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Surgical Technique |

Immediate Autogenous Cartilage Grafts in Rhinoplasty After Alloplastic Implant Rejection

Ullas Raghavan, FRCS; Nick S. Jones, MD, FRCS; Thomas Romo III, MD
Arch Facial Plast Surg. 2004;6(3):192-196. doi:10.1001/archfaci.6.3.192.
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Background  It is accepted in rhinoplasty that complications are more common with alloplastic implants than with autografts. There is little guidance in the literature on how to deal with the cosmetic and/or functional problems that follow alloplastic implant rejection. The conventional advice has been to remove the allograft and not place any graft at the same time. The present article presents our experience treating allograft rejection and immediately repairing any structural defect with autografts.

Objective  To demonstrate that immediate nasal reconstruction using autogenous cartilage is a good technique when an alloplastic material has to be removed because of rejection, inflammation, or infection.

Design  A retrospective analysis of outcome for a case series.

Methods  A retrospective review of the management of 8 patients who presented to 2 tertiary referral centers with alloplastic implant rejection following rhinoplasty. In 7 cases, the alloplastic implant had to be removed because it had migrated and caused a foreign body reaction; in 1 case, the implant had caused a bacterial infection.

Results  In all 8 cases, the nasal deformity that followed the removal of the allograft was so marked that the nose was immediately reconstructed with autogenous cartilage. The patients all made a good recovery after immediate reconstruction, although skin changes associated with the alloplastic implant remained after a mean follow-up of 3 years 3 months.

Conclusion  The use of autogenous cartilage is a good option for nasal augmentation immediately after the removal of an alloplastic implant.

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Figures

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Figure 1.

Preoperative views of patient 1 showing a swollen nose and nasion due to rejection of a silicone implant. The red skin changes have been disguised with makeup.

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Figure 2.

Postoperative views of patient 1.

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Figure 3.

Preoperative views of patient 5 showing a displaced Silastic implant and erythema and swelling of the left side.

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Figure 4.

Perioperative view of the removal of the Silastic graft in case 5.

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Figure 5.

Perioperative view of the carved placement of a rib graft in case 5.

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Figure 6.

Postoperative views of patient 5.

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