Is the Silicone Implant actually in the Subperiosteal Pocket in Augmented Rhinoplasty?

Purpose: To identify the right plane in augmented rhinoplasty to help facilitate the facial plastic surgeons in creating more natural look in oriental noses. Materials and methods: One hundred and ten adult Thai cadavers comprising 61 males and 49 females from Department of Anatomy, Faculty of Science, Mahidol University were included in this study. Augmentation rhinoplasty with the closed technique was performed by using silicone prosthesis; then, surgical incision was done at midline from nasion to nasal tip to identify the correlation between silicone and periosteum in the area of rhinion and nasion. Results: This study included 61 male and 49 female cadavers. At the rhinion, silicones were placed in subperiosteal plane of 65 cadavers (59.1%) and above periosteum of 45 cadavers (40.9%). In nasion area, silicones were successfully inserted below periosteum of 109 cadavers (99.1%). However, silicone was placed in the supraperiosteum of only one cadaver (0.9%). Conclusion: Silicone can be inserted into subperiosteal layer in the area of nasion easier than in the area of rhinion. Augmented rhinoplasty by using silicone insertion in subperiosteal plane, at lease in the nasion area, makes it more natural look, stable and can prevent misalignment.