Revision rhinoplasty of Asian noses: analysis and treatment.

OBJECTIVE

To analyze postrhinoplastic deformities in Asian noses and the differences between noses of white and Asian patients. For a successful revision rhinoplasty, one of the most difficult and unpredictable procedures in plastic surgery, an accurate diagnosis and analysis of error are needed.

DESIGN

A retrospective study of 84 revision rhinoplasties performed by the senior author (C.H.P.) from January 2001 through December 2006.

SETTING

Tertiary care rhinology clinic.

PATIENTS: The study population comprised 84 patients (28 men and 56 women), with a mean age of 36 years (range, 20-58 years).

MAIN OUTCOME MEASURES: The postrhinoplastic deformities were divided anatomically into the upper, middle, and lower thirds of the nose with further subdivision of the deformities within each group.

RESULTS

In the 84 patients studied, the mean number of rhinoplasties per patient was 2.3. Of the 84 patients, 75 (89%) underwent revision rhinoplasty for upper-third deformities. Overall, deviated dorsum was the most common deformity, followed by irregular dorsum and asymmetric tip. Most of the upper-third deformities were treated with a rasp, camouflage graft, and expanded polytetrafluoroethylene (Gore-Tex; W. L. Gore & Associates Inc, Flagstaff, Arizona) augmentation. To correct lower-third deformities, mostly tip problems, we used transdermal and interdermal sutures.

CONCLUSIONS

In Asian noses, unlike noses of white patients, the most common cause of revision rhinoplasty is upper-third deformities. As most upper-third deformities in Asian noses result from inadequate insertion or dislocation of the augmentation graft material, we must be careful in our selection of implants and augmentation.