Rhinoplasty is one of the most complex surgical procedures in Plastic Surgery, which demands from the surgeon, knowledge, expertise, precision and the most optimal result in each particular case.
Functional aesthetic alterations, complications, undesirable results and patient dissatisfaction, are increasingly increasing in the daily consultation of the specialist.
The most common complaint of postoperative dissatisfaction is discomfort with the nasal lobe or tip, which is the most difficult aspect to correct in the nose.
Among the most frequent deformities is the impingement of the nasal tip, the ill-defined tip, the under the projected tip, the ptosic, asymmetric tip, the deviated tip and the alar impingement, among others.
Generally, the cause of the poor results is the lack of adequate preservation of the nasal support structures of the tip and their mechanisms of action (the lower lateral cartilages and the properties of the ligaments).
A great variety of techniques have been described to recreate the support structures of the nasal tip and its vectors, as well as a variety of graft materials, among which the following stand out the cartilages of the nasal septum, the ear shell and of the ribs; skull bone, olecranon, iliac crest, bone and tissue bank, and alloplastic materials; and the broadest spectrum for the implantation, configuration and fixation of such materials.
Many of these techniques and materials improve the projection of the nasal tip and its definition, but problems such as wing impingement, asymmetries of the nasal wings, asymmetry of the tip, and the collapse of the anterior nasal leaflet remain unremarkable addressed.
Materials And Methods
There were 345 patients who underwent secondary and/or revision rhinoplasty by Dr Germán G. Rojas Duarte, in a period of time between 2003 and 2013, of which in 110 the auricular concha graft was used for reconstruction of the alar cartilage.
A retrospective study was carried out on the results of the applied techniques for the management of the nasal tip, asymmetries and aesthetic and functional alterations caused by previous surgeries. Likewise, a review was made of the patient’s clinical history, the annotated clinical examination and the profilometry data of the patients who underwent secondary and/or revision rhinoplasty. Likewise, a database was created in which measurements, diagnoses and alterations of the nasal tip and preoperative dorsum, operative manoeuvres, use of grafts, evolution and results were recorded.
The study patients attended controls in which photographic records were made of the front and profile at six months, one and two years, as well as the respective annotations of their evolution and the final results of the same.
Statistical analysis was performed in which an association was sought between postoperative results, diagnosis and pre-surgical alterations.
Reconstructive Surgical Technique
The surgical technique used in the reconstruction of alar cartilage with an auricular shell graft is a technique with which harmonious and natural functional results are obtained, which last with the passage of time and ageing.
Graft Collection And Design
The graft is taken from the anterior aspect of the pinna, 2 mm lower than the internal edge of the helix, in order to camouflage the incision scar. Subsequently, the dermoperichondrial flap of the cymbal conchae is raised to reconstruct the alar cartilage and, if necessary, the cavum conchae to recreate and define other structures of the nasal tip (Figure 1). It is very important to preserve the cartilaginous structure of the helix root to avoid aesthetic deformities in the natural appearance of the pinna. Careful and thorough hemostasis is performed with the placement of a drain to avoid postoperative hematoma.…