Problems Associated with Alloplastic Materials in Rhinoplasty

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Abstract

Purpose

Augmentation 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 Methods

We 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.

Results

Among 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.

Conclusion

Optimal 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.

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Most cited references 40

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Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns.

Laura D Wainwright (1995)

Scarring and contracture are major long-term sequelae of meshed split-thickness autografting for full-thickness skin injury. In the absence of dermis, mature fibroblasts secrete collagen in the altered pattern of scar. This case report illustrates the use of an acellular dermal matrix processed from human allograft skin (AlloDerm) in the treatment of a full-thickness burn injury. The processing technique results in an acellular dermal matrix with normal collagen bundling and organization and an intact basement membrane complex. In these patients, AlloDerm exhibited a high percentage 'take' and supported an overlying meshed split-thickness skin autograft, applied simultaneously. The clinical observations of 'take' were confirmed with histological and electron-microscopic evaluation of biopsies which demonstrated host cell infiltration and neovascularization of the AlloDerm. No specific immune response was detected, either by histology or by lymphocyte proliferation assay. By providing a dermal replacement, the grafted dermal matrix permitted the use of a thin, widely meshed autograft from the donor site, without the undesirable scarring and contracture at the wound site that commonly results from this technique. If effective, this approach would markedly reduce the amount of donor skin required for split-thickness autografts in full-thickness burn injuries.

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Blindness following cosmetic injections of the face.

Michele Figus, Marco Nardi, Davide Lazzeri … (2012)

Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury. The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face. Twenty-nine articles describing 32 patients were identified. In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite. Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible. Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pretraumatized tissues should be avoided. Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues. Risk, V.

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Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes.

M Eisemann, Victorien Wolters, Gottfried Lemperle … (2009)

Genuine granuloma formation following implantation of injectable dermal fillers is a rare complication, with incidences ranging from one in 100 patients (1 percent) to one in 5000 (0.02 percent). Foreign body granulomas occur several months to years after injection at all implantation sites at the same time. Without treatment, they may grow to the size of beans, remain virtually unchanged for some years, and then resolve spontaneously. Three clinical and histologic types of foreign body granulomas can be distinguished:Permanent implants are not characterized by a higher rate of foreign body granuloma per se than temporary implants; however, their clinical appearance is more pronounced and their persistence longer if not treated adequately.

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Author and article information

Journal

Journal ID (nlm-ta): Yonsei Med J

Journal ID (iso-abbrev): Yonsei Med. J

Journal ID (publisher-id): YMJ

Title: Yonsei Medical Journal

Publisher: Yonsei University College of Medicine

ISSN (Print): 0513-5796

ISSN (Electronic): 1976-2437

Publication date (Print): 01 November 2014

Publication date (Electronic): 08 October 2014

Volume: 55

Issue: 6

Pages: 1617-1623

Affiliations

[1 ]Nose Aesthetic Plastic Surgery Clinic, Busan, Korea.

[2 ]I & Co Aesthetic Plastic Surgery Clinic, Busan, Korea.

[3 ]Department of Plastic and Reconstructive Surgery, Dong-A University School of Medicine, Busan, Korea.

Author notes

Corresponding author: Dr. Keun-Cheol Lee, Department of Plastic and Reconstructive Surgery, Dong-A University School of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea. Tel: 82-51-240-2968, Fax: 82-51-243-5416, pokdungi@ 123456dau.ac.kr

Article

DOI: 10.3349/ymj.2014.55.6.1617

PMC ID: 4205703

PubMed ID: 25323900

SO-VID: 8c8307fe-5275-44d7-91f2-ed926624058f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 10 January 2014

Date revision received : 13 March 2014

Date accepted : 13 March 2014

Funding

Funded by: Dong-A University

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Problems Associated with Alloplastic Materials in Rhinoplasty

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Abstract

Purpose

Materials and Methods

Results

Conclusion

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IEEE: COVID-19 related research

Most cited references 40

Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns.

Blindness following cosmetic injections of the face.

Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes.

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Cited by 9

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