“Ride-on” technique and other simple and logical solutions to counter most common complications of silicone implants in augmentation rhinoplasty

ABSTRACT

Augmentation rhinoplasty can be carried out using a wide range of materials including autologous bone and/or cartilage as well as alloplasts. Use of biologic bone and cartilage grafts results in lower infection rates, but they are associated with long-term resorption and donor-site morbidity. Alloplastic materials, in particular silicone, have been associated in literature with extrusion, necrosis of the tip, mobility and deviation or displacement of the implant, immobile nasal tip and infection. However, they have the advantages of being readily available and easy to reshape with no requirement for harvesting autografts. Aim: To overcome these problems associated with silicone implants for which the authors have devised a novel technique, the “rideon technique”. Materials and Methods: The present study was carried out on 11 patients over a period of 4 years. The authors have devised a simple technique to fix the silicone implant and retain it in place. Restricting the implant to only dorsum avoided common complications related to the silicone implant. Results: The authors have used this technique in 11 patients with encouraging results. Follow-up ranged from 12 months to 36 months during which patients were assessed for implant mobility, implant extrusion and tip necrosis. There was no incidence of above mentioned complications in these patients. Conclusion: The “rideon technique” provides excellent stability to silicone implants and restricting the implant only to dorsum not only eliminates chances of tip necrosis and thus implant extrusion but also maintains natural shape, feel and mobility of the tip.

KEY WORDS

Alloplasts - autografts - rhinoplasty - silicone implants

• REFERENCES

• 1 Vuyk HD, Adamson PA. Biomaterials in rhinoplasty. Clin Otolaryngol Allied Sci 1998; 23: 209-17
• 2 Tardy ME, Schwartz MS. The evolution of rhinoplasty outcome: Long term results. In: Daniel RK. editor Rhinoplasty. Boston: Eittle, Brown & Co.; 1993. p 778-814
• 3 Gunter JP, Rohrich RJ. Augmentation rhinoplasty: Dorsal onlay grafting using shaped autogenous septal cartilage. Plast Reconstr Surg 1990; 86: 39-45
• 4 Krause CJ. Augmentation rhinoplasty. Otolaryngol Clin North Am 1975; 8: 743-52
• 5 Wheeler ES, Kawamoto HK, Zarem HA. Bone grafts for nasal reconstruction. Plast Reconstr Surg 1982; 69: 9-18
• 6 Romo rd T, Jablonski RD. Nasal reconstruction using split calvarial grafts. Otolaryngol Head Neck Surg 1992; 107: 622-30
• 7 Leaf N. SMAS autografts for the nasal dorsum. Plast Reconstr Surg 1996; 97: 1249-52
• 8 Regnault P. Nasal augmentation in the problem nose. Aesthetic Plast Surg 1987; 11: 1-5
• 9 Khoo BC. Augmentation rhinoplasty in the orientals. Plast Reconstr Surg 1964; 34: 81-8
• 10 Beekhuis GJ. Silastic alar-columellar prosthesis in conjunction with rhinoplasty. Arch Otolaryngol 1982; 108: 429-32
• 11 Adams JS. Grafts and implants in nasal and chin augmentation. A rational approach to material selection. Otolaryngol Clin North Am 1987; 20: 913-30
• 12 Gilmore J. Use of Vicryl mesh in prevention of postrhinoplasty dorsal irregularities. Ann Plast Surg 1989; 22: 105-7
• 13 Juraha LZ. Experience with alternative material for nasal augmentation. Aesthetic Plast Surg 1992; 16: 133-40
• 14 Fanous N. Mersilene tip implants in rhinoplasty: A review of 98 cases. Plast Reconstr Surg 1991; 87: 662-71
• 15 Wellisz T. Clinical experience with the Medpor porous polyethylene implant. Aesthetic Plast Surg 1993; 17: 339-44
• 16 Godin MS, Waldman SR, Johnson Jr CM. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. A 6-year experience. Arch Otolaryngol Head Neck Surg 1995; 121: 1131-6
• 17 Queen TA, Palmer 3 rd FR. Gore-Tex for nasal augmentation: a recent series and a review of the literature. Ann Otol Rhinol Laryngol 1995; 104: 850-2
• 18 Vilar-Sancho B. An old story: An ivory nasal implant. Aesthetic Plast Surg 1987; 11: 157-61
• 19 Hiraga Y. Complications of augmentation rhinoplasty in the Japanese. Ann Plast Surg 1980; 4: 495-9
• 20 Wang JW. A new pattern of silastic prosthesis for augmentation rhinoplasty. Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi 1987; 3: 284-5 320
• 21 Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: A decade of clinical experience. Plast Reconstr Surg 1998; 102: 1230-7
• 22 Shirakabe Y, Suzuki Y, Lam SM. A systematic approach to rhinoplasty of the Japanese nose: A thirty-year experience. Aesthetic Plast Surg 2003; 27: 221-31
• 23 Tham C, Lai YL, Weng CJ, Chen YR. Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg 2005; 54: 1-5
• 24 Liao WC, Ma H, Lin CH. Balanced rhinoplasty in an Oriental population. Aesthetic Plast Surg 2007; 31: 636-42
• 25 Zeng Y, Wu W, Yu H, Yang J, Chen G. Silicone implant in augmentation rhinoplasty. Ann Plast Surg 2002; 49: 495-9