1955, sihata used solid silicone rubber for rhinoplasty for the first time and achieved success. Solid silicone rubber is stable in performance, easy to shape, low in tissue rejection rate, non-toxic and carcinogenic, and easy to take out once complications occur. This method was quickly recognized and welcomed by doctors all over the world. Up to now, solid silicone rubber is still the main prosthetic material for rhinoplasty.
In 1963, Kunei and Goulian reported the success of rhinoplasty with liquid silicone rubber. Because liquid silicone rubber can be used for rhinoplasty by injection, it can be shaped at will, with ideal shape, no need for surgery and little pain, and it has been popular all over the world. However, after 10 years of clinical practice, it is found that liquid silicone rubber is also prone to rejection. Once complications occur, it is difficult to take out the nail body, which often leads to serious adverse consequences. It is not uncommon for the skin on the back of the nose to fester and necrosis, leading to deformity. The United States banned the use in the 1980s. Although there is no explicit prohibition in China, the China Society of Plastic Surgery has repeatedly called for stopping using it.
In the early 1990s, some manufacturers introduced rhinoplasty by injecting liquid hydroxyapatite. Hydroxyapatite, also known as artificial bone, has been used in orthopedics for many years, with good effect, low tissue reaction and easy shaping. However, liquid hydroxyapatite can diffuse along the gap and its shape is irregular after solidification. Once complications such as rejection occur, it is difficult to completely remove the prosthesis. Therefore, the application and popularization of this method are limited.
With the improvement of medical knowledge and the development of medical materials, the types and quality of non-tissue substitutes will be developed and improved. Up to now, high-quality silicone rubber is still the main material for rhinoplasty.
Rhinoplasty materials are selected according to their own conditions.
1. Autologous costal cartilage is suitable for patients with severe saddle shape or severe rejection of artificial tissue materials, with excellent histocompatibility and difficult absorption; However, after partial costal cartilage transplantation, there are some shortcomings such as residual scar on the chest, less trauma and easy bending and deformation. Fascia and partial spiral cartilage transplantation are also suitable for nasal tip plastic surgery.
2. Expanded PTFE is soft, and its flexibility is closer to soft tissue than other artificial vegetation. It is an inert swelling polymer, and its interior consists of many nodules. The tiny fibers between nodules are interwoven in all directions, which is a super-porous structure with the characteristics of firm and soft, allowing tissue to grow in.
3. Solid silicone prosthesis is the most widely used rhinoplasty material in China at present, which has the following advantages: ① stable performance, little irritation, non-absorption, and long-term storage in tissues; 2 beautiful appearance, easy to shape, no deformation; (3) The price is cheap, the amount of materials is not limited, and it is not cut from the body and bones, so it is easy to be accepted by patients. The disadvantage of silica gel is that if there are adverse reactions such as deformation and prosthesis deviation, and silica gel will adhere to the tissue, it is not very simple to take it out.
Comparison between silica gel and canopy
(1) Compare the histocompatibility of the two materials. Expansive materials and silicone prostheses are good, resistant to high and low temperatures, chemical stability, corrosion resistance, good histocompatibility, non-toxic, non-carcinogenic and non-teratogenic. However, very few people will reject them. Due to the special structure of the swelling material, blood vessels and nerves can gradually grow into the swelling body, so that the swelling body can grow with human tissue, while the silicone prosthesis can not grow with human tissue. After implantation, there may be a mild one-off inflammatory reaction in the local area, and a thin fibrous capsule will be formed around it in the later stage. It is the most widely used and effective material in rhinoplasty.
(2) Compare the plastic properties of the two methods. Although the expanded material has certain flexibility, its elasticity and three-dimensional effect are poor, so it is not suitable for carving and shaping, and the effect of supporting the nose column and tip is not good. The silicone prosthesis itself has the basic shape of the nose and can be carved at will. Silicone rubber can be prefabricated into various shapes and models of nasal prosthesis, such as nose tip, nose wing, nose column and so on. , commonly used are "L" shape, "T" shape and willow shape. Good flexibility and elasticity, strong three-dimensional sense.
(3) In the case of organized growth, the expanded material will lose its original elasticity and become very solid, which will make its appearance and feel unreal and make its nose look dull and unnatural. But silicone prostheses don't have this problem. It will not change its corresponding shape with the passage of time, tissue growth will not occur, and it will not change its feel. Toughness and elasticity are relatively stable, so it is natural.
(4) The expanded material has the characteristics of tissue ingrowth, which brings trouble to the patient's second operation. Through observation, we found that the longer the swelling stays in the body, the more unfavorable it is to take it out. Due to the growth and swelling of tissues, the cavity formed is getting smaller and smaller, so if the swollen substance is taken out, it is like taking out a piece of your own tissue, which is self-evident. In the body, silicone prosthesis has no trouble of tissue growing together. In general, the cavity of the prosthetic body will not change much during surgery. The prosthesis is wrapped in a fiber envelope just like wearing a dress, so taking out the silicone prosthesis is as simple as taking something out of your pocket, and it will not cause any damage to the surrounding tissues.
(5) The cost of expanded materials is generally about 2 times that of silicone materials, but the cost of surgery is 3 to 5 times that of silicone materials, so this is also the reason why expanded materials are highly praised by some plastic surgery institutions. Korean rhinoplasty materials widely used are as follows:
Rhinoplasty and implantation;
The advantages of polytetrafluoroethylene (PTFE) rhinoplasty are no allergy and immune rejection, low incidence of inflammation, and tissue can grow into it. Because it is soft and elastic, it is natural after implantation, and it is the most advanced and safest alternative material in the world. This material is mostly used to fill nasolabial groove, lip and facial wrinkles, rhinoplasty, forehead augmentation and facial suspension surgery, and has achieved good results.
Solid medical silicone rubber rhinoplasty;
This is a synthetic polymer material, and its main component, silicon, is an element contained in human body. Therefore, the performance of solid medical silicone rubber after rhinoplasty is stable and the rejection reaction is small. Because of its light weight, easy carving, low price and wide application, it has become the most commonly used material for rhinoplasty in cosmetic surgery.
Autologous cartilage rhinoplasty;
Autologous cartilage augmentation rhinoplasty is taken from autogenous costal cartilage or auricular cartilage, and is artificially carved and shaped. Because it is its own material, there is no rejection after transplantation, which is especially suitable for simple nose tip and alar plastic surgery. Repair of defects after nasal tip and alar elevation and extension. 1, autologous cartilage
Advantages: Autologous cartilage implantation has no stimulation to tissues and is easy to shape. Commonly used autologous cartilage tissues: costal cartilage, auricle cartilage and nasal septum cartilage. The former is rich in bone source and suitable for those with serious deformity and large bone demand; The latter is suitable for patients with mild saddle nose or low nose due to limited bone source. Autologous cartilage tissue is often used for rhinoplasty.
Disadvantages: Autologous cartilage rhinoplasty may also absorb deformation, but it is less likely.
2. Heterogeneous organizations
Advantages: the material source is convenient, rich and easy to form. Heterogeneous tissues include bovine nasal septal cartilage, bovine costal cartilage and calf sternum, which can be used for rhinoplasty after special treatment.
Disadvantages: Although specially treated, heterogeneous tissues cannot guarantee the strong antigenicity of all, and the phenomenon of rejection is not excluded. Because it can be used in human body after special treatment, there is a technical breakthrough. The application of heterogeneous tissue in rhinoplasty is rare.
3. Solid silica gel
Advantages: It was used as early as 1972. After more than 20 years of observation, although the incidence of complications can reach 5%-20%.
Disadvantages: unable to establish blood circulation with the body, forming tissue connection, only wrapped by fibrous tissue, so it can penetrate the skin at weak tissue. Due to the contracture of fibrous capsule, the surface of silicone prosthesis can protrude, which affects the appearance of rhinoplasty.