Injectable Cartilage Microtissue Regenerated by Autologous Chondrocytes for Nasal Augmentation: A 5-Year Follow-Up Study

BACKGROUND

A lack of ideal filling materials is a critical limitation in current rhinoplasty. Cartilage sheet regeneration by autologous chondrocytes is expected to provide an ideal source of material. However, the inability to perform minimally invasive transplantation of cartilage sheets has greatly limited the clinical application of this material. In this article, the authors propose the concept of injectable cartilage microtissue (ICM) based on cartilage sheet technology, with the aim of achieving minimally invasive augmentation rhinoplasty in clinical practice.

METHODS

Approximately 1.0 cm2 of posterior auricular cartilage was collected from 28 patients. Isolated chondrocytes were expanded, then used to construct autologous cartilage sheets by high-density seeding and in vitro culture in chondrogenic medium with cytokines (eg, transforming growth factor beta-1 and insulin-like growth factor-1) for 3 weeks. Next, ICM was prepared by granulation of the cartilage sheets; it was then injected into a subcutaneous pocket for rhinoplasty.

RESULTS

ICM was successfully prepared in all patients, and its implantation efficiently raised the nasal dorsum. Magnetic resonance imaging confirmed that regenerative tissue was present at the injection site; histologic examinations demonstrated mature cartilage formation with typical cartilage lacunae and abundant cartilage-specific deposition of extracellular matrix. Excellent or good postoperative patient satisfaction results were achieved in 83.3% of patients over 5 years of follow-up. Obvious absorption of grafts occurred in only two patients (8.3%).

CONCLUSIONS

These results demonstrated that ICM could facilitate stable cartilage regeneration and long-term maintenance in the human body; the implantation of ICM enabled natural augmentation of the depressed nasal dorsum.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.

Design and Application of a Novel Silicone Nasal Implant

Background

Traditional silicone implants used in augmentation rhinoplasty lead to postoperative complications.

Objectives

To introduce a novel silicone implant designed to reduce postoperative complications.

Methods

The author designed a novel modification for the traditional silicone nasal implant, which has a particle surface, vertical and horizontal grooves, and a special vertical board to support the nasal tip. A total of 114 consecutive clinical cases were retrospectively reviewed from September 2016 to November 2022, with a minimum of 36 months and an average 51 months of follow-up. All patients underwent augmentation rhinoplasty using this novel implant, with 97 (85.09%) patients using only the silicone and 17 (14.91%) the silicone implant with conchal cartilage. Surgical complications such as sliding down, redness, extrusion, deviation, translucency, capsular contracture, or infection were recorded.

Results

The median patient age was 28 (range, 18-55) years, with 109 female and 5 male patients. Among the 114 cases, 46 (40.35%) involved primary surgery and 68 (59.65%) involved revisional surgery. The overall complication rate was 4.39%, and 0.88% of the patients had slight redness, 0.88% had intermittent pain, and 2.63% had infections. No other complication was observed, and all complications occurred in revisional surgeries. A total of 109 patients (95.61%) showed satisfying results without any postoperative complication. None of the patients with primary surgery reported postoperative complications.

Conclusions

The novel silicone nasal implant can effectively reduce the rate of postoperative complications. Therefore, augmentation rhinoplasty using this implant enables a more natural-looking outcome.

Level of Evidence 3

Promising Implants in Rhinoplasty

Many dilemmas in rhinoplasty tempt surgeons to use exogenous materials. We have long looked toward implants to decrease operative time, to achieve a more reliable result, or when there is a paucity of autologous material. More than ever, the innovative and highly lucrative field of nasal implantology is developing technologically advanced products. This article looks at some popular nasal implant choices with a look toward what might be on the horizon.

Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis

Background

Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials.

Materials and methods

After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis.

Result

Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively.

Conclusion

The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57).

Trial registration

This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644).

The Relationship Between Inter-canthal Distance and Implant Height in Asian Rhinoplasty

Augmentation rhinoplasty is one of the top three anesthetic surgeries in Asia. I-shaped silicone-polytetrafluoroethylene composite implants are feasible for both primary and secondary augmentation rhinoplasty in Asians. This series was to analyze and evaluated the effect of the rhinoplasty to the intercanthal distance and to compare the height of the implantation with those differences in ICD before and after rhinoplasty. We retrospectively reviewed data from a single medical center via a single surgeon (Hsiao YC), at Chang Gung Memorial Hospital, between 2011 and 2017 with follow-up through 2018. There were 223 patients who received augmentation rhinoplasty with an I-shaped composite silicone-polytetrafluoroethylene ePTFE-lined silicone dorsal composite implant (Implantech, Ventura, CA) with a glabellar component (chimeric technique) or without a glabellar component. There were 169 patients with the height of the I-shaped composite implant over 3 mm, and 15 patients were less than 3 mm. There was no distribution significance between two groups even in gender, age, type of surgery, or indication. The paired difference of ICD/IPD ratio was statistically significant in the group with the height of composite implant over 3 mm (1.04% ± 0.11, p < 0.005, 95%). The normalized ratio of the ICD to IPD is estimated to decrease by 1-2%. Appropriate candidates including those with a wide ICD should be informed about these data during preoperative decision-making.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Revisiting the Use of GORE-TEX as an Interpositional Material in Surgical Management of Severe Temporomandibular Joint Ankylosis

(1) Defining a protocol for management of patients with severe temporomandibular joint ankylosis. (2) Review the results of use of GORE-TEX as an interpositional material in gap arthroplasty. All cases which were treated with surgical intervention for severe TMJ Ankylosis with use of GORE-TEX as an interpositional material have been included. Amongst 40 patients, 11 were male and 29 were female with age group ranging from 4 to 36 years. 22 patients had bilateral ankylosis and 18 patients had unilateral ankylosis needing unilateral condylectomy. In all the patients GORE-TEX was used as an inter-positional material to form a pseudo joint. Postoperative mouth opening was around 3 fingers (3-3.5 cm) for period of 2 years i.e. last follow up. Migration or extrusion of implant was not seen in any of our cases. Use of GORE-TEX as an inter-positional material can prevent recurrences with good restoration of the physiological joint and occlusion.

The Use of Expanded Polytetrafluoroethylene in Short Nose Elongation: Fourteen Years of Clinical Experience

BACKGROUND

Short nose elongation is a relatively common rhinoplasty procedure, especially in Asia. The selection of the adequate graft material is challenging. Previous reports have described the application of expanded polytetrafluoroethylene (ePTFE) for dorsal augmentation rhinoplasty, but studies using ePTFE for nose elongation are lacking. We propose ePTFE as an alternative treatment for short noses, describe the technique, and discuss outcomes, patient selection, and complications based on our 14-year experience.

METHODS

From February 2003 to December 2016, 206 patients with varying degrees of short noses were included in this retrospective study. All patients underwent nose elongation surgery using an ePTFE implant. Nasal lengths before and after surgery were measured using a 3-dimensional simulation technology. Outcomes and complications including possible underlying reasons were analyzed. Patient satisfaction was evaluated using a self-assessment survey.

RESULTS

Nasal elongation was successfully achieved using ePTFE. Mean increase in nasal length was 4.36 ± 0.85 mm. The mean follow-up period was 13.3 months, ranging from 6 months to 8 years. Follow-up examinations demonstrated stable results. The overall complication rate was 6.8%. Complications included infection, implant extrusion, migration, deviation, visibility, and/or prominence, tissue reaction, and reddening of the nasal skin. Most patients (93.6%) rated their outcome as improved and much improved.

CONCLUSIONS

Nasal elongation using ePTFE implantation is a feasible therapeutic approach for patients with short noses. Reliable outcomes and the absence of donor site morbidity contribute to the high patient acceptance. Meticulous surgical technique and careful patient selection are prerequisites for successful results.

Onlay Fascial Grafts to Silicone-Polytetrafluorethylene Composite Implants in Augmentation Rhinoplasty: A Retrospective Study of 241 Cases

BACKGROUND

Silicone-polytetrafluoroethylene composite implants are fast gaining popularity in Asian rhinoplasty. Nonetheless, implant displacement, erythematous reactions, and infections still occur in the authors' patient group during long-term follow-up.

OBJECTIVES

The authors reported successful experience of combining the utilization of silicone-polytetrafluoroethylene composite implants with onlay temporal fascial grafts to circumvent these complications.

METHODS

Sixty-four patients of Asian ethnicity underwent augmentation rhinoplasty utilizing an I-shaped composite implant with an onlay fascial graft from January 2015 to June 2018, with a mean follow-up period of 13.5 months. This patient group was compared with a control group of 177 Asian patients who underwent augmentation rhinoplasty utilizing the same composite implant but without the addition of a fascial graft; the control group was treated from February 2012 to June 2015, with a mean follow-up of 42.0 months. Complications were compared between these 2 patient groups, specifically focusing on malposition/deviations, erythema, and infections.

RESULTS

There was a marked decrease in complication rates with the addition of an onlay temporal fascial graft to cover the composite implant in augmentation rhinoplasty (7.8% vs 14.7%) as well as the rate of erythematous reactions (0% vs 6.2%, P = 0.04), infection (1.6% vs 1.1%), and implant malposition/deviation (0% vs 4.5%). Harvesting the temporal fascia and fashioning the onlay graft added an additional 33 minutes on average per procedure. No donor site morbidity was encountered.

CONCLUSIONS

Although the operative time increased, the benefits of adding onlay fascial grafts to silicone-polytetrafluoroethylene implants in alloplastic augmentation rhinoplasty outweigh the drawbacks, as evidenced by the decrease in erythematous reactions.

LEVEL OF EVIDENCE: 4

Surgical Site Infections in Aesthetic Surgery

Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors and varies depending on the specific operation performed. Understanding the risk factors for infection development is critical because careful patient selection and appropriate perioperative counseling will set the right expectations and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course, and avoid long-term sequelae.

Safety and Efficacy of Cosmetic Augmentation of the Nasal Tip and Nasal Dorsum With Expanded Polytetrafluoroethylene: A Randomized Clinical Trial

Importance

Expanded polytetrafluoroethylene (ePTFE) is a widely used alloplast, but studies of augmentation of the nasal tip and nasal dorsum with ePTFE are lacking.

Objective

To investigate whether attaching the conchal cartilage as shield grafts at the distal end of the graft can prevent extrusion and whether the use of ePTFE in the nasal tip can achieve a stable aesthetic outcome.

Design, Setting, and Participants

A randomized clinical trial was performed from April 1, 2006, to October 31, 2008. Follow-up was completed in 2012 and 2017. The study was conducted at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. One hundred fifty patients seeking rhinoplasty were recruited, and 129 were eligible for inclusion in the study. All the recruited patients were intent-to-treat populations who were randomized into 2 groups: an ePTFE-only group and an ePTFE with conchal cartilage group.

Interventions

Expanded PTFE was used for augmentation of the nasal tip and nasal dorsum in both groups. Conchal cartilage was placed above the distal end in the ePTFE with conchal cartilage group.

Main Outcomes and Measures

Preoperative and postoperative standard photographs were obtained. Postoperative satisfaction and complications were evaluated.

Results

Of the 129 patients (mean age [range], 28 years [21-45 years]; 6 male and 123 female) eligible for inclusion in this study, 76 (mean age [range], 31 years [22-45 years]; 4 male and 72 female) were available for follow-up (mean [range], 106.9 months [100-131 months]) through 2017, including 39 in the ePTFE-only group and 37 in the ePTFE with conchal cartilage group. Infection occurred in 2 patients (5%) in the ePTFE-only group vs 1 patient (3%) in the ePTFE with conchal cartilage group (infection rate [OR, 1.946; 95% CI, 0.169-22.413; P > .99]). Soft-tissue reaction occurred in 0 patients in the ePTFE-only group vs 1 patient (3%) in the ePTFE with conchal cartilage group (soft-tissue reaction rate [OR, 0.000; 95% CI, 0.000-8.538; P = .49]). Irregularity occurred in 0 patients in the ePTFE-only group vs 3 patients (8%) in the ePTFE with conchal cartilage group (irregularity rate [OR, 0.000; 95% CI, 0.000-1.066; P = .11]). Extrusion occurred in neither of the 2 groups.

Conclusions and Relevance

A new technique using ePTFE alone for augmentation of the nasal tip and nasal dorsum achieved safe, attractive, and acceptable outcomes in nasal contouring and patient satisfaction. The use of conchal cartilage as a shield in the nasal tip is not necessary.

Level of Evidence

1.

Trial Registration

Chinese Clinical Trial Registry identifier: ChiCTR-INR-17011101.

Treatment of Infected Facial Implants

Alloplastic facial implants have a wide range of uses to achieve the appropriate facial contour. A variety of materials such as metals, polymers, ceramics and synthetic injectable fillers are available to the reconstructive and aesthetic surgeon. Besides choosing the right surgical technique and the adequate material, the surgeon must be prepared to treat complications. Infection is an uncommon but serious complication that can cause displeasing consequences for the patient. There are few references in literature regarding treatment and management of facial implant-related infections. This study aims to discuss the role of biofilm in predisposing alloplastic materials to infection, to provide a review of literature, to describe our own institutional experience, and to define a patient care pathway for facial implant-associated infection.

African American rhinoplasty

Rhinoplasty in patients of African descent requires a patient-specific approach, because the goals and ideal proportions differ from the white nose. This article discusses approaches to surgical correction of common anatomic variations. In addition, common pitfalls are outlined.

Augmentation rhinoplasty using a folded "pure" dermal graft

BACKGROUND

Although there are several reports about the use of dermal or dermofat grafts, there are only a few reports about augmentation rhinoplasty performed using a "pure" dermal graft. Authors introduce the refined techniques, clinical experience, and report an aesthetically pleasing result of augmentation rhinoplasty performed using a folded pure dermal graft.

MATERIALS AND METHODS

Between 2008 and 2012, augmentation rhinoplasty was performed in 68 cases using a folded pure dermal graft. Pure dermal graft was harvested from one side of the buttock close to the intergluteal crease and the graft length was approximately 7-8 cm and the graft width was 1.5-2 cm, and the epidermis and fat were completely removed. Tip-plasty was performed using a conchal or septal cartilage as a columellar strut and an onlay graft. Pure dermal grafts are folded into 2 layers and sculpted to the desired size and shape, and are inserted into the supraperiosteal pocket. Ultrasonography was performed to know the absorption rate of the folded pure dermal grafts.

RESULTS

The thickness of a dermal graft at postoperative 12 months was 60.3% of that at postoperative 1 month. Even with 39.7% of reduction in the thickness of the dermal graft, the height of nasal dorsum after postoperative 1 year is considered to be well maintained. Among the 68 cases that underwent augmentation rhinoplasty (43 primary and 25 secondary), most of the patients sustained consistent cosmetic results; however, 12 patients (17 %) showed over-absorption, under-absorption or contour irregularity of the dermal graft, and slight erythema. There were no aesthetically or medically serious problems needing secondary rhinoplasty such as hematoma formation, warping of the graft, graft extrusion, infection, and rejection of the graft.

DISCUSSION

Augmentation rhinoplasty using a folded pure dermal graft has many advantages and is a very useful surgical option in patients who have an aversion to the use of artificial implants, who want to change the postoperative appearance of their nose due to insertion of an artificial implant into a more natural appearance, and when there is too much thinning of the skin due to repeated insertion of silicone implants.

Management of complications from alloplastic implants in rhinoplasty

PURPOSE OF REVIEW

Alloplasts have long been used in rhinoplasty, but their use remains controversial. Many complications are associated with their implementation in rhinoplasty. This article elucidates these complications and provides recommendations for management.

RECENT FINDINGS

Several recent articles have been published presenting experience and outcomes regarding alloplast use in rhinoplasty. In many of these studies, a specific section has been dedicated to outlining the complications encountered by the authors. Oftentimes, a short summary of the complications and their management is provided. By examining the data from these studies, one can conclude several things about the management of complications involving alloplastic implants in rhinoplasty: each case must be approached on an individual basis; clinical decision-making is dictated by physical exam findings and severity of the complication; removal of the implant must be strongly considered; and revision rhinoplasty after an alloplastic complication usually necessitates an autologous graft.

SUMMARY

Alloplasts continue to be a controversial option in rhinoplasty. The surgeon must be cognizant of the risks and benefits of their use. A frank preoperative discussion of possible complications with the patient is important. Additionally, prompt recognition and appropriate management of complications is essential to minimize permanent sequelae.

Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: A 15-year experience

BACKGROUND

Asians have low nasal dorsum, thick skin envelope, low defined alar cartilage, low projection of nasal tip and broad alar base. Augmentation rhinoplasty with silicone prosthesis has been performed with predictable results, but unfavourable results and complications still present. This series show techniques and results from single surgeon experience.

MATERIALS AND METHODS

We retrospectively reviewed 548 patients chart during January 1995 to December 2009. All patients underwent custom-made S-shape implant silicone augmentation rhinoplasty operated by a single surgeon. There were three major operative steps: (1) Intra-operative S-shape implant carving; (2) pocket dissection through bilateral rim incision and (3) tension adjustment before closure. All the patients were recorded for early surgical complications and satisfaction.

RESULTS

There were 519 women and 29 men. The mean age is 25.5 years (18-56 years). Mean follow-up period was 6 months (1-60 months). The majority of patient were appointed for esthetic augmentation (86.8%). 515 cases (94.9%) showed well satisfaction following the operation. The total complication rate was 6.5% (4.9% deviation, 0.7% extrusion, 0.5% hematoma and 0.3% infection). All the complications were corrected with uneventful sequelae.

CONCLUSION

Augmentation rhinoplasty with custom-made S-shape silicone implant by closed approach provides high satisfaction with acceptable early complication rate.

Effects of carving plane, level of harvest, and oppositional suturing techniques on costal cartilage warping

BACKGROUND

Cartilage warping has plagued reconstructive and cosmetic rhinoplasty since the introduction of extra-anatomical cartilage use. With the present level of knowledge, there is no evidence of the warping properties with respect to cartilage harvest and suture techniques and level of rib harvest. This report aims to improve understanding of costal cartilage warping.

METHODS

The sixth through tenth costal cartilages were harvested from six fresh cadavers aged 54 to 90 years. Warping characteristics were followed with respect to level of harvest (i.e., sixth versus seventh), carving orientation, and oppositional suturing. Digital photography of the specimens was performed at various time points (immediately, 1 hour, and 1 month postoperatively).

RESULTS

All specimens showed signs of warping beyond 1 hour of carving that continued in a linear fashion to 1 month. There was no statistical difference in the amount of warping specific to the level of harvest, orientation, or with or without oppositional suturing (p<0.05).

CONCLUSIONS

Cartilage warping remains a problematic obstacle in nasal reconstruction and revision rhinoplasty, but costal cartilage remains the workhorse graft and is an excellent autologous option. Our findings are the first to be described in the literature regarding warping characteristics of costal cartilage with regard to the level of harvest, orientation of carving, and oppositional suturing techniques in a cadaveric model.

Imaging of cosmetic facial implants and grafts

SUMMARY

A wide variety of implants and grafts have been used for cosmetic facial surgery, including forehead, nose, cheek, lip, and chin augmentation. Some of the implant materials include silicone, expanded polytetrafluoroethylene (Gore-Tex), hydroxylapatite, and porous polyethylene (Medpor). Grafts include bone and cartilage, which can be prepared as "Turkish Delight" for rhinoplasty. Imaged facial implants and grafts can be encountered incidentally or purposely to evaluate complications. Many of these materials have distinct radiologic imaging features and should not be misinterpreted as pathology. Conversely, implant complications should be appropriately recognized by using a focused imaging approach. The purpose of this article was to review the different types of cosmetic facial implants and grafts with an emphasis on their expected and complicated radiologic imaging appearances.

Imaging features of rhinoplasty

SUMMARY

Cosmetic rhinoplasty encompasses a diverse group of procedures, including alteration of the radix, nasal dorsum, nasal tip, and nasal base; premaxillary augmentation; septoplasty; and combinations thereof. Similarly, many different types of grafts and alloplastic materials can be used in cosmetic rhinoplasty, such as cartilage, bone, silicone, porous polyethylene, expanded polytetrafluoroethylene, and calcium hydroxylapatite. Complications of rhinoplasty that can be observed on imaging include retained metallic surgical instrument fragments, infection, implant extrusion, nerve impingement by implants, nasal valve collapse, and implant deformity. Knowledge of the basic surgical procedures and potential complications of cosmetic rhinoplasty is important for adequately interpreting postoperative radiologic imaging studies.

Dorsal Approach Rhinoplasty

Direct dorsal excision of skin and subcutaneous tissue is employed in rhinoplasty cases characterized by thick rigid skin to achieve satisfactory esthetic results, in which attempted repair by more conventional means would most likely frustrate both surgeon and patient.

This historical review reminds us of the lesson: ‘History repeats itself.’ Built on a foundation of reconstructive rhinoplasty, modern cosmetic and corrective rhinoplasty have seen the parallel development of both open and closed techniques as ‘new’ methods are introduced and reintroduced again. It is from the perspective of constant evolution in the art of rhinoplasty surgery that the author presents, in Part II, his unique ‘eagle wing’ chevron incision technique of dorsal approach rhinoplasty, to overcome the problems posed by the rigid skin nose.

How to cite this article

Dubeta KR. Dorsal Approach Rhinoplasty. Int J Otorhinolaryngol Clin 2013;5(1):1-23.

Problems in rhinoplasty

In this review, the complications of rhinoplasty are examined in terms of their timing of presentation. An algorithmic approach to postoperative problems is discussed. Complications can frequently be avoided by meticulous technique, recognition of pitfalls, and early attention to perioperative morbidity. Reoperative rates can be minimized with good patient education and proper command of the postoperative situation, so that unnecessary procedures are not undertaken.

Rhinoplasty in the patient of African descent

We are in the midst of truly changing times, as patients of African descent actively embrace facial cosmetic surgery. Gaining surgical consistency in patients of African descent has proven to be elusive and unpredictable for many rhinoplasty surgeons. Surgical success relies on the surgeon's ability precisely to identify anatomic variables and reconcile these anatomic realities with the patient's expectations for aesthetic improvement and ethnic identity. An appreciation for underlying heritage provides a link culturally to connect with prospective patients and serves as a tool for establishing realistic aesthetic goals. This article highlights the significance of exploring ancestry in the rhinoplasty consultation; identifies key anatomic variables in the nasal tip, dorsum, and alar base; and reviews surgical logic that has facilitated the achievement of consistent, balanced aesthetic outcomes.

Correction of difficult short nose by modified caudal septal advancement in Asian patients

BACKGROUND

Correction of a short nose, defined by a reduced distance from the nasal radix to the tip, has been regarded as one of the most challenging procedures in rhinoplasty. Some short nose cases are too difficult to treat with conventional grafts because of their scanty, flimsy, pliable, or deviated septum or depleted donor supply of septal or conchal cartilage. Although costal cartilage graft may be an option, patients may be reluctant to undergo this invasive surgery.

OBJECTIVE

The author presents his two-year aesthetic results from the treatment of difficult short noses with the modified caudal septal advancement method.

METHODS

From November 2006 to August 2008, 41 patients (ages 23-59 years) with a short nose were treated with modified caudal septal advancement, with or without extracorporeal septoplasty.

RESULTS

Among the 36 patients who remained for six months to two years of follow-up, 20 patients achieved "excellent" results and 12 patients showed "good" results, both based on nasal lengthening measurements taken by the author. Four patients had only "fair" results. Patients in this last group, including three with overlengthening and one with inadequate elongation, required revision surgery.

CONCLUSIONS

In the Asian population, when short-nosed patients present with weak or deviated caudal septums or a limited supply of donor conchal or septal cartilage, the modified caudal septal advancement method can more predictably and efficiently provide a stable nasal base support than the conventional extension grafts, spreader grafts, or extended spreader grafts. The author believes that this technique is a safe, effective, and reliable alternative to costal cartilage grafts in dealing with difficult short noses.

Reconstruction of traumatic nasal deformity in Orientals

PURPOSE

The application of rhinoplasty in the treatment of traumatic nasal deformity remains one of the most challenging problems for surgeons. Not only is the skeletal structure severely deformed, but the soft tissue may also be disfigured by a previous injury. Although autogenous bone and cartilage have been the primary choice for nasal reconstruction, synthetic material is desirable for various reasons. This article presents our experiences in the reconstruction of traumatic nasal deformity by using porous polyethylene (Medpor) implant in Orientals.

MATERIALS AND METHODS

From May 1998 to January 2005, 32 patients, including 15 males and 17 females, underwent augmentation rhinoplasty for the correction of traumatic nasal deformity. Of these, 30 patients had experienced associated midfacial bone fractures. The surgical procedures employed consisted of the open-tip approach that was followed by implant carving, placement and fixation. Twenty patients received lateral nasal osteotomies, and septoplasty procedures were performed in nine patients, simultaneously. External taping was done, and nostril tampons were placed postoperatively and left in situ for 3 days. The outcome was assessed by an independent investigator and the patients themselves.

RESULTS

The patients were, on average, 22 years old at the time of reconstruction and were followed up for an average period of 25.4 months. The interval from injury to the rhinoplasty procedure was 304 days, on average. The average length of dorsal grafts was 44.9 mm. The overall aesthetic-improvement rate was 90.6%, and the patient-satisfaction rate was 84.4%. There were three complications, including an implant-tip exposure and two implant infections.

CONCLUSION

A porous polyethylene (Medpor) implant is an effective alternative to autograft for correction of traumatic nasal deformity in Orientals to achieve a pleasing appearance of the nose without donor-site morbidity. A meticulous execution of concomitant procedures and impregnation of the implant by submerging it in an antibiotics solution prior to use were helpful in decreasing the complications.