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We describe our technique using polydioxanone (PDS) foil for the correction and stabilization of caudal septal deviation. In addition, we evaluate the effectiveness of this technique in the treatment of the C-shaped craniocaudal sepal deviation. A retrospective review was conducted of 55 patients who underwent open septorhinoplasty with PDS splinting for the correction of a caudal septal deviation. The mean age was 35 years (range, 25-45 years), 38 of 55 (69%) were females and all had symptomatic nasal obstruction. Preoperatively, there were osteocartilaginous involvement and hypertrophy of the inferior turbinate at the opposite side of the septal deviation in all cases; whereas 30 (54.5%) patients had a bone spur, 20 (36.3%) had collapse of the external nasal valve due to septal deviation. Five patients complained of sinus headache that resolved after surgical correction. All patients were pleased with their functional improvement and 52 (95%) with their aesthetic results. Only 1 patient required surgical revision, which was due to the development of asymptomatic posterior septal perforation identified at follow-up endoscopy. There were no additional postoperative complications. Splinting of the septal cartilage with a PDS foil was feasible, safe, and effective for the treatment of severe caudal septal deviation. This technique emerges as an alternative to traditional cartilage grafting, especially in patients with insufficient cartilage for harvest or in patients with thin nasal dorsum in whom the use of a spreader graft can widen the nose and modify the normal nose contours, providing long-term support and stability of the septum.

Introduction: Nasal tip revision remains one of the most challenging procedures for plastic surgeons. Performing 3-dimensional anatomic nasal tip reconstruction by complete replacement of alar cartilages with ear cartilage allows optimal nasal tip correction in patients with severe alar distortion. We aim to describe this reconstructive surgical technique and report our experience with this procedure. Materials and Methods: We performed a retrospective analysis of patients who underwent complete replacement of alar cartilages as part of a revision rhinoplasty. Results: From January 2010 to December 2014, 569 patients underwent revisions, 20 (3.5%) of them with complete alar replacement. Additional grafts used were as follows: 8 columellar struts, 6 onlay grafts, and 3 spreader grafts. There were no in-hospital complications. At follow-up (mean 24 months), all patients reported satisfaction with the esthetic outcome and improvement in functional symptoms. No patient underwent further augmentation or repeat revision. Conclusions: Complete replacement of alar cartilages is an efficient surgical alternative for nasal tip reconstruction during revision rhinoplasty. This technique recreates the severely injured alar cartilage structure and returns the original nasal tip appearance.

Severe lateral crura concavity (LCC) can lead to an important deformity of the nasal tip and to external nasal valve insufficiency. The lower lateral crural reverse plasty represents a valuable technique for the correction of severe LCC, but often requires additional cartilage to gain more alar rim support. We describe a modified version of the reverse plasty, in which a polydioxanone plate is sutured as a strut at the dome junction to increase alar rim support. We report our experience with this technique in 10 women (age range 24–56 years). The procedure was performed in eight primary rhinoplasties and in two cases alone without rhinoplasty. All patients had aesthetic complaints, whereas three had obstructive symptoms. Eight patients had unilateral problems. A one-year follow-up was completed in 100 % of patients. There were no surgical complications and all patients had optimal short and long-term aesthetic and functional results. Acikel C (Aesthetic Plast Surg 36:862–865, 2012) The adjunctive use of a polydioxanone plate during lateral crural reverse plasty was feasible and led to satisfying functional and cosmetic long-term results in patients with severe LCC. This surgical maneuver appears reproducible and emerges as an alternative way of gaining stronger support during lateral crura reverse plasty while avoiding additional tissue. 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 .