Five South Korean plastic surgeons (Drs. Seo, Kwon, Kim, Lim, and Park) writing in the Archives of Facial Plastic Surgery have reported their experience with a new but relatively simple technique for better defining the tip of the nose in Asian rhinoplasty.
The Asian nose is typically more bulbous at its tip than in the non-Asian. In some patients, the tip may appear to be rotated upward without much forward projection.
The best way to define the tip entails grafting of spare pieces of cartilage harvested from the patient's own nasal septum (cartilage between the nostrils), but there are technical challenges.
For one, there is less septal cartilage available to spare in the Asian nose and so the amount that can be grafted may be insufficient to effect a noticeable change. Trying to suture tiny layered fragments of fragile cartilage together can be difficult.
For another, common problems after such surgery include rotation or displacement of the grafts to an undesired angle.
To address both of these problems, the authors have come up with an ingenious solution: glue. Using a topical skin adhesive (Dermabond ® - Ethicon, Inc.), the surgeons have devised a method to create prefabricated, three-dimensional implants of glued-together septal cartilage fragments that can then be inserted beneath the skin of the nasal tip through a small incision made along the margin of the nostril.
No significant protrusions or dislocations were noted and no inflammation, redness, or pain were reported in 42 patients over an average follow-up period of 18 months. Tip projection achieved with the technique was excellent compared to using conventional techniques (or cartilage from other sources such as the ear or rib) in which grafted implants are easily displaced or rotated.
Also noted as a nice side-effect of better nasal tip projection and elongation was a significant reduction in the width or flare of the alar base, decreasing the need for additional alar base resection.