Autologous costal cartilage for nasal tip surgery: report of 86 cases / 中华医学美学美容杂志

Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty,and to report the surgical results and complications in 86 consecutive rhinoplasty cases.Methods All operations were performed by the first author (Liu AT) with open approach,costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty,after removing the previous injection material,L-shaped implant or hypertrophic scar tissue in the tip.Medical charts and operative records were reviewed retrospectively to summary the complications.Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft,sometimes with anterior sheath of rectus abdominis.Patients' subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse,2 no change,3 improved,and 4 much improved).Results From September 2015 to March 2017,86 patients underwent rhinoplasty at our hospital.The postoperative follow-up duration was 6 to 20 months.Overall,functional and aesthetic outcome was satisfactory in most patients,and the mean score by the patients' self-evaluation was 3.3 ± 0.6.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.Conclusions Even with minimal complications and morbidities,autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose,contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested.

Nasal Tip Plasty Using a Batten Graft with Ear Cartilage in East Asians

BACKGROUND: Plastic surgeons have constantly investigated methods of nasal tip plasty and nasal lengthening in rhinoplasty. The septal extension graft has been widely applied as a very useful method for East Asians who have different internal nasal structures and nasal skin from those of Caucasians. In this study, we performed nasal tip plasty with a batten-type septal extension graft using ear cartilage. METHODS: Nasal tip plasty was performed for 48 patients by batten graft with ear cartilages at the Cocoa Plastic Surgery Clinic and in the plastic surgery unit of Hanil General Hospital from January 2009 to January 2015. A batten-type septal extension graft was constructed with cymba of the concha cartilage. An average area of 2.0 cm × 1.4 cm of the cymba and 1.0 cm × 1.0 cm of the cavum from the concha cartilage was harvested. RESULTS: Of the 48 patients who underwent batten-type septal extension graft using ear cartilages, nasal tip plasty and columellar lengthening were successfully achieved in almost all of the patients. The nasal tip's height was well-maintained for the follow-up period ranging from 6 months to 5 years after surgery. CONCLUSIONS: Nasal tip plasty using a septal extension graft is a very useful method for East Asians with a low nasal tip. The septal extension graft with ear cartilage enables the creation of a desirable nasal shape because there is a sufficient amount of ear cartilage to stably support the nasal tip, thus creating a natural and smooth nose shape.

Bulbous Tip Correction Focusing on Skin Soft Tissue Envelope in Asian Rhinoplasty

BACKGROUND: Correction of a bulbous tip is a difficult procedure in Asians, because their lower lateral cartilage is relatively small and structurally weak to support the thick skin soft tissue envelope (SSTE). Therefore, lower lateral cartilage manipulation alone yields inadequate bulbous tip correction. In this study, authors aim to provide a new bulbous tip definition reflecting nasal tip SSTE and categorization with a suitable surgical procedure. METHODS: One hundred sixty-three patients with tip rhinoplasty between January 2009 and December 2012 were studied who had a tip lobular width greater than 60% of the alar base width. Depending on cartilage size and characteristics of the nasal tip superficial musculoaponeurotic system (SMAS) with SSTE thickness, the following classifications were made: Group I: thin SSTE with a large lower lateral cartilage, Group II: thick SSTE with a small lower lateral cartilage, Group IIa: thick SSTE with loose SMAS, and Group IIb: thick SSTE with dense SMAS. We evaluated the degree of surgical improvement by comparing pre- and postoperative photographs. RESULTS: After comparing pre- and postoperative photos, we observed improvements in tip bulbosity by 11.7% in Group I (n=41), 11.9% in Group IIa (n=64), and 7.1% in Group IIb (n=58). CONCLUSIONS: In Asians, nasal tip bulbosity is often due to excess SSTE. Therefore, a bulbous tip should be defined and evaluated based on its underlying SSTE. Adequate soft tissue resection in addition to lower lateral cartilage support and manipulation are warranted to achieve a refined tip.

Application of porous high-density polyethylene combined with auricular cartilage in nasal tip plasty / 中华医学美学美容杂志

Objective To explore the methodology and the indications of applying the porous high-density polyethylene(Medpor)combined with auricular cartilage in nasal plasty.Methods A total of 36 cases of nasal plasty were treated with the 8.5 mm thick Medpor implant(speader strut graft)and combined with the auricular cartilage graft to highlight the nasal tip.Results All 36 cases were satisfactory with the effects,and there were no complications such as infection,exposure of the implants and so on.Conclusions Medpor can supply the powerful supporting strength to the nasal tip,and it is a safe,effective implant to rebuild the supporting constructions of nasal tip,especially suitable to correct the over-rotation of nasal tip,flat nasal tip,and short nose.

Histologic Changes and Photographic Analysis of AlloDerm(R) at Tip Plasty of the Nose

AlloDerm(R) is human cadaveric dermis that has been decellularized. It is easy to handle and simple to use, and has superb tissue compatibility; hence it has been used in several fields. But studies about the effect and the histologic changes of AlloDerm(R) in soft tissue augmentation are lacking. We measured the heights of pronasale and supretip breakpoint through Pre-and post- operative photographs in 13 patients who had undertaken AlloDerm(R) tip plasty surgery from April 2004 to July 2005. Histologic changes were investigated by H&E and CD34 immunochemistry staining of tissue samples from 10 patients who had AlloDerm(R) removed by re-operative procedures from January 2005 to March 2006. The result of photographic analysis is as follows supratip breakpoint heights were 2.43+/-0.36, 2.64+/-38, 2.52+/-0.38mm in the pre-operative(T1), early post-operative(T2) and late post-operative(T3) periods, respectively. Pronasale heights were 2.68+/-0.33, 2.93+/-0.44, and 2.79+/-0.38mm, respectively. Statistical analysis of corrective value of T1-T2, T2-T3 and T1-T3 revealed a statistically significant difference in both pronasale and supratip breakpoint heights. Histological analysis showed chronic inflammatory signs with foreign body reactions around grafted AlloDerm(R). We concluded that AlloDerm(R) neovascularization and fibroblast ingrowth were also noted. AlloDerm(R) is effective in raising the nasal tip, but considering the late-term partial absorption, an overcorrection of about 50% is recommended.

Strut Graft with Septal Cartilage for Nasal Tip Plasty; Increment of the Nasolabial Angle

There are several characteristics of the nasal tip of Orientals. The skin is thick with severe tension and a bulbous nasal tip, the nostrils are wide, and the projection of the nose is limited due to a poorly developed alar cartilage with a short columella. Until now, in order to well outline the nasal tip and project the nose, the alar cartilage was realigned, the domes of the cartilage sutured together, silicone or cartilage was used to improve the appearance of the tip. However, it was difficult to achieve satisfactory results in Orientals due to a short columella and a acute nasolabial angle. From May 1998 to March 2000, the authors attempted to realign the alar cartilage with an open rhinoplasty approach and used the septal cartilage to project the nasal tip and lengthen the columella by designing the increased nasolabial angle in 20 cases. The cartilage was then inserted in the alar cartilage and fixed on the anterior nasal spine. The results, considered satisfactory in all patients without any complications, are as follows: 1. The changes of nasolabial angles were from 88.7 degrees to 95.3 degrees, 2. The average increase in columellar height was 3.5 mm, 3. The average decrease of the alar width was 3.0 mm, 4. The changes of the angle between the long axis of the external naris was from 92.2 degrees to 71.5 degrees. This procedure is an effective method in improving nasolabial angle and columella length.