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 Wash out dorsum or saddle deformity Deficient tip projection Deficient tip projection Wide lobule, thick lobular skin Wide lobule, thick lobular skin Abundant subcutaneous fatty tissue Abundant subcutaneous fatty tissue Alar flaring Alar flaring Retracted columella Retracted columella

Asian saddle nose

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

Augmentation Asian Rhinoplasty

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

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

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

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

From raw materials to finished bioprosthesis

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

Bioprostheses correct the dorsum injecton of liquid silicone

Bioprostheses in miscellaneous conditions

Bioprostheses and Asian Rhinoplasty

ขยายความจาก มติชน สุดสัปดาห์ โปรเฟสเซอร์ แวร์เนอร์ มางก์ จาก รพ. โบเก็นเซ ซึ่งมีชื่อเสียงทางศัลยกรรมตกแต่งจมูกได้สวยที่สุด คนหนึ่งได้กล่าวว่า “ กระดูกอ่อนที่หู เป็นวัสดุชั้นยอด สำหรับ การตกแต่งจมูกใหม่ ไม่ใช่ซิลิโคน ” “ กระดูกอ่อนที่หู เป็นวัสดุชั้นยอด สำหรับ การตกแต่งจมูกใหม่ ไม่ใช่ซิลิโคน ”

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

In cartilage tissue engineer lab

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