Application of a Porous Polyethylene Spreader Graft for Nasal Lengthening in Asian Patients

Abstract

Background: Rhinoplasty maneuvers to lengthen the nose include placing an alloplastic implant, caudally rotating the lower lateral cartilage (LLC), and stretching the soft tissue skin envelope (STSE) downward. Tissue tension associated with these procedures can result in implant extrusion or tip retraction. Objectives: The authors performed rhinoplasty with implantation of porous polyethylene (Medpor). The Medpor device enabled transfer of tension from the LLC and STSE to the juncture of the septal cartilage and upper lateral cartilage (ULC), thereby stabilizing the nasal structures. Methods: Twenty-six patients who underwent rhinoplasty with nasal augmentation and lengthening were evaluated in a prospective study. Two pieces of Medpor were placed as a spreader graft, and a third piece was inserted as a columellar strut. The released LLC was rotated caudally, and the domal segments were wrapped over the caudally projected tip of the implant. Surgical outcomes were assessed with a patient satisfaction questionnaire and by photogrammetry. Results: Patients were monitored for an average of 9.6 months. The patients' mean nasolabial angle (NLA) was 106.2° ± 4.7° preoperatively and 94.3° ± 3.7° postoperatively (t < 0.0001). Most patients were fairly or completely satisfied with the operative outcome. One patient had impending implant extrusion and underwent explanation. Conclusions: Medpor material is easy to shape and is sufficiently strong to function as a spreader graft and withstand the tension associated with repositioning of the LLC and STSE.