Lengthening the short nose in Asians: key maneuvers and surgical results.

IMPORTANCE: Using objective anthropometric measurement, this study reports the outcome of surgical correction of short-nose deformities in Asian patients. OBJECTIVE: To present our experience in lengthening the short nose in Asians and report the surgical results. DESIGN, SETTING, AND PATIENTS: In this retrospective review, we study the cases of 36 patients who underwent surgical correction of short-nose deformity. The effect of nasal lengthening was analyzed using anthropometric measurement, including nasion to tip-defining point (N-TDP), nasal tip projection (NTP), nasofrontal angle (NFA), and columellar-facial angle (CFA). EXPOSURES: Surgical correction of short-nose deformity. MAIN OUTCOME MEASURES: The preoperative and postoperative N-TDP, NTP, NFA, and CFA and patient satisfaction. RESULTS: The mean postoperative follow-up duration was 29.8 months. The cause of the short nose was congenital in 18 cases and secondary to previous rhinoplasty in 18 cases. Septal tissue, conchal cartilage, costal cartilage, and conchal composite tissue were used as graft materials. The key procedures for lengthening included septal extension graft reinforced with extended spreader, dorsal onlay, and tip grafts. The N-TDP increased by 11.2%, and CFA decreased from 122.6° to 111.1°. The NFA changed from 148.9° to 148.5°. The NTP ratio, measured using the Goode method, decreased from 0.53 to 0.50. The increase of N-TDP was greater in patients undergoing the costal cartilage grafting procedure than in those who received septal or conchal cartilage. All patients were satisfied with the aesthetic results, and there were no serious complications. CONCLUSIONS AND RELEVANCE: In Asians, the key maneuvers for lengthening were septal extension graft reinforced with extended spreader and dorsal onlay graft. Rib cartilage provided superior lengthening effect compared with other cartilage. LEVEL OF EVIDENCE: 4.

Morphological and histological changes of the septal cartilage after unilateral versus bilateral mucoperichondrial flap elevation.

BACKGROUND: Bilateral mucoperichondrial flap elevation is often needed to properly correct the septal deformity although it has been discouraged because of possible complications. This study investigated the effect of unilateral versus bilateral mucoperichondrial flap elevation on the morphological and histological changes of the septal cartilage in a rabbit model. METHODS: Eighteen mature New Zealand white rabbits were categorized into three groups (six animals for each) according to the procedures they received: unilateral mucoperichondrial flap elevation versus bilateral mucoperichondrial flap elevation versus no flap elevation. In each group, one-half of the animals were killed 3 months after the procedure and the other half were killed 6 months after the procedure. Thickness of cartilage was measured and histological changes of chondrocyte and extracellular matrix were evaluated using hematoxylin and eosin, Masson's trichrome, Alcian blue, and Verhoeff's elastic stains. RESULTS: There was no difference in changes of thickness of the cartilage among the three groups. Histological examination revealed that the chondrocyte numbers and dystrophic features as well as the ratio of chondroblast were not different among three groups. Masson's trichrome stain in the bilateral group showed lesser dense collagen fibers than the other groups. Alcian blue stain for proteoglycan documented that the peripheral zone showed lower expression in the bilateral group than the other groups. However, Verhoeff's elastic stain did not differ among the three groups. CONCLUSION: Bilateral mucoperichondrial flap elevation of a rabbit model decreased deposition of collagen fibers and proteoglycan while maintaining the similar chondrocyte cellularity compared with the other groups.

Reconstruction of nasal alar defects in asian patients.

OBJECTIVES: To present the aesthetic and functional outcomes of nasal alar reconstruction in Asian patients and to propose a working surgical algorithm. METHODS: Seventeen patients underwent nasal alar reconstruction at a university-based facial plastic surgery practice from March 1, 1998, through February 28, 2010. The male-female ratio was 10:7, with a median age of 59 years (range, 34-78 years), and the mean follow-up duration was 64 months. RESULTS: The defect was mostly caused by basal cell carcinoma resection (14 of 17 [82%]), followed by the resection of squamous cell carcinoma, trauma, and excision of a previous scar. The mean defect size was 1.71 cm (range, 1-4 cm). The full-thickness defects were noted for 8 patients, whereas 9 had partial-thickness defects. The choice of reconstruction method was primarily based on the size and depth of the surgical defect. Most of the defects 1 to 2 cm in diameter needed nasolabial flaps (10 of 17 [59%]), whereas full-thickness defects larger than 2 cm needed forehead flaps (3 of 17 [18%]) to reconstruct the external defect. Smaller defects less than 1 cm were reconstructed with composite grafts (2 of 17 [12%]), a bilobed flap (1 of 17 [6%]), or primary closure (1 of 17 [6%]). Seven of 8 full-thickness defects had the internal nasal lining reconstructed using a septal mucoperichondrial flap, and 1 case was reconstructed using a cutaneous turn-in flap. Reinforcement cartilage graft was used in 8 patients. No flap failure occurred except in 1 case, in which necrosis of the internal lining flap caused contraction of the external flap with resultant alar rim elevation. An elevation of the alar margin and alar groove blunting occurred in 3 cases. No functional problems emerged. Subjective surgical outcome on a 4-point satisfaction scale revealed that 5 patients (29%) were much satisfied, 10 patients (59%) were satisfied, 1 patient (6%) was fairly satisfied, and 1 patient (6%) was dissatisfied. CONCLUSIONS: The choice of reconstruction method of nasal alar defect in Asian patients depends primarily on the size and depth of the defect. Staged local flaps, use of cartilage reinforcement grafts, and internal lining reconstruction using septal mucoperichondrial flaps are key elements for achieving optimal aesthetic and functional results.