Clinical Effectiveness and Safety of Collagen Sheet for Dorsal Augmentation in Rhinoplasty

Abstract

In Asian rhinoplasty, dorsal augmentation often requires the use of alloplastic materials because sufficient amounts of autograft are difficult to harvest. Given considerations of aesthetics, costs, and the characteristics of the oriental nose, silicone or Gore-Tex is commonly used when augmenting the nasal dorsum to a great extent. Such materials can often result in postoperative complications and foreign-body sensations. Moreover, extrusion or visualization of the implant may occur because of thinning of the skin over time. Permacol collagen implants are specifically indicated for soft tissue reinforcement and repair of the head and face in plastic and reconstructive surgery. The handling versatility of the flexible collagen sheet allows it to be layered over itself until the requisite thickness and desired shape are obtained. A total of 50 patients who underwent nasal augmentation rhinoplasty between December 2007 and May 2011 were observed for at least 24 months. Depending on the nasal dorsum, we layered the collagen sheet up to a maximum of 4 times and we have not seen any case of severe resorption or overcorrection in the nasal configuration. Collagen implant material is safe for use in select rhinoplasty patients because of its low complication rate, as shown in our series. It could therefore be considered as a useful alternative when reconstruction is problematic because of the low quality or lack of available autologous grafts.

Solid Implants in Facial Plastic Surgery: Potential Complications and How to Prevent Them

“…Acute trauma Secondary posttraumatic Table 2 Advantages and disadvantages of common solid implant materials 2,3,5,10,19,23,37 Material Description Advantages Disadvantages Common uses and secondary rhinoplasty. Mandibular augmentation is most frequently used for defects caused by microgenia or a poorly defined mandibular angle border.…”

East Asia Superciliary Arch Augmentation With Silicone Implant

“…It also provides excellent, reproducible results without the need for reoperation. [14][15][16][17][18] A capsule can form around the silicone implant when placed properly, which provides a vascularized protective barrier and avoids surrounding tissue damage if it needs to be removed. 16,17 Eppley 8 described different operative techniques for bony forehead and brow bone reduction and biomaterials for forehead and brow bone augmentation.…”

“…For many East Asian patients pursuing superciliary arch augmentation, silicone gel has become preferred over implants due to the advantages of low infection rates, time savings during surgery, ease of engraving and modification, and minimal morbidity. It also provides excellent, reproducible results without the need for reoperation 14–18 . A capsule can form around the silicone implant when placed properly, which provides a vascularized protective barrier and avoids surrounding tissue damage if it needs to be removed 16,17 .…”

“…In contrast, autologous tissue allows for incorporation and revascularization, theoretically reducing the risk of infection and extrusion. However, applying autologous tissue has primary drawbacks, such as donor site morbidity, associated increased recovery time, and tissue resorption 14,15 . Chao et al 16 performed a retrospective review of 215 Asian patients undergoing alloplastic facial augmentation and proved alloplastic implants can safely be used as a first-line option for Asian facial augmentation when utilizing proper surgical techniques, such as the creation of a precise subperiosteal pocket, placing the implant away from the incision site, and leaving well-vascularized soft tissue coverage under minimal tension.…”

The Ageing Nose: Challenges and Solutions

“…Furthermore, there are potential donor site complications such as haematoma, numbness and pain. Other suitable grafts include allografts such as Alloderm [32] and xenografts such as Permacol [33]. These grafts have the benefit of no additional incisions beyond the nose but pose the risk of adverse reactions.…”