AUGMENTATION RHINOPLASTY - OBSERVATIONS ON 1200 CASES

Over the past 14 years, from January of 1975 to December of 1988, we have done 1263 aesthetic rhinoplasties using ear cartilage. In the field of augmentation rhinoplasty, many kinds of materials, such as bone, septal cartilage, ear cartilage, and prostheses, were used. In this paper, we limit discussion to our experience with the technique for the augmentation of the nasal dorsum using the ear cartilage and compare this with other materials. Patient ages ranged from 15 to 72 years, with an average of 24 years. Some 95 percent of patients (1199) were female, and only 5 percent (64) were male. Patients were followed for a minimum of 6 months and a maximum of 20 months, with average follow-up only 8 months. Of course, we know that this is a very short follow-up period, but we could not follow patients longer because if they had no complaint about the results at the 6-month visit, they never returned, despite our efforts. Five-hundred and ten of the 1263 patients (40 percent) had been augmented elsewhere, and the silicone prosthesis was already in place. However, 753 patients (60 percent) had no previous operation. For the 510 patients (secondary rhinoplasty patients), too-high or too-large a prosthesis was the largest complaint in number, totaling 378 cases (74 percent), and psychological dissatisfaction, such as pain or an uncomfortable sensation, was the second largest in number, totaling 104 cases (20 percent). For the 753 patients (primary rhinoplasty patients), the main complaint was too-short or too-flat a nose (100 percent). In terms of results, almost all the patients obtained the hoped-for contour of their nose in size and height, and in particular, the psychological dissatisfaction disappeared in almost all patients. However, complications occurred in 51 patients (4 percent). Analysis of 51 complications revealed the following: malposition was the largest, totaling 42 patients, and needed a minor repair operation later; local infection occurred in 6 patients, but was treated conservatively using antibiotics and healed within 2 months. We therefore think that this procedure is safe and acceptable, but there are some disadvantages. In terms of advantages, the ear cartilage is part of the human body, so rejection never occurs; it is strong against infection; and it is easy to harvest as compared with bone and septal cartilage. In terms of disadvantages, compared with insertion of a prosthesis, the operative procedure is difficult and lengthy. Consequently, it is not suitable for children. In addition, graft resorption sometimes occurs. Nevertheless, despite such disadvantages, from our 14 years of experience in over 1200 cases, we believe that the use of ear cartilage is the best procedure as compared with other materials for Japanese augmentation rhinoplasty.