Nasal Implant Infection: could change Asian Rhinoplasty
I am here in China discussing the future of silicone nasal implants in Asian rhinoplasty. Nasal implant infection is apparently having an effect on the choice of material for nasal bridge augmentation in Asian Rhinoplasty. It is very interesting to me that the Chinese rhinoplasty surgeons are moving toward using the patient’s own tissue instead of an implant. I was surprised by this because the silicone implant for the bridge of the nose is very easy to do. It is also cheap. BUT (and this is the real problem) there is a 3-7% chance of infection with the use of a silicone implant. It is also true that the risk does not go away over time. I have treated many late complications of nasal implant infections. Not easy problems to deal with.
Diced Cartilage and Fascia
My understanding from speaking with the Chinese surgeons is that the patients are now quite aware of the problems and are choosing to have rib cartilage, cadaver rib cartilage, or ear as the source of cartage for the dorsal graft. Many are using the diced cartilage and fascia technique that Rollin Daniel and I published in 2004. They are sometimes using rectus abdominus fascia instead of deep temporalis fascia. This is because it is easy to harvest. Also, it does not make much of a difference in the thicker skin patients.
With that said, the lack of cartilage in the septum of many Chines patients makes this difficult. Therefore, more rib harvests are being done. Also, the demand for cadaver rib cartilage is increasing. The invention of off the shelf, tissue engineered cartage will certainly impact this operation. It will depend on the ability of the engineered cartilage to function like real cartilage. Not an easy task. So for now, we will see more ribs and cadaver ribs being used in China, Korea, and Japan. For more examples, click here to see before and after photos.