The platyrrhine nose may require nasal dorsal and tip augmentation, as well as a thin columnella strut and small particle premaxillary plumper implants. The over-resected noses will generally require reconstruction with bilateral, thin, curved nasal battens as well as a short, thin, columnella strut, small particle plumper implants, and a nasal dorsal implant without tip augmentation. Of course each nose is different and the particular techniques used for each patient will depend on the specific problems encountered and the desired outcome by the patient. The external rhinoplasty approach is the procedure of choice when undertaking these types of nasal reconstruction. Likewise, patients habitually using cocaine are advised to seek treatment of the addiction prior to any attempts at reconstruction.
Septal cartilage is the gold standard material for nasal augmentation.
It is quickly harvested in the same operative field and has no risk of disease transmission, rejection, or toxicity. However, prior surgery or trauma may preclude its use. Another option is conchal cartilage. In addition, it may be insufficient when significant augmentation is needed, and it requires a separate operative site. Bone options include iliac crest and calvarium Iliac crest provides flat bone for dorsal augmentation, however, it carries significant risk of morbidity from its harvesting.