Perspectives in asian rhinoplasty

Overview

Asian patients typically present with a lower bridge, a less projected tip and thicker skin, so most operations add height rather than reduce it. The authors summarise how tip work and bridge work are usually combined, which grafts are used at the tip, and how implant material should be chosen. Rib cartilage is discussed as a reserve option.

Sections of note

• Review article. No patient numbers, study design, follow-up length or complication rates are reported.
• Augmentation rhinoplasty is described as the most commonly performed procedure in this group.
• The usual sequence is tip surgery with the patient's own cartilage followed by dorsal augmentation with an alloplastic implant.
• Tip grafting methods listed are shield grafting, multilayer tip grafting, onlay grafting and modified vertical dome division.
• Implant choice is said to depend on surgeon experience, the pros and cons of each material, and host factors including skin thickness, associated deformities and aesthetic goals.
• Costal cartilage is described as best reserved for difficult revisions, apart from a small number of primary cases with a very poorly developed nasal skeleton and thick skin.

What it means for a patient

• Augmentation surgery is a different operation from reduction rhinoplasty, with different grafts and different risks.
• Thicker skin limits how much tip definition can be achieved, which is why tip cartilage is built up rather than trimmed.
• The article gives no comparative data, so it does not show which implant material or tip graft performs best.
• Rib cartilage is presented as a fallback for hard cases, not a first choice for most primary surgery.

Why this paper matters

It sets out the prevailing framework for augmentation rhinoplasty in Asian patients, including the split between autologous tissue at the tip and synthetic material on the bridge. Left unanswered is how implants compare with the patient's own cartilage for long term safety on the dorsum.

Terms

• Augmentation rhinoplasty: surgery that builds the nose up rather than reducing it.
• Alloplastic implant: an implant made of synthetic material.
• Dorsum: the bridge line running down the front of the nose.
• Shield graft: a cartilage piece placed in front of the tip to add projection and definition.
• Costal cartilage: rib cartilage taken from the patient's own chest.
• Vertical dome division: cutting the tip cartilage at its highest point to change tip shape.