Heung-Kyu Kim1, Seung Chul Rhee. 1. From the *Elle Plastic Surgery Clinic, and †Department of Plastic and Reconstructive Surgery, Ilsan Paik Hospital, Inje University, Seoul, Republic of Korea.
Abstract
BACKGROUND: Although there are several reports about the use of dermal or dermofat grafts, there are only a few reports about augmentation rhinoplasty performed using a "pure" dermal graft. Authors introduce the refined techniques, clinical experience, and report an aesthetically pleasing result of augmentation rhinoplasty performed using a folded pure dermal graft. MATERIALS AND METHODS: Between 2008 and 2012, augmentation rhinoplasty was performed in 68 cases using a folded pure dermal graft. Pure dermal graft was harvested from one side of the buttock close to the intergluteal crease and the graft length was approximately 7-8 cm and the graft width was 1.5-2 cm, and the epidermis and fat were completely removed. Tip-plasty was performed using a conchal or septal cartilage as a columellar strut and an onlay graft. Pure dermal grafts are folded into 2 layers and sculpted to the desired size and shape, and are inserted into the supraperiosteal pocket. Ultrasonography was performed to know the absorption rate of the folded pure dermal grafts. RESULTS: The thickness of a dermal graft at postoperative 12 months was 60.3% of that at postoperative 1 month. Even with 39.7% of reduction in the thickness of the dermal graft, the height of nasal dorsum after postoperative 1 year is considered to be well maintained. Among the 68 cases that underwent augmentation rhinoplasty (43 primary and 25 secondary), most of the patients sustained consistent cosmetic results; however, 12 patients (17 %) showed over-absorption, under-absorption or contour irregularity of the dermal graft, and slight erythema. There were no aesthetically or medically serious problems needing secondary rhinoplasty such as hematoma formation, warping of the graft, graft extrusion, infection, and rejection of the graft. DISCUSSION: Augmentation rhinoplasty using a folded pure dermal graft has many advantages and is a very useful surgical option in patients who have an aversion to the use of artificial implants, who want to change the postoperative appearance of their nose due to insertion of an artificial implant into a more natural appearance, and when there is too much thinning of the skin due to repeated insertion of silicone implants.
BACKGROUND: Although there are several reports about the use of dermal or dermofat grafts, there are only a few reports about augmentation rhinoplasty performed using a "pure" dermal graft. Authors introduce the refined techniques, clinical experience, and report an aesthetically pleasing result of augmentation rhinoplasty performed using a folded pure dermal graft. MATERIALS AND METHODS: Between 2008 and 2012, augmentation rhinoplasty was performed in 68 cases using a folded pure dermal graft. Pure dermal graft was harvested from one side of the buttock close to the intergluteal crease and the graft length was approximately 7-8 cm and the graft width was 1.5-2 cm, and the epidermis and fat were completely removed. Tip-plasty was performed using a conchal or septal cartilage as a columellar strut and an onlay graft. Pure dermal grafts are folded into 2 layers and sculpted to the desired size and shape, and are inserted into the supraperiosteal pocket. Ultrasonography was performed to know the absorption rate of the folded pure dermal grafts. RESULTS: The thickness of a dermal graft at postoperative 12 months was 60.3% of that at postoperative 1 month. Even with 39.7% of reduction in the thickness of the dermal graft, the height of nasal dorsum after postoperative 1 year is considered to be well maintained. Among the 68 cases that underwent augmentation rhinoplasty (43 primary and 25 secondary), most of the patients sustained consistent cosmetic results; however, 12 patients (17 %) showed over-absorption, under-absorption or contour irregularity of the dermal graft, and slight erythema. There were no aesthetically or medically serious problems needing secondary rhinoplasty such as hematoma formation, warping of the graft, graft extrusion, infection, and rejection of the graft. DISCUSSION: Augmentation rhinoplasty using a folded pure dermal graft has many advantages and is a very useful surgical option in patients who have an aversion to the use of artificial implants, who want to change the postoperative appearance of their nose due to insertion of an artificial implant into a more natural appearance, and when there is too much thinning of the skin due to repeated insertion of silicone implants.