Lengthening of the Postoperative Short Nose: Combined Use of a Gull-Wing Concha Composite Graft and a Rib Costochondral Dorsal Onlay Graft

Abstract

Several causes of short nose are known: congenital anomaly, developmental problem, trauma, and various types of rhinoplasty-the postoperative short nose being one of the most difficult problems to correct in plastic surgery. Contracted skin envelope, tissue deficiency of cartilage and mucosal lining, and poor circulation make postoperative short nose difficult to lengthen and susceptible to recurrence. Thus, for effective lengthening and long-term maintenance of it, specific grafts should be used to supplement the missing lining and cartilage and a mechanical support also is needed to withstand the skin contraction. The nose consists of three structural layers: the outer skin envelope, middle osteocartilaginous framework, and inner mucosal lining. Many methods have been proposed to correct short nose deformity. Those procedures lengthen the nose slightly, but none of them take into account the unique characteristics of postoperative causes and the structural concept of the nose. The procedures have resulted in only limited success. On the basis of the above clinical findings and the structural concept, we developed a surgical technique to correct postoperative short nose according to the structural layers. Our method consists of three main surgical maneuvers: (1) a gull-wing concha chondrocutaneous composite graft to supplement the deficient middle and inner layers, (2) a rib costochondral onlay graft on the dorsum to reinforce the framework, and (3) wide dissection of the outer skin envelope to cover the lengthened framework without tension. We prefer a closed surgical approach rather than an open approach to avoid too much tension on the columellar incision site and to allay patients' fear of an additional scar. From 1988 to 1998, we performed our lengthening technique on six female patients. All six patients demonstrated a significant lengthening and improved appearance postoperatively. After the lengthening procedure, the average nasolabial angle improved from 116 degrees to 104 degrees. The mean follow-up period was 8.7 months, with a range of 3 to 17 months. Sometimes, epidermal sloughing in the vertical strut of the gull-wing

Nose Elongation: A Review and Description of the Septal Extension Tongue-and-Groove Technique

“…In most patients, an adequate soft tissue envelope that covers the lengthened nose can be obtained by extensive undermining. 1,2,8,17 When the undermined soft tissue envelope is insufficient (whether in posttraumatic patients or, occasionally, congenital patients), flaps must then be considered as part of an extensive nasal reconstruction. 19,22,23 Nasal lengthening obviously involves increasing the intranasal surface area.…”

“…Features found in the subjective short nose may include a low radix, a low and deep nasion, concavity of the dorsum, an overrotated tip, an obtuse nasolabial angle, or a long tip. 1,2 The etiology of the short nose can be classified into two broad categories: congenital-developmental and acquired (Table 3). Congenital short nose may occur in isolation or as the result of a group of malformations, including craniofacial dysmorphisms such as cleft lip.…”

Treatment of gummy smile: Nasal septum dysplasia as etiologic factor and therapeutic target

“…Although rare in Caucasians, this condition is becoming more and more frequent also in Western countries due to an increasing Asian ethnic population. 32,33 The clinical manifestation of septal dysplasia as seen in short nose and 32,34e37 However, strengthening of an extremely hypoplastic septum requires a considerable amount of autologous material, but is complicated by tissue shortage and fragility due to frequently existing fibrosis. 38 The relatively firm ePTFE is not only readily available, but also exhibits optimal material properties such as high biocompatibility, low complication rates, and excellent long-term stability.…”

Revision Rhinoplasty for Short Noses in the Asian Population

“…2,[25][26][27] To lengthen the nose in cases of moderate and severe nasal shortening, various autologous grafts can be used to generate a graft with the desired shape and length that can then be anchored to the existing nasal framework. [1][2][3]8,13,14,17,28 For septal reconstruction in the present study, 4 different surgical techniques were used ( Figure 1). The type C method is derived from the tongue-andgroove technique outline by Guyuron and Varghai 8 in which septal cartilage is harvested and shaped into 2 extended spreader grafts and 1 columellar strut.…”