Abstract
Background
Dorsal nasal augmentation plays an important role in cosmetic and reconstructive rhinoplasties performed to achieve an aesthetically pleasing result while creating facial harmony. Although it is known that the ideal implant should be biocompatible, biointegrated, nonabsorbable, and without inflammatory response, the selection of an ideal implant still remains controversial as to whether it should be biologic or synthetic. This study introduces a new question: ‘‘What is better for the nasal dorsum, a soft or a hard implant?’’.
Methods
In this study, 21 women and 7 men with a mean age of 23.5 years underwent augmentation rhinoplasty between December 2007 and July 2011. Conchal and septal cartilage grafts and Medpor were categorized as hard implants and applied for 15 patients. Soft implants, inserted in 13 patients, included diced auricular cartilage wrapped in Surgicel sheets, dermofat blocks, and rolls of Prolene mesh.
Results
Patient satisfaction was assessed through simple postoperative questionnaires. The satisfaction rate in the soft implant group was 100 %, whereas the overall satisfaction rate was 82.2 %. Unsatisfactory results and complications were recorded in the hard implant group, which had a dissatisfaction rate of 33.3 %, contributing to a general dissatisfaction rate of 17.8 % in the whole series.
Conclusion
The authors recommend soft implants for both aesthetic and reconstructive surgeries because of their better ability to achieve a dorsum with a smoother contour and pad. Soft implants have fewer complications and higher satisfaction rates and can be applied for most indications using both closed and open methods.
Level of Evidence II
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References
Adams JS (1987) Grafts and implants in nasal and chin augmentation: a rational approach to material selection. Otolaryngol Clin North Am 20:913–930
Ahn J, Honrado C, Horn C (2004) Combined silicone and cartilage implants: augmentation rhinoplasty in Asian patients. Arch Facial Plast Surg 6:120–123
Arima LM, Velasco LC, Tiago RS (2012) Influence of age on rhinoplasty outcomes evaluation: a preliminary study. Aesthetic Plast Surg 36(2):248–253. doi:10.1007/s002660119805-x
Brent B (1979) The versatile cartilage autograft: current trends in clinical transplantation. Clin Plast Surg 6:163–180
Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E (2011) A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg 35:569–579
Cardenas JC, Carvajal J (2007) Refinement of rhinoplasty with lipoinjection. Aesthetic Plast Surg 31:501–505
Chauhan N, Warner J, Adamson P (2010) Adolescent rhinoplasty: challenges and psychosocial and clinical outcomes. Aesthetic Plast Surg 34:510–516
Ching S, Thoma A, McCabe RE, Antony MM (2003) Measuring outcomes in aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 111:469–482
Çöloğlu H, Uysal A, Tiftikçioğlu YÖ, Oruç M, Koçer U, Coşkun E, Ramadan SU, Astarcı MH (2012): Comparison of autogenous cartilage, acellular dermis, and solvent-dehydrated pericardium for the prevention and correction of dorsal nasal irregularities: an experimental study. Aesthetic Plast Surg. 36(3):732–741. doi:10.1007/s002660119865-y
Colombo G, Caregnato P, Stifanese R, Ferrando G (2010) A vast intranasal filler-induced granulomatous reaction: a case report. Aesthetic Plast Surg 34:660–663
Copas JB, Robin AA (1989) The Facial Appearance Sorting Test (FAST): an aid to the selection of patients for rhinoplasty. Br J Plast Surg 42:65–69
Dancey AL, Perry MJ (2004) Late presentation of alloplastic implant extrusion. Plast Reconstr Surg 113:1081–1082
Deva AK, Merten S, Chang L (1998) Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 102:1230–1237
Erlich MA, Parhiscar A (2003) Nasal dorsal augmentation with silicone implants. Facial Plast Surg 19:325–330
Ersek RA, Delerm AG (1988) Processed irradiated bovine cartilage for nasal reconstruction. Ann Plast Surg 20:540–546
Faidiga GB, Carenzi LR, Yassuda CC, Silveira F, Do Lago T, Leite M, Lima W (2010) Long-term evaluation in aesthetic rhinoplasty in an academic referral center. Braz J Otorhinolaryngol 76:437–441
Fatemi MJ, Rajabi F, Moosavi SJ, Soltani M (2012) Quality of life among Iranian adults before and after rhinoplasty. Aesthetic Plast Surg 36(2):448–452. doi:10.1007/s002660119820-y
Gruber RP, Pardun J, Wall S (2003) Grafting the nasal dorsum with tandem ear cartilage. Plast Reconstr Surg 112:1110–1122
Gunter JP, Rohrich RJ (1990) Augmentation rhinoplasty: dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg 86:39–45
Hubbard TJ (1998) Bridge narrowing in ethnic noses. Ann Plast Surg 40:214–218
Iannetti G, D’Arco F (1977) The use of lyophilized dura in reconstruction of the orbital floor. J Maxillofac Surg 5:58–62
Kangesu L, Goodacre TE, Stanley PR (1991) Survival of irradiated glutaraldehyde preserved bovine cartilage in nasal reconstruction: retrospective study. Br J Plast Surg 44:483–485
Lopes D, Andrade B, Vaena M, Mota D (2011) Single-block costal cartilage graft in rhinoplasty. Rev Bras Cir Plast 26:453–460
McMahon D, Lin A, Reddy V, Gruber RP (2012) Rhinoplasty sizers. Aesthetic Plast Surg 36:72–76
Monreal J (2011) Fat grafting to the nose: personal experience with 36 patients. Aesthetic Plast Surg 35:916–922
Nguyen A, Pasyk KA, Bouvier TN (1990) Comparative study of survival of autologous adipose tissue taken in transplanted by different techniques. Plast Reconstr Surg 85:378–386
Owsley TG, Taylor CO (1994) The use of Gore-Tex for nasal augmentation: a retrospective analysis of 106 patients. Plast Reconstr Surg 94:241–250
Planas J (2011) The use of Integra in rhinoplasty. Aesthetic Plast Surg 35:5–12
Powell NB, Riley RW (1987) Cranial bone grafting in facial aesthetic and reconstructive contouring. Arch Otolaryngol Head Neck Surg 113:713–719
Rees LS, Myers S, Bradbury E (2012) A comprehensive screening, education, and training tool for the psychological assessment of patients seeking aesthetic surgery: “DESIRABLE OP?”. Aesthetic Plast Surg 36(2):443–447. doi:10.1007/s002660119808-7
Romo T III (1998) Sclafani A, Sabini P: use of porous high-density polyethylene in revision rhinoplasty and in the platyrrhine nose. Aesthetic Plast Surg 22:211–221
Sclafani AP, Romo T, Sliver L (1997) Clinical and histological behavior of exposed porous high-density polyethylene implants. Plast Reconstr Surg 99:41–50
Sclafani AP, Thomas JR, Cox AJ (1997) Clinical and histologic response of subcutaneous expanded tetrafluoroethylene (Gore-Tex) and porous high-density polyethylene (Medpor) implants to acute and early infection. Arch Otolaryngol Head Neck Surg 123:328–336
Tabbal N, Tepper OM (2011) Diced cartilage versus solid grafts in rhinoplasty. Aesthetic Plast Surg 35:580–581
Tardy ME, Denneny J, Fritsch MH (1985) The versatile cartilage autograft in reconstruction of the nose and face. Laryngoscope 95:523–533
Tham C, Lai YL, Weng CJ, Chen YR (2005) Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg 54(1–5):6–7
Tostes R, Ferreira F, Andrade J, Lima J, Almeida P, Meira A, Ferreira E, Coelho A (2011) Filling the nasal dorsum with Gore-tex in rhinoplasties. Rev. Bras Cir Plast 26:461–465
Wellisz T, Kanel G, Anooshian RV (1993) Characteristics of tissue response to Medpor porous polyethylene implants in the human facial skeleton. J Long-Term Effect Med Implants 3:223–235
Yanaga H, Imai K, Yanaga K (2009) Generative surgery of cultured autologous auricular chondrocytes for nasal augmentation. Aesthetic Plast Surg 33:795–802
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El-Shazly, M., El-Shafiey, H. Soft Versus Hard Implants in Dorsal Nasal Augmentation: A Comparative Clinical Study. Aesth Plast Surg 36, 1019–1027 (2012). https://doi.org/10.1007/s00266-012-9941-y
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DOI: https://doi.org/10.1007/s00266-012-9941-y