1, the higher the mountain root, the better it looks.
Overthrowing the method of rhinoplasty that relied solely on a silicone nasal bone in the past, Dean Xu stressed that structural rhinoplasty should be adopted now, because the structure of the nose is divided into mountain roots, bridge of the nose, tip of the nose, alar, nostril and nose column, and everyone's nose shape is different, and there is not only one way to match the five senses. If only the method of rhinoplasty is applied to everyone, everyone will look like a Korean.
There are many ways of rhinoplasty. In addition to implanting silica gel nasal bone and kamala nasal membrane, auricular cartilage and costal cartilage can also be used. Dr. Xu Yingzhe thinks that tailor-made rhinoplasty is very important! Ear cartilage is often used to pad the nose, and its own tissue hardness is moderate, which can fine-tune the desired nose. If the ear cartilage is not enough, costal cartilage will be used to strengthen the shape of the nose.
Speaking of mountain roots, the beauty in the eyes of professional doctors is no longer the higher the better, but may become an avatar, which is visually unattractive. Dean Xu said that the best position of the mountain root is probably the horizontal position above the center line of dark circles. Of course, because each face is unique, it must be carefully adjusted according to the distance between the eyes.
The nose is located in the center of the face, and having a beautiful nose shape will affect the overall appearance. Therefore, rhinoplasty should find a doctor who is good at facial plastic surgery, nasal reconstruction surgery and aesthetic feeling, so as to make the operation not only beautiful but also more natural. Successful rhinoplasty will not only make the facial features three-dimensional, but also make the eyes look good.
2. What are the types of rhinoplasty?
(1) Prosthesis implantation for rhinoplasty
1. augmentation rhinoplasty with silicone prosthesis implantation
Generally speaking, under local anesthesia, a skin incision is made in one nostril (generally on the right side) along the medial and lateral foot front edges of alar cartilage, and instruments are used to dive under the nasal dorsal fascia to form a corresponding tunnel, then a silicone prosthesis is implanted, and the nose shape after implantation is observed from the front and side, and the distal end of the implant is best to reach the midpoint of the connecting line between the eyebrows and the inner canthus of both eyes, that is, the "golden section". If the length and height of the implant are appropriate, the contour curve of the nose is harmonious and natural, and the skin incision can be sutured.
Silicone prosthesis is a kind of high molecular silicide with good biocompatibility. Silicone material is hard, elastic, easy to process and shape, strong in plasticity, widely available, low in cost and has a long application history. Most doctors are familiar with the silicone material, and it is not easy to deform after being clamped. The technical requirements for doctors during surgery are relatively simple, so it is still the mainstream choice for many doctors in China. Prostheses of various shapes and models such as nasal tip, alar and columella can be prefabricated. There are two kinds in common use, one is willow shape and the other is "L" shape.
However, silicone prosthesis also has some insurmountable shortcomings: first, silicone prosthesis is composed of silicone molecules, which is irritating to our tissues and cells. After a long time, it will cause some changes in the tissues we contact, such as thinning of skin and subcutaneous tissue or dilation and congestion of subcutaneous capillaries. Therefore, after augmentation rhinoplasty with silicone prosthesis, the skin on the back of the nose tends to be shiny, red and transparent, the tip of the nose becomes sharper and the skin becomes thinner, which is an unnatural phenomenon, which doctors call it. For people with small nose and thin skin on the back of nose, the above phenomenon is easy to occur when silicone prosthesis is implanted. In view of the above shortcomings of silicone prosthesis, in addition, because silicone can not be closely combined with human tissue, the prosthesis may shake and shift left and right after operation.
2. rhinoplasty
Generally, under local anesthesia, augmentation rhinoplasty with expansion implant is to make a skin incision in a nostril (usually on the right side) along the medial and lateral foot front edge of alar cartilage, then use instruments to sneak under the dorsal fascia of nose to form a corresponding tunnel, then implant a silicone prosthesis, and then observe the nose shape after implantation from the front and side. The distal end of the implant should reach the midpoint of the line between the eyebrows and the inner canthus of both eyes, that is, the "golden section". If the length and height of the implant are appropriate, the contour curve of the nose is harmonious and natural, and the skin incision can be sutured.
Expanded polytetrafluoroethylene (e-PTFE) was first developed by Gore-Tex Company of the United States. Originally used in cardiovascular surgery, such as artificial blood vessels. 1989 was first used in nasal plastic surgery by American doctor Rothstein, which opened the application of e-PTFE in plastic surgery.
The expanded material has extremely fine pores into which human tissue cells can grow, so its histocompatibility is very good, it is very stable in human body, it is not easy to reject, and it is firmly combined with autologous tissue, so the implanted prosthesis is not easy to move and shift. In addition, because the expanded material is soft and can be closely attached to the autologous tissue after implantation, the postoperative appearance and feel are more natural and realistic.
(2) augmentation rhinoplasty with autologous cartilage transplantation
① according to the amount of cartilage or bone needed for rhinoplasty, determine the cartilage donor area;
② Take cartilage. Generally, the cartilage behind the ears, nasal septum or ribs is taken out and carved for later use;
③ Gently implant the carved cartilage into the nose and fix it.
The advantage of this method is that there is no rejection and it can exist forever. The disadvantage is that it is very painful to take cartilage tissue from patients; Can't be shaped in advance, which prolongs the operation time; Buried for a long time, it will also undergo slight absorption deformation.
Cartilage is a special tissue in human body, which has certain hardness and considerable flexibility. Unlike muscle, it does not need a lot of blood vessels for nutrition, and losing a part will not bring great losses to the human body. Therefore, it has become one of the most important sources of autologous transplantation. Autologous cartilage used for rhinoplasty comes from three parts: ear cartilage, nasal septum cartilage and costal cartilage.
(3) Injecting rhinoplasty
1. Hyaluronic acid injection for rhinoplasty
Hyaluronic acid (HA) is a macromolecular polysaccharide and a natural substance in tissues. Widely distributed in connective tissue, mucous tissue, eyeball lens and some bacteria in nature, it plays an important role in the dermis of human skin, and plays an important role in the overall maintenance of tissue structure and the transportation between cells.
Hyaluronic acid has the characteristics of insolubility, low metabolic rate, high water absorption, high water retention, and difficult tissue transfer. Recently, its popular development is its application in soft tissue filling. Hyaluronic acid for rhinoplasty is purified. After injection, it will blend with the original components of the human body, and the skin will swell. Plastic surgeons will pinch out a nose shape suitable for beauty according to the proportion of the patient's five senses. The biggest feature of hyaluronic acid material is that the side effects are very small and the rhinoplasty effect is very good. After rhinoplasty with hyaluronic acid, there may be redness, swelling and cyanosis according to individual physique, and sometimes the skin will have a grainy feeling, and most people will disappear around 1 week. But the disadvantage is that the maintenance time of rhinoplasty with hyaluronic acid injection can only last about 6~ 12 months.
2. Collagen injection rhinoplasty
Collagen is a polymer protein. Filamentous collagen fibers can keep skin firm and elastic. Collagen and elastic fibers work together to form reticular support, which provides stable and powerful support for dermis. Long-acting collagen implant is a kind of skin filler, which can increase the volume of tissues in the skin by injection, thus playing a role in shaping the five senses. It is a good material for rhinoplasty. The advantages of collagen injection rhinoplasty are safety and beauty. The disadvantage is that it doesn't last long, usually in September-65438+February.
3. Avilan injection rhinoplasty
Authelet Evilan, commonly known as Evilan, also known as Ivan Lu or autran, is a new substance suitable for human skin invented by Dr. NicoleBonzon, a natural science researcher in Bordeaux, France, while studying degradable cardiac sutures. After 8 years of more than 300 thousand clinical injections, its safety has been fully proved.
Evilan's principle of action is based on the study of "the regenerative function of temporary cell matrix in tissues". Because Ivanhoe's molecular chain has mild positive charge, it can attract negatively charged molecules (soluble collagen fibers, elastin, glycosaminoglycan) in extracellular matrix to penetrate into the cell matrix and adhere to the surrounding tissues. When the charge is balanced, it will no longer attract, so as to achieve the purpose of filling, and there will be no excessive proliferation. Authelet-Evian can be divided into four types according to their composition and effectiveness. Types ⅰ to ⅲ are completely degradable, which are composed of cationic polypropylene N, N- dimethyl allylamine salt polymer, phosphoric acid buffer solution, sodium chloride and water for injection, with mild positive charges, forming a multi-molecular network structure and being completely degradable. The fourth is to add non-degradable polyvinyl alcohol porous microspheres into degradable components, the size of which is about 65438 05 microns, and there are micropores with the size of about 65438 05 nanometers on the microspheres. The structure of porous microspheres allows collagen to grow in it and form a permanent cell matrix, and the effect is natural and lasting, without granuloma, and the content of microspheres is high, which can be kept above 65%. According to different models, the effect duration can reach 5 years, 8 years, 10 years or long-term effects.
4. Aibeifu injection rhinoplasty
Anecell is a kind of filling injection material developed by Professor Lemperle in the Netherlands, which is harmless to human body. Its main components are polymethyl methacrylate and bovine collagen. 20% of Aibeifu filler is polymethyl methacrylate microspheres and 80% is bovine collagen. After injection, when bovine collagen is gradually absorbed by human body, because the microspheres are not swallowed by phagocytes, it is not easy to cause tissue reaction, and it can stimulate tissue to grow into fibroblasts for a long time, so that collagen fibers form connective tissue packages in the microspheres to replace the gradually absorbed bovine collagen, and play a lasting role in filling or shaping.
Compared with Iverson, Iverson and Iverson are both injection-filled plastic materials, which have a long-lasting action time, but their action mechanisms are different. Iverson is based on the principle of "regenerative function of temporary cell matrix in tissue". Iverson mainly contains two effective components: PMMA microspheres and collagen; The effect can be seen immediately after the injection of Aibeifu, and the positive and negative charges are balanced after the injection of Evilan for two months, achieving good results; In addition, because Aibeifu contains foreign proteins, although it has been desensitized in industrial production, allergic reactions may still occur. Evilan is not of animal origin and is safer.
5. Hydroxyapatite injection for rhinoplasty.
Hydroxyapatite, commonly known as Radiesse, is a kind of biological soft ceramics. Its main internal structure and composition is calcium hydroxyapatite (CaHA), and its external part is a gel-like carrier composed of water (USP distilled water for injection) and glycerol (USP), and the mixing ratio is 3: 7. CaHA is in the form of a tiny crystal ball, with the size of 25~45 microns, which is ideal. It is large enough to escape the phagocytosis of macrophages and small enough to pass through tiny pinholes and penetrate the epidermis into the collagen reticular layer deep in the dermis.
Microcrystalline porcelain is more suitable for filling bone structure. When the microspheres enter the plastic part, they can be wrapped and fixed by the fiber membrane and are not easy to move. After several months, the gel tissue of microspheres gradually degrades and is replaced by collagen of human body. However, the degradation speed of microspheres is very slow, and they can stay in the plastic surgery site for a long time to form a skeleton structure, so that new collagen can be staggered and embedded in it, which plays the role of bone induction and filling. Microcrystalline porcelain has been approved by FDA and CEMark of EU as a soft tissue filler for facial plastic surgery.
(4) Korean rhinoplasty
Korean rhinoplasty is a new type of rhinoplasty technology introduced from Korea. Different rhinoplasty schemes were designed according to the overall situation of the individual nose before operation, and three-stage prosthesis transplantation with different materials was mainly carried out for the back of nose, tip of nose and columella during operation. Compared with traditional rhinoplasty, Korean rhinoplasty pays more attention to the shaping of the tip of the nose and the overall structure of the nose. The postoperative scar is hidden and the effect is harmonious and natural.
(5) augmentation of nasal tip
The methods of rhinoplasty are mainly divided into three categories, namely, injection rhinoplasty, autologous cartilage rhinoplasty and rhinoplasty:
① Injection rhinoplasty: Injection rhinoplasty is usually filled by injecting hyaluronic acid or collagen into the nasal tip tissue. Currently available hyaluronic acid materials are restylane hyaluronic acid and Runbaiyan hyaluronic acid; The commonly used collagen material is bimei collagen.
② Autologous cartilage is used to enlarge the tip of the nose: firstly, the nostril is disinfected and sterilized, then it is cut and peeled off in the hidden place in the nostril, and the body cartilage is taken to fill the tip of the nose. Among them, autologous cartilage is often used as auricular cartilage, nasal septum cartilage and costal cartilage, but the supporting force of the first two is slightly weak, which has certain limitations on the height of nasal tip protuberance; Costal cartilage has a strong supporting force, which has a good effect on the serious collapse of the tip of the nose and the nose facing the sky.
③ augmentation rhinoplasty: when choosing augmentation rhinoplasty implants, generally choose two or three-stage silicone prosthesis or breast augmentation, and after implantation, it can be filled with dermal pad outside the prosthesis; Or transform autologous cartilage material at the tip of the nose.
3. Sequela of prosthetic rhinoplasty
1, the appearance after rhinoplasty is not ideal.
This may be related to the poor communication between beauty seekers and doctors, which leads to the failure to achieve the expected effect of beauty seekers after surgery. Once the rhinoplasty operation is not ideal, it is difficult to take it out. Only experienced doctors can take out the breast augmentation prosthesis completely.
Step 2 refuse
Nasal edema did not disappear for a long time, and yellow liquid flowed out of the incision. This sequela of rhinoplasty is related to the personal physique of beauty seekers, so we can consider replacing autologous cartilage rhinoplasty. Autologous cartilage has the characteristics of no rejection to autologous tissue. This method of rhinoplasty is suitable for the overall shaping of nose shape and the special shaping of nose tip. Good compatibility with nasal tip cartilage, lifelike.
3, rhinoplasty prosthesis exposed
The sequelae of rhinoplasty show that the prosthesis penetrates the nasal skin or mucosa and is exposed to the outside, which is mainly related to the doctor's surgical operation, and may lead to excessive tension of the nasal skin in order to excessively pursue the height of rhinoplasty. Once this happens, go to the hospital as soon as possible to avoid infection, or larger perforation and skin ulceration, forming scars.
4. The prosthesis is unstable or skewed after rhinoplasty.
The sequela of rhinoplasty is that the contour of the implanted prosthesis is faintly visible. When you touch your nose, you can feel the implanted silicone rubber and other nose bridge prostheses shaking under the skin. This sequela of rhinoplasty is related to the doctor's surgical skills. If you choose a highly skilled and experienced doctor for surgery, these sequelae can be completely avoided.
5, rhinoplasty prosthesis light transmission
After augmentation rhinoplasty, the reflection of the nose is enhanced, which makes people feel the existence of subcutaneous prosthesis. This is relatively common, and it may be enhanced after rhinoplasty, which makes people feel unnatural. This may be caused by the individual's different skin color, or it may be related to the color of rhinoplasty prosthesis. In fact, each patient's own situation is different, and the surgical effect is naturally different. Be sure to communicate with the doctor more before the operation, so that the nose can be beautiful, instead of being the shadow of others.