Nasal Tip-Plasty with Silicone Implant and Medpor(R) Onlay and Strut Implant

Jo, Dong In; Uhm, Ki Il

Abstract

In traditional concepts, the beautiful nose was defined as showing a round tip and having a good relationship with his or her own face. Esthetically, it is thought to be good that the ratio of nasal lobule to columella is 1 : 1.618. Comparing oriental and Caucasian nose, oriental nasal tip has more oily skin and more thin cartilages than that of Caucasians. In addition, in case of cleft patients, Orientals have a shortage of nasal skin. Therefore oriental nasal tip shows more tension following nasal tip-plasty. Until now, for tip-plasty, we have applied many surgical methods, such as lengthening of columella with V-Y advancement or composite graft from concha, advancement of retruded columella by septal cartilage graft, Converse's method, Millard's method and silicone implant or bone graft. Above mentioned methods have several advantages of own themselves, but also have several disadvantages such as donor site morbidity, scar formation and so on. Nowadays, we have used silicone and cartilage graft or Alloderm for augmentation rhinoplasty and tip-plasty because of their simplicity. But autogenous cartilage graft has some disadvantages such as absorption, distortion and possibility of donor site morbidity. We think that there's no specific rationale to insist to use autograft or allograft on the nasal tip while using the silicone, which is synthetic material, on the nasal dorsum. Medpor is such a rigid, elastic and microporous material that can be fixed firmly on its original site by allowing an in-growth of fibrovascular tissues into its own micropores. In addition, it is free from donor site morbidity and offers simpler operation procedure. From November 1999 to January 2001, authors performed augmentation rhinoplasty to 32 patients with I-shaped silicone implant through an alar rim incision. Thereafter on nasal tip portion of implant we performed Medpor onlay implant and on the columella, from its base to the nasal tip area, we performed Medpor strut implant as we wanted. As a result of mean 6 months follow-up, we can achieve a good nasal tip projection, lengthening of columella, natural columella appearance and improvement to obtuse nasolabial angle. No specific complications were reported except for 2 cases. One case showed slight hardness on nasal tip area. We think more follow-up period is needed for this situation. The other case showed minimal displacement of silicone implant. But it did not require any additional operations because the patient wanted no more operation. We think that tip-plasty using Medpor onlay and strut implant is effective and simple method which can be performed at out-patient department.