eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Rhinoplasty, Multiracial: Follow-up

Author: Manoj T Abraham, MD, FACS, Clinical Assistant Professor, Division of Facial Plastic & Reconstructive Surgery, New York Medical College, New York Eye & Ear Infirmary; Private Practice, Facial Plastic, Reconstructive & Laser Surgery PLLC
Coauthor(s): Thomas Romo III, MD, FACS, Chief, Clinical Instructor, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary
Contributor Information and Disclosures

Updated: Oct 7, 2008

Outcome and Prognosis

Using techniques described herein, the vast majority of multiracial patients undergoing rhinoplasty are happy with surgery outcome. Romo and Shapiro reported 100% satisfaction with cosmesis in 75 multiracial patients 2-7 years after they underwent rhinoplasty with autogenous cartilage grafts and techniques described in this chapter (see Images 3-4).16 In a follow-up study of 187 patients who received Medpor implants, 35.3% of whom were multiracial, only 1 patient requested revision of a dorsal implant. This favorable result is largely predicated on ensuring that patients understand the goals and limitations of ethnic rhinoplasty and have realistic expectations of surgery.

Future and Controversies

Open approach

The art and science of rhinoplasty is continually evolving. In recent years, a shift toward open-rhinoplasty techniques has occurred, especially in challenging cases such as multiracial rhinoplasty. The authors believe that the open decortication approach offers the best visualization, allowing for accurate graft placement when needed. Achievement of adequate aesthetic reconstruction may be more limited with classic intranasal techniques, which were used more extensively in the past.

Osteotomies

The need for osteotomies during multiracial rhinoplasty has been debated in the literature. Hubbard, Stucker, Larrabee, Nishioka, and others contend that the illusion of a wide nasal dorsum is created by lack of dorsal height in multiracial persons. These authors advocate placement of a dorsal augmentation graft without nasal osteotomies. Matory and Falces suggested that osteotomies actually might overnarrow the dorsum with respect to the lobule, creating a racially incongruous appearance.3 However, the authors agree with Rohrich, who recommends osteotomy if the nasal bony width is more than 80% of the intercanthic distance. Narrowing of the upper third of the nose must be performed in proportion with alar base reduction and with increased tip projection and sculpting to ensure a balanced appearance to the nose.

Autografts versus alloplasts

The quest continues for the ideal autologous or alloplastic implant material when adequate nasal septal cartilage is not available. This topic is particularly relevant to multiracial rhinoplasty because septal cartilage is often deficient in these individuals. Other autologous and homologous graft materials have been considered. Auricular cartilage may be harvested, but use is often restricted because of the innate curvature of the cartilage. Monasterio and Michelena described the use of rib cartilage for correction of the nonwhite nose, but warping of the graft is a problem. Use of split calvaria, iliac, olecranon, and other bony graft material has also been proposed. Almost all homologous graft materials (eg, irradiated cartilage) and many autologous grafts are prone to resorption or fracture. All autologous graft materials, excluding nasal septal cartilage, are saddled with the inherent and potentially significant morbidity of a second operative donor site and additional operative time.

On the other hand, autologous grafts are less likely to become infected or extrude. Toriumi points out that, unlike alloplastic material, autologous grafts are unlikely to permanently harm the overlying soft tissue envelope of the nose.17

Because of availability and carving ease, many synthetic materials have been introduced for use in nasal reconstruction. These materials include silicone rubber (Silastic), polyamide mesh (Supramid), polytetrafluoroethylene carbon (Proplast, Teflon), polypropylene mesh (Prolene), polyethylene terephthalate (Mersilene mesh), and expanded polytetrafluoroethylene (e-PTFE, Gore-Tex). However, high rates of infection, extrusion, and resorption, along with excessive fibrosis and contracture due to chronic foreign body response, have left most surgeons dissatisfied with alloplasts.

Most of these implant materials are not rigid enough to provide structural support and have been used primarily for augmentation purposes. L-shaped silicone struts provide some structural support and have been used in multiracial rhinoplasty because the thick overlying skin better protects the implant. Deva et al reviewed their experience with silicone nasal implants in 422 patients, the majority (98%) of whom were women from Southeast Asia.18 The study highlighted a 9.7% complication rate due to hemorrhage, displacement, extrusion, overprominence, supratip deformity, or excessive pressure, requiring removal of the graft. The study reported a 15.8% patient dissatisfaction rate.

In the authors' opinion, Medpor alloplastic implants offer the greatest promise. Medpor implants are rigid and allow fibrovascular ingrowth, thus promoting stability and resistance to infection. In 1998, Romo et al published a retrospective review of 187 patients who had undergone nasal reconstruction with Medpor implants (66 patients for multiracial rhinoplasty, 121 patients for revision surgery).19 Postoperative follow-up ranged from 6 months to 3.5 years, with an average of 26 months. Complications were limited to 5 patients (2.6%), all of whom had impaired healing secondary to heavy smoking, cocaine abuse, collagen vascular disease, or multiple previous surgeries. Of these, 3 patients had early infection and 2 patients had delayed infection necessitating implant removal. Implants were removed easily, without damage to the overlying soft tissue and skin envelope. Additional favorable long-term results have been published.

 


More on Rhinoplasty, Multiracial

Overview: Rhinoplasty, Multiracial
Workup: Rhinoplasty, Multiracial
Treatment: Rhinoplasty, Multiracial
Follow-up: Rhinoplasty, Multiracial
Multimedia: Rhinoplasty, Multiracial
References
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Further Reading

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Keywords

rhinoplasty, multiracial rhinoplasty, African American nose, Black nose, Negro nose, Asian nose, Latino nose, Hispanic nose, non-Caucasian nose, platyrrhine nose, mesorrhine nose, plastic surgery, nose job, nasal surgery, cosmetic surgery

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Contributor Information and Disclosures

Author

Manoj T Abraham, MD, FACS, Clinical Assistant Professor, Division of Facial Plastic & Reconstructive Surgery, New York Medical College, New York Eye & Ear Infirmary; Private Practice, Facial Plastic, Reconstructive & Laser Surgery PLLC
Manoj T Abraham, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association of Physicians of Indian Origin, American College of Surgeons, American Medical Association, American Rhinologic Society, American Society for Cell Biology, California Medical Association, Medical Society of the State of New York, New York Academy of Medicine, New York County Medical Society, Sigma Xi, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Romo III, MD, FACS, Chief, Clinical Instructor, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary
Thomas Romo III, MD, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

Medical Editor

Paul S Nassif, MD, FACS, Consulting Surgeon, Facial Plastic and Reconstructive Surgery, Spalding Drive Cosmetic Surgery and Dermatology
Paul S Nassif, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dean Toriumi, MD, Department of Otolaryngology, Associate Professor, University of Illinois Medical Center
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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