title: Surgical Techniques for the Correction of Postrhinoplasty Depressed Scars on the Nasal Tip.
abstract: OBJECTIVE
  Augmentation rhinoplasty is common in the Asian population and the lack of suitable autologous material for augmentation has led to the use of alloplastic materials. Many of these patients develop complications, including a depressed dimple-like scar of the nasal tip. Causes of such dimpling include the use of large implants, infection, extrusion, and surgeon incompetence.
  
  
  OBJECTIVE
  To describe the various techniques that can be used to correct dimpling of the nasal tip.
  
  
  METHODS
  Data were retrospectively reviewed from 28 patients who had undergone surgical procedures from January 1, 2013, through July 31, 2014, in a rhinoplasty clinic in Seoul, Korea, for the correction of a contracted nose with nasal scars secondary to previous rhinoplasties. Data analysis was conducted from August 1, 2014, through February 16, 2015.
  
  
  METHODS
  Before surgery, a complete rhinological examination was conducted, digital photographs were taken, and an assessment was made regarding the severity of the dimpling, the condition of the nasal skin, and the underlying supporting structures. Based on these factors, the appropriate type of procedure was planned.
  
  
  METHODS
  Patient satisfaction with change after surgery was assessed using a 3-point Likert scale (3 indicates satisfied; 2, fairly satisfied; and 1, dissatisfied). Outcomes were also reviewed by 2 surgeon-peers who gave an outcome score ranging from 1 to 10 (1 indicates a poor cosmetic outcome; 10, the best possible outcome).
  
  
  RESULTS
  The nasal contour and tip symmetry were restored to aesthetic standards with these relatively simple techniques. Eleven patients (39.2%) were treated with unilobed flap, 4 (14.2%) with a bilobed flap, 3 (10.7%) with Z-plasty, 9 (32.1%) with soft-tissue interposition, and 1 (3.5%) with a transposition flap. Twenty-four of the 28 patients (85.7%) were satisfied with their outcomes and 4 (14.3%) patients were dissatisfied and were given a revision procedure, following which they were satisfied with their outcomes. The follow-up period ranged between 6 to 32 months (mean, 12.3 months). The mean surgeon-reviewed outcome score for soft-tissue interposition procedure was 8.0 of 10; for the unilobed flap, 8.0 of 10; for the bilobed flap, 7.5 of 10; for the transposition flap, 8.0 of 10; and for Z-plasty, 7.8 of 10.
  
  
  CONCLUSIONS
  These techniques are reproducible and the choice of the technique depends on the shape, size, and location of the scar; skin condition; patient expectations; and the surgeon's experience and comfort level with the procedure.
  
  
  METHODS
  4.
authors.affiliation: Department of Rhinoplasty and Facial Cosmetic Surgery, Shimmian Rhinoplasty Clinic, Seoul, South Korea.
authors.forename: Dong Hak
authors.initials: DH
authors.lastname: Jung
authors.affiliation: Department of Nose, Sinus, and Allergy, Medikeri's Superspecialty ENT (Ear, Nose, and Throat) Center, Bangalore, India.
authors.forename: Gaurav S
authors.initials: GS
authors.lastname: Medikeri
authors.affiliation: Department of Rhinoplasty and Facial Cosmetic Surgery, Shimmian Rhinoplasty Clinic, Seoul, South Korea.
authors.forename: Guen-Uck
authors.initials: GU
authors.lastname: Chang
authors.affiliation: Department of Rhinoplasty and Facial Cosmetic Surgery, Shimmian Rhinoplasty Clinic, Seoul, South Korea.
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Hyun
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty; D016896:Treatment Outcome