Combined alloplastic implant and autologous dermis graft for nasal augmentation rhinoplasty in Asians

Overview

Synthetic implants used to raise the bridge can thin the skin above them, show through as a shine, or work their way out. The authors describe adding a layer of the patient's own deep skin between the implant and the overlying tissue for both dorsal and tip augmentation. They report their early series.

Sections of note

• Case series of 37 Chinese patients; the article is graded level of evidence V.
• The technique combines an alloplastic implant with an autologous dermal graft for dorsum and tip.
• The stated problems being addressed are skin thinning over the implant, extrusion and translucency.
• Thirty-five patients (94.6 percent) were satisfied with the result.
• No implant extrusions occurred during the follow-up period, which extended up to 24 months.
• The authors call the findings preliminary and suggest the method suits patients with thin tip skin.

What it means for a patient

• Thin skin over the tip is the situation where implants most often become visible or break through, and this method targets that group.
• Satisfaction was self reported by patients, with no independent or photographic scoring described.
• There was no comparison group receiving an implant alone, so the added benefit of the dermis layer is not measured.
• The dermal graft has to be taken from somewhere on the body, and the abstract gives no donor site details or donor site problems.
• Two years is short for implant complications, which can appear many years later.

Why this paper matters

Implant extrusion is the main long term risk of synthetic augmentation, and covering the implant with living tissue is one of the standing proposals for reducing it. Whether the dermis layer actually lowers extrusion rates over five or ten years is unanswered here.

Terms

• Alloplastic implant: an implant made of synthetic material rather than body tissue.
• Autologous dermis graft: a layer of the patient's own deep skin moved to another site.
• Extrusion: an implant working its way out through the skin or lining.
• Translucency: the implant outline showing through thin overlying skin.
• Dorsal augmentation: building up the bridge of the nose.