Aesthetic Outcomes of Rhinoplasty Performed in the Early Posttrauma Period after Nasal Bone Fracture.

The optimal timing of rhinoplasty for patients with nasal bone fractures remains controversial. We investigated whether the timing of rhinoplasty after nasal trauma affects the aesthetic outcome of the procedure. A total of 41 adult patients with nasal bone fractures who underwent rhinoplasty between 2006 and 2021 were enrolled in this study. A visual analog scale (VAS) was used to indicate the assessor's satisfaction with the surgical outcome after a comparison of the pre- and postoperative facial photographs of each patient. Of the 41 patients, 28 underwent rhinoplasty within 14 days after nasal trauma (early rhinoplasty group), whereas 13 underwent rhinoplasty more than 14 days after nasal trauma (late rhinoplasty group). The rate of receiving spreader and shield graft was higher in the late rhinoplasty group (p = 0.043 and 0.018, respectively). Patients with type IV or V nasal bone fracture and patients with preoperative saddle noses had higher VAS scores than those with types I to III fractures and those without preoperative saddle nose (p = 0.003 and 0.020, respectively). There was no significant difference in overall aesthetic outcome between the early and late rhinoplasty groups. Both groups achieved significantly better radix height, dorsal height, and tip projection after rhinoplasty. The aesthetic outcome of rhinoplasty performed in the early posttrauma period is comparable with that of rhinoplasty performed more than 2 weeks after nasal bone fracture. Rhinoplasty can be considered a safe surgical treatment option for nasal bone fracture, even in the early posttrauma period. LEVEL OF EVIDENCE: : 4.

Factors Affecting the Complication Rate of Septoplasty: Analysis of 1,506 Consecutive Cases of Single Surgeon.

Based on the analysis of a single surgeon's consecutive cases, we present the incidence of septoplasty complications and factors that contribute to the increased risk of complications. We retrospectively reviewed the medical records from 1,506 patients diagnosed with deviated nasal septum who underwent septoplasty by a single surgeon from January 2003 until May 2020. The incidence of different complications was investigated. Predisposing factors for specific complications were examined with univariate analysis. The average age of patients was 35 (11-76) years. Out of 1,506 patients, 1,252 were male, and 254 were female. The most frequent complication was insufficient correction (78 cases, 5.2%), and revision septoplasty was performed in 21 cases. We also reported 59 (3.9%), 55 (3.7%), 33 (2.2%), 20 (1.3%), and 18 (1.2%) cases of olfactory dysfunction, hematoma, synechia, abscess, and septal mucosal defect, respectively. Additionally, there were nine (0.6%), six (0.4%), five (0.3%), four (0.3%), and four (0.3%) cases of septal perforation, postoperative bleeding, saddle nose, chondritis, empty nose syndrome, respectively. The proportion of insufficient correction was higher in revision cases than in primary cases. Hematoma formation, abscess formation, and septal mucosal defect occurred more frequently in the bilateral flap elevation group. Olfactory dysfunction was significantly more frequent when the bony batten was inserted, while hematoma, abscess formation, and septal mucosal defect were more frequent when the cartilage batten was used. Septoplasty was associated with the risk of several complications, while complication rates were influenced by choice of surgical techniques and approaches.

Impact of the Location of Nasal Septal Deviation on the Nasal Airflow and Air Conditioning Characteristics.

The location of nasal septal deviation (NSD) directly impacts nasal physiology. The objective is to examine, using computational fluid dynamics (CFD), the difference in the airflow and air conditioning characteristics according to the location of NSD. Twenty patients with septal deviation were divided into two: 10 caudal septal deviation (CSD) and 10 posterior septal deviation (PSD). Physiological variables were compared and numerical models for nasal cavity were created with CT scans. Cases with CSD had distinctive features including restricted airflow partition, larger nasal resistance, and decreased surface heat flux in the more obstructed side (MOS), and lower humidity and air temperature in the lesser obstructed side (LOS). Physiological differences were observed according to the location of septal deviation, CSD cases exhibit significantly more asymmetric airflow characteristics and air conditioning capacity between LOS and MOS.

Revision Rhinoplasty Using Glued Diced Costal Cartilage Shaped With Mold for Management of Complicated Silicone Rhinoplasty.

BACKGROUND: Complicated silicone nose is a common clinical problem. Selection of replacement material for revision dorsal augmentation is a challenging task. OBJECTIVES: The authors presented their experience in the use of molded glued diced cartilage graft (GDCG) for revision rhinoplasty in patients who had complicated silicone augmentation. METHODS: The authors performed a retrospective review of the medical records of 28 patients who underwent silicone implant removal and revision dorsal augmentation with costal cartilage at a tertiary center between February 1, 2018, and February 28, 2022. Patient demographics, surgical technique, anthropometric measurements, and complication data were retrieved and analyzed. Aesthetic outcome scoring and anthropometric measurements were performed. RESULTS: Twenty-eight patients (9 males and 19 females) who underwent revision rhinoplasty with augmentation were reviewed. The principal indication for revision was cosmetic dissatisfaction. Mean postoperative follow-up duration was 18.3 months. All patients had revision dorsal augmentation with molded GDCG. Other key surgical techniques include the use of caudal septal extension and extended spreader and tip grafts. The majority of the patients were judged to have good or excellent outcomes (91.1%). There were significant percentage increases in dorsal height, radix height, nasal length, and nasal tip projection (2.78%, 2.26%, 7.53%, and 2.40%, respectively; P < .05) and reduction of nasal axis deviation of 1.15° (P < .05) postoperatively. Two patients had postoperative complications, including infection and cosmetic dissatisfaction. CONCLUSIONS: Revision rhinoplasty following unsuccessful silicone augmentation is commonly encountered in the Asian population. Molded GDCG for revision dorsal augmentation is a reliable option that delivers good to excellent aesthetic outcomes with acceptable complication rates.

Histomorphological Findings of Cartilage and Surrounding Tissues According to Thickness and Manipulations in Rabbits.

BACKGROUND: Costal cartilage is commonly employed as a dorsal implant in Asian rhinoplasty. To achieve better outcomes, it is important to know which types of costal cartilage are most appropriate for dorsal augmentation. OBJECTIVES: The authors investigated how various forms of costal cartilage affect the surrounding tissues and their resorption over time, as well as their clinical appearance, using histomorphological analysis. METHODS: Cartilage samples were collected from the anterior chest wall of 10 rabbits. Four forms of cartilage-2-mm solid block, 1-mm solid block, diced, and crushed-were prepared and inserted into the subcutaneous tissue pockets of the nasal dorsum of each rabbit. The animals were killed 3 and 6 months later, and graft specimens were examined. RESULTS: Histomorphological analysis revealed important findings of the cartilage and surrounding tissues. The thickness of thick cartilage significantly decreased over time, but the thickness of thin cartilage did not significantly change (P = 0.038). Additionally, the thick cartilages showed a lower degree of vascularization than the thin cartilages (P < 0.001). A comparison of the cartilage forms revealed that the diced cartilages had better chondrocyte survival than the solid block cartilages (P < 0.001). Fat tissues were prominently observed surrounding the diced cartilages at 3 months (P = 0.01), and fibrosis was more prominently observed in the crushed cartilage than in the other types of cartilages (P = 0.04 and P = 0.005 at 3 and 6 months, respectively). CONCLUSIONS: This study revealed differences in resorption depending on the thickness of the costal cartilage in rabbits. Among the various forms of costal cartilages, diced and thin solid-block cartilage were the best option for dorsal augmentation when considering long-term graft survival.

Human rhinovirus serotypes induces different immune responses.

BACKGROUND: Different species of human rhinovirus (HRV) can induce varied antiviral and inflammatory responses in human blood macrophages and lower airway epithelium. Although human nasal epithelial cells (HNECs) are a primary infection route of HRV, differences between major and minor groups of HRV in the upper airway epithelium have not been studied in detail. In this study, we investigated viral replications and immune responses of major and minor groups of HRV in the HNECs. METHODS: Viral replication, immune responses of IFN-ß, IFN-λ, proinflammatory cytokines, and viral receptors, and mRNA expression of transcription factors of HRV16 (major group) and HRV1B (minor group) in the HNECs were assessed. RESULTS: Compared with HRV16, HRV1B replicated more actively without excessive cell death and produced higher IFN-ß, IFN-λ1/3, CXCL10, IL-6, IL-8, and IL-18 levels. Furthermore, low-density lipoprotein receptor (LDLR), TLR3, MDA5, NF-κB, STAT1, and STAT2 mRNA levels increased in HRV1B-infected HNECs. CONCLUSION: HRV1B induces a stronger antiviral and inflammatory response from cell entry to downstream signaling compared with HRV16.

Reconstruction of a Severely Damaged Cartilaginous Septum with a Bypass L-Strut Graft using Costal Cartilage.

OBJECTIVE: Reconstruction of a weakened septal cartilage is a key procedure for the correction of deformed noses. However, when septal mucoperichondrium dissection is technically challenging, reconstruction of the lower two-thirds of the nose should be performed bypassing the damaged septal cartilage and mucosa. This article summarizes our experience with treating patients with severely damaged septal cartilage with bypass L-strut graft using costal cartilage. METHODS: We retrospectively reviewed 26 patients who underwent rhinoplasty using bypass L-strut graft. Autologous costal cartilage was used for creating L-strut in two different ways: (1) by fashioning the L-shaped graft as one unit using the sixth rib cartilage and (2) by integrating a dorsal strut with a columellar strut using slices of the seventh rib cartilage. The caudal strut is fixated to the anterior nasal spine; the dorsal L-strut is placed on the nasal dorsum with no fixation to the nasal bone. Medical records were assessed for demographic, clinical, and treatment information. RESULTS: One-piece-type L-strut graft was used for 11 patients and integrated-type L-strut graft was used for 15 patients. No statistical differences were found in postoperative aesthetic outcomes between the two groups. The postoperative assessment of surgical outcomes was excellent in 10 patients, good in 10, fair in 6, and poor in none. Functionally, all 26 patients experienced improvements in nasal breathing. CONCLUSION: Bypass L-strut graft using costal cartilage is a useful surgical maneuver of septal reconstruction in particular nasal deformity when the creation of the septal mucoperichondrial pocket is difficult or better to be avoided.

Alar Lifting Technique for the Correction of Tilted Alar Base.

BACKGROUND: Frequently, a tilted alar base characterized by a discrepant level of the nostril sill and alar insertion on both sides is encountered in patients seeking rhinoplasty. Herein, we report our surgical technique and outcome of alar lifting technique for correcting tilted alar base. METHODS: The medical records of 18 patients with alar base asymmetry who underwent rhinoplasty using the alar lift technique between January 2014 and December 2019 were retrospectively reviewed. The alar lifting procedure included a pointed ellipse-shaped excision of vestibular skin just inside the nostril sill, and sutures using 5-0 monocryl. Surgical outcomes were determined on the frontal view of facial images by comparing pre- and postoperative angles formed by a line drawn parallel to the lowermost part of both pupils and a line connecting the lowermost part of the base of the ala. RESULTS: Of 18 patients, 12 (66.7%) were men, and 6 (33.3%) were women. The mean age was 31.8 years (range 16-55). The alar lifting technique was performed on the left side in 12 cases and on the right side in 6 cases, and concurrent tip plasty was performed in 15 (83.3%) cases. The mean alar tilt angle was 3.9 preoperatively and 2.0 postoperatively. The mean angle change was 1.9°. Sixteen (88.9%) out of 18 patients had decreased alar level discrepancy. No patient had complications. CONCLUSIONS: Our alar lifting technique can serve as a useful adjunctive technique in rhinoplasty in patients with a tilted ala. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Special Consideration in the Management of Hump Noses in Asians.

Although not as prevalent as in Caucasian rhinoplasty, correction of a hump nose also poses a significant problem for East Asian rhinoplasty. The hump noses in East Asians can be classified as generalized humps, isolated humps, and relative humps with a low tip. Appropriate management of the Asian hump nose demands a good understanding of the anatomical characteristics unique to East Asians. As the East Asians generally prefer to have a nose with a prominent tip and well-augmented nasal dorsum, the concept of redistribution is significant in managing convex dorsum of the East Asians. Hump reduction should be done in a conservative and incremental manner, including careful removal of the bony cap and cartilaginous hump. Tip augmentation using a septal extension graft is an essential maneuver to achieve an aesthetically pleasing tip height, which has a tremendous impact on the overall aesthetic outcome. Midvault reconstruction, dorsal augmentation, and camouflage are additional key elements for the success of the operation. Complications such as undercorrection and dorsal irregularities are not uncommon, requiring surgeons to take utmost care to address them.

Mono-Unit Alar Rim Graft Technique for Tip-Alar Margin Support.

BACKGROUND: The appropriate treatment of alar rim deformities, such as alar pinching or concavity, and soft triangle notching is essential for perfecting nasal aesthetics. OBJECTIVES: The authors introduced the "mono-unit alar rim graft" technique as a treatment option for these abnormalities. METHODS: A case series of 29 rhinoplasties conducted by the senior author between May 2017 and June 2019 utilizing the mono-unit alar rim graft technique was retrospectively reviewed. The surgical technique involved an open approach with costal cartilage harvesting. The cortical portion of the harvested costal cartilage was sectioned into a 1-mm-thick strip and soaked with saline for about 15 minutes to let the natural warping occur. The curved cartilage graft was then trimmed, and the midportion was sutured to the tip in an onlay fashion. Both ends of the graft were housed in the vestibular pocket. Patient demographic data and pre- and postoperative facial photos were reviewed. RESULTS: Among the 29 cases analyzed, 14 (48.3%) were men and 15 (51.7%) were women. Ten (34.5%) patients had a preoperative parenthesis deformity, but a near-complete correction was achieved in 8 (80.0%) cases. An alar concavity from the basal view was found in 16 patients, 15 (93.8%) of whom had a partial or near-complete correction. Eleven patients had soft triangle notching, 9 (81.8%) of whom had a partial or near-complete correction. There were no technique-related complications in this patient series. CONCLUSIONS: The mono-unit alar rim graft technique is a viable option for treating various alar rim deformities.

Autophagy deficiency in myeloid cells exacerbates eosinophilic inflammation in chronic rhinosinusitis.

BACKGROUND: Eosinophilic inflammation is a major pathologic feature of chronic rhinosinusitis (CRS) and is frequently associated with severe refractory disease. Prostaglandin (PG) D2 levels are increased in patients with CRS, and PGD2 is an important contributing factor to eosinophilic inflammation. Autophagy has a pleiotropic effect on immune responses and disease pathogenesis. Recent studies suggest the potential involvement of autophagy in patients with CRS and the PG pathway. OBJECTIVE: We sought to investigate whether altered function of autophagy is associated with eosinophilic inflammation and dysregulated production of PGD2 in patients with CRS. METHODS: We used myeloid cell-specific deletion of autophagy-related gene 7 (Atg7), which is vital for autophagy, and investigated the effects of impaired autophagy on eosinophilic inflammation in a murine model of eosinophilic chronic rhinosinusitis (ECRS). The effect of autophagy on PGD2 production and gene expression profiles associated with allergy and the PG pathway were assessed. RESULTS: We found that impaired autophagy in myeloid cells aggravated eosinophilia, epithelial hyperplasia, and mucosal thickening in mice with ECRS. This aggravation was associated with gene expression profiles that favor eosinophilic inflammation, TH2 response, mast cell infiltration, and PGD2 dysregulation. Supporting this, PGD2 production was also increased significantly by impaired autophagy. Among other myeloid cells, macrophages were associated with autophagy deficiency, leading to increased IL-1ß levels. Macrophage depletion or blockade of IL-1 receptor led to alleviation of eosinophilic inflammation and sinonasal anatomic abnormalities associated with autophagy deficiency. CONCLUSION: Our results suggest that impaired autophagy in myeloid cells, particularly macrophages, has a causal role in eosinophilic inflammation and ECRS pathogenesis.

Dorsal Augmentation in Facial Profiloplasty.

Nasal profile line has central importance in forming an aesthetically balanced facial profile. Thus, rhinoplasty is a critically necessary surgery in shaping ideal profile line. For successful rhinoplasty, meticulous preoperative evaluation and proper planning should be performed before surgery. The nasal dorsum is the broadest and most prominent part of the nose; any minor imperfection is readily appreciated by an observer. Thus, dorsal augmentation is one of the most challenging areas in rhinoplasty as there is virtually no single ideal graft material and method for the nasal dorsum, which is free of aesthetic complication The surgeon should be able to discern the pattern of the abnormal nasal profile and to strategize the best possible surgical option to create a long-lasting, aesthetically pleasing dorsal line in good harmony with the overall facial profile. This study addresses our strategy to deal with various types of aesthetically unpleasant nasal profile line. The characteristics of augmentation materials and considerations in surgical technique are also addressed.

Refinements in Saddle Nose Reconstruction.

Saddle nose correction remains a challenging procedure for rhinoplasty surgeons due to both aesthetic and functional issues. The most common causes of saddle nose are nasal trauma and prior septal surgery, and a defective relationship between the caudal septum and the anterior septal spine is the principal postoperative pathology. The authors propose their own classification system for saddle nose with one new category and several approaches to deal with this condition in accordance with the level of severity. They strongly advocate major septal reconstruction for most cases of saddle nose, either by placing extended spreader grafts, caudal extension grafts, or a new extracorporeally made L strut. For extreme cases, integrated dorsal implant with columellar strut can successfully bypass the saddled nasal dorsum without dissecting the septal mucoperichondrial pocket and achieve adequate dorsal height. Further dorsal augmentation can be achieved by applying side/gap grafts or dorsal onlay grafts in different forms. In cases with retracted columella, a premaxillary plumping graft is another useful technique. Finally, in autoimmune-related saddling patients, the evidence indicates that their aesthetic problems can be managed safely with surgery as long as the disease is well under control.

Failure of Synthetic Implants: Strategies and Management.

Dorsal augmentation with synthetic implants is the most commonly performed rhinoplasty procedure, especially in the East-Asian region. However, as in all other surgical procedures, complications are inevitable. Complications that need to be managed surgically include displacement, deviation, suboptimal aesthetic outcome, extrusion, inflammation, infection, and changes in skin quality. Most complications can be easily managed with revision surgery. After the removal of the synthetic implant from the nasal dorsum, different dorsal implant materials such as dermofat, alloderm, or fascia-wrapped diced cartilage, conchal cartilage with perichondrial attachment, and costal cartilage are preferred. An irreversible change in the skin/soft tissue envelope poses a challenge that usually requires reconstructive surgery with a local flap. Therefore, early detection and prompt management of the complication are essential for minimizing the severity of the deformity and the complexity of the surgical procedures.

Bone and Soft Tissue Nasal Angles Discrepancies and Overlying Skin Thickness: A Computed Tomography Study.

BACKGROUND: The aim of this study was to derive the normal values for bone and soft tissue nasal angles as well as the overlying skin thickness and to attempt to determine the correlation between differences in bone and soft tissue angles and overlying skin thickness in Middle Eastern patients. MATERIALS AND METHODS: Three-dimensional cephalometric analysis was performed for 100 patients who underwent computed tomography of the paranasal sinuses. The nasofrontal angle, pyramidal angle-nasal root, pyramidal angle-tip of the nasal bone, and overlying skin thickness were measured, and the results were analyzed according to sex, age, and body mass index (BMI). RESULTS: All soft tissue angles were significantly larger than the bone angles, with the mean difference being 11.62°, 30.80°, and 27.05° for the nasofrontal angle (P = 0.000), pyramidal angle-nasal root (P = 0.000), and pyramidal angle-tip of the nasal bone (P = 0.000), respectively. The mean overlying skin thickness was 3.89 ± 1.48 mm at the nasion, 1.16 ± 0.6 mm at the rhinion, and 2.93 ± .97 mm at the nasal tip. Differences in the nasofrontal angle were strongly correlated with the skin thickness at the nasion (P = 0.001). CONCLUSION: A simple clinical exam of the soft tissue nasal angles does not reflect the underlying bone angles that will be encountered during rhinoplasty. BMI does not influence nasal shape, and rhinoplasty surgery should take into account the ethnic group, age, and sex of the patient. Surgeons should leave a minor skeletal hump at the end of the nasal bone for Middle Eastern patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Recent Understandings of Biology, Prophylaxis and Treatment Strategies for Hypertrophic Scars and Keloids.

Hypertrophic scars and keloids are fibroproliferative disorders that may arise after any deep cutaneous injury caused by trauma, burns, surgery, etc. Hypertrophic scars and keloids are cosmetically problematic, and in combination with functional problems such as contractures and subjective symptoms including pruritus, these significantly affect patients' quality of life. There have been many studies on hypertrophic scars and keloids; but the mechanisms underlying scar formation have not yet been well established, and prophylactic and treatment strategies remain unsatisfactory. In this review, the authors introduce and summarize classical concepts surrounding wound healing and review recent understandings of the biology, prevention and treatment strategies for hypertrophic scars and keloids.

Development of a mouse model of eosinophilic chronic rhinosinusitis with nasal polyp by nasal instillation of an Aspergillus protease and ovalbumin.

One subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by the development of a T-helper type 2 (Th2) response and eosinophilic infiltration. Here, we aimed to establish an eosinophilic CRSwNP murine model, which would be essential to understand the underlying pathogenesis and establish a treatment strategy. C57BL/6 mice were challenged intranasally with a mixture of an Aspergillus oryzae-derived protease (AP) and ovalbumin (OVA) for 6, 8, or 12 consecutive weeks (12 mice/group); control mice received the same volume of phosphate-buffered saline for 12 weeks (n = 12). Sinonasal samples were evaluated histologically, and interleukin (IL)-4, IL-5, IL-13, eotaxin, keratinocyte chemoattractant, and macrophage inflammatory protein-2 mRNA levels in sinonasal mucosa were measured by real-time PCR. Protein levels of Th2 cytokines, INF-γ, IL-17A, and chemokines in nasal lavage fluid, and total serum IgE were measured by ELISA. Greater eosinophil infiltration in the subepithelial layer was observed in the challenged groups, compared with the control group. Polypoid mucosal lesions were predominantly observed in the 12-week group, which also exhibited mucosal thickening on micro-CT scans. The IL-4, IL-5, and IL-13 mRNA and protein levels were elevated in the sinonasal mucosa and nasal lavage fluid. INF-γ and IL-17A were undetectable or not elevated relative to the control group levels. In contrast, eotaxin levels were particularly elevated in the sinonasal mucosa and nasal lavage fluid in the 12-week group. In conclusion, intranasal AP and OVA exposure successfully induced Th2-specific CRSwNP in a murine model.

Assessment of satisfaction based on age and gender in functional and aesthetic rhinoplasty.

The aim of this study was to assess patients' satisfaction based on gender and age using the Rhinoplasty Outcomes Evaluation (ROE) post-rhinoplasty from both functional and aesthetic outcomes. The study design was a prospective observational study. A total of 103 patients who underwent Rhinoplasty were prospectively investigated from January 2011 through December 2013 at King Abdulaziz University Hospital in Riyadh, Saudi Arabia. The sample included 61 males (59.2%) and 42 females (40.7%). The overall mean age was (25.2 ± 5.9) years (range 17-48 years). ROE was distributed pre- and post-surgery. The overall difference in satisfaction was significant (p < 0.0001). The mean satisfaction difference of function was increased by 21.5%, raising the satisfaction percentage from 57.1% initially to 78.5% post-surgery (mean -0.215, CI -0.269, -0.161). Satisfaction of shape post-rhinoplasty showed that the mean satisfaction increased by 31.3% (mean -0.313, CI -0.369, -0.256), which changed the satisfaction from a mean of 44.2% before surgery to 75.5% post-rhinoplasty (p = 0.000). There was no significant difference in satisfaction between males and females, nor was there a significant difference in satisfaction among different age groups (p > 0.05). There was a significant overall increase in patients' satisfaction from functional and aesthetic outcomes post-surgery based on ROE. Our study showed that age and gender did not significantly affect satisfaction. The ROE was a useful tool to implement for assessing the quality-of-life post-rhinoplasty.

Dorsal Augmentation using Alloplastic Implants.

Dorsal augmentation is an essential procedure not only for Asians, who generally have indistinct and poorly developed nasal bridges, but also for Africans and Caucasians, who have similar dorsal deficiencies. There is no single ideal implant or graft for dorsal augmentation. Dorsal augmentation with autologous materials is considered ideal by many surgeons. However, harvesting autologous material is associated with donor-site complications, and these materials are difficult to handle and shape. Despite concerns over complications such as infection, extrusion, and deviation, alloplastic implant materials such as silicone or Gore-Tex have a critically important role in typical cosmetic dorsal augmentation due to their ease of use in producing a cosmetically appealing outcome and evading donor-site complications. A thorough understanding of the shape of an aesthetically pleasing nose, appropriate surgical technique, and proper management methods for complications are the mainstay for the success of dorsal augmentation using alloplastic implants.