Fundamental Procedures for Correction of Short and Bulbous Nose in Asians with Deficient Septum
The typical characteristics of the Asian nose include shortened, upturned tip with wide alar base due to weak and deficient cartilage. To correct these deformities, septal extension graft is widely performed to increase the tip projection and lengthen the nose simultaneously. However, its’ failure such as deviation or loss of nasal tip projection is a common occurrence as a result of improper extension graft itself and insufficient release of soft tissues skin envelope (STSE) and underlying structural support. We present an effective and reliable strategy for definite correction of short and bulbous nose with deficient septum using modified septal extension graft.
Methods/Technique:
A total of 248 patients underwent open rhinoplasty (209 primary and 39 secondary cases) from August 2010 to May 2013. Routine and fundamental steps were as follows: 1) STSE lengthening by wide dissection –while preserving fibrous capsule to reinforce the thinned skin from a previous alloplastic implant, dual plane dissection was done in secondary cases. This maneuver made the extension graft be situated snuggly without any tension; 2) Underlying structural support lengthening by separating lower lateral cartilage from upper one – full release of scroll and hinge area, sometimes cutting the accessary cartilage. Inner mucoperichondrial lining was also widely undermined, if necessary ; 3) Septal extension graft with caudal septal supporting graft to strengthen the caudal septum and to prevent the rotation of the graft; 4) Combined procedure - alar base surgery, dorsal augmentation, etc. The average follow-up period was 12.4 months.
Results/Complications:
The overall results were satisfactory and showed nasal tip to be projected and de-rotated. The complications were minor, with 18 patients (7.3%) of tip deviation, 3 patients (1.2%) of remarkable loss of tip projection, and 23 patients (9.3%) of undercorrection. In 34 patients with severely deficient septum, fascia-covered Medpor® and concha cartilage were used as a supporting graft.
Conclusion:
The technique we have adopted will not only prevent the loss of tip projection but also the deviation by placing supporting graft at the caudal end of L-strut after full release of soft tissue and cartilage framework.