title: Oriental nose elongation using an L-shaped polyethylene sheet implant for combined septal spreading and extension.
abstract: BACKGROUND
  The currently recommended strategies for short nose elongation were designed primarily for the Caucasian nasal framework. For Oriental patients, more elongation often is required because a hypoplastic septal cartilage requires more elongation, resulting in a higher risk of complications. This report proposes a modified technique for Oriental nose elongation, which adjusts the pressure points after nasal elongation using an L-shaped implant.
  
  
  METHODS
  Between January 2007 and December 2009, 58 patients underwent Oriental nose elongation using an L-shaped, porous, high-density polyethylene sheet implant. Augmentation rhinoplasty and conchal cartilage shield grafts were performed depending on the nasal shape. Pre- and postoperative nasal length, height, and projection as well as columella-labial angle, columella-lobular angle, and nasal tip angle were measured and compared. A patient satisfaction survey was performed postoperatively. All occurring complications were recorded.
  
  
  RESULTS
  The postoperative nasal length was significantly elongated from 47.0±10.4 mm to 49.3±10.1 mm (p=0.003), and the nasal height increased significantly from 48.5±9.1 mm to 50.4±8.5 mm (p=0.011). The initially obtuse columella-labial angle improved significantly from 100.8°±12.1° to 92.5°±15.5° (p=0.014). No significant changes were found regarding nasal projection, nasal tip angle, or columella-lobular angle. The majority of the patients (91.3%) were highly satisfied or satisfied with the aesthetic results. A major complication in terms of implant exposure was observed in one case. The minor complications included stiffness of the nasal tip (3 patients) and tip redness (1 patient).
  
  
  CONCLUSIONS
  In Oriental nose elongation, the use of an L-shaped graft is a feasible and safe treatment option that allows for an excellent aesthetic outcome and reduces the incidence of complications.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
authors.forename: Jia
authors.initials: J
authors.lastname: Zhou
authors.forename: Xiaolu
authors.initials: X
authors.lastname: Huang
authors.forename: Danning
authors.initials: D
authors.lastname: Zheng
authors.forename: Haizhou
authors.initials: H
authors.lastname: Li
authors.forename: Tanja
authors.initials: T
authors.lastname: Herrler
authors.forename: Qingfeng
authors.initials: Q
authors.lastname: Li
mesh_terms: D000328:Adult; D044466:Asian People; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000601:surgery*; D009666:Nose / Q000033:anatomy & histology / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D020959:Polyethylene; D011183:Postoperative Complications / Q000503:physiopathology; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods*; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020959:Polyethylene