Aesth Plast Surg DOI 10.1007/s00266-014-0312-8
EDITOR’S INVITED COMMENTARY
AESTHETIC
Commentary on ‘‘Combined Alloplastic Implant and Autologous Dermis Graft for Nasal Augmentation Rhinoplasty in Asians’’ Babak Saedi
Received: 27 March 2014 / Accepted: 30 March 2014 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2014
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Alloplastic Implant Nasal augmentation Rhinoplasty Asian
I was invited to give a commentary on the article ‘‘Combined alloplastic implant and autologous dermis graft for nasal augmentation rhinoplasty in Asians’’, which presents a new modification to the popular controversial use of alloplastic in Asian rhinoplasty. What is the best material to use in augmentation rhinoplasty is still a topic of debate. The use of autogenic cartilage is usually the first choice of all surgeons, but lack of enough material in revision cases or morbidities at donor sites for graft extraction have encouraged researchers to find an alternative substance [1–3]. Silicone, Medpor, Mersiline, and Gortex are used by different surgeons, but none of them can be considered ideal [4, 5]. The ideal material should be biocompatible, stable with respect to reabsorption, and resistant to infection. However, none of the products mentioned above is ideal, and complications from their use, including extrusion, develop during patient follow-up [6, 7]. With respect to rhinoplasty in ethnic groups, Asian rhinoplasty is somewhat different. Lack of a strong bony
cartilaginous structure combined with thick skin encourages some surgeons to frequently use implants in Asian rhinoplasty. The current article is a nice modification of the use of alloplastic implants in Asian rhinoplasty [8]. The authors used autologous dermis over the implant probably to reduce the extrusion rate. According to some clinical investigations, the site of implantation and skin thickness play important roles in the success of the rhinoplasty [7]. Thus, some surgeons wrap the implant with fascia or dermis but the final results are unpredictable when this is done [8]. In addition, the possible effect of this thick layer of dermis on the vascularization of the tissue surrounding the implant should be considered before this modified technique is fully implemented. In addition, 5 months is a very short period of time to evaluate the results of alloplastic implants. The main concern about these implants is extrusion in the long term. Also, I personally believe that outcome measurement of rhinoplasty needs more precise subjective and objective tools. In summary, despite an innovative modification of the use of alloplastic implants in Asian rhinoplasty presented in this article, it is necessary to have a longer follow-up period with a higher level of evidence before encouraging the use of this technique. Conflict of interest disclose.
The author has no conflicts of interest to
References B. Saedi (&) Otolaryngology Department, Tehran University of Medical Sciences, Hemmat Hwy, Tehran, Iran e-mail: [email protected]
1. Lupo G (1997) The history of aesthetic rhinoplasty: special emphasis on the saddle nose. Aesthetic Plast Surg 21:309–327 2. Regnault P (1987) Nasal augmentation in the problem nose. Aesthetic Plast Surg 11:1–5
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Aesth Plast Surg 3. Paule C, Regnault L (1980) Reconstructive rhinoplasty with nasal implants. Aesthetic Plast Surg 4:79–86 4. Wolfgang G, Annette K (1998) Our experience with silicone in rhinomentoplasty. Aesthetic Plast Surg 22:237–244 5. Augustus J, Valauri L (1982) Maxillofacial prosthetics. Aesthetic Plast Surg 6:159–164 6. Razmpa E, Saedi B, Mahbobi F (2012) Augmentation rhinoplasty with combined usage of Medpor graft and irradiated homograft rib cartilage in saddle nose deformity. Arch Iran Med 15:235–238
123
7. Zeng Y, Wu W, Yu H, Yang J, Chen G (2002) Silicone implants in augmentation rhinoplasty. Aesthetic Plast Surg 26:85–88 8. Leo Z, Juraha G (1992) Experience with alternative material for nasal augmentation. Aesthetic Plast Surg 16:133–140
EDITOR’S INVITED COMMENTARY
AESTHETIC
Commentary on ‘‘Combined Alloplastic Implant and Autologous Dermis Graft for Nasal Augmentation Rhinoplasty in Asians’’ Babak Saedi
Received: 27 March 2014 / Accepted: 30 March 2014 Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2014
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Alloplastic Implant Nasal augmentation Rhinoplasty Asian
I was invited to give a commentary on the article ‘‘Combined alloplastic implant and autologous dermis graft for nasal augmentation rhinoplasty in Asians’’, which presents a new modification to the popular controversial use of alloplastic in Asian rhinoplasty. What is the best material to use in augmentation rhinoplasty is still a topic of debate. The use of autogenic cartilage is usually the first choice of all surgeons, but lack of enough material in revision cases or morbidities at donor sites for graft extraction have encouraged researchers to find an alternative substance [1–3]. Silicone, Medpor, Mersiline, and Gortex are used by different surgeons, but none of them can be considered ideal [4, 5]. The ideal material should be biocompatible, stable with respect to reabsorption, and resistant to infection. However, none of the products mentioned above is ideal, and complications from their use, including extrusion, develop during patient follow-up [6, 7]. With respect to rhinoplasty in ethnic groups, Asian rhinoplasty is somewhat different. Lack of a strong bony
cartilaginous structure combined with thick skin encourages some surgeons to frequently use implants in Asian rhinoplasty. The current article is a nice modification of the use of alloplastic implants in Asian rhinoplasty [8]. The authors used autologous dermis over the implant probably to reduce the extrusion rate. According to some clinical investigations, the site of implantation and skin thickness play important roles in the success of the rhinoplasty [7]. Thus, some surgeons wrap the implant with fascia or dermis but the final results are unpredictable when this is done [8]. In addition, the possible effect of this thick layer of dermis on the vascularization of the tissue surrounding the implant should be considered before this modified technique is fully implemented. In addition, 5 months is a very short period of time to evaluate the results of alloplastic implants. The main concern about these implants is extrusion in the long term. Also, I personally believe that outcome measurement of rhinoplasty needs more precise subjective and objective tools. In summary, despite an innovative modification of the use of alloplastic implants in Asian rhinoplasty presented in this article, it is necessary to have a longer follow-up period with a higher level of evidence before encouraging the use of this technique. Conflict of interest disclose.
The author has no conflicts of interest to
References B. Saedi (&) Otolaryngology Department, Tehran University of Medical Sciences, Hemmat Hwy, Tehran, Iran e-mail: [email protected]
1. Lupo G (1997) The history of aesthetic rhinoplasty: special emphasis on the saddle nose. Aesthetic Plast Surg 21:309–327 2. Regnault P (1987) Nasal augmentation in the problem nose. Aesthetic Plast Surg 11:1–5
123
Aesth Plast Surg 3. Paule C, Regnault L (1980) Reconstructive rhinoplasty with nasal implants. Aesthetic Plast Surg 4:79–86 4. Wolfgang G, Annette K (1998) Our experience with silicone in rhinomentoplasty. Aesthetic Plast Surg 22:237–244 5. Augustus J, Valauri L (1982) Maxillofacial prosthetics. Aesthetic Plast Surg 6:159–164 6. Razmpa E, Saedi B, Mahbobi F (2012) Augmentation rhinoplasty with combined usage of Medpor graft and irradiated homograft rib cartilage in saddle nose deformity. Arch Iran Med 15:235–238
123
7. Zeng Y, Wu W, Yu H, Yang J, Chen G (2002) Silicone implants in augmentation rhinoplasty. Aesthetic Plast Surg 26:85–88 8. Leo Z, Juraha G (1992) Experience with alternative material for nasal augmentation. Aesthetic Plast Surg 16:133–140
