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Dorsal Concavity Rhinoplasty

Dr. Philip Young of Seattle and Aesthetic Facial Body Plastic Surgery Discusses Dorsal Concavity and its Treatment

Below is an Asian Ethnic Patient who received a Rhinoplasty. We used medpor - porous polyethylene nasal dorsal implant to recostruct her bridge. A flat piece of medpor was used to project her tip and her tip cartilages were advanced over the medpor placed in an extender spreader graft position. She also had weir excisions to correct her nostrils and alae. Her alae were overhanding her nostrils from the sides and we brought them back up as you can see in the side view.

Asian Wide Flaring Nostrils Asian Wide Flaring Nostrils

Below is a side view of the Dorsal Concavity and Deficiency Short Dorsum.

Asian Flat Bridge, Short Nose Asian Flat Bridge, Short Nose

 

Procedure Details and Options Explained for Dorsal Concavity and Lack of Projection:

To begin with, the procedure is usually started with an incision at the bottom of the nose between the nostrils along the column of tissue called the columella. This is the approach that is termed the open approach to Rhinoplasty:

Transcolumellar incision open approach

Below is a picture of the nose open after an open approach Rhinoplasty. The blue outlines the tip cartilages. The dorsal medpor implant will be carved to fit and placed above the cartilages in the pocket that is retracted by the aufricht rhinoplasty retractor. The medpor implant is fixated on the bridge in a location in between the eyes. Between the tip cartilages in blue, we will place a caudal extension graft that will support the tip cartilages in a new position. The tip can be projected, rotated and positioned in the most aesthetic way over the caudal medpor extension graft. See more below:

Open Rhinoplasty Lower Lateral Cartilages

The caudal extension graft is seen below outlined in blue. The green line shows where the edges of the septum are located. The blue caudal extension graft is attached to the septum in that location. The strength of this connection is strong and allows the tip cartilages to be projected in a strong long lasting way.

Medial, Middle, Lateral Crura

What other options for augmenting the dorsum is there:

Native Cartilage: You can use your own cartilage. We can use your ear cartilages and rib cartilages to build your nose. Most of the time with ear cartilages we may need to do both ears. The incision behind the ears hides well and we usually take the concha cavum shown in blue labeled "Concha". This concha portion can be taken without affecting the appearance of the ears. Usually we use one ear for the tip and caudal extension graft and the other ear can be used for the dorsal reconstruction.

Dorsal Reconstruction: For the dorsal concavity the alternative to the medpor porous polyethylene implant is to use ear cartilage or rib cartilage. Most people are weary about taking cartilage from the rib. With the ear cartilage, you can mince it into small pieces and this can then be placed in a rolled up tissue of muscle covering called fascia. This has been often referred to or coined the "turkish delight". This is then used to augment your bridge.

Ear Cartilage Graft for Rhinoplasty

Dorsal Concavity Non Invasive Options:

There are options for non invasive correction of the Low Nasal Bridge | Dorsum or Dorsal Concavity. Injectible fillers are a more subtle alternative. This option can be done in the office under just topical anesthesia and can be done in 30 minutes. Another option that is less invasive than surgical procedures with extensive cutting is Fat Grafting. With this option you have less control but you can use someone's own fat to reconstruct the nose. Meaning, you have less control in trying to change the shape of the nose. The fat has less structure or anatomy changing properties or abilities when compared to a Rhinoplasty. Hence, these options are considered inferior to a Rhinoplasty correction.

Dorsal Concavity Reconstruction Patient #1: The patient below received a turkish delight to reconstruct her bridge with ear cartilage. She had multiple previous rhinoplasties with implants in the bridge and tip made up of implants and not cartilage from herself. We did a bridge reconstruction and recontoured the tip to make it look less pointy and more natural:

Asian Revision Rhinoplasty with Diced Ear Cartilage Fascia Nasal Bridge Graft | Implant and Tip Refinement Replacing Silicone Nasal Dorsal Graft and Goretex Tip Implant Asian Revision Rhinoplasty with Diced Ear Cartilage Fascia Nasal Bridge Graft | Implant and Tip Refinement Replacing Silicone Nasal Dorsal Graft and Goretex Tip Implant

Before Asian Revision Rhinoplasty with Diced Ear Cartilage Fascia Nasal Bridge Graft After Asian Revision Rhinoplasty with Diced Ear Cartilage Fascia Nasal Bridge Graft