Rhinoplasty with Cartilage and Alloplastic Materials, Nasal SMAS Management in Asian Rhinoplasty, Contracture Classification, and Secondary Rhinoplasty with Contracture

Abstract

Rhinoplasty for Asians is quite different from that of Westerners. Most Asians desire a raised nasal bridge with a projected nasal tip, similar to that of Westerners. Nevertheless, most Asian nasal bones, and upper and lower lateral cartilages are inadequately developed. This largely necessitates the use of a nasal alloplastic material such as a silicone implant, most frequently utilized in nasal cosmetic surgery for Asians. Shaping of the silicone implant is rather easy and its removal is also simple, in the case of a complication or undesired result. The disadvantage of a nasal silicone implant, like that of silicone implants of the breast, is the fibrous capsular formation, which may lead to capsular contracture. The frequently employed types of nasal silicone implant include (1) the boat type in which the silicone implant descends down to the nasal tip, (2) the L-shape in which the silicone implant further extends to the anterior nasal spine (ANS) after passing the tip, and (3) the three-quarter type for which the silicone implant extends down to the upper lateral cartilage. In conjunction with the silicone implant, the cartilages of the ear and the nasal septum are commonly used to create or lengthen tip projection. Asians generally have cartilage with inadequate anatomical development. Instead, they often have an anatomically thick fibrous fatty layer including underdeveloped superficial musculoaponeurotic system (SMAS). Patients with a thick fibrous tissue layer have a bulbous tip. This nasal tip is the area where severe capsular contracture occurs after insertion of a silicone implant. It is imperative that the surgeon properly understands the nasal anatomical characteristics of Asians, and selects an appropriate implant together with a suitable donor cartilage to attain a safe and aesthetically pleasing nose. The same principle should apply to reoperation cases; the fibrofatty layer of SMAS along with the capsular contracture must be removed or released to gain a sufficient soft tissue volume. This provides further stability to the cartilage framework.

Application of Auricular Cartilage Scaffold Combined With L-Shaped Prosthesis in Asian Rhinoplasty

“…The second part relates to the existence of significant structural deficiency. If there is a serious deviation of the nasal septum, rebuilding the nasal framework and correcting complex anatomy will require an appropriate selection of grafting materials like costal cartilage 8 . Third, it is very critical to consider the patient’s expectations.…”

Customized Augmentation Rhinoplasty With Morpheus 3-Dimensional Scanner

“…8 Although the pros and cons of autogenous and alloplastic materials exist, nasal alloplastic materials, such as silicone implants, are more frequently used in dorsal augmentation for Asians. 9 This is because autogenous materials are unpredictable in resorption, leading to unsatisfactory esthetic outcomes. On the other hand, carving and removal of the alloplastic nasal implant are relatively straightforward.…”

Increasing Nasal Tip Projection Using Structural Grafts: A Review of Outcomes

“…2 Autologous cartilage structural grafts do not undergo contracture, but in certain cases may be partially resorbed. 2 Because of the heightened risk of postoperative complications with alloplastic implants, autologous grafts often are preferred when it is possible to harvest adequate cartilage for the procedure. 3 The two most commonly used cartilage structural grafts for increasing NTP are septal extension grafts (SEGs) and columellar strut grafts (CSGs).…”

“…Both autologous cartilage structural grafts and alloplastic grafts often are used for increasing NTP. Alloplastic implants are easily shaped, placed, and removed; however, the use of an exogenous material increases the risk for contracture 2 . Autologous cartilage structural grafts do not undergo contracture, but in certain cases may be partially resorbed 2 .…”

“…Alloplastic implants are easily shaped, placed, and removed; however, the use of an exogenous material increases the risk for contracture 2 . Autologous cartilage structural grafts do not undergo contracture, but in certain cases may be partially resorbed 2 . Because of the heightened risk of postoperative complications with alloplastic implants, autologous grafts often are preferred when it is possible to harvest adequate cartilage for the procedure 3 …”