Nasal sill augmentation: an overlooked concept in rhinoplasty-a technical note and review of the literatures

Nasal Surgery in the Younger Patient

Nasal surgery can be carried out safely in the younger patient. In cases of trauma, it is recommended that corrective surgery be carried out in a short time frame before scar contracture, aberrant remodeling, and malunion of structures occurs. In the less common situation of performing cosmetic surgery on the younger patient there are several principles and guidelines to be considered.

Balancing the Anteroposterior Diameters of the Nostril Lengths in Cleft Rhinoplasty

BACKGROUND

Osteocartilaginous deformities in cleft rhinoplasties may be restored with numerous techniques. However, the anteroposterior (AP) diameter lengths of the nostrils may still be unequal and should also be addressed. A technique was designed to balance nostril AP diameter lengths and apical shapes.

MATERIALS AND METHODS

Balance between AP nostril diameters was accomplished by reduction of the AP diameter of the nostril at the non-cleft side by medial crural reduction and augmentation of the AP diameter of the nostril at the cleft side by three-parted mini-flap reconstruction at the soft triangle. The cleft-side AP diameter length was divided by the non-cleft-side AP diameter length of the same preoperative, per-operative and 1-year postoperative base view photographs of each patient, and "nostril balancing ratio" was obtained. The more this ratio was near to "one," the more the AP nostril diameters were equal.

RESULTS

Seventy-eight unilateral-cleft rhinoplasty were performed between January/2019 and May/2022. Forty-two of them required nostril AP diameter equalization. Twenty-nine patients were female, thirteen were male. Thirty-three of them were operated for a primary cleft rhinoplasty. Nine of them for secondary cleft rhinoplasty. Mean age was 28 years (22-39 years). Mean follow-up was 25 months (6-40 months). The preoperative, per-operative and postoperative mean "nostril balancing ratios" were 0.714 (0.621-0.813), 0.743 (0.721-0.752) and 0.971 (0.943-0.976), respectively.

CONCLUSION

Balancing AP diameter symmetry with MCO at the non-cleft side and three-parted mini skin flap reconstruction at the cleft side may provide the satisfactory results. Three mini-flaps at the soft triangle may remold the nostril apex in an oval shape, which may result in a better shape symmetry.

LEVEL OF EVIDENCE IV

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Rhinoplasty Technique for Improving Nasal Base Aesthetics: Lateral Columellar Grafting

BACKGROUND

One of the most important factors in nasal base aesthetics is symmetry. In the age of social media, the expectations of rhinoplasty patients and the rate of requests for a more symmetrical nose have increased. In this article, a lateral columellar grafting technique that can be applied to augment the more defective side of the columella and obtain a more symmetrical nasal base is presented.

METHODS

A total of 86 patients (women, 79; men, 7) were included in this study. The surfaces of the right and left lateral margins of the columella were evaluated from the basal view at the final stage of surgery, and a lateral columellar graft was placed on the more defective side. All patients who were included in the study were assessed with the Rhinoplasty Outcome Evaluation questionnaire before and 1 year after surgery.

RESULTS

The median age of the patients was 28.3 years (range, 18-56 years). Eighty-two patients were primary rhinoplasty patients, and 4 patients were secondary rhinoplasty patients. The median Rhinoplasty Outcome Evaluation score was 68.3 points before surgery and 92.3 points 1 year after surgery, showing a significant increase ( P = 0.003). Patient satisfaction was found to be excellent in 93% of the included patients.

CONCLUSIONS

Using the lateral columellar grafting technique, greater symmetry of the columella and nostrils can be obtained by augmenting the more defective side of the lateral columellar surface.