Dr. Dean Toriumi Develops a New Technique for Building a Natural-Looking Nasal Bridge

    MARINA DEL REY, CA, January 12, 2010 /24-7PressRelease/ -- Toriumi, a world-renowned facial plastic surgeon at the University of Illinois at Chicago, uses rib cartilage for nasal dorsal augmentation, among other measures, in his technique.
Patients needing augmentation of their nasal dorsum include Asian/Asian-American patients, those with a saddle nose deformity, or those with a congenitally low bridge, Toriumi said, and many of these patients undergo surgery to raise their nasal dorsum to create a more natural and prominent bridge.

Making a natural-looking nasal bridge can be accomplished in many different ways, Toriumi said. A popular option is to undergo injection of a filler material into the bridge to increase dorsal height, but, having witnessed problems associated with such treatment, Toriumi recommends against it, preferring the use of rib cartilage to raise the nasal dorsum.

"Using rib cartilage is a very complex method, because it requires harvesting from the chest and carving the cartilage carefully to prevent it from warping," Toriumi said. "This is a very experience-dependent operation."

Toriumi typically performs over 100 rib cartilage grafts per year and is one of the most experienced surgeons using rib cartilage in rhinoplasty. His technique using rib cartilage minimizes some of the problems associated with using such cartilage for dorsal augmentation, such as the movement of the dorsal graft on the bridge because of the lack of good fixation.

Toriumi's approach involves harvesting the covering of the rib called perichondrium (a thick layer of fascial tissue covering the rib) at the time of harvesting the rib cartilage. After the dorsal graft is carved to the correct shape, a strip of perichondrium is sutured to the undersurface of the dorsal graft. Then the bony bridge is rasped with an instrument to create a raw bone surface. When the dorsal graft is placed over the rasped bony bridge, the perichondrium fixes to the bone thereby creating an immobile dorsal graft. The perichondrium acts like Velcro to make the dorsal graft fix into place.

There are many surgical methods for raising the bridge in a patient. This is typically done by placing an artificial implant or tissue graft onto the bridge of the nose. In Asia, for example, it is very popular to have a solid silicone implant placed on the bridge of the nose to create height and definition. Most patients who undergo placement of such an implant do well, Toriumi said. However, some can develop an infection or extrusion of the implant. Additionally, most implants feel unnatural and can move freely over the bridge of the nose.

"One of the biggest problems is warping of the cartilage that can leave a severe deformity of the nasal dorsum," Toriumi said. His approach prevents warping of the cartilage by using special carving techniques and employing specific parameters when choosing the proper graft for the dorsum of the nose.

"I like to use a curved segment of cartilage to make the dorsal graft. This curvature is used in a manner to take advantage of the tendency to bend," he added. Toriumi places the concave surface of the graft against the top of the nasal dorsum and then sutures the graft to the bridge. By fixing the graft in this fashion, the tendency for curvature of the graft is offset by the fixation of the graft to the bridge. The combination of placing the curvature downward against the bone and placing the perichondrium in-between the graft and bone for fixation helps to minimize the chance of warping or movement of the graft.

Occasionally dorsal grafts can be visible at the junction between the graft and the native nasal bridge. To prevent this problem, Dr. Toriumi frequently places perichondrium along the junction between the dorsal graft and the native bridge to camouflage this junction. The combination of these maneuvers helps to create a natural-appearing nasal dorsum that is immobile and long-lasting.

For more information, please contact Dr. Dean Toriumi, MD

(312) 255-8812

60 East Delaware Place, Suite 1460
Chicago, IL 60611

email: [email protected]
http://www.deantoriumi.com

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