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Original Investigation |

Surgical Techniques for the Correction of Postrhinoplasty Depressed Scars on the Nasal Tip

Dong Hak Jung, MD, PhD1; Gaurav S. Medikeri, MS(ENT)2; Guen-Uck Chang, MD1; Sang Min Hyun, MD1
[+] Author Affiliations
1Department of Rhinoplasty and Facial Cosmetic Surgery, Shimmian Rhinoplasty Clinic, Seoul, South Korea
2Department of Nose, Sinus, and Allergy, Medikeri’s Superspecialty ENT (Ear, Nose, and Throat) Center, Bangalore, India
JAMA Facial Plast Surg. 2015;17(6):405-412. doi:10.1001/jamafacial.2015.0911.
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Importance  Augmentation rhinoplasty is common in the Asian population and the lack of suitable autologous material for augmentation has led to the use of alloplastic materials. Many of these patients develop complications, including a depressed dimple-like scar of the nasal tip. Causes of such dimpling include the use of large implants, infection, extrusion, and surgeon incompetence.

Objective  To describe the various techniques that can be used to correct dimpling of the nasal tip.

Design, Setting, and Participants  Data were retrospectively reviewed from 28 patients who had undergone surgical procedures from January 1, 2013, through July 31, 2014, in a rhinoplasty clinic in Seoul, Korea, for the correction of a contracted nose with nasal scars secondary to previous rhinoplasties. Data analysis was conducted from August 1, 2014, through February 16, 2015.

Interventions  Before surgery, a complete rhinological examination was conducted, digital photographs were taken, and an assessment was made regarding the severity of the dimpling, the condition of the nasal skin, and the underlying supporting structures. Based on these factors, the appropriate type of procedure was planned.

Main Outcomes and Measures  Patient satisfaction with change after surgery was assessed using a 3-point Likert scale (3 indicates satisfied; 2, fairly satisfied; and 1, dissatisfied). Outcomes were also reviewed by 2 surgeon-peers who gave an outcome score ranging from 1 to 10 (1 indicates a poor cosmetic outcome; 10, the best possible outcome).

Results  The nasal contour and tip symmetry were restored to aesthetic standards with these relatively simple techniques. Eleven patients (39.2%) were treated with unilobed flap, 4 (14.2%) with a bilobed flap, 3 (10.7%) with Z-plasty, 9 (32.1%) with soft-tissue interposition, and 1 (3.5%) with a transposition flap. Twenty-four of the 28 patients (85.7%) were satisfied with their outcomes and 4 (14.3%) patients were dissatisfied and were given a revision procedure, following which they were satisfied with their outcomes. The follow-up period ranged between 6 to 32 months (mean, 12.3 months). The mean surgeon-reviewed outcome score for soft-tissue interposition procedure was 8.0 of 10; for the unilobed flap, 8.0 of 10; for the bilobed flap, 7.5 of 10; for the transposition flap, 8.0 of 10; and for Z-plasty, 7.8 of 10.

Conclusions and Relevance  These techniques are reproducible and the choice of the technique depends on the shape, size, and location of the scar; skin condition; patient expectations; and the surgeon’s experience and comfort level with the procedure.

Level of Evidence  4.

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Figure 1.
Appearance of Dimple on the Nasal Tip After Silicon Implantation and Subsequent Removal Owing to Rejection

A 40-year-old man presented with a depressed nasal tip scar following rejection and removal of a silicon implant.

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Figure 2.
Images of a Patient Who Underwent Soft-Tissue and Cartilage Placement to Elevate the Depressed Scar Tissue

A, Before surgery. B, Six months after surgery. B-E, Photographs and illustration demonstrating the technique of securing the graft to the dimpled area of skin.

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Figure 3.
Images of a Patient in Whom the Unilobed Flap Was Used to Correct a Dimpling Deformity With a Pseudohump

A, Before surgery. B, Fourteen months after surgery. C-E, Photographs and illustration demonstrating the unilobed flap procedure.

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Figure 4.
Images of a Patient With Bilateral Dimpling Deformities With a Pseudohump

A and B, Photographs demonstrating the bilateral unilobed flap. C, Deformity seen after augmentation procedure. D, Image 8 months after bilateral unilobed flap procedure showing correction of the deformity.

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Figure 5.
Images Before and 12 Months After Surgery of a Patient With a Dimpling Deformity Without a Pseudohump After Rejection of the Silicone Implant

A, Before surgery. B, Twelve months after surgery. C and D, Photograph and illustration of bilobed flap repair that was performed with a revision rhinoplasty for augmentation.

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Figure 6.
Transposition Flap in a Patient With Extrusion of the Alloplastic Implant Over Which the Patient Had Placed a Skin-Toned Sticker

The patient had a contracted nose for which a revision augmentation rhinoplasty with dimpling correction was performed. A, Before surgery. B, Six moths after surgery. C and D, Photograph and illustration demonstrating the transposition flap technique.

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Figure 7.
Images Showing Depressed Nasal Tip Scars in a Patient Who Underwent Alar Rotation Flap for Alar Discrepancy

A, Image after alar rotation flap demonstrating scars and pinching of the nose. B, Image 8 months after Z-plasty. C-E, Images demonstrating the Z-plasty procedure.

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