Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm

  • Kim, Yong Kyu (YK Aesthetic Plastic Surgical Clinic) ;
  • Shin, Seungho (Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital) ;
  • Kang, Nak Heon (Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital) ;
  • Kim, Joo Heon (Department of Pathology, Eulji University School of Medicine)
  • Received : 2016.06.07
  • Accepted : 2016.10.20
  • Published : 2017.01.20
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Abstract

Background Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. Methods Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. Results Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. Conclusions It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

Keywords

References

  1. Wu WT. The Oriental nose: an anatomical basis for surgery. Ann Acad Med Singapore 1992;21:176-89.
  2. Jung DH, Kim BR, Choi JY, et al. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases. Plast Reconstr Surg 2007;120:1997-2003. https://doi.org/10.1097/01.prs.0000287323.71630.e6
  3. Cochran CS, Landecker A. Prevention and management of rhinoplasty complications. Plast Reconstr Surg 2008;122: 60e-67e. https://doi.org/10.1097/PRS.0b013e31817d53de
  4. Granchi D, Cavedagna D, Ciapetti G, et al. Silicone breast implants: the role of immune system on capsular contracture formation. J Biomed Mater Res 1995;29:197-202. https://doi.org/10.1002/jbm.820290209
  5. Steiert AE, Boyce M, Sorg H. Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies. Med Devices (Auckl) 2013;6:211-8.
  6. Henriksen TF, Fryzek JP, Holmich LR, et al. Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors. Ann Plast Surg 2005;54:343-51. https://doi.org/10.1097/01.sap.0000151459.07978.fa
  7. Berghaus A, Stelter K. Alloplastic materials in rhinoplasty. Curr Opin Otolaryngol Head Neck Surg 2006;14:270-7. https://doi.org/10.1097/01.moo.0000233599.14671.4a
  8. Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 1998;102:1230-7. https://doi.org/10.1097/00006534-199809020-00052
  9. Tham C, Lai YL, Weng CJ, et al. Silicone augmentation rhinoplasty in an Oriental population. Ann Plast Surg 2005;54: 1-5. https://doi.org/10.1097/01.sap.0000141947.00927.49
  10. Parker Porter J. Grafts in rhinoplasty: alloplastic vs. autogenous. Arch Otolaryngol Head Neck Surg 2000;126:558-61. https://doi.org/10.1001/archotol.126.4.558
  11. Zeng Y, Wu W, Yu H, et al. Silicone implant in augmentation rhinoplasty. Ann Plast Surg 2002;49:495-9. https://doi.org/10.1097/00000637-200211000-00009
  12. Shirakabe Y, Shirakabe T, Kishimoto T. The classification of complications after augmentation rhinoplasty. Aesthetic Plast Surg 1985;9:185-92. https://doi.org/10.1007/BF01570849
  13. Shirakabe Y, Shirakabe T, Takayanagi S. A new type of prosthesis for augmentation rhinoplasty: our experience in 1600 cases. Br J Plast Surg 1981;34:353-7. https://doi.org/10.1016/0007-1226(81)90030-8
  14. Davis PK, Jones SM. The complications of silastic implants: experience with 137 consecutive cases. Br J Plast Surg 1971; 24:405-11. https://doi.org/10.1016/S0007-1226(71)80099-1
  15. Winkler AA, Soler ZM, Leong PL, et al. Complications associated with alloplastic implants in rhinoplasty. Arch Facial Plast Surg 2012;14:437-41. https://doi.org/10.1001/archfacial.2012.583
  16. Jung DH, Moon HJ, Choi SH, et al. Secondary rhinoplasty of the Asian nose: correction of the contracted nose. Aesthetic Plast Surg 2004;28:1-7.
  17. Lee MR, Unger JG, Rohrich RJ. Management of the nasal dorsum in rhinoplasty: a systematic review of the literature regarding technique, outcomes, and complications. Plast Reconstr Surg 2011;128:538e-550e. https://doi.org/10.1097/PRS.0b013e31822b6a82
  18. Spear SL, Baker JL Jr. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 1995;96:1119-23. https://doi.org/10.1097/00006534-199510000-00018

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