Two most common pathologic mechanisms which cause
secondary rhinoplasty are related with nasal framework and it's
envelope. The reasonable definition defining key features of the
secondary rhinoplasty 'Scarred nasal soft tissue envelope
overlying adherent and distorted nasal framework' gives full
explanation about main deformities in the secondary rhinoplasty,
and leads us to focus on reconstructing and reinforcing both
structures when the secondary rhinoplasty is performed.
Moreover, artificial alloplastic implants and injectable materials,
popularly used for augmentation rhinoplasty, erode skin and
give damages to skin and appendages. It is, therefore, essential
to understand the importance of skin problem and to know that
one must be ready to suffer from another more difficult operations
and its unpredictable results, unless it is properly reinforced. I
have used several autogenous materials (n=294) and two kinds
of xenografts (n=35) in the secondary rhinoplasties during the last
8 years for reinforcing the envelopes in pathologic conditions
and augmenting the dorsal volume. I have learned a lesson from
these 8 years of experience about dorsal augmentation in
secondary rhinoplasty. 1) Even though it seems to be time
consuming and annoying to harvest and prepare autogenous
graft materials, no xenografts or artificial materials are safer and
more consistent than autogenous materials, and no convenience
is more valuable than consistency and safety in secondary
rhinoplasty. 2) If you need to augment nasal dorsum in
secondary rhinoplasty, get the permission from the nasal
envelope. 3) Remind this aphorism: Alloplastics are only
convenient on the day of surgery.