Complete septal extension grafts using porous high-density polyethylene sheets for the westernization of the Asian nose

Abstract

Background: In Asian rhinoplasty, most patients need correction of the nasal tip and columella along with dorsal augmentation. A complete septal extension graft can effectively and concomitantly correct less projected tips, retracted columellar bases, and acute columella-labial angles. However, the amount of septal cartilage is not sufficient as a source for the graft; therefore, the authors used porous high-density polyethylene sheets as their graft material.

Methods: Fifty-eight patients were enrolled in the study between April of 1994 and July of 2001. The authors evaluated a total of 11 measurement items (three for nasal tip, three for columella, two for alar shape or flaring, one for nostril shape, and two for symmetry of the alae and columella) by photogrammetry using standardized clinical photogrammetric techniques.

Results: Nasal tip projection, nasal bridge length, height of nose, and columella-labial angle increased significantly during an average follow-up period of 21 months, but nostril axis inclination, columellar length (Rt-Lt), and alar length (Rt-Lt) decreased significantly during the same study period. Implant exposure was noted in two cases, which was resolved by trimming the implants. Minor complications were stiffness of the columella (12 patients), buckling of the implant (nine patients), and excessive columellar show (two patients).

Conclusions: A complete septal extension graft resulted in a more projected and caudally lengthened nasal tip; in addition, retracted columella and the acute columella-labial angle were improved aesthetically. Most complications were lower risk and preventable. Therefore, with careful use of porous high-density polyethylene, the authors could modify Asian noses into more Westernized noses.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.