Nostril Asymmetry Research Articles

A spear flap surgical revision

A 55-year-old male presented with a recurrent infiltrative basal cell carcinoma of the right nasal ala. Previous incomplete excision was repaired with second intention healing resulting in a contracted ala with columellar deviation and nostril asymmetry. [...]

The Effectiveness of Releasing the Lower Lateral Cartilage Through Intranasal Z-plasty Incision on the Vestibular Web During Secondary Correction of Nasal Deformities in Complete Unilateral Cleft Lip and Palate.

The primary goal in the secondary correction of unilateral cleft lip nose deformity is to achieve symmetry of the nose and nostril. This study aimed to investigate the efficacy of freeing the lower lateral cartilage from the pyriform ligament through an intranasal Z-plasty incision on the vestibular web in adult patients with complete unilateral cleft lip and palate. Thirty-six patients with complete unilateral cleft lip and palate, who underwent open rhinoplasty between August 2014 and December 2021, were identified retrospectively. Five parameters for nose form and nostril symmetry were measured on basal views through 2-dimensional photographic analysis. The patients were divided into subgroups with or without septoplasty. Cleft-to-non-cleft ratios between the Z (13 patients) and non-Z groups (23 patients) were compared using the Mann-Whitney U test. The mean follow-up was 12.9 months (6-31mo). In the Z group, there were significant differences between the preoperative and postoperative values for nostril angulation, regardless of septoplasty (all P <0.05). Despite septoplasty, significant differences in the postoperative changes in nostril angulation were found between the Z and non-Z groups (all P <0.05). Intranasal Z-plasty on the plica vestibularis is an effective technique for releasing the lower lateral cartilage, improving the nostril asymmetry in cleft lip nose deformity.

Inferiorly Based Alar Groove Flap for Correction of Alar Base Malposition and Nasal Stenosis.

Summary:When the external nasal valve (ENV) is excessively narrow or lacks support, nasal obstruction can develop causing decreased airflow. Although cartilage grafts may support a collapsed nasal ala, addressing severe nasal stenosis requires further intervention. Techniques to move flared ala inward are well-known; however, repositioning a medially displaced alar base is less commonly described. Our surgical team developed an inferiorly based alar groove flap to achieve lateral movement of a malpositioned alar base, with goals of widening the ENV and improving nasal symmetry and cosmesis. A retrospective chart review was performed on a series of five patients over a two-year period. Charts were reviewed for demographic data, medical and surgical history, functional airway complaints, and subjective aesthetic concerns. All patients presented with unilateral ENV collapse, alar base malposition, and nostril asymmetry. Our operative method consisted of repositioning the affected alar base laterally and inferiorly to alleviate nostril stenosis and using an alar rim graft to support the ENV. Postoperatively, all patients demonstrated immediate alleviation of subjective nasal obstruction and improvement in size of ENV aperture, nostril symmetry, and overall cosmesis. Four patients showed lasting postoperative results. One patient experienced restenosis by 4 months and required revision. Our inferiorly based alar groove flap provides a reproducible solution for repositioning a medially displaced alar base. This technique reliably corrects ENV stenosis, relieves airway obstruction, and improves nasal symmetry and cosmesis.

Role of Derotation Suture in Bulbous Tip Correction in Asian Rhinoplasty

In bulbous tip correction, consideration should be given to the presence of cephalic malposition of lower lateral cartilage as well as volume reduction. Derotation suture is a suture technique for tip lengthening but may contribute to bulbous tip correction through the caudal reposition of lower lateral cartilage.From 2016 to 2018, a total of 50 Asian patients underwent bulbous tip correction with derotation suture. The derotation suture was performed by suture the most convex part of lower lateral cartilage as a spanning suture to the caudal septum with caudal traction of the lateral crus. The chart and pre and postoperative photographs were analyzed to evaluate the effectiveness and complication of the surgery.In most (96%) patients, there was a significant improvement in tip bulbosity and supratip fullness. Complications included tip drooping (4%), nostril asymmetry (2%), and undercorrection (4%) and no pinching deformity occurred.In correction of bulbous tip of Asians with cephalic malposition of lower lateral cartilage, derotation suture is a useful method to create an ideal shaped nasal tip.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Congenital Aplasia of Lower Lateral Cartilage, the Reconstruction via Closed (Endonasal) Rhinoplasty Approach

Congenital nasal anomalies are rare. Hypoplasia and atrophic anomalies represent the most common class of congenital nasal anomalies. A 27-year-old female presented with obvious right nostril asymmetry, alar notching, and retraction. The patient underwent a closed (endonasal) septorhinoplasty approach under general anesthesia. The lower lateral cartilage exposed by the cartilage delivery technique was discovered the absence of right lower lateral cartilage. In this case, reconstruction was performed by using two grafts the resected cephalic portion of lateral crura of left lower cartilage as medial crus and harvested septal cartilage as lateral crus, with satisfactory functional and cosmetic results.

Modification of Nasal Dorsal Onlay Graft Based on Anatomic Findings of Rhinion Area.

The angulation of nasal bones and superior border of septal cartilage forms a slight convex profile at rhinion area. Taking this angulation into account, we bring forth a modification of dorsal onlay graft. Sixty-one consecutive patients underwent primary rhinoplasty between the years of 2017 and 2020 were enrolled in the study. The angle between nasal bones and superior border of septal cartilage, angle of external dorsal contour, thickness of soft tissue at sellion and rhinion were measured on reformed computed tomographic scanning image. Three variants of dorsal onlay graft modification were designed. Sixty-one patients underwent primary nasal augmentation were enrolled in this study. Mean follow-up was 13.1 months. The angle between nasal bones and the superior border of the septal cartilage was 166.7° by mean. Mean angle of external dorsal contour was 180.2°. Thickness of soft tissue at sellion was 4.01 and 2.03 mm at rhinion by mean. All cases showed content dorsal profiles. Two patients (3.3%) presented discernible nostril asymmetry due to the deviation of the columellar grafts and underwent secondary surgery with satisfying outcomes. Modification of the dorsal onlay graft reserves nasal midvault to the most extent especially in small-humped nose and fits the dorsal contour properly. 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 .

Facial Asymmetry in Unilateral Congenital Superior Oblique Muscle Palsy.

This study was conducted to evaluate facial asymmetry in unilateral congenital superior oblique muscle palsy (SOP). The results showed that all facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic individuals. This study aimed to evaluate the characteristics of facial asymmetry in unilateral congenital SOP and compare with orthotropic individuals. This cross-sectional comparative case series was conducted in 58 patients with ocular torticollis caused by SOP (mean ± standard deviation age, 18 ± 12 years) and 58 orthotropic individuals (mean ± standard deviation age, 19 ± 13 years). The exact form of torticollis was determined by direct observation from yaw, roll, and pitch axes. Four photographs were taken from patients: (1) with torticollis to calculate the amount of head tilt; (2) with the head in the straight position to calculate the facial angle and relative facial size (RFS); and (3 and 4) with the head positioned downward (to compare the cheek size) and upward (to assess columella deviation and nostril asymmetry). Twenty-nine patients (50%) had a head tilt, 23 (39.66%) had combined head tilt and a face turn, and 6 (10.44%) had a pure face turn. The mean ± standard deviation of head tilt, facial angle, and RFS was 10.11 ± 6.31°, 1.11 ± 1.67°, and 1.003 ± 0.126 in SOP patients, respectively, and the mean RFS and facial angle were significantly higher in SOP patients compared with orthotropic individuals (both P < .001). Facial hemihypoplasia, unilateral cheek compression, nostril asymmetry, and columella deviation were observed in 43 (74.1%), 31 (53.4%), 39 (67.2%), and 38 patients (65.5%), respectively, which were all significantly more common compared orthotropic individuals (P < .001). Facial asymmetry was seen in 52 patients (91.2%) and 17 orthotropic subjects (29.3%), respectively (P < .001). All quantitative and qualitative facial asymmetry parameters had a higher frequency in SOP patients compared with orthotropic subjects.

Versatile Approach to Septonasal Deformity: Skyscraper Construction Based on an Old Relic.

Severely deformed noses usually harbor a combination of both bony pyramid and septal deformities. In this retrospective study, the authors aimed to evaluate our results of repair in patients with severe nasal deformities and importance of a versatile approach in these cases. A total of 32 cases with congenital or acquired (traumas or surgeries) severe nasal deformity were included in this retrospective study. Gender, age, etiology, reconstruction methods, complications, and results were recorded. Preoperative and postoperative pictures were compared; additionally, patients' reviews on the esthetic and functional outcomes were noted. Open approach, weak L-strut template preparation attached to a strong keystone skeleton and reconstruction with a stable L- or T-strut on this template were carried out in all cases. In addition, glabellar flaps were used in 2 cases to restore the contracted skin envelope and wide-angle L-shape cartilage grafts in 7 cases for extensive alar cartilage reconstruction. Favorable esthetic and functional results were obtained in most of the patients. The postoperative problems were recorded as intranasal synechiae; costochondral graft displacement; residual external deviation; nostril asymmetry; residual alar, columellar and tip problems; and prolonged edema. Sufficient sizes and amounts of skin, mucosa, cartilage, and bone tissue must be available to plan versatile repair using flaps and grafts according to the needs of each patient. Preserved stability of the keylock area is substantial. The authors advocate construction of a new structure based on the native weakened skeleton free from the extrinsic and intrinsic forces is an effective method.EBM LEVEL 4.

Correction of the deviated tip and columella in crooked nose.

The primary procedural components of deviated nose correction are as follows: osteotomy to correct bony deviation, septal deviation correction, manipulation of the dorsal septum to correct upper lateral cartilage deviation, and correction of functional problems (manipulation for correction of internal valve collapse and hypertrophy of the inferior turbinate). The correction of tip and nostril asymmetry cannot be overemphasized, because if tip and nostril asymmetry is not corrected, patients are unlikely to provide favorable evaluations from an aesthetic standpoint. Tip asymmetry, deviated columella, and resulting nostril asymmetry are primarily caused by lower lateral cartilage problems, which include deviation of the medial crura, discrepancy in the height of the medial crura, and asymmetry or deformity of the lateral crura. However, caudal and dorsal septal deviation, which is a more important etiology, should also be corrected. A columellar strut graft, correction of any discrepancy in the height of the medial crura, or lateral crural correction is needed to correct lower lateral cartilage deformation depending on the type. In order to correct caudal septal deviation, caudal septal shortening, repositioning, or the cut-and-suture technique are used. Surgery to correct dorsal septal deviation is performed by combining a scoring and splinting graft, a spreader graft, and/or the clocking suture technique. Moreover, when correcting a deviated nose, correction of asymmetry of the alar rim and alar base should not be overlooked to achieve tip and nostril symmetry.

Systematic Surgical Approach to Alar Base Surgery in Rhinoplasty.

In an era with smartphone photography and social media (specifically, "selfies"), basal view aesthetics is becoming increasingly important. Achieving balance between the nasal base and the remainder of the nose and face while preserving or restoring external valve function are essential to a successful rhinoplasty. Without a systematic approach to the nasal base, it is more difficult to achieve an ideal outcome from both aesthetic and functional standpoints. This article outlines an organized and systematic approach to the nasal base, beginning with comprehensive nasofacial analysis. The authors continue by describing idealized basal view aesthetics and provide a treatment algorithm for common deformities that include alar flaring and a wide nasal base. The authors attempt to provide a comprehensive approach to the treatment of the nasal base by discussing the implications of treating columellar deformities, tip positioning, or alar-columellar discrepancies on the overall aesthetics of the lower third of the nose. Furthermore, technical considerations are given for common surgical maneuvers addressing the alar base to help guide treatment and prevent complications such as poor scarring, notching, nostril asymmetry or stenosis (external valve obstruction), and alar deformities ("parenthesis" or "bowling pin"), to name a few.

Modified Use of Costal Cartilage in Asians for the Correction of Nostril Asymmetry in Unilateral Secondary Cleft Lip Nasal Deformity.

BackgroundWeak alar cartilage and lack of soft tissue on the cleft side are considered to be the main critical factors leading to the asymmetry of bilateral nostrils. The costal cartilage can provide strong structural support and can be used to maintain long-term stability of nostril shape after surgical correction. With the advancement in rhinoplasty techniques, the application and understanding of costal cartilage in cleft lip nasal deformity is still on going. Herein, we present our technique of applying costal cartilage to provide nostril support and correct asymmetry in Asian patients with unilateral secondary cleft lip nasal deformity.MethodsNinety-seven patients who underwent nostril asymmetry correction from January 1, 2013, to October 31, 2018, were analyzed retrospectively. Modified integrative alar cartilage strut and diced nostril augmentation with costal cartilage were implemented to improve the collapsed and flat cleft-side nostril. The release and restoration of muscle and bone were also performed when required. Surgical outcomes were analyzed based on the comparison of nostril parameters, the shape and contour, and symmetry of bilateral nostrils after surgery. During postoperative follow-up, the patients' satisfactions with the corrective outcomes were also investigated.ResultsAll patients received the corrective operations with complete survival of all implanted cartilages. The nostril width was narrower in postoperative group (P < 0.05). The nostril height and long axis angle were higher postoperatively (P < 0.05). After correction, the proportion of moderate type increased from 13.4% to 80.4%, whereas the proportion of horizontal type decreased from 86.6% to 17.5%. The symmetry score on the nostril parameters manifested the rate of high score (AS >3) in postoperative groups were 84.5%, 93.8%, and 87.6% for width, height, and angle of the long axis, respectively. They were higher compared with those of preoperative group (0%). More than 95% of the patients were satisfied with the overall aesthetic outcome of the surgery.ConclusionsThrough ameliorating its constructive technology and optimizing its filling form, the modified use of costal cartilage displayed excellent correction effects in the width, height, and long axis angle asymmetry of Asian patients' nostril. Precise and comprehensive rhinoplasty technique is the cornerstone for achieving satisfactory long-term aesthetic outcomes, especially in severe cases, such as secondary cleft lip nasal deformity.

Morphological Classification of Nostrils and the Role of Sill Augmentation.

Nostril sill asymmetry is one of the most challenging problems in rhinoplasty. Some studies have been performed regarding nostril shape; however, no studies have been conducted on nostril shape in the Persian population. Additionally, the shape of the nostril in frontal view has rarely been evaluated. This study has two aims. The first is to evaluate nostril shape in Persian patientswho were candidates for primary rhinoplasty in basal and frontal views. The second is to assess augmentation silloplasty in patients with different sill heights to resolve nostril asymmetry. This research was performed in two phases. The first phase was a cross-sectional study carried out on the deidentified photographs of 122 patients nominated for rhinoplasty surgery at the facial plastic clinic of a tertiary university hospital. The second phase of the research was an interventional study without a control group consisting of 22 patients. The subjects were categorized as Phase 1. Next, an attempt was made to symmetrize nostril heights by sill augmentation surgery. One year after silloplasty surgical outcome was evaluated by measuring the differences in sill heights. In the first phase, classification was performed of the nostril shapes of the patients using two views: frontal and basal. Morphologic study has revealed that there are two types of nostrils in the frontal view and three types in the basal view. In the second phase of this research, augmentation silloplasty was employed for the correction of asymmetric sill heights between the right and left sides. The results show that the height differences in the two sills decreased by 44.26% one year after surgery compared to before surgery (CI: 95%, range - 20.59 to - 67.93), which is statistically significant (p = 0.0002) CONCLUSIONS: Classification of nasal base and nostrils relying on visual inspection is still an important tool for clinical evaluation and communication among physicians. This classification is also crucial in selecting the proper method for correcting nasal base asymmetry. Augmentation silloplasty can help surgeons correct nostril asymmetry due to sill height discrepancy. 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 arrow tip technique for bilateral hanging ala: a 3-year review

Hanging ala is one of the alar-columellar discrepancies encountered in a rhinoplasty procedure among the Asian population. The principle of lifting both the ala effectively while keeping its symmetry remains a challenge. The arrow tip technique is designed to address the bilateral hanging ala which allows greater alar mobility and lifting effect, producing a desirable outcome of the overall nasal feature. This retrospective review is aimed to analyse the effectiveness of the proposed alar surgical technique and assesses the possible complications that require revision surgery. Fifteen Asian patients underwent the ‘arrow tip technique’ alar surgery in conjunction of a rhinoplasty procedure in a single-centre 3-year study for bilateral hanging ala. Pre- and post-operative clinical and photographic nasal analyses were performed for changes of alar vertical height on lateral and frontal views. On the frontal view, the mean percentage of alar shortening was 13.11%, 95%CI [11.46%, 14.76%]. On the lateral view, the mean percentage of alar shortening was 20.36%, 95%CI [19.01%, 21.71%]. The mean frontal-lateral alar shortening was − 7.25%, 95%CI [− 8.76%, − 5.74%]. Two patients required revision surgery for scars (13.3%) and another for nostril asymmetry (6%). This innovative technique is effective, safe and predictable in correcting the hanging ala. Understanding the relevance of performing an effective alar surgery through safe surgical landmarks, the use of full-thickness skin grafts and taking proper precautions can avoid the unnecessary fear of the complications of an external approach to an alar surgery such as scarring, bleeding, alar asymmetry and recurrence. Level of evidence: Level IV, therapeutic study.

Does the Nostril Shape Change After Le Fort I Advancement in Patients With Unilateral Complete Cleft Lip?

Patients with unilateral cleft lip and palate (UCLP) may require Le Fort I advancement to correct maxillary hypoplasia after reaching skeletal maturity. The underlying cleft anatomy, previous operations, and scarring can affect nostril changes after maxillary advancement. The purpose of the present study was to determine whether Le Fort I advancement affects the nostril configuration (ie, width, axis, shape) in patients with UCLP. The specific aims were to (1) compare cleft and noncleft nostrils in patients with UCLP after maxillary advancement and (2) compare the changes in nostril configuration in patients with UCLP with those in noncleft controls after Le Fort advancement. A retrospective case-control study of nonsyndromic, skeletally mature patients with UCLP and a case-matched control group without UCLP who had undergone single-piece Le Fort I advancement with alar cinch suture from 2010 to 2014. Patients were included if they had undergone pre- and postoperative 3-dimensional photogrammetry without intervening nasal revision. Three-dimensional anthropometry was used to evaluate changes in nostril axis and width, soft triangle angle, columellar show, and nasal width after orthognathic correction. The present study included 19 patients with UCLP (11 males; mean age, 18.0years) and 19 noncleft controls (11 males; mean age, 18.7years; P=.276). The mean sagittal advancement in the patients with UCLP and noncleft controls was 7.5mm and 6.3mm, respectively (P=.143). On average, the nostrils widened, the soft triangles flattened, and the columellar show increased. No significant difference was found in the changes to the nostril configuration between the cleft and noncleft sides in the patients with UCLP. No significant differences were found in the nostril changes between patients with UCLP and noncleft controls. Baseline nostril asymmetry is not altered by Le Fort osteotomy in patients with UCLP because both nostrils respond similarly to the deforming forces of maxillary advancement. Similarly, no differences were found in the nostril changes between the cleft and noncleft controls. These findings can aid proper surgical planning for cleft nasal revisions.

Evaluation of Results and Patients’ Satisfaction of Alar Base Resection Surgery after Rhinoplasty Operations in 15 Khordad Hospital

Background: Alar base surgery is one of the controversial issues in rhinoplasty. In this surgery the nasal base width and alar flaring is got smaller with some kind of procedures. One of these procedures is wedge resection of alar base. This procedure may accompany with either some dissatisfaction of scars and adverse effects or complications. In this study, we evaluate the patient satisfaction of scar and possible complications. Materials and Methods: A total of 120 rhinoplasty patients at 15 khordad hospital were candidates for alar base wedge resection due to broad nasal base and / or alar flaring who were chosen for this study. We recorded and examined these patients before and minimum 6 months after surgery, then evaluated these information and data, which finally, compared all the preoperation and postoperation findings. Results: Mean age of patients was 30.11 years old. The full satisfaction of scar was 85.5% (103), but 6.7% (8) of patients had not satisfaction of scar due to visible scar in their alar facial groove. The rate of nostril symmetry satisfaction was 79.2% (95) and 8.3% (10) was dissatisfied due to nostril asymmetry. There was no external valve incompetency nor alar and sill notching in our study. There was not any narrowing of nostrils as well. The mean interalar distance preoperatively was 35.88 mm, which reduced to 32.61mm of mean diameter after surgery, (P-value = 0.000). Alar flaring correction was 88% (106) which was an acceptable consequence. Conclusion: The results of present study showed that in spite of surgeons fear for scar and some common complications after alar base resection, the satisfaction rate of our patients in this study were high, and complications frequencies were low. Therefore, we advise that it is better and wiser to do this operation in indicated patients surely within primary rhinoplasty and do not postpone it to another surgery.

The effect of caudal extension graft on nostril in rhinoplasty

Caudal extension graft technique is a versatile technique in rhinoplasty providing good tip support and maintaining tip projection. In this study, we evaluated the clinical outcomes of this technique and performed anthropometric analysis of nostril shape from the basal view. Thirty-two patients undergoing caudal extension graft technique were identified from December 2011 to July 2016. Patients with a minimum of 12 month follow-up were included. Quantitative analysis was performed on standard pre- and postoperative photos. Nasal tip protrusion and columellar width were increased significantly (p value < 0.001), while apex angle was decreased significantly (p value <0.001). Caudal extension graft placement resulted in a non-significant decrease in nostril size on the side of graft placement. There was no significant change in columellar length or nostril width. Caudal extension graft technique is a versatile and reliable technique for addressing poor tip support and setting tip projection. Disadvantages of caudal extension graft include asymmetric nostrils and over projection in cases where projection reduction is needed. We showed that while there is a significant increase in columellar width, there is no significant increase in nostril asymmetry. Level of Evidence: Level IV, risk/prognostic study.

Aesthetic Outcomes of Alar Base Resection in Asian Patients Undergoing Rhinoplasty

Combined sill and alar excision is a useful procedure for correcting a wide nasal base and flared alar lobules. However, the aesthetic outcomes of this technique remain poorly reported. To evaluate the aesthetic outcomes of combined sill and alar excision in Asian patients undergoing rhinoplasty. A retrospective cohort study of 73 consecutive patients who underwent combined sill and alar excision from March 1, 2004, to January 31, 2013, was conducted at a tertiary referral hospital in Korea. Combined sill and alar excision. Changes in the ratio of the interalar distance to intercanthal distance and frequencies of alar flaring, nostril symmetry, and nostril shape, as measured by reviewing photographs taken before and after the surgery. Among the 73 patients (50 men and 23 women; mean [SD] age, 36.5 [12.3] years) the mean (SD) ratio of interalar distance to intercanthal distance changed significantly from 1.07 (0.11) to 1.04 (0.08) (P < .001). Of the 60 patients with alar flaring, 45 (75%) no longer had flaring after the procedure. The frequency of nostril symmetry increased from 38 patients (52%) to 46 (63%) (P < .001). The frequency of horizontally shaped nostrils decreased from 21 patients (29%) to 2 (3%), while the frequency of the preferred pear-shaped nostrils increased from 20 patients (27%) to 35 (48%) (odds ratio, 1.16; 95% CI, 0.63-2.14; P = .02). There were 4 cases of complications, namely, alar deformity (1 patient [1%]), unsatisfactory correction of asymmetrical nostrils (1 [1%]), and unsatisfactory correction of alar flaring (2 [3%]). Combined sill and alar excision was a useful technique with a low complication rate for correcting wide alar base, alar flaring, nostril asymmetry, and nostril shape. 4.

Auto-Rim Flap Technique for Lateral Crura Caudal Excess Treatment.

There are many variables that influence nose tip harmony. Even in a rhinoplasty that appears successful in profile, one may see nostril asymmetries, alar retractions, or irregularities in the soft triangle, and patients express their dissatisfaction with these simple deformities. In this study, we define the ratio of caudal and cephalic excess of the lower lateral cartilage. We evaluate whether it is possible to eliminate nostril asymmetries and alar retractions by means of supporting the facet polygon with the help of a lower lateral cartilage auto-rim flap, a technique we have developed in our rhinoplasties. The auto-rim flap was used successively on 498 primary rhinoplasty patients on whom the same surgeon operated between May 2013 and June 2015, performing marginal incisions. Of the 498 patients in the series, only 1 of the first 10 required a revision due to tip asymmetry related to the auto-rim flap. A minimal nostril asymmetry that did not require intervention occurred in 10 patients. In none of the patients could an increased alar retraction be seen postoperatively. All patients exhibited alar cartilage in the anatomically correct position. With the auto-rim flap technique, a part of the caudal excess of the alar cartilage remains as a flap in the facet region; therefore, there is no need in the cephalic region to perform more of an excision than what is strictly necessary. 4 Therapeutic.

Comprehensive rhinoplasty with costal cartilarge and e-PTFE

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage and e-PTFE, and to observe the outcome and possible complications. Methods A 3-4 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes. Structural reconstruction of the nasal tip was then done with these costal cartilage parts. Radix augmentation was conducted with e-PTFE. Results From Jan. 2013 to Sept. 2014, 48 patients were treated with this method, all females, aged 22-35 years. 36 of them had received rhinoplasty before, 12 of them received none. Satisfying aesthetic contouring of the nasal tip and dorsum had been achieved in 45 patients. Deviation of the collumella and nostril asymmetry were found in 3 patients. Among all patients, no such complications as pneumothorax, hemothorax, infection, or hemotoma were observed. The scar on the donor site was not obvious. Conclusions Costal cartilage is sufficient, supportive and easily shapable, when applied to the structural reconstruction of the nasal tip, which can meet the demands of patients who prefer more outstanding and delicate nasal tip contouring. Key words: Autologous costal cartilage; Rhinoplasty; Expanded polytetrafluoroethylene

Revision Rhinoplasty for Short Noses in the Asian Population.

Short nose, especially postoperative short nose in Asian patients, remains a challenging problem for plastic surgeons. To determine the outcomes of revision rhinoplasty of postoperative short noses in Asian patients. We performed a retrospective medical record review of 41 Asian patients with postoperative short nose who underwent revision rhinoplasty in a tertiary care referral center in South Korea from October 1, 2006, through August 31, 2014. Patient demographic, surgical technique, graft use, anthropometric measurement, complication, and aesthetic outcome assessment data were retrieved. The 41 enrolled patients were a mean (SD) of 36.5 (12.6) years old. There were 16 men and 25 women. The most commonly used dorsal graft in the previous rhinoplasty was silicone, followed by fascia with or without cartilage. Various surgical techniques were applied, including septal reconstruction, cartilage flap technique, tip surgery, lateral compartment correction, and dorsal augmentation. Autologous costal cartilage was the most commonly used septal reconstruction material. Eleven patients (27%) developed postoperative complications, including infection, nostril asymmetry, and pollybeak deformity. Revision rhinoplasty yielded statistically significant improvements in nasal length (increase of 12.0%, P < .001), nasal tip projection (increase of 13.4%, P < .001), nasofrontal angle (decrease of 2.39°, P = .04), nasolabial angle (decrease of 7.62°, P < .001), and columella-lobular angle (increase of 3.25°, P < .001). More than 90% (37) of the patients were judged to have good or excellent aesthetic results. Correction of postoperative short nose in Asian patients requires complicated surgery that usually involves more than one kind of surgical technique. Complications are not uncommon, and patients should be informed of this before surgery. 4.