Filling materials, saddle nose, rhinoplasty. The above materials may be too irritating and the discharge rate is high; Or fragile and easily broken; Or because the price is high and the source is difficult, they have all been abandoned. In the 1920s, liquid paraffin was widely used as a filler for decades, and it was not used until it was widely reported that it was easy to cause paraffin tumors. In recent 30 or 40 years, with the rapid development of chemical industry, various polymer materials have come out one after another and been applied to plastic surgery, and good results have been achieved. But for rhinoplasty, because of the high discharge rate and uncertain long-term effect, many doctors advocate using autologous bone tissue or cartilage tissue as rhinoplasty material. However, due to the absorption of bone tissue and the increase of patients' pain, its application is also limited. Clinical application shows that the materials used in rhinoplasty, whether autologous or allogenic, active or inactive, natural or chemically synthesized, have certain advantages and disadvantages, and should be selected according to the specific situation. Let's introduce one by one:
Biological tissue substitutes:
With the development of science and technology and the progress of chemical synthesis industry, biological tissue substitutes suitable for human body have become a reality. The progress of tissue substitutes will promote the development of cosmetic plastic surgery. In 1970s, the commonly used biological tissue substitutes were liquid silica gel, ivory, dental materials, solid silica gel, artificial bone materials and expanded polytetrafluoroethylene.
Liquid silica gel: Liquid silica gel was widely used in China in the late 1970s and early 1980s. Clinical observation shows that liquid silica gel injection can cause persistent erythema swelling of the nose, skin necrosis of the bridge of the nose, tooth swelling and even facial injury. Moreover, liquid silica gel can diffuse, permeate and permeate around, and there is no clear boundary, so it is difficult to handle. The United States has strictly banned the use. Many domestic scholars advocate that it is forbidden to use it or use it with caution.
Ivory: ivory has good biocompatibility and generally does not cause rejection, but it is gradually abandoned for rhinoplasty because of its high hardness, difficult carving and animal protection.
Tooth-building materials: polymethyl methacrylate (PMMA) is a tooth-building material used in rhinoplasty, and it is one of the solid biological tissue substitutes used in rhinoplasty earlier. Good biocompatibility, it needs to be blended when it is used for rhinoplasty, and it is very easy to be polluted. If the pollution is not completely removed before operation, it will easily lead to complications such as infection, pain and rejection. Its prosthetic equipment is relatively complex and difficult to operate, so it is rarely used at present.
Solid silica gel: it is a common rhinoplasty material at present, and it is a polymer silicide. It was used as early as the middle of the 20th century. After more than 20 years of observation, although the incidence of complications can reach 5%-20%, it is still one of the first choice materials for rhinoplasty because of its good biocompatibility and low price. Its main disadvantage is that it can not establish blood circulation with the body and form tissue connection, and it is only wrapped by fibrous tissue, so it can penetrate the skin at weak tissue. Due to the contracture of fibrous capsule, it can cause the surface of silicone prosthesis to protrude, which affects the appearance effect.
Artificial bone material: mainly refers to hydroxyapatite. It is the main inorganic component of human bone tissue, so it has good biocompatibility and no side effects such as teratogenesis, sensitization and carcinogenesis. It has been widely used in stomatology and orthopedics. It has been used for rhinoplasty and cosmetology since the mid-1980s. It is easy to operate and shape, especially for people with low nose bridge, and the postoperative effect is particularly satisfactory. Because there is no supporting effect, it has poor effect on people with low nasal tip.
Expanded polytetrafluoroethylene (ePTFE): from the medical point of view, it is the most ideal biological tissue substitute at present. Because of its good biocompatibility and unique microporous structure, it is non-toxic, non-carcinogenic and non-allergenic. Human tissue cells and blood vessels can grow into its micropores to form tissue connections, just like autologous tissue. The effect of rhinoplasty with it is satisfactory. Expanded PTFE rhinoplasty material was introduced into China from the United States on 1995, but its high price affected its universal application.
Advantages of augmentation rhinoplasty with expanded materials:
A, softer than silicone rubber, and more natural after operation.
B, there is no redness at the tip of the nose after operation.
C, tissue can grow into the material, long-term fixation is better.
D, the nasal tip is very soft after the operation. If the patient doesn't say it himself, no one can see that he has received rhinoplasty.
E, it is easy to operate on patients with thin nasal skin.
Disadvantages of augmentation rhinoplasty with expanded materials:
A, due to good curing, the material and the human body become a whole, and it is more difficult than silicone rubber when it needs to be disassembled.
Of course, because one-time operation can be maintained permanently, this problem will only occur when you are not satisfied with the effect of the operation and need another operation. But surgeons with rich experience in this material generally have mastered the special skills of demolition, so don't worry.
B, more expensive than silicone rubber.
C, sculpture needs rich experience.
Autologous bone tissue:
Autologous bone tissue rhinoplasty is one of the earliest materials used for rhinoplasty. Its main advantages are easy survival after transplantation and no rejection. Autologous bone tissue of rhinoplasty is mostly taken from ilium, but also from ribs, tibia, skull and so on. Autologous bone augmentation rhinoplasty has some problems, such as poor elasticity of bone tissue and difficult shaping. Therefore, the postoperative appearance is not very natural, the autogenous bone is inconvenient to obtain, the bone source is limited, and the resection will cause secondary pain and even complications for the patient. Bone resorption can also occur for a long time, leading to changes in external morphology, which is difficult for patients to accept. At present, it is rarely used in rhinoplasty and beauty. However, for the correction of complex nasal deformity or severe saddle nose, autologous bone transplantation is still needed.
Autologous cartilage tissue:
Autologous cartilage tissue is often used for rhinoplasty. Its main feature is that it has no blood vessels and is easy to survive. After implantation, it has no irritation to the tissue, can maintain its original volume and cell morphology for a long time, and is easy to cut into the required size and shape, so the appearance after rhinoplasty is natural and realistic. Like augmentation rhinoplasty with autologous bone tissue, augmentation rhinoplasty with autologous cartilage tissue may be deformed by absorption. At the same time, surgery will also cause trauma outside the nose, which is unacceptable for patients without special deformities. Autologous cartilage used for rhinoplasty is the most commonly used cartilage, followed by auricle cartilage and nasal septum cartilage. The former is rich in bone source and suitable for those with serious deformity and large bone mass; The latter is suitable for those with mild saddle nose or low nose due to limited bone source.
Allogeneic tissue:
Rhinoplasty with allogenic tissue refers to rhinoplasty with fresh cadaver bone and cartilage tissue as rhinoplasty materials after special treatment. After augmentation rhinoplasty, allogenic bone and cartilage only played a temporary mechanical support role, and were eventually replaced by autologous bone. Because of the difficulty in source, quantity and quality, allogenic tissue was gradually abandoned.
Heterogeneous organization:
The heterogeneous tissues used for rhinoplasty are mainly bovine nasal septal cartilage, bovine costal cartilage and calf sternum, which can be used for human rhinoplasty after special treatment. Its advantages are convenient and abundant materials and easy molding. Its disadvantage is that although it has been specially treated, some individuals still have weak antigenicity and may be rejected: they have different degrees of absorption, so the long-term effect is not satisfactory. It is difficult to be widely used because it can only be used in human body after special treatment. At present, few people use heterogeneous tissues in rhinoplasty.
In short, the choice of materials should be based on their own conditions and economic conditions, combined with the doctor's diagnosis and tips, and then make a decision.