Analysis of nasal periosteum and nasofrontal suture with clinical implications for dorsal nasal augmentation

Background: Subperiosteal placement of nasal implants has been performed widely for dorsal nasal augmentation in Asia. The authors introduced anatomical and biomechanical studies to investigate the influence of the periosteum on the subperiosteal technique. Methods: Nasal periosteum on 20 cadavers was investigated by hematoxylin and eosin staining and biomechanical methods. Nasal profiles (n = 160) and motility testing (n = 1317) were used to analyze patients who underwent augmentation rhinoplasty between 2003 and 2008. An alternative high-split subperiosteal technique was developed for higher placement of the nasal implant. RESULTS:: In the cadaver study, the authors discovered that the periosteum and bone were bound together by Sharpey's fibers below the nasion (1.3 ± 0.6 mm) that penetrated into the nasofrontal suture. The nasal periosteum above the nasofrontal suture (1.77 ± 0.19 mm) was thicker than the one below the suture (0.83 ± 0.15 mm) (p <0.001). Men had relatively thicker periosteum (1.41 ± 0.49 mm) compared with women (1.18 ± 0.5 mm), and the difference was statistically significant (p <0.001). Motility testing for clinical cases revealed that there was a higher percentage of the mobilized implant in women than in men (p = 0.042). When the subperiosteal technique was compared with the subcutaneous technique, analysis of the Poisson ratio for the periosteum (0.33 ± 0.02) indicated greater strength than in the subcutaneous tissue (0.45 ± 0.02). The alternative high-split subperiosteal technique significantly shortened the radix-to-glabella distance, increased the radix height, and made the nasofrontal angle more obtuse than the conventional subperiosteal technique (p <0.001, p <0.001, and p = 0.02, respectively). CONCLUSION:: Analysis of the nasal periosteum provided scientific support for using the subperiosteal technique in dorsal nasal augmentation.