λ-Shaped Implant for Augmentation of Anterior Nasal Spine in Asian Rhinoplasty as an Ancillary Procedure

Abstract

There is often a preexisting acute columella-labial angle in Asian noses and in most of these cases, the nasal spine is underdeveloped or sometimes even absent. Moreover, nasal tip projection by a tip graft or cephalic rotation of the nasal tip may get worse at the retracted columella-labial junction in the Asian nose with an underdeveloped anterior nasal spine, thus requiring the use of a maxillary spine graft or an implant. In many instances, however, the ideal source of autogenous tissue may not be available or the donor site for these tissues may be objectionable. So I have designed the lambda-shaped silicone implant for augmenting the underdeveloped anterior nasal spine (ANS) to correct the acute columella-labial angle. From March, 1996 until September, 1999, I have done ANS augmentations using the lambda-shaped silicone implant in Asian rhinoplasty on 37 female patients. The correction of an acute columella-labial angle was readily accomplished by application of the lambda-shaped implant using the unilateral intranasal approach. The author suggests that ANS augmentation with the lambda-shaped implant is a simple and effective method as an ancillary procedure in Asian rhinoplasty providing esthetically pleasing results in properly selected Asian patients.

Quantitation of nasal development in the early prenatal period using geometric morphometrics and MRI: a new insight into the critical period of Binder phenotype

“…Interestingly, the timing of fusion of the premaxillary–maxillary suture varies among humans, and this contributes to the mid‐facial profile . A population with a low nose generally has a smaller ANS, and a population with a high nose generally has a larger ANS . Mooney and Siegel reported that the timing of fusion of the suture is earlier in people of European origin than in people of African origin.…”

“…Patients with Binder phenotype generally present with the absence or hypoplasia of the anterior nasal spine (ANS); the absence of the ANS is one of the main diagnostic parameters for Binder phenotype . Individuals with a low nasal profile, such as Asians, generally have a hypoplastic ANS . Thus, the development of the ANS is closely related to the protrusion of the nose, and the ANS is a unique anatomical structure in humans .…”

Postoperative effects of anterior nasal spine bone harvesting on overall nasal shape

“…As a part of the piriform aperture, the ANS plays an important role as a bony structure supporting the columella and nasal tip while maintaining the individual NLA (Watanabe & Matsuo ). In cases where ANS is underdeveloped or retropositioned, or where the underlying bony support is atrophied, a drooping nasal tip, characteristic of aging nose, could be secondarily manifested (Watanabe & Matsuo ; Park ). The ANS removal in this technique might have similar effects.…”

“…Cartilage or bone graft on the retropositioned ANS are frequently employed to improve these sequelae. The use of a bone graft or implant on the ANS is also required with rhinoplasty for nasal tip correction (Park ).…”

Extensional midline framework built with porous polyethylene implant (Medpor) in rhinoplasty

“…In the late 1990s, some basic concepts of rhinoplasty in the West were introduced into East Asia by Korean physicians. They were dorsal augmentation with implant and tip plasty with autonomous cartilages harvested from the septum, choncha, and rib [1][2][3][4][5]. Autogenous septal cartilage is generally accepted as the gold standard nasal grafting material; however, the amount of septal cartilage remaining is usually insufficient because of prior trauma, surgery, or infection.…”