Augmentation Rhinoplasty Research Articles

The Application of Fibrin/Hyaluronic Acid-Poly(l-Lactic-co-Glycolic Acid) Construct in Augmentation Rhinoplasty.

Although many graft materials have been used for augmentation rhinoplasty, an ideal graft has not yet been developed. As the field of tissue engineering has been developing, it has been applied to the reconstruction of many organs, but its application in the rhinoplasty field is still limited. This study evaluated the utility of allogenic chondrocytes with fibrin/hyaluronic acid (HA)-poly(l-lactic-co-glycolic acid) (PLGA) constructs in augmentation rhinoplasty. Chondrocytes from rabbit auricular cartilage were isolated and cultured with fibrin/HA hydrogels and implanted into PLGA scaffolds. After 8weeks of in vitro culture, the scaffolds were implanted in the nasal dorsum of six rabbits. Eight weeks postoperatively, the implanted sites were evaluated with gross, radiologic, and histologic analysis. In vitro, more than 90% of the seeded chondrocytes in the PLGA scaffolds survived for 2weeks, and they produced a large amount of extracellular matrix and were well differentiated. The grafts maintained their initial shape for 8weeks after implantation. Radiological and histological evaluations showed that the structure was well maintained with minimal inflammatory response and appropriate elevation levels. However, the formation of neo-chondrocytes was not observed. PLGA scaffolds seeded with fibrin/HA and allogenic chondrocytes can be a biocompatible augmentation material in rhinoplasty in the future.

Usefulness of Cross-Linked Human Acellular Dermal Matrix as an Implant for Dorsal Augmentation in Rhinoplasty.

Asian noses are relatively small and flat compared to Caucasians; therefore, rhinoplasty procedures often focus on dorsal augmentation and tip projection rather than reduction in the nasal framework. Various autologous and alloplastic implant materials have been used for dorsal augmentation. Recently, human acellular dermal matrices have been introduced as an implant material for dorsal augmentation, camouflaging autologous implants without an additional donor site. Here, we introduce a cross-linked human acellular dermal matrix as an implant material in augmentation rhinoplasty and share the clinical experiences. Eighteen patients who underwent augmentation rhinoplasty using acellular dermal matrix from April 2014 to November 2015 were reviewed retrospectively. Clinical outcomes and complications were assessed at the outpatient clinic during the follow-up period ranging from 8 to 38months. Contour changes were assessed through comparison of preoperative and postoperative photographs by two independent plastic surgeons. Patient satisfaction was assessed at the outpatient clinic by six questions regarding aesthetic and functional aspects. Postoperative photographs demonstrated the height of the nasal dorsum did not decrease over time except two patients whose ADM was grafted into a subperiosteal pocket. Others who underwent supraperiosteal implantation showed acceptable maintenance of dorsal height. No major complication was reported. Overall, patient satisfaction scored 81.02 out of 100. Cross-linked human ADM has advantages of both autogenous and alloplastic materials. The surgical results remain stable without complications. Therefore, it is a suitable alternative implant material for dorsal augmentation in rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Learning Curve in Surgical Practice and Its Applicability to Rhinoplasty.

The learning curve as a concept has been considered, discussed and debated in medical education and healthcare for over two decades. The precise usage has been recognised in surgical disciplines both broad specialties and sub-specialties. Rollin Daniel in his book stated that, rhinoplasty is the most difficult of all cosmetic operations for three reasons, (a) nasal anatomy is highly variable, (b) the procedure must correct form and function and (c) the final result must meet the patients expectations. With this in mind a study was carried on the perception of learning curve in rhinoplasty based on a surgeon questionnaire at Marien Hospital, Stuttgart, Germany under Prof. Gubisch. Aims of the study were, (1) to extract the perception of learning curve of Rhinoplasty from surgeons across a spectrum of experience, i.e. less experienced to experienced, (2) To calculate the perception of learning curve in rhinoplasty as for other surgical procedures i.e. minimum number, interquartile range, surgical time, accelerators, (3) To chart-out a road-map for a novice rhinoplasty surgeon for continued improvement in surgical skills and ability. The conclusion derived was the concept of learning curve in rhinoplasty cannot be applied to the operation of Septo-Rhinoplasty as a whole because the two factors i.e. interquartile range and minimum number to achieve proficiency have a wide range and cannot be generalized. It is thought that each type of Rhinoplasty should be dealt with separately and learning curve calculated accordingly, i.e. hump reduction, crooked nose and augmentation rhinoplasty.

One-Stage Treatment for Adult Patients With Crouzonoid Appearance by Orthognathic and Face Contouring Surgery.

Crouzon syndrome is a rare genetic disorder with autosomal-dominant inheritance that shows a triad of hallmark characteristics: craniosynostosis, exophthalmos, and midface retrusion. General treatment protocol for patients with Crouzon syndrome has already been established, but there is no standard treatment strategy for adult patients with Crouzonoid appearance. The authors present clinical patients of 1-stage orthognathic and face contouring surgery to achieve functional and aesthetic improvement.One-stage surgery was performed in adult patients with Crouzonoid appearance without a history of facial surgery. Orthognathic 2-jaw surgery was first performed to treat class III malocclusion. Face contouring surgery was conducted next to improve the aesthetic appearance using midface augmentation with onlay rib bone graft, advancement genioplasty, augmentation rhinoplasty, and ancillary procedures such as neck lift, fat graft, or fillers.Five patients (2 men, 3 women) were enrolled in this study. The mean age at the time of surgery was 19.0 years. No specific surgery-related complications such as infection, nerve injury, or recurred malocclusion were observed during the 3.5 years of follow-up. Normal class I occlusion was reached in all patients. The frontonasal angle, nasolabial angle, and labiomental angle improved from 125.1° to 135.1° (P > 0.05), 60.9° to 86.3° (P = 0.018), and 146.3° to 125.0° (P = 0.018), respectively. The Global Aesthetic Improvement Scale score was 4.75 and 5.00 in frontal and profile views, respectively.One-stage orthognathic and face contouring surgery may be an effective surgical option with good postoperative functional and aesthetic improvement in adult patients with Crouzonoid appearance.

Skin Necrosis with Oculomotor Nerve Palsy Due to a Hyaluronic Acid Filler Injection.

Performing rhinoplasty using filler injections, which improve facial wrinkles or soft tissues, is relatively inexpensive. However, intravascular filler injections can cause severe complications, such as skin necrosis and visual loss. We describe a case of blepharoptosis and skin necrosis caused by augmentation rhinoplasty and we discuss the patient’s clinical progress. We describe the case of a 25-year-old female patient who experienced severe pain, blepharoptosis, and decreased visual acuity immediately after receiving a filler injection. Our case suggests that surgeons should be aware of nasal vascularity before performing an operation, and that they should avoid injecting fillers at a high pressure and/or in excessive amounts. Additionally, filler injections should be stopped if the patient complains of severe pain, and appropriate measures should be taken to prevent complications caused by intravascular filler injections.

Procedure, applications, and outcomes of autologous fat grafting

ObjectiveTo systematically review the procedure, applications, and outcomes of autologous fat grafting, a promising technique with various clinical applications.Patients and methodsLiterature review of publications concerning autologous fat grafting.ResultsSince its introduction, lipofilling has become increasingly popular; however, its results are variable and unpredictable. Several modifications have been made to the procedures of fat harvesting, processing, and injecting. Surgical excision and low negative-pressure aspiration with large-bore cannulas minimize adipocyte damage during fat harvesting. The “wet” method of fat harvesting involves fluid injection at the donor site and facilitates lipoaspiration while minimizing pain and ecchymosis. For fat processing, centrifugation at a low speed is preferable to high-speed centrifugation, gravity separation or filtration. Fat injection at the recipient site should be performed using small-gauge cannulas in a fanning out pattern over multiple sessions, rather than a single session. Fat grafts exhibit not only dermal filler properties but also regenerative potential owing to the presence of stem cells in fat tissue. Thus, the clinical applications of autologous fat grafting include correction of secondary contour defects after breast reconstruction, release of painful scar contractures, and treatment of burn scars and radiodermatitis. Lipofilling is also used in aesthetic surgery, such as facial and hand rejuvenation, augmentation rhinoplasty, and breast and gluteal augmentation. The complications of lipofilling are minimal and include bruising, swelling, pain, infection, necrosis, and calcification.ConclusionsLipofilling is a low-risk procedure that can be used to correct soft-tissue defects in the face, trunk, and extremities, with minimal discomfort for patients.

Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty.

Studies comparing surgical results of rhinoplasty using autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are rare. To compare the clinical results of major augmentation rhinoplasty using ACC vs IHCC and analyze the histologic properties of both types of cartilage. A retrospective clinical study was conducted among patients who had undergone rhinoseptoplasty using ACC or IHCC from January 1, 2009, to December 31, 2014. Patients were followed up for more than 1 year after surgery and the histologic characteristics of ACC and IHCC were compared. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity, were evaluated by reviewing medical records and facial photographs. Patients' subjective satisfaction with aesthetic and functional results was evaluated using a questionnaire. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity; patients' subjective satisfaction with aesthetic and functional results' objective evaluation of surgical outcomes, including symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result; and histologic structures. Objective evaluation of surgical outcomes was graded using the Objective Rhinoplasty Outcome Score, which assessed symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result. Histologic structures were evaluated using hematoxylin and eosin, Masson trichrome, Alcian blue, and Verhoeff elastic stains. A total of 63 patients (27 males and 36 females; mean [SD] age, 30.6 [9.5] years) had rhinoseptoplasty using ACC and 20 (9 males and 11 females; mean [SD] age, 35.4 [15.4] years) had rhinoseptoplasty using IHCC. Among observed complications, only notable resorption occurred more frequently in patients using IHCC (6 [30%]) than with ACC (2 [3%]) (P = .002). In subjective evaluations of aesthetic satisfaction, patients who received ACC showed significantly greater satisfaction (37 of 51 patients [73%] were very satisfied) than did those who received IHCC (6 of 20 [30%]) (P = .001). However, there was no between-group difference in subjective functional outcomes: 4 of 51 patients receiving ACC (8%) and 5 of 20 receiving IHCC (25%) were satisfied (P = .50) and 45 of 51 receiving ACC (88%) and 15 of 20 receiving IHCC (75%) were very satisfied (P = .15). Regarding objective aesthetic outcomes, all scores for both ACC and IHCC were more than 3.1 (between good and excellent). Histologic analyses showed larger, more evenly distributed, uniform chondrocytes and more collagens and proteoglycan contents in ACC than in IHCC. Compared with patients receiving IHCC, those receiving ACC for rhinoseptoplasty showed superior aesthetic satisfaction; ACC also had less frequent notable resorption. Autologous costal cartilage also had better histologic properties than IHCC did, suggesting it as an ideal graft material with less chance of long-term resorption. 3.

Cartilage Scales Embedded in Fibrin Gel.

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

Dorsal Augmentation Using Autologous Costal Cartilage or Microfat-Infused Soft Tissue Augmentation

Costal cartilage grafting is increasing in popularity with increased demand for augmentation rhinoplasty and increased need for grafting material for structure rhinoplasty techniques. Use of costal cartilage for dorsal grafting is both art and science. The art is demonstrated in the act of carving a dorsal graft that will reflect the actual contour of the nasal dorsum. The science is linked to the methodology of how the grafts are contoured to match the patient's desires and how the graft is fixed to the bony dorsum to minimize the risk of warping and displacement. Variations in dorsal graft design and methods of fixation are described. Use of the perichondrial interface between dorsal graft and perforated/rasped nasal dorsum acts to ossify the dorsal graft to the underlying bone, creating an immobile and natural appearing nasal dorsum. The fixation of the dorsal graft limits movement and hence decreases the likelihood of warping or deformity. Use of microfat in rhinoplasty has tremendous potential for camouflage and to promote healing of compromised tissues. Using microfat-infused soft tissue augmentation (MISTA), the surgeon is able to deliver microfat to an open surgical field, promote healing, and provide soft tissue augmentation. In this technique, microfat is injected into soft tissue carriers (perichondrium, temporalis fascia, etc.) and then implanted into the surgical field. MISTA has tremendous potential utility in many areas of cosmetic and reconstructive surgery.

Silicone Implant Sandwiched between Intact Nasal Bones with Fractured Nasal Bone Segments.

As the number of people who have undergone augmentation rhinoplasty has increased recently, nasal fractures are becoming more common after rhinoplasty. A silicone implant can affect the nasal fracture pattern, but there is no significant difference in treatment methods commonly. A 28-year-old female who had undergone augmentation visited our clinic with a nasal fracture. Computed tomography revealed that the silicone implant was sandwiched between the intact nasal bones with fractured bone fragments. In this case, open reduction was inevitable and a new silicone implant was inserted after reduction. Migration of the silicone implant beneath the nasal bone is a very rare phenomenon, but its accurate prevention and diagnosis is important because a closed reduction is impossible.

Augmentation Rhinoplasty With Silicone Implant Covered With Acellular Dermal Matrix.

Alloplastic materials are a mainstay in Asian rhinoplasty. However, the outline of alloplastic implants can become conspicuous over time in rhinoplasty patients, which is a significant cause for revision. In revision rhinoplasty, alloplastic materials can remain a viable and affordable option in Asian patients. The acellular dermal matrices (ADM) are often used to interface between the silicone material and the skin envelope. This study assesses histologic changes following implantation of ADM-covered silicone material in rats. To demonstrate differences at the histologic level, silicone blocks with and without ADM were implanted in the subcutaneous plane of 10 rats. These implants were harvested after 9 weeks and examined histologically for capsule thickness and myofibroblast activity. In the in vivo study, the presence of ADM was associated with significantly decreased capsule thickness and myofibroblast activity around the implant and maintained the structure of ADM well. The authors suggest that using the ADMs to cover silicone implants can be an alternative method for decreasing the visibility of implant contour, by the prevention of capsular contracture and the addition of a soft tissue layer to the dorsal skin envelope.

Silicone-Polytetrafluoroethylene Composite Implants for Asian Rhinoplasty.

Silicone and Gore-Tex implants are mainstays of Asian rhinoplasty. Silicone implants are inexpensive and wieldy, but may elicit a foreign-body reaction and are prone to migration. Gore-Tex implants are more biocompatible and capable of ingrowth but expensive. Silicone-polytetrafluoroethylene (PTFE) composites have a silicone core and PTFE liner. Composite implants have been marketed for several years, but are not yet established alternatives for rhinoplasty because of a lack of relevant reports. From February 2012 to June 2015, 177 Asian patients underwent primary (n = 63) or secondary (n = 114) rhinoplasty using an I-shaped composite implant. One hundred fifty-nine women and 18 men were 19 to 72 years old (mean, 34 years) at the time of surgery. Composite implants were 1.5 to 5 mm thick and 3.8 to 4.5 cm long. Autologous cartilage from the septum, concha, or both was used for tip refinement in every case. Glabellar augmentation was performed in 19 (10.7%) cases. Follow-up was 6.0 months (range, 1-36 months). There were 19 (10.7%) complications including malposition/deviation (4.5%), erythema (2.3%), and infection (1.1%). Four patients were unsatisfied, citing inadequate dorsal height correction. There was an 8.8% revision rate; 7 of 12 revisions were for malposition/deviation. We did not observe implant step-offs or extrusion. There were no differences in outcomes after primary or secondary rhinoplasty, although there was a trend toward higher infection rate after primary rhinoplasty (P = 0.06). I-shaped silicone-PTFE composite implants are feasible for both primary and secondary augmentation rhinoplasty in Asians. Early outcomes data suggest an overall complication rate that is comparable to PTFE alone.

Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm.

BackgroundSilicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed.MethodsPhotographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV.ResultsGrade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes.ConclusionsIt is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

The outcome of temporalis fascia versus diced cartilage wrapped in temporalis fascia for dorsal augmentation in septorhinoplasty

Objective: Rhinoplasty is a difficult operation and has the highest rates of revision surgery. It is often accompanied by septoplasty. Osseocartilagenous vault irregularity, radix depression and saddle deformity of the nose are common problems encountered in rhinoplasty. Deep temporalis fascia available in large quantity can be used alone or in combination with diced cartilage for augmentation rhinoplasty, and to camouflage the nasal dorsal irregularities. A wide variety of grafts is used to augment the nasal dorsum. The aim of the study was to note the nasofrontal, nasolabial, nasofacial angles measurements, functional and aesthetic assessment before and after septorhinoplasty. Methods: A retrospective chart review was done on 69 patients, who underwent septorhinoplasty at our institute (Jan 2011 – Jan 2014). Out of these, 31 patients underwent dorsal augmentation with temporalis fascia as a blanket endonasal coverage in one group and diced cartilage with temporalis fascia in the other group (38 patients). The diced cartilage was obtained from nasal septum in 16 cases (42.1%), chonchal cartilage in 14 cases (36.84%), rib cartilage in 5 cases (13.15%) and Goretex in 3 cases (7.89%) wrapped in temporalis fascia for dorsal augmentation was included in the same group.The operative details, surgical outcome, and complications noted have been mentioned. Results: The nasofrontal angle, nasal labial angle and nasofacial angle were reduced in the dorsal augmentation using diced cartilage with temporalis fascia group compared to the temporalis fascia alone group. As per the functional point of view (breathing quality) score, we found in the first group that all 31 patients were satisfied (100%), while in the second group we found that 37 patients out of 38 were satisfied (97.4%). Only one patient (3.2%) out of 31 patient in the first group was not satisfied form the aesthetic point of view while in the second group we found that 6 patients (15.5%) out of 38 were not satisfied. Conclusion: Temporalis fascia used in any form like a blanket, or with diced cartilage wrapped with fascia offers the advantage of smooth nasal dorsum, a reasonable functional improvement and a better option for nasal dorsal osseocartilagenous reconstruction.

Postoperative Satisfaction in Nasal Bone Fracture Patients Who Had Rhinoplasty.

Nasal bone fracture is the most common type of facial bone fracture. There are 2 main reduction methods for treating nasal bone fractures: open reduction and closed reduction. A secondary operation was required when there was a deviation of shape after the operation, so there have been many studies conducted on patient satisfaction after reduction. However, there was few study on the satisfaction of nasal bone fracture patients with rhinoplasty depending on treatment modality. This study focused on the characteristics of nasal bone fracture rhinoplasty patients and on the satisfaction of patients who had previous rhinoplasty and their satisfaction after closed fracture reduction. The 22 patients, who had previously undergone augmentation rhinoplasty using silicone implants, visited Sanggye Paik Hospital from 2009 to 2014 for isolated nasal bone fractures. A satisfaction survey was conducted by telephone. The patients were asked of their subjective satisfaction after rhinoplasty, after the nasal bone fracture, and after the closed or open reduction. The satisfaction scores were recorded on a 5-point numerical scale. As the control group, 149 nasal bone fracture patients who were operated in the year 2013 were selected, and a phone survey was performed. Also, all facial three-dimensional computed tomography scans were reviewed to analyze characteristics of nasal bone fractures in the previously augmented rhinoplasty patients. Satisfaction and other characteristics of the 2 groups were evaluated with the independent t test and χ test using SPSS software (Version 18.0; SPSS Inc, Chicago, IL). Seven patients of 22 were able to complete the phone questionnaire (31.8%). Six of the 7 participants went through closed reduction and 1 had open reduction. Before plastic surgery, patient satisfaction was 2.333; after rhinoplasty it increased to 3.833. After the nasal bone fracture, patient satisfaction was 2.25, and after the reduction, it improved to 3.167. Of the 149 patients of the control group, 87 were able to complete the phone survey (58.3%). Before the injury, patient satisfaction was 3.512, whereas after the fracture it was 2.314. After closed reduction, the satisfaction was 3.326. There were no statistical significance on before trauma (P value >0.05), before reduction (P value >0.05), after reduction (P value >0.05). The rhinoplasty group and the control group were similar in terms of broad characteristics. However, the rhinoplasty group demonstrated a lower diagnostic rate by simple x-ray (40.9%) than the control group (68.5%), a difference that was statistically significant (P value = 0.012). Because there was no significant difference between 2 groups, the closed reduction method is more helpful in patients without deviation, exposure, or destruction of the implant. Also, in rhinoplasty patients who have sustained nasal trauma, the authors suggest facial three-dimensional computed tomography to prevent misdiagnosis.

Puzzle-Formed Modified Turkish Delight for Nasal Dorsum Augmentation

Structural deficiencies of the nasal dorsum are most commonly of congenital, traumatic, or iatrogenic etiology. Various grafts, including autografts, homografts, and synthetic materials, have been used to this end and are described in the literature.Autologous septal cartilage is the most commonly used graft material when limited augmentation rhinoplasty is planned. However, it is difficult to retain sufficient cartilage to allow of such augmentation in instances where most of the septal cartilage has been used. The authors place moderately crushed cartilage beneath a monolayer of surgicel when performing limited nasal dorsum augmentation. The aim of the present study is to describe authors' approach and its utility by reviewing other methods reported in the literature.

Filler Rhinoplasty Evaluated by Anthropometric Analysis.

There are no reports of objectively evaluating the efficacy of filler rhinoplasty by anthropometric techniques. To objectively demonstrate the effectiveness of filler rhinoplasty by anthropometric analysis. A total of 242 patients who revisited the clinic within 2 months of undergoing hyaluronic acid filler rhinoplasty were analyzed based on the injection site, injected volume, and the change in anthropometry. Among the 242 patients, 112 (46.3%) were in the nasal dorsum augmentation group, 8 (3.3%) were in the tip rotation group, and 122 (50.4%) were in the whole nose augmentation group. Average injection volume was 1 ± 0.4 mL for nasal dorsum and 0.9 ± 0.3 mL for tip rotation, whereas 1.6 ± 0.5 mL was used for whole nose augmentation. On follow-up, the radix height, nasofrontal angle, and nasolabial angle (NLA) had increased by 78.3%, 5.7 ± 4.1°, and 9.4 ± 4.5°, respectively, whereas the modified nasofacial angle had decreased by 1.9 ± 2.9°. Three cases (1.2%) of vascular complications were encountered. Filler rhinoplasty is a simple and effective treatment modality producing outcomes comparable with surgical augmentation rhinoplasty. Among various anthropometric measurements, the nasal radix height was the most useful for evaluating dorsum augmentation, whereas the NLA was the best for nasal tip rotation.

An Overview of Asian Rhinoplasty

East Asian rhinoplasty is an expanding topic in the field of rhinoplasty. Although the main principles of various rhinoplasty techniques apply equally to the East Asian nose, East Asian rhinoplasty is unique owing to its different anatomy and ethnicity. In recent years, there have been some noteworthy developments in East Asian rhinoplasty. Traditional techniques using alloplastic implants with endonasal approach are changing due to the advent of new beauty concept, introduction of new techniques, and development of newly improved materials expended polytetrafluoroethylene as an alloplastic material has gained popularity in Asian augmentation rhinoplasty. Soft expended polytetrafluoroethylene sheets as augmentation material provide promise in the future. In this review, we will highlight some of the recent advances of Asian rhinoplasty with emphasis on dorsal augmentation, advances in implant material, and tip surgery using autologous cartilage.

Nasal radix augmentation in rhinoplasty: suggestion of an algorithm

The purpose of this study was to evaluate four standard techniques for radix augmentation during primary rhinoplasty: Skoog, crushed septal cartilage, temporalis fascia, and crushed cartilage wrapped in temporalis fascia. The main criterion for a patient to be included in this study was the need for radix augmentation, which was determined through preoperative evaluations. All patients requiring total dorsal augmentation were excluded from the study. This study included 63 rhinoplasty patients who underwent radix augmentation. The Skoog technique was applied in 15 patients, crushed septal cartilage in 16, temporalis fascia in 17, and crushed cartilage wrapped in temporalis fascia in 15. In those undergoing the Skoog technique, sharp edges of graft were palpable in three patients and were even visible in one patient. In the crushed cartilage group, seven patients showed irregularities during the postoperative follow-up. The results of this study indicate that all four autologous grafts represent acceptable graft material for radix augmentation. The algorithm suggests using the easier techniques first and that secondary donor sites should be considered only when the ideal result is not achieved.

Sepsis Leading to Mortality after Augmentation Rhinoplasty with a Septal Extension Graft and Fat Grafting.

Infection is the most serious complication after rhinoplasty, with rates reported to range from 2.6% to 5.3% [[1]]. In that study, most infections were found to be localized and improved after removal of the implant and appropriate antibiotic therapy. Although a case report has described staphylococcal spinal osteomyelitis after septoplasty as a consequence of bacteremia [[2]], no case of sepsis resulting in death after rhinoplasty has been reported. We report the case of a male patient who expired due to infection after rhinoplasty with a septal extension graft, silicone implant, and fat grafting, and then review and discuss the relevant literature.