シリコンインプラントの適応と限界

摘要

The materials used for augmentation rhinoplasty can be divided into prostheses (silicone implants, etc.) and autologous grafts (bone, cartilage, fascia, etc.). I think these materials do not compete with each other. A material (sometimes two or more materials) suitable for a given case is selected from these alternatives, on the basis of assessment of the advantages and disadvantages of individual materials in a given case. Most of the patients consulting aesthetic surgeons, with a desire of undergoing augmentation rhinoplasty, have relatively mild nose deformation such as flat nose and. saddle nose. To increase the height of the area from the bridge to dorsum of the nose, silicone implant is the material of first choice. If the patient desires elevation of the nasal tip simultaneous with augmentation rhinoplasty, nasal tip surgery (e. g., suture of the domes of the alar cartilages to one another, conchal cartilage transplantation and so on) is often performed in addition to augmentation rhinoplasty. Attempts to elevate the nasal tip with an implant alone may lead to skin thinning or exposure of the implant. Silicone implant, which is a foreign body, is not optimal in cases where secondary surgery of the cleft-lip nose or correction of severe saddle nose or twisted/deviated nose is needed or cases where scarred tissue (due to injury, etc.) is present. In such cases, autologous tissue grafting is the treatment of first choice.