The New method of Controlling The Nasal Tip Projection
Chien-Yen Chen MD ,Shing-Won Wong MD.
1. Objective: According to Dr. Adamson's article,the allograft is suitable to volume filling not for structure support , for the high incidence of infection and protrusion. So autografts superior to allografts in rhinoplasty. We encountered the different problems between the Asian and Caucasian . The nasal septum and ear cartilage don't give enough materials to correct the Asian nose,if the patient need a beautiful and prominent nose. Asian nose is charactered by thick skin, short nose, retracted columella,the wide base of the nostril. The setal cartilage and ear choncha are too small to correct the thick skin and the short nose. We need a large amount of cartilage for dorsum and columella , the rib cartilage usually provides enough autograft material in the procedure.
A proficient practice in harvesting costal cartilage will prevent pneumothrorax .A good technician carve the costal cartilage for the nasal dorsum and nasal tip , can save much time in operation.
The key point of rhinoplasty is the success of reshaping the nasal tip , ,this including the angle of the nasal tip and the relationship between the tip and nasal dorsum and alars. The close approach can control the nasal tip more precise than that of the open approach does,because the procedure preserve the nose contours in the operation. The open ones give more good vision between the operation ,but the contour is changed,,and the direction of the nasal tip become more hard to control. How to combine the two methods, and get the benefits in both.Need further investigation. The Asian rhinoplastic evolution by the carved bullet shape nasal tip cartilage and external fixation will benefit nasal tip projection and shape the nasal tip.
a. We use the open approach in rhinoplasty,and put the accurate dorsal cartilage in propered position.
b. A dart- shape strut between the medial crus of low lateral cartilage was sutured , the lateral crus of low lateral cartilage may be recontructed be ear choncha, or cortex of the costal cartilage, or elongated by the intact low lateral cartilage.
c. A umbrella cartilage is sutured in the columella and nasal tip.
d. After suturing the incision in the columella, the contour can be noted,and put the bullet-shape nasal tip into the proper position.
e. The nasal tip to desired angle is adjucted.
f. External fixation is performed.
a. Good result compared with the 7-shaped silastic prothesis in nose,even with ear cartilage implant in the nasal tip.
b. Good result compared with open approach, and the nasal tip cartilage was sutured with the low lateral cartilage in open wound.
a. Many ways were introduced in the textbooks and articles to elongate the nasal tip.
(a) medial crus sutured by cartilage strut.
(b) Low lateral cartilage tip sutured.
(c) Ear concha recontruct the low lateral cartilage
(d) Nasal septum elongated
(e) Elevated the margin of nasal alar.
(f) Tripod theory ,in broken distal part of lateral crus of low latateral cartilage.
(g) Narrow the nostril base
(h) Purple violet location method
(i) Umbrella strut sutured.
The Asian nose contour qualification is not so good than Caucasian's,so combined more than two methods of above description with our procedures will get better result.
b. Close approach can put the cartilage more accurate than that of open approach does.
c. Exteral fixation can preserve the right position.
d. Even the skin and soft tisse were shorter than that we need post the operation in one or two weeks , they will grow along the cartilage framwork and rdownward rotation. On other word, the skin and soft tissue will elongate their lengths in future 6 months to 1 year.
e. The 7-shape silastic synthesis will be retracted by the skin and soft tissue for a long term, so the nose tip will upward rotation and gradually be slided to the glabella. The nasal tip will not grow along with the silastic bar, and then the width of the nasal tip will make nose look apperantly dull.