Silicone Augmentation Rhinoplasty Research Articles

Analysis of the Effect of Autogenous Costal Cartilage Transplantation Combined with Silicone Augmentation Rhinoplasty in Nasal Cosmetic and Plastic Repair

Purpose: To analyze the application value of autogenous costal cartilage transplantation combined with silicone augmentation rhinoplasty. Methods: From January 2022 to January 2023, 84 patients with cosmetic and plastic repair of nose were divided into observation group (44 cases were treated with autogenous costal cartilage transplantation combined with silicone augmentation rhinoplasty) and control group (40 cases were treated with silicone augmentation rhinoplasty) according to the surgical intention of the patients. Compare the difference of prognosis indexes between the two groups after operation, and compare the changes of nasal parameters before and after operation between the two groups, and finally compare the difference of patients' satisfaction between the two groups. Results: ①The 3dVAS score of the observation group was lower than that of the control group (P<0.05), and the wound healing time was shorter than that of the control group (P<0.05); ②The incidence of postoperative complications in the observation group was 4.5%, and that in the control group was 15%. The incidence of postoperative complications in the observation group was lower than that in the control group (P＜0.05); ③There was no significant difference between the two groups (P>0.05) in the angle of nose, the height of nose root and the angle of nose face before operation. The angle of nose tip, the height of nose root and the angle of nose face in the observation group were higher than those in the control group 3 months after operation (P<0.05); ④The satisfaction of the observation group was higher than that of the control group (P<0.05). Conclusion: Autogenous costal cartilage transplantation combined with silicone augmentation rhinoplasty has the advantages of short wound healing time, less postoperative complications and good repair effect, which is helpful to improve the satisfaction of patients and can be widely used.

Analysis of subclinical infections and biofilm formation in cases of capsular contracture after silicone augmentation rhinoplasty: Prevalence and microbiological study.

BackgroundImplant-related deformities in aesthetic rhinoplasty are a major problem for rhinoplasty surgeons. Capsular contracture is believed to be the pathological cause of delayed contour deformities, comparable to breast implant-related contracture. This study investigated the prevalence of bacterial biofilms and other epidemiological factors related to capsular contracture in cases of silicone augmentation rhinoplasty.MethodsThirty-three patients who underwent corrective rhinoplasty due to a delayed contour deformity or aesthetic revision after implant rhinoplasty were studied from December 2014 to December 2016. All recruited patients received surgical correction by the authors. The patients were categorized by clinical severity into four grades. Demographic data and related confounding factors were recorded. Samples of capsular tissue and silicone removed from each patient were analyzed for the presence of a biofilm by ultrasonication with bacterial culture and scanning electron microscopy.ResultsThirty-three paired samples of capsular tissue and silicone implants from the study group were analyzed. Biofilms were detected in one of 10 subjects (10%) with grade 1 contracture, two of four (50%) with grade 2 contracture, 10 of 14 (71.40%) with grade 3 contracture, and four of five (80%) with grade 4 contracture (P<0.05). The organisms found were Staphylococcus epidermidis (47.10%), coagulase-negative staphylococci (35.30%), and Staphylococcus aureus (17.60%).ConclusionsAs with breast implant-related capsular contracture, silicone nasal augmentation deformities likely result from bacterial biofilms. We demonstrated the prevalence of biofilms in patients with various degrees of contracture. Implant type and operative technique seemed to have only vague correlations with biofilm presence.

Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm.

BackgroundSilicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed.MethodsPhotographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV.ResultsGrade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes.ConclusionsIt is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: A 15-year experience

Background:Asians have low nasal dorsum, thick skin envelope, low defined alar cartilage, low projection of nasal tip and broad alar base. Augmentation rhinoplasty with silicone prosthesis has been performed with predictable results, but unfavourable results and complications still present. This series show techniques and results from single surgeon experience.Materials and Methods:We retrospectively reviewed 548 patients chart during January 1995 to December 2009. All patients underwent custom-made S-shape implant silicone augmentation rhinoplasty operated by a single surgeon. There were three major operative steps: (1) Intra-operative S-shape implant carving; (2) pocket dissection through bilateral rim incision and (3) tension adjustment before closure. All the patients were recorded for early surgical complications and satisfaction.Results:There were 519 women and 29 men. The mean age is 25.5 years (18-56 years). Mean follow-up period was 6 months (1-60 months). The majority of patient were appointed for esthetic augmentation (86.8%). 515 cases (94.9%) showed well satisfaction following the operation. The total complication rate was 6.5% (4.9% deviation, 0.7% extrusion, 0.5% hematoma and 0.3% infection). All the complications were corrected with uneventful sequelae.Conclusion:Augmentation rhinoplasty with custom-made S-shape silicone implant by closed approach provides high satisfaction with acceptable early complication rate.

New nasal fracture classification for patients with silicone implants

Aesthetic nasal augmentation has increased in popularity among Asian populations, and nasal bone fracture is the most common type of facial bone fracture. In Asia, the frequency of nasal bone fractures is also increasing among patients who have undergone silicone augmentation rhinoplasty. The increasing prevalence of this injury presents a challenge to the surgeon. Thirty-six patients who had previously undergone augmentation rhinoplasty with silicone implant presented with nasal bone fracture from June 2007 through December 2011. The patients were grouped into three categories: patients with fractures in the high level (type I), patients with fractures in the low level (type II), and patients with fractures throughout the entire nasal bone, from base to top (type III). The largest group comprised patients with type I fractures (n = 24, 67%), followed by type II (n = 4, 11%), and Type III (n = 8, 22%) fractures. Symptoms and surgical outcomes for nasal bone fractures may be different in patients with silicone implants. A novel classification system for nasal bone fractures is required, as is a new approach to diagnosis and treatment.

Alar Cartilage Used as Tip Grafts in Secondary Silicone Augmentation Rhinoplasty in Chinese Patients

To introduce the use of alar cartilage as tip grafts in secondary silicone augmentation rhinoplasty in Chinese patients and to assess its short-term results in nasal tip modification. Eight Chinese patients who were not satisfied with a primary silicone augmentation rhinoplasty because of unimproved short nose, less projection, and bad nasal tip definition were treated with this method. The lateral crura were transected from the caudal ends, turned over, placed on the implanted silicone, and sutured together. Photo documentations were obtained before and after surgery, and a questionnaire was used for the evaluation of short-term patient satisfaction. After a mean follow-up period of 15 months, all 8 patients showed an increased nose length, tip projection, and improved tip contour. Seven thought the results were excellent, and 1 thought the results were good. The outcomes remained unchanged over time. No complications or nasal deformities were noted. The use of alar cartilage as tip grafts provides a new option for Chinese patients who were dissatisfied with primary silicone augmentation rhinoplasty, specially those with short nose, less projection, and bad nasal tip definition.

Asian Rhinoplasty

Rhinoplasty for the Asian patient mandates an entirely different strategy than for the Occidental nose. The objective for Asian rhinoplasty is augmentation rather than reduction in which the dorsum is raised and the nasal tip projection and definition are enhanced. The watchword today is ethnic preservation rather than effacement for the Asian patient. An ethnically sensitive standard for aesthetic rhinoplasty for the Asian nose is proposed. Also, a thorough discussion of cultural issues that can be important when working with the Asian patient is undertaken to guide a surgeon through every phase of patient care. Finally, the technical details are elaborated on both rhinoplasty and revision rhinoplasty for the Asian nose with an emphasis on correcting previous silicone augmentation rhinoplasty, the most popular choice for material in the Far East but that has failed the author in achieving consistent results.

Invited Discussion: Silicone Augmentation Rhinoplasty in an Oriental Population

Invited Discussion: Silicone Augmentation Rhinoplasty in an Oriental Population

Biomechanics in augmentation rhinoplasty

During the past 6 years, we have treated 406 patients with classical silicone augmentation rhinoplasty. The types and incidence of complications after subcutaneous or subfascial implantation were examined. We have proposed that most complications are related to the depth of the implant and the character of the tissues. In order to improve our operation and prove our hypothesis, we performed subperiosteal augmentation rhinoplasty in 22 cases with satisfactory results. In order to determine scientifically which layer the silicone implant should be inserted into, we investigated the biomechanics of human nasal periosteum and fascia, including tensile strength, stress - strain relationship and stress relaxation characters under uniaxial tension. Although having less failure strain, the periosteum has more tensile strength than the fascia. So, in the view of biomechanics, the periosteum is thicker, tougher and stiffer than the fascia, thus is more suitable for covering silicone implants.

Silicone Augmentation Rhinoplasty in an Oriental Population

Aesthetic augmentation rhinoplasty is gaining in popularity among Oriental populations. Despite being widely criticized in the literature, silicone implants remain the most commonly used as a result of their ease of application and lack of donor site morbidity. The authors present 355 consecutive Chinese patients who underwent silicone augmentation rhinoplasty from January 1999 to April 2003. During a mean follow-up period of 160 days, 28 patients (7.9%) developed major complications that required either removal or revision of the implant. The patients who had received the largest volume implants had the highest extrusion and infection rates, indicating that overaugmentation is the main cause. The authors hypothesize that the lower complication rates in Oriental compared with white populations is primarily the result of structural differences in the soft tissue envelope of the nose. In our series of patients, nasal augmentation with silicone implants proved to be effective and safe.

Mechanical properties of nasal fascia and periosteum

Objective. To determine under which layer the silicone implants should be inserted into, the biomechanical properties of fascia and periosteum were investigated. Design. Biomechanical testing of cadaveric tissues. Background. In silicone augmentation rhinoplasty, most complications are closely related to the depth of implant and the mechanical character of the tissue surrounding the implant. Methods. Biomechanical properties of human nasal periosteum and fascia were studied, including tensile strength, stress–strain relationship and stress relaxation under uniaxial elongation. Result. Although with less failure strain, the periosteum has more tensile strength than fascia. The slope of the linear part of stress–strain curve of the periosteum is bigger than that of fascia, which indicates the periosteum is stiffer than fascia. The stress-relaxation slope of periosteum is smaller than that of fascia. Conclusion. In the view of biomechanics, the periosteum is thicker, stronger and stiffer than fascia. Under periosteum the silicone implants are easier to be fixed at desired position, thus periosteum is more suitable for covering silicone implants. Relevance The periosteum is more suitable than fascia for covering silicone implants in augmentation rhinoplasty.

Silicone implant in augmentation rhinoplasty.

During the past 6 years the authors have treated 406 patients with classic silicone augmentation rhinoplasty. The types and incidence of complications after subcutaneous or subfascial implantation are examined and discussed. They propose that most complications are related to the depth of the implant and the character of the tissues. To improve their operation and to prove their hypothesis, they performed subperiosteal augmentation rhinoplasty in 22 patients with satisfactory results. At the same time, they investigated the biomechanical properties of human nasal periosteum and fascia, including tensile strength, the stress-strain relationship, and stress relaxation characteristics under uniaxial tension. Although it has less failure strain, the periosteum has more tensile strength than fascia. So, in the view of biomechanics, the periosteum is thicker, tougher, and stiffer than fascia, and thus more suitable for covering silicone implants.

Silicone in Nasal Augmentation Rhinoplasty: A Decade of Clinical Experience

A number of materials, both biologic and alloplastic, have been used for nasal augmentation. Although biologic bone and cartilage grafts are associated with lower infection rates, they are also associated with long-term resorption and donor-site morbidity. Alloplastic materials, in particular silicone, have been associated in the literature with extrusion and infection but have the advantages of being affordable and easy to reshape with no requirement for harvesting autografts. A 10-year experience with silicone nasal augmentation documenting clinical experience, acute and long-term complications, and patient satisfaction was reviewed. All patients undergoing silicone augmentation rhinoplasty between July of 1985 and December of 1995 were reviewed. Preoperative nasal phenotype, operative data, and postoperative outcome were recorded. Long-term follow-up was undertaken using a telephone survey. There were 422 patients who underwent silicone nasal augmentation from July of 1985 to December of 1995. Only nine were men. The indications were for aesthetic nasal augmentation in 98 percent, and the majority (98 percent) were of South East Asian origin. Mean age was 26 (range 17 to 36), and 41 of the 422 patients had had previous nasal augmentation performed before presentation. Twenty-three patients (5.5 percent) had complications requiring removal of the implant within 30 days of surgery. These included displacement, prominence, hemorrhage, and excessive pressure in addition to obvious supratip deformity. On late follow-up, a further 18 patients (4.3 percent) had subsequent removal of the prosthesis. The most common reason for this was either displacement or over-prominence, more often judged by the surgeon than the patient. There were only two patients (0.5 percent) who had extrusion of the prosthesis. A total of 266 patients (63 percent) were contacted for a telephone interview. The majority of patients (84.2 percent) were satisfied with their nasal shape. Of the 42 patients (15.8 percent) who were not satisfied, 21 patients still wanted further augmentation of their nose. Photographic analysis of 198 patients showed a mean augmentation of 16.5 percent (range 4.0 to 27.5). Amount of augmentation correlated with preoperative nasal phenotype. Silicone nasal augmentation is a safe and effective procedure when used for moderate increases in nasal height. Contrary to previous reports, this series showed no associated infection. If the implant is shaped appropriately to the patient's nasal phenotype, the risk of extrusion may be reduced. (Plast. Reconstr. Surg. 102: 1230, 1998.)

Silicone in Nasal Augmentation Rhinoplasty: A Decade of Clinical Experience

A number of materials, both biologic and alloplastic, have been used for nasal augmentation. Although biologic bone and cartilage grafts are associated with lower infection rates, they are also associated with long-term resorption and donor-site morbidity. Alloplastic materials, in particular silicone, have been associated in the literature with extrusion and infection but have the advantages of being affordable and easy to reshape with no requirement for harvesting autografts. A 10-year experience with silicone nasal augmentation documenting clinical experience, acute and long-term complications, and patient satisfaction was reviewed. All patients undergoing silicone augmentation rhinoplasty between July of 1985 and December of 1995 were reviewed. Preoperative nasal phenotype, operative data, and postoperative outcome were recorded. Long-term follow-up was undertaken using a telephone survey. There were 422 patients who underwent silicone nasal augmentation from July of 1985 to December of 1995. Only nine were men. The indications were for aesthetic nasal augmentation in 98 percent, and the majority (98 percent) were of South East Asian origin. Mean age was 26 (range 17 to 36), and 41 of the 422 patients had had previous nasal augmentation performed before presentation. Twenty-three patients (5.5 percent) had complications requiring removal of the implant within 30 days of surgery. These included displacement, prominence, hemorrhage, and excessive pressure in addition to obvious supratip deformity. On late follow-up, a further 18 patients (4.3 percent) had subsequent removal of the prosthesis. The most common reason for this was either displacement or over-prominence, more often judged by the surgeon than the patient. There were only two patients (0.5 percent) who had extrusion of the prosthesis. A total of 266 patients (63 percent) were contacted for a telephone interview. The majority of patients (84.2 percent) were satisfied with their nasal shape. Of the 42 patients (15.8 percent) who were not satisfied, 21 patients still wanted further augmentation of their nose. Photographic analysis of 198 patients showed a mean augmentation of 16.5 percent (range 4.0 to 27.5). Amount of augmentation correlated with preoperative nasal phenotype. Silicone nasal augmentation is a safe and effective procedure when used for moderate increases in nasal height. Contrary to previous reports, this series showed no associated infection. If the implant is shaped appropriately to the patient's nasal phenotype, the risk of extrusion may be reduced.