Polycaprolactone Mesh for Asian Rhinoplasty: Outcomes and Complications of Composite Septal Extension Graft Compared to Mesh-Only Graft

Facial Plastic Surgery ◽

10.1055/s-0041-1730962 ◽

2021 ◽

Author(s):

Seung Hyun ◽

Seung Woo ◽

Rong-Min Baek

Keyword(s):

Asian Population ◽

Septal Cartilage ◽

P Value ◽

Mesh Exposure ◽

Nasal Tip ◽

Patients Satisfaction ◽

Tip Projection ◽

Septal Extension Graft ◽

Aesthetic Rhinoplasty ◽

Extension Graft

AbstractDespite the great demand of aesthetic rhinoplasty in Asian population, it is difficult to obtain the lasting ideal tip projection along with lengthening of the nose due to the small and weak nasal septum. The shortage of available septal cartilage to work with is another major obstacle. A retrospective study was conducted between January 2017 and December 2019 in Seoul, Korea. A total of 774 patients underwent septorhinoplasty using polycaprolactone (PCL) mesh for the cosmetic enhancement of the nasal tip and the projection. Comparisons of aesthetic outcomes, patients' satisfaction surveys, and complications were performed between PCL mesh-only group and composite PCL group. Of all the patients, 97.5% of the patients in composite PCL group were rated more than 3 scores in aesthetic outcomes, whereas 90.4% in mesh-only group (p-value = 0.0002). About 96.7% of the patients with composite PCL rated their satisfaction level as more than satisfied, whereas 94.3% in mesh-only group (p-value = 0.0365). Overall, there were 17 patients in composite PCL group who exhibited complications including decreased tip projection, deviated nasal tip, mesh infection, and mesh exposure. However, there were two patients who had mesh injection in mesh-only group. Septorhinoplasty with septal extension graft using composite PCL graft provides robust support to the aesthetically modified projection and the lengthened nose without obvious complications on the nasal tip. Such technique allows surgeons to overcome the nature of Asian nose that is weak and small, and also provides satisfaction to patients who desire ideal tip projections and dramatic changes.

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

Ear Nose & Throat Journal ◽

10.1177/0145561319881570 ◽

2019 ◽

Vol 99 (9) ◽

pp. 599-604 ◽

Cited By ~ 1

Author(s):

Tae Hwan Ahn ◽

Tao Zheng ◽

Hee Jeong Kang ◽

Byung Joon Yoo ◽

Jae Ho Chung ◽

...

Keyword(s):

Septal Cartilage ◽

P Value ◽

Ethmoid Bone ◽

Sandwich Technique ◽

Nasal Tip ◽

Tip Projection ◽

Septal Extension Graft ◽

Nasolabial Angle ◽

Nasal Tip Plasty ◽

Extension Graft

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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Nasal Tip Surgery in Asians

Otolaryngology ◽

10.1016/j.otohns.2008.05.102 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P31-P31

Author(s):

Tae-Bin Won ◽

Hong-Ryul Jin ◽

Hyeon-Jong Lee

Keyword(s):

Surgical Techniques ◽

Tertiary Hospital ◽

Initial Diagnosis ◽

Saddle Nose ◽

Nasal Tip ◽

Tip Projection ◽

Septal Extension Graft ◽

Low Profile ◽

Extension Graft ◽

Onlay Grafts

Objective The authors intended to review our surgical techniques used in Asian tip surgery and to suggest effective techniques, according to the types of the nasal tip that are addressed. Methods 107 patients who had nasal tip surgery from Jan. 2005 to Dec. 2006 in a tertiary hospital were enrolled in the study. Medical records, graphic operation records, and standardized patient photographs were retrospectively reviewed. Initial diagnosis, types of nasal tip surgery, associated operative techniques, surgical results and complications were analyzed. Results Initial diagnosis included deviated nose, hump nose, combine deviated and saddle nose, low profile nose, short nose, and cleft nose deformity, in order of frequency. Nasal tip surgery included augmentation of projection, control of rotation, restoration of symmetry and volume reduction, among which augmentation was used in all cases. External approach was used in 74% and intranasal approach in 26%. For augmentation of the tip projection, onlay grafts (39%), septal extension grafts (25%), and tip modifying suture with onlay grafts (20%) were the most commonly used methods. Infection or extrusion of the grafts was not found. Complications included tip deviation due to the deviation of the septal extension graft in 1 case, visible tip graft in 1 case, and slight upward rotation of the tip in 1 case. Conclusions In Asians, augmentation of the tip projection is the main issue in tip surgery and is best performed with cartilage onlay grafts or septal extension graft rather than suture modification.

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Folded Cymba Concha: Is It Large and Stable Enough for Caudal Septal Extension Graft in Asian Rhinoplasty?

Aesthetic Surgery Journal ◽

10.1093/asj/sjab079 ◽

2021 ◽

Author(s):

Sik Namgoong ◽

Soobyn Kim ◽

Hyung-Rok Kim ◽

Seong-Ho Jeong ◽

Seung-Kyu Han ◽

...

Keyword(s):

Septal Cartilage ◽

Men And Women ◽

Nasal Tip ◽

Tip Projection ◽

Tongue In Groove ◽

Physical Validity ◽

The Mean ◽

Nasal Tip Projection ◽

Extension Graft

Abstract Background Septal extension grafting (SEG) is used for nasal tip projection and positioning. Often, insufficient quadrangular cartilage is available for grafting in Asians and in most secondary cases, the septum is already harvested. We utilized the folded cymba concha as an alternative for caudal SEG (CSEG) by modifying a tongue-in-groove technique. Objectives To evaluate the physical validity of the cymba concha for CSEG and compare its outcomes with those of septal quadrangular cartilage. Methods The mean length and width of 311 harvested consecutive folded cymba conchae were measured from intraoperative photographs. Data from 220 patients with >12 months of follow-up were retrospectively reviewed for clinical outcomes. Clinical demography was determined based on the need for additional spreader grafts. For clinical reliability, anthropometric photographs of patients in whom folded cymba conchae were used were compared with those in whom quadrangular cartilage was used. Results Mean lengths and widths of the folded cymba conchae in men and women were 24.2 ± 3.9 and 22.4 ± 3.7 mm, and 7.8 ± 1.9 and 7.2 ± 1.9 mm, respectively. Using the folded cymba concha graft significantly increased nasal tip projection by 28.9% and columellar-labial angle by 9.7%, improving both aspects postoperatively. Anthropometric comparison revealed no significant differences between folded cymba conchae and septal cartilage in terms of nasal tip projection (p = 0.264) and postoperative columellar-labial angle (p = 0.182). Conclusions Folded cymba conchal cartilage can be a primary option for CSEG in Asian septorhinoplasty cases or for individuals with insufficient septal cartilage remnants.

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Centering a Deviated Nose by Caudal Septal Extension Graft and Unilaterally Extended Spreader Grafts

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419894617 ◽

2019 ◽

Vol 129 (5) ◽

pp. 448-455 ◽

Cited By ~ 2

Author(s):

Yung Yuan Chen ◽

Shin Ae Kim ◽

Yong Ju Jang

Keyword(s):

Postoperative Complications ◽

Anthropometric Measurements ◽

Study Patient ◽

Open Rhinoplasty ◽

Nasal Tip ◽

Tip Projection ◽

Deviated Nose ◽

Septal Extension Graft ◽

Nasal Tip Projection ◽

Extension Graft

Objective: The deviated nose presents a tremendous challenge for rhinoplasty surgeons, especially the correction of the cartilaginous dorsum deviation. In this study, we introduce the surgical techniques of correcting a deviated cartilaginous vault by creating a new center of the lower third using a caudal septal extension graft combined with unilaterally extended spreader grafts. Methods: This retrospective observational study was conducted in a university-based tertiary medical center from December 2014 to January 2018. Thirty-two patients who underwent primary open rhinoplasty for correction of a deviated nose using this method participated in the study. Patient characteristics and surgical records were collected. Anthropometric measurements and analyses were performed based on preoperative and postoperative photographs. The aesthetic outcome consensus of three rhinoplasty surgeons was evaluated specifically for nasal dorsum deviation correction. Postoperative complications were reviewed from the medical records. Results: Among the 32 patients, there were 18 males and 14 females. The mean (SD) age of the patients was 26.7 (8.76) years. Anthropometric measurements showed significant improvements in dorsal deviation angle (a 3.7° change towards midline, P < .001), nasal tip projection (increase of 6.96% measured by Goode’s method, P < .001), and nostril shape (nostril axis inclination decrease of 11.7°, P < .001) after surgery. The nasolabial angle showed no significant change. Aesthetic outcomes were excellent in seven patients (21.9%), good in fourteen patients (43.7%), fair in eight patients (25.0%), and no change in three patients (9.4%). Minor postoperative complications (four patients) were observed during follow-up. Conclusion: Centering the cartilaginous vault using a caudal septal extension graft combined with unilaterally extended spreader grafts is a useful technical option in the correction of a deviated nose, and provides improvement in nasal tip projection and nostril shape.

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