Irradiated homologous costal cartilage for augmentation rhinoplasty.

Although the ideal reconstructive material for augmentation rhinoplasty continues to challenge plastic surgeons, there exists no report in the literature that confines the use of irradiated homologous costal cartilage, first reported by Dingman and Grabb in 1961, to dorsal nasal augmentation. The purpose of this paper is to present a retrospective analysis of the author's experience using irradiated homologous costal cartilage in augmentation rhinoplasty. Twenty-seven dorsal nasal augmentations were performed in 24 patients between 16 and 49 years of age with a follow-up ranging from 1 to 27 months. Good-to-excellent results were achieved in 83.3% (20 of 24). Poor results requiring revision were found in 16.7% (4 of 24). Complication rates included 7.4% infection (2 of 27) and 14.8% warping (4 of 27). The resorption rate was zero. These results compare favorably with other forms of nasal augmentation. Advantages and disadvantages of irradiated homologous costal cartilage are discussed.

Psoralen phototherapy and phototoxicity.

Psoralen therapy followed by exposure to long-wave ultraviolet (UV-A) light, a combination called PUVA therapy, stimulates pigmentation of the skin. PUVA therapy is effective in the treatment of vitiligo and hypopigmented scars. Because psoralens sensitize skin to UV-A light, phototoxic reactions are frequent. Patients with such reactions can present to the plastic surgeon because they clinically mimic thermal burns. We report a patient with vitiligo who treated herself with oral and topical psoralens and then exposed herself to sunlight. She developed an intense, burnlike reaction, with erythema, edema, and bullae. "Sunburn" may be a major injury in the psoralen user.