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Asian rhinoplasty using a thin rib cartilage graft and ultrafine diced cartilage wrapped in fascia: A comparative study between septal cartilage graft and rib cartilage graft

  • Hojin Park
    Affiliations
    Department of Plastic and Reconstructive Surgery, Korea University, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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  • Yeongsong Kim
    Affiliations
    Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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  • Jong Woo Choi
    Correspondence
    Corresponding author: Jong-Woo Choi, MD, PhD, MMM, Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong Songpa-gu, Seoul 138-736, Korea, Phone: 82-2-3010-3604, Fax: 82-2-476-7471
    Affiliations
    Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
    Search for articles by this author
Published:November 21, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.022

      ABSTRACT

      Background: A 1–2-mm thin rib cartilage graft was used as a septal extension graft to overcome the pitfalls of traditional rib cartilage rhinoplasty, which often results in a stiff nasal tip. The remaining rib cartilage was placed on the nasal dorsum as an ultrafine diced cartilage wrapped in fascia (UDCWF) graft. This study aimed to assess the stability of thin rib cartilage grafts and to measure the resorption rate of the UDCWF graft.
      Methods: This retrospective study included 53 patients who underwent rhinoplasty with septal extension grafting and nasal dorsum augmentation using a septal cartilage (SC group) or rib cartilage (RC group) graft between June 2017 and June 2020. The nasal length, tip height, sellion height, and nasolabial angle in the preoperative, immediate postoperative, and long-term postoperative periods were analyzed using three-dimensional photogrammetry.
      Results: Of the patients, 26 received rib cartilage grafts and 27 patients received septal cartilage grafts. The RC group showed greater maintenance of tip height, nasal length, and tip de-rotation over time. The relapse ratio in tip height was -3.3±1.6% and -8.4±4.3% in the RC and SC groups, respectively (p=0.001). The resorption rate of the UDCWF graft was -7.5±3.6% and -7.8±2.3% at the sellion and rhinion, respectively.
      Conclusions: The thin rib cartilage provided sufficient intrinsic strength to maintain tip height and tip rotation. It can be an effective alternative for rhinoplasty in Asians with features such as thick skin and a short nose. Moreover, the UDCWF graft exhibited an approximately 7.5% resorption rate, leading to lower probabilities of dorsal irregularity and stepping deformity.

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      REFERENCES

        • Paik MH
        • Chu LS.
        Correction of short nose deformity using a septal extension graft combined with a derotation graft.
        Arch Plast Surg. 2014; 41: 12-18
        • Westreich RW
        • Courtland HW
        • Nasser P
        • Jepsen K
        • Lawson W.
        Defining nasal cartilage elasticity: biomechanical testing of the tripod theory based on a cantilevered model.
        Arch Facial Plast Surg. 2007; 9: 264-270
        • Suh YC
        • Jeong WS
        • Choi JW.
        Septum-Based Nasal Tip Plasty: A Comparative Study between Septal Extension Graft and Double-Layered Conchal Cartilage Extension Graft.
        Plast Reconstr Surg. 2018; 141: 49-56
        • Han K
        • Jeong JW
        • Kim JH
        • et al.
        Complete septal extension grafts using porous high-density polyethylene sheets for the westernization of the Asian nose.
        Plast Reconstr Surg. 2012; 130: 106e-115e
        • Sawh-Martinez R
        • Perkins K
        • Madari S
        • Steinbacher DM.
        Control of Nasal Tip Position: Quantitative Assessment of Columellar Strut versus Caudal Septal Extension Graft.
        Plast Reconstr Surg. 2019; 144: 772e-780e
        • Woo JS
        • Dung NP
        • Suh MK.
        A Novel Technique for Short Nose Correction: Hybrid Septal Extension Graft.
        J Craniofac Surg. 2016; 27: e44-e48
        • Marin VP
        • Landecker A
        • Gunter JP.
        Harvesting rib cartilage grafts for secondary rhinoplasty.
        Plast Reconstr Surg. 2008; 121: 1442-1448
        • Lee TY
        • Lee KI
        • Dhong ES
        • Jeong SH
        • Kim DW
        • Han SK.
        Long-Term Resorption Rate of Autogenous Onlay Graft in East Asian Rhinoplasty: A Retrospective Study.
        Plast Reconstr Surg. 2022; 149: 360-371
        • Tas S.
        Ultra Diced Cartilage Graft in Rhinoplasty: A Fine Tool.
        Plast Reconstr Surg. 2021; 147: 600e-606e
        • Manuel CT
        • Leary R
        • Protsenko DE
        • Wong BJ.
        Nasal tip support: a finite element analysis of the role of the caudal septum during tip depression.
        Laryngoscope. 2014; 124: 649-654
        • Willson TJ
        • Swiss T
        • Barrera JE.
        Quantifying Changes in Nasal Tip Support.
        JAMA Facial Plast Surg. 2015; 17: 428-432
        • Jeong JY.
        Obtaining maximal stability with a septal extension technique in East asian rhinoplasty.
        Arch Plast Surg. 2014; 41: 19-28
        • Kim JS
        • Han KH
        • Choi TH
        • et al.
        Correction of the nasal tip and columella in Koreans by a complete septal extension graft using an extensive harvesting technique.
        J Plast Reconstr Aesthet Surg. 2007; 60: 163-170
        • Cochran CS
        • Gunter JP.
        Secondary rhinoplasty and the use of autogenous rib cartilage grafts.
        Clin Plast Surg. 2010; 37: 371-382
        • Cochran CS.
        Harvesting Rib Cartilage in Primary and Secondary Rhinoplasty.
        Clin Plast Surg. 2016; 43: 195-200
        • Wang L
        • Niu Y
        • Zhang H
        • Li B.
        Reinforcement of Lower Lateral Cartilage Using Sliced Costal Periphery to Reconfigure Nasal Tip in Asian Rhinoplasty.
        J Craniofac Surg. 2018; 29: 1212-1215
        • Anderson JR.
        A new approach to rhinoplasty.
        Trans Am Acad Ophthalmol Otolaryngol. 1966; 70: 183-192
        • Kim SK
        • Kim HS.
        Secondary Asian rhinoplasty: lengthening the short nose.
        Aesthet Surg J. 2013; 33: 353-362
        • Gunter JP
        • Clark CP
        • Friedman RM.
        Internal stabilization of autogenous rib cartilage grafts in rhinoplasty: a barrier to cartilage warping.
        Plast Reconstr Surg. 1997; 100: 161-169
        • Daniel RK.
        Diced cartilage grafts in rhinoplasty surgery: current techniques and applications.
        Plast Reconstr Surg. 2008; 122: 1883-1891
        • Baker SR.
        Diced cartilage augmentation: early experience with the Tasman technique.
        Arch Facial Plast Surg. 2012; 14: 451-455
        • Kim DW
        • Shah AR
        • Toriumi DM.
        Concentric and eccentric carved costal cartilage: a comparison of warping.
        Arch Facial Plast Surg. 2006; 8: 42-46