Treatment of Nasal Deviation With Underlying Bony Asymmetry Secondary to Augmentation Rhinoplasty in Asian Patients

Overview

When an implant is placed on the bridge, it can mask an underlying asymmetry of the nasal bones rather than correct it, and the nose looks deviated afterward. The authors used CT scans to identify the bony cause and used those findings to plan the corrective operation.

Sections of note

• Retrospective study of 15 women with nasal deviation after augmentation rhinoplasty and CT-confirmed bony asymmetry.
• 14 of the 15 had developmental keystone asymmetry; 1 had osteotomy-induced keystone deviation.
• 6 patients also had developmental glabella asymmetry.
• Revision used paramedian osteotomy plus unilateral extended spreader grafts on the concave side of the keystone region.
• For patients with combined glabella and radix deviation, implants of expanded polytetrafluoroethylene or the patient's own fascia were placed.
• Average follow-up 11.2 months, range 6 to 24 months.
• Revision was considered successful in 13 patients; 2 required further surgery for residual deviation.

What it means for a patient

• A nose that looks crooked after an implant is often crooked in the bone underneath, not just in the implant position.
• CT imaging can identify that before revision surgery, which changes the operative plan.
• Most of these asymmetries were present from birth rather than caused by the first operation.
• Limits: 15 patients, all women, one center, retrospective, no comparison group, and average follow-up of about 11 months.

Why this paper matters

Revising a deviated augmented nose by simply repositioning the implant repeats the original error if the bone is asymmetric. Establishing imaging before revision is the practical contribution. The sample is small and success was judged without a stated objective measure.

Terms

• Augmentation rhinoplasty: Surgery adding height to the bridge, often with an implant.
• Keystone: The junction where the nasal bones meet the cartilage of the middle nose.
• Paramedian osteotomy: A bone cut placed beside the midline.
• Extended spreader graft: A long cartilage strip alongside the septum reaching toward the tip.
• Glabella and radix: The area between the eyebrows, and the root of the nose beneath it.