Background Proper nasal tip projection and rotation are essential for an aesthetically pleasing nose. However, East Asians usually have thicker skin and underdeveloped nasal cartilage compared to Caucasians. Thus, techniques such as the septal extension graft, columellar strut graft, and L-shaped alloplastic implants have been introduced for additional nasal tip support and projection. However, no consensus exists regarding the optimal method.Methods A hybrid columellar strut made of an osteochondral graft recombined with the nasal crest of the maxilla and conchal cartilage was devised. In a cadaveric study, changes due to an external bending force of the hybrid strut and costal cartilage in the same dimension were measured. In a comparative study, we divided 20 subjects into two groups according to the material used for the columellar strut graft: a hybrid columellar strut (experimental group) and a double-layered conchal columellar strut (control group). Preoperative, 1-month postoperative, and 1-year postoperative anthropometric measurements were compared between groups.Results In the cadaveric study, the hybrid columellar strut showed superior mechanical strength. In the comparative study, the average 1-year postoperative change of the columellar labial angle was significantly smaller in the experimental group (–0.7°±1.16° vs. 2.2°±1.32°, P=0.015). The hybrid columellar strut showed superior postoperative nasal tip stability.Conclusions We devised a new hybrid columellar strut and confirmed its superior mechanical firmness and stability. Considering the suggested indications and contraindications, the hybrid columellar strut graft can be a new modality for tip plasty in East Asian rhinoplasty that can provide sufficient long-term nasal tip stability.

Known to be chemically inert, Aquafilling filler has been widely used in local aesthetic clinics in South Korea for breast augmentation. However, Aquafilling is only approved as a dermal filler and is not approved as an injectable filler for breast augmentation by the U.S. Food and Drug Administration or the Ministry of Food and Drug Safety. Several reports of complications following large-volume Aquafilling injections in the breast have been published. In this study, an HIV (human immunodeficiency virus)-infected transgender patient presented to the emergency room with a purulent infection of the breast and systemic fever. The patient had a history of large-volume Aquafilling injection in both breasts 3 years earlier to obtain a feminized appearance of the breasts. After using intravenous antibiotics and performing several surgical debridements over 4 weeks, the overall inflammatory response subsided. The skin defect site was covered successfully using an Integra Wound Matrix Dressing and there were no recurrent complications over 2 years of follow-up visits. Before injecting Aquafilling to augment patients’ breasts, a thorough consultation is mandatory, and doctors must notify patients that the risk of complications may be relatively high. Furthermore, any fillers including Aquafilling must not be used for unapproved purposes.

Skin avulsions are severe traumatic injuries, in which sections of skin and subcutaneous tissue are torn off from the body, and the surgical management and salvage of these injuries are quite challenging due to their high morbidity and mortality. The entire or partial loss of an avulsed flap is prone to occur. If this happens, scars can be particularly conspicuous, and additional surgery, such as skin grafts or local flaps or even composite grafts, might be required. A 24-year-old male patient presented to the emergency room with a severe traumatic avulsion injury on his nose. We used a combination of three therapies to minimize the loss of the distal portion of the avulsed flap: polydeoxyribonucleotide injection, continuous non-rebreather mask oxygen therapy, and chemical leeching. We achieved complete flap salvage of the avulsed wound, and the patient showed full satisfaction in both aesthetic and functional aspects. Although this report is confined to a single case of severe avulsed injury, we suggest this triple-combination therapy as a good combined modality for maximizing the salvage of an avulsed flap on the basis of this case and a literature review.