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Below we
will discuss your options in nasal augmentation, both from synthetic and
biological sources...
Such as Implantech
makes a wide variety of implants as shown above, as well as carvable
silicone blocks. Implantech has over 140 shapes and sizes and add new
designs often. They are my favorite implant company and can
recommend them with good conscience.
There are
also nasal implants made from expanded, tubular polytetrafluoro-ethylene
(ePTFE) implants from Softform or Gore-Tex and even ePTFE blocks to
customize an implant for the patient.
Let's
Review Your Options
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Silicone Implants: Solid
silicone has been used as a material for facial implants since about
1956. The silicone facial implants are solid, yet flexible and
very durable. They are manufactured in different durometers
(degrees of hardness) to be soft or quite hard. These implants
are designed to enhance soft tissue areas and not the underlying
bone structure. They are usually easily removed as they
are quickly encapsulated by scar tissue.
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Expanded
Polytetrafluoroethylene (ePTFE): These
implants are porous and utilize the benefits of tissue integration
as well to keep it in place. Not as firm as the more harder
silicone implants. There is less bone resorption underneath (ePTFE)
implants as opposed to silicone implants. When used for cosmetic
purposes this implant rarely exhibits a biochemical reaction.
However, when used in functional surgeries such as TMJ disorder or
hip replacement, fragments can rub off of the implant and cause
inflammation within the joints.
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Polyethylene
Implants: These
implants are bio-compatible and place no extra stress on the body or
effect it whatsoever. Not saying that Silicone does,
it's just another option for your nasal augmentation. They are
porous and rely on tissue integration instead of titanium screws,
for stability. These are more difficult to remove.
- Hydroxyapatite
Implants: Medical
Science has come up with a way to alter coral into an even closure
match to bone and that is called Hydroxyapatite or simply, HA.
It has both the porous structure and chemical make-up of bone so
that the body accepts it wholeheartedly and even incorporates normal
tissue integration and not capsulization like synthetic implants.
A patented process converts Calcium Carbonate into hydroxyapatite
while maintaining the three-dimensional integrity of the coral
yielding Coralline Hydroxyapatite (CH). All the proteins are
removed by intense heat. This renders the structure totally non-immunogenic
so it becomes a nearly perfect bone lattice. Closest to bone grafts
but without the bone.
So how exactly is HA
made? "The synthetic material is prepared by heating the
coral-which is essentially calcium carbonate with ammonium
phosphate at more than 200 °C for 24 to 60 hours to obtain
about 95% Hydroxyapatite. The material is processed into block or
granular form and sterilized by gamma radiation." (American
Chemical Society)
How long does it last
you ask? "The natural porosity of the material does have the
drawback of reducing its strength, notes David C. Mercer,
Interpore's president and chief executive officer. But the porous
structure provides room for bone tissue to immediately grow into the
pores of the implant. However, the material is only partially
resorbed and replaced by natural bone. The company is now evaluating
in pre-clinical studies a related new product that has a higher
resorption rate." (American
Chemical Society)
*Also available in an
injectable or spreadable, non-porous paste. See
below.
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Injectable Tissue
Augmentation Products: These
products offer ease of placement with less downtime although the
permanent micro-implants are not easily removed. Some products
are temporary and could be used to "try on" what nasal augmentation would look like although asymmetry is possible as the
injectable solution is, of course, not pre-formed and subject to
migration within the first few minutes to days. Not all products can
be sued for augmentation but some may be used for a buffering
material to cover bumpy raphs or fill in dents.
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Bioplastique®:
(technically:
copolymer formed by polydimethylsiloxane/ methylpolysiloxane
vulcanized, texturized, fully polymerized, suspended in
polyvinylpyrrolidone) Whew!!! Which, in a hand-basket, is
a polymer micro-implant 100 and 600 micrometer in size. Bioplastique®
is a biphasic (meaning having two phases) copolymer (a
product consisting of two substances that combine to make a larger
molecule) This copolymer consists of a solid, permanent
phase/substance and a carrier gel phase/substance which is absorbed
and excreted by the body. Very small, texturized particles of
a biocompatible inert polymer, were fabricated and mixed with
a hydro-gel solution. The hydro-gel has the consistency similar to
honey with exceptional lubricating characteristics. The polymer
is freely transported through tissue fluids and excreted, with no
changes, by the kidneys. This hydro-gel has been used as a carrier
fluid for a variety of medications that have been absorbed and
excreted without incident.
Many of us are quite concerned with migration of micro-implants such
as Bioplastique®. Here is an explanation to help you
understand what size a substance must be in order to not
migrate. Most Free Silicone particles, although not proven to cause
harm and disorders within the body, are small enough to
migrate freely within cell walls and infra-structures. Bioplastique®,
however, can not. In order for a substance to remain stationary and
be encapsulated by our body's own collagen, its size must be large
enough not to be absorbed by the body's cells and vessels and must
not be small enough for ease of transportation to the body's lymph
nodes. This could prove dangerous as small enough particles could
cause cell die off. Bioplastique® particles are both large enough
and textured permitting ease of collagen encapsulation (in under 4
weeks).
From
Emedicine.com:
"Bioplastique
(Uroplasty BV, Netherlands) is a biphasic material. It consists of
solid silicone particles (ranging in size from 100-400 mm) suspended
in a polyvinylpyrrolidone (CHNO) carrier.
Once
injected, the material elicits a low-grade inflammatory reaction.
The carrier is removed by the body and excreted by the kidneys.
Collagen encapsulates and localizes the silicone, and animal studies
have shown no evidence of foreign body migration. Deposition of
collagen progresses, replacing the organic component of the material
in a ratio slightly higher than 1:1. Therefore, overcorrection is
not advised.
Case
series have reported no major complications with Bioplastique other
than overcorrection. Subcutaneous placement is recommended to avoid
palpable nodularity. Bioplastique is not yet approved by the
FDA." (Emedicine.com - Soft Tissue Implants)
This
material is not approved for wrinkle or lip augmentation and is
still experimental in areas other than the tissue surrounding urethra
walls. This is because it is normally utilized in urinary
incontinence. However it has been successfully used in dermis
augmentation as well as secondary rhinoplasty applications.
It takes up to a week for the hydro-gel to be absorbed and excreted
thereafter and is still moldable during that period. Bioplastique® is
not "soft" and it is not rock hard, but more like cartilage
once encapsulated by your body's own collagen. It is reversible
although not easily. The particles must be removed with a micro
needle, as in micro-liposuction. It is possible that the area to be
corrected (or augmented) may lose it indigenous tissue as well when
suctioned out, resulting in an even smaller lip or deeper pitted
section of dermis.
Allergy test: Advisable
Longevity: Permanent, yet reversible.
Cost: Unknown
*Note: Bioplastique is not approved by the FDA for use in the
US for nasal augmentation.
Autologous
Options: Using Your Body's Resources:
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Bone
Grafts: This can be a
serious surgery depending upon the donor site, and there is a degree
of it absorption. There is a longer recovery time with bone grafts and
an increased risk of bone infection as well as excessive
calcifications. Although rib grafts are sometimes reported to
"curl", there are conflicted reports from different surgeons
on this occurrence. Below is an explanation of how bone grafts are
incorporated:
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"1)
Induction: Activation of host osteoblasts and
differentiation of primitive mesenchymal cells into chondroblasts
and osteoblasts.
2)
Inflammation: Graft invaded by PMN’s and its cellular
elements are degraded. Neurovascularization and mesenchymal
proliferatrion follow. Small avascular autografts can become
vascularized within 4-5 days.
3)
Soft tissue callous formation: The cellular matrix of the
invading granulation tissue becomes more dense and the vascularity
increases. Osteoclasts continue to remove dead bone, while
chondroblasts deposit a new matrix of chondroid on the old bone;
this begins to calcify. In cortical bone there is a
preferential removal of necrotic Haversian systems rather than
lamellae leading to an increased porosity of the graft.
4)
Hard callus formation: Osteoclasts continue to remove dead
bone and also begin degrading calcified cartilage, while
osteoblasts lay down membranous bone to replace it.
5)
Remodeling: Graft is remodelled into lamellar bone and a
medullary canal is established."
above
credit: Yale Medical University Core Curriculum
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Cadaver
Bone Grafts: The above
without the additional surgery site. It's from a dead person. Not
exactly "autologous" (not actually YOUR tissue) but hey, you
can borrow a little from someone who doesn't need it anymore.
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Septal
Cartilage: Sometimes
when an individual needs cartilaginous augmentation and doesn't opt
for synthetics he or she may be a candidate for augmentation via
septal cartilage. Septal cartilage is , of course, from your septum
and if you have a good supply it can be used sparingly.
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Ear
Cartilage (rim and concha): If
a patient does not have adequate septal cartilage or would risk
collapse due to septal cartilage removal there is always the ear
cartilage which can be used, Usually a tiny sliver is excised from the
posterior (back) of the ear, just behind the rim. This results in an
inconspicuous scar and usually adequate cartilage for minor to medium
rebuilding. Sometimes both ears are used for more extensive
rebuilding. This is actually pretty common in patients who have had
too much cartilage removed or have experienced collapse after a
primary rhinoplasty or several rhinoplasties by less experienced
surgeons.
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Rib
Cartilage: Of course if
none of the above are options or if in fact you need more cartilage
supply for an extensive rebuilding procedure or simply because of
surgeon-preference. Rib cartilage and sometimes even a bone graft from
your rib is used. It is usually removed from one of your lower
"floater" ribs and although I have had reports of both
resorption and "curling" if not placed correctly or simply
unfavorable circumstances - it is still a viable option.
In
Conclusion
Nasal deformity may result from repeat surgeries, disease, cartilage
deteriorating traumas, congenital disorders and even from prolonged
drug (inhalant) use. These deformities may inhibit a person's social life
and self esteem. With today's medical technology, these deformities can be
corrected and in turn, can restructure an individual's social life and
confidence. There is simply no reason for an individual to suffer from low
self esteem due to aesthetic objections.
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