Learn about the materials used in nasal plastic surgery (Part 3)

Materials used in rhinoplasty are materials of natural or artificial origin that are used to transplant into the structure of the nose during plastic surgery to change the structure and size of each part or the entire nose for therapeutic or aesthetic purposes.

SURGICAL IMPLANT MATERIAL

A. Surgical implant material

1. Ear cartilage (auricular cartilage): indications for shaping the tip of the nose, wings of the nose

How to get:

Take Cavum & Cymba cavity, in both ears through an incision before or after the speaker. Pay attention to the protection of Helix, anti-helix, so as not to be at risk of deformation of the ear tragus. Perichodrium can be attached or left depending on the surgeon.

2. Septal cartilage: indications for lifting, making the nasal column, stretching the tip of the nose, extending the septal cartilage.

• How to get:

• Local anesthesia reduces pain and perichondrial dissection

• Injection under the cartilage membrane lidocaine has 1/100000 epinephrine at least 3 points

• Incise the gill cartilage 2 mm from the sun's tail

• Dissect the perichondrium, exposing the cartilage

• Make a cartilage incision 10-15 mm from the caudal edge of the cartilage and the superior edge

• Cut off the sun along the incision with scissors and separate the cartilage head from the bone

• The perichondrium was sutured and drainage was placed

• Insert compresses 2 sides of the nasal cavity for 1-3 days after surgery to prevent hematoma and keep the remaining cartilage frame from deforming.

3. Rib cartilage: indications when the volume of ear cartilage and partitions does not meet the requirements

How to get:

• The skin incision is made along the crease under the breast to hide the scar

• Cartilage needs to be # 3 cm short, take 5 or 6 cartilage through the inframammary fold

• Cartilage needs to be 5-6 cm long, taken from ribs 7-8-9

• Incision of the skin 3 cm in the line of breast folds from 1 cm inside the point connecting the nipple down the line of breast folds

• Separation of the muscles reveals the cartilage membrane, incision of the H-shaped cartilage membrane reveals the cartilage. Use cartilage lifter to cut 2 heads

• Make sure the underlying cartilage membrane and pleura are not damaged.Check the safety with a physiological saline solution at the place where rib cartilage is obtained

• Soak the cartilage mass in 30’ brine to stabilize the shape before hewing

• Depending on the requirements monolithic rib cartilage can be used or thinly sliced or finely chopped wrapped

4. Pelvic crest: indicated when there is no place to take the cartilage on its own or because surgeons prefer to use the pelvic crest sponge.

How to get:

• Local anesthesia

• Make a 3 cm skin incision of the iliac crest

• Dissection to expose the iliac crest

• Chisel grabs the pelvic crest bone mass according to the skin tissue of the bridge of the nose, the tip of the capsule.

5. Temporal weighing: indications when it is necessary to wrap the lifting material of the bridge of the nose. When additional volume of stromal tissue is needed for the bridge of the nose or spots that need the thickness of the skin and subcutaneous tissue.

How to get:

• Location of the temporal Zone, 1 cm ahead and 3 cm above the ear tragus

• Make a 3 cm skin incision

• Dissection reveals the deep weight of the temples. Avoid shallow temporal artery damage

• Take the area of ​​the deep temporal fascia as required

• Close the incision

6. De-epithelized dermofat graft: indications to add volume to the nasal Tower. When it is necessary to increase the thickness of the skin-tissue of the spine of the caps and tip of the nose, wings of the nose.

How to get:

• Location: buttocks, sacrococcygeal area, hypogastric area and areas with thick skin and tissue

• If the same-amputated area is taken, the incision must deviate from the middle line so that the wound is flaxy and not at risk of exposing the sacrum-amputated

• Draw the area where the skin flap needs to be removed...

• Local anesthesia

• Peeling off the epidermis (de-epithelial)

• Make an incision to remove the fat layer and subcutaneous tissue

• Since the skin-fat graft can shrink after grabbing and also after grafting, it is necessary to take the grafted flap of a larger area and volume than required.

7. Silicone: Silicone used as a cosmetic implant is a high-molecular compound (Polymer) of silicon (Si) with carbon, hydrogen, oxygen and some other elements (polydimethylsiloxane). Chemical-structured Silicone is the long bonding chain of Silicon (Si) and Oxygen (-Si-O-si - O-si-).

The change in molecular structure by horizontal bonds with other molecules produces products of different formats such as liquid silicone (oil), flexible Silicone (resin), solid silicone (rubber).

A composition of silicone commonly used in nasal shaping is Silastic

8. Silastic is the trade name of silicone elastomer registered by Dow Corning in 1948. Silastic is a cross-linked polydimethylsiloxane with a hydrogen molecule.

This type of Silicone is very familiar to the beauty world because it is the type of implant for many areas of the body: the bridge of the nose, chin, cheeks, calves, pectoral muscles, buttocks... This form of silicone has been used for a long time and is still in popular use in the world.

In addition to the general characteristics of silicone, silastic has many advantages for use such as soft, tough, strong, easy to operate during surgery, easy to peel and edit as required, easy to shape according to The Shape of the organ to be transplanted. If the aesthetic results are not satisfied can be removed to change the correction very easily.

CHARACTERISTICS OF SILICONE NOSE IMPLANT

Long-term aesthetic effect. Forming capsule cover should not stick to the neighboring organization, portable, easy to remove replacement Editing. Calcification due to calcium deposition on the implant or inner surface of the capsule makes the rugged life shape visible or palpable.

1. Gore-Tex: trade name of ePTFE (expanded polytetrafluoroethylene)

PTFE (polytetrafluoroethylene) is a polymer of ethylene (polyethylene) invented in 1966 by John Cropper, New Zealand. In 1969, Wilbert L.Gore, Robert Gore and colleagues (USA) have researched PTFE stretching technology to create ePTFE is a Styrofoam product, has many porousmolecular structure, is resistant to water and evaporation ePTFE (water proof and breathable). Patent registration in 1976. In 1978 the product was launched under the trade name Gore-Tex applied in many areas of life (such as Teflon fabric).

The GORE-TEX membrane has 9 billion micropores per square inch. Each pore is 20,000 times smaller than a water droplet and 700 times larger than a water-vapor molecule, so liquid water cannot penetrate while internal moisture can evaporate. (W. L. Gore & Associates, Inc., 2013). Fiber diameter: 5–10 µm; pore size: 10–30 µm (Thomas Romo et al.).

ePTFE was first used clinically by Soyer in 1972 for vascular splicing. In 1983, Neel was used in facial shaping. In 1993 it was approved by the FDA for use in cosmetic shaping. Usually used in 2 forms: sheet & solid block. The grate has smaller holes in the form of blocks and is softer. In nasal shaping mainly use the form of solid blocks that can be sculpted block type.

Characteristic:

• The aesthetic effect is less stable than silicone

• The format can be adjusted after placement

• Not forming capsules that neighboring tissue grows in and adjacent to the implant, so less torsion, less mobility that is difficult to remove when needed

• The risk of infection is higher than other materials

• Less prone to calcification than silicone

2. Medpor (Porex, Plastipor): preparation of porous ePTFE

It was invented by Paul O'keeffe in 1999 and produced by Porex Surgical under the trade name Medpor. The hole size of the large Medpor 100-250 U allows not only soft tissue, but also bone cartilage tissue to grow into adhesion.

Medpor and Gore-Tex are the two most common rhinoplasty materials in the United States. 2 this material has different properties in which Gore-Tex is relatively safer, softer Medpor should be used more. The infection rate of Gore-Tex is 5%, Medpor is 19%. According to Thomas Romo with 300 cases in 9 years, the infection rate is 3-4%. Medpor can be used as the bridge of the nose ,Columella strut

3. Supramid mesh (polyamid mesh) : product of Ethicon sommerveille, New York, is an organopolymer of e-caprolactam, soft structure with soft tissue, containing melanin (black pigment) capable of binding development to cell organizing in situ. Infection rate 0.8%, deformation rate 1.5%.

4. Mersilene mesh (polyethylene mesh): also the product of Ethicon Sommerveille, was born in 1950. The product is nonabsorble (nonabsorble) 30 X30 cm, which can be sterilized. Soft properties, not palpable under the skin.

5. Prolene mesh( polypropylene mesh): has a woven fiber mesh (like prolene thread) structure. Products of Ethicon Prolene Suppliers.

6. Surgicel (methylcellulose): also the product of Ethicon in the form of a cellulose fiber knitting mesh, insoluble. Often used for hemostasis in surgery,can be a filler, soft, safe.

Dr. Doctor. Cao Ngoc Bich

Head of Plastic Surgery Department, An Sinh Hospital

Vice President of City Beauty Association. Ho Chi Minh

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Department of Aesthetics, An Sinh Hospital

1st Floor, Building A, 10 Tran Huy Lieu, Phu Nhuan District, City. HCM

Phone: (028) 38457777 - ext: 130, 164, 165, 166, 167

Source :http://www.ansinh.com.vn/News.aspx?NewsID=1838&CatID=68&TypeID=2