Short Nose Deformity Research Articles

A Grading System-Guided Approach to the Severely Contracted Nose.

Capsular contracture is a rare but serious complication of silicone implant-based augmentation rhinoplasty. When severe, the contracture can affect all layers of the nose, causing significant scarring and disfigurement. There is currently no standardized method of evaluating contracted noses and a paucity of literature on the treatment of severe contracture. Therefore, this study aimed to establish a comprehensive grading system and treatment approach for patients with nasal contracture secondary to silicone implant-based rhinoplasty. We conducted a retrospective analysis on patients who presented with nasal contracture from 2012 to 2021. All preoperative photographs were evaluated by two plastic surgeons, twice at 1-month intervals. The proposed grading system comprised: normal (grade I), mild contracture with detectable implant (grade II), moderate contracture with skin thinning (grade III), severe contracture with short nose deformity (grade IV), and destructive contracture with scarring of the dorsal skin (grade Va), or columella deficiency (grade Vb). Inter- and intraobserver agreement was assessed using the kappa value to determine the reliability of the system. Based on 87 patients, interobserver agreement was substantial for both evaluation time points (k = 0.701 and 0.723). Intraobserver agreement was excellent for evaluator 1 (k = 0.822) and substantial for evaluator 2 (k = 0.699). Using this grading system, we propose a graduated treatment algorithm for contracted noses. Most notable is our use of radial forearm free or forehead flaps to reconstruct the columella in grade Vb patients. By combining reconstructive and aesthetic principles, this treatment approach provides an effective and elegant solution for the management of the severely contracted nose. 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 .

Study on the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty

To investigate the influence of buried thread nasal augmentation on dorsal soft tissue of nose and revision rhinoplasty. A clinical data of 29 patients requesting revision rhinoplasty after buried thread nasal augmentation, who were admitted between July 2017 and July 2019 and met the selection criteria, was retrospectively analyzed. All patients were female with an average age of 26.8 years (range, 18-43 years). The patiens were admitted to the hospital at 3-48 months after buried thread nasal augmentation (median, 15 months). Among them, there were 18 cases of insufficient nasal tip projection, 22 cases of insufficient nasal root projection, 7 cases of threads ectasia, 5 cases of threads exposure, 3 cases of infection, and 10 cases with two or more conditions. There were 9 cases of combined short nose deformity, 1 case of spherical hypertrophy of the nasal tip, 3 cases of deviation of the nasal columella, 3 cases of excessive width of the nasal base, and 1 case of nasal hump. Three infected patients only underwent threads removal and debridement. The rest patients underwent revision rhinoplasty, and the dorsum of the nose was made with polytetrafluoroethylene expansion; the tip of the nose was reshaped by taking autologous rib cartilage and alar cartilage in 16 cases, and by taking autologous septal cartilage and alar cartilage in another 10 cases. The threads and surrounding tissue specimens removed during operation were subjected to histologic observation. Nasal length and nasal tip projection were measured after revision rhinoplasty and the ratio was calculated to evaluate the nasal morphology; patient satisfaction was evaluated using the Likert 5-grade scale. Patients were followed up 12-48 months (mean, 18 months). Inflammation was controlled in 3 patients with infections caused by buried thread nasal augmentation. The remaining 26 patients had satisfactory results immediately after revision rhinoplasty. Before revision rhinoplasty and at 7 days and 6 months after revision rhinoplasty, the nasal length was (4.11±0.34), (4.36±0.25), and (4.33±0.22) cm, respectively; the nasal tip projection was (2.34±0.25), (2.81±0.18), and (2.76±0.15) cm, respectively; and the nasal tip projection/nasal length ratio was 0.57±0.08, 0.65±0.05, and 0.64±0.04, respectively. There were significant differences in the nasal length and the nasal tip projection between time points ( P<0.05). There was a significant difference in the nasal tip projection/nasal length ratio between pre- and post-operation ( P<0.05), but there was no significant difference between 7 days and 6 months after operation ( P>0.05). The Likert score for satisfaction ranged from 1.5 to 5.0 (mean, 4.05). During follow-up period of 26 patients, no nasal prosthesis was exposed, and the shape of the nose was stable, and the nasal skin of 5 patients with exposed threads could be seen with different degrees of scarring; there was no infection, cartilage resorption, and no cartilage deformation, displacement, or exposure. Histological observation showed that absorbable threads were not only absorbed after implantation, but also with the prolongation of time, the inflammatory changes in the surrounding tissues caused by decomposition and absorption of the threads showed a gradual aggravation of the first, the heaviest inflammatory reaction in 6 to 12 months, and then gradually reduce the trend. After implantation of the absorbable thread into the subcutaneous tissue of the nasal dorsum, the nature of the thread is different from the body's own tissue, which will affect the soft tissue compliance of the nasal dorsum. The degradation and absorption of the thread will stimulate the infiltration of inflammatory cells and the proliferation of fibroblasts in the surrounding tissue and then form scar tissue, which will affect the design and effect of revision rhinoplasty.

M-Shaped Auricular Cartilage Grafts for Correcting Short Nose Deformity in Asians: A Retrospective Study.

The demand for rhinoplasty in Asia is growing annually, and short nose deformity has been one of the main reasons for the surgery due to its high incidence. There is an urgent need for rhinoplasty suitable for Asians because of their different facial features from Westerners. The M-shaped auricular cartilage rhinoplasty has been developed as a new method for correcting short nose deformity for Asians. This study aimed to evaluate the aesthetic and functional results of M-shaped auricular cartilage rhinoplasty compared to clinically commonly used rhinoplasty methods. A total of 45 patients were enrolled and divided into three groups of 15 patients: The first group underwent M-shaped auricular cartilage rhinoplasty, the second group underwent auricular-septal cartilagerhinoplasty, and the third group underwent overlapped auricular cartilagerhinoplasty. All of these patients underwent comprehensive rhinoplasty and had silicone or expanded polytetrafluoroethylene implants in the dorsum of their noses. The patient score improvements on the three patient-reported outcome measures were higher in the M-shaped auricular cartilagerhinoplasty group (1.65/1.79/0.11) compared with the overlapped auricular cartilagerhinoplasty group (1.40/1.51/0.05), and the score improvements in the auricular-septal cartilagerhinoplasty group (2.04/1.98/0.28) were the highest. This is a retrospective clinical study demonstrating the clinical efficacy of M-shaped auricular cartilage rhinoplasty. Compared with the overlapped auricular cartilage rhinoplasty, the effect of this novel M-shaped method is better. However, when compared to the auricular-septal cartilage rhinoplasty with septal extension and reinforcement using nasal septal cartilage, its effect is slightly worse. 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 .

Correction of Short Nose Using M-shaped Cartilage in Asian Patients: Finite Element Analysis and Recommendations for Surgery.

Using M-shaped cartilage grafts is a new method for the correction of short nose deformity with good effect for Asians. Although the basic approach to M-shaped cartilage surgery is well understood, there is a great deal of uncertainty when plastic surgeons perform the procedure, and still a lack of standard guidance on the specific details. In this study, the authors used finite element analysis to explore and compare postoperative cartilage stability of different fixing methods, different suturing positions, and different sizes of M-shaped cartilage. The authors applied a 0.01 N load to a 1 cm2 area of the nasal tip to simulate nasal tip palpation and compared the maximum deformations of different groups, which were used to make stability judgments. The maximum deformation of the model was the leastwhen the M-shaped cartilage was fixed medially to the septal cartilage and laterally to the outer crura of the lower lateral cartilage. At the same time, the maximum deformation was the least when the M-shaped cartilage was sutured to the middle of the nasal septal cartilage. Besides, the length of M-shaped cartilage was preferably around 30 mm, while its width was not worthy of being overly concerned. For optimal postoperative stability of Asian short nose correction, the M-shaped cartilage should be sutured and fixed medially to the middle of the septal cartilage and laterally to the lateral crura of the lower lateral cartilage, and the length of the M-shaped cartilage should be controlled at around 30 mm. 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 ethmoid bone is the ideal graft to strengthen nasal septum L-strut among different grafts: An evaluation based on finite element analysis.

In the rhinoplasty of Asian short nose deformity, the surgeon cuts a portion of septal cartilage and retains the nasal septum L-strut, but a deviated nasal septum is formed after the surgery under forces of soft tissue contracture. Although various autologous grafts are used to reinforce the L-strut, there is a lack of objective "mechanical theory" to support the clinical findings in other studies at the present time. A simplified and geometrical finite element model of L-strut reinforced with clinically common materials, including auricular cartilage, nasal septal cartilage, and perpendicular plate of ethmoid, was established. Simulating the mechanical environment of nasal tip in reality, when the force was loaded, the von Mises stress and directional deformation of the L-strut were observed under different widths. Kruskal-Wallis test was used to examine the significance of intergroup differences of L-strut, and P<0.05 indicated statistical significance. All autologous grafts decreased the maximum directional deformation of L-strut, and the variance of nasal tip displacement was reduced; the perpendicular plate of ethmoid showed a distinct effect. The increasing width of the L-strut reduced the maximum displacement of the nasal tip, but the influence of using grafts as a reinforcement to the L-strut was much greater than the residual width (p=0.003). The graft reinforcement significantly increased the stability of the L-strut, which enhanced the resistance to deformation in the long-term action of tension, and the effect of the perpendicular plate of ethmoid to reinforce was significantly better than that of auricular and nasal septal cartilage.

Short Nose Lengthening in Primary and Revision Rhinoplasty in Asians.

Surgical techniques and graft materials are important factors for short nose lengthening in both primary and revision rhinoplasty in Asian patients. Other subunit of the nose need to be improved as well to achieve aesthetic perfection. A cohort of 98 patients who underwent primary and revision rhinoplasty for moderate to severe short nose deformity from January 1, 2019, to December 31, 2020, were enrolled. Nasal elongation was achieved via an open rhinoplasty approach using autologous costal cartilage exclusively for grafting. Aesthetic outcomes were evaluated by anthropometric measurement and satisfaction assessment from patients and physicians. The mean duration of follow-up was 10.6 months. In both primary and revision cases, nasal length relative to preoperative measurements increased significantly, while nasal tip projection did not differ significantly. Columellar-facial angle and nasofrontal angle decreased significantly in both groups. Both physicians and patients reported improvement in aesthetic outcomes. Aesthetic satisfaction was reported from both patients and physicians. Autologous costal cartilage is an ideal graft material that offers strong structural support. Caudal septal extension graft using autologous costal cartilage sandwiched by extended spreader grafts achieve satisfactory lengthening of the central compartment and also increase nasal tip projection and rotation.

Short Nose Correction: Septal Cartilage Combined With Ethmoid Bone Graft.

Multiple methods are employed to correct short nose deformities, with septal extension graft representing the first choice for Asians. However, the volume of the septal cartilage in many Asian patients is not sufficient to be used alone for such operation. The present work developed a new method combining the septal cartilage with ethmoid bone graft to overcome this issue in Asian patients with short noses. Thirty-five women with short noses underwent septal extension graft from February 2015 to March 2017. The endoscopic technique was utilized to harvest the ethmoid bone to enhance the L-strut structure. An L-strut, comprising 0.8 cm segments of the caudal and dorsal cartilaginous septa, is left altered in order to harvest more cartilage for septal extension. The harvested the septal cartilage, approximately 1.0 mm thick and 16 to 20 mm long, underwent grafting on one side of the caudal septum. This was followed by alar cartilage fixation at the septal cartilage graft end. Finally, nose length, nasal tip projection and nasolabial angle were assessed before and after the surgery. Septal cartilage combined with ethmoid bone graft yielded an adequate nose lengthening and reduced nostril show, also in individuals showing extremely little septal cartilage. This new method is effective for short nose deformity correction in Asian patients. Combining the septal cartilage with ethmoid bone graft yields ideal outcome without overt complications, achieving commendable patient satisfaction.

A Novel Technique for Short Nose Correction in Asians: M-Shaped Conchal Cartilage Combining With Septal Extension Graft.

Multiple techniques are available for short nose deformity correction. The septal extension graft represents the commonest method employed in Asians. However, a large number of surgeons hardly obtain esthetically satisfactory results since the majority of designs do not reflect the normally encountered surface anatomy of the nasal tip cartilage. The authors designed a novel technique, which combined the M-shaped conchal cartilage with the septal extension graft for overcoming the above shortcoming in Asians. Between February 2013 and March 2016, 33 patients presenting short nose deformity were surgically treated with the M-shaped conchal cartilage combined with the septal extension graft. The graft was an altered septal extension graft using the septal cartilage alongside the conchal cartilage. The harvested septal cartilage was located to the caudal septum and fixed with sutures. The conchal cartilage was trimmed into 2 strips, which were sutured together in an M-shape and firmly fixed in a bilateral manner to the caudal septal extension graft. Then, the alar cartilage was fixed with the M-shape graft. In all patients, nasal lengths, nasal tip projections, and nasolabial angles were assessed before and after surgery, respectively. Nasal tip projections and nasal lengths showed remarkable increases, while columellar-labial angles were overtly decreased, in individuals surgically treated by the novel technique. This study presents a new method for correcting short nose deformity in Asians. The M-shaped conchal cartilage combined with the septal extension graft may effectively lengthen the nose while closely representing the actual surface of the esthetic nasal tip.

Abstract: Reconstruction of Nasal Tip Defects with Superior-Based Pedicle Nasolabial Island Flap

INTRODUCTION: Nasal tip reconstruction is a very challenging surgical procedure in aesthetic and reconstructive surgery.1,2 The main purpose of nasal tip reconstruction is to repair with similar texture tissues without disturbing facial aesthetics and function. In this study, reconstruction of the nasal tip defects with superior-based tunnellized pedicle nasolabial island flap is presented. METHODS: 10 patients who were operated for non-melanoma skin cancer including nasal tip area were included in the study. Patient’s medical records were reviewed, digital photography was taken before surgery. All of patients were assessed by detailed physical, ultra-sonographic, endoscopic nasal-airway examination. Each lesion was excised with at least 5mm margin. An elliptical-shaped superior pedicle nasolabial flap was designed based on angular artery. Pedicle of flap was dissected cephalic direction and subcutaneously to the superior of the defect area. The flap was moved to the defect by a tunnel. At the 12th month postoperatively, symmetry of nasal shape and face were evaluated with patient satisfaction scale (-1: not satisfied, 0: neutral, 1: moderate, 2: good, 3: very satisfied). RESULTS: 4 patients were male, 6 female and ages ranged from 61 to 83 years (mean 72.1). In all patients, there was no pathological lymph-node and no internal and external nasal valve dysfunction. Defects were between 4 cm2 and 7.56 cm2 after surgical excision. There were no infection, hematoma and total flap failure; but a partial (20%) flap necrosis due to venous congestion was seen in one diabetic patient and treated conservatively. None of the patients had sensory, speech, chewing and laughing problems after surgery. Temporary sagging of upper lip related to levator muscle damage was seen in one patient, but it improved at 6th month. Three patients were good and 7 patients were very good satisfied with nasal shape and face symmetry. Nine patients reported that the donor side of the face looked like younger than other; one of them didn’t. Nasolabial scar healed uneventfully in all patients. CONCLUSION: Various flaps have been defined for nasal tip defects.3 However, many flaps cause donor site morbidity, seconder intervention for defatting and revision, stage repair. Superior pedicle nasolabial island flap is an alternative flaps used in nasal reconstruction because of texture and color matching, minimal donor site morbidity, good and constant nutrition, safety and transportability to all nasal subunits. Reference Citations: 1. Nogushi M, Matsuo K, Hirose T. Reconstruction of short nose deformity using nasolabial flaps pedicled on the infraorbital vessels. Br J Plast Surg. 1991;44:567–569. 2. Turan A, Kul Z, Tu¨rkaslan T, et al. Reconstruction of lower half defects of the nose with the lateral nasal artery pedicle nasolabial island flap. Plast Reconstr Surg. 2007;119:1767-1772 3.Cox A, Fort M. Nasal Reconstruction Involving Multiple Subunit Defects. Facial Plast Surg. 2017 Feb;33(1):58–66.

Treatment Strategy for Revision Rhinoplasty in Asians.

Revision rhinoplasty in Asian patients is associated with problems related to the use of grafts or implant materials. Moreover, the septal cartilage of Asian individuals is generally weak and small, which makes it particularly vulnerable to injury or secondary deformity during primary surgery. Hence, there is an increased demand for major reconstruction of the septal cartilage framework during revision surgery in Asian patients. In revision rhinoplasty of the nose in Asian patients, appropriate management of the graft or implant is vital. The common problems resulting in the need for revision surgery include displacement, malposition, extrusion, recurrent inflammation, and infection of dorsally implanted alloplastic material. A short-nose deformity following silicone rhinoplasty is also a common problem that is difficult to manage. Furthermore, residual or recurrent deviation of the deviated nose, undercorrection of the convex nasal dorsum, and tip graft-related complications are frequently encountered problems that require revision. In revision rhinoplasty for Asian patients, autologous tissues, such as conchal cartilage and costal cartilage, play a pivotal role for use as a new dorsal implant or building block for major septal reconstruction. Therefore, it is imperative for surgeons to familiarize themselves with the appropriate use of autologous tissues, particularly costal cartilage.

A Novel Technique for Short Nose Correction: Hybrid Septal Extension Graft.

There are many techniques for correcting short nose deformities and the septal extension graft is the most commonly performed technique among Asians. In many Asian patients septal cartilage, however, is too small and insufficient to perform an effective septal extension graft. Therefore, we designed a novel technique, named hybrid septal extension graft to overcome this pitfall in Asian tip plasty. From February 2010 to March 2013, 41 patients with primary (N = 30) or secondary (N = 11) short nose deformity underwent a hybrid septal extension graft. The hybrid septal extension graft is a modified septal extension graft which uses the small septal cartilage along with irradiated homologous costal cartilage. Irradiated homologous costal cartilage was carved into a shape of a thin batten and securely fixed bilaterally to the caudal septum. Harvested septal cartilage was located between the 2 irradiated homologous costal cartilage batten grafts and fixed with sutures. Then, the alar cartilage was fixed at the end of the septal cartilage graft. The nasal lengths, nasal tip projections, and nasolabial angles were measured pre- and postoperatively. The hybrid septal extension graft showed enough nose lengthening and a decreased nostril show, even in cases with a very small septal cartilage. The authors present a novel technique for correction of short nose deformity in Asians. The hybrid septal extension graft provides good results with minimal complications and overall patient satisfaction was very high.

Effective Use of a Silicone-induced Capsular Flap in Secondary Asian Rhinoplasty.

Summary:Performing secondary rhinoplasty in patients who underwent primary rhinoplasty using a silicone implant is difficult due to thinning of nasal skin and formation of a capsule. Excess capsule formation can cause capsular contracture, resulting in short nose deformity or implant deviation, migration, or implant demarcation. Revision rhinoplasty using a capsular flap, dorsal silicone implant, and tip plasty was performed in 95 Korean patients (91 women and 4 men; mean age, 27 years) who previously underwent primary augmentation rhinoplasty using silicone implants. The capsular flap was composed by creating a dual plane above the anterior capsule and below the posterior capsule. The existing silicone implant was removed, and a new silicone implant was placed under the posterior capsule. The patients were followed up for 6 months to 4 years (mean, 31.7 months). Of the 95 patients who underwent secondary augmentation rhinoplasty using a capsular flap, 88 patients (92.6%) showed satisfactory results. There was no hematoma or nasal skin vascular compromise. There was no visible or palpable capsule resorption or recurrent capsular contracture. Early implant malpositioning (within 30 days postoperatively) was observed in 4 patients, and tip shape dissatisfaction (within 60 days postoperatively) was reported by 3 patients. Four patients underwent revision surgery and had successful outcomes. Nasal augmentation using a silicone implant and capsular flap in secondary rhinoplasty avoids complications caused by removal of the capsule. Recurrent capsule formation or clinically noticeable resorption of the capsular flap was not observed in this study.

Correction of short nose deformity using a septal extension graft combined with a derotation graft.

In patients having a short nose with a short septal length and/or severe columellar retraction, a septal extension graft is a good solution, as it allows the dome to move caudally and pushes down the columellar base. Fixing the medial crura of the alar cartilages to a septal extension graft leads to an uncomfortably rigid nasal tip and columella, and results in unnatural facial animation. Further, because of the relatively small and weak septal cartilage in the East Asian population, undercorrection of a short nose is not uncommon. To overcome these shortcomings, we have used the septal extension graft combined with a derotation graft. Among 113 patients who underwent the combined procedure, 82 patients had a short nose deformity alone; the remaining 31 patients had a short nose with columellar retraction. Thirty-two patients complained of nasal tip stiffness caused by a septal extension graft from previous operations. In addition to the septal extension graft, a derotation graft was used for bridging the gap between the alar cartilages and the septal extension graft for tip lengthening. Satisfactory results were obtained in 102 (90%) patients. Eleven (10%) patients required revision surgery. This combination method is a good surgical option for patients who have a short nose with small septal cartilages and do not have sufficient cartilage for tip lengthening by using a septal extension graft alone. It can also overcome the postoperative nasal tip rigidity of a septal extension graft.

Nasal bone length in Saudi rhinoplasty: a clinical-radiological study

BACKGROUND AND OBJECTIVESHump reduction in the presence of short nasal bones can result in significant esthetic and/or functional problems in patients seeking rhinoplasty in the Middle East. The aims of this study were to determine the mean length of nasal bones, amount of nasal dorsum it forms in relation to the whole nose, and incidence of short nasal bones in the Middle Eastern population.DESIGN AND SETTINGSA prospective study that has been carried out in a tertiary care hospital.PATIENTS AND METHODSA total of 154 patients (80 females and 74 males) who were scheduled for computed tomography scan for the paranasal sinuses were included in the study. The inclusion criteria were adults with no history of facial/nasal trauma, sinus space occupying lesions, or surgery.RESULTSIn males, the mean clinical nasal bone length was 19.59 mm and the mean radiological nasal bone length was 24.96 mm. In females, the mean clinical nasal bone length was 18.17 mm and the mean radiological bone length was 22.82 mm.CONCLUSIONThe bony vault represents 44.2% of the female nose and 44.3% of the male nose. In the present study, no patients displayed a short nasal bone that was less than one-third of the whole nasal length.

Lengthening the Short Nose in Asians

Using objective anthropometric measurement, this study reports the outcome of surgical correction of short-nose deformities in Asian patients. To present our experience in lengthening the short nose in Asians and report the surgical results. In this retrospective review, we study the cases of 36 patients who underwent surgical correction of short-nose deformity. The effect of nasal lengthening was analyzed using anthropometric measurement, including nasion to tip-defining point (N-TDP), nasal tip projection (NTP), nasofrontal angle (NFA), and columellar-facial angle (CFA). Surgical correction of short-nose deformity. The preoperative and postoperative N-TDP, NTP, NFA, and CFA and patient satisfaction. The mean postoperative follow-up duration was 29.8 months. The cause of the short nose was congenital in 18 cases and secondary to previous rhinoplasty in 18 cases. Septal tissue, conchal cartilage, costal cartilage, and conchal composite tissue were used as graft materials. The key procedures for lengthening included septal extension graft reinforced with extended spreader, dorsal onlay, and tip grafts. The N-TDP increased by 11.2%, and CFA decreased from 122.6° to 111.1°. The NFA changed from 148.9° to 148.5°. The NTP ratio, measured using the Goode method, decreased from 0.53 to 0.50. The increase of N-TDP was greater in patients undergoing the costal cartilage grafting procedure than in those who received septal or conchal cartilage. All patients were satisfied with the aesthetic results, and there were no serious complications. In Asians, the key maneuvers for lengthening were septal extension graft reinforced with extended spreader and dorsal onlay graft. Rib cartilage provided superior lengthening effect compared with other cartilage. 4.

Secondary Asian Rhinoplasty: Lengthening the Short Nose

Short nose deformity results from primary short nose, previous rhinoplasty, or trauma. A septal extension graft using rib cartilage can be placed to address this deformity. Indications for this procedure include previously damaged septal cartilage, innate septal issues, saddle nose deformity, skin problems, and secondary deformities of the cleft lip and nose. The authors describe their experience using rib cartilage grafts for septal extension to correct short nose deformity in Asian patients. From January 2005 through February 2010, the authors used a rib cartilage graft for septal extension in 38 consecutive Asian rhinoplasty patients with primary (n = 5) or secondary (n = 33) short nose deformity. In cases where the septum had been overresected in a previous rhinoplasty, a reinforcement procedure was performed using additional supportive rib cartilage grafts. The mean duration of follow-up was 2.5 years. Of the 38 treated patients, 7 were male and 31 were female (mean age, 28.5 years). A single septal extension graft with rib cartilage was used in 32 cases, whereas a double graft was used in 6 cases. The average external lengthening of the nose from nasal root to tip was 8 mm. All patients were satisfied with the shape of the lengthened nose. There was 1 case of pneumothorax, but complications were otherwise rare. Neither cartilage exposure nor infection was observed. The authors have obtained good aesthetic results using a rib cartilage graft for septal extension in the treatment of short nose. This technique may be particularly useful in cases where the septal cartilage is unavailable for harvest because of previous rhinoplasty or trauma.

Revision of the Surgically Overshortened Nose

The short nose deformity may arise from multiple etiologies including iatrogenic following rhinoplasty. The weakening of the cartilaginous support and the contractile forces imposed by the healing soft tissue envelope may result in the short nose deformity. The focus of this article is to present the senior author's approach to this nasal deformity.

Management of the Short Nose Deformity in Revision Rhinoplasty

The short nose is a complex and frustrating problem that many rhinoplasty surgeons face in their practice. It can be seen in both the hereditary nasal deformity patient as well as in patients having undergone previous nasal surgery. In the revision rhinoplasty patient, the short nose can result from overresection of the nasal dorsum, a deficiency in the middle third causing a saddle nose and tip retraction, and from structural loss in the lobule. Several methods have been described regarding the treatment of this deformity. They range from simple tip grafting in the mildly affected patient to complete nasal reconstruction in the patient with severe structural loss and skin retraction. We will discuss the anatomy of the short nose and describe our techniques for addressing specific deficiencies.

Nasal Tip Surgery in Asians

Objective The authors intended to review our surgical techniques used in Asian tip surgery and to suggest effective techniques, according to the types of the nasal tip that are addressed. Methods 107 patients who had nasal tip surgery from Jan. 2005 to Dec. 2006 in a tertiary hospital were enrolled in the study. Medical records, graphic operation records, and standardized patient photographs were retrospectively reviewed. Initial diagnosis, types of nasal tip surgery, associated operative techniques, surgical results and complications were analyzed. Results Initial diagnosis included deviated nose, hump nose, combine deviated and saddle nose, low profile nose, short nose, and cleft nose deformity, in order of frequency. Nasal tip surgery included augmentation of projection, control of rotation, restoration of symmetry and volume reduction, among which augmentation was used in all cases. External approach was used in 74% and intranasal approach in 26%. For augmentation of the tip projection, onlay grafts (39%), septal extension grafts (25%), and tip modifying suture with onlay grafts (20%) were the most commonly used methods. Infection or extrusion of the grafts was not found. Complications included tip deviation due to the deviation of the septal extension graft in 1 case, visible tip graft in 1 case, and slight upward rotation of the tip in 1 case. Conclusions In Asians, augmentation of the tip projection is the main issue in tip surgery and is best performed with cartilage onlay grafts or septal extension graft rather than suture modification.

Case report and surgical solution for nasal spine agenesis in a woman with Binder syndrome

Binder syndrome is an uncommon disorder of unknown etiology. It is characterized by hypoplasia of the nose and maxilla and altered morphology of the associated soft tissue. We report a 19-year-old Binder syndrome patient with short-nose deformity and anterior nasal spine agenesis. We present a surgical technique for nasal spine agenesis treatment. We used a titanium screw without a graft, which supported the nasal tip and increased tip projection. As there is good soft-tissue coverage over the screw, infection or extrusion was not encountered, and the patient had no complaints 1 year after surgery.