Guide Lines of Successful Augmentation Rhinoplasty

ABSTRACT

Augmentation rhinoplasty is one of the most popular aesthetic procedures in Korea. It is precise surgery in which the margin of error is measured in millimeters, thus the surgeon must have a full knowledge of nasal anatomy and the basic principle of surgical procedures. In fact, many surgeons, in particular, inexperienced with lack of the basic principle, face dissatisfactory surgical result frequently. While a considerable number of studies have been made on the "advanced procedures" of rhinoplasty over the past few years, few attempts have so far been made on the "basic principle". This article shows what is the basic principle of successful augmentation rhinoplasty. The six steps for successful augmentation rhinoplasty are as follows incision, approach, pocket dissection, implant fabrication, suture, and dressing. Marginal incision should be made at the caudal border of the alar cartilages to avoid disruption of soft triangle area and visible scar formation, which could be occurred when it is made at the immediate nostril rim area. The soft tissue envelope is sharply elevated in a plane intimate to the perichondrium with Peck- Joseph dissecting scissors to minimize tissue trauma and bleeding. The periosteum is sharply elevated with a Joseph periosteal elevator at the caudal margin of the nasal bone and dissection continued superiorly in a subperiosteal plane to the radix area. This pocket must be made with ample and symmetric dissection. Silicone rubbers, especially, soft type are the best as implants for rhinoplasty. It should be fabricated at the nasofrontal angle and its contact surface with the nasal bone should be carved more concavely to have a plastic suction pad effect. Silicone rubbers carved like this adhere closely to the nasal bone and make an even capsular formation. The incision should be closed very carefully, if not, asymmetric nostril or deviated columella can be occurred. Joseph dressing is routinely placed at the final step. In this procedure, we expect that any dead space between implants and the nasal bone can be obliterated by placing two or three pieces of gauze on the nasal root. We are sure that this article can be a little help to inexperienced plastic surgeons by providing the basic principle of successful augmentation rhinoplasty.