Algorithm for Rhinoplasty in the Patient of African Origin Using Frozen Rib Graft

Goals/Purpose: Rhinoplasty in patients of African origin requires an individualized and well-planned approach to achieve typical aesthetic goals of increased tip projection, heighted dorsum, and tip refinement. Nuances involved in African rhinoplasty involve patient-specific planning and aesthetic evaluation, and from a surgical standpoint complexities can include skin thickness, lack of structural support, and procurement and morbidity involved with the use of cartilage grafts. The purpose of this study is to present a treatment algorithm that accounts for the nuances involved in African rhinoplasty and evaluate the use of frozen rib graft as a replacement for autologous rib.

Methods/Technique:

An algorithm for evaluation and treatment of rhinoplasty in the patient of African origin was created through a review of the primary author’s experience with this patient population. Preoperative and postoperative photos were reviewed, aesthetic analysis performed, and surgical technique and maneuvers assessed. We also evaluated the value of using frozen rib graft (Musculoskeletal Transplant Foundation, Edison, NJ) instead of autologous rib in our patients by analyzing nasal projection and dorsal height measurements. Complications were also reviewed.

Results/Complications:

A total of 27 patients were reviewed in the this study from 2014 to 2019. A minimum postoperative followup was one year and postoperative photographs were required . Most common preoperative aesthetic concerns include: low nasal dorsum (17 patients), excessive tip width and size (22 patients), widened alar base (21 patients), and lack of tip projection (20 patients). Based on these aesthetic concerns, most common surgical maneuvers include dorsal onlay grafting (18 patients), septal extension graft (SEG) (23 patients), lateral crural strut grafts (15 patients), supratip smasectomy (23 patients), and alar base reduction (22 patients). After one year, the average nasal tip projection increase was 2.2 mm, and average dorsal height increase was 1.4 mm). Based on patient discussion and photographic analysis, patients with a radix below the level of the midpupillary line required dorsal only grafting and SEG, while a midpupillary dorsum or higher could potentially have a SEG alone. Visible warping occurred in 2 patients postoperatively, and extrusion of the MTF graft in one patient.

Conclusion:

Rhinoplasty in patients of African origin involves an individualized approach to achieve aesthetic goals. The use of frozen rib graft is an acceptable substitute for autologous rib, with a low complication rate and without the potential morbidities and increased operative time. Our algorithm can provide a consistent and reproducible strategy for surgical management of this complex and unique patient population. Septal extension grafting and dorsal onlay grafting provide the framework of creating a more aesthetic nasal profile.