Figure - available from: Ear, Nose, & Throat Journal
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Surgical technique and anthropometric measurement. (Left) Illustration of cartilage and bone complex. (Right) Measurement points. NL indicates nasal length; NTP, nasal tip projection; NFA, nasofrontal angle; NLA, nasolabial angle; CLA, columella-lobular angle.
Source publication
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...
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Ear reconstruction surgeries are a challenge in medicine, requiring complex and qualified techniques, the most commonly using autogenous material (cartilage rib from the own patient). It is a handmade process in which the surgeon must manually sculpt the cartilage to form the three-dimensional model of the ear, called framework. Thus, the end resul...
Citations
... The authors also prepare other ear cartilage grafts namely cap grafts or shield grafts that will be sutured in the tip of the nose covering the double tower SEG. Ahn et al. 8 use the SEG technique with "sandwich graft," a cartilage-bone complex graft. Sandwich graft is built from vomer and the perpendicular plate of the ethmoid bent with a double layer of septal cartilage and then sutured together to achieve strong SEG. ...
... The overall effect of estimated NLA shows significant improvement in the postintervention group ( p = 0.02). Tip projection data were only compared in three primary studies (Ahn et al., 8 An et al., 10 and Mo et al. 9 ) due to different methods of measurement. The estimated tip projection index of the combined study was 1.09 (CI 0.76, 1.42) assessment using fixed effect models. ...
... Previous studies reported that the weakness of Asian nasal cartilage (with an average thickness of 0.2 mm) leads to insufficient support of the tip and sometimes generates graft absorption if we choose the wrong graft or undersized craving graft. Three authors Zhang et al., 7 Ahn et al., 8 and Mo et al. 9 added a new technique to strengthen the nasal tip framework which is adding the thickness of graft with double-layered cartilage, bending cartilage without incision, or layering it with bone. Mo et al. 9 added in their study, a trick on bending graft cartilage without incision to develop a mechanically robust unit that maintains support on the graft and strengthens the tip projection. ...
Introduction
Asian nose is characterized by thick skin, abundant soft tissue, and weak cartilage framework, resulting in under-projection of the nasal dorsum and tip. Anatomical knowledge consideration is needed to achieve an ideal and natural-looking Asian nasal tip. Various nasal tip surgery techniques for Asian nose have been introduced recently. However, a comparison of techniques and postsurgical results has not yet been undertaken.
Objective
This systematic review aims to highlight the basic understanding of nasal tip dynamics aesthetic Asian nose and analyze related studies in search for the best technique and post-operative improvement for Asian tip-plasty.
Method
Two independent reviewers conducted a comprehensive database search from four major medical databases (PubMed, Scopus, EBSCOhost, and EMBASE). Methodology quality and risk of bias in each study were assessed with the Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I tools).
Result
The initial literature search (May–July 2023) yielded 53 articles, of which 26 were removed (duplicated). The title and abstract screening reduced the count to 6 articles, and two were excluded for specific reasons. Finally, four articles were included in the systematic review and proceeded to methodological quality check and risk of bias assessment.
Conclusion
New techniques such as combining spreader graft, septal extension graft, and columellar strut graft for Asian tip-plasty show promising effect after surgery. Increasing nasal length, projecting the tip, and strengthening the nasal tip framework become key points for Asian tip-plasty.
... However, due to patients' anatomical characteristics, such as short septal cartilage, weak lower lateral cartilage, and thick-soft tissue, many plastic surgeons have difficulty correcting the short nose in Asians. 13 It is speculated that the L-strut on the dorsal and caudal sides must be retained to support during rhinoplasty, and most Asian studies stated the width of 15 mm is the best choice. 16 Compared to Westerners, the cartilage of Asians is weaker, and their ability to support the nasal dorsum is significantly reduced. ...
... In 2016, Tae et al. 13 reshaped the nasal tip using the perpendicular plate of ethmoid and evaluated its effect. Compared to their study, we used the same materials, but the surgical methods were slightly different, resulting in varied anthropometry. ...
Background:
The perpendicular plate of ethmoid (PPE) was used to correct short noses in rhinoplasty in Asians, but the safe harvest of the plate and the assessment of its clinical application has been perplexing to plastic surgeons.
Aims:
To explore how to safely cut the perpendicular plate of ethmoid bone and evaluate its application effect.
Patients/methods:
A finite element model was established to guide the clinical operation. A total of 30 patients with short noses were selected. Among them, 15 patients used autologous septal cartilage to lengthen the nasal tip, and 15 patients used the PPE to strengthen the L-shape nasal septum. The differences in the esthetic parameters of the nose, complications, and patients' satisfaction were compared between the two groups.
Results:
Significant differences were noted in the nasal dorsal length (p = 0.001), Goode's ratio (p = 0.001), and nasofrontal angle (p = 0.003) after rhinoplasty, and no significant differences were noted in any of the esthetic parameters between the two groups. The symptoms of nasal obstruction in the experimental group were significantly lighter than those in the control group (p = 0.04). There was no statistically significant difference in the doctors' assessment of outcomes between the two groups (p = 0.48).
Conclusion:
The safest region to harvest the PPE is in the middle and lower third. Rhinoplasty improves the esthetics of the patient's nose. The PPE used to strengthen the L-shape nasal septum structure has a smaller probability of nasal septal deviation with the time in Asian short noses.
... AHRQ rating Ahn T.H. et al. (2020) 34 38 33 ...
Background:
Refinement of the nasal tip plays an important role in rhinoplasty surgery outcomes and may be considered the most technically challenging aspect of the procedure. Numerous techniques have been described for nasal tip augmentation utilizing grafts. The aim of this study was to systematically review the existing literature on nasal tip grafts and critically appraise it.
Methods:
A PubMed search was performed to identify journal articles related to nasal tip grafts from the last decade. A total of 44 studies met inclusion criteria. The Newcastle-Ottawa Quality Assessment Scale (NOQAS) and Jadad Scale were used to appraise 38 observational studies and six randomized trials, respectively, to determine the quality of the studies.
Results:
Critical assessment revealed that the studies were highly variable in focus and encompassed autologous, homologous, and alloplastic grafts. The quality of the data included an average NOQAS score of 6.5 (out of 9) and Jadad score of 2.5 (out of 5). A majority (86.4%) of studies included objective outcomes via anthropometric measurements and a portion (27.3%) of studies also included patient-reported outcomes.
Conclusions:
The results of this systematic review suggest that more than one type of nasal tip graft may result in satisfactory outcomes. This review provides an expansive collection of studies on nasal tip grafts which serves as an invaluable tool to the plastic surgeon engaging in rhinoplasty.
... 3 Nasolabial angle defines the inclination of the columella (distance between the base of nose and the nasal tip) regarding to the upper lip. 6,7 The nasofrontal angle is a potentially important factor in the perception of facial profile attractiveness. The angle may be used to analyse the relationship between the glabellar region and the nasal dorsum in profile view. ...
... 6 Nasolabial angle is defined as angle between nasal tip, base of nose and anterior upper lip. 6,7,10 Also, an inclination of the columella (distance between the base of nose and the nasal tip) regarding to the upper lip. 6,7 Naso-frontal angle is defined as the angle between the glabella, radix and dorsum of the nose. ...
... In a study performed by Ahn et al on 30 patients underwent septorhinoplasty aged between 31 ± 9 years, the nasolabial angle was found as 94.0 ± 9.3° and 107.2 ± 9.6° in preoperative and post-operative period, respectively. 7 In Brazilian population, the same angle was measured in groups without tooth extraction (95.1 ± 14.1°) and in groups with tooth extraction (102.9 ± 12.5°). 10 11 In present study, the nasolabial angle was found as 100.04 ± 15.61° and 108.04 ± 14.39° in males and females, respectively. ...
Background
An essential aspect of rhinoplasty is the enhancement of the nasal dorsal contour by performing dorsal augmentation (DA) rhinoplasty. A wide range of techniques are available for DA as the demand for aesthetic nasal refinement grows. This review aims to provide a comprehensive overview of the current techniques used in DA rhinoplasty.
Main body
Research articles on DA rhinoplasty techniques were identified through a comprehensive literature search. Scopus, PubMed, and Web of Science were used as electronic databases. Each database was searched for articles published since its inception. DA rhinoplasty techniques were examined in this literature review. Methodological quality was assessed for the selected studies, and data was extracted to examine materials used, surgical approaches, and reported outcomes for each technique. Various DA methods, including autologous grafts and synthetic implants, are examined in-depth in this review. Comparing approaches can help better understand their respective advantages and limitations.
Conclusion
A wealth of techniques is available for DA rhinoplasty, each with advantages. Patients’ nasal anatomy, desired outcomes, and potential risks must be considered by surgeons when determining their surgical approach. DA methods continue to evolve rapidly, creating a need for a thorough understanding of the current landscape to make informed decisions.
This letter to the editor discusses the technique of tip-plasty in rhinoplasty, focusing on the use of suture techniques for reshaping the nasal tip cartilage. We, The authors, propose a modification to the standard technique, introducing a tip adjustment suture to achieve a unified and symmetrical tip complex. By using fine needles and nylon or prolene threads, the suture is applied in a cross manner to align the dome in both sides of the nose. We suggest that this modified technique may offer improved outcomes in primary rhinoplasty cases, particularly for patients with uneven tip and those undergoing revision rhinoplasty. Further studies are recommended to evaluate the clinical effectiveness of this approach.
Objectives:
Nasal tip projection (NTP) is an important criterion when evaluating the result of rhinoplasties. Increasing NTP is essential for nasal function and visual aesthetics. Grafts such as columellar strut grafts (CSGs) and septal extension grafts (SEGs) are commonly used. We analyzed the safety and efficacy of the most commonly used grafts for increasing NTP during surgical rhinoplasty.
Methods:
The authors reviewed all English-language articles in PubMed, Embase, and Web of Science between 2000 and 2020 that reported original outcomes on structural grafts used to increase NTP. We recorded and analyzed the following at 6 months postoperatively: NTP change, Goode ratio, nasolabial/columellar-labial angle, postoperative complications, and subjective patient assessments. A total of two structural grafts in 35 studies (21 CSG, 14 SEG) were included.
Results:
Of the 2290 included patients, 1707 received CSGs (21 studies) and 583 received SEGs (14 studies). Overall NTP increased after using either graft. Subgroup analysis showed that more patients experienced postoperative complications after receiving SEGs (23.7%) than CSGs (9.7%). For patient satisfaction, three CSG studies found 83.3% of patients rated their satisfaction high, 12.1% moderate, and 4.5% not satisfied (n = 66). Most patients reported improvement in tip projection (97.0%), breathing (86.4%), and olfaction (83.3%). There was a significant increase in average patient satisfaction on the Visual Analog Scale (n = 39).
Conclusions:
Findings show that CSG and SEG grafts were safe and effective at increasing NTP. We suggest that CSG may be safer and more effective than SEG at increasing NTP in rhinoplasties. Further prospective studies may elucidate the mechanisms underlying the differences between CSGs and SEGs in patient safety and satisfaction when increasing NTP in surgical rhinoplasty.
Background
Due to the small and weak septal cartilage of Asians, it’s a challenge to obtain ideal tip projection and nose lengthening by septal extension graft using only septal cartilage.
Objectives
This study was aim to introduce a septal extension graft complex using nasal septal cartilage and the perpendicular plate of ethmoid (PPE) bone as well as bilateral auricular cartilage, and examine its effectiveness in terms of morphological and mechanical support.
Methods
Septal cartilage was harvested under an endoscope according to standard techniques. Two pieces of PPE were placed on either side of the “L” strut, served as two spreader grafts. A double-layer of auricular cartilage was fixed as columellar strut grafts. Three-dimensional facial scanning was used to examine the change of three parameters. Nasal tip resistance was evaluated by a digital Newton meter.
Results
A total of 25 patients were followed up over a mean postoperative duration of 25.9 months. The analysis showed significant differences in both contour parameters and nasal resistance; nasal length (41.4±4.0 vs 46.2±3.4 mm, p<0.05) and nasal tip projection (21.3±3.2 vs 24.4±2.7 mm, p<0.05) appeared to increase postoperatively, while nasolabial angle (117.6±5.9° vs 109.5±5.3°, p<0.05) showed a significant decrease after surgery. The resistance of the nasal tip also increased significantly (p < 0.05) at the displacement of 1mm, 2mm, and 3mm. All patients were satisfied with the aesthetic results, and no serious complications occur.
Conclusions
This kind of modified SEG technique can effectively adjust nasal morphology for short-nose East Asians.
Rhinoplasty in Asia is becoming increasingly widespread. When taking into consideration the anatomical differences between the features of Caucasian and Asian patients, it is unsurprising that knowledge gained from research on Caucasian rhinoplasty is not always applicable to Asian rhinoplasty. Furthermore, reviews aimed at describing the recent developments in Asian rhinoplasty are rare. This review aims to provide a comprehensive summary of the latest trends in rhinoplasty for Asians by classifying it into three parts: methods, materials, and three-dimensional techniques, hopefully providing surgeons with references to aid in conducting rhinoplasty on Asians.
