We Performed 3rd Revision Augmentation Rhinoplasty For Asian Patient

Tertiary Asian Revision Nose Job

We performed an augmentation rhinoplasty a procedure designed to enlarge the nose on a patient with an Asian facial structure who had previously undergone two rhinoplasty surgeries at a different clinic. The procedure aimed to both increase the length of the nose and enhance its forward projection. During the initial consultation, we identified the following issues:

- Retracted columella

- Under-projected nasal tip

- Flattened nasal dorsum (bridge)

- Irregularities along the nasal dorsum (notably sharp-edged protrusions, particularly on the left side)

- Depressions in the upper region of the nostrils

- Significantly small nasal bone volume

We planned a tertiary revision rhinoplasty—utilizing an open approach and a micromotor—to increase nasal projection and augment the nasal dorsum, employing both temporal fascia and rib cartilage.

Intraoperative Findings

Irregularities were observed on the nasal dorsum (suspected to be remnants of previously placed, diced cartilage fragments).

The structural support for the nasal tip was extremely weak. The skin of the nasal tip appeared thick and oily.

Surgical Details

The procedure was initiated using an open approach. Irregularities on the nasal dorsum were corrected with the aid of a tungsten burr attached to a micromotor. Temporal fascia was layered (doubled) and placed over the nasal dorsum to both camouflage the existing irregularities and provide augmentation to the bridge. A "tongue-in-groove" technique and septal extension grafts were utilized. Cap grafts were placed, and marginal rim grafts were inserted into the weakened nasal alae. This achieved both an increase in the length of the nose and a more substantial appearance when viewed from the side.

For patients with Asian facial features and almond-shaped (slanted) eyes, excessive reduction of the nasal hump is not advisable!

In patients with prominent cheekbones and almond-shaped eyes—as is the case with this patient—reducing the nasal hump during rhinoplasty can exacerbate a "flat" nasal appearance and make the distance between the eyes seem wider. In such cases, augmenting the nasal dorsum can help the nasal bridge appear narrower from a frontal view and create a more natural appearance in the intercanthal (between-the-eyes) region. Simply put, if the apex of a triangle is reduced, it inevitably appears wider from the front; the same principle applies to the reduction of a nasal hump.

Advantages of Using Fascia in Augmentation Rhinoplasty

The use of the patient’s own fascia—a tissue harvested from their own body—in revision or augmentation rhinoplasty offers the following advantages:

- It utilizes fresh, autologous tissue with a robust blood supply, which is particularly beneficial for patients at risk of circulatory compromise.

- As a soft tissue, it is highly effective for smoothing out irregularities along the nasal dorsum.

- It carries a lower risk of infection compared to synthetic (industrial) grafts.

- While the placement of rigid grafts such as crushed or block cartilage on the nasal dorsum may not cause visible asymmetry during the immediate postoperative period (due to swelling), it can lead to asymmetrical contours in the long term as seen in this patient once the postoperative edema has fully resolved. In the long term, fascia provides a smooth augmentation, much like the effect of an injected filler.

- It is easily harvested; for instance, a temporal fascia graft can be readily obtained from the temple region.

- When block cartilage grafts—such as rib cartilage—are placed on the nasal dorsum, issues can arise, such as the graft shifting to the right or left, or moving when the patient smiles.

Comparing the patient’s postoperative images with the preoperative ones, it is evident that a smoother appearance has been achieved on the nasal dorsum, along with a natural increase in the volume of the nose.

You can read articles related to "revision rhinoplasty" prepared by Dr. Murat Enöz and published on this website via this search result link (you can see the articles by clicking on "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=revision+rhinoplasty

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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