• Archives of Plastic Surgery
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• 제35권1호
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• pp.86-91
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• 2008

Purpose: The performance of rhinoplasty on the patient who has already undergone unsatisfactory results or complications after augmentation rhinoplasty is a challenging surgical problem. Because the dead space is remained after removal of the foreign body and the thickness of the skin is not even, the deformity would be more conspicuous if the nose is reconstructed again with hard implant only or autogenous cartilage. In these cases, the autogenous fascia can be used to get a good result. We present our clinical experience of secondary rhinoplasty using Scarpa's fascia of lower abdomen. Methods: Thirty-two patients underwent the procedure from March of 2002 to February of 2007. Nine patients were reconstructed with Scarpa's fascia only, eighteen patients were reconstructed with silicone implant and fascia, and five patients were reconstructed with cartilage and fascia for secondary rhinoplasty. Results: There were no major complications. Most of the patients were satisfied with the results. The deviation of the silicone implant and postoperative hypertrophic scar of the donor site were seen in one case each. Postoperative absorption of fascia were seen in two cases using Scarpa's fascia only. Conclusion: Secondary rhinoplasty using Scarpa's fascia is very useful method which offers a minimized donor site scar, low complication rate, shorter operation time and patient satisfaction and prevents the alopecia caused by the harvest of temporalis fascia.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.785-791
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• 2007

Purpose: Paraffin has been used to augment depressed nasal contour for many years by illegally. Reported complications of nasal paraffinoma were skin thinning, displacement of nasal profile, redness, chronic inflammation and malignant change to skin cancer. The current authors report results of the secondary rhinoplasty after excision of nasal paraffinoma. Methods: Through the open rhinoplasty incision, paraffinoma was removed under direct vision. Saline irrigation and meticulous hemostasis were performed. Simultaneously, the secondary depressed nasal deformity was corrected with autogenous dermofat graft harvested from inferior gluteal fold. The dermofat was fixed to the nasofrontal area with bolster suture, and the interdormal area of the tip. Results: A total of 13 patients underwent secondary augmentation with autogenous dermofat graft after removal of paraffinoma from 2000 to 2004. The mean follow-up period was 15 months. There were no postoperative complications. All patients were satisfied with their surgical results. However, there were 10 to 20 percent resorption of the grafted dermofat. Conclusion: It is suggest that autogenous dermofat be one of good materials for the correction of the secondary deformity after removal of nasal paraffinoma. In addition, autogenous dermofat graft presented easy harvesting and manipulation for transfer, high survival rate by firm fixation to the recipient site and stable surgical results.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.53-62
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• 2011

Purpose: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. Methods: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. Results: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. Conclusion: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

• 대한두개안면성형외과학회지
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• 제11권2호
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• pp.77-84
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• 2010

Purpose: The nasal bones are the most common fracture sites of the facial bones, and a careful reduction may still result in secondary deformities, such as saddle nose, deviated nose, hump nose etc, requiring secondary cosmetic rhinoplasty. Therefore, this study examined the clinical characteristics of nasal bone fractures to propose guidelines for patient selection and surgical procedures to achieve more satisfactory results and to prevent secondary deformities with simultaneous augmentation rhinoplasty and bony reduction. Methods: The study was based on 26 out of 149 nasal bone fracture patients who underwent simultaneous augmentation rhinoplasty with bony reduction between May 2008 and April 2009. Retrospective analysis was performed according to the clinical data, surgical techniques and postoperative results. Results: Of the 26 patients, there were 15 males and 11 females. The incidence according to the Stranc's classification revealed that 62% of patients were injured by a frontal impact and 38% by a lateral impact. Frontal impact plane I (50%) was the most frequent type. At the follow up, 18 (81.2%) out of 22 patients were satisfied with their postoperative outcome, and the remaining 4 patients were fair. No one was dissatisfied. However, 5 cases in 3 patients (23%) had some complications; minimal implant deviation in 2 cases, minor irregularity on the nasal dorsum in 2 cases and palpable implant movement under palpation in 1 case. None of these cases required surgical correction. Conclusion: With the proper guidance, simultaneous augmentation rhinoplasty with bony reduction can prevent secondary deformities and satisfy the cosmetic outcomes.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.607-614
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• 1996

중앙안면골 골절 환자에서 비골 골절과 동반되는 경우가 많으며, 주로 안면골 골절의 정복시 비골도 동시에 정복하지만 여러 가지의 원인에 의하여 이차 비성형술을 시행하여야 하는 경우가 많다. 그러므로 중앙안면골 골절 환자의 초진시 비골 골절에 대한 정확한 진단과 정확한 비골 골절의 정복 그리고 일차 비골 골절의 정복후 이의 적절한 유지와 고정이 중요하지만 이차 비성형술의 가능성에 대비하여야 하며, 일차 비골 골절의 정복시 대칭적인 정복을 시행함으로서 비교적 간단하게 이차 비성형술을 시행할 수 있으리라 생각되었다. 또한 중앙안면골 골절환자에서는 비부의 연조직이나 연골의 이차변형에 의하여 이차 비성형술을 시행할수도 있으므로 일차 수술후 주의깊은 관찰이 요구된다. 이러한 이차 비성형술에는 자가이식재 및 Silicone이나 $Medpore^{(R)}$등이 이용될 수 있으며, 특히 인공이식재의 경우 공여부의 정확한 형성과 적절한 고정이 필수적이며 향후 이러한 인공이식재의 안정성에 대한 더 많은 연구가 이루어져야 할것으로 사료된다.

• Archives of Plastic Surgery
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• 제44권1호
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• pp.59-64
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• 2017

Background Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. Methods Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. Results Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. Conclusions It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

• 대한두개안면성형외과학회지
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• 제23권5호
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• pp.211-219
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• 2022

Background: Correction of secondary cleft nose deformity is one of the most important portions in the management of cleft lip patients. Various techniques have been introduced to achieve adequate shape, balance, and symmetry of anatomical landmarks. None of these methods can claim to universally solve all aspects of the problems encountered in secondary cleft deformity surgery. Some authors overlook the aspect of functional rehabilitation with regard to nasal respiratory pathway problems, which is present in over 90% of the patients. This study aimed to evaluate the aesthetic and functional improvements of the authors' non-destructive technique. Methods: With over 15 years of experience, open rhinoplasty was performed, which included total remodeling of the deformed lower lateral cartilage using several suture fixation techniques without any graft or implantation with septo-turbinoplasty. A total of 150 questionnaires were sent by e-mail, but 55 completed questionnaires were returned. Surgical outcomes were evaluated using questionnaire responses, and outcomes were divided into five categories each for esthetic and functional analyses. Results: The satisfaction rate ranged from 75 % to 98%, which means "more or less," "very much," and "absolutely yes" in the esthetic and functional viewpoints. Conclusion: The results of this study strongly recommend performing the suture fixation technique and functional rehabilitation simultaneously for cleft lip/nose correction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제19권2호
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• pp.135-142
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• 1997

Despite the current accomplishments with the repair of cleft lips, the surgical management of the nasal deformity remains a functional and aesthetic dilemma for patients, their families, and reconstructive surgeons. Recent improvements in the understanding and technical execution of te primary cleft lip repair have significantly reduced secondary sequelae and the consequent need for secondary surgical correction. But, secondary surgical corrections are necessary according to numerous factors. Such factors include the secondary surgical corrections are necessary according to numerous factors. Such factors include the severity of the initial deformity, the surgical plan, precision of execution of the primary repair, and success of the postoperative management. We preformed the secondary correction of cleft lip and palate in 11 patients via various methods. In conclusion, primary repair of cleft lip and palate patients is the most important to prevent the secondary deformities, and most of cleft lip and palate with secondary deformities must be treated with combined cheiloplasty and rhinoplasty.

• Archives of Plastic Surgery
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• 제32권1호
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• pp.37-42
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• 2005

The human nose is located in the center of the face and it's cosmetic importance is high. The contour of the nasal dorsum and side walls play a major role in the shaping of the nose, and even a slight distortion may results in significant variance of the human facies. However, in the case of patients with wide nasal bone, augmention rhinoplasty can make nasal planes look wide, resulting in bulbous appearing noses or lateral borders of the nasal implant may be visible after the surgery making the final cosmetic results unsatisfactory. To solve such problems, from march, 1999 to march, 2004, the authors have performed augmention rhinoplasty in 36 patients. The cause of operations were as follows: flat nose 20, hump nose 5, deviated nose 4, secondary rhinoplasty 7. Paramedian osteotomy was performed at a distance that was the same as the width of the implant from the midline(5 mm + 5 mm). To prevent it from connecting to the roof at the lateral osteotomy line, intentional green stick fracture of the roof was performed. Agumentation rhinoplasty was done with either Silicone or Gortex and ear cartilage as a supplement. The follow up period was 2 weeks to 13 months with an average of 5.5 months. There were no infections and postoperative bleeding. As a result, the nose was augmented higher and narrower than before which we and the patient both found highly satisfactory.

• 대한구순구개열학회지
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• 제6권1호
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• pp.17-25
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• 2003

본 교실에서 최근 4년 동안 행해진 수술의 경향을 분석한 결과를 정리해 보면 이차 비기형의 교정은 양측성의 경우 비교적 이른 시기인 4-5세에 시행되었고 편측성의 경우에는 치조성형술(alveoloplasty)의 시행을 먼저 고려한 후 10세에서 13세 경에 시행된 것을 알 수 있었다. 교정부위는 편측성의 경우 비대칭을 교정하는 수술이 중점적으로, 양측성의 경우 비주 연장술이 중점적으로 행해졌는데 아동과 성인에서 모두 비주와 비첨 수술이 거의 90%정도를 차지하였다. 그 외에 비중격 성형술, 비공 성형술 등이 10% 내외로 시행되었다. 비첨 성형술은 양측성 구순열의 경우 모두Millard's forked flap으로 시행되었고 편측성의 경우 간단하게 연골을 박리하고 Tajima suture를 시행한 경우가 아동에서 77%, 성인에서 30% 였다. 개방형 비성형술을 시행한 경우는 아동에서 40%, 성인에서 71%를 보였다. 자가 연골이식을 시행한 경우는 아동에서 23%, 성인에서 70%를 보였다. 비중격의 편향을 보이는 편측성 구순열 환자 모두에서 비중격 수술이 시행된 것은 아니었는데, 비익의 비대칭에는 적극적인 치료가 이루어진 반면 비중격의 비대칭에는 그렇지 못한 것을 알 수 있었다. 대부분의 수술이 심미적인 부분에 초점을 맞추고 있었으며 비중격 성형술의 시행에 있어 비강폐쇄의 객관적 평가가 이루어지지 않은 것이 개선해야 할 부분으로 사료되었다.