Background: Augmentation of the nose is a frequently needed maneuver in rhinoplasty surgery. This is particularly needed in many ethnic patients who are genetically prone to low and wide nasal bones and lack of an elevated straight dorsal line. Dorsal augmentation requires some form of material which can be either synthetic or harvested from the patient. This has lead to an historic and controversial debate between nasal implants vs. cartilage grafts.
While the use of nasal implants may be controversial and prone to a higher long-term rate of complications, they are the most widely performed method for nasal augmentation. The most common material used is silicone and they are manufactured in a wide range of styles and sizes. The benefits of silicone in the nose, like the rest of the face and body, is that they are easily inserted and also easily removed.
Implant materials are most safely used in the dorsum or bridge of the nose. Keeping an implant material off the tip of the nose from just under the skin is the surest method to avoid complications. The dorsal skin can tolerate implant materials fairly well as the skin can be stretched more easily and it has an uninterrupted blood supply when an open rhinoplasty is used to place it.
The size of the most commonly used nasal implants has a thickness ranging from 2mm to 5mms for most styles of implants. For some patients with very low nasal bridges/nasal dorsal concavities, a custom nasal implant design may be needed for optimal dorsal line elevation.
Case Study: This 30 year-old male had a history of a prior rhinoplasty that used a standard sized silicone implant of 5mms thickness. While he clearly was improved over his natural nasal shape, he desired further nasal height as it approached the radix and glabellar areas. He also wanted the bridge area to be wider to have a more masculine appearance. The tip had a downward inclination and also needed to be elevated. A custom nasal implant was designed that provided 8mms of dorsal height and 12mms of width that tapered downward to the tip. The nasal implant length was 40mms.
Under general anesthesia, an open rhinoplasty was performed and his existing silicone nasal implant was removed. The new custom nasal implant was placed and one end of it was placed and secured under the dome cartilages. The tip of the nose was built up with ear cartilage grafts to increase tip projection.
A custom nasal implant can be used to create dorsal nasal dimensional changes that can not be achieved by standard implant designs. This approach is usually done when the patient already has an dwelling nasal implant that has proved inadequate for their aesthetic nasal needs. It is important in a nasal implant design that its size not stress the overlying thin nasal skin excessively.
Highlights:
1) A dorsal augmentation rhinoplasty builds up the bridge or dorsal line of the nose.
2) Nasal implants are frequently used because of their simplicity and reliable amount of smooth augmentation.
3) A custom nasal implant can be used when the traditional sizes of nasal implants are inadequate.
Dr. Barry Eppley
Indianapolis, Indiana