Methods for Carving Expanded Polytetrafluoroethylene Prostheses in Augmentation Rhinoplasty and Their Impact on Nose Shape

Abstract

Sir:FigureProsthesis shape will directly impact postoperative nose aesthetics in augmentation rhinoplasty. This article reports methods of carving the prosthesis and their impact on nose shape. The commercial name of the expanded polytetrafluoroethylene used in our hospital operations was Tisuthes (Shanghai Suokang Medical Implants, Shanghai, People's Republic of China).1 Its dimensions were 70 × 15 × 8 mm. Low-lying noses were divided into three types: low nasion (type A), low nasal bridge (type B), and low nasal bridge and tip (type C) (Fig. 1, above). Prostheses were carved into a short willow shape, a long willow shape, or an L shape, respectively.Fig. 1: Three types of low-lying noses (low nasion, low nasal bridge, and low nasal bridge and tip) and the carving procedures to create the short willow-shaped, long willow-shaped, and L-shaped prostheses.For length (Fig. 1, second row), the starting point, A, was the horizontal line 3 to 4 mm above the midline between the eyebrows and eyes. The ending point, B, was the tangent point of the prosthesis and nasion skin for type A and B. For type C, it marked the junction of the facial vertical line of the columella-lobular angle and the prosthesis. A triangular section was cut from both sides of the prosthesis at point B to divide it into a long segment (used on the nasal bridge) and a short segment (used for the columella, approximately 10 mm). The width at the junction of the long and short segments was 3 to 5 mm. For the ventral surface (Fig. 1, third row), for type A, a triangular section was obliquely cut from both the cephalic end and nasal end of the ventral surface of the prosthesis to maximize the attachment between the ventral surface of the prosthesis and the nasal bridge. Type B was approached the same as type A. If there was a small bump on the nasal bridge, a hole was made at the corresponding spot on the ventral surface of the prosthesis. For type C, the long segment is the same as type B. The short segment of the prosthesis was obliquely trimmed from point B and varied from 1 to 3 mm thick beyond that point. For width (Fig. 1, fourth row), for types A and B, a wedge was cut from both sides of the prosthesis to achieve the desired width, which was approximately 12 mm for male patients and 10 mm for female patients. The width at point B was approximately 5 mm. For type C, the long segment is the same as for type B. The short segment was gradually tapered to 1 mm or to have an angle near its tip. For the dorsal surface (Fig. 1, fifth row), for type A, a 135- to 140-degree angle was carved at point A of the prosthesis dorsal surface, which was trimmed to a desired thickness of no more than 3 mm for type A. For type B, the thickness is usually no more than 8 mm for male patients and 6 mm for female patients. For type C, the long segment is the same as for type B. The prosthesis was cut open transversely at the superficial layer of the junction of the long and short segments. The short segment was then folded ventrally to form an L-shaped prosthesis. The impact of each factor on nose shape is summarized in Table 1.1–4Table 1: The Impact of Length, Width, Dorsal Surface, and Ventral Surface on Nose ShapeXudong Zhang, M.D. Qinjian Peng, M.D. Yongcheng Xu, M.D. Department of Cosmetic Surgery, Beijing Huangsi Aesthetical Surgery Hospital, Beijing, People's Republic of China DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.