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Page 2 of 16 Won et al. Plast Aesthet Res 2019;6:6 I http://dx.doi.org/10.20517/2347-9264.2018.82

Table 1. Causes of revision rhinoplasty in Asians [1]
Main etiology for revision rhinoplasty (n = 52)
Alloplast related (n = 33) 33 (63%)
Deviation 12
Foreign body 5
Extrusion 5
Infection 4
Unnatural look 4
Contracture (short nose) 3
Alloplast unrelated (n = 19) 19 (37%)
Mainly upper two-thirds problem (n = 12)
Residual deviation 7
Dorsal irregularity or depression 4
Residual hump 1
Mainly tip problem (n = 7)
Tip underprojection (loss of projection) 2
Upturned, overrotated tip 2
Visible graft 2
Tip deviation 1
Nasal obstruction 4

Like other revision surgeries, the difficulty of revision rhinoplasty arises not only from the effort it takes
to correct the specific deformities and scars left by the primary surgery, but also from the psychological
stress experienced by both the patient and the surgeon. An in-depth understanding and sufficient
experience in various rhinoplasty techniques together with familiarity with the alloplasts’ characteristics
and related complications become necessary with dealing with the highly variable cases of Asian revision
[2-7]
rhinoplasty .

Remnant septal cartilage and/or conchal cartilage can be used for the revision procedure. However, as
the deformities become more severe, adequate revision requires more volume and strength of grafting
materials. This usually far exceeds available septal cartilage and the need for adequate strength precludes
the use of conchal cartilage. Autogenous costal cartilage is a favorable grafting material and may be the only
practical choice in these circumstances.

In this review, common causes of revision rhinoplasty in Asians are discussed as well as operative
techniques that focus on the use of autologous costal cartilage are presented.

REVISION RHINOPLASTY IN ASIANS
The main reasons for revision rhinoplasty in Asians often involve issues with alloplastic implants. Common
[1]
indications for revision rhinoplasty that we have encountered are as follows and are summarized in Table 1 .

Alloplast-related complications such as deviation, extrusion, infection, short and contracted nose after
multiple surgeries involving alloplastic impants, dorsal deviation and/or irregularity and tip problems
related to septal extension graft.

Alloplast related complications
Even though trends change silastic implants remain the single most commonly used alloplastic implant
[7-9]
in Asia . Despite the fact that they can be better tolerated by the thicker skin and soft tissue envelope
(SSTE) of the Asian nose , silicone implants have been heavily criticized for their association with
[10]
[11]
various complications . Typical examples of alloplast-related complications include unnatural or operated
appearance, deviation, extrusion of the implant, infection, foreign body reaction and compromised
SSTE. Proper selection of patients, adherence to proper surgical techniques and acquiring the necessary
[1,7]
techniques to manage complications when they occur are important .