ABSTRACT
BACKGROUND: Botulinum toxin type A (BTxA) is used for cosmetic procedures, but its use for nasal dorsum augmentation has, to our knowledge, never been studied. OBJECTIVE: Here, we describe a method for using BTxA injection for nasal dorsum augmentation. METHODS: This was a pilot study. Participants aged 20 to 60 years were recruited and injected with BTxA in the upper nasal area with either Xeomin® (Merz Pharmaceuticals GmbH, Frankfurt, Germany) or Dysport® (Galderma Laboratories, Fort Worth, Texas). The primary outcome measured was the upper nasal area's volume change from baseline, calculated using a Quantificare camera (San Francisco, California). The volumizing effect was subjectively graded by two blinded dermatologists and participants, and pain scores and adverse events were recorded. RESULTS: Fourteen participants, including two men and 12 women, aged 35.78±9.16 years were recruited. Overall, the volume of the upper nasal area increased after BTxA injection (p<0.001). The volume increase immediately and, at one week after injection, presented a statistically significant difference from baseline, with median (interquartile range) volume differences of 0.095mL (0.010-0.205; p<0.001) and 0.095mL (0.0475-0.155; p<0.001), respectively. Two blinded dermatologists and all participants observed volumizing of the nasal dorsum. The effect appeared to last for one month. CONCLUSION: This study suggests that injecting BTxA in the upper nasal area is a convenient, minimally invasive technique with minimal side effects for nasal dorsum augmentation.
ABSTRACT
BACKGROUND: Alternative techniques for nasal dorsum augmentation are of paramount importance in reconstructive and plastic surgery. In contrast to autologous cartilage grafts, tissue-engineered grafts can be created de novo and yield low-none donor site morbidity as compared to autologous grafts like rib or ear cartilage. To address this demand, this study investigated the in vivo regenerative potential of polycaprolactone-based implants as an alternative to autologous cartilage grafting during rhinoplasty. METHODS: Implants were placed at the nasal dorsum in two groups of minipigs and kept in situ for 2 and 6 months, respectively. Subsequently, the implants were harvested and examined by histology (hematoxylin-eosin, alcian blue, and safranin O) and immunostaining (collagen I and collagen II). Further analysis was performed to measure diameter and distance of polycaprolactone struts. RESULTS: Histological examination revealed a persistent formation of connective tissue with some spots resembling a cartilaginous-like matrix after 6 months. In such areas, cells of chondrocyte appearance could be identified. There was a significant decrease in strut diameter but a non-significant difference in strut distance. CONCLUSION: Our results indicated that the investigated polycaprolactone-based implants have shown a regenerative and stable nasal dorsum augmentation after 6 months in vivo. Thus, we believe that customized polycaprolactone-based implants could become an alternative technique for nasal dorsum augmentation without the need for autologous cartilage grafts.
Subject(s)
Polyesters , Prostheses and Implants , Rhinoplasty/instrumentation , Tissue Engineering/methods , Animals , Swine , Swine, MiniatureABSTRACT
Objective To present our experience and techniques with the use of autologous costal cartilage grafts in Asian rhinoplasty,and to report the surgical results and complications in 86 consecutive rhinoplasty cases.Methods All operations were performed by the first author (Liu AT) with open approach,costal cartilages and perichondrium were used to reconstruct the nasal tip projection according to the tripod theory in rhinoplasty,after removing the previous injection material,L-shaped implant or hypertrophic scar tissue in the tip.Medical charts and operative records were reviewed retrospectively to summary the complications.Nasal dorsum augmentation was done by costal cartilage or I-shaped allograft,sometimes with anterior sheath of rectus abdominis.Patients' subjective satisfaction of the postoperative nasal appearance was self-evaluated with grading (1 worse,2 no change,3 improved,and 4 much improved).Results From September 2015 to March 2017,86 patients underwent rhinoplasty at our hospital.The postoperative follow-up duration was 6 to 20 months.Overall,functional and aesthetic outcome was satisfactory in most patients,and the mean score by the patients' self-evaluation was 3.3 ± 0.6.Graft exposure,mobility,or significant resorption,pneumothorax or significant donor-site pain were not observed.Conclusions Even with minimal complications and morbidities,autologous costal cartilage grafts in Asian rhinoplasty is a versatile and reliable graft material for nasal tip surgery in severe short or saddle nose,contracted nose due to previous L-shaped augmentation and revision rhinoplasty in which the septal cartilage has already been harvested.
