Invited Discussion on: Multilayered Costal Cartilage Graft for Nasal Dorsal Augmentation
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: Multilayered Costal Cartilage Graft for Nasal Dorsal Augmentation Ali Sajjadian1 • Shawn Moshrefi2
Received: 22 July 2020 / Accepted: 23 July 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V 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. The art of rhinoplasty and particularly ethnic rhinoplasty is moving from reductive to augmentation and/or ‘‘preservation’’ type rhinoplasty. Asian rhinoplasty is a form of ethnic rhinoplasty gaining in popularity internationally with particular attention to augmentation of nasal dorsum as well as refinement of the nasal tip. Many modalities to address the often ‘‘low’’ nasal dorsum of the Asian rhinoplasty patient has been discussed including use of alloplastic materials, cadaver cartilage, and the already longstanding use of autologous cartilage. [1–3] Autologous cartilage provides the benefit of cost-saving from a materials standpoint and the avoidance of foreign materials that may be more prone to infection or extrusion, however, the amount of cartilage needed to address the Asian nasal dorsum often necessitates rib cartilage be utilized for this purpose. While costal autologous cartilage provides abundant working material, it too is plagued with the disadvantages of a sometimes painful surgical site, risk of pneumothorax, a secondary scar, and most importantly, warping over time. During the past few decades, a variety & Ali Sajjadian [email protected] Shawn Moshrefi [email protected] 1
Department of Plastic Surgery, Hoag Hospital, 496 Old Newport Boulevard, Newport Beach, CA 92663, USA
2
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA
of different techniques have been described to combat the warping effects of costal cartilage including balanced cross-sectional harvesting, irradiated cartilage, harvesting including perichondrium, harvesting excluding perichondrium, using Kirschner wires (similar to rebar in concrete), micro-plating, suturing, sharp scoring, and electrocautery among others [4]. This discussion will focus on the cartilage warping mitigation efforts of the Namgoong et al. article ‘‘Multilayered Costal Cartilage Graft for Nasal Dorsal Augmentation’’ [5]. They have nicely demonstrated methods of utilizing autologous costal cartilage in a fashion that diminishes warping. Specifically, the focus of the authors’ study is evaluating the use of autologous costal cartilage as a single block that is contoured to the appropriate shape versus that of multiple splits of the rib cartilage sutured together. These pieces are cut longitudinally and then are sutured together in a fashion meant to counteract one piece of warping compare
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