Rhinoplasty Combined With Centrofacial Lipofilling to Optimize Facial Proportions

Nasofacial proportions and relationships between facial soft-tissue and bony framework play a role in determining the ideal rhinoplasty for each patient. Preoperative facial and nasal analysis is essential not only to determine surgical steps but also to manage patient’s expectations. Planning the rhinoplasty relies on multiple factors to achieve facial balance that include facial volumes and contours, symmetry, age, sex, and ethnic group.

Association of nasal hump and skeletal deficiencies such as malar hypoplasia, periapical hypoplasia, and microgenia is not uncommon. Because of its central position on the face and its relation to surrounding structures, concurrent treatment of the nose and the malar prominence, pyriform aperture, and/or chin may provide optimization of the overall outcome. Creating convexity to a deficient midface alters the perception of an otherwise prominent nose and may influence the surgeon to plan the ideal nose accordingly. Likewise, in patients with under-projected chin, a nose may appear to project excessively, even though nasal projection may be appropriate to the face.

Over the past decade, lipofilling has emerged as an effective and safe alternative to facial implants and/or advancement osteotomies. Autologous fat graft is a durable filler material easily harvested by means of a minimally invasive approach. Advantages of its use as an adjunct to rhinoplasty include low-associated morbidity, ease to precise titration to patient’s specific needs, and long-lasting results. Complications associated with facial lipofilling are considered small and are easily managed. They include oil cysts, lumps, asymmetries, overcorrections, and undercorrections.

Despite the remarkable gain in popularity of facial fat grafts and its indications in recent years, few studies have reported the simultaneous association of lipofilling and rhinoplasty.