Complete Septal Extension Grafts Using Porous High-Density Polyethylene Sheets for the Westernization of the Asian Nose

Han, Kihwan; Jeong, Jin Wook; Kim, Jun Hyung; Son, Daegu; Kim, Sukwha; Park, Sang Woo; Choi, Jaehoon; Choi, Tae Hyun

doi:10.1097/prs.0b013e318254b460

Cited by 33 publications

(30 citation statements)

References 25 publications

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“…Additionally, an underprojected tip, a retracted columella, and an acute columellar labial angle are all improved aesthetically (►Figs. [7][8][9][10][11].…”

Section: Resultsmentioning

confidence: 99%

“…We try to harvest a maximal amount of the septal cartilage because the septal cartilage is often severely hypoplastic in Asians and its availability is almost always inadequate. 7,8 In our evolving experience, three aspects for harvesting the maximal amount of the septal cartilage have been established.…”

Section: Harvest Of the Maximal Amount Of The Septal Cartilagementioning

confidence: 99%

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Asian Rhinoplasty: Correction of the Short Nose with a Septal Integration Graft

Kim

Han

2015

Seminars in Plastic Surgery

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Correction of the short nose is the most challenging part in a rhinoplasty. It is even more difficult in Asians compared with Caucasians due to the thicker skin soft tissue envelope and weaker cartilaginous frameworks. Additionally, most of the Asian patients need augmentation of the nasal dorsum, and projection of the nasal tip at the same time of short nose surgery, which makes short nose correction more complex. Septal extension grafts can effectively and concomitantly correct a short nose. However, the amount of the septal cartilage is not sufficient as a source for the graft often; therefore, the authors devised a septal integration graft in which a septal cartilage graft was fixed to the caudal septum (columellar L-strut) in an end-to-end position to save an amount of the septal cartilage for correction of the short nose. A septal integration graft application resulted in lengthening of the short nose. In addition, the retracted columella and the acute columellar labial angle were improved aesthetically. Therefore, the authors suggest a septal integration graft, a modification of the septal extension graft, for correction of the short nose in an Asian rhinoplasty.

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“…Additionally, an underprojected tip, a retracted columella, and an acute columellar labial angle are all improved aesthetically (►Figs. [7][8][9][10][11].…”

Section: Resultsmentioning

confidence: 99%

Section: Harvest Of the Maximal Amount Of The Septal Cartilagementioning

confidence: 99%

Asian Rhinoplasty: Correction of the Short Nose with a Septal Integration Graft

Kim

Han

2015

Seminars in Plastic Surgery

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“…Temptations to close skin tightly or defat the tip may perpetuate implant exposure and visibility in the short and long term. 21,22 The choice of alloplastic 5,11,13 versus autologous tissue in tip modulation and nasal lengthening is surgeon dependent; we prefer autologous tissue for its engraftment potential and lesser extrusion and infection risks. Unfortunately, scarce resources challenge patient and surgeon goals in this context.…”

Section: Discussionmentioning

confidence: 99%

An Economical Approach to Ethnic Asian Rhinoplasty

et al. 2016

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Septal cartilage is deficient in Asians seeking augmentation rhinoplasty. Economized utilization of resources is necessary for durable tip enhancement that complements a dorsal implant. We introduce a modified tongue-in-groove method designed to transmit forces across the dorsum, eliminating the need for robust caudal support and prioritizing nasal lengthening and tip projection. We aim to promote the roundness index parameter and demonstrate the feasibility of a novel method in the context of Asian rhinoplasty. Between 2012 and 2014, a total of 104 Taiwanese patients underwent rhinoplasty with dorsal augmentation and lengthening with a modified tongue-in-groove technique. The concept borrows from methods established by Byrd, Guyuron, and Toriumi but distinguished by exaggerated forward positioning of a septal extension graft. Paired extended spreader grafts obviate the need for a columellar strut. Soft-tissue changes were analyzed with photogrammetry. A new parameter, the roundness index, was measured. Tip projection, dorsal length, nasal height, alar and columellar length increased significantly after 5.5 months of follow-up. Nasal tip angle, roundness, columella-labial angle, and nostril axis inclination decreased. There were no statistically significant differences in the magnitude of change in patients followed for less than and greater than 6 months. The most common complication was new or persistent tip deviation in five cases (5%). This technique was designed for a nasal anatomy typified by deficient septal cartilage. Significant photogrammetric changes were maintained after 6 months. Economized tissue allocation, dorsal septal load sharing, and relative independence from caudal support are key features of this feasible method.

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“…5 Therefore, various modified surgical techniques for SEG are a challenge for tip surgery or correction of short nose in Asian patients. 4,[6][7][8][9][10][11][12][13] We introduce a new surgical technique to give optimal outcomes of nasal tip support, projection, and lengthening using an SEG composed of a cartilage-bone complex using the vomer and perpendicular plate of the ethmoid.…”

Section: Introductionmentioning

confidence: 99%

New Technique in Nasal Tip Plasty: Sandwich Technique Using Cartilage and Septal Bone Complex

et al. 2019

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Objectives: It is extremely difficult to obtain ideal tip projection and nose lengthening by septal extension graft using only septal cartilage in Asians, because their nasal septal and alar cartilages are small and weak. Therefore, we introduce a new septal extension graft using a cartilage–bone complex with the vomer and the perpendicular plate of the ethmoid bone as well as cartilage to obtain optimal outcomes. Methods: Participants included 30 patients who underwent surgery by external approach. The septal cartilage, vomer, and perpendicular plate of the ethmoid bone harvested by septoplasty were used. There were 2 layers of cartilage on each side and bone in between to create a strong cartilage–bone complex for projection and lengthening. The bony portion was placed in the tip side, and the double-layered cartilage portion was placed in the inferior portion of the caudal septum of the L-strut to create powerful fixation. Results: There were statistically significant improvements in nasal length (4.71 ± 0.65 vs 5.15 ± 0.53 cm, P value <.0001), tip projection (2.66 ± 0.40 vs 3.18 ± 0.42, P value <.0001), and nasolabial angle (94.0° ± 9.3° vs 107.2° ± 9.6°, P value <.0001) postoperatively. All patients were subjectively satisfied, and 2 different surgeons had excellent or good opinions in 28 (94%) patients. Conclusions: The sandwich technique using cartilage and bone complex results in satisfactory outcomes with stronger tip support, especially in Asians with a weak nasal tip who desire ideal tip projection and dramatic change.

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Complete Septal Extension Grafts Using Porous High-Density Polyethylene Sheets for the Westernization of the Asian Nose

Abstract: Therapeutic, IV.

Cited by 33 publications

References 25 publications

Asian Rhinoplasty: Correction of the Short Nose with a Septal Integration Graft

Asian Rhinoplasty: Correction of the Short Nose with a Septal Integration Graft

An Economical Approach to Ethnic Asian Rhinoplasty

New Technique in Nasal Tip Plasty: Sandwich Technique Using Cartilage and Septal Bone Complex

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