Rhinoplasty in the Asian nose

Overview

Many Asian patients present with a low bridge, a low tip and thick skin, so surgery adds height rather than removing it. Deformities of the nose are also described as common in this group. The article covers building up the bridge with synthetic implants, several tip grafting methods, and correcting a crooked nose or a convex bridge.

Sections of note

• Review article. No study design, patient numbers, outcome rates or follow-up length are reported.
• Augmentation is stated to be the most common procedure in this population.
• Frequent use of dorsal augmentation material and grafting is stated to result in a relatively high rate of revision surgery to correct complications.
• Dorsal augmentation using alloplastic implant materials is described.
• Several tip grafting procedures are described.
• Correction of a deviated nose and a convex dorsum is discussed, with emphasis on extracorporeal septoplasty as modified by the senior author.
• A technical guide for that condition is included.

What it means for a patient

• Augmentation rhinoplasty carries a different risk profile from reduction surgery, weighted toward implant and graft problems.
• The article states the revision rate in this population is relatively high, but gives no figure, so the size of the risk is not quantified here.
• Extracorporeal septoplasty means the septum is taken out, straightened outside the nose, and put back, which is a larger undertaking than straightening it in place.
• No comparison between implant materials or between grafting methods is reported.

Why this paper matters

It states plainly that the technique dominating this field, implant based dorsal augmentation, is also the source of its revision burden. Unanswered is which material or technique lowers that rate.

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.
• Extracorporeal septoplasty: removing the septum, reshaping it outside the body, and replacing it.
• Convex dorsum: a bridge that curves outward, seen as a hump in profile.
• Revision surgery: a further operation to correct the result of an earlier one.