再次隆鼻的手术时机选择

目的 隆鼻手术失败取出假体按传统方法需3个月以后才能行再次隆鼻术，患者往往难以接受。该研究观察假体取出后同时进行隆鼻的临床效果，并就隆鼻失败的常见原因、表现形式及具体处理措施进行了详细探讨。方法 通过隧道剥离层次的改变、导引器的使用、缝线或印膜外固定、高质量隆鼻材料，以及材料形态的改变等措施对79例患者进行了假体取出后即刻隆鼻术。结果 经过3个月至5年的随访观察，除3例肿胀消退时间较长以外，其余患者都取得了满意的手术效果。结论 采取一些措施后，隆鼻失败假体取出即刻行隆鼻术可以取得与传统手术方法同样的临床效果，但它减少了手术次数和费用，减轻了受术者的痛苦。     

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.     

New nasal fracture classification for patients with silicone implants

Abstract

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.     

硅橡胶隆鼻美容术并发症诱发因素分析及其处理措施

目的：探讨硅橡胶隆鼻美容术并发症诱发因素及处理措施，有效的治疗及预防硅橡胶隆鼻术的并发症。方法：收集2010年12月至20012年3月间收治的50例行硅橡胶隆鼻术后出现并发症的患者，对术后出现的外形不美、假体偏移或漂浮等并发症进行总结分析，并总结并发症的处理措施。结果：对患者出现并发症诱因分析后所有患者均得了治愈，患者满意度为100％。结论：分析硅橡胶术后并发症的诱因并进行合理的治疗是解决并发症关键，同时对于隆鼻术进行积极的预防措施并发症是可以避免的。     

Foreign Body Removal and Immediate Nasal Reconstruction with Superficial Temporal Fascia

For nasal augmentation, various materials have been used for many years. The injection of foreign body has been carried on, although it is performed mostly by laymen. Because many complications arise after augmentation rhinoplasty by foreign body injection, secondary correction has been needed. These complications have included headaches, swelling, redness, palpable mass, skin discoloration, telangiectasia and fear of cancer. The authors treated 10 patients who had undergone injection of foreign body to the nose. After the foreign body was removed, we immediately reconstructed nasal deformity by silicone implant wrapping with superficial temporal fascia. This method has many advantages including easy contouring of nasal shape and fixation, absence of foreign body reaction, reduced inflammatory reaction, no or minimal concerns regarding the migration or extrusion of the implants, and nonvisible donor scar. The mean follow-up period was 8 months, and no complications occurred. The authors conclude that nasal deformity can be successfully reconstructed immediately using silicone implant wrapping with superficial temporal fascia after foreign body is removed from the nose. In the authors’ experience, this procedure has improved aesthetic appearance and met patients’ expectations.     

Our Experience with Silicone in Rhinomentoplasty

Based on a review of the literature and our own experience, we propose criteria for the site of implantation that, in our eyes, is suitable for a silicon implant or a cartilage transplant. Special interest is focused on rhinoplasty and chin augmentation, as both determine the facial profile of the patient. During the last 17 years we have treated 443 patients with augmentation rhinoplasty, of whom 360 received autologous ear cartilage grafts and 83 received autologous rib cartilage grafts. At the same time we saw 30 patients requiring removal of artificial implant materials that were used by other surgeons for rhinoplasty augmentation purposes. Since 1986 we have performed 60 chin augmentations with anatomically shaped silicone implants (McGhan), of which 40 patients had a combined rhinomentoplasty done.     

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.     

自体耳软骨联合硅胶假体在隆鼻术后再次鼻整形中的应用

目的 探讨自体耳软骨联合硅胶假体移植在再次鼻整形中的应用价值.方法 对29例初次应用硅胶假体隆鼻术形态欠佳的患者,使用自体耳软骨联合硅胶假体移植进行修复.结果 本组29例患者随访3~12个月,27例鼻部形态良好,鼻背延长,鼻尖抬高,鼻唇角角度改善,鼻尖皮肤无红肿,未发现假体外形显露、下移、排异反应等并发症,手术效果满意.其中2例患者术后拆线时发现鼻背部不对称,予以假体包囊分离缝合固定后效果满意.结论 自体耳软骨联合硅胶假体能延长鼻背,抬高鼻尖,有效防止鼻尖假体外形显露、张力过大、皮肤变薄、鼻尖皮肤穿孔等并发症发生,手术效果满意,值得推广.     

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.KEY WORDS: Aesthetic surgery, Asians, augmentation rhinoplasty, silicone implant, surgical complication     

膨体聚四氟乙烯联合硅胶假体在隆鼻术中的应用

目的：探讨膨体聚四氟乙烯与固体硅胶假体联合植入进行隆鼻的方法.方法：将雕塑好的膨体聚四氟乙烯固定在L形硅胶假体鼻尖部,形成膨体-硅胶假体联合体,进行鼻背筋膜下隆鼻.结果：本组71例受术者经6个月～1年随访,均出现极大程度的外形改善,所有患者均未出现假体外露,感染,鼻尖皮肤破溃等并发症,均获得满意临床效果.结论：应用膨体聚四氟乙烯联合硅胶假体隆鼻操作简单、有效,适合推广应用.     

Evaluation of porous polyethylene for external ear reconstruction

Autogenous rib cartilage and silicone rubber are materials currently used for ear reconstruction. Increased morbidity and operative time with rib cartilage grafts and a high rate of extrusion with silicone implants render them less than ideal for reconstruction of the human ear. The purpose of the current investigation is to determine the efficacy of porous polyethylene as an alternative synthetic material for ear reconstruction. Porous polyethylene and silicone rubber discs of equal sizes in two thicknesses were implanted in lieu of the cartilage in the external ear of eight baboons. Histological evaluation of the sites after nine weeks revealed excellent anchorage of the thin porous polyethylene implants (1.5 mm) in the surrounding tissues. Silicone rubber implants, however, were encapsulated in a thickened granulation tissue capsule. When thicker implants (3.0 mm) were used, exposure or extrusion occurred in all cases. Porous polyethylene implants demonstrated only partial exposure; half of the silicone rubber implants were extruded; and the other two silicone rubber implants were almost completely extruded. Porous polyethylene was thus better incorporated into the soft tissues than silicone rubber as long as the overlying soft tissues were not stressed by an oversized implant or inadequate soft tissue coverage.     

膨体聚四氟乙烯在鼻整形术中的应用

目的 探讨应用膨体聚四氟乙烯在鼻整形中应用价值.方法 局部麻醉下应用膨体聚四氟乙烯假体或复合自体耳甲腔软骨进行隆鼻手术.结果 本组20例患者术后随访鼻外形均良好,无免疫排斥反应、假体外露、假体摆动等情况发生.结论 膨体聚四氟乙烯在鼻整形中效果良好;假体复合自体耳甲腔软骨能有效延长鼻长度,抬高鼻尖.     

隆鼻术失败原因分析与再手术时机选择

目的：总结隆鼻术失败原因,并观察研究假体取出后即刻隆鼻术的临床效果.方法：从假体放置层次、雕刻形态等方面综合分析68例隆鼻术失败原因,并通过假体放置层次、假体质量以及假体形态的改变等措施对68例患者进行假体取出后即刻手术.结果：假体形态不佳、偏移是再手术的主要原因,经再手术后3个月～2年的随访观察,除5例肿胀消退时间较长外,其余患者均取得了满意效果.结论：由专科医师实施手术是减少隆鼻术失败的关键.采取一些措施后,隆鼻术失败假体取出后即刻行隆鼻手术是一种可行的方法.     

Combined silicone and cartilage implants: augmentation rhinoplasty in Asian patients

Various alloplastic materials are used for nasal augmentation in Asian patients. Of these, silicone is the most prevalent because it is durable and facilitates sculpting. However, silicone grafts have been associated with complications, including tip extrusion, infection, and graft shifting. Often the nasal tip is involved, with skin discoloration and possible implant extrusion due to increased mechanical pressure. Autogenous material provides a safer alternative for nasal augmentation, but the supply of septal or auricular cartilage in Asian patients is limited. To augment optimally and reduce extrusion risk, we use auricular cartilage grafts at the nasal tip and silicone implants for the nasal dorsum in Asian patients. We report the results of this technique in 100 Asian patients with up to 5 years of follow-up. Patients were extremely satisfied, and no implant extrusions resulted. Other complications included further surgical revision due to misalignment of the silicone dorsal implant (5 patients), tip graft shifting (2 patients), and recurrent dorsal edema over the implant requiring removal (1 patient).     

应用自体鼻中隔软骨与自体真皮组织修复假体隆鼻术后远期并发症的临床研究

目的探讨应用自体组织综合性修复假体隆鼻并发症的方法和疗效。方法针对36例固体硅胶假体隆鼻术后鼻背、鼻尖发红及鼻尖假体显露、穿出的患者,采取经鼻小柱开放性切口取出假体,剥除包膜,应用患者自体鼻中隔软骨及臀部真皮组织进行综合鼻整形修复。自体鼻中隔软骨应用于鼻小柱支撑及鼻尖覆盖物,白体真皮组织去表皮及脂肪后,修剪成合适形态,置于鼻背及鼻尖处,修复变薄的皮肤组织,塑造合适的形态。结果本组共36例患者,术后均I期愈合;术后未出现感染、软骨外露及移位等情况,疗效满意。结论自体鼻中隔软骨联合真皮组织移植,可有效修复假体隆鼻引起的并发症,术后外观形态好,值得临床推广。     

Nasal grafts and implants in revision rhinoplasty

Problems associated with primary rhinoplasty are often due to overresection of the nasal skeleton. One of the primary goals in revision rhinoplasty is to restore nasal architecture. To do so, the facial plastic surgeon can choose from numerous grafting materials. A key understanding of the benefits and limitations of each implant or graft and implants commonly used in revision rhinoplasty surgery.     

λ-Shaped Implant for Augmentation of Anterior Nasal Spine in Asian Rhinoplasty as an Ancillary Procedure

There is often a preexisting acute columella-labial angle in Asian noses and in most of these cases, the nasal spine is underdeveloped or sometimes even absent. Moreover, nasal tip projection by a tip graft or cephalic rotation of the nasal tip may get worse at the retracted columella-labial junction in the Asian nose with an underdeveloped anterior nasal spine, thus requiring the use of a maxillary spine graft or an implant. In many instances, however, the ideal source of autogenous tissue may not be available or the donor site for these tissues may be objectionable. So I have designed the λ-shaped silicone implant for augmenting the underdeveloped anterior nasal spine (ANS) to correct the acute columella-labial angle. From March, 1996 until September, 1999, I have done ANS augmentations using the λ-shaped silicone implant in Asian rhinoplasty on 37 female patients. The correction of an acute columella-labial angle was readily accomplished by application of the λ-shaped implant using the unilateral intranasal approach. The author suggests that ANS augmentation with the λ-shaped implant is a simple and effective method as an ancillary procedure in Asian rhinoplasty providing esthetically pleasing results in properly selected Asian patients.     

Silicone breast implants and immune disease.

Silicone was originally regarded as inert in the human body. Silicone medical devices have been associated with various complications that may involve an immune reaction to silicone or a silicone organic complex. There have been more than 80 cases reported in the medical literature of a varied systemic autoimmune illness in patients who have had various foreign materials placed in the breast. Controversy exists as to which complications have a cause and effect relationship, and which represent coincidental findings. It is difficult to distinguish between nonspecific local reactions and reactions that have an immunological basis. Approximately 1,000,000 to 2,000,000 women in the United States have had silicone breast implants inserted for reconstruction or augmentation mammaplasty; 28 of those patients have been reported to have developed a systemic autoimmune disease. Data on the 28 reported cases do not in any way prove a causal relationship between breast implants and immune disease. Given the natural incidence of autoimmune diseases, we would expect a coincidental occurrence in the United States of more than 1,000 cases of autoimmune disease in women who had undergone breast implant surgery. Additional information must be obtained to resolve the question. The true incidence of autoimmune disease in patients with implants needs to be determined. A prospective registry of implant patients should be established and comprehensive retrospective information obtained on the implant patient population. Further experimental work is necessary on the bioreactivity of silicone. Patients with implants and autoimmune disease, once identified, must be carefully evaluated by physicians who are experienced in the treatment of autoimmune disease.     

Augmentation rhinoplasty of the Asian nose with the "bird" silicone implant

Augmentation rhinoplasty of the Asian nose has a long legacy of safety in the Orient. The silicone implant design that is proposed resembles a bird in configuration and represents an intermediary form between the traditional I- and L-shaped implants. A pronounced lobular component often poses problems in the nasal tip: This implant exhibits a more diminutive proximal tip segment. Therefore, augmentation of the nasal dorsum and tip can be accomplished safely and successfully with the technique described for carving and inserting the implant. If complications should arise (e.g., infection, extrusion, mobility, or displacement), the implant can be removed simply and quickly because of the capsular formation around the implant. Infection occurred in only 3% of patients in this series and was managed easily with implant removal, oral antibiotics, and reinsertion. Displacement can be addressed with implant removal and reinsertion, and was also observed in 3% of patients. Mobility and extrusion have not been encountered. This technique has proved to be a safe, simple, reliable, and reversible technique in 1,079 rhinoplasties performed during a 10-year period.     

Nasal augmentation in the problem nose

The author emphasizes that nasal implants made of pierced silicone material, or conchal cartilage, are extremely satisfactory in selected cases. Their use should be restricted to dorsal implants, and the type of implant individually adapted to each case. The implant used should be made of solid silicone with numerous large holes piercing its form to create a natural fixation. In addition, the author stresses that cartilage grafts are very satisfactory, especially for small depressions or tip augmentation.