Sir: Augmentation rhinoplasty using a ready-made silicone implant is a common procedure in Asian rhinoplasty. However, implant insertion for dorsum augmentation tends to make the nasion level higher and more cephalic (Fig. 1). The resulting unnatural nasion level may be conspicuous and lead to unsatisfactory results in Asian patients, in whom nasal nasions are generally lower and positioned more caudally than in Caucasian patients.1 A few methods have been described to prevent this problem.2,3 However, these methods not only are difficult to practice but also demand excessive operation times. The purpose of this study, therefore, was to devise a new, simple augmentation rhinoplasty method that avoids the possibility of unnatural nasion augmentation in Asian patients.Fig. 1.: Significant cephalic transposition of the nasion level after augmentation rhinoplasty using a ready-made silicone implant.A suitable ready-made silicone implant was selected for each patient. Multiple radiating incisions were cut into the inner surface of the silicone implant at around the expected nasion level. This procedure makes the nasion area of the implant highly flexible and allows the implant to correspond fully to the curvature of the nasion surface, thereby permitting the implant to contact nasions without any dead space. Using this method, augmentation of nasion height was possible without significant cephalic transposition of the nasion level (Fig. 2).Fig. 2.: Modified silicone implant with radiating incisions at the nasion level on the inner surface.Twenty-eight patients underwent augmentation rhinoplasty using the endonasal or open approach,4,5 and 22 patients were available for long-term postoperative evaluation, which was conducted at least 12 months after the procedure (mean, 15 months). The vertical distance between the line connecting the bilateral endocanthions and the nasion was determined preoperatively and postoperatively for these long-term follow-up patients, and changes in the cephalocaudal nasion levels were evaluated. Patient satisfaction was also measured using a 5-point visual analogue scale (1 = very unsatisfied, 5 = very satisfied). Little difference was observed between preoperative and postoperative nasion levels. The mean vertical distance between the line connecting the bilateral endocanthions and the nasion for preoperative patients was 3.5 ± 0.9 mm; the postoperative value was 5.0 ± 1.0 mm, a mean increase of 1.5 mm. A subjective evaluation of outcomes revealed a very satisfied result with a mean value of 4.0 points. There were no postoperative complications, such as implant extrusion, displacement, or infection. The placement of simple radiating incisions on the inner surface of a silicone implant widens its arc angle and increases its flexibility, thus allowing the implant to be adjusted and to closely match variable nasofrontal shapes. Their net effect is to preclude cephalic transposition of the nasion level. Furthermore, soft-tissue growth will gradually fill the wedge-shaped spaces created between these radiating incisions over time, and the additional adhesion that is created guarantees a natural nasofrontal profile in the long term. As such, the devised method can produce highly satisfactory results with respect to nasofrontal profile shape. In addition, this method is easily performed and reduces operative time. Moreover, in the present study, no postoperative complications exclusively linked to the radiating incisions in the silicone occurred during follow-up, and as described above, almost all patients were satisfied with their resulting nose shape. Chi-Ho Lee, M.D., Ph.D. Seung-Kyu Han, M.D., Ph.D. Sang-Bum Kim, M.D. Deok-Woo Kim, M.D. Woo-Kyung Kim, M.D., Ph.D. Department of Plastic Surgery Korea University College of Medicine Seoul, Korea