Secondary Augmentation of the Dorsum

Abstract

The principles of secondary dorsal augmentation are largely the same as those used in primary rhinoplasty. However, owing to the previous surgical disruption of nasal soft tissues, scar contracture and/or fibrosis may complicate or limit secondary dorsal augmentation. Frequently, wide undermining of the soft-tissue envelope is necessary to enable adequate dorsal augmentation. In severe cases preoperative conditioning of the fibrotic skin envelope with stretching exercises and/or repeated massage is necessary to gradually loosen the tethered and noncompliant soft-tissue envelope. Unfortunately, the nose is poorly suited to the use of conventional tissue expanders, and while self- or autoinflating expanders may offer effective alternatives, we have no experience with these devices.