Treatment of iatrogenic contracture nasal deformity / 中华医学美学美容杂志

Objective To explore the method and clinical effects of treatment for correcting severe contracture nasal deformity after rhinoplasty.Methods Totally 19 patients with severe contracture nasal deformity after rhinoplasty were treated with a new procedure in our hospital since March 2014.The soft tissue was treated with manual traction preoperatively to improve nasal skin and mucosa extensibility and flexibility.The costicartilage was taken as structure transplantation to build the nasal support structure.Results This group of patients were followed up for 5-27 months,contracture of nasal deformity was corrected and the shape of the nose was improved with no obvious contracture deformation.Conclusions Nasal shape is improved by nasal scaffold and coated tissue.It is a simple and feasible method to modify the condition of soft tissue by manual traction and autogenous costicartilage support reconstruction to ensure the long-term efficacy of backing;two combination therapy for correction of iatrogenic contracture nasal deformity can achieve better long-term nasal prolonged postoperative effect,which is suitable for clinical promotion.

Analysis on the complications after rhinoplasty by barbed sutures / 中华整形外科杂志

Objective@#To investigate the complications and related etiologies after thread rhinoplasty.@*Methods@#From January 2017 to January 2018, 21 cases with postoperative complications after thread rhinoplasty were reviewed. The complications included thread exposure at gum (n=5), thread exposure at nose (n=2), compromised blood supply (n=5), infection (n=6), and ulceration (n=3). The medical history and clinical symptoms were analyzed.@*Results@#7 patients with thread exposure have recovered. The localized hyperpigmentation was left on patients with compromised blood supply. The skin of the infection cases basically returned to normal. The hyperpigmentation and local scar left on the rest of patients. The causes of these complications are complex, including the threads buried plane, the threads textures, skin tension, surgical manipulation, the early rejection, and the chronic inflammation, etc.@*Conclusions@#Patients, with complications after thread rhinoplasty, could obtain a better outcome, if timely operation and comprehensive treatment were provided.

Analysis of related risk factors for infection after expanded polytetrafluoroethylene rhinoplasty / 中华整形外科杂志

Objective@#to investigate the risk factors of postoperative local infection in patients with polytetrafluoroethylene implant in rhinoplasty, and to provide evidence for reducing the risk of postoperative infection.@*Methods@#Retrospective analysis of 923 cases of rhinoplasty implanting ePTFE prosthesis were conducted, those related factors included were as follows: gender, age, operation, history of nasal surgery, nasal pore bulky excessive sebum secretion, cartilage cap on the tip-defining points, columella support, nasal septum cartilage harvest, extend the septum cartilage transplantation, interdomal fat pad resection, adjust the alar cartilage, reduce the ala nasi, severe postoperative swelling, prevention of postoperative infection duration, postoperative folliculitis, nasal vestibular mucosa was damaged postoperative, whether the surgical incision has abnormal healing and so on are being investigated and recorded, all of which were established as multivariate logistic regression model analysis of the risk factors for independent prognosis of postoperative infection.@*Results@#The excessive sebum of the nasal pores, adjustment of the alar cartilage and the postoperative nasal collision are the independent risk factors for postoperative infection(P<0.05).@*Conclusions@#Patients with large nasal pores and sebum secretion are more likely to render infection after operation. Partial separation and partial nasal resection of nasal alar cartilage and postoperative nasal impact will increase postoperative risk of infection.

Changes in Implant Thickness after Rhinoplasty Using Surgiform

BACKGROUND: Gore-Tex implants started out as a product with the distinct advantage of producing a natural nose shape, but using Gore-Tex, it is difficult to predict the height of the nose after rhinoplasty because Gore-Tex contracts over time, making the nose shrink. However, Surgiform, a new form of expanded polytetrafluoroethylene (ePTFE) implant, enables prediction of the height of the nose after rhinoplasty because the implant does not change in thickness even after many years. Thus, we investigated whether changes in implant thickness occurred after rhinoplasty using Surgiform implants. METHODS: This study enrolled 12 patients who had Surgiform nasal implants removed for any reason after receiving rhinoplasty in 2007 or later. After the Surgiform implants were removed, we measured the thickness of the central part of the implants using calipers. RESULTS: At the time of the initial operation, the mean implant thickness was 4.48±0.30 mm at the supra-tip. At the time of implant removal, the mean thickness was 4.32±0.29 mm. The implants maintained 96.5% of their initial thickness. There was a negligible reduction in the Surgiform implants' thickness over time. CONCLUSIONS: Surgiform implants maintained their shape after rhinoplasty, making it possible to predict the height of the nose. Thus, Surgiform is more useful for nasal implants than other ePTFE implants.

Augmentation Rhinoplasty with Dermofat Graft & Fat Injection

PURPOSE: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. METHODS: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. RESULTS: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. CONCLUSION: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

A Case of Infection of Tutoplast-Processed Fascia Lata in Augmentation Rhinoplasty

Numerous materials have been used in augmentation rhinoplasty. The representative materials include silastics, Gore-Tex, autologous cartilage, and homologous materials. The use of alloplastic materials in rhinoplasty is often discouraged due to possible risk of infection and extrusion. Currently, the use of Tutoplast-processed fascia lata (TPFL) in augmentation rhinoplasty is increasing in Korea because it can avoid donor site morbidity and decrease the surgical time. However, there have been no reports of infections related to rhinoplasty using TPFL in Korea. We experienced a case of infection that occurred after rhinoplasty using TPFL. We report this case along with a brief review of the literature.

Simultaneous Augmentation Rhinoplasty with Bony Reduction in Nasal Bone Fracture

PURPOSE: The nasal bones are the most common fracture sites of the facial bones, and a careful reduction may still result in secondary deformities, such as saddle nose, deviated nose, hump nose etc, requiring secondary cosmetic rhinoplasty. Therefore, this study examined the clinical characteristics of nasal bone fractures to propose guidelines for patient selection and surgical procedures to achieve more satisfactory results and to prevent secondary deformities with simultaneous augmentation rhinoplasty and bony reduction. METHODS: The study was based on 26 out of 149 nasal bone fracture patients who underwent simultaneous augmentation rhinoplasty with bony reduction between May 2008 and April 2009. Retrospective analysis was performed according to the clinical data, surgical techniques and postoperative results. RESULTS: Of the 26 patients, there were 15 males and 11 females. The incidence according to the Stranc's classification revealed that 62% of patients were injured by a frontal impact and 38% by a lateral impact. Frontal impact plane I (50%) was the most frequent type. At the follow up, 18 (81.2%) out of 22 patients were satisfied with their postoperative outcome, and the remaining 4 patients were fair. No one was dissatisfied. However, 5 cases in 3 patients (23%) had some complications; minimal implant deviation in 2 cases, minor irregularity on the nasal dorsum in 2 cases and palpable implant movement under palpation in 1 case. None of these cases required surgical correction. CONCLUSION: With the proper guidance, simultaneous augmentation rhinoplasty with bony reduction can prevent secondary deformities and satisfy the cosmetic outcomes.

Rhinoplasty using Various Autogenous Tissues

PURPOSE: In Korean rhinoplasty, alloplasts such as silicone rubber have been used for dorsal and tip augmentations. However, alloplasts have produced complications such as deviation, exposure, and infection. Although autogenous tissue is an ideal material, the amount of the cartilage in Korean is not sufficient. Therefore, the authors developed a method to harvest the maximum amount of the septal and conchal cartilage. The authors first performed a complete septal extension graft for short and retruded columella and then performed nasal augmentation using various autogenous tissues. METHODS: These surgical techniques were performed on 11 patients. Their average age was 27 years. An open approach with a V-shaped columellar labial incision was performed. At first, the complete septal extension graft was fixed on the entire caudal margin of the septum, and the alar cartilage was suspended to the septal extension graft to make the tip projected and the columella advanced caudally. A temporal fascial ball was used for radix augmentation. For dorsal augmentation, a batten-shaped septal cartilage graft wrapped with or without the temporal fascia or a diced cartilage graft wrapped with the temporal fascia was performed. For nasal tip augmentation, a shield graft and a cap graft or a folded conchal cartilage graft was performed. RESULTS: The mean follow-up period was 11.2 months. The overall results were natural and satisfactory. Two patients underwent slight absorption and caudal displacement. With the exception of these cases, no complications were observed. CONCLUSION: Korean rhinoplastic surgeons are accustomed to using the alloplasts despite of serious complications. When rhinoplasty using autogenous tissue was performed, some complications occurred such as the displacement of the diced cartilage graft wrapped with the fascia, but many of the complications of alloplastic rhinoplasty were avoided. Therefore, we propose that by this time Korean rhinoplastic surgeons need to change their preference from alloplastic rhinoplasty to autogenous rhinoplasty.

Clinical application of ear cartilage in augmentation rhinoplasty / 中华医学美学美容杂志

Objective To investigate the superiority of augmentation rhinoplasty by using ear cartilage.Methods We excised ear cartilage from patient's unilateral ear.106 cases were performed through suitable ear cartilage that was carved to some shape and then transplanted to nasal tip and columella,and two alar cartilages were sutured and implant was used for rhinoplasty.Results All cases were followed up for one year after operation without implant slipping and malposition of implant,with better figure after enhancing and lengthening nasal tip.Conclusions This method of augmentation rhinoplasty using ear cartilage can avoid complications such as slipping,malposition and exposure of implant.Therefore,it is deserved to recommend clinical application.

Epidermal Cyst of the Nasal Tip Presenting as Foreign Body Reaction

PURPOSE: Epidermoid cyst may be congenital or acquired. Acquired cysts are most commonly of traumatic origin and result from an implantation or downward displacement of an epidermal fragment. Traumatic epidermoid cysts are rare tumors occurring on the nasal tip, especially resulting aesthetic procedure. So, we report a rare case of an iatrogenic epidermoid cyst in the nasal tip following rhinoplasty. METHODS: A 44-year old man had undergone rhinoplasty for several times. First time, the previous augmentation rhinoplasty and wedge osteotomy were performed nineteen months ago, lastly implant removal and unknown filler injection were performed one year ago at another local clinic. He had induration and tenderness on nasal tip and dorsum continued for 3 months. We thought that it was caused by the foreign body reaction with residual alloderm in nose. For removal of residual alloplastic material, open approach using transcolumellar incision was done. But, incidentally we found cystic mass on the nasal tip. RESULTS: The findings were of an 0.8x0.5x0.5cm sized round cystic mass containing cream coloured material with a thick cheese-like consistency. The mass was completely excised and submitted for histology. This confirmed the diagnosis of an epidermoid cyst lined by keratinizing squamous epithelium. There was no induration, tenderness or sign of recurrence after excision of the mass. CONCLUSION: Epidermal cyst of the nasal tip region represents an unusual clinical lesion and it presents as foreign body reaction. And then, our case demonstrates that meticulous surgical approach and suture technique are the keys to prevent iatrogenic nasal epidermoid cyst, especially in secondary rhinoplasty.

Analysis and treatment of the complications caused by polyacrylamide hydrogel injection for augmentation rhinoplasty / 中华医学美学美容杂志

Objective To analyze the causes and explore suitable treatments for the complica-tions induced by polyacrylamide hydrogel (PAHG) injection for augmentation rhinoplasty. Methods The causes of the complications of 52 cases who accepted PAHG injection for augmentation rhinoplas-ty were analyzed and summarized. All the patients were treated by surgical operations to remove the injected PAHG. Results The complications included infection, granuloma, skin ulceration, bad shape, pain and serious psychological stress. Each case had 1 to 4 complications. Satisfactory results were obtained after suitable treatments. Some cases had silicone or expanded polytetrafluoroethylene implant augmentation rhinoplasty at the same time or secondary to the PAHG removal. A few cases had sequelae and long time psychological stress or tend pain of nose. Conclusions The complications induced by PAHG injection for augmentation rhinoplasty are various, and may relate to the inherent character of PAHG and the anatomic features of the nasal soft tissue. Surgery can remove the PAHG as completely as possible, which is a better method to treat the complications of PAHG injection for augmentation rhinoplasty.

A Case of Silicone Rubber-Induced Foreign Body Granuloma with Skin Defect / 대한피부과학회지

Silicone has become one of the most commonly used biomaterials in modern medicine. There are three forms of silicone in medical use: silicone oil, gel, and rubber. Among these, silicone rubbers are used as heart valves, shunts, coatings on pacemakers and implants of cosmetic surgery. In tissues, silicone produces a range of histological reactions depending on the form of silicone. We report a case of a foreign body granuloma due to the prescence of silicone rubber inserted for nasal augmentation fifteen years previously, and review the complications of augmentation rhinoplasty using silicone implants.

A histological study on several implants for augmentation rhinoplasty in mouse calvarium

Repairing the outpocketing of nasal tip and thin skin after the augmentation rhinoplasty combined Autogeneic dermis with silicone prosthesis / 重庆医科大学学报

Objective:To explore a new method for repairing the outpocketing of nasal tip and thin skin after the augmentation rhinoplasty Methods:Autogeneic dermis been obtained from the gluteal fold were properly cut and sutured to the tip of "L" model silicone prosthesis. Then the combined material of dermis and prosthesis were been put to the lacouna. Results:The phenomenon of outpocketing and thin skin of nasal tip disapeard and the noddle of nose satiated. The patients were traced 6~12 months, no obvious absorption and sharpping of nasal tip were found.Conclusion:Combind autogeneic dermis and silicone prosthesis can properly repaired the complication of the outpocketing of nasal tip and thin skin after augmentation rhinoplasty and the result can lasted a long time. We concluded that autogeneic dermis is a pragmatic and utility repairing meteria for the augmentation rhinoplasty.

The Infection after Augmentation Rhinoplasty Using Silicone Implant

Augmentation rhinoplasty using silicone implant is one of the most common cosmetic procedures in Korea, but is not without several complications such as exposure of the implant, its deviation and deformity. Above all, infection and extrusion through the skin is most serious complication. The purpose of this study was to determine the type of microbial colonization on silicone implant removed from symptomatic patients and to prevent from the infection. Over the past 11 years, from February of 1996 to February of 2007, we have done 134 aesthetic rhinoplasties using silicone implant in our clinic, patient ages ranged from 15 to 62 years with an average of 29.2 years. 78 percent of patients (105) were female, and 22 percent (29) were male. Among them, four cases had the local infection. The infection rate was 2.9 percent. Total six cases of implant including the other two case augmented elsewhere having the infection were removed and submitted for Gram stain, standard aerobic and anaerobic bacterial culture, and fungal cultures. Staphylococcus aureus was isolated most frequently (four cases), followed by Pseudomonas aeruginosa (one case) and Proteus mirabilis (one case). No fungal infections were identified. In order to reduce the infection rates after augmentation rhinoplasty using silicone implant, rhinorrhea as a source of bacterial nutrients should thoroughly be managed perioperatively. The hairs of the nostril should appropriately be shaved, and the patient's entire face and internal nares meticulously prepared. The implant should be shaped to be shorter, smaller and thinner, appropriately to the patient's nasal phenotype. Also, subperiosteal implantation rather than subcutaneous or subfascial is better choice.

Guide Lines of Successful Augmentation Rhinoplasty

Augmentation rhinoplasty is one of the most popular aesthetic procedures in Korea. It is precise surgery in which the margin of error is measured in millimeters, thus the surgeon must have a full knowledge of nasal anatomy and the basic principle of surgical procedures. In fact, many surgeons, in particular, inexperienced with lack of the basic principle, face dissatisfactory surgical result frequently. While a considerable number of studies have been made on the "advanced procedures" of rhinoplasty over the past few years, few attempts have so far been made on the "basic principle". This article shows what is the basic principle of successful augmentation rhinoplasty. The six steps for successful augmentation rhinoplasty are as follows: incision, approach, pocket dissection, implant fabrication, suture, and dressing. Marginal incision should be made at the caudal border of the alar cartilages to avoid disruption of soft triangle area and visible scar formation, which could be occurred when it is made at the immediate nostril rim area. The soft tissue envelope is sharply elevated in a plane intimate to the perichondrium with Peck- Joseph dissecting scissors to minimize tissue trauma and bleeding. The periosteum is sharply elevated with a Joseph periosteal elevator at the caudal margin of the nasal bone and dissection continued superiorly in a subperiosteal plane to the radix area. This pocket must be made with ample and symmetric dissection. Silicone rubbers, especially, soft type are the best as implants for rhinoplasty. It should be fabricated at the nasofrontal angle and its contact surface with the nasal bone should be carved more concavely to have a plastic suction pad effect. Silicone rubbers carved like this adhere closely to the nasal bone and make an even capsular formation. The incision should be closed very carefully, if not, asymmetric nostril or deviated columella can be occurred. Joseph dressing is routinely placed at the final step. In this procedure, we expect that any dead space between implants and the nasal bone can be obliterated by placing two or three pieces of gauze on the nasal root. We are sure that this article can be a little help to inexperienced plastic surgeons by providing the basic principle of successful augmentation rhinoplasty.

Augmentation Rhinoplasty Combined with Tip Plasty Using AlloDerm(R)

Because the Korean nose has a flat dorsum and depressed tip, tip projection procedure has frequently been performed as an ancillary procedure of dorsal augmentation. Although various materials have been used for tip plasty, an ideal technique has not yet been described. The authors performed classic augmentation rhinoplasty using a silicone implant to correct flat dorsum. Alloderm(R)(Life Cell Corporation, the Woodlands, Texas), acellular human dermis, was used for soft and smooth projection of the nasal tip. From January of 2000 to August of 2003, 20 patients underwent this procedure in Department of Plastic and Reconstructive Surgery. The patients were followed up for 2 to 26 months. Postoperative course was uneventful. Although partial graft resorption was noted in 3 patients, long-term follow-up showed good results. Alloderm(R) usage for tip plasty allows natural contour of the nasal tip, decreases donor site morbidity, and obviates time consuming procedures for graft harvesting. In conclusion, Alloderm(R) graft could be an appropriate alternative in tip projection procedure.

Surgical Correction of Cleft Lip and Nose Deformity Associated with Augmentation Rhinoplasty Using Silicone Implant

The correction of secondary cleft lip and nose deformity often presents an extremely difficult plastic surgical problem. The deformity is a complex, three dimensional alteration in nasal anatomy with defects in all tissue layers : skin, cartilage, vestibular lining and bone. The patient who has these kinds of deformities undergoes the aggravation of deformities, as the patient grows older. And the decreased length of maxilla is accompanied by the deficiency of posterior development. As a result, the depression of nose and midface is usually developed and especially the depression of nose is severely noted in an oriental. To correct this secondary cleft lip nose deformity in Oriental patients, alar cartilge mobilization and suspension techniques have been developed. But, these techniques have critical limitations in the suspension vector and power. Oriental people usually have thin alar cartilages and thick skin. So, the suspended, deformed alar cartilage may relapse and pull the normal alar cartilage to the deformed side. To overcome these limitations, we have carried out the augmentation rhinoplasty using a silicone implant with Tajima's inverted U incision and interdomal suturing at the same time, which is inexpensive and easily handled, to twelve patients of secondary cleft lip and nose deformity for recent 2 years. The results were considerably satisfactory, so we report this paper and then can ascertain the further aesthetic benefits, such as the postoperative augmentation of a nose, finer nasal tip and the symmetry of both nostrils.

A Suture Fixation Method to Avoid Deviation & Extrusion of Silicone in Closed Augmentation Rhinoplasty

The augmentation rhinoplasty using silicone implant is one of the most popular cosmetic procedure in Asians. But complications such as deviation and extrusion are often noted. For prevention of these problems, we discussed and assessed the effectiveness of augmentation rhinoplasty through unilateral infracartilaginous incision and fixation of the silicone to the septal cartilage. Among 121 patients who underwent closed rhinoplasty using anchoring suture in silicone fixation and covering the silicone tip with medial border of lateral crus in both alar cartilage by intercrural suture, we analyzed 47 patients. No other procedures were used. The average follow-up period was 11 months. This technique showed good results without deviation or extrusion of silicone implants. In addition, this procedure yields good nasal tip projections. Herein, this treatment will be a future promising treatment modality for reducing complications with high level of patient satisfaction

Nasal augmentation using goretex