Structure Rhinoplasty Research Articles

Temporary unilateral upper eyelid retraction: an unreported rare complication of rhinoplasty

BackgroundUpper eyelid retraction may develop due to various neurogenic, myogenic, and mechanistic causes. Although the development of lagophthalmus after rhinoplasty has been described in the literature, upper eyelid retraction after uncomplicated rhinoplasty has not been reported before.Case presentationThis report presents a case of unilateral upper eyelid retraction observed six days after uncomplicated rhinoplasty. A 40-year-old female patient presented with left upper eyelid retraction on the sixth day of uncomplicated closed-approach structural rhinoplasty. The patient was able to close her eyelids completely and eye movements were normal in all directions of gaze. Anterior and posterior segment examinations were in normal range. We prescribed artificial tear drop and night-time liquid tear gel. After four weeks of conservative treatment, the upper eyelid retraction was improved without any complication. No recurrence was observed at 6-month follow-up.ConclusionThis is the first case presenting with upper eyelid retraction without lagophthalmus after uncomplicated rhinoplasty. Ophthalmologists should be aware that such a complication may occur quite rarely and may regress without sequelae with conservative treatment.

Intraoperative Measurement-Based Approach to Supratip Deformity in Open Structural Rhinoplasty.

Supratip deformity is one of the most common complications after open rhinoplasty. This study aimed to define a new risk scoring system for supratip deformity and determine the distances that should be left between the tip defining point (TDP) and anterior septal angle (ASA) to prevent it. Four hundred sixty-nine patients who underwent open rhinoplasty between 2018-2022 were included in this retrospective study. The patients were evaluated according to the risk scoring system consisting of four parameters (skin thickness, lower lateral cartilage anatomy, amount of hump resection, and soft tissue procedures). Because of the presence of supratip deformity at the postoperative 12th month, the patients were divided into two groups: (i) without supratip deformity (n = 418) and (ii) with supratip deformity (n = 51). Statistical inferences were made regarding the development of supratip deformity by evaluating the relationship between the risk scores and the intraoperative TDP-ASA distances. There was a significant difference between the groups in risk scores (P < 0.05). In cases with high-risk scores, it was calculated that the probability of developing supratip deformity decreased significantly when the TDP-ASA distance was above 7.5 mm and increased significantly when the TDP-ASA distance was below 6.5 mm. In cases with low-risk scores, it was found that the probability of developing supratip deformity was reduced considerably when the TDP-ASA distance was over 6.0 mm. The authors recommend keeping the TDP-ASA distance above 6.0 mm in low-risk patients and 7.5 mm in high-risk patients to avoid supratip deformity.

Preservation Rhinoplasty by the Ones Who Do It: A Worldwide Survey.

Dorsal preservation (DP) rhinoplasty techniques, including surface techniques (STs) and foundation techniques (FTs) have garnered significant attention internationally over the past few years. The practice patterns and opinions from 117 of these surgeons were surveyed from a cohort of these surgeons who participate in an online Evidence-Based Rhinoplasty Research Group. The findings of the survey are merely a snapshot of the international rhinoplasty community's practices, yet did capture data from surgeons from a diverse geographic, years of experience, and training background. STs were most used for the bone changes, and the high-strip technique was preferred for the cartilaginous septal surgery. STs are mostly performed by younger surgeons (<10 years of experience), whereas FTs were more common in older surgeons (10-30 years of experience). STs were considered more stable (p < 0.001), more predictable (p < 0.001), and associate with a shorter learning curve (p = 0.015). Revision surgery rates were not different. Regarding why many surgeons using DP still perform structural rhinoplasty, the most cited concern was hump persistence/recurrence. In summary, among surgeons using DP rhinoplasty techniques, the majority perform DP in over half of their primary rhinoplasty surgeries, highlighting the importance of updating educational programs in medical training, conferences, and courses.

Measurement of Nasal Contour Landmarks in Septorhinoplasties with Special Regard to the Course of Postoperative Swelling Using a Three-Dimensional Camera.

The integration of three-dimensional (3D) cameras into clinical practice for pre-operative planning and post-operative monitoring of rhinoplasties remains controversial. However, this technology offers the advantage of capturing the 3D surface without exposing patients to potentially harmful radiation. Continuous assessment allows the follow-up of swelling patterns, cartilage alignment, and bone remodeling. The primary objective of our study was to quantify changes in nasal structure before and after rhinoplasty by using 3D photography. Our study cohort consisted of 29 patients who underwent open structural rhinoplasty. We used the Artec Space Spider camera to acquire a total of 103 3D images. We collected pre-operative and at least two or three post-operative follow-up scans, which were taken one, three, and six months after surgery. We evaluated paired scans that included various time intervals to improve our understanding of swelling behavior and to ensure an objective analysis of changes. Eleven specific anatomical landmarks were identified for measurement. Two independent raters determined the distances between these landmarks over time. The calculation of intraclass correlation coefficients showed low inter-rater variability. Statistically significant changes over time (p < 0.05) were observed for various anatomical landmarks, including soft tissue nasion, soft tissue orbitale right, soft tissue maxillofrontale left, soft tissue maxillofrontale right, nasal bridge, and nasal break point. Conversely, no significant changes (p > 0.05) were observed in the measurements of soft tissue orbitale left, pronasale, subnasale, alare right, or alare left. A visual assessment was conducted using surface distance maps. The results indicate that the complete decrease in swelling takes at least 6 months or even longer. Additionally, 3D photography can provide an objectively comparable analysis of the face and external contours. Furthermore, it allows for a comparison of external contours and therefore pre- and post-operative differences.

The Nasal Locator: An Innovative Instrument to Define the Exact Point of Osteotomy in Preservation or Structural Rhinoplasty.

One of the most common components of most dorsal preservation (DP) techniques is subdorsal septal excision. Whatever the instrument used for this procedure (piezoelectric, Rongeur, or long scissors), it is paramount to be able to determine the exact subdorsal point (SDoP) at which the osteotomy/ostectomy (or cartilage cut) has been reached. First, to avoid any unnecessary extension of the osteotomy that increases the risk of fracture spreading into the cribriform plate and a consequent cerebrospinal fluid leak; second, to be sure that the subdorsal cut is high enough and can be combined/unified with the planned radix osteotomy.In addition, transverse osteotomies are usually necessary in both preservation and structural rhinoplasties. Even though many surgeons are satisfied with their osteotomy lines, it sometimes proves difficult to be sure of their position, especially during a DP rhinoplasty when both the transverse lines have to go in the direction of the planned radix osteotomy.We have developed the Nasal Locator (NL) to precisely define various nasal points of interest, such as a subdorsal cut (cartilaginous or bony), or a transverse or medial osteotomy line. It ends in two tips. The lower tip is placed at the point we wish to determine (e.g., SDoP or a transverse osteotomy), while the upper tip is fixed a certain distance from it (in all three dimensions), showing its exact location.Our in-depth research of the literature and the market has not revealed any device similar in form and function to the NL.We have been using the NL for almost 2 years and are confident of its usefulness. It is easy to use, and practically no time is needed to become familiar with it. During surgery, it is needed for less than 30 seconds and is risk-free. It is fully sterilizable and can be used repeatedly.

Structural Rhinoplasty as an Effective Surgical Approach for Frontonasal Dysplasia.

Frontonasal dysplasia (FND), a rare congenital craniofacial disorder, primarily influences the development of midline craniofacial structures. A notable manifestation of this condition is nasal hypoplasia. This report details the treatment of a 19-year-old male patient diagnosed with FND accompanied by a severe case of nasal hypoplasia. The authors used structural rhinoplasty to achieve total nasal reconstruction. Albeit with some minor sequelae, the outcome of this surgery was markedly positive, enhancing both the cosmetic appearance and functional capacity of the nose. This case underscores the effectiveness of structural rhinoplasty as a feasible therapeutic approach for individuals suffering from FND and its associated nasal hypoplasia.

Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty

Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A "delta" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-dorsal preservation rhinoplasty cohorts were associated with improved overall crowdsourced aesthetic outcomes and improved outcomes across all subparameters. Overall, delta (d) improved in both dorsal preservation (0.300, 95% CI +/- 0.047) and structural (0.377, 95% CI +/- 0.055) cohorts. When raters were asked to predict whether a patient had surgery, the correlation coefficient between the confidence in the prediction and that prediction being correct was 0.74 (95% CI +/- 0.47 in the structural group, suggesting that a crowd worker was likely to be correct in identifying whether a patient had structural rhinoplasty. However, the correlation coefficient was -0.0554 (95% CI +/- 0.058) in the dorsal preservation group. This suggests the raters were unable to consistently identify which patients had dorsal preservation rhinoplasty with any confidence. Conclusion In the ongoing challenge to achieve better aesthetic outcomes in plastic surgery, crowdsourcing is a valuable tool for helping to measure these outcomes. We compared the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We found that significant improvements in overall aesthetic outcomes were achieved with both techniques, while a more natural “unoperated” outcome was achieved when performing a dorsal preservation technique. With this type of study and assessment tool, we helped to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome.

Approach to the nasal dorsum in rhinoplasty : preservation or structural?

In modern rhinoplasty, two foundational approaches for modifying the nasal dorsum developed in the beginning of the 20th century: -preservation and structural techniques. Preservation involves -maintaining the nasal structure by displacing the hump into the nose without directly resecting it. This method preserves structural integrity and avoids nasal valve collapse but can lead to mid-vault widening and hump recurrence. In contrast, structural rhinoplasty entails -directly removing bone and cartilage, offering precise hump reduction but risks over-resection, dorsal irregularities, and mid-vault collapse. The patient's individual anatomical factors guide the practitioner in choosing the most suitable -approach for correcting the nasal dorsum.

Nasal Dorsum Anatomy of Major Different Ethnicities-Surgical Implications: A Multicenter Radiologic Study.

The heterogeneity of nasal features across different racial and ethnic groups is evident. This large-scale multicenter study was performed to evaluate the dorsal keystone area and its relation to superficial nasal anatomy through computed tomography (CT) scans. Six populations were included: South Caucasian, Middle Eastern, Black South African, Eastern Asian, Mestizo, and Eastern European. Each center obtained CT scans performed between January of 2020 and December of 2022 from patients presenting a nasal hump and from an age- and sex-matched control group. Osteocartilaginous measurements in relation to ethmoidal point and to rhinion, as well as their relation to superficial nasal anatomy, were collected from nasal CT scans in midsagittal view. These were compared between populations and, in each center, between patient groups (nasal hump versus no nasal hump). The study population included 600 patients (254 with nasal hump) with a mean age of 33.98 years (range, 18 to 59 years); 55.6% were women. Average distances from the ethmoidal point were 10.1 ± 3.5 mm to the rhinion and 1.68 ± 0.23 mm to the beginning point of the nasal hump. In 96% of cases, the ethmoidal point was cranial or no more than 5 mm caudal to the beginning of the nasal hump. S-shaped nasal bones were associated with nasal hump, but angulation (kyphion angle) did not correlate with nasal hump height. In most patients, the nasal hump has no ethmoid bone underneath it, and the apex is located over the septal cartilage. The ethmoidal point is a reliable landmark and should be considered when evaluating established and new preservation and structural rhinoplasty approaches.

Anatomical Conditions in Simultaneous Orthognathic Surgery and Structural Rhinoplasty. A Clinical Series

Anatomical Conditions in Simultaneous Orthognathic Surgery and Structural Rhinoplasty. A Clinical Series

Double Lateral Osteotomy: Not Only the Correction of Crooked Noses but a Relevant Aesthetical Refinement in Structural Rhinoplasty.

Osteotomy represents a crucial step in structural rhinoplasty; however, there is not a unique approach accepted. Double lateral osteotomy has proven to be effective in the long-term correction of a deviated nose. In this series, we evaluated its aesthetic value also in non-deviated cases. 864 patients who underwent primary structural rhinoplasty from 2012 to 2020 were divided into four groups. Group A and B included patients with a crooked nose treated with asymmetrical double osteotomy and bilateral double osteotomy, respectively. Patients who did not present nasal deviation were divided into group C, including cases treated with bilateral single osteotomy, and group D, including patients who underwent bilateral double osteotomy. Postoperative evaluations were performed by three independent plastic surgeons blinded to the surgical technique. Patient's satisfaction was assessed through the FACE-Q rhinoplasty module. FACE-Q scores reported a satisfaction rate higher than 30% for every item in all groups; however, group B and group D showed statistically higher satisfaction (p < 0.01). According to the evaluations performed by physicians, group B and group D showed the most satisfactory outcomes (p < 0.01). bilateral double osteotomies represent a significant aesthetic refinement in structural rhinoplasty, not only in crooked noses but also in non-deviated cases, since the reduction in the width of the nose is an aesthetical aspect very appreciated by patients.

Use of the Interalar Ligament Flap for Tip and Supratip Contouring in Primary Open Structural Rhinoplasty.

Precise tip contouring is paramount to achieve pleasant cosmetic results in rhinoplasty. Loss of tip projection or rotation, supratip deformities, and long-lasting edema may jeopardize the outcome and lead to patient dissatisfaction or to reintervention. Several approaches have been reported, sometimes with considerable drawbacks or conclusions supported mainly by experience. The aim of this study was to describe the interalar ligament flap for tip and supratip contouring and to comparatively assess its efficacy and safety. The study included 147 patients who underwent primary structured open rhinoplasty and were divided into 2 groups: group 1 underwent harvesting and repositioning of the interalar ligament flap, and group 2 underwent conventional tip dissection. Tip edema, supratip definition, and fullness were blindly scored at 2-, 6-, and 12-month postoperative follow-up. Nasolabial angle was measured at 2 and 12 months postoperatively. Univariate analysis and multivariable regression modeling were performed. Supratip definition was significantly higher in group 1 at the 2-, 6-, and 12-month postoperative follow-up visits ( P < 0.05, P < 0.01, and P < 0.01, respectively). Tip edema and supratip fullness were significantly lower in group 1 at each time point ( P < 0.01). Nasolabial angle, and its modification between 2 and 12 months after intervention, did not differ in the 2 groups. All findings were confirmed when controlled for eventual confounders. The interalar ligament flap has proven to be versatile, effective, and consistently reliable in reducing tip edema and improving supratip definition. It may be tailored to the patient, partially folded to improve tip projection, or used to camouflage tip grafts. Therapeutic, III.

Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales.

Dorsal preservation techniques have been preferred and gained popularity in recent years. The current study compares the effects of dorsal preservation and dorsal reduction rhinoplasty on nasal patency and aesthetic outcomes by using Patient-Reported Outcome Measures (PROMs) and rhinomanometry. To our knowledge, this is the first study to compare dorsal preservation and dorsal reduction techniques with rhinomanometry. This is a prospective study of 34 patients who underwent rhinoplasty between January 2021-June 2022. The patients were randomly selected preoperatively and divided into two groups as structural rhinoplasty (SR) and preservation rhinoplasty (PR). Nasal Obstruction and Symptom Evaluation (NOSE), Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scales and rhinomanometric evaluation were performed preoperatively, at 3rd month and 12th month postoperatively. Nineteen patients (10 female, 9 male) were in SR group, 15 patients (7 female, 8 male) were in PR group. There was not significant difference in terms of age and gender between groups. In both groups, NOSE, SCHNOS-O and SCHNOS-C results were found to be significantly lower at postoperative 3rd and 12th month compared to preoperatively (p < 0.001 for the entire SR group, p = 0.001 for the entire PR group). There was no significant difference between groups in terms of PROMs. Mean total nasal volume (TNV) at 12th month were statistically higher than preoperative value in PR group (p = 0.031). Also there was no significant difference in SR group and between groups in terms of rhinomanometry results. Dorsal preservation with pushdown technique provides good functional and aesthetic results comparable with structural rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . A well-designed prospective clinical trial.

An update on rib grafting in rhinoplasty: which rib is right?

In revision or posttraumatic rhinoplasty, the quantity and quality of septal cartilage available for grafting is often deficient and auricular cartilage often provides insufficient strength for structural nasal reconstruction. Accordingly, rib cartilage serves as a reliable, abundant source of cartilage for grafting. However, the various sources of rib cartilage carry respective benefits and weaknesses. This review examines recent studies, novel applications and a comparison of the primary sources of rib cartilage, including autologous cartilage, irradiated cadaveric rib and fresh frozen cadaveric cartilage. Options for rib cartilage include autologous, irradiated cadaveric rib, and more recently, reports on fresh frozen cadaveric cartilage. Studies continue to conclude that autologous and irradiated donor cartilage carry equivalent results, have similar rates of complication and have a comparable cost profile. Regardless of the source, rib cartilage plays an important role in structural rhinoplasty, especially in revision cases. Although the risks, benefits and long-term results of autologous and radiated homologous cartilage have been evaluated in observational studies, fresh frozen rib cartilage will need further follow up before widespread use, although preliminary literature shows promise.

Risks and complications in rhinoplasty. A comparative study in structural vs preservation rhinoplasty

Introduction. Rhinoseptoplasty is considered the most challenging operation because many techniques have to be taken into consideration to achieve an optimal aesthetic and functional results. Rhinoseptoplasty techniques have been perfected over time, following two main surgical approaches: structural rhinoplasty (resection/ reconstruction) and conservative (preservation rhinoplasty). Methods. The authors present the risks and complications in a comparative study of 100 cases with patients in primary rhinoseptoplasty performed between 2019-2021: 50 cases in Structural Rhinoplasty and 50 cases in Preservation Rhinoplasty. The study presents two surgical concepts of rhinoplasty regarding the main advantages, disadvantages and indications of each type of rhinoseptoplasty surgery. Results and conclusions. Complications post-rhinoseptoplasty can be considered as perioperative, functional, anatomic (aesthetic) and psyhological. In this study 10 cases (10%) of primary rhinoplasty required revision surgery. The most frequent postoperative deformity is the “pollybeak” when a deep naso-frontal angle, cartilaginous hump and reduced tip projection are present preoperatively. The pollybeak was the indication in 4 cases (40%) of all revision rhinoplasties. Other frequent postoperative deformities are: wide nasal tip, retractions of the columella base and irregularities of the nasal dorsum. These deformities are very often combined and caused by a loss of septal support. Septorhinoplasty is a difficult procedure and the surgeon must have accurate anatomical knowledge and rich clinical experience. The risks for rhinoplasty-complications can be reduced with increasing experience. It is very important to make distinction between complication and mistake.

Subdorsal Cantilever Graft for Elevating the Dorsum in Ethnic Rhinoplasty.

Augmentation of the nasal dorsum is frequently required in the ethnic rhinoplasty patient to create a narrowing effect and to balance the upper two thirds of the nose with the desired increase in tip projection. The subdorsal cantilever graft (SDCG) provides a method to elevate the nasal dorsum to complement the increase in nasal tip projection. SDCG type A is situated below the bony dorsum and acts to raise the dorsum with limited elevation of the radix. The SDCG type B extends through a radix osteotomy site and raises the radix down to the supratip after complete release of the bony dorsum and middle nasal vault. Placement of the SDCG below the dorsum has many advantages, including preserving the features of the natural dorsum (dorsal aesthetic lines), controlled narrowing, and camouflage of the subdorsal graft. This is a complex procedure that requires a good understanding of dorsal preservation techniques. Use of the SDCG to raise the nasal dorsum in ethnic patients combines structure rhinoplasty with the principles of dorsal preservation for augmentation of the profile in patients with a low dorsum.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Application of Ultrasonic Piezoelectric Technology for Rhinoplasty.

Preservation Rhinoplasty: Open or Closed?

Preservation rhinoplasty (PR) is an evolving philosophy. The open approach was initially utilized, but the author felt a closed approach might be of benefit in certain patients. A total 162 primary rhinoplasty cases were studied retrospectively between May and November 2020. One hundred cases had at least 1 year of follow-up. Patients had follow-up at 1 week, 1 month, 3 months, and 1 year after surgery. Technical details were recorded, including dissection planes, preservation of the dorsum (DP) vs component reductions, surface vs foundational DP techniques, and open vs closed approach. One hundred patients had at least 1 year of follow-up. Fifty-six patients underwent an open approach and 44 a closed approach. Eighty-three patients had preservation of the dorsal soft tissue envelope. All patients who underwent a closed approach had preservation of the dorsal soft tissue envelope. Sixty-seven patients underwent DP, with 38 receiving surface techniques and 29 undergoing impaction techniques. Thirty-three patients underwent structural rhinoplasty with piezoelectric osteotomies and mid-vault reconstruction. All structural cases were performed employing an open approach. Four revision surgeries were necessary. Open and closed approaches have indications depending on the tip and dorsal deformities. A closed PR is favored with thin skin, minimal dorsal modification, osseocartilaginous preservation (foundation techniques), less complex tip deformities, and overprojected noses. An open PR is favored for extensive dorsal modification, S-shaped nasal bones, complex tip deformities, and tip augmentation. Structural dorsal rhinoplasty is always conducted open and preferred for complex dorsal deformities and severe septal deviations.

Reduction Rhinoplasty Re-Endorsed: When Conservative and Measured

SUMMARYReduction rhinoplasty has been widely criticised and dismissed due to the current preference for structural rhinoplasty. The criticism is related to airway compromise and secondary structural deformities, both early and late, due to overzealous resection. This two-year study attempted to prospectively assess the risk of airway and structural problems following reduction rhinoplasty in 30 consecutive patients. The findings showed no statistically significant difference either in the NOSE score (subjective sense of breathing) or in nasal valving (objective observations), at the 3-month follow-up. Subsequent 12-month telephone reviews revealed no change in the patients’ functional or aesthetic outcomes. There was a 3% structural complication rate (requiring secondary surgery) and a 20% rate for further refining reduction surgery.The findings confirmed the author's impression that conservative, measured reduction rhinoplasty, performed with due consideration to preserving the nasal supportive framework, is a technique well worth endorsing with confidence to reduce the disproportionately large nose. Contemporary surgeons need not feel obliged to only use the more complex later-developed structural rhinoplasty techniques.

Understanding the Use of Polycaprolactone in East Asian Structural Rhinoplasty: Questions and Answers

Surgery as an art in rhinoplasty involves grafting techniques wherein materials (usually autologous) are taken from the septum and supplemented by conchal cartilage. However, not all noses have adequate cartilage material. The quest for materials as possible replacement for human tissue have led to invention of synthetic (e.g. silicone, e-PTFE, porous polyethelene) and non-synthetic products (e.g. processed homograft and xenograft). In this era of advanced medical science, tissue engineering has started the use polycaprolactone (PCL) as a template and scaffold for tissue growth. Because of this characteristic feature, PCL as a mesh has a significant role in structural rhinoplasty.&#x0D; &#x0D; What is structural rhinoplasty?&#x0D; The surgical goal of rhinoplasty is to achieve functional improvement in breathing and aesthetic overall look, most notably the tip. The tip is determined by the final shape of the lower cartilage in its proper location - - but since the lower cartilage is a floating structure supported only by fibrous tissue and ligaments, there is a high incidence of tip drooping post op. So, the idea of structured rhinoplasty was conceptualized in 1997 by Dr. Byrd and popularized by Dr. Toriumi.1,2 A piece of central septum is harvested and fashioned as an extension of the caudal margin of the septum. This is called a septal extension graft (SEG) and the lower cartilage is sutured to the caudal margin of the SEG for better control of the tip. Since then, the technique has been the main workhorse support graft for the tip.3 (Figure 1)&#x0D; &#x0D; Why is structural rhinoplasty needed in East Asian noses?&#x0D; East Asian noses, particularly Southeast Asian noses are usually short and small, with low dorsum and upturned bulbous nose. Tremendous strength in the design of the structural support with its foundation base at the caudal septum should be achieved in order to elongate the nose, counter rotate and project the tip. (Figure 2) This is made possible by using the central harvested cartilage as a SEG attached to the residual strong dorsal and caudal strut.4 (Figure 3)