Material For Rhinoplasty Research Articles

APPLICATIONS OF THE USE OF PLATELET-RICH FIBRIN (PRF) IN RHINOPLASTY IN PATIENTS WITH THIN SKIN

Introduction: Rhinoplasty demands intense knowledge about the reconstruction of the osteocartilaginous structure. Depending on the thickness of the skin and subcutaneous tissue, the results after rhinoplasty may be more evident, with retractions and demarcations of the underlying structures, leading to an unaesthetic result. Objective: The present study aims to describe the platelet-rich fibrin (PRF) technique and the application options for the material in rhinoplasty, according to evidence from scientific studies. Methods: Two clinical cases are reported, showing the great improvement in...

Complications Associated with Alloplastic Materials in Rhinoplasty and Their Operative Management.

Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound. LEVEL OF EVIDENCE: N/A.

Biological Changes of Autologous Auricular Cartilage in Rhinoplasty.

Autologous auricular cartilage is used extensively as a good graft material in rhinoplasty. In this study, clinical specimens from patients who underwent revision rhinoplasty with auricular cartilage grafts were collected to compare the changes before and after auricular cartilage transplantation with the use of histologic, immunohistochemical, and quantitative assays. Patients who underwent revision rhinoplasty from 2018 to 2022 were analyzed. Fresh auricular cartilage left after surgery and auricular cartilage graft tissue were examined and compared. Compared with fresh auricular cartilage, local fibrosis was seen in the transplanted auricular cartilage with a slight decrease in elastic fibers, type II collagen, and extracellular matrix secretion. Quantitative assays showed a decrease in glycosaminoglycan, DNA, and total collagen content in the transplanted auricular cartilage tissue. The results of the study suggest that the histologic characteristics, cell functionality, and biochemical composition of the grafted cartilage changed to a certain extent after autologous auricular cartilage graft rhinoplasty. These results provide insights into the selection of graft/filler materials for rhinoplasty and what changes to expect.

Optimizing the Use of Autografts, Allografts, and Alloplastic Materials in Rhinoplasty.

After studying this article, the participant should be able to: 1. Understand the autologous graft options available to the rhinoplasty surgeon, including septal cartilage, auricular cartilage, costal cartilage, and bone. 2. Understand the autograft and allograft options available to the rhinoplasty surgeon, including cadaveric costal cartilage, silicone, Medpor, and Gore-Tex. 3. Identify the ideal situations to use each of these implant materials. 4. Understand the advantages and disadvantages of the different autografts, allografts, and implants in rhinoplasty. This review focuses on the graft options available to the modern rhinoplasty surgeon. Autologous options are varied in the quality of cartilage harvested and the morbidity of the donor site. In addition, surgeons should understand the allograft options should autologous grafting be unfeasible or undesirable. New technological advances in processing of allograft cartilage makes this an attractive secondary option.

Long-Term Outcomes of Secondary Nasal Tip Plasty After Degradation of a Polycaprolactone (PCL) Mesh.

In secondary nasal tip plasty, it is often difficult to harvest appropriate septal extension grafts for sufficient tip projection. Therefore, studies using numerous alloplastic materials in rhinoplasty have been reported. This study aimed to evaluate the nasal tip change over time after tip plasty using a PCL mesh. We conducted a retrospective study of 86 Asian patients who received secondary tip plasty by septal extension grafting with a PCL mesh as a batten graft. Patient demographics and surgical outcomes were examined. The outcome variables were nasolabial angle, nasofrontal angle and Goode ratio. Measurements were performed with photographs obtained at short-term (postoperative 4-6 months) and long-term (more than postoperative 24 months) follow-ups. Aesthetic outcomes and safety were assessed using the Global Aesthetic Improvement Scale. Among 86 patients, 56 had a long-term follow-up. The mean age was 33.33 years, and the male-to-female ratio was 17.44:82.56. The nasolabial and nasofrontal angles did not change significantly between the short-term and long-term follow-ups. The Goode ratio, which is a useful tool to evaluate nasal projection, was decreased by 5.00%. Nevertheless, all patients were satisfied, and the long-term aesthetic outcomes were improved in 54 (96.4%) patients. There were two cases (2.33%) of complications, including one infection and one case of PCL-mesh protrusion. The present study demonstrated the usefulness and safety of PCL meshes when used in septal extension grafts as batten grafts. Although biodegradation seems to affect the nasal projection, PCL is still useful in secondary tip plasty along with other alloplastic materials. 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 .

Is Irradiated Homologous Costal Cartilage Reliable? A Meta-Analysis of Complication Rates in Rhinoplasty.

Background: Irradiated homologous costal cartilage (IHCC) may be a convenient, cost-effective and efficient alternative source of graft material in rhinoplasty; however, a systematic review and meta-analysis on this topic have not been previously performed. Objectives: We sought to summarize and pool data on complications associated with the use of IHCC grafting in rhinoplasty. Methods: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We conducted PubMed, Cochrane, Embase, Web of Science database searches, and screened articles using specific inclusion and exclusion criteria. Pooled complication rates were analyzed using a random-effects model. Results: Of the 13 studies that met criteria for systematic review, 11 studies involving 1017 patients, with 1956 IHCC grafts used, were included in the meta-analysis. Mean follow-up across all studies was 47 months. Overall, the pooled complication rates were 1.14% (95% CI: 0.3%-2.0%) for resorption, 0.5% (95% CI: 0.1%-0.9%) for warping, 1.2% (95% CI: 0.3%-2.1%) for infection, 1.0% (95% CI: 0.1%-2.0%) for mobility, and 0.8% (95% CI: 0.1%-1.6%) for graft removal or replacement. No allergic reactions or systemic disease associated with IHCC use were reported in any of the studies. Conclusions: The overall complications associated with IHCC use in rhinoplasty were very low. Costal cartilage allografts are an area of renewed interest that may represent an alternative to autologous costal cartilage grafting in rhinoplasty due to their low complication rates, convenience, cost-effectiveness, and elimination of donor-site complications.

Reconstruction of an iatrogenic anterior conchal defect with a revolving-door flap

BackgroundAuricular concha has been widely used as a supporting material in rhinoplasty or repairing of auricular defects. However, complications, trauma or iatrogenic excision often result in concha defects which destroy the normal structure of the external ear and further influence daily life. Local flaps are often applied to repair the defects because of their safety and satisfactory functional and aesthetic results.Case presentationWe report a 24-year-old female who presented with a concha defect that resulted from a complication of concha cartilage graft for rhinoplasty. The anterior concha defect was covered by a revolving-door (RD) flap as a single-stage procedure. The aesthetic and functional outcomes were satisfactory at 6 months post operation.ConclusionWe recommend the RD flap as an excellent choice for conchal defect reconstruction. Satisfactory aesthetic and functional results can be achieved by this easy-to-learn technique in relatively short surgical time.

Application of internal fixation technique with absorbable material for rhinoplasty to correct secondary nose deformity of unilateral cleft lip with or without cleft palate

Objective It is crucial to restore and fix the position of nasal septum which elaborates supportive function in rhinoplasty for secondary nose deformity of cleft lip and palate patients. The aim of this study was to explore the fixation technique with absorbable material in rhinoplasty for correction cleft lip nose deformity. Methods Nineteen cases with unilateral cleft lip /with or without palate cleft were included in this study. Absorbable screw was used to fix the implanted and re-positioned grafted cartilage septum which was shaped into strip with anterior nasal spine. Results Full success was achieved for all of 19 cases with internal fixation technique to re-position nasal septum to correct nasal deformity. There was no complications occurred. Conclusions Internal fixation technique with absorbable material could be used to correct secondary nasal deformity in cleft lip and palate patients and fixed re-positioned grafted cartilage septum can apply a strong support to ala nasi cartilage in cleft site. Key words: Cleft lip; Internal fixation; Nose; Deformity; Absorbable screw

Feasibility of a polydioxanone plate as an adjuvant material in rhinoplasty in Asians.

BackgroundNasal framework-supporting procedures such as septal extension grafts, derotation grafts, and columellar strut grafts are usually required in rhinoplasty in Asian patients because the skin envelope is tight, but the nasal framework is small and weak. Autologous materials are preferred, but they have some limitations related to the amount that can be harvested and the frequency of use. Therefore, synthetic materials have been used to overcome these limitations.MethodsA total of 114 patients who received a polydioxanone (PDS) plate as an adjuvant material in rhinoplasty from September 2016 to August 2017 were retrospectively investigated. The PDS plate was used as to support the weak framework and to correct the contour of the alar cartilages. The PDS plate was used for reinforcement of columellar struts and septal L-struts, alar cartilage push-down grafts, fixation of septal extension grafts, and correction of alar contour deformitiesResultsPrimary and secondary rhinoplasty was performed in 103 and 11 patients, respectively. Clinically, no significant inflammation occurred, but decreased projection of the tip was observed in seven patients and relapse of a short nose was noted in five patients.ConclusionsPDS plates have been used in the United States and Europe for more than 10 years to provide a scaffold for the nasal framework. These plates can provide reinforcement to columellar struts, L-struts, and septal extension grafts. In addition, they can assist in deformity correction. Therefore, PDS plates can be considered a good adjuvant material for Asian patients with weak and small nasal cartilage.

Anatomical Characteristics of the Perpendicular Plate of the Ethmoid: An Analysis of Paranasal Sinus Computed Tomography via Three-Dimensional Reconstruction.

In recent years, the perpendicular plate of the ethmoid (PPE) has emerged as a new autogenous grafting material in rhinoplasty and septoplasty of nasal deviation. However, no studies have outlined the precise size, shape, and morphologic features of the PPE. Therefore, this study aimed to provide detailed information on the anatomical and morphologic characteristics of the PPE to assist surgeons in performing surgeries that are more precise. About 104 Chinese patients who underwent paranasal computed tomography were assessed in this study. By analyzing the features of the PPE reconstructed with 3-dimensional models, the characteristics of the PPE at different stages of development and according to sex were observed. The PPE had a flat shape, and its lower part was relatively thin. It usually developed horizontally with age, which contributed to expansion of the PPE area. The dimensions of the PPE were significantly larger in male patients than in female patients. Through the reconstruction and measurement of Chinese patients' PPE, the authors have established precise information about the PPE's anatomical and morphologic features. The flat shape and proper size, which are similar to those of nasal septum cartilage, make the PPE an ideal alternative to conventional autogenous grafting materials. The findings might be useful to surgeons in helping them perform surgeries that are more precise.

Clinical Application of Three-Dimensionally Printed Biomaterial Polycaprolactone (PCL) in Augmentation Rhinoplasty.

This clinical study aimed to investigate the safety and surgical outcome of three-dimensionally (3D) fabricated polycaprolactone (PCL) mesh in rhinoplasty. In particular, this study explored how a 3D-printed PCL mesh performs as a bioabsorbable scaffold after a long period following implantation. A retrospective review of 101 patients who received primary or secondary rhinoplasty with a PCL mesh was performed. Patient demographics and surgery-related outcomes were examined. Clinical efficacy and safety were evaluated using the Global Aesthetic Improvement Scale at postoperative 18months. From two revisional cases, a biopsy specimen of implanted PCL was acquired and histopathological analysis was performed. Of all the patients, 98.0% showed no postoperative infection-related foreign body reaction or distinct abnormal reaction, and the implants were observed to maintain long-term efficacy until 18-month follow-up. In patients who received spreader grafts, significant differences between preoperative and postoperative Cottle sign scores were found. Histopathological analysis showed features of adjacent tissue infiltration into pores of the PCL mesh and regeneration of neo-cartilaginous tissue and collagen around the mesh 20months after implantation. This study demonstrates that a novel biodegradable PCL mesh with a 3D structure is a safe and effective material for corrective rhinoplasty because it is easy to use and capable of maintaining its volume in the long term without foreign body response. This biocompatible material will have a wide range of applications as the most suitable alternative to nonabsorbable materials in rhinoplasty and reconstruction surgeries, such as fashioning spreader grafts and septal extension grafts. 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 .

The Application of Fibrin/Hyaluronic Acid-Poly(l-Lactic-co-Glycolic Acid) Construct in Augmentation Rhinoplasty.

Although many graft materials have been used for augmentation rhinoplasty, an ideal graft has not yet been developed. As the field of tissue engineering has been developing, it has been applied to the reconstruction of many organs, but its application in the rhinoplasty field is still limited. This study evaluated the utility of allogenic chondrocytes with fibrin/hyaluronic acid (HA)-poly(l-lactic-co-glycolic acid) (PLGA) constructs in augmentation rhinoplasty. Chondrocytes from rabbit auricular cartilage were isolated and cultured with fibrin/HA hydrogels and implanted into PLGA scaffolds. After 8weeks of in vitro culture, the scaffolds were implanted in the nasal dorsum of six rabbits. Eight weeks postoperatively, the implanted sites were evaluated with gross, radiologic, and histologic analysis. In vitro, more than 90% of the seeded chondrocytes in the PLGA scaffolds survived for 2weeks, and they produced a large amount of extracellular matrix and were well differentiated. The grafts maintained their initial shape for 8weeks after implantation. Radiological and histological evaluations showed that the structure was well maintained with minimal inflammatory response and appropriate elevation levels. However, the formation of neo-chondrocytes was not observed. PLGA scaffolds seeded with fibrin/HA and allogenic chondrocytes can be a biocompatible augmentation material in rhinoplasty in the future.

Autologous vs Irradiated Homologous Costal Cartilage as Graft Material in Rhinoplasty.

Studies comparing surgical results of rhinoplasty using autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are rare. To compare the clinical results of major augmentation rhinoplasty using ACC vs IHCC and analyze the histologic properties of both types of cartilage. A retrospective clinical study was conducted among patients who had undergone rhinoseptoplasty using ACC or IHCC from January 1, 2009, to December 31, 2014. Patients were followed up for more than 1 year after surgery and the histologic characteristics of ACC and IHCC were compared. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity, were evaluated by reviewing medical records and facial photographs. Patients' subjective satisfaction with aesthetic and functional results was evaluated using a questionnaire. The details of the surgical procedures and complications, including warping, infection, resorption, and/or donor-site morbidity; patients' subjective satisfaction with aesthetic and functional results' objective evaluation of surgical outcomes, including symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result; and histologic structures. Objective evaluation of surgical outcomes was graded using the Objective Rhinoplasty Outcome Score, which assessed symmetry, dorsal height, dorsal length, dorsal width, tip projection, tip rotation, tip width, and overall result. Histologic structures were evaluated using hematoxylin and eosin, Masson trichrome, Alcian blue, and Verhoeff elastic stains. A total of 63 patients (27 males and 36 females; mean [SD] age, 30.6 [9.5] years) had rhinoseptoplasty using ACC and 20 (9 males and 11 females; mean [SD] age, 35.4 [15.4] years) had rhinoseptoplasty using IHCC. Among observed complications, only notable resorption occurred more frequently in patients using IHCC (6 [30%]) than with ACC (2 [3%]) (P = .002). In subjective evaluations of aesthetic satisfaction, patients who received ACC showed significantly greater satisfaction (37 of 51 patients [73%] were very satisfied) than did those who received IHCC (6 of 20 [30%]) (P = .001). However, there was no between-group difference in subjective functional outcomes: 4 of 51 patients receiving ACC (8%) and 5 of 20 receiving IHCC (25%) were satisfied (P = .50) and 45 of 51 receiving ACC (88%) and 15 of 20 receiving IHCC (75%) were very satisfied (P = .15). Regarding objective aesthetic outcomes, all scores for both ACC and IHCC were more than 3.1 (between good and excellent). Histologic analyses showed larger, more evenly distributed, uniform chondrocytes and more collagens and proteoglycan contents in ACC than in IHCC. Compared with patients receiving IHCC, those receiving ACC for rhinoseptoplasty showed superior aesthetic satisfaction; ACC also had less frequent notable resorption. Autologous costal cartilage also had better histologic properties than IHCC did, suggesting it as an ideal graft material with less chance of long-term resorption. 3.

한국인의 비배 융기술에서 동종 대퇴근막의 유용성

Background: Although autologous material is ideal, autologous nasal dorsal grafts have limitations including limited tissue availability, donor site morbidity and postoperative deformities owing to warping or resorption. Tutoplast processed fascia lata (TPFL)has been popularly used in Asian dorsal augmentation these days. Our aim was to evaluate the effectiveness and surgical outcomes of TPFL as graft material for nasal dorsal augmentation in Koreans. Methods: 91 patients(68 male, 23 female), who underwent TPFL grafting to the nasal dorsum were included. The age distribution varied from 16 to 61 years (mean age of 29.9 years), All surgical procedures were performed by the single surgeon. Patient’s record was reviewed retrospectively including age, sex, indications for surgery, dorsal graft material, and postoperative complications. Surgical outcome was evaluated using the comparison of preoperative photograph with postoperative photograph. The follow-up period ranged from 6 months to 39 months, with a mean follow-up of 11.3 months. Results: TPFL was used in 65 cases of deviated nose. Other cases included 14 flat noses, 8 hump noses, 3 revision cases after dorsal silicone graft and one saddle nose. During the follow-up period, no major complications such as infection, graft displacement, or extrusion were observed in fascia lata group. The only complication was major resorption in two cases (2.2%) who needed revision surgery. Conclusions: The TPFL alone or TPFL in combination with other materials may be useful for a minor dorsal augmentation and dorsal contouring material in rhinoplasty. (J Clinical Otolaryngol 2015;26:219–224)

The Application of Three-Dimensional Printing in Animal Model of Augmentation Rhinoplasty.

The role of three-dimensional (3D) printing has expanded in diverse areas in medicine. As plastic surgery needs to fulfill the different demands from diverse individuals, the applications of tailored 3D printing will become indispensable. In this study, we evaluated the feasibility of using 3D-printed polycaprolactone (PCL) scaffold seeded with fibrin/chondrocytes as a new dorsal augmentation material for rhinoplasty. The construct was surgically implanted on the nasal dorsum in the subperiosteal plane of six rabbits. The implants were harvested 4 and 12weeks after implantation and evaluated by gross morphological assessment, radiographic imaging, and histologic examination. The initial shape of the implant was unchanged in all cases, and no definite post-operative complications were seen over the 3-month period. Radiologic evaluation confirmed that implants remained in the initial location without migration or extrusion. Histologic evaluations showed that the scaffold architectures were maintained with minimal inflammatory reactions; however, expected neo-chondrogenesis was not definite in the constructs. A new PCL scaffold designed by 3D printing method seeded with fibrin/chondrocytes can be a biocompatible augmentation material in rhinoplasty in the future.

Cultured chondrocyte and porcine cartilage-derived substance (PCS) construct as a possible dorsal augmentation material in rhinoplasty: A preliminary animal study

As there is no single ideal material for dorsal augmentation in rhinoplasty, there has been a continuing need for the development of improved materials. Therefore, we aimed to evaluate the outcome of using a novel tissue-engineered construct composed of autologous chondrocytes cultured with a porcine cartilage-derived substance (PCS) scaffold as an augmentation material in rhinoplasty. A scaffold derived from decellularized and powdered porcine articular cartilage was prepared. The rabbit articular cartilage was used as the source of homologous chondrocytes, which were expanded and cultured with the PCS scaffold for 7 weeks. The chondrocyte-PCS constructs were then surgically implanted on the nasal dorsum of six rabbits. Four and eight weeks after implantation, the gross morphology, radiologic images, and histologic features of the site of implant were analyzed. The rabbits showed no signs of postoperative inflammation and infection. The degree of dorsal augmentation was maintained during the 8-week postoperative observation period. Postoperative histologic examinations showed chondrocyte proliferation without an inflammatory response. However, neo-cartilage formation from the constructs was not confirmed. The biocompatibility and structural features of tissue-engineered chondrocyte-PCS constructs indicate their potential as candidate dorsal augmentation material for use in rhinoplasty.

Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysis.

Although autologous rib cartilage is a preferred source of graft material in rhinoplasty, rib cartilage for dorsal augmentation has been continuously criticized for its tendency to warp and for high donor-site morbidities. However, no meta-analysis or systemic review on complications associated with autologous rib cartilage use in rhinoplasty has been conducted. To carry out a systematic review and a meta-analysis of available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty. The studies reporting complications associated with the autologous rib cartilage use in rhinoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for sources published from 1946 through June 2013. The selected articles included clinical studies conducted with at least 10 patients and at least 1 postoperative long-term complication or donor-site morbidity in rhinoplasty. Excluded were nonhuman studies; review articles; case reports; abstracts; and reports of nasal reconstruction as indication for surgery, use of homologous rib cartilage, and diced or laminated methods. Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model. Number of patients; follow-up duration; and rates of complication, donor-site morbidity, and revision surgery. Also noted were study authors and year of publication. Ten studies involving a total 491 patients were identified. Mean follow-up across all studies was 33.3 months. In meta-analysis, the combined rates were 3.08% (95% confidence interval [CI], 0%-10.15%) for warping, 0.22% (95% CI, 0%-1.25%) for resorption, 0.56% (95% CI, 0%-2.61%) for infection, 0.39% (95% CI, 0%-1.97%) for displacement, 5.45% (95% CI, 0.68%-13.24%) for hypertrophic chest scarring, 0% (95% CI, 0%-0.32%) for pneumothorax, and 14.07% (95% CI, 6.19%-24.20%) for revision surgery. The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon's attention. Because a limited number of studies and patients were eligible, and consistent definitions of complications were lacking in this meta-analysis, future studies with a larger series of patients and objective outcome measurements are needed to obtain more reliable results. 4.

Various applications of deep temporal fascia in rhinoplasty.

PurposeIn Asians, nasal dorsal and tip augmentation procedures are usually performed at the same time, and most dorsal augmentations use implants. In this study, dorsal augmentation was given by various types of grafts using deep temporal fascia (DTF) for primary rhinoplasty cases using only autologous tissues to improve the curve of hump noses and depressions. For secondary rhinoplasty cases, DTF was used to improve implant demarcation and transparency. Such effectiveness and utility of DTF is discussed.Materials and MethodsBetween May 2009 and May 2012, we performed rhinoplasty using DTF in 175 patients, which included 78 secondary surgery patients and 128 female patients. The mean age of the patients was 31.4. DTF was utilized with various types of grafts without implants to improve the curve in dorsal augmentation of hump noses and cases that required curve betterment. DTF was used to improve implant demarcation and transparency for secondary cases.ResultsThe mean follow-up duration was 1.5 years. Of the 175 patients, 81% were satisfied with the natural correction achieved, whereas 19% complained of undercorrection, which was resolved with additional surgery. No specific complications such as nasal inflammation or contractures were observed.ConclusionDTF can be used with various graft methods for correction of radix, dorsal, and tip irregularities. It can also be used to correct implant contour transparency in secondary rhinoplasty and thus may be considered as a useful supplementary graft material in rhinoplasty for Asians.

Analysis of the Development of the Nasal Septum and Measurement of the Harvestable Septal Cartilage in Koreans Using Three-Dimensional Facial Bone Computed Tomography Scanning

BackgroundThe septal cartilage is the most useful donor site for autologous cartilage graft material in rhinoplasty. For successful nasal surgery, it is necessary to understand the developmental process of the nasal septum and to predict the amount of harvestable septal cartilage before surgery.MethodsOne hundred twenty-three Korean patients who underwent three-dimensional (3D) facial bone computed tomography (CT) were selected for evaluation of the midsagittal view of the nasal septum. Multiple parameters such as the area of each component of the nasal septum and the amount of harvestable septal cartilage were measured using Digimizer software.ResultsThe area of the total nasal septum showed rapid growth until the teenage years, but thereafter no significant change throughout the lifetime. However, the development of the septal cartilage showed a gradual decline due to ossification changes with aging after puberty in spite of a lack of change in the total septal area. The area of harvestable septal cartilage in young adults was 549.84±151.26 mm2 and decreased thereafter with age.ConclusionsA 3D facial bone CT scan can provide valuable information on the septal cartilage graft before rhinoplasty. Considering the developmental process of the septal cartilage identified in this study, septal surgery should not be performed until puberty due to the risk of nasal growth impairment. Furthermore, in elderly patients who show a decreased cartilage area due to ossification changes, septal cartilage harvesting should be performed carefully due to the risk of saddle nose deformity.

Problems associated with alloplastic materials in rhinoplasty.

PurposeAugmentation rhinoplasty using alloplastic materials is a relatively common procedure among Asians. Silicon, expanded polytetrafluoroethylene (Gore-tex®), and porous high density polyethylene (Medpor®) are most frequently used materials. This study was conducted to analyze revisional rhinoplasty cases with alloplastic materials, and to investigate the usage of alloplastic materials and their complications. We also reviewed complications caused by various materials used in plastic surgery while operating rhinoplasty.Materials and MethodsWe report 581 cases of complications rhinoplasty with alloplastic implants and review of the literature available to offer plastic surgeons an overview on alloplastic implant-related complications.ResultsAmong a total 581 revisional rhinoplasty cases reviewed, the alloplastic materials used were silicone implants in 376, Gore-tex® in 183, and Medpor® in 22 cases. Revision cases and complications differed according to each alloplastic implant.ConclusionOptimal alloplastic implants should be used in nasal structure by taking into account the properties of the materials for the goal of minimizing their complications and revision rates. A thorough understanding of the mechanism involved in alloplastic material interaction and wound healing is the top priority in successfully overcoming alloplastic-related complications.