Stabilisation of Columella using Ear Cartilage in Secondary Rhinoplasty

An Asian rhinoplasty is one of the most popular procedures in plastic surgery. The anatomical characteristics of the Asian nose are quite different from those of other races, including low dorsum height, short columella, a thick soft tissue covering on the tip with flaccid lower lateral cartilage, and a sunken midface with relative protrusion of the mouth due to maxilla or premaxillary retrusion.

Secondary surgery is also increasing in frequency due to greater patient sophistication and higher expectation that the end rhinoplasty result to be more harmonious with the patient's overall facial structure. In these circumstances, a rhinoplasty using autologous ear cartilage gives strong support and enough amount of the cartilage to correctly deform the structure and midface skeletal retrusion. If properly performed with enough experience, a ear cartilage rhinoplasty will provide excellent and long-lasting results with low risk.

This week, IFAAS Faculty Dr Jae Yong Jeong, a plastic surgeon with 15 years of Asian Rhinoplasty experience from South Korea shares his exclusive technique on stabilisation of columella using ear cartilage in secondary rhinoplasty (This particular patient had 3 prior rhinoplasty surgeries) in the following video:

A major problem in rhinoplasty, if not the largest problem, is the collapse of the tip of the nose, which manifests as reduction of the nasolabial (NL) angle and the loss of nasal tip projection.

What is the cause of nasolabial reduction and the loss of nasal tip projection?

This process occurs due to the loss of mechanical and structural support of the nasal tip, which can be caused by factors including:

1) Unfavourable anatomical characteristics of the alar and upper lateral cartilage, the septal cartilage, and its ligaments;

2) Ethnically specific anatomical features; the aging process

3) The influence of gravity;

4) The size of the nose;

5) Previous nose or septum surgery;

6) The loss of the upper incisors and upper alveolar ridge atrophy;

7) Trauma and infections of the nose and its supporting structures.

Correction of this deformity requires relatively complex operating procedures.

The columellar strut is one of the most important solutions to this difficult problem in both functional and aesthetic rhinoplasty. The most logical solution to the problem of a distorted nose tip lies in solid tissue implantation, which, in this case, is made out of the patient's own ear cartilage.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4656167/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738128/

Enjoyed this article? Stay tuned for our next week's newsletter, Dr Jeong will be sharing his personal technique on Dorsal refinement with Deep temporal fascia.

Learn more about the cutting-edge techniques in Asian Rhinoplasty and practise the techniques through hands-on training by registering for:

Fresh Cadaver Hands-on Master Class

Advanced Hybrid Facelift & Asian Rhinoplasty

September 14-15, 2018, Singapore

The 2 days Hands-on Master Class is designed to focus on the following 3 major topics: * Advanced Hybrid Face Lift combing surgical facelifting with threads * Facial Fat Transfer for Total Facial Rejuvenation * Advanced Asian Rhinoplasty: Basics, Harvest of Grafts, Asian Tip Plasty, Complication Management