In the early cosmetic surgery, people used paraffin, tortoise shell, fish bones and animal bones for rhinoplasty. Practice has proved that these materials will produce various adverse reactions after being implanted into human body, so they have been abolished. Later, German doctors used ivory rhinoplasty to achieve good results, which once attracted people's attention. However, ivory is rarely used because of its excellent texture, time-consuming processing and difficult source.
After World War II, with the development of chemical industry, people gradually paid attention to synthetic materials. At first, some people used synthetic resin material for rhinoplasty, but this material was quickly eliminated because of its brittle and hard texture, easy fracture and light transmission. Later, people gradually turned their attention to flexible silicone products. At first, industrial black silica gel was used, but because of the color problem, the injection method was backward and the postoperative effect was not ideal. Mixed liquid injection and liquid silica gel injection were once popular, but in the end they were eliminated because the surgical effect was not ideal and the stimulation to human tissues was not good.
At present, DMPR based on silicon is used internationally. The material is harmless to human body, easy to process and shape, soft and firm in texture, and does not deteriorate for a long time, so it is an ideal filling material for cosmetic surgery. At present, hospitals all over the world will make various silicone models of rhinoplasty according to doctors' habits, and then modify the models according to the specific conditions of each patient, and directly use them for surgery after strict disinfection. Whether it is congenital or caused by disease or trauma, people have been looking for suitable materials to cushion it.
There are two main methods of rhinoplasty, transplantation and implantation.
Transplantation: tissue transplantation, which mainly fills the nose with bone and cartilage tissue.
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 used for rhinoplasty is mostly taken from ilium, skull, ribs and fibula. Autologous bone has some problems, such as poor elasticity of bone tissue and difficult to shape. So the postoperative appearance is not very natural. Moreover, it is inconvenient to obtain autologous bone and the bone source is limited. Cutting will also cause secondary pain and even complications. In the long run, bone absorption will occur, which will lead to changes in appearance, which is difficult for patients to accept. Currently, it is used less. However, for the correction of complex nasal deformity or severe saddle nose, autologous bone transplantation may still be needed.
Autologous cartilage tissue
Autologous cartilage tissue is the most commonly used tissue in rhinoplasty. Its main characteristics are: no blood vessels, survival by tissue fluid, no stimulation to tissue after implantation, long-term maintenance of the original volume and cell morphology, easy to carve into the required size and shape, so the postoperative appearance is natural and realistic. Like autologous bone tissue, autologous cartilage tissue transplantation may also be absorbed and deformed.
Autologous fascia tissue
Fascia is hardly absorbed, but it will be compressed and thinned, and its volume will be reduced (about 20%). It may take several operations to be used alone. At present, it is mostly used to wrap cartilage or artificial materials, which can reduce cartilage absorption and make the appearance natural and smooth. The earliest site was fascia lata, but now it is mostly superficial temporal fascia, with little surgical trace.
Autologous dermis/dermal fat
It is too absorbed after transplantation and is rarely used at present. It is mainly used for patients with secondary rhinoplasty. It can also be used like fascia tissue. The cutting part is hidden, mostly under the coccyx and in the hip fold.
Characteristics of man-made materials
Artificial materials are sometimes priceless to rhinoplastic surgeons, which can partially replace tissue transplantation, and even better than autologous materials in physical and chemical properties and lasting effects.
Solid silica gel
It is a common rhinoplasty material at present, and it is a polymer silicide. It was used as early as 1972. 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, chemical inertia, non-toxicity, non-carcinogenicity and low price.
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.
Expanded polytetrafluoroethylene (ePTFE)
High density polyethylene
In short, the choice of rhinoplasty materials should be based on the patient's own conditions and economic conditions, combined with the doctor's diagnosis, experience and knowledge, and then make a decision.
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.