Download PDF
Facial Plast Surg 2019; 35(01): 058-064
DOI: 10.1055/s-0038-1666992
Original Research
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients

Tsutomu Mizuno
1   Aesthetic Surgery, Anesis Biyou Clinic, Nagoya, Aichi, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
02 November 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18–43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.

Keywords

nasal dorsal augmentation - septal extension graft - Asian rhinoplasty

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The paper has never been presented before. All patients gave written informed consent.


 

  • References

  • 1 Ishii CH. Current update in Asian rhinoplasty. Plast Reconstr Surg Glob Open 2014; 2 (04) e133
    CrossrefPubMedGoogle Scholar
  • 2 Jung DH, Kim BR, Choi JY, Rho YS, Park HJ, Han WW. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases. Plast Reconstr Surg 2007; 120 (07) 1997-2003
    CrossrefPubMedGoogle Scholar
  • 3 Moon BJ, Lee HJ, Jang YJ. Outcomes following rhinoplasty using autologous costal cartilage. Arch Facial Plast Surg 2012; 14 (03) 175-180
    CrossrefPubMedGoogle Scholar
  • 4 Park JH, Jin HR. Use of autologous costal cartilage in Asian rhinoplasty. Plast Reconstr Surg 2012; 130 (06) 1338-1348
    CrossrefPubMedGoogle Scholar
  • 5 Kim DW, Shah AR, Toriumi DM. Concentric and eccentric carved costal cartilage: a comparison of warping. Arch Facial Plast Surg 2006; 8 (01) 42-46
    CrossrefPubMedGoogle Scholar
  • 6 Swanepoel PF, Fysh R. Laminated dorsal beam graft to eliminate postoperative twisting complications. Arch Facial Plast Surg 2007; 9 (04) 285-289
    CrossrefPubMedGoogle Scholar
  • 7 Farkas JP, Lee MR, Rohrich RJ. Technical maneuvers to decrease warping of peripheral costal cartilage grafts. Plast Reconstr Surg 2016; 138 (02) 228e-232e
    CrossrefPubMedGoogle Scholar
  • 8 Taştan E, Yücel OT, Aydin E, Aydoğan F, Beriat K, Ulusoy MG. The oblique split method: a novel technique for carving costal cartilage grafts. JAMA Facial Plast Surg 2013; 15 (03) 198-203
    CrossrefPubMedGoogle Scholar
  • 9 Nuara MJ, Loch RB, Saxon SA. Reconstructive rhinoplasty using multiplanar carved costal cartilage. JAMA Facial Plast Surg 2016; 18 (03) 207-211
    CrossrefPubMedGoogle Scholar
  • 10 Gunter JP, Clark CP, Friedman RM. Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping. Plast Reconstr Surg 1997; 100 (01) 161-169
    CrossrefPubMedGoogle Scholar
  • 11 Jung DH, Choi SH, Moon HJ, Chung IH, Im JH, Lam SM. A cadaveric analysis of the ideal costal cartilage graft for Asian rhinoplasty. Plast Reconstr Surg 2004; 114 (02) 545-550
    CrossrefPubMedGoogle Scholar
  • 12 Tabbal N, Tepper OM. Diced cartilage versus solid grafts in rhinoplasty. Aesthetic Plast Surg 2011; 35 (04) 580-581
    CrossrefPubMedGoogle Scholar
  • 13 Park P, Jin HR. Diced cartilage in fascia for major nasal dorsal augmentation in Asians: a review of 15 consecutive cases. Aesthetic Plast Surg 2016; 40 (06) 832-839
    CrossrefPubMedGoogle Scholar
  • 14 Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 2008; 122 (06) 1883-1891
    CrossrefPubMedGoogle Scholar
  • 15 Kelly MH, Bulstrode NW, Waterhouse N. Versatility of diced cartilage-fascia grafts in dorsal nasal augmentation. Plast Reconstr Surg 2007; 120 (06) 1654-1659 , discussion 1654–1659
    CrossrefPubMedGoogle Scholar
  • 16 Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993; 91 (04) 642-654 , discussion 655–656
    CrossrefPubMedGoogle Scholar
  • 17 Toriumi DM, Pero CD. Asian rhinoplasty. Clin Plast Surg 2010; 37 (02) 335-352
    CrossrefPubMedGoogle Scholar
  • 18 Huang J, Liu Y. A modified technique of septal extension using a septal cartilage graft for short-nose rhinoplasty in Asians. Aesthetic Plast Surg 2012; 36 (05) 1028-1038
    CrossrefPubMedGoogle Scholar
  • 19 Lin J, Chen X, Wang X. , et al. A modified septal extension graft for the Asian nasal tip. JAMA Facial Plast Surg 2013; 15 (05) 362-368
    CrossrefPubMedGoogle Scholar
  • 20 Jung DH, Loh I. The “X-graft” for nasal tip surgery. Plast Reconstr Surg 2011; 128 (02) 79e-80e
    CrossrefPubMedGoogle Scholar
  • 21 Kang JG, Ryu J. Nasal tip surgery using a modified septal extension graft by means of extended marginal incision. Plast Reconstr Surg 2009; 123 (01) 343-352
    CrossrefPubMedGoogle Scholar
  • 22 Ha RY, Byrd HS. Septal extension grafts revisited: 6-year experience in controlling nasal tip projection and shape. Plast Reconstr Surg 2003; 112 (07) 1929-1935
    CrossrefPubMedGoogle Scholar
  • 23 Byrd HS, Andochick S, Copit S, Walton KG. Septal extension grafts: a method of controlling tip projection shape. Plast Reconstr Surg 1997; 100 (04) 999-1010
    CrossrefPubMedGoogle Scholar
  • 24 Guyuron B, Varghai A. Lengthening the nose with a tongue-and-groove technique. Plast Reconstr Surg 2003; 111 (04) 1533-1539 , discussion 1540–1541
    CrossrefPubMedGoogle Scholar
  • 25 Çelik M, Tuncer S. Nasal reconstruction using both cranial bone and ear cartilage. Plast Reconstr Surg 2000; 105 (05) 1624-1627
    CrossrefPubMedGoogle Scholar
  • 26 Neu BR. Segmental bone and cartilage reconstruction of major nasal dorsal defects. Plast Reconstr Surg 2000; 106 (01) 160-170
    CrossrefPubMedGoogle Scholar
  • 27 Choi JY, Kang IG, Javidnia H, Sykes JM. Complications of septal extension grafts in Asian patients. JAMA Facial Plast Surg 2014; 16 (03) 169-175
    CrossrefPubMedGoogle Scholar
  • 28 Gerstle TL, Ibrahim AMS, Kim PS, Lee BT, Lin SJ. A plastic surgery application in evolution: three-dimensional printing. Plast Reconstr Surg 2014; 133 (02) 446-451
    CrossrefPubMedGoogle Scholar
  • 29 Mizuno T. A case of septal extension and augmentation rhinoplasty with various autologous tissues: 6 years follow up study. J Jpn Aesthet Plast Surg 2016; 38 (01) 20-26
    PubMedGoogle Scholar