Dorsal Augmentation in Secondary Rhinoplasty

Kim, Hyun Soo

Abstract

Two most common pathologic mechanisms which cause secondary rhinoplasty are related with nasal framework and it's envelope. The reasonable definition defining key features of the secondary rhinoplasty 'Scarred nasal soft tissue envelope overlying adherent and distorted nasal framework' gives full explanation about main deformities in the secondary rhinoplasty, and leads us to focus on reconstructing and reinforcing both structures when the secondary rhinoplasty is performed. Moreover, artificial alloplastic implants and injectable materials, popularly used for augmentation rhinoplasty, erode skin and give damages to skin and appendages. It is, therefore, essential to understand the importance of skin problem and to know that one must be ready to suffer from another more difficult operations and its unpredictable results, unless it is properly reinforced. I have used several autogenous materials (n=294) and two kinds of xenografts (n=35) in the secondary rhinoplasties during the last 8 years for reinforcing the envelopes in pathologic conditions and augmenting the dorsal volume. I have learned a lesson from these 8 years of experience about dorsal augmentation in secondary rhinoplasty. 1) Even though it seems to be time consuming and annoying to harvest and prepare autogenous graft materials, no xenografts or artificial materials are safer and more consistent than autogenous materials, and no convenience is more valuable than consistency and safety in secondary rhinoplasty. 2) If you need to augment nasal dorsum in secondary rhinoplasty, get the permission from the nasal envelope. 3) Remind this aphorism: Alloplastics are only convenient on the day of surgery.