Contracted Nose after Silicone Implantation: A New Classification System and Treatment Algorithm

다국어 초록 (Multilingual Abstract)

Background Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed.
Methods Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV.
Results Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%).
Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes.
Conclusions It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.

참고문헌 (Reference)

1 Davis PK, "The complications of silastic implants: experience with 137 consecutive cases" 24 : 405-411, 1971

2 Shirakabe Y, "The classification of complications after augmentation rhinoplasty" 9 : 185-192, 1985

3 Wu WT, "The Oriental nose : an anatomical basis for surgery" 21 : 176-189, 1992

4 Henriksen TF, "Surgical intervention and capsular contracture after breast augmentation : a prospective study of risk factors" 54 : 343-351, 2005

5 Deva AK, "Silicone in nasal augmentation rhinoplasty : a decade of clinical experience" 102 : 1230-1237, 1998

6 Zeng Y, "Silicone implant in augmentation rhinoplasty" 49 : 495-499, 2002

7 Granchi D, "Silicone breast implants : the role of immune system on capsular contracture formation" 29 : 197-202, 1995

8 Tham C, "Silicone augmentation rhinoplasty in an Oriental population" 54 : 1-5, 2005

9 Jung DH, "Secondary rhinoplasty of the Asian nose: correction of the contracted nose" 28 : 1-7, 2004

10 Cochran CS, "Prevention and management of rhinoplasty complications" 122 : 60e-67e, 2008

11 Lee MR, "Management of the nasal dorsum in rhinoplasty: a systematic review of the literature regarding technique, outcomes, and complications" 128 : 538e-550e, 2011

12 Jung DH, "Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty: 221 revision cases" 120 : 1997-2003, 2007

13 Parker Porter J, "Grafts in rhinoplasty: alloplastic vs. autogenous" 126 : 558-561, 2000

14 Winkler AA, "Complications associated with alloplastic implants in rhinoplasty" 14 : 437-441, 2012

15 Spear SL, "Classification of capsular contracture after prosthetic breast reconstruction" 96 : 1119-1123, 1995

16 Steiert AE, "Capsular contracture by silicone breast implants: possible causes, biocompatibility, and prophylactic strategies" 6 : 211-218, 2013

17 Berghaus A, "Alloplastic materials in rhinoplasty" 14 : 270-277, 2006

18 Shirakabe Y, "A new type of prosthesis for augmentation rhinoplasty : our experience in 1600 cases" 34 : 353-357, 1981