols. A red light at an intersection means stop; a wedding ring symbolizes a man and woman’s commitment to each other. The American flag represents the values, principles, and hard work that built America. The true power of symbols comes from their ability to evoke certain thoughts and feelings.

A souvenir you bought on a trip reminds you of all the fun you had there and just the sight of the object stimulates memories and feelings about the trip. A framed photo of your favorite car hanging on the wall in your office subconsciously reminds you of the freedom you feel on the weekends driving down a country road, briefly leaving your worries behind. Family photos invoke feelings of joy and fond memories just from glancing at them for a moment as they sit on our desk or hang on our refrigerator.

While we can all agree and articulate what many symbols mean, what makes them so mysterious is that the same symbol may have completely different meanings to different people. Let us now decode some popular Illuminati symbols and uncover their occult “hidden” meanings and see why they are used and what they mean to insiders. Most of these symbols themselves aren’t “evil” in and of themselves, they’ve just been adopted by groups or people who are evil, so various symbols have taken on a negative connotation. The swastika was a popular Hindu symbol of health and wellbeing before the Nazis incorporated it as the logo of the Nazi party, and so now we have a negative association to what was originally a positive symbol. The symbol itself is certainly not evil, but we have come to associate it with evil, when in reality it was hijacked and perverted, so for

most people its meaning has been tainted from what it originally meant to convey.



The Sun

To the ancient Mystery Schools in the past, as well as numerous modern mystical or enlightenment groups, (including the Illuminati), the sun is their primary symbol and is often incorporated into their logos and artwork. The sun represents power and light. The word Illuminati means enlightened ones, and the word enlighten contains the word light, which comes from the sun. Someone is said to be bright if they are intelligent and are also called brilliant, which, if you look that word up in the dictionary, you will also find that it means “shining brightly.”

The sun rises and brings life to the world by chasing away the cold and scary darkness of the night. It is an awesome, enormous, and mysterious power that affects all life on planet earth. We tell time based on the sun, it affects the seasons, and it even has an immense effect on our psyche and our health. The 28th degree in Freemasonry is called the Knight of the Sun, and is just one example of how Masons pay homage to this massive star at the center of our solar system.



The Pyramid

The pyramid represents the social hierarchy of society, symbolically depicting a small enlightened few at the top, and the masses of ignorant “worker bees” on the bottom. A sun on top of a pyramid symbolically represents the small number of Illuminati “enlightened leaders” at the top of the social hierarchy ruling over the masses of ignorant slaves below who make up the base of the pyramid.

The Dictionary of Symbols explains, “The base is square and represents the earth. The apex is the starting-point and the finishing-point of all things —the mystic ‘center.’ Joining the apex to the base are the triangular-shaped faces of the pyramid, symbolizing fire, divine revelation and the threefold principle of creation. In consequence the pyramid is seen as a symbol expressing the whole of the work of creation in its three essential aspects.”258

The ancient Egyptian pyramids, built over four thousand years ago, are still one of the seven wonders of the world and have been an endless source of mystery still to this day. While mainstream historians believe the pyramids were built as tombs for the Pharaohs, the belief in the Illuminati is that they were actually temples where the Mystery Schools taught their secrets.

33rd degree Freemason Manly P. Hall explains, “The Great Pyramid was not a lighthouse, an observatory, or a tomb, but the first temple of the Mysteries, the first structure erected as a repository for those secret truths which are the certain foundation of all the arts and sciences…Through the mystic passageways and chambers of the Great Pyramid passed the illumined of antiquity. They entered its portals as men; they came forth as gods. It was the place of the ‘second birth,’ the womb of the Mysteries, and wisdom dwelt in it as God dwells in the hearts of men.”259



As I’m sure you are aware, a pyramid with an all-seeing eye can be found on the back of the one-dollar bill, which many people believe is basically a stamp of ownership by the Illuminati. The man who designed this Great Seal was a Freemason named Charles Thomson, confirming many peoples’ suspicions that a hidden hand strategically placed the symbol on the currency as a secret sign of their power.

The phrase Novus Ordo Seclorum (Latin for New Order for the Ages) has appeared on the bottom of the pyramid on the back of the one dollar bill since 1935. At the opening of the 110th Congress on January 4th 2007, Speaker of the House Nancy Pelosi made a cryptic reference to the Great Seal, announcing, “Our Founders envisioned a new America driven by optimism, opportunity, and courage. So confident were they in the new America they were advancing, they put on the Great Seal of the United States, ‘Novus ordo seclorum’—a new order for the ages…This vision has sustained us for more than 200 years, and it accounts for what is best in our great nation: liberty, opportunity, and justice. Now it is our responsibility to carry forth that vision of a new America.”



The All-Seeing Eye

The symbol of one eye, often with rays of light emanating from it, represents God’s omniscient power and dates back to ancient Egypt where it represented the sun God Horus who could see all. It’s sometimes called the Eye of Providence, and as you know, sits on top of the pyramid on the back of the one dollar bill. This all-seeing eye symbol also represents Big Brother and the Orwellian power of the intelligence agencies watching what everyone does, what they buy, and cataloging their online activities.

Not only are there all-seeing eyes watching people in shopping malls and walking down the streets of major cities, but most people have willingly installed an all-seeing eye in their living rooms—and even their bedrooms—and with the click of a few keys these eyes can be activated by crafty hackers or government agencies. Of course I’m talking about webcams that are built into tablets, laptops, and televisions, not to mention, perhaps even more disturbing, listening to people as well through the microphones that accompany them.

Check out my previous book, Big Brother: The Orwellian Nightmare Come True to learn about actual high-tech spy gadgets, mind-reading machines, government projects, and emerging artificial intelligence systems that seem as if they came right out of George Orwell’s novel Nineteen Eighty-Four and how our own world is unfortunately eerily paralleling the dystopia in his classic book.

While much of this has become fairly well known by now, one interesting point few people ponder is that the all-seeing eye—aside from representing the Illuminati—may actually become a symbol of the Antichrist himself. One Bible prophecy about the Antichrist is that an attempt will be made on his life that will take out or damage one of his eyes.260 Since the symbol often represents a “God,” it’s possible that the

coming counterfeit Christ may literally embody this symbol as a tactic to convince the masses that he himself is God. In Islam, Muslims have a prophecy almost identical saying that the Antichrist, who they call the Dejjal, will be symbolized by one eye.



Snakes and Serpents

The symbol of the serpent is perhaps best known as the creature in the Garden of Eden who tempted Adam and Eve into disobeying God by eating from the Tree of Knowledge of Good and Evil. The very word snake has negative connotations, meaning someone is a liar or deceptive. While the typical connotation of a snake is negative, and the Biblical story of Adam and Eve depicts Satan as the enemy of God and mankind, the occult interpretation is quite different. Occultists and Satanists praise the serpent and believe it brought wisdom to Mankind, enabling humans to become gods.

Again we look to the revelations of 33rd degree Freemason Manly P. Hall who explains, “The serpent is true to the principle of wisdom, for it tempts man to the knowledge of himself. Therefore the knowledge of self resulted from man’s disobedience to the Demiurges, Jehovah [God].”261 Hall continues, saying “The serpent is the symbol and prototype of the Universal savior, who redeems the worlds by giving creation the knowledge of itself and the realization of good and evil.”262

The Secret Doctrine says, “The Serpent of Eternity and all Knowledge, that Manasic spirit [the rational faculty of the mind], which made him learn the secret of creation on the Kriyasaktic, and of procreation on the earthly planes—led him as naturally to discover his way to immortality, notwithstanding the jealously of the Gods.”263

The evil scumbag Aleister Crowley had this to say: “This serpent, Satan, is not the enemy of Man, [because it is he] who made Gods of our race, knowing Good and Evil.”264



Like Satanists and occultists, Freemasons adore the serpent as a savior and worship its wisdom. Here is a quote from Albert Pike’s Morals and Dogma about the serpent, reading, “It is the body of the Holy Spirit, the Universal Agent, the Serpent devouring its own tail.”265

Complicating the meaning of the serpent symbol are several cryptic statements in the Bible, the first of which is when Jesus advised people to be as wise as serpents yet as gentle as doves in Mathew 10:16. This statement seems to acknowledge that serpents contain wisdom or represent a power that may be used for either good or evil. Another interesting and hard to reconcile story about serpents is when Moses made a brazen (brass) serpent and attached it to the top of his staff in order to heal the Israelites who had been bitten by snakes in the desert. The American Medical Association’s logo is a snake coiled around on a staff and the same symbol is often found on ambulances as a symbol of health and healing. When someone reaches the 25th degree of Freemasonry, they are called a Knight of the Brazen Serpent.

One of the reasons serpents have come to symbolize wisdom and enlightenment is because their eyes are always open since they don’t have any eyelids. Snakes are very unique creatures because they have no legs yet move around shooting across the ground like a bolt of lightning. To early Man, they may have seemed magical because they can appear out of nowhere and then disappear into the grass or into the earth itself. The shedding of their skin has come to symbolize a rebirth or immortality, possibly because primitive man thought that snakes were immortal and would give birth to a new self, when a snake “died” it would rise again leaving behind its old “carcass” in the form of its shed skin and continue to live on.

It’s possible that the serpent does not necessarily represent evil in and of itself, but may represent a force that may be used for either good or evil.



The Phoenix

A phoenix is a large mythical bird that symbolizes cyclical renewal, immortality, or resurrection. The creature is depicted similar to an eagle and is often associated with the sun, and many myths talk about the phoenix dying, decomposing, and then rising again out of its own ashes. Some believe that many of the eagle symbols we see today are actually secretly symbols of a phoenix, including the double-headed “eagle” that is a symbol of the 33rd degree of Freemasonry.

The eagle that has come to be a popular symbol of America, and found on the back of the one dollar bill, is also believed by some to occultly signify a phoenix. The Secret Teachings of All Ages states that “The hand of the mysteries controlled in the establishment of the new government for the signature of the mysteries may still be seen on the Great Seal of the United states of America. Careful analysis of the seal discloses a mass of occult and masonic symbols chief among them, the so-called American Eagle...only the student of symbolism can see through the subterfuge and realize that the American eagle upon the Great Seal is but a conventionalized phoenix.”266

The book, published in 1928, also states that, “Not only were many of the founders of the United States government Masons, but they received aid from a secret and august body existing in Europe which helped them to establish this country for a peculiar and particular purpose known only to the initiated few. The Great Seal is the signature of this exalted body— unseen and for the most part unknown—and the unfinished pyramid upon its reverse side is a teeterboard setting forth symbolically the task to the accomplishment of which the United States Government was dedicated from the day of its in conception.”267



The phoenix has been proposed to be the name of the new unified global currency that international banksters have long awaited. The cover of the January 1988 edition of The Economist magazine read “Are you ready for a world currency” and contained an article that explained, “Thirty years from now, Americans, Japanese, Europeans, and people in many other rich countries, and some relatively poor ones will probably be paying for their shopping with the same currency. Prices will be quoted not in dollars, yen or D-marks but in, let’s say, the phoenix. The phoenix will be favored by companies and shoppers because it will be more convenient than today’s national currencies.”268

The metaphor of “rising from the ashes like a phoenix” refers to a rebirth, or something being killed or destroyed in order to give birth to something new, and so by killing off the U.S. Dollar and other currencies around the world through inflation, the banksters are symbolically giving birth to their new currency, which many plan to call the “phoenix.”



The Owl

When discussing Illuminati symbolism, the owl is most known for its connections to the Bohemian Grove, the Illuminati’s summer retreat in northern California. Esoterically, the owl represents wisdom because it sees in the dark, and the Owl of Athena was chosen by Adam Weishaupt as one of the symbols of the Bavarian Illuminati. Early civilizations saw the owl as mysterious because it is only seen at night since they are nocturnal animals.

The Dictionary of Symbols explains, “In the Egyptian system of hieroglyphs, the owl symbolizes death, night, cold and passivity. It also pertains to the realm of the dead sun, that is, it is of the sun which has set below the horizon and which is crossing the lake or sea of darkness.”269

A tiny owl can also be found hidden on the one dollar bill, perched on the upper left corner of the frame that surrounds the “1” located in the upper right hand corner of the bill. Many people see an owl designed into the street layout of Washington D.C., right on top of the U.S. Capitol building when viewing the location from overheard or looking at it on a map.

Pictures of owls are often seen in classrooms standing on a small stack of books in order to symbolize knowledge. The National Press Club’s logo also contains an owl standing on a book. Owls are also seen as guardians and often owl statues are put on the top of buildings to scare away other birds.



The Skull and Crossbones

The skull and crossbones symbol has a sinister look to it, which is why it has been used by nefarious groups for centuries—from pirates and biker gangs, to the Nazis. It represents death, or the power over life and death, which is why it appeals to megalomaniacs and psychopaths. The Nazi SS officers in charge of concentration camps where over six million people were exterminated wore a skull and crossbones symbol on their uniforms, the same emblem used by the Skull & Bones secret society as their logo. The Nazis called it the Totenkopf (German for skull or dead man’s head) and it was a blatant statement of their intention and purpose. Hitler personally handed out a Death’s Head ring to elite SS soldiers.

The Knights Templar incorporated the symbol into their lives because they were dedicated to fight to the death and vowed never to be taken alive as a prisoner. Many Freemasons have a human skull (or a replica) sitting on their desk to remind them of their own mortality and that their life is quickly ticking away. It is meant to urge them to work towards the achievement of their goals before it’s too late.

As you may recall from earlier, both the Bavarian Illuminati and Skull & Bones society at Yale use the object in their induction ceremony with their four different skulls and the question about which one is the fool, the wise man, the beggar or the king. The answer to this induction riddle, “Whether poor or rich, all’s the same in death,” is meant to reinforce their mortality to them and remind them that the clock of life is ticking so they had better do all they can to become kings here in this life because when you’re dead—to them—nothing matters. The riddle is obviously meant to convey that they don’t believe in an afterlife or a final judgment from God.



Baphomet

Baphomet is an occult idol that is depicted as an androgynous man with female breasts that has the head of a goat. The torch of Prometheus is often sticking out of its head and intertwining serpents are rising from its crotch. It’s a mysterious and hideous looking figure that dates back to the 1300s when the inner circle of Knights Templar allegedly incorporated it into their rituals and secret doctrine.

An early depiction of the figure comes from an 1854 book titled Transcendental Magic that was written by a French occultist Eliphas Levi.270 Accompanying his illustration, Eliphas Levi wrote, “According to some, the Baphomet was a monstrous head, but according to others, a demon in the form of a goat. A sculptured coffer [chest] was disinterred [dug up] recently in the ruins of an old Commandery of the Temple, and antiquaries observed upon it a Baphometic figure, corresponding by its attributes to the goat of Mendes and the androgyne of Khunrath.”271

Many Satanists have proudly incorporated the Baphomet figure into their symbols and rituals. Aleister Crowley wrote that the serpent or the “devil’s emblem” was Baphomet, who he also called the “hieroglyph of arcane perfection.”272

One version of the figure is the Church of Satan’s logo, which is printed on the cover of The Satanic Bible. While many people claim that the Catholic Church fabricated the claims that the Knights Templar were using it in secret rituals as an excuse to arrest them and confiscate their wealth during the Inquisition, most Satanists and occults hold the belief that the Catholic Church’s claims were actually true.273



Again, Eliphas Levi boldly proclaimed in his book Transcendental Magic, “Yes, in our profane conviction, the Grand Masters of the Order of the Templars worshipped the Baphomet, and caused it to be worshipped by their initiates.”274



The Pentagram

An upside down pentagram drawn inside of a circle is one of the most obvious and familiar satanic symbols that is used by occult organizations, rebellious teenagers, and rock stars today. It is a lower level occult symbol often used to represent dark powers or sinister forces. Because it’s so widely known, it’s never really used by high-level occultist or the Illuminati, who instead use much less familiar symbols like pyramids, allseeing eyes, owls, black and white checkerboards, and other, less polarizing images.

A pentagram differs from an ordinary five-pointed star in a few ways. First, a pentagram is drawn using five straight lines making up the points and also forming a pentagon in the center. The Satanic pentagram is drawn upside down, and often encompassed by a circle. The reason Satanists use it is because Christians originally used the five points of a (right-side up) pentagram (called the pentalpha) to symbolize the five wounds of Jesus (the two spikes through his hands, two through his feet, and the spear that pierced his side). Satanists like to pervert things and flip Christian symbols upside down or backwards to signify their opposing views and beliefs, and this is how their use of upside down pentagrams came into being.

The Dictionary of Symbols entry on the star reads, “As far back as in the days of Egyptian hieroglyphics a star pointing upwards signified ‘rising upwards towards the point of origin’ and formed part of such words as ‘to bring up,’ ‘to educate,’ and ‘the teacher.’ The inverted five-pointed star is a symbol of the infernal and used in black magic.”275

In Freemasonry, the pentagram is called the Blazing Star and represents the sun, Lucifer, carnal knowledge and power. To Wiccans and Pagans, the five points of the star represent air, fire, water, Earth, and spirit.

The female branch of Freemasonry, called Eastern Star, actually uses an upside down pentagram as their emblem.



Square and Compass

A square (the tool used by carpenters to lay out a right angle or a “square” angle) overlaid on top of a compass (the tool used for drawing circles and arches—not the navigation tool for identifying direction) is a popular symbol in Freemasonry and is often seen with the letter G in the center. The square and compass signify the alchemical doctrine of “as above, so below” or the joining of heaven and earth by forming two opposite facing pyramids with one pointing up and the other one pointing downward. The letter G in the center stands for God or Gnosis [the Greek word for knowledge.] It is also often said to stand for the “Great Architect of the Universe,” a term many masons use to refer to God.



The Statue of Liberty

If you asked the average American what the Statue of Liberty represented, they’ll probably tell you it has to do with “America,” “freedom,” or “democracy.” Some may know that it was given to America by the French, but few know its very design and creation was orchestrated by Freemasons, the secret society, not the government of France, who then gave it to America as a “gift” and placed it in New York Harbor.

Frederic Bartholdi, the designer of the Statue of Liberty, was, of course, a Freemason, and very familiar with occult and Illuminati symbolism and philosophies. In fact, the three major figures involved with the Statue—Frederic Bartholdi, who designed the statue itself; Gustave Eiffel, who designed the inner support structure; and Richard Hunt, who designed the pedestal—were all Freemasons.

Bartholdi’s original plan for a giant statue of this type was actually that it be placed in a harbor in Egypt. After his proposal was turned down by the Egyptian government, he changed his design a little bit and approached America to see if he could erect his newly designed statue in the United States. The point is, he originally wanted to build a bizarre “God-like” statue and have it stand somewhere other than America. Bartholdi’s first choice for his mystical statue was Egypt, not the United States.

The original name of the statue was “Liberty Enlightening the World,” not the “Statue of Liberty.” Again, the word Enlightening fits in with the Illuminati theme—Enlightening, enlightenment, light, the sun, intelligence, bright, brilliance, Lucifer. You get the picture by now.

A near mirror image of the Statue of Liberty stands in France, also on an island, in the Seine River in Paris, that was set up in 1889, just three

years after the one in America was completed. If it’s an “American” symbol then why is there an almost identical one in France? There are actually hundreds of nearly identical “Statue of Liberty” figures all around the world, including Leicester, England; Lviv, Ukraine; Carinthia, Austria; Cenicero, Spain; Arraba in Israel, and many, many other places.

The Statue of Liberty is essentially a modern version of the Colossus of Rhodes, which was a 100-foot-tall statue depicting the Greek sun god Helios (Helios being Greek for sun) that once stood in ancient Greece. The Colossus was created in the 3rd century B.C. and depicted Helios (the Sun God) holding a torch high in one hand and stood on the island of Rhodes facing the water. “This gigantic gilded figure, with its crown of solar rays and its upraised torch, signified occultly the glorious Sun Man of the Mysteries, the Universal Savior,” says The Secret Teachings of All Ages.276

There is a poem printed on a plaque that sits prominently near the base of the Statue of Liberty titled The New Colossus, clearly signaling that it was modeled after the Greek sun god. There was a Masonic cornerstone ceremony conducted when construction began, and a Masonic plaque was placed on the site as well. The statue also symbolizes a composite of a variety of ancient goddesses who represent the feminine principle.

The torch that the Statue of Liberty is holding represents the torch of Prometheus, who occultly signifies Lucifer. The Greek mythological story of Prometheus is the same allegory of stealing fire (i.e. knowledge) from God or the Gods, and giving it to humans, thus angering God.

Here is Manly P. Hall again, one of Freemasonry’s greatest philosophers, explaining in Lectures on Ancient Philosophy, that, “Man wandered hopelessly in the gloom of mortality, living and dying without light or understanding in his servitude to the Demiurgus [the creator God] and his host of spirits. At last the spirit of rebellion entered the creation in the form of Lucifer, who in the guise of a serpent tempted man to revolt against the mandates of Jehovah (the Demiurgus). In Greece this character was known as Prometheus, who brought from the gods the impregnating

flame that would release the life latent in this multitude of germlike potentialities.”277

The seven horn-looking spikes coming out of the Statue of Liberty’s head represent rays of the sun, and symbolically represents the spirit radiating from the mind as knowledge or “enlightenment.” There are seven of them because the rays represent the seven liberal arts and sciences, thus comprising an essential knowledge base. The statue is also holding a book, obviously, symbolic of knowledge and information—again fitting in with the theme of knowledge and enlightenment, because knowledge is power, and that is what the Illuminati has.



Rockefeller Center’s Prometheus

Rockefeller Center in New York City is a huge 22-acre complex made up of nineteen different buildings and the home of Bank of America, NBC, General Electric and other major international Illuminati-controlled corporations. Standing prominently within the property is a huge gold colored statue of Prometheus holding a ball of fire in one hand as he flies through the air. The mythological Greek story of Prometheus stealing fire from the Gods and giving it to mankind despite the punishment he will face is seen by occultists as identical to the story of Lucifer giving mankind the knowledge of good and evil that God had forbid us to have.

So essentially this statue that stands outside of Rockefeller Center is a tribute to Lucifer, which goes unnoticed by the average person not familiar with Illuminati symbolism. Most people are probably not even familiar with the Prometheus myth, or have long since forgotten about it since studying Greek mythology in high school and simply think the statue is just another random piece of art with little to no significance.

Helena Blavatsky explains in her classic occult work, The Secret Doctrine, that, “The allegory of Prometheus, who steals the divine fire as to allow men to proceed consciously on the path of spiritual evolution, thus transforming the most perfect of animals on Earth into a potential god, and making him free to take the kingdom of heaven by violence. Hence also, the curse pronounced by Zeus against Prometheus, and by Jehovah [God] against his ‘rebellious son,’ Satan.”278

So as you can see, it’s not just me making the connection between Prometheus and Lucifer—It’s occultist insiders themselves, and of course it’s no coincidence this stands on a Rockefeller property, a family with generational ties to the Illuminati establishment.



The Washington Monument

The Washington Monument, which is located directly west of the United States Capitol building in Washington DC, standing approximately 555 feet high, dominates the sky throughout the city and can be seen from miles around, especially at night with the red light shining from the top looking like the evil Eye of Sauron in the Lord of the Rings movies. The monument is an Egyptian obelisk with a pyramid capstone on the top and was completed in 1884.

The structure is one of the most important symbols in America to the Illuminati, although most people are clearly unaware of it having any hidden meaning. Occultists see the monument as an enormous phallic symbol—a big penis—representing masculine energy and dominance. One would expect the “Washington” Monument to be a statue of George Washington himself, much like the Lincoln Memorial houses a huge statue of Abraham Lincoln, but instead it’s a giant erect penis of the Egyptian god Baal. Of course, it too was designed and built by Freemasons, who even had a ceremony to lay the cornerstone when construction began.

Fritz Springmeier, author of Bloodlines of the Illuminati, wrote, “Every morning when the United States President wakes up he can look out the window, see the Masonic obelisk and be reminded of who controls America. If the president has any training in the Mystery Religion of Egypt, he will also know what body part is symbolically erected in the Washington Memorial.”279 Springmeier goes so far as to say, “If the U.S. were ever to return to serving God, that monument would be a good one to destroy. God asked the Israelites not just simply to avoid worshiping such abominations, He asked His people to destroy them, for their very creation was an abomination.”280



Cleopatra’s Needle

While the Washington Monument may be the most well-known Egyptian obelisk in America, it isn’t the only one. Another one stands in Central Park in New York City—called Cleopatra’s Needle, and this one is actually an authentic Egyptian obelisk that dates back to around 1500 B.C. and was transported to New York in 1881.

Similar “Cleopatra’s Needles” actually stand in London and Paris, signifying the Illuminati’s rule in those countries as well. Not surprising, there is also one in Vatican City as well. The one in New York’s Central Park stands 70-feet tall and weighs 220 tons. Why and how it was brought to America all the way from Egypt is an interesting story.

For some reason Henry G. Stebbins, who was the Commissioner of the Department of Public Parks in New York in the 1880s, announced he was looking for help financing a plan to bring the statue to America. William H. Vanderbilt, who was one of the wealthiest men in the world, was asked to help make it happen and donated over $100,000 (over $2 million in 2014 dollars) to help. Interestingly, the shipping costs for the one sent to London were paid for by Dr. Erasmus Wilson, a Freemason.

Once the obelisk arrived in America, thousands of Freemasons took part in a parade as it was rolled up Fifth Avenue from 14th Street to 82nd Street. When it was erected at its final destination in the park, the Grand Master of Masons in New York performed a cornerstone laying ritual as a celebration. When it first arrived in New York in 1881, Cleopatra’s Needle was covered with clearly visible hieroglyphics about the sun god Horus, but most of the carvings have since been warn away from acid rain. While they survived 3000 years in Egypt, it seems the ancient relic was no match for the pollution of New York City.



Movies and Music

For hundreds of years, knowledge of the Illuminati and their symbols was largely contained within the Mystery Schools that taught the esoteric tradition. Outsiders didn’t even think twice about most occult symbols because they were seen as ordinary art and few people paid much attention to them. But with the birth of the information age, things started to change. In the 1990s and early 2000s, a growing number of websites and forums were dedicated to investigating secret societies, and began to expose these once little known issues to a larger number of people.

For decades, those interested in such material were considered a fringe minority of patriots and “conspiracy theorists,” but with the emergence of social media becoming a standard feature in most people’s lives, and with video sharing websites like YouTube changing the nature of media and information exchange, an interesting phenomenon began to occur early in the twenty-first century. Illuminati and occult symbolism spilled over from what was once primarily the topic of fringe websites, and “computer geeks” on Internet forums, to became part of pop culture finding its way into various mainstream music videos and blockbuster movies.

While a sizable portion of the population has become familiar with the use of Illuminati symbolism in rap videos and supposed “Illuminati hand signs” being flashed by celebrities, most people who pay attention to this aspect of the symbolism barely have a basic understanding of the history of the symbols or their meanings. Many people who have heard the oftentimes farfetched claims about “Illuminati celebrities” have dismissed the existence of the Illuminati all together as a conspiracy theory or believe it’s simply a secret society in Hollywood that top celebrities are part of.

Checkout my previous book Illuminati in the Music Industry to read about this fascinating history since it is a very lengthy analysis in and of

itself. While there certainly have been countless allegations made against a variety of celebrities like Jay-Z, Beyoncé, Lady Gaga, Kanye West and others, when you take a critical analysis of celebrity as a whole and the power their music and personas have over the culture, it becomes very clear that music is not always “just entertainment.”

As the Illuminati prepare to announce the “royal secret,” as they call it, by declaring that Satan is the King of the Earth and the “savior of mankind,” hoping to finally overthrow the “inferior” and “evil” Creator God to complete the New World Order “utopia,” celebrities have recently played a major part in paving the path to the apocalypse.

The vast majority of the public literally worship celebrities who function as modern day Gods that shape our cultural attitudes and beliefs since their every action is mimicked, and every opinion they voice is seen as profound.

The general public is growing to see the Illuminati—not as a threat to their freedoms or a corrupt mafia of politicians, bankers and businessmen— but as a “cool” group of powerful men they wish they could be a part of. The moral decay and erosion of the work ethic have resulted in the average person willing to do almost anything for just a taste of the Illuminati’s “success.” Pop culture has begun portraying the Illuminati as holding the secret to success or a secret society of the rich and famous.

Occasionally films have portrayed the Illuminati or an affiliated group as the antagonist in a plot to convey a warning to the audience, and some celebrities have publicly denounced them as the shadowy puppet masters pulling the strings in global affairs, but the overwhelming majority of mainstream media content and celebrity idols paint the Illuminati as holding the master key to success and as a result countless people would practically kill their own mother to join them in order to have a bigger piece of the pie.







Insiders’ Hints

If you want to truly understand what the Illuminati is, what they are doing, what they are planning, and what they believe, there’s no better place to go than to elite insiders themselves who can’t always keep their mouths shut, and occasionally can’t help but brag about their “great work.” While there’s a long list of people who claim to be Illuminati defectors that speak about their alleged activities while supposedly being a “member of the Illuminati,” most of these people are hoaxers and fraudsters with no credibility who are just trying to make a few bucks from selling books, or just looking for attention, and many of them have been easily debunked.

Of course if you do an Internet search for “the Illuminati,” you’ll find countless websites making claims about what they are, what they do, who’s supposedly involved, etc. There’s even a Wikipedia page giving a few details about them, although it’s largely incomplete and inaccurate. While it’s not difficult at all to find Illuminati conspiracy theories online, what is difficult; however, is finding accurate and reliable information that is properly sourced and verified, and this is my primary goal with this book.

While everyone seems to have an opinion about the Illuminati these days, most people think “research” consists of watching a few YouTube videos or glancing over a Wikipedia article. There are, however, some very well connected and powerful men who have either dropped hints about the Illuminati and their secret agenda, or those who have gotten close enough to the power structure to see for themselves that a powerful secret society does exist and has tremendous influence over the world.



David Rockefeller

The Rockefeller family is often mentioned as one of the families that has been involved with the Illuminati for generations and have accumulated a vast amount of wealth and influence because of this. The Rockefeller family made most of their money in oil and banking, and using their wealth they have wrapped their tentacles around some of the most infamous groups and conspiracies connected to the Illuminati.

For example, Rockefeller money was instrumental in the early growth of the Council on Foreign Relations, the Trilateral Commission, and the Bilderberg Group. They were a major funder of Eugenics and the CIA’s MK-ULTRA mind control experiments at over 30 American Universities, hospitals, and government facilities. The Rockefellers bought seventeen acres of land for the United Nations headquarters to be built in Manhattan; and even financed the development of facial recognition systems through their Rockefeller University that recruited and funded a man named Joseph Atick in the early 1990s who was given use of the Computational Neuroscience Laboratory where he developed his facial recognition systems.

In his 2002 book, Memoirs, Illuminati kingpin David Rockefeller arrogantly admitted, “For more than a century ideological extremists at either end of the political spectrum have seized upon well-publicized incidents such as my encounter with Castro to attack the Rockefeller family for the inordinate influence they claim we wield over American political and economic institutions. Some even believe we are part of a secret cabal working against the interests of the United States, characterizing my family and me as “internationalists” and conspiring with others around the world to build a more integrated global political and economic structure—one world, if you will. If that’s the charge, I stand guilty, and I am proud of it.”281



In a 1980 PBS documentary titled The World of David Rockefeller, host Bill Moyer said that “David Rockefeller is the most conspicuous representative today of the ruling class, a multinational fraternity of men who shape the global economy and manage the flow of its capital. Rockefeller was born to it, and he has made the most of it. But what some critics see as a vast international conspiracy, he considers a circumstance of life and just another day’s work... In the world of David Rockefeller it’s hard to tell where business ends and politics begins.”282



Carroll Quigley

In 1966 an Establishment insider and mentor of President Bill Clinton published a book for fellow Establishment insiders titled Tragedy & Hope to help them understand how the Illuminati empire works. Carroll Quigley, a professor at Georgetown University, knew that most of the public doesn’t read books or newspapers and are more interested in sports entertainment and celebrity news than business or politics.

Quigley openly revealed, “There does exist, and has existed for a generation, an international Anglophile network which operates, to some extent, in the way the radical Right believes the Communists act. In fact, this network, which we may identify as the Round Table Groups, has no aversion to cooperating with the Communists, or any other groups, and frequently does so. I know of the operations of this network because I have studied it for twenty years and was permitted for two years, in the early 1960’s, to examine its papers and secret records. I have no aversion to it or to most of its aims and have, for much of my life, been close to it and to many of its instruments. I have objected, both in the past and recently, to a few of its policies (notably to its belief that England was an Atlantic rather than a European Power and must be allied, or even federated, with the United States and must remain isolated from Europe), but in general my chief difference of opinion is that it wishes to remain unknown, and I believe its role in history is significant enough to be known.”283

He described how the financial elite created front groups to influence governments around the world, writing, “…in New York it was known as the Council on Foreign Relations, and was a front for J. P. Morgan and Company in association with the very small American Round Table Group. The American organizers were dominated by the large number of Morgan ‘experts’… The Round Table for years (until 1961) was edited from the

back door of Chatham House grounds in Ormond Yard, and its telephone came through the Chatham House switchboard.”284

Quigley also explained how it was to the elite’s advantage to have only two political parties for people to choose from. The reason being, “The two parties should be almost identical, so that the American people can ‘throw the rascals out’ at any election without leading to any profound or extensive shifts in policy.”285

Regarding the Federal Reserve and the financial takeover of governments by private banks he said, “The powers of financial capitalism had a far-reaching aim, nothing less than to create a world system of financial control in private hands able to dominate the political system of each country and the economy of the world as a whole. This system was to be controlled in a feudalist fashion by the central banks of the world acting in concert, by secret agreements arrived at in frequent meetings and conferences. The apex of the systems was to be the Bank for International Settlements in Basel, Switzerland, a private bank owned and controlled by the world’s central banks which were themselves private corporations. Each central bank...sought to dominate its government by its ability to control Treasury loans, to manipulate foreign exchanges, to influence the level of economic activity in the country, and to influence cooperative politicians by subsequent economic rewards in the business world.”286

Basically in his lengthy and dry book, Tragedy & Hope, he quietly confirmed what many “conspiracy theorists” had been saying for decades, but unlike most outsiders, he was in a position learn directly from the perpetrators.



Cecil Rhodes

The most notorious diamond monopoly man in history, and the person behind the elite Rhodes Scholarships, which awards young men and women who the Establishment feel will be willing and useful servants with a free ride to Oxford University and basically an invitation to the Illuminati, was a man named Cecil Rhodes, who didn’t just talk about his plans to further the Invisible Empire, he actually wrote in his will that after he died his fortune would go to finance this.

Rhodes is the man behind the DeBeers diamond cartel who became extremely wealthy by monopolizing diamond mines in Africa and then launching a brilliant propaganda campaign with the help of Edward Bernays designed to brainwash women around the world into thinking that when a man proposes marriage he must do so with a diamond ring.

Rhodes, who died in 1902, wrote in his will that his fortune was to be used, “To and for the establishment, promotion and development of a Secret Society, the true aim and object whereof shall be for the extension of British rule throughout the world, the perfecting of a system of emigration from the United Kingdom, and of colonization by British subjects of all lands where the means of livelihood are attainable by energy, labor and enterprise, and especially the occupation by British settlers of the entire Continent of Africa, the Holy Land, the Valley of the Euphrates, the Islands of Cyprus and Candia, the whole of South America, the Islands of the Pacific not heretofore possessed by Great Britain, the whole of the Malay Archipelago, the seaboard of China and Japan, the ultimate recovery of the United States of America as an integral part of the British Empire, the inauguration of a system of Colonial representation in the Imperial Parliament which may tend to weld together the disjointed members of the Empire and, finally, the foundation of so great a Power as to render wars impossible, and promote the best interests of humanity.”287



To help carry out his plan, certain money from his estate is designated to what’s called the Rhodes Scholarship, which is a student fund that awards carefully chosen individuals who don’t necessarily come from wealthy families but who are seen as likely assets of the Illuminati with a free ride post graduate education at England’s Oxford University, where they are groomed to later become pawns of the global elite. President Bill Clinton was awarded a Rhodes Scholarship to bring him into the fold, as was the liberal lesbian Rachel Maddow of MSNBC who uses her national mainstream media platform to promote bigger government and the radical liberal agenda on a continual basis.



Edward Bernays

In 1928 Edward Bernays, the man considered to be the father of public relations, revealed in his book Propaganda that, “Those who manipulate the unseen mechanism of society constitute an invisible government which is the true ruling power of our country. We are governed, our minds are molded, our tastes formed, our ideas suggested, largely by men we have never heard of...in almost every act of our lives whether in the sphere of politics or business in our social conduct or our ethical thinking, we are dominated by the relatively small number of persons who understand the mental processes and social patterns of the masses. It is they who pull the wires that control the public mind, who harness old social forces and contrive new ways to bind and guide the world.”288

He went on to admit, “Whatever of social importance is done today, whether in politics, finance, manufacture, agriculture, charity, education, or other fields, must be done with the help of propaganda. Propaganda is the executive arm of the invisible government.”289

Bernays also stated plainly that, “The invisible government tends to be concentrated in the hands of the few because of the expense of manipulating the social machinery which controls the opinions and habits of the masses.”290

The Department of Defense (previously called the Department of War) actually hired Bernays to help influence public opinion to support America’s involvement in World War I. The tobacco industry also paid him to use his methods to encourage women to smoke cigarettes since at the time it was seen as unattractive.291 Bernays is also the person all men can thank for having to cough up thousands of dollars for a diamond ring when we propose marriage since that tradition was started as a clever marketing ploy he crafted for the DeBeers diamond monopoly.



Woodrow Wilson

The 28th President of the United States, Woodrow Wilson, was the man responsible for signing the Federal Reserve Act into law and handing America’s banking system over to the money manipulating mafia in 1913. Wilson later admitted, “Since I entered politics, I have chiefly had men’s views confided to me privately. Some of the biggest men in the United States, in the field of commerce and manufacturing, are afraid of something. They know that there is a power somewhere so organized, so subtle, so watchful, so interlocked, so complete, so pervasive, that they better not speak above their breath when they speak in condemnation of it.”292

After he was out of office, Woodrow Wilson allegedly voiced regret for cooperating with the banking cartel’s plan for the Federal Reserve Banking system, reportedly saying, “I am a most unhappy man. I have unwittingly ruined my country. A great industrial nation is now controlled by its system of credit. We are no longer a government by free opinion, no longer a government by conviction and the vote of the majority, but a government by the opinion and duress of a small group of dominant men.”293



John F. Kennedy

When speaking to the American Newspaper Publishers Association in 1961, President Kennedy actually condemned secret societies, saying, “The very word ‘secrecy’ is repugnant in a free and open society; and we are as a people inherently and historically opposed to secret societies, to secret oaths and to secret proceedings.”294

He continued, “We decided long ago that the dangers of excessive and unwarranted concealment of pertinent facts far outweighed the dangers which are cited to justify it…For we are opposed around the world by a monolithic and ruthless conspiracy that relies primarily on covered means for expanding its sphere of influence, on infiltration instead of invasion, on subversion instead of elections, on intimidation instead of free choice, on guerrillas by night instead of armies by day. It is a system which has conscripted vast human and material resources into the building of a tightly knit highly efficient machine that combines military, diplomatic, intelligence, economic, scientific and political operations, its preparations concealed, not published, its mistakes are buried not headlined, it’s dissenters are silenced not praised, no expenditure is questioned, no rumor is printed, no secret is revealed.”

Kennedy issued an interesting Executive Order (number 11110) in 1963 that many interpret as directing the Secretary of the Treasury to start once again issuing silver certificates (which looked similar to dollar bills) that would be redeemable for their face value in silver coins or bullion, in what many saw as an attempt to remove power from the Federal Reserve Bank and give it back to the Treasury department.

Silver certificates [called United States Notes] were originally put in circulation in 1878 by the Treasury department and used as money, but

Federal Reserve Notes (commonly known as U.S. dollars) replaced them after the creation of the Federal Reserve banking system in 1913.

Kennedy’s Executive Order 11110 was soon reversed by President Lyndon B. Johnson after he was sworn in as JFK’s replacement after his assassination. Many people cite Kennedy’s supposed opposition to the Federal Reserve cartel as a major factor in the reason he was assassinated, believing the CIA orchestrated the event and blamed “patsy” Lee Harvey Oswald. Others believe Kennedy planned to pull out of the Vietnam War, in opposition to secret Establishment, which was another motive for wanting him dead.

A Gallup poll was published in 2013 as the 50th anniversary of his death approached showed that 61% of Americans believed someone other than Lee Harvey Oswald was involved in the assassination.295 The poll notes that at one time 81% of Americans thought there was more than one person involved in the shooting, despite the official story of Oswald acting alone, and the “JFK conspiracy” is one of the most popular conspiracy theories in history.



President Dwight Eisenhower

President Dwight Eisenhower, who was a five-star general during World War II, gave his Farewell Address to the Nation on January 17, 1961 where he popularized the term “Military Industrial Complex” after he warned about the dangers of weapon manufacturers influencing the government to go to war primarily for profit.

“This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence— economic, political, even spiritual—is felt in every city, every statehouse, every office of the federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.”296

One part of the speech that still resonates today is when he said, “In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military– industrial complex. The potential for the disastrous rise of misplaced power exists, and will persist. We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals so that security and liberty may prosper together.”

This Military Industrial Complex can be seen functioning today when major defense companies receive no-bid contracts handed to them by their politician friends to hire ex-soldiers as private security guards in war torn countries, or when the Bilderberg Group meeting includes CEOs from

private defense companies who meet with current U.S. military heads to come to a consensus about a current or future military action.



President George Bush Senior

Two hours after bombing in Iraq and Kuwait began in 1991 (Operation Desert Storm) kicking off the first Gulf War, President Bush addressed the nation from the Oval Office explaining his goal, saying, “We have before us the opportunity to forge for ourselves and for future generations a New World Order, a world where the rule of law, not the law of the jungle, governs the conduct of nations. When we are successful, and we will be, we have a real chance at this new world order, an order in which a credible United Nations can use its peacekeeping role to fulfill the promise and vision of the U.N.’s founders.”297

A few weeks later at his State of the Union Address in 1991, President Bush was talking about America’s military action in the Gulf when he doubled down, saying, “What is at stake is more than one small country, it is a big idea—a New World Order.”298

Before becoming Ronald Reagan’s vice president, and then president himself after that, George Bush Senior was the head of the Central Intelligence Agency in the late 1970s, not to mention a member of Skull & Bones and the Bohemian Grove, where he and his son George W. Bush were photographed giving a Lakeside talk in 1995 where Bush Senior reportedly told the audience his son would make a fine president one day.299



President George W. Bush

Shortly after the September 11th terrorist attacks on the World Trade Center and the Pentagon in 2001, sparking the never-ending “War on Terror,” President George W. Bush addressed the growing “conspiracy theories” from people thinking the U.S. government was behind the attacks —or at the bare minimum—allowed them to happen on purpose as a pretext to launch the pre-planned wars in the Middle East. While speaking at a United Nations conference Bush announced, “Let us never tolerate outrageous conspiracy theories concerning the attacks of September the 11th; malicious lies that attempt to shift the blame away from the terrorists themselves, away from the guilty.”300

The fact that the president even addressed the “conspiracy theories” shows just how far they were spreading, and what would come to be known as the 9/11 Truth Movement started making headlines in the years to come and gained a sizable number of supporters who were suspicious of the “official story” of 9/11.301

A leaked memo from a 2003 meeting between President Bush and British Prime Minister Tony Blair later revealed that Bush once proposed luring Saddam Hussein into the War on Terror by flying an unmanned drone disguised as a United Nations airplane into Iraqi airspace hoping it would get shot down so the United States could then use the event as a justification for expanding the War on Terror into Iraq.302 As we all know, he later did invade Iraq after fabricating “evidence” claiming Saddam Hussein was working with Al Qaeda to soon nuke the United States. Many people still weren’t convinced there was any proof of this, but the administration’s mantra was, “We don’t want the smoking gun to be a mushroom cloud.”

In 2004 when Bush was campaigning for reelection he appeared on NBC’s Meet the Press where host Tim Russert surprisingly asked him about

being a Bonesman. “You were both in Skull & Bones, the secret society,” Russert stated, referring to both Bush and his Democrat opponent John Kerry.

“It’s so secret we can’t talk about it,” Bush responded.

“What does that mean for America? The conspiracy theorists are going to go wild,” Russert pressed.

“I’m sure they are. I don’t know. I haven’t seen the web pages yet.” (Laughs)303

Of course, George W. Bush was not the mastermind behind the 9/11 attacks or the War on Terror, but rather a willing servant and asset of the Illuminati whose strings were being pulled by the powers that be from behind the scenes. Having sworn allegiance to Skull & Bones and being part of a Bones family, he undoubtedly felt obligated to carry out the Order’s directives.



Vice President Dick Cheney

When giving a speech at a Council on Foreign Relations meeting in 2002, Vice President Dick Cheney cracked an inside joke about his affiliation with the organization, saying, “I want to thank you all for the warm welcome today. I see a lot of old friends in the room. And it’s good to be back at the Council on Foreign Relations. As Pete mentioned, I’ve been a member for a long time, and was actually a director for some period of time. I never mentioned that when I was campaigning for reelection back home in Wyoming (laughter) but it stood me in good stead. I value very much my experience, exposure to the tremendous people involved and the involvement and the ideas and the debates on the great policy issues of the day.”304

The reason everyone laughed when he said he never mentioned he was a member when he was campaigning is because they all know the sinister reputation their group has. Anyone unfamiliar with the history and activities of the CFR would have no idea why everyone laughed, but those “in the know” surely “got” what he said.

A Pulitzer Prize winning journalist for The New Yorker named Seymour Hersh reported that his sources revealed to him that Cheney once proposed creating a false flag “Gulf of Tonkin” type of scenario in the Middle East to expand the War on Terror into Iran by having some U.S. Navy SEALS attack American ships in the Straits of Hormuz in order to make it appear as if Iranian PT boats had done it.305 Cheney is seen by many as one of the evil Neocon architects behind the 9/11 attacks and the ensuing War on Terror. Of course, he publicly advocated torture and refused to testify under oath at the 9/11 Commission hearings.306



Smedley Butler

A United States Marine Corps Major General, the highest rank at that time, came forward in 1934 revealing a conspiracy that was organized by Wall Street bankers who wanted to overthrow President Roosevelt and replace him with a fascist dictator to serve the will of the financial elite. A congressional committee named the McCormick Dickstein Committee was formed to investigate General Butler’s allegations.

Butler testified that a Wall Street insider named Gerald P. MacGuire approached him on behalf of a secret organization hoping he would lead a coup against the United States government that was to be backed by three million dollars (over 35 million in 2014 dollars) coming from the Wall Street elite. The conspiracy was dubbed the Business Plot.

While no one was indicted, the congressional committee concluded that some of Butler’s claims were true, and that such a plan was discussed and contemplated, but the committee questioned whether an actual coup by the group was actually an immediate threat or just some wild scheme the bankers had fanaticized about.

The Congressional committee’s final report stated, “In the last few weeks of the committee’s official life it received evidence showing that certain persons had made an attempt to establish a fascist organization in this country...There is no question that these attempts were discussed, were planned, and might have been placed in execution when and if the financial backers deemed it expedient.”307

Butler would later go on to write his famous book War is a Racket that denounced most major wars and military actions as money-making schemes hatched by corrupt politicians intertwined with the weapons industry.



Zbigniew Brzezinski

The national security adviser for President Jimmy Carter, founding member of the Trilateral Commission, and protégé of David Rockefeller, Zbigniew Brzezinski has made some startling admissions about the secret establishment. Brzezinski was in charge of covertly funding Osama Bin Laden and the Mujahedeen army in Afghanistan in the 1980s so they could fight off the Soviet Union who were trying to move into that area. This radical group of Muslims who America funded with several billion dollars, coordinated by Brzezinski, would later morph into Al Qaeda.

Back in 1970 he published a book called Between Two Ages: America’s Role in the Technetronic Era, where he wrote, “The technocratic era involves the gradual appearance of a more controlled society. Such a society would be dominated by an elite, unrestrained by traditional values...The capacity to assert social and political control over the individual will vastly increase. It will soon be possible to assert almost continuous surveillance over every citizen and to maintain up-to-date, complete files, containing even most personal information about the health or personal behavior of the citizen in addition to more customary data. These files will be subject to instantaneous retrieval by the authorities.”308

In his 1997 book, The Grand Chessboard, he lamented, “…as America becomes an increasingly multicultural society, it may find it more difficult to fashion a consensus on foreign policy issues, except in the circumstances of a truly massive and widely perceived direct external threat.”309

He seems to suggest a false flag attack as a pretext to carry out his plans, saying, “The public supported America’s engagement in World War II largely because of the shock effect of the Japanese attack on Pearl Harbor.”310



In a speech which can be seen on You Tube, he openly admitted, “I am deeply troubled that a very vague emotionally stated semi-theologically defined diagnosis of the central global menace is obscuring our national ability to comprehend the historically unprecedented challenge which is being posed in our time by a massive global political awakening and thus is obstructing our ability to deal effectively with the global political turmoil that this awakening is generating.”311

At a Council on Foreign Relations meeting in Montreal, Canada, Brzezinski again lamented to his fellow elitists that a “global political awakening,” was occurring and that the world had become more difficult to manage because it was “lacking internal unity with many of its members in bilateral antagonisms” and that “For the first time in all of human history mankind is politically awakened—that’s a total new reality—it has not been so for most of human history…[and the] “politically awakened masses makes it a much more difficult context for any major power, including, currently, the leading world power, the United States.”312



John Hylan

A former mayor of New York City made a detailed denouncement against “the interests” in 1922, in a speech that is often incorrectly attributed to President Theodore Roosevelt. John Hylan, who was major from 1918 to 1925, revealed, “The real menace of our Republic is the invisible government, which like a giant octopus sprawls its slimy legs over our cities, states and nation. To depart from mere generalizations, let me say that at the head of this octopus are the Rockefeller–Standard Oil interests and a small group of powerful banking houses generally referred to as the international bankers. The little coterie of powerful international bankers virtually run the United States government for their own selfish purposes.”313

He continued, “They practically control both parties, write political platforms, make cats paws of party leaders, use the leading men of private organizations, and resort to every device to place in nomination for high public office only such candidates as will be amenable to the dictates of corrupt big business.”314

“These international bankers and Rockefeller–Standard Oil interests control the majority of the newspapers and magazines in this country. They use the columns of these papers to club into submission or drive out of office public officials who refuse to do the bidding of the powerful corrupt cliques which compose the invisible government. It operates under cover of a self-created screen [and] seizes our executive officers, legislative bodies, schools, courts, newspapers and every agency created for the public protection.”315



Winston Churchill

One of the most well-known prime ministers of England, Winston Churchill, once made a statement warning about what he called a “world conspiracy” and even named Illuminati founder Adam Weishaupt as the perpetrator.

“From the days of ‘Sparticus’ Adam Weishaupt, Karl Marx, Trotski, Belacoon, Rosa Luxenberg and Ema Goldman, this world conspiracy has been steadily growing. This conspiracy played a definite recognizable role in the French Revolution. It has been the mainspring of every subversive movement during the 19th century. And now at last, this band of extraordinary personalities from the under-world of the great cities of Europe and America have gripped the Russian people by the hair of their head and have become the undisputed masters of that enormous empire.”316



The Rothschilds

The patriarch of the Rothschild international banking dynasty was Mayer Amschel Rothschild, whose family fortune would become the largest fortune in the history of the world in the 1760s. He is seen as the “founding father of international finance,” and Forbes magazine listed him as one of the “Twenty Most Influential Businessmen of All Time.”317 Mayer arranged marriages for his five sons so they married their first or second cousins in order to keep his massive wealth within the family. He also assigned each of his sons to different countries to each run those regions’ economy.

A quote often attributed to Mayer Rothschild, although unverified, alleges that he once stated, “Let me issue and control a nation’s money and I care not who writes the laws.” Whether he actually said this or not is uncertain, but what is certain, however, is that one of his sons, Nathan, made an almost identical statement that has been confirmed by the wellrespected historian Niall Ferguson, whose book The House of Rothschild reports that in 1815 Nathan stated, “I care not what puppet is placed upon the throne of England to rule the Empire on which the sun never sets. The man who controls the British money supply controls the British Empire, and I control the British money supply.”318

Nathan multiplied the family fortune many fold partly due to his advanced knowledge of the British victory at the Battle of Waterloo over the French in 1815, which enabled him to rake in a fortune on the London Stock Exchange. A Rothschild courier was able to get word of Duke Wellington’s victory over Napoleon’s French Army to Nathan hours before anyone else in London learned of the outcome which gave him an enormous advantage over other investors whose financial future largely hinged on the outcome of this event. Rothschild also allegedly put out the false rumor that Duke Wellington and the British had lost, thus enabling him to further capitalize on the market since he knew the opposite was true.



The Rothschild family downplays the significance of this event and the amount of money they made from it, but historians do agree that a courier did in fact reach Rothschild informing him about the outcome of the battle before anyone else.319 Sometimes people are accused of “anti-Semitism” for pointing out the Rothschild influence in the world of international banking, a claim that is often thrown at people who are critical of someone who happens to be Jewish.

Heir Nathaniel Rothschild lost a libel lawsuit he filed against London’s Daily Mail after the paper claimed he was the billionaire “puppet master” behind convincing the European Union Trade Commissioner Lord Mandelson to lift some trade barriers involving importing aluminum from Russia.320 So in a sense, by losing the libel suite, the court confirmed that he was indeed a “puppet master” pulling the strings of back-room big business and political dealings.

Many people point the finger at the Rothschild family as being one of the primary sources of the Illuminati’s finances, and the family helped fund the initial Jewish occupation of Israel and have been a major financial supporter of Zionism.



James Paul Warburg

James Paul Warburg (August 18, 1896 – June 3, 1969) was the son of Paul Warburg, the “father” of the Federal Reserve Bank, and the man who organized the secret Jekyll Island meeting to formulate their plan. The apple didn’t fall too far from the tree in this case, because his son James went on to become the financial adviser for President Roosevelt, and a member of the Council on Foreign Relations—of which he was a founding member. At an appearance before the U.S. Senate Committee on Foreign Relations he once flatly stated, “We shall have world government, whether or not we like it. The question is only whether world government will be achieved by consent or by conquest.”321



Henry Kissinger

One of the most infamous political figures in American history is Henry Kissinger, a man who is seen by many as a treacherous war criminal for helping the CIA organize various covert operations designed to overthrow democratically elected leaders in several countries (Chili, and Argentina, for example) in order to install a leader who was more in tune with American foreign policy.322 Award winning journalist Bob Woodward and Carl Bernstein, the guys who blew open the Watergate scandal, revealed that Kissinger once referred to our military men and women as “dumb, stupid animals” to be used as pawns for America’s foreign policy.323

Kissinger once remarked that power was the greatest aphrodisiac. Back in 2001 President George W. Bush chose him to be the Chairman of the 9/11 Commission to investigate the September 11th attacks, but shortly after it was revealed he was Bush’s choice outraged victims’ family members who had learned of his financial ties to the Bin Laden family forced the commission to drop him. His sole purpose as head commissioner would have been, of course, to prevent the truth about what really happened from seeing the light of day. The 9/11 attacks are seen by many as another false flag attack, or an incident that was purposefully allowed to happen in order to spark the endless War on Terror and justify the reduction of American liberties.

David Rothkopf, the managing director of Kissinger and Associates, an international advising firm founded by the infamous Henry Kissinger, wrote a very interesting book in 2009 titled Superclass: The Global Power Elite and the World They are Making, where he openly discussed the ruling elite and the various organizations that largely influence the political and economic landscape of the world. While not revealing any earth-shattering insider secrets, his book serves to confirm many of the allegations made against the ruling elite by so called “conspiracy theorists.”



Rothkopf wrote that, “A global elite has emerged over the past several decades that has vastly more power than any other group on the planet. Each of the members of the superclass has the ability to regularly influence the lives of millions of people in multiple countries worldwide. Each actively exercises this power, and they often amplify it through the development of relationships with others in this class.”324

He goes on to say, “That such a group exists is indisputable. Heads of state, CEOs of the world’s largest companies, media barons, billionaires who are actively involved in their investments, technology, entrepreneur, oil potentates, hedge fund managers, private equity investors, top military commanders, a select few religious leaders, a handful of renowned writers, scientists, and artists, even terrorist leaders and master criminals, meet the above criteria for membership.”325

He proposes that this ruling elite, or “superclass” as he calls them, consists of roughly 6,000 people.326 The Occupy Wall Street protesters often spoke out against what they called the “1%” who they saw as being the ruling elite, but this equates to approximately 70 million people. (1% of the earth’s 7 billion people is 70 million.) Of course Occupy’s assessment of who is the problem is wildly inaccurate. Using Rothkopf’s figure, it wouldn’t be the 1%, but more like the .0001%. In reality, it’s probably more like the .00001% which is around 700 people who are the Illuminati or their associates.

Another interesting admission is when Rothkopf says, “From behind the scenes, it was clear that these individuals influenced everything from the way currencies were priced worldwide to which political candidates would have sufficient funding for their presidential campaigns.”327

Perhaps Rothkopf started to grow a conscience after being so close to the superclass and seeing exactly what they’re doing to the planet. He even admitted that in the post-9/11 era and with the War on Terror being waged to fight al Qaeda, that much of the information coming from the

government was basically fear mongering to achieve a political goal. “While the United states was in a real struggle with Communist Russia, the assertion that Communists were everywhere and intent on undermining the United States was vastly exaggerated in much the same way that the terror threat is exaggerated today.”328

He even said the Bilderberger Group meetings reveal the “informal mechanisms of power” that shape the world329 and was well aware of the allegations made about the Bohemian Grove, writing, “Critics on the left worry about political conspiracy and global policies plotted at the Grove, while critics on the right cite stories of homosexual rituals, devil worship, and child sacrifice.”330



President Richard Nixon

In his memoirs, published in 1978, President Richard Nixon wrote, “If I were to choose the speech that gave me the most pleasure and satisfaction in my political career, it would be my Lakeside Speech at the Bohemian Grove in July 1967. Because this speech traditionally was off the record it received no publicity at the time. But in many important ways it marked the first milestone on my road to the presidency.”331

The University of California, Berkeley, located on the San Francisco Bay, has a photograph in their archives of Nixon sitting at a table with Ronald Reagan inside the Bohemian Grove during this same visit. The two were said to have sat down to “work a political deal wherein Reagan was to run only if Nixon faltered.”332

While Nixon publicly praised the Bohemian Grove to the small group of politically minded people who would read his memoirs, privately he had something quite different to say. In one of the now publicly available Watergate tapes released by the National Archives, Nixon can clearly be heard expressing disgust for the Grove when speaking in the Oval Office with his Chief of Statt H. R. Haldeman and aid John D. Ehrlichman. “The Bohemian Grove—which I attend, from time to time—it is the most faggy goddamned thing you could ever imagine, with that San Francisco crowd. I can’t shake hands with anybody from San Francisco.”333

The Bohemian Grove yearbooks show members dressed in drag and rumors of homosexual activities by members have persisted for decades.



George Washington

President George Washington acknowledged the Illuminati’s presence in America in his personal correspondence in one particular letter dated October 24th 1798, that’s been preserved at the Library of Congress. This was thirteen years after the Illuminati was discovered and eleven years after they were banned and allegedly stamped out according to “sources” like Wikipedia.

Washington acknowledged, “It was not my intention to doubt that the Doctrines of the Illuminati and principles of Jacobinism had not spread in the United States. On the contrary, no one is more truly satisfied of this fact than I am.”334

In the letter George Washington clarifies that he did not believe that Freemasonry as a whole was involved in the conspiracy, but that certain individuals within certain lodges did in fact have these aims. If you look up the letter on the Library of Congress website, it can be difficult to read his handwriting, but it is accompanied by an official transcript.

Part of the letter reads, “The idea that I meant to convey, was, that I did not believe that the Lodges of Freemasons in this country had, as Societies, endeavored to propagate the diabolical tenets of the first, or pernicious principles of the latter (if they are susceptible of separation). That individuals of them may have done it, or that the founder, or instrument employed to found, the Democratic Societies in the United States, may have had these objects; and actually had a separation of the people from their government in view, is too evident to be questioned.”

So there you have it—George Washington was concerned that the “doctrines of the Illuminati” had spread to the United States and were using

certain Masonic lodges to “separate people from their government.” In fact, it was “too evident to be questioned,” he said.



Dick Morris

One of President Bill Clinton’s former advisors, Dick Morris, made a startling admission on the Fox News Channel in 2009 when talking to Sean Hannity about the New World Order and a global currency.

Morris began: “There is a big thing that’s going to happen in London at this G-20, and they’re hiding it, they’re camouflaging it, they’re not talking about it. The coordination of international regulation. What they are going to do is to put our Fed and our SEC under the control, in effect, of the IMF.”335

Hannity: “Oh, come on. You believe they’ll do this?”

Morris: “That’s what was in the draft agenda. They call it ‘coordination of regulation.’ What it really is, is putting the American economy under international regulation. And those people who have been yelling, ‘oh the U.N. is going to take over—global government…”

Hannity: “Conspiracy theorists.”

Morris: “Conspiracy theorists…they’ve been crazy, but now…they’re right! It’s happening!”

Hannity: When Geithner said he would be open to the idea of a Global Currency last year, those conspiracy people had said and suggested that for years. You're not wrong.”

Morris: “What they always do at these conferences is they have the center show here, and the side show they don’t want you to pay attention to.

The center show is the size of the stimulus package, but the real show is international regulation of the financial institutions which is going to happen under the IMF control.

A few years earlier Morris had revealed why, despite being a personal friend of the Clintons and working as Bill’s advisor, he cut all ties with them, saying, “I finally parted company with Hillary Clinton when I saw how she was using private detectives to investigate the women who were linked to her husband to cow [intimidate] the women into silence so that he could get elected president.”336



Cass Sunstien

President Obama appointed a Harvard law professor named Cass Sunstein to head up the Office of Information and Regulatory Affairs which is an executive office of the president responsible for issuing policies regarding information technology, privacy, and information regulation. Sunstien’s Orwellian philosophy of how the government should handle information technology was detailed in a white paper published in 2008 titled Conspiracy Theories, where he argued that the government should ban “conspiracy theories” or “impose some kind of tax, financial or otherwise, on those who disseminate such theories.”337

He took things further than the typical political rhetoric by actually proposing that government trolls inundate the comment sections on “conspiracy” websites, videos, and social media accounts with outlandish comments in order to derail the discussion and introduce issues into the conversation in hopes of tarnishing the image of such websites, videos, or social media pages.338 He even suggested government operatives should attend meetings and events organized by “conspiracy theorists” saying, “We suggest a distinctive tactic for breaking up the hard core of extremists who supply conspiracy theories…whereby government agents or their allies (acting either virtually or in real space, and either openly or anonymously) will undermine the crippled epistemology of believers by planting doubts about the theories and stylized facts that circulate within such groups, thereby introducing beneficial cognitive diversity.”339

Aside from going after “conspiracy theorists” (translation: prominent independent media outlets who have successfully bypassed the editorial control of the mainstream media), Sunstein also set his sights on the Second Amendment and with a straight face lied to a group of students at the University of Chicago Law School saying that “The Supreme Court has

never suggested that the Second Amendment protects an individual’s right to have guns.”340

Of course his claim about the Second Amendment couldn’t be further from the truth, because its sole purpose is to authorize individual citizens to have guns. In his lecture he went on to predict that in the future the Second Amendment would be repealed and the right of citizens to own guns would be eliminated.

In 2014 Sunstein published a book titled Conspiracy Theories and Other Dangerous Ideas, where he warned that conspiracy theorists were dangerous anti-government terrorists. Of course what he means by “conspiracy theorists” are people who report on the real reasons for the War in Iraq, or who think the September 11th attacks were a false flag, and anyone who sees the Bilderberg Group as suspicious.



Edward Snowden

In June of 2013, word spread like wild fire around the world that a former NSA contractor with a high level security clearance had stolen thousands of classified documents detailing the technical capabilities of the National Security Agency. 30-year-old Edward Snowden fled the country to avoid imprisonment and was giving asylum in Russia, and the cache of classified documents he obtained revealed the shocking details of how powerful Big Brother had become.

As the Illuminati have been setting up an all-powerful global government, they have also been focused on building an Orwellian society where all citizens are tracked, traced, and databased. While many people reasonably assumed such a system was being built, Snowden’s leaks provided irrefutable proof that Big Brother had been born and was more powerful than most people had ever imagined.

The Snowden leaks also proved that the NSA was not just illegally conducting mass surveillance of Americans (and virtually everyone around the world) without warrants, and clearly violating the Fourth Amendment— but they also proved the government’s protocols extended far beyond ordinary eavesdropping.

Laptop computers were routinely intercepted from UPS during shipment after being purchased from online retailers like Amazon and then fitted with special hardware, including micro cellular modems so their hard drives could be accessed even if the computers weren’t connected to WiFi or an Ethernet cable. (This operation is called INTERDICTION.)341 We also learned that the government has the ability to manipulate online polls on websites (UNDERPASS); they restrict YouTube videos from going viral or have them removed for phony “terms of service violations”

(SILVERLORD); or, if they want, make certain videos receive massive views to make it appear as if they’ve gone viral (SLIPSTREAM).342

They’ve intercepted millions of webcam feeds and scanned the people chatting over them with facial recognition systems to identify them (OPTIC NERVE);343 they collect naked and compromising photos of people so they can be blackmailed or publicly humiliated by releasing them (LOVEINT);344 and they even have the ability to record and store every single phone call in the entire world. Not just the record of who called who and when, but the actual audio of all calls (MYSTIC).345 They can also spoof anyone’s email address and send emails under any identity (CHANGELING), not to mention spoof any phone number. This is just a sample of their capabilities, and of course this is all done under the umbrella of “National Security.”

This technology allows the government to have “turn key tyranny” power and with the flip of a switch they can target anyone, anywhere in the world. Not only can they physically locate you and bug you through cell phones or webcams in the area, but the NSA operatives can find out everything about a target, from your most intimate communications sent though text messages or emails, to obtaining personal photos, to uncovering health problems, shopping habits, eating habits, political views, friends, family, acquaintances, personal finances, gun ownership, etc., etc.

This power is so incredible that no man can resist abusing it, and in the final phase of the New World Order, the Illuminati and their inner circle of government agents will come down on dissenters with a digital iron fist and make them disappear down the memory hole like something right out of George Orwell’s Nineteen Eighty-Four.

Orwell ominously wrote, “The telescreen received and transmitted simultaneously. Any sound that Winston made, above the level of a very low whisper, would be picked up by it; moreover, so long as he remained within the field of vision which the metal plate commanded, he could be seen as well as heard. There was of course no way of knowing whether you

were being watched at any given moment. How often, or on what system, the Thought Police plugged in on any individual wire was guesswork. It was even conceivable that they watched everybody all the time. but at any rate they could plug in your wire whenever they wanted to. You have to live —did live, from habit that became instinct—in the assumption that every sound you made was overheard, and, except in darkness, every movement scrutinized.”346

Checkout my previous book Big Brother: The Orwellian Nightmare Come True if you’d like to read my analysis of Orwell’s novel and how it eerily parallels our world today. Orwell didn’t just accurately forecast the invasive Big Brother surveillance system, but also ominously warned about our current dumbed down and heartless society; endless wars perpetuated to justify reducing civil liberties; and the erosion of the language and the breakdown of families and relationships in order to shift people’s obedience and reliance to the State.







“Ex-Illuminati Members”

Similar to government whistleblowers or career criminals turned into informants who reveal the closely kept secrets of their organization, a handful of people have come forward over the years claiming to have been involved with the Illuminati in one way or another, and offer up what they claim to be insider information about the activities and goals of the network. Most of these people are complete frauds and are simply con artists trying to sell books and lectures, or just enjoying the attention from the conspiracy community since many people believe their stories—hook, line, and sinker.

In my previous book, The Illuminati: Facts & Fiction, there is a detailed analysis of John Todd and William Schnoebelen, who are two of the most popular men who have made such claims, but there are also others whose stories have spread far and wide on the Internet like urban legends, so in this book we’ll take a close look and determine whether or not there is any legitimacy to them.

So far none of the alleged “defectors” have offered up any kind of evidence to back up their claims, but instead have only told tales based on the publicly known information about the history, beliefs, and activities of the Illuminati. None of the “former members” have ever revealed any new information that wasn’t already published in literature widely available in the conspiracy culture. But if you read through some of the comments on any of the YouTube videos featuring their claims, you will see that a very sizable percentage of the audience wholeheartedly believes these individuals and see them as heroic whistle blowers who “escaped” their dark past and are now on a mission to “expose” the Illuminati.

For an astute student dedicated to the truth and who doesn’t approach these people’s stories with confirmation bias—and if one has diligently done their own research—the inaccuracies and fabrications stick out like

sore thumbs. For those who are new to investigating the Illuminati, or to those who are quite gullible, these “former Illuminati members” only serve to confirm their greatest fears. Most of these “defectors” are simply gifted storytellers presenting publicly known information from a first-person perspective as if they themselves actually witnessed it or participated in it. Some of these people are perhaps mentally ill and may actually believe what they are saying, but the evidence proves one after the other to be fake.

Let’s take a close look at some of these individuals’ stories so we can prevent them and future hoaxers from deceiving people who are trying to find answers and accurate information regarding the Illuminati and the New World Order.



Doc Marquis

Joseph “Doc” Marquis (born on October 26th 1956) is allegedly a former U.S. Army medic which is how he says he got his nickname “Doc,” and is one of several self-proclaimed “former Illuminati members” who says he was born into an Illuminati family but now is dedicated to “exposing” them.

“Doc,” who claims to have been raised as a seventh generation witch, says when he was three-years-old his family brought him to a special ceremony and dedicated him to Lucifer in a satanic baptism.347 For the next ten years, he says, he was in the “outer court” of the Illuminati which he described as a satanic seminary school where he supposedly learned about the philosophies and secret symbols, and what he claims are the “eight nights of human sacrifice” that Illuminati members allegedly celebrate.

According to his story, when he was thirteen-years-old he was “fully initiated as a member of the Illuminati”348 after signing his name in his own blood in a book made of lamb skin which he called the Book of the Dead, which just so happens to be the name of an ancient Egyptian scroll containing information on how to navigate through the afterlife in order to enter into Heaven.

Four years later, when he was seventeen, “Doc” says he underwent another initiation ceremony and became what he called a Master Witch, or a High Druid Priest, which granted him “automatic authority over a region of the United States” where he was in charge of over 1000 other Illuminati members.349 This, all before he even graduated high school! His superiors, he says, then ordered him to join the United States Army in order to help the Illuminati infiltrate the armed forces. Within two weeks of being stationed at Fort Lewis in Washington he says he had twenty people recruited for the Illuminati, and just a couple months later says he had more

than a hundred more!350 In reality, the actual Illuminati most likely consists of no more than a few hundred men, but when “Doc” Marquis was just seventeen-years-old, he says he was “in charge” of over 1000 of them!

During an online lecture produced by Prophecy Club, he says he practiced human sacrifices eight times a year and had “constant communication with Demons.”351 Marquis claims to have personally witnessed dozens of human sacrifices before he “got out,” but no law enforcement agency has ever expressed any interest in him and have never considered him to be a suspect or a witness to any murders whatsoever. Trash television, on the other hand, gave him a platform to spread his nonsense in the late 1980s. He was once a guest on The Oprah Winfrey Show where he was talking about all these supposed murders and said, “The thing is, we didn’t body bag these people afterwards. We’d just take them [and], throw them in the woods, on the side of the road on a highway. Somebody’s going to find them.”352 Of course, no one ever has because these “victims” don’t exist.

The “eight nights of human sacrifice” that Marquis claims to have celebrated was concocted from the eight festivals that Pagans celebrate (or Sabbats as Wiccans call them) which are commemorated throughout the year on solstices, equinoxes, and the four mid-points in between—none of which involve human sacrifices. I’m certainly not saying that Satanists don’t commit human sacrifices still to this day, because such occurrences have been well documented,353 but the closest Marquis has come to one was watching a horror movie.

Local authorities would have taken him into custody for questioning if there was even a shred of evidence to back up his claims and no one involved with such crimes would dare speak about them out of fear of being arrested. Obviously in the 1980s, before the Internet, the average person could not easily confirm or disprove most claims made about the Illuminati and the occult, and very few people knew much about the subject at all. This is what led to the “satanic panic” in the 1980s when stories like Marquis’ were spread through tabloids and trash TV talk shows causing

people who didn’t know any better to think Satanists were abusing children and sacrificing people in communities across the country.

“Doc” says that in between committing his evil deeds, he was repeatedly asked by Christians if he wanted to go to church or if he knew Jesus, and for whatever reason—despite being a “high level Illuminati master,” he decided to go to church on Easter Sunday in 1979, where he realized he was a “sold out slave of Satan,” became a Christian, and “left the Illuminati.”354

In one of his video lectures titled Arrival of the Antichrist he can be seen giving the usual history lesson about Adam Weishaupt and the formation of the Bavarian Illuminati, their structure and goals, and shows the all-seeing eye on the back of the one dollar bill while telling the audience to pull out their wallets to look at the dollar themselves as if this was some major revelation.355 The eye on the back of the one dollar bill has become so elementary and Illuminati 101 that most middle school students are now aware of it, but back in the 1980s and 90s when Marquis began giving his lectures, things were quite different.

After his discussion on the one dollar bill symbology, he goes on to cover the well-known quotes from Pike’s book, Morals and Dogma, and then shows the interesting designs in the street layout of Washington D.C. and then complains about the government, the dumbing down of America, the Constitution, the demonization of Christians, etc., etc… Of course he concludes that the Illuminati is going to declare martial law and is setting up a New World Order for the reception of the antichrist.

When conducting my research into the Illuminati and coming across Doc Marquis’ claims of being a former Illuminati member, I painfully listened to his lectures online, which, like nearly every other selfproclaimed “former Illuminati member” didn’t reveal a single shred of information that wasn’t already widely known. Not only that, but many of his claims are clearly ridiculous to anyone who has basic knowledge about the Illuminati conspiracy.



For example, he says that they place a $10,000 bounty on anyone’s head who tries to leave.356 After he “left the Illuminati” he says they tried and failed to kill him at least six times!357 The Illuminati can assassinate world leaders and other heads of state, but they’ve failed over twenty times to kill this guy? Absurd.

Of course there are no police reports or news stories about any of these alleged murder attempts against him and since the Illuminati is the most powerful secret society in the world, they would have no problem killing anyone, especially no-name loser like “Doc” Marquis.

He sells a DVD called Frontmen of the Illuminati which consists of nothing more than a poorly produced home video of him sitting at a table showing different photos of symbols and people while talking about the Illuminati. The information on a website selling his DVDs reads, “Doc Marquis is a former Satanist who was trained in the Illuminati Plan before he came out of the coven to become a Christian. In 1992, Doc was hired by the Boston Police Department to train their homicide detectives how to spot evidence in a crime scene that the perpetrator was a practicing occultist. Doc also has appeared on the following TV shows: Oprah Winfrey; Geraldo Rivera; Hard Copy; and Inside Edition. He is the author of numerous books, video tapes and audio cassette series and has appeared as an expert witness in a number of documentaries.”

His claim of having worked with the Boston Police department has not been verified and to think that this man would be hired to “train” homicide detectives is laughable, particularly after having claimed to have murdered a bunch of people in satanic rituals! I guess the police just decided to forgive him of all those supposed murders!

Marquis has also claimed to have degrees in sociology, and history, and once claimed he would soon be getting his doctorate in psychiatry from Baptist Christian University in Shreveport, Louisiana, but it was later revealed he wasn’t even attending the school. He then said the school would

be accepting a book he was writing on the occult as his doctoral dissertation!

Marquis wrote several books (as does every supposed “Illuminati defector”) hoping to make a few bucks off the conspiracy community. Marquis and other “Christians” who claim to be “former Illuminati” members like Bill Schnoebelen and John Todd—while being complete phonies—may, in their own mind, actually believe that they are helping people learn about the Illuminati conspiracy. There is, after all, a massive conspiracy, and these individuals do actually expose some of it, but their fabricated pasts and long lists of lies about being personally involved with the Illuminati—when they clearly don’t even have some of their basic facts straight—shows that men like Doc Marquis are not only frauds, but quite pathetic and shameful as well.



Leo Zagami

Another man claiming to be an Illuminati defector who went on to give interviews and lectures about the nefarious plans he learned while supposedly “inside” the secret society is Leo Zagami (born in Rome on March 5th 1970). While other alleged defectors claim to have become born again Christians after “leaving the Illuminati” and say that Jesus helped them realize they were on the wrong path and found support from Christian audiences, Leo Zagami instead has taken the New Age angle. He insists the Illuminati hold “the truth” but are a corrupt group of enlightened ones who have hijacked the Mystery School teachings so he decided to leave the Illuminati in order to preach their secret philosophy to the masses.

To help spread the “enlightening truth” kept suppressed by the Illuminati, Leo Zagami claims to have started a new “religion” called Matrixism that’s based on the popular Matrix movies! He says he started this new “religion” in 2004 to commemorate the 100th anniversary of the “deliverance” of Aleister Crowley’s Book of the Law, the short blood thirsty book Crowley claimed was dictated to him by a demon while he was visiting Egypt in 1904. Yes, Zagami is a fan of dirt bag Aleister Crowley, whose philosophies he considers “the truth.”

His website described his new “religion” as, literally having been inspired by the Matrix movies, but insists it was “conceived by an anonymous group in the summer of 2004 [and] has attracted over 16,000 adherents.”358

The explanation goes on to say, “The Matrix trilogy, along with related mass media products such as video games, is generally considered to be the ‘sacred text’ of the movement.”359 He literally says The Matrix movies and video games are “sacred texts” of his “religion.” He also says the “faith” can be traced back to a book called The Promulgation of Universal Peace,

published in 1922 that consist of a series of speeches given by Abdu’lBaha, the founder of the Bahá'í Faith. All of this information, he says, comes from his knowledge of being an “Illuminati Grand Master” himself.

Zagami’s website claims that he is, “a high-ranking Illuminati Grand Master, who gained considerable attention in the conspiracy research community between 2006 and 2008 as a defector and whistle-blower.”360 He once went by the name Khaled Saifullah Khan after having supposedly converted to Islam, but later changed his name back to Leo. He claims that his goal is to now organize “the Knights Templars of the Apocalypse” to fight the Illuminati, and says this “group” has recruited 12,000 troops from the U.S. Military, CIA, FBI, etc., who are going to stop the “Dark Illuminati plans.”361

In Leo’s mind, the main enemies of humanity are: The Jesuits, which he calls “the head of the serpent”; Zionists, who he says are “the economic arms of the Vatican New World Order”; the United Nations which is “a corrupt organization in the hands of the Jesuits and their Zionist allies dedicated to enslave mankind”; and “all religious fundamentalist because organized religion in all shapes and forms is a legal mafia manipulated by the Vatican and Jerusalem in the hands of corrupt individuals who work for the elite families and their intelligence services to keep our race in ignorance and superstition in the end of times.”

Despite Leo’s strange and rambling history and his new “religion” that he created based on The Matrix movies, and his claiming to still be involved with the “good” Illuminati and the “Knights Templars of the Apocalypse” and other undercover “Illuminati Resistance” members in the CIA, FBI, military, and police; and despite revealing no new information about the workings of the Illuminati—some completely gullible fools actually believe that he actually was, or still is involved with the secret society.

Leo Zigami’s claims never gained anywhere close to the traction of other supposed “defectors” before him such as John Todd or Bill Schnoebelen, because he’s not a gifted storyteller like some other hoaxers.

And we were well into the information age by the time Leo decided to step on the scene (in 2006), whereas John Todd started his talks in the 1970s, and Bill Schnoebelen in the early 1990s before the Internet was fully utilized by most people who can now quickly fact check claims online. Even with this resource at people’s fingertips, however, a shocking number of people still believe the stories from “ex-members” like “Doc” Marquis, Leo Zagami, John Todd, and others.

Many people enjoy conspiracy entertainment or conspiratainment as I call it, and have little to no concern about actual facts or the truth. They simply love the sometimes cleverly concocted tales by people who are inspired by actual events or conspiracies and then manufacture a sometimes entertaining conspiracy mythology based on grains of truth. It’s sort of like a good science fiction story that’s based in part on actual technology and then extrapolates into a fantasy designed to entertain the audience.



Supriem Rockefeller

A man calling himself “Supriem Rockefeller” and claiming to be a member of the famous Rockefeller family created a bit of a stir on the Internet in 2010 after announcing that the Rockefellers were launching a plan to fund the building of the Third Temple in Jerusalem, in what was called the “Temple Now Project.” The Third Temple refers to the rebuilding (again) of Solomon’s Temple in Israel, which was originally destroyed in 586 BC by the Babylonians, and later rebuilt only to be destroyed again by the Romans in 70 AD. Christians believe that when the temple is rebuilt for the third time, it will signify the fulfillment of one of the final prophecies concerning the rise of the Antichrist and the return of Jesus.

Currently, a Muslim mosque called the Dome of the Rock stands on the ruins of the temple, and the only way Solomon’s Temple can be rebuilt on that spot is if Israel destroys the mosque and occupies that part of the land. This is why the “Rockefeller” announcement of supposed plans to build the Third Temple caught so many people’s attention.

A few official sounding websites published a press release about the “Supriem Rockefeller” plan without attempting to verify his identity or the supposed plan’s legitimacy. With sites like CNNMoney.com and MarketWatch having the press released posted, that was all the evidence many conspiracy blogs needed to run with the story that one of the final Biblical prophecies was about to be fulfilled thanks to the Rockefellers.362

None of this was true, however, and “Supriem Rockefeller” didn’t exist. The man behind the hoax was identified as a high school dropout named Kris from Louisiana, who was born in 1975. While living with his mother he worked as a cashier at a fast food restaurant and tried to make money by gambling and selling ringtones on various websites.



After he was fired from his job for allegedly stealing, the thirty-fouryear-old then started going by “Supriem Rockefeller” online and saying he was the secret son of David Rockefeller Jr. “Supriem” posted online about how he was authorized to finalize the New World Order and “revealed” that the Rockefeller family had descended from the Annunaki, the supposed ancient race of aliens, who are believed by some to be responsible for the creation of humans.

It appears his “Temple Now Project” hoax was an attempt to receive donations from people who wanted to support the plan, hoping to fulfill Bible prophecy. One press release claimed he would be “raising funds to go towards building the Third Temple in Jerusalem in strict coordinance with The Temple Institute, Rabbi Hiam Richman and The Palestinian National Interest Committee (PNIC),” and his mission was to “build the Temple and to create a One Israel-Palestine state.”

What made this hoax believable for some, aside from the Christian prophecy of the Third Temple, was the very real Jewish plan to one day accomplish this very task. Ever since 1987 a non-profit Jewish group called the Temple Institute has been working to do just this. In fact, in 2008 they announced they had the High Priest’s garments already made along with dozens of other items they plan on using in “sacred rituals” once it is rebuilt. Of course the Temple Institute had nothing to do with “Supreium Rockefeller,” but he cleverly included their name in his press release to add an aura of credibility to his claims, since they are a real group working to accomplish this very goal.

This hoax didn’t last too long and his Facebook page was soon deleted, but many Jews and Christians continue to await the actual rebuilding of the Temple, an event that will be seen by Christians as one of the Bible’s final prophecies being fulfilled because in this Temple it is believed the Antichrist will announce himself to be “God” and order the people of earth to worship him as such.



In the 1970s, 80s and 90s, Illuminati phonies were able to pull off their scams with a remarkable amount of success, and while the Internet can put an end to most of these scams rather quickly today, countless people are simply lost in the sea of information available on the web and continue to spread Illuminati hoaxes far and wide, believing every word. These are the same kinds of people who believe that every time a famous celebrity dies from a drug overdose, car accident, or health problem—they think they were actually “murdered” by the Illuminati or faked their own death. If you search YouTube for keywords like “Paul Walker Illuminati Sacrifice,” “Michael Jackson Murdered by Illuminati,” or “Tupac killed by Illuminati,” you will find literally hundreds of videos with millions of views and countless comments from people who are 100% convinced the Illuminati is behind every celebrity death.

The “Supriem Rockefeller” Third Temple hoax is not the first time that someone has posed as a member of the famous Rockefeller family. A man who called himself Clark Rockefeller (real name Christian Karl Gerhartsreiter) was sentenced to 27 years in prison for murdering his landlord’s son which put an immediate end to his elaborate scam.363 Gerhartsreiter even fooled his own wife into thinking he was a Rockefeller for years by taking extreme measures to hide his real identity. To accomplish this he had his wife file her income taxes as an individual instead of jointly as most married couples do, so his real name wouldn’t have to be on the couple’s tax returns, which she most likely would have noticed.364 He even forged their marriage license to avoid having her see his actual name.365

Another man calling himself Christian Rockefeller (real name Christopher Rocancourt) actually swindled tens of millions of dollars from rich people in New York in the 1990s through fake investment scams after they thought he could increase their wealth because they believed he was a Rockefeller.366



Svali

The list of people who have come forward claiming to be former members of the Illuminati are mainly men, but in 2006 a woman calling herself “Svali” popped up on the Internet claiming to come from an Illuminati family in Germany who then relocated to America when she was very young. “Svali” said when she was a kid she was told that she was “special” and that the Illuminati had big plans for her. At 12-years-old she underwent her “initiation” at the Vatican, as she claimed all the leadership in the Illuminati do, and by the time she was twenty-two, she was the youngest person in the “Illuminati leadership council” in Southern California.

“Svali” said that secret Illuminati meetings were held three times a week in Escondido, California, which is a lower income area inland where no wealthy or powerful members of the Illuminati would ever go, let alone choose to live. I have personally lived near this area for over 15 years and have friends who have lived in Escondido and I’ve seen the city with my own eyes many times. It’s primarily a Mexican ghetto and would be the last place in the world the Illuminati would ever think about going.

The security for these “Illuminati” meetings, she said, was a “spy” who had climbed up into a tree with a walkie talkie to spot unwanted visitors and would then radio ahead to the group so they could “leave within five minutes.” I guess the group would just run off into the woods if the person in the tree saw anyone unexpected rolling up to the house! You’d think the Illuminati’s security detail would be a bit more sophisticated than someone climbing into a tree with a walkie talkie! Her claims get dumber by the second the more she tells her story.

The source of the information coming from Svali appears to lead back to a man named Greg Szymanski who wrote (or may continue to write) for

a little known website called ArcticBacon.com, one of countless amateur websites that contains posts about the Illuminati, the Jesuits, and other conspiracy issues. “Svali” allegedly reached out and contacted him with her claims, so he then interviewed her in January of 2006 on his virtually unknown Internet radio show. Audio of the interview can found on YouTube if you can force yourself to listen to more than 30 seconds of her incoherent rambling.

In the interview she said her adult co-conspirators would, “get up in the middle of the night to attend meetings,” and while the adults were doing their thing, the kids were “learning how to march and shoot guns and were being trained in martial arts.” She claims her initiation at the Vatican included a child sacrifice and throughout the interview she was very scatterbrained and had a hard time explaining her story, which isn’t even remotely convincing. Greg the interviewer ate it up though, and seemed to believe every word she was saying, as did a measurable number of people on the Internet who happened to come across her story.

When she was allegedly hanging out with the Illuminati, she claimed to be a “head programmer” involved in mind control programs but never offered up any details about what her supposed responsibilities were and couldn’t even articulate the basic concepts or history of mind control.

Svali isn’t even a clever hoaxer like some others before her, and appears to be a mentally deranged person just looking for someone to pay attention to her. It’s also possible that Greg Szymanski, the man who first interviewed her, actually crafted the Svali hoax himself by working with a female friend to concoct the entire story so he could be the person to have the “exclusive” interview and forever be linked to her as the person who first “broke her story.”

His website is just one of countless virtually unknown sites in the sea of conspiracy theories online so it makes no sense why a “former Illuminati member” would reach out to him since there are a large number of fairly prominent conspiracy websites that cover such topics. She did try selling an

e-book titled Breaking the Chain: Breaking Free of Cult Programming, but it’s not even listed in any of the major e-book stores and seems like a failed attempt to try to make a few bucks by selling a PDF file from a website.

I can attest to the fact that I have received multiple e-mails from different people making extremely bizarre claims such as being stalked or harassed by cults and the rambling and incoherent nature of their emails clearly show that they are from mentally disturbed and insane people sounding very much like this woman.

Actual Illuminati members are educated, intelligent, and well-spoken people. They are very persuasive and convincing—none of which can be attributed to Svali, whose stories are so convoluted they’re hard to follow as she jumps from thought to thought. How did she eventually “escape” the clutches of the Illuminati? Well, she said she left the organization because she started to realize, “what I was doing was wrong.” Now that she is a “former member” she is a born again Christian and has repented of the activities she claims to have participated in. Today, the woman says she’s a “diabetic educator” living in Texas with her husband and two children.

The bio on the website of the man responsible for conducting the interview reads, “Greg is first and foremost a satirist, a writer and a reporter,” so he was likely just playing a role and trying to have fun with conspiracy theories by producing a new Internet urban legend of conspiracy theory fiction about the “woman who left the Illuminati.”



Brice Taylor

A woman calling herself Brice Taylor (a pseudonym) published a book in 1999 titled Thanks For The Memories: The Truth Has Set Me Free! The Memoirs of Bob Hope’s and Henry Kissinger’s Mind-Controlled Slave where she details what she says is her account of being a CIA mind control victim who was used as a sex slave by the Illuminati.

David Icke, a popular conspiracy writer best known for his theories that the Illuminati are an alien race of shape-shifting reptilians, is listed as an endorsement on Amazon.com’s listing of the book, as well as Ted Gunderson, a former FBI Agent from Los Angeles who said, the book “confirms facts furnished by many other witnesses.”

With endorsements by such heavy hitters in the conspiracy world as David Icke and Ted Gunderson, many people are inclined to believe her claims, but upon even a brief analysis of the book, the woman’s story quickly goes from being hard to believe, to being completely ludicrous and impossible by any stretch of the imagination.

The first wobbly leg of this story comes when we learn Brice Taylor is just a pseudonym and the authors’ real name is Susan Lynne Eckhart Ford who admits that from a young age she suffered from multiple personality disorder. “But as I began to heal and remember more of my hidden past, I realized that ritual abuse was merely the mind control trauma base my ritually abused, programmed pedophile father, Calvin Charles Eckhart, and others used to condition me for participation in the still active top secret Project Monarch, the Central Intelligence Agency’s white slavery operation that is related to MKULTRA and its numerous sub-projects,” she writes.367



“The result of many years of trauma, intentionally inflicted on me by my father and others to create within me multiple personalities, was that I was transformed into a programmed, totally robotical slave that could not remember to think or tell what happened to me, due to the mind control and sophisticated programming I was under. I was used frequently in child and adolescent prostitution and pornography. By my pre-teen years, I had many personalities specifically programmed to be the perfect sex slave—a ‘presidential mode’ with government mind files and a photographic memory equipped to deliver (most often through sexual encounters) messages, some cryptic, to top government officials, entertainers, and other world figures.”368

She writes that when her memories started coming back to her at the age of thirty-five she, “began having vivid, detailed memories of being used both as a sex slave and human mind file computer to some of our nation’s highest level government officials in and out of the White House.”369 She then goes on to list Presidents John F. Kennedy, Lyndon Johnson, Gerald Ford, Ronald Reagan, George Bush, Jimmy Carter, as well as Henry Kissinger, Nelson Rockefeller, Bob Hope (the popular entertainer), and many others as men she says all abused her.

Taylor says that while meditating she began to remember things all the way back to when she was four months old! (Not four years old, four months old.) She says her father worked as a welder who owned a welding shop in Los Angeles, but was somehow also secretly working for the CIA as a mind control programmer. “My father began the rigorous training and intentional torture required to shatter my base personality with the goal of creating many separate individual personalities for training and use by others as I grew older.”370

Her mom too, she says, was under mind control and “was listening to music she was told to listen to in order to keep her memory of our actual life locked deeply within her subconscious mind, while the programmed reality of herself and our ‘perfect happy family’ was kept alive through programmed phrases in the music.”371



Most of the book consists of lengthy and rambling tales of alleged abuse by such a long list of people, both famous, and ordinary people in her community, that it reads like a parody of a poorly written horror story. The people involved in the conspiracy include her ballet teacher, her doctor, her dentist, her choir teacher, her next door neighbor, the people at her local church (who she says all had tunnels under their homes connecting them to each other and also leading to the church); the owners of the local bowling alley were also in on it, and of course the Freemason Shriners, and even the owners of a local gas station! They were all sacrificing children and shooting snuff films or involved with the “CIA’s mind control program” she says.372

The list of her alleged abusers and human-sacrificing CIA Satanists she was involved with just goes on and on. Prince Philip, Prince Charles, and even Sylvester Stallone are on her seemingly endless list of abusers. Sylvester Stallone, she claims, directed several bestiality films where she says she had sex with dolphins and other sea creatures! Other celebrities such as Jane Fonda and Barbara Streisand were also under mind control she says, and Elton John was aware of such things and tried to help the victims with the lyrics in his music.

Aside from listing half the people in her community as being “in on it,” and a dozen presidents and celebrities, she also names some very odd places where she says everyone sexually abused her or “programmed” her with mind control. One of these supposed places was Disneyland where she says her father introduced her to Walt Disney himself when she was fiveyears-old, who then made her look into a View-Master box containing dead cats and dead people.

“Brice Taylor” said she would also meet Henry Kissinger there at Disneyland where he would “program” her using CIA mind control techniques. One of these “programming sessions,” she said, needed to be done in front of a carrousel for some unknown reason. “I also continued to be taken to Disneyland for base programming for my new government mind

file system,” she wrote.373 Who would have thought the CIA was using Disneyland as a secret mind control center? Like I said, her book reads like a bad parody of a horror story written by a teenager.

She goes on to claim she was also taken to various McDonald’s around the country and “programmed there too.” And of course she says she was also taken inside the National Archives, the State Department, NASA, the Pentagon, the Federal Reserve, the World Health Organization, and other military bases around the country—and insists she was “programmed” at every one. Why her handlers would need to take her to the Federal Reserve Bank to “program” her using mind control techniques isn’t said, and these claims are clearly ridiculous and the result of another over-active imagination of a clearly insane person, or by a horrible storyteller fabricating such tales hoping to sell a ton of books to the conspiracy community.

She wrote that she was even told that in a few years she would be killed and her services wouldn’t be needed any longer. Why would her handlers inform her that they would kill her at some point in the future? Wouldn’t they keep this to themselves and lead her on? After all, if she knew she was going to be killed soon, wouldn’t this give her even more reason to betray them and escape before this happened? The more of Brice Taylor’s story you read, the more absurd it gets, well beyond the point of nonsense.

The book is self-published because I’m sure that not even a small fringe conspiracy publisher would invest their money in such a worthless piece of garbage filled with fictional delusions. Near the end of the book , as expected, she starts talking about the elite’s plan for a New World Order. Then there is a “suggested reading” list which includes the staple books of New World Order and Illuminati literature such as None Dare Call it Conspiracy by Gary Allen (published in 1972), Tragedy and Hope by Carroll Quigley (published in 1966), as well as books by conspiracy authors like David Icke, Texe Marrs, Fritz Springmeier, and other titles about mind control, the CIA, and brainwashing.



The question remains…why would this woman make up all these horrific things that she says happened to her? What would compel a woman to write such a book? I speculate that the only truthful part of the book is that perhaps she was sexually abused as a child, but not by any of the political figures or celebrities she mentioned, but at the hands of a relative or perhaps even her own father. She may feel justified and achieve some degree of healing by venting her anger and betrayal in a fictionalized book where she has projected that the perpetrators of her abuse are men in high positions of power within society. It’s also likely that she wrote the book purely as “conspiracy fiction” hoping to pass it off as factual to the often gullible conspiracy community.

The reason some people believe her claims is because there are grains of truth (albeit tiny miniscule grains) since the CIA did do horrific mind control experiments in their MK Ultra program, and they did drug, hypnotize, and torture people in those experiments trying to create mind controlled slaves. In 1994 the US government awarded 77 people $100,000 each in financial compensation for experimenting on them,374 but Brice Taylor (whose real name is possibly Sue Ford) never even went to court over her allegations and was not one of the recipients.

A few years before Brice Taylor’s book was published, another woman named Cathy O’Brien released a book titled The Transformation of America where she had claimed to be a test subject for the CIA’s MK Ultra program, and a “sex slave” of the Illuminati’s top politicians. O’Brien even claims to have been taken inside Bohemian Grove. It’s most likely Brice Taylor was inspired by Cathy O’Brien’s book and hoped she could cash in by making similar claims. While Brice Taylor is clearly a fraud, Cathy O’Brien’s claims are a bit more believable (but also possibly fabricated), and are analyzed in detail in my previous book The Illuminati: Facts & Fiction if you are interested in reading about them.



“Jess LaVey”

A man calling himself “Jess LaVey” saying he was the son of Anton LaVey, the infamous founder of the Church of Satan and the author of The Satanic Bible, threw his hat into the conspiracy entertainment ring around the year 2000 and got himself a small amount of attention on a few Internet radio shows who eagerly took the bait and gave him a platform to spread his nonsense.

“Jess LaVey” not only claimed to have been the son of Anton LaVey (whose real name was Howard Levey by the way), but also said he climbed the ranks of Satanism all the way up to the Illuminati. In one interview “Jess” claims, “I never could forget the counsel of thirteen, they were very wicked looking men. When I reached the age of twelve, my father told me I had to go before them…They warned me of what could happen to me if I did not do as they suggested. George H.W. Bush Senior was one of these men. I stood before them and told them I was not going to follow their ways and I was not going to take my dad’s place, and that there was nothing they could do to me….I told them I believe in a higher power and that higher power said in His Word that no harm can come to me.”375

After he refused this “invitation” to the Illuminati, he says they castrated him as his punishment. He also talked about the KimballCherokee Castle in Sedalia, Colorado, a 1450s style castle built in the 1950s on a 3,100-acre ranch in Colorado where, he claimed the Illuminati meet every year to do human sacrifices. “Satanists come together and do unspeakable things…To think that Bush and his whole family is a part of this kind of thing is hard for some people to believe. The whole Bush family is Satanists…I have met Bush Jr. once when he came to a ritual at the castle once with his father….He is a very cold man for Satan. Like a lethal weapon.”376



Other “insider” satanic “leaders” have come forward over the years, mainly in the 1980s and 90s such as Mike Warnke and Stephen Dollins, trying to use their supposed “satanic credentials” to boost their new career as Christian evangelists, but most were never involved in any organized cults or groups and wildly exaggerated the supposed activities they claimed to have participated in.377

In 2002 John W. Morehead of the Watchman Fellowship, a group that monitors the activities of cults, was given a copy of what “Jess LaVey” claimed to be his social security card which was clearly fake and when the number was run for a background check it was proven to be invalid.

“Sadly, many have claimed to be LaVey’s child in order to gain financial support from churches and to give credibility to their ministries allegedly addressing Satanism and the occult,” Morehead told Charisma Magazine in 2002.378

Anton LeVay, Aleister Crowley, Helena Blavatsky, Manly P. Hall, and other real occult insiders have revealed plenty of details to see exactly what is going on in various Satanic groups and secret societies, but conspiracy con men seem to keep coming up with the idea that they can make some money by claiming to have been an “insider” who is offering a “first-hand account” of what they have allegedly seen and done.

The interviews “Jess LaVey” did can be found on YouTube and after listening to one for about five seconds, any sane adult should obviously be able to tell he is making up his story pretty much as he goes along and doesn’t even have the faintest hint of legitimacy. Anton LaVey (again whose real name was Howard Levey) had two daughters and only one son; a boy named Satan Xerxes who was born in 1993.



George Green

A supposed former investment banker named George Green claims to have once sat in on secret Illuminati meetings where men were making “god-like decisions as to who lives and who dies” and contemplated “dropping neutron bombs” on major American cities to reduce the population in accordance with the Georgia Guidestones. “I actually sat in on the meetings. I was in the game big time. In fact, I was making such a mess, they decided rather than kill me, which they could, they invited me in to the inner group and asked me to be the finance chairman, and at that point, I probably would have been secretary of the treasury or whatever they wanted to do with me.”379 The financial chairman of the Illuminati, huh? This I gotta hear about!

In his interview, which can be seen on YouTube, Green talks about the World War Three looming in the Middle East, a coming one world currency, FEMA concentration camps, the coming economic collapse of America, the planned extermination of the majority of the world’s population to save the earth’s natural resources for the elite, and rattles off a list of well-known plans of the Illuminati. Green doesn’t reveal an ounce of new information whatsoever and like many others, just talks about the same old widely available claims while presenting them from the perspective of a supposed insider who says he literally sat in on the meetings. Of course he too is trying to sell a book titled Chaos in America, which never gained much traction.

If George Green actually did attend any of the Illuminati meetings, he would be able to at least reveal some previously unknown details about their plans, but instead he just recycles the same old material that has been floating around the Internet and patriot circles for many years. An interesting phenomenon in the information age is that if you claim to have

some kind of Illuminati “scoop” and throw the video online, people are going to find it and people will believe it.

Aside from the typical Illuminati talking points about the Georgia Guidestones, FEMA camps and the collapse of America, George Green goes straight into crazy town and says the Illuminati have been making “synthetic people.” He’s not talking about secret cloning programs, which most likely exist—he claims that most presidents have been “replaced” by these synthetic clones! That’s right. He says our major world leaders are all grown in an Illuminati lab and are just pretending to be real people.

To “prove” this is happening he points to the movie Boys from Brazil, a 1978 film about Nazi scientists creating clones of Hitler to rebuild the Third Reich. This cloning technology, he says, was given to us by the “greys” (aliens), and he says he knows this because while working in the Air Force he claimed to have “top secret” clearance which gave him access to some dead Nordic-type aliens called the Pleiadians who came to earth from the Pleiades star cluster.

While aliens may actually be directing the Illuminati, and top secret human cloning programs most likely do exist, George Green’s presentation is so poorly executed and unconvincing, it reeks of a hoax from the very moment he opens his mouth. And again, he hasn’t provided a single piece of new “evidence” that wasn’t already widely known by most conspiracy researchers.

Not to mention nobody has been able to verify any part of his supposed background as an “investment banker” or having any kind of “top secret” security clearance in the military. But then again, we’re living in a world where countless people believe Tupac faked his death which just goes to show that some people will believe just about anything, no matter how crazy it is, despite zero evidence, and defying all logic and common sense.



Kevin Trudeau

Kevin Trudeau is a man that almost everyone in America has seen on TV (whether they know his name or not) over the course of twenty years pitching various products on infomercials such as health supplements, antiaging cream, and methods to get “free money.” He is an extraordinary salesman who could sell ice to Eskimos, as the cliché goes, and has been labeled the “infomercial king” due to the massive hours of airtime and the large number of different products he has pitched over the years.380

As a follow up to his bestselling book Natural Cures ‘They’ Don’t Want You to Know About (2005), he published More Natural ‘Cures’ Revealed (2006) where he claimed to have been a member of a powerful secret society, hinting it was the Illuminati—and through his supposed membership in this society, he learned how the world really worked, including how drug companies were suppressing natural cures for diseases in order to allow them to sell more drugs instead of helping people to be cured.

Trudeau alleges that because of his drive for wealth and his knowledge of the human mind, he was approached by members of “the Brotherhood” secret society and recruited by them to join. Trudeau wrote, “As a member of this secret society I have sat in private meetings with heads of state from countries around the world. I have attended secret international business meetings where business leaders, politicians, and media moguls coerce together to create the new world order with global control over individual people everywhere.”381

Sounds a lot like the Bilderberg Group, doesn’t it? During an interview on the Alex Jones Show in 2009, a very convincing Trudeau discussed his knowledge of the Bohemian Grove and other secret societies, and stated that he had friends who attended the Bilderberg meeting that year in Greece

and that he had personally “sat in on meetings” where the elite talked about reducing the world’s population by killing off “the dumb people.”382 Later in the interview he mentioned “what we talked about at Bilderberg” prompting Jones to interrupt him for clarification asking, “Did I hear you correctly, were you at Bilderberg?” to which Trudeau answered, “Yeah, I was in Greece, because I have friends who were there…All I can say is that I was in the area, and many of the people that were there and who are members are in fact people I converse with on a regular basis.”383 Of course Trudeau’s name has never appeared on a Bilderberg attendee list and all this was building up to his latest money making scheme, the Global Information Network, which I’ll get into in a few moments.

A member of this “elite Brotherhood,” Trudeau says he worked covertly for the wealthiest families on earth and during his alleged involvement, he says he made hundreds of millions of dollars and lived a life many could only dream of. “Members of this society includes politicians, captains of industry, news journalists, celebrities, musicians, writers, scientists, law enforcement officials, movie stars, and more,” he says.384

In his book More Natural ‘Cures’ Revealed, he goes on to write that after he became a member of this “elite secret society,” he discovered they had two groups, and that one was evil, and the other good, and both were using the organization’s advanced knowledge and power to influence the world. “I was on the dark side doing evil; now I have repented, changed my ways, and turned my life around…Now I am going against the masters that I once served. I am telling people the truth about Big Pharma, the food industry, the oil industry, governments, and the media.”385

Trudeau has an extremely checkered past, including a conviction for fraud and larceny which resulted in him serving two years in prison in the 1990s.386 He was also banned by the Federal Trade Commission from selling products like health supplements and beauty creams on TV and fined $37 million dollars for making false claims in infomercials about his book The Weight-Loss Cure ‘They’ Don’t Want You To Know About.387 He found a major loophole however, and continued selling books and audio

recordings because these items weren’t seen as “products,” but were considered information, thus protected by the First Amendment right to free speech.

In More Natural ‘Cures’ Revealed, he claimed that his prison sentence in the 1990s wasn’t really because he was a criminal, but instead, “The society needed me to go to prison for a very specific mission.”388 So what he means apparently, is that this all-powerful “Brotherhood” wanted him to commit credit card fraud and larceny because they “needed” him to go to prison for a “mission.” He goes on to write that during his sentence he spend most of his time not in a prison cell, but hanging out at the Officer’s Club at Edwards Air Force base eating “the finest food in the club,” all because he was a member of this Illuminati-type secret society!389

As if Trudeau’s claims weren’t already hard enough to believe, they get much, much stranger. He also wrote, “I have been to Area 51 in Nevada. This is where much of our technology has been developed. Area 51 houses most extraterrestrial artifacts, including a working spacecraft and dead alien bodies. I have seen these things with my own eyes.”390 He actually says he has been inside Area 51 and saw the aliens with his own eyes! I guess they have a family and friends night and even give tours to infomercial pitchmen!

Trudeau keeps his discussion on his alleged involvement with the Brotherhood and aliens brief in his More Natural ‘Cures’ Revealed book, but states that unless he is the victim of an “unforeseen accident,” he will discuss this “secret society” in detail in a future book he planned to write.

At the end of 2009, Trudeau launched a new infomercial for an audio series titled Your Wish is Your Command where he claimed to teach magical methods of the “law of attraction” found in The Secret, the popular DVD produced by Rhonda Byrne, released a few years earlier which discusses mystical ideas about how your own thoughts and beliefs can metaphysically alter your physical reality.



The new infomercial was designed to look like an ordinary talk show with Trudeau as the guest and can be viewed in its entirety on YouTube. He starts of by saying that when he was 15-years-old, he was exposed to “the Brotherhood” secret society which he says took him in and taught him how to use The Secret and enabled him to make millions of dollars before his eighteenth birthday. In high school, he was actually voted most likely to succeed when he graduated in the class of 1981 from Saint Mary’s High School in Lynn, Massachusetts.

Instead of simply regurgitating The Secret’s “law of attraction” philosophy, Trudeau cleverly mixed secret societies in with his sales pitch, since he likely knew a growing segment of the population were highly interested in researching them.

In the infomercial he says, “Quite frankly, these are the same techniques that members of Skull & Bones have learned from Yale University; the Bilderberg Group—some people may be familiar with some of these organizations—the power elite. When you get to the highest level in Freemasonry, the 33rd degree level of Freemasonry—these are secrets of these various associations and societies on how to—we call it manipulating energy—it’s really just how to beam the frequency in your brain of what you want so it will come into your life.”391

He went on to say that all the popular self-help books, such as Napoleon Hill’s classic, Think and Grow Rich, and Norman Vincent Peale’s Power of Positive Thinking, were missing the “key ingredient” which makes these mystical ideas work, and only his audio program would reveal them. During part of his sales pitch he even says, “If a guy is watching this right now and doesn’t get the Your Wish is Your Command program, they’ll always be a loser.”

The host asks him why the wealthy people in the past didn’t want others to know this information (a scripted and preplanned question, of course) to which he answered, “When you’re in Skull & Bones, the secret society, or the highest levels of Freemasonry, or the Bilderberg Group or the

Trilateral Commission or the Council on Foreign Relations, or the Brotherhood—like I was a member of—you’re basically a part of a group that believes ‘we want to keep this information to ourselves, we don’t want competition.’”

He later claims he left “the Brotherhood” in 1999 because he didn’t believe that the information should be kept from everyone else and tells the audience that if they “call today” they’ll get his 14 CD program at 70% off the “regular price” of $1,000. “I would just really encourage people to take advantage of this secret knowledge on how to have, be, or do whatever they want.” He also says he has received death threats from “the Brotherhood” for revealing these “secrets,” but apparently they have enough power to rule the world but couldn’t successfully assassinate a TV pitchman!

Trudeau then started offering people a membership to “a very elite society” which he called the Global Information Network, a supposed network of former Illuminati members, Skull & Bones members, Bilderberg Group insiders, 33rd degree Freemasons, Bohemian Grove members, etc., who all left those organizations to start GIN with him to help reveal their insider secrets to the world! Trudeau’s Global Information Network is not to be confused with Global Information Network, Ltd., a non-profit news agency started in 1986 in New York City which specializes in news from Africa.

While Trudeau is an extraordinary salesman, he is a terrible teacher and a pathetic motivational speaker. As part of my research on Trudeau I have actually listened to all 14 CDs, approximately one hour each, as I sat painfully waiting for something of any value to be said, but there was nothing. For most of the 14 hours I was extremely bored and had to force myself to keep listening, and occasionally I sat in awe at Trudeau’s marvelous ability to sound like he was about to reveal something of incredible importance but never actually getting to the point. Through the entire program he just kept regurgitating a wide variety of popular analogies that have been used by self-help gurus for decades.



The website, GlobalInformationNetwork.com described his organization as being, “conceived by a group of individuals from around the world who are the highest ranking members of several private societies, associations, clubs, and groups whose membership has been exclusive to the privileged elite class of the world,”392 including supposed members from just about every Illuminati connected secret society and organization you can think of. The website originally actually listed the Illuminati, Bohemian Grove, the Bilderberg Group, Skull & Bones, Freemasons, the Council on Foreign Relations, the Trilateral Commission and more, saying that members from all these groups had defected and were now part of the Global Information Network’s secret council.

The website went on to claim that, “For the first time in human history, the highest ranking members of these secret societies have encouraged the formation of a new, private, member only group that allows people who do not qualify to become members of the above listed societies to join together and be exposed to the same secrets revealed and taught to members of those societies and clubs.”393

The site went on to say that a New World Order is forming that “is designed to increase the gap between the wealthy and the average working man” and that “GIN does not agree with this movement” and they believe “EVERY person has the right to know the secrets of creating the life they want and enjoying freedom, pursuing happiness, and achieving all their dreams and desires.”

“Members” of GIN apparently got several CDs and books shipped to them each month to further their education on the “law of attraction” and other Illuminati secrets. What did you have to do to “join” this secret society of Illuminati defectors who were ready to reveal their insider secrets to the world? All you had to do was pay $1000.00 down and $150 a month, each and every month after that! Once you were a “member” you could get a $200 commission for every one of your friends you suckered into signing up as well. Each new member was given an affiliate code that was used as a “secret invitation” to the Global Information Network, which they gave out to others who they hoped would then sign up, earning them $200 bucks.



When I first began investigating GIN, there was a section on their website to “join” their “society” that asked for the “invitation affiliate code,” so I simply typed in Kevin as the code which was accepted because I was then taken to the payment page asking for my credit card number to pay the $1,000 initiation fee, which of course I didn’t pay. I also tried Trudeau as the affiliate code, and it worked as well. GIN was so “exclusive” that I guessed two of their secret passwords in two seconds!

Buying “Illuminati secrets” didn’t end there though. After paying a $1000.00 down payment and a $150 each month, new “members” were only given access to the first of twelve different levels within the “society.” To rise to the next level and learn more “Illuminati secrets” to success, each person had to pay more and more money with payments exceeding $10,000.00 dollars!

When I first began looking into the website, there was a section for a description and “member benefits” for each level but all the details, including the costs, were marked “classified information,” except for the $1,000 initiation fee to join the first level.

The site claimed, “Members must qualify for each membership level by meeting specific requirements and being approved by the Global Information Network membership acceptance committee. Each higher membership level in GIN gives the member additional classified benefits, substantial cash bonuses, and other financial and monetary rewards.”394 I had a sneaking suspicion that in order to “qualify” for the next level, all you needed to do was pay a large amount of money without your credit card being declined.

The site said that the “requirements” for the next level would be revealed in the previous level, but insisted that although the “benefits” were “classified and confidential,” they, “may include cash bonuses of over 1 million dollars, all-expense paid exotic vacations, one-on-one mentoring

with high level GIN members, monthly residual payments of over $100,000, luxury automobiles, private jets, and more.”395

A YouTube video advertising the Global Information Network had the following description, “For the first time in the history of mankind, the Illuminati is opening their doors to qualified people.” This video was created by someone who signed up as an affiliate and was trying to lure people to join so they could get their $200 commission through the website’s affiliate program designed to pull in new “members.” As absurd as this all sounds, as P.T. Barnum said, there’s a sucker born every minute.

The GIN website boasted, “Affiliates could potentially earn hundreds of thousands of dollars in commissions,” but included a disclaimer saying, “Individual results will vary. There are no guarantees that you will make any sales or make any money as an affiliate.”

If this didn’t sound like a good enough reason to pay the $1,000 initiation fee, they claimed that, “members could be given hundreds of thousands of dollars in surprise bonuses” as they qualify for various levels within the GIN membership organization and could get, “All expense paid trips to exotic locations around the world, luxury automobiles, private jet trips, and more,” a claim which was immediately followed by another disclaimer saying, “Legally we are required to say that there are no guarantees that you will earn money as an affiliate or a member of the Global Information Network.”

And if this still didn’t sound good enough to get someone to join, they insisted, “This is just the tip of the iceberg. Surprising as it seems, the majority of member benefits are not discussed here. The most significant members benefits are confidential and only revealed to members.”

The site claimed that members would have access to, “experts, the powerful and affluent, celebrities, professional athletes, authors, scientists, politicians, successful business people, doctors and medical experts, leaders in various fields, plus many others.”



Basically, Trudeau was trying to sell a ridiculously expensive membership [$1,000 down—later reduced to $500—and $150 a month] to join his own “secret society” that he made to appear was comprised of former Illuminati members. Trudeau carefully crafted an image of being an insider affiliated with groups like the Illuminati who was “leaking” the secrets to the average Joe who also dreams of being rich and powerful or who wanted to be a part of the Illuminati themselves.

He even advertised a special pay-per-view video “seminar” mid-2012 where he claimed he would reveal the secrets of December 21st 2012, which, you may recall, was supposedly the date that the Mayan Calendar indicated would be the end of the world. In a video posted on his YouTube channel promoting his pay-per-view “special,” Trudeau said, “There is something coming, significant, December 21st 2012...We now have the data. I now have the data authenticated. I now have the data verified through multiple sources. Something significant that you need to know is going to happen on December 21st 2012.”396

He went on to say, “I’m going to be revealing in a two hour webinar, exactly what is going to happen December 21st 2012. This is information you and your family need to know. It is information that you categorically 100% need to know. You need to know this. It is vital.” Gullible fools thought he got this “data” from his Freemasonry, Bilderberg, Bohemian Grove buddies who supposedly made up the “GIN Council.”

Trudeau is, in my opinion, an extraordinary liar and con artist and has fabricated his alleged connections with the Illuminati and the Bilderberg Group just like so many others, but added his own ingenious twist by creating his own “secret society” and selling “memberships” to suckers who thought they were going to get rich quick. If only Trudeau would have moved to Hollywood decades ago, he could have perhaps earned hundreds of millions of dollars as an Oscar winning actor and may have avoided his many legal troubles.



I’m sure that some of the information in Trudeau’s Natural ‘Cures’ books, and “getting out of debt books,” is legitimate and useful, and perhaps has helped a fair number of people get healthier and manage their finances better. But the extraordinary claims of seeing alien bodies in the Area 51 hanger, and being recruited for an elite secret society when he was 15-years-old and having to go to prison for a mission to help them are truly ridiculous.

And anyone who was dumb enough to buy into his $1,000 (or later reduced to $500) “initiation” fee to join his “elite society” which he claimed had members of the Illuminati and Bohemian Grove as a part of it, then those people are truly gullible fools who were blinded by their own desperate hopes of becoming rich without having to work hard.

Trudeau’s claims of being affiliated with an elite secret society and his carefully crafted Global Information Network scheme clearly, in my opinion, shows him to be concerned more with fooling gullible people out of large amounts of money than helping anyone get cured from any disease.

While he may discuss various useful home remedies in his “Natural Cures” books, and tout them as ‘cures’ for diseases, many health professionals have expressed concerned that people with real illnesses may have taken his advice while abandoning traditional medical treatment for what may be very serious diseases. The fact that Trudeau has been a pitchman for a wide variety of products, almost all of which play off people’s basic desires to be healthy, look beautiful, or to get out of debt, shows that he has a knack for presenting supposed easy solutions to difficult problems.

Finally, I should point out that in his More Natural ‘Cures’ Revealed book where he first claims he was a member of an elite secret society and offers cures for all kinds of diseases, on the page immediately following the Table of Contents, is a disclaimer with a paragraph reading in part, “This book is considered by some a work of fiction, yet inspired by a true story. The truth is sprinkled in to spice things up. On occasion, names, dates, and

events have been changed or made up for fun.” It goes on to say the book is, “for entertainment purposes only.”397 How clever of Trudeau for including this legal disclaimer which hardly anyone even noticed, which attempts to protect him from the legal ramifications of the claims he is making. Since when is a book containing “cures” for diseases “entertainment?” It’s shameful.

So basically if you believe Trudeau’s wild tales of attending Bilderberg meetings and being connected to the Illuminati, may I remind you that in his own words he admits that it is all for “entertainment purposes only.”

After I posted several videos on YouTube exposing Kevin Trudeau beginning in 2009, some of his supporters posted angry comments on the video and on my Facebook page saying things like, “Maybe you're the one working with the Illuminati to try and discredit him for leaving them in the first place and exposing the truth.”

Another of the countless crazy comments by the gullible GIN members said, “Kevin Trudeau and his friends have dossiers of the crimes of the Illuminati all over the world and if anything happens to the GIN council it will be released to every news agency.”

In March of 2014, Trudeau was sentenced to ten years in prison for violating his court order not to make deceptive claims on infomercials.398 Court documents revealed that his Global Information Network took in over $100 million dollars in just a few years,399 all the while Trudeau claimed to be broke and didn’t pay a single penny towards his $37 million dollar fine the Federal Trade Commission levied against him.400 One court document states, “Trudeau denies having any personal property other than $2000 worth of clothing, but spent more than $15,000 in one trip to a high-end men’s clothier in Zurich [Switzerland] only months before he filed the ‘sworn’ statement.401

In court it was revealed that GIN technically listed in his wife’s name, a Ukrainian girl, twenty-three years younger than him (who some speculate

was possibly a “mail order bride”) as the named officer and director.402 During court proceedings she “took the fifth” when asked how she met Trudeau.403 Court documents reveal Trudeau was accused of hiding assets in a variety of ways including a convoluted ownership structure of various companies, off-shore trusts, and even using casino chips.404

A major key to Trudeau’s book sales were his infomercials which appealed to a sizable segment of society who weren’t very tech savvy, like many baby boomers and senior citizens—many of whom were facing declining health and desperate to try something hoping for a cure for their ailments. If, instead of ordering his books using the 1-800 number from the infomercial, they would have looked up the books on Amazon.com, then they would have seen many of the reviews were one star, and many of them ripping Trudeau for his outlandish claims and criminal past.

It is for these many reasons that, in my opinion, Kevin Trudeau is the biggest Illuminati hoaxer in history and is virtually unmatched by anyone in his ability to deceive people and put a fresh new spin on the ancient art of selling snake oil. At his sentencing, Trudeau told the judge—who called him deceitful to the core, “If I ever write a book again, if I ever do another infomercial again, I promise no embellishment, no puffery and absolutely no lies.”405 And if you believe that, I’ve got a bridge to sell you!



Mark Cleminson

Mark Cleminson is a Seventh-day Adventist Christian who says he was born into an Illuminati family and at the age of twelve was able to bend spoons, move objects, and even levitate himself through telekinesis! Cleminson claims to be a descendent of Pope Clement, and says he once worked for IBM allegedly making “hundreds of thousands of dollars a year” but left that job in 2001 for whatever reason to apparently “expose” the Illuminati. His parents attended a Roman Catholic Church as a cover for their occult “Illuminism” he says, and his father and grandfather were supposedly raised by Jesuits in the “Himalayan Mystery Schools.”

A few of his interviews can be found on YouTube where he duped a couple small Christian groups into talking with him. In the videos he looks presentable, wearing a suit and tie, appearing to be in his mid-forties, although his delivery is extremely dry and boring and consists of the typical “my life was threatened when I left” claims. First of all, the Illuminati doesn’t “attempt” to kill someone. If they want you dead, there’s any number of ways to do it, from the CIA’s frozen poison dart guns, to swabbing poison on the door handle of your car that will be absorbed into the skin and cause an undetectable heart attack, to walking next to a target and spraying them with hydrogen cyanide (HCN) or cyanogen chloride (ClCN) gas or other poison that will induce a timely death and be attributed to a heart attack, stroke, or other natural causes.

Cleminson says that shortly after “leaving the Illuminati” he was at a secluded property his family owned in upstate New York when “twenty or so” men in “full regalia masonic gear” gathered at the property next door in order to “intimidate him” and “threaten him for leaving.” He says as he walked over to confront the men, who he said he recognized as his former associates, all of a sudden the Egyptian god of the underworld Anubis appeared to him standing twenty feet tall in the woods. “You can have my

body, but you can’t have my soul,” he says he told the demon, which caused it to vanish.

His story lacks details and is so vague and unconvincing it appears at times that he’s making it up off the top of his head as he’s telling it. But, like agent Fox Mulder in the popular 1990s TV series The X-Files, so many people “want to believe” that they turn off their critical thinking and absorb every word he and other “former Illuminati members” say because it reinforces their current world view and makes them feel as if they are special for discovering these “little known truths.”

Regarding his supposed ability to “bend spoons,” with his “telekinesis” Illuminati power, this is one of the oldest parlor tricks in the book which is accomplished by using one pre-bent spoon and a second spoon handle that’s been cut off from a different spoon by removing the head, and then by holding both pieces in one’s hand and making it look like they’re only holding one spoon, magicians make it appear as if the spoon is bending.

Cleminson may have dabbled in New Age philosophy and witchcraft on a personal level, unaffiliated with any organization, and then later found interest in Christianity, but his claims of coming out of an “Illuminati family” trained by the Jesuits and “Himalayan Mystery Schools” is preposterous and purely an attempt to tap into the anti-Illuminati sentiment by portraying himself as another supposed insider who is revealing their plot. Of course in the hand full of interviews gullible suckers conducted with him, he never once revealed a single detail that wasn’t already widely known in conspiracy circles, and what little information he did offer up consisted of little more than claiming “the Rothschild’s control the banking industry.”

Maybe he did work at IBM, and was possibly fired for any number of reasons—in my opinion, probably for incompetence—but as far as having any affiliation whatsoever with the Illuminati, or having anything more than a basic understanding of them, Mark Cleminson completely misses the mark.



In August of 2014 I received an e-mail from someone who said they graduated high school with Cleminson twenty-five years earlier and was in the same circle of “jock friends” growing up. This person, whose name I won’t mention, happened to see my YouTube video about Cleminson and reached out to me to let me know what a “liar and a fraud” he was, but that’s pretty obvious to anyone with any common sense.





Conclusion

Even skeptics and debunkers have to admit that oftentimes no matter how “crazy” many so-called “conspiracy theories” sound, there are often undeniable truths at their foundation. It’s a full time job to separate the facts from the fiction when talking about conspiracy theories or the Illuminati since there is so much disinformation, misinformation, half-truths and hoaxes out there. I hope this book has helped you in your quest for the truth and shown you solid, verifiable information and helped you see through much of the B.S. that’s floating around out there.

For over ten years I’ve been tirelessly researching this material and carefully assembling the pieces of the puzzle to create an accurate picture of this monumental mystery. Even the most adamant “debunkers” have to admit that at the core of this massive conspiracy are many disturbing truths that cannot be ignored.

A writer for the New York Times who aimed to “debunk” Illuminati conspiracies in his 1983 book Architects of Fear, had to admit, “Elitism has always been the dark side of illuminism; the revolutionary vanguard that seizes control because it knows what’s good for the people, the philosopherking who knows the truth, the technocrat who knows how to run societies and wars—all try to hoard the light at the top of the pyramid. Reason, which can be used to rescue man from churches and kings, can also be used to enslave him with dogmas of its own. Knowledge is power that can be abused.”406

Elitists and Big Government New World Order promoters want people to believe that rights come from the government, instead of from God. The United States Declaration of Independence says “All men are endowed by our Creator with certain unalienable rights,” which means our rights can’t be taken away, and are permanent from the moment we are born. No society can vote to eliminate them—no government can charge you money in

exchange for granting them—they are inherent, irrevocable, and unchangeable. The State (the government) is God in the New World Order, and that’s why most bureaucrats and the mainstream media portray presidents as modern day Pharaohs who they want you to believe are the only God you need. The Illuminati want the government to be the ultimate authority, not God. They want your loyalty to be to them, not to your family, community, or religious dogma. The law is considered the Gospel. The government is your protector, provider, and teacher. It knows what’s best for you.

Because of the 24-hour cable news and satellite networks, the Internet, and social media—many people are inclined to think that we are able to quickly resolve all the world’s problems since we are instantly informed about them, but this information age seems to be a double edged sword. On one level, this technology informs us about major events or problems, but at the same time, it usually prevents people from taking action to actually resolve them. The term narcotizing dysfunction refers to the theory that because of modern media, when people are informed about a particular issue they substitute taking action to resolve it, for simply knowing about it.407

Most people feel that by posting information about a particular issue on social media that they have “done something” to help by “getting the word out” but this “slactivism” as it has been called, often has little to no actual effect. People can post all day long about earthquake victims needing help, but if nobody gets off their computer or puts away their mobile device to actually do anything to help them, then all of their talk is futile.

This is similar to the bystander effect which explains the phenomena where almost everybody assumes that someone else is taking action to resolve a problem, resulting in nobody taking action because everyone thinks someone else will do it or is already working on it.408

Terrible tragedies like airline disasters, terrorist attacks, or other high profile crimes get constant news coverage for a short news cycle often

lasting no more than a few days and then the next big scandal or tragedy is put on the front pages and runs its brief cycle, and then that too disappears from people’s minds as they are occupied by the next “top story” and the cycle endlessly repeats itself, with people’s focus quickly jumping from one tragedy to the next with the vast majority of people never actually doing anything about it. This endless barrage of sensationalist stories keeps most people in a virtual hypnotic trance, preventing them from ever looking beyond the tip of the iceberg in terms of what’s really going on in the world.

Cultural Marxism creates an invisible pressure that prevents most people from breaking away from the crowd and keeps almost everyone following the herd and subscribing to the norms of society and afraid to question the deeply engrained patterns of their peers.

Since esoteric information is hard to contain these days, and bits and pieces of it occasionally leak out, sometimes the mainstream media has to do some damage control to prevent the masses from waking up to the magnitude of the reality we are experiencing. Sometimes scholars and college professors are rolled out by mainstream media in an attempt to discredit “conspiracy theories” and hoping to keep people from peeking behind the curtain.

One such “debunker” named Michael Burkun wrote a book titled, A Culture of Conspiracy, where he ridicules “conspiracy theories” that he says almost always include “ridiculous” claims such as the [supposed] “systematic subversion of republican institutions by a federal government utilizing emergency powers; the gradual subordination of the United States to a world government operating through the United Nations; the creation of sinister new military and paramilitary forces, including governmental mobilization of urban youth gangs; the permanent stationing of foreign troops on U.S. soil; the widespread use of black helicopters to transport the tyranny’s operatives; the confiscation of privately owned guns; the incarceration of so-called patriots in concentration camps run by FEMA; the implantation of microchips and other advanced technology for surveillance and mind control; the replacement of Christianity with a New Age world

religion; and, finally, the manipulation of the entire apparatus by a hidden hierarchy of conspirators operating through secret societies.”409

He actually lists these events as “ridiculous conspiracy theories” when a brief examination of current events reveals that they’re basically all obviously true. Burkun also tries to associate “conspiracy theorists” with “anti-government right-wing extremists” like Timothy McVeigh.410

Another popular “debunker” is Daniel Pipes, who just so happens to be a member of the Council on Foreign Relations and the founder of Campus Watch, an organization that some say was set up to harass scholars who are critical of Israel.411 Pipes, who is the author of Conspiracy: How the Paranoid Style Flourishes and Where It Comes From, says “I have yet to see a clandestine effort by these so-called secret societies to gain power and to harm other people, or to fulfill their own ambitions to gain power.”412 In his book, there isn’t a single mention of the Bilderberg Group or Bohemian Grove, not a single word, not even once.

Pipes even ridicules people for being concerned about implantable microchips saying that some people fear one day, “tiny microchips will be inserted into American’s buttocks to keep track of each person’s whereabouts and activities.”413 He actually said conspiracy theorists are worried about the government implanting tracking devices in their butts! I guess he never heard of the Verichip or other implantable RFIDs or bioelectric tattoos, or wearable WiFi enabled devices or NFCs that are growing in popularity. Implantable and wearable tracking devices are very real, but Pipes attempt to trivialize the legitimate concerns about such technology is clearly ridiculous.

Furthermore, Pipes states that only conservatives and Republicans are conspiracy theorists and says Democrats and liberals are all simply too smart for such nonsense. Pipes writes, “With uncommon exceptions, the conspiracy theorists on the Right consist of skinheads, neo-Nazis, and other yahoos who express vicious ideas about Jews and batty ones about secret societies. Most of them suffer from a lack of qualifications; many have little

education and work at menial occupations…In all earnestness, right-wing authors cite as sources the National Enquirer, a grocery store tabloid, and other publications with no pretentions to accuracy.”414

Regarding liberals and Democrats, however, Pipes claims, “The Left offers densely reasoned economic analysis and presents an idealistic vision. The one presents a face contorted with malice; the second offers a smile and a hope.”415

Pipes also tries to paint “rightwing” conspiracy theorists as mostly anti-Semites. He quotes a supposed “study” on the American Militia movement, saying “leaders are careful to talk about ‘international bankers’ or the ‘Federal Reserve’ or the ‘Trilateral Commission’ or ‘eastern elites.’ But these are code phrases, carefully picked by the leadership to pull people into their movement without greeting them with overt anti-Semitism and that militias even if they call it something else and never mention Jews, they are referring to Jews.”416

He even says that the Illuminati is good! “The Order of the Illuminati represented his [Adam Weishaupt’s] effort to build a just community within a corrupt society and to modernize Germany through the discipline of a secret society.”417

In a History Channel special titled Secret Societies, Pipes concludes, “Basically all the conspiracy theories about secret societies wanting to take over the world are wrong.”418

Many people who criticize “conspiracy theorists” claim that we all have a “confirmation bias” which is the tendency for people to favor information that supports their current worldview or hypothesis—which in many cases is an accurate assessment of conspiracy theorists, but this certainly isn’t the case for me. For several years after the 9/11 attacks on the World Trade Center, I fully believed the official account of what happened and I believed the conspiracy theory about Iraq having weapons of mass destruction that they were prepared to use against us at any moment. It was

only when faced with growing evidence to the contrary that the American government’s lies started to slowly unravel, allowing me to see things differently.

Since searching for the truth is difficult and painful, not to mention time consuming, most people never even start out on the journey. Instead they turn their mind, body, and soul over to the mesmerizing mainstream media, or to celebrity news or sports entertainment, so I congratulate you on your determination to be different and for taking the road less traveled. I hope I’ve been able to provide you some of the answers that you’ve been seeking, because I too have a burning desire to know the truth and we are on the same path.

In this book we’ve covered a variety of evidence, ranging from the original writings of the Illuminati, to how they were discovered, what their plans are, and tracking them to their Skull & Bones, Bohemian Grove and the Bilderberg Group offspring. We’ve seen some little-known insider revelations, looked into their philosophies, symbols, and more—which when carefully assembled form an undeniable picture proving the Illuminati is still alive.

I wish you well on your journey wherever it may take you from this point forward. If you found this book valuable in your quest please review it on Amazon.com or whatever e-book store you got it from to help support my work, and I encourage you to check out some of my other books which I’m sure you will find interesting as well. I doubt you’ll ever look at the world the same way now that you’ve peeked behind the curtain and seen Inside the Illuminati.





Further Reading

The Illuminati: Facts & Fiction

Secret societies have both fascinated and frightened people for hundreds of years. Often the infamous Illuminati is mentioned as the core of conspiracies which span the globe. The Illuminati is actually a historical secret society which had goals of revolutions and world domination dating back to the 1770s.

Since then, rumors and conspiracy theories involving the Illuminati continue to spread, sometimes finding their way into popular novels like Dan Brown’s Angels & Demons and Hollywood movies like Lara Croft: Tomb Raider. Some men have even come forward claiming to be former members, offering details of what they allege are the inner workings of the organization. When you sift through all of the information available on the subject, you may be surprised that the truth is stranger than fiction.

In The Illuminati: Facts & Fiction, conspiracy and occult expert Mark Dice separates history from Hollywood and shows why tales of the secret society won't die.



The New World Order: Facts & Fiction

What is the New World Order? Proponents say that it’s an anticipated new era of global cooperation between diverse nations and cultures aimed at ushering in a utopia providing all the earth's citizens with everything they need.

Detractors claim it’s the systematic take-over by secret societies, quasigovernment entities and corporations who are covertly organizing a global socialist all-powerful government which aims to regulate every aspect of citizens lives, rendering them a perpetual working-class while the elite leadership lives in luxury.

Conspiracy theory expert Mark Dice looks at the evidence, claims, and conspiracy theories as he takes you down the rabbit hole to The New World Order.



Illuminati in the Music Industry

Famous pop stars and rappers from Jay-Z and Rick Ross to Rihanna and Christina Aguilera are believed by many to be a part of the infamous Illuminati secret society. These stars allegedly use Illuminati and satanic symbolism in their music videos and on their clothes that goes unnoticed by those not “in the know.”

Since these stars appear in our livings rooms on family friendly mainstream shows like Good Morning America, Ellen, and dozens of others —and are loved by virtually all the kids—they couldn’t possibly have anything to do with the infamous Illuminati or anything “satanic,” could they? Some famous musicians have even publicly denounced the Illuminati in interviews or songs.

Illuminati in the Music Industry takes a close look at some of today’s hottest stars and decodes the secret symbols, song lyrics, and separates the facts from the fiction in this fascinating topic. You may never see your favorite musicians the same way ever again.



Big Brother: The Orwellian Nightmare Come True

In Big Brother, Mark Dice details actual high-tech spy gadgets, mindreading machines, government projects, and emerging artificial intelligence systems that seem as if they came right out of George Orwell’s novel Nineteen Eighty-Four.

Orwell’s famous book was first published in 1949, and tells the story of a nightmarish future where citizens have lost all privacy and are continuously monitored by the omniscient Big Brother surveillance system which keeps them obedient to a totalitarian government.

The novel is eerily prophetic as many of the fictional systems of surveillance described have now become a reality. Mark Dice shows you the scary documentation that Big Brother is watching you, and is more powerful than you could imagine.



The Resistance Manifesto

The Resistance Manifesto by Mark Dice contains 450 pages of extensively researched and documented information drawing from declassified documents, mainstream news articles, religious texts, and personal interviews. A dark web of evil is exposed like never before, making Bible Prophecy and the New World Order crystal clear.

Learn the most powerful information about the Illuminati, plans for the rise of the Antichrist, the institutions, people, and powers involved, and how you can fight them.





About the Author

Mark Dice is a media analyst, author, and political activist who, in an entertaining and educational way, gets people to question our celebrity obsessed culture and the role the mainstream media and elite secret societies play in shaping our lives.

Mark’s YouTube channel has received over 85 million views and his viral videos have been mentioned on ABC’s The View, the Fox News Channel, CNN, the Drudge Report, TMZ, the New York Daily News, the New York Post, and other media outlets around the world.

He has been featured on various television shows including the History Channel’s Decoded and America’s Book of Secrets, Conspiracy Theory with Jesse Ventura, Secret Societies of Hollywood on E! Channel, America Declassified on the Travel Channel, and is a frequent guest on Coast to Coast AM, The Alex Jones Show, and more.

Mark Dice is the author of several popular books on secret societies and conspiracies, including The Illuminati: Facts & Fiction, Big Brother: The Orwellian Nightmare Come True, The New World Order, Facts & Fiction, The Resistance Manifesto, Illuminati in the Music Industry, and Inside the Illuminati, which are all available in paperback on Amazon.com or e-book on Kindle, iBooks, Nook or Google Play.

While much of Mark’s work confirms the existence and continued operation of the Illuminati today, he is also dedicated to debunking conspiracy theories and hoaxes and separating the facts from the fiction; hence the “Facts & Fiction” subtitle for several of his books.



While having respect for all authentic religions and belief systems, Mark Dice is a Christian and holds a bachelors degree in communication from California State University. He lives in San Diego, California.

He enjoys causing trouble for the New World Order, exposing corrupt scumbag politicians, and pointing out Big Brother’s prying eyes. The term “fighting the New World Order” is used by Mark to describe some of his activities, and refers to his and others’ resistance and opposition (The Resistance) to the overall system of political corruption, illegal wars, elite secret societies, mainstream media, Big Brother and privacy issues; as well as various economic and social issues. This Resistance involves selfimprovement, self-sufficiency, personal responsibility and spiritual growth.

 



Connect with Mark on:

Facebook.com/MarkDice

Twitter.com/MarkDice.com

YouTube.com/MarkDice

MarkDice.com





Copyright Info

 

Inside The Illuminati © 2014 by Mark Dice All Rights Reserved Published by The Resistance Manifesto San Diego, CA

 

No part of the text within this book may be reproduced or transmitted in any form and by any means, graphic, electronic, or mechanical, including photocopying, recording, taping, or by any information storage retrieval system, without the written permission of the author.

 

Visit www.MarkDice.com

E-book ISBN: 978-0-9887268-5-7



1

Washington Post “First Lady Launches Counterattack” by David Maraniss (January 28, 1998)

2

CBS News “White House Admits WMD Error” by Lauren Johnston (July 9th 2003)

3

New York Times “500 Conspiracy Buffs Meet to Seek the Truth of 9/11” by Feuer, Alan (June 5, 2006)

4

Hall, Manly P. - The Secret Destiny of America page 53-54

5

Hall, Manly P. - The Secret Destiny of America page 54

6

http://energy.gov/management/office-management/operational-management/history/manhattanproject

7

Groves, Lesley - Now it Can Be Told: The Story of the Manhattan Project (1962) page 140

8

Hall, Manly P. – The Secret Teachings of All Ages page 40

9

Baddeley, Gavin - Lucifer Rising page 71

10

July 20th, 1785

11

http://www.bavarian-illuminati.info/2008/11/lang-or-lanz-myths-about-the-myths/

12

Robison, John – Proofs of a Conspiracy p. 79

13

Full name: Thomas Maria Baron de Bassus

14

Barruel, Abbe – Memoirs Illustrating the History of Jacobinism Volume III page v

15

Barruel, Abbe – Memoirs Illustrating the History of Jacobinism Volume III page 5



16

Robison, John – Proofs of a Conspiracy p. 76

17

Robison, John - Proofs of a Conspiracy page 7.

18

See my previous book, The New World Order: Facts & Fiction

19

Barruel, Abbe -Memoirs Illustrating the History of Jacobinism page 685

20

Ibid

21

Barruel, Abbe - Memoirs Illustrating the History of Jacobinism page 687

22

Ibid.

23

Ibid

24

Ibid.

25

Barruel, Abbe - Memoirs Illustrating the History of Jacobinism page 687-688

26

Barruel, Abbe - Memoirs Illustrating the History of Jacobinism page 688

27

Stauffer, Vernon - New England and the Bavarian Illuminati page 176

28

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 453 [Paris: 1914], Arche reprint, 2001. (Quote translated in English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 27)

29

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 468-469 [Paris: 1914], Arche reprint, 2001. (Translated in English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 29)



30

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 468-469 [Paris: 1914], Arche reprint, 2001. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 29)

31

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 468-469 [Paris: 1914], Arche reprint, 2001. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 29)

32

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 507-508 [Paris: 1914], Arche reprint, 2001. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 40)

33

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 507-508 [Paris: 1914], Arche reprint, 2001,pp 507-508. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 40)

34

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 507-508 [Paris: 1914], Arche reprint, 2001 pp 507-508. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 40)

35

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 614-615 [Paris: 1914], Arche reprint, 2001. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 56)

36

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 614-615 [Paris: 1914], Arche reprint, 2001. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 56)

37

Rene, Le Forestier - Les Illuminés de Bavière et la franc-maçonnerie allemande page 614-615 [Paris: 1914], Arche reprint, 2001. (Translated to English in Perfectabilists: The 18th Century Bavarian Order of the Illuminati by Terry Melanson page 56)

38

Koselleck, Reinhart - Critique and Crisis: Enlightenment and the Pathogenesis of Modern Society Cambridge, Mass MIT Press (1988) page 92-32

39

Robison, John – Proofs of a Conspiracy p. 124-125



40

Robison, John – Proofs of a Conspiracy p. 134

41

Robison, John – Proofs of a Conspiracy p. 123

42

Robison, John – Proofs of a Conspiracy p. 112

43

Robison, John – Proofs of a Conspiracy p. 66

44

Robison, John – Proofs of a Conspiracy p. 77

45

Robison, John – Proofs of a Conspiracy p. 67

46

Quoted in Steven Luckert, Jesuits, Freemasons, Illuminati and Jacobins: Conspiracy theories, secret societies and politics in late eighteenth-century Germany, Ph.D dissertation, State University of New York at Binghamton, pages 285-286.

47

Robison, John – Proofs of a Conspiracy p. 77

48

Robison, John – Proofs of a Conspiracy page 224

49

Robison, John - Proofs of a Conspiracy p. 84

50

Robison, John – Proofs of a Conspiracy p. 85

51

Robison, John – Proofs of a Conspiracy p. 106

52

A Sermon Preached in Lancaster … on the Anniversary of Our National Independence … Before the Washington Benevolent Societies of Lancaster and Guildhall (Windsor, Vermont: Thomas M. Pomroy, 1812), pp. 14–15 (July 4, 1812)

53

Robison, John – Proofs of a Conspiracy p. 124



54

Robison, John – Proofs of a Conspiracy p. 124

55

Robison, John – Proofs of a Conspiracy p. 85

56

Robison, John – Proofs of a Conspiracy p. 86

57

Robison, John – Proofs of a Conspiracy p. 89

58

Morse, Jedediah, A Sermon Exhibiting the Present Dangers, and Consequent Duties of the Citizens of the United States of America Delivered in Charlestown, 1799

59

Robison, John – Proofs of a Conspiracy p. 111

60

Robison, John – Proofs of a Conspiracy p. 94

61

Robison, John – Proofs of a Conspiracy p. 111

62

Fox News “School: We Have a Right To Ban God” by Todd Starnes (July 11th 2014)

63

http://www.exeter.edu/admissions/109_1220_11688.aspx

64

Robison, John – Proofs of a Conspiracy p. 112

65

Ibid.

66

Robison, John – Proofs of a Conspiracy p. 113

67



Melanson, Terry - Perfectibilists: The 18th Century Bavarian Illuminati page 60

68

Final Report of the Select Committee to Study Government Operations With Respect to Intelligence Activities. April 1976. pp. 191–201

69

Final Report of the Select Committee to Study Government Operations With Respect to Intelligence Activities. April 1976. pp. 191–201

70

YouTube “CIA Admits Using News To Manipulate the USA” (1975)

71

Sunstein, Cass R & Vermeule, Adrian “Conspiracy Theories: Causes and Cures” 17 Journal of Political Philshophy 202 (2008) page 22

72

TechDirt.com “New Snowden Doc Reveals How GCHQ/NSA Use The Internet To 'Manipulate, Deceive And Destroy Reputations’ by Mike Masnick (February 25th 2014)

73

The Guardian “GCHQ has tools to manipulate online information, leaked documents show” by James Ball (July 14th 2014)

74

Fortune Magazine “Hollywood’s Military Complex” by Soo Youn (December 19, 2013)

75

The Guardian "Hollywood reporter: The caring, sharing CIA: Central Intelligence gets a makeover” by John Patterson (October 5th 2001)

76

Cinema Review Magazine "The Recruit: About the Production” (2003)

77

Robison, John – Proofs of a Conspiracy p. 91

78

Ridley, Jasper – The Freemasons p. 181

79

Robison, John – Proofs of a Conspiracy p.112

80

Robison, John – Proofs of a Conspiracy p. 63

81

Robison, John – Proofs of a Conspiracy p. 129



82

Lodge of Saint Theodore vom guten Rat in Munich from 1780

83

Macky, Albert – The Lexicon of Freemasonry page 201

84

Bailey, Alice - Externalization of the Hierarchy page 513

85

Robison, John - Proofs of a Conspiracy page 110

86

http://freemasonry.bcy.ca/texts/illuminati.html

87

Schüttler, Hermann - Die Mitglieder des Illuminatenordens [Members of the Illuminati 1776– 1787/93. Ars Una, München 1991

88

Melanson, Terry - The Perfectabilists: The 18th Century Bavarian Order of Illuminati page 72

89

Barruel, Abbe - Memoirs Illustrating the History of Jacobinism page 780

90

Springmeier, Fritz – Bloodlines of the Illuminati page 1

91

Springmeier, Fritz – Bloodlines of the Illuminati page 1

92

See my previous book, The Illuminati: Facts & Fiction to read my complete analysis of John Todd.

93

Lecture The Top 13 Illuminati Bloodlines produced by Prophecy Club, available on YouTube

94

Blavatsky, H.P. - The Secret Doctrine v. II p. 237)

95



Blavatsky, H.P. - The Secret Doctrine v. II p. 235)

96

New York Times “Chronicle” by Nadine Brozan (October 28th 1996)

97

The Daily Mail “Is ruling in the genes? All presidents bar one are directly descended from a medieval English king” (August 4th 2012)

98

The Wire “12 Million Americans Believe Lizard People Run Our Country” by Philip Bump (April 2nd 2013)

99

Icke, David - The Biggest Secret page 295

100

Hall, Manly P. - The Secret Teachings of All Ages page 316

101

Levi, Eliphas – Transcendental Magic p. 7-8

102

Levi, Eliphas – Transcendental Magic p. 307

103

LaVey, Anton - The Satanic Bible page 136

104

Hall, Manly P. – The Secret Teachings of All Ages p. 316

105

Night & Lomas – The Book of Hiram p. 434

106

Levi, Eliphas – History of Magic p. 211

107

Picknett & Prince - The Templar Revelation page 106

108

King, Francis - The Magical World of Aleister Crowley page 78

109

Picknett & Prince - Templar Revelation page 176

110

Hall, Manly P. - Lectures on Ancient Philosophy page 439



111

Levi, Eliphas - History of Magic page 31-32

112

NBC News “Inside the Vatican: The $8 billion global institution where nuns answer the phones” (Feb 14, 2013)

113

Associated Press “Pope affirms Catholicism as only way to salvation” By Nicole Winfield (July 11, 2007)

114

NBC News “Pope: Other denominations not true churches” (July 10, 2007) .

115

BBC Documentary“Sex Crimes and the Vatican” (October 2006)

116

Thomas Doyle, The 1922 instruction and the 1962 instruction “Crimen sollicitationis” promulgated by the Vatican

117

The Guardian “Vatican told bishops to cover up sex abuse: expulsion threat in secret documents” by Antony Barnett (August 17, 2003)

118

Crimine solicitations documents “Instruction on proceeding in cases of solicitation” page 3 paragraph 11.

119

Crimine solicitations documents “Instruction on proceeding in cases of solicitation” page 4paragraph 13

120

The Guardian “Vatican told bishops to cover up sex abuse: expulsion threat in secret documents” by Antony Barnett (August 17, 2003)

121

Ibid.

122

McIntosh, Christopher – The Rosicrucians p. 43

123



Hall, Manly P. - Lectures on Ancient Philosophy page 433

124

dictionary.com

125

Pike, Albert - Morals and Dogma p. 104-105

126

Pike, Albert - Morals and Dogma page 819

127

Pike, Albert - Morals and Dogma page 102

128

Pike, Albert - Morals and Dogma p. 321

129

Grant, Kenneth – Aleister Crowley and the Hidden God page 174

130

Crowley, Aleister - Confessions of Aleister Crowley page 669

131

William H. Upton - Negro Masonry, New York: AMS Press, 1975

132

Brown, Walter Lee - A Life of Albert Pike page 439-440

133

Bailey, Alice - Externalization of the Hierarchy page 511

134

http://askthescholar.com/AskTheScholar2.aspx?q=1098

135

The Independent “Anger at 'cloak of secrecy' for Freemason judges” (November 10th 2009)

136

The Independent “Revealed: How gangs used the Freemasons to corrupt police” (January 13th 2014)

137

Ibid.

138



Macky, Albert - The Encyclopedia of Freemasonry, Entry on Illuminati of Bavaria

139

Robbins, Alexandria - Secrets of the Tomb page 127

140

IRS Form 990 RTA Incorporated OMB no 1545-0047 line 18

141

Robbins, Alexandria - Secrets of the Tomb page 164

142

Yale Daily News “Yalie joins Homeland Security” By Michelle Rosenthal (January 29, 2002)

143

Robbins, Alexandria - Secrets of the Tomb pages 181-182

144

The Guardian “How Bush's grandfather helped Hitler's rise to power” by Ben Aris and Duncan Campbell (September 25, 2004)

145

Robbins, Alexandria - Secrets of the Tomb pp. 48, 50, 127

146

The Iconoclast (1873)

147

New York Observer “At Skull and Bones, Bush’s Secret Club Initiates Ream Gore” by Ron Rosenbaum (April 23rd 2001)

148

Ibid.

149

CNN “Fareed Zakaria GPS: Is it Time To Correct the Constitution?” (June 20th 2011)

150

IRS Form 990 2012 EIN: 06-0706508 Kingsley Trust Association, Line 18: Total Expenses and Line 22: Net Assets

151

The New Yorker “The Bishop’s Daughter” by Honor Moore (March 3, 2008 Issue)

152

IRS Form 990 2012 EIN: 06-6069051 Phelps Association, Line 18: Total Expenses and Line 20: Net Assets



153

Allan, Gary – None Dare Call It Conspiracy page 35

154

The Communist Manifesto - Preface to the German Edition of 1872

155

Eleventh Report Senate Investigating Committee On Education published by the Senate of California page 169

156

Eleventh Report Senate Investigating Committee On Education published by the Senate of California page 170

157

Eleventh Report Senate Investigating Committee On Education published by the Senate of California page 170

158

Eleventh Report Senate Investigating Committee On Education published by the Senate of California page 170

159

Ibid.

160

Crème, Benjamin – The Reappearance of the Christ and the Masters of Wisdom p. 190-191

161Stephen

G. Wheatcroft, "Victims of Stalinism and the Soviet Secret Police: The Comparability and Reliability of the Archival Data. Not the Last Word", Source: Europe-Asia Studies, Vol. 51, No. 2 (Mar. 1999), pp. 315–345

162

Barruel, Abbe- Memoirs Illustrating the History of Jacobinism page 582

163

Jones, Alex - The Order of Death (2005)

164

Ibid.

165

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) Page 67



166

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 127

167

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 95

168

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 92

169

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 93

170

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 111

171

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making page 284

172

Domhoff, William - The Bohemian Grove and Other Retreats: A Study in Ruing-Class Cohesiveness Preface

173

Domhoff, William - The Bohemian Grove and Other Retreats: A Study in Ruing-Class Cohesiveness Page 1

174

New York Times “Sotomayor Defends Ties to Association” by Savage, Charlie and Kirkpatrick, David D (June 15th 2009)

175

Politico “Sonia Sotomayor found friends in elite group” by Keneth Vogel (June 4th 2009)

176

The New York Times “A Club for the Women Atop the Ladder” by Pamela Rychman (April 2, 2011)

177

New York Times “Status is ... for C.E.O.'s; Having a Networked Secretary” by John Glassie (November 15th 1998)



178

Fortune Magazine “Corner Office Confidential” by Jennifer Reingold (August 31st 2009)

179

New York Times “Status is ... for C.E.O.'s; Having a Networked Secretary” by John Glassie (November 15th 1998)

180

New York Times “Status is ... for C.E.O.'s; Having a Networked Secretary” By John Glassie (November 15, 1998)

181

Crowley, Aleister – The Book of The Law page 31

182

Crowley, Aleister – The Book of The Law page 40

183

Crowley, Aleister – The Book of The Law page 41

184

Crowley, Aleister – The Book of The Law page 47

185

Crowley, Duquette, & Hyatt - Enochian Sex Magick page 116

186

Crowley, Duquette, & Hyatt - Enockian Sex Magick page 117

187

Crowley, Aleister - Confessions of Aleister Crowley page 702

188

Stephenson, Nathaniel Wright - Nelson W. Aldrich: A Leader in American Politics (1930) page 485

189

Vanderlip, James - From Farmboy to Financier, autobiography (1935)

190

Paul, Ron – End the Fed page 22

191



Greider, William - Secrets of the Temple page 276

192

Reportedly from a speech at the University of Texas in the 1920s but the source of this quote is unverified.

193

Memoirs, Correspondence, and Private Papers of Thomas Jefferson, vol. 4, Thomas Jefferson Randolph, ed., 1829, pp. 285-288.

194

McGeer, Gerald Grattan - The Conquest of Poverty Chapter 5 - Lincoln, Practical Economist page 186 (Gardenvale, Quebec: Garden City Press 1935)

195

Keynes, John Maynard - The Economic Consequence of the Peace page 235-236

196

No relation to the Zodiac Club music venue in Oxford, England

197J.

P. Morgan Jr Papers “Archives of The Pierpont Morgan Library” New York 401 The Zodiac Club Dinners 1913–41

198

The Gathamist “Inside The Zodiac Club: NYC's 145 Year Old Secret Dinner Society” by Danielle Oteri (May 16, 2013)

199

Ibid.

200

Ibid.

201

YouTube “Hillary Clinton addresses the Council on Foreign Relations, admits CFR runs the government”

202

Sutton, Antony – America’s Secret Establishment p. 3-4

203

HBO “Realtime with Bill Maher” - Richard Hass Interview (April 29th 2010)

204

Pastor, Robert - Toward a North American Community: Lessons from the Old World for the New page 115

205

Finkbeiner, Ann - The Jasons: The Secret History of Science's Postwar Elite (2006) page (xxiv)



206

The Nautilus Institute “Tactical Nuclear Weapons in 1966”

207

Finkbeiner, Ann - The Jasons: The Secret History of Science's Postwar Elite (2006) page xxvi.

208

Finkbeiner, Ann - The Jasons: The Secret History of Science's Postwar Elite (2006) page 33

209

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 93

210

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 92

211

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 91

212

Tucker, Jim – Jim Tucker’s Bilderberg Diary page 231

213

Tucker, Jim – Jim Tucker’s Bilderberg Diary page 218

214

“Governor’s Visits abroad Paid with Private Money” by Rachel O’neal and Larry Rhodes

215

John R. Rarick, Congressional Record, 92nd Congress, 1st Session, Wednesday, Volume 117, No. 133, 15 September 1971, pp. E9615-E9624

216

Eisenhower memo from March 11th 1955

217

2008 IRS Form 990-PF OMD No 1545-0052

218



2009 IRS Form 990-PF OMD No 1545-0052

219

YouTube: “Ron Paul talks about the Bilderberg Group” (posted August 16th 2008)

220

YouTube: “Did Hillary Clinton Attend the 2006 Bilderberg Conference?”

221

Fox News Channel “Glenn Beck Program” (June 2010)

222

Pike, Albert - Morals and Dogma p. 104-105

223

Hall, Manly P. - The Wisdom of the Knowing Ones page 127-128

224

Blavatsky, H.P. - The Secret Doctrine v. II p. 162

225

Blavatsky, H.P. - The Secret Doctrine v. II page 513

226

Crowley, Aleister - Magick: In Theory and Practice p. 193

227

Blavatsky, Helena - The Secret Doctrine v. I page xvii

228

Hall, Manly P. - The Wisdom of the Knowing Ones page 19

229

Barton, Blanche - The Authorized Biography of Anton LaVey page 218-219

230

Barton, Blanche – The Authorized Biography of Anton LaVey page 133

231

C-Span - September 14th 2001

232

The Project for the New American Century “Rebuilding America’s Defenses” page 51

233

ABC News “US Military wanted to provoke war with Cuba” by David Ruppe (5-01-2001)

234

CNN “Kissinger Resigns as Head of 9/11 Commission” (December 13, 2002)



235

Wall Street Journal “In Crisis, Opportunity for Obama” by Gerald Seib (November 21 2008)

236

Reuters “Albinos in Tanzania murdered or raped as AIDS ‘cure’ by Fumbuka Ng’Wanakilala (May 5th 2011)

237

Ibid.

238

Telegraph “South African men rape babies as 'cure' for Aids” by Jane Flanagan (November 11th 2001)

239

Ibid.

240

BBC “Lostprophets' Ian Watkins sentenced to 35 years over child sex offences”

241

Crowley, Aleister - Magick: In Theory and Practice page 95

242

Daily Mail “House of horrors: Daughter tells how she was forced to sleep with 1,800 men by the time she was 18 as part of Satanic sex cult” by Jennifer Smith (September 21, 2014)

243

Ibid

244

DeCamp, John - The Franklin Cover-Up page 326-327

245

DeCamp, John - The Franklin Cover-Up page 326-327

246

The Alex Jones Show - Alex Jones Interviews John DeCamp, Author of The Franklin Cover-up (July 21, 2004)

247

Washington Times “Homosexual Prostitution Inquiry Ensnares VIPs with Reagan, Bush” by Paul Rodriguez and George Archibald (June 29th 1989)

248

Washington Post “How BBC star Jimmy Savile got away with allegedly abusing 500 children and sex with dead bodies” by Terrence McCoy (June 27th 2014)



249

Daily Mail “Are we evolving into a NEW type of human? 'Different' species will have evolved by 2050, scientist claims” by Ellie Zolfagharifard (September 11th 2014)

250

Telegraph “Peter Thiel: the billionaire tech entrepreneur on a mission to cheat death” by Mick Brown (September 19th 2014)

251

The Wall Street Journal “Will Google's Ray Kurzweil Live Forever?” by Holman W. Jenkins Jr. (April 12th 2013)

252

Wired “It’s Time To Consider Restricting Human Breeding” by Zoltan Istvan (August 14th 2014)

253

PBS “Charlie Rose” - Guest Ted Turner (April 1st 2008)

254

Christian, Robert – Common Sense Renewed p. 14-15

255

Christian, Robert – Common Sense Renewed page 6

256

National Public Radio NPR (July 1st 1998)

257

TechnoCalyps - Part II - Preparing for the Singularity (2008) Documentary by Frank Theys

258

Cirlot, J.E - Dictionary of symbols page 255.

259

Hall, Manly P. - Secret Teachings of All Ages page 118

260

Zechariah 11:17

261

Hall, Manly P. - The Secret Teachings of All Ages p. 272

262

Hall, Manly P – The Secret Teachings of All Ages p. Ixxxviii

263



Blavatsky, H.P. – The Secret Doctrine v. II p. 283

264

Crowley, Aleister - Magick: In Theory and Practice p. 193

265

Pike, Albert – Morals and Dogma p. 734

266

Hall, Manly P. - The Secret Teachings of All Ages p. 282

267

Hall, Manly P. - The Secret Teachings of All Ages p. 283

268

The Economist “Get Ready for the Phoenix” (01/9/88) Vol. 306, pp 9-10

269

Cirlot, J.E.– Dictionary of Symbol 235-236

270

Levi, Eliphas - Transcendental Magic

271

Levi, Eliphas - Transcendental Magic page 316

272

Crowley, Aleister – Magick: In Theory and Practice page 193

273

Levi, Eliphas - Transcendental Magic p. 7-8

274

Levi, Eliphas – Transcendental Magic p. 307

275

Cerlot, J. E - The Dictionary of Symbols page 295

276

Hall, Manly P. – The Secret Teachings of All Ages p. 189

277

Hall, Manly P. - Lectures on Ancient Philosophy page 163

278

Blavatsky, H.P. – The Secret Doctrine v. II p. 244

279

Springmeier, Fritz – Bloodlines of the Illuminati page 191



280

Ibid

281

Rockefeller, David - Memoirs page 405.

282

PBS The World of David Rockefeller (1980) hosted by Bill Moyers

283

Quigley, Carroll – Tragedy and Hope page 950

284

Quigley, Carroll – Tragedy and Hope pages 951-952

285

Quigley, Carroll – Tragedy and Hope pages 1247-1248

286

Quigley, Carroll – Tragedy and Hope page 324

287

Rotberg, Robert - The Founder: Cecil Rhodes and the Pursuit of Power (1988) page 101-102

288

Bernays, Edward – Propaganda page 37-38

289

Bernays, Edward – Propaganda page 47-48

290

Bernays, Edward – Propaganda page 63

291

New York Times - “Group of Girls Puff at Cigarettes as a Gesture of Freedom” (April 1st 1929)

292

Wilson, Woodrow -The New Freedom, Chapter I: The Old Order Changeth

293

This quote is disputed and various sources purporting to be its origin are debated.

294

President Kennedy’s address before the American Newspaper Publishers Association (April 27th 1961)



295

Gallup “Majority in U.S. Still Believe JFK Killed in a Conspiracy” by Art Swift (November 15, 2013)

296

President Dwight Eisenhower’s Farewell Address to the Nation (January 17, 1961)

297The

New York Times “NYT transcript of Bush speech from the Oval office January 16, 1991” (January 17, 1991)

298

George H. W. Bush State of the Union Speech (January 29th 1991)

299

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making page 284

300

White House Press Release “President Bush Speaks to United Nations” (11/10/2001)

301

The Washington Post “The Disbelievers” by Michael Powell (September 8th 2006)

302

The Independent “Bush plotted to lure Saddam into war with fake UN plane” By Andy McSmith (February 3rd 2006)

303

NBC “Meet the Press” (2/08/2004)

304

CFR.org “Launch of the Maurice R. Greenberg Center for Geoeconomic Studies with Vice President Dick Cheney” (February 15th 2002)

305

Think Progress “To Provoke War, Cheney Considered Proposal To Dress Up Navy Seals As Iranians And Shoot At Them” by Faiz Shakir (July 31, 2008)

306

New York Times “Bush-Cheney 9/11 Interview Won't Be Formally Recorded” by Elizabeth Bumiller and Philip Shenon (April 28 2004)

307

74th Congress House of Representatives Report, pursuant to House Resolution No. 198, 73d Congress, February 15, 1935. Quoted in: George Seldes, 1000 Americans (1947), pp. 290–292. See also Schmidt, p. 245



308

Brzenzinski, Zbigniew - Between Two Ages: America's Role in the Technetronic Era (1970 Viking Press)

309

Brzenzinski, Zbigniew The Grand Chessboard page 211

310

Brzenzinski, Zbigniew - The Grand Chessboard page 25

311

YouTube: Zbigniew Brzenzinzki Deeply Troubled

312

YouTube: CFR Meeting - Zbigniew Brzenzski Fears Global Awakening

313

New York Times “Hylan Adds Pinchot to Presidency List; Foresees a Revolt” (December 10, 1922)

314

Ibid

315

Ibid

316

The London Press (1922)

317

Forbes “The Twenty Most Influential Business Men of All Time” by Michael Noel (7-29-2005)

318

Ferguson, Niall - The House of Rothschild (vol. 2) : The World's Banker: 1849-1999 Diane Publishing Co. (1999)

319

Ferguson, Niall - The House of Rothschild (vol.1): Money’s Prophets, 1798-1848 Penguin Publishing (1999)

320

The Independent “Rothschild loses libel case, and reveals secret world of money and politics” (April 29th 2014)



321

Senate Report (Senate Foreign Relations Committee) (February 17th 1950). Revision of the United Nations Charter: Hearings Before a Subcommittee of the Committee on Foreign Relations, Eighty-First Congress. United States Government Printing Office. p. 494.

322

SMH.com.au “Why the law wants a word with Kissinger” by Christopher Hitchens (April 30th 2002)

323

Bob Woodward & Carl Bernstein The Final Days second Touchstone paperback edition (1994) Chapter 14, pp. 194-195

324

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making Preface page xiv

325

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making Preface page xiv

326

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making Preface page xiv

327

Rothkopf, David- Superclass: The Global Power Elite and the World They are Making Preface page xviii

328

Rothkopf, David - Superclass: The Global Power Elite and the World They are Making page 257

329

Rothkopf, David- Superclass: The Global Power Elite and the World They are Making Page 265

330

Rothkopf, David- Superclass: The Global Power Elite and the World They are Making Page 283

331

Nixon, Richard - Memoirs (1978)

332

Phillips, Peter - A Relative Advantage: Sociology of the San Francisco Bohemian Club. A Doctoral Dissertation (1994) page 95 citing Domhoff 1974 p.42



333

President Richard M. Nixon on the Watergate tapes in 1971 conversation with John D. Ehrlichman, and H. R. Haldeman made public in 1999 by the National Archives

334

The Writings of George Washington from the Original Manuscript Sources, 1745-1799. John C. Fitzpatrick, Editor. Mount Vernon, October 24, 1798.

335

Fox News Channel “Hannity” (March 30th 2009)

336

Hillary: The Movie (2008) produced by Citizens United

337

Sunstein, Cass R. “Conspiracy Theories” Harvard University - Harvard Law School (January 15, 2008) page 14

338

Sunstein, Cass R. & Vermeule, Adrian “Conspiracy Theories: Causes and Cures,” 17 Journal of Political Philosophy 202 (2008)

339

Sunstein, Cass R. & Vermeule, Adrian “Conspiracy Theories: Causes and Cures,” 17 Journal of Political Philosophy 202 (2008) page 15

340

YouTube “Cass Sunstein Predicts Repealing Right To Bear Arms”

341

USA Today “NSA Intercepts Computer Deliveries” by Raphael Satter, Associated Press (December 29, 2013)

342

TechDirt “Latest Snowden Revelations Suggest GCHQ Is Just Like 4Chan Trolls, But With More Firepower” by Mike Masnick (July 14th 2014)

343

TIME Magazine “U.K. Spy Agency Stored Millions of Webcam Images” by Denver Nicks (February 27th 2014)

344

ABC News “LoveINT: Given Immense Powers, NSA Employees Super Cyber-Stalked Their Crushes” by Lee Ferran (September 27th 2013)



345

Washington Times “NSA program MYSTIC culls 100 percent of phone records from foreign country” by Douglas Ernst (March 18th 2014)

346

Orwell, George — Nineteen Eighty-Four page 2

347

Prophecy Club: The Arrival of the Antichrist presentation by Doc Marquis (YouTube video at 1:52 mark)

348

Prophecy Club: The Arrival of the Antichrist presentation by Doc Marquis (YouTube video at 2:46 mark)

349

Prophecy Club: The Arrival of the Antichrist presentation by Doc Marquis (YouTube 4:13 mark in video)

350

Prophecy Club: The Arrival of the Antichrist presentation by Doc Marquis (YouTube 5:33 mark in video)

351

Prophecy Club: The Arrival of the Antichrist presentation by Doc Marquis (YouTube 6:21 mark in video)

352

The Oprah Winfrey Show (June 24th 1987) WLS-TV Transcript #W203

353

Daily Mail “Sickening smile of teen accused of kidnapping, raping and murdering 15-year-old girl in 'satanic ritual’” by Michael Zennie (February 11th 2014)

354

Prophecy Club: America’s Occult Holidays, presentation by Doc Marquis

355

Prophecy Club: The Arrival of the Antichrist presentation by Doc Marquis (YouTube)

356

The Oprah Winfrey Show (June 24th 1987) WLS-TV Transcript #W203

357

The Oprah Winfrey Show (June 24th 1987) WLS-TV Transcript #W203

358

LeoZagami.com



359

http://www.leozagami.com/index.php?option=com_content&view=article&id=44&Itemid=55

360

Ibid.

361Ibid.

362

World Net Daily “Will Rockefeller build 3rd Temple? Internet abuzz with report of biblical proportions” (02/03/2010)

363

ABC News “Fresh Details on Mystery Man Clark Rockefeller as Trial Opens” by Michele McPhee (May 26th 2009)

364

Boston Globe “‘Rockefeller’ Seeks Dismissal of False Name Charge” (March 13th 2009)

365

Vanity Fair “The Man in the Rockefeller Suit” (January 2009)

366

CBS 60 Minutes “The Counterfeit Rockefeller” (April 18th 2003)

367

Taylor, Brice - Thanks for the Memories page 1

368

Taylor, Brice - Thanks for the Memories page 1

369

Taylor, Brice - Thanks for the Memories page 2

370

Taylor, Brice - Thanks for the Memories page 4

371

Taylor, Brice - Thanks for the Memories page 6

372



Taylor, Brice - Thanks for the Memories page 9

373

Taylor, Brice - Thanks for the Memories page 30

374

Canada.com “Woman sues Ottawa over CIA brainwashing at Montreal hospital” (January 11, 2007)

375

YouTube: Interview with “Jess LaVey”

376

Ibid.

377

Cornerstone Magazine Issue 98 “Selling Satan” (1992)

378

Charisma Magazine “Alleged son of Anton LaVey fails to prove identity” (7/31/2002)

379

YouTube “This is how they plan to KILL us - Elite Insider George Green”

380

ABC News “Infomercial King Kevin Trudeau Loses On $38 Million Appeal” by Alan Farnham (December 20th 2011)

381

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page 11

382

The Alex Jones Show (May 26, 2009) Guest Kevin Trudeau

383

Ibid.

384

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page 13

385

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page 13

386

ABC News “Infomercial King Kevin Trudeau Ordered to Jail” by James Hill (September 18th 2013)



387

FTC.gov “Judge Orders Kevin Trudeau to Pay More Than $37 Million for False Claims About Weight-Loss Book” (January 15, 2009)

388

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page 12

389

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page 12

390

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page 11

391

Your Wish is Your Command Infomercial with “host” Skip Linderman on “A Closer Look” (11:52 mark of interview)

392

Original explanation from www.GlobalInformationNetwork.com

393

Ibid.

394

Ibid

395

Ibid.

396

YouTube.com “Kevin Trudeau reveals 2012 Mayan Calendar TEOTWAWKI, Planet X” (posted April 2nd 2012 on Official Kevin Trudeau YouTube Channel)

397

Trudeau, Kevin - More Natural ‘Cures’ Revealed (2006) page vii

398

USA Today “TV Pitchman Kevin Trudeau Gets 10-Year Sentence” (March 18th 2014)

399

KSHB Kansas City “As infomercial king Kevin Trudeau heads to jail, his secret global club faces uncertain future” by Ryan Kath (October 17, 2013)

400

Chicago Tribune “TV pitchman Kevin Trudeau Sentenced to 10 Years in Prison” by Jason Meisner (March 17th 2014)



401

Trudeau Civil Case Document 713 07-15-13 (DX25 at 6; FTCX 90 at 103)

402Case:

1:03-cv-03904 Document #: 481-1 Filed: 07/13/12 Page 8 of 22 PageID #:6777

403

Case: 1:03-cv-03904 Document #: 713 Filed: 07/15/13 Page 3 of 35 PageID #:11594 (FTCX 14, Babenko Dep. 96:16-97:3, 100:3-24.)

404Case:

1:03-cv-03904 Document #: 481-1 Filed: 07/13/12 Page 14 of 22 PageID #:6783

405

Chicago Tribune “TV pitchman Kevin Trudeau sentenced to 10 years in prison” by Jason Meisner (March 17th 2014)

406

Johnson, George – Architects of Fear Page 222

407

The term was first identified in the article Mass Communication, Popular Taste and Organized Social Action, by Paul F. Lazarsfeld, and Robert K. Merton.

408

Psychology Today “What Is the Bystander Effect?”

409

Barkun, Michael - A Culture of Conspiracy page 39-40

410

Barkun, Michael - A Culture of Conspiracy Preface page ix

411

San Francisco Chronicle “Professors Want Own Names Put on Middle East Blacklist by Tanya Schevitz (September 8th 2002)

412

History Channel “History’s Mysteries: Secret Societies” (2001)

413



Pipes, Daniel - Conspiracy: How the Paranoid Style Flourishes and Where it Comes From page 8

414

Pipes, Daniel - Conspiracy: How the Paranoid Style Flourishes and Where it Comes From page 159.

415

Pipes, Daniel - Conspiracy: How the Paranoid Style Flourishes and Where it Comes From page 161-162

416

Pipes, Daniel - Conspiracy: How the Paranoid Style Flourishes and Where it Comes From page 142

417

Pipes, Daniel - Conspiracy: How the Paranoid Style Flourishes and Where it Comes From page

62

418



History Channel “History’s Mysteries: Secret Societies” (2001)

The

New World Order Facts & Fiction

Mark Dice The Resistance San Diego, CA

The New World Order: Facts & Fiction © 2010 by Mark Dice and The Resistance All Rights Reserved Published by The Resistance San Diego, CA No part of the text within this book may be reproduced or transmitted in any form and by any means, graphic, electronic, or mechanical, including photocopying, recording, taping, or by any information storage retrieval system, without the written permission of the publisher and the author. Printed in the United States of America First edition printed in February 2010 Visit www.MarkDice.com

Table of Contents About the Author

Introduction

Calls for a New World Order

World Governed by the Elite Through Occult Secret Societies

Mainstream Media Controlled

High Level Officials and Institutions within the NWO are Above the Law

Immorality and Destructive Behavior is Encouraged

Banking, Money, and Taxes

One World Currency

Population Reduction

One World Religion

A Global Dictator Claiming to be God

Global Police and Military Force

A Nation of Spies

Elimination of the Right to Bear Arms

Elimination of National Sovereignty

Monitoring the Population with Big Brother.

A Medicated and Sedated Population

Science and Technology

Global Warming / Climate Change

Fringe Topics

Conclusion

Footnotes

About the Author Mark Dice has loved to read nonfiction books since just after he graduated High School in 1996 as he tried to figure out the world and find his place in it. Some things didn’t quite make sense to him until he learned about the powerful elite private organizations and secret societies that hold the true power in politics, banking, and the media.

After countless hours of research Mark has written several books on the subjects of secret societies, Big Brother, and the New World Order. His passion and dedication of educating others has been covered by numerous mainstream media outlets, many of which have simply attacked Mark for his beliefs that a global criminal mafia called the Illuminati operates under the cover of various organizations and manipulate political and financial arenas, slowly eroding the Constitution and America’s sovereignty and leading us into a New World Order. Mark Dice believes that the Illuminati are fulfilling Bible Prophecy by creating a global government called the New World Order, that will one day be the infrastructure that the Antichrist will use to become a global dictator. He also believes that the New World Order promotes immorality, selfishness, materialism, and purposefully aims to keep the population entertained with television and issues of little significance in order to separate them from the political process, thus allowing the Illuminati to operate without much opposition. Whatever religion you are, or if you consider yourself agnostic or atheist, you will find the information Mark brings forth in his writings to be extremely thought provoking and enlightening. Through his books, radio interviews, and YouTube videos, Mark hopes people will become enlightened to the hidden realities of the New World Order, and can more effectively manage their lives after becoming aware of the agendas and mechanisms used to keep people mentally enslaved. Mark is a nondenominational Christians and has respect for a wide variety of faiths and belief systems. He has a bachelor’s degree in communication and lives in San Diego, California.

Introduction The world is changing at a faster pace every day. New technologies, new social trends, new threats and fears, new governmental regulations and laws, and new media content and entertainment to keep us amused for hours

on end. While it is easy to notice the fun and new benefits that this rapidly advancing world has to offer us, we are often too caught up in the moment to notice the things that are falling by the wayside and getting lost to history. “The good old days,” as some call it. With every step that civilization seems to take forward, it also seems to leave behind qualities that are universally accepted as better, but were unable to remain because “times are changing.” One thing that hasn’t changed is basic human nature. If we look back at history, thousands of years ago people were having the same basic struggles that they are having today. Struggles with health, money, and relationships; the three major categories to which nearly every human problem can be traced. Humanity’s needs have not changed, despite the dramatically different landscape and culture we find ourselves living in today. People have always struggled against oppressive and tyrannical leaders who use their power to take advantage of others. People have worked to provide themselves and their family with enough food and shelter so that they can avoid the harsh conditions that life without such things entails. And people have tried to remain healthy and hoped to avoid or cure sickness and disease. History has noted several major life-changing revolutions in mechanics and technology that altered the landscape of societies forever. The agricultural revolution allowed people to grow and store food on a massive scale and sell it to others who, as a result, did not have to grow their own food, leading to labor diversification and specialization. The industrial revolution introduced mechanical devices allowing people to build and use machines that could do the work of hundreds of people and have strength and power beyond what a human workforce could produce, forever altering agriculture, mining, manufacturing, and transportation. The digital revolution, or the information age of computers and mass communication allowed instant access to information of nearly any kind from around the world with the push of a button. We have also seen humanity grow from tribes to villages, and to cities, states, and countries. Proponents of what is called the New World Order believe that a global government is the next evolutionary step in civilization. While international agreements and cooperation between

countries around the world is needed to ensure peace and facilitate economic activities, what is disturbing is that the proponents of the New World Order have been planning and implementing their agreements in secret—often denying such plans were in the works—until agreements were finalized and no public scrutiny was given. The elite groups and individuals involved in this planning see themselves as the rightful masters of the universe and are shaping the world to fulfill their own selfish and twisted desires. Leadership circles throughout history have known how to control large populations of people through various means, many of which are underhanded and ruthless. Fear, threats, propaganda, appeals for blind patriotism and allegiance to the leadership or the country, are all strategies that continue to be used to keep the population as a whole in line and allow the current power structure to continue to operate unopposed. In today’s society, particularly in America, most people simply don’t care about politics or what is happening in Washington DC. There are, however, measurable numbers of those dedicating themselves to watchdog and activist groups who work as a check and balance system to the power structure and sometimes have measurable effects in regards to preventing certain legislation from being passed or fighting to repeal certain laws or practices that have been enacted which are unconstitutional or unfair. While many of these groups and their members mean well, they are often only aware of the tip of the iceberg of what shapes the political landscape. For those who truly seek to understand the power structure of the political world, if they look hard enough, or are lucky enough, they inevitably find the proverbial rabbit hole that leads them to discover the reality that secret societies and elite private organizations largely pull the strings and contain networks of power whose members and policies are directly responsible for corrupt and unfair legislation, nearly every major war, economic collapses, and other world altering events. Some of these organizations, such as the Council on Foreign Relations, appear on the surface to be some sort of government entity, but in reality are private organizations which yield tremendous influence over the White House and Congress. Other organizations, such as the Bilderberg group and

the Skull and Bones society are more secretive, yet when we look at the membership of such organizations and the activities these members have been involved in, it becomes clear that these groups provide the financial, personal, and logistical support to get their agendas to become realities. These agendas are frequently anti-American, unconstitutional, unfair, and completely counter to the interests of the vast majority of the population. The members of these groups put on a face of public servants and fighting for the little people, yet their allegiance is to their wealthy friends and business associates. These organizations are not merely social clubs, but are highly organized, well-funded and motivated policy makers, essentially, who operate without any oversight or checks and balance systems. The activities of such groups should take place in the halls of Congress and be open to public scrutiny, yet they have lurked behind the scenes for decades with little awareness or opposition. After even a minimal amount of investigating and research into the secret societies and private organizations such as Skull and Bones, the Bilderberg group, and the Bohemian Grove, it becomes obvious that the mainstream media is working in collaboration with such organizations in order to do everything in their power to prevent even the mere mentioning of such groups from making it on the airwaves or in print. Surely after over fifty years of Bilderberg group meetings, major television stations and newspapers would at least attempt to cover such an event, but year after year, there is usually not a single mention of it by the establishment press. Speculation and conspiracy theories aside, surely it is at least interesting that such an event occurs with such powerful politicians, business leaders, media moguls, and royalty, and should warrant some kind of coverage. Every time the G-20 meets or a similar economic forum consisting of the leaders of the world’s most powerful countries, it’s the top story around the world, yet practically the only coverage of the Bilderberg meetings comes from smaller freelance journalists and websites, or perhaps an occasional European newspaper article. Only a fool could claim that such repeated blackouts are because the event is not news worthy. And only a fool can say that there is not a secret agreement between the American mainstream media owners and the Bilderberg group itself, where the two entities have

agreed that editors will act as gate-keepers and kill any story by any reporter who even attempts to cover the event. This is largely how the New World Order was able to be created without much opposition. It is only now after the foundation has been built and its construction is near completion that word of such a thing is mentioned publicly, as its secret creators promise it will bring a new era of world peace and prosperity. The New World Order is basically the plan to create a socialist global government headed up by one world leader and a wealthy ruling class of elite politicians and businessmen, and render the rest of the world’s population powerless peasants who are endlessly stuck in the daily grind. Everyone living in the New World Order will use a single global electronic currency, have little to no political power, and have an advanced high-tech surveillance system watching over everyone to keep them in line. Historian Webster Griffin Tarpley explains, “The New World Order is a more palatable name for the Anglo-American world empire. It’s the planetary domination of London, New York, and Washington over the rest of the world. It’s hard to get people to join that or think they have a part in it if you call it the Anglo-American world empire. If you call it the New World Order, then people in India or someplace like that, or the European [i] Union, might think, well, there’s something in there for us too.”

There are other reasons most people haven’t heard of the New World Order until recently, as well. The culture implants ideas of inferiority in us, leading many to believe that they need a new car every five years, and that they need the newest cell phone with the latest features or else they themselves are old fashioned and out of touch with the times. But what shapes the culture and creates these kinds of invisible social pressures on us? It’s largely the mainstream media: The television, films, music and magazines that continuously bombard us with their materialistic and antisocial self-destructive content. Their carefully crafted messages are absorbed subconsciously by the audience which has no idea that they are essentially Pavlovian dogs being trained how to feel and how to act. The lyrics to a popular song by the 1970s rock band Rush , eloquently illustrates this by saying:

We’ve taken care of everything The words you hear, the songs you sing The pictures that give pleasure to your eyes It’s one for all, all for one We work together, common sons Never need to wonder how or why This song, titled The Temple of Syrinx , is sung from the perspective of the rulers of a fictional world where the elite leadership enjoy all the pleasures of life, while the masses of people live in servitude. This book is by no means a complete analysis of the New World Order and the people, institutions, secret societies, and ideologies involved in its creation and control. My book The Resistance Manifesto (2005, 2008) provides a thorough analysis of these issues, and lays a solid foundation of understanding that this book builds upon. This book contains additional material and focuses on more modern issues and activities involving the New World Order. If one has not read The Resistance Manifesto , I strongly advise you to do so as soon as possible, because that book will take you further down the rabbit hole than you can imagine. The Illuminati, the Bohemian Grove, Satanism, the spiritual beliefs, histories, and goals of the secret societies and elite organizations involved in creating and maintaining the New World Order are covered in detail. If you have not yet read the manifesto, do not worry, because your desire to learn the truth about this world will find nourishment with the book that is in your hands. Some of your suspicions will be confirmed with the information you find within these pages, and some things you will discover will be hard to believe. Once you have fallen down the proverbial “rabbit hole” nothing is as it seems, and it can be difficult at first to determine what is real and what is not. My book The Illuminati: Facts & Fiction has over four hundred pages of information separating some of the wild speculation

and fraudulent information from the facts regarding the Illuminati secret society, if you wish to continue on the path of discovery you are now on. In The New World Order , we will look at modern political policies that are being pushed or implemented in regards to the New World Order, as well as various social and cultural issues such as the population reduction agendas of the elite and the destruction of family values and morality that the mainstream media is helping to perpetuate. Other issues involving science and technology such as weather weapons, vaccines, and pharmaceuticals will be addressed as well. Let’s face it, there is plenty to be worried about concerning the New World Order. With the countless examples of declassified government operations and experiments involving chemical and biological agents, advanced technology, false flag terror attacks, COINTELPRO, sabotage, elite politicians involved in occult secret societies and participating in bizarre rituals at the Skull and Bones headquarters in Connecticut or in the forest at the Bohemian Grove, people can get very distraught over this information, and even paranoid. Some of the paranoia is completely understandable. With all of the proven cases of evil and corruption, when someone first hears of yet another instance that is along the same lines, it doesn’t surprise them that such a thing would be happening, and so sometimes they just simply believe it and start passing the information on to their friends and families thinking that it is true. Some of this false information is posted on the Internet by people who really do mean well, and just jump to conclusions about certain news events or rumors they hear, and get all worked up over them, when if they took a calmer approach and spent a little bit of time fact checking they could realize that their initial assumption was incorrect. A small number of people who are interested in learning about the New World Order are mentally ill people, or are prone to mental illness, and the information they discover in books, videos, and on the Internet, is so overwhelming that they can’t adequately deal with it and it serves as a catalyst sparking their illness. The establishment loves to highlight these rare individuals or others with wildly bizarre views concerning the New World Order, so that they may serve as a straw man as they are presented to

a mainstream audience to show that “all” people who talk about the New World Order or secret societies pulling the strings in major world events are “crazy” and should be ignored or ridiculed. To illustrate how people involved in researching this kind of material may jump to conclusions, I will explain two instances involving emails to me or posts on my Facebook page (Facebook.com/MarkDice). One email I received read, “The ATM machine that I use, at the local Quik-Chek convenience store here in northern New Jersey, has read: ‘Temporarily Out of Service’ for the past six days. Is anyone else seeing similar outages?” Clearly this individual is paranoid, thinking that because one ATM is out of service that there must be a national outage as some plot to prevent people from getting cash. Now, in his defense, it certainly is likely that someday large numbers of ATMs in multiple cities, or perhaps the entire country will be out of commission due to a cyber attack, so his fear is not completely unwarranted. The fact that he posted such a question for other Facebook users to give their feedback on to either confirm or deny that such a thing was happening in other cities shows the level of fear and suspicion this person has in his mind. An ordinary person or someone who isn’t so paranoid would have just assumed the machine hadn’t been fixed yet because the high school dropout working at the store making minimum wage couldn’t care less about calling the company to tell them their machine was broken. Another example also comes from my personal Facebook page where a woman posted a comment and also emailed me asking me about a friend request she had gotten from “Nathan Rothschild.” The Rothschild family, for those who don’t know, have long been involved with the elite Illuminati secret society, so when this woman got a friend request from someone with that name, she got a little worried. As it turns out, just as I immediately suspected as soon as I read her email, someone had created a page as a satire pretending to be Mr. Rothschild and listed references to wanting to take over the world and enslave humanity on the “interests and activities” section. Such a practice is actually fairly common. When this woman was told this by another Facebook friend, she emailed me back telling me not to worry about it and that, “The Rothschild page was just a parody...Jason

Bermas told me. Sorry I was freaking out. I didn’t sleep well last night. Maybe tonight will be better. My mind can rest again.” Many people often fear that one day soon they are going to get rounded up by police or military and taken to a FEMA concentration camp because they know too much, or they listen to Alex Jones’ radio show and they’ve been tracked by the government using Carnivore or Echelon, and they’re on a government watch list, or they’ve ordered several books from Amazon.com about the Illuminati or the New World Order, and so now the establishment sees them as a threat. Again, some of their suspicions and fears are justified, yet fears like this tend to be overblown and fanciful. A measurable amount of suspicion and even perhaps worry is healthy, but so is balancing it with skepticism and fact checking. People who find the proverbial rabbit hole often say that they can never look at the world in the same way, or live the same way ever again, but I strongly urge you not to turn your back on other important aspects of your life such as your family, friends, career, and fun hobbies. It is good to be aware of issues that are found within this book, but you must not let them cripple you with fear. By being aware and making others aware in a calm and rational manor, collectively we can help minimize or prevent major injustices from occurring simply due to massive grass roots resistance to such things, but you must guard your mind against becoming paranoid over such things or jumping to conclusions. My goal with this book is to give you the reader tangible evidence of a corrupt and out of control government and what the secret establishment has done, and what they are hoping and planning on doing in the future and how it will affect you. It is also my hope that with the information I bring forth in my books that you the reader can have a better understanding of the who, what, and why in our world, so that you and your family and friends can live more happy, healthy, and productive lives. It is not my intention to scare you, although some of the information is horrifying. “All I’m offering you is the truth,” as Morpheus told Neo in The Matrix . And what you see will be what was right in front of you the whole time, you just weren’t aware of it until now.

What most people think are examples of an out of control bureaucracy, are of little significance compared to the abuses of power and the freedomdestroying policies being implemented by politicians who are bought by the secret establishment. Paying too high of taxes or getting a ticket from a red light camera pale in comparison to the gross injustices that are occurring on a massive scale. Without large numbers of citizens resisting and voicing their disgust over proposed policies, we would be in a much worse situation with far fewer freedoms, but as we are coming to realize, often it doesn’t matter how loud the outcry is against a particular issue, the mainstream media is able to limit the exposure to the masses or attack those voicing the opposition to minimize their effectiveness. We have also found that large numbers of politicians will vote whatever way their owners tell them to, no matter how much they betray the people in their state or districts. The secret establishment offers them more benefits than they could imagine in the form of cash, power, and privileges. Many are compromised and blackmailed into doing what the secret establishment wants. Their extramarital affairs, illegal activities, and personal perversions are often known and documented by the establishment, and when the time arises such things are held over their head and used to coerce them to act in ways that seem contrary to logic. As the pieces of the puzzle are assembled one by one, a clear picture begins to emerge. The corrupt leadership that has weaseled their way to the pinnacles of power are doing their very best to create a New World Order where an untouchable elite is able to live lavish lifestyles and fulfill their every perverted desire, while the majority of the public is being kept occupied and out of the way by issues of celebrity drama or professional sports. The wealthy business titans have worked hand in hand with politicians to ensure that their wealth remains concentrated in the hands of their families for endless generations as they own and control the banks, vast real estate, and the infrastructure society depends on to function. These men will stop at nothing to maintain their power and wealth, and certainly wouldn’t blink an eye when stealing the retirement savings of good hard working people, encouraging immoral and reckless behavior in

society, particularly the youth, or even killing billions of people in a global genocide. This is the New World Order.

Calls for a New World Order It’s interesting that the term, “New World Order,” is not just some idea coined by conspiracy theorists to describe changes in the organization and distribution of wealth and power in the world, but is instead a term used by elitist politicians to describe their own philosophy and plans. We don’t really need a “New World Order” to ease or eliminate world hunger, mass genocide, human trafficking, or political oppression. The elitists who are in power and whose organizations support their power are the ones responsible for such horrific conditions existing on the earth. No all-powerful global government is needed to stop these things. When the term is used by politicians, what they really mean is that they want a larger bureaucracy, bigger government, more regulation, higher taxes, and they want the government to direct and control more aspects of people’s lives. They often include beautiful catchphrases of hope, peace, and change, in with their New World Order dreams, sounding like Miss America contestants wishing to end world hunger or bring about world peace. They are simply good sounding ideas with no real strategies or desire to strive for such changes and are used as a cover story to conceal their true motives. But people like things that are new. New cars, new clothes, new technologies, traveling to new places, and having new experiences. Often something new is appealing simply for the novelty of it, and the experience of change. After all, there is always room for improvement in most people’s lives. Very few people are satisfied with the fact that they have to work until the age of 65, and only enjoy perhaps two weeks of vacation a year and by the time they reach their mid-sixties, may not even have accumulated enough assets or resources to quit working, so claims of prosperous changes and a new era of abundance and economic prosperity always sound good to the average Joe, who is simply a lifetime slave to the system.

For decades, a small minority of Americans and people around the world knew of the elite’s plans for a New World Order, and had frequently tried to warn others that such a plan was in the works. And, for decades, they were frequently ignored or faced with doubts and ridicule, but as time went on, in the late twentieth century and escalating into the twenty-first century, major global political figures had begun publicly mentioning their hopes and plans for a New World Order. Even political pundit and former campaign manager for Bill Clinton, Dick Morris, admitted during an interview on the Fox News Channel that, “Those people who have been yelling the UN [United Nations] is going to take over…global government, they’ve been crazy…but now…they’re [ii] right.”

Barack Obama 44th President of the United States Barack Obama traveled to Berlin, Germany when he was running for President in 2008, where he said, “Tonight, I speak to you not as a candidate for President, but as a citizen — a proud citizen of the United States, and a fellow citizen of the world.” On an appearance on David Letterman’s show, Obama was talking about the problems with the War in Iraq, and said, “the way we’re going to win in the long term is not just militarily…we’ve got to give them a stake in creating the kind of world order that I think all of us would like to see.”

Nancy Pelosi Speaker of the House at the opening of the 110th Congress on January 4th 2007. “Our Founders envisioned a new America driven by optimism, opportunity, and courage. So confident were they in the new America they were advancing, they put on the great seal of the United States, ‘Novus ordo seclorum’—a new order for the ages…This vision has sustained us for more

than 200 years, and it accounts for what is best in our great nation: liberty, opportunity, and justice. Now it is our responsibility to carry forth that vision of a new America.”

George H.W. Bush 41st President of the United States “Out of these troubled times, our fifth objective – a New World Order – can emerge: a new era – freer from the threat of terror, stronger in the pursuit of justice, and more secure in the quest for peace. An era in which the nations of the world, East and West, North and South, can prosper and live in harmony. A hundred generations have searched for this elusive path to peace, while a thousand wars raged across the span of human endeavor. Today that new world is struggling to be born, a world quite different from the one we’ve known.”

Gary Hart Former Senator (D) Colorado and Co-Chair of the CFR Just three days after the 9/11 attacks, the co-chair of the Council on Foreign Relations stated, “There is a chance for the President of the United States to use the disaster…to carry out what his father – a phrase his father used I think only once, and it hasn’t been used since – and that is a New World Order.”

Henry Kissinger Former Secretary of State Henry Kissinger has been intimately involved with nearly every major organization or front group that is behind the push for a New World Order and was originally named the Chairman of the 9/11 Commission by President Bush which was set up to (pretend to) investigate the terrorist attacks on September 11th 2001. Kissinger resigned after widows of 9/11 [iii] victims discovered his business ties with the Bin Laden family.

In an interview on CNBC in February 2009, Kissinger was asked about the problems the new Obama administration was facing regarding the ongoing “War on Terror” and the economic meltdown, where he responded that Obama, “can give new impetus to American foreign policy partly because the reception of him is so extraordinary around the world. His task will be to develop an overall strategy for America in this period when, really, a New World Order can be created. It’s a great opportunity, it isn’t just a crisis.”

Bill Clinton President of the United States from 1993-2001 At the Kennedy Center in Washington D.C., President Bill Clinton was giving a speech which was broadcast on C-Span where he said, “From 1945 and the end of the war through 1989 and the end of the cold war, we had a world view, Republican and Democratic presidents alike, from Harry Truman to George Bush…and after 1989 President Bush said, and it’s a phrase that I often use myself, and that is we need a New World Order.”

Richard Nixon President of the United States from 1969-1974 In the October 1967 edition of Foreign Affairs; (which is the Council on Foreign Relations publication) then president Richard Nixon said that, “The developing coherence of Asian regional thinking is reflected in a disposition to consider problems and loyalties in regional terms, and to evolve regional approaches to development needs and to the evolution of a New World Order.”

Angela Merkel Chancellor of Germany When giving a speech to mark the 20th anniversary of the fall of the Berlin Wall, the German Chancellor Angela Merkel said, “The most important thing, when attempting to overcome barriers, is: Are the nation states ready

and willing to give competencies over to multilateral organizations, no matter what it costs?…This world will not be a peaceful one if we do not [iv] work for more global order and more multilateral cooperation.”

Tony Blair British Prime Minister from 1997-2007 Tony Blair has publicly stated his desire for a New World Order on multiple occasions, once even saying, “There is a New World Order like it or not.” [v]

[vi]

[vii]

He used the term on November 12, 2001

and in 2002

and again [viii]

on January 7, 2003,

just to name a few.

Gordon Brown Prime Minister of England Gordon Brown at the 2009 G-20 meeting in London, England called for a New World Order to save the global economy from the recession sparked in 2008 by the housing collapse. He said, “I think the New World Order is emerging, and with it the foundations of a new and progressive era of international cooperation.”

Pope John Paul II Head of the Catholic Church On January 1, 2001 the pope declared at a service to mark the Roman Catholic Church’s World Day of Peace, that, “More than ever, we need a new international order that draws on the experience and results achieved in these years by the United Nations.” The headline in the London Guardian [ix] read, “Pope Calls for a New World Order.”

World Governed by the Elite Through Occult Secret Societies For anyone who takes an in-depth and unbiased look at the political process and geopolitics, the role of secret societies and elite secretive private organizations masquerading as government entities or committees, truly hold the keys to power and function as a good old boy network consisting of a small number of elite politicians and businessmen who shape the political landscape and who either are the movers and shakers seen in the mainstream media, or are the brains and puppet masters behind those who we view publicly as the popular ones. For a more complete list and analysis of these secret societies and elite organizations, you will find it in this author’s previous book titled, The Resistance Manifesto . You may already be familiar with many of these organizations, but even if this information is completely new to you, you will begin to develop a clear picture of just how the power structure of politics truly looks. Benjamin Disraeli, a British Prime Minister in the 19th century famously stated, “The world is governed by very different personages from what is imagined by those who are not behind the scenes.” These powerful groups are numerous, such as the Bilderberg group, the Council on Foreign Relations, the Skull and Bones society, the Freemasons, the Bohemian Grove, and more. The Bilderberg group meets once a year under tight security where powerful politicians, bankers, businessmen, media moguls and royalty meet to secretly discuss and disseminate their agenda for the coming months and years. The Council on Foreign Relations, which sounds like a committee in Congress, is actually a private organization used to spread New World Order propaganda and push the Bilderberg’s wishes into law. The Skull and Bones society is a recruiting center at Yale University that operates as a fraternity which invites college juniors who the organization feels will later

rise to positions of power and prestige in their career, and then grooms them and gives them access to the organization’s incredible post-graduate social network. The Bohemian Grove acts as a vacation spot where hundreds of these elite men meet in private in the rural setting of a resort built in a redwood forest grove, where they talk informally without the fear of being quoted in the press. This is also a place where they engage in bizarre rituals and sexual debauchery. The inner circles of many of these organizations often overlap each other with people involved in multiple organizations at the same time. This inner circle of elite leaders is often referred to as the Illuminati, which is a term used to identify this group of organized criminals and means “enlightened ones.” President John F. Kennedy once made a profound and chilling statement about secret societies when speaking to the American Newspaper Publishers Association. Kennedy clearly had intimate knowledge of the workings of the Illuminati and didn’t want to go along with them. Audio of this statement is widely available on the Internet. He said, “The very word ‘secrecy’ is repugnant in a free and open society; and we are as a people inherently and historically opposed to secret societies, to secret oaths and to secret proceedings.” He continued, “We decided long ago that the dangers of excessive and unwarranted concealment of pertinent facts far outweighed the dangers which are cited to justify it…For we are opposed around the world by a monolithic and ruthless conspiracy that relies primarily on covered means for expanding its sphere of influence, on infiltration instead of invasion, on subversion instead of elections, on intimidation instead of free choice, on guerillas by night instead of armies by day.” “It is a system which has conscripted vast human and material resources into the building of a tightly knit, highly efficient machine that combines military, diplomatic, intelligence, economic, scientific and political operations, its preparations concealed, not published, its mistakes are buried not headlined, its dissenters are silenced not praised, no expenditure is questioned, no rumor is printed, no secret is revealed.”

Several months prior to his assassination, John F. Kennedy had signed Executive Order No. 11110, which attempted to strip the Federal Reserve of their power to loan money to the United States government at interest. Many see this act as the major motive for the Illuminati orchestrating his assassination. More recently, former Presidential candidate congressman Ron Paul stated, “I think there are 25,000 individuals that have used offices of powers, and they are in our Universities and they are in our Congress, and they believe in one world government. And if you believe in one world government, then you are talking about undermining national sovereignty and you are talking about setting up something that you could very well call a [x] dictatorship – and those plans are there.”

The idea of secretive organizations of powerful, wealthy, and intelligent men goes back thousands of years, and should come as no surprise to anyone. What is often surprising is the occult and spiritual nature of some of these modern groups, and the beliefs and rituals that members are involved in. In the ancient past when the human race was largely unaware of science and medicine, advances in these areas were extremely important and held the power of life and death. People were also largely ignorant to the spiritual principles in the world and formulated ideas about God or gods who they believed ruled over them and controlled the weather, seasons, the crops, disease, and other aspects of life. Those intelligent thinkers who pondered the workings of the spiritual world banded together and formed what were called the Mystery Schools, which were essentially secret societies that taught these principles to its members in the form of philosophies, symbols, allegories, and rituals. The preface for The Secret Teaching of All Ages , which is one of the most popular and comprehensive books on the Mystery Schools and their teachings, reads, “It was inevitable that the initiates of the Mysteries should unite themselves against the forces seeking their extinction. Thus, while the secret doctrine with its body of disciples functioned more or less openly in ancient society, it later passed almost completely from public view. This circumstance should not be interpreted as a decline of plan or purpose. The esoteric schools remained as a powerful force for the regeneration of human

institutions…The use of indirect communication was based entirely upon practical considerations. To remain unknown was the best way to prevent a [xi] repetition of the disaster which occurred to the Knights Templar.”

Manly P. Hall, the author of The Secret Teachings of All Ages was under the impression that Mystery Schools in ancient days taught men morals, fairness, and philosophies to make them better people, and were not evil, dangerous, or devious in any way. Hall and some other New Age authors are under the impression that the Mystery Schools had been hijacked and taken over by greedy and immoral men. Certainly it is understandable that the members of such schools who were on the cutting edge of advancing knowledge in science, mathematics, and medicine could develop a superiority complex and use their knowledge and social networks to take advantage of others who were uninformed. Hall believes, “[T]he black magicians of Atlantis continued to exercise their superhuman powers until they had completely undermined and corrupted the morals of the primitive Mysteries. By establishing a sacerdotal [meaning priesthood] caste they usurped the position formerly occupied by the initiates, and seized the reins of spiritual government. Thus black magic dictated the state religion and paralyzed the intellectual and spiritual activities of the individual by demanding his complete and unhesitating acquiescence in the dogma formulated by the priest craft…These sorcerers then began the systematic destruction of all keys to the ancient wisdom, so that none might have access to the knowledge necessary to reach adeptship [xii] without first becoming one of their order.”

Alice Bailey, a famous New Age author in the twentieth century, wrote material openly explaining how occult secret societies held the true power in the world, not to expose their activities with hopes of informing the population, but rather her books were written for elite businessmen, politicians, and spiritual leaders. In her book The Externalization of the Hierarchy , she explains, “The Masonic Movement when it can be divorced from politics and social ends and from its present paralyzing condition of inertia, will meet the need of those who can, and should wield power. It is the custodian of the law; it is the home of the Mysteries and the seat of

initiation. It holds its symbolism the ritual of Deity, and the way of salvation is pictorially preserved in its work. The methods of Deity are demonstrated in its temples, and under the All-seeing Eye the work can go forward. It is a far more occult organization than can be realized, and is intended to be the training school for the coming advanced occultists. In its ceremonials lies hid the wielding of the forces connected with the growth and life of the kingdoms of nature and the unfoldment of the divine aspects [xiii] in man.”

Bailey’s writings and other occultists such as Helena Blavatsky, who wrote The Secret Doctrine (1888) are held in the highest regard by the establishment, and explain the philosophies and plans of elite secret societies quite openly. The information is considered hidden in plain sight and is mostly only found by those who have a desire to join the establishment. Most people, if they even read books at all, are only concerned with the latest pop culture novels anyway, and don’t have the desire, nor the mental capacity to understand the esoteric philosophies and plans that are written openly in occult books, such as Alice Bailey’s or Helena Blavatsky’s. Bailey openly admits, “The Hierarchy directs world events, as far as mankind will permit…the unfolding consciousness may express itself through developing and adequate social, political, religious and economic world forms. They give direction; They throw a light; They impress those who are in contact with Them, and through the inflow of ideas and through [xiv] revelation They definitely influence the tide of human affairs.”

She goes on to write, “The Hierarchy directs and controls, more than is realized, the unfolding cyclic cultures and their resultant civilizations. These can then provide adequate forms, temporarily useful for the emerging soul humanity. The format of cultures and civilizations receives special [xv] attention.”

This Hierarchy that she is talking about is the continuation of the ancient Mystery Schools, such as Freemasonry and the Illuminati.

In the most popular Masonic book ever written, Morals and Dogma , author Albert Pike brags, “The World will soon come to us for its Sovereigns [meaning government leaders] and Pontiffs [meaning religious leaders]. We shall constitute the equilibrium of the Universe, and be rulers over the [xvi]

Masters of the World.”

This book was published in 1872 and is considered the bible of Freemasonry. Freemasonry is often included in discussions about the New World Order, a charge many Masons dispute. Many Freemasons deny any claims that their organization is involved in anything other than charity work, a social club, and a method to teach enlightenment philosophies, but these Masons are either trying to keep the inner circle of Freemasonry from being discussed openly, or are themselves ignorant that the secret society they are a member of has another secret society functioning within. Manly P. Hall, who is considered one of Freemasonry’s greatest philosophers and a 33rd degree mason admits, “Freemasonry is a fraternity within a fraternity—an outer organization concealing an inner brotherhood of the elect…It is necessary to establish the existence of these two separate yet interdependent orders, the one visible and the other invisible. The visible society is a splendid camaraderie of ‘free and accepted’ men enjoined to devote themselves to ethical, educational, fraternal, patriotic, and humanitarian concerns. The invisible society is a secret and most august fraternity whose members are dedicated to the service of a [xvii] mysterious arcanum arcandrum [meaning a secret or a mystery].

In Morals and Dogma Albert Pike reveals that Masons who are “in the know” about the true beliefs and activities of Freemasonry, would never reveal them to anyone. “Masonry, like all the Religions, all the Mysteries, Hermeticism and Alchemy, conceals [emphasis in original] its secrets from all except the Adepts and Sages, or the Elect, and uses false explanations and misinterpretations of its symbols to mislead those who deserve only to be misled; to conceal the Truth, which it [the Mason] calls Light, from [xviii] them, and to draw them away from it.”

Again, those in the lower levels of Freemasonry will deny that the organization is anything more than a fraternity, but Pike and others openly admit that it is a religion. “Every Masonic Lodge is a temple of religion; [xix] and its teachings are instruction in religion.”

The original writings of Adam Weishaupt, the man credited with starting the original Illuminati in Germany in 1776 had his and others secret letters discovered and seized by authorities in 1786 and when they are read, it becomes clear that he formulated specific goals and strategies for his network to occupy positions of power and privilege and operate without the public’s knowledge. His attitude is the same as that reflected in the writings of Albert Pike, although more diabolical because Weishaupt never intended them to be seen by anyone other than Illuminati members. Weishaupt wrote, “I shall therefore press the cultivation of science, especially such sciences as may have an influence on our reception in the world; and may serve to remove obstacles out of the way…Only those who are assuredly proper subjects shall be picked out from among the inferior classes for the higher mysteries…And in particular, every person shall be made a spy on another and on all around him.” “Nothing can escape our sight; by these means we shall readily discover who are contented, and receive with relish the peculiar state-doctrines and religious opinions that are laid before them; and, at last, the trustworthy alone will be admitted to a participation of the whole maxims and political constitution of the Order.” “In a council composed of such members we shall labor at the contrivance of means to drive by degrees the enemies of reason and of humanity out of the world, and to establish a peculiar morality and religion fitted for the great Society of mankind.” Weishaupt never intended his correspondence or network to become public, but in the years that passed, the Illuminati’s philosophies and goals have obviously been carried on by men who share the same vision outlined and developed by Weishaupt in 1776.

In 1966 a professor and elite insider at Princeton University named Carroll Quigley published a book titled Tragedy and Hope , which openly admits that a network of secret societies hold the true power in politics and banking. The book was meant for other elitists as a way to teach them how the world really works. Quigley wrote, “The chief problem of American political life for a long time has been how to make the two Congressional parties more national and international…(therefore the) argument that the two parties should represent opposed ideals and policies, one, perhaps, of the Right and the other of the Left, is a foolish idea acceptable only to doctrinaire and academic thinkers…Instead the two parties should be almost identical, so that the American people can ‘throw the rascals out’ at any election without leading [xx] to any profound or extensive shifts in policy.”

One might wonder why he would openly admit that it didn’t matter which political party, Republican or Democrat, was in power since the leadership of both will work in concert with the secret agenda to create the New World Order, but Quigley and other elite insiders know that the majority of the public would never even think of reading his book, and instead read novels about vampires (the Twilight Series) or young sorcerers (Harry Potter). In October 2009 a YouTube video was posted of Obama’s White House communications director Anita Dunn speaking to a group of students where she told them that her favorite political philosopher is Mao Tse Tung, the Chinese Communist revolutionary responsible for the murders of millions of Chinese during his reign. Most of the students probably didn’t even know who Mao Tse Tung was, or the atrocities he committed, but Dunn’s admiration for the dictator shows the mindset of the New World Order’s leadership circle. Another interesting video clip giving a glimpse into the minds of modern elite politicians comes from Ron Bloom, Obama’s manufacturing czar. At a forum for the Union League Club in New York City which took place on February 27th and 28th in 2008, Bloom told attendees, “Generally speaking, we get the joke. We know that the free market is nonsense. We know that the whole point is to game the system to beat the market, or at least find

someone who will pay you a lot of money because they’re convinced that there is a free lunch. We know that this is largely about power. That this is an adults only, no limit game. We kind of agree with Mao that political power comes largely from the barrel of a gun. And we get it, that if you want a friend you should get a dog.” Some say he was saying such comments in jest, while others insist the comments reveal the actual beliefs of the secret establishment. The modern organizations that are shaping the New World Order have carried on the tradition of the ancient Mystery Schools by elevating themselves and their members above the rest of society through their good old boy networks, control of the mainstream media, and their influence over politicians through bribes, coercion, and in some cases blackmail. They have done a great job of keeping the general public distracted with sports, pop culture, and issues of little significance, while they make and implement decisions that negatively affect us all. Establishment insiders become arrogant, selfish, and corrupt and while politicians masquerade as “public servants,” they really only serve themselves and their partners in crime. They are very often Luciferians or Satanists which means that they identify Satan or Lucifer as being a hero for breaking the rules and doing what he wants. Whether their “worship” of Satan is literal or metaphorical is debatable, but what is not debatable is that they privately philosophically see Satan as a source of good, knowledge, and wisdom and systematically break the golden rule of life while thinking only of themselves and having no regard for the thoughts, feelings, or rights of others. Helena Blavatsky wrote openly in The Secret Doctrine that, “Satan will now be shown, in the teaching of the Secret Doctrine, allegorized as Good, [xxi]

and Sacrifice, a God of Wisdom,”

and this is what these people believe. If this concept is new to you, it is quite shocking, and perhaps unbelievable, but when you come to understand more of this philosophy, it becomes undeniable that most of the inner circle of the Illuminati establishment and their subsidiary networks are Luciferians or Satanists. They believe, as most

occultists do, that Lucifer and Satan are symbolic of knowledge and intelligence, and that humans were nothing but ignorant animals until Satan came to the Garden of Eden and “set Man free” by convincing Adam and Eve to eat from the tree of knowledge of good and evil. This may just be an allegorical belief which the elite use to convince themselves and their collaborators that there is no afterlife, no Heaven or Hell, and thus they have decided to live the high life here and now and will take all they can get no matter how unfair or how many people get shortchanged, hurt, or killed as a result. Since in their mind there is no judgment by God for their sins after their death because they believe we are just advanced animals, they see nothing holding them back from doing whatever they want. The fact that most elite politicians, businessmen, and bankers are members of organizations like the Skull and Bones society, and enjoy visiting the Bohemian Grove and participating in, or viewing what can only be described as human sacrifice reenactment rituals using effigies, shows that these individuals revel in the fact that they are considered the “evil rulers of the world.” Their satanic world view and philosophy is really no different than the Jewish Pharisees who held a monopoly on spiritual knowledge and used it for their own personal benefit at the expense of those less informed. One of the main themes taught by the story of Jesus in the New Testament is that He represents God in human form, who came to earth to allow everyone a direct line to, and knowledge of God and the Kingdom of Heaven. Barrack Obama has quoted lines from Communist Saul Alinsky’s book Rules for Radicals during his speeches when he was running for president in 2008 and Hilary Clinton wrote her college thesis on Alinsky when she [xxii]

was at Wellesley College.

It’s interesting to note that in the Dedication page of his book, Alinsky pays tribute to the people he saw as past “radicals,” and lists them off, and then writes, “Lest we forget at least an over-the-shoulder acknowledgment to the very first radical: from all our legends, mythology, and history...the first radical known to man who rebelled against the establishment and did it so effectively that he at least won his own kingdom — Lucifer.”

Hollywood producer Aaron Russo became politically active later in his career and in 2006 did a sit down interview with Alex Jones from Infowars.com where he described his friendship with Nick Rockefeller and the insider information he revealed to him. The Rockefeller family, for those who don’t know, have been at the core of the New World Order for generations and have used their family’s enormous wealth and influence to move the agenda for the New World Order from the secret meetings of the Bilderberg group and other informal gatherings, into the minds of globalist politicians and businessmen. The Rockefeller family and their “non-profit” foundations have their fingerprints on nearly every aspect of the New World Order. In this amazing interview that Aaron Russo gives, he explains that Nick Rockefeller had befriended him after seeing his film Mad as Hell and learning that Russo was running for governor of Nevada in 1998. Apparently Rockefeller thought that Russo may be of service to their agenda, even suggesting that he join the Council on Foreign Relations. Throughout the course of their meetings as their relationship progressed, Rockefeller revealed some startling insider information to him. “He was the one who told me 11 months before 9/11 that there was going to be an event, never told me what the event was going to be, but there was going to be an event, and out of that event, we would invade Afghanistan to run pipelines from the Caspian Sea; We were going to invade Iraq to take over the oil fields and establish a base in the Middle East and make it all part of the New World Order; and we’d go after Chavez in Venezuela…and there’s going to be this War on Terror, of which there is no real enemy and the whole thing is a giant hoax, but it’s a way for the government to take over the American people,” Russo explained. “9/11 was done by people in our own government and our own banking system to perpetuate the fear of the American people into subordinating themselves to anything the government wants them to do. That’s what it’s about; and to create this endless War on Terror. Look, this whole War on Terror is a fraud. It’s a farce. It’s very difficult to say it out loud because people are intimidated against saying it, cuz if you say it they want to make you out to be a nutcase.”

Russo goes on to say that Rockefeller conveyed to him that the endgame was to get the entire population chipped with RFID tags and that the global economy would be controlled by elite banksters and politicians. Russo recalls that Nick asked him what he thought woman’s liberation was about, and after he answered the conventional answer about women’s rights and equal pay, he says Nick laughed at him and called him an idiot and went on to inform him that the Rockefellers funded the women’s liberation movement for two major reasons. One was because only half of the population was being taxed, since primarily only the men worked, and the second reason was to break up the family so the state can have more time with children to indoctrinate them. He also says that Rockefeller thought the world’s population should be reduced by half. Russo didn’t have the same world view as his friend, and did not become involved in the globalist organizations that have covertly established the New World Order system. In 2006 he produced America: Freedom to Fascism which discusses the Federal Reserve Banking system, the IRS income tax, VeriChip RFIDs, and other political issues. Russo died on August 24, 2007 from cancer at the age of 64. Another, more powerful member of the Rockefeller family, David Rockefeller, wrote in his 2002 book, Memoirs on page 405, “For more than a century ideological extremists at either end of the political spectrum have seized upon well-publicized incidents such as my encounter with Castro to attack the Rockefeller family for the inordinate influence they claim we wield over American political and economic institutions. Some even believe we are part of a secret cabal working against the interests of the United States, characterizing my family and me as “internationalists” and conspiring with others around the world to build a more integrated global political and economic structure—one world, if you will. If that’s the charge, I stand guilty, and I am proud of it.” “The anti-Rockefeller focus of these otherwise incompatible political positions owes much to Populism. “Populists” believe in conspiracies, and one of the most enduring is that a secret group of international bankers and capitalists and their minions control the world’s economy.”

David Rockefeller is one of the grandchildren of John D. Rockefeller, the founder of Standard Oil, and at the time when he lived, John D was the richest man in the world. David Rockefeller has had his hands in nearly every major New World Order organization in existence in the twentieth and twenty-first centuries. In fact, he is the founder of the Trilateral Commission and was once the Chairman of the Council on Foreign Relations. He also attends nearly every Bilderberg meeting. At the time of [xxiii]

this writing, David Rockefeller (senior) is 94 years old.

He has a son, David Rockefeller Jr., who sits on the boards of numerous Rockefeller foundations. When looking into the wealthy secretive organizations behind the New World Order, besides the usual culprits of the Bilderberg group, the Council on Foreign Relations, Skull and Bones, and the Rockefellers, often Cecil Rhodes is mentioned. Cecil Rhodes (1853-1902) was a British born businessman who moved to Africa and became a politician and founder of the state of Rhodesia in Africa, which is named after him. There are two interesting aspects to Cecil Rhodes concerning the New World Order, most importantly his will which called for creating a secret society to function with the purpose of extending and maintaining British rule around the world. Also interesting is the fact that Cecil Rhodes was the founder of the DeBeers diamond monopoly which at one time controlled 90% of the world’s diamonds. Through a slick marketing campaign designed by Edward Bernays, the DeBeers diamond company has brainwashed most of the world’s women into feeling that they need a large diamond ring, earrings, and necklaces, or else their husband/boyfriend doesn’t love them. Men pay thousands of dollars to accommodate their woman’s desires for the stones, when in reality the value of diamonds are dramatically over-inflated simply because DeBeers won’t release most of their inventory to the public. Concerning Rhode’s will, it reads, “To and for the establishment, promotion and development of a Secret Society, the true aim and object whereof shall be for the extension of British rule throughout the world, the perfecting of a system of emigration from the United Kingdom, and of colonization by

British subjects of all lands where the means of livelihood are attainable by energy, labour and enterprise, and especially the occupation by British settlers of the entire Continent of Africa, the Holy Land, the Valley of the Euphrates, the Islands of Cyprus and Candia, the whole of South America, the Islands of the Pacific not heretofore possessed by Great Britain, the whole of the Malay Archipelago, the seaboard of China and Japan, the ultimate recovery of the United States of America as an integral part of the British Empire, the inauguration of a system of Colonial representation in the Imperial Parliament which may tend to weld together the disjointed members of the Empire and, finally, the foundation of so great a Power as to render wars impossible, and promote the best interests of humanity.” Rhodes will also created Rhodes Scholarships which are given to students who the establishment view as likely participants in their New World Order plan. President Bill Clinton is perhaps the most well-known Rhodes Scholar.

Mainstream Media Controlled by the Elite Any educated person knows, to some extent, the power of the mainstream media and its ability to shape public opinions. Some are also aware of the often pointless information it presents to the masses as if it were something if importance, as well as the complete blackout and non-coverage of issues that should often be the top story. Adding to the confusion are prominent members of the mainstream media who claim daily to actually be fighting the mainstream media. These are the Sean Hannity’s and Rush Limbaugh’s, whose very shtick involves pretending to be an alternative to the mainstream media, when they themselves are the most powerful propagandists and gate-keepers for this very establishment. Even though most radio and TV hosts will be seen as a left-wing person attacking the right-wing or vice a versa, mainstream hosts on either side of the political spectrum are very careful not to scratch beyond the surface of partisan politics and will never address the true power structure operating

behind the scenes which controls both right and left-wing politicians. Instead, these hosts will only focus on partisan issues many of which are of little significance, while they will never address key issues such as the Bilderberg group, the Skull and Bones society, the Bohemian Grove, or the Illuminati. Most national hosts are simply paid promoters of a political party who blame all of the country’s problems and misfortunes on the opposing political party, while never admitting the wrong doing or corruption of their own.

Adam Weishaupt on Media Adam Weishaupt, the man credited with founding the Illuminati secret society back in 1776, knew the power in controlling information, and in one of his original letters, he wrote, “By establishing reading societies, and subscription libraries, and taking these under our direction, and supplying them through our labours, we may turn the public mind which way we will.” “In like manner we must try to obtain an influence in the military academies (this may be of mighty consequence), the printing-houses, booksellers shops, chapters, and in short in all offices which have any effect, either in forming, or in managing, or even in directing the mind of man: painting and engraving are highly worth our care.” He and his fellow Illuminists also understood how powerful controlling newspapers could be to smear their enemies. One correspondence reads, “We get all the literary journals. We take care, by well-timed pieces [articles], to make the citizens and the Princes a little more noticed for certain little slips.” Their “certain little slips” refers to anything they say or do that will not be looked at favorably by the public, and the Illuminati’s “well timed pieces” will be sure to inform people of this if they didn’t like that person.

Professional Sports

Karl Marx, the secretary who was commissioned to type and publish the Communist Manifesto , is well known for a quote pertaining to religion where he called it the “opiate of the masses,” when in reality such a phrase accurately describes professional sports. Each weekend, as well as Monday nights during football season, millions upon millions of Americans eat, sleep, and dream about the NFL football games that are played. It’s fascinating when one is enlightened and “unplugged from the Matrix” to see these millions of zombies focusing all of their time, energy, and emotions on something so meaningless. People yell and scream at the TV, and often their entire mood in the following days is dependent upon whether their favorite team won or lost. Somehow, a bunch of over-paid muscle heads chasing a ball on a field of grass has become one of the most important events in their lives. They can discuss at length the poor strategies that lead to their team losing the game, and they can rattle of statistic after statistic of the performance of their favorite players, yet most of these people have no clue about the New World Order, or even current events. Super Bowl Sunday is basically a national holiday, and the stores and shopping malls look about as empty as they do on Christmas day. You can hear shouts and celebrations coming from neighbors homes from multiple directions as people jump up and down yelling and cursing at their television over the performance of their team. The next morning, the “Super Bowl Champions” are plastered on the entire front page of every major newspaper in the country, as if winning the game makes them heroes like they just saved a group of children from a burning building. Who is the mayor of the city they live in, many couldn’t tell you, but they can tell you the score of the Super Bowl and who won and what their favorite commercial was. The character Tyler Durden from the film Fight Club mocks such priorities by sarcastically saying, “Murder, crime, poverty, these things don’t concern me. What concerns me are celebrity magazines, television with 500 channels, some guy’s name on my underwear.”

Jay Leno’s “Jay Walking”

A hilarious and popular segment created by comedian Jay Leno, titled “Jay Walking” shows just how out of touch many Americans are with issues that really matter, and are instead able to recall details about the personal lives of celebrities or how a certain football team is doing. A popular question Jay asks people is simply, “Who is the Vice President of the United States?” It’s shocking how many people don’t know. Sometimes he even brings photos of prominent political figures or business leaders and asks people who they are. Many don’t know. He then pulls out photos of pop singers and actors, and everyone is able to instantly identify them. The segment shows in a sad yet hilarious way that pop culture and celebrities are what is important to most Americans, not reality, politics or personal finance. This author has shot several YouTube videos with similar themes including one where I got people to sign a petition to increase inflation and cause hyper-inflation, and one where I tried to sell a one ounce solid gold coin worth over $1,150 at the time for only $50, but nobody had a clue how much gold was worth and nobody wanted it. With some people I dropped the price to just $5 but the people didn’t see the point in buying the gold [xxiv] coin.

The Fairness Doctrine One of many Orwellian plans in the New World Order is the “Fairness Doctrine,” which is the idea that the government needs to control the mainstream media in order to (as they claim) attempt to present both sides of issues so that one opinion or belief does not dominate the media. There is surely nothing fair about it, and the name and the concept clearly promote unfairness and only attempts to eliminate the free market and the voices of opposition against government policies. The original Fairness Doctrine was a policy of the Federal Communications Commission (FCC) which regulates broadcast licenses, and was introduced in 1949 and required broadcasters to present controversial issues in a way the FCC viewed as balanced and honest. The doctrine was challenged in

court and in 1969 the United States Supreme court upheld the FCC’s right to enforce it, although later, in 1987 the Fairness Doctrine was abolished. Since then, a sizeable number of prominent (mostly Democrat) politicians have publicly stated their desire to have the Fairness Doctrine reinstated. The reason left-wing politicians favor such an idea is because liberals want larger government and want the government to be involved in people’s lives in every aspect. Another reason left-wingers tend to support the Fairness Doctrine is because talk radio has been dominated by conservatives, and so the liberals see the Fairness Doctrine as a way to silence or minimize the effect of right-wing radio. In June 2007, Senator Richard Durbin (D-Illinois) said, “It’s time to [xxv]

reinstitute the Fairness Doctrine,”

and around this same time, Speaker of the House Nancy Pelosi of San Francisco told reporters that her fellow Democratic Representatives did not want to forbid reintroduction of the Fairness Doctrine and later when asked point blank if she personally [xxvi] supported its revival, she answered, “Yes.”

Illuminati kingpin Bill Clinton threw his support behind reinstatement during a February 13, 2009 interview on the Mario Solis Marich radio show, where he said, “Well, you either ought to have the Fairness Doctrine or we ought to have more balance on the other side, because essentially there’s always been a lot of big money to support the right wing talk shows.” [xxvii]

U.S. [xxviii]

Representative Anna Eshoo (Democrat of California),

Senator [xxix]

Debbie Stabenow (D-Michigan),

Senator Tom Harkin (D-Iowa), [xxx]

and others have all publicly expressed their desire to have the program reinstated. Democratic Senator Jeff Bingaman of New Mexico,

Operation Mockingbird

Intelligent people have varying degrees of suspicion that the US government is in bed with the American mainstream media, and anyone who monitors the news media with discerning eyes can quite easily identify specific stories and strategies that are being used to persuade and intimidate the population. For those who want “evidence” of such manipulation, one needs to look no further than the findings of a Senate Select Committee in 1975, which confirms and details this, has occurred for decades on a scale larger than most people could imagine. Operation Mockingbird, as it was called, was exposed in 1975 during the Church Committee investigation, which then published its findings the following year. The full name of the committee which investigated and uncovered such activities was called, “The United States Senate Select Committee to Study Governmental Operations with Respect to Intelligence Activities” which was chaired by Senator Frank Church (D-ID). Through this investigation it became clear that such a program was developed in the 1950s for the purpose of persuading American and foreign media, as well as to use the media as gate-keepers to prevent certain information from being published and reaching the masses. In 1948 an espionage and counter-intelligence branch within the CIA was created for the purpose of “propaganda, economic warfare; preventive direct action, including sabotage, anti-sabotage, demolition and evacuation measures; subversion against hostile states, including assistance to underground resistance groups, and support of indigenous anti-Communist elements in threatened countries of the free world.” Later that year Operation Mockingbird was established to influence the domestic and foreign media. Philip Graham, the owner of The Washington Post, was first recruited to run the project within the industry and develop a network of assets. After 1953, the network had influence over twenty-five newspapers and wire agencies and was overseen by Allen Dulles, who was director of the CIA. The Mockingbird program also involved major television broadcasters, including William Paley, the CEO of CBS broadcasting.

Thomas Braden, who was the head of the International Organizations Division (IOD), which was a division of the CIA dealing with human intelligence services, played a substantial role in Operation Mockingbird and would later reveal, “If the director of CIA wanted to extend a present, say, to someone in Europe—a Labour leader—suppose he just thought, this man can use fifty thousand dollars, he’s working well and doing a good job —he could hand it to him and never have to account to anybody... There was simply no limit to the money it could spend and no limit to the people it could hire and no limit to the activities it could decide were necessary to conduct the war—the secret war....It was multinational.” According to the Congressional report published in 1976, “The CIA currently maintains a network of several hundred individuals around the world who provide intelligence for the CIA and at times attempt to influence opinion through the use of covert propaganda. These individuals provide the CIA with direct access to a large number of newspapers and periodicals, scores of press services and news agencies, radio and television stations, commercial book publishers, and other foreign media outlets.” The committee also concluded that the cost of the program was approximately $265 million a year, which when adjusted for inflation as of 2010 means that in today’s dollars the program costs an astounding one billion dollars a year. A year after the Church Committee released its findings on Operation Mockingbird, Rolling Stone magazine published an article on the program and named various prominent journalists who they alleged to be involved with it. Some of these included Ben Bradlee, who wrote for Newsweek , Stewart Alsop, who wrote for the New York Herald Tribune , James Reston (New York Times ), Charles Douglas Jackson (Time Magazine ), Walter Pincus (Washington Post ), William C. Baggs (The Miami News ), and others. In 2007 a large amount of documents known as the “Family Jewels” were declassified and released by the National Security Archive, which also revealed that the CIA had routinely wiretapped Washington-based news reporters. These individuals were most likely seen as a threat to the

establishment and were not playing along with the propaganda and gatekeeping efforts within the media establishment. As with nearly every other case of rampant institutional corruption in government agencies, the CIA claims to have ended the program—another claim that is laughable.

The Military Wanted to Hire Bloggers for Propaganda Since the Internet has been a haven for independent journalists and countless “alternative” news sites, along with bloggers who have gained a large following of people who don’t rely only on mainstream corporate news to get their information, this posed a major problem for the establishment. The major broadcast TV and radio networks, as well as the cable channels, consist of tens of millions of dollars in equipment and expensive services such as satellite feeds and camera crews, but the Internet had opened the door for one individual with a website costing only a few dollars a month to have the potential to reach millions of people simply by posting their own articles or videos. With people able to copy and paste a link from a blog and sent it out to their email list or post it on their Facebook, MySpace, or Twitter pages, a simple blog written by an ordinary person can spread like a virus around the web. Of course, the establishment saw the dangers that blogs and nonmainstream websites held for their monopoly of information, so they decided to use prominent bloggers as paid propagandists just like the talking heads in the mainstream media. In 2006 a report from the Joint Special Operations University titled Blogs and Military Information Strategy , outlined this plan. “Hiring a block of bloggers to verbally attack a specific person or promote a specific message may be worth considering,” read the report. It was written by James Kinniburgh and Dororthy Denning. The report also suggested the government hack the blogs of those seen as detrimental to the propaganda they want to spread. It reads, “[T]he enemy blog might be used covertly as a vehicle for friendly information operations. Hacking the site and subtly changing the messages and data—

merely a few words or phrases—may be sufficient to begin destroying the blogger’s credibility with the audience. Better yet, if the blogger happens to be passing enemy communications and logistics data, the information content could be corrupted.”

High Level Officials and Institutions within the NWO are Above the Law As many people are aware, certain politicians and businessmen seem to be untouchable regarding the corruption and criminal activities they are involved in. This occurs because of the power of the invisible empire and their use of coercion, threats, and blackmail. The Illuminati keep files on practically every congressman and woman, as well as media figures, business leaders, judges, military officials, and anyone of influence in the public sphere. If a politician cheats on his wife, the invisible empire most likely know about it and have documentation proving it. If a person cheats on his taxes, uses cocaine, has any bizarre hobbies or interests, they know. Frequently they will entrap people simply to gather such evidence. Imagine that you’re a prominent politician who genuinely cares for America and wants to do the right thing in a particular segment of society such as lowering taxes. Also imagine that at one time, perhaps years or even decades ago, you made the terrible mistake of cheating on your wife, or even sleeping with a high class prostitute, perhaps provided and paid for by a colleague after a cocktail party. The odds are that the Illuminati has documentation of this. Echelon, the secret electronic snooping system, probably has a recording of a telephone conversation of you bragging about it with a friend. Perhaps the person you thought was your friend who provided the prostitute for you was doing so for the express purpose of entrapping you, and the guest bedroom in the mansion of the party, or the hotel you had sex with her at, was rigged with cameras and caught the whole thing on tape.

Now fast forward to the present time where you are a politician trying to save the American people from rising taxes, and imagine you get a phone call from someone not identifying themselves but telling you that they have evidence of what you did, and perhaps play the audio of your phone call when you spoke about it. The voice on the phone now tells you to stop pressing so hard for the tax reform, or even tells you to drop your support of it all together or they will show your wife photos of what you did. What do you do? This is just one of the methods used to get people in the pocket of the secret establishment. The History Channel produced a show called, Presidential Secrets which included a segment about J. Edgar Hoover, the infamous former Director of the FBI, which quite clearly and openly explained that Hoover keep dirt on everyone he could, and used that dirt to influence people in whatever way he wanted. For 48 years Hoover was the director of the FBI under eight different presidents. He died on May 2, 1972 at the age of 77 from a heart attack. It was only after his death that the depths of corruption Hoover sunk to were revealed. Despite 35 file cabinets of his personal files being destroyed after his death by his loyal aids, volumes of information are now public which show just how dark the soul was of Hoover, as well as how powerful people can be when they have the resources of the FBI behind them. Hoover was able to use the FBI to influence both politicians, as well as Hollywood pictures. In 1971 he was told Jane Fonda would star in a film titled Klute about a prostitute helping a detective solve a mystery, and he created a file and determined to have the part removed. He hand wrote in the margin of one of the documents which was declassified, saying “Certainly, I don’t want any reference to the FBI in any picture which this tramp, Jane Fonda appears.” He was able to have various films killed or the scripts changed to prevent the portrayal of the FBI in a negative light, including preventing John Wayne from starring in a TV show titled The FBI, which ran from 1965 to 1974, because Wayne was a member of the John Birch Society, which Hoover despised. The John Birch Society is known for its political activism particularly against globalism and in support of traditional conservatism.

Anti-war rock and roll musicians were also a target of J. Edgar Hoover. Janis Joplin, Jimmy Hendrix, and particularly John Lennon of the Beatles. In 1969 Lennon released an album containing protest songs which were enraging to Hoover and the establishment, so he tried to get him deported over a marijuana charge from England. Hoover also thought that John Lennon’s outspokenness threatened Richard Nixon’s reelection. J. Edgar Hoovers files also reveal how ruthless and powerful President Roosevelt was. It was believed that his wife Eleanor was having an affair, and after this was investigated by the FBI and pretty much confirmed, FDR wanted all of the agents who worked on the case killed so they would not spread rumors about his wife’s infidelities. The files reveal that he personally ordered all men who worked on the case to be “immediately relieved of his duties and sent to the south pacific for action against the Japs until they were killed.” Hoover himself was a homosexual and hired his long-time lover Clyde Tolson, who rapidly climbed the ranks of the FBI, ultimately becoming the Associate Director of the FBI, the second highest position in the organization. The FBI and historians openly admit the rampant corruption led by J. Edgar Hoover, and of course claim to have made changes to prevent such abuses from continuing, which we know is a lie, but looking back at how much influence Hoover was able to have decades ago can send chills up one’s spine when thinking of what is possible with today’s technology.

Barney Frank One of the most perverted cases of a politician who is above the law involves Barney Frank, who has been a House Representative from Massachusetts 4th congressional district since 1982. Barney Frank is considered by many to be one of the most powerful men in Congress and became the chairman of the House Financial Services Committee in 2007 and was a major force in Obama’s economic “stimulus” package in 2009. Frank is also openly gay and back in the 1980s met a gay prostitute from a personal ad in the newspaper who later became his roommate and ran a gay

prostitution ring out of their apartment. There are also allegations that Frank has had sexual relations with underage boys as well. The Washington Times reported in 1989 that, “Frank, one of two openly gay members of Congress, confirmed Friday that he paid [Stephen L.] Gobie for sex, hired him with personal funds as an aide and wrote letters on congressional stationery on his behalf to Virginia probation officials.” [xxxi] The article continues, “Although Frank and Gobie differ in some details of their relationship, they agree on the story line. They met on April Fool’s Day 1985. The representative answered a classified ad in the Washington Blade , the local gay weekly. ‘Exceptionally good-looking, personable, muscular athlete is available. Hot bottom plus large endowment equals a [xxxii] good time.’”

The article goes on to explain that Barney Frank paid Gobie $80 for sex which marked the beginning of their relationship. Frank was in his third term then, and despite later admitting this activity, went on to become an extremely powerful man in Washington DC. Barney Frank’s current live-in boyfriend, James Ready, was arrested in [xxxiii]

2009 for growing marijuana in their backyard.

Frank claimed he had no knowledge of the plants just as he claimed to have no knowledge of Stephen L. Gobie’s gay prostitution ring he was running out of their apartment when they lived together in the 1980s. It is very interesting that Eliot Spitzer, the former governor of New York, was busted for using high class female prostitutes ending his political career and forcing him to resign, yet Barney Frank has had a sordid past with admissions of using prostitutes himself and a roommate who was a gay pimp, while Frank is hailed as a hero. Eliot Spitzer was causing trouble for AIG and other big Wall Street firms who would eventually go bankrupt and then be given billions of dollars for free by government bailouts. Some suspect that Spitzer getting busted was simply a way to get him out of the way and stop him from poking his nose around where the Illuminati didn’t want it.

Barney Frank’s admissions of paying gay prostitutes for sex, while being reprehensible by itself, pales in comparison to the allegations that he also had sexual relations with young boys who were underage and connected to the infamous Franklin Cover-up scandal in the late 1980s. Below is a transcript from a court appearance in 1999 of a man named Paul Bonacci, who claims that he engaged in sexual relations with Frank when he was underage. IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEBRASKA PAUL A. BONACCI, ( 4:91CV3037) Plaintiff, vs. TRANSCRIPT LAWRENCE E. KING, Defendants. Hearing held before the Honorable Warren K. Urbom, Senior United States District Judge, on February 5, 1999 in Lincoln, Nebraska. APPEARANCES: Mr. John DeCamp Attorney at Law 414 South llth Street Lincoln, Nebraska for Plaintiff I -N-D-E-X WITNESS Direct Cross Redirect Recross Noreen Gosch 5 Russell Nelson 36

Paul Bonacci 101 Denise Bonacci 155 (At 9:01, the following proceedings were held.) THE COURT: This is the case of Paul A. Bonacci versus Lawrence E. King, 4:91CV3037. I see the plaintiff, Mr. Paul Bonacci, here with his counsel Mr. DeCamp. I do not see anyone representing Lawrence E. King. Is there anyone here representing Mr. King? I take it not. A default judgment has been entered against him. And the purpose of this proceeding is to determine the amount of damages that are to be awarded. Mr. DeCamp, you may proceed. Want to make an opening statement or not is entirely up to you. You may do that or call your witnesses as you choose. MR. DECAMP: May it please the Court, a very, very brief opening statement. What I want to establish here today, Your Honor, if at all possible, is the entire picture or scene in which Mr. Bonacci lived and prove to this Court’s satisfaction the stories he tells in his petition are in fact true and the trauma that results from those stories is in fact very real. And even, Your Honor, we would hope that the Court, after hearing some of the evidence and information today for the first time ever, would maybe even on its own initiative take some appropriate action to correct some other wrongs or launch some other investigations that may be needed, Your Honor. THE COURT: That’s not within my authority. So I can’t do that. But I can award damages. And that’s why we’re here today. The witness, Paul Bonacci, was then asked about instances involving him being sexually abused at adult parties when he was a young boy. ANSWER: A lot of the parties when we went to, that we went to and stuff, the ones in the Twin Towers were basically for one reason. And that was for sex. QUESTION: Sex between who?

ANSWER: There was sex between adult men and some other adult men but most of it had to do with young boys and young girls. QUESTION: Young boys and young girls with each other or with older folks? ANSWER: With the older folks. Also some of the parties, there was some parties above The French Cafe that they would bring people in and stuff that were from out of town. Those were specifically for sex with minors. Also in Washington, D. C. there were, there was also parties like Rusty had already talked about where there was parties after a party. Where they would have a party where they would have a legitimate party with like some politicians, businessmen. And a lot of them never knew about what happened at the after, you know, the party afterwards and stuff. Like in Washington, D. C. there was a lot of parties where they would be senators and congressmen who had nothing to do with the sexual stuff. But there was some senators and congressmen who stayed for the parties afterwards. And one person that I’m not afraid to talk about because his, because Larry King always said him and this guy were on the opposite ends of the field because this guy was a Democrat and Larry King was a Republican. That’s a known fact and stuff. And this guy, every time I see him on TV and stuff, my wife knows my hatred for him. Because every time I see him and stuff it disgusts me because it’s—his name is Barney Frank. QUESTION: Did you have relationships with him? ANSWER: Yes. QUESTION: Where? ANSWER: In Washington, D. C. And also I was sent to a house, I believe it was in Massachusetts in Boston where I believe it was his house because there’s pictures on the wall that, with him and with different people and stuff. And that he had met I guess. But it was in his basement. End of Transcript

White House Enemies List Anyone with any sense knows that the President of the United States can order the CIA, FBI, or any agency or combination of, to illegally investigate anyone he sees as a threat to his administration’s goals, such as other politicians, reporters, or political activists. While it would be political suicide for any politician to mention this fact, one Republican Senator made a startling comment on the Senate floor about the Obama administration compiling an enemies list. Republican Conference Chairman Lamar Alexander (Tenn.), who served in the Nixon White House, said, “Based upon that experience and my 40 years since then in and out of public life, I want to make what I hope will be taken as a friendly suggestion to President [xxxiv] Obama and his White House: Don’t create an enemies list.”

Alexander went on to describe the corruption that occurred during the Nixon administration and said he sees “symptoms of this same kind of animus developing in the Obama administration.” He also read off a list of examples he said support his views, such as a reported attempt by the Health and Human Services Department to put a gag order on the insurer Humana, and demonizing insurance companies during the government run health care debate. He also cited the administration’s hatred of the Fox News Channel, along with Obama’s alleged taking names of bondholders who resisted the General Motors and Chrysler bailouts. Alexander also pointed out how he and Senator Bob Bennett (R-Utah) were “called out” on the White House’s blog after questioning the power of White House czars saying, “This behavior is typical of street brawls and political campaign consultants…If the president and his top aides treat people with different views as enemies instead of listening to what they have to say, they’re likely to end up with a narrow view and a feeling that the whole world is out to get them. And as those of us who served in the Nixon White House know, that can get you into a lot of trouble.” While not exactly the most reputable tabloid, The Globe published an article in September 2009 headlined 25 Enemies Obama Wants to Silence

and listed among them, Alex Jones from Infowars.com.

The Clinton Body Count While mainly a thing of the past because Bill Clinton hasn’t been president since the year 2000, the Clinton Body Count still warrants mention in our discussion of the unlimited (and illegal) power and activities that a president has. The Clinton Body Count is the name given to the long list of people who have either been murdered, or died under suspicious circumstances who had personal or professional ties to Bill Clinton. The 1994 film The Clinton Chronicles documents some of the deaths found on the Clinton Body Count and is available to watch for free on the Internet.

2008 Economic Bailout The words “stimulus” and “stimulus package” entered the public lexicon at the end of 2008 after the housing market collapsed in the United States, and caused a wave of economic destruction to sweep around the world. The Dow Jones Industrial Average was falling sometimes five and seven hundred points a day and people were getting understandably worried about the state of the economy. This is when the Bush administration proposed their staggering 700 billion dollar bailout which they said was needed to avert an economic disaster. Many were understandably against the bailout and wanted the free market to take its course and correct itself naturally when things stabilized, but the Bush administration (along with their Illuminati banking connections) wanted the stimulus package to be passed as soon as possible. Some members of Congress were privately told that if the bailout didn’t pass a vote, the country would completely collapse into a depression and massive civil unrest and martial law would be imposed to prevent massive crime and violence. Congressman Brad Sherman blew the whistle on such [xxxv] threats and called them unjustified fear mongering.

California Senator Diane Feinstein publicly admitted that her office received 91,000 phone calls and emails about the bailout, and that 85,000 of them were opposed to it, but she voted for the bailout anyway because she

said people were “confused” and “didn’t understand it” and she needed to do what was in the best interest of the country. The economic bailouts and stimulus packages of 2008 and 2009 are lengthy subjects in and of themselves, so for the sake of keeping this book to a manageable length, they are only mentioned here briefly. There are several important points to be learned regarding these issues, one of which being that Diane Feinstein’s admission that 93% of the phone calls to her office opposed the bailout, yet she voted for it anyway, shows where the allegiance lies of elite politicians and how they couldn’t care less about actually representing their constituency, but rather bow to the private interests who supply them with power and wealth. The fear-mongering and threats of a total collapse and martial law also show the low levels those in power will sink to get their way. It’s also critical to remember that only several days after the first bailout was passed by Congress in 2008, the Federal Reserve and the Treasury Department completely changed their mind about where the $700 billion dollars would go and who would get the money. Many of the firms that did get the money paid out huge year-end bonuses to their CEOs and top executives. Most people who have the potential to earn a bonus at their job will only qualify for it if they achieve certain goals such as a hitting certain sales figures, but numerous bankers on Wall Street got tens of millions of dollars each in bonuses as their companies collapsed in bankruptcy. Only if one is a member of the invisible empire can one get rewarded for a historic failure.

Electronic Voting Machines Voter fraud has been something that has occurred in American elections for hundreds of years. Stuffing the ballot, vote buying, misrecording of votes, and other methods of fraud have been problems in elections around the world. Joseph Stalin is quoted as once saying, "He who votes decides nothing; he who counts the votes decides everything.” While safeguards have been put in place to minimize voter fraud in elections, the increased use of electronic voting machines have complicated this process. The designs of electronic voting machines and their software

are closely guarded secrets by industry insiders but some whistle blowers have been able to show that the machines can be programmed to report whatever vote counts their creators want them to show. A documentary produced by HBO titled Hacking Democracy shows how one hacker was able to alter the vote totals to whatever numbers he wanted just by hacking the memory card for such machines. He didn’t even need access to the machine itself, the software code, or anything. All he did is place a program on a standard removable memory card for a machine, which are widely available, and he was able to alter the tallies. Many people suspect that operatives fixed the 2000 election in favor of George W. Bush using electronic voting machines. The 2004 presidential election is also suspected to have been fixed, particularly in the state of Ohio where exit polls showed John Kerry would win, but miraculously the vote counts showed different. Walden O’Dell, the CEO of Diebold Election Systems, had written a Republican fundraising letter in 2003 where he said his company was “committed to helping Ohio deliver their electoral votes to the President next year.” He was obviously referring to President Bush who was facing John Kerry in the 2004 election. When asked about this, Mark Radke, Diebold’s marketing director answered, “that quotation that appeared in a letter is something that, uh…he regrets. It’s a situation where his personal preference has come over into his business practice and he has committed to keeping a much lower profile when it comes to those kinds of activities.” So it is sad but probably true that your vote doesn’t matter in a presidential election. Whichever candidate will better serve the interests of the New World Order will be the one who secret operatives will make sure gets the most votes and becomes the next president. Such tampering actually takes place before the presidential election and is used in the primaries to ensure a particular candidate gets the nomination of his party. The final two candidates of the Republican and the Democratic parties are both most likely aware of the shady vote tampering and can only hope that the secret establishment chooses them to throw their weight behind to select as the next president of the United States.

The Original Blueprint of Domination Knowing about the rampant corruption and the methods of blackmail and coercion that go on in politics, it is interesting to look back several hundred years at the original writings of Adam Weishaupt, the founder of the Illuminati. These writings were discovered by Bavarian officials in 1786 and published shortly after. English translations and excerpts were made available in books like John Robison’s Proofs of a Conspiracy (1798), Abbe Barruel’s Memoirs Illustrating the History of Jacobinism (1797), and Proof of the Illuminati by Seth Payson (1802). The writings give a clear view into the mind and mission of founder Adam Weishaupt. He wrote, “There must (a la Jésuite ) not a single purpose ever come in sight that is ambiguous, and that may betray our aims against religion and the state. One must speak sometimes one way and sometimes another, but so as never to contradict ourselves, and so that, with respect to our true way of thinking, we may be impenetrable.” “This can be done in no other way but by secret associations, which will by degrees, and in silence, possess themselves of the government of the States, and make use of those means for this purpose…” “…the Order will, for its own sake , and therefore certainly , place every man in that situation in which he can be most effective. The pupils are convinced that the Order will rule the world. Every member therefore becomes a ruler.” Some people believe the mainstream history that says the Illuminati were dissolved after their discovery, but reading Weishaupt’s own words reveal that he had taken this possibility into consideration and made the appropriate steps to ensure the group would continue if this were to happen. He wrote, “By this plan we shall direct all mankind. In this manner, and by the simplest means, we shall set all in motion and in flames. The occupations must be so allotted and contrived, that we may, in secret, influence all political transactions…I have considered everything, and so prepared it, that if the Order should this day go to ruin, I shall in a year reestablish it more brilliant than ever.”

Wars and False Flag Terrorism No book on the New World Order would be complete without a discussion about the role wars and false flag terrorism play in the construction and expansion of the global government. This is an extremely detailed and unsettling subject and will only be briefly mentioned here. Entire books are available on specific aspects of this subject if you are interested in learning more. But it must be stated that major wars and terrorist attacks often cover sinister activities and goals the public is largely unaware of. The reasons for going to war are almost always greatly exaggerated and in numerous instances completely fabricated so the public on a large scale, and the military soldiers who will be risking their lives for that war, will believe that they are fighting for a just cause, such as protecting the United States. In reality, members of the armed forces are often used as imperialistic pawns who unknowingly help construct and expand the New World Order. For example, the Gulf of Tonkin Incident, as it is called, was the straw that broke the camel’s back and resulted in America getting fully involved in the Vietnam War. This incident refers to an event where North Vietnamese gunboats were reported to have attacked an American ship in international waters, prompting President Johnson to retaliate by entering the war. Years later private presidential tapes were released that show President Johnson and Robert McNamara, his secretary of defense, conspiring to lie and say the American ship was attacked, when in fact it was not. As any informed American now knows, the War in Iraq was based on lies that Saddam Hussein had weapons of mass destruction and attempts to link him to the terrorist attacks of September 11th 2001 in New York City and Washington DC. The 9/11 attacks, as many know, were a false flag terrorist attack, meaning they were aided by elements of US and foreign intelligence agencies so this traumatic event could be used to justify invading the Middle East, as well as passing legislation domestically such as the Patriot Act which eliminated various rights outlined in the Constitution. Such strategies are insidiously genius because they are so hard to oppose. After all, if there is an alleged threat, or an actual terrorist attack said to

have been perpetrated by a specific country or group, it seems only appropriate to retaliate. False flag terrorism is essentially a terrorist act carried out by a government or intelligence agency, often against one’s own people or country, which is made to look like it was done by another country or group. It is basically framing others for the act which can then be used to justify military action in response. Since most ordinary citizens, as well as those in the military and government would never imagine that leaders in their own government could be behind such an attack against their own country, the idea of incidences being false flag attacks are rarely thought of. These subjects are massive, and there is no room in this book to detail the piles of evidence for these statements, so if you are interested in learning more about the 9/11 attacks and false flag operations, you are advised to read The New Pearl Harbor by David Ray Griffin, 9/11 Synthetic Terror by Webster Tarpley, or The Terror Timeline by Paul Thompson. There are also various films that are often available to view for free on the Internet which detail the purposeful frauds that have been created by the U.S. government in order to start wars. Several of the best are: War Made Easy , Why We Fight , Terrorstorm , 9/11 Press for Truth , and Loose Change: Final Cut . Also, an interesting historical note regarding wars involves Major General Smedley Butler, who at the time of his death in 1940 was the most decorated U.S. Marine in history. Butler published a small book titled War is a Racket which exposed the corrupt profit motives for going to war. Butler also testified before a congressional committee in 1934 where he explained how he was asked to participate in a plot to overthrow president Roosevelt and install a fascist dictatorship. Since Butler was a high ranking and influential man in the Marines, the conspirators hoped he could secretly gather 500,000 men to aid in this takeover. The men behind the attempted plot were wealthy businessmen with strong ties to the Illuminati. The term “Military-industrial complex” was coined by President Dwight D. Eisenhower in his Farewell Address to the Nation on January 17, 1961. The phrase refers to the relationship between the government, particularly the armed forces, and the industries in the commercial sector that provide the weapons, development, and research for such programs and materials.

Eisenhower realized the tremendous money-making capacities of such industries and relationships, and firmly warned of the dangers such relationships could cause if abused. His speech reads in part, “A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction…” “This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence — economic, political, even spiritual — is felt in every city, every statehouse, every office of the federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society. In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist. We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals so that security and liberty may prosper together.”

Immorality and Destructive Behavior is Encouraged In the 1950s Elvis Presley’s swinging hips and sexually suggestive dancing caused a tremendous stir around the world. Some TV stations were ordered only to shoot him from the chest up in an attempt to censor his on-stage antics from the home audience. Now contrast this with today’s pop culture icons who dress like sluts like Britney Spears and others such as Christina Aguilera, Beyonce Knowles, and Lady Gaga, just to name a few.

Self-destructive, sexually immoral, and materialistic idols are built up by the media and presented to the youth as role models, while Christianity and traditional healthy values are ridiculed as old fashioned and uncool. The family is under attack, and family values and the family unit itself have slowly but dramatically deteriorated over the last few decades, and is reflected in the divorce rates and high numbers of sexually transmitted diseases, abortions, and unwed mothers. A wildly popular show amongst teenagers and young adults was MTV’s Jackass which aired from 2000 to 2002, and consisted of nothing more than amateur video footage of people performing various dangerous and childish stunts and pranks. Soon after the show began airing, a slew of reports detailed the injuries of various people imitating or attempting to recreate the idiocy they had seen on the show. The types of “stunts” performed on the show often involved people getting kicked or hit in the testicles by various objects, as well as smashing shopping carts, and even one individual (Steve-O) having things stapled to his bare butt using a staple gun. It’s also interesting to note that this individual, Steve-O, has a tattoo on his arm of the “Jesus fish” with the word “Satan” written inside, and had gotten a tattoo of a man raping a baby on his arm, but after even his close friends found it appalling, he had an ostrich tattooed over the baby to cover it up. The tattoo now shows a man [xxxvi]

having sex with the ostrich.

In the MTV Cribs episode featuring cast members of Jackass , Steve-O picks up the kitten at his apartment and introduces it to the camera as ‘Lucifer.’ On March 9, 2008, Steve-O’s friends forced him to check into Thalians [xxxvii]

Mental Health Center due to ongoing drug abuse problems.

He was placed on a 72 hour psychiatric hold which was later lengthened to 14 days [xxxviii] due to an alleged suicide attempt.

In June 2008, Steve-O pleaded guilty to felony possession of cocaine and [xxxix] avoided jail by the successful completion of his treatment program.

In a later MTV documentary covering his road to sobriety titled Steve-O:

Demise and Rise , he admitted that he would hear voices and thought that, “I was possessed by demons, and I think that’s pretty evident in some of this footage.” A spin-off from Jackass aired from 2003 to 2005, titled Viva La Bam , which consisted of a series of destructive and even cruel pranks done by Bam Margera and his friends on each other—especially on Bam’s family and was an MTV favorite for many viewers. Several views from within Bam’s home reveal a large symbol resembling an upside down satanic pentagram within a circle, called a ‘heart o gram,’ which is supposed to represent both good and evil. This heart o gram is also used as a hood ornament on Bam’s Mercedes and is the symbol for Bam’s favorite band HIM which has songs such as “Your Sweet Six Six Six.” The logo for the show Viva La Bam features the satanic hand sign ‘el Diablo’ of raising the index and pinky fingers, which has been drawn in as the letter “I” in the word “Viva,” complete with illuminating rays coming from behind it. When Jackass first aired, every teenager in the country knew who Johnny Knoxville and the other Jackasses were and the show inspired countless kids to videotape themselves and their friends trying to be “Jackasses” themselves.

Popular Music Nearly everyone in the world is familiar with the meteoric rise and fall of pop star Britney Spears as we watched her go from a sweet and seemingly innocent teen idol, to a whacked-out, shaved-head, train wreck of a mother. Her first album was release in 1999 and with each new album she sunk to new moral lows with her legions of preteen and teenage fans mimicking her every move. In 2009 Spears released an album titled Circus which contained a song named, “If You Seek Amy,” which on the surface seemed innocent enough until you heard the lyrics sung. The chorus goes, “Love me, hate me, but can’t you see what I see, all of the boys and all of the girls are begging to if you seek Amy.” It may not seem like anything unless you give it a second read, or hear the song for yourself.

The words “if you seek Amy,” blend together to sound like the letters F, U, C, K, and the word “me.” So what she is really saying is all of the boys and all of the girls want to fuck her. It’s important to note that this is not simply a coincidence or that this author is reading too much into the lyrics. The song was specifically designed to sound like this. The official video for the song begins with a news broadcast with a banner on the bottom of the screen reading, “New Britney Spears lyrics spell out obscenity in disguise.” Her album The Singles Collection , also released in 2009, includes a song titled “3” which contains lyrics about having a three-some and having sex with two guys at the same time. “Living in sin is the new thing,” she sings. Some other lyrics read: 1, 2, 3 not only you and me Got one eighty degrees And I'm caught in between In the early morning hours of November 12, 2009, someone hacked Britney’s Twitter account and changed the background graphic from one promoting her new album to one featuring pyramids inscribed with the word “Illuminati” with an all-seeing eye at the top. They also “Tweeted” (Twitter terminology for posting a message), “I hope the New World Order will arrive as soon as possible” and that “I give myself to Lucifer every day [xl]

for it to arrive as soon as possible. Glory to Satan!”

Her Twitter account had 3.7 million followers at the time, and her staff scrambled to regain control of the account as soon as the hack was discovered. Obviously the hacker is fully aware that Spears is an Illuminati icon and is promoted to poison the minds of young girls. A pop singer who goes by the name Katy Perry (Real name Katherine Hudson) was placed in the limelight in 2008 following the release of her single, “I Kissed a Girl,” which was a song about her sexually

experimenting by making out with a girl. “I kissed a girl, and I liked it / the taste of her cherry ChapStick / I kissed a girl just to try it / hope my boyfriend don’t mind it,” she sings. What’s more disturbing is that Perry’s parents are Christian pastors and she released a self-titled gospel album in 2001 before turning to the dark side. Another look at the 230 year old writings of Adam Weishaupt reveals that icons like Britney Spears and Katy Perry are playing right into the hands of the Illuminati without even knowing it. Weishaupt wrote, “There is no way of influencing men so powerfully as by means of the women. These should therefore be our chief study; we should insinuate ourselves into their good opinion, give them hints of emancipation from the tyranny of public opinion, and of standing up for themselves; it will be an immense relief to their enslaved minds to be freed from any one bond of restraint, and it will fire them the more, and cause them to work for us with zeal, without knowing that they do so; for they will only be indulging their own desire of personal admiration.” Almost everyone in the world is familiar with rapper Eminem (Marshall Mathers) but many may not be aware of just how violent and disgusting his lyrics are. Many of his songs are about killing people, raping women, doing drugs, and other violent acts. It would be foolish to say that people who listen to such music aren’t encouraged and inspired to commit violent acts as a result. In 2005 a man in London was arrested for killing a woman for [xli]

no reason after performing Eminem songs at a karaoke bar.

The man was said to idolize Eminem and even had several tattoos similar to the rap star. Eminem is also a member of a rap group called D-12, which produces music that is exclusively violent and vile, with some lyrics saying, “I will shit on you I don’t care who you are / I’ll shit on you / I don’t give a fuck about you or your car / Fuck your house / Fuck your jewelry / And fuck your watch / Fuck your wife / Fuck your kids / Fuck your family / I’ll shit on you.” Most of the group’s songs are about killing people and doing drugs. D-12 has sold over 10 million albums worldwide. On April 11th 2006 one of the

group’s members named DeShaun Dupree Holton (stage name Proof) was shot in the head and killed at a Detroit bar by a bouncer after the rapper had shot and killed another man after an altercation. He was Eminem’s best friend. Eminem also launched the career of 50 Cent who in 2008 was estimated to be worth $450 million dollars and one of the richest rappers. An example of 50 Cent’s lyrics which appear in the song I’ll Be the Shooter , are, “I-I’ll be the shooter / I-I’ll use the Colt, the Taurus, or the Ruger / I’ll pop some through ya / Dirty is what I’ll do ya / I-I’ll use the Sig, the pump, or the German Luger.” The examples of pop music containing overtly violent and sexually explicit material could go on and on. What is important to note here is not that such music exists, but that the singers and rap stars who perform such songs are built up in the mainstream media as gods and role models that children often imitate. Songs about three-somes and violence create a culture where such behavior is seen as normal. At one point in time, not that distant in the past, such songs would have been completely shunned or created a national outrage, but today many young boys and girls continuously fill their minds with such garbage from their iPods and television sets and their parents don’t have a clue, or don’t even care.

Television Commercials Everyone knows that sex sells, and using attractive women in commercials is an expected part of TV ads, but some commercials center around messages that have nothing to do with the product while still encouraging or finding humor in immoral behavior while the product may be completely innocent. One such commercial that was popular in 2009 was one for Minute Maid juice where a man is approached by a woman who is his child’s teacher saying, “I think you’re the father of one of my kids” and he mistakes her for some girl he had a drunken one night stand with on Spring Break years earlier. Teachers often refer to their students as “my kids” and apparently someone at the Minute Maid company thought it would be funny to make a commercial centered around a scumbag who slept with some slut on Spring Break when he was drunk and thought he knocked her up.

The online dating site, AshelyMadison.com advertises on TV showing a couple making out with each other and getting undressed in bed and then displays text on the screen reading, “This couple is married…but not to each other.” The company’s trademarked slogan is, “Life is short. Have an affair.” There was a time in the past when such a commercial would never be played, because no TV network would air such garbage, but in the New World Order nearly every last hint of morality has been tossed away, and hedonism, selfishness and immorality are the norm. AshleyMadison.com boasts of having 3.86 million users and is designed exclusively for married people who want to find someone else to have sex with, without their spouse knowing about it. For years now, television commercials advertising Las Vegas end with the slogan, “What happens in Vegas, stays in Vegas,” which means that you and your friends are encouraged to go there and sleep with hookers, do illegal drugs, and gamble all you can, and that nobody must mention these activities to other friends, girlfriends, wives, or family members, because most decent people would be completely appalled by such behavior. This phrase is actually trademarked by the Las Vegas Convention and Visitors Bureau. Las Vegas has been known as the “Sin City” for decades, but in 1999 this new “What happens in Vegas stays in Vegas” slogan was coined and was implemented in multiple television commercials encouraging people to visit the city and take part in all forms of debauchery it has to offer, but to keep it to themselves to avoid any social repercussions once they return home.

Video Games Today, both kids and adults enjoy playing video games and the graphics and action are beyond what anyone could have imagined who grew up playing the Atari or Nintendo game systems in the 1980s. Game types range from role playing adventures, to sports games and shoot ’em ups. With the increased processing power and graphics capabilities of these systems, there is an increased realness to the games, and when an abnormal amount of time is spent playing violent shoot ’em up games, many psychologists fear that it desensitizes people to such violence. Such games place the user in

the position where they “kill” dozens, perhaps hundreds of people, and in some games the targets aren’t “bad guys,” but instead are ordinary innocent people or police, and the point of some games is to just create havoc and kill as many people as you can, and enjoy doing it. Where passively watching countless hours of television or films depicting such violence desensitizes people to it, the active involvement of these realistic videogames dramatically increase this desensitization and teach the users to find pleasure and rewards for the more people they kill. One of the most notoriously violent videogames is the Grand Theft Auto series where players attempt to rise up the ranks of the criminal underworld through various objectives and are encouraged to commit mindless violent criminal acts. For example, in one mission the player gains points by killing people and causing destruction throughout the city and if they steal a police car and run people over with it, they receive double the number of points since they are killing with a police car, instead of if they had stolen an ordinary vehicle. The game has generated a decent amount of controversy from parents who are outraged that a game exists with such sinister goals, and the game’s creators have had multiple lawsuits filed against them claiming the game has encouraged or inspired several people to steal cars and commit multiple murders. William Buckner, who was 15 at the time, and his younger brother Josh (13) ended up killing two people after shooting them while they were driving on the freeway. They told police they went out to shoot at the side [xlii] of trucks after playing Grand Theft Auto III .

The victims’ families filed a $246 million dollar lawsuit against Rockstar Games, Take-Two Interactive Software, Wal-Mart, and Sony Computer Entertainment America who manufactures the Playstation 2 game counsel. Rockstar and its parent company, Take-Two, filed for dismissal of the lawsuit in 2003, stating in U.S. District Court that the “ideas and concepts as well as the ‘purported psychological effects’ on the Buckners are protected by the First Amendment’s free-speech clause.”

An attempt to move the lawsuit into a state court was unsuccessful under Tennessee’s consumer protection act and the plaintiffs dismissed the case. Another lawsuit involving the game was started in 2005 after a 17 year old named Devin Moore shot and killed three police officers in Alabama after he was questioned regarding a stolen vehicle. When being questioned, Moore took a gun from one of the police officers and shot and killed him and two others and then fled in a police car. One of Moore’s attorneys, Jack Thompson, claimed it was Grand Theft Auto’s graphic nature—with his constant playing time—that caused Moore to commit the murders, and Moore’s family agrees. At the time of this writing, the case has not been resolved and is ongoing. Lawyer Jack Thompson has said, “There’s no doubt in my mind that but for Devin Moore’s training on this cop killing simulator, he would not have been able to kill three cops in Fayette, Alabama who are now dead and in the ground. We are suing Take-Two, Sony, Wal-Mart, and GameStop for having trained Devin Moore to kill. He had no history of violence. No criminal record.” Another teenager named Cody Posey who was said to obsessively play the game murdered his father, stepmother, and stepsister in New Mexico. In 2009, a six-year-old boy took his mom’s car attempting to drive himself to school because he missed the bus, only to crash the car and luckily avoid serious injury. The child was able to drive the car over ten miles before crashing, and told the sheriff that he had trained how to drive on video [xliii] games, specifically mentioning Grand Theft Auto .

The Guinness World Records lists the game as the most controversial videogame series in history for glamorizing violence and its connections to [xliv] actual crimes.

Another videogame that wastes countless hours of people’s lives is the online role-playing game World of Warcraft . It’s sort of an advanced Dungeons and Dragons type of game, which has become synonymous with an antisocial outcast living in his parent’s basement. The game type is a

massively multiplayer online role-playing game (MMORPG) which requires players to subscribe to a monthly service in order to play with other online gamers. The game made the Guinness Book of World Records for the most subscribed MMORPG, with more than 11.5 million monthly subscriptions. Such a game takes the players into a completely fictional fantasy land where they often find themselves spending dozens of hours a week. Such a large chunk of time obviously takes away from social activities such as hanging out with friends or going to parties, as well as physical activities like playing sports. Instead, many World of Warcraft players find themselves sitting in front of their computer screen alone hour after hour, with their social skills and physical fitness deteriorating with every passing minute.

Gay Children’s Books Everyone knows how impressionable children are. They believe in Santa Clause, the Easter Bunny, and the Tooth Fairy, after all. While parents cannot have complete control over the values and behaviors of their children, it is undeniable that the environment children are exposed to and the values and behaviors of the adults in their life largely influence them. For example, the children of Anton LaVey, the founder of the Church of Satan, all grew up and continued to carry on the legacy of their father and are avowed Satanists themselves. While homosexuality is a complex and sensitive issue, it cannot be denied that heterosexual desires, behaviors, and couples are normal, and the small percentage of homosexuals represent an abnormal minority whose strange desires and behaviors are the result of some kind of neurological or hormonal disorder. This is not to say that they should be hated for what could be something they cannot fully control. But to teach young children that homosexuality is a normal and natural thing is an absolute abomination, yet in the 21st century the homosexual indoctrination of children took a disturbing turn when various children’s books began to find their way into schools which involved plots of gay characters and were being forced on the young students.

In 2006 at Estabrook Elementary School in Lexington, Massachusetts, a teacher had chosen the theme of “weddings” for reading time, and the book she chose to read to the children was a picture book titled King and King which tells the story of two men who fall in love and get married. The book begins with a Queen nagging her unmarried son, the prince, because he is not married, saying, “When I was your age, I’d been married twice already.” The Queen brings in a bunch of princesses from neighboring kingdoms for him to choose from to be his wife, but he ended up being attracted to one of the princess’s brothers. “At last, the prince felt a stir in his heart. It was love at first sight,” the book reads. The two princes get married after a whirlwind courtship and are then crowned “king and king,” instead of king and queen. The last page shows a drawing of the two “kings” kissing each other on the lips. A similar book titled And Tango Makes Three, describes two male penguins who adopt a baby penguin and raise it together. The two penguins are clearly identified as being two men, and at one point in the story the zoo keeper says they must be in love. One school superintendent, Jennifer Filyaw, said she considered the book [xlv]

“adorable” and appropriate for children ages 4 to 8.

Parents pressured the school to have the book removed from the school library, and were opposed by gay activists who claimed that would amount to “censorship.” At the Alameda Unified School District in California in 2009 the school board voted to uphold a special LBGT (Lesbian, Bisexual, Gay and Transgender) curriculum, and forced 2nd graders to read And Tango Makes [xlvi] Three .

The interesting thing about those who push the homosexual agenda is that they claim everyone should not be judgmental and that all views and lifestyles should be accepted, yet at the same time, they attack conservatives or Christians who are opposed to such agendas. So while claiming people shouldn’t judge, many gays themselves judge others who have differing

opinions and values regarding homosexual agendas, even when those opposed to such things are respectful in their differences. The original writings of the Illuminati read, “We must win the common people in every corner. This will be obtained chiefly by means of the schools, and by open, hearty behavior, show, condescension, popularity, and toleration of their prejudices, which we shall at leisure root out and dispel.”

Obama’s Perverted “Safe Schools Czar” Kevin Jennings, the person president Obama appointed to be his “safe schools czar” is a homosexual who acknowledged that when he was a schoolteacher he advised a 15 year old boy to use condoms when having sex with an older man he met at a bus station bathroom. Not only did Jennings fail to report this incident of statutory rape to authorities, but in the months following he befriended this young boy who would come by his office and tell him of his gay “adventures.” Jennings writes about this in his 2007 autobiography, Mama’s Boy, Preacher’s Son: A Memoir . On page 162, Jennings writes: “Robertson soon told me the tale, about someone he’d met in Boston, how he thought he loved him, how heartbroken he was when his calls never got returned…” On page 169, he continues: “As the fall wore on, Robertson continued to drop by my office to chat, often updating me on his latest ‘adventures.’ Sometimes these startled me, and I began to underline the importance of safe sex to him.” It wouldn’t be surprising if Jennings secretly had a crush on this young boy and found sexual gratification from hearing about all of his homosexual encounters. Jennings is also the author/editor of a book titled One Teacher in 10 , which is, “A collection of more than 30 accounts by gay and lesbian teachers from schools and universities across the country. Each narrative recounts its author’s experiences either as an openly gay or lesbian teacher or during the period of coming out.” Jennings has also written about his past drug use and his contempt for religion, and promotes homosexuality in schools. Department of Education spokesman Justin Hamilton declined to comment on Jennings’ statements

about encouraging the young boy to have sex with the older man, but Arne Duncan who is Obama’s Secretary of Education, said he was “honored” to work with Jennings and described him as “uniquely qualified for his job.” [xlvii] Some defenders say the Obama administration wasn’t aware of Jennings past, but it was written clearly in his autobiography and as Peter Sprigg of the Family Research Council said, “This controversy about the possible statutory rape was raised in 2004 when he received an award from the NEA. So it’s not like it’s been a secret. So I think it shows yet another failure of the Obama administration’s vetting process.” As if these issues weren’t bad enough, the perversions of Kevin Jennings actually get much worse. In March 2000 the Gay, Lesbian, and Straight Education Network (GLSEN) of Massachusetts held a conference where workshop leaders taught children as young as 14 how to “fist” each other, which is the dangerous sexual practice of sticking an entire hand up the rectum of another individual. Kevin Jennings is the founder of GLSEN and was the keynote speaker at this conference. In 2007 he was paid over $250,000 as its executive director. At the 2001 GLSEN conference, activists handed out over 400 “fisting kits” which included rubber gloves and lubrication to the children who attended. In 2005 this same organization handed out hundreds of copies of a booklet to kids titled The Little Black Book: Queer in the 21st Century which contained sections titled: Fucking; Licking Butt; Piss Play, and Fisting , each of which describes in very graphic language the practices of these different types of gay sex activities.

Slutty Halloween Costumes It’s a well-known aspect of Halloween that young adults, particularly female college students, like to dress up in the skimpiest and sluttiest outfits possible that night, but a disturbing trend can be seen in the costumes for young children. Very skimpy and slutty costumes are now found on the shelves for very young children and some parents who are lost in the culture of the New World Order don’t think anything of it.

Fortunately there are still parents with morals and decent values. “If girls get used to dressing like this, they might want to become a whore after Halloween,” said Harlem mom Malinda Martinez, 33, who has a 6-year-old [xlviii] girl. “They’re far too grown up for kids.”

The marketing message for many children’s costumes are more blatantly sexual than ever before. “The Navy ships won’t want to leave the dock unless this cute sailor girl is on board,” reads one catalog entry for a teenyweeny sailor costume in sizes that can fit a 4-year-old that was sold by a Party City store on West 14th Street in New York City. “It is so wrong,” said Sharon Lamb, author of the book Packaging Girlhood: Rescuing Our Daughters From Marketers’ Schemes . “The message being put out there is that it’s right to be slutty on Halloween. That’s what Halloween is all about now. The one night when it’s OK to live your fantasies, marketers are telling children their fantasies should involve [xlix] sex. It is very damaging.”

An article in the New York Post explains that a reporter found an array of slutty Halloween costumes for children at a Party City on East Fourth Street in New York City, including: A Goldilocks costume suitable for a Penthouse party with clingy gingham lace-up peasant dress with a white petticoat “that’s all grown up, and you can have your porridge and more.” A pirate costume called the “High Seas Hottie” made in sizes to fit an 8year-old. A women-in-chains fantasy costume called “Convict Cutie” that features a spandex dress and lace-up bodice. A “Devil Grrrl” costume for 10 to 14-year-olds that includes a flaming-red dress and tail, skanky fishnet hose and gloves and a tiny pitchfork. “This grrrl devil likes to get things heating up!” the packaging boasts.

One blogger wrote, “Every year, it gets harder and harder to find a costume for my oldest daughter that won’t get her picked up by the cops as a street walker…I’m still on my search to find a costume that doesn’t have a miniskirt, lace-up corset or have the word ‘cutie’ in it for my 5-year-old. I may [l] have to resort to making her a ghost by throwing a sheet over her.”

Jack Black’s Prayer to Satan on MTV At the 2009 Video Music Awards on MTV, a popular award show, actor Jack Black decided to offer up a prayer of thanks to Satan. “Since we’re giving a rock award tonight, who wants to pray to the Devil with me? Let me see those horns! (referring to the El Diablo hand sign of extending the index and pinky fingers.) Now take the hand of the person next to you. Dear dark lord Satan…just wanted to ask you to grant tonight’s winners continued success in the music industry.” Much of the crowd cheered with encouragement and many held up their “Devil horns” in unison with Black. MTV continues to be a major sewer pipe pouring garbage of all kinds into the living rooms of millions.

Anti-God Advertisements in New York Sub-way Stations A coalition of eight different atheist organizations purchased a month’s worth of advertising space in a dozen subway stations in Manhattan in order to promote atheism and attack belief in God. One poster reads “A million New Yorkers are good without God. Are you?” The groups behind the ads, which calls themselves the Big Apple Coalition of Reason, say they are, “part of a coordinated multi-organizational advertising campaign designed [li] to raise awareness about people who don’t believe in a god.”

The New York City subway system is used by more than 5 million people per day. The organizers bragged that the 2009 American Religious Identification Survey indicated that approximately 15% of those surveyed check “none” for religion, up from 8% in 1990 and said that this was just the beginning of a nationwide effort to post their materials in transit systems across the country.

Atheism is promoted by the Illuminati and the establishment because they know that most religions instill moral values in people and promote a code of conduct that enriches peoples’ lives and helps them to be happier, healthier, and create systems of accountability through friends to discourage and minimize destructive, immoral, and unhealthy behaviors. A population of hedonists whose lives are in shambles because of credit card debt, alcohol and drug abuse, and destructive broken relationships are going to be too wrapped up in their own lives and problems to care about looking into what their lawmakers and politicians are doing. Such people are not going to become organized or even speak up about any issues directly affecting them and will not get in the way of the New World Order.

Alcohol and Drug Abuse Encouraged Since a population trapped in a downward spiral of drug and alcohol abuse will not care to learn about political issues or get involved, this behavior is also encouraged. Celebrities are worshiped by the mentally enslaved who mimic their behavior and habits, finding them cool and exciting. It’s interesting to learn that many musicians are complete phonies who portray a lifestyle in their music that is completely different from their personal lives. Others become nearly destroyed by the very attitudes and behaviors that shot them to stardom. Rap celebrity Dr. Dre released an album called The Chronic in 1992 which featured a large pot leaf printed on the CD face (chronic is a slang term for marijuana) and contained numerous references to smoking weed, doing drugs, and committing crimes. In August of 2008 Dr. Dre’s first son Andre Young Jr. died at the age of 20 from an overdose [lii] of heroin and morphine.

Rapper 50 Cent burst on the music scene in 2003 with his single In Da Club with lyrics saying, “You can find me in the club, bottle full of bub [alcohol] / Look mommy I got the X [Ecstasy] if you’re into taking drugs,” portraying the image of a club hopping party animal, but in interviews 50 Cent has repeatedly stated that he is a home body and doesn’t like to go out to clubs. One particular radio station in San Diego, and I’m sure in multiple other cities as well, plays the sound of a water bong (a device used for smoking

marijuana) every day at 4:20pm celebrating “420” which is a number used by pot smokers to signify smoking marijuana. This author observed a scene once in the TV show Nip/Tuck where a character pulled out a water bong and smoked weed with his grandmother. The show airs on the cable station FX. Showing a water bong being smoked on TV is something that never happened until the 21st century when society sunk to a new level as it continued to deteriorate. This author is personally fairly libertarian when it comes to marijuana laws and sees the criminalization of possession and use largely a money making ploy for private prisons, but it’s not just marijuana that is being portrayed as cool and fun. Films like Blow (2001) starring Johnny Depp sensationalize cocaine use, and Trainspotting (1996) did the same thing for heroine.

Banking, Money, and Taxes Perhaps you have noticed that frequently the largest and most extravagant buildings in most cities (and even small towns) are banks. It’s fascinating how banks make money off interest, which is one of the most lucrative businesses known to man. While most businesses build a product or provide some kind of service involving manual labor or specialized knowledge, banks make enormous profits through the seemingly magical practice of lending people money and collecting interest on the loans. When one really looks into how money is created and used, and how interest is generated from loans, it becomes clear that the banking industry is one of the pillars of the New World Order and is at the core of the elite’s ability to control people, politicians, and even governments of large countries. You’ll often hear people familiar with this issue say that the banks “create money out of nothing, and then loan it out at interest.” Such a statement is hard to grasp at first, but conveys just how big of a con the banking industry is involved in. Such a con game goes back thousands of years and is often blamed on the Jews due to their money lending practices in Biblical times.

In the 10th century the Knights Templar figured out this amazing strategy and became the first international bankers in Europe and the practice contributed greatly to their wealth. On October 13, 1307 (Friday the 13th ) the leadership of the Knights Templar was arrested in France for allegedly practicing strange and satanic rituals, a charge most prominent occultists admit was true. Surviving Knights Templar went underground and are believed to have started Freemasonry which they used as a cover for their occult beliefs and practices. Freemasons then continued to operate (and still continue) as a Mystery School which the Illuminati was able to graft onto. Besides functioning as a place to learn occult theology and mysticism, other areas of life are also taught and nurtured in these Mystery Schools such as science, business, and banking. Because the business of banking is extremely profitable, and the banks owners don’t have to build any products or really provide any services involving extensive manual labor, cunning businessmen saw the potential for virtually unlimited easy money and became involved in the industry. People like Paul Warburg, J.P. Morgan, and others monopolized the industry, thus securing their wealth for countless generations and giving them the ability to buy politicians and fund their personal plans for a global government.

The Federal Reserve In understanding the role of money and banking in the New World Order, it is important to know about the true nature of the Federal Reserve (often simply called “the Fed”). Most people think the Federal Reserve is a government owned bank in the United States or a branch of the Department of the Treasury, but this couldn’t be further from the truth. “The Federal Reserve is no more federal than Federal Express” is the joke that people familiar with this issue often tell. And they’re right. The Federal Reserve is a private group of banks that lends money to the United States government in the same way your local bank lends you money. This ingenious scheme was put in place in 1913 with the passing of the Federal Reserve Act which was drawn up in secret by a group of wealthy banksters when they met on Jekyll Island off the coast of Georgia

three years earlier. Ever since the Federal Reserve Act was put into law, the United States has become a servant to the elite international bankers and the national debt has skyrocketed out of control. Thomas Jefferson, the 3rd president of the United States once said, “I believe that banking institutions are more dangerous to our liberties than standing armies. If the American people ever allow private banks to control the issue of their currency, first by inflation, then by deflation, the banks and corporations that will grow up around [the banks] will deprive the people of all property until their children wake-up homeless on the continent their fathers conquered. The issuing power should be taken from the banks and restored to the people, to whom it properly belongs.” Alan Greenspan, who worked as the Chairman of the Federal Reserve for over eighteen years, made an extremely candid statement once about how powerful the Federal Reserve is when being interviewed on PBS while he was promoting his book The Age of Turbulence (2007). The interviewer, Jim Lahr, asked him what the proper relationship should be between the chairman of the Federal Reserve and a president of the United States, to which Greenspan answered, “Well, first of all, the Federal Reserve is an independent agency, and that means basically that there is no other agency of government which can overrule actions that we take…what the relationships are don’t frankly matter.” To learn more about this fascinating and important issue, you are urged to watch the films, Money As Debt , The Money Masters , or Monopoly Men .

Gold and Silver People against the New World Order will often be interested in investing in gold and silver—particularly physical gold and silver—meaning they purchase coins or bars that they themselves take physical possession of, rather than just buying gold or silver stocks or certificates. The reason for this is because gold and silver are seen as real money, as opposed to a fiat currency like the US dollar. A fiat currency is a currency that isn’t backed by gold or silver. Before 1971 the US dollar was backed by gold which meant that for every dollar in circulation, there was one dollar worth of gold

in possession by the federal government or the Federal Reserve Bank. This was a way to keep inflation low since the gold supply only slowly increased, so then would inflation. But in 1971 President Nixon took the US dollar off the gold standard, meaning the Federal Reserve could print money and put it in circulation that was not backed by gold, so the rate of inflation was no longer connected to the amount of gold in existence, but rather to the number of dollars the Federal Reserve wanted to print. For decades, patriots and those in The Resistance had worried that the Federal Reserve Banking System, which is controlled by a group of private banks operating as if they were a government entity, would one day make the US dollar practically worthless because it would print so many of them it would create what is called hyper-inflation, thus destroying the value of the currency as was seen in the Weimar Republic in Germany in the 1930s, and recently in Zimbabwe, Africa where the inflation rate was so high that a bunch of bananas cost literally billions of Zimbabwe dollars. Since the year 2000 gold has went from $300 an ounce to over $1100 an ounce in the beginning of 2010. Silver went from $5.25 an ounce to $18 an ounce in the same timeframe. Some market analysts predict that gold will hit $2000 an ounce sometime into the 2010 decade, and others are even predicting $5000 an ounce. Much of the increase in the price of gold and silver isn’t because the metals are getting rarer, but rather the price is a reflection of the weakening US dollar. Gold and silver have been seen as a hedge against inflation for decades and most financial advisers recommend that 10% of a person’s investments should be held in gold. In a video that got several hundred thousand views on YouTube, this author offered to sell random strangers walking along a boardwalk on a beach a one ounce gold coin for $50, and in some cases, $20, and once tried to trade it for a cup of coffee, but nobody expressed any interest. Some didn’t want the coin because it was Canadian and didn’t think it had much value in America, not realizing that a one ounce gold coin stamped with a picture of Mickey Mouse is still an ounce of gold and can be sold at any coin shop for whatever the spot price of gold is going for that day.

Some of the comments on the video by the viewer’s said they thought the people I approached thought it was a fake coin and that was why they didn’t want to buy it for fifty bucks. These people missed the point of the video which was to show that very few people have any clue whatsoever about what the value of gold is, so I shot another video to clearly illustrate this. In the follow up video I offered random passers-by the coin for free if they knew or could guess how much gold was trading for that day within 25%. You have to see the video to really grasp the impact of it, and if you watch it you will see that adults over the age of 30 guessed as low as thirty-eight cents and as high as $245. At the time the video was shot, gold was trading for $1150 per ounce. After the “contestants,” as I called them, gave me their answer, I told them how much the coin was actually worth and captured their reactions on the video. People concerned with the New World Order are especially interested in owning physical gold and silver because they are aware of the elite’s ultimate goal of establishing one currency for the whole world, and in order to accomplish this it is likely that the United States dollar will have to be made practically worthless through hyper-inflation at which point the solution for this currency crisis will be the introduction of a new regional currency or an adoption of a global currency. (See One World Currency ) Another reason for physically holding a collection of silver coins (usually one ounce coins which is the standard weight) is the possibility that a community barter system or an underground economy may have to be used for a period of time during a hyper-inflation scenario. In the event of a hyper-inflationary depression and the US dollar becomes practically worthless, or loses 90% of its value in a short time frame, small mom and pop stores, as well as neighborhoods and perhaps entire communities may start using one ounce silver coins as money to exchange goods and services. A small local bakery may only sell loaves of bread for a one ounce silver coin, or someone with a large farm or garden may sell their produce to others in their community, but only for silver. If this sounds far-fetched you should be aware that during the hyper-inflation in Zimbabwe, street vendors stopped taking the country’s currency because of the massive daily [liii] inflation, and would only accept grams of gold for payment.

Since a one ounce gold coin has a fairly high value, it is advised that you purchase and hold onto at least a small amount of one ounce silver coins because their value can be matched with various products or services. In the event of this kind of a black market economy arising, very few transactions would need to be made in gold because one ounce of gold is worth approximately 50 times what an ounce of silver is worth. If a loaf of bread is selling for one ounce of silver, and all you have is one ounce gold coins (or even half ounce or quarter ounces) then you’re going to have to buy way more bread than you could possibly need at the moment. This would be like shopping at a Dollar Store with only $100 dollar bills and the store wouldn’t be able to give you any change.

Income Tax and the IRS A faction of The Resistance is adamant about the federal income tax being illegal, and don’t believe the 16th Amendment was properly ratified, therefore they don’t believe the income tax should be paid. Some people who believe this actually stop paying their income taxes, and a handful of people who have done so and been taken to court over it and won, are used as examples by these people as evidence that they are correct. This is a dangerous fight to pick and is extremely difficult to win. Most people who believe the income tax is illegal, still pay their taxes because they know that when it comes to the government wanting its money, they will stop at nothing to get it. Thomas Jefferson said, “the power to tax is the power to destroy,” and he was correct. Aaron Russo’s 2006 film America: Freedom to Fascism is perhaps one of the most popular films on the subject of the income tax being illegal. In the film he interviews former IRS agents, tax protesters, and others who all subscribe to the belief that the tax is illegal. Ed and Elaine Brown are a married couple from New Hampshire who got national media attention in 2007 after they had a five month standoff with federal authorities after refusing to turn themselves in after having been convicted of tax crimes. Their home was designed to function “off the grid” and they had stockpiled food and supplies, but also had help from various visitors who were allowed on the property during the standoff. The Browns

were known to be armed and police had feared another Ruby Ridge type of incident if they tried to forcefully arrest them. After the five month standoff they were eventually arrested by undercover officers posing as supporters who were invited into the house by the Browns on October 4, 2007 and were immediately arrested without incident. Four individuals who assisted the Browns during the standoff were later convicted in connection with the matter. Their sentences ranged from two and a half years to thirty six years in prison for bringing the Browns food and supplies during the standoff. Regarding tax protesters, it’s significant to note that Irwin Schiff, the father of economic guru and Senate candidate Peter Schiff, was sentenced to thirteen years in prison after being found guilty of tax evasion. The courts claimed Irwin owed over $2 million dollars in back taxes. Irwin was a prominent tax protester and conducted seminars teaching people why he thought paying income tax was illegal.

2009 Tea Party Protests April 15,th as you probably know, is “Tax Day” in America, and is the deadline for filing your yearly income tax statement. While nobody likes paying taxes, and they continuously go up with little opposition from citizens, Tax Day in 2009 was different in the United States. The Tea Party protests, as they have become known as, were (and continue to be) a nationwide coordinated protest against big government, economic stimulus packages, government spending, and high taxes in general. Millions of Americans gathered in rallies across the country to show their displeasure with the out of control government. The name “Tea Party” is a reference to the Boston Tea Party from the American Revolution where colonists boarded British ships in 1773 and destroyed large quantities of tea by throwing it in the water as a symbolic protest against taxation without representation. The liberal media collectively labeled the Tea Party protesters as “tea baggers” which is a slang term for sucking on testicles. Liberal

commentators all knew this which was evident by their inability to contain their smirks and giggles every time they said it. CNN’s Anderson Cooper (a homosexual) was interviewing David Gergen about opposition to the 2009 stimulus packages, when Gergen commented that the Republicans “still haven’t found their voice” referring to a consensus on how to deal with the ensuing recession, when Cooper jumped in and said, “it’s hard to talk when you’re tea bagging.” Cooper’s disgusting comment with clear sexual overtones caused his guests to all giggle like children. Despite a backlash by people upset with his vulgar joke, no [liv] disciplinary action was taken.

Rachel Maddow on MSNBC (another homosexual) covered the Tea Party protests with a perverted slant, emphasizing the words “tea bagging” throughout the segment, causing her off camera staff (a camera man or production assistant) to laugh out loud which was clearly audible. “They [lv]

don’t want to tea bag alone, if that’s even possible,”

she joked, again referring to the sexual connotations that such a term holds. Another left wing MSNBC host, Keith Olbermann, made a joke about cleaning up after the tea bagging and then admitted, “and that will be my last intentional double entendre on this one, at least until the end of the segment.” A double entendre is a figure of speech which is meant to be understood in either of two ways, one being straightforward, and the other less so, often risqué or inappropriate. A report posted on the Anti-Defamation League’s (ADL) website, titled Rage Grows in America: Anti-Government Conspiracies , lists the Tea Party protests as evidence that since the election of Barack Obama as president, “a climate of fervor and activism with manifestations ranging from incivility in public forums to acts of intimidation and violence” has occurred in America. The report contains a section titled The Tea Parties which reads, “The rapid growth of anti-government anger in the wake of Obama’s election first became apparent in the spring of 2009, when conservative groups and grass-roots activists organized a nationwide series of anti-government

rallies dubbed ‘Tea Parties.’ At these events, and later sequels, antigovernment sentiments and conspiracy theories proliferated, with a common theme being that somehow Obama had ‘stolen’ the country from [lvi] Americans.”

This report also lists Alex Jones from Infowars.com as the “Conspiracy King” and says, “Further out into the extremist fringe, one person in particular has been responsible for stirring up anti-government and antiObama conspiracy theories in the United States.”

Establishment Attempts to Demonize Critics of Obama’s Economic Policies MSNBC host Carlos Watson, who is an African American, was addressing the increased use of people labeling President Obama as a socialist because of his policies, when Watson stated, “you start to wonder, in fact, if the word socialist is becoming a code word, whether or not socialist is [lvii] becoming the new N-word.”

After a story broke about Barrack Obama’s wife Michelle having 26 aids, and conservatives were questioning why she would need so many and were concerned about the cost, MSNBC’s Chris Matthews tried to quell such criticism by stating, “When I heard people going after the first lady and the number of staff that they have, it sounds racist to me. It sounds like people [lviii] are mad we have a black first lady.”

Comedian Janeane Garofalo stated on MSNBC’s Countdown with Keith Olbermann that the Tea Party protests in 2009 were not about protesting out of control government spending or increasing taxes, but that, “Let’s be very honest about what this is about. It’s not about bashing democrats, it’s not about taxes, they have no idea what the Boston Tea Party was about. They don’t know their history at all. This is about hating a black man in the White House. This is racism straight up…and there is no way around that.” She was not joking.

Former Democratic President Jimmy Carter told Brian Williams during an interview on NBC that, “I think an overwhelming portion of the intentionally demonstrated animosity towards President Barrack Obama is based on the fact that he is a black man, that he’s African American….and I think it’s bubbled up to the surface because of a belief among many white people, not just in the south, but around the country, that African Americans [lix] are not qualified to lead this great country.”

The Servant Class So a private bank (the Federal Reserve) has a stranglehold over the United States government, in much of the same way that many consumers are in debt to credit cards or other unsecured loans. (An unsecured loan is a loan that is not backed by collateral.) Much of consumer debt is due to people “buying things they don’t need with money they don’t have” as the cliché goes. Dining out, bar tabs, new clothes, and vacations often rack up enormous credit card debt which then continues to rise with compounding interest, with people often only making the minimum payment that doesn’t even cover the previous month’s interest. The larger the national debt of the United States government goes, the higher taxes are raised, and the lower the standard of living gets. You often hear that “the middle class is shrinking,” which means that more and more people will never own a home or be able to retire, and will never really accumulate any valuable assets. Another cliché, “the rich get richer and the poor get poorer” is sadly coming true. A major financial goal for the New World Order is to completely erode the middle class and leave only two social classes remaining: the wealthy, and the poor working class who will forever be slaves to the system, laboring away to pay their taxes and fuel the lifestyles of the elite Illuminati. While many people fear this coming and are trying to fight against it, the vast majority of Americans are happy as long as they can get drunk and watch football on the weekends, and have come to embrace their slavery. The elite are pleased with this servant class since they are uninformed and out of the way, and while living only for the moment, they don’t even

consider the possibility that there is more to life or that they have been reduced to mere peasants.

One World Currency People who are aware of the emerging New World Order often warn of a coming one world currency, and the “mark of the beast.” In fact, many Christians are aware of Revelation 13:16-18 which states, “And he causeth all, both small and great, rich and poor, free and bond, to receive a mark in their right hand, or in their foreheads: And that no man might buy or sell, save he that had the mark, or the name of the beast, or the number of his name. Here is wisdom. Let him that hath understanding count the number of the beast: for it is the number of a man; and his number is six hundred threescore and six.” The infamous mark of the beast is fairly well known in Christian circles, and secular circles as well. The term refers to a passage in the Book of Revelation, which is the last book in the Bible, and indicates some kind of mark that the Antichrist world dictator will force everyone to take on their right hand or on their forehead, and if they don’t, then they will not be able to buy or sell anything or partake in any kind of financial transactions using money. This book of the Bible is believed by most scholars to have been written sometime between the year 68 A.D. and 90 A.D. by John of Patmos and describes his apocalyptic visions of the last days of the earth. While most Christians have heard of the mark of the beast and have some idea of what it is, unfortunately most of them do not see the underlying forces and institutions that are continuously striving to bring such a thing into reality. For decades resistance groups and those who were concerned about a New World Order saw the signs that one day the elite bankers around the world hoped to implement a single global currency and eliminate all other forms of money. This unified global currency will be transferred into an electronic currency then, and the use of cash and coins will practically be eliminated and a thing of the past.

Once this electronic currency is the universally accepted method of payment for all goods and services, every person in the world will be subjected to having each and every one of their financial transactions recorded in a database. Exactly what you buy, when you buy it, how much you paid, and what store location you bought it from will be cataloged and stored indefinitely. The days of making cash transactions for things like selling an old car, or even mowing a neighbor’s lawn will be a thing of the past. Once this system is implemented the government can ensure that they will be aware of each and every financial transaction, no matter how large or small, and be sure to tax you as they see fit. The financial transaction database on each person can also be used in ways that most people could never imagine. The financial institutions connected to your mark of the beast can sell your entire purchasing history to advertisers or even insurance companies. Are you purchasing large quantities of chocolate cake on a weekly basis? Cigarettes? Beer? Your insurance company would love to know these things, and could use such information to either increase your rates, or to place you lower on the priority list when you need medical treatment since your purchasing profile shows that you buy a lot of chocolate cake and beer and aren’t paying any monthly dues to a gym or health club. President Bill Clinton’s mentor at Georgetown University, the establishment insider named Carroll Quigley wrote in his 1966 book Tragedy and Hope that “The powers of financial capitalism had (a) far-reaching aim, nothing less than to create a world system of financial control in private hands able to dominate the political system of each country and the economy of the world as a whole. This system was to be controlled in a feudalist fashion by the central banks of the world acting in concert, by secret agreements arrived at in frequent meetings and conferences. The apex of the systems was to be the Bank for International Settlements in Basel, Switzerland, a private bank owned and controlled by the world’s central banks which were themselves private corporations. Each central bank...sought to dominate its government by its ability to control Treasury loans, to manipulate foreign exchanges, to influence the level of economic activity in the country, and to influence cooperative politicians by subsequent economic rewards in the [lx] business world.”

The Amero The Amero is the new currency that elite globalist organizations are pushing to replace the American dollar, the Canadian dollar, and the Mexican peso. This will likely happen after the North American Union becomes official, which they are also pushing. Once regional currencies are established around the world, all those currencies will then be merged into the one world currency, and then transformed into an electronic currency. The Amero was first proposed in 1999 by a Canadian economist named Herbert G. Grubel who published a book titled The Case for the Amero . [lxi]

This was the same year that the Euro became the official currency in Europe for the European Union. Chairman of the Council on Foreign Relations, Robert Pastor, later had a book published in 2001 titled Toward a North American Community , where he wrote, “In the long term, the amero is in the best interests of all three [lxii]

countries,”

referring to the United States, Canada, and Mexico. Anyone who has spent any time looking at the elite organizations at the heart of the New World Order knows that the Council on Foreign Relations usually gets what it wants, and it is very telling when the chairman writes a book about wanting a North American Union and a new regional currency. An economist at the Federal Reserve Bank of New York, Eric van Wincoop, co-authored a journal article in 2001 which discussed what he said were the benefits of a regional currency, saying, “The use of different moneys across borders can form a barrier as there are costs in exchanging currencies in spot and forward markets and traders face uncertainty about currency movements that cannot always be hedged. A common currency also leads [lxiii] to greater transparency of price differentials.”

It is very interesting that elite members of the Council on Foreign Relations and the Federal Reserve Bank of New York have been promoting the idea of creating a new regional currency involving the United States, Canada,

and Mexico, while at the same time such an idea is called a conspiracy theory by most so-called financial or political experts. The reason for this is so that such a plan may be formulated and finalized without the public’s awareness so the plan for such a currency will be just a few steps from completion before it or its supporters are faced with any opposition. Since the insider’s discussions of such a plan are mainly in literature only read by other insiders and not in the mainstream press, it is basically an open secret which goes unnoticed by the masses who are distracted by the pop culture circus that is presented to them by the mainstream media.

Hal Turner’s Amero Hoax A man named Hal Turner posted a video on his YouTube channel on October 4th 2008 titled “Hal Turner Shows New AMERO Currency,” where he claimed to have in his possession an actual Amero coin he obtained from a contact at the Denver Mint. The video quickly received over 400,000 views and reached the number one spot on Google Video’s top 100 list and was spread around the Internet like wildfire. A lot of people gullibly accepted his claims, and believed that the Amero would soon be released to the public. What most people didn’t realize is that Hal Turner is a white supremacist who worked for the FBI as an informant and an agent provocateur. More on this later. The “Amero” that Turner held in his hand for his video was simply a novelty replica that could be purchased from www.AmeroCurrency.com or www.DC-Coin.com. As he is displaying his coin in his video, at one point the camera zooms in on the front and back of the coin to show the designs as he attempts to “prove” its authenticity, and if you compare the coin he is holding to the replicas sold on the Internet, they are EXACTLY the same. After someone does two minutes of research, Hal Turner’s claims become absurd and can be seen as completely fraudulent, but some of his supporters still defended him online saying that he himself was “duped” into believing that he had been sent a “real” Amero by an informant who worked at the Denver Mint. After all, the Council on Foreign Relations and other New World Order organizations have been planning such a thing for years. The previous year Turner had posted photos of “real” Amero coins on his

website, which also spread around the web, and interestingly enough he would later buy or obtain the replica and show it off to be real. A quick Google search shows anyone that the pictures of the coins were taken from the various websites that create novelty coins and replicas. Countless people must have emailed him to point this out to him, as did the comments on his blog post, so he had to know that the coins were simply replicas, but that didn’t stop him from trying to continue the hoax a year later by claiming to have an actual coin. Posting comments on the video on his YouTube channel of his alleged discovery had been disabled by him, obviously because people would post comments and links showing his coin was nothing but an easily obtained replica. Numerous counter videos were posted to YouTube exposing this hoax, and various bloggers had posted articles pointing it out as well. Two months later, on December 3rd 2008 Turner posted photos of “Amero paper currency” and wrote, “To the chagrin of the government, I have obtained new “AMERO” paper currency notes! You know, the “AMERO” . . . . the new currency that is going to replace the US Dollar, The Canadian Dollar and the Mexican Peso? Yea, the new currency that all three [lxiv] governments claim doesn’t exist. . . I have it.”

His article goes on to say how over a year ago he “first broke” the story about Amero coins being secretly created at the Denver Mint, referring to the photos he posted on his website. His article also claims that YouTube notified him that the video he had posted showing his alleged Amero coin had been deleted and his account “permanently closed at the request of the United States Treasury Department.” Turner wrote, “The Treasury department told YouTube/Google that my video was destabilizing the U.S. [lxv] Dollar and was thus a threat to national security.”

While his articles allow readers to post comments, the user is notified that the administrator (Turner) must approve all comments first, and if and when this happens, it will show up on the website. So obviously, all comments posted informing him and the readers that the photos and his claims are

fraudulent, were simply not approved, and never found their way on the website. It is incredible the number of gullible people that continue to believe Turner. By reading the comments that he had approved, it becomes clear the inability of Turner’s readers to distinguish fact from fiction. What’s worse is that Turner’s articles are often copied and pasted into emails and sent around to others by people who believe his writings and aren’t aware of his continuous lies and his admitted role as a government agent. One can see how a large percentage of the viewers of his video claiming to show an Amero will believe him at first—that the Ameros are already being coined, only to later dismiss the idea of the U.S. Dollar collapsing and being replaced by a new currency—because it turns out the video was a hoax. It’s a classic case of disinformation by mixing facts with fiction, in an attempt to prevent the public from focusing on the impact of such issues that we will ultimately face in the near future. Turner has a history of urging and hoping for violence against others, including judges, and has posted their home addresses on his website and written blogs celebrating their murders. In July 2009 Turner was arrested for allegedly posting threats to federal judges. During a court appearance his lawyer Michael Orozco pleaded with the judge saying Turner worked for the FBI beginning in 2002 as an “agent provocateur” and was taught by the agency “what he could say that [lxvi] wouldn’t be crossing the line.”

“His job was basically to publish information which would cause other parties to act in a manner which would lead to their arrest,” Orozco said. [lxvii] So it is clear that not only was Turner wrong about having an actual Amero coin, but he was purposefully lying about it in an attempt to create the idea that a regional currency, likely to be called the Amero, is a hoax and something American’s don’t need to worry about or look into. This way when people hear about such a plan, they quickly dismiss it as a conspiracy theory or a hoax thanks to actions like Turner’s.

Turner’s admission that he worked for the FBI and his somewhat creative hoaxes about the Amero led many to believe that he worked as a disinformation agent, whose job it was to put out false and fraudulent information about the Amero, in order to make anyone who talked about such a thing seem like they were falling for Turner’s scam and that there was no such thing in the works.

China Calls for Global Currency In May of 2009 just before the G-20 economic summit in London, an official from China’s central bank made news around the world when they began calling for a new global currency to replace the U.S. dollar. The proposal came from Beijing’s central bank governor, Zhou Xiaochuan, who said that “the world economic crisis shows the inherent vulnerabilities and systemic risks in the existing international monetary system.” He recommended creating a currency that would be controlled by the International Monetary Fund in order “to achieve the objective of safeguarding global economic and financial stability.” China has been getting concerned about the value of the U.S. dollar because of Beijing’s estimated 1 trillion dollars in U.S. Treasuries and other government debt.

U.S. Treasury Secretary Timothy Geithner Immediately after news surfaced of China’s desire for a one world currency, U.S. Treasury Secretary Timothy Geithner was asked what his thoughts were on the proposals while he was speaking at a Council on Foreign Relations conference. A reporter asked, “[unintelligible]…about the Chinese proposal for a global currency…” Geithner answered, “I haven’t read the governor’s proposal…we’re actually quite open to that suggestion.” The previous day Geithner was asked by United States Representative Michelle Bachman, “I’m wondering, would you categorically renounce the United States moving away from the dollar and going to a global currency

as suggested this morning by China and also by Russia?,” to which Geithner replied, “I would. Yes.” She then asked Federal Reserve Chairman Ben Bernanke, who was sitting right next to him, and he answered, “I [lxviii] would also.”

So in a 24 hour period Geithner completely changed his mind, from being against a global currency, to supporting it, and while speaking at a Council on Foreign Relations press conference none the less.

Russia Calls for Global Currency The Kremlin (Russia’s Parliament) published its priorities just prior to the G-20 meeting in March 2009, where they openly called for the creation of a supranational reserve currency that they said should be part of the strategy to reform the global financial system which began collapsing in the fourth quarter of 2008. (The G-20 meeting is a yearly forum consisting of the finance ministers and central bank governors of the world’s largest 20 economies who meet to discuss international financial issues.) Russia urged the International Monetary Fund to create a new “super reserve currency accepted by the whole of the international community.” [lxix]

Russian President Shows Off Sample Coin of New ‘World Currency’ at G-8 Just a few months later at the 2009 G-8 meeting held in L’Aquila, Italy, the President of Russia, Dmitry Medvedev pulled a coin out of his pocket and displayed it for the press saying it was a sample of the coin of a “united future world currency.” The sample coin was minted in Belgium and was presented to the heads of the G-8 delegations. It bears the words, “unity in diversity.” He said the coin, “means they’re getting ready. I think it’s a good sign that we [lxx] understand how interdependent we are.”

Remember that just a few months earlier during the April 2009 G-20 meeting, Russia proposed creating a new supranational currency and questioned the U.S. dollar’s future as the global reserve currency.

Euro Contributor Endorses Global Currency Kazakstan was part of the Soviet Union until it became an independent nation in 1991, and is the ninth largest country in the world. It borders Russia, China, Uzbekistan and Turkmenistan. While not thought of as a key player in global events, it is still noteworthy that the President, Nursultan Nazarbayev, also proposed a new global currency which he called the “acmetal.” What is also interesting, is that Robert Mundell, a man who played a key role in creating the Euro currency for the European Union voiced support for Nazarbayev’s idea saying, “I must say that I agree with President Nazarbayev on his statement and many of the things he said in his plan, the project he made for the world currency, and I believe I’m right on track [lxxi] with what he’s saying,” adding the idea held “great promise.”

Robert Mundell is an economics professor at Columbia University in New York City and was given the Nobel Prize in economics in 1999 for his role in creating the Euro currency for the European Union which unified currencies in many European countries—including Germany, Greece, Ireland, Italy, Spain, Finland, Austria, and others.

Population Reduction At the time that this first edition of The New World Order: Facts & Fiction was first published in 2010, the earth’s population was around 6.795 billion [lxxii]

people.

One of the main goals of the New World Order is to massively reduce this number by billions of people. You read that correctly. A reduction of billions of people. Depending on the elitist, the goals of population reduction efforts range from reducing population by 50% to 95%. The elite politicians and businessmen say that the current population

levels are dangerously high and will soon result in the depletion of the earth’s natural resources. To accomplish this reduction, various strategies have been implemented such as promoting contraception, abortions, and one child policies. Mass genocide has also been discussed, including using biological weapons to kill off large numbers of people in developing countries. Many fear that such a tactic will one day be attempted in developed countries as well. The rationale behind such massive and horrific population reduction plans is quite chilling. The elite feel that since most tasks involving a large amount of physical labor have been accomplished, such as clearing countless acres of land for interstate highway systems, building infrastructure, such as dams and power plants, mining national resources, etc., and so now only a maintenance force is needed. Just think for a moment about the immense number of man hours it took to build the roads, bridges, and buildings that you take for granted every day. While at one point in time, people had to mine for minerals with simple hand tools, we now have enormous pieces of machinery that can do a job that used to take hundreds of men to do. The human species has been able to streamline nearly every process through the use of mechanical and technological means. During the incredible construction process of much of the world’s infrastructure, the workers needed food, clothes, shelter, medicine, and a variety of other things which are part of modern life. But now that most of the work is done, the elite see these people as using up valuable resources and simply being in the way and detrimental to the way of life that the elite hope to maintain. While people may find these claims hard to believe, as you keep reading you will find solid evidence and sources for them. The Illuminati want you dead.

Ted Turner Billionaire founder of CNN, Ted Turner, was interviewed Tuesday April 1st 2008 on Charlie Rose’s PBS show, where he revealed his beliefs about reducing the global population, but this was no April Fool’s joke. Turner

began by parroting the sensationalized fears of climate change, saying it needed to be stopped. “Not doing it will be catastrophic. We’ll be 8 degrees hotter in 10, not 10 but 30 or 40 years and basically none of the crops will grow. Most of the people will have died and the rest of us will be cannibals. Civilization will have broken down. The few people that are left will be living in a failed state like Somalia or Sudan. And living conditions will be intolerable. The droughts will be so bad there will be no more corn growing. Not doing it will be like suicide.” Then he went on to say, “After that, we’ve got to stabilize the population. There’s too many people. That’s why we have global warming. We have global warming because too many people are using too much stuff, if there were less people, they’d be using less stuff.” Ted Turner himself has five children. In 1996, Turner stated in an interview with an environmental magazine Audubon that, “A total population of 250-300 million people, a 95% decline from present levels, would be ideal.” In 1997 he donated one billion dollars to the United Nations to support their goals, which include population reduction.

Dr. Eric Pianka Dr. Eric Pianka (born January 23, 1939) is a biology professor at the University of Texas at Austin, who made national news in March of 2006 after his acceptance speech for the Distinguished Texas Scientist Award given by the Texas Academy of Science. A science writer named Forrest Mims was in attendance during this speech and was shocked at what he had heard, and soon after wrote an article about it for The Citizen Scientist , claiming that Pianka had advocated genocide to reduce the world’s population. In this article Mims recounts that an official of the Academy approached the video camera operator at the front of the auditorium and, “engaged him in animated conversation. The camera operator did not look pleased as he pointed the lens of the big camera to the ceiling and slowly walked away.”

So, by Forrest Mims account, Pianka’s speech was not allowed to be videotaped, and he writes that he noticed this curious incident because of his many years of experience as a writer and editor, and that it raised a red flag in his mind. Dr. Pianka began his speech by “explaining that the general public is not yet ready to hear what he was about to tell us,” Mims wrote. After Dr. Pianka told the audience that there were too many people on the earth and listing all the evils of humanity, Mims wrote that Pianka stated, “the only feasible solution to saving the Earth is to reduce the population to 10 percent of the present number…He then showed solutions for reducing the world’s population in the form of a slide depicting the Four Horsemen of the Apocalypse. War and famine would not do, he explained. Instead, disease offered the most efficient and fastest way to kill the billions that must soon die if the population crisis is to be solved.” He then explains that Pianka displayed a slide showing rows of human skulls and says he was deeply disturbed, not only by Pianka’s speech, but because he “watched in amazement as a few hundred members of the Texas Academy of Science rose to their feet and gave a standing ovation to a speech that enthusiastically advocated the elimination of 90 percent of [lxxiii] Earth’s population by airborne Ebola.”

After learning of the sinister nature of Pianka’s speech, an affiliate of Mims named William Dembski informed the Department of Homeland Security [lxxiv] which resulted in the FBI interviewing Pianka.

While Pianka’s speech was not allowed to be videotaped, one can read his own words on his official University of Texas website where he wrote, “Humans have overpopulated the Earth and in the process have created an ideal nutritional substrate on which bacteria and viruses (microbes) will grow and prosper. We are behaving like bacteria growing on an agar plate, flourishing until natural limits are reached or until another microbe [lxxv] colonizes and takes over, using them as their resource.”

“First, and foremost, we must get out of denial and recognize that Earth simply cannot support many billions of people, at least not in the lifestyles we would all like to live.” “I am convinced that the world, including all humanity , WOULD clearly be much better off without so many of us.” [The bold face and capital print is in the original text on his website, and was not added in this book.] One of the links on his website is to an obituary that he posted of himself, although at the time of this writing he is still alive. One more disturbing detail regarding Dr. Pianka is that on this website he shows pictures of a [lxxvi] bison he raised on his land whose name is identified as Lucifer.

World-Famous Microbiologist Planned Genocide In 2001 shocking information was released showing that decades in the past a world-famous microbiologist and winner of the Nobel prize named Sir Fram Macfarlane had secretly urged the Australian government to develop and use biological weapons against Indonesia and other “overpopulated” countries in South-East Asia to target food crops and spread infectious diseases in order to kill large numbers of the population. Such plans, which were developed in 1947, were revealed to the public in 2001 after the top-secret files were declassified by the National Archives of Australia. The release of the reports were faced with resistance from the Department of Foreign Affairs and Trade, which fought to prevent them from becoming public after historian Philip Dorling uncovered information on biological warfare in the National Archives in 1998. It wasn’t until 2001 that the damning files were released to Dorling, which included a detailed memo Sir Macfarlane wrote for the Defense Department in 1947, where he said that Australia should develop biological weapons that would work in tropical Asia without spreading to Australia’s more temperate population centers. “Specifically to the Australian situation, the most effective counteroffensive to threatened invasion by overpopulated Asiatic countries would

be directed towards the destruction by biological or chemical means of tropical food crops and the dissemination of infectious disease capable of spreading in tropical but not under Australian conditions,” the [lxxvii] microbiologist said.

It’s important to note that his plans to unleash such weapons were not because Australia was at war, but because he wanted to reduce the large populations that were using the national resources. His reference to an “invasion by overpopulated countries” doesn’t refer to a military invasion but refers rather to the overpopulation itself. Another unclassified document reads that he noted, “Its use has the tremendous advantage of not destroying the enemy’s industrial potential which can then be taken over intact.” Sir Macfarlane was the head of the Walter and Eliza Hall Institute of Medical Research, and won the Nobel prize in 1960 for medicine. In September, 1947, he joined a chemical and biological warfare subcommittee of the New Weapons and Equipment Development Committee in Australia, where he would develop his genocidal ideas where he recommended, “the possibilities of an attack on the food supplies of S-E Asia and Indonesia using B.W. agents should be considered by a small study group.” In 1951, he recommended that “a panel reporting to the chemical and biological warfare subcommittee should be authorized to report on the offensive potentiality of biological agents likely to be effective against the local food supplies of South-East Asia and Indonesia.”

Prince Philip Prince Philip, Duke of Edinburg, is the husband of the Queen of England, and at the time of this writing in 2010, he is 57 years old (born in 1921). The British royal family has long been involved with the Illuminati, and some say they themselves believe that they are descended from the lost tribe of Dan from Israel.

The Prince made a disturbing statement years ago regarding the world’s population, where he said, “In the event that I am reincarnated, I would like to return as a deadly virus, in order to contribute something to solve [lxxviii] overpopulation.”

Prince Philip is the father of Prince Charles, and the grandfather of Prince William and Prince Henry of Whales. Some people believe that the Antichrist will come from this family and that they are crypto-Jews, meaning they are hiding their Jewish ancestry. Regardless of whether this is true or not, the British Royal Family has been a major part of the secret establishment for many generations.

President Obama’s Science Advisor President Obama appointed a man named John Holdren to be his chief science czar, which means he is basically the top advisor to Obama regarding science and technology and their effects domestically and internationally. Immediately after his appointment bloggers began looking into his past and discovered that he was the co-author of a science text book in 1977 titled Ecoscience: Population, Resources, Environment, which contains several startling proposals to deal with what the authors perceived to be issues society would soon face regarding overpopulation and resource shortages. Adding Sterilants to Water Supply Holdren’s book openly discusses the idea of adding chemicals to the water supply to sterilize entire populations, saying, “Adding a sterilant to drinking water or staple foods is a suggestion that seems to horrify people more than most proposals for involuntary fertility control. Indeed, this would pose some very difficult political, legal, and social questions, to say nothing of the technical problems. No such sterilant exists today [in 1977], nor does one appear to be under development. To be acceptable, such a substance would have to meet some rather stiff requirements: it must be uniformly effective, despite widely varying doses received by individuals, and despite varying degrees of fertility and sensitivity among individuals; it must be free of dangerous or unpleasant side effects; and it must have no effect on

members of the opposite sex, children, old people, pets, or livestock.” [lxxix] Involuntary Fertility Control Another disturbing idea the book outlines is forcing women to become sterilized after having two or three children. “A program of sterilizing women after their second or third child, despite the relatively greater difficulty of the operation than vasectomy, might be easier to implement [lxxx] than trying to sterilize men,” the text reads.

Aside from forcing women to become sterilized after having several children, the authors also postulated that young girls could be forced on birth control to prevent them from having children, and that the birth control method would only be removed if the government allowed it. “The development of a long-term sterilizing capsule that could be implanted under the skin and removed when pregnancy is desired opens additional possibilities for coercive fertility control. The capsule could be implanted at puberty and might be removable, with official permission, for a limited [lxxxi] number of births.”

Mandatory Abortions As if adding a sterilant to the water supply or forcing young girls to submit to birth control until the government approves of them having a child weren’t horrific enough ideas, the textbook goes on to discuss and endorse forcing women to have abortions if they get pregnant without government permission. The book uses the term “compulsory” which is a fancy word meaning mandatory or forced against one’s will. The book reads, “Indeed, it has been concluded that compulsory population-control laws, even including laws requiring compulsory abortion, could be sustained under the existing Constitution if the population crisis became sufficiently severe to [lxxxii] endanger the society.”

Notice how these population ideas are not something only for 3rd world countries, but also for America as the authors point out that forced abortions, they believe, would be legal under the Constitution! Two Child Limit John Holdren and his co-authors try to equate their tyrannical reproduction policies with other laws concerning public safety. “In today’s world, however, the number of children in a family is a matter of profound public concern. The law regulates other highly personal matters. For example, no one may lawfully have more than one spouse at a time. Why should the law not be able to prevent a person from having more than two children?” [lxxxiii] Toward a Planetary Regime After reading the Nazi-style reproduction regulations in Holdren’s book and seeing that decades after its publication he would find himself in President Obama’s inner circle, it should come as no surprise that he would also suggest an all-powerful global government structure to enforce his nightmarish ideas, and to regulate other aspects of our lives. He wrote that current government agencies around the world, “might eventually be developed into a Planetary Regime—sort of an international super-agency for population, resources, and environment. Such a comprehensive Planetary Regime could control the development, administration, conservation, and distribution of all natural resources, renewable or nonrenewable, at least insofar as international implications exist. Thus the Regime could have the power to control pollution not only in the atmosphere and oceans, but also in such freshwater bodies as rivers and lakes that cross international boundaries or that discharge into the oceans. The Regime might also be a logical central agency for regulating all international trade, perhaps including assistance from DCs to LDCs, and including all food on the international market.” “The Planetary Regime might be given responsibility for determining the optimum population for the world and for each region and for arbitrating

various countries’ shares within their regional limits. Control of population size might remain the responsibility of each government, but the Regime [lxxxiv] would have some power to enforce the agreed limits.”

Abortions are Good for the Economy Speaker of the House, Nancy Pelosi was interviewed on NBC’s Meet the Press where she explained why she appropriated hundreds of millions of dollars to expand Planned Parenthood and similar services as part of an economic stimulus package. A brief transcript of this encounter follows: STEPHANOPOULOS: Hundreds of millions of dollars to expand family planning services. How is that stimulus? PELOSI: Well, the family planning services reduce cost. They reduce cost. The states are in terrible fiscal budget crises now and part of what we do for children’s health, education and some of those elements are to help the states meet their financial needs. One of those—one of the initiatives you mentioned, the contraception, will reduce costs to the states and to the federal government. STEPHANOPOULOS : So no apologies for that? PELOSI: No apologies. No. We have to deal with the consequences of the downturn in our economy. End of Transcript

The Limits to Growth The Club of Rome, a notorious elite globalist think tank, published a book in 1972 titled The Limits to Growth which would mark the first major propaganda piece warning of a rapidly growing population and finite natural resources. The book was written by Dennis L. Meadows, Donella H. Meadows, Jorgen Randers, and William W. Behrens III. World population, industrialization, pollution, food production, and resource depletion were the main focus of the report which argued that

while population grows exponentially, technology and the availability of natural resources only grow linearly. This would be the beginning of the growing campaign and propaganda aimed at justifying a massive population reduction around the world.

Global 2000 Report The Council on Environmental Quality and the State Department released a report in 1980 that was commissioned by President Jimmy Carter which continued to lay the foundation for propaganda concerning population reduction, diminishing resources, and global warming. The Global 2000 Report supposedly used computer models to make projections concerning these issues for the coming decades, and aimed to show what life would be like in the year 2000 (twenty years after its publication). “Computer projection models” were seen as extremely high-tech in 1980 when this report was published—an aspect to this report that was highlighted in an attempt to add to its credibility. It concluded by saying, “If present trends continue, the world in 2000 will be more crowded, and more vulnerable to disruption than the world we live in now. Serious stresses involving population, resources, and environment are clearly visible ahead. Despite greater material output, the world’s people will be poorer in many ways than they are today.”

Agenda 21 Agenda 21 is a program launched by the United Nations (UN) pertaining to what they call “sustainable development” around the world, which is a fancy term for reducing the population and preserving natural resources. The name Agenda 21 refers to the UN’s agenda for the 21st century. The full text of Agenda 21 was revealed at the United Nations Earth Summit in 1992 (officially called the Conference on Environment and Development) that was held in Rio de Janeiro. At this Earth Summit, 178 governments voted to adopt the Agenda 21 program, which is a blueprint for members of the UN and other governments and groups to take action to increase regulations in every area where humans have an impact on the environment.

There are 40 chapters in the Agenda 21 report which cover topics such as: changing consumption patterns of natural resources, controlling pollution, educating children about such issues, and implementing new financial mechanisms to achieve these goals.

United Nations Population Fund The United Nations Population Fund (UNFPA), originally called the United Nations Fund for Population Activities, was started in 1969 to supposedly provide supplies and services involving reproductive health, but a dark cloud has lingered over the fund for decades because of coerced sterilizations and forced abortions. When word of these practices surfaced, groups pressured the Regan administration as well as both Bush administrations (George H.W. and George W.) to withhold funding from UNFPA. As a result of the United States cutting off funding for the program, a nonprofit organization called Americans for UNFPA was started and compensated for the loss by raising donations. After Barack Obama was sworn in as president in January 2009, he restored U.S. funding to UNFPA which resulted in taxpayers’ money once again funding forced abortions and sterilizations in foreign countries. According to its Annual Report, the UNFPA received a total of $845.3 million dollars in funding in 2008, with $118 million coming from the Netherlands, $53 million from the United Kingdom, 52 million from Spain, and the European Commission and Japan each donated 36 million. In 2009 UNFPA released a report titled State of World Population which is 104 pages long and blames global warming on too many people living on the earth. “Slower population growth...would help build social resilience to climate change’s impacts and would contribute to a reduction of greenhouse-gas emissions in the future,” it says. “Population growth is among the factors influencing total emissions in industrialized as well as developing countries.” “Each person in a population will consume food and require housing, and ideally most will take advantage of transportation, which consumes energy,

and may use fuel to heat homes and have access to electricity.” “The growth of population can contribute to freshwater scarcity or degradation of cropland, which may in turn exacerbate the impacts of climate change…So too can climate change make it more difficult for governments to alleviate poverty and achieve the Millennium Development Goals.” “Fear of appearing supportive of population control has until recently held back any mention of ‘population’ in the climate debate…Nonetheless, some participants in the debate are tentatively suggesting the need at least to consider the impacts of population growth.”

The Georgia Guidestones The topic of the Georgia Guidestones monument is fascinating, yet disturbing, and a complete analysis of the subject can be found in this author’s previous book, The Resistance Manifesto , so for the sake of keeping this book to a manageable length, I will only briefly discuss them and their mysterious origins here. Basically, a large 19 foot tall granite monument stands in the small town of Elberton, Georgia, in the United States, consisting of four major stone slabs standing upright and assembled in a paddle wheel formation. Each of the eight stone faces are inscribed with ten commandments, with each set consisting of a different language: English, Russian, Hebrew, Arabic, Hindi, Chinese, Spanish, and Swahili. While some of the “guides” as they are called, are somewhat benign, there are several of them which are quite chilling. The first one reads, “Maintain the earth’s population at 500,0000,000” (500 million). Others speak of creating a world court and allude to a global religion, and finally the tenth one reads, “Be not a cancer on the earth. Leave room for nature.” As if this isn’t strange enough, the story of the Georgia Guidestones gets stranger the closer one looks into it. The monument was created in 1980 and was the result of a mysterious man calling himself “R.C. Christian” who said he represented a group of concerned citizens and wanted to erect a monument for mankind. He worked with a local granite company to design

the stones, and he paid for the entire project, an estimated cost of tens of thousands of dollars. The stones currently sit on public property on the highest point in Elberton County. To anyone familiar with the Rosicrucians, the pseudonym that this man chose, “R.C. Christian,” is clearly a reference to this enlightenment group which dates back to the early 1600s. Several years after the monument’s completion this same man published a book titled Common Sense Renewed , under the admitted pseudonym Robert Christian, and proclaimed, “The hearts of our human family must be touched and warmed to welcome a [lxxxv] global rule by reason.”

The book basically outlines his political philosophy and says that the first two printings were sent to several thousand political officials and shapers of public opinion throughout the world, and all members of the United States Congress. The Georgia Guidestones were not a simple task to complete and certainly cost several tens of thousands of dollars to construct, and after reading their depopulation commandments, it comes as no surprise that the mysterious individual who commissioned them used a pseudonym with Illuminati overtones. In December of 2008 some vandals spray painted several messages across the stones, such as, “Death to the Globalists,” “No North American Union,” and “Skull and Bones Suck Dick,” referring to the Skull and Bones secret society at Yale University, which serves as a recruiting ground for the elite Illuminati. Photos of the vandalism were posted on the Internet. This author was later contacted by a freelance journalist named Randall Sullivan who was working on a story about the monument, and when his article was published in April 2009, he wrote, “While Dice denies any [lxxxvi]

involvement in the assault, he seems to have inspired it,”

because I had publicly expressed my disgust for the stones and my desire to have them removed.

Life Extension Technology Aside from wanting to reduce the world’s population by 90 to 95%, the elite New World Order kingpins are also hoping that very soon scientists will be able to prevent them from aging and possibly live forever by using some form of molecular repair, organ replacements, or transhumanist development (merging computers and machines with the human body). While anti-aging creams and remedies have been around for decades and often associated with quackery, scientists are working very hard to figure out how they can prevent the oxidization of cells, or to get cells to reproduce themselves indefinitely, thus ensuring a healthy body as long as this process continues. Ray Kurzweil and others have proposed that nanorobots could one day be injected in the body and perform cellular repair from within. These ideas are not fanciful thinking of science fiction writers, but are instead very serious branches of science that are making tremendous advances in their quest. Even if the elite are not able to live indefinitely by using some of this coming technology, they will certainly be able to extend the human lifespan several decades or perhaps longer. Such an extension obviously means that people will use more natural resources during the course of their prolonged life, and this is another reason the elite are concerned with the global population and desire to dramatically reduce it. As miraculous life extending technologies become possible, the enormous cost for such procedures will be unaffordable by most people and will not be covered by insurance. This puts the technology exclusively in the hands of the wealthy, who are the same people shaping the New World Order. As this technology becomes closer to a reality, the elite will be even more compelled to unleash their genocidal plans.

One World Religion When discussing the goals of the New World Order, often three objectives are found at the top of the list: A one world government, a single global currency, and a unified world religion. The reason for this unified single religion is said to be a prerequisite to the Messiah arriving, who religious prophecies predict will be the savior of all mankind and will unveil the mysteries of existence and lead the world into an era of everlasting peace. Many religions speak of this Messiah figure, and while Christians believe that he arrived as Jesus Christ and will later return at the end of time, other religions are still looking for the Messiah’s arrival. In order to set the groundwork for this individual (who Christians believe will be a counterfeit claiming to be God and later defeated by the return of Jesus) the New World Order must set the philosophical foundation for this “Christ” to be seen as the appearance of God on earth, and be worshiped as such. The main problem for this philosophy and the coming counterfeit to be universally accepted as the Messiah, is the traditional belief in Christianity and the Bible’s description of the Antichrist, as well as Christians desire to live by a set of traditional values that are taught in the Bible. These are the reasons that traditional Christianity and family values are the largest obstacle to the New World Order’s coming unified religion, and thus traditional Christianity has been targeted for a revision or total destruction. Manly P. Hall explains, “Christianity is not the sole revelation of God to man. It is but a fractional part of the body religious. It is simply a crutch upon which the genus homo leans until he learns to stand and walk alone. It is something he believes in before he is capable of believing in himself with understanding. Like all external things it will finally pass away and be remembered only for that which it contributed to the inner realization of its [lxxxvii] devotees.”

Christians who do not convert to a more liberal and universal form of Christianity will be seen as problematic for the New World Order since

their conservative and traditional beliefs will be seen as holding back the global utopia and ruining the fun and “anything goes” attitude of the majority of society.

“Hate Speech” Laws It’s well known that some Christians can make judgments of other people for their sexuality, stance on abortion, and ideas of what is socially acceptable behavior. Some Christians speak out against such things using harsh criticism, while others simply express their disagreement. Most Christians tend to be socially conservative and lean towards more traditional views of family dynamics and sexual activity. People who are not religious can be very liberal in these areas, and the two different ideologies occasionally clash in disputes over what is being taught to children, or what is being distributed in the popular culture. In the United States of America, people are luckily able to exercise the freedom of speech which is outlined and guaranteed by the First Amendment to the Constitution. This freedom is only supposed to be restricted in the case of defamation and incitement to riot, but many fear that living in the New World Order will create criminals of Christians for simply voicing their opinions on certain social issues or behaviors, or even quoting the Bible. In recent years various legislation has been introduced regarding what is called hate speech, which aims to criminalize certain statements or opinions when expressed publicly. In 2001, a man was arrested in Canada for “inciting hatred” after submitting a newspaper ad containing Bible quotes [lxxxviii]

about homosexuality.

He was forced to pay out $1500 to each of four different homosexuals who filed a complaint against him. Canadian officials signed a bill into law in 2004 that reinforced such rules. In Britain a woman was visited at her home by two police officers after she wrote a letter to her city council expressing her displeasure that a gay pride parade was scheduled for her neighborhood. In the letter, she referred to homosexuals as sodomites and perverts and the police threatened to charge her with a criminal offense because “a hate incident is any incident that is

perceived by the victim or another person as being motivated by prejudice [lxxxix] or hatred.”

In 2004 a group of eleven Christians were arrested and charged with multiple crimes, including felonies in Pennsylvania for peacefully [xc]

demonstrating against a gay pride parade.

The demonstrators were said to have committed “hate speech” for preaching to the homosexuals and holding signs with Bible verses printed on them.

501(c)(3) Tax Exempt Churches It’s pretty much common knowledge that most churches don’t have to pay taxes since they are considered “not for profit” organizations, but most people have no idea what kind of restrictions this license places on these churches. A 501c organization is a provision in the United States Tax code which lists 26 different types of organizations that are exempt from federal income tax. Churches fall under section 3 of the 501c code, meaning they are a religious organization. Organizations that fall under section 501(c)(3) are prohibited from certain political activities and even comments. The Internal Revenue Service website explains, “Under the Internal Revenue Code, all section 501(c)(3) organizations are absolutely prohibited from directly or indirectly participating in, or intervening in, any political campaign on behalf of (or in opposition to) any candidate for elective public office. Contributions to political campaign funds or public statements of position (verbal or written) made on behalf of the organization in favor of or in opposition to any candidate for public office clearly violate the prohibition against political campaign activity. Violating this prohibition may result in denial or revocation of tax-exempt status and the imposition of certain excise taxes.” [xci] The tax code goes on to say, “voter education or registration activities with evidence of bias that (a) would favor one candidate over another; (b) oppose a candidate in some manner; or (c) have the effect of favoring a

candidate or group of candidates, will constitute prohibited participation or [xcii] intervention.”

Language saying activities may not “have the effect of favoring a candidate or group of candidates,” or that they are “absolutely prohibited from directly or indirectly participating in, or intervening in, any political campaign on behalf of (or in opposition to) any candidate for elective public office,” mean that if a pastor gives a sermon about certain social issues such as homosexuality, gay marriage, or abortion, the church will be in violation of the law and could have their tax exempt status revoked because the pastor is “indirectly participating in” a political activity. In 2005, the 3500 member All Saints Episcopal Church in Los Angeles, California was threatened by the IRS that they could lose their tax exempt [xciii]

status after the Reverend gave an anti-war message.

The church’s tax attorney Marcus Owens said the IRS offered to drop the proceedings if the church admitted wrongdoing. A United Methodist Church in New Jersey lost its tax exempt status in 2007 after officials refused to allow two lesbian couples to have their “weddings” [xciv]

on church property.

After it was discovered that members of the Mormon Church organized to support Proposition 8 passing in California in 2008, which banned gay marriage, many homosexual groups attempted to have their tax exempt status revoked as well. Most church goers have no idea that there are federal restrictions placed on what the pastor or priests can say to their congregation. Not only has the federal government locked churches into a contract preventing them from even indirectly influencing political affairs, but they also have been secretly working with major churches to get their leaders to teach their flocks what the government wants them to.

Government Secretly Working With Churches In May of 2006 a pastor came forward saying that FEMA (the Federal Emergency Management Agency) had implemented a secret program to

train pastors of large churches and have them work secretly with FEMA in order to encourage their congregations to obey the government’s demands in the case of martial law, firearm seizures, forced vaccinations, or forced relocations. [xcv]

The pastor, who contacted Infowars.com

to make such events public, wanted to remain anonymous but said that he and other religious representatives were invited to a secret meeting which encouraged and trained pastors to help implement FEMA and Homeland Security directives. The first directive was for pastors to preach to their congregations a message based on Romans 13 in the Bible, which when taken out of context urges people to obey their government and says the government was established by God. The informant also reported that it was made clear they were to start preaching subservience to authorities now, in order to condition their congregations to accept such ideas. He also reported that those in attendance were told that quarantines, martial law, and forced relocations were a problem for authorities when enforcing federal mandates because of what they called a “cowboy mentality” of people standing up for their rights and not going along with such demands. Some people may be skeptical of such claims, especially since the pastor chose to remain anonymous, but one year later in August of 2007, a TV station in Shreveport, Louisiana reported on this, confirming what this pastor had claimed. KSLA news reported that FEMA was secretly working with what they called Clergy Response Teams that were being trained by the federal government to “quell dissent” and pacify people in order to obey any orders given by the government in the event of martial law.

Adam Weishaupt on Christianity John Robison, one of the first authors to publish English translations of the writings of Illuminati founder Adam Weishaupt, wrote, “It surely needs little argument now to prove, that the Order of Illuminati had for its

immediate object the abolishing of Christianity (at least this was the intention of the Founder), with the sole view of overturning the civil government, by introducing universal dissoluteness and profligacy of manners, and then getting the assistance of the corrupted subjects to overset the throne. The whole conduct in the preparation and instruction of the Presbyter and Regens is directed to this point.” Robison quotes an original correspondence between Illuminati members from the 1700s where one member wrote, “I have been at unwearied pains to remove the fears of some who imagine that our Superiors want to abolish Christianity; but by and by their prejudices will wear off, and they will be more at their ease. Were I to let them know that our General holds all Religion to be a lie, and uses even Deism, only to lead men by the nose.”

Albert Pike’s Alleged 3 World Wars Letter A letter allegedly written by Albert Pike and sent to an Italian politician named Giuseppe Mazzini, dated August 15, 1871 outlined sinister plans for three different world wars that would purposefully be orchestrated to bring about the New World Order and set the stage for Luciferianism to become the world’s religion. Albert Pike is of course the author of Morals and Dogma and remains one of Freemasonry’s most influential members. In this letter, Pike allegedly wrote, “The First World War must be brought about in order to permit the Illuminati to overthrow the power of the Czars in Russia and of making that country a fortress of atheistic Communism. The divergences caused by the ‘agentur’ (agents) of the Illuminati between the British and Germanic Empires will be used to foment this war. At the end of the war, Communism will be built and used in order to destroy the other governments and in order to weaken the religions.” “The Second World War must be fomented by taking advantage of the differences between the Fascists and the political Zionists. This war must be brought about so that Nazism is destroyed and that the political Zionism be strong enough to institute a sovereign state of Israel in Palestine. During the Second World War, International Communism must become strong enough in order to balance Christendom, which would be then restrained and held

in check until the time when we would need it for the final social cataclysm.” “The Third World War must be fomented by taking advantage of the differences caused by the ‘agentur’ of the "Illuminati" between the political Zionists and the leaders of Islamic World. The war must be conducted in such a way that Islam (the Moslem Arabic World) and political Zionism (the State of Israel) mutually destroy each other. Meanwhile the other nations, once more divided on this issue will be constrained to fight to the point of complete physical, moral, spiritual and economical exhaustion… We shall unleash the Nihilists and the atheists, and we shall provoke a formidable social cataclysm which in all its horror will show clearly to the nations the effect of absolute atheism, origin of savagery and of the most bloody turmoil. Then everywhere, the citizens, obliged to defend themselves against the world minority of revolutionaries, will exterminate those destroyers of civilization, and the multitude, disillusioned with Christianity, whose deistic spirits will from that moment be without compass or direction, anxious for an ideal, but without knowing where to render its adoration, will receive the true light through the universal manifestation of the pure doctrine of Lucifer, brought finally out in the public view. This manifestation will result from the general reactionary movement which will follow the destruction of Christianity and atheism, both conquered and exterminated at the same time.”

Alice Bailey’s Open Admissions The respected New Age author Alice Bailey writes in her book The Externalization of the Hierarchy , “It has therefore become possible to synchronize the Approach of the divine to the human and to instruct the masses of men in the technique of thus invoking the Approach. This attitude of humanity will lead to a new revelation, to the new world religion and to new attitudes in the relation of man to God (religion) and of man to man [xcvi] (government or social relationships).”

“The Members of the Hierarchy are seen to be the Custodians of the divine Plan….The spiritual Hierarchy of the planet, the ability of mankind to contact its Members and to work in cooperation with Them, and the

existence of the greater Hierarchy of spiritual energies of which our tiny planetary sphere is a part—these are the three truths upon which the coming [xcvii] world religion may be based.”

Bailey also discusses the role of Freemasonry in the creation of this one world religion. Since Freemasonry is a continuation of the ancient Mystery Schools, it should come as no surprise that the Universalist teachings of the fraternity are laying the philosophical foundation for the New World Order religion. She writes, “There is no dissociation between the One Universal Church, the sacred inner Lodge of all true Masons, and the innermost circles of the esoteric societies…It must not be forgotten that only those souls who are on the Probationary Path or the Path of Discipleship will [xcviii] form the nucleus of the coming new world religion.”

“The new religion will manifest, for instance, through organizations like Masonry. In Freemasonry is embedded the core or secret heart of the occult [xcix] Mysteries—wrapped in number, metaphor and symbol.”

Unification Church Most people are shocked to find, or simply don’t believe, that the founder and owner of the Washington Times claims to be the Second Coming of Christ and is the leader of what is called the Unification Church. Sun Myung Moon is a Korean billionaire who has millions of people who follow him and see him as the return of Jesus. Moon’s Unification Church and his enormous following show just how easily people are duped into believing false religious doctrines and how wealthy and powerful these fake prophets can be. Aside from being a billionaire and owning the Washington Times , Sun Myung Moon has maintained close relationships with powerful politicians around the world who have no problem with the fact that he thinks he’s the return of Christ.

The Vatican

Vatican City in Rome is an entire sovereign country which is basically a small city owned and run by the Catholic Church. It has enormous wealth and its own police force, along with the Pope’s personal army, the Swiss Guard. The Catholic Church has long been intertwined with the Illuminati, and its society of Jesus (the Jesuits) are the Vatican’s foot soldiers attempting to make the Catholic Church the world’s leading religious authority. In 2007, Pope Benedict XVI announced that the Catholic Church was the only way to salvation, and that all other denominations are not true [c]

churches. He wasn’t talking about non-Christian religious organizations such as Islam or Buddhism, the Pope was talking about all Christian churches other than the Catholic Church. The Catholic Church, the popes, and bishops are basically the same as the Pharisees that Jesus denounced over 2000 years ago for their hypocrisy and their pride and arrogance due to their spiritual knowledge. One needs to look no further than the Inquisition or the massive institutional cover-up of countless pedophile priests to see the core of the Catholic Church is corrupt. The Catholic Church also diverts and perverts the teachings of Jesus in numerous ways, such as having people confess their sins to a priest (who is called Father, which the Bible says nobody but God should be called that) as well as selling indulgences and worshipping the virgin Mary and other saints. The selling of indulgences, if you don’t know, means that people used to pay money to a church and in return the priest would forgive that person’s sins and tell them they could then get into Heaven. Some indulgences were even sold for sins people would commit in the future. Such a practice was clearly a shameful abuse of power and completely contradictory to the teachings of Jesus. The Catholic Church basically took the freeing messages of Jesus and packaged them up and then sold them to the public, when Jesus had intended it to be accessible to all for free. This is the same thing the Jewish Pharisees did with Judaism. It is for these reasons and more that the Vatican, and specifically the Pope is looked at with suspicion regarding the New World Order and is believed by some to one day be the false prophet spoken about in the Bible. The counterfeit Christ (the Antichrist) will be a

political figure and the leader of the world, and the false prophet is believed to be a global religious leader who will (wrongfully) confirm to the world that the Christ has returned when the Antichrist announces he is God. Since the Catholic Church is trying to reinstate itself as the only Christian authority, many see the Pope as a prime candidate for this false prophet. A strange revelation was made by the Vatican at the end of 2009 concerning space aliens when the Vatican’s chief astronomer said that there could be other “extraterrestrial brothers” of ours out in space who “remained in full [ci]

friendship with their creator.”

Reverend José Gabriel Funes, head of the Vatican Observatory and a scientific adviser to Pope Benedict XVI, said “Why can’t we speak of a ‘brother extraterrestrial?’” And suggested our “brothers” could be more evolved than humans. While the subject of space aliens is filled with speculation, misidentification, and craziness, the idea of other intelligent life existing in other solar systems is a fascinating one, and certainly is likely. But what is interesting about the statements from Reverend Funes is that he said these beings could still be “in full friendship with their creator,” meaning they are in an unfallen state, unlike mankind. This means they would be without sin. It’s a very interesting statement that some see as setting the stage for an alien being to arrive on earth that will claim to be the return of Jesus, when in fact, it could be the Antichrist. This is, of course, only speculation, but the role of the corrupt Catholic Church in the New World Order’s coming new religion should be monitored very closely, and the Pope, whoever it is, and the leadership of the Vatican should be seen for the imposters and criminals they are.

Israel The State of Israel in the Middle East remains the focus of world events due to the continuous fighting between Arabs and Jews as they argue and kill each other over who has the right to the land, the Palestinians or the Jews. The State of Israel was created in 1948 following World War II so the Jews could return to the land their ancient ancestors once inhabited. This plan was organized by Britain as a sort of reparation for the persecution of the

Jews during the war and the Holocaust. The current population of Israel is around 7.5 million with 5.62 million being Jewish. The creation and existence of the Jewish country remains controversial for several reasons. First of which is that the Jews are seen by many as having stolen the land they are now occupying, having run off the Arabs who were inhabiting the area prior to the creation of Israel. Most Jews believe that God had promised them that land and have a Jewish supremacist view that they are entitled to the land because they believe God said they were. Controversy also surrounds the fact that Israel was created as a country for a specific race of people—the Jews. It is difficult to criticize Israel because the Jews and their blind supporters quickly label any criticism as antiSemitic—no matter how valid it is. Israel also remains a focal point for Christians and those who study Bible prophecy and the New World Order. Mainline Christians believe that Israel will be the capitol of the New World Order and will be the geographic location where the Antichrist will rule from, and where Jesus Christ will return to at the end of time. Many Jews have a similar view of the role of Israel in the New World Order, but they believe that Jesus was not the Messiah, and are still waiting for this individual to arrive and lead the Jews and the rest of the world into a utopia of peace and prosperity. The Illuminati and New Age secret societies and cults also look forward to this world leader, who they say will arrive and be identified as the long awaited Christ and Messiah.

A Global Dictator Claiming to be God It is basically common knowledge that Christians believe that at some point in time, a global leader will rise to power and will wreak havoc on the earth as a dictator known as the Antichrist. Other religions such as Islam, have similar prophecies which foresee such a scenario as well. In Christian theology this dictator will rise to power at a point in time when the planet is engulfed in chaos and war, and he will promise world peace if given the

power to lead the world. According to the prophecies, this individual will not only be a tyrannical dictator once in power, but he will also claim to be God incarnate and demand to be worshiped as such. This isn’t exactly a novel idea. If one looks at the history of past civilizations, similar events have occurred over and over again. The pharaohs of Egypt claimed to be gods and demanded their people treat them as such. Nero, the emperor of Rome, expected such treatment as well. A more modern example is that of Adolf Hitler, who saw himself as the savior of Germany and the white race, and who was essentially worshiped as the messiah. A “God complex” seems to fall upon the most power-hungry men throughout history as their thirst for power and recognition leads them to the conclusion that they themselves are a god, and can do whatever they like with their power, no matter how unjust. There are a few fascinating points that I would like to address regarding this Antichrist scenario, and how it ties directly into the secret societies that are shaping the New World Order. As you should have gathered by now from my writings, a main theme within the secret societies is that the teachings elevate the initiate to a level of enlightenment where they themselves become a god, or god of their own perceived universe. Manly P. Hall explains in his classic book, The Secret Teachings of All Ages that, “The Mysteries were therefore established for the purpose of unfolding the nature of man according to certain fixed rules which, when faithfully followed, elevated the human consciousness to a point where it was capable of cognizing its own constitution and the true purpose of existence. This knowledge of how man’s manifold constitution could be most quickly and most completely regenerated to the point of spiritual illumination [cii] constituted the secret, or esoteric, doctrine of antiquity.”

Such enlightenment philosophies are not that dangerous by themselves, although considered heretical by Christianity and other religions, but instead it is the potential that one can develop this God complex and then place himself above all others and think that the rules of basic human conduct don’t apply to them.

While people defend occult organizations such as the Freemasons and other fraternities that teach the ancient Mysteries because they see the teachings as a way to build moral character and make sense of the world and their place in it through the spiritual and symbolic teachings found within such schools, it is undeniable that within such organizations there exists a corrupt core, who many say have hijacked and perverted the ancient Mysteries. The Illuminati is the key culprit who admittedly infiltrated Freemasonry in 1782 and created an inner circle to function covertly under the cover of the fraternity. Others say that the corruption had occurred centuries earlier. We do find clear evidence of the corrupt core today, and they continue to give a bad name to secret societies and are the source of countless conspiracy theories surrounding them. It is an interesting debate to discuss whether or not the Mysteries themselves are inherently evil, or whether they have been hijacked and abused by organized criminal networks that pervert them for their own gain. Now, let’s analyze the striking parallels between Christian Bible prophecy and the published plans and hopes of the elite secret societies. The Book of Revelation, the final book in the Bible, describes a man who is said to be the Antichrist, or a worker of Satan, who claims to be God and the savior of the world, but in reality is a ruthless dictator. The teachings of the Mystery Schools are believed to enlighten a man so he may become god-like and as we know men are inclined to get a God complex and become over taken by megalomania and selfishness. What is also interesting is that the Bible describes the counterfeit Christ as a world leader who will claim to be God and demand to be worshiped as such, and will do so in the new Solomon’s temple in Jerusalem. This temple, as of early 2010 when this book was first published, has not been rebuilt. The original location of the historical Solomon’s temple is currently occupied by a Muslim mosque called the Dome of the Rock. Solomon’s temple was destroyed twice in the past, once in 586 BC by the Babylonians, and again in 70 AD by the Romans. Jews have long hoped and planned for the third temple to be rebuilt on the original location, but since the Dome of the Rock stands there, they have a problem. This mosque will surely be destroyed

during a conflict sometime in the future and the land will be taken over by Jews, who will then rebuild their long awaited temple. It’s pivotal to note that Freemasonry is a modern Mystery School teaching the same philosophies that had been carried on in secret fraternal orders for thousands of years. Freemasons also consider their lodge where they meet, a temple, but not just any temple. It represents the Temple of Solomon. The head Mason of a lodge is called the Worshipful Master—an interesting choice for a leader. He is so enlightened, Masons believe, that he is a master of the universe and has achieved godhood, so he is “worshipful.” It is not hard to see then that the leader of the New World Order, or the “president of the world” will be a 33rd degree Freemason and believed by himself and his inner circle of associates to have achieved godhood, and will be a “worshipful master” and will take up the rebuilt Temple of Solomon as his own personal temple or office. In 2 Thessalonians 2:4-8, the Bible explains that the Antichrist will sit in the Temple of Jerusalem where he will exalt himself above God, claiming that he is God, saying, “Who opposeth and exalteth himself above all that is called God, or that is worshipped; so that he as God sitteth in the temple of God, shewing himself that he is God.” Matthew 24: 15-16 quotes Jesus speaking to His disciple, saying, “When ye therefore shall see the abomination of desolation, spoken of by Daniel the prophet, stand in the holy place [meaning the temple], (whoso readeth, let him understand), then let them which be in Judea flee into the mountains.” New Age guru Benjamin Crème writes about the appearance of what he calls the Maitreya or the Christ, saying, “This will lead to the Day of Declaration, when He will appear on the radio and television networks of the world linked by satellite. On that day Maitreya will mentally overshadow the whole of humanity simultaneously. All will hear His words inwardly in their own language. This telepathic communication will reach everyone, not only those watching or listening, and hundreds of thousands of miraculous healings will take place throughout the world. On that day, there will be no doubt that Maitreya is the Christ, the Imam Mahdi,

Maitreya Buddha, Kalki Avatart: the World Teacher. His open worldwide [ciii] mission will have begun.”

While Benjamin Crème may think that such an event will be the result of this individual’s “super natural power,” there is actually a perfectly logical explanation for how this kind of “telepathic” phenomena can occur.

Project Bluebeam In February of 1999, the Washington Post reported that operations were drawn up during the first Gulf War to project a huge holographic image of [civ]

Allah [the Islamic god] in the sky over Baghdad.

Then, using a 515KHz acoustic beam, the appearance of Allah talking would also have been manufactured, telling the Iraqi people to turn on Saddam. A similar plan was considered in Project Mongoose to overthrow Fidel Castro, where a Jesus-like figure would have been projected, telling the Cubans to overthrow “Godless Communism.” This technology has been labeled Project Blue Beam, and is likely ready to be used at any time. Of course, such technology is classified under national security, but this explains perfectly how Benjamin Crème’s prediction could come true of the “Christ” telepathically communicating with people, fooling them into believing he has supernatural powers and is God.

The Holy Bloodline Theory Ideas that Jesus Christ had a child with Mary Magdalene have been introduced to the mainstream though various books and novels, most popular of which is Dan Brown’s The Da Vinci Code ,which was released in 2003 and made into a film starring Tom Hanks in 2006. Such an idea has no real evidence, yet it has taken hold in millions of people’s minds as being the truth. This idea has several large implications on the New World Order’s goal of eroding faith in Christianity, as well as providing a possible justification for the supposed divine right of the Antichrist to rule earth, as he claims to be the long awaited Messiah.

Since secret societies like the Knights Templar and the Freemasons are said to be guardians of the Holy Grail, which in this theory means the bloodline of Jesus and not some cup or book of knowledge, this theory could very well be used as “evidence” that the Antichrist is the physical reincarnation of Jesus, or a direct descendent of him in an attempt to dupe Christians and Agnostics into believing he is divinely ordained to rule the New World Order.

The Rapture According to many Christians, when the end times come and the world has decayed into a disastrous wasteland and the Antichrist is about to take power, Christians will miraculously disappear from the face of the earth and be spared the harsh existence the rest of the world will face at the hands of this global tyrant. While many faithful Christians point to various Bible verses they believe verify this idea, it is highly doubtful such an event will occur, and it is this author’s opinion that the Rapture is a misinterpretation of the Bible, and a hoax. Some people who see the idea of all faithful Christians magically disappearing off the face of the earth and leaving everyone else behind to live in the New World Order as foolish, adhere to what is called a post tribulation rapture, which they say is a rapture of the Christians after the rule of the Antichrist. This idea is at least more realistic than a pre-trib (pretribulation) rapture. A major downfall to believing in the pre-trib rapture (the idea that Christians will be taken to Heaven as soon as the Antichrist comes on the scene, therefore being spared from the chaos and persecution) is that by believing they will supernaturally be taken off the earth and avoid the troubling times when the global dictator Antichrist is in power, they do not see a need to resist the New World Order or any major political or social policies being implemented, because they think that before things get too bad they’re going to go to Heaven and they won’t have to deal with it. When told about the encroaching Big Brother surveillance system and the VeriChip or similar device replacing paper currency and fulfilling the prophecy of the mark of the beast, instead of speaking out against it or

pushing for some kind of accountability or alternative for such a system, Rapture believing Christians are actually pleased such things are right around the corner because they think it means the Rapture is one step closer. Such a pathetic and cowardly attitude only allows their freedoms, privacy, and liberties to be taken away much more easily.

Other Implications of the Dictator This counterfeit Christ who claims to be God will espouse a very liberal and immoral philosophy on the world. Any sort of moral judgment on behaviors traditionally seen as immoral or reprehensible will be faced with extreme consequences. A very hedonistic lifestyle will be embraced and conservatives and Christians who oppose such behaviors will be labeled as the evil ones who are out of touch with the times. Many Christians will not believe that this man is God and will be aware of the massive fraud that is being perpetuated, and these individuals will be targeted as the trouble makers and the ones who are preventing the New World Order utopia from being realized. Some prophecies predict that the Antichrist will be nearly killed in an assassination attempt (or an accident) and will seemingly come back to life but with a massive wound to one of his eyes. His miraculous recovery will be touted as a miracle by his inner circle and will be more justification in the minds of his supporters that he has supernatural powers and has the divine right to rule. It’s interesting to note that the symbol for the Illuminati is one eye, often drawn inside a triangle or placed at the top of a pyramid. If this dictator is missing one eye after he is “resurrected” after his attack (or accident), the Illuminati would surely link their symbol of their God (the all-seeing eye) with their leader, who will also have one eye. This too may be seen as another “sign” that he is the Messiah.

Global Police and Military Force There have been suspicions that UN (United Nations) troops could be deployed on American soil for any number of reasons, such as supposedly to aid Americans in the event of a major terrorist attack from biological or

nuclear weapons, or to take over American infrastructure in the event of the U.S. dollar collapsing and becoming worthless as foreign countries try to recoup their losses. Such fears are stoked by videos that surface of the American military training foreign troops on US soil, sometimes practicing urban exercises where they simulate taking over a town’s main buildings, locking down the area, and even rounding up civilians who are willing participants in the exercises who pretend to be upset that they are being detained. Some videos even show make-shift prison camps where detainees are checked in and [cv] given ID badges and held inside tents surrounded by barbed wire.

One main reason for people’s uneasiness about such situations is that if UN forces are used on American soil for any reason, they do not have any loyalty to this country or the Constitution. We are nothing but foreigners to them. They would not be protecting their own neighborhoods or cities, but instead would simply be doing a job. Such troops will likely have no problems confiscating guns from house to house or rounding up large numbers of Americans for relocation to prison camps. President Obama’s chief science czar John Holdren wrote in his 1977 book Ecoscience about what he felt were the advantages of a global police force, saying, “If this could be accomplished, security might be provided by an armed international organization, a global analogue of a police force. Many people have recognized this as a goal, but the way to reach it remains obscure in a world where factionalism seems, if anything, to be increasing. The first step necessarily involves partial surrender of sovereignty to an [cvi] international organization.”

This is the same man who wrote in this same book about adding sterilizing agents to the water supply and forcing all women onto birth control or else forcing them to have an abortion if they get pregnant after having two children. Another unsettling aspect concerning military troops in the New World Order is the existence of private contractors being employed. Such a strategy became fairly well known during the Iraq War when the infamous

Blackwater private security company became the focus of controversy after the public learned that these “contractors” were being paid a large amount of money and were given luxurious living conditions and great food compared to regular US soldiers. These Blackwater troops are basically paid mercenaries who do not have the same chain of command and codes of conduct that members of the US military have. Such mercenaries don’t have any loyalty to any particular country either, and will accept a paycheck and orders from practically anyone.

Blackwater Now called simply Xe (pronounced Zi), is the new name for the private military contracting company formerly called Blackwater that became known for various controversies surrounding its employees activities during the War in Iraq. The company is the largest tactical training facility which trains more than 40,000 people per year in military offensive and defensive operations. In early 2009, the company changed its name from Blackwater to Xe and the new name, “reflects the change in company focus away from the business of providing private security.” The company denied the new strange name has any significance or special meaning. They did, however, admit that the name Blackwater became too closely associated with the [cvii]

company’s work in the occupation of Iraq.

The company’s license to operate in Iraq was not renewed and the new Iraqi government made several attempts to have them kicked out of the country during the course of [cviii] the war.

Xe (Blackwater) is still the largest private security contractor used by the United States government. 90% of the company’s money comes from [cix]

government contracts; two-thirds of which are no-bid contracts

— meaning they are the only company providing a quote to the government for the job—so multiple companies won’t have to compete with each other for the job by offering a lower price than the others.

The scandals and controversies surrounding corruption and murder involving Blackwater (Xe) mercenaries are numerous. In one instance executives at Blackwater authorized secret payments of nearly $1 million dollars to Iraqi officials in order to buy their silence regarding a 2007 incident where Blackwater security guards killed 17 Iraqi civilians in [cx]

Bagdad.

Blackwater’s president Gary Jackson was fingered by four former executives as having personally approved the bribes. The CIA also contracted Blackwater to create a hit squad and assassinate leaders of resistance groups in Iraq.

American Police Force A mysterious private security company came to the attention of concerned citizens in September 2009 which went by the name American Police Force, and used a Serbian coat of arms as its logo. The company had been contracted to run an empty prison facility in the city of Hardin, Montana, which drew suspicion of local residents. Local officials had hoped the facility would be used to detain prisoners that were held at the prison at Guantanamo Bay in Cuba, which President Obama claimed he would close. The contract between the city of Hardin and American Police force was [cxi] reported to be a 10-year, multimillion dollar deal.

American Police Force is owned by a man named Michael Hilton, whose criminal record shows he “pleaded guilty in March 1993 to 14 felonies, including 10 counts of grand theft, one count of attempted grand theft and three counts of diversion of construction funds, according to Orange County court records. He was sentenced to two years in prison, but it is unclear how [cxii] much time he served.”

Hilton is said to speak English with a heavy accent and told reporters he is a naturalized US citizen who is originally from Montenegro, which borders Serbia. Orange County, California court records show Hilton has used sixteen different aliases, one of which, Michael Miodrag, is listed as being

connected to a multimillion dollar fraud case in Australia from 2007. Shortly after all the controversy surrounding the American Police Force and people looking into Michael Hilton’s shady past, the city of Harding announced that American Police Force would not be taking over the abandoned prison facility. The Serbian government also forced American Police Force to change its logo, since it was a coat of arms used by the Serbian government. Mystery still surrounds this strange “American Police Force” company and how they were able to get a ten million dollar deal to operate an abandoned prison. When news reports first started surfacing about this issue, some people began fearing that this prison would be operated as a concentration camp for US citizens who some feared would be rounded up for not taking the H1N1 swine flu vaccine that the government was pushing at the time. It’s also strange that a private security company was allowed to operate using a name that impersonates the police, when such an action is a felony.

Other Private Military Companies While Blackwater and Private Police Force may be two of the most wellknown contracted military or mercenary companies, the list is fairly long of other lesser known companies. MVM Inc. provides contracting services for the CIA and the NSA (National Security Agency) and is located in Vienna, Virginia, which is just 6 miles from the CIA headquarters in Langley, Virginia. DynCorp is another infamous contracting company used by the military, which has been implicated in kidnapping children from Russia and Romania and selling them as sex slaves. KBR Inc. (Formerly Kellogg Brown and Root) is another private military contractor whose employees have also been implicated in human [cxiii]

trafficking.

Numerous women have also reported being gang raped by their fellow employees while working for KBR. One woman, Jamie Leigh Jones, testified before a Congressional hearing that she had been gang-raped by approximately seven of her coworkers when she worked for

[cxiv]

KBR in Iraq back in 2005.

Jones’ lawyers said that 38 other women reported similar experiences. KBR was a subsidiary of Halliburton at the time. Dick Cheney, if you recall, was the CEO of Halliburton from 1995 to the year 2000, before becoming vice president under George W. Bush and then pulling strings so his former company would make millions in no-bid contracts.

Posse Comitatus Act The Posse Comitatus Act was a law passed in 1878 which specifically prohibited the U.S. military from being used on American soil for law enforcement purposes. The term is Latin for “power of the county.” The reason for such a law was to prevent a dictatorship from arising in America by prohibiting a corrupt president from ordering the Army or other military branch to enforce laws that may be unconstitutional. After 9/11, numerous instances of uniformed military personnel helping police conduct security checks began to be reported as violations of Posse Comitatus, but all instances were described by officials as merely “training exercises,” thus claiming there was no collaboration between police and military, when clearly there was. One concerned citizen videotaped a brief conversation with a uniformed officer in Kingsman, Arizona where the citizen was subjected to a vehicle checkpoint. The military officer admitted, “We’re just helping with security and traffic and stuff for the races.” The solider was then asked if he was under the control of the police and working for the city, to which he responded, “I have no idea, I just do what I’m [cxv] told.”

In 2008, the California Highway Patrol announced its officers would work [cxvi] with US Marines to staff sobriety and driver’s license checkpoints.

An ABC affiliate KESQ reported on this after locals expressed concern that this violated the Posse Comitatus Act. The Marines, of course, denied this and Lieutenant Thomas Beck claimed, “We were not actively participating [cxvii] in enforcing any laws. We were there to observe and observe only.”

Another instance of our military working with police was captured on video by a member of the political activist group We Are Change, where they traveled to Newport, Kentucky during River Fest. The person was questioning a uniformed Army soldier who was staking out public streets. The soldiers were in full uniform and armed with handguns and had [cxviii] military Hummers parked on the side of the road.

Another soldier who was part of this same operation was asked if he would follow orders to confiscate guns from American citizens door-to-door, like what occurred after Hurricane Katrina in 2005. He answered, “I’m just a [cxix] soldier. I do what I’m told.”

This author (Mark Dice) has lived in the San Diego, California area for over ten years and has numerous friends who have been stationed at Camp Pendleton in Oceanside, California, which is in the North County of San Diego. One friend informed me that it is against policy for Marines to wear their uniforms anywhere out in public other than from their home directly to the base or vice a versa. They are not allowed to stop off at the grocery store and go shopping, or take a stroll through the mall, because seeing a Marine in camouflage out in public can be unsettling for people and gives the feeling of a police state with public areas being patrolled by the military. The Department of Defense’s slick legal team always insists that such collaborations of military and police are just “training” exercising and claim they do not violate the Posse Comitatus Act. Such claims are of course lies.

John Warner Defense Act A bill passed by Congress in 2006 under the Bush administration known as the John Warner National Defense Authorization Act (H.R. 5122), greatly expanded the president’s power to declare martial law and deploy the National Guard into US cities without state governor authorizations when public order has been lost or is seen as being potentially lost. Before this, there were strict limitations on the president’s ability to do so and the authority was delegated to state governors, but now the president can make the decision himself.

At some point, this authority will ultimately be superseded by the United Nations or the president of the world who will then have the authority to deploy troops and declare martial law anytime and anywhere they see fit.

Military Commissions Act of 2006 The United States Military Commissions Act of 2006 (HR-6166), was an Act of Congress signed into law by President George W. Bush in order to “authorize trial by military commission for violations of the law of war, and for other purposes.” What this really did was allow the President of the United States (Bush and future presidents) to declare someone (including a U.S. citizen) to be considered an “enemy combatant,” which then eliminates their right to habeas corpus, meaning they no longer would have the right to challenge their imprisonment, and could be detained without having any charges even filed against them. Such a practice is in clear violation of the Constitution which says a person can’t be held without being charged with a crime. The language in the law is so broad that it can be used to label anyone an “enemy combatant” who is engaged in hostilities or who has supported hostilities against the United States. This “support” could be financial, [direct or indirect] or simply counseling. The Act also suggests that the label “unlawful enemy combatant” refers to any person, “who, before, on, or after the date of the enactment of the Military Commissions Act of 2006, has been determined to be an unlawful enemy combatant by a Combatant Status Review Tribunal or another competent tribunal established under the authority of the President or the Secretary of Defense.” This basically means that if the President says you [cxx] are an enemy combatant, then you are one.

The language in the Act also made this power retroactive, which means that since it was passed, people can be detained and not charged for something they allegedly did before the Act was passed in 2006, when such detainment was not authorized.

Concentration Camps When one hears of concentration camps, images of Nazi Germany and the Holocaust immediately come to mind, but many American’s would never think that innocent citizens in their country would ever be rounded up and placed in prison camps. Many Americans distracted by professional sports and pop culture are unaware that during World War II, President Roosevelt had 120,000 Japanese Americans rounded up and placed in prison camps. The conditions of living were certainly not what Jews and other prisoners faced in Nazi Germany, but nonetheless, innocent American citizens were taken from their homes and placed in large prison camps called War Relocation Camps for several years. Even if some people are aware of the Japanese internment, they dismiss such events as being a thing of the past, and never suspect that large scale detention facilities exist today. During the Republican National Convention of 2004 in New York City, hundreds of protesters were rounded up and taken to an old dilapidated bus garage by the Hudson River, which was converted into a secret detention [cxxi] camp by the NYPD in preparation for the convention.

The facility was dirty with motor oil on the ground and the building was contaminated with asbestos. People were held in crowded conditions for long hours, and the facility was dubbed “Guantanamo on the Hudson” in reference to Camp X-ray in Cuba, where suspects in the “War on Terror” are held without having any charges filed against them. Another secret prison camp that was discovered and made public was in Austin, Texas in an abandoned airplane hangar at an airport. The hanger was equipped with barbed wire fences, shackles on the ground, and mattresses for detainees to sleep on. This secret prison was created in the build-up to the year 2000 because officials worried that there would be massive civil unrest and possibly the breakdown of civilization if the rumored Y2K bug shut down computers.

Such facilities are now plentiful in America as the New World Order continues to be constructed and such prisons are not new. In the 1980s during the Iran-Contra hearings, Jack Brooks (D-TX) tried to learn about Oliver North’s role in FEMA’s plans to suspend the Constitution and detain political dissidents during a declared state of national emergency. During the hearings, Chairman Daniel Inouye (D-HA) prevented Brooks from further questioning as indicated in a transcript of the hearing. Brooks: Colonel North, in your work at the N.S.C. [National Security Council] were you not assigned, at one time, to work on plans for the continuity of government in the event of a major disaster? Brendan Sullivan: [North’s counsel]: Mr. Chairman? Inouye: I believe that question touches upon a highly sensitive and classified area so may I request that you not touch upon that? Brooks: I was particularly concerned, Mr. Chairman, because I read in Miami papers, and several others, that there had been a plan developed, by that same agency, a contingency plan in the event of emergency, that would suspend the American constitution. And I was deeply concerned about it and wondered if that was an area in which he had worked. I believe that it was and I wanted to get his confirmation. Inouye: May I most respectfully request that that matter not be touched upon at this stage. If we wish to get into this, I’m certain arrangements can be made for an executive session. End of Transcript The goofy admitted alcoholic Mormon Glenn Beck became practically a house hold name after he left CNN and moved over to the Fox News Channel in January 2009. Beck’s attempt to imitate Robert Beale of the popular 1970s film Network has gotten him a large fan base who see him as an honest average American, even though he signed a $50 million dollar [cxxii] contract for his radio show alone.

A concerned looking Beck appeared on Fox and Friends , a morning show on the Fox News Channel to promote his new show on their network, and told the hosts, “I have to tell you, I’m doing a story tonight. I wanted to debunk these FEMA camps, you know about them? I’m tired of hearing about them. I wanted to debunk them, well, now for several days we’ve done research on them…I can’t debunk them. And we’re going to carry this [cxxiii]

story tonight.”

He goes on to explain to the other hosts, “FEMA prisons, FEMA camps. These are actually prisons that were built under the Bush administration…they’re sitting there empty…you’ll see that tonight. Something just doesn’t sit right with me.” Later that night during The Glenn Beck Program when viewers were expecting to learn more about these prison camps, Beck took a complete 180 degree turn and denied that such camps even exist. He actually decided not to air the segment, and instead told his audience, “I told you that I was going to tell you about the FEMA camps or the FEMA prisons today…I don’t believe in the FEMA prisons, if you don’t know I’ll tell you about it in a couple of days.” He then said he was going to talk about it today but that his research was “incomplete” and he needed to wait a few more days. He then admitted, “this is going to drive the conspiracy theorists crazy. I’ll add this. They’re making me say this. Help,” and went on to imply that nobody from management killed the story, and that he only answers to himself. The following week Beck had James Meigs on as a guest, who is the editor of Popular Mechanics magazine and the two had a field day attacking the “conspiracy theories” about the FEMA camps, and denied that there are such things. James Meigs is the same man who presents himself as having “debunked” the “9/11 conspiracy theories” by choosing straw men arguments and fringe theories about the 9/11 attacks and then claiming the entire body of research supporting 9/11 was an inside job must be false. For anyone of any intelligence, Glenn Beck’s complete reversal is obvious, and proves that the higher ups at the Fox News Channel killed his original story and then produced a new one with the help of “debunker” James Meigs. In other instances Beck has made numerous slanderous remarks about 9/11 Truthers (those who see the 9/11 attacks were an inside job) and in one

instance Beck has fabricated statements saying that the nutcase who shot a security guard at the Washington DC holocaust museum was a “hero” to the [cxxiv]

9/11 Truthers.

These instances and others prove Glenn Beck to be a slick disinformationist and a gate-keeper who works to prevent important information from reaching the public, while pretending to bring his audience cutting edge commentary and news. The film Camp FEMA (2009) produced by Gary Franchi and directed by Richard Lewis documents the existence of modern concentration camps, a topic that is beyond the scope of this book.

MTV Warns about Martial Law and Concentration Camps A series of several brief commercials, or perhaps more accurately PSAs (Public Service Announcements), aired on MTV, of all places, in 2008 depicting situations where an out of control police force rounded up citizens in the back of trucks and put them on trains at gunpoint. At the end of the segment, the scene froze and faded into a historical photograph of Jews being rounded up for the Holocaust in a similar manor. The segments were only thirty seconds long, but were extremely disturbing. They concluded with a printed message on the screen reading, “The Holocaust happened to people like us.”

Abusing, Torturing, and Raping Prisoners As the Iraq War drug on for years and the lies continued to unravel about the reasons America started the war, word began to spread about American soldiers abusing prisoners. Hundreds of photos were made public that soldiers themselves had taken of each other abusing detainees for their own amusement, and the abuse was blamed on a handful of soldiers who were said to have acted on their own and not in accordance with their superiors. Other photos were never made public which show soldiers raping and sodomizing detainees, although such activities are officially denied to have occurred. While some photos of abuse were made public, President Obama prevented the release of over 2000 others shortly after he was sworn in as president,

despite his earlier promises to have them released. Major General Antonio Taguba was the Army officer in charge of conducting an inquiry into the Abu Ghraib jail in Iraq and gave an interview with the London Telegraph admitting that, “These pictures show torture, abuse, rape and every [cxxv] indecency.”

Just one month after Obama flip flopped and changed his mind about releasing photos, he stated, “The most direct consequence of releasing them, I believe, would be to inflame anti-American public opinion and to put our troops in greater danger,” but those on the inside like Major General Taguba know the real reason for not releasing them. “The mere description of these pictures is horrendous enough, take my word for it,” Taguba said. One such description was released under the US Freedom of Information Act where an Egyptian translator named Kasim Mehaddi Hilas said, “I saw [name of a translator] fucking a kid, his age would be about 15 to 18 years. The kid was hurting very bad and they covered all the doors with sheets. Then when I heard screaming I climbed the door because on top it wasn’t covered and I saw [name] who was wearing the military uniform, putting his dick in the little kid’s ass…and the female soldier was taking pictures.” [cxxvi] Despite all the now sealed photos and descriptions by eyewitnesses, this level of abuse is officially denied by the US government. What was admitted, after being denied of course, is the use of waterboarding, which is pouring water down the mouth and nose of someone who is strapped to a table, thus making them feel like they are drowning due to inhaling water into their lungs. Waterboarding has been illegal under international law and is considered torture by countless legal experts, war veterans, medical experts, and human rights organizations. This didn’t stop the Bush administration from using it though, and after numerous denials that the CIA and military officials were waterboarding suspects and prisoners, they finally admitted it, but called it an “enhanced interrogation technique” and denied that it was torture.

Fox News’ Operation Mockingbird asset Sean Hannity, an avid war propagandist and George W. Bush defender, continuously stated that waterboarding was no big deal and when asked live on television by one of his guests if he would volunteer to be waterboarded, Hannity agreed to do it for charity. He never followed through with his promise, and completely ignored the fact that he made such a statement. MSNBC’s Keith Olbermann publicly offered to pay $1000 to charity for every second Hannity was subjected the practice, but of course it never happened. Mancow Muller, a popular Chicago radio host, had also spoken publicly in support of waterboarding and denied that it was torture, that is, until he himself voluntarily underwent the procedure. Mancow thought that he could be waterboarded and then say it was no big deal and that liberals who were against it and those who called it torture would be proven wrong, but immediately after the procedure began Mancow ended it and admitted he thought it constituted torture. An EMT was present in case anything went wrong. Immediately after ending the experiment, Mancow said, “It is way worse than I thought it would be…Look…all that’s been done to this country, and I heard about water being dropped on someone’s face, I never considered it torture, even when I was laying there, I thought this is gonna be no big deal, I go swimming, it’s gonna be like being in the tub…it was instantaneous. I thought I could hold out 30 seconds, 60 seconds, it was instantaneous, and I don’t want to say this…absolutely torture. Absolutely, I mean that’s [cxxvii] drowning.”

COINTELPRO A sinister covert and highly illegal program admittedly conducted by the FBI between 1956 and 1971 was called COINTELPRO (an acronym for Counter Intelligence Program) which investigated and disrupted political organizations deemed problematic by the establishment. Since its discovery and the nature of its crimes and activities, of course the FBI says the program was dissolved and no such thing exists anymore. Such claims are laughable, and COINTELPRO’s discovery only served as a learning

experience for the FBI and measures were put in place to prevent such activities from being discovered and exposed in the future. The original program targeted groups seen as “subversive” or groups suspected of being subversive. Martin Luther King Jr. and other leaders in the Civil Rights Movement and those associated with the NAACP (the National Association for the Advancement of Colored People), and the Southern Poverty Law Center were also targeted, as well as groups protesting the Vietnam War, including many college students. The directives of COINTELPRO were given by J. Edgar Hoover, who was the head of the FBI at the time, and ordered agents to “expose, disrupt, misdirect, discredit, or otherwise neutralize” the leaders and activities of such groups. Agents involved in the program used a lot of dirty tricks, such as mailing letters to leaders of organizations claiming to be from someone else and making accusations that they had been sleeping with that person’s wife, for example. In one instance a recording of Martin Luther King Jr. that was taken illegally from a hotel room and proved he was cheating on his wife. FBI agents then anonymously mailed the recording to his wife because they wanted to discourage King from pushing for civil rights. Illegal wire taps, spreading false and slanderous rumors about people, frame-ups and worse were all common in COINTELPRO and are still methods used today by elite law enforcement and intelligence agents.

The MIAC Report A joint venture between the Department of Homeland Security and local law enforcement in Jefferson City, Missouri called The Missouri Information Analysis Center (or MIAC), is said to analyze terrorist threats and criminal activity in order to help prevent them. This MIAC was fairly unknown until March of 2009, when an eight page report the organization had wrote up was leaked to the public titled The Modern Militia Movement , which contained some disturbing information regarding the kinds of individuals the report labeled as potentially dangerous or domestic terrorists.

When the MIAC report first surfaced, a lot of people thought it was a hoax since the criteria it used to identify potential militia members and terrorists was completely absurd, but the report was confirmed authentic by Lieutenant John Hotz, the Assistant Director of the Public Information and [cxxviii]

Education Division of the Missouri State Highway Patrol.

The report contains what it called common symbols and media associated with terrorists in order for officials to more easily identify them. These items include bumper stickers showing support for Congressman Ron Paul, owning gold coins, and Aaron Russo’s film America: Freedom to Fascism. The report begins by trying to explain why the militia movement gained numbers in the 1980s and 90s, saying, “It was during this timeframe that many individuals and organizations began to concoct conspiracy theories to explain their misfortunes. These theories varied but almost always involved a globalist dictatorship, the ‘New World Order (NWO),’ which conspired to exploit the working class citizens…Much of this rhetoric would become anti-Semitic, claiming that the Jews controlled the monetary system and media, and in turn the ‘Zionist Occupied government (ZOG).’” In a section titled The Militia Post September 11th 2001 it reads, “Newer versions of the NWO conspiracy have been concocted in order to empower the movement. The NWO is seen as using law enforcement, military, national guard, and federal agencies in order to carry out its elitist one world government.” It goes on to say, “Many militia organizations feel that the U.S. government will fall due to economic or racial issues. They believe that during the chaotic fall of the government, moves will be made to install Martial Law, confiscate firearms, and imprison many citizens.” The report mentions the North American Union and says, “conspiracy theorists claim that this union would link Canada, the United States, and Mexico. The NAU would unify its monetary system and trade the dollar for [cxxix] the AMERO.”

Radio Frequency Identification Devices (RFIDs) are also mentioned, saying “there is a fear that the government will enforce mass RFID human implantations. This process would make it possible for the government to [cxxx] continually know the locations of all citizens.”

The report is a tremendous piece of propaganda aimed at convincing police that anyone who discusses these particular issues should be viewed as a potential threat. It says, “The militia subscribes to an anti-government and NWO mindset, which creates a threat to law enforcement officers. They view the military, National Guard, and law enforcement as a force that will confiscate their firearms and place them in FEMA concentration camps.” Since most people familiar with the New World Order learn about the private Federal Reserve Bank and its role in the economy, the MIAC report also included this topic in their report painting these people as extremists. “Members of the militia movement are strongly against the FRS (Federal Reserve System) and see it as a mechanism of the elitist New World Order. In November, End the FED protests were held nationwide at Federal Reserve Banks in opposition to the FRS. Many right-wing extremists oppose the FRS and propose a system that would be backed by gold,” it reads. Also, since many who see the left vs. right paradigm one of controlled opposition, and the leadership of both the Republicans and the Democrats as being globalists with ties to the secret establishment, many people begin favoring third party candidates who don’t have to bow down to any special interests. While this is a conclusion any thinking American would come to after learning about how the political structure actually functions, the MIAC report chose to demonize such people. “Militia members most commonly associate with 3rd party political groups. It’s not uncommon for militia members to display Constitution Party, Campaign for Liberty, or Libertarian material. These members are usually supporters of former Presidential Candidates Ron Paul, Chuck Baldwin, and [cxxxi] Bob Barr.”

The report even warns that people who display political messages on their vehicles in the form of bumper stickers should be suspects. “Militia members commonly display pictures, cartoons, [and] bumper stickers that contain anti-government rhetoric. Most of this material will depict the FRS, IRS, FBI, ATF, CIA, UN, Law Enforcement, and ‘The New World Order’ [cxxxii] in a derogatory manor.”

Shortly after word spread of this report and the demonizing language in it, even mainstream media outlets covered it in shock saying it amounted to political profiling. Soon afterward, by the end of March 2009, the report was said to be scrapped and the director of the MIAC was reassigned. “For that reason, I have ordered the MIAC to permanently cease distribution of the militia report,” said Chief James Keathley of the Missouri State Patrol. “Further, I am creating a new process for oversight of reports drafted by the MIAC that will require leaders of the Missouri State Highway Patrol and the Department of Public Safety to review the content of these reports before they are shared with law enforcement. My office will [cxxxiii] also undertake a review of the origin of the report by MIAC.”

Department of Homeland Security Labels Veterans as Possible Terrorists and Extremists While some skeptics say the MIAC report was just one insignificant report drafted and circulated in the state of Missouri, not soon afterwards a similar report was made public that was drafted by the Department of Homeland Security which labeled veterans and pro-life organizations as possible extremists or terrorists. The report, titled Right-wing Extremism: Current Economic and Political Climate Fueling Resurgence in Radicalization and Recruitment , also says that due to the collapse of the economy which began near the end of 2008 and the election of Barack Obama as the first black president of the United States, that “rightwing extremists” are having an easier time recruiting supporters who are concerned about illegal immigration, restrictions of firearms, abortion, and the loss of US sovereignty.

The report even admits, “threats from white supremacist and violent antigovernment groups during 2009 have been largely rhetorical and have not indicated plans to carry out violent acts,” but suggests that, worsening economic conditions, potential new restrictions on firearms and “the return of military veterans facing significant challenges reintegrating into their communities could lead to the potential emergence of terrorist groups or lone wolf extremists capable of carrying out violent attacks.” The report says that rightwing extremism, “can be broadly divided into those groups, movements, and adherents that are primarily hate-oriented (based on hatred of particular religious, racial or ethnic groups), and those that are mainly anti-government, rejecting federal authority in favor of state or local authority, or rejecting government authority entirely. It may include groups and individuals that are dedicated to a single issue, such as opposition to abortion or immigration.” “[T]he consequences of a prolonged economic downturn—including real estate foreclosures, unemployment and an inability to obtain credit – could create a fertile recruiting environment for right-wing extremists and even result in confrontations between such groups and government authorities similar to those in the past,” the report reads. It also warns that, “Proposed imposition of firearms restrictions and weapons bans likely would attract new members into the ranks of rightwing extremist groups as well as potentially spur some of them to begin planning and training for violence against the government…The high volume of purchases and stockpiling of weapons and ammunition by rightwing extremists in anticipation of restrictions and bans in some parts of the country continue to be a primary concern to law enforcement.” The report also mentions what it calls people who believe in antigovernment conspiracy theories about gun confiscations, citizen detention camps, and a Jewish-controlled ‘one-world government’ and says that, “end times prophecies could motivate extremist individuals and groups to stockpile food, ammunition and weapons. These teachings also have been linked with the radicalization of domestic extremist individuals and groups in the past, such as the violent Christian Identity organizations and extremist members of the militia movement.”

It also attempts to cast suspicion on veterans, saying, “Returning veterans possess combat skills and experience that are attractive to right-wing extremists…DHS/I&A (Department of Homeland Security’s Office of Intelligence and Analysis) is concerned that right-wing extremists will attempt to recruit and radicalize veterans in order to boost their violent capacities.” People who support enforcing immigration laws and who oppose illegal immigration or speak out against it are also demonized in the report. “DHS/I&A assesses that right-wing extremist groups’ frustration over a perceived lack of government action on illegal immigration has the potential to incite individuals or small groups toward violence.” The report concludes that the Department of Homeland Security will work with state and local officials in the near future to determine the levels of right-wing extremist activity in their areas.

Project Megiddo In the months preceding the turn of the twenty-first century, the FBI released a report warning of violence they thought would likely be carried out to mark the new millennium at the hands of people who believed in the “New World Order conspiracy theory.” The report specifically listed white supremacists, Black Hebrew Israelites, the militia movement, and apocalyptic cults as groups who the FBI should be on the lookout for. While it is true that a very small number of white supremacists and apocalyptic cults have carried out violence driven by their ideologies, the Project Megiddo report casts suspicion on anyone who talks about the New World Order. This 32 page report was titled Project Megiddo because, as it explains, “The Hebrew word ‘Armageddon’ means ‘hill of Megiddo.’ In English, the word has come to represent battle itself. The last book in the New Testament of the Bible designates Armageddon as the assembly point in the apocalyptic setting of God’s final and conclusive battle against evil. The name ‘Megiddo’ is an apt title for a project that analyzes those who believe the year 2000 will usher in the end of the world and who are willing to perpetrate acts of violence to bring that end about.”

In the section focusing on the militia, the report tries to paint those who talk about the New World Order or the United Nations as potential violent extremists, saying, “Meanwhile, for members of the militia movement the new millennium has a political overtone rather than a religious one. It is their belief that the United Nations has created a secret plan, known as the New World Order (NWO), to conquer the world beginning in 2000.” [cxxxiv] The report goes on to demonize gun owners and supporters of the Second Amendment who oppose gun control measures, reading “The passage of the Brady Bill and assault weapons ban in 1994 were interpreted by those in the militia movement and among the right-wing as the first steps towards [cxxxv] disarming citizens in preparation for the UN-led NWO takeover.”

“In light of the enormous importance and prominent role that extremist groups place on the Second Amendment, it is probable that recent government actions aimed at controlling guns are perceived to be [cxxxvi] compelling signs of the UN-led NWO takeover.”

It is well known to those who are aware of the New World Order that FEMA has constructed various prison camps, detention centers, and socalled emergency relocation centers which are usually kept secret from the [cxxxvii] public, and in some cases have been covered by mainstream news.

Most people who are familiar with these “FEMA camps” are not very comfortable with their existence and the secrecy which surrounds them. The Megiddo report addresses these worries, saying, “One can find numerous references in militia literature to military bases to be used as concentration camps in the NWO and visiting foreign military personnel conspiring to [cxxxviii] attack Americans.”

One of the most unsettling ideas conveyed in the report is that Christians who are uneasy about the New World Order for its prophetic implications regarding the end times are viewed as cult members who may act out violently in order to bring about the end of the world. “Cults with an apocalyptic agenda, particularly those that appear ready to initiate rather

than anticipate violent confrontations to bring about Armageddon or fulfill ‘prophesy’ present unique challenges to law enforcement officials.” [cxxxix] “Religiously motivated extremists may initiate violent conflicts with law enforcement officials in an attempt to facilitate the onset of Armageddon, or to help fulfill a ‘prophesy.’ … Likewise, extremists who are convinced that the millennium will lead to a One World Government may choose to engage [cxl] in violence to prevent such a situation from occurring.”

It certainly is interesting that since this report was released in October 1999, talk of the New World Order by major political figures around the world has become common place, and the vast majority of people around the world who speak out against it are viewed as dangerous extremists who the government and law enforcement agencies claim are prone to violence.

A Nation of Spies In the New World Order, the mainstream media and the government purposefully create a climate of fear, putting the population on edge with the threat of terrorism they claim can come from any number of individuals or groups. The ethereal “al Qaeda” became the focal point of such fears after the September 11th 2001 terror attacks in New York City and Washington DC and the fear mongering went on practically daily throughout the Bush administration. While it is understandable that law enforcement would put out information urging people to be on the lookout for specific suspicious behavior in hopes of preventing any crimes from taking place, the rhetoric accompanying such alerts has created a climate where people are urged to spy on their neighbors and are made to feel powerful by doing so, as if they themselves are working in cooperation with law enforcement. During the 2008 presidential campaign in America, Barrack Obama made a startling statement referring to his desire to create a program which sounds

like it was coming right out of George Orwell’s dystopian novel Nineteen Eighty-Four . Obama proclaimed, “We cannot continue to rely only on our military in order to achieve the national security objectives that we’ve set. We’ve got to have a civilian national security force that’s just as powerful, just as strong, just as well-funded.” The man chosen by President Obama to be his chief of staff, Rahm Emanuel, made equally unsettling statements in the past. On August 21, 2009 Rahm Emanuel, who was a Democratic member of the House of Representatives, was interviewed on C-Span about his book The Plan: Big Ideas for America , and when asked specifically what he meant by the idea of a “universal citizen service” Emanuel answered, “Citizenship is not an entitlement program. It comes with responsibilities. Everybody between the ages of 18 and 25 will serve three months of basic training and understanding in a kind of civil defense.” In George Orwell’s classic novel Nineteen Eighty-Four , the children spy on their parents and neighbors and accuse the lead character Winston Smith of being a “thought criminal,” meaning he has negative thoughts about the government. These same children report their father as a thought criminal as well, and he is arrested based on these accusations. The idea of civilians spying on other civilians by simply keeping their eyes and ears open for anything they might say or do that seems to criticize the ruling party was something that people thought occurred only in Nazi Germany or the Communist Soviet Union, but there have been multiple attempts by leadership in both Republican and Democratic parties to create a culture in America where people feel empowered because they are on the lookout for anyone that is not in step with current leadership and their ideologies. Often such programs are defended citing “things have changed since 9/11,” referring to the September 11th terrorist attacks and claims that a secret society of Muslim extremists are living among us plotting their next attack and waiting for the right moment or the green light from Osama Bin Laden, the mythical leader of this society of radicals.

Operation TIPS A snitch program implemented under the fear-mongering years of President George W. Bush was called Operation TIPS, which was an acronym for the Terrorism Information and Prevention System . This program was aimed at workers who had access to people’s homes, such as cable installers and telephone repairmen, who were encouraged to look for and report “suspicious” activity to authorities. The program was intended to begin in August 2002 and hoped to include over one million workers in ten US cities. John Ashcroft who was the Attorney General under President Bush admitted that information generated by Operation TIPS would then be stored in databases for various law enforcement agencies. Senator Patrick Leahy from Vermont criticized the program and likened it to J. Edgar Hoover’s misuse of the FBI when he hired citizens to spy on their neighbors if they were political protesters during the 1960s. Legislation was introduced in the House version of the Homeland Security Bill that prohibited the creation of Operation TIPS, but senator Joe Lieberman blocked its removal from the Senate’s version. The Senate later passed the House version which called for the program’s termination in November 2002. However, in 2008 it was reported that ordinary people such as utility workers and others had been trained as what are called Terrorism Liaison Officers who report “suspicious” activity that could be signs of terrorist. [cxli]

InfraGuard InfraGard is a program developed by the FBI which basically functions as a secret society of businessmen, academics, utility workers, and law enforcement agents who secretly look for suspicious activity and share information and intelligence in order to supposedly prevent terrorist attacks against critical infrastructure in the United States. InfraGuard stands for Infrastructure Guardians and began in 1996. As of December 2009, the organization reported their membership to be more than 34,000 people. Most people have never heard of InfraGuard.

In 2008, Matthew Rothschild reported in the journal The Progressive that several InfraGard members told him if martial law was declared that InfraGuard members would be given orders to “shoot to kill” in order to [cxlii]

protect critical infrastructure and would not be prosecuted.

The FBI has denied this. The article in The Progressive also reported that the American Civil Liberties Union (ACLU) said there “is evidence that InfraGard may be closer to a corporate TIPS program, turning private-sector corporations— some of which may be in a position to observe the activities of millions of [cxliii] individual customers—into surrogate eyes and ears for the FBI.”

iWatch A citizen spy program launched in Los Angeles, California called iWatch is promoted as being the “21st century version of Neighborhood Watch.” [cxliv]

Through brochures, meetings with community groups, and even television commercials, the iWatch program lists what they call suspicious behavior that should compel people to call the police. Several of these “indicators” are: If you smell chemicals or other fumes; If you see someone wearing clothes that are too big and too heavy for the season; And, if you see someone purchasing supplies or equipment that could be used to make bombs. So, I guess you’re supposed to call the police if your neighbor is spray painting something in their backyard or using paint thinner to clean some tools in his garage and you smell the fumes, or if someone is buying a steel pipe at the hardware store to fix some plumbing. The program also created a toll-free telephone number for people to report such activities to, as well as a website. Mike German, who is a former FBI agent now working with the American Civil Liberties Union (ACLU) admits that many of the iWatch indicators are all relatively common behaviors and worries that people will use the program to report people who are thought to look like a terrorist based on personal biases and stereotypes.

Supporters of the program hope iWatch will become as successful and as well-known as the Smokey Bear campaign used to prevent wildfires. “There he is with his Smokey the Bear hat, similarly here, we hope that this program, even though it’s in its birthing stages right now, in a few years will become that well known to the American public,” said Los Angeles police Chief William Bratton. One of the television commercials for the program consists of a dozen or so people each saying a sentence or two and then cutting to the next in a montage, saying, “What is iWatch? It’s a way to report suspicious behavior, or activities that relates to terrorism. Terrorism is a crime. It is our shared responsibility to keep America safe. That’s why I, iWatch. It’s like a neighborhood watch for the whole city. If you see, hear, or smell something suspicious, report it. Reporting is easy. Use the web, or the phone. Let law enforcement determine if it’s a threat. And let the experts decide. A single report can lead to actions that can stop a terrorist attack. Think about the power of that. Think about the power of iWatch. I watch. I report. I keep us safe.”

Cash Payments Given to Snitches Chicago implemented a “tax whistle-blower” program offering people a cash reward for informants who turn in businesses that are cheating on their taxes. The amount of the reward is a percentage of the tax money the city recovers as a result of the informant’s tip. “It’s just another way of bringing people into compliance,” Revenue Department spokesman Ed Walsh told [cxlv] the Sun-Times.

“It would probably be a business knowing that a competitor is not remitting a tax. An employee [of the tax-dodging business] could know that, too. [cxlvi] Typically, you need to provide some type of incentive.”

Boy Scouts and Girl Scouts In a move that could lead to a scenario similar to Hitler Youth in Nazi Germany, the Department of Homeland Security created a program where

they decided to “partner” with the Boy Scouts of America to allegedly help Americans to prepare for and respond to emergencies. “We are delighted to partner with the Department of Homeland Security on this very important initiative for America,” said Roy Williams, Chief Scout Executive. The New York Times ran an article discussing the Boy Scouts activities with Homeland Security and showed a photo of some kids dressed up in SWAT [cxlvii] gear and holding fake rifles.

The article tells how the practice drill the children were involved in included the goal of rounding up a terrorist, who in this case was a “disgruntled Iraq war veteran,” and admits that thousands of young people were being trained to “confront terrorism” and the program aimed to “prepare youths for more traditional jobs as police officers and firefighters.” [cxlviii] “Scouting embodies the very essence of being prepared and has specific training and merit badges designed to encourage proper awareness and planning in our Scouts. To partner on a program such as this allows us to reinforce the importance of preparation to families throughout the nation,” said Roy Williams, Chief Scout Executive. In an equally strange move, the Department of Homeland Security also decided to team up with the Girl Scouts as well, in order to “combat hurricanes, pandemics, terror attacks and other disasters.” The head of the Department of Homeland Security, Janet Napolitano, said “As a former Girl Scout, I know the ‘Be Prepared’ motto well, and I look forward to working with the Girl Scouts to spread the preparedness message to all of our nation’s citizens.” It was reported that Homeland Security designed a new “preparedness badge” that the girls can earn while defending America.

Climate Cops

A British website called ClimateCops.com geared for children ages 7 to 11 features cartoon images and downloadable materials for children to become “climate cops” so they can keep a watchful eye over their parents and then build a “Climate Crime Case File” to report back to their parents and make sure they, “don’t commit those crimes again (or else)!” The site also warns children that they “may need to keep a watchful eye” to prevent future violations. When one logs onto the website they are first shown a brief cartoon introducing them to four characters, the “climate cops,” who are going to fight against global warming because it is “threatening our world” and the viewer is told “it’s time to fight back” and that they “need new recruits and your training starts here.” The user then can play various games or “missions” as they are called, and can download tickets to report “climate crime” which are used to write up violations for their parents for instances like leaving the room and not turning the light off, or leaving a cell phone charger plugged in when it’s not being used. One ticket even lists “using a tumble dryer on a sunny day” and carries the assumption that people should line dry their clothes and not use a dryer. Another one says, “Putting hot food in a fridge or freezer is in fact, a crime. Climate Cops know that waiting for it to cool is the right time.” Not only does this kind of propaganda push the global warming theory onto children, but gives them the feeling of authority over their parents and teaches them that they are the ones in power and can give the orders. Global warming poster boy Al Gore once told a group of school kids that, “There are some things about our world that you know that older people don’t know…Why would that be? Well, in a period of rapid change, the old assumptions sometimes just don’t work anymore because they’re out of date. New knowledge, new understandings are much more widely available, sometimes to young people who are in school who aren’t weighed down with the old flawed assumptions of the past.” The hoax of deadly man-made climate change and the Armageddon said to occur unless people pay carbon taxes and give in to a global government is covered in its own section of this book. (See Global Warming/Climate Change)

Elimination of the Right to Bear Arms The Second Amendment to the Constitution of the United States outlines the right for citizens to bear arms—meaning to own guns. It can’t be at random that this Amendment immediately follows the right to free speech (the First Amendment), which is one of the most cherished freedoms Americans enjoy. So placing an amendment guaranteeing the right to own guns as the second one shows just how important the founding fathers felt this right was. They knew that if masses of citizens were armed, that an out of control government would have a much more difficult time imposing its will on the people because they would be able to organize and fight against such an event. In Asia, people made nunchucks and other weapons out of commonly available materials in the ancient past when all weapons were banned and only members of the military were allowed to possess such things. Nunchucks, for example, were first made from a flail used to thresh rice or soybeans. Corrupt tyrants and governments throughout history have disarmed their own citizens so they couldn’t organize and resist. A disarmed public also causes people to rely more on the government for their safety, instead of being able to protect themselves. Even modern anti-gun activists fail to see how citizens owning guns actually prevents crime. Often their anti-gun attitudes are installed in them by the mainstream media that tries to impress on people that only police and military personnel are qualified to own and carry guns. Thomas Jefferson, quoting Cesare Beccaria in On Crimes and Punishment (1764) famously said, “Laws that forbid the carrying of arms disarm only those who are neither inclined nor determined to commit crimes…Such laws make things worse for the assaulted and better for the assailants; they serve rather to encourage than to prevent homicides, for an unarmed man may be attacked with greater confidence than an armed man.”

If a burglar breaks into someone’s home armed only with a knife or baseball bat, they are the one who will be in control of the situation, and could bash the brains in of the homeowner and then rape his children and wife with little to stop him. The reason people call the police in the event of a burglary is because the police have guns and can hopefully stop the burglar and protect the victims, but it makes no sense to rely on such a strategy when the homeowner himself could own a firearm and neutralize the burglar immediately upon his discovery. Despite reliable statistics that show for every crime committed with a gun, even more are prevented, people are still often convinced that guns should only be used by police and military. The November 2009 shooting at Fort Hood in Texas, where thirteen people were killed by gunman Nidal Hason, shows that even supposed trained professionals can be mass murderers. Hason was a U.S. Army Major and was stationed at the base. Some believe Hason was a victim of MK-ULTRA mind control and programmed to kill. Others see him as a Muslim terrorist who became unstable and murderous as he grew more upset with the United States involvement in the Middle East. Whatever the truth surrounding this tragedy, there are numerous other instances each year of police and military committing murder and/or suicide despite being trained professionals who are trusted with firearms. Anti-gun activists also fail to see that an extremely small percentage of humans will commit murder by any means necessary to them, even if a gun is not available. If these unstable individuals cannot get their hands on a gun, they will simply stab, bludgeon, poison, or run over their victims. Groups like the National Rifle Association and Gun Owners of America help to organize Second Amendment advocates and try to minimize the effects of anti-gun tactics, although many see the NRA as having given in to anti-gun legislation and not taking a strong enough stand against it. Despite the numbers and money behind such groups, unconstitutional and unfair gun policies have been written into law in America and the ultimate goal of banning all guns from citizens, is a very real possibility.

Gun Bans in American Cities

Despite the Second Amendment clearly outlining that people have the right to own guns, Anti-American politicians and judges have been able to successfully ban guns in certain cities. Hand guns, for example, were illegal in Washington DC until a landmark case in June 2008 (District of Columbia v. Heller), which overturned the ban, once again making the district compliant with the Second Amendment for the first time since 1976. Washington DC was not the only city to have such a ban in place. Other cities such as Chicago and New York had also banned handguns and placed such ridiculous restrictions on rifles and shotguns that the laws practically render the guns useless. Alan Gura of Alexandria, Virginia, who successfully argued the Heller case at the high court, is also scheduled to argue the McDonald case in Chicago hoping to lift the ban on handguns there as well. Before the 2008 overturning of the DC gun ban, an appeals court ruled in the Chicago case that their handgun ban did not violate the Constitution because the Supreme Court had not yet declared whether its decision in the Heller case established a fundamental right for citizens to own guns. Many antigun activists say the Second Amendment doesn’t apply to average citizens, but instead applies only to the police and military. While we can look at the 2008 lifting of the DC gun ban as a victory for the Second Amendment, this is likely only a temporary lifting. After just a handful of highly publicized murders involving guns by lone nuts, the antigun propaganda will go into full force and the establishment will do everything they can to get as many guns out of the hands of honest, law abiding citizens as they can.

Gun Confiscation After Hurricane Katrina Immediately after Hurricane Katrina struck the Gulf Coast in September 2005, police were confiscating guns from people in their homes in New Orleans as they went door to door in what looked like affluent middle class neighborhoods. One video aired on a local news channel shows police tackle an elderly woman and steal a small revolver from her that she had for personal protection. This woman was inside her own home on dry land.

The National Rifle Association (NRA) produced a short video titled The Untold Story of Gun Confiscation After Katrina , which shows interviews of several other law abiding citizens who also had their guns taken away unlawfully by the police in the aftermath of the hurricane. One man interviewed explains how he complied with the officers and turned over his rifle and asked for some kind of receipt documenting that they had taken possession of the gun, and the officer informed him that no such policy was in place. The man then asked how he could get his gun back after things had settled down and the officer told him to get a lawyer.

Oath Keepers In March of 2009, an organization was founded with the intent of educating police and military about the possibility of unlawful and unconstitutional orders being given, and aimed to prevent such illegal orders from being carried out by those who were on the receiving end of them. Oath Keepers was founded by a man named Stewart Rhodes, and when joining, the new members swear an oath to the following ten things they will not engage in: 1. We will NOT obey orders to disarm the American people. 2. We will NOT obey orders to conduct warrantless searches of the American people. 3. We will NOT obey orders to detain American citizens as “unlawful enemy combatants” or to subject them to military tribunal. 4. We will NOT obey orders to impose martial law or a “state of emergency” on a state. 5. We will NOT obey orders to invade and subjugate any state that asserts its sovereignty. 6. We will NOT obey any order to blockade American cities, thus turning them into giant concentration camps. 7. We will NOT obey any order to force American citizens into any form of detention camps under any pretext.

8. We will NOT obey orders to assist or support the use of any foreign troops on U.S. soil against the American people to “keep the peace” or to “maintain control.” 9. We will NOT obey any orders to confiscate the property of the American people, including food and other essential supplies. 10.We will NOT obey any orders which infringe on the right of the people to free speech, to peaceably assemble, and to petition their government for a redress of grievances. Left-wing propagandist and gate-keeper Chris Matthews had Stewart Rhodes as a guest on MSNBC’s Hardball and tried to misinform the audience about the Oath Keeper’s mission. Matthews states, “What I don’t like about people who are armed who are being recruited to stand up in some operation, I want to know when you would call your forces together and challenge the authority of the US government?” Rhodes had to clarify the organization’s goals and explained, “It’s not calling forces together, it’s simply saying they’re not going to comply with orders to violate the rights of the American people. We’re not talking about asking them to go fight, we’re saying simply, don’t fight.” Matthews went on to patronize Rhodes about his beliefs in potential concentration camps in America and citizens being rounded up and detained. In a report by the ADL (Anti-Defamation League) about growing anger in America aimed at the government, the Oath Keepers were attacked, saying, “One manifestation of the ideology of resistance was the creation in March 2009 of the Oath Keepers, an anti-government group that tries to recruit police and military personnel and veterans. Members refuse to obey hypothetical “orders” from the government, “orders” that speak more to their own paranoid and conspiratorial beliefs than to any realistic [cxlix] government action.”

The ADL was obviously trying to divert attention away from the fact that such actions are very plausible and in some cases have already occurred.

Supreme Court Justice Sonia Sotomayor In 2009, after Barack Obama was sworn in as president, he nominated Sonia Sotomayor to sit as a Supreme Court justice. It was no surprise that Obama’s pick was a Latino woman, as he was doing his best to select people for high level positions, not based on their qualifications, but instead on their race and gender. One of the things which make Supreme Court Justice Sotomayor anti-American and a willing conspirator in implementing the New World Order is her stance on the Second Amendment. In Maloney v. Cuomo, a case from January 2009, Judge Sotomayor ruled that the Second Amendment only applies to the federal government and not [cl]

individual states or cities.

According to her and her ruling, it is perfectly constitutional for any city or state to ban gun ownership. A 2004 opinion she joined which is now cited as precedent, states that “the right to possess a gun is clearly not a fundamental right.”

Rahm Emanuel’s Hopes of Disarming Americans President Obama’s chief of staff, Rahm Emanuel, can be seen in a video clip widely available on the Internet where he is giving a talk about how he and Obama hope to eliminate the Second Amendment, which clearly states that individual citizens have the right to own guns. Rahm declared, “The most simple thing we can do, and we’ve got to make this a number one issue, as a test vote and then take it into the election, and that is if you are on the no-fly list because you are known as maybe a possible terrorist, you [cli] cannot buy a handgun in America.”

The “no-fly list” isn’t really a no-fly list, it’s more of a watch list which supposedly contains the names of suspected terrorists, or people who may have terrorist ties, and if such a person attempts to board a flight, then extra security measures are taken to ensure that they aren’t carrying any explosive devices or weapons with them onto the aircraft. While on the surface, such a procedure can surely be understood, what makes this “no-fly list” such a slippery slope is the fact that the standards and criteria for landing one’s name on the list is kept secret. Not only that, but over one

[clii]

million people are on this list,

including many young American [cliii]

children

and even a CNN reporter who describes having to go through [cliv] enhanced security checks every time he flies.

There is also no known way for an individual to get their name off the list. So if Rahm Emanuel got his way of using this list to justify confiscating all firearms registered to persons on that list and prevent them from purchasing one if they didn’t already own any, it would then eliminate the Second Amendment right guaranteed by the Constitution of the United States, all without a conviction of any crime or even an arrest. Think of the implications. By some government agent simply adding your name to the no-fly list, for any reason, you now lose your guns. Hopefully in the months and years that come, such an underhanded policy would be faced with such opposition that it can never be enacted, but the very fact that Rahm Emanuel spoke publicly about such an idea shows just how low the power players in Washington are willing to sink in order to disarm the American people.

Open Carry Groups While extremely surprising to many people, most states in America allow people to publicly carry an unconcealed visible handgun on their person, with the exception of places banned by federal laws such as school zones, post offices, government buildings, and state parks. Such a right is called open carry, and in many states the gun can actually be loaded, while in others the gun may be carried openly but cannot be loaded. Such a practice came to national attention shortly after Barack Obama became president and started pushing for a nationalized healthcare system. President Obama had a town hall meeting in Portsmouth, New Hampshire on August 10, 2009, where a man joined the protesters across the street with a loaded handgun in a holster attached to his leg. This was perfectly legal. The man was interviewed by Chris Matthews on MSNBC where Matthews expressed his utter shock that someone would do such a thing and tried to make it out that the guy wished harm upon Obama. When this practice continued by other open carry advocates, liberals tried to make such people

out as racists, but at an event in Phoenix, Arizona, an African American man brought an AR15 rifle which was strapped hanging off his back. Talking heads on CNN and other news networks expressed their shock, but the fact that this event involved an African American made it impossible for the media to spin the story as if a bunch of right-wing racists were bringing guns to Obama’s events. About a dozen others at the same event were also armed. The Secret Service can declare an area surrounding the president to be a Federal Zone where weapons are not allowed. During these events where open carry advocates had their weapons, Obama was nowhere near them and wouldn’t have been anywhere close to being in the line of fire. The anti-gun propagandists at MSNBC and CNN led viewers to believe that Obama could have been shot by one of these individuals if they were unstable, which wasn’t the case.

“Assault Weapons” Much of the ignorant public supports so-called “assault weapon” bans because they believe that an “assault weapon” means a fully automatic weapon like a machine gun. So when anti-gun activists and politicians talk about their desire to ban assault weapons, it seems like a reasonable idea to many people, since they falsely believe they are trying to get machine guns off the streets. The National Firearms Act of 1934 specifically addresses the ownership, possession, and use of fully automatic weapons, which are highly regulated and extremely rare. A gun is usually classified as an assault weapon because it contains several features in combination such as a detachable magazine along with a folding or telescoping stock or a pistol grip. Flash suppressors and bayonet mounts are also included in these lists. The state of California has the strictest gun laws in the United States and has their own list of what they deem “assault weapons.” In addition, for over a decade California has had a law in place that prevents the manufacture, sale, or transfer of magazines that hold more than ten rounds. The law is for every gun; handguns, rifles, and assault weapons. Some standard magazines for handguns are capable of holding sixteen rounds, but

the only people legally allowed to possess such magazines are people who owned them prior to the ten round restriction becoming law on January 1, 2000. So let it be clear that what the government calls an “assault weapon” is not a machine gun as they would like people to believe, but is instead a classification given to a firearm because it contains a combination of features such as a flash suppressor, a collapsible stock, a pistol grip, or other features. It’s also important to understand that frequently when the mainstream media airs stories about “assault weapons” or renewing the “assault weapon” ban, they show footage of people in the desert or at shooting ranges using fully automatic guns which have been basically illegal for civilians too use for over 75 years.

California’s Ammo Tracking Policy As governor of California, Arnold Schwarzenegger signed a bill into law which required stores that sell ammunition to thumbprint everyone who buys, as well as log their driver’s license and require a signature for each sale. Each person who buys ammo now is entered into a federal database and a running tally of what they buy and when they bought it is kept on record indefinitely. As a result of the law, all Internet and mail order sales to California are now a thing of the past. Schwarzenegger claimed to be against such a policy in the past but changed his mind saying, “Although I have previously vetoed legislation similar to this measure, local governments have demonstrated that requiring ammunition vendors to keep records on ammunition sales improves public [clv] safety.”

Sam Paredes, the executive director of Gun Owners of California, said the new law treats gun owners like registered sex offenders. The database will be used to flag anyone who buys what the government considers a large amount of ammo and may be considered probable cause to investigate the individual further or place them under surveillance.

Elimination of National Sovereignty America has been the envy of the world for generations and the leader in human rights and freedoms as well as military power and economic prosperity. The problem is, in order for the New World Order to be complete, America must yield its political, economic, and military power over to the global government that will then use it, not for what’s best for America, but what the elite establishment see as the best thing for the New World Order. Sovereignty is defined as the quality of having supreme, independent authority over a territory, which in this case we are talking about the United States; a quality which may have been set up to fail by the Illuminati a long time ago when America was first created. Britain, the United States, and Israel are at the heart of the New World Order, and have been the major forces behind its creation. Manly P. Hall, an occult insider, explains in his book The Secret Teachings of All Ages that secret societies have been covertly using America since its creation to carry out their goal of a global utopia. He wrote, “European mysticism was not dead at the time the United States of America was founded. The hand of the Mysteries controlled in the establishment of the new government, for the signature of the Mysteries may still be seen on the Great Seal of the United States of America. Careful analysis of the seal discloses a mass of occult and Masonic symbols chief among them, the so-called American Eagle...only the student of symbolism can see through the subterfuge and realize that the American eagle upon the [clvi] Great Seal is but a conventionalized phoenix.”

He continues, “Not only were many of the founders of the United States government Masons, but they received aid from a secret and august body existing in Europe which helped them to establish this country for a peculiar and particular purpose known only to the initiated few. The Great Seal is the signature of this exalted body—unseen and for the most part unknown—and the unfinished pyramid upon its reverse side is a teeterboard

setting forth symbolically the task to the accomplishment of which the United States Government was dedicated from the day of its inception.” [clvii] A video posted on YouTube showing Walter Cronkite accepting the Norman Cousins Global Governance Award in 1999 at a United Nations conference includes a disturbing joke about Satan running the New World Order and countries giving up their sovereignty. Cronkite was the anchor for the CBS evening news from 1962 to 1981. During this event Cronkite said, “What Alexander Hamilton wrote about the need for law among the thirteen states applies today to the approximately two hundred sovereignties in our global village, all of which are going to have to be convinced to give up some of that sovereignty to the better greater union, and it’s not going to be easy.” He then referenced how some Christians believe the construction of the global government is the work of the Devil, at which point Cronkite added, “Well, join me, I’m glad to sit here at the right hand of Satan.” This video is widely available on YouTube. Cronkite is believed to be the voice for Moloch played over the loudspeakers in the Bohemian Grove during the Cremation of Care human effigy sacrifice done each summer.

The United Nations As many people know, the United Nations (UN) is an international organization aiming to facilitate international law between countries around the world, and claim to be working for economic development, human rights, and world peace. The UN was founded in 1945 after World War II and replaced the League of Nations. There are currently 192 member states. [clviii] Supporters of the UN see it as a global forum for world leaders to exchange ideas and discuss policies that affect the rest of the world such as wars, economic policies, and human rights issues. Opponents see the UN as an authority that the United States will one day give up its sovereignty to,

causing the elimination of various Constitutional rights and liberties that Americans have enjoyed since the founding of the country. It’s interesting to note that the John Birch Society began criticizing America’s membership in the UN back in 1959 with their “get US out of the UN” campaign, and warned the UN’s goal was to establish a one world government. Criticism of the United Nations continues to this day by various groups and for various reasons. The United Nations Population Fund, for example, has provided support for different groups promoting forced abortions and sterilizations. Another controversial issue has been the UN’s connection with Lucis Trust (formerly called Lucifer’s Trust) which is Alice Bailey’s occult organization that continues to publish her books, including The Externalization of the Hierarchy . Robert Muller, the former Assistant Secretary General of the United Nations was known as the “philosopher” of the UN, and openly praised Bailey’s occult writings.

The North American Union Just like multiple countries in Europe joined together to form the European Union (EU) and agreed on a single common currency (the Euro), a similar plan has been drafted for the North American continent that would merge the United States, Canada, and Mexico in what would be called the North American Union (NAU), and then introduce a common currency (the Amero) for the region as well. (See the Amero) Just as the New World Order has been denied for decades and called a conspiracy theory, the North American Union was also denied and said to be the figment of people’s imaginations. In 2006 a government website, www.SPP.gov went online which contained information on what was called the Security and Prosperity Partnership of North America, which is a code term for the North American Union that would advance the global unified government in a major step. Other regional unions are also planned such as the Asian Union, the Middle Eastern Union, and the African Union. Once each of these regions are unified with their laws and currency, the next step then is to merge all unions into one system, as well as merge all of their regional currencies into the global currency. (See One World Currency )

Illegal Immigration Traditionally most conservatives support enforcing immigration laws and securing America’s borders, particularly the southern border with Mexico, since that is where millions of illegal aliens have snuck in from, while liberals usually turn a blind eye to immigration laws and even encourage massive influxes of illegal aliens breaking into America. By allowing and encouraging illegals to come to American, it causes various strains on the economy such as the workers not paying taxes; 20 to 30% of federal prison inmates are illegal aliens; they use medical services without paying for them; and they take jobs that would otherwise go to American citizens. As of 2010 the number of illegal aliens living in America range from between 6 and 13 million. While on the surface it makes no sense to have allowed such a practice to continue for decades, allowing illegal immigration to continue at massive levels has been a core strategy by the elite to usher in the North American Union and the New World Order. It became fairly obvious to thinking Americans that Republican President George W. Bush had no interest in slowing illegal immigration when after the terrorist attacks of September 11th 2001 the borders were not regulated, and during Bush’s entire eight years as president, he did nothing to attempt to do so. Common sense would say that if an army of dark skinned terrorists from Al Qaeda were dedicated to sneaking into America to plot and carry out more terrorist attacks, then one would think tightly regulating the borders would be a prime concern, but it wasn’t. Not only was it not a concern for President Bush, but after a group called the Minutemen formed and began voluntarily patrolling the borders with nothing more than binoculars, walkie talkies, and cell phones, President Bush attacked them, calling them [clix] “vigilantes.”

What is perhaps even more shocking is that illegal aliens in Los Angeles, [clx]

[clxi]

California had been given mortgage loans

and credit cards,

and in cities around the country, groups were fighting to prevent poll workers

from checking the ID of people who voted to insure they were a citizen and [clxii]

were who they said they were.

Other states wanted to allow illegal [clxiii] aliens to get valid driver’s licenses.

In the over ten years that this author (Mark Dice) has lived in San Diego, California, every morning in the same exact locations all over the city I have witnessed a dozen or more “day laborers” standing on the sides of roads or in front of businesses waiting to be picked up by people who need physical labor. The vast majority of these day laborers are illegal aliens from Mexico, and loiter every single day, week after week, month after month, year after year, in the same places where locals know they can pick them up and pay them cash to do yard work or other manual labor. They are paid cash for this work, and such a practice is very common in southern California, Arizona, New Mexico, and Texas. U.S. Immigration and Customs Enforcement does absolutely nothing and largely ignore the day labor pick-up locations. People not familiar with the practice, or who don’t live in border states may imagine that such workers would be extremely cheap, but I can attest first hand that they make more than you think. Back in 2003 I worked for a company that would occasionally use one of these men to “sign spin,” meaning that a person stands on the side of the road holding, spinning, or moving a sign advertising a business. On multiple occasions the owner of the business I worked at, which was a retail store, had me drive to the nearest day labor spot and pick up a guy for the job. There were often a dozen or more men who would all crowd around my truck when I pulled up, each of them hoping to be chosen for the job so they could make some money. They would ask how many hours of work was needed, and how much I was going to pay. Out of the dozen or more men standing around looking for work, none of them would get in my vehicle unless I said I was going to pay them $10.00 an hour. This is, of course, cash, so it’s really like they were making $12 or $13 an hour. My boss at the time was cheap and didn’t want to pay them very much, so he told me to see if I could get a worker for $7 or $8 an hour, but nobody would take it.

Allowing the illegal immigrants in America from Mexico also causes the government bureaucracy to grow and consume more tax payer’s money to deal with the economic and social burdens that the millions of illegals cause to the healthcare system, law enforcement and prisons, as well as straining our schools and social welfare programs. This is all, of course, looked at favorably by the elite, and allows them to expand the size and scope of government in conjunction with the New World Order. Some government officials have been pushing hard for complete amnesty of all illegal aliens which will automatically turn them into official American citizens. The vast majority of Mexicans are Democrats and after granting amnesty to them they will be able to vote, and will then support the liberal Democrats socialist agendas aimed at solidifying the New World Order.

Monitoring the Population with Big Brother Personal privacy has been slowly eroding in recent decades due to new technology and legislation such as the Patriot Act, but this slow and gradual process is speeding up and will soon advance at such a high pace that many aspects of the personal privacy we once enjoyed will be left to the past and never experienced again. There was a time not long ago, when if your boss tried to call you at home after work or on the weekend and you weren’t home or didn’t answer the phone, then he would be out of luck and have to wait until you returned to work to speak to you. This was before cell phones and caller ID, but today if your boss wanted to get a hold of you, he would simply call your cell phone and even if he didn’t leave a message, you would be expected to return his call within minutes or hours because he knows you will see the missed call on your call log. While cell phones have amazing advantages, they have also changed the social customs in ways most people do not notice unless they step back and really look at the implications such technology has carried with it.

But this social change can be seen as tremendously insignificant compared to other implications stemming from Radio Frequency Identification Devices (RFIDs), facial recognition cameras, and fingerprint scanners. Such devices do in fact offer some advantages but also hold a large potential for abuse in ways that most people couldn’t even imagine.

VeriChip and RFID An RFID (Radio Frequency Identification Device) is a small computer chip that can be encoded with information and then read from various distances by a receiver. They are sort of electronic bar codes and have various uses, including tracking products as they travel around a warehouse or en route to a delivery. The VeriChip is the world’s first implantable RFID which is the size of a grain of rice and is implanted in the body of animals as well as humans. In pets and livestock, the device is used as an electronic dog tag to identify the animal. The VeriChip company is planning to have their chips implanted into people’s hands or arms to replace debit cards and drivers licenses. The VeriChips have been used to enter VIP areas in clubs and pay bar tabs since [clxiv]

around 2004.

The device’s manufacturer has been promoting the chip as a simple alternative to carrying around cash, credit cards, or a driver’s license, and is hoping to make the implantable VeriChip or an invisible tattoo the standard form of ID and payment around the world. While the original version of VeriChip only acts as an identifier that can be read by a receiver from a short distance away, in the future, smaller versions equipped with GPS will be small enough to also be implanted under the skin as well, and will be able to be tracked wherever the person implanted with one goes.

GPS Tracker for Children In October 2009, a tracking device was put on the market called the Little Buddy, which consists of a fairly large unit that the company promotes as a safety device which can be placed in a child’s backpack or lunchbox and

can then be located and tracked via GPS on the parent’s cell phone or computer. The device also allows boundaries to be set up by the parents and activated during specific time periods, and if the device travels outside of that specified area, a text message or email will be sent to the parent notifying them of this. For example, a boundary could be set up around a one block radius from the child’s school during the school hours, and if the device travels outside that area during this timeframe, the parent would be immediately notified. This device is rather large and cannot be easily concealed, so most children would be aware that such a device was placed in their backpack by their parent, but future versions of such a device will be incredibly smaller and can be placed on a person without their knowledge. When these smaller devices are available, they will open the door for horrendous implications involving stalking and personal privacy issues. One newscaster on the Fox News Channel even joked about placing the device in her boyfriend’s car so she could keep tabs on exactly where he went and when. Most people would obviously be unaware such a device was placed in their vehicle. One commercial for the Little Buddy tracking device said, “Get peace of mind. Build trust. And be confident that your child is OK when you can’t be with them.” It’s unclear what they meant by “building trust” with the device, since using such a thing is a clear sign of an overbearing, controlling, or paranoid parent. The device costs under one hundred dollars.

Plans to Implant U.S. Soldiers with RFIDs Aside from the VeriChip corporation first marketing their Orwellian product as a life-saving medical device, and later entering into talks with banks hoping their chip will replace credit and debit cards as a form of payment for goods and services, the company aggressively pursued the Pentagon with hopes that their RFID chips would be implanted in the 1.4 million [clxv] soldiers in the armed forces as a replacement for their metal dog tags.

The D.C. Examiner called the company “one of the most aggressive marketers of radio frequency identification chips,” and reported that they were in discussions with the Pentagon about implanting them in soldiers. VeriChip spokeswoman Nicole Philbin told the Examiner that, “The potential for this technology doesn’t just stop at the civilian level.”

Facial Recognition Cameras In George Orwell’s novel Nineteen Eighty-Four , he described what he called Telescreens which were placed in every home and on every street that were television screens which could also watch whatever was going on in its field of view. These Telescreens were monitored and recorded by the Thought Police and kept everyone under a constant state of surveillance to make sure they wouldn’t conspire against the ruling Party or even speak negatively of them. While security cameras have been a common fixture in banks, stores, and parking lots for decades as a method to deter crime or allow their videotapes to be reviewed in order to gather evidence if a crime is committed, new computer software allows cameras to be able to spot someone out of a crowd if they are entered into the system as a target. These facial recognition cameras have been used in casinos for years in order to spot suspected card counters who the casinos want to keep an eye [clxvi]

on.

Such systems spot them as soon as they enter the casino even if they are wearing a disguise. In the New World Order, facial recognition systems will one day be as common as street lights and will record everyone’s movements throughout their day. The information stored by these systems will be able to trace your exact movements throughout an entire city (and country), as well as log the names of any individuals you happen to meet during the course of your day. This system can be programmed to detect if and when two or more specific individuals come into close proximity to each other. Supporters of these systems claim they prevent crime and fight terrorism but the potential for stalking and other abuses are horrifying.

In the New World Order it may even become common place for cameras to be in people’s homes that are wired into a universal database and can be monitored by officials. There will be very few places where the all-seeing eyes are not constantly looking at you.

Echelon Even many electrical engineers find it hard to believe that the United States government has an advanced spy system that can monitor practically every phone call, fax, email, and text message in real time. This system is so powerful that it uses what are called “dictionaries” to flag certain keywords used in conversations around the world. If a series of keywords appear in a single conversation, then that telephone conversation will be flagged and analyzed to determine if it is a threat or not. For example, if a person uses words such as “bomb,” “kill,” “president,” and “White House” in a conversation, then the Echelon system will detect it and the conversation will be flagged and analyzed by authorities. Most conversations are recorded and stored for a period of time and are only deleted if they are not deemed important. This system also has voiceprint technology that is capable of detecting a specific person’s voice among the millions of voices that are being transmitted over satellites at any given time. If a specific individual is targeted for surveillance, even if that person uses a payphone, their voiceprint will be detected by Echelon, and their location will be identified and the phone call will be recorded. This is no more difficult than Google instantaneously finding a specific article among the tens of millions of web pages after a specific set of words are searched for. It may be alarming to people that simple systems are able to activate specific cell phones and listen to the conversations, and can even turn on the cell phone’s microphone and listen to the surrounding area even when the phone is off. Surely this technology violates the rights of people and the 4th Amendment to the Constitution that protects against unauthorized searches and seizures, but the authorities in control of this technology couldn’t care less. Only fools believe them when they say that it isn’t abused and doesn’t infringe upon peoples’ rights.

The Internet While valuable information still gets past the mainstream media gatekeepers, most people spend hours each week on Facebook and Twitter selfpromoting themselves and posting meaningless drivel about how good their lunch was, or how they are feeling at the moment. The comments that their friends post on their status updates make the user feel important as if they are their own celebrity with a fan base who follow their every move. These same zombies often cyberstalk people of the opposite sex who they are interested in and spend hours looking through all of their Facebook or MySpace pictures and fanaticizing about having that person as a part of their life. These same types of fools subscribe to YouTube channels like “Fred,” “Hot for Words,” or “Sxephil.” These kinds of people are of no concern to the establishment, since they are continuously amused and are kept out of the way. It is the people who are awake to the New World Order and who use the Internet to its fullest capacity to bypass the gate-keepers and propaganda who are a danger to their monopoly. People like you.

Carnivore It shouldn’t come as a surprise that the FBI, CIA, NSA, and any number of other government agencies can identify every website you’ve been on, what files you downloaded, and read any email you’ve ever sent. The computer system that was first created to do this was called Carnivore and was implemented by the FBI. The system was first used during the Clinton administration after the Internet became widely used, and its sophistication has grown in step with advancing technology. After repeated negative coverage in the press due to personal privacy concerns, the FBI changed the name of the Carnivore system to DCS1000, which stands for “Digital Collection System.” In 2001 the FBI also started using commercially available software such as NarusInsight to monitor the [clxvii]

Internet traffic of targeted individuals.

The software can easily monitor a target’s Internet usage in real time, as well as go back and trace

them step by step, through each web page they visit, link they click, and file they download. Most laptop computers have built in microphones and webcams that can also be used to watch and listen to suspects without their knowledge. It also shouldn’t come as a surprise that any one of the “alphabet agencies” can also get access to your computer’s hard drive, if the computer is online, and can search and copy its contents.

Google Ousts Blogger Over Name Calling A lot of people with blogs, websites, and YouTube accounts don’t use their real name and instead use a handle or pseudonym. The reasons for using a handle usually stem from them wanting anonymity to prevent crazy stalkers from coming to their home or place of work because they are either fans of their content, or want to hurt them because they hate what they post online. Most bloggers enjoy this anonymity but there are increasing risks that if someone posts a blog or video saying derogatory things about a specific person or group, then their identity may be discovered and they may be sued or even charged with a “hate crime.” In January 2009 a model sued Google to get the identity of a blogger who [clxviii]

called her a “skank” and an “old hag.”

Liskula Cohen, a blond beauty who has modeled for Giorgio Armani, Versace, and Vogue magazine wanted to sue the blogger for defamation. The blog was on Google’s Blogger service and titled “Skanks in NYC” where the blogger wrote, “I would have to say the first-place award for ‘Skankiest in NYC’ would have to go to Liskula Gentile Cohen.” A Manhattan Supreme Court judge ruled that Cohen was entitled to know the name of the blogger and ordered Google to reveal her name which is Rosemary Port. The model then filed a $3 million defamation lawsuit against the Port.

The Cyberbullying Act

The Cyberbullying Act of 2009 (HR 1966, the Megan Meier Cyberbullying Prevention Act), is named after the high-profile “MySpace suicide” of a young 13-year-old girl named Megan Meier who killed herself after being harassed on MySpace by her classmate’s mother who pretended to be a teenage boy online. It’s meant to prevent people from using the Internet to “coerce, intimidate, harass, or cause substantial emotional distress to a person” but the vague language in the bill has alarmed people because it so broadly defines “cyberbullying” that it could be interpreted to apply to practically any situation, including blog posts critical of public officials. The National Crime Prevention Council defines cyberbullying as “when the Internet, cell phones or other devices are used to send or post text or images intended to hurt or embarrass another person.” UCLA Law Professor Eugene Volokh wrote on his blog that everyday situations could be considered cyberbullying. “I try to coerce a politician into voting a particular way, by repeatedly blogging (using a hostile tone) about what a hypocrite/campaign promise breaker/fool/etc. he would be if he voted the other way. I am transmitting in interstate commerce a communication with the intent to coerce using electronic means (a blog) ‘to support severe, repeated, and hostile behavior’— unless, of course, my statements aren’t seen as ‘severe,’ a term that is entirely undefined and [clxix] unclear,” Volokh wrote.

Parry Aftab, a lawyer and Internet security expert said, “We have existing harassment statutes in all 50 states that already cover this problem. We [clxx]

don’t need Linda Sanchez’s law.”

(Linda Sanchez (D-CA) introduced the Cyber Bullying Act.) According to the text in the Cyber Bullying Act, people who “bully” others via any electronic means could face fines, two years in prison, or both. This means if you sent a nasty text message to your ex or post derogatory comments on someone’s YouTube video, you could be arrested. It also means you post something insulting or judgmental about someone on your Facebook, MySpace, or Twitter pages, or on any Internet forum, then you may be violating the law.

Researchers say that anywhere from 40 percent to 85 percent of kids have been exposed to some kind of “cyberbullying,” such as being called “fat” via instant message or postings on social networking sites.

Cybersecurity Act of 2009 The Cybersecurity Act of 2009 gives the president the ability to declare a “cybersecurity emergency” and shut down or limit Internet traffic in any “critical” information network “in the interest of national security.” This bill does not define what a critical information network or a cybersecurity emergency is, because that definition would be decided by the president of the United States. The bill also grants the Secretary of Commerce “access to all relevant data concerning [critical] networks without regard to any provision of law, regulation, rule, or policy restricting such access.” This means the government can access or monitor any data on private or public networks without regard to privacy. This creepy, Big Brother power was introduced by none other than Jay Rockefeller, the great-grandson of John D. Rockefeller, nephew of banker David Rockefeller. When discussing how “dangerous” the Internet was and why he felt the Cyber Security Act is important, Jay Rockefeller stated, “It really almost makes you ask the question, would it have been better if we had never invented the Internet.” So using the authority given to the government by the Cyber Security Act, in the event of an emergency such as a major terrorist attack or a pandemic, the government could turn off practically every website in the country, except ones they deemed “critical” which would be mainstream media sites that would gladly parrot government talking points about what the public should do. The government could also cause every website to “point to” or forward to a government website that contained propaganda about what had just occurred and would give only one-sided instructions about evacuations or inoculations. This is identical to the Emergency Broadcast System used in television which allows the government to interrupt every station in the country simultaneously and broadcast whatever message they want.

A Medicated and Sedated Population [clxxi]

27 million Americans are on antidepressants,

which is approximately 10% of the population. People are familiar with the well-known pills such as Prozac or Zoloft, but there are thirty different drugs used as antidepressants—including: Paxil, Celexa, Lexapro, Luvox, Buspar, Nardil, Elavil, Sinequan, Pamelor, Serzone, Desyrel, Norpramin, Tofranil, Adapin, Vivactil, Ludiomil, Endep, Parnate, Remeron, and more. Some of these drugs have extremely dangerous side effects. A 2004 study in the Journal of the American Medical Association reported that “the risk of suicidal behavior is increased in the first month after starting [clxxii] antidepressants, especially during the first one to nine days.”

In the New World Order, the fun and joy of life is often missing from where it once was. It’s no wonder people are depressed since many social activities such as parties or just chatting with your neighbor for a half an hour have been replaced by videogames, watching television, or surfing the Internet. In the vast majority of depression cases, instead of someone taking a drug to alleviate the symptoms, all they need to do in order to experience the joy in life is to simply change their lifestyle and their habits. This would then attack the root of the problem instead of just masking the symptoms by taking drugs. But the pharmaceutical industry would rather everyone take a pill every day for the rest of their lives while living the same pathetic existence they did before, rather than join some social clubs or recreational sports team to alleviate their boredom and depression. A study of antidepressant use in private health insurance plans conducted by the New England Research Institute found that 43 percent of those who had been prescribed antidepressants had no psychiatric diagnosis or any

[clxxiii]

mental health care beyond the prescription of the drug.

The drug companies don’t want people cured, they just want their business.

Drug Commercials The famous comedian Chris Rock, whose stand-up is often based on the truth, has a hilarious but true joke based on his observation of the massive advertising campaigns by the drug companies and the amount of money doctors and medical companies make by not curing diseases. “There ain’t no money in the cure,” Rock blasts. “The money’s in the medicine. That’s how you get paid!” Rock goes on, “The government…they don’t want you to use your drugs… they want you to use their drugs. So every night on TV you see a weird ass drug commercial trying to get you hooked on some legal shit. They just keep naming symptoms till they get one that you fucking got. It’s like, are you sad? Are you lonely? Do you got athletes’ foot? Are you hot, are you cold? And they just keep naming symptoms…are you depressed…do your teeth hurt?…I got that! I’m sick! I need that pill!”

The H1N1 Swine Flu Vaccine In the summer of 2009 the government and mainstream media launched a massive fear-mongering campaign trying to convince everyone in the world that they needed to take a vaccine for the H1N1 virus—the so-called “swine flu” virus. It was the top story for days when it first hit, and then the continued fear-mongering lasted for months as a supposed vaccine was made available to the public in October. It was a pandemic and everyone needed the shot, they said, or tens of thousands would die. In the 1970s a similar scare was spread about a swine flu virus, and after a vaccine was pushed onto the public, numerous people got sick and died from the vaccine itself. This time around with the H1N1 swine flu virus, government propagandists claimed the vaccines were safe and those who decided not to take it were even called “extremists” by the chief medical [clxxiv] examiner in England.

Public health workers such as doctors and nurses in the state of New York were first told by State Health Commissioner Richard F. Daines that they would have to take the vaccine by November 30th 2009 or risk discipline, including losing their job. After massive resistance and a public demonstration, Governor David Paterson reversed the policy, but said it was [clxxv] prompted by a vaccine shortage.

The Public Employees Federation, New York’s second-largest state employees union, sued over the requirement and was awaiting a state Supreme Court hearing scheduled for October 30, 2009, when the Governor announced the decision to drop the mandatory vaccinations. On a CNN segment broadcast in October 2009, Dr. Mehmet Oz, who is Vice-Chair and Professor of Surgery at Columbia University and a wellknown medical correspondent and host of the Dr. Oz Show , urged everyone to get vaccinated but when Campell Brown, the host, asked him if his children were getting the vaccine, he said, “I’ll tell you, my wife is not going to immunize our kids, cuz I’ve got four of them, and when I go home, I’m not Dr. Oz, I’m Mr. Oz.” Shepard Smith of the Fox News Channel told his audience not to believe the “conspiracy theories” about the vaccine, or the “negative hype” after a [clxxvi]

guest was on urging everyone to take the vaccine.

Dr. Nancy Snyderman, MSNBC’s chief medical editor, addressed the large numbers of people who were suspicious of the vaccine and weren’t going to take it telling them to, “forget the conspiracy, listen to our government agencies, these guys are telling the truth. There’s no conspiracy here folks, just get [clxxvii] your damn vaccine.”

One of the major reasons large numbers of people were refusing to take the shot was because of the fear of side effects similar to the ones from the 1970s swine flu vaccine. The 2009 H1N1 swine flu outbreak was so overhyped in the mainstream media that people began to get suspicious that there was a conspiracy to scare everyone into taking the vaccine. Some saw the reason for the fear-mongering being a way for the vaccine manufacturers to make hundreds of millions of dollars from the sale of their

product, while others saw this as a plot to forcibly inject everyone with thimerosal and mercury laced vaccines for the purpose of dumbing down the masses by the neurological damage caused from such preservatives found in most vaccines. Some even believed the “vaccine” was designed to kill them in order to carry out the population reduction agenda of the elite.

RFID Bracelet Hoax In early September 2009 the person with the YouTube channel “Entimes777” posted a video with the title “URGANT MESSAGE!!!! Make this viral!!!” [the word urgent was misspelled in the title of the original video] which consisted of a video blog of a woman claiming to be a U.S. soldier who says she was training with California police to set up freeway checkpoints and force H1N1 swine flu vaccinations on the public, and then also force them to wear a bracelet containing an RFID tracking device once they were vaccinated. The woman also claimed that those who refuse to take the vaccination at the checkpoints will be immediately taken to a concentration camp. The video was spread around the Internet and posted on numerous alternative news websites as possible evidence that such plans were being implemented. A few days later the woman posted a new video saying that in a week she would delete the previous video from her account, which she did, but not before others downloaded the video and reposted it on YouTube where it can still be seen today if one searches for “Soldier Claims Authorities Training To Intern Americans Who Refuse Swine Flu Shot.” Peoples’ response to the woman’s claims varied, as was noted by the variety of comments, ranging from calling her a “crackpot” to saying, “God Bless You, the Truth is out there cuz of people likeyou.” A few months earlier on July 29th 2009, former Kansas state trooper Greg Evensen published an article on the web titled The Death of Liberty: The Final Scene Unfolds , where he wrote, “Have you been made aware of the massive roadblock plans to stop all travelers for a vaccine bracelet (stainless steel band with a micro-chip on board) that will force you to take the shot? Refuse it? You will be placed on a prison bus and taken to a quarantine

camp. What will you do when your children are NOT allowed into school without the shot? What will you do when you are not allowed into the workplace without the vaccine paperwork? Buy groceries? Go to the bank? Shop anywhere?? Get on a plane, bus or train? Use the toilet in the mall? Nope. Police officers will become loathed, feared, despised and [clxxviii] remembered for their ‘official’ duties.”

A video was posted on YouTube of Evenson speaking at a conference where he was asked about his article where he reiterated his claims that he had been told by numerous state troopers that such a plan was in existence, and then said that he had a “medical specialist” in Milwaukee, Wisconsin tell him that they had witnessed, “A semi-tractor trailer being unloaded at the hospital loading dock with pallets and pallets, scores of cases of metal bracelets, that once put on, would slip into place and be either pegged in there with some kind of device to hold it in place, but the band was meant to be permanent. On top is a chip, and on that chip will contain all kinds of [clxxix] information about you and the fact that you have been inoculated.”

Of course no such plan was ever enacted and Greg Evenson is either a fraud or a dupe. This does not mean, however, that a future outbreak of a disease or a virus will not lead the government to launch a forced vaccination and quarantine program. Such an event will likely occur one day, but unfortunately misinformation and paranoia about checkpoints for the H1N1 vaccine didn’t end here.

Vaccine Checkpoint Hoax In mid-September 2009 some bloggers and alternative news sites posted a story after someone claimed to have come across a vaccine checkpoint east of San Diego, California. The problem was that the H1N1 vaccine wasn’t even available yet. The story was accompanied by a photo the person allegedly took, which looked like an ordinary border checkpoint that are common in southern California. The person, who remains anonymous, said they were traveling from California to Arizona, headed east of San Diego when he was subjected to

an unusual checkpoint. “As I approached I noticed armed military personnel had most of the cars pulled over and there were a lot of people going in and out of a mobile trailer. The people looked confused and some upset. Seeing what was going on made me really nervous,” the person said. He then went on to claim that he was approached by a women in military fatigues who asked him where he was headed and mentioned “something about a vaccination.” “I got scared and told her I was a state geologist doing field research and because I was doing so much driving back and forth I had my vaccine on campus. She didn’t say anything for a few seconds and then the car behind me started honking and she got pissed and waved me on. I was so scared!,” he concludes. One comment on the story read, “That checkpoint is for the Border Patrol along Interstate 8 just west of Imperial Valley. The reason why the BP is there is because I-8 is within one mile of the border. If you have white skin, they let you through. If you have brown skin and 20 passengers in your Ford Econoline, you are going to get pulled over and interrogated. Yes, checkpoints are un-American and Stalin-esque, but this has nothing to do with Swine Flu. Knock it off with the fear mongering. That crap gets old.” Another skeptical reader posted, “Besides, the swine flu vaccine is not readily available yet (two more weeks). So why would they be checking to see if people had received it?” So whoever it was that started this rumor by sending this email and photo out to alternative news sites was either a paranoid and delusional person who somehow after the fact that he was subjected to a standard border patrol checkpoint dreamed up that the officers were talking about a vaccine, or the person simply sent out the email as a purposeful hoax to see if they could fuel the fear that people had about such checkpoints being set up.

Dangers of Vaccines Robert Kennedy Jr., the son of Robert “Bobby” Kennedy, the younger brother of President John F. Kennedy, has been active in exposing the link

between thimerosal in vaccines and autism in children. In 2005 he wrote a powerful article titled Deadly Immunity which was published in Rolling Stone magazine and on Salon.com, where he said, “Since 1991, when the CDC and the FDA had recommended that three additional vaccines laced with the preservative be given to extremely young infants—in one case, within hours of birth—the estimated number of cases of autism had increased fifteen fold, from one in every 2,500 children to one in 166 children.” Many people are aware of the dramatic increase in autism cases since the 1990s and many doctors and parents point to mercury and thimerosal preservatives that are found in such vaccines as the catalyst for the disorder. Such a link is officially denied by the medical establishment, but the information Kennedy covers in his article is extremely disturbing. He wrote about a secret meeting of doctors where they had allegedly discussed the dangers of vaccines and how they could cover it up. He explains, “According to transcripts obtained under the Freedom of Information Act, many at the meeting were concerned about how the damaging revelations about thimerosal would affect the vaccine industry’s bottom line. ‘We are in a bad position from the standpoint of defending any lawsuits,’ said Dr. Robert Brent, a pediatrician at the Alfred I. duPont Hospital for Children in Delaware. ‘This will be a resource to our very busy plaintiff attorneys in this country.’ Dr. Bob Chen, head of vaccine safety for the CDC, expressed relief that ‘given the sensitivity of the information, we have been able to keep it out of the hands of, let’s say, less responsible hands.’ Dr. John Clements, vaccines advisor at the World Health Organization, declared that ‘perhaps this study should not have been done at all.’ He added that ‘the research results have to be handled,’ warning that the study ‘will be taken by others and will be used in other ways beyond the control of this group.’” Kennedy’s article is very lengthy and is available in full on the web. He also gave a very unsettling interview on MSNBC about the issue where he said, “We are injecting our kids with 400 times the amount of mercury that the FDA or the EPA considers safe.”

About thimerosal causing autism, Kennedy says, “The science is out there today for anybody who bothers to read it, and I have read it…The same regulatory bureaucrats that green lighted thimerosal originally are now [clxxx] trying to cover their tracks.”

He went on to say that he had obtained the transcript of the secret meeting of doctors, pharmaceutical companies, and scientists from our government in the year 2000, who say that the link is undeniable and that they would not give the vaccines to their own children, but conspired to hide the evidence from the American people. Kennedy concluded the interview on MSNBC by saying, “We have the guys who are supposed to be protecting American’s health, who are actually conspiring to keep this stuff in the vaccines.” Actress Jenny McCarthy has a child who was diagnosed with autism, and she has publicly made some statements about the possible link between vaccines and autism but many people in the media ridiculed her and called her crazy because she is known for playing bimbos, although in real life she is very well spoken.

Mercury Poisoning is Good for Children? K-Eye News, a CBS affiliate in Austin, Texas aired a brief segment about vaccines which was so absurd that it could have been a satire produced by Saturday Night Live . As you now know, there has long been a controversy over mercury in vaccines causing neurological damage, and even triggering autism in children, but this bizarre newscast claimed, “Mercury containing vaccines may help, not harm kids according to two new studies in the Journal of Pediatrics .” The story went on to say, “There have been wide spread concerns that mercury based preservatives in vaccines might impair the neurological development of children. These new studies suggest the opposite, that the preservatives may actually be associated with improved behavior.” What they meant by “improved behavior” is basically that your children will be mildly brain damaged by the vaccines, and will be more like zombies and less likely to act like normal energetic children.

Sodium Fluoride in Drinking Water A lot of people who see the New World Order as a threat to their way of life and the freedoms people have enjoyed in places such as America and Europe, see the fluoridation of the drinking water as a way to massively drug the population for the purpose of creating a docile populace that is more willing to accept their present living conditions. The official explanation for adding sodium fluoride to the public water supplies is to supposedly reduce tooth decay and prevent cavities, but other research shows that consuming sodium fluoride has effects on the brain such as calming people down and even reducing their IQ. G. D. Searle & Company (which is now part of Pfizer) was a company involved with researching and developing pharmaceuticals and agriculture products and is often mentioned in regards to fluoridating drinking water in America. G.D. Searle & Company is claimed to have spearheaded water fluoridation in America and the CEO of the company between 1977 and 1985 was none other than Donald Rumsfeld. This is the same Donald Rumsfeld who would go on to be the Secretary of Defense under George W. Bush and who helped fabricate the lies that were used to justify the invasion of Iraq in 2003. Rumsfeld was also a member of the Project For a New American Century, which published a document outlining the Neocon strategy for the Middle East and how they needed a “new Pearl Harbor” type of attack on America in order to implement it. This is a whole other issue in and of itself, but since Rumsfeld was involved in such sinister activities with the Bush administration, it is interesting to see that he was also the CEO of the company some claim was responsible for getting sodium fluoride added to the drinking water of cities around the country. Many believe that it was Rumsfeld’s job to get this done, with the goal of drugging the population on a large scale. Recall Obama’s science czar John Holdren who proposed adding a sterilant to the water supply. There is conflicting science and conflicting claims about the effects of drinking water containing sodium fluoride. The medical establishment denies any side effects from the chemical being consumed, but there are also medical doctors and scientists who say it dumbs people down and

shouldn’t be drank. We shouldn’t put it past the secret establishment to drug the people through the water supply, so as a precaution it is advised to drink bottled water without the sodium fluoride additive, or have a filtering system installed on your tap water at home. There are also atmospheric water generators that take the water out of the air and can generate several gallons of clean drinking water per day, but these systems are very expensive.

Science and Technology Advances in science and technology are a double edged sword, creating amazing communication abilities and life saving devices, but also creating powerful killing machines and nightmarish mind control devices capable of implanting thoughts into people’s minds through invisible radio waves. Such a claim may spark an image of a tin foil hat, but as you will soon learn, such technology is very real. In the New World Order, advanced technology is sometimes looked at with suspicion due to the capacity for abuse and the corrupt power-hungry elite and politicians who are in control of such technology. Chemtrails, weather modification, HAARP, Eugenics, secret and immoral medical testing and more, are often mentioned as proof of such abuse. Some of these subjects had been considered conspiracy theories by most people for decades, but have recently been the focus of headlines around the world admitting such technology exists and has been used in the past, or is currently being used today.

HAARP The High Frequency Active Auroral Research Program (HAARP) is allegedly an “investigation project” that is funded by the Defense Advanced Research Projects Agency (DARPA), which is an agency of the Department of Defense. The US Air Force and the Navy are also involved with HAARP and claim its purpose is to investigate the ionosphere and any communication or surveillance capabilities it may enable. The project was started in 1993 and is located north of Gakona, Alaska. Photos that are

available of some of the facility look like acres and acres of radio antennas numbering approximately 180 total, which are over 70 feet tall and are all linked together to form one large antenna. It’s reported that this antenna system can aim 3.6 million watts of energy into a specific location of the ionosphere. The largest legal AM radio station in America broadcasts 50 thousand watts, making HAARP 72 times more powerful. Suspicions and controversy over HAARP grew shortly after its creation when scientists familiar with such technology claimed that it was being developed as a weapon capable of knocking out missiles, enemy satellites, and even causing earthquakes if desired. HAARP is only one of several ELF (Extremely Low Frequency) wave transmitters. The United States owns three different facilities which are located in Gakona, Alaska; Fairbanks, Alaska; and one in Arecibo, Puerto Rico. Russia also has a similar facility in Vasilsursk, and the European Union has one in Tromso, Norway. In the 1980s a physicist named Bernard Eastlund developed some of the concepts later used in HAARP and proposed using radio frequency waves to affect the ionosphere in a way that would disable enemy missiles and knock out targeted satellite communications, but the technology has far more dangerous capabilities than this. A brief series on the History Channel called That’s Impossible featured an episode that dedicated some time to looking into such technology and concluded, “Working in tandem, these transmitters could potentially alter the weather anywhere in the world, changing the jet streams course entirely, triggering massive rain storms or droughts. Even hurricane steering would be possible by heating up the atmosphere and building up high pressured domes that could deflect or change the course of hurricanes.” Dr. Brooks Agnew, of the Phoenix Science Foundation, used ELF waves to discover underground pockets of oil and gas in what is called earth tomography. He believes that this same technology accidentally triggered an earthquake in 1987 in Roseburg, Oregon. Dr. Agnew reported that as soon as his team energized the ELF wave generator there was a 4 to 4.5 earthquake. In the episode of That’s Impossible , Dr. Agnew designed and

built a scale model of the ground conditions found in Rosenberg, and also had a small ELF wave generator aimed at it. As soon as he turned the device on, a large rock sitting on a slanted slope representing a fault line, immediately slid downward. In this demonstration he used a simple 30 watt stereo speaker to generate the ELF waves. Remember, HAARP is capable of blasting 3.6 million watts. In 1995 a book titled Angels Don’t Play This HAARP: Advances in Tesla Technology was published by Nick Begich Jr., who is the son of Congressman Nick Begich Sr., (D-Alaska) and brother of Senator Mark Begich (D-Alaska), where he claimed that the project in its present stage could be used for “geophysical warfare.” In August 2002, Russia issued a press release about HAARP reading, “The U.S. is creating new integral geophysical weapons that may influence the near-Earth medium with high-frequency radio waves…The significance of this qualitative leap could be compared to the transition from cold steel to firearms, or from conventional weapons to nuclear weapons. This new type of weapon differs from previous types in that the near-Earth medium [clxxxi] becomes at once an object of direct influence and its component.”

This statement is interesting because Russia has its own ionospheric heater system nearly identical to HAARP which is called Sura, and the real reason for issuing the statement showing concern over HAARP was believed to be due to America withdrawing from the Russian-American Anti-Ballistic Missile Treaty in 2002. The Convention on the Prohibition of Military or Any Other Hostile Use of Environmental Modification Techniques is an international treaty that was signed by over 75 different countries in 1978, prohibiting the military or other entities acting on behalf of a government from using environmental modification techniques in a hostile manor. Why was there a treaty signed that weather modification won’t be used as a weapon if it isn’t possible for such a thing to occur? Obviously people familiar with the technology are worried about it and are aware of the disastrous effects.

With all the hysteria over so-called climate change and global warming, it should be noted that some believe HAARP is capable of causing such a thing since it is an ionosphere heater and tampers with the earth’s atmosphere. Former Governor of Minnesota Jesse Ventura hosted a TV show on the Tru network called Conspiracy Theory and investigated HAARP in one episode. As Ventura and his video team were attempting to enter the facility, all of their equipment malfunctioned. Ventura stated in a radio interview promoting the show, “I went all the way up to Alaska and went to this location…it’s a very interesting thing going on up there. It falls under the military, and yet it is given the distinction of being an unclassified research center, yet I was not allowed in. Now, bear in mind I used to have a top secret clearance with the United States government during my six years as a member of underwater demolition team twelve and SEAL team one. I was also a mayor and a governor, yet I was not allowed to go into this supposed unclassified research center. If it’s [clxxxii] unclassified [then] anybody should be able to go in there.

This episode of Conspiracy Theory left Jesse Ventura visibly upset after he learned that HAARP could be used as a massive weapon and nobody would even know. Ventura’s show was historic because it marked the first time that certain issues were addressed in a serious manner on TV.

Microwave Auditory Effect The subject of mind control is an extensive and disturbing one, and for this book, we will focus only on one aspect of this practice involving the microwave auditory effect, which is a way of using microwave frequencies to beam sounds and even words and sentences into peoples’ heads which are perceived auditorially by them but appear to be coming from inside the person’s own head or from God. For an expanded analysis of mind control including brainwashing and a history of the MK-ULTRA program you may wish to read The Resistance Manifesto .

While the subject of mind control is vast with the majority of methods involving some kind of physical contact with the subject, technology using radio waves to literally beam thoughts into peoples’ heads is infinitely more insidious because it can be used covertly without the consent or knowledge of the person being targeted. Again, such an idea sounds absurd, but you will discover is very real. Such experiments have been carried out at the Walter Reed Army Institute of Research in what was called Project Pandora where externally induced auditory input microwave audiograms of words or oral sounds created the effect of hearing voices. An Air Force document on the subject stated, “The signal can be a ‘message from God’ that can warn the enemy of impending doom, or encourage the enemy to surrender.” In 1996 the United States Air Force submitted a patent which was later awarded on October 22, 2002 for a device called the Radio Frequency Hearing Effect (Patent number: 6,470,214) where the description reads, “A method of encoding an input audio signal a(t) to produce a double sideband output signal having a ωc carrier frequency, which when transmitted to the head of a receiving subject, will by the radio frequency hearing effect induce a thermal-acoustic signal in the bone/tissue material of the head that replicates the input audio signal and is conducted by the bone/tissue structure of the head to the inner ear where it is demodulated by the normal processes of the cochlea and converted to nerve signals which are sent to the brain, thereby enabling intelligible speech to be perceived by the brain.” In 2007, the Washington Post ran an article titled Mind Games which investigated claims of individuals who believed the government was using such devices on them. The beginning of the article makes it seem as if the people are crazy, but then further into it the article actually outlined some of the technology and research the government has been involved in that is able to accomplish such a thing. It reads, “In 2002, the Air Force Research Laboratory patented precisely such a technology: using microwaves to send words into someone’s head. That work is frequently cited on mind-control Web sites. Rich Garcia, a spokesman for the research laboratory’s directed energy directorate, declined to discuss that patent or current or related

research in the field, citing the lab’s policy not to comment on its [clxxxiii] microwave work.”

A successful African American novelist named Gloria Naylor, best known for her novel The Women of Brewster Place , which was made into a miniseries by Oprah Winfrey, has a lesser known book titled 1996 which describes her experiences as an alleged victim of microwave mind control. She begins, “I didn’t want to tell this story. It’s going to take courage. Perhaps more courage than I possess, but they’ve left me no alternatives…I am in a battle for my mind. If I stop now, they’ll have won, and I will lose myself.” She explains how she thought she had a mental illness at times such as schizophrenia, but says she witnessed other strange occurrences such as people mimicking her every movement and people driving by her isolated vacation home. “I would lie in bed while the conversations were going on, and I’d ask: Maybe it is schizophrenia?” she wrote. The voices, she said, would taunt her and swear at her, telling her she was stupid and that she couldn’t write. Naylor went to see a psychiatrist and was given a prescription for an antipsychotic medication, but it didn’t stop the voices. She says she was a victim of such harassment by the voices for almost four years until she discovered mind-control forums on the Internet and learned about technology and secret government programs involving such phenomena. Whether or not Gloria Naylor was simply hallucinating and had some kind of mental illness that eventually was cured, or whether she was a victim of microwave auditory effect technology may never be known. If in fact she was not hallucinating or having some kind of neurological problem causing her to perceive the voices, then why would she be targeted by such technology? One possible explanation could be that someone who worked on such systems and has access to the microwave transmitters knew Naylor personally and perhaps had a personal vendetta against her and found joy and revenge in tormenting her. Perhaps an ex-boyfriend from high school or college later became involved in the government program and chose to target her for his personal amusement.

Perhaps she was chosen as an unknowing test subject who was toyed with and monitored to study what the results of such harassment would be. Or, perhaps maybe she really did have a temporary bout with a mental illness and after learning about such technology her mind somehow corrected itself and was healed. But the fact that such technology does exist leads one to wonder what kinds of horrible tests have been carried out to study the effects of this technology. Certainly the CIA or the Department of Defense would want to see what people would do when they all of a sudden started hearing voices in their head. Surely such tests were carried out on ordinary citizens without their knowledge and their reactions were monitored to learn how they would react to such a scary occurrence. And surely most of these victims kept such a thing to themselves and didn’t even tell their closest friends or loved ones out of the fear that they would be seen as completely insane for “hearing voices.” But just think for a minute about the ramifications of such technology. Such a system could easily make people think that they were hearing God, or even the Devil, or that they were going completely insane. And how would they know such a system was being used, since practically nobody is even aware that such technology even exists. There would be no evidence that such a system was being used on a targeted individual, unless the device’s operator was apprehended with some strange looking electronic device that was seized as evidence and analyzed by electrical engineers who would likely be able to determine its purpose. And people who are victims of such technology would most likely never mention it to anyone since “hearing voices” is the epitome of being “crazy.” It is for these reasons that this author feels it is extremely important that the public be made aware of such technology, and that we learn how to detect, and prevent its use. Khalid Sheikh Mohammed, the alleged mastermind behind the September 11th 2001 terrorist attacks was said to claim that Allah (the God of Islam) had visited him in his prison cell one night and told him to cooperate with his captors and that things would be much easier on him and his fellow detainees. If this report is accurate and he actually did believe that God visited him in his cell one night and told him this, then it certainly would

not be far-fetched to think that the microwave auditory effect was used on him to make him think that he was hearing God. This is, of course, just a hypothesis, and if such a thing did occur it likely would never be declassified because of the incredible power that such a technique holds. Think about this. What if such a strategy was used in prisons? What if officials used this technology to speak to high profile suspects and told them to confess to their crimes and not to tell anyone that “God” had told them to do so. Or, what if this strategy was used to trick the person into doing, or saying things that are completely immoral? What if “God” told the prisoner to kill another inmate, or to confess to the crime even though they were innocent? If the person believes in God, such an experience would be hard to resist. After all, if God told you to confess to a crime you didn’t commit, then surely there must be some bigger picture that he sees and you don’t, or else why would he tell you to confess? The ramifications of abuse of such systems are endless. How many politicians, business leaders, or political activists could be targeted by such technology and have an experience that “God” was talking to them. The possibilities are extremely disturbing to think about and this is the same technology that will most likely be used by the counterfeit Christ of the New World Order in an attempt to convince everyone that he has supernatural powers and is God himself.

Sonic Nausea Systems While using the microwave audio effect may be limited to those with fairly complicated technology, a widely available and inexpensive device that uses ultra-sonic waves to induce headaches and nausea can be purchased on the Internet or in catalogs selling law enforcement products. The ShomerTech catalog sells such a device for only $29.99. The online catalog reads, “Hiding this device in your inconsiderate neighbor’s house might put an end to their late-night parties. The abusive bureaucrat’s office, the executive lunchroom... the possibilities are endless for that small portion of inventive payback.”

Another more advanced version is also sold called the Super Sonic Nausea system which is advertised to, “disrupt speeches, demonstrations, crowd dynamics, etc. This device has been used to ‘influence’ more of these than you might expect. Deployed near the podium, you might just have a case of an increasingly un-impressive speaker with diminished sharpness and lacking concentration, or perhaps is even unable to complete his presentation. Or, loitering youths on your property might be enticed to move along with no confrontations necessary.” This “Super Sonic Nausea system” is said to be a “rarely-available government model” that is produced by a company called DSG Laboratories. This version sells for only $99.99. Just imagine for a minute what kind of similar devices are in existence but not made commercially available. Such devices are extremely small and portable, and could easily be covertly used to inflict discomfort on any number of people, in any number of situations, without anyone even having a clue.

Chemtrails Since approximately 1995 or 1996, increasing numbers of people have been intrigued by, and suspicious of what look like white contrails (short for condensation trails) that follow the path of jetliners in the sky but do not seem to dissipate as fast as such vapor trails used to in the past. These new type of trails that linger in the sky have been called “chemtrails,” short for chemical trails, and are believed by some to be the result of some kind of additive that is being mixed with jet fuel. These suspected additives are said to be used for a variety of reasons, usually for some kind of weather modification or to expose massive numbers of people to some kind of chemicals intended to alter our cognitive abilities. Skeptics of these claims say that on most days when people see what they call chemtrails (chemical trails), they are really only seeing contrails (condensation trails) caused by a combination of certain atmospheric conditions and a newer type of jet engine called the high bypass ratio turbofan engine, which was first placed on the market in the mid-1990s. This is the same time that people started to notice these strange vapor trails that lingered in the sky for longer than they had in the past. Chemtrail

skeptics say that the newer high bypass ratio engines compress the air and the moisture to a higher degree than the older types of engines would, and say this is the reason for the trails lingering for longer periods of time than in the past. Sometimes the vapor trail disappears right after it comes out of the back of the jet, and other times it lingers in the sky and slowly disperses. Some people call these the chemtrails, while others say atmospheric conditions and high bypass ratio turbofan engines cause this to occur. Adding to the controversy over chemtrails are the numerous instances of governments in multiple countries having declassified various programs where it has been admitted that they sprayed large amounts of dangerous chemicals and biological agents into the air.

Mainstream News Coverage KSLA news in Louisiana aired a segment on November 9th 2007, which asked, “Could a strange substance found by a southwest Arkansas man be part of a government test? Well, that’s the question at the heart of a phenomenon called ‘chemtrails’ now getting wide spread attention.” [clxxxiv]

The segment covers a man who began seeing suspicious trails in the sky that seemed to differ from the typical condensation trails left behind jets. The man says he also noticed small particles falling from the sky from the trials, so he collected some in bowls that he placed out in his back yard. KSLA news had the samples tested at a laboratory and found that they contained high levels of Barium, a toxic substance. 6.8 parts per million, in fact, which is over three times the level deemed toxic by the EPA. There were other strange chemicals in the samples as well. In May 2006, NBC in Los Angeles, California aired a similar segment investigating the phenomena and interviewed several individuals who were concerned about chemtrails.

HR 2977 On October 2, 2001, Congressman Dennis Kucinich from Ohio introduced a bill (H. R. 2977) titled the “Space Preservation Act of 2001” which

mentions chemtrails as an exotic weapon. The bill was to “preserve the cooperative, peaceful uses of space for the benefit of all humankind by permanently prohibiting the basing of weapons in space by the United States, and to require the President to take action and implement a world treaty banning space-based weapons.” Dennis Kucinich is an interesting Congressman who doesn’t seem to be concerned about addressing controversial issues which are outside of the mainstream political paradigm. In 2008, he addressed Congress with 35 articles of impeachment against George W. Bush, and read them out loud in their entirety on the floor of the House of Representatives. Among the reasons he listed for impeachment were lies about the 9/11 attacks, secretly torturing detainees, and illegally wiretapping American citizens.

In Pop Culture Alternative rock singer, Beck, released a song titled “Chemtrails” on his 2008 album, Modern Guilt . Some lyrics say, “I can’t believe what we’ve seen outside…You and me watching the jets go by.” On April 27, 2009, the musician Prince mentioned chemtrails during an interview on PBS with Tavis Smiley. During the interview Prince discusses a DVD by comedian and activist Dick Gregory and explains that, “he said something that really hit home about this phenomenon of chemtrails.” Prince goes on to mention an increase in aircraft trails that coincided with an increase in fighting and arguing in his neighborhood. On March 3, 2009, a television station in Australia aired a film titled Toxic Skies , which starred Anne Heche who plays a medical doctor investigating a series of mysterious illnesses. She concludes that the illnesses are due to “chemtrails” which are described as toxic chemicals added to aircraft fuel and dispersed over the population though the exhaust. Toxic Skies was written by Andrew Erin and Kyle Hart.

Unclassified US Army Testing of Bio Agents In 1977 the US Army unclassified hundreds of pages of documents titled “US Army Activity in the US Biological Warfare Programs” which detail

that 239 populated areas were contaminated with biological agents between 1949 and 1969 by the Army in secret testing programs. One test involved scientists disguised as ordinary passengers who were [clxxxv] spraying bacteria in Ronald Reagan Washington National Airport.

[clxxxvi]

Another involved a jet releasing material over Victoria, Texas.

The report includes information about a test where a Navy ship sprayed material in the San Francisco bay that traveled more than thirty miles. Other tests involved similar spraying of agents on New York City’s subway system, [clxxxvii] which affected people with weak immune systems.

Government Accountability Office Report In February, 2008, the Government Accountability Office (GAO) released a report titled, Chemical and Biological Defense, DOD and VA Need to Improve Efforts to Identify and Notify Individuals Potentially Exposed during Chemical and Biological Tests which admitted that tens of thousands of people in the military, as well as civilians, may have been exposed to biological agents at the hands of the Department of Defense. Several years earlier in 2003, the Department of Defense reported that 5,842 military personnel and approximately 350 civilians were potentially exposed during testing between 1962 and 1973 in a program called Project 112. Many of the people who were identified as being subjected to these secret tests without their knowledge have suffered from long term illnesses [clxxxviii] as a result.

Project SHAD Another on the long list of government experiments using unwilling humans as test subjects occurred during Project SHAD, which stands for Project Shipboard Hazard and Defense. This program used primarily United States military personnel and was part of Project 112, which began in 1962 during the Kennedy Administration.

The official purpose of Project SHAD was “to identify U.S. war ships vulnerabilities to attacks with biological or chemical warfare agents and to develop procedures to respond to such attacks while maintaining a war fighting capability.” 46 tests were done involving exposing military personnel to chemical and biological agents without their knowledge. VX nerve gas, Sarin, and Tabun gas (all of which are classified as weapons of mass destruction by the United Nations) were some of the chemical agents used, as well as biological agents including Bacillus globigii, ociella burnetti (which causes Q fever) and Francisella (which causes rabbit fever). The US government officially denied that Project SHAD even existed until 1998, and as a result of this denial, soldiers who were affected by the tests were not able to receive any aid for any health issues they had as a result of the tests. If it were not for a dedicated investigative journalist named Eric Longabardi, who began looking into the program in 1994, the public nor the victims may have never been aware of its existence. Years later in 2002, Congressional hearings were held on the subject which prompted a class action lawsuit on behalf of Navy personnel who were exposed during the testing.

Weather Modification Fairly recently at the turn of the 21st century, any discussion of modifying the weather such as causing massive rain storms or creating blue skies, was labeled nothing more than a conspiracy theory or fanciful thinking. But incredibly effective and powerful weather modification programs have not only been declassified by American and British governments that occurred back as far as the 1950s, but are now openly discussed in mainstream news and such practices are becoming common knowledge. Besides simply causing rain or clearing clouds, the practice of weather modification holds the power to be used as a massive weapon against an enormous geographic area without the population even suspecting anything other than bizarre weather.

An interesting series first aired on the History Channel in the summer of 2009 titled That’s Impossible , which covered the existence of various advanced technology that seems as if it was pulled directly from science fiction movies. One episode covered “Weather Warfare” and presented evidence that the U.S. military was able to make massive and strategic changes to weather around the world, including creating hurricanes or torrential rain storms. Brief clips of the show can probably be found on YouTube.

Project Cumulus In the 1950s the British government developed a weather modification program called Project Cumulus which used cloud seeding and tested the potential of causing massive amounts of rain to effectively bog down enemy movement due to the downpour and saturated ground conditions. On August 16, 1952, a major flood occurred in the town of Lynmouth in north Devon after nine inches (229 millimeters) of rain fell in one day, causing the East Lyn River to overflow. This flood destroyed homes, businesses, and bridges, and killed thirty-five people. Several days before this disaster, a seeding experiment from Project Cumulus took place over southern England. While it is denied, of course, that Project Cumulus had anything to do with the miraculous flooding, it certainly doesn’t take a stretch of the imagination to think that the two events were not merely a coincidence. In fact, an old radio broadcast on Radio 4 contains an interview of an aeronautical engineer and pilot named Alan Yates, who worked on Project Cumulus at the time, where he explains, “I was told that the rain had been the heaviest for several years—and all out of a sky which looked summery...there was no disguising the fact that the seedsman had said he’d make it rain, and he did. Toasts were drunk to meteorology and it was not until the BBC news bulletin [about the Lynmouth flood] was read later on, [clxxxix] that a stony silence fell on the company.”

Project Cumulus was allegedly closed down after this tragedy, and [cxc]

classified documents involving the project went missing.

The UK is not the only government to meddle with such forces. The United States not only investigated the possibilities of such science, but actually used it as a weapon during the Vietnam War.

Project Popeye The United States military was involved in a cloud seeding operation during the Vietnam War which extended and enhanced the monsoon season over Laos and caused landslides along roadways, softened road surfaces, and washed out river crossings. Operation Popeye, as it was called, went on from 1967 to 1972 and was considered a success. Investigative reporter Jack Anderson published a story in March 1971 about these operations, and the following year Operation Popeye was mentioned [cxci]

in the Pentagon Papers

and also in an article in the New York Times . [cxcii] The stories led to investigations by members of Congress and then the U.S. House and Senate passed a series of resolutions banning environmental warfare. The Environmental Modification Convention (ENMOD), formally the Convention on the Prohibition of Military or Any Other Hostile Use of Environmental Modification Techniques is an international treaty that prohibits the use of such environmental manipulation.

China’s Admitted Modifications In October 2009 China’s air force used a variety of chemicals to clear the smog out of the air for a parade celebrating the 60th anniversary of Communist China. The day before the parade, chemicals were dispersed in the sky which caused a light rain and cleared the fog. The senior air force meteorologist in China bragged, “Only a handful of countries in the world could organize such large-scale, magic-like weather

[cxciii]

The parade was the biggest in China’s history.

modification.”

The meteorologist said they used certain chemicals to make it rain, and if the rain persisted for too long threatening the parade, then they had another batch prepared to spray that would stop it. Clearing the skies of smoggy air was only just the beginning of China’s weather modifications that were widely reported in 2009. Just one month later, the Chinese state media reported that their meteorologists had made it snow in Beijing after seeding the clouds, causing the country’s earliest snow fall. The government implemented such a strategy in an effort to fight a continuing drought. “We won’t miss any opportunity of artificial precipitation since Beijing is suffering from the lingering drought,” said Zhang Qiang, head of the [cxciv] Beijing Weather Modification Office.

Russia’s Use of Weather Modification In 2009 the mayor of Moscow publicly promised that he would keep it from snowing on the city by using the Russian Air Force to spray chemicals into storm clouds before they reached the capitol, causing them to release their snow outside the city. One of the major reasons for the project is to ease the city from the need to constantly plow the streets, which are usually covered in snow from November to March. In past years Moscow had used weather modification to ensure that rain didn’t spoil their Victory Day and City Day parades. “You know how every year on City Day and Victory Day we create the weather?” Yury Luzhkov, the mayor stated. “Well, we should do the same with the snow! Then outside Moscow there will be more moisture, a bigger harvest, while for us [cxcv] it won’t snow as much. It will make financial sense.”

His plan was approved by the Moscow City Council. Such a feat involves having the Air Force spray cement power, dry ice, or silver iodide in the clouds at a cost of $6 million dollars, which is reportedly half of what the

city would spend on street clearing. Some are not happy about the plan because the outlining suburbs of the city will get the extra snow falling on them as a result.

Eugenics Dictionary.com defines Eugenics as, “the study of or belief in the possibility of improving the qualities of the human species or a human population, especially by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits (negative eugenics) or encouraging reproduction by persons presumed to have inheritable desirable traits (positive eugenics).” The practice of Eugenics was at the core of Nazi Germany’s occult and racist ideologies and fueled their belief that the Aryan race needed to be purified from other inferior races so they could develop into god-men in future generations. The practice of Eugenics essentially takes the breeding practices used in animals such as race horses or show dogs, and applies it to humans with the hope of desired traits being passed onto the next generation, while at the same time preventing others from breeding because they are not seen as fit enough to pass on their genes. If one subscribes to the ideologies of Eugenics, as Adolf Hitler and the Nazi party did, it is difficult not to reduce humans down to nothing more than animals and develop a social Darwinist world view where one who is dubbed “more genetically fit” looks at others who are not, as if they are subhuman, or not as valuable of a person. Since the rule of the Nazi party has long since passed, many think that the practice of Eugenics crumbled along with them, but some see the modern elite or Illuminati as continuing the practice through covert means, attempting to pass their intelligence onto the next generation of Illuminati members, while continuing the structure of a small intellectual and wealthy elite being in power and ruling over the dumbed down and inferior masses. Well before Hitler came to power, back throughout history, the upper class of every society enjoyed better living conditions, food, medical care, and education, which they did their best to preserve and prevent the lower

classes from partaking in. Year upon year of poor nutrition, health care, and harsh working conditions kept the lower classes of people from fulfilling their true potential as human beings. Many who oppose the New World Order and have investigated the secret societies which hold the true power and wealth, see such Eugenics practices continuing today by the masses of population in developed countries living on processed food that is filled with preservatives or genetically modified organisms (GMO), while the elite enjoy healthy natural foods and home cooked meals prepared by their chefs and dieticians. Many also believe that the elite Illuminati and their social networks do not take the vaccines given to most people, believing that the vaccines themselves and their mercury preservatives cause neurological damage and have other biological harmful effects that are inflicted on the masses, while the elite quietly avoid such things. Add to this the widespread abuse of alcohol and drugs, and people’s pathetic eating and exercise habits, and you clearly have a recipe for tens of millions of unhealthy people who actually enjoy their own slow and gradual deaths. A popular evolutionary theorist from the London School of Economics, named Oliver Curry, predicts that the human race will one day split into two separate species, one being a ruling elite who are intelligent and attractive, and the underclass of dumb, ugly, goblin-like creatures. Such an event, Curry says, will happen 100,000 years in the future, and believes the human race will reach its peak by the year 3000, at which point the subspecies will [cxcvi] begin to regress.

“Physical features will be driven by indicators of health, youth and fertility that men and women have evolved to look for in potential mates,” says a report written by Curry which also says that humans will be between 6ft and 7ft tall and live up to 120 years. Curry’s report, which was commissioned for the Bravo TV channel, says that men will develop deeper voices, symmetrical facial features, and bigger

penises, while women all will have large breasts, hairless skin, and glossy hair. Dr. Curry said, “The report suggests that the future of man will be a story of the good, the bad and the ugly.” Such ideas are similar to those found in H. G. Wells 1895 novel, The Time Machine , where Wells describes the human race as having evolved into two different species, the healthy and intelligent ruling class, the Eloi, and the ugly, slave class, the Morlocks.

Margaret Sanger Next to Adolf Hitler, perhaps the other name most closely associated with Eugenics is Margaret Sanger, who was an American birth control activist in the early 1900s and later founded Planned Parenthood. Sanger was a negative Eugenicist, meaning that she believed that human hereditary traits can be improved through social interventions such as selective breeding, sterilization, and even euthanasia. In her 1932 book, A Plan for Peace , Sanger proposed that the American government “Keep the doors of immigration closed to the entrance of certain aliens whose condition is known to be detrimental to the stamina of the race, such as feebleminded, idiots, morons, insane, syphilitic, epileptic, criminal, professional prostitutes, and others in this class barred by the [cxcvii] immigration laws of 1924.”

In this same book, Sanger urged that the government, “Apply a stern and rigid policy of sterilization and segregation to that grade of population whose progeny is already tainted or whose inheritance is such that [cxcviii] objectionable traits may be transmitted to offspring.”

Her first pamphlet on the subject read, “It is a vicious cycle; ignorance breeds poverty and poverty breeds ignorance. There is only one cure for both, and that is to stop breeding these things. Stop bringing to birth children whose inheritance cannot be one of health or intelligence. Stop bringing into the world children whose parents cannot provide for them.

Herein lies the key of civilization. For upon the foundation of an enlightened and voluntary motherhood shall a future civilization emerge.” In 1923 Sanger opened the first birth control clinic in the United States after receiving grants from John D. Rockefeller Jr’s Bureau of Social Hygiene. Further grants were made from Rockefeller but were done so anonymously after 1924 to avoid the Rockefeller’s connection with Sanger’s agenda.

Global Warming / Climate Change Global warming, as nearly everyone knows, is the idea that human activities and industries are dramatically contributing to changes in the earth’s temperatures which proponents claim threatens humanity. Supporters of this idea have recently changed the terminology they use to “climate change,” instead of “global warming” since regions of the earth are actually cooling, thus conflicting with their idea that the earth is getting warmer. Former Vice President Al Gore has undoubtedly become the face of global warming advocates since his 2006 film An Inconvenient Truth, which won him an academy award for best documentary. While no decent human being would want to pollute the earth by littering or dumping harmful chemicals into the environment or not properly disposing of them, many global warming advocates have criticized people for setting their thermostat too low during the Summer and running the air conditioner for extended periods of time to keep their home or business cool and comfortable. These same green freaks also get angry at people for not using specific types of light bulbs or appliances. Such fanatics have been using a new term saying that such activities create a “carbon footprint,” which is the total amount of greenhouse gas (GHG) that is emitted by an organization, person, or a specific product. “Carbon footprints” and “greenhouse gas emissions” are seen as a threat to humanity by global warming fanatics, and bigger government and new taxes and regulations are said to be the only hope for mankind. Speaker of the House, Nancy Pelosi once stated in a conversation about global [cxcix]

warming that “I’m trying to save the planet,”

a very lofty goal for a politician, when such a cheesy slogan has usually only been said by comic book superheroes like Superman. Those who simply don’t believe the propaganda and fear mongering are often labeled “global warming deniers” with the intentional connection to the term “holocaust denier.” The biggest pushers of the man-made global

warming theory, such as Al Gore, who is basically the symbolic leader of the idea since his 2006 film An Inconvenient Truth , frequently say “the debate is over,” or “all scientists agree” with their ideas, when in reality, there are scores of scientists who refute the man-made global warming propaganda, and some even say the earth is cooling. Most of the key players behind the global warming propaganda, such as politicians, scientists, and businessmen, have large financial interests in new government regulations which supposedly will work to save the world. Perhaps the brains behind the climate change hysteria is a billionaire named Maurice Strong who is considered to be one of the leading proponents of the United Nations involvement in international affairs. Strong was the CEO of Petro-Canada, one of Canada’s largest oil companies, and is on the board of directors for the Chicago Climate Exchange (CCX), which is the first greenhouse gas emission registry reduction system for emission sources. 10% of the Chicago Climate Exchange is owned by Goldman Sachs (GS) and another 10% is owned by Generation Investment Management (GIM), which is an investment firm started by Al Gore who is also the chairman. Hank Paulson, who was the Treasury Secretary under George W. Bush and former CEO of Goldman Sachs, was also a founding member of GIM. While Maurice Strong was born in Canada, he spends most of his time living in China where he has been working to build the communist country into a superpower, and continues to use his wealth and influence to strengthen the grip of climate change propagandists. One of the most visible and outspoken people who says that man-made global warming is a hoax perpetuated by those who have financial interests in the matter is Lord Christopher Monckton, who is a former advisor to Margaret Thatcher. Monkton asserts that a man named Ben Santer deleted parts from the Intergovernmental Panel on Climate Change report (IPCC), that showed conflicting data about climate change, in order to make the report appear to fully endorse the idea of man-made climate change. Ben Santer doesn’t deny these claims, and in fact admitted that he removed parts of the report before its publication. The IPCC was created by the United Nations Environment Program (UNEP), which interestingly enough, was

headed up by Maurice Strong after the UN General Assembly unanimously voted him in as the chair.

The Kyoto Protocol The Kyoto Protocol is a formal agreement of the United Nations aimed at fighting global warming that was adopted back in 1997. It is part of the United Nations Framework Convention on Climate Change (UNFCCC or FCCC), which is an international treaty with the goal of achieving “stabilization of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system.” As of November 2009, 187 states have signed and ratified this protocol, which states that the countries commit themselves to a reduction of four greenhouse gases (carbon dioxide, methane, nitrous oxide, sulphur hexafluoride) by 5.2% from their levels in 1990.

Climate-gate People’s suspicions that climate change was a hoax aimed at justifying carbon taxes, more government regulations, and the New World Order, had many of their suspicions confirmed after an incident that came to be known as “climate-gate” ensued. One of the most prominent institutions that is credited with studying “climate change” is the Hadley Climate Research Unit in Britain. In November 2009 Russian hackers were able to steal thousands of documents including emails that were exchanged between climate scientists over the previous ten years and published the information on the Internet. Some of the email exchanges show how scientists were trying to manipulate data, hide information showing declining temperatures, and prevent other scientific research from being published in academic journals that is counter to the global warming propaganda being pushed by man-made global warming advocates. The emails were admitted to be authentic, although officials at Hadley deny there were any attempts to manipulate data to conform with the idea of man-made global warming.

In one exchange the center’s director, Phil Jones, emailed Michael E. Mann at Pennsylvania State University and asked whether academics who question the link between human activities and global warming should have their work published in the Intergovernmental Panel on Climate Change (IPCC) report, which is a global organization that evaluates the risk of socalled climate change allegedly caused by human activity. “I can’t see either of these papers being in the next IPCC report,” Jones wrote. “Kevin and I will keep them out somehow—even if we have to redefine what the peer-review literature is!” In another email, Phil Jones and Michael E. Mann discuss how they can pressure an academic journal not to accept the work of scientists whose research doesn’t conform with their climate change belief. Michael Mann wrote, “Perhaps we should encourage our colleagues in the climate research [cc] community to no longer submit to, or cite papers in, this journal.”

In one message sent to a long list of colleagues, Phil Jones himself wrote of having completed a “trick” with recent temperature data to “hide the decline.” An email from Kevin Trenberth of the National Center for Atmospheric Research in Boulder, Colorado spoke of the unusually cool autumn that Colorado was experiencing, and went on to say, “The fact is that we can’t account for the lack of warming at the moment and it is a travesty that we can’t.” Phil Jones, the head of the Climatic Research Unit, released a statement saying, “My colleagues and I accept that some of the published e-mails do not read well,” but still denied that they showed any fraud was occurring. Left wing radical Nancy Pelosi, who is an avid climate change pusher, was asked about the emails and if they changed her stance on man-made global warming. “You call it ‘Climate-gate,’ I call it ‘email-theft-gate,’” she answered, and was more concerned about the emails being stolen than their shocking content.

Former British Prime Minister Tony Blair commented on the climate-gate scandal and said the science may not be “as certain as its proponents allege” but he still believed the world should act to fight climate change, and said it would be “grossly irresponsible” not to. The popular novelist Michael Crichton, author of Jurassic Park , wrote a book titled State of Fear (2004) which contains a plot centered around scientists and politicians who conspire to create public panic about global warming. Crichton is known for writing novels with an underlying factual basis, and in State of Fear he includes twenty pages of footnotes which he said provide facts found in the non-plotline elements of his story.

Arnold Schwarzenegger’s Damage Control Shortly after the climate-gate scandal began and wouldn’t go away, California governor Arnold Schwarzenegger pulled a publicity stunt where he displayed a map of San Francisco and warned that in one hundred years, much of it would be underwater due to rising sea levels caused by climate change. His map was unveiled on Treasure Island alongside Eric Schmidt, the CEO of Google, where Arnold said, “Within a century, Treasure Island, this place where we are right now, could be totally under water…It is technology in the end that will save us.” He also warned that 2.5 trillion dollars in property and assets were at risk. The map he showed along with a propaganda video was posted on a new website www.climatechange.ca.gov. The video was narrated by Schwarzenegger and warned of California’s temperatures rising 7 degrees in the next century, water shortages, and virtually all snow melting on the mountains in California, which he said would, “nearly eliminate skiing, snowboarding, and other recreational activities.” It’s interesting that Schwarzenegger is on board with the climate change advocates because he is a Republican, when this issue is clearly divided between party lines with many Republicans not believing the hype, while most Democrats embrace the idea in order to justify bigger government and more taxes and regulations. Schwarzenegger is an elite insider who has visited the Bohemian Grove and is friends with Nazis and Illuminati

members, so it is no surprise that he is on board with the climate change fear-mongering.

Fox Admits Inserting Global Warming Propaganda in TV Shows A short four minute promotional video produced in 2006 by News Corporation openly admits that executives have been incorporating global warming propaganda into popular television shows produced by Fox which is owned by News Corp. The video starts with Fox Television Chairman Gary Newman who says, “we want to set an example in our industry and other industries that no matter what the size of your carbon footprint is, you can make a difference.” The video then cuts to a montage of television shows which aired on Fox, and the global warming propaganda that News Corp. (Fox’s parent company) incorporated into those shows. Clips from Prison Break , The Simpsons , King of the Hill , My Name is Earl , Family Guy , 24 , and more were all shows containing these messages. For example, a clip of Family Guy shows a character in a car dealership where he says, “Look at all those Hummers…what kind of jerk would drive one of those?” Kiefer Sutherland even gives a heartfelt message to the camera about reducing global warming. Dana Walden, Fox Television Chairman says, “the most powerful way that we could communicate the commitment on behalf of our company was to change the practices within the production as well as work in a message about global warming, about environmental changes, and about empowering people to take responsibility.” Chairman Gary Newman echoes this admitting, “The biggest thing we have done is inserting messages about the environment into some of our content.”

Cap and Trade Certain researchers and alternative radio hosts had been warning for years that a new kind of tax would one day be forced on the American people,

and on citizens of countries around the world. This so-called “carbon tax” seemed like the figment of people’s imagination since it appeared too outrageous for governments to implement a global warming tax, but as the years went by, such a plan began to peak its head out from the secretive Bilderberg group meetings and into the halls of Congress and global conferences. Cap and Trade (also called emissions trading) is an approach allegedly using economic incentives to reduce greenhouse gasses and pollution. The term Cap and Trade comes from the idea that a government or a global committee will set a limit, or a cap, on the amount of “pollution” that a factory (and possibly a household) can emit in a given period of time. These companies or households will purchase permits which grant them the right to have allowances or credits that represent their authorized amount of greenhouse gasses they may emit. These companies then cannot emit more than they are allowed to, because of their cap, unless they purchase more “credits.” These purchased credits are called a “trade,” which is basically a fee for emissions.

Carbon Footprint on Food Labels As everyone knows, nearly every food product you buy at a grocery store has a nutritional label on it listing the ingredients, calories, fat content, carbohydrates, etc. Such labels are very useful in helping determine how much of a particular item we should consume (or if we should eat it at all) depending on our health and nutritional goals or needs. But in 2007 an odd new kind of food label began surfacing in Britain, which listed the greenhouse gas emissions created by the foods production, transport and disposal. “More and more, businesses are looking for ways to reduce their impact on the environment. To help them achieve that we need a reliable, consistent way to measure these impacts that businesses recognize, trust and understand,” said Ian Pearson, Britain’s environment minister. “This will be fundamental in our efforts to move Britain towards a low-carbon economy [cci] in the decades ahead.”

This bizarre fear-mongering continued in the coming years. In 2009, ABC’s Good Morning America interviewed Michael Pollan, author of The Omnivore’s Dilemma , who discussed the carbon footprint left behind by a McDonald’s quarter-pounder with cheese. Pollan said, “You need oil to make the fertilizer to grow the corn. You need petroleum to make the pesticides to grow the corn. You need oil to move it all around the country…The result is a product that takes a huge environmental toll and obviously takes a health toll as well.” He then said that a quarter-pounder amounts to 26 ounces of oil. It will be interesting to see if the practice of listing a product’s carbon footprint on its packaging will become a trend that companies are pressured or forced to follow in the future.

The Day After Tomorrow Perhaps the first major film, in what will likely be a long and growing list in the coming years, involving climate change was The Day After Tomorrow (2004). The film stars Dennis Quaid who plays a scientist who tries to alert the United Nations about global warming, but after his attempts fall on deaf ears, global warming causes glaciers to melt which affect ocean currents and disrupts the entire earth’s climate causing an ice age. The film grossed over 540 million dollars and was the second highest grossing movie not to be number 1 at the box office. An interesting side note besides the film serving as a massive propaganda piece for climate change pushers, is that the Vice President in the film was played by Kenneth Welsh, who looks strikingly similar to the then Vice President Dick Cheney. The film was written, directed, and produced by Roland Emmerich, who admitted that he intended the characters of the President and the Vice President to convey criticism of the environmental [ccii] policies of then President George W. Bush.

Fringe Topics

When looking into the New World Order, one will find countless verifiable pieces of evidence that elite politicians have been covertly working to erode the Constitution and America’s sovereignty and integrate the country into a global government system, much of which has been accomplished through secret societies or private organizations like the Council on Foreign Relations, the Bilderberg group, the Skull and Bones society, and other Illuminati groups. When someone is new to this information, many people may find some of the claims they come across unbelievable and perhaps incorrect, or even a hoax. After more study and tracing sources and references, many things that people once found hard to believe can be proven beyond a doubt to be factual. Other information, however, is more difficult to verify, and some does fall into the realm of speculation or conjecture. On the fringe, one will find a large amount of information about a variety of topics connected to the New World Order, some of which is even considered far-fetched and crazy to many who are fairly aware of how strange the New World Order can be. Stories of aliens from other planets said to work with elite government officials, the shape-shifting reptilians, Satanism, and even organized ritual child abuse are subjects that are all connected in some way to the New World Order. Since people will inevitably come across such subjects as they continue on their journey down the rabbit hole, some of these fringe topics will be addressed briefly here in order for you to have a solid foundation of understanding when confronted with such ideas.

Satanism While the satanic and Luciferian philosophies of elite secret societies have been briefly touched upon in this book, the subject is still often considered to be on the fringe of the New World Order. Elite politicians have openly stated their desire for a “New World Order” and we can easily see the corrupt legislation that hopes to further erode the Constitution and various liberties Americans have enjoyed for hundreds of years. It’s easy to document and prove the moral decay of society and the influence of the

mainstream media on our culture, but the personal and private philosophies or spiritual beliefs of New World Order kingpins are not as easily shown. Often the satanic and occult aspects of the New World Order turn people off because on the surface they seem completely ridiculous and absurd. Others aren’t too concerned with them because there is an abundance of evidence of corruption and greed that can more easily be exposed. But it is important to be familiar with the irrefutable evidence that elite politicians, bankers, and businessmen are deeply involved in the occult, and the occult plays a huge role in the creation of the New World Order. Helena Blavatsky’s The Secret Doctrine, Alice Bailey’s writings, the rituals of the Skull and Bones society and the Bohemian Grove clearly illustrate a Luciferian doctrine that the elite adhere to. This is one of the most shocking aspects to the New World Order, but when one fully understands that is the mindset of elite individuals, things begin to make more sense. With that said, if you are attempting to educate others about the New World Order, I strongly advise that you carefully address the issue of Satanism and do not make it the central issue when explaining what is happening in the world. Bluntly telling someone new to this material that a group of powerful Satanists run the world is going to make you look insane and cause them to not even want to listen to anything else you have to say. There is a time and a place for these discussions, but you must be careful not to begin your discussion by talking about the elite’s desire to reduce the world’s population and then immediately jump to calling them a bunch of Satanists who do rituals out in the forest of the Bohemian Grove. This would be like explaining basic math to a child in school, and then immediately telling them about calculus. You must build a foundation of understanding before you present such material.

Sexual Abuse While much of the information surrounding the New World Order such as government corruption, out of control taxes, and elite secret societies running the show are disturbing, nothing is more painful to read about than the grotesque allegations of child abuse said to occur at the hands of elite Illuminati members. It is believed that some high powered politicians and

businessmen participate in sexual abuse against children, particularly boys. The most well-known scandal of this type occurred in the late 1980s, in what was called the Franklin Cover-up. A font page Washington Times article ran the headline, “Underage [cciii]

Prostitution Ring Ensnares VIPs with Reagan, Bush”

and described how underage boys were taken on a tour of the White House around midnight by one of their abusers. Allegations have been made that such abuse took place inside the Bohemian Grove by elite members and was even videotaped. If one can come to grips that such abuse takes place, one can’t help but wonder why someone would be interested in doing such things, and how could such events not be rare, isolated incidences committed by some lone sicko, but instead are done by an organized group of wealthy politicians. Answers are not easy to find, but inevitably come down to the perpetrators finding enjoyment in having absolute power over another helpless human being. Other explanations involve what is called sex magic (sometimes spelled magick) where the practitioners enjoy an adrenaline rush from committing such atrocities, and believe it opens their mind up to be able to harness metaphysical powers.

Planet X There are a small number of people who believe that a large planet not known or denied to exist by mainstream astronomers, will one day either collide with planet earth and destroy it, or that it will orbit near the earth and then the aliens claimed to live on this planet will then invade earth. This supposed planet is either called Planet X or Nibiru. This idea is believed to have originated in 1995 by a woman named Nancy Lieder who runs the website ZetaTalk.com. Lieder describes herself as an emissary who receives messages from extra-terrestrials who live in the Zeta Reticuli star system and says that she was chosen by the aliens to warn people that Planet X would arrive in May 2003 (later revised to 2010) and that a pole shift would destroy the world.

Another individual associated with Planet X is Zacharia Sitchin, who has written numerous books about how he believes that aliens called the Anunnaki created the human race by using their own DNA and mixing it with monkeys, thus creating humans. Sitchin hypothesizes it is a planet in a highly elliptical orbit around the Sun which completes an orbit every 3,600 years. David Morrison, a Senior Scientist at NASA’s Astrobiology Institute at Ames Research Center, says he receives 20–25 emails each week asking him about Nibiru. He said some of the people are worried about such an event, and others say that he is part of a conspiracy to keep the truth of this [cciv] impending event from becoming public.

Nephilim and Anunnaki The Nephilim are beings mentioned in the Old Testament of the Bible which are sometimes described as supernatural beings or fallen angels who came to earth and had children with human woman. Many Christians are surprised that such references are made in the Bible, and in the Contemporary English translation it actually calls them “supernatural beings.” Those who believe that there were such beings that came to earth and had children with human woman believe that these creatures and their offspring were killed off during Noah’s flood. Others say the term does not refer to fallen angels or supernatural beings, but instead is a title given to a hero or great men of size and strength. If you search the Internet for this kind of information you will come across various photographs of what look like archeological digs that have uncovered enormous skeletons that look human, or have strange looking skulls that are said to be from the ancient Nephilim, but all such photos are frauds and have been made with Photoshop. There are a small fraction of people who believe that the Nephilim are in fact supernatural beings whose bloodline continues to exist today and makes up the inner circle of the Illuminati. These people also believe that royal families in the ancient past were descendents of the Nephilim and say that this is where the idea of the divine right of kings comes from. You may

occasionally see family trees that trace many famous presidents and members of the British Royal Family to numerous other famous and powerful leaders back through history. In these people’s minds, the half demon, half humans maintained power for generation after generation and kept interbreeding with each other in order to centralize their power. An idea similar to the Nephilim comes from the Anunnaki, which refers to Sumerian and Babylonian gods from ancient times. Zecharia Sitchin and others believe that these Anunnaki are actually some kind of aliens who came to earth in the ancient past and created people by tweaking the DNA of monkeys to make humans. According to this theory then, these ancient humans saw these aliens as gods. Some who believe this kind of theory say that the Anunnaki created humans as slaves in order to mine gold that they say was needed to repair the atmosphere at the home planet of the Anunnaki. This, they say, is the source of human’s obsession with gold and the reason it has been used as money for 5000 years. Some believers in the Anunnaki think that they live on Planet X and will return to earth some day and rule over humans like they did in the ancient past. The writers of Transformers 2 the movie were clearly aware of these theories and in the film viewers found that ancient Transformers came to earth and were worshiped as gods in Egypt thousands of years ago. These Transformers even looked similar to the elaborate head dresses that the pharaohs used to wear. Zecharia Sitchin and others say that they get their ideas from interpreting ancient hieroglyphics that they say ancient man used to record these events. While most people see ancient Egyptian writings about gods living on the earth as mythology, some interpret them as being literal history and say that these “gods” were actually aliens.

Reptilians You may occasionally hear people say that “Reptilians” (or Reptoids) run the New World Order or comprise the inner circle of the Illuminati. What these often mentally deranged people are referring to is the idea that the elite Illuminati rulers are actually some kind of aliens or beings from another dimension who pose as humans so they can rule over us like gods. The most well-known author and speaker in the genre of the Illuminati and

the New World Order to profess such beliefs is Britain’s David Icke. Icke professes that these “reptilians” as he calls them, have to drink human blood in order to keep their human form or else they would “shape-shift” back into a reptile-looking creature, and be exposed. In recent times, Icke has minimized his focus on reptilians and instead talks about more tangible issues. David Icke and his claims are discussed further and debunked in The Illuminati: Facts & Fiction (2009). It’s interesting to note that the premise for the 1983 science fiction series called V was based on a group of human-looking aliens who traveled to earth in need of natural resources. As the series progressed, the viewers learned that the Visitors, as they were called, were actually lizards who wore rubber suits to make themselves look human, and actually ate human beings for food. A remake of the series was released in 2009. While many see the 1980s version of V as being the inspiration for David Icke’s wild theories, supporters of the “reptilian agenda” insist that the producers of V are just trying to cover up for the reptilians that rule the world.

December 21st 2012 Depending on when you are reading this book, the infamous date of December 21, 2012 is either rapidly approaching, or is now history and a thing of the past along with the over-hyped and sensationalized Y2K event that many feared would shut down computers around the world and unleash the apocalypse. For those who remember the weeks building up to the year 2000, you can understand the hype around 2012. As you likely know, some believe (or are making claims they know to be false in order to sell books) that a cataclysmic or transformative event will occur on or around December 21, 2012 which is believed to be the end-date of a 5,125-yearlong Mayan calendar. Some say that earth’s magnetic field will reverse due to the earth being aligned with the sun and the center of the galaxy, and some people falsely believe that all nine planets will be aligned in a straight line, causing a tremendous gravitational pull on the oceans, making them shift and flood most of the planet. Some New Age proponents are looking forward to the date and think the planet will undergo some metaphysical shift or

transformation marking the New Age. And of course, some people think that the December 21, 2012 date marks the beginning of the apocalypse or the return of Jesus. As early as 2009 entire shelves in Barnes and Noble book stores were full of books about 2012 and these foolish claims. A movie with the title of 2012 was released in 2009 and had over the top special effects of the earth being nearly destroyed as a result of an enormous solar flare causing massive earthquakes and floods. 2012 the movie was directed by Roland Emmerich, who also wrote and directed the climate change propaganda film, The Day After Tomorrow (2004). As the December 21, 2012 date passes and the world doesn’t end and the Anunnaki aliens don’t invade earth, many of the believers in the 2012 prophecy will grasp at straws and point to unrelated minor events as proof that the prophecies were correct, but the catastrophe wasn’t as bad as people thought. Others will simply go on with their life and forget they believed such foolishness, and some will even say that the calendar must have been misinterpreted and will move the date of earth’s destruction into the future, such as the year 2020 and will relive the hype all over again.

Black Helicopters People who talk about conspiracies or the New World Order are often ridiculed by others and asked about “black helicopters,” so the subject will be briefly addressed here to clarify how this term came to be used as an insult. Its use began to be used by militia and patriot groups in the 1990s as a description of black unmarked helicopters used by the military for various exercises or domestic missions. The helicopters drew suspicion by some and were said to be from the United Nations or part of a military takeover of the United States. The concept stems from the fact that many government agencies use dark and unmarked helicopters such as the ones deployed during the Ruby Ridge standoff in 1992. Some paranoid and delusional people think when a helicopter flies over their house that it is watching them or tracking them somehow. Law enforcement have been known to fly helicopters over residential areas at a low altitude and use an infrared sensor to identify grow houses used

specifically for growing marijuana because the houses emit an abnormal amount of heat from all the indoor lighting, which can be detected by infrared scanners. Today most mentions of black helicopters are by people using the term as an insult, such as asking people who talk about the Illuminati if they’ve “seen any black helicopters.” The people who use this term as an insult like this show their own ignorance of important issues about the New World Order.

Underground Bases and Tunnels An entire chapter can be found in this author’s previous book, The Resistance Manifesto , detailing the existence of massive underground bases and tunnels that are engineering marvels and is a fascinating subject to explore. In brief, there are a series of underground tunnels in the United States and most likely the rest of the world, that connect to various underground bases, and have access points from government (and likely private) buildings. The tunnels are created by TBM’s (Tunnel Boring Machines) which are enormous structures that burrow through solid rock. The Robbins Company is the largest builder of TBM’s and their website www.TheRobbinsCompany.com contains photos of these massive machines and information about their capabilities. The existence of tunnels and underground bases have been openly admitted in several instances, including specific locations, but the extent of the underground tunnel network remains something the government won’t discuss. It’s likely a network spans the country, as well as the globe. The tunnels exist as a passage way for politicians and elite government officials to use in the event of a massive nuclear attack on America, so they can travel to different parts of the country that haven’t been hit and then can safely return to the surface. They operate as a secret underground subway system. A man named Phil Schneider would forever link these structures to the New World Order when he gave a series of lectures in the 1990s claiming to have worked on such structures, and during this work he says he got into a shootout with some aliens that were living in the tunnels. Schneider’s

fascinating but fraudulent claims are detailed and debunked in The Illuminati: Facts & Fiction if you wish to read more about this subject. But for the sake of this book, it should be known that such tunnels and bases do exist, and can be hidden in plain view. For example, the Greenbrier is a luxury resort in West Virginia that secretly had a bunker built inside during a fake renovation in the 1950s. The bunker had remained secret from the public for over 30 years until a 1992 article in the Washington Post. Immediately after the article was published the bunker was decommissioned and has been a tourist attraction for visitors of the resort ever since.

Manchurian Candidates The subject of mind control appears on the surface to be nothing more than science fiction, but the ability to manipulate people’s behavior against their will has been thoroughly investigated by the CIA and other government agencies. The term “Manchurian Candidate” refers to someone who is a victim of mind control who is “programmed” to assassinate someone. Many people don’t believe such a thing is possible, but after looking into the declassified documents from MK-ULTRA and learning the power of hypnotism, the idea of a mind controlled assassin “programmed” to kill isn’t far-fetched at all, and instead can be seen as a very real scientific fact. In 1979 a former State Department Officer named John D. Marks published a book titled The Search for the Manchurian Candidate which details the CIA’s efforts to create such assassins. Only a small amount of material was declassified regarding these programs but the available information clearly shows that as far back as the 1950s the US government was developing such methods. Some suspected Manchurian Candidates are as follows: Sirhan Sirhan, who assassinated Senator Robert F. Kennedy in 1968. Mark David Chapman, who murdered John Lennon in 1980. Some believe the Columbine High School shooters, Eric Harris and Dylan Klebold, were programmed assassins, as well as Nidal Malik Hasan who killed 13 people and wounded 30 others in the Fort Hood shooting in Texas in November 2009.

Fake Suicides and “Accidents” Aside from being able to mentally program people to become assassins or carry out tasks against their will, as if they were a robot, elements within the CIA have the ability (and have used this ability) to murder people and then make it look like they either committed suicide or died in an unfortunate accident. The term “suicided” refers to an incident where someone is murdered but their death was made to look like a suicide. This is able to occur by various black operation groups that work for the CIA and have guns that use a C02 cartridge to shoot a tiny piece of a frozen tranquilizer into the subject, rendering them unable to move or knocking them unconscious. The agents then are able to stage a hanging, push the victim off a tall building, or even placing the victim’s own gun in their hand and point it at their head and pull the trigger. Deborah Jeane Palfrey, the woman known as the DC madam who operated an elite prostitution service with powerful clients in Washington DC supposedly committed suicide in May 2008. She had previously stated publicly that she would never do such a thing, and even feared she would be killed in a staged accident or suicided. [ccv]

Gary Webb, a reporter for the San Francisco Chronicle largely responsible for uncovering the CIA’s involvement in cocaine trafficking in the 1980s allegedly committed suicide. Webb was found dead from two (that’s right, two) gunshot wounds to the head. Sacramento County coroner Robert Lyons determined that it was suicide. Two teenage boys, Don Henry and Kevin Ives were murdered in 1987 and had their bodies placed on a railroad track in attempts to cover it up after they had curiously stumbled onto the CIA’s cocaine importing operation located in Mena, Arkansas. The boys murders were initially ruled suicides, but after their families pushed for an investigation, a grand jury ruled they were murdered but named no suspects. A total of six other people connected to this case were murdered in the coming months as well, as the [ccvi] perpetrators attempted to silence all witnesses.

On July 11, 1990, the lead investigator of the Franklin Cover-up, Gary Caradori, was killed when his small plane had a mid-air explosion. Prior to the flight Caradori had informed others working on the case that he had obtained critical evidence that would prove a group of perverted politicians and businessmen with connections to the Reagan administration were involved in sexually abusing children. Many people in Britain and around the world think that Princess Dianna was murdered and a member or members of the paparazzi used some kind of laser pointer to blind the limo driver, or believe the car had been tampered with causing it to crash. The list of suspicious deaths and suicides of people who could implicate high level politicians in various crimes goes on and on.

The Svalbard Global Seed Vault The Svalbard Global Seed Vault is an enormous seed bank located about 800 miles from the North Pole on the Norwegian island of Spitsbergen. The vault holds a wide variety of plant seeds from around the world and keeps them frozen in order to preserve them in case of a global catastrophe such as a nuclear war. Such an event could potentially destroy an entire region of the world, so seeds for food, vegetation, trees, and other plants are kept in the vault, in the event that the natural habitat containing such species would be destroyed. The Svalbald Seed Vault seems like the result of someone’s paranoid delusion, but the project is very serious, as well as expensive. It’s interesting that some people ridicule others who have long-term storable food in case of an emergency such as a natural disaster, massive terrorist attack, sudden economic collapse leading to food shortages, or rioting preventing people from getting to a grocery store to buy food. Such a precaution is a good idea, and the fact that millions of dollars have gone into the Svalbard Seed Vault shows that even the elite are prepared for the worst.

Conclusion

You are now, undoubtedly, able to see the New World Order and what is likely in store for your future. You may still find some of the information in this book to be unbelievable, and if this is the case, feel free to check the numerous sources that have been cited, many of which are from congressional hearings, declassified documents, mainstream media, or sound bites you can find for yourself on YouTube. It is at the very least interesting that in the 1980s and 1990s, when patriots and concerned citizens would warn of a New World Order being planned and slowly implemented, that they were called crazy and conspiracy theorists, yet today, we have prominent politicians around the world publicly stating their desire for such a thing, even using the term “New World Order” to describe their utopian dream. Some still think it’s only a conspiracy theory, and some wrestling fans think it refers to Hulk Hogan and his gang of wrestlers who were attempting to “take over” World Wrestling Entertainment with their group who called themselves the “New World Order.” The uninformed and apathetic public has only helped the elite Illuminati construct their global government and Big Brother surveillance society. New taxes have been implemented without much resistance, and more and higher taxes are only right around the corner. While most of the population is lost in a world of professional sports, sitcoms, and Facebook; others like you are aware, or are becoming aware that the American dream is being stolen, and are learning of the people and institutions which are to blame. Whether this book is a starting point on your journey to awakening, or whether it is just one more resource you have discovered to assemble the pieces of the puzzle, you should be grateful that your eyes are open. Where and how you channel your knowledge, energy and activism from this point forward is an important decision that you will have to make. Will you just keep this information to yourself, or will you tell others? Will you be an armchair quarterback, or will you attend public rallies and town hall meetings? Will you be afraid to speak up when faced with propaganda and lies, or will you say something? It can be difficult to articulate and explain some of this information to others who are completely unaware of it. It can be hard to cite sources off the top of your head, or to answer all the questions they may have. It is for these reasons that I encourage you to pass this book on to them so they can

have at their fingertips the exact quotes, sources of information, and the details necessary to show them what they are missing. Even if you have been looking into the New World Order for many years, I can confidently say that this author has compiled the best, most accurate, and important information about the subject and if you spend any amount of time reading my other books, I can assure you that you will find pieces of the puzzle you did not even think existed. People often ask me how I got involved in all of this, or how I was able to write several books on the subject at a fairly young age. The answer is that I studied mainstream media in college and saw from an early age how the media can influence culture, trends, attitudes, and actions. I had to write a lot of papers in college on a variety of subjects and found myself able to explain complicated concepts and issues in a way that could be easily understood by the reader. I enjoyed staying up late listening to music and working on my papers. I also excelled at public speaking. It is a gift, and I am a talkative person who is fascinated by the political process and the mysteries of life. When I discovered the hidden realities of the September 11th 2001 terrorist attacks it led me on a journey down the rabbit hole and I began to see the big picture of the New World Order. I found a whole new world of information that was right in front of me the whole time, but I hadn’t stopped for a minute to even look. I began documenting the information I found so I could get it clear in my mind and share it with others. I sifted through the countless allegations and claims about a wide variety of issues all stemming from 9/11, the Illuminati, or the New World Order. I know after speaking with others and getting emails from people who also find themselves on a similar journey, that it is a life-changing one. The fact that you are reading this shows that you are on a path similar to the one I was on when I first discovered this kind of material. It is my sincere hope that by reading my books, listening to my interviews, and watching my videos that you can learn to separate the facts from the fiction and not get distracted by useless controversies that arise in the context of this information.

I, like most of us, was once duped by the establishment, and out of my anger at them, and out of my love and respect for my fellow human beings, I feel it is my duty to do what I have done and inform others of the corrupt, power-hungry scum that are making life more difficult for others and who ruthlessly take advantage of others and couldn’t care less about their health, happiness, or well-being. Their game is primarily that of occult knowledge, which means hidden knowledge, and selfishness and greed. Some people feel helpless and say that the elite are too strong or that the prophecies are going to get fulfilled no matter what we do, so they throw up their hands and surrender. If Martin Luther King Jr. had such an attitude that the system was too strong, then he wouldn’t have had the courage to stand up against it and peacefully fight the injustice that millions of African Americans faced. There are countless of examples of public outrage that have led to new policies being abandoned or laws being changed. While we can also list examples that the establishment has won in the face of massive resistance, we must not overlook the times when they have lost. There is a famous quote that says, “all that is necessary for the triumph of evil is that good men do nothing.” So now that this book is finished and you know what the New World Order is, and what its creators and supporters envision it to be in the future, my question to you is, will you do nothing and let them win without a fight?

Bibliography Books Note: News articles and websites are cited in the footnotes on the pages where they are referenced. Bailey, Alice The Externalization of the Hierarchy Lucis Publishing Company 1957 ISBN: 0-85330106-9 Bailey, Alice A Treatise on White Magic Lucis Publishing Company (June 1998) ISBN-10: 0853301239

Blavatsky, Helena .P. - The Secret Doctrine v. I & II The Theosophical Publishing Company 1888 ISBN: 1-55700-002-06 Christian, Robert Common Sense Renewed 1986 Stoyles Graphic Serves Lake Mills Iowa ISBN: 089279-078-4 Crème, Benjamin. The Reappearance of the Christ and the Masters of Wisdom . 2007 Share International Foundation ISBN: 90-71484-32-7 Crowley, Aleister. Magick: In Theory and Practice 1979 Smith Peter ISBN: 0844654760 Crowley, Aleister. Book of the Law 1938 Ordo Templi Orientis ISBN: 087728-334-6 DeCamp, John W. The Franklin Cover-up: Child Abuse, Satanism, and Murder in Nebraska ISBN: 0963215809 A W T, Incorporated 1992 Elberton Granite Museum. The Georgia Guidestones “Elberton’s Most Unusual Granite Monument” 1980 Elberton Granite Museum and Exhibit Pamphlet. Elberton, GA 30635 Estulin, Daniel The True Story of the Bilderberg Group 2007 TrineDay ISBN: 0-9777953-4-9 Griffin, G. Edward The Creature from Jekyll Island American Media; 4th edition (2002) Hall, Manly P. The Lost Keys of Freemasonry: Or, the Secret of Hiram Abiff 1994 ISBN: 0880530448 Macoy Publishing & Masonic Supply Company Hall, Manly P. The Secret Teachings of All Ages the Philosophical Research Society Press Philosophical Research Society 1999. ISBN: 0893145483 Hall, Manly P. Lectures on Ancient Philosophy Tarcher (2005) ISBN: 1585424323 Holdren, John; Ehrlich, Paul R.; Ehrlich, Anne H. – Ecoscience: Population, Resources, Environment W H Freeman & Co (1977) LaVey, Anton The Satanic Bible Avon (December 1, 1976) ISBN-10: 0380015390 Leverett, Mara. The Boys on the Tracks: Death, Denial, and a Mother’s Crusade to Bring her Son’s Killers to Justice 1999 St. Martin’s Press ISBN: 0312198418

Marks, John. The Search for the “Manchurian Candidate”: The CIA and Mind Control, the Secret History of the Behavior Sciences 1979 Norton and Company, New York ISBN: 0393307948 Millegan, Kris. Fleshing our Skull and Bones: Investigations into Americas Most Powerful Secret Society . TrineDay, LLC Walterville, OR 2003 ISBN: 0-9752906-0-6 Orwell, George Nineteen Eighty Four (Centennial Edition) Plume Printing (1983) ISBN: 0-45228423-6 Pastor, Robert - Toward a North American Community: Lessons from the Old World for the New Pike, Albert. Morals and Dogma of the Ancient and Accepted Scottish Rite Freemasonry Reprinted by Kesslinger Publishing ISBN: 0-7661-2615-3 Quigley, Caroll Tragedy and Hope A History of the World in Our Time G. S. G. & Associates, Incorporated (June 1975) ISBN-10: 094500110X Sauder, Richard Ph. D. Underground Bases and Tunnels: What is the government trying to hide? Adventures Unlimited Press. 1995 ISBN: 0-932813-37-2 Tucker, Jim Jim Tucker’s Bilderberg Diary American Free Press (2005) ISBN-10: 0974548421

Government Reports and Documents Project For a New American Century Chemical and Biological Defense, DOD and VA Need to Improve Efforts to Identify and Notify Individuals Potentially Exposed during Chemical and Biological Tests Intergovernmental Panel on Climate Change Report (IPCC) The MIAC Report: The Modern Militia Movement page (2009) Project Megiddo Report by the FBI (1999) Right-wing Extremism: Current Economic and Political Climate Fueling Resurgence in Radicalization and Recruitment , (2009)

YouTube Videos

These videos are sourced in the footnotes on the pages that they are referenced. These videos come from a variety of sources including mainstream news broadcasts Dick Morris: Conspiracy Theorists were Right . Gold for Bread - Zimbabwe MSNBC Host: Word "Socialist" Code For The "N-Word" Chris Matthews Proclaims Criticizing Michelle Obama Having 26 Aides Is Racist Aired September 1, 2009 Jimmy Carter: Opposition to Obama is Racist Tim Geithner Lies : Flip Flops On New World Currency Originally aired on CNN’s Lou Dobbs Tonight on March 25, 2009. Violating Posse Comitatus: National Guard on the Streets of Kingman, Arizona WeAreChange Ohio Investigates military check points An Inconvenient Mormon , a speech by Glenn Beck Glenn Beck Mentions FEMA Camps on Fox & Friends Glenn Beck ties Holocaust Shooter to 9/11 Truthers Mancow Waterboarded (2009) Rahm Emanuel: If you are on no fly list, no gun! Fox Hypes H1N1 Nasal Vaccine - Don't believe the "Conspiracy Theories" MSNBC: Get the Damn Flu Vaccine RFID Bracelet Once You Have Had Swine Flu Vaccination Robert Kennedy on the Vaccine Autism Cover-up



Footnotes

[i]

The Obama Deception (2009) produced by Alex Jones [ii]

Video clip available on YouTube. Dick Morris: Conspiracy Theorists were Right . [iii]

CNN Kissinger resigns as head of 9/11 commission December 13, 2002 [iv]

Earth Times Merkel: No world peace without multilateral cooperation November 9,2009 [v]

http://www.number10.gov.uk/Page1535 [vi]

http://www.number10.gov.uk/Page1661 [vii]

BBC Blair returns to New World Order January 4, 2002 by Nyta Mann [viii]

http://www.number10.gov.uk/Page1765 [ix]

London Guardian Pope calls for a New World Order January 2, 2004 by John Hooper [x]

Matrix of Evil (2000) a film by Alex Jones [xi]

Hall, Manly P. – The Secret Teachings of All Ages page 6 [xii]

Hall, Manly P. – The Secret Teaching of All Ages page 315 [xiii]

Bailey, Alice – Externalization of the Hierarchy page 511 [xiv]

Bailey, Alice – Externalization of the Hierarchy p. 519 [xv]

Bailey, Alice – Externalization of the Hierarchy p. 519-520 [xvi]

Pike, Albert – Morals and Dogma page 817 [xvii]

Hall, Manly P. – Lectures on Ancient Philosophy page 433 [xviii]

Pike, Albert – Morals and Dogma page 104-105

[xix]

Pike, Albert – Morals and Dogma page 213 [xx]

Quigley, Carroll – Tragedy and Hope pages 1247-1248 [xxi]

Blavatsky, H.P. – The Secret Doctrine v. II p. 237 [xxii]

MSNBC Reading Hillary Rodham’s hidden thesis By Bill Dedman May 9, 2007 [xxiii]

Born June 12, 1915 [xxiv]

YouTube.com/MarkDice [xxv]

The Hill.com GOP preps for talk radio confrontation June 27, 2007 by Alexander Bolton [xxvi]

Human Events Pelosi Supports ‘Fairness’ Doctrine by John Gizzi June 25, 2008 [xxvii]

CNS News Democratic Senator Tells Conservative Radio Station He'd Re-impose Fairness Doctrine--on Them by Pete Winn October 22, 2008 [xxviii]

San Francisco Peninsula Press Club Rep. Eshoo to push for Fairness Doctrine December 16, 2008 [xxix]

World Net Daily # Another senator lines up behind 'Fairness Doctrine' February 5, 2009 [xxx]

Politico.com Sen. Harkin: 'We need the Fairness Doctrine back' by Michael Calderon February 11, 2009 [xxxi]

Washington Post TV Movie Led to Prostitute's Disclosures 'Mayflower Madam' Gave Gobie Idea By Bill Dedman August 27, 1989 [xxxii]

Ibid [xxxiii]

FoxNews.com Barney Frank Present When Partner Arrested for Pot November 6, 2009 [xxxiv]

http://www.politico.com/news/stories/1009/28549.html

[xxxv]

The Los Angeles Times Senate approves bailout after revisions, 7425 October 2 2008 [xxxvi]

24 Hours with Steve-O broadcast on 2 July 2007 on ITV1 in the UK with host Jamie Campbell [xxxvii]

Baltimore Sun “Jackass” Star Steve-O Hospitalized March 13, 2008. [xxxviii]

Ibid [xxxix]

Reality TV World. Steve-O pleads guilty to felony cocaine charge but avoids jail time Jun 4, 2008 [xl]

TMZ.com Britney – The Devil Made Me Do It! Posted Nov 12th 2009 12:50AM [xli]

BBC Rap fan guilty of suitcase murder December 1, 2005 [xlii]

Salon.com Grand Death Auto by David Kushner February 22, 2005 [xliii]

The Washington Post Boy, 6, Misses Bus, Takes Mom's Car Instead January 7, 200 [xliv]

Guinness World Records 2009 Gamer's Edition . p. 108-109 [xlv]

Associated Press Gay penguin book shakes up Illinois school By Jim Suhr Updated 11/17/2006 7:39 AM ET [xlvi]

Fox News: Do You Know What Text Books Your Children Are Reading? [xlvii]

CBS News Kevin Jennings Gets Boost from White House October 1, 2009 [xlviii]

New York Post Trashy Halloween costumes for kids worry parents October 12, 2009 By Shari Logan and Adam Nichols [xlix]

Ibid [l]

http://www.baristanet.com/baristakids/blog/why-is-it-so-hard-to-find-agirls-halloween-costume-that-wouldnt-get-her-on-the-slut-list/

[li]

CNN.com Atheist ads to adorn New York subway stations October 21, 2009 [lii]

People Magazine Coroner: Dr. Dre's Son Died From Overdose of Heroin and Morphine by Ken Lee January 2, 2009 [liii]

YouTube: Gold for Bread - Zimbabwe [liv]

World Net Daily CNN gutter talk complaint awaits review at FCC April 24, 2009 Bob Unruh [lv]

MSNBC: The Rachel Maddow Show: Insani-Tea: Conservatives Rally Around "Teabagging" [lvi]

http://www.adl.org/special_reports/rage-grows-in-America/default.asp [lvii]

YouTube: MSNBC Host: Word "Socialist" Code For The "N-Word" [lviii]

YouTube: Chris Matthews Proclaims Criticizing Michelle Obama Having 26 Aides Is Racist Aired September 1, 2009 [lix]

YouTube: Jimmy Carter: Opposition to Obama is Racist [lx]

Quigley, Carroll – Tragedy and Hope page 324 [lxi]

The New York Times The amero conspiracy By Drake Bennett November 25, 2007 [lxii]

Pastor, Robert - Toward a North American Community: Lessons from the Old World for the New page 115 [lxiii]

Anderson, James E., Van Wincoop, Eric (September 8, 2001). "Borders, Trade and Welfare" (PDF). Brookings Trade Forum (Washington: Brookings Institution Press): 207–244 [lxiv]

http://www.halturnershow.blogspot.com/2008/12/urgent-new-ameropaper-currency-exposed.html [lxv]

Ibid [lxvi]

Daily Freeman White supremacist Turner worked for FBI, lawyer says August 19, 2009

[lxvii]

Ibid [lxviii]

YouTube: Tim Geithner Lies : Flip Flops On New World Currency Originally aired on CNN’s Lou Dobbs Tonight on March 25, 2009. [lxix]

The Moscow Times At G20, Kremlin to Pitch New Currency March, 17 2009 By Ira Iosebashvili [lxx]

Bloomberg.com Medvedev Shows Off Sample Coin of New ‘World Currency’ at G-8 By Lyubov Pronina July 10 2009 [lxxi]

Herald Sun Nobel-prize winner backs world currency March 11, 2009 [lxxii]

http://www.census.gov/ipc/www/popclockworld.html [lxxiii]

The Citizen Scientist Meeting Doctor Doom by Forrest M. Mims III March 2006 [lxxiv]

Austin American-Statesman Professor’s population speeches unnerve some April 5, 2006 [lxxv]

http://uts.cc.utexas.edu/~varanus/Everybody.html [lxxvi]

http://uts.cc.utexas.edu/~varanus/obit.html [lxxvii]

The Age Burnet’s solution: The plan to poison S-E Asia By Brendan Nicholson March 10, 2002 [lxxviii]

Deutsche Press Agentur (DPA) His Royal Virus August, 1988. [lxxix]

Holdren, John – Ecoscience page 787-788 [lxxx]

Holdren, John – Ecoscience pages 786-787 [lxxxi]

Holdren, John – Ecoscience pages 786-787 [lxxxii]

Holdren, John – Ecoscience page 837 [lxxxiii]

Holdren, John – Ecoscience page 838 [lxxxiv]

Holdren, John – Ecoscience pages 942-943 [lxxxv]

Christian, Robert – Common Sense Renewed p. 6

[lxxxvi]

Wired Magazine American Stonehenge: Monumental Instructions for the Post–Apocalypse By Randall Sullivan 04.20.09 [lxxxvii]

Hall, Manly P. – Lectures on Ancient Philosophy page 150 [lxxxviii]

World Net Daily Bible verses regarded as hate literature by Art Moore February 18, 2003 [lxxxix]

CBN News UK Christian Target of Hate Crimes Law by Gary Lane October 31, 2009 [xc]

World Net Daily Christians arrested at homosexual event October 15, 2004 [xci]

http://www.irs.gov/charities/charitable/article/0,,id=163395,00.html [xcii]

Ibid [xciii]

USA Today Church could lose tax-exempt status for anti-war sermon 11/08/2005 [xciv]

The New York Times Group Loses Tax Break Over Gay Union Issue September 18, 2007 by Jill Capuzzo [xcv]

PrisonPlanet.com Secret FEMA Plan To Use Pastors as Pacifiers in Preparation For Martial Law May 24 2006 [xcvi]

Bailey, Alice – Externalization of the Hierarchy p. 409 [xcvii]

Bailey, Alice – Externalization of the Hierarchy page 416 [xcviii]

Bailey, Alice – Externalization of the Hierarchy page 513 [xcix]

Bailey, Alice – Externalization of the Hierarchy page 82 [c]

Associated Press Pope affirms Catholicism as only way to salvation By Nicole Winfield July 11, 2007 [ci]

The New York Times Vatican astronomer cites possibility of extraterrestrial 'brothers' [cii]

Hall, Manly P. – The Secret Teachings page 231

[ciii]

Crème, Benjamin – The Reappearance of the Christ and the Masters of Wisdom p. 25 [civ]

Washington Post When Seeing and Hearing Isn’t Believing By William M. Arkin Feb. 1, 1999 [cv]

Police State 2000 by Alex Jones [cvi]

Holdren, John – Ecoscience page 917 [cvii]

The Associated Press In shift, Blackwater dumps tarnished brand name by Mike Baker February 13, 2009 [cviii]

The Washington Post Iraq to Deny New License To Blackwater Security Firm: U.S. Embassy's Preferred Contractor Accused of Killings by Ernesto Londoño and Qais Mizher January 29, 2009 [cix]

The Virginian-Pilot Blackwater: On the Front Lines by Bill Sizemore and Joanne Kimberlin 7-25-2007 [cx]

The New York Times Blackwater Said to Pursue Bribes to Iraq After 17 Died By Mark Mazzetti and James Risen November 10, 2009 [cxi]

Billings Gazette Montana Attorney general to investigate APF by Jennifer McKee October 1, 2009 [cxii]

Billings Gazette APF Hilton has Criminal Past September 30, 2009 by Ruffin Prevost [cxiii]

AFP Nepalese man sues KBR on human trafficking charges August 27, 2008 [cxiv]

The New York Times Limbo for U.S. Women Reporting Iraq Assaults February 13, 2008 by James Risen [cxv]

YouTube: Violating Posse Comitatus: National Guard on the Streets of Kingman, Arizona [cxvi]

CHP News Press Release December 10, 2008 [cxvii]

http://www.kesq.com/Global/story.asp?S=9534627

[cxviii]

YouTube: WeAreChange Ohio Investigates military check points [cxix]

Ibid [cxx]

The Jurist Challenging the Military Commissions Act October 4th 2006 [cxxi]

CBS2 New York News Pier 57 Likened To Guantanamo [cxxii]

YouTube: An Inconvenient Mormon , a speech by Glenn Beck [cxxiii]

YouTube: Glenn Beck Mentions FEMA Camps on Fox & Friends [cxxiv]

YouTube: Glenn Beck ties Holocaust Shooter to 9/11 Truthers [cxxv]

The London Telegraph Abu Ghraib abuse photos 'show rape' By Duncan Gardham and Paul Cruickshank May 27, 2009 [cxxvi]

Ibid [cxxvii]

YouTube: Mancow Waterboarded (2009) [cxxviii]

Columbia Day Tribune ‘Fusion center’ data draws fire over assertions by T.J. Greaney March 14, 2009 [cxxix]

The MIAC Report: The Modern Militia Movement page 4 [cxxx]

Ibid [cxxxi]

The MIAC Report: The Modern Militia Movement page 7 [cxxxii]

The MIAC Report: The Modern Militia Movement page 7 [cxxxiii]

World Net Daily Homeland Security on guard for 'right-wing extremists' April 12, 2009 [cxxxiv]

Project Megiddo Report (1999) page 6 [cxxxv]

Project Megiddo Report (1999) page 12 [cxxxvi]

Project Megiddo Report (1999) page 13 [cxxxvii]

CBS2 New York News Pier 57 Likened To Guantanamo

[cxxxviii]

Project Megiddo Report (1999) page 21 [cxxxix]

Project Megiddo Report (1999) page 29 [cxl]

Project Megiddo Report (1999) page 32 [cxli]

The Denver Post Terror watch uses local eyes 181 Trained in Colo. By Bruce Finley 6-29-2008 [cxlii]

The Progressive Exclusive! The FBI Deputizes Business by Matthew Rothschild February 7, 2008 [cxliii]

Ibid. [cxliv]

Associated Press Police chiefs endorse anti-terror community watch by Eileen Sullivan and P. Solomon Banda October 3, 2009 [cxlv]

NBCChicago.com Rats! City to Pay for Informing on Tax Cheats By Andrew Greiner [cxlvi]

Ibid [cxlvii]

The New York Times Scouts Train to Fight Terrorists, and More by Jennifer Steinhauer May 13, 2009 [cxlviii]

Ibid [cxlix]

http://www.adl.org/special_reports/rage-grows-inAmerica/default.asp [cl]

FoxNews.com Sotomayor's Gun Control Positions Could Prompt Conservative Backlash May 28, 2009 [cli]

YouTube: Rahm Emanuel: If you are on no fly list, no gun! [clii]

http://www.aclu.org/privacy/spying/watchlistcounter.html [cliii]

http://www.msnbc.msn.com/id/10725741/ [cliv]

http://www.cnn.com/2008/US/07/17/watchlist.chertoff/index.html [clv]

USA Today New California law tracks ammunition sales October 12, 2009

[clvi]

Hall, Manly P. – The Secret Teachings of All Ages p. 282 [clvii]

Hall, Manly P. – The Secret Teachings of All Ages p. 283 [clviii]

UN Member States as of January 2010 [clix]

World Net Daily Minutemen: Don't call us 'vigilantes' April 14, 2005 by Larry Elder [clx]

CNNMoney.com Banking on illegal immigrants August 8, 2005 by Shaheen Pasha [clxi]

The North County Times Credit cards for illegal immigrants cause controversy February 25, 2007 by Edward Sifuentes [clxii]

Associated Content Voting Without ID is the Real Scam January 14, 2008 by Barry Dennis [clxiii]

World Net Daily Where Illegals go for Driver’s License July 22, 2005 [clxiv]

BBC News Barcelona clubbers get chipped September 29, 2004 [clxv]

http://archive.newsmax.com/archives/ic/2006/8/21/232558.shtml [clxvi]

The Herald Sun Biometrics helps spot banned gamblers by Tom Wilemon 5-5-05 [clxvii]

Associated Press / FoxNews.com FBI Ditches Carnivore Surveillance System January 18, 2005 [clxviii]

New York Daily News Model Liskula Cohen sues Google over blogger's 'skank' comment By Jose Martinez January 6th 2009 [clxix]

http://volokh.com/posts/1241122059.shtml [clxx]

FoxNews.com Cyberbullying Bill Could Ensnare Free Speech Rights May 14, 2009 By Steven Kotler [clxxi]

USA Today Number of Americans taking antidepressants doubles 84-2009 by Liz Szabo

[clxxii]

Hershel Jick; James A. Kaye; Susan S. Jick Antidepressants and the Risk of Suicidal Behaviors Journal of the American Medical Association July 21, 2004; 292: 338 - 343. [clxxiii]

Scientific American February 2008 issue The Medicated Americans: Antidepressant Prescriptions on the Rise by Charles Barber [clxxiv]

Times Online Medical chief warns of extremists’ attacking flu vaccination campaign by David Rose [clxxv]

http://www.cnn.com/2009/HEALTH/10/23/new.york.flu.vaccine/index.html [clxxvi]

YouTube: Fox Hypes H1N1 Nasal Vaccine - Don't believe the "Conspiracy Theories" [clxxvii]

YouTube: MSNBC: Get the Damn Flu Vaccine [clxxviii]

http://www.newswithviews.com/Evensen/greg142.htm [clxxix]

YouTube: RFID Bracelet Once You Have Had Swine Flu Vaccination [clxxx]

YouTube: Robert Kennedy on the Vaccine Autism Cover-up [clxxxi]

News Bulletin (Moscow: Interfax) Russian parliament concerned about U.S. plans to create qualitatively new weapons August 8, 2002 [clxxxii]

The Alex Jones Show 11-10-09 [clxxxiii]

The Washington Post Mind Games By Sharon Weinberger January 14, 2007 [clxxxiv]

http://www.ksla.com/Global/story.asp?s=7339345 [clxxxv]

PBS Timeline: Biological Weapons: American Experience . December 15, 2006 [clxxxvi]

http://www.globalsecurity.org/wmd/systems/bw.htm. [clxxxvii]

BBC Hidden history of US germ testing February 13, 2006

[clxxxviii]

Salt Lake Tribune Report: Army still reluctant to find those affected by Utah weapons tests by Matthew .LaPlante February 28, 2008 [clxxxix]

The Guardian RAF rainmakers 'caused 1952 flood' by John Vidal and Helen Weinstein August 30, 2001 [cxc]

BBC News Rain-making link to killer floods August 30, 2001 [cxci]

The Pentagon Papers, Gravel Edition, Volume 4, Chapter 2, US Ground Strategy and Force Deployments , 1965-1968, pp. 277-604, 3rd section Mtholyoke.edu. [cxcii]

The New York Times Rainmaking Is Used As Weapon by U.S.; Cloud-Seeding in Indochina [cxciii]

Reuters China weather "magic" conjures blue sky for parade October 1, 2009 [cxciv]

AFP Beijing's first snow of season 'artificially induced' November 2, 2009 [cxcv]

Time Magazine Moscow Mayor Promises a Winter Without Snow By Simon Shuster Oct. 16, 2009 [cxcvi]

Daily Mail Human race will 'split into two different species' By Nail Firth October 26, 2007 [cxcvii]

Sanger, Margaret – A Plan For Peace , Birth Control Review, April 1932, p. 106 [cxcviii]

Ibid. [cxcix]

ABC This Week with George Stephanopoulos [cc]

The Washington Post In the trenches on climate change, hostility among foes By Juliet Eilperin November 22, 2009 [cci]

The Guardian Carbon labels to help shoppers save planet By Tania Branigan and Helen Carter May 31, 2007 [ccii]

USA Today 'The Day After Tomorrow' heats up a political debate by Scott Bowles May 26, 2004

[cciii]

Washington Times June 29, 1989 [cciv]

Discovery.com Armageddon from Planet Nibiru in 2012? Not so fast by David Morrison (2008) [ccv]

PrisonPlanet.com DC Madam Predicted She Would Be Suicided May 1, 2008 by Paul Joseph Watson [ccvi]

World Net Daily The boys on the tracks July 17, 2000 by Maralyn Lois Polak

Introduction

Every Spring since 1954 an elite group of around one hundred of the world’s most powerful politicians, businessmen, bankers, media executives, and international royalty have been quietly gathering for a secret meeting in an evacuated five-star hotel while being protected by armed guards who stand watch. Inside, for three days, the attendees engage in lengthy off-therecord talks about the top issues facing the world. They’re called the Bilderberg Group, or often just “Bilderberg” for short, and for over a half century there wasn’t much more than a peep about the meeting in the American mainstream media.

For decades, many people believed this meeting was an urban legend, but as you will soon see, it is very real and very well documented. Rumors about the Bilderberg Group do seem like something out of a Hollywood movie with the cliché claims of a “secret meeting” of a group of wealthy men trying to “take over the world,” but “as crazy as it sounds,” in recent years a lot of allegations about the Bilderberg Group that had floated around on the Internet began to surface in some mainstream publications. To many people’s surprise, such a meeting exists, and the “rumors” were true.

Between 100 to 120 of the world’s top politicians, businessmen, financial fat cats, military leaders, heads of intelligence agencies, reporters, and executives from major media outlets fly half way around the world to gather once a year in the end of May or early June in a closed down fancy hotel for three days and are protected by private security contractors and local police who stand watch outside to prevent any uninvited guests from dropping by. Temporary security fences are even set up to prevent anyone from stepping foot on the property, and attempt to block the view from any onlookers who are watching from across the street to see who shows up.



The attendees arrive one after the other in tinted Lincoln Town Cars driven by professional drivers. Independent journalists and photographers have been able to discover the time and place for many of these meetings in recent years and have gotten clear photographs of some of the men and women who have attended, but most still refuse to even acknowledge they know anything about it.

Some people refer to them as “the 1%” but this label is far from accurate if you do the math. One percent of the earth’s seven billion people is 70 million people! Bilderberg is more like the .00001% which is approximately 700 people, a figure that accounts for the steering committee and the regular attendees over the past few decades.

The meeting is named after the Bilderberg Hotel located in Oosterbeck, Holland, which was the site of their first gathering organized by Prince Bernhard of the Netherlands in 1954. Then, and still today, attendees agree not to discuss publicly who was in attendance or what specifically was discussed, and (until recently at least) most of them have denied any knowledge of the Bilderberg Group at all when—on the rare occasion—someone asked them about it—usually a citizen journalist or YouTuber.

For decades, news of the shadowy Bilderberg Group spread in socalled “anti-government” Patriot circles, in underground newsletters, and “conspiracy” websites, until the advent of YouTube and social media finally forced some major mainstream media outlets to admit that Bilderberg is real and some very powerful people attend. After these decades of news blackouts, with the rise of social media and video sharing sites like YouTube, slowly more and more major news outlets have begun to at least mention the Bilderberg Group, albeit ever so briefly, and usually including the caveat that “conspiracy theorists” are upset or “paranoid” about them. Through the increase in popularity of alternative news websites and the emergence of social media, more and more people began learning about this strange and secretive meeting, and it got to a point where mainstream outlets basically had to at least mention it was happening in attempts to

avoid looking like they were covering it up by purposefully avoiding the issue.1

For years, if anyone called into any of the major syndicated talk radio shows like Rush Limbaugh, Sean Hannity, Glenn Beck and others, and told the call screener they wanted to ask about the Bilderberg Group, that person’s call would never be put through. “We’re not taking calls on that right now, sorry. Click.” If the person calling gave the call screener a bogus question and happened to be put on air and then asked the host about the Bilderbergers, they would be ridiculed and the call would be dropped immediately (something that’s happened to me many times).2

Why not take it seriously? Why pretend for so many years they don’t exist? Are these radio talk show hosts and other major news editors and reporters “in on it?” Has there been a “conspiracy” to keep the meeting out of the press? It’s foolish to deny that there hasn’t been an arrangement between the Bilderberg Group and the American mainstream media to keep them out of the news and to have the top political analysts and talk show hosts pretend like they don’t know anything about them all these years. When 100 of the world’s most influential politicians, media owners, banking executives, and business elite fly half way around the world to meet for three days in a closed down luxury hotel that’s fenced off and surrounded by armed guards, nobody can say that’s not a newsworthy or interesting event!

Critics see this small, tightly knit group as an Aristocracy or an Oligarchy, comprised of men (and some women) who see themselves as having the right to rule because of their wealth and “superior intelligence” who put their own interests above anyone else’s—with little to no regard for the consequences. Without the proper checks and balances put in place, which was the intention of the Founding Fathers when they split the government into three different branches (Executive, Judicial, and Legislative) in what’s called the separation of powers, a government can become so powerful it is difficult to oppose them when their actions are unfair or illegal. And when their discussions aren’t open to public scrutiny it makes keeping them in check even more difficult.



Many people believe that this meeting is possibly a violation of the Logan Act, which prohibits unauthorized citizens from negotiating with foreign governments, a law that was implemented to prevent people from interfering with international relations between the United States and other countries. It specifically states, “Any citizen of the United States, wherever he may be, who, without authority of the United States, directly or indirectly commences or carries on any correspondence or intercourse with any foreign government or any officer or agent thereof, with intent to influence the measures or conduct of any foreign government or of any officer or agent thereof, in relation to any disputes or controversies with the United States, or to defeat the measures of the United States, shall be fined under this title or imprisoned not more than three years, or both.”

Is the Bilderberg Group negotiating foreign policy? Is this where the ruling elite come to a consensus to guide the direction of the world in their favor? Or is it simply “just another conference?” Or, are the “conspiracy theorists” right? What is the evidence? How were they first discovered? What are they doing? And should the public be concerned? Do they choose who the next president of the United States will be? Do they covertly coordinate economic booms and busts?

Do they manipulate foreign policy and decide which wars will be launched and when from behind these closed doors? Is this annual meeting of the power elite really just not interesting or newsworthy? Has there been a cover-up or a conspiracy to keep them out of the headlines? Why the secrecy and the denials for so many years? Is this the “shadow government?” Those questions and more will be answered in The Bilderberg Group: Facts & Fiction.





THE MARRIOTT HOTEL IN CHANTILLY, VIRGINIA PROTECTED BY A TEMPORARY PRIVACY AND SECURITY FENCE SET UP FOR THE 2012 MEETING.

  PROTESTERS TRYING TO IDENTIFY THE ATTENDEES AS THEY ARRIVE FOR THE 2012 MEETING IN CHANTILLY, VIRGINIA.



The Attendees

Each year the list of attendees reads like a who’s who of the ruling class. Just a small sample of some of the people who attend are: David Rockefeller and Henry Kissinger, who have both been regular attendees for decades (and helped finance the group as is shown on their tax returns); banking bigwigs like the CEOs or chairmen from Goldman Sachs, Citigroup, HSBC, Deutsche Bank, JP Morgan Chase, American Express, etc; not to mention the head and former head of the Federal Reserve Bank like Ben Bernanke and Alan Greenspan, as well as U.S. Treasury secretary Timothy Geithner and other international financial fat cats like the head of the World Bank and the IMF.3

In the tech world we’ve seen Microsoft founder Bill Gates, Google’s Executive Chairman Eric Schmidt;4 Jeff Bezos CEO of Amazon.com (just before buying the Washington Post in 2013);5 Louis Gerstner the CEO of IBM; Peter Thiel, founder of Pay Pal and major investor in Facebook; as well as Chris Hughes, the co-founder of Facebook and other tech titans all attend.

Over the years leading media figures such as the publisher of the Washington Post, as well as the chief editors of the New York Times, Los Angeles Times, the Wall Street Journal, Time, Newsweek, and other major newspapers and magazines have all attended or regularly attend. Executives from the top television networks like News Corp CEO Rupert Murdoch and representatives from ABC, NBC, and CBS are also key fixtures, as well as popular political commentators and reporters.

Top military brass and U.S. intelligence figures like David Petraeus (former head of the CIA), General Michael Haden (former NSA chief), General Keith Alexander (current head of the NSA);6 Donald Rumsfeld, former Secretary of Defense and one of the architects of the Iraq War;

General Colin Powell; NATO’s Secretary General, the head of Britain’s Secret Service; and others are also regular attendees.

Top American politicians like Secretary of State John Kerry, Senators John Edwards, Tom Daschele, Chuck Hagel, Hillary Clinton have all attended; as well as members of British Parliament and European royalty. Even Presidents Clinton and Ford (before they were elected). No seated president ever attends because their schedule and whereabouts is so closely monitored they couldn’t risk brining so much attention to the event.

Could all these globalist movers and shakers be getting together just to have coffee and hang out? Or, as many believe, could this think tank be a place where an elite consensus is arrived about how to best maintain and expand their power and influence?

The British newspaper The Observer (sister paper to The Guardian) surprisingly ran an article back in 1963 that remarked, “These people [Bilderbergers] maintain that the future belongs to technocrats, because the rumor among them is that the grave questions of international affairs are too delicate to be left in the hands of diplomats. However, the ‘clandestiny’ of their debates shows that they only seek one thing: effective domination over the peoples of the world, but by dissimulating [concealing] themselves and by leaving the responsibility of the governments in the hands of petty politicians.”7



 



 

PROTESTERS TRYING TO GET A PHOTO OF WHO IS ARRIVING IN THE BACK OF THIS TINTED LINCOLN TOWN CAR AT 2012 BILDERBERG MEETING.

 





Recent Meetings

The conference is held in various countries throughout Europe at luxury hotels and usually every fourth year it returns to the United States— on election years, which is no coincidence—often meeting in Chantilly, Virginia which is just a short drive outside Washington D.C. This makes it convenient for politicians and the Eastern Establishment in New York City to attend without drawing too much suspicion since they don’t have to leave the country and create a cover story for their prolonged absence.

The entire hotel is cleared out around noon the day before the meeting and no reservations are accepted during this time so only Bilderberg members and guests are allowed in the hotel. Actually—to be more specific —only members and guests are allowed on the property since barricades and temporary fences are set up and local police and private security teams patrol the perimeter and guard the entrances.

The hotels which are chosen are secluded on large plots of land, and never downtown in a major city. This makes it easier for members and guests to arrive without being identified. If the meeting were held at a hotel in downtown Manhattan for example, onlookers could easily hang out on the side walk or across the street to catch a glimpse (or take photos or video) of the attendees coming or going. It is for this reason the location is always at a resort-style hotel with plenty of land, hidden away from nearby streets and neighboring buildings.

The hotel staff is also sworn to secrecy and may likely be coerced into signing non-disclosure agreements to prevent them from talking to the press (and the protesters). When I was at the Marriott in Chantilly, Virginia the day before it was cleared out for the 2012 Bilderberg meeting, I asked the bar tender if he knew what was about to happen over the next few days and he said he couldn’t talk about it.



There is a core group of regulars, many of whom have been involved for decades. A steering committee decides who is invited and what topics will be disguised. Each day’s meeting is broken up into two sessions in the morning and two sessions in the afternoon, except the final day which only has the two morning sessions. A different topic is discussed during each session. Some recent meeting locations and dates are as follows:





•

2015 Telfs, Austria (May 29th - June 3rd) at the Interalpen hotel.

•

2014 Copenhagen, Denmark (May 29th - June 3rd) at the Marriott hotel.

•

2013 Watford, United Kingdom (June 8th - 9th) at the Grove Hotel.

•

2012 Chantilly, Virginia, USA (May 31st - June 3rd) at Westfields Marriott hotel.

•

2011 St. Moritz, Switzerland (June 9th - 12th) at the Suvretta House.

•

2010 Sitges, Spain (June 3rd - 7th) at the Hotel Dolce.

•

2009 Vouliagmeni, Greece (May 14th - 17th) at the Astir Palace resort.

•

2008 Chantilly, Virginia, USA (June 5th - 8th) at the Westfields Marriott.

•



2007 Istanbul, Turkey (May 31st - June 3rd) at the Ritz-Carlton Hotel in Sisli.

•

2006 Ottawa, Ontario, Canada (June 8th - 11th) at the Brookstreet Hotel in Kanata.

•

2005 Rottach-Egern, Germany (May 5th - 8th ) at the Dorint Sofitel Seehotel Überfahrt.





A FEW HUNDRED PROTESTERS SHOW THEIR DISAPPROVAL OF BILDERBERG 2012



How Were They First Discovered?

In 1957 a Pulitzer Prize winning columnist named Westbrook Pegler who wrote for Scripps Howard News Service, the Chicago Tribune, and other papers, published the first article on the Bilderberg Group—although he didn’t know their name at the time—his report marked the beginning of the unraveling of one of the most interesting “conspiracy theories” of all time.

Pegler wrote, “Something very mysterious is going on when a strange assortment of 67 self-qualified, polyglot [bilingual] designers and arbiters of the economic and political fate of our western world go into a secret huddle on an island of Brunswick, GA and not a word gets into the popular press beyond a little routine AP story. These gumshoe super state architects and monetary schemers were drawn from all NATO countries. The fact of this weird conclave as spooky as any midnight meeting of the Ku Klux Klan in a piney woods, was bound to get known to the world eventually.”8

He continued to explain how he first learned of this meeting, saying, “I got my first word of it from a reader who happened onto St. Simon Island, Brunswick, [Georgia] on her way to West Palm Beach. She wrote that the hotel on St. Simon was almost deserted, but that when she commented on this, the clerk said the place had been alive with mysterious characters a few days earlier and with Secret Service and FBI too.”

While not yet knowing their name, Westbrook did see similarities between this meeting and the secret Jekyll Island meeting that was held in 1910 by a small group of America’s elite where they discussed and drew up plans for the Federal Reserve Banking System. He said, “Senator Aldrich of Rhode Island, called this one into being. He was the father of Winthrop Aldrich. There have been many excited versions of that ancient hoe-down on Jekyll Island, but relatively few have ever heard of it all.”



After he began criticizing executives of the powerful Hearst Corporation, which owned and controlled almost 30 different newspapers in America at the time, he was fired. Hearst newspapers literally created “yellow journalism” which refers to sensationalistic headlines and careless reporting with a disregard for the facts in order to sell more newspapers, something that has pretty much become standard practice in American mainstream media.

A man named Willis Carto read Westbrook Pegler’s article about this intriguing meeting and it inspired him to begin investigating the issue himself. A year after Westbrook Pegler’s article came out, Willis Carto began publishing a newsletter called Liberty Lowdown and would later begin publishing a newspaper called The Spotlight which was largely dedicated to tracking and exposing this elusive group.

Over two decades later, a reporter named Jim Ticker would learn of the Bilderberg Group when going to work for The Spotlight. Tucker immediately became obsessed with them, and would later become the world’s foremost expert on the meeting. Tucker explained, “Had it not been for Willis A. Cato, who hired me as editor of The Spotlight and then put me on the tack of Bilderberg, I would probably—almost assuredly—never heard of the word ‘Bilderberg.’ Having had the opportunity, through Carto’s good offices as founder of Liberty Lobby, publisher of The Spotlight, to begin what ultimately proved to be a generation of world-wide Bilderberghunting, I was able to bring news about Bilderberg to literally millions of folks who would like myself have otherwise remained in the dark about these globalist schemers.”9

Tucker had somehow gained the support of an insider who would leak information to him every year about the location and date of the meeting, as well as attendee lists and other details. Tucker obsessively tracked the Bilderberg Group from 1975 until his death in 2013 at the age of 78. His book, titled Jim Tucker’s Bilderberg Diary contains decades of information

about where the Bilderbergers met, who was in attendance, and what was discussed.10

As Tucker’s health began to fail, he turned over his trusted source (or sources) who tipped him off each year as to the meeting’s location and dates, to Alex Jones from Infowars.com. Love him or hate him, Alex Jones played a large role in getting major media to finally cover the Bilderberg Group meetings in the early 2000’s. In 2006 he traveled to Ottawa, Canada after being tipped off that was where they were going to meet, and Alex Jones has announced the location every year since and has been able to get a growing number of supporters (expanding from a few hundred in 201211 to over 2000 in Hertfordshire, England in 2014) to meet outside the hotel to peacefully protest and raise awareness about the meetings.12

With Alex’s huge audience and massively popular website, it became impossible for the Bilderberg Group to hide anymore, and now in the last few years they quietly admit when and where they are meeting through their simple website BilderbergMeetings.org. In 2011 the massively popular news site, the Drudge Report, first posted links to Infowars articles and some European papers which covered the event.13 This was basically the dam bursting since the Drudge Report has a tremendous influence on what topics people talk about, and is the homepage of many reporters and political analysts in the United States.14





JIM TUCKER TALKS TO A GROUP OF PROTESTERS ABOUT HIS ADVENTURES

TRACKING BILDERBERG.

ALEX JONES SPEAKS TO THE PROTESTERS OUTSIDE THE 2012 BILDERBERG MEETING IN CHANTILLY, VIRGINIA.

 





Tax Returns

I have been able to obtain several recent years of Bilderberg’s IRS filings since they are registered as a 501c3 “charitable foundation” certain financial information must be made available for public inspection—if you know where to look.15 I discovered they operate under the business entity “American Friends of Bilderberg” and the documents show that in 2008 they received $645,000 in contributions to fund their annual meeting, with money coming from Goldman Sachs ($25,000), Microsoft ($75,000), Henry Kissinger ($20,000), David Rockefeller ($50,000) and other wealthy donors. The 2009 returns show the Washington Post newspaper donated $25,000.16

Under the “Summary of Direct Charitable Activities,” the forms list the organization’s goals as “Organizing & sponsoring conferences which study & discuss significant problems of the western alliance [and] collaborating on the Bilderberg meetings held in Europe & North America.”

The expenses on the 2008 and 2012 documents (when they met in the United States) are listed as approximately $900,000 per year, which covers renting out the entire hotel for three days, paying the private security forces and compensating local police for the extra man-hours, the catering companies (or hotel restaurants) to feed them, and presumably for paying the travel expenses of members and attendees. There is most likely a European entity that functions as a counterpart to “American Friends of Bilderberg” that is used to pay the bills when the group meets in Europe because the recent forms I have been able to obtain show the expenses drop to around $100,000 per year when the group meets outside the United States, and then jump up close to one million dollars in the years they meet in the U.S.17



The documents list James Johnson as the treasurer, who is also the chairman of Perseus, a merchant bank and private equity fund management company based in Washington D.C. with offices in New York and an associated advisory firm in Munich, Germany.18 The name Perseus comes from Greek Mythology and is the demigod who beheaded Medusa. James Johnson was once the Chairman of the Executive Committee at Fannie Mae [The Federal National Mortgage Association]; and before that he was a managing director at Lehman Brothers, the fourth-largest investment bank in the U.S. (which failed during the economic crisis of 2008).19 He’s also on the Board of Directors for Goldman Sachs and a member of the Council on Foreign Relations.20

I have personally been to the offices of Perseus in Washington D.C. seeking a comment on the documents, which I held in my hand during my visit, and as soon as I mentioned “Bilderberg,” James Johnson’s secretary said they have no comment, ordered me to leave, and slammed the door. A video of this encounter is posted on my YouTube channel, YouTube.com/MarkDice.21 The person listed on the forms as the accountant is Robert T. Foldes of Leon D. Alpern & Company, and when I called them, the secretary confirmed they handle the taxes for American Friends of Bilderberg but declined to give me any further information. I have published some of the financial records on MarkDice.com where you can download the PDFs if you want.22

 

 





Politicians Silent

Attendees of the meeting agree to the Chatham House Rule, which is an anonymity policy created by the Royal Institute of International Affairs (nicknamed Chatham House) which is an elite think tank established in 1920 in the United Kingdom that analyzes and promotes their international political policies. The Chatham House Rule basically means that people in attendance are forbidden from discussing who attended and may not attribute any specific statements made by anyone in attendance at any time in the future. It’s basically a “what happens in Vegas, stays in Vegas” kind of oath.

The rule is supposedly in place to facilitate frank and honest discussions about any controversial topics which people may not want to go on the record about due to the political or personal consequences of letting their true feelings be publicly known.

Chatham House is essentially Britain’s counterpart to the Council on Foreign Relations in America, which sounds like a committee in Congress, but is in fact a private organization that serves up its political propaganda on a silver platter to the elite politicians and journalists who are members. While some politicians will acknowledge their affiliation with the CFR— admitting anything about the Bilderberg Group is a whole other story.



Barack Obama

As Election Day in 2008 approached, then presidential candidate Barack Obama ditched the reporters traveling with him on his campaign so he could attend a secret meeting which his press secretary Robert Gibbs refused to give any information about.23 It just so happened the Bilderbergers were meeting at this same time. As is common during the approach of a presidential election, reporters from major media outlets travel around the country with the candidates to give continuous coverage of their every move, and in June of 2008—on the same day the Bilderberg Group was meeting in Chantilly, Virginia (about 30-40 minutes outside of Washington D.C.)—reporters found out that Obama had ditched them after they were all stuck on a flight which they were told he was scheduled to be on with them.

“Reporters traveling with Obama sensed something might be happening between the pair [Obama and Hillary] when they arrived at Dulles International Airport after an event in Northern Virginia and Obama was not aboard the airplane,” the Associated Press reported.24 Not only was he not aboard the plane, as everyone was led to believe he would be, but his campaign literally trapped reporters on the flight so they couldn’t follow him.

“Why were we not told about this meeting until we were on the plane, the doors were shut and the plane was about to taxi to take off?” one reporter asked, confronting Obama’s spokesman Robert Gibbs on the flight about what had just happened. The confrontation was caught on camera by one reporter and can be seen on YouTube.25

Gibbs replied, “Senator Obama had a desire to do some meetings, others had a desire to meet with him tonight in a private way, and that is

what we are doing.”

Another reporter asked, “Is there more than one meeting, is there more than one person with whom he is meeting?”

“I am not going to get into all the details of the meeting,” Gibbs replied.

Of course, it’s not a stretch of the imagination to assume Obama was meeting with the Bilderberg Group, who usually schedule their event within a short driving distance from Washington D.C. every election year.



Hillary Clinton

When Hillary Clinton was running for president in 2008, someone asked her about the Bilderberg Group at an event when she was at a campaign stop in New Hampshire. It was a brief encounter that happened when she was shaking hands with people in the crowd, and the person who asked her videotaped the interaction and posted it on YouTube. “What’s going on at the Bilderberg meeting and what are you guys talking about up there?” he asked, in a polite and sincere tone.26

Hillary cackled, “Ha ha ha. I have no idea what you’re talking about.” The man responded, “Why are they such top secret meetings?” To which she answered (looking like a kid with their hand caught in the cookie jar), “Sir, I have no idea what you’re talking about,” and then she turned from him and walked away.27

How could she have no idea what he was talking about? How could one of the most politically connected and powerful women in the world not know what the Bilderberg Group is or what they do? It’s ridiculous to believe that she isn’t intimately aware of them and was obviously playing dumb so she wouldn’t betray they them by acknowledging they exist.

After being the First Lady during her husband Bill Clinton’s presidency in the 1990s, Hillary went on to become a senator in New York and then Secretary of State during Barack Obama’s first term as president; and at the time I’m writing this book, is running for president again in 2016. Since her college days, she has carefully plotted her political career and has long hoped to become the first female president of the United States.



In 1969 she wrote her senior thesis on Saul Alinsky, a left-wing extremist who detailed his subversive tactics aimed at creating a New World Order in is 1971 book Rules for Radicals, which he literally dedicated to Lucifer in the foreword. For years the Clintons were able to have the 92page thesis sealed, and it wasn’t made public until someone leaked it in 2007.28 The president of Hillary’s alma mater, Wellesley College in Massachusetts, approved sealing the thesis at the Clintons’ request under the bizarre new rule that any senior thesis written by a president or first lady of the United States would be sealed, but the work of every other alumni was publicly available for anyone who wanted to read them.29



Bill Clinton

When Bill Clinton was out campaigning for his wife Hillary in 2008, a protester in the audience began making a scene and shouting about his little known meeting with Bilderberg Group in the early 1990s causing Clinton to try to defuse the situation by saying, “This is the deal folks, all these people that are paranoid about the world come and scream at me everywhere.”30

The protester kept shouting him down while he tried to speak, forcing Bill to plead with him since security hadn’t yet been able to reach the man in the middle of the crowd to usher him out. “You said you would go if I answered the question right? All right here’s the answer. I happened to be in Europe then on my way to Russia, I was invited to go to Bilderberg by Vernon Jordan, a friend of mine, and a genuine hero of the civil rights movement. And to the best of my knowledge, NAFTA was not discussed by anybody in my presence. I was talking to people from Europe who did not give a rip about NAFTA. Now goodbye. Thank you.”31

According to leaks, NAFTA—the North American Free Trade Agreement, was a Bilderberg idea and they were instrumental in getting the treaty drafted, which was signed into law by Bill Clinton in 1993, merging Canada, the United States and Mexico into one trilateral trading bloc, reducing or eliminating tariffs and other trade barriers.

Before attending Bilderberg in 1991, Bill Clinton was a virtually unheard of governor of the small and little noticed state of Arkansas, but those in the Establishment caught notice of his silver tongue and his lust for power and thought he would be the perfect puppet to promote their policies as president. They don’t call him “Slick Willie” for nothing. Bill Clinton’s ability to lie convincingly and cleverly use vague language to avoid painting himself in a corner is unmatched by most politicians.



At a different Hillary 2008 campaign event when Bill Clinton was speaking, another heckler began shouting at him, this time about the Bohemian Grove—a less formal, sort of Bilderberg camping trip and secret elite men’s retreat held every summer. Once again, trying to appease the protester who completely derailed his speech, Clinton responded, “The Bohemian Club? Did you say Bohemian Club? That’s where all those rich Republicans go up and stand naked against redwood trees right? I’ve never been to the Bohemian Club but you ought to go. It’d be good for you. You’d get some fresh air.”32

His comment about Republicans “standing naked against redwood trees” refers to the common practice of Bohemian Grove members openly urinating on the side of trees or in the bushes while hanging out deep within the club’s 2700-acre redwood forest in Northern California where the world’s most wealthy and well-to-do men meet for a private party every July.33

Video of Clinton’s confrontation is on YouTube if you’d like to see it, and if you’re not familiar with the Bohemian Grove or would like to read an in depth analysis of this truly bizarre “Bilderberg in the woods,” I encourage you to pick up my book Inside the Illuminati: Evidence, Objectives, and Methods of Operation in paperback from Amazon.com or download it onto your tablet or e-reader from any major e-book store.



Senator Barbara Boxer

In June 2012 just one day after the Bilderberg meeting came to a close that year, my friend Luke Rudkowski, a YouTube producer and founder of We Are Change, happened to spot California Senator Barbara Boxer inside the Hart Senate Office Building in Washington D.C. in the press area giving an interview. Of course we took the opportunity to try to get a statement from her on Bilderberg as soon as her interview was over. A video of this confrontation is available on YouTube.34

Both Luke and I walked up to her with our professional-looking handheld wireless microphones as she was making her way down the hall and asked in a polite tone, “What are your thoughts on the important Bilderberg meeting that happened this weekend?” She immediately turned to one of her assistants who was with her and said, “Zack, do you want to make a statement?”

Boxer’s Assistant: “Sure. Why don’t you just give us a call (handing me his business card) and we’d be happy to get you a statement.”

Me: “We’d like your statement right now. The Bilderberg meeting happened and [there was] no major media or press coverage. Just one statement about the Bilderberg meeting.”

At this point she enters an elevator and when I tried to follower her inside, her aid blocked me and she said it was for “Senators only.”

Me: “Why no comment on the Bilderberg meeting?”

Boxer: “Do your job and call my office.”



Me: “Do your job and answer a question please.”

As the door is closing she says “Thank you very much. Thank you so much.” Luke Rudkowski kept holding the door, causing it to retreat back into the wall for a few seconds and preventing the elevator from moving.

I continued to press her. “The Bilderberg meeting just happened this year…”

Boxer: “Thank you so much. I appreciate it. Just call the office. Thanks a lot.”

At this point, one of her two aids exited the elevator to block us and prevent Luke from holding the door open any longer, and then it finally closed and she escaped. I did call her office just like her assistant asked, and left a message, but nobody ever called me back. Go figure.



Ben Bernanke

Independent journalist Luke Rudkowski, who has confronted countless powerful politicians on a variety of issues using his own unique style of ambush journalism, once asked Federal Reserve Chairman Ben Bernanke face to face for a comment on Bilderberg at a black tie event in New York City, but Bernanke refused and turned away.35

Luke: “Hey Ben, just really quick. What did you do at the 2008 Bilderberg meeting?”

Ben: “I’m not doing any press today.”

Luke: [Repeating his question again] “I mean what did you do at the Bilderberg Group?”

Ben: “I’m not doing any press today.” [turns away]



David Rockefeller

One quote floating around the Internet attributed to David Rockefeller senior, a longtime Bilderberg attendee and financier, is, “We are grateful to The Washington Post, The New York Times, Time magazine and other great publications whose directors have attended our meetings and respected their promises of discretion for almost forty years. … It would have been impossible for us to develop our plan for the world if we had been subject to the bright lights of publicity during those years. But, the world is now much more sophisticated and prepared to march towards a world government. The supranational sovereignty of an intellectual elite and world bankers is surely preferable to the national auto-determination practiced in past centuries.”36

He allegedly made this statement at the Bilderberg meeting in BadenBaden Germany in 1991 and the comments were printed in several rightwing French newspapers but its authenticity is uncertain and disputed.

What is not disputed, however, is David Rockefeller’s admission in his own memoir which he published in 2003, that, “For more than a century, ideological extremists at either end of the political spectrum have seized upon well-publicized incidents such as my encounter with Castro to attack the Rockefeller family for the inordinate influence they claim we wield over American political and economic institutions. Some even believe we are part of a secret cabal working against the best interests of the United States, characterizing my family and me as ‘internationalists’ and of conspiring with others around the world to build a more integrated global political and economic structure — one world, if you will. If that is the charge, I stand guilty, and I am proud of it.”37



Dick Cheney

When giving a speech in 2002 at Bilderberg’s sister society, the Council on Foreign Relations, Vice President Dick Cheney cracked an inside joke about his membership, saying “I want to thank you all for the warm welcome today. I see a lot of old friends in the room. And it’s good to be back at the Council on Foreign Relations. As Pete mentioned, I’ve been a member for a long time, and was actually a director for some period of time. I never mentioned that when I was campaigning for reelection back home in Wyoming (laughter) but it stood me in good stead. I value very much my experience, exposure to the tremendous people involved and the involvement and the ideas and the debates on the great policy issues of the day.”38

He never mentioned his membership when campaigning because he— and everyone else in the audience—knows very well the sinister reputation the CFR has. Everyone laughed because they “got” why he never mentioned it. Despite masquerading as if it were just another benign committee in Congress and trying to hide in plain sight, Dick Cheney’s joke shows that they have not been able to fool everyone about the nature of their activities. This is the same organization that Hillary Clinton once admitted she goes to in order to be “told what we should be doing and how we should think about the future.”39

The CFR was founded in 1921 by Woodrow Wilson’s chief advisor Colonel Edward Mandell House; along with Paul Warburg, who was at the secret Jekyll Island meeting in 1910 which gave birth to the Federal Reserve Bank; Elihu Root, who was the Secretary of War under both President McKinley and Roosevelt; and a handful of other elitists who then received funding for their venture from the Rockefeller family.



Ron Paul

Congressman Ron Paul is one of the rare honest politicians who never sugar coated his statements and never shied away from criticizing his own party when he felt their actions were going against their principles throughout his 23 years as a Congressman from Texas.

At a book signing in 2008 he was once asked about the Bilderberg Group by a fan who videotaped the interaction and posted it on YouTube. “Did you hear about that recent Bilderberg Group meeting in Chantilly, Virginia?” the person asked.40

Ron Paul responded, “Yeah, recently there was one and there were some reports on it—I didn’t read a whole lot about it, but they certainly were there.”41

The person then asked what he thought they were doing, and Ron Paul responded, “Well, they probably get together and talk about how they’re going to control the banking systems of the world and natural resources— and we get together and talk about how we’re going to get our freedom back. So we have our own things to talk about too.”42

Ron Paul didn’t play dumb by pretending he didn’t know what the guy was talking about, and he didn’t laugh off his question either—instead, he answered it quite frankly, which is surprising for a politician, especially when it comes to talking about the infamous Bilderberg Group. Ron Paul (and his son Rand) are (and still may be, depending on what happens after this book is published) the only politicians in the last forty years (at the time I’m writing this) to have ever even uttered the word “Bilderberg,” and to have answered people’s questions in a serious manor is quite commendable.

It’s possible that with awareness of the Bilderberg Group spreading, more politicians may seriously address the issue when asked, since it’s almost impossible to pretend they don’t know about it at this point in time.



Rand Paul

Luke Rudkowski from the YouTube channel We Are Change asked Kentucky Senator and 2016 Presidential Candidate Rand Paul (son of Ron Paul) about the Bilderberg Group in 2012, and just like his father, instead of ducking the question, he answered it quite candidly.43

Luke: “Our organization confronted [Federal Reserve Chairman] Ben Bernanke on his ties with the Bilderberg Group. Do you know anything about the Bilderberg Group?”

 

Rand: “Only what I’ve learned from Alex Jones.”

 

Luke: “For the people who don’t know what’s going on can you tell people who are the Bilderberg Group, if you feel comfortable doing so?”

 

Rand: “I’m not probably the world’s expert on it, but I think it’s people who get together who are very wealthy people who I think manipulate and use government for their own personal advantage. And I think that’s the biggest thing that would help us combat this, is that they want to make this out like they’re just out to help humanity and world government will be good for humanity, but guess what? World government is good for their pocketbook. They’re very wealthy and they use

government to make more money for themselves and that’s where you expose them.”



John Rarick

In 1971 a member of the U.S. House of Representatives from Louisiana named John Rarick somehow heard about these meetings and became suspicious. He wanted to know if tax dollars were being used to pay for American officials to attend. John Rarick typed up a ten-page statement and actually entered it into the official Congressional Record.

His statement begins, “Mr. Speaker, on several occasions during recent months, I called the attention of our colleagues to activities of the Bilderbergers—an elite international group comprised of high government officials, international financiers, businessmen, and opinion-makers…”

“This exclusive international aristocracy holds highly secret meetings annually or more often in various countries. The limited information available about what transpires at these meetings reveals that they discuss matters of vital importance which affect the lives of all citizens. Presidential Advisor Henry Kissinger, who made a secret visit to Peking from July 9 to July 11, 1971, and arranged for a presidential visit to Red China, was reported to be in attendance at the most recent Bilderberg meeting held in Woodstock, Vermont, April 23 to April 25, 1971. The two points reportedly discussed at the Woodstock meeting were, ‘the contribution of business in dealing with current problems of social instability’ and ‘the possibility of a change of the American role in the world and its consequences.’”

He continues, “Following these secret discussions, which are certainly not in keeping with the Western political tradition of ‘open covenants openly arrived at,’ the participants returned to their respective countries with the general public left uninformed, notwithstanding the attendance of some news media representatives, of any of the recommendations and plans

agreed upon as a result of the discussions—or for that matter even the occurrence of the meeting itself.”44

Since Rarick’s statements in 1971, to date (at the time I’m writing this at least) no Congressman has even uttered the word “Bilderberg” on the floor of the House or the Senate, or anywhere publicly for that matter, other than Ron Paul and his son Rand as I previously mentioned.



President Dwight D. Eisenhower

President Dwight D. Eisenhower, best known for warning the world about the Military Industrial Complex in his 1961 farewell address, wrote a memo to his assistant in 1955 about that year’s Bilderberg meeting which took place in Barbizon, France. While Eisenhower didn’t mention them by name, it’s pretty obvious who he was talking about in the memo when he says, “I understand next week Prince Bernhard is having a meeting at Barbizon, continuing his exploration looking toward improving European and American relations. If personally you can fit such a trip into your schedule, I suggest you find the money and go to France.”45

Even though he didn’t mention “Bilderberg” by name, but he was clearly talking about them since Prince Bernhard was the founder and chairman of the Bilderberg Group at the time, and since the meeting was to focus on “European and American relations.”

Just a friendly reminder, or a heads up if you’re not aware—when leaving office in 1961 President Eisenhower warned, “In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military–industrial complex. The potential for the disastrous rise of misplaced power exists, and will persist. We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals so that security and liberty may prosper together.”

Unfortunately this rings even more true today than it did over 50 years ago when he said it and with the lies and broken promises from both major political parties in America regarding warrantless wiretapping, the use of

drones to assassinate people (including American citizens) and the never ending and always expanding War on Terror sparked by the attacks on September 11th 2001, it is clear the military-industrial complex has grown exponentially in size and power since President Eisenhower warned about it back in 1961.





CALIFORNIA SENATOR BARBARA BOXER REFUSES TO ANSWER ANY QUESTIONS ABOUT BILDERBERG AND ESCAPES IN A “SENATORS ONLY” ELEVATOR IN THE HART SENATE BUILDING IN WASHINGTON D.C.

LUKE RUDKOWSKI’S LIVESTREAMING RIG HE USED TO BROADCAST THE 2012 BILDERBERG PROTEST TO VIEWERS ON THE INTERNET.



Actions and Effects

What’s talked about at Bilderberg or the consensus that the group comes too, often soon finds its way into becoming policy around the world. From the decades of leaked documents and insider revelations it appears that the birth of new legislation, economic booms and busts, and even the start of new wars and military actions around the globe are often traced back to Bilderberg.

One of their primary goals has been to form a New World Order global government, and over the last sixty years they have made tremendous progress with most of their plans already accomplished. In today’s information age with popular independent media outlets and social media keeping an eye on the Bilderberg Group, it’s almost impossible now for them to stay a secret, but the decades of denials and media blackouts prove they have been deceptive from the start. Now that they are getting fairly well known, the denials and tactics of playing dumb have changed into trying to pass themselves off as an ordinary business conference like the G8, G20, or the Davos World Economic Forum.

David Rothkopf, the managing director of Kissinger and Associates, an international advising firm founded by the infamous Henry Kissinger, wrote a very interesting book in 2009 titled Superclass: The Global Power Elite and the World They are Making, where he discussed the ruling elite and the various organizations that largely influence the political and economic landscape of the world. While not revealing any earth shattering insider secrets, Rothkopf does confirm some of the persistent allegations made about the ruling class by so-called “conspiracy theorists.”

He wrote, “A global elite has emerged over the past several decades that has vastly more power than any other group on the planet. Each of the members of the superclass has the ability to regularly influence the lives of

millions of people in multiple countries worldwide. Each actively exercises this power, and they often amplify it through the development of relationships with others in this class.”46

He continues, “That such a group exists is indisputable. Heads of state, CEOs of the world’s largest companies, media barons, billionaires who are actively involved in their investments, technology, entrepreneur, oil potentates, hedge fund managers, private equity investors, top military commanders, a select few religious leaders, a handful of renowned writers, scientists, and artists, even terrorist leaders and master criminals, meet the above criteria for membership.”47

“In fact, [the Bilderberg Group, Trilateral Commission, and the World Economic Forum] are an important part of the story of the superclass. They are places to convene, places to network, places to cultivate relationships, places to share views. To paraphrase Mark Malloch Brown, they are the village greens of the global elite.”48

“The reality of these meetings and what they reveal about the informal mechanisms of power is much more interesting than the hyped-up conspiracy theories and their hysterical visions of total control.”49

He also admits that, “Bilderberg does its best to stay under the radar.”50 While he denies that they are planning “world domination,” he does say, “They share similar goals in many cases a similar view of the world and the direction it should take,” and that “In linking together with one another, they aim not to conspiracy as a group but to enhance their own power by advantageous associations.”51

Sociologist William Domhoff said that, “I believe there is a national upper class in the United States….this means that wealthy families from all over the country, and particularly from major cities like New York, San Francisco, Chicago, and Houston, are part of interlocking social circles which perceive each other as equals, belong to the same clubs, interact frequently, and freely intermarry.”52



Domhoff writes that elite social clubs are informal centers of policy making,53 and that these organizations are consensus-seeking and policyplanning organizations of the upper class.54

He concludes that, “I think it makes a very good case for the hypothesis that the social upper class is a ruling class, especially in light of the amazingly disproportionate amount of wealth and income controlled by that small group of families.”55

Another sociologist named Peter Phillips from the University of California, Davis, who earned his Ph.D. by writing his doctoral dissertation on the Bilderberg Group’s more informal sister organization, the Bohemian Grove, says, “Involvement of these socio-economic and political institutional leaders in the activities at the Grove [and Bilderberg] gives them extensive periods of off-the-record discussion time with campmates and other Bohemians [and Bilderbergers] about the prevailing social issues of the day… All of these chats and talks work toward the building of a consensual mind set regarding current political and social issues.…In other words the general parameters of major policy and socio-political decisions can and do evolve at the Bohemian Grove and [Bilderberg] Club.”56

Phillips concludes that secret elite gatherings like the Bohemian Grove and the Bilderberg Group “are examples of how elite consensus building around key policy issues occur. After the weekend each participant could then return to his own power base and proceed with individual action rooted in consensual understandings obtained on the weekend.”57

What kind of understandings is he talking about? Let’s find out.



Creating a One World Government

Despite denials for decades that the economic and political elite were secretly working towards a global government, one of the founding members of the Bilderberg Group who sat on the steering committee for 30 years once admitted that the critics aren’t entirely wrong. In 2001 when talking to Jon Ronson, a documentary producer for the BBC and author of Them: Adventures with Extremists, Denis Healy said, “To say we were striving for a one-world government is exaggerated, but not wholly unfair. Those of us in Bilderberg felt we couldn’t go on forever fighting one another for nothing and killing people and rendering millions homeless. So we felt that a single community throughout the world would be a good thing.”58

An Establishment insider and mentor of President Bill Clinton named Carroll Quigley published a book in 1966 for fellow ruling class insiders titled Tragedy & Hope: A History of the World in Our Time in order to help them understand how the world works and the elite’s vision for the future. Quigley, who was a professor at Georgetown University in Washington D.C. (the oldest Jesuit institution of higher learning in the United States— founded in 1789), knew that most of the general public doesn’t read books or newspapers and are more interested in sports entertainment and celebrity news than what’s happening in Washington D.C.

Quigley alluded to the Bilderberg Group when he wrote, “There does exist, and has existed for a generation, an international Anglophile network which operates, to some extent, in the way the radical Right believes the Communists act. In fact, this network, which we may identify as the Round Table Groups, has no aversion to cooperating with the Communists, or any other groups, and frequently does so. I know of the operations of this

network because I have studied it for twenty years and was permitted for two years, in the early 1960’s, to examine its papers and secret records.”

“I have no aversion to it or to most of its aims and have, for much of my life, been close to it and to many of its instruments. I have objected, both in the past and recently, to a few of its policies (notably to its belief that England was an Atlantic rather than a European Power and must be allied, or even federated, with the United States and must remain isolated from Europe), but in general my chief difference of opinion is that it wishes to remain unknown, and I believe its role in history is significant enough to be known.”59

Regarding the Federal Reserve and the financial domination by a handful of international banks, he said, “The powers of financial capitalism had a far-reaching aim, nothing less than to create a world system of financial control in private hands able to dominate the political system of each country and the economy of the world as a whole. This system was to be controlled in a feudalist fashion by the central banks of the world acting in concert, by secret agreements arrived at in frequent meetings and conferences. The apex of the systems was to be the Bank for International Settlements in Basel, Switzerland, a private bank owned and controlled by the world’s central banks which were themselves private corporations. Each central bank...sought to dominate its government by its ability to control Treasury loans, to manipulate foreign exchanges, to influence the level of economic activity in the country, and to influence cooperative politicians by subsequent economic rewards in the business world.”60

Quigley’s Tragedy & Hope is not a book “exposing” a “conspiracy” but rather a history book for elitists to help them understand how the Establishment works and what their plans are.



European Union

Documents from the 1955 Bilderberg meeting discovered at the estate of a deceased member show they were planning the European Union and a central currency back in the 1950s, decades before the EU was formed and their new Euro currency introduced.61 The documents came from the personal files of former Labour Party leader Hugh Gaitskell which had been stored at a local University after his death. They are marked “Personal and strictly confidential,” and “Not for publication either in whole or in part,” and were made available to the BBC during an investigation in 2003.62 Wikileaks also obtained the documents and then published them through their website.63

Gaitskell was part of Bilderberg’s steering committee and had attended the very first meeting in 1954 and kept years of the itineraries which included his own handwritten notes about the different speakers and topics. Historian Dr. Hugh Wilford showed Simon Cox of BBC Radio 4 the archive. “This is from Hugh Gaitskell to his friend and Labour Party colleague Dennis Healey in which he’s telling him about the conference. He describes it as a rather special kind of conference, very hand-picked with the proceedings private, and ends by saying that he hopes that he’ll be able to give Healey further details but meanwhile would you please treat the whole matter as absolutely confidential—say nothing about it to anybody,” explains Wilford.

Simon Cox: “So, real secrecy from the very beginning.”

Hugh Wilford: “Yes.”



Simon Cox: “Because you can see when you hear about the way that it’s set up, why people have these conspiracy theories.”

Hugh Wilford: “Yes, now I can quite see why that is the case, and the fact that so much secrecy was insisted upon for these early meetings, and I mean it doesn’t really necessarily look very good that the leader of the British Labour Party is consorting with various representatives of the secret services and American Capitalists and doing so in such a clandestine fashion, so yes, I can see why conspiracy theorists have sprung up and surrounded Bilderberg.”64

Simon Cox: “The papers show exactly what was discussed within the secret confines of Bilderberg. What’s striking is the degree of consensus reached by those at the meeting on contentious topics like European integration…Here’s another paper from the first ones about the European Union. It’s interesting here saying some sort of European Union has long been a Utopian dream, but at the conference it was agreed it was now a necessity of our times. So this is 50 years ago saying we must have a European Union.”

Hugh Wilford: “Yes, again reflecting the fact that many of the people involved in planning Bilderberg had also played leading roles in getting the European movement going in the late 1940s and early 50s.”

Simon Cox, the BBC investigator, concluded, “Without Bilderbergers, Europe could be a very different place.”

Two years after the documents discovered in Gaitskell’s estate were drawn up for the 1955 meeting, the European Union started to take shape with the creation of the European Economic Community (EEC) in 1957 which merged the markets of six European countries—France, Germany, Italy, Belgium, the Netherlands and Luxembourg. This later grew into the European Union in 1993 containing 28 nation states: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania,

Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom.

Sociologist Mike Peters from Leeds Beckett University in England confirms, “The single currency [the Euro] was rooted first by people who were connected with Bilderberg,” and concludes, “The sheer wealth and importance of the people who attend Bilderberg suggest that this is one of the most important political forums in the modern world.”65

Documents from Bilderberg’s less secretive sister organization, the Council on Foreign Relations, reveal they have plans for several other massive regional unions around the world, including the Eastern European Union, the Middle Eastern Union, an Asian-Pacific Union, African Union, South American Union, and a North American Union. Part of this plan includes unifying the currencies of each of these different unions as well. For example, in the case of the North American Union—Canada, the United States and Mexico would all use what has been proposed as the amero for all financial transactions.66

The idea is, once these various regional unions are formed, and their currencies unified, the final step will be to merge the unions (along with each of their respective currencies) into one global governing body, and at the same time introduce a global currency in the form of a digital dollar, ushering in the era of a completely cashless society.67 Some have proposed this new global currency be called the Phoenix, named after the mythological bird which is said to rise from the ashes of its predecessor after death in a cycle of rebirth and renewal.68 From ashes of the death of all previous currencies, the new global currency will emerge.



Selecting World Leaders

Many consider Bilderberg to be the Kingmakers or the place where a consensus is made about which political candidate the Establishment will throw their support behind and which ones they’ll throw under the buss. With the power to make major editorial decisions in the newsrooms of the world’s primary media outlets and by controlling the purse strings of the big banks and political financiers, they “can make or break presidents, popes, or prime ministers,” as the character Howard Beale famously warned in the classic 1976 film Network.

George Bush Senior attended in 1985 and became president in 1988. Bill Clinton attended in 1991 and then became president a year later. Tony Blair was invited in 1993 and became Prime Minister of England in 1997. Romano Prodi attended in 1999 and later that year he became president of the European Union Commission. In 2004, Senator John Edwards spoke with the group and was later chosen to be the Democratic vice presidential nominee by presidential candidate John Kerry, who—like his opponent George W. Bush—is a member of the Skull & Bones society which made it a win/win for the Establishment no matter who was chosen to be president.69

There was a surprising little mention of John Edwards covert visit by a reporter for the New York Times in an article about the VP selection process which noted, “Several people pointed to the secretive and exclusive Bilderberg conference of some 120 people that this year drew the likes of Henry A. Kissinger, Melinda Gates and Richard A. Perle to Stresa, Italy, in early June, as helping win Mr. Kerry’s heart. Mr. Edwards spoke so well in a debate on American politics with the Republican Ralph Reed that participants broke Bilderberg rules to clap before the end of the session.

Beforehand, Mr. Edwards traveled to Brussels to meet with NATO officials, brandishing his foreign-policy credentials.”70

The article then quoted an anonymous source and associate of John Kerry who was in attendance for Edwards’ debate, who said, “His performance at Bilderberg was important,” and admitted it was largely responsible for him being chosen as the candidate for Kerry’s vice president.71

Jim Tucker reported that in 1989 one of the agendas on the menu was ousting British Prime Minister Margaret Thatcher because she opposed surrendering Britain’s sovereignty to the European Union by refusing to join the EU.72 The following year people within her own party conspired, and succeeded, to replace her with John Major, who then helped facilitate the rise of the European Union, fulfilling Bilderberg’s long-held dream.

Again, Carroll Quigley openly revealed how it was to the elite’s advantage to have only two political parties for people to choose from and how they would be engineered to intersect at their core. The reason being, he said was, “The two parties should be almost identical, so that the American people can ‘throw the rascals out’ at any election without leading to any profound or extensive shifts in policy.”73

The meeting, which moves from country to country around Europe and the United States, is usually held nearby Washington D.C. on election years, which certainly can’t be a coincidence. Even if presidential candidates themselves don’t go, they often send their representatives to lobby to Bilderberg and highlight their associate’s usefulness and to report back to them after the meeting about what issues were discussed and what the consensus was on each topic.



The Iraq War

At the 2002 meeting, leaks revealed the consensus arrived was that the invasion of Iraq wouldn’t happen until Spring of 2003 when many in the mainstream media were anticipating the war would start in the late summer or early Fall of 2002.74 Jim Tucker reported that Donald Rumsfeld, who was then the Secretary of Defense, assured the Bilderberg Group that the invasion wouldn’t happen until the following year,75 which of course it did. Apparently some of the European allies needed more time to convince their people the invasion was “necessary” or to prepare to take advantage of the situation economically once it occurred.

As the world now knows, every reason given to justify the invasion of Iraq was a lie; from the hoaxes and fear mongering about their supposed weapons of mass destruction,76 to the fabricated yellow cake uranium documents,77 to the debunked claims about Saddam Hussein being involved with Al Qaeda and connected to the September 11th attacks.78 Some people point to the little known Washington D.C. based Neocon think tank the Project for the New American Century (PNAC for short) as laying out the strategy years earlier to maintain America’s dominance in the world by preemptively attacking foreign countries or inserting America’s military “even in conflicts that otherwise do not directly engage U.S. interests.”79

One PNAC document titled Rebuilding America’s Defenses (written in September of 2000) seems to suggest they needed a major catastrophe to occur in order to justify carrying out their plans. At one point it says, “Furthermore, the process of transformation, even if it brings revolutionary change, is likely to be a long one, absent some catastrophic and catalyzing event—like a new Pearl Harbor.”80



Of course, this “new Pearl Harbor” was the September 11th attack on the World Trade Center in New York City which has been cited as the reason for just about every restriction of liberty and expansion of military power ever since.81 Many people believe the attacks were allowed to happen on purpose in order to provide a pretext (reason) for implementing the Project for the New American Century’s plans, but this is whole other issue in and of itself.82

At the 2004 White House Correspondence dinner, the annual red carpet event where the White House wines and dines mainstream media reporters who are supposed to act as watch dogs carefully monitoring the government’s actions, President George W. Bush was cracking jokes about not finding any WMDs in Iraq. When he was at the podium addressing the crowd, a photo of him bending over looking under his desk in the Oval Office was put up on the screen as he said, “Those weapons of mass destruction got to be somewhere.” The audience laughs and applauds.83

“Nope. No weapons over there.” The laugher continues. Then another photo is shown of him bending over in an awkward position in another part of his office. “Maybe over here,” he says, as a devilish grin appears on his face. Much of the audience again laughs.

 

 





THESE PROTESTERS THINK BILDERBERG ARE “SCUM.”

  ME TALKING TO THE POLICE GUARDING THE MEETING TO LET THEM KNOW WHO THEY ARE PROTECTING.



Talk Show Hosts Play Dumb

Radio talk shows provide an interesting platform for news and commentary, and the most-listened to shows have audiences of millions and often include popular politicians (and even presidents) as their guests. A popular feature of the show’s format is that most of them take calls from the audience live on the air—well, live with a seven second delay, and calls that are pre-screened by a producer who first decides which ones will be put through to the host.

Many people are unaware that before a host puts a caller on the air, a producer first takes the call and if the question or comment is approved, that call is added to the call bank along with a note for the host about what the person wants to say. Occasionally myself and others have managed to get on the air with some of these hosts and instead of asking the question the producer approved during the screening process—we asked about Bilderberg or other blacklisted topics. Transcripts to some of those calls will follow, along with some footnotes which will show you where you can go to hear the archived audio clips for yourself.



Glenn Beck

When hosting his popular television show on the Fox News Channel, Glenn Beck once claimed that talking about the Bilderberg Group was going down a “tin foil hat road,” and said he didn’t care about the Bilderberg Group, and then compared them to a toy company.

In July 2010 he said, “The Bilderbergers had their meeting, I don’t really know much about these people, and I don’t really care. I know probably more about the Build a Bear people in the malls, and I know those people are brainwashing our kids with teddy bears. I don’t know what kind of secret meetings they have to get our kids into the bear industry, but I don’t like it. If the Bilderberg’s are half as evil as the teddy bear people, look out.”84

Beck then went on to say that those inside the Bilderberg meeting were probably talking about how to help the world. On his syndicated radio show he later joked that the Bilderberg Group were shapeshifting Reptilians.



Sean Hannity

On January 29th 2009 I got through on Sean Hannity’s radio show and asked him very nicely if could explain what the Bilderberg Group is and what they do. The call can be heard on YouTube and here is a transcript:85

Hannity: Mark, KFMB San Diego, next on the Sean Hannity Show— how are you Mark?

Mark: Pretty good, but with all this economic crises going on and everyone looking for answers and blame, I was wondering if you could talk about the Bilderberg Group and the role that they play in the global economy and geopolitics?

Hannity: I have no idea what you’re talking about. [drops call]. Let’s go to Amy in Cincinnati on 55KRC, what’s up Amy?



Michael Savage

After years of denying that Bilderberg had any significance or influence at all, Michael Savage later changed his tune and spoke quite candidly about them in 2010. A transcript of a call I made to him in 2009 went as follows:86

Savage: Right here on the Savage Nation—San Diego—Mark, go ahead please.

Mark: Let’s talk about the Bilderberg Group. You’re talking about conspiracies to bankrupt the economy—what can you tell the audience about the Bilderberg Group and why isn’t that mentioned ever in any mainstream media?

Savage: Well that’s like talking about the Council on Foreign Relations. It’s too esoteric for the audience. I don’t think we have to go any further than Obama, [Timothy] Geithner, Nancy Pelosi, Dianne Feinstein, and Hillary Clinton, is that enough for you? We don’t need a Bilderberg Group, we have the Democrat socialist group that I just mentioned.

Mark: Every year the Bilderberg Group meets in secret and Obama has [gets cut off]

Savage: We know this. We understand it but I don’t want to talk about some esoteric group called the Bilderberg Group. What good is going to come of talking about the Bilderberg Group which I’ve heard since 1990? Tell me what good’s going to come of it?



Mark: Why don’t we expose them? Maybe they’re violating the Logan Act [cut off again]

Savage: What needs to be exposed is Obama’s hypocrisy, so that the idiots finally get it and stop him before he does more damage. That’s what needs to be done. Not talking about some esoteric conspiracy group! You’re 100% wrong! Thanks for the call. [Savage drops the call]

Just one year later he had a totally different view. In a monologue in 2010 which was recorded and uploaded to YouTube by a listener, Savage said, “I gotta tell you, for the last few years I’ve been going through thoughts about leaving radio. I’m bored. Burned out. Sick of Obama. Sick of the communists and the Bilderberg Group taking over the media and the government. But something is happening. The Bilderberg schemers are losing control of the global game. The puppet masters are losing control of the marionettes. When you see that the Bilderbergs are meeting secretly right now and many of the same people who brought about the economic collapse [of 2008] by rigging the system are there doing it again—the same people who put Obama in power are there again, you have to understand the danger you’re in.”87



Rush Limbaugh

In 2010 Rush Limbaugh (who signed a $400 million dollar contract with Clear Channel in 2008 to do another eight-years of radio)88 gave a rather lengthy monolog about the Bilderberg Group after reading an article saying that Fidel Castro, the longtime Communist Cuban dictator, had just discovered them and expressed concerns about their power. Rush made Bilderberg sound like a big joke and something only “kooks” believed in, and appeared to attempt to link anyone who was interested or suspicious of the Bilderberg Group with Fidel Castro. A partial transcript of his monologue follows:89

Rush: I saw this yesterday afternoon and last night. The headline intrigued me. I read it and I started laughing out loud. “Fidel Castro Fascinated by Book on Bilderberg Club.” This is from the Associated Press: “Fidel Castro is showcasing a theory long popular both among the far left and far right: that the shadowy Bilderberg Group has become a kind of global government, controlling not only international politics and economics, but even culture. The 84-year-old former Cuban president published an article Wednesday that used three of the only eight pages in the Communist Party newspaper Granma to quote—largely verbatim—from a 2006 book by Lithuanian-born writer Daniel Estulin. Estulin’s work, ‘The Secrets of the Bilderberg Club,’ argues that the international group largely runs the world. It has held a secretive annual forum of prominent politicians, thinkers and businessmen since it was founded in 1954 at the Bilderberg Hotel in Holland.”90

This gets better. (laughing) They run the world, and they didn’t tell Castro. He’s just learning it here at 84 and he finds it fascinating. “Castro offered no comment on the excerpts other than to describe Estulin as honest and well-informed and to call his book a ‘fantastic story.’ Estulin’s book, as

quoted by Castro, described ‘sinister cliques and the Bilderberg lobbyists manipulating the public ‘to install a world government that knows no borders and is not accountable to anyone but its own self.’ The Bilderberg group's website says its members have ‘nearly three days of informal and off-the-record discussion about topics of current concern’ once a year, but the group does nothing else.” So they get together three days a year and control the world (joking).

They had a conspiracy, they didn’t tell Fidel about it, and he’s only learning about it now when he’s retired and can’t join it and do anything about it. Walter Lippmann created the Beatles to distract people. Not only that, the Bilderbergs created feminism to get men and women at war with one another to distract us while they destroyed world economies. That did work. (laughing)

Folks, from the very first day, back in Kansas City, when I uttered my first political comment on the radio, I was set upon by these conspiracy people. Oh-ho-ho-ho yes. They no longer bother with me. (Off air question by producer in Rush’s ear) I’ve never been to a Bilderberg meeting, Snerdley. No. I’ve never been to the Socialists International. I’ve never been to a CFR meeting or Trilateralist Commission meeting. Remember, I’m the guy that came up with the kook test. Yeah, the kook test was to distract people from me being part of the conspiracy. Yeah. Remember one of the questions on the kook test? (laughing) If trilateralist A is driving west at 60 miles an hour and the Council on Foreign Relations member B is driving east at 40 miles an hour, how long does it take for both of them to take over the world?



Alan Colmes

I personally called the Alan Colmes radio show and got on the air several times to try to get him on record about the issue. Colmes once hosted a show with Sean Hannity on the Fox News Channel called Hannity & Colmes between 1996 and 2009 but he was dropped by the network and the show renamed just Hannity. One call made on February 2nd 2009, which I saved from the show’s archive and posted on YouTube, goes as follows:91

Alan: Hello.

Mark: Don’t the American people deserve to know that Obama met with the Bilderberg Group and why is it that you won’t talk about them ever?

Alan: Because we talk about them when people like you call up to spread these crazy conspiracy theories. [Colmes drops the call]

Someone else once got on the air and asked him a very normal, rational question about Bilderberg. Someone (perhaps the caller himself) posted the audio on YouTube in 2012. Colmes again ridicules the caller:92

Caller: I was curious—what’s your take on the theory that the Bilderberg Group basically groomed Obama [Colmes cuts off the caller]

Colmes: Oh, cut it out with the Bilderbergers already, it’s a bunch of crap. C’mon.



Caller: Well you hear a lot about it.

Alan: Yeah, yeah, you hear a lot about it from conspiracy freaks.



Dennis Miller

A caller in 2009 got on the air on the Dennis Miller show and asked him about Bilderberg as well. Here is a transcript of that call, which can also be heard on YouTube.93

Miller: Keith in Texas, what’s up?

Caller: Hey Dennis. Great show. I went to my first Tea Party July 4th and I learned a lot of things, but I came out worried because as a Texan, here we have Rick Perry and he’s running for governor against Kay Bailey Hutchisun, and some people say he’s going to be running for president possibly. The thing that bothers me is I saw on News 8 in Austin—local news here—about him attending the Bilderberg conference, and that concerns me because [Miller cuts off caller and drops the call].

Miller: Aw, that’s creeping me out, I’m sorry baby, I’m going to rock. I need my “burgs” with an “erg” at the end, as in James Cameron’s Titanic. Once you start spelling it otherwise I get conspiracy and I don’t have time right now. You know there’s certain words as soon as you hear them. When a guy says “Bilderbergian” and you say ‘can you explain that’ and they keep going, you know that they…in the middle of appearing measured, he’s dropped a huge steaming ideological cow pie, and you should move on from it. Alright. Dennis Miller Show. [Cuts to commercial]



Fareed Zarkaria

Just before the 2011 Bilderberg meeting, CNN’s Fareed Zakaria wrote a blog on CNN.com titled “Why do we embrace conspiracy theories?” which started out saying how a lot of people on Facebook and Twitter were asking him about President Obama’s birth certificate being faked and saying they thought Osama Bin Laden’s death was possibly staged.

“The propensity of Americans to embrace conspiracy theories has long been attributed to their great suspicion of state authority,” he says. “America was founded as a revolt against centralized power and there has always been a fear of coordinated action taking place in the dark behind closed doors. American conspiracy theories implicate Wall Street, the Federal Reserve, the U.S. government, the intelligence community and many others.”94

He continues, “I can’t tell you how many times people ask me about the conspiracy of the Bilderberg Group. It is a conference I’ve occasionally been invited to and have attended once or twice.” He admits he has attended once or twice? You’d think a person would remember if they’ve been to the historic Bilderberg meeting once or if they came back a second time since it’s kind of a big deal.

He went on to say, “If only the people who wrote the alarmist treatises on the Bilderberg Group were allowed in. They would be so utterly disappointed. It’s just a conference like dozens of others around the world. And anyway, the idea that a finance minister or a banker would say something with a group of 150 people that is any different than what he would say in public is crazy in today’s world where everything leaks instantly. In my experience, they say the same fairly banal platitudes inside as they say outside.”95



Fareed says that inside the meeting men speak the same way they do in public? And they don’t say anything at Bilderberg they don’t say publicly? Why the Chatham House Rule then? Why all the secrecy and denials for decades? Why not just broadcast Bilderberg live on C-SPAN if it’s “just another conference” like dozens of others around the world?

He concludes his blog post saying, “So on the few occasions in my life when I’ve been inside centers of the conspiracy, I’ve been disappointed and relieved to find they were pretty much like the world on the outside.”96

 



Bilderberg’s Goals

A Global Socialist Government

Often called the “New World Order,” a primary goal of the Bilderberg elite is to integrate all the world’s governments into one unified system. The United Nations was basically the beginning of this, but in order to accomplish the final phase of their plan, the sovereignty of the United States and all other countries would have to be eliminated—and their laws, militaries, and Constitutions all placed under a single planetary political authority.

The New World Order plan also consists of making this super State a socialist system that will function as a Nanny State which will “take care” of all humanity through massive redistribution of wealth, huge subsidies, and unlimited free handouts to those who don’t work, funded through exorbitant taxes on those who do.

Presidents from George Bush Senior to Bill Clinton and Barack Obama have all publicly proclaimed that their goal is to form a New World Order, and the justification is always a current crisis that this New Age will supposedly solve. Just three days after the 9/11 attacks in 2001, the co-chair of the Council on Foreign Relations (and Bilderberg member) Gary Hart stated, “There is a chance for the President of the United States to use this disaster—to carry out what his father—a phrase his father used I think only once, and it hasn’t been used since—and that is a New World Order.”97



Longtime Bilderberg member and financier Henry Kissinger stated that the problems Barack Obama’s administration was facing regarding the ongoing War on Terror and the economic collapse of 2008, “can give new impetus to American foreign policy partly because the reception of him is so extraordinary around the world. His task will be to develop an overall strategy for America in this period when, really, a New World Order can be created. It’s a great opportunity, it isn’t just a crisis.”98

This is the same man who, according to Bob Woodward and Carl Bernstein—the reporters who blew open the Watergate scandal, refers to members of the U.S. military as “dumb, stupid animals” who are used as pawns for America’s foreign policy.99

Perhaps the most infamous admission is when George Bush Senior stated the purpose of the Gulf War was to implement the “big idea” of the “New World Order.” James Warburg, the son of Paul Warburg, the “father” of the Federal Reserve Bank, said at an appearance before the U.S. Senate Committee on Foreign Relations that, “We shall have world government, whether or not we like it. The question is only whether world government will be achieved by consent or by conquest.”100

One of the problems is that in order for this to happen, some of the freedoms and policies we cherish in the United States will have to be eliminated and repealed. During his acceptance speech when receiving the United Nations Global Governance Award in 1999, the former anchor for CBS News—Walter Cronkite—told the audience that all the countries in the world, “are going to have to be convinced to give up some of that sovereignty to the better, greater union, and it’s not going to be easy.”101

We’ve already seen the United Nations try to change laws in the United States claiming their authority exceeds that of our state and federal governments. For example, after Colorado, Washington, Oregon, and Alaska legalized recreational marijuana use, the UN declared it was against international law and is trying to assert their authority over the states’ decision to legalize pot.102



The UN continues to adopt new “hate speech laws” which seek to criminalize speech (and books) that some see as “discriminatory,” which is an obvious violation of America’s First Amendment, but in the age of political correctness gone amuck, many in the United States and other supposedly “free” countries are actually supporting such tyrannical legislation.103

It must be emphasized that this “global government” is not something that started at the grass roots level and has worked its way up the channels of government—it is exactly the opposite. The plan was started (in secret) at the very highest levels of powerful corporations and private organizations which function to influence international policy for their own benefit.

The plan for a New World Order global government is also something that was called “just a conspiracy theory” for decades, but in recent years it is now obviously happening and being promoted by countless politicians and heads of international corporations as something the average citizen should embrace with open arms.



Global Currency and Cashless Society

As previously mentioned, the personal papers of UK’s Labour Party leader Hugh Gaitskell revealed that ever since their beginning in the 1950s, Bilderberg was working towards the creation of a unified Europe and common currency.104 In more recent years they have been tirelessly attempting to replicate that formula with other regional territories and currencies, with the ultimate goal of finally merging them all into one global digital currency and eliminating cash and coins (as well as gold and silver) as mediums of exchange. On the surface, a global unified currency may seem appealing due to its ability to be used universally anywhere throughout the world without having to exchange currencies when traveling or spending money in different parts of the world, but there are many downsides which are often overlooked, ignored, or covered up.105

Credit and debit cards of course were the first phase of the cashless society, and recently a major leap occurred when Apple Pay and the Apple Watch rolled out in April of 2015.106 Fewer and fewer people are using cash, or even carrying any of it in their wallet at all. A study in 2014 showed that almost half of Americans carry $20 or less on them when they leave the house, eighty percent carry less than $50, and about ten percent of people carry no cash at all.107 Many Millennials and those in Generation Z see cash as old fashioned and something that grandma and grandpa used to buy things with before the digital age.

A growing number of banking officials are pushing hard to have cash eliminated as soon as possible. In April of 2015 a top Citibank economist suggested that cash should be abolished, and in order to coerce people into going digital, he also proposed the use of cash should be taxed at such a high rate that it would discourage most people from using it at all.108 Jim Leaviss, a banker with M&G investments in the UK, soon followed by

suggesting outright banning cash. “Forcing everyone to spend only by electronic means from an account held at a government-run bank would give the authorities far better tools to deal with recessions and economic booms,” he said.109

He also suggested negative interest rates (i.e. fees) on anyone who kept large amounts of money in their checking or savings account, and proposed the government could fluctuate these fees in order to encourage people to spend the money they have, rather than just lose it on fees, if the government wanted people to pour more money into the economy. “And once all money exists only in bank accounts—monitored, or even directly controlled by the government—the authorities will be able to encourage us to spend more when the economy slows, or spend less when it is overheating,” Leaviss concluded.110

For years now, when you’re on an airplane, if you want to buy something from the snack cart, many of the flight attendants only accept debit or credit cards.111 Many will literally not accept cash for the food or drinks. Buying anything with cash these days is seen as suspicious. Storing cash in safe deposit boxes is against the rules at many banks, and the FDIC even suggests against it and urges people to deposit any and all cash they may have into a bank account instead.

In fact there are countless cases of police confiscating people’s cash when they haven’t even been arrested or charged with a crime.112 It’s called Civil Asset Forfeiture, which allows police and other government agencies to literally confiscate the cash a person is carrying when they are pulled over for a routine traffic stop because the cash itself is seen as suspicious. Even if there is no evidence it was obtained by criminal means, police still have the authority to take it on the spot because the money itself is seen as evidence of a crime, even if no arrest is made and there is no actual evidence of a crime, and no one has claimed the person has committed one.113



If you just sold an old car, motorcycle, or boat for a few thousand dollars cash, or if you happen to be traveling with an envelope of it on your way to poker night with guys—if it is discovered by police during a routine traffic stop, they can (and do all the time) confiscate it, even if there are no illegal drugs, weapons, or any evidence at all that the money was obtained illegally.114 You are guilty until proven innocent.

In the past, concerns about the approaching cashless society were ridiculed when so-called “conspiracy theorists” in the 1990s and early 2000s would warn about it getting close, but now that it is actually being implemented, those decades of denials are ignored and the new system is being promoted from the top down as the key to a consumerist Utopia.

Did you just buy a pregnancy test? Some medication to treat an embarrassing medical condition? Are you seeing a psychiatrist or a therapist for some mental health issues or personal problems? Did you purchase some personal items for you and your spouse to use in the bedroom? Are you buying certain books that the government may misinterpret as suspicious? In a cashless society, all of these transactions and more are basically made available—not only to the government—but to countless third parties such as advertisers and international corporations who have access to your entire purchasing history due to the terms of service you implicitly agreed to with the use of a debit or credit card.115

Not to mention, the centralization of all points of purchase and relying on one single digital network to facilitate them all is begging for trouble in the event there is a systemwide failure. A power outage, computer glitch, or a cyber-attack would be absolutely devastating to perhaps tens or hundreds of millions of people, completely crippling their ability to purchase gas or food, or even buy a bus ticket or subway pass to get home from school or work.



Global Military Force

In attempts to supposedly put an end to war, the plan is to unite all the different militaries around the world into one supranational security force that will be directed based on the decisions of the globalist leaders. The beginning of the “Global Police” can be seen with NATO soldiers and UN “Peacekeeper” troops which are comprised of people from many nations and may be deployed by any nation-state that is a partner.116

Agencies like DARPA (the Defense Advanced Research Projects Agency) are working to make these military men and women virtually invincible. The quest for Super Soldiers has led to the design of exoskeleton suits that give the people wearing them super strength and speed.117 President Obama once joked that “We’re building Ironman,” referring to the Marvel comic book character who uses an exoskeleton suit to fight crime, but these systems are no longer science fiction.118 It has also been proposed that military soldiers have neural interface implants wired into their brains, turning them into literal cyborgs by merging man with machine in a “Transhumanist upgrade.”119

Department of Defense documents drawn up in 1996 detail their plans to implant neural interfaces in soldiers’ brains—and in the heads of the civilian population as well. One document titled Information Operations: A New War-Fighting Capability outlines technology they hoped to have in place by the year 2025, and reads, “The implanted microscopic brain chip performs two functions. First, it links the individual to the IIC [Information Integration Center] creating a seamless interface between the user and the information resources. In essence, the chip relays the processed information from the IIC to the user, second the chip creates a computer generated mental visualization based upon the user’s request.”120



The documents claim such things would help increase security, saying, “An implanted microscopic chip does not require security measures to verify whether the right person is connected to the IIC [Information Integration Center], whereas a room, helmet, or sunglasses requires additional time-consuming access control mechanisms to verify an individual’s identity and level of control within the Cyber Situation.”121

The document addressed the expected resistance to such devices, saying, “Implanting ‘things’ in people raises ethical and public relations issues. While these concerns may be founded on today’s thinking, in 2025 they may not be as alarming,” and goes on to say, “The civilian populace will likely accept any implanted microscopic chips that allow military members to defend vital national interests.”122

The finale phase of the plan is to replace most human soldiers with Terminator-style artificially intelligent robots. This was thought to be science fiction just a few years ago, but has recently become a serious endeavor by the United States and militaries around the world.123 Robotic soldiers, whether in the form of Unmanned Aerial Vehicles, TALON tanklike robots, or android Terminators, would follow orders without question, no matter how unethical or inhumane they were.124

Elon Musk, founder and CEO of Tesla Motors and SpaceX, revealed in his authorized biography that he is concerned that Google’s planned artificially intelligent robot army may end up exterminating the human race if it gets out of control or perceives our species as a threat to its existence. “Please note that I am normally super pro technology and have never raised this issue until recent months. This is not a case of crying wolf about something I don’t understand.”125 He equated creating artificial intelligence with “summoning a demon.”126

Other leaders working in information technology and science have also recently expressed concerns that the creation of an AI could be disastrous for humans. Stephen Hawking has warned it could be the biggest mistake in the history of humanity,127 Microsoft founder Bill Gates has

stated he’s not sure why more people aren’t concerned,128 and Apple cofounder Steve Wozniak, who once dismissed such fears as unfounded, has recently changed his mind due to the rapid advance of AI and is now warning an artificial intelligent entity could enslave the human race and treat us like pets.129



Elimination of Right to Bear Arms

In the New World Order “socialist Utopia” everyone will supposedly live in peace and harmony, with the global government taking care of everyone’s needs and protecting them like a loving parent or big brother. A primary promise of this new era is that supposedly “nobody needs to own guns” except the government, which is said to be the only group that can be trusted to use them responsibly. In order to finally eliminate crime, officials claim they need to ban citizens from owning guns and repeal the Second Amendment in the name of peace and prosperity.

Incrementally the Second Amendment of the Constitution has been slowly eroded, and with every gun tragedy that’s turned into a national story, more and more restrictions are placed on gun owners and the types of guns and accessories that can be sold to the public.130 Instead of addressing the underlying causes of violence, the guns themselves are blamed and said to be the problem, not a symptom of it.

Many have tried to argue that the Second Amendment of the American Constitution does not declare that citizens have the right to own guns.131 This argument is absolutely absurd but continues to be repeated by those on the left who believe it was put in place to authorize the government to own guns, which is 100% the opposite of its purpose.132 It was specifically included in the Bill of Rights to ensure ordinary citizens have the right to own guns as a way to—not only protect themselves and their families from burglars and thugs—but also to serve as a deterrent to prevent the federal, state, or local government from abusing its power and violating basic civil liberties of Americans.

Rapper Ice-T summed up the purpose of the Second Amendment during an interview on British television when he was asked by Krishnan

Guru-Murthy, anchor of Channel 4 News, if he has any guns at home. “Yeah, it’s legal in the United States. It’s part of our Constitution. You know, the right to bear arms is because that’s the last form of defense against tyranny. Not to hunt. It’s to protect yourself from the police.”133

In 1997 Britain basically outlawed all guns and the law has been a blueprint Bilderberg hopes to duplicate around the rest of the world.134 Slowly but surely they are making progress with many political pundits on television repeating their talking points about how now is the time to follow Britain’s lead and round up Americans’ guns for everyone’s safety.135

Former Attorney General Eric Holder once stated on C-SPAN2 that the government needed a new strategy to change the way people thought about the Second Amendment, and concluded, “We have to be repetitive about this. We need to do this every day of the week, and just really brainwash people into thinking about guns in a vastly different way.”136

CNN’s Fareed Zakaria, who is a member of the Bilderberg Group,137 the Council on Foreign Relations, and Skull & Bones’ sister society Scroll & Key at Yale University, argues that the Bill of Rights are outdated and should be “fixed” in order to remove the Second Amendment to “modernize the Constitution for the 21st Century.”138

China’s official government-run news agency, Xinhua, has also demanded the United States tighten up gun control laws in America.139 The United Nations has long wanted the American Second Amendment repealed, and is attempting to do so incrementally through small arms treaties.140 Before you say “this couldn’t happen in America,” stop and think about all the freedoms that have been lost over the last generation, and see how quickly people forget.



Population Reduction and Stabilization

Because of healthcare advances and the continued exponential expansion of the world’s population, many Bilderbergers fear that the earth does not have the natural resources to sustain the current population, let alone if it continues to increase. As far back as the 1970s environmentalists and the political elite were warning the planet’s population would soon balloon out of control and cause a global catastrophe.141

The billionaire founder of CNN, Ted Turner (who has five children himself), once remarked, “There’s too many people. That’s why we have global warming. We have global warming because too many people are using too much stuff, if there were less people, they’d be using less stuff.” After drastically cutting greenhouse gas emissions, he said “We’ve got to stabilize the population.”142

He went on that, “Not doing it will be catastrophic. We’ll be 8 degrees hotter in 10, not 10 but 30 or 40 years and basically none of the crops will grow. Most of the people will have died and the rest of us will be cannibals. Civilization will have broken down. The few people that are left will be living in a failed state like Somalia or Sudan. And living conditions will be intolerable. The droughts will be so bad there will be no more corn growing. Not doing it will be like suicide.”143

Agenda 21 is a program launched by the United Nations in 1992 to deal with what they call “sustainable development” around the world, focusing on changing consumption patterns, preserving natural resources, and moving to more renewable energy sources. Part of Agenda 21 (the 21 meaning the 21st century) includes implementing birth control programs to slow down the population growth. The United Nations Population Fund, which was supposed to provide supplies and services for reproductive

health and birth control in third world countries, was discovered to have also been involved with secret sterilizations and forced abortions.144

President Obama’s chief science advisor John Holdren once wrote a book which proposed adding sterilants to nations’ water supplies,145 forcing women to get sterilized after their second child,146 and making them have abortions if they got pregnant for a third time.147 The book, titled Ecoscience, reads, “Indeed, it has been concluded that compulsory population-control laws, even including laws requiring compulsory abortion, could be sustained under the existing Constitution if the population crisis became sufficiently severe to endanger the society.”148 [Compulsory means forced or mandatory, by the way]

Some see even more sinister methods on the table in order to accomplish this goal. The mysterious Georgia Guidestones monument calls for a global population of only 500 million people. The strange monument consists of four giant slabs of granite which stand 19-feet-tall, laid out in a paddlewheel formation, each with 10 different commandments carved into each of their eight faces, each one in a different langue (English, Spanish, Chinese, Russian, Swahili, Hindi, Hebrew, and Arabic). The structure, sometimes called “America’s Stonehenge,” is also said to contain the “Guides to the New Age.” It was built in 1980 and stands in the middle of nowhere in a field in the state of Georgia and is the creation of an unknown man who said he represented an unnamed group who wanted the monument built. Some call it the 10 Commandments of the New World Order since some of the “Guides” call for a global government, a one world universal language, and says the overpopulation of humanity is a “cancer on the earth.”



Total Surveillance Society

There will be no more privacy if Bilderberg gets their way; no more anonymity, no more secrets—at least for the majority of us “regular folk.” Members of the Party [the government] in George Orwell’s Nineteen Eighty-Four could actually turn off the Telescreens in their homes, a luxury ordinary citizens didn’t have; and the billionaires of Bilderberg will likely include some safeguards to ensure their own privacy remains in place while the rest of the world is forced to live in a fish bowl with everything we say, everywhere we go, everything we do, and everything we buy recorded, catalogued, and stored indefinitely.149

Facial recognition systems have been beta tested since the 1990s and are now fully operational and being used at Las Vegas casinos,150 hotels,151 shopping malls,152 sporting events,153 airports,154 government buildings,155 and on the streets of major cities.156 Edward Snowden, the NSA whistle blower, confirmed what many had suspected for some time—the U.S. government had a science fiction-like system capable of recording all electronic communications and hacking into people’s email, social media accounts, and cell phones with the click of a few keys, and with virtually no oversight or constraints.157

Smart TVs and artificial intelligent personal assistants like Siri, Amazon Echo, and Jibo have the capability to remotely record the most personal of moments and conversations within people’s homes and bedrooms.158 Orwell’s Nineteen Eighty-Four, which was published back in 1949, reads, “The telescreen received and transmitted simultaneously. Any sound that Winston made, above the level of a very low whisper, would be picked up by it, moreover, so long as he remained within the field of vision which the metal plaque commanded, he could be seen as well as heard… You had to live—did live, from habit that became instinct—in the

assumption that every sound you made was overheard, and, except in darkness, every movement scrutinized.”159

Of course the argument is always, “if you don’t have anything to hide, then you have nothing to fear,” but as Thomas Jefferson once stated—if you give up liberty in the name of security, you will have neither. In the name of “safety” and convenience, most people have willingly given up every last bit of privacy in our digital age. Most haven’t even considered what could happen if civil liberties continue to slip or if the government were to grow too powerful and get out of control.

The ability of government agencies to profile, Orwellianly discriminate against, or target individuals for IRS audits, ordinance violations, or other forms of harassment based on their religious, personal, or political views is a reality everyone is now vulnerable to getting swept up in.160

Most major software developers and hardware manufactures have been coerced into building backdoors into their products so the government can easily remotely access people’s devices and cloud accounts, as well as bypass any encryption that has been applied to their files.161 The NSA even has a program where they intercept laptop computers and other products customers order online and then install special spyware and hardware on them and then package the items back up and send them on their way.162

William Binney, a former high-level NSA official who worked for the agency for more than 30 years, resigned in 2001 after he discovered the surveillance systems they were using gave the government the potential for what he called “a turnkey totalitarian state.”163 His home was raided by the FBI in 2007 after he was suspected of leaking classified information to the New York Times about the NSA’s spying programs. He was never charged with a crime and the read was seen as a show of force to intimidate any potential whistleblowers from reviling what the NSA was doing.



Some even see the omnipresent surveillance system growing far beyond just eyes and ears, into something so strange it sounds like science fiction. Tech titans are working to give birth to an artificial intelligent “God” that they hope will solve humanity’s problems and intimately watch over everyone like a guardian angel, using its super intelligence to do “what’s best” for humanity.164

See my previous book Big Brother: The Orwellian Nightmare Come True if you would like to read the details of the shocking parallels between George Orwell’s classic novel Nineteen Eighty-Four and our current society in terms of actual NSA high-tech spy systems, mind-reading machines, secret government projects, advanced weapons, and emerging artificial intelligence systems.



Mainstream Media Uniformity

To manage the minds of billions of people, the information those people receive about the world must be carefully managed. Information is power, and mass communication systems are central sources of this power. People often point to Communist countries and their state-run media as examples of propaganda, while thinking places like the United States has a “free press,” but the fact is the mainstream media in America is carefully controlled as well.

Edward Bernays, considered to be the ‘father of public relations,’ wrote, “Those who manipulate the unseen mechanism of society constitute an invisible government which is the true ruling power of our country. We are governed, our minds are molded, our tastes formed, our ideas suggested, largely by men we have never heard of...in almost every act of our lives whether in the sphere of politics or business in our social conduct or our ethical thinking, we are dominated by the relatively small number of persons who understand the mental processes and social patterns of the masses. It is they who pull the wires that control the public mind, who harness old social forces and contrive new ways to bind and guide the world.”165

He went on to admit, “Whatever of social importance is done today, whether in politics, finance, manufacture, agriculture, charity, education, or other fields, must be done with the help of propaganda. Propaganda is the executive arm of the invisible government.”166

In America this is done through a combination of the centralization of media ownership and through secret government programs which work to influence the news and entertainment media. In the 1970s a Senate investigation uncovered the CIA’s media manipulation program called

Operation Mockingbird, which was paying a billion dollars a year (in today’s dollars adjusted for inflation) to the top editors and journalists of every major newspaper and television network to function as covert gatekeepers and propagandists for the government.167

The director of the program, Thomas Braden, would later admit, “If the director of the CIA wanted to extend a present, say, to someone… suppose he just thought, this man can use fifty thousand dollars, he’s working well and doing a good job—he could hand it to him and never have to account to anybody...There was simply no limit to the money it could spend and no limit to the people it could hire and no limit to the activities it could decide were necessary to conduct the war—the secret war...It was multinational.”168

According to the Congressional report into the matter, which was published in 1976, “The CIA currently maintains a network of several hundred individuals around the world who provide intelligence for the CIA and at times attempt to influence opinion through the use of covert propaganda. These individuals provide the CIA with direct access to a large number of newspapers and periodicals, scores of press services and news agencies, radio and television stations, commercial book publishers, and other foreign media outlets.”169

Of course the CIA and top media figures deny such thing continues today—a claim which is absurd and demonstrably false. The Mockingbird program [or whatever codename it operates under today] keeps certain stories out of the news or at least prevents them from being a top story, and also functions to direct the news networks to highlight specific stories or cast them in a certain light. Top stories and issues stuck circling in the news cycle for days or weeks are often carefully chosen for specific purposes.

Even seemingly innocent entertainment is often covertly controlled and carefully crafted to function as propaganda. It’s an open secret that the CIA and the Department of Defense have Entertainment Liaison Offices which work directly with Hollywood producers and writers to help them

make TV shows and blockbuster movies that deliver certain political messages in their story lines.170 Shows like 24 and films like Zero Dark Thirty were used to promote the idea that suspected terrorists need to be tortured in order to save people’s lives, and that the heroes sometimes have to break the rules in order to save the day.171

These liaison offices also provide consultants, access to military bases which are used for shooting locations, expensive equipment like aircraft carriers, jets, tanks, etc., which are used in the projects, and even uniformed U.S. military soldiers who serve as extras.172 In exchange for this priceless equipment, large numbers of extras, and access to actual military bases; TV and film studios agree to turn over the final script approval to the entertain liaison officers who make changes in screenplays in order to mold them into delivering the message they desire and have the final say over the plot.173

The emergence of social media has provided a problem for the dominant traditional media outlets, since they give anyone the ability to potentially have their message reach just as many people as content distributed through the mainstream media channels. While this has empowered the average person who can write a blog, post something on Facebook, or upload a video on YouTube and make it available for anyone to see, the corporate controllers have been scrambling to attempt to control this medium as well.

Facebook and Instagram can—and do—make content containing specific keywords, certain hashtags or pictures, disappear down the memory hole and the posts just don’t show up on others feeds or in searches.174 These services can prevent posts from going viral by limiting their distribution, largely without anyone detecting a post is being censored.175 By using these popular social media and video sharing services, everyone must agree to their terms of service, which allow these companies to restrict free speech under the banner of what they deem “inappropriate.”176 People are locked out of accounts as punishment for several days or have their entire account shut down for “violating the terms of service” if they post something the companies have deemed violates their standards.177



By the time most of these major social media companies became widely used by the public, they were quietly purchased by massive corporations after being auctioned off at the secretive Sun Valley Conference which is held in Idaho every summer.178 This small gathering in a remote town brings together the newest social media startups to meet with the current big names in technology, media, as well as heads of the CIA, NSA, and other government agencies where they come to a consensus on how to deal with new, independent communication companies and emerging technology.179

It’s a Brave New World, and even though we’re living in the Information Age, most people unfortunately couldn’t care less about current events, history, or the direction society is headed. They instead have become lost in an entertainment wasteland and are constantly streaming digital distractions to occupy their mind with meaningless gibberish, crude comedy, and gratuitous violence in what many people now consider to be an Idiocracy or the Entertainment Age.

 



Conclusion

Is the press in America really free and independent when, for over 50 years, every major American newspaper and television network have buried their heads in the sand each year when the Bilderberg Group meets? Did they all just miss the story year after year, decade after decade? No news editor or journalist can honestly say the annual meeting isn’t interesting and newsworthy. Certainly it can’t be called a coincidence when word of Bilderberg began to go viral through social media and alternative news websites, that finally some mainstream outlets began mentioning it in passing—almost always, of course, pointing out that “conspiracy theorists” were suspicious.

Their tax returns show that media companies like the Washington Post have literally helped to pay for their meetings, and major talk radio show hosts who have their finger on the pulse of politics in America have either played dumb pretending to know nothing about Bilderberg, or ridiculed anyone asking reasonable questions about the group or their activities.

Perhaps now that they’ve been forced out of the shadows, Bilderberg will attempt to “go legit” and pretend the decades of denials, news blackouts, and ridicule of the “conspiracy theorists” who are curious or concerned about them just didn’t happen at all. As we’ve seen countless times throughout history, after corrupt politicians and corporate leaders repeatedly dodge questions, deny facts, and ridicule inquiries—the truth of their activities eventually comes out.

Everyone knows that politics is a dirty business and lying is pretty much the only policy politicians are consistent on. They flip flop, they soften their positions in order to gain favor with certain groups and avoid offending others hoping to get elected, and if anyone knows anything about politicians and billionaire businessmen it’s that they will do anything to

gain and maintain their power. The list of massive deceptions perpetuated by those in power is long. “There are Weapons of Mass Destruction in Iraq.” “The NSA isn’t spying on American citizens.” “If you like your health insurance policy, you can keep it.” “Read my lips, no new taxes.” And now we can add “the Bilderberg Group is just a conspiracy theory,” to that list as well.

In 2011 when the digital dam began to burst, and the Drudge Report first posted about it, Forbes magazine finally decided to write an article which started off saying, “The annual Bilderberg Conference will convene this weekend, thus throwing the Internet into a tizzy,” and that “Conspiracy theorists believe the Bilderbergers control the course of world events. That through crisis and uncertainty they steer society’s great developments with an ultimate goal of establishing a New World Order.”180

After making the customary dig at “conspiracy theorists,” the Forbes article surprising got somewhat serious, saying, “It is certainly concerning that representatives from Washington, Wall Street and the media will meet with no account of their dealings or details of their plans. Their counterparts from across the North Atlantic will attend too. It reeks of collusion and intrigue. The lack of transparency and potential for concentrated power spurs the imagination, while unsettling the mind. The media, despite some of its most influential personalities participating, will ignore the proceedings.”181

That same week Time magazine also broke their silence, admitting, “In the past few years, the mystery surrounding the Bilderberg group has faded slightly because of interest from journalists,” and as expected, added, “the defenders of the ‘conspiracy theory’ who keep denouncing the ‘Illuminati’ are still active.”182

Only time will tell what happens regarding the Bilderberg Group’s secret history. You can’t put the toothpaste back in the tube, as the saying goes, so I wrote this book as a record of the decades of denials and news blackouts of one of the world’s biggest conspiracy facts.



Unfortunately most of their work is pretty much done. The New World Order global government is in its final phase; the Big Brother Orwellian surveillance systems have been built to track, trace, and database all electronic communications;183 the American Constitution has been subverted; most of the population has been sedated, distracted, and dumbed down through endless entertainment available at the click of a mouse or the tap of a finger. But thankfully at the same time, the era of Bilderberg’s secrecy is coming to an end, and for those who take the time to research things for themselves instead of just consuming what the mainstream media is dishing out, a clear vision of reality can come into focus.

Thanks for reading this book to the very end. I hope you have found it concise and to the point without getting bogged down by unnecessary filler or unconfirmable wild accusations. I personally have been studying the Bilderberg Group for over ten years and it has been fascinating to see word spread so far and wide about them in the age of social media and YouTube.

If you found this book interesting or valuable in your pursuit of the truth please take a moment to write a brief review and rate it on Amazon.com or at the e-book store where you downloaded it from. And if you’d like to continue reading about similar subjects, I encourage you to download the e-book or order the paperback version of one or more of my other titles. They will save you countless years of research and have most of the esoteric pieces of the puzzle assembled and organized in in one place.

Thanks again for being a reader and a lover of books. It is certainly a dying pastime in our entertainment age, as we are on the verge of an apparent Idiocracy as society continues to sink down a cultural abyss. As media analyst Neil Postman wrote in his 1985 classic Amusing Ourselves to Death, “When a population becomes distracted by trivia, when cultural life is redefined as a perpetual round of entertainments, when serious public conversation becomes a form of baby-talk, when, in short, a people become an audience and their public business a vaudeville act, then a nation finds itself at risk; culture-death is a clear possibility.”184



 





Further Reading

The Illuminati: Facts & Fiction

Secret societies have both fascinated and frightened people for hundreds of years. Often the infamous Illuminati is mentioned as the core of conspiracies which span the globe. The Illuminati is actually a historical secret society which had goals of revolutions and world domination dating back to the 1770s.

Since then, rumors and conspiracy theories involving the Illuminati continue to spread, sometimes finding their way into popular novels like Dan Brown’s Angels & Demons and Hollywood movies like Lara Croft: Tomb Raider. Some men have even come forward claiming to be former members, offering details of what they allege are the inner workings of the organization. When you sift through all of the information available on the subject, you may be surprised that the truth is stranger than fiction.

In The Illuminati: Facts & Fiction, conspiracy and occult expert Mark Dice separates history from Hollywood and shows why tales of the secret society won't die.



The New World Order: Facts & Fiction

What is the New World Order? Proponents say that it’s an anticipated new era of global cooperation between diverse nations and cultures aimed at ushering in a utopia providing all the earth's citizens with everything they need.

Detractors claim it’s the systematic take-over by secret societies, quasi-government entities and corporations who are covertly organizing a global socialist all-powerful government which aims to regulate every aspect of citizens lives, rendering them a perpetual working-class while the elite leadership lives in luxury.

Conspiracy theory expert Mark Dice looks at the evidence, claims, and conspiracy theories as he takes you down the rabbit hole to The New World Order.



Illuminati in the Music Industry

Famous pop stars and rappers from Jay-Z and Rick Ross to Rihanna and Christina Aguilera are believed by many to be a part of the infamous Illuminati secret society. These stars allegedly use Illuminati and satanic symbolism in their music videos and on their clothes that goes unnoticed by those not “in the know.”

Since these stars appear in our livings rooms on family friendly mainstream shows like Good Morning America, Ellen, and dozens of others—and are loved by virtually all the kids—they couldn’t possibly have anything to do with the infamous Illuminati or anything “satanic,” could they? Some famous musicians have even publicly denounced the Illuminati in interviews or songs.

Illuminati in the Music Industry takes a close look at some of today’s hottest stars and decodes the secret symbols, song lyrics, and separates the facts from the fiction in this fascinating topic. You may never see your favorite musicians the same way ever again.



Big Brother: The Orwellian Nightmare Come True

In Big Brother, Mark Dice details actual high-tech spy gadgets, mind-reading machines, government projects, and emerging artificial intelligence systems that seem as if they came right out of George Orwell’s novel Nineteen Eighty-Four.

Orwell’s famous book was first published in 1949, and tells the story of a nightmarish future where citizens have lost all privacy and are continuously monitored by the omniscient Big Brother surveillance system which keeps them obedient to a totalitarian government.

The novel is eerily prophetic as many of the fictional systems of surveillance described have now become a reality. Mark Dice shows you the scary documentation that Big Brother is watching you, and is more powerful than you could imagine.



The Resistance Manifesto

The Resistance Manifesto by Mark Dice contains 450 pages of extensively researched and documented information drawing from declassified documents, mainstream news articles, religious texts, and personal interviews. A dark web of evil is exposed like never before, making Bible Prophecy and the New World Order crystal clear.

Learn the most powerful information about the Illuminati, plans for the rise of the Antichrist, the institutions, people, and powers involved, and how you can fight them.



Inside the Illuminati

When looking into the existence and alleged activities of the infamous Illuminati secret society, one finds an overwhelming amount of conspiracy theories, hidden history, half-truths and hoaxes.

But how much truth is there to some of these claims? What is the real history of the mysterious group? Do they continue to exist today? What is the evidence? And what are they doing?

After a decade of research sifting through the facts and the fiction, secret society expert Mark Dice will help you navigate through the complex maze from the original documents to rare revelations from elite politicians, bankers and businessmen, as he takes you Inside the Illuminati



About the Author

Mark Dice is a media analyst, author, and political activist who, in an entertaining and educational way, gets people to question our celebrity obsessed culture and the role the mainstream media and elite secret societies play in shaping our lives.

Mark’s YouTube channel has received over 85 million views and his viral videos have been mentioned the Fox News Channel, CNN, the Drudge Report, TMZ, the New York Daily News, the Washington Times, and other media outlets around the world.

He has been featured on various television shows including the History Channel’s Decoded and America’s Book of Secrets, Conspiracy Theory with Jesse Ventura, Secret Societies of Hollywood on E! Channel, America Declassified on the Travel Channel, and is a frequent guest on Coast to Coast AM, The Alex Jones Show, and more.

Mark Dice is the author of several popular books on secret societies and conspiracies, including The Illuminati: Facts & Fiction, Big Brother: The Orwellian Nightmare Come True, The New World Order, Facts & Fiction, The Resistance Manifesto, Illuminati in the Music Industry, and Inside the Illuminati, which are all available in paperback on Amazon.com or e-book on Kindle, iBooks, Nook or Google Play.

While much of Mark’s work confirms the existence and continued operation of the Illuminati today, he is also dedicated to debunking conspiracy theories and hoaxes and separating the facts from the fiction; hence the “Facts & Fiction” subtitle for several of his books.



While having respect for all authentic religions and belief systems, Mark Dice is a Christian and holds a bachelor’s degree in communication from California State University. He lives in San Diego, California.

He enjoys causing trouble for the New World Order, exposing corrupt scumbag politicians, and pointing out Big Brother’s prying eyes. The term “fighting the New World Order” is used by Mark to describe some of his activities, and refers to his and others’ resistance and opposition (The Resistance) to the overall system of political corruption, illegal wars, elite secret societies, mainstream media, Big Brother and privacy issues; as well as various economic and social issues. This Resistance involves selfimprovement, self-sufficiency, personal responsibility and spiritual growth.





Connect with Mark on: Facebook.com/MarkDice Twitter.com/MarkDice.com YouTube.com/MarkDice Instagram.com/MarkDice MarkDice.com



Copyright Info

 

The Bilderberg Group: Facts & Fiction © 2015 by Mark Dice All Rights Reserved Published by The Resistance Manifesto San Diego, CA

 

No part of the text within this book may be reproduced or transmitted in any form and by any means, graphic, electronic, or mechanical, including photocopying, recording, taping, or by any information storage retrieval system, without the written permission of the author.

 

Visit MarkDice.com

E-book ISBN: 978-0-9887268-9-5

 

Cover design by Jason Bermas Cover images licensed from iStockPhoto Internal photos all taken by Mark Dice

 



1

Time Magazine “Bilderberg: The Uber-Powerful Global Elite Meet Behind Closed Doors in St. Moritz” by Anne Fournier (June 9th 2011)

2

Many of these calls were recorded or the clips were taken from the show’s pod