Abstract: Autologous Rib Cartilage Rhinoplasty for Harmonious Asian Face: Combining an Extended Columellar Strut Graft with a Pair of Maxillary or a Premaxillary Graft

Abstract

PURPOSE: It is critical that the aim of the rhinoplasty should not only be an improvement of the nose itself but should also pursue a harmonious relationship with other facial structures. Recently, rib cartilage rhinoplasty for Asian nose is widely used, because of increased revision cases due to complications of implants and higher expectation of the patients.1 Additionally, it is a common the characteristic that the midfacial skeleton of the Asian, which is the basement of the nose, is flat or sunken. Therefore, when performing rhinoplasty, Asian rhinoplasty should include evaluation and augmentation of the retruded midface for the harmonious facial relationship.2 The purpose of this presentation is an evaluation of the effect of the combining the extended columellar strut graft with a pair of maxillary or a premaxillary graft in Asians who have sunken midface for the harmonious face in the autologous rib cartilage rhinoplasty. METHODS and MATERIALS: We conducted a retrospective review of the medical charts and postoperative photographs of the selected 403 patients over three months follow-up among 890 cases who underwent autologous rib cartilage rhinoplasties between March 2010 and December 2016, without deformity or procedures on the glabella and chin, in VIP international plastic surgery center, Seoul, South Korea. Selected 403 cases were divided into three groups; Type 0 – extended columellar strut graft (ECSG) alone; Type I – ECSG + a pair of maxillary grafts; and Type II – ECSG + a premaxillary graft. For the objective evaluation of the effect of combining grafts, the angle of facial convexity angle on the profile view of the standardized photographs was measured. Since the facial convexity angle which was connected between soft tissue glabella, subnasale and soft tissue pogonion is a useful tool for the evaluation of the general harmony of the forehead, midface and lower face.3 RESULTS: Total number of cases is 403. Complication rate is 11.7% (45/403, 29 minor, 16 major). Mean follow-up period is 19.4 (maximum=72, minimum=3). The pre and postoperative FCA changes were as follows; Type 0 (N=45) -1.62 ± 1.42 from 170.38 ± 3.36 to 168.76 ± 2.91; in type I (N=305) -4.97 ± 1.68 from 174.17 ± 2.11 to 169.38 ± 2.10; and in type II (N=53) -8.26 ± 2.08 from 180.43 ± 3.20 to 172.17 ± 2.57 (p<0.05). CONCLUSION: We recommend combining ECSG with a pair of maxillary grafts for moderate retruded midface patients and with a premaxillary graft for severe retruded patients in Asian rib cartilage rhinoplasty.