Most Filipino noses are featured by a series of very typical characteristics, like very short nose wrapped within a thick and non expandable cutaneous cover, making thus any lengthening and augmentation maneuvers very challenging, limited and rebellious; the best example is this case in which the skin is terribly thick and inelastic, for a dramatically short nose in need of massive lengthening and augmentation; the dorsum was, fortunately, optimal and needed no correction.
Once open approach and columella lengthening rotational flaps were tailored the septum could be accessed, confirming its massively shortfall; the lower lateral or alar cartilages were, as usual in Asian patients, thin, weak and non supportive; the upper lateral or triangular cartilages were equally short and problematic.
Grafting was harvested from the deep septum and both ear concha bowls; these cartilaginous elements were tailored as per the anatomical demands deemed intraoperatively suited.
Then the first reconstructive stage was lengthening the septum to a desirable nasolabial angle, by means of a one on one septal extension graft and paired or double L shaped septocolumellar grafts to build a reliable, strong and supportive pillar onto which the new nose could be assembled.
An extended tip and columella en bloc graft served as tip rebuild and columellar reshaping, sutured to the previously built caudal septum.
The lateral cruras were repositioned and transposed as triangular cartilages caudal extension graft, in order to provide skeletal cover to the lengthened nasal walls.
Lateral cruras caudal extension grafts acted as new lateral cruras and as rim contour grafts at the same time, so that the nostril rims were also lowered.
Finally the columellar lengthening flaps were rotated and thus the nostrils indirectly reduced; notwithstanding the enormous tension of the closure, due to the inelastic skin and the massive augmentation, lead to wound breakdown and delayed healing, satisfactorily in the end though; this is a typical issue in tension closures after nasal lengthening or augmentation procedures.
The upper asian eyelids were managed using the modified and most ;UPDATEd version of Park's technique of epicanthoplasty and zetaplasty, allowing eradication of the epicanthus and clearance or exposure of the lacrimal lake.
The double eyelid technique was evidently incisional so that the moderate excess of skin could be removed, the fat bags prominence eliminated and the neo tarsal crease or double eyelid could be created, using internal sutures to attach the skin to the upper tarsal plate cartilage.
The radically changed and spectacular postoperative look needs little comment; the nose acquired the minimally acceptable length, the tip was redefined and the width narrowed; the new eyelids also boost patient's beauty and her overall facial balance is a brand new appealing one.
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