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Original Investigation |

Comparison of the Surgical Outcomes of Dorsal Augmentation Using Expanded Polytetrafluoroethylene or Autologous Costal Cartilage

Yeon Hee Joo, MD1; Yong Ju Jang, MD, PhD2
[+] Author Affiliations
1Department of Otolaryngology, Gyeongsang National University, Changwon Hospital, Changwon, Republic of Korea
2Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
JAMA Facial Plast Surg. 2016;18(5):327-332. doi:10.1001/jamafacial.2016.0316.
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Importance  Dorsal augmentation material includes alloplastic implants and autologous tissues. However, there has been no comparison to date of dorsal augmentation using different materials performed by the same surgeon.

Objective  To compare the aesthetic outcomes and complications of dorsal augmentation using expanded polytetrafluoroethylene (ePTFE) and autologous costal cartilage (ACC) in rhinoplasty.

Design, Setting, and Participants  A retrospective review of the medical records of 244 patients who underwent dorsal augmentation performed by the same surgeon at the Asan Medical Center using ePTFE or ACC from March 1, 2003, through September 31, 2015.

Main Outcomes and Measures  Patient demographics and surgical procedures were analyzed. The aesthetic outcomes were scored from 1 (worst) to 4 (best) by 3 otolaryngologists. Changes in dorsal height and radix height were measured by comparing preoperative and postoperative profile views. Postoperative complications were also evaluated.

Results  A total of 244 patients who underwent augmentation rhinoplasty were reviewed in this study, including 141 men (57.8%) and 103 women (42.2%). The ePTFE group included 176 patients, and the ACC group comprised 68 patients. In the ePTFE and ACC groups, 96 patients (54.5%) and 45 patients (66.2%) were male, respectively. The patient ages ranged from 11 to 69 years, with a mean (SD) age of 30.3 (11.49) years in the ePTFE group and 36.04 (12.65) years in the ACC group. The mean (SD) aesthetic outcome scores were comparable between the 2 groups: 2.99 (0.05) in the ePTFE group and 2.99 (0.06) in the ACC group (P = .93). The change of dorsal (2.64% in ePTFE group and 5.82% in ACC group) and radix (3.62% in ePTFE group and 3.77% in ACC group) heights were significantly increased after augmentation in both groups (P < .001) even though the dorsal height of the ACC group after augmentation showed a significantly greater increase compared to the ePTFE group (P < .001). However, the complication rate was significantly higher in the ACC group: 4.0% in ePTFE group and 11.8% in ACC group (P = .02).

Conclusions and Relevance  Dorsal augmentation with ACC produces similar aesthetic outcomes but a higher complication rate than dorsal augmentation with ePTFE. This higher complication rate may justify the use of ePTFE implants for dorsal augmentation in Asian patients undergoing rhinoplasty.

Level of Evidence  3.

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Figures

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Figure 1.
Measurement of Parameters in the Profile View

DH indicates dorsal height; RH, radix height; VL, vertical line.

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Figure 2.
Aesthetic Outcomes According to the Augmentation Material Used

A, Excellent and poor outcomes were observed more often in the expanded polytetrafluoroethylene (ePTFE) group compared with the autologous costal cartilage (ACC) group. B, There was no statistically significant difference between the aesthetic outcomes in the ePTFE and ACC groups.

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Figure 3.
Patients With Good Aesthetic Outcomes After Dorsal Augmentation Using Expanded Polytetrafluoroethylene

Preoperative (A, C, E, and G) and postoperative (B, D, F, and H) photographs are shown.

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Figure 4.
Patients With Good Aesthetic Outcomes After Dorsal Augmentation Using Autologous Costal Cartilage

Preoperative (A, C, E, and G) and postoperative (B, D, F, and H) photographs are shown.

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Figure 5.
Patients With Poor Aesthetic Outcomes

Preoperative (A) and postoperative (B) photographs of a patient after dorsal augmentation using expanded polytetrafluoroethylene and preoperative (C) and postoperative (D) photographs of a patient after dorsal augmentation using autologous costal cartilage are shown. Although the postoperative dorsal and radix height was considerably elevated compared with preoperative photographs, both patients had too high radix and an unnatural-looking nasal dorsum.

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