[Contracted Nose] Deep Analysis of the 5th Stage of Contracted Nose Correction / Part_04 Appropriate Grafting for the Nasal Bridge and Tip

April 31 Plastic Surgery, 4th Stage of Contracted Nose Correction

Hello.

This is April 31 Plastic Surgery.

Today, we would like to talk about the 4th stage of contracted nose surgery.

In-depth discussion on appropriate grafting for the shape of the nasal bridge and tip April 31 Plastic Surgery Contracted Nose PART_04

Last time, we looked at PART03_ fixation of the loosened cartilage structure.

If you have not seen stage 3 of contracted nose correction, we recommend that you review stage 3 before reading this post.

▼ Go to Contracted Nose Correction 5-Stage PART_03 ▼

Up to the 3rd stage, we straightened the damaged and twisted cartilage structure of the nose and restored the skeletal structure to an upright position.

In other words, it was the process of 'creating a normal structure.'

In fact, that simply means returning to the appearance before the first surgery, so it may seem like simply inserting an implant or performing an appropriate cartilage graft on top of it would make the nose normal. However, contracted nose cases are not like that.

Three reasons why it is difficult to return a contracted nose to its preoperative state

① The skin structure covering the nose is not in a normal state

② It is bumpy and mixed with scar tissue

③ It has been dissected very thinly in order to stretch the skin

April 31 Plastic Surgery

Even if the underlying structure has been built to a normal height, or close to normal, since the reconstruction work has only just begun,

simply leaving an implant or artificial material in place makes it vulnerable to pressure or inflammation, which could result in the carefully made nose becoming severely damaged.

Of course, even in contracted nose cases, if the skin is fully preserved and the risk of inflammation is judged to be very low, an implant can be inserted into the nasal bridge.

The key in contracted nose surgery is to create a structure that is close to the original nose shape before surgery.

Even when inserting an implant, it is better to use a small one if possible so that there is less pressure on the skin or the lower cartilage structure. If there is even a slight concern about inflammation, autologous tissue grafting is the best option.

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The 대표적인 autologous tissues used to supplement the height of the nasal bridge are rib cartilage and autologous dermis.

Over the past 30 years, while observing tens of thousands of contracted nose cases, we have grafted various types of autologous tissue to the nasal bridge, and through many trials and errors as well as long-term follow-up, we have learned a great deal.

< Rib Cartilage >

Rib cartilage uses ribs 6, 7, and 8 out of the 12 ribs. Methods using rib cartilage include:

Rib Cartilage Dicing

1. Carving the rib cartilage into the shape of an implant and grafting it

2. Slicing the rib cartilage thinly and layering it to create shape and grafting it

[Prevents the warp phenomenon]

3. Dicing rib cartilage or ear cartilage, septal cartilage, etc., and placing it in the area

[Advantages] Safe, clear shape, maintains sufficient volume

[Disadvantages] Early bending and curvature, donor-site scarring, anesthesia or surgery time burden

< Autologous Dermofat >

April 31 Plastic Surgery paper on the use of autologous dermofat grafting

(Using dermofat grafting in revision rhinoplasty)

April 31 Plastic Surgery autologous dermofat

1. Harvested from the area with the thickest dermis

2. A harvesting method that minimizes dermal irritation and reduces wound-healing problems

3. Special molding technique

① Lowers the absorption rate by 30-40%

② Solves the existing donor-site wound-healing issues

[Advantages] Safe, sufficient volume, hides scars, stabilizes contracture or inflammation

[Disadvantages] Absorption, wound-healing issues

Long-term follow-up results over 10 years

Both tissues were safely and usefully used as grafts for the nasal bridge in contracted nose correction, but after long-term follow-up, that is, after more than 10 years, we concluded that it is better in the long run to consider the problems of the overlying skin at the early stage of corrective surgery.

Contracted nose correction surgery also begins with a focus on reconstruction and restoration, but as time passes, the desire to improve the aesthetic aspects continues to grow.

Next time, we will talk about methods for maintaining the results, both by the medical staff and by the patient.

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