Treatment of over-resected nose
Posted on   2009-10-16 12:10:30

Over resection of the nasal profile also known as saddle nose deformity is a common finding for patients who have previously undergone rhinoplasty. This deformity is also seen commonly in individuals such as African-Americans and Asian population due to the inherent nature of their nasal growth (ethnic rhinoplasty). Over resection of the nasal profile is typically treated with augmentation of the profile using patient’s bone tissues and cartilages.

As the Director of The Institute for Rhinoplasty & Nasal Reconstruction in Newport Beach and Beverly Hills, California, Dr. Azizzadeh, has crafted an algorithm to treat saddle nose deformity in a careful and precise manner in order to recreate the normal nasal appearance while maintaining the patient’s ethnicity and original nose in consideration.

The first step in treating a saddle nose deformity is to understad what the cause of the saddle nose deformity is. The causes of saddle nose deformities can include the loss of septum during the primary rhinoplasty, over resection of the nasal bones and cartilages or natural inherent nasal appearance due to the patient’s ethnicity. Once the appropriate diagnosis has been made, Dr. Azizzadeh and the patient during the consultation will review using advanced digital morphing the possible surgical correction for the saddle nose deformity. Once the aesthetics have been determined, the options will be outlined. The options for nasal dorsal reconstruction include:

1. Nonsurgical augmentation utilizing fillers (also known as non-surgical nose job). The fillers that could be utilized include Restylane, Juvederm, Radiesse and Perlaine.
2. Utilizing temporalis fascia, which is a tissue in the scalp that is very easily harvested and can fill in subtle defects very naturally and permanently.
3. Utilizing septal cartilage. Septal cartilage can be used en bloc or can be diced and wrapped with temporalis fascia to contour the nasal dorsum. This approach can create extremely long lasting and satisfactory results with excellent outcomes and minimal complications.
4. Utilizing ear cartilage with either en bloc or diced and wrapped around temporalis fascia.
5. Utilizing acellular dermis (also known as AlloDerm). AlloDerm is a dermal skin that can be placed very safely and effectively if the patient does not desire utilization of other areas of the body.
6. Irradiated rib graft. Irradiated rib grafts can be obtained from blood banks and utilized to build the nasal dorsum if there is a significant defect of the nasal dorsum that is not amenable for treatment with conventional grafts from the patient’s own cartilage if the patient does not desire harvesting from his or her own rib area. This approach provides very safe and long lasting results with good outcome.
7. Autologous rib graft. The patient’s own rib provides a significant amount of cartilage which can be utilized to build the profile up significantly with either en bloc or also used as a diced cartilage with temporalis fascia.
8. Calvarial bone graft. In some patients, bone can be grafted from the scalp to the nose to build up the bridge without the use of other cartilage. Bone grafts can be harvested from the scalp very quickly and efficiently with minimal complications. The bone graft provides a very solid support and in patients who have significant functional and breathing issues, it can represent an excellent option if the patient does not desire rib graft harvest.

In summary, nasal dorsal augmentation can be one of the most satisfactory aspects of revision rhinoplasty in patients who have saddle nose deformity or in patients who are desiring Asian rhinoplasty or African-American rhinoplasty (aka ethnic rhinoplasty). Saddle nose deformity is one of the most common areas that Dr. Azizzadeh sees in his Beverly Hills practice for patients who are requiring revision rhinoplasty, and during your consultation he will discuss all the above options in further detail and the patient and Dr. Azizzadeh can determine which option would be most appropriate for their care.