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Wei M, Wang G, Zhao R, Zhou G, Zhen Y, Bu X, Li D, An Y. Morphological Measurement of Asian Osteal Nasal Base for Paranasal Augmentation. Aesthetic Plast Surg 2024; 48:1728-1736. [PMID: 37940704 DOI: 10.1007/s00266-023-03724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Paranasal augmentation has been a popular approach in restoring Asian patients' lateral profile. Irregular surface in the surgical area emphasizes the importance of morphological evidence for the preoperative evaluation and the design of paranasal implants. METHODS We retrospectively collected craniofacial computer tomography scans of patients in the department of plastic surgery from 2020 to 2022. The imaging data were imported to Mimics (version 20.0; Materialize, Leuven, Belgium) for three-dimensional reconstruction. Measurements of osteal nasal base were performed in 3-matics (version 12.0; Materialize). The severity of paranasal concavity was graded by a senior doctor to study the correlation with measured variables. RESULTS Fifty-seven patients with a median age of 27 years (IQR: 22-33) were included in the study. For design of paranasal implants, the lengths of both lower and lateral edge were measured for reference. In the regression analysis, the alar base-alveolar process angle was significantly associated with the degrees of paranasal concavity (OR = 1.222, p = 0.00001). CONCLUSIONS Morphological data of osteal nasal base were measured and presented in the current study. The analysis supported that alar base-alveolar process angle be used for preoperative grading and evaluation to help guiding treatment decisions. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Muqian Wei
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Runlei Zhao
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Guangjin Zhou
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xi Bu
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Li
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Xiang X, Wang X, Wang S. The Treatment of Alar Base Depression in Rhinoplasty with Diced Autologous Cartilage or Mass Cartilage: A Systematic Review. Aesthetic Plast Surg 2024:10.1007/s00266-024-04008-y. [PMID: 38609657 DOI: 10.1007/s00266-024-04008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Alar base is the basal part where the two sides of the nose and the upper lip are connected. Alar base depression affects the overall facial contour by making the nasolabial folds deepen, the nasolabial angle smaller, the center of the face flat, etc. Despite the rapid development of rhinoplasty, controversy still exists regarding the treatment of alar base depression. This systematic review aims to evaluate the efficacy and safety of two prevalent techniques-diced autologous cartilage and mass cartilage-for addressing alar base depression. METHODS A systematic review was conducted by searching the literature published in PubMed, Embase and Web of Science, Cochrane from January 2000 to April 2023 with the key words 'alar base depression or depressed alar base' and 'alar base augmentation,' and 2 investigators independently screened the retrieved literature according to inclusion and exclusion criteria. RESULTS A total of 269 articles were obtained through database search. After removing duplicates, reading titles and abstracts, and finally reviewing the full text, 6 articles were included in the final study, including 165 patients. CONCLUSIONS The results demonstrate that both diced autologous cartilage and mass cartilage techniques exhibit favorable outcomes in correcting alar base depression. Diced autologous cartilage offers better malleability, lighter border contours, and a more natural appearance. On the other hand, diced autologous cartilage seems to offer superior long-term effects, while mass cartilage presents certain surgical procedural advantages. Also, compared to diced cartilage, mass cartilage may have a lower rate of long-term resorption and a lower risk of displacement. This review emphasizes the need for personalized treatment selection based on individual patient characteristics. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. www.springer.com/00266 .
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Affiliation(s)
- Xingyu Xiang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Shuyuan Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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Wang G, Wei M, Zhen Y, Li D, An Y. Three-Dimensional Morphological Study on the Effectiveness of Expanded Polytetrafluoroethylene Prosthesis in the Paranasal Augmentation. Aesthetic Plast Surg 2024; 48:398-406. [PMID: 38133836 DOI: 10.1007/s00266-023-03755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The paranasal depression is a common facial feature of Oriental populations. One of the most wildly used method to improve it was paranasal augmentation using expanded polytetrafluoroethylene (ePTFE). The effectiveness of it should be tested by three-dimensional morphological measurements. METHODS Patients who underwent paranasal augmentation using ePTFE between January 2017 and December 2022 were recruited in the study. The preoperative and postoperative clinical variables and three-dimensional measurement of patients were also collected. The satisfaction outcome were assessed. RESULTS By establishing a coordinate system based on the Frankfurt plane, 16 landmarks including nasal alar crest, subnasal point, upper lip, pogonion, glabella, sub-cheek, orbitale, tragion in left and right side of faces were marked. Five segments, 4 ratios, and 3 angles were measured based on it. The significant increase of segments, ratios, and angles indicated that paranasal augmentation could increase the protrusion of paranasal area, both in absolute value and relative proportion. The significant decrease of other data indicated that the protrusion difference between paranasal base and upper lip, forehead, and chin, respectively, were shortened after surgery. The average size of implant was 6.54 ± 1.02 mm, and the average increase of paranasal height was 4.38 ± 1.04 mm postoperatively. This indicates that two-thirds of its height will ultimately be reflected effectively in the sagittal elevation of the paranasal base. CONCLUSIONS Paranasal augmentation using ePTFE could effectively increase paranasal height and improve subunits relationships, and the ePTFE prosthesis should be designed and carve considering the 1/3 loss of height after implantation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Guanhuier Wang
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Muqian Wei
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yonghuan Zhen
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Dong Li
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Sohail M, Bashir MM, Bajwa MS, Farooq UK. Comparing definitive unilateral cleft rhinoplasty with and without diced-cartilage alar-base augmentation: A retrospective cohort study. J Craniomaxillofac Surg 2023:S1010-5182(23)00078-1. [PMID: 37353403 DOI: 10.1016/j.jcms.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/19/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023] Open
Abstract
This retrospective cohort study aimed to compare the long-term aesthetic outcomes and satisfaction of patients who underwent two techniques of definitive unilateral cleft rhinoplasty. The two cohorts, comprising patients with mature unilateral cleft deformity, were managed with definitive rhinoplasty, either with or without diced-cartilage alar-base and peri-alar augmentation (ABPA). Thirty patients were included in each cohort. Anthropometric measurements, complications, patient satisfaction scores, and third-party surgeon assessment scores were reviewed. In both cohorts, anthropometric parameters improved. Rhinoplasty with ABPA was the superior cohort in terms of columellar length (10.3 ± 1.0 in the cohort with ABPA, compared with 7.9 ± 0.6 in the cohort without ABPA; p < 0.001), alar-base angle (0.2 ± 0.2, compared with 4.3 ± 0.3; p < 0.001), and columellar deviation (2.5 ± 1.4, compared with 10.3 ± 2.1; p < 0.001). This cohort also had more symmetry in nostril height and nostril width (p < 0.001), a lower recurrence rate (one case compared with 22 cases; p < 0.001), a higher patient satisfaction score (p = 0.002), and a higher surgeon assessment score (p < 0.001, Cronbach's alpha = 0.706, Kendall's coefficient of concordance = 0.787). Within the limitations of this study, it appears that the described technique for augmenting the alar-base and peri-alar maxillary area is manageable, and yields consistent long-term results.
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Affiliation(s)
- Muhammad Sohail
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan.
| | - Muhammad Mustehsan Bashir
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan
| | - Mohammad Suleman Bajwa
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan
| | - Usman Khalid Farooq
- Department of Plastic and Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, Lahore, Hospital Rd, Anarkali Bazaar, Lahore, Punjab, 54000, Pakistan
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Zhao R, Pan B, Li D, An Y. Application of Paranasal Augmentation Rhinoplasty in Asians With Midfacial Concavity. Ann Plast Surg 2023; 90:S147-S152. [PMID: 36921322 DOI: 10.1097/sap.0000000000003428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
BACKGROUND For Asian rhinoplasty patients with midfacial concavity, the conventional method is to solve the problem by using structural rhinoplasty to increase the nasal height and length. However, the results are not satisfying, and many complications are caused.Paranasal augmentation as an adjunct to rhinoplasty can improve surgical results and increase satisfaction. However, there are limited studies focusing on the details and evaluation of this technique. OBJECTIVES To investigate a minimally invasive method to correct midfacial concavity simultaneously with rhinoplasty, as well as improve satisfaction and reduce complications. MATERIALS AND METHODS Between January 2010 and December 2019, we reviewed all rhinoplasty patient records from patients who had midfacial concavity and underwent simultaneous paranasal augmentation with our technique. The patient demographics, surgical characteristics, and outcomes were reviewed retrospectively. Satisfaction was evaluated by an independent medical staff who reviewed the preoperative and postoperative photos. RESULTS Sixty-seven patients were included in the study. The mean age of the patients was 28.7 ± 8.0 years, and the median follow-up time was 26 months (range, 2-60 months). Overall satisfaction was high (90%). Eight (12%) patients had complications, including 5 (7.4%) cases of implant displacement and 3 (4.4%) cases of infection. All patients healed uneventfully after revision surgery. CONCLUSIONS Paranasal augmentation can improve the outcome and increase satisfaction in Asian rhinoplasty patients who have midfacial concavity. Preoperative patient evaluation, surgery planning, and surgery details are crucial to ensure a favorable result. The expanded polytetrafluoroethylene implant has advantages over other materials and therefore is recommended in paranasal augmentation surgery.
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Affiliation(s)
- Runlei Zhao
- From the Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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Application of 3D Imaging-Assisted Precise Aesthetic Evaluation in Midfacial Depression Treatment. Aesthetic Plast Surg 2022; 46:2799-2806. [PMID: 35475937 DOI: 10.1007/s00266-022-02867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/13/2022] [Indexed: 01/01/2023]
Abstract
Most Chinese have unpleasant facial profile of midfacial depression, which could be caused by multiple reasons. In the past, LeFort osteotomy and orthodontic methods were applied for surgical treatment of midfacial concavity. As the development of plastic surgery filling techniques, nasal base filling or concurrent comprehensive rhinoplasty has been widely used to improve midfacial depression. However, most of the related studies focus on surgical techniques or filling materials, yet lack accurate and objective aesthetic evaluation. In the current study, we used 3D imaging to collect 3D facial profile of 66 patients suffering from midfacial depression. Related linear distance and angles were measured accurately using 3D software. Patient satisfaction and physician evaluation were also collected in the follow-up period. The results showed that patients' midfacial depression were significantly improved after the surgery and the overall patient satisfaction was 100%. Our study demonstrated the positive role of nasal base filling in improving the midfacial depression, and illustrated the advantages of 3D imaging technology in personalized preoperative communication, surgical simulation and postoperative effect evaluation.Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Application of Patient-Specific PEEK Implant for Aesthetic Considerations in Paranasal Augmentation. J Craniofac Surg 2022; 33:e877-e880. [PMID: 35968952 DOI: 10.1097/scs.0000000000008824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022] Open
Abstract
The paranasal area is closely associated with midfacial esthetics. However, there is no special technique available to achieve ideal esthetics paranasal restoration. The present study aims to apply the 3D printed PolyEtherEtherKetone (PEEK) implants as an innovative solution for esthetic paranasal reconstruction. On the basis of the CT scan, the patient-specific PEEK implant and a surgical guiding plate were manufactured aided by a computer. Preoperative and postoperative CBCT data were utilized to evaluate esthetic outcomes. The average follow-up period was 13 months. All patients' wounds healed by first intention. The statistical analysis of preoperative and postoperative esthetic indices revealed light levels of postoperative paranasal depression (P<0.001) and the wrinkle severity rating scale for nasolabial folds (P<0.001). Moreover, the nasolabial angle increased (P<0.05). The established 3D-printing PEEK implanted prosthesis can individually correct the depressed deformity of the paranasal region, and achieve favorable clinical esthetic outcomes.
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Application of Diced Autologous Rib Cartilage for Paranasal Augmentation in Cleft Nose. Aesthetic Plast Surg 2021; 45:1169-1175. [PMID: 33200239 DOI: 10.1007/s00266-020-02036-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to investigate the clinical effect of diced cartilage on correcting nasal alar base depression in Asian cleft rhinoplasty. METHODS A retrospective study was conducted on 25 patients with nasal deformity, who underwent the second cleft rhinoplasty between January 2018 and January 2020. Autologous costal cartilage was harvested in all the patients to reconstruct the contour of the nose, while the remaining cartilage from the surgery was cut into 1.0×1.0 mm pieces and filled into the nasal alar base. The preoperative and postoperative effects of visual images were compared and analyzed using Adobe Photoshop CS6 software. The patients were followed up for 8-18 months (mean 12 months) to investigate the satisfaction and complication rate. RESULTS The nasal alar base depression was corrected, and the profile of malformed noses was significantly improved in 25 patients after the surgery. The postoperative effect was satisfactory, and no obvious graft shift or other complications were observed in the follow-up. CONCLUSIONS The application of diced cartilage to correct nasal alar base depression after cleft lip surgery is a feasible method. Its advantages include mainly the crafty use of the remaining cartilage and the presentation of a more natural appearance than mass cartilage. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Yen CI, Chang CS, Chen HC, Yang SY, Chang SY, Yang JY, Chuang SS, Hsiao YC. Paranasal Augmentation With Composite Graft Transfer in Overresection of Alar Base and Nostril Contracture. Ann Plast Surg 2021; 86:133-136. [PMID: 32732489 DOI: 10.1097/sap.0000000000002485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many Asian patients desire a narrower nasal base with less flaring of the alar lobules. However, patients who underwent multiple rhinoplasty surgeries with nostril contracture or an overreduction of the alar base may experience nostril contracture and deformity, which may lead to further airway obstruction. We present a technique that combines paranasal augmentation with composite chondrocutaneous graft transfer to overcome this problem. METHODS Nine patients underwent composite chondrocutaneous graft transfer to the soft triangle or alar base combined with paranasal augmentation using preshaped porous polyethylene implants to correct nostril contracture and airway obstruction between September of 2014 and May of 2018. Preoperative and postoperative alar base distances and cross-sectional areas of the nostrils were measured and compared. RESULTS The average thickness of paranasal augmentation was 5.5 mm (range, 4.0-7.0 mm). Eighteen composite grafts were located over the soft triangle (n = 3) and the alar base (n = 15). The average number of composite grafts for each person was 2 (range, 1-4). All composite grafts survived totally or partially, and no graft failed. The average follow-up was 10.9 months (range, 3-28 months). The alar base increased 13.9% (range, 2.2%-23.9%), and the nostril area increased an average of 78.1% (range, 4.5%-316.8%) postoperatively. Patients had satisfactory aesthetic and functional outcomes. CONCLUSIONS Combining paranasal augmentation and composite graft transfer increased the cross-sectional area of the external valve and improved nostril contracture and airway obstruction after the overresection of the alar base or nose contracture after multiple rhinoplasty surgeries.
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Affiliation(s)
- Cheng-I Yen
- From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
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Lee TY, Chung HY, Dhong ES, Jeong SH, Han SK. Paranasal Augmentation Using Multi-Folded Expanded Polytetrafluorethylene (ePTFE) in the East Asian Nose. Aesthet Surg J 2019; 39:1319-1328. [PMID: 30944924 DOI: 10.1093/asj/sjz103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Paranasal augmentation has commonly been performed utilizing alloplastic materials such as silicone or porous polyethylene. However, there are problems such as bone absorption, implant migration, and infection risk attributable to intraoral approaches. OBJECTIVES The authors attempted anterior positioning of the alar crease junction as an adjunct method of rhinoplasty. The authors aimed to determine the long-term results of the intranasal approach for placement of multi-folded expanded polytetrafluorethylene (ePTFE). METHODS A retrospective review was conducted of patients who underwent intranasal surgical approach for paranasal augmentation employing multi-folded ePTFE implants in 19 septorhinoplasties who were followed-up for 3 to 10 years. Patient charts were reviewed for demographic information, concomitant operations, and complications. Preoperative and postoperative photographs were utilized to evaluate operative outcomes. The photographs were reformatted to 2-dimensional images employing standard photographic methods. RESULTS Of the 19 patients treated, 17 were female and 2 were male; ages ranged from 18 to 58 years. All patients reported improvement in their lateral profiles and were pleased at follow-up. There were no major complications, no nerve or vascular supply compromise, and no cases of implant malposition. The average increase in soft tissue outline near the alar crease junction was more than 3.2 mm (P < 0.001), but the alar base did not became wider. CONCLUSIONS Paranasal augmentation with multi-folded ePTFE is a simple, safe, and effective method that can readily improve the lateral profile. In particular, the intranasal approach combined with rhinoplasty can synergistically improve outcomes and lead to greater patient satisfaction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Tae-Yul Lee
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ha-Yoon Chung
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea
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Paranasal Fat Grafting Improves the Nasal Symmetry in Patients With Parry-Romberg Syndrome. J Craniofac Surg 2019; 30:958-960. [PMID: 30839470 DOI: 10.1097/scs.0000000000005424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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