Download PDF
Facial Plast Surg 2024; 40(04): 485-492
DOI: 10.1055/s-0043-1772846
Original Research

Complications Associated with Alloplastic Materials in Rhinoplasty and Their Operative Management

Katharina Storck
1   Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
,
Sebastian Kotz
1   Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
,
Frank Riedel
2   Department of Otorhinolarnygology, HNO-Zentrum Rhein-Neckar, Mannheim, Germany
,
Johannes Veit
3   Department of Otorhinolarnygology, Praxis für Nasenchirurgie München, Munich, Germany
4   Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Mannheim, Mannheim, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.

Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound.

Level of Evidence N/A

Keywords

rhinoplasty - augmentation rhinoplasty - autologous material - nasal dorsum augmentation - diced cartilage - revision rhinoplasty


Publication History

Article published online:
14 September 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 North JF. The use of preserved bovine cartilage in plastic surgery. Plast Reconstr Surg 1953; 11 (04) 261-274
    CrossrefPubMedGoogle Scholar
  • 2 Moshaver A, Gantous A. The use of autogenous costal cartilage graft in septorhinoplasty. Otolaryngol Head Neck Surg 2007; 137 (06) 862-867
    CrossrefPubMedGoogle Scholar
  • 3 Kridel RW, Ashoori F, Liu ES, Hart CG. Long-term use and follow-up of irradiated homologous costal cartilage grafts in the nose. Arch Facial Plast Surg 2009; 11 (06) 378-394
    CrossrefPubMedGoogle Scholar
  • 4 Toriumi DM. Autogenous grafts are worth the extra time. Arch Otolaryngol Head Neck Surg 2000; 126 (04) 562-564
    CrossrefPubMedGoogle Scholar
  • 5 Toriumi DM. Discussion: use of autologous costal cartilage in Asian rhinoplasty. Plast Reconstr Surg 2012; 130 (06) 1349-1350
    CrossrefPubMedGoogle Scholar
  • 6 Na HG, Jang YJ. Dorsal augmentation using alloplastic implants. Facial Plast Surg 2017; 33 (02) 189-194
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Kim IS. Augmentation rhinoplasty using silicone implants. Facial Plast Surg Clin North Am 2018; 26 (03) 285-293
    CrossrefPubMedGoogle Scholar
  • 8 Kim HS, Park SS, Kim MH, Kim MS, Kim SK, Lee KC. Problems associated with alloplastic materials in rhinoplasty. Yonsei Med J 2014; 55 (06) 1617-1623
    CrossrefPubMedGoogle Scholar
  • 9 Lee KC, Ha SU, Park JM, Kim SK, Park SH, Kim JH. Foreign body removal and immediate nasal reconstruction with superficial temporal fascia. Aesthetic Plast Surg 2006; 30 (03) 351-355
    CrossrefPubMedGoogle Scholar
  • 10 Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 1998; 102 (04) 1230-1237
    CrossrefPubMedGoogle Scholar
  • 11 Zeng Y, Wu W, Yu H, Yang J, Chen G. Silicone implant in augmentation rhinoplasty. Ann Plast Surg 2002; 49 (05) 495-499
    CrossrefPubMedGoogle Scholar
  • 12 Moon KM, Cho G, Sung HM. et al. Nasal anthropometry on facial computed tomography scans for rhinoplasty in Koreans. Arch Plast Surg 2013; 40 (05) 610-615
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Tham C, Lai YL, Weng CJ, Chen YR. Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg 2005; 54 (01) 1-5 , discussion 6–7
    CrossrefPubMedGoogle Scholar
  • 14 Graham BS, Thiringer JK, Barrett TL. Nasal tip ulceration from infection and extrusion of a nasal alloplastic implant. J Am Acad Dermatol 2001; 44 (02) 362-364
    CrossrefPubMedGoogle Scholar
  • 15 Pak MW, Chan ES, van Hasselt CA. Late complications of nasal augmentation using silicone implants. J Laryngol Otol 1998; 112 (11) 1074-1077
    CrossrefPubMedGoogle Scholar
  • 16 Toriumi D. Structure Rhinoplasty: Lessons Learned in 30 Years. Vol. 3. Chicago: DMT Solutions; 2019
    Google Scholar
  • 17 Takeda A, Akimoto M, Ishikawa S. et al. Immediate reconstruction after removal of nasal prosthesis using diced cartilage wrapped with temporal fascia. J Craniofac Surg 2014; 25 (02) 535-538
    CrossrefPubMedGoogle Scholar
  • 18 Kovacevic M, Riedel F, Wurm J, Bran GM. Cartilage scales embedded in fibrin gel. Facial Plast Surg 2017; 33 (02) 225-232
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Hoehne J, Gubisch W, Kreutzer C, Haack S. Refining the nasal dorsum with free diced cartilage. Facial Plast Surg 2016; 32 (04) 345-350
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Daniel RK, Calvert JW. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg 2004; 113 (07) 2156-2171
    CrossrefPubMedGoogle Scholar
  • 21 Daniel RK. Diced cartilage grafts in rhinoplasty surgery: current techniques and applications. Plast Reconstr Surg 2008; 122 (06) 1883-1891
    CrossrefPubMedGoogle Scholar
  • 22 Erol ÖO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg 2000; 105 (06) 2229-2241 , discussion 2242–2243
    CrossrefPubMedGoogle Scholar
  • 23 Baker SR. Diced cartilage augmentation: early experience with the Tasman technique. Arch Facial Plast Surg 2012; 14 (06) 451-455
    CrossrefPubMedGoogle Scholar
  • 24 Tasman AJ, Diener PA, Litschel R. The diced cartilage glue graft for nasal augmentation. Morphometric evidence of longevity. JAMA Facial Plast Surg 2013; 15 (02) 86-94
    CrossrefPubMedGoogle Scholar
  • 25 Bullocks JM, Echo A, Guerra G, Stal S, Yuksel E. A novel autologous scaffold for diced-cartilage grafts in dorsal augmentation rhinoplasty. Aesthetic Plast Surg 2011; 35 (04) 569-579
    CrossrefPubMedGoogle Scholar
  • 26 Sclafani AP, Saman M. Platelet-rich fibrin matrix for facial plastic surgery. Facial Plast Surg Clin North Am 2012; 20 (02) 177-186 , vi
    CrossrefPubMedGoogle Scholar
  • 27 Kovacevic M, Kosins AM, Göksel A, Riedel F, Bran G, Veit JA. Optimization of the soft tissue envelope of the nose in rhinoplasty utilizing fat transfer combined with platelet-rich fibrin. Facial Plast Surg 2021; 37 (05) 590-598
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Kim SH, Kim JW, Jang YJ. Radiologic findings of complicated alloplastic implants in the nasal dorsum. Clin Exp Otorhinolaryngol 2021; 14 (03) 321-327
    CrossrefPubMedGoogle Scholar
  • 29 Kosins AM. Comprehensive diagnosis and planning for the difficult rhinoplasty patient: applications in ultrasonography and treatment of the soft-tissue envelope. Facial Plast Surg 2017; 33 (05) 509-518
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Jung YG, Kim HY, Dhong HJ. et al. Ultrasonographic monitoring of implant thickness after augmentation rhinoplasty with expanded polytetrafluoroethylene. Am J Rhinol Allergy 2009; 23 (01) 105-110
    CrossrefPubMedGoogle Scholar