Secondary augmentation rhinoplasty with dermofat graft.

Yang, Soon Jae; Kim, Byung Sang; Kim, Jae Hoon

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Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 1998;25(1):152-160.
Published online January 1, 1998.

Secondary augmentation rhinoplasty with dermofat graft.

Soon Jae Yang, Byung Sang Kim, Jae Hoon Kim

Department of Plastic and Reconstructive Surgery, College of Medicine Soonchunhyang University, Seoul, Korea.

Abstract

The nose is an important aesthetic projection affecting the profile of the face. Correction of the flat nose is one of the most popular aesthetic procedures in the orient. The Asian nose is characterized by flat, bulbous appearance due to thick and dense skin. Flared nostrils and restriction of nasal tip projection due to underdevelopement of the medial crus of alar cartilage, and short columella are also characteristic of Asian noses. Nasal augmentation has taken an increasingly important role in rhinoplasty. There are many procedures and materials for augmentation. Various implants have been used for many years but several kinds of complications have still occurred after these augmentations. After the primary augmentation rhinoplasty using foreign body such as paraffin, silicone, and ivory, some patients experienced complications. Experienced complications such as : 1) thinning of the skin on nose dorsum 2) hypertrophy of capsule 3) displacement of nasal tip 4) thinning of the skin creating dead space 5) movable implants In above cases, we could not reapply with silastic implant. In general, the use of foreign materials was mentioned only to be condemned for the purposes of above cases. The failure and complication rates were high, and the complications frequently result in distortions that were permanent and irreparable. In view of the availability, variety, and quality of autogenous materials, it was impossible to recommend anything but autogenous materials for secondary rhinoplasty. Dermofat was an autogenous material that could be as effectively used in nose dorsum. Its clinical record of survival and contouring in the author's practice has been excellent. Originally 276 patients underwent primary augmentation rhinoplasty. Out of the 276, 29 patients with nose complications underwent secondary augmentation rhinoplasty with dermofat. Our study, which began in September 1993 and ended in September 1996, concerned these 29 Patients. The follow up interval ranged for 3 to 36 months. Tissues must have time to heal so that an accurate assessment of the secondary procedure is made possible. The minimal time of two or three months is recommanded of patients with previous operation but we removed foreign body and then simultaneously augmented with dermofat when there is no evidence of inflammation and further resolution. As part of the procedure in order to minimize the scar on donor site, we harvested dermofat, in an elliptical shape, 5cm above from infra-gluteal fold. We harvested about 10% more dermofat than was required because of its potential decreased in volume caused by primary contracture and resorption. Primary contracture is the main cause of the decrease in volume. To prevent contracture, resorption and displacement of the dermofat, we have to accurately fix the implant in the central porticn of the nose. Using this method, we could have prevented complications and yielded more satisfactory results by accurately fixing the dermofat in the central portion.

Keywords: Augmentation rhinoplasty; Dermofat graft

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