• #5-2. Rhinoplasty Techniques for an Attractive Outline of the Nose


    The Importance of Nasal Tip Height

    The shape of the alar cartilage determines the aesthetics of the nasal tip. In particular, the middle crus and medial crus of the columella provide upward support much like the columns of a tent (Image 3). This cartilage is thin and weaker in Asians which provides weaker support and creates a rounded nasal tip.


    Image 3. The alar cartilage.


    To create a taller triangle of the bottom of the nose, the column (crus) should be reinforced. Ear cartilage and septal cartilage are used for reinforcing the support.

    There are three types of cartilages in the human body; hyaline cartilage, fibrous cartilage, and elastic cartilage. The ear cartilage, which is an elastic cartilage, is the most similar to the alar cartilage (costal cartilage or septum fall in the hyaline cartilage category). I use the ear cartilage often but it is difficult to create a straight structure due to its curved shape. It can be folded to create a stable, straight shape (Image 4).


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    Image 4. Ear cartilage is curved but can be folded to create a straight structure to be used in nasal tip correction.


    When harvesting the nasal septum, preserve the supportive column and harvest only the inner cartilage. The cartilage is tied to the existing nasal septum for support and elevation of the nasal tip (or can be used separately to form a column shape). This method is relatively convenient as harvest and transplant can be carried out in a single procedure but it can make the nasal tip rigid.

    Medpor or L-shaped silicone implants were used in the past for nasal tip elevation, however, they have fallen out of favor recently (Image 5).


    Image 5. L-shaped silicone is visible in CT imaging.


    -To be continued-

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