NOSE AUGMENTATION RHINOPLASTY
Nose Augmentation Rhinoplasty
Augmentation rhinoplasty refers to the surgery that uses autogenous tissues or implants for the patients who have low nasal height due to congenital defects, trauma, infection, excessive reduction rhinoplasty, or submucosal resection.
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IMPLANT TYPES OF AUGMENTATION RHINOPLASTY
The silicone implants that are used in rhinoplasty are of two types: L shaped implant or dorsal shaped implants.
L Shaped-One of the main benefits of L-shaped implants is that continuity between the dorsum and lobules is excellent; Therefore, it is possible to enlarge both the dorsal and lobule of the nose. However, when the strut of L-shaped silicone implants comes into contact with the nasal spine or upper maxilla,. Disasters such as nasal implant extrusion from the tip of the nose, depending on the patient’s predetermined skin thickness, firmness of the implant, degree of tip and partial tissue release, and long-term motion of the surrounding area. Skin necrosis may occur.
SIMPLE IMPLANT AUGMENTATION RHINOPLASTY
Nasal augmentation is a surgery done mostly in patients with low radix and dorsum. This is done to improve the elevation of the dorsum. Implant or alloplastic is the readily available material that can be used to increase the height of the dorsum. This is to be done in patients who have limited source of graft material or those who do not wish to give cartilage from other areas. Once you decided to use the implant then comes the decision of deciding the shape of implant that will suite the patient. It has specific length, height and width available and you can also cut intra operation. It is equally important to consider several operative guidelines to appropriately shape the implant to reduce the incidence of adverse effects and postoperative complications. The most common postoperative complications include infection, changes in nasal elevation, movement of implant prostheses, and silicone implant protrusion.
Cosmetic and reconstructive rhinoplasty is one of the most challenging, but also one of the most rewarding, operations in plastic surgery. Rhinoplasty requires an understanding of the principles of facial proportions and balance. An aesthetically pleasing result can only be achieved when the subparts of the nose are in sync with each other and the nose, as a whole, other features of the face, including the chin, lips, midrace, orbit, and forehead.
Dorsal deficiencies in the anatomy of the nose are particularly unpleasant. Dorsal augmentation is an important part of surgery to give excellent results. A weak nasal dorsum appears as an obtuse nasal frontal angle. However, dorsum cannot be treated in isolation. Often associated with dorsal deficiencies are a low radix, poor tip projection and definition, a small columella, and an acute nasolabial angle. During the rhinoplasty procedure, these characteristics should also be adequately addressed, often requiring the use of other techniques, including columellar strut grafts, tip grafts, lower lateral cartilage suture, and spreader grafts.
To enhance the dorsum large amount of material is required and this can be taken from septum, concha, and ribs. Alloplastic materials, including silicon and polyethylene, avoid donor site morbidity and ease of use but leads to significantly higher rates of infection, displacement, and risk. In cases where autograft septal cartilage is not present in sufficient quantities for necessary grafting, it is our preference to use irradiated homograft costal cartilage. It provides an easily available source of cartilage but in our center, we don’t use it because of a lot of medical problems.
AUTOGENOUSLY TISSUE LIMIT
Once the patient agrees with the rib graft then there is no shortage of cartilage from the rhinoplasty for it is a huge source of cartilage. The only problem is a scar in the chest and slight discomfort for a few days. Initially, there was a lot of problem of warping But with special technique, you can avoid warping to a lot of extents. The advantage is that it an autogenous tissue once taken up it is like normal tissue. Dr. S. S. Gambhir likes to use the autogenous tissue only and he is not in favor of implant unless absolutely essential.