Classification and Treatment of Glabella-Radix Deficiency in Primary Augmentation Rhinoplasty

Background

A systematic approach to treating glabella-radix deficiency is lacking, and the management of brow-tip aesthetic lines remains technically challenging.

Objectives

The authors describe implantation of a customized Gore-Tex prosthesis combined with primary augmentation rhinoplasty to address the glabella-radix deficiency.

Methods

Fifty Asian patients with glabella-radix deficiency who received implantation and primary augmentation rhinoplasty were retrospectively evaluated in an 8-year period. Patients were assigned to categories based on brow-tip contour lines and symmetry patterns, and implant dimensions were ascertained from the contour type and from simulated postoperative results.

Results

Eleven men and 39 women were included in the study; the mean patient age was 27.22 years, and mean follow-up was 22.8 months. Seven of the patients were assigned to the type I/Ia category, 24 to type II/IIa, and 19 to type III/IIIa. Forty-five patients were considered to have satisfactory surgical results, with curved, symmetric, and normally spaced brow-tip lines on front view and a smooth frontonasal transition on profile view. Complications occurred in 5 patients and included infection (1 patient), inadequate augmentation (2), and palpable margin folding of the Gore-Tex device (2).

Conclusions

Deformities of brow-tip contour lines coincide with glabella-radix deficiencies in terms of severity. Knowledge of the patterns of brow-tip lines, combined with postoperative image simulation, can help the surgeon design an appropriate glabella-radix prosthesis. When placed in conjunction with other augmentation rhinoplasty procedures, the glabella-radix implant yields sufficient, predictable nasal projection and a harmonious facial aesthetic.

Level of Evidence: 4

Complications of the nasal dorsum reconstruction using autologous or alloplastic grafts: evidence from systematic review and meta-analysis

Introduction

Augmentation rhinoplasty depends mainly on intact stable bony and cartilaginous parts. Many trials have used different materials as a graft to perform the operation and support the nose. Debate exists whether alloplastic or autogenic grafts are more appropriate. Common available alloplastic grafts include silicone, medpor, and gore-tex. Autogenic grafts are usually derived from costal cartilages. Warping, infection, and hypertrophic scars are the main complications of the procedure. Yet no subgroup analysis has been performed to investigate the effect of different risk factors.

Objective

To investigate the effect of different types of grafts and the association of the income level of the country on surgery complications.

Methods

A comprehensive literature search of articles was conducted in PubMed, Cochrane Library, Web of Science, and SCOPUS databases through October 2019. We included articles that used autologous or alloplastic grafts in nasal dorsum reconstruction surgery. We performed subgroup analysis according to the type of graft used, region, and income level of the country. A meta-regression analysis model was carried out from the period of 1999–2018, to study the incidence of these complications over time.

Results

The overall complication rate was 7.1%, which was higher in the alloplastic group (7.8%) than the autogenic group (6.9%). The most common complications were secondary surgery for re-correction (4.1%), infection (2.1%), warping (1.6%), and hypertrophic scars (1.6%). All outcomes were homogeneous (I² < 50%).

Conclusion

Patients with autogenic grafts are less liable to develop complications than their peers reconstructed with alloplastic grafts. Moreover, Asian patients are less susceptible to overall rhinoplasty complications. Attention should be noted for low-income countries in which surgical complications are more prone to occur.

Use of Nasal Implants and Dorsal Modification When Treating the East Asian Nose

Dorsal augmentation and tip surgery are essential procedures for East Asians seeking rhinoplasty, because they generally have thicker skin and poorly developed nasal dorsum and tip. For dorsal augmentation, many Asian surgeons prefer using alloplastic material, like silicone, Gore-Tex, and filler injection, for cost-effectiveness, easy handling, and short operation times. Compared with autologous implant materials, the use of synthetic implant is suggested to be associated with many complications, such as infection, extrusion, and deviation. However, even with the use of the autologous material, problems such as reabsorption after grafting, donor site complications can take place.