Background Complicated silicone nose is a common clinical problem. Selection of replacement material for revision dorsal augmentation is a challenging task. Objectives We present our experience in the use of molded glued diced cartilage grafting (GDCG) for revision rhinoplasty in patients who had complicated silicone augmentation. Methods We performed a retrospective review of the medical records of 28 patients who underwent silicone implant removal and revision dorsal augmentation with costal cartilage, at a tertiary center between 1 February 2018 and 28 February 2022. Patient demographic, surgical technique, anthropometric measure, and complication data were retrieved and analyzed. Aesthetic outcome scoring and anthropometric measurements were performed. Results Twenty-eight patients (9 men and 19 women) who underwent revision rhinoplasty with augmentation were reviewed. Main indication for revision was cosmetic dissatisfaction. Mean postoperative follow-up duration was 18.3 months. All patients had revision dorsal augmentation with molded GDCG. Other key surgical techniques include the use of caudal septal extension, extended spreader and tip grafts. Majority of the patients were judged to have good or excellent outcome (91.1%). There was significant percentage increase in dorsal height, radix height, nasal length, and nasal tip projection (2.78%, 2.26%, 7.53%, 2.40%, P<0.05) and reduction of nasal axis deviation of 1.15° (P<0.05) postoperatively. Two patients had postoperative complications, including infection and cosmetic dissatisfaction. Conclusions Revision rhinoplasty following unsuccessful silicone augmentation is commonly encountered in the Asian population. Using molded GDCG for revision dorsal augmentation is a reliable option which delivers good to excellent aesthetic outcome with acceptable complication rates.
ObjectivesThis study aimed to evaluate the sequential postoperative changes in tip aesthetics, by evaluating the aesthetic performance of the septal extension graft with or without tip grafting.MethodsA total of 62 patients who underwent rhinoplasty with tip plasty were included. Using a three‐dimensional scanner, we measured anthropometric aesthetic features of the nasal tip, including tip height, tip width, nasolabial angle, and columellar lobular angle. Preoperative and 1‐month and 12‐month postoperative anthropometric parameters were compared. The patients were grouped according to surgical techniques (i.e., septal extension only and septal extension plus tip grafting groups) and subtype of tip graft.ResultsThe 1‐month postoperative values of all four aesthetic features were significantly increased compared with the preoperative values. The tip height, tip width, and nasolabial angle at 12 months were significantly decreased compared with 1 month post‐operation values, whereas the tip height and width were still greater than the preoperative values. No difference was found between 1 and 12 month values of columellar lobular angle. There were no differences in the degree of decrease in tip height, tip width, nasolabial angle, and columellar lobular angle between the septal extension graft only and septal extension graft plus tip graft groups. There were no differences in the tip graft by subtypes, single‐ and multi‐layer tip grafts.ConclusionsIncreased tip height, tip width, and widened nasolabial angle gained immediately after septal extension grafting surgery gradually decreased over the year regardless of addition of tip graft or tip grafting methods.Level of EvidenceLevel IV Laryngoscope, 2023
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