An Overview of Nasal Dorsal Augmentation

Abstract

Structural deficiencies of the nasal dorsum most commonly derive from congenital, traumatic, and iatrogenic etiologies. Alternatively, dorsal deficiency may be a manifestation of a generally underprojected nose with otherwise appropriate relationships between the radix, dorsum, and tip. In analyzing dorsal deficiency, associated anatomic abnormalities leading to compromise of both aesthetic form and respiratory function must be recognized and incorporated into the reconstructive plan. The cornerstone of augmentation rhinoplasty employs either autologous graft or alloplastic implant material to restore dorsal height and structural support to the nasal skeleton. Many autologous and alloplastic materials are currently available to the rhinoplasty surgeon, each of which carries a characteristic profile of relative advantages and limitations. Although most rhinoplasty surgeons prefer autologous materials, the choice of material must be individualized to each patient. The reconstructive plan ultimately formulated emerges after thoughtful consideration of the extent of the dorsal deficiency, characteristics of the overlying skin-soft tissue envelope, history of prior surgery, associated structural abnormalities, preferences of the surgeon, and views of the patient. Regardless of the specific methods used to augment the nasal dorsum, optimizing the aesthetic profile and maximizing respiratory function in a sustainable manner with minimal patient risk and morbidity remain the primary objectives.

Polypropylene meshes and other alloplastic implants for soft tissue and cartilage nasal reconstructive surgery – a literature review

“…Due to these characteristics, the implant firmly adheres to the surrounding tissues and prevents migration. It can fill or contour a defect, but it provides little structure at the implant site 3 . In a multicenter, retrospective study on 309 patients who underwent dorsal nasal augmentation with Gore-Tex implants, 3.2% of the implants were infected in the patients with nasal septal perforation 36 .…”

“…The ideal alloplast must be chemically inert, biocompatible 3 , not physically modified by soft tissue; it should elicit no chronic inflammatory reaction or foreign body reaction, integrate into soft tissue or bone, resist mechanical strains. The site of implantation must meet the following conditions: no infection, no poor soft-tissue coverage, no poor blood supply from scarring, no history of radiotherapy, no soft-tissue tension 2 .…”

Costal cartilage nasal augmentation rhinoplasty: Study on warping

“…Achieving a symmetric, smooth, stable, and desired nasal dorsum that fulfills the criteria of adequate form, function, and patient expectation remains a principle challenge during primary or secondary rhinoplasties. [1] Though alloplastic implants provided a good alternative, a good number of patients developed complications including thinning of the skin over the implant, extrusion, infection, displacement, translucency of the implant, and chronic pain. Although such treatment initially caused increase in dorsal nasal height and projection, sustaining this over a time period was not feasible.…”

“…[23] It is reported that with proper carving and meticulous construction, augmentation rhinoplasty using costochondral material can produce excellent results. [1–3]…”

Imaging Features of Rhinoplasty

“…32 This complication is more common with alloplastic implants than autografts. 14 The postoperative infections most often remain localized to the skin and subcutaneous tissues of the nose but occasionally extend intracranially or result in generalized septicemia. 32 MR imaging or CT can be used to delineate the extent of infections, which can appear as fluid collections, sclerosis and enhancement of osseous structures, and soft-tissue inflammatory changes (Fig 11).…”