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.

The Fate of Calvarial Bone Graft in Nasal Tip Plasty Patients Followed Up for Over 10 Years

PURPOSE: In order to maintain corrected nasal tip projection, strong support is important. Authors used calvarial bone graft method for this purpose. Patients were followed up about permanency of the bone graft for a long time. METHODS: From 1995 to 1998, author performed calvarial bone graft on 30 adult patients with secondary cleft lip and nose deformity. Patients were observed for 34 months. There were no specific complications, and results were satisfactory. We could confirm the permanence of the calvarial bone graft in 3 patients by photography and radiologic studies for 10 years follow-up. RESULTS: None of the patients showed size change or displacement. But the portion of graft facing the tip was absorbed resulting in loss of tip projection and short nose in two patients. One patient had fracture on the middle of the graft. This caused depression from lower portion of the dorsum to the tip. CONCLUSION: Despite of autogenous grafts such as calvarial bone, absorption of the bone may occur when compressed with tension for a long period. And the graft in the nasal tip not having any contact with the nasal bone may cause absorption of the graft.

Tip Plasty of Plunging Nasal Tip through Endonasal Approach: Resection of Cephalic Lateral Crus & Caudal Septum and Suturing

Usually the open rhinoplasty is used to correct the plunging nasal tip, but it can increase patient's psychological trauma and lengthen the operation time. In this study, the authors present a simple and effective surgical procedure to correct the plunging nasal tip with minimal morbidity. Between April 2005 and February 2006, we performed our nasal tip plasty in 6 patients who were concerned about the long nose with plunging nasal tip. We used the suture method after cephalic resection of the alar cartilage and caudal resection of the septal cartilage through endonasal approach. After that, we evaluated the nasal profile and compared the result with preoperative photographs. We followed these patients for 1 to 4 months. We could achieved good nasal tip projection, improvement of the columellolabial angle and shortening of long nose. The result were relatively satisfactory and there were no complications such as visible scar, alar deformity or asymmetry. Our tip plasty through endonasal approach could reform the plunging nasal tip properly and easily without external scar. We believe that this procedure could be applicable for correcting the plunging nasal tip and an alternative technique which helps to form the harmonious nasal profile with augmentation rhinoplasty.

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.

Augmentation Rhinoplasty Combined with Tip Plasty Using AlloDerm(R)

Because the Korean nose has a flat dorsum and depressed tip, tip projection procedure has frequently been performed as an ancillary procedure of dorsal augmentation. Although various materials have been used for tip plasty, an ideal technique has not yet been described. The authors performed classic augmentation rhinoplasty using a silicone implant to correct flat dorsum. Alloderm(R)(Life Cell Corporation, the Woodlands, Texas), acellular human dermis, was used for soft and smooth projection of the nasal tip. From January of 2000 to August of 2003, 20 patients underwent this procedure in Department of Plastic and Reconstructive Surgery. The patients were followed up for 2 to 26 months. Postoperative course was uneventful. Although partial graft resorption was noted in 3 patients, long-term follow-up showed good results. Alloderm(R) usage for tip plasty allows natural contour of the nasal tip, decreases donor site morbidity, and obviates time consuming procedures for graft harvesting. In conclusion, Alloderm(R) graft could be an appropriate alternative in tip projection procedure.

Correction of the Nasal Profile in Mild Hump by Tip Plasty and Resection of Depressor Septi Nasi Muscle

Oriental hump nose is characterized by mild degree of the hump, broad dorsum, low nasal height and drooping tip. The conservative rasping of hump or humpectomy and osteotomy is too invasive to the patient with mild hump and may yield unnecessary complications for example under or over correction, nasal stenosis. For these reasons we have performed augmentation tip plasty by shield graft with columellar strut using autogenous conchal cartilage and resection of the depressor septi nasi muscle to 8 patients with mild hump. All patients have been very satisfied with the result and no serious complications were noted.

Anatomical Nasal Tip Plasty with Autogenous Cartilage Graft

Augmentaion rhinoplasty is one of the most common aesthetic surgery in Korea. Plastic surgeons have been more interested in not only simple augmentation of nasal dorsum, but making more beautiful and natural nasal tip. In the people who has depressed nasal bridge with round and blunted tip, simple augmentation of the nasal dorsum with silicone or Gore-Tex implants could aggravate the tip's disfigurement, so the need for tip plasty has been more emphasized in those persons. There have been used two traditional techniques in endonasal autogenous cartilage tip graft for increasing tip projection, Sheen's shield graft and Peck's onlay graft. But these techniques have several disadvantages such as displacement, visibility of graft margin and flattening of infralobule. The most criticizable problem is that these grafts have limitation in producing the natural and anatomical tip contour.We have done 45 consecutive nasal tip plasties using anatomically-shaped cartilage grafts which was developed from the idea of combination of Sheen's shield and Peck's onlay graft. We followed up the patients from 2 to 14 months. Most patients have been very satisfied with the results and no serious complications were noted. Author's graft was designed to minimize displacement by stable placement on both alar domal and lobular segments, minimize graft visibility by increasing graft contact to nasal tip skin, manipulate the cephalo-caudal length by modification of onlay thickness, and most of all, reproduce the anatomical tip projection and contour.

Nasal Tip-Plasty with Silicone Implant and Medpor(R) Onlay and Strut Implant

In traditional concepts, the beautiful nose was defined as showing a round tip and having a good relationship with his or her own face. Esthetically, it is thought to be good that the ratio of nasal lobule to columella is 1 : 1.618. Comparing oriental and Caucasian nose, oriental nasal tip has more oily skin and more thin cartilages than that of Caucasians. In addition, in case of cleft patients, Orientals have a shortage of nasal skin. Therefore oriental nasal tip shows more tension following nasal tip-plasty. Until now, for tip-plasty, we have applied many surgical methods, such as lengthening of columella with V-Y advancement or composite graft from concha, advancement of retruded columella by septal cartilage graft, Converse's method, Millard's method and silicone implant or bone graft. Above mentioned methods have several advantages of own themselves, but also have several disadvantages such as donor site morbidity, scar formation and so on. Nowadays, we have used silicone and cartilage graft or Alloderm for augmentation rhinoplasty and tip-plasty because of their simplicity. But autogenous cartilage graft has some disadvantages such as absorption, distortion and possibility of donor site morbidity. We think that there's no specific rationale to insist to use autograft or allograft on the nasal tip while using the silicone, which is synthetic material, on the nasal dorsum. Medpor is such a rigid, elastic and microporous material that can be fixed firmly on its original site by allowing an in-growth of fibrovascular tissues into its own micropores. In addition, it is free from donor site morbidity and offers simpler operation procedure. From November 1999 to January 2001, authors performed augmentation rhinoplasty to 32 patients with I-shaped silicone implant through an alar rim incision. Thereafter on nasal tip portion of implant we performed Medpor onlay implant and on the columella, from its base to the nasal tip area, we performed Medpor strut implant as we wanted. As a result of mean 6 months follow-up, we can achieve a good nasal tip projection, lengthening of columella, natural columella appearance and improvement to obtuse nasolabial angle. No specific complications were reported except for 2 cases. One case showed slight hardness on nasal tip area. We think more follow-up period is needed for this situation. The other case showed minimal displacement of silicone implant. But it did not require any additional operations because the patient wanted no more operation. We think that tip-plasty using Medpor onlay and strut implant is effective and simple method which can be performed at out-patient department.

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.

Correction of Blunt Nasal Tip with "Contour Tip Gragt" and Alar Cartilage Modification

The aim of aesthetic rhinoplasty is to produce harmonious contour of the nasal tip as well as to provide dorsal augmentation. The nasal tip should look definite but not too pointed or artificial. Natural contour is most desirable. Among the patients(n = 140) who had augmentation rhinoplasty between 1995 to 1999, 107 patients were classified to have blunt tips. The cases who have other types of tip deformities were excluded. In this study, we present our tip plasty technique for the correction of blunt tips. The blunt tip deformities were divided into bulbous tip(n = 82) and broad tip(n = 25). As for the operation, different tip thinning procedures were done according to this classification. Then dorsal augmentation with silastic implant was performed. Authors used "Contour Tip Graft" technique to produce aesthetic oriental nasal tip. This technique made use of the graft of stacked autogenous cartilages with small pieces of diced cartilage around it. The stacked cartilages were for tip projection and surrounding pieces for natural contour. This method can yield more natural appearance of the tip and lobule. Our tip plasty technique combined with dorsal augmentation is very useful and effective procedure in the correction of blunt tip.

Septal Cartilage Graft for Nasal Tip

No abstract available.