Revision Rhinoplasty for Short Noses in the Asian Population

Overview

A nose shortened and rotated upward by earlier surgery is one of the hardest problems to correct. The authors reviewed 41 such patients treated at a tertiary referral centre in South Korea between October 2006 and August 2014.

Sections of note

• 41 patients, mean age 36.5 years, 16 men and 25 women.
• The most common dorsal graft used in the previous operation was silicone, followed by fascia with or without cartilage.
• Techniques used at revision included septal reconstruction, cartilage flap technique, tip surgery, lateral compartment correction and dorsal augmentation.
• Autologous costal cartilage was the most common material for rebuilding the septum.
• 11 patients (27 percent) had complications: infection, nostril asymmetry and pollybeak deformity.
• Significant changes: nasal length up 12.0 percent, tip projection up 13.4 percent, nasofrontal angle down 2.39 degrees, nasolabial angle down 7.62 degrees, columella-lobular angle up 3.25 degrees. More than 90 percent (37 patients) were judged to have good or excellent aesthetic results.

What it means for a patient

• Lengthening a nose that previous surgery made too short usually needs several techniques in the same operation, not one fix.
• More than a quarter of patients had a complication, which is high compared with first-time rhinoplasty, and the authors state patients should be told this beforehand.
• Rebuilding the framework generally required rib cartilage, meaning a second surgical site on the chest.
• Retrospective, single centre, no comparison group, and outcomes were graded by clinicians rather than patients.

Why this paper matters

It documents the cost of correcting a specific failure pattern that follows implant-based Asian rhinoplasty, with measured geometry rather than description. The 27 percent complication rate is the practical number for consent discussions. What is unanswered is how the corrected length holds over years and whether patients agree with the clinician grading.

Terms

• Short nose: a nose whose length from root to tip is reduced, often with the tip rotated upward.
• Revision rhinoplasty: an operation to correct the result of previous nasal surgery.
• Septal reconstruction: rebuilding the central partition of the nose to restore support.
• Costal cartilage: cartilage from the ribs, used as structural graft material.
• Pollybeak deformity: fullness above the tip that gives the profile a parrot-beak shape.