Complications of a Barbed Thread in Rhinoplasty.

Rhinoplasty using threads has been popular for the benefits of being free from anesthesia, shortness of post-surgical recovery process, and surgery-related complications. Compared with its beneficial aspects, studies that evaluated thread rhinoplasty-related complications are relatively limited. Recently, we experienced a patient who underwent barbed thread rhinoplasty in 12 months before visiting our clinic. She presented with a firm mass-like lesion palpated through the nasal dorsum, making hump-looking appearance. During revision rhinoplasty, we found that previously inserted threads were identified from the nasal dorusam and tip area not being resorted. Threads and soft tissue on nasal dorsal area formed firm mass-like lesion and were firmly attached to surrounding soft tissues. Herein, we introduce our case in which the formation of nasal mass on dorsal area is a later complication of thread rhinoplasty.

Delayed Hematoma After Rhinoplasty in Young Adult With Hypertension.

Rhinoplasty is one of the most commonly performed plastic surgical procedures. It has been reported that the overall incidence of complications is low, and hematoma is the most common complication. Recently, the authors experienced a young patient who developed nasal dorsal bleeding and hematoma formation 2 weeks after undergoing rhinoplasty. He had a history of hypertension and was on medication. Due to severe nasal dorsal swelling caused by bleeding and hematoma, the authors ultimately performed an open approach to control the bleeding and evacuate the hematoma. Herein, the authors report the case of a patient with delayed dorsal bleeding 2 weeks after rhinoplasty. The authors learned a lesson that although the patient was young and healthy, in patients with a history of hypertension, the possibility of delayed operative site bleeding should be considered.

Decreased Tip Projection and Tip Stiffness Due to A Calcified Septal Extension Graft.

A septal extension graft is frequently applied in esthetic rhinoplasty in Asia. Autologous cartilage is usually selected for the graft material, and nasal septal cartilage is the most commonly used in septal extension grafts. Although the complication rate is reported to be very low, the authors recently encountered a patient who complained of decreased nasal tip projection and stiffness of the nasal tip. The patient had previously undergone a rhinoplasty, including dorsal augmentation with silicone implant and septal extension graft with septal cartilage. Based on the images, the authors hypothesized that the septal extension graft was calcified, and the intraoperative findings confirmed severe calcification of the previously inserted septal cartilage graft. Herein, the authors report the case of a patient with decreased tip projection and stiffness due to calcification of a previous septal extension graft that used septal cartilage and share the lessons the authors learned from this case.

Correction of a Visible Silastic Implant Using the Dual-layered Capsular Flaps.

Alloplastic implants used for dorsal augmentations can induce surgical and cosmetic complications. One of these cosmetic complications is when the implant is visible through the skin. In these cases, it is recommended to use an autologous soft tissue to reinforce the area between the skin and the implant. Recently, a patient visited our institute complaining of a previously inserted silastic implant being visible through the skin. Based on the implant, we hypothesized that the surrounding soft tissue might have formed 2 capsular layers, and the implant might have separated from the capsular. During the revision rhinoplasty, we peeled off the 2 capsular layers and used them to reinforce the area between the implant and skin without harvesting autologous tissue. This procedure had a satisfactory surgical outcome and a shorter operative time than harvesting autologous tissue. Here, we describe our experience and share lessons from this case.

Unrecognized Fracture of a Silicone Implant During Closed Rhinoplasty.

ABSTRACT: Rhinoplasty via a closed approach is rarely performed due to provide limited exposure and inadequate operative field. Nevertheless, there are some cases in which closed approach is performed using L-shaped silicone implants. The authors recently encountered an interesting complication in a 33-year-old woman who had previously undergone rhinoplasty via a closed approach and who sought revision rhinoplasty at our institution. The authors accidently found a fractured silicone implant on lateral nasal x-ray. She had no nasal trauma history since previous rhinoplasty. The authors assumed that the silicone implant can be fractured as 1 of complications during the rhinoplasty via a closed approach.

Circumferential Calcification of Silicone Implant Misunderstood as a Bony Substitute.

Silicone implant is known to be safe and easy to handle, and frequently used in Asian rhinoplasty. Compared with breast implant, complication studies about silicone calcification used in rhinoplasty are very limited. Recently, the authors experienced an interesting patient who underwent revision rhinoplasty in our institution. Based on preoperative images, previously inserted dorsal augmentation material was identified. It was circumferentially enclosed with bony material and hypertrophied bony lesion induced hump on the mid portion of nasal dorsum. During operation, the authors found it was the calcified capsule of silicone implant, and the calcification was surrounding the whole implant material.

Quantitative Mandibular Angle Ostectomy Facilitated by Oscillating-Blade Saw With Scalable Guide.

BACKGROUND: Although various techniques of mandibular angle ostectomy have been devised to correct overly prominent bony contours, none have incorporated methods to delineate the surgical line with precision. Herein, the authors describe one means of marking an ostectomy line more easily, using a specially designed oscillating-blade saw. METHODS: Between July 2013 and June 2014, a total of 75 patients underwent quantitative mandibular angle ostectomy using a custom oscillating-blade saw equipped with a scalable guide. Corticectomy, also done routinely to improve frontal appearance, called for a reciprocating saw only. Aesthetic outcomes gauged subjectively by the questionnaire about satisfaction and symmetry after postoperative 6 months. RESULTS: Satisfaction score was 4.9 and symmetric score was 4.7. No major complications, such as persistent nerve injury or fracture, were encountered. CONCLUSIONS: Use of an oscillating-blade saw equipped with a scalable guide facilitated quantitative mandibular angle ostectomy, enabling precise, and reproducible surgery with satisfactory outcomes with less complications.

Gene therapy using hepatocyte growth factor expressing adenovirus improves skin flap survival in a rat model.

Hepatocyte growth factor (HGF) is a potent angiogenic factor that can stimulate the production of blood vessels in ischemic tissue. We investigated whether gene therapy using HGF-expressing adenovirus could enhance skin flap survival. Sprague-Dawley rats were randomly divided into three groups. Rats were subdermally injected with HGF-expressing adenovirus (HGF virus group), recombinant HGF (rhHGF group), or phosphate buffered saline (PBS group) 2 days before and immediately after 3 × 9 cm caudal flap elevation. The survival area of the skin flap, the ratio of blood flow, CD31-positive vessels and, VEGF expression were examined. Skin flap viability was significantly increased in the HGF virus group compared to the rhHGF and PBS groups (71.4% ± 5.9%, 63.8%± 6.4%, and 39.2% ± 13.0%, respectively) (P = 0.025). Furthermore, the blood flow ratio was significantly increased in the HGF virus group. In the HGF virus group, the number of CD31-positive vessels and vascular endothelial growth factor (VEGF) expression were significantly increased. Gene therapy using HGF-expressing adenovirus increase VEGF expression, the number of viable capillaries, and blood flow to the flap, thereby improving skin flap survival.

Spontaneous Fracture of a Silicone Implant: A Delayed Complication of Rhinoplasty.

Silicone implants are commonly used alloplastic materials for rhinoplasty in Asia, as they are easy to manipulate, provide adequate volume augmentation, and exhibit excellent biocompatibility. However, they are associated with complications such as infection, displacement, and extrusion. Recently, we encountered an interesting complication in a 53-year-old woman presenting with palpable and visible stepping of the nasal dorsum. The patient had previously undergone rhinoplasty with an L-shaped silicone implant, and symptoms had been noticeable for approximately 1 year. Lateral nasal computed tomography revealed a fractured silicone implant. Because the patient reported no history of nasal trauma since rhinoplasty, we assumed that the silicone implant might have fractured spontaneously. The findings in this case suggest that spontaneous implant fracture can be a late complication of rhinoplasty with silicone implant.

A case study of an undetected expanded polytetrafluoroethylene implant material mimicking a nasal dorsal hump.

Augmentation rhinoplasty using alloplastic materials is a relatively standard procedure in Asian patients. Expanded polytetrafluoroethylene (ePTFE) is one of the commonly used alloplastic materials because it has a high biocompatibility and is easy to handle. Recently, a patient who had previously undergone augmentation rhinoplasty using ePTFE as the implant material visited our clinic. She had the implant material surgically removed after three years and visited our clinic with a nasal dorsal hump. The patient underwent revision rhinoplasty at our institution. Unexpectedly, we found some ePTFE material that was not identified on the preoperative X-rays. After removing the ePTFE material, the nasal dorsal hump was corrected, and we did not need to perform a nasal dorsal hump reduction.

A Comparative Analysis Between Primary and Secondary Nasal Tip Drooping.

OBJECTIVE: Recently, many commercial one-piece alloplastic materials are used in nasal dorsum augmentation and increased nasal tip projection, but there is no study about their effects with regard to size on nasal shape so far. The aim of this study is to evaluate the impact of oversized one-piece alloplastic implant on nasal tip projection. METHODS: We categorized nasal tip drooping as primary (group 1: no rhinoplasty or trauma history) and secondary (group 2: previous history of augmentation rhinoplasty with one-piece alloplastic materials), and retrospectively compared the characteristics of primary and secondary nasal tip drooping on the basis of pre- and postoperative rhinological parameters (nasolabial angle [NLA], rotation angle, nasofrontal angle [NFA], and Goode ratio). RESULTS: A total of 50 patients were enrolled and completely reviewed. The mean age was 27.46 years (ranging from 19 to 49 years) in group 1 and 31.33 years (ranging from 20 to 47 years) in group 2. The postoperative NLA and rotation angle were not statistically different between 2 groups, but the postoperative NFA and postoperative Goode ratio were statistically different between 2 groups by independent t test. When we further performed univariate and multivariate analysis, the postoperative Goode ratio was the only factor that was significantly different between the 2 groups. CONCLUSION: Insertion of one-piece alloplastic implants from nasal tip glabella to dome of nasal tip may induce secondary nasal tip drooping. The degree of recovery of nasal tip projection is different between 2 groups and may be obtained by a more delicate surgical techniques.

External radiopaque marking of Gillies posterior zygomatic arch osteotomy in reduction malarplasty.

Although the Gillies (temporal) approach to reduction malarplasty helps preserve supportive soft tissue and avoid facial scars, the osteotomy site is difficult to gauge when using this blind technique. Our experience with external radiopaque marking of the zygomatic arch to guide this process is presented herein. This retrospective review included all patients who underwent reduction malarplasty (as above) at our clinic between August 2013 and September 2015. Procedures entailed L-shaped osteotomy only (no segmental excision) of the zygomatic body by the intraoral route, and posterior zygomatic arch osteotomy by the Gillies approach, guided by external radiopaque markings. Patient characteristics, surgical outcomes, and complications were analyzed to assess the merits of this strategy. Postoperative results were evaluated by both the patients and the surgeon. Most patients expressed satisfaction during the follow-up period (range, 3-27 months). Posterior osteotomies were properly performed as planned, with no major complications (i.e., malunion or nonunion, cheek drooping, or facial nerve injury), although minor complications were recorded in three instances. Use of external radiopaque markings provides guidance during malarplasty by the Gillies approach and may help avoid procedural complications.

Modulation of heat shock protein 90 affects TGF-ß-induced collagen synthesis in human dermal fibroblast cells.

Heat shock protein 90 is a chaperone molecule that aids in proper folding of target proteins. Recently, heat shock protein 90 was found to play a role in would healing through regulation of fibroblast functions. The aim of the present study was to investigate the role of heat shock protein 90 in collagen synthesis in human dermal fibroblasts. The effects of transforming growth factor-ß, 17-N-allylamino-17-demethoxygeldanamycin, and transfection of heat shock protein 90 were evaluated by real-time PCR, western blot, and immunofluorescence assays. The Smad 2/3 and Akt pathways were evaluated to identify the signaling pathways involved in collagen synthesis. Heat shock protein 90 and collagen levels were compared in keloid and control tissues by immunohistochemical analysis. The expression of collagen was significantly increased after treatment with transforming growth factor-ß, while 17-N-allylamino-17-demethoxygeldanamycin inhibited transforming growth factor-ß-induced collagen synthesis. Overexpression of heat shock protein 90 itself with or without transforming growth factor-ß increased collagen synthesis. These effects were dependent on Smad 2/3 pathway signaling. Finally, expression of heat shock protein 90 was increased in keloid tissue compared with control tissues. Taken together, these results demonstrate that modulation of heat shock protein 90 influences transforming growth factor-ß-induced collagen synthesis via regulation of Smad 2/3 phosphorylation.