Nasal Tip Plasty Research Articles

Classification pattern and step-by-step procedure for cartilage grafts with silicone implants for nasal tip plasty in Asians

Dorsal augmentation using silicone and tip plasty with autogenous cartilage is commonly performed in Asians. No study has investigated the classification pattern and step-by-step procedure for tip plasty using silicone implants. Therefore, this study classified cartilage grafts using silicone implants in Asians and developed a step-by-step procedure for their implementation. The study included 39 patients who had undergone augmentation rhinoplasty with a silicone implant combined with a conchal cartilage graft as a shield, an onlay graft, or both. We classified the implant-conchal cartilage complex into two main types (edge and no-edge types). In the edge type, the shield graft tip was located 1-2mm above the silicone implant or onlay graft. In the no-edge type, it was located at the same level as the silicone implant or onlay graft. Each type was classified into three groups depending on the number of onlay grafts: group I, 0; group II, 1; and group III, ≥2. The cartilage complex was placed on the dorsum. The conchal cartilages were harvested through a post-auricular incision while preserving the radix helicis as cartilage bars. The donor site was closed primarily without a tie-over dressing. Of the 39 patients, 35 were satisfied with the outcome. Three revision operations for implant displacement and one revision for a patient who changed her dorsal height preference were performed. No donor site morbidity occurred. This method may be safe and reliable, with minimal morbidity associated with graft harvesting for tip plasty in Asians.

Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip Plasty in Asians.

The objective of this study was to illustrate a novel technique for lifting of the aging upper lip with nasal tip plasty in Asians. With this procedure, a shortening of the philtrum, an increase of the vermilion, and a natural and nicer mouth can be obtained, with increase of the tip of the nose simultaneously. Thirty patients were the subjects of this study. Incisions were made bilaterally beginning at the alar fold, entering nostrils, and rising medially on the skin below the lower margin of the medial crura. Excess skin of the philtrum was eliminated in two separate pieces and the muscle was suspended to the base of the nose with interrupted stitches. All patients expressed a high degree of satisfaction. The average ratio between the L1 reference line and the height of the upper lip measurement preoperatively was 0.43 ± 0.05. This ratio was improved postoperatively to an average of 0.32 ± 0.05. The nasolabial angle was 91.31 ± 4.19 degrees before surgery and 105.62 ± 5.04 degrees after surgery. The angle of the upper lip was 48.97 ± 2.41 degrees before surgery and 38.21 ± 3.34 degrees after surgery. Lip lift is an effective tool for correcting a natural tendency of the upper lip to cover the upper teeth during aging. There is a dramatic improvement in the patient's facial aesthetic appearance during smiling and at rest. The authors strongly recommend this technique as part of the surgical procedure to achieve a youthful face. Therapeutic, V.

Clinical application of autologous auricular cartilage in nasal tip plasty

Objective To observe and discuss the application and clinical effect of different forms of ear cartilage in nasal tip plasty. Methods Auricular cartilage was used to prune it as halberd at first, and then the extended transplantation and the cartilage fornix reconstruction were carried out by using single or combined septum cartilage. Meanwhile, nasal tip plasty was performed by using cap shape or shield shape cartilage grafting. Results 136 patients were followed up for 6 to 24 months after operation. 119 cases were satisfied, accounting for 87.5%, of which 11 cases (ear cartilage weakness) were not improved obviously, accounting for 8%. However, there were only 6 cases with the unsatisfactory feedback as the nasal tip that was decreased by 1~2 mm one year after the operation, accounting for 4.41%. Conclusions The auricular cartilage is pruned as halberd singly or combined with septal cartilage as an extended graft, reconstructing the cartilage fornix in the meantime, which is the way better than the traditional way of making nasal tip plasty to obtain the ideal nasal tip protrusion. Key words: Rhinoplasty; Ear cartilage; Autografts; Halberd shape; Cartilage fornix reconstruction

Discussion: Septum-Based Nasal Tip Plasty: A Comparative Study between Septal Extension Graft and Double-Layered Conchal Cartilage Extension Graft.

Chicago, Ill. From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago. Received for publication July 23, 2017; accepted July 26, 2017. Disclosure:The author has no financial interest to declare in relation to the content of this Discussion or of the associated article. Dean M. Toriumi, M.D., Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago, 1855 W Taylor Street, Room 2.42, Chicago, Ill. 60612-7242

Contracted Nose Correction with Dermofat and Conchal Cartilage.

Contracted Nose Correction with Dermofat and Conchal Cartilage.

3D Photogrammetric Analysis of the Nasal Tip Projection and Derotation Based on the Nasal Tip Quadripod Concept.

Regarding septal fixation in nasal tip plasty, the nasal tip tripod theory may require modification. We performed three-dimensional (3D) photogrammetric analysis of the "Skiff graft," which is a quadripod method involving folded conchal cartilages fixated on the caudal septal angle, paired lateral crura reinforced by a derotational conchal cartilage graft, and conjoined medial crus on the columella base. We assessed the efficacy of the Skiff graft in maintaining tip projection and preventing cephalic rotation of the nasal tip. In total, 39 patients who underwent nasal tip plasty with the Skiff graft during 2012-2015 and underwent 3D photogrammetry before (T0), immediately postoperatively (T1, average of 1week postoperatively), and an average of 215days postoperatively (T2) were included. Nasal tip projection was objectively measured from images using a software program. The average differences between the T0 and T1, T0 and T2, and T1 and T2 lengths were 4.81, 3.57, and 0.85mm, respectively. Thus, 81% of the change in tip projection length that had been achieved immediately postoperatively was maintained at T2 based on 3D photogrammetry (P<0.001). The relapse ratio of the examined technique was 19.26% (mean, 0.85mm; P<0.001). Nasal tip plasty with the Skiff graft preserves septal support and is an effective primary and revision rhinoplasty technique in Asian patients. This approach may be suitable as an alternative to nasal tip plasty with the septal extension graft in terms of maintaining nasal tip projection, rotational controllability, and nasal mobility. 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 .

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty: Effects on Nasal Tip Projection and Rotation.

Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation. To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements. This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images. Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically. Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002). This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.

Application of ear cartilage in reconstruction of domal graft in nasal tip rhinoplasty

Objective To investigate the application of auricular cartilage in nasal plastic surgery and its clinical effects of the different tip graft and reconstructed domal graft (RDG). Methods From October 2009 to May 2015, the surgical procedure was performed on 286 patients, through the application of cymba and conchae cartilages into various tip graft and RDG in nasal tip plasty. Results A total of 286 patients were followed up post-operatively for 3 months to 5 years, 245 patients (85.7% achieved expected stability tip, the tip down to 1-2 mm after one year. Tip skin thinning was observed in 10 patients after one year, nasal tip down occurred in 89 patients; the columella skew and asymmetric nostrils occurred in 31 patients. Conclusions The ear cartilage can be made into various tip graft for rhinoplasty, with satisfactory clinical outcomes. Key words: Auricular cartilage; Rhinoplasty; Graft

Clinical efficacy of M-shaped cartilage used in nasal tip cosmetic plasty

Objective To explore a new method of nasal tip plasty and its clinical effect, which is much accorded with biomechanical properties of the human body. Methods From June 2010 to March 2016, a total of 33 cases of nasal tip surgery, 6 males and 27 females, were performed. Ages ranged from 22 to 46 years in this group. Ear cartilage was trimmed into two strips and sutured them together in a M shape. When located to the original position of the nasal alar cartilage, the M shaped cartilage could be used in nasal tip; when fixing part of it on the nasal septum or lengthened nasal septal cartilage, the M shaped cartilage could be used in cosmetic surgery of nasal tip lengthening. Results The follow-up period was from one month to 60 months, with average 14 months. 29 patients (87.9%) were satisfied with the efficacy and 2 patients were suffered from infection (6.1%). Conclusions When the M-shaped cartilage is fixed with lengthened nasal septum, it can lengthen the nasal tip much more and the contouring and texture of nasal tip are better than that of using a shield or a cap cartilage graft. Key words: Nasal tip; Rhinoplasty; M-shaped cartilage

Nasal Tip Plasty Using a Batten Graft with Ear Cartilage in East Asians

Nasal Tip Plasty Using a Batten Graft with Ear Cartilage in East Asians

Fibroareolar Tissue Wrap-Around Flap for Tip Plasty in Rhinoplasty in Asians

Background Asians tend to have bulbous, wide, and thick-skinned noses, leading to limitations in tip augmentation. Therefore, following various tip plasty procedures, the use of a dermal graft or a fat graft may be considered for additional augmentation. For definition of the Asian nasal tip, thick fibroareolar and subcutaneous tissues are resected. However, these previously discarded tissues may be a useful material for tip augmentation. Hence, we would like to propose the fibroareolar tissue wrap-around flap as an adjuvant augmentation procedure. Methods Tip plasty procedures, including various suture techniques and cartilage grafts, were performed. Near the scroll area, the fibroareolar tissues above both lower lateral cartilages were dissected in the supraperichondrial plane. Caudally based fibroareolar tissue flaps were elevated around the nasal tip. The tip portion of the alar cartilage framework was covered with the flaps. The flaps were fixed to the middle or medial crura of the lower lateral cartilages. Results A total of 13 patients underwent the fibroareolar tissue wrap-around flap procedure for nasal tip plasty. No complaints were reported at follow-up by 12 patients. No cases of major infection, hematoma, or vascular compromise occurred. Conclusions The fibroareolar tissue wrap-around flap offers several advantages for tip plasty in Asians, including additional tip projection, soft tissue volume reduction, redraping, and a naturally soft nasal tip, and likely aids in preserving the volume of other cartilage grafts. Therefore, this fibroareolar tissue wrap-around flap is worth considering as a useful adjuvant option for tip plasty in rhinoplasty in Asian patients. Keywords: Asian continental ancestry group, Rhinoplasty, Surgical flaps

Complications of Septal Extension Grafts in Asian Patients

IMPORTANCE Nasal tip-plasty is one of the most important and difficult parts of rhinoplasty. Three-dimensional positioning of the nasal tip is a vital component in the overall appearance of the tip. The use of a septal extension graft (SEG) is a versatile technique that can supply nasal tip support and aid in positioning of the tip, as well as provide projection and lengthening. However, complications with this method can occur, and the incidence of these issues has risen with the increased use of this technique. OBJECTIVE To investigate the problems resulting from nasal tip surgical procedures using an SEG. DESIGN, SETTING, AND PARTICIPANTS This study involved a retrospective review of 44 consecutive patients who underwent nasal tip-plasty using an SEG. Patient results were analyzed with medical record review, patient questionnaires, and preoperative and postoperative photographs. Anthropometric measurements and analysis were performed for the pre- and postoperative tip projection and nasolabial angle. MAIN OUTCOMES AND MEASURES Prevalence of different complications of SEGs in Asian patients. RESULTS Eighty-six percent of the patients who had SEGs were satisfied with the cosmetic appearance of their nasal tip. Septal cartilage was the most frequently used material for SEGs. Complications in patients who had SEGs included nasal tip stiffness (45.5%), a decrease of projection (45.5%), nasal tip deviation (11.4%), and infection (4.5%). The revision rate was 9.0%. CONCLUSIONS AND RELEVANCE Asian nasal tip-plasty using an SEG can result in successful outcomes, providing nasal tip support, projection, and length. However, care needs to be taken to prevent complications such as hardness, loss of projection, nasal tip deviation, and infection.

L-Shaped Columellar Strut in East Asian Nasal Tip Plasty

BackgroundNasal tip support is an essential consideration for rhinoplasty in East Asians. There are many techniques to improve tip projection, and among them, the columellar strut is the most popular technique. However, the conventional design is less supportive for rotating the tip. The amount of harvestable septal cartilage is relatively small in East Asians. For an optimal outcome, we propose an L-shaped design for applying the columellar strut.MethodsTo evaluate the anthropometric outcomes, the change in nasal tip projection and the columella-labial angle were analyzed by comparing preoperative and postoperative photographs. The anthropometric study group consisted of 25 patients who underwent the same operative technique of an L-shaped strut graft using septal cartilage and were followed up for more than 9 months.ResultsThere were statistically significant differences between the preoperative and postoperative values in the nasal tip projection ratio and columella-labial angle. We did not observe any complications directly related to the L-shaped columellar strut in the anthropometric study group.ConclusionsThe L-shaped columellar strut has advantages not only in the controlling of tip projection and rotation, but in that it needs a smaller amount of cartilage compared to the conventional septal extension graft. It can therefore be an alternative technique for nasal tip plasty when there is an insufficient amount of harvestable septal cartilage.

Nasal Tip Plasty: The Delivery Approach Revisited

The delivery approach, though very appropriate for remodeling the tip of the nose, has been overlooked in recent years and has often been passed over for the open approach. One reason for this is the intercartilaginous incision used for the delivery approach, which may cause scarring at the nasal valve area, leading to postoperative functional obstruction of the nose. The delivery of the alar cartilages is another negative, as this maneuver will disrupt the collagen fibers that attach the upper lateral cartilages to the cephalic margin of the alar cartilages, leading to a weakening of the tip's support. We propose a modification to the traditional delivery approach by using a transcartilaginous instead of an intercartilaginous incision to prevent damage to the valve area. We also suggest taking advantage of the interference to the tip's support caused by the disruption of the collagen fibers of the scroll area. The purpose of this article is to describe this modification of the delivery approach and to emphasize the advantages that this controlled interference to the tip's support may have in selected cases. 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 .

Application of caudal septal advancement technique in nasal tip plasty

Objective To build the steady framework of the nasal tip by using caudal septal advancement technique to obtain the permanent nasorostral configuration.Methods From Oct 2009 to Apr 2011,the caudal septal advancement technique was used to reconstruct the septum to make the septal anterior angel and the caudal septal margin reach the anticipated height and length of the tip,then medial crus and the vault of the lower lateral cartilage were sutured to the caudal septum to form the steady supporting structure of the nasal tip.Results 3-16 months follow-up in 26 cases showed that 2 cases appeared the staircase deformity in the junction of the bone and the cartilage in the dorsum,but the nasorostral configuration was good.3 cases whose tip and columella were deviated before the operation appeared the deviation again after 3 months but the nasorostral configuration was better than before.The other 21 cases were good.Conclusions It is a available method of using caudal septal advancement technique to form the steady nasorostral configuration. Key words: Caudal septal advancement technique; Caudal septum; Septal anterior angle; Vault of lower lateral cartilage

A New Method for Evaluating the Outcome of Rhinoplasty on the Nasal Tip

Sir:FigureSixty-two female patients, ranging in age from 17 to 46 years (mean, 23.7 years), were enrolled for this study and divided into four groups according to the surgical treatment as follows: group 1, columella strut by autogenous cartilage transplantation and lateral crural transposition; group 2, lateral crural partial truncation; group 3, columella strut by autogenous cartilage transplantation and lateral crural partial truncation; and group 4, columella strut by autogenous cartilage transplantation and lateral crural steal.1 The onlay graft was performed in all four groups. This research was conducted according to the Declaration of Helsinki as a statement of ethical principles. The nasal tip of both was photographed both before and after rhinoplasty (1 to 6 months). The nasal points, angles, and nasal base soft areas were measured using computer-assisted imaging software. The points consisted of nasion, pronasale, subnasale, alare, alar curvature point, and columella top point (Fig. 1).2 The angles were defined as the nasolabial angle.3 The nasal base soft areas were defined as areas of nasal base. The view of the nasal base was trapezoidal.Fig. 1: Nasal landmarks in base view. prn, pronasale; alr, right alare; all, left alare; c, columella top point; sn, subnasale; acr, right alar curvature point; acl, left alar curvature point.The overall area of nasal base was divided into upper base (nasal tip trapezoid) and bottom base (nostril trapezoid) areas. The upper base was constructed by connecting both sides of the intermediate crural domal segments intersecting at the alar rim tangents, whereas the lower base was constructed by connecting both sides of the lower poles of the nostrils intersecting at the alar rim tangents (Fig. 2). The following formulas were used to calculate the areas of trapezoids: nasal tip trapezoid = (upper base + middle base) * [(subnasale-pronasale) – (columella top point-subnasale)] * 1/2; and nostril trapezoid = (middle base + lower base) * (columella top point-subnasale) * 1/2.Fig. 2: The nasal base areas. prn, pronasale; c, columella top point; sn, subnasale.The index of each parameter in Table 1 represented its change from before to after rhinoplasty in each group. It was found that indexes 4, 8, 10, 11, and 12 were significantly correlated with the difference of surgical technique in rhinoplasty (Table 1). No columella strut procedure was performed in group 2, whereas an increase in index 4 in the other three groups reflected an increase in the length of the columella caused by the cartilage transplantation. According to the Anderson tripod theory,4 the lateral crural transposition in group 1 might result in pushing the lateral crus forward and was indicated by a decrease in index 8 (nasolabial angle), whereas an increase in this index was associated with lateral crural partial truncation in groups 2 and 3 and with the lateral crural steal in group 4.Table 1: Comparison of Index before and after Surgery in the Four Groups*In group 2, the onlay graft could enlarge the size of the tip despite lateral crural partial truncation,5 which was indicated by an increase in index 11 or by a decrease in index 12. In groups 1, 3, and 4, the larger columella size was seen because of the columella strut, and was reflected by an increase in both indexes 10 and 12 or by a decrease in index 11. These findings suggest that the indexes of geometry graph consisting of related linears may be used for precisely evaluating the outcome of the nasal tip plasty. Zhenyu Yang, M.D. Xiaoyan Tan, M.D. Plastic Surgery Hospital of Hangzhou Hua Li, M.D. Sir Run Run Shaw Hospital Jun Fang, Plastic Surgery Hospital of Hangzhou, Hangzhou, Zhejiang, People's Republic of China DISCLOSURE The authors have no financial interest in any of the products, devices, or drugs mentioned in this article. PATIENT CONSENT The patient provided written consent for use of the images.

Versatility of Three-Dimensional Total Alar Cartilage Dissection in Aesthetic Rhinoplasty

In many cases, Asians' noses are shorter; their nasal tips have a bulbous shape and typically lack the projection. To correct these problems, we completely dissected the alar cartilage in a three-dimensional manner by which the alar cartilage could be repositioned. Thus, no external force was exerted to the alar cartilage. For approximately 4 years, a total of 502 patients were treated with this surgical method. Using the open rhinoplasty, the alar cartilage was dissected in such a manner that it should be completely isolated from the skin, nasal mucosa, and upper lateral cartilage in 3 layers. Thereafter, using various nasal tip plasty techniques, the alar cartilage was reshaped and then repositioned. Patients were followed up for a mean period of 18 months. Then, the degree of subjective satisfaction of patients was analyzed with the use of 4-point visual analog scale scores. On the assessment of the degree of subjective satisfaction of patients, of a total of 502 patients, 87% responded as "very satisfactory" or "satisfactory." Through an analysis of the photographs taken before and after surgery, in patients with a short nose, the current surgical procedure was effective in extending the length of nose without the septal extension graft. The nasolabial angle was ideally expressed. Through meticulous cartilage manipulation, the tip projection improved and a bulbous shape of the nasal tip was resolved. In an aesthetic rhinoplasty for Asians, if plastic surgery of the nasal tip should be performed using a three-dimensional dissection of the alar cartilage, it would be helpful for surgeons to effectively and freely manipulate the alar cartilage according to their plans.

Korrektur der Nasenspitze durch endonasale Zugänge und Nähte

Over the last two decades, the use of the external approach for primary and secondary rhinoplasties has become increasingly popular. This article illustrates the versatility of endonasal techniques for the correction of nasal tip deformities on the basis of four cases. The approach to the nasal tip and the chosen technique as used in 100 consecutive rhinoplasties were reviewed. For primary and revision tip plasty, endonasal approaches were used in 81% of cases. Preferred incisions were the infracartilaginous approach and the transfixion incision. Using these approaches, correction of the tip was achieved by using sutures to reposition and reshape the alar cartilages and the columella without grafts to the nasal tip in most cases. Nasal tip plasty via endonasal approaches using sutures is technically more challenging compared to the external approach with its superior exposure. This drawback is outweighed by less operating time and faster patient recovery. Contrary to the general trend, the authors believe that endonasal tip plasty techniques using sutures can obviate the external approach and grafts in many cases and should form an integral part of the rhino-surgeon's repertoire.

Application of porous high-density polyethylene combined with auricular cartilage in nasal tip plasty

Objective To explore the methodology and the indications of applying the porous high-density polyethylene(Medpor)combined with auricular cartilage in nasal plasty.Methods A total of 36 cases of nasal plasty were treated with the 8.5 mm thick Medpor implant(speader strut graft)and combined with the auricular cartilage graft to highlight the nasal tip.Results All 36 cases were satisfactory with the effects,and there were no complications such as infection,exposure of the implants and so on.Conclusions Medpor can supply the powerful supporting strength to the nasal tip,and it is a safe,effective implant to rebuild the supporting constructions of nasal tip,especially suitable to correct the over-rotation of nasal tip,flat nasal tip,and short nose. Key words: Porous high-density polyethylene; Medpor; Nasal tip plasty; Auricula; Cartilage

Alar groove plasty using a subcutaneous flap technique in bulbous nose repair after cleft lip plasty

Bulbous nose is a ball-like nasal deformity, frequently seen in postoperative cleft lip patients, that is hard to prevent despite numerous techniques available for nasal tip plasty. Here we describe a new method for correcting bulbous nose in cleft lip patients by creating an ideal alar groove. A subcutaneous flap with the pedicle of the overlying skin connected circumferentially is made just beneath the position for the ideal alar groove. The subcutaneous flap is fixed to the septum cartilage to create the alar groove depression on the nasal tip. This method is generally performed in conjunction with other rhinoplasty using the open nasal approach. Three postoperative cleft lip and nose patients underwent alar groove plasty combined with rhinoplasty. All retained good contour after the operation. Alar groove plasty using the subcutaneous flap technique improves bulbous nose deformities of cleft lip patients and can retain good postoperative contour.