Tissue Grafting and Transplanting and Its Influence on the Revision Rhinoplasty Rate
For the last 15 years there has been a trend towards not only reducing certain structures of the nose in size by shaping, filing and sculpting, but "adding on" to achieve a certain desired effect. The adding on must be done by the importation of additional tissue in addition to maneuvering the tissues that remained after the minimization. Traditionally, the most common tissue used to help build up the tip in the case of a flat, poorly formed tip has been cartilage taken from the internal nasal septum. There is also cartilage available from the bowl of the ear. Some surgeons have even used pieces of rib bone or pieces of skull bone to build up the bridge of the nose. While these material structures are not difficult to obtain at the same surgical session, the outcome of the transplantation is never certain. The cartilage may shrink, it may soften, and it may curl such that the end result of the placement is not satisfactory. Typically, the more that is done, the greater the chance that some elements will not be successful. We believe that is one of the reasons why we are seeing so many patients come in who are unhappy with their nose; because it has lumps and bumps and other consequences of multiple cartilage, bone or other tissue grafting.
Today, we have an excellent array of "filling materials." These so-called "injectables" will "plump out" depressions, grooves, moguls and irregularities such that the need for surgery is erased.
Most of today's injectables such as Restylane, Juvederm, collagen and Perlane are not permanent, however, their longevity may be for months, up to a couple years. One substance with an over 50-year track record of successful use is permanent, medical grade liquid silicone.
The injectable silicone is the liquid form of the same silicone formula that can be hardened and used as implants for joints or artificial heart valves.
One nice technique that patients should be aware of, which will help them understand the end result of correction using fillers is what we call the "salt water demo."
For those considering filling injections, this demo using sterile saline (the same material used in intravenous fluids) can be used to predict the anticipated result. The surgeon fills the depressed area with the saline and immediately the patient can see the end results. Photographs can be taken before and after for the patient's file and for the patient to take home and even show a friend or family member. Within several hours, the salt water will just dissipate with no consequences to the tissue.
If the patient is satisfied with the appearance following the same demo, then he or she can be confident that the results of the permanent filling injection will be satisfactory.
SALINE (SALE-WATER) DEMO
To demonstrate results of permanent silicone injections
Left : Before saline injection to raise bridge of nose. Right : After saline injection to raise bridge of nose.
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