The Augmentation Rhinoplasty in Asian NosesDepartment of Otolaryngology, Chosun University Hospital, KwangJu, South Korea

Ji Yun Choi M.D.*, Nam Yong Do M.D., Jun Han Lee M.D., Sung Il Cho M.D., Gun Hyung Kim M.D.

Results

- Chart review was done on 1898 patient who underwent augmentation rhinoplasty at out clinic from July 2003 to July 2006. Various type of nose presenting for augmentation. - Type I : Simply underprojected nose

Type II : Short nose Type III : Small nose (both underprojected and short) Type IV : Adequately projected wide nose leading to the

appearance of underprojected nose Type V : Saddle nose with weak or absent nasal septum

Various type of nose presenting for augmentation. Type I, II, III, IV and V from left.

Methods

Adding augmentation only to noses that are lacking in projection would present no problem. However, if the nose is also short, such approach can rotate the tip, further shortening the appearance. Systematic analysis followed by applying the most proper techniques have led to excellent results in our experience.

Especially in cases with small noses, better patient satisfaction can be seen after both augmentation and lengthening using extended septal graft.

Conclusions

IntroductionAugmentation is the most commonly performed type of

rhinoplasty in Asians. However, the Asian nose is not only underprojected but also often short in length. This means not only is dorsal augmentation necessary but also lengthening must be carried out at times. In addition, weak structural support may present from underdeveloped or iatrogenicallytraumatized septum and nasal skeleton.

We present a method to analyze each Asian nose presenting for rhinoplasty and suggest the most appropriate technique for each type.

Type IV

Type I

Origins of septal reconstructionPrevious septal operation 40(51.3%)Trauma 26(33.3%)Congenital 12(15.4%)Total 78(100%)

Implants for augmentationGore-tex 1462(84%)Autologous costal cartilage 80(4.6%)Alloderm 74(4.3%)Irradiated costal cartilage 38(2.2%)Dermofat 38(2.2%)Alloderm & Gore-tex 28(1.6%)Autologous septal or ear cartilage 8(0.4%)Dermofat & Gore-tex 6(0.3%)Irradiated costal cartilage & Dermofat 2(0.1%)Dermofat & Alloderm 2(0.1%)Silicone 2(0.1%)Total 1740(100%)

Combined operations with augmentationTip surgery 1702(89.7%)

On-lay or Shield graft 1588(83.7%)Strut 1182(62.3%)Cephalic resection 592(31.2%)Transdormal suture 294(15.5%)Plumping graft 8(0.4%)

Osteotomy 221(11.6%)Alar base surgery 436(23%)

Classifications of Operation types

Type1 Only augmentation 922(48.6%)

Type2 Only ESG 40(2.1%)Type3 Augmentation with ESG 768(40.5%)Type4 Only osteotomy 90(4.7%)Type5 With septal reconstruction 78(4.1%)Total 1898(100%)

Type II

Type III

Type V

Comparison between Closed and Open approach Closed approach 38(2%) Open approach 1860(98%)Total 1898(100%)

Intraoperative photo demonstrating the placement of extended septalgraft onto the caudal septum, resulting in lengthening of the nose.

Illustration of lengthening of the nose.

Results

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