Anatomy of the African American Nose:
Dorsum and Nasal Frontal Angle
Board Certified Facial Plastic Surgeon in New York and New Jersey
Nasal - Dorsal Angle Augmentation Using Custom Designed Silastic “S” Implant in 44 African American Patients.
Objective: To evaluate the satisfaction of African American patients with nasal - dorsal angle augmentation using custom designed “S” nasal - dorsal angle implant and provide a better technique for dorsal augmentation of the African American nose.
Methods: A retrospective review of 44 rhinoplasties on African American patients was collected by way of a patient questionnaire. Data Analyzed included questions pertaining to patient satisfaction, subjective evaluation of ethnic changes, and changes in self-esteem.
Procedure: An open approach rhinoplasty was used on all 44 patients. A midline pocket was created in the sub-SMAS plane of the nasal dorsum. From a solid silicone block (Implantech) a 2 to 6 mm high, 4 cm long and 4mm wide silicone piece was carved from the block using a #10 blade. The nasal frontal angle was assessed visually and the cephalic end of the silicone implant was beveled to approximate the angle. The implant was then placed into the dorsal pocket and adjustments were made on the width, length and height using #15 blade and a suppercut scissor. Occasionally, dorsal height was added by stacking silicone pieces and securing them with a 5-0 nylon. Once the perfect implant was designed the implant was placed back into the pocket and secured to the upper lateral cartilages using a 5-0 nylon. If the pocket was too large the implant was further secured with a 5-0 silk stitch through and through dorsal skin and implant using a cotton bolster and left in place until the cast was removed at 7 days. All implants were soaked in Technacare wash prior to pocket insertion
Result: Our data shows a significant increase in self esteem (p < .01) post-surgically, with a significant preservation of ethnic characteristics (p < .05). There was a high rate of patient satisfaction postoperatively (92.9%) with a low rate of revision (.05%). One revision was performed to further decrease the height of an implant, and once case of infection was recorded (.02%) and necessitated implant removal.
Conclusion: Custom designed “S” nasal dorsal implant are a superior alternative to other forms of nasal augmentation materials for the enhancement of the typically depressed naso-dorsal frontal angle.
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