World Renowned Facial Reconstructive Surgeon, Dr. Dean Toriumi, Develops Techniques for a Natural Looking Bridge for Rhinoplasty Patients

    MARINA DEL REY, CA, February 28, 2010 /24-7PressRelease/ -- Many rhinoplasty patients do not have adequate height to their nasal bridge, therefore, enhancement requires building a natural looking nasal dorsum. In response to the needs of these patients, Dr. Dean Toriumi has developed a technique to create a more prominent and natural nasal bridge.

Dr. Dean Toriumi uses rib cartilage for nasal dorsal augmentation, among other measures.

"Patients needing augmenting of the nasal dorsum include some Asian and Asian/American patients. Many patients undergo surgery to raise their dorsum and create a more natural and prominent bridge," says Dr. Toriumi.

"Making a natural looking nasal bridge has been accomplished in many different ways," says Dr. Toriumi. "A popular option is to use injection of a filler material to increase dorsal height, but having witnessed numerous problems associated with this, I advises patients against this," he explains. Dr. Dean Toriumi suggests the use of rib cartilage to raise the nasal dorsum.

"Using rib cartilage can be a very complex method as it requires harvesting rib cartilage from the chest, carving it carefully to prevent warping," he explains. Dr. Dean Toriumi says, "This can be difficult and should only be done by a very experienced surgeon," he continues.

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

Dr. Dean Toriumi's approach involves harvesting the covering of a rib called the perichondrium, (this is a thick layer of fascial tissue that covers the rib) at the time he harvests the rib cartilage. After the graft is carved to the correct shape, a strip of perichondrium is sutured under the surface of the dorsal graft. Then the bony bridge is rasped with an instrument to create raw bone surface. When the dorsal graft is placed on the rasped bony bridge, the perichondrium fixes to the bone creating an immobile dorsal graft. The perichondrium acts like velcro making the dorsal graft fix into place.

There are many surgical methods to raise the bridge in a patient. Typically, this is done by placing an implant or tissue graft onto the bridge of the nose. For example, in Asia, it is quite popular to have silicone implant placed on the bridge to create height and definition. Dr. Dean Toriumi explains, "While most patients who undergo this placement can do well, some can develop an infection or extrusion of the implant. Additionally, these implants feel unnatural and may move freely over the bridge of the nose, as in the diagram above.

"One of the biggest problems I've seen is the warping of the cartilage that leaves a severe deformity of the dorsum," Dr. Dean Toriumi stated. His approach prevents this warping of the cartilage by using the special carving techniques and employing specific parameters while choosing the proper graft for the dorsum.

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

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

For more information please see http://www.deantoriumi.com/

Dean M. Toriumi, MD
Facial Plastic and Reconstructive Surgeon
900 N. Michigan Ave.
60 East Delaware Street, Suite 1460
Chicago, IL 60611

312-255-8812

Email: [email protected]

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