Availability and Safety of Osteotomy in Esthetic Rhinoplasty of East Asian Patients.

OBJECTIVE: East Asians usually have short and flat noses and broad nasal bones. Therefore, rhinoplasty with dorsal augmentation and nasal osteotomy is often required. However, many surgeons are wary of performing nasal osteotomy in conjunction with augmentation with silicone. The authors sought to evaluate the availability and safety of osteotomy in esthetic rhinoplasty of East Asian patients. METHODS: In a clinical study, a retrospective chart review was performed for 227 patients who had undergone nasal osteotomy (paramedian oblique osteotomy plus percutaneous lateral osteotomy) and dorsal augmentation with silicone. Patient satisfaction after surgery was evaluated by the Rhinoplasty Outcome Evaluation test. In addition, a cadaveric study was conducted in which 5 fresh cadavers received different osteotomies on each side of the nose (right side: paramedian oblique and percutaneous lateral osteotomy; left side: medial oblique and intranasal continuous lateral osteotomy). RESULTS: In the clinical study, patients were satisfied with the outcome after esthetic rhinoplasty with nasal osteotomy (paramedian oblique osteotomy plus percutaneous lateral osteotomy) and augmentation with silicone. The results revealed a low complication rate. The average Rhinoplasty Outcome Evaluation test score significantly increased (P < 0.001), with 91.2% of patients scoring their postoperative result better than "good." In the cadaveric study, stability was greater when paramedian oblique and percutaneous lateral osteotomy was performed. CONCLUSIONS: Paramedian oblique and percutaneous lateral osteotomy is effective for reducing broad nasal bones, thus providing a stable framework and a reliable method for achieving a good outcome when augmentation with silicone is performed simultaneously.