Cadaveric study of the nasal periosteum and implant position after augmentation rhinoplasty

Augmentation rhinoplasty is one of the most common cosmetic procedures done in Asia. A technique believed to be helpful in reducing complications is subperiosteal placement of silicone implant. A deeply placed implant should benefit from having thicker soft tissue coverage. Tough periosteal tissue is hoped to provide better implant fixation and prevent undesirable mobility. Experienced surgeons often claim that they can preserve the nasal periosteum and achieve complete implant coverage via nasal rim incision(s). However, success of implant placement and preservation of periosteal integrity after nasal augmentation has never been studied before.Nose augmentation with silicone implant was conducted in 12 fresh cadavers with the closed technique used in real practice. Open dissection of the nose was then carried out to verify implant position and the integrity of the periosteum. Factors that could affect the outcomes, including blade sizes of periosteal elevators, use of Aufricht retractor, and surgeon's experience, were analyzed.We found that all silicones could be implanted in the subperiosteal plane independent of instruments, surgeon's technique, and experience. Nonetheless, the covering nasal periosteum was always torn at its periphery and disconnected from the surrounding bone. As a result, lateral sides of the inserted silicones were not immediately covered with the periosteum.In conclusion, the surgeon's experience, the size of the periosteal elevator, and the Aufricht retractor did not affect the success of implant placement in the subperiosteal plane. Periosteal coverage was always incomplete and did not provide immediate implant fixation as previously understood.