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Augmented Asian Rhinoplasty The Art and The Science Past, Present and Future Thanee Sakhakorn MD.

Augmented Asian Rhinoplasty The Art and The Science Past, Present and Future Thanee Sakhakorn MD. Characteristics of Asian nose. Wash out dorsum or saddle deformity Deficient tip projection Wide lobule, thick lobular skin Abundant subcutaneous fatty tissue Alar flaring

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Augmented Asian Rhinoplasty The Art and The Science Past, Present and Future Thanee Sakhakorn MD.

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  1. Augmented Asian RhinoplastyThe Art and The SciencePast, Present and FutureThanee Sakhakorn MD.

  2. Characteristics of Asian nose • Wash out dorsum or saddle deformity • Deficient tip projection • Wide lobule, thick lobular skin • Abundant subcutaneous fatty tissue • Alar flaring • Retracted columella

  3. Asian saddle nose

  4. Asian Rhinoplasty requires • Augmentation of dorsum area • Augmentation of middle portion of upper and lower lateral cartilage areas • Augmentation of columella-tip area for tip projection and increase nasal length • Refining the lobule/tip area • Decrease the width of the nostrils

  5. Augmentation Asian Rhinoplasty

  6. In the old day of Asian rhinoplasty • Injected liquid paraffin or liquid silicone • L-shaped alloplastic implant, mainly silicone elastomer. • Rib autograft or homograft.

  7. To the Present time • Novel design silicone implant with tip protection using ear, septal or lower lateral cartilage. • Autogenous costal cartilage graft. • Autogenous ear cartilage graft in multiple layers(onlay graft).

  8. To the present time(continue) • Bioplastic. The weird technology: hard silicone in solvent. • Fabricated perichondrocartilage complex from both ears into auto-nasal bioprosthesis.

  9. What is the perichondrocartilage complex? • Cartilage with intact perichondrium. • In asian rhinoplasty, we harvest this complex from both external ears. • The complex will function as a living tissue when it is implanted in human body.

  10. From raw materials to finished bioprosthesis Harvest Design Fabricate Finish

  11. Bioprostheses correct the problems of silicone prosthesis in Asian rhinoplasty • Infection • Protrusion • Perforation

  12. Bioprostheses correct the dorsum injecton of liquid silicone Liquid silicone injection

  13. Bioprostheses in miscellaneous conditions Bioplastic injection Fracture costal cartilage graft

  14. Bioprostheses and Asian Rhinoplasty

  15. ขยายความจาก มติชน สุดสัปดาห์ โปรเฟสเซอร์ แวร์เนอร์ มางก์ จาก รพ. โบเก็นเซ ซึ่งมีชื่อเสียงทางศัลยกรรมตกแต่งจมูกได้สวยที่สุดคนหนึ่งได้กล่าวว่า “ กระดูกอ่อนที่หู เป็นวัสดุชั้นยอด สำหรับการตกแต่งจมูกใหม่ ไม่ใช่ซิลิโคน”

  16. The future is coming • Regenerative medicine : In the future, tissue damages will be replace with tissue substitutes. • Tissue engineering: Bioengineer and biomedical engineer make tissue substitutes as “body parts” and ready to use. No more donor site morbidity and deformity at all.

  17. In cartilage tissue engineer lab

  18. Conclusion • Silicone elastomer and new inert biomaterials still have place in asian rhinoplasty. • Autogenous cartilage fabrication in the form of nasal prosthesis will replace and use more and more. • Cartilage tissue engineering in the form of nasal prostheses will be used in the future.

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