Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions.

BACKGROUND: The use of topical vasoconstrictors is a common practice in nasal surgery. These agents reduce bleeding and enable a good surgical field. Topical cocaine and epinephrine, which are frequently used in cosmetic rhinoplasty, are considered safe and effective, but secondary effects have been described. The aim of the present study was to evaluate and compare the benefits and risks of epinephrine and cocaine employed as topical vasoconstrictive agents in cosmetic rhinoplasty. METHODS: This prospective non-randomised study included 65 consecutive female patients undergoing primary closed rhinoplasty. Patients were treated with topical aqueous solutions of 4 % cocaine (n = 33) or 1:1000 epinephrine (n = 32). Benefits and risks of drug use were compared between groups. Vasoconstriction was assessed by quantitative and qualitative evaluation of bleeding during surgery. Systemic effects were studied in terms of cardiovascular changes during the procedure. The Mann-Whitney test and mixed-effects models were used to compare continuous variables and to assess the effects of vasoconstrictor treatment, respectively. RESULTS: Cocaine exerted a stronger and more predictable vasoconstrictive effect than epinephrine. This difference was linked to better field quality, but did not relate to shorter surgery times. Increased heart rate was detected with both agents and was significantly higher with cocaine (p < 0.05). Blood pressure did not significantly differ between groups. CONCLUSIONS: Both cocaine and epinephrine, at the concentrations used in this study, are suitable as topical vasoconstrictive agents in aesthetic rhinoplasty. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Biocompatibility of agarose gel as a dermal filler: histologic evaluation of subcutaneous implants.

BACKGROUND: The search for safe and effective tissue fillers has been an ongoing effort in plastic and cosmetic surgery over recent decades. Biocompatibility is a prerequisite for any substance to be used as an implant material, and potential biomaterials need to be characterized by histologic evaluation of tissue responses. Collagen is a well-known tissue filler. Agarose gel is widely used in bioengineering. Both products are considered biocompatible. The purpose of this study was to evaluate the bioactivity of agarose gel as a dermal filler compared with collagen. METHODS: Tissue responses to agarose gel and collagen were evaluated in a rat in vivo model (n = 96). Four groups were evaluated: group 1 (n = 24), rats with agarose gel implants; group 2 (n = 24), rats with collagen implants; group 3, a placebo group (n = 24); and group 4, a control group (n = 24). Responses and biocompatibility were assessed by histopathologic and histomorphometric evaluation at 1 week to 8 months after implantation. RESULTS: Agarose gel showed marked bioactivity and biodegradation, although the implants integrated well into tissues: newly formed collagen bands were observed inside the implants and no granulomas were detected. Collagen implants showed low cell infiltration and a significant loss of product over time. CONCLUSIONS: Agarose gel is a biocompatible product that can be considered for use as a tissue filler. Further investigation is required to assess its long-term efficacy and safety.

Biocompatibility of two novel dermal fillers: histological evaluation of implants of a hyaluronic acid filler and a polyacrylamide filler.

BACKGROUND: Several biomaterials are currently available for soft-tissue augmentation. Biocompatibility is an indispensable condition for any such product. Appropriate histologic evaluation is a prerequisite for understanding the responses of tissues to implant materials. Recently, hyaluronic acid and polyacrylamide gel products have been introduced as dermal fillers. Both types of product are widely considered to be biocompatible. METHODS: The present study compared tissue responses in a rat in vivo model (n = 80) to a hyaluronic acid filler (Restylane Perlane; Q-Med AB, Uppsala, Sweden) and a polyacrylamide gel filler (Aquamid; Contura SA, Montreux, Switzerland). Four groups were evaluated: group 1 (n = 20) received the Restylane Perlane implant, group 2 received the Aquamid implant (n = 20), group 3 comprised a placebo group (n = 20), group 4 was the control group (n = 20). Responses and biocompatibility were assessed by histopathologic and histomorphometric evaluations between 1 week and 8 months after implantation. RESULTS: The two products induced very different tissue responses. The polyacrylamide gel filler was highly bioactive, undergoing cell infiltration and integration into tissues. The hyaluronic acid filler underwent minimal cell infiltration, and the product remained surrounded by a uniformly thin capsule. CONCLUSIONS: This study reveals that two soft-tissue fillers considered to be biocompatible induce very different tissue reactions. This indicates that their behavior in clinical practice is likely to be different.