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Pascali M, Gratteri M, Savani L, Rega U, Marchese G, Persichetti P. Fresh Frozen, In-Alcohol, or Autologous Costal Cartilage? Analysis of Complications in Over 650 Revision Rhinoplasties. Aesthet Surg J 2024; 44:897-908. [PMID: 38428952 DOI: 10.1093/asj/sjae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND When there is insufficient autologous septal cartilage for graft sculpting in revision rhinoplasty, valid alternatives need to be found. Both autologous and homologous costal cartilage usage has been described in the literature. As there is no universally accepted consensus on cartilage choice, experience with different types of cartilage assumes significant importance in the rhinoplasty learning process. OBJECTIVES This multicenter prospective study outlined an overview of the authors' experience regarding short-term and long-term complications following revision rhinoplasty procedures in which either fresh frozen (FFCC), in-alcohol (IACC), or autologous costal cartilage (ACC) was used. METHODS A total of 671 patients undergoing revision rhinoplasty between June 2015 and September 2020 were divided into 3 groups according to the type of cartilage used (Group 1, 212 patients with FFCC; Group 2, 239 patients with IACC; Group 3, 202 patients with ACC). Sociodemographic and clinical characteristics and short- and long-term complications were described and discussed. A statistical analysis investigating a possible significance of the differences in complication rates was conducted. RESULTS The data obtained indicated a short-term general complication rate of 5.05%, and a long-term complication rate of 7.04%. A statistically significant difference was identified in cartilage warping rate between the homologous cartilages in comparison to ACC. CONCLUSIONS FFCC, IACC, and ACC can be safely used in revision rhinoplasty with no statistically significant differences regarding short- and long-term complication rates. Cartilage warping rate is significantly higher for ACC compared with FFCC and IACC. LEVEL OF EVIDENCE: 2
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Wayne I. Contemporary Male Rhinoplasty Surgery. Facial Plast Surg Clin North Am 2024; 32:399-408. [PMID: 38936997 DOI: 10.1016/j.fsc.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
In general, fewer male patients seek rhinoplasty surgery than females. The surgical principles are similar in both populations with some special anatomic considerations that will need attention. There is a higher rate of body dysmorphic syndrome in males seeking rhinoplasty as well as greater challenges with patient satisfaction, and the consultation process needs to be thorough and deliberate when undertaking aesthetic surgery in this population to maximize positive outcomes.
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Affiliation(s)
- Ivan Wayne
- Department of Otorhinolaryngology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA; W Aesthetics, 10001 Broadway Extension, Suite A, Oklahoma City, OK 73114, USA.
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Hanna SA, Mattos D, Datta S, Reish RG. Outcomes of the Use of Fresh-Frozen Costal Cartilage in Rhinoplasty. Plast Reconstr Surg 2024; 154:324-328. [PMID: 37815290 DOI: 10.1097/prs.0000000000011125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Rhinoplasty is made more challenging when there is insufficient septal cartilage for use as graft material. Several autologous and homologous graft options have been used in the past, although each comes with its own set of challenges. Fresh-frozen costal cartilage (FFCC) is an increasingly popular alternative that yields the benefits of homologous tissue while having a lower theoretical risk profile. Given the relatively novel nature of this option, the authors analyzed the complication rates of Musculoskeletal Transplant Foundation FFCC. METHODS A retrospective chart review of the use of FFCC in rhinoplasty in the senior author's (R.G.R.) practice was conducted between March of 2018 to December of 2021. A total of 282 cases were reviewed and analyzed for rates of infection, warping, and resorption. Patients with a minimum of 12 months of follow-up were included. RESULTS The mean age of the study group was 35.8 years, and 27 male and 255 female patients were included. Forty cases were primary rhinoplasties; the remaining 242 were revisions. The mean follow-up period was 20.3 months. Six patients (2.1%) required empiric antibiotics postoperatively; no patient had clinical signs of warping, resorption, or displacement, and 6 patients (2.1%) required operative revision unrelated to the FFCC. CONCLUSIONS This study provides follow-up data on the complication profile of FFCC in rhinoplasty. Acute infection, warping, and resorption rates were found to be no greater than rhinoplasty complication rates when autologous or homologous tissue is used. FFCC is a safe, convenient, and patient-centered option for graft tissue in rhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Steven A Hanna
- From the Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital
| | - David Mattos
- From the Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital
- New York Plastic Surgical Group
| | | | - Richard G Reish
- From the Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital
- New York Plastic Surgical Group
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Kadhum M, Khan K, Al-Ghanim K, Castanov V, Symonette C, Javed MU. Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes. Aesthetic Plast Surg 2024:10.1007/s00266-024-03977-4. [PMID: 38528125 DOI: 10.1007/s00266-024-03977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. METHODS The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. RESULTS Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). CONCLUSION Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). LEVEL OF EVIDENCE III Rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Murtaza Kadhum
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | - Karishma Khan
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Valera Castanov
- London Health Sciences Centre (LHSC), London, ON, Canada
- Division of Plastic and Reconstructive Surgery, Western University, London, ON, Canada
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Kowalczyk DM. Commentary on: "Outcomes of Autologous Versus Irradiated Homologous Costal Cartilage Grafts in Rhinoplasty" by Virginia E. Drake et al. Facial Plast Surg Aesthet Med 2024. [PMID: 38502837 DOI: 10.1089/fpsam.2024.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
In this commentary, I discuss Drake et al.'s manuscript, "Outcomes of Autologous versus Irradiated Homologous Costal Cartilage Grafts in Rhinoplasty"1 and its greater implications for cartilage selection for grafting in septorhinoplasty. The authors provide a robust institutional example of the similarities shared between both autologous costal cartilage and irradiated homologous costal cartilage in terms of warping, infection, resorption, and overall result possible. This study adds to the current body of literature regarding this topic and helps surgeons make better, evidence-based decisions regarding cartilage grafting for their rhinoplasty patients.
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Kauke-Navarro M, Knoedler L, Knoedler S, Deniz C, Stucki L, Safi AF. Balancing beauty and science: a review of facial implant materials in craniofacial surgery. Front Surg 2024; 11:1348140. [PMID: 38327548 PMCID: PMC10847330 DOI: 10.3389/fsurg.2024.1348140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Facial reconstruction and augmentation, integral in facial plastic surgery, address defects related to trauma, tumors infections, and congenital skeletal deficiencies. Aesthetic considerations, including age-related facial changes, involve volume loss and diminished projection, often associated with predictable changes in the facial skeleton. Autologous, allogeneic, and alloplastic implants are used to address these concerns. Autologous materials such as bone, cartilage, and fat, while longstanding options, have limitations, including unpredictability and resorption rates. Alloplastic materials, including metals, polymers, and ceramics, offer alternatives. Metals like titanium are biocompatible and used primarily in fracture fixation. Polymers, such as silicone and polyethylene, are widely used, with silicone presenting migration, bony resorption, and visibility issues. Polyethylene, particularly porous polyethylene (MedPor), was reported to have one of the lowest infection rates while it becomes incorporated into the host. Polyether-ether-ketone (PEEK) exhibits mechanical strength and compatibility with imaging modalities, with custom PEEK implants providing stable results. Acrylic materials, like poly-methylmethacrylate (PMMA), offer strength and is thus mostly used in the case of cranioplasty. Bioceramics, notably hydroxyapatite (HaP), offer osteoconductive and inductive properties, and HaP granules demonstrate stable volume retention in facial aesthetic augmentation. Combining HaP with other materials, such as PLA, may enhance mechanical stability. 3D bioprinting with HaP-based bioinks presents a promising avenue for customizable and biocompatible implants. In conclusion, various materials have been used for craniofacial augmentation, but none have definitively demonstrated superiority. Larger randomized controlled trials are essential to evaluate short- and long-term complications comprehensively, potentially revolutionizing facial balancing surgery.
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Affiliation(s)
- Martin Kauke-Navarro
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
- Craniologicum, Center for Craniomaxillofacial Surgery, Bern, Switzerland
| | - Leonard Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Samuel Knoedler
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States
| | - Can Deniz
- Craniologicum, Center for Craniomaxillofacial Surgery, Bern, Switzerland
| | - Lars Stucki
- Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria
| | - Ali-Farid Safi
- Craniologicum, Center for Craniomaxillofacial Surgery, Bern, Switzerland
- Medical Faculty, University of Bern, Bern, Switzerland
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Dermody SM, Lindsay RW, Justicz N. Considerations for Optimal Grafting in Rhinoplasty. Facial Plast Surg 2023; 39:625-629. [PMID: 37348541 DOI: 10.1055/a-2116-4566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
A wide variety of grafting materials and techniques can be used to create functional and aesthetic changes in rhinoplasty. Choosing the optimal grafting approach is critical to achieving an optimal patient outcome. We present a review of autografts, allografts, and alloplasts used in primary and revision rhinoplasty and discuss factors that impact graft choice. Autologous grafts serve as the pillar for grafting material in rhinoplasty given their reliable long-term outcomes, low rates of infection, resorption, and extrusion, and ability to provide structural scaffolding as well as contour. Cadaveric allografts can be utilized as a source of grafting material in certain clinical scenarios including revision rhinoplasty and have been shown to be equally safe and effective as autologous grafts while avoiding donor-site morbidity. Alloplasts can prove useful in rhinoplasty in cases of iatrogenic nasal deformities or revision cases. Careful consideration of clinical scenario, patient factors, and outcome goals is necessary to choose the appropriate grafting approach to address functional and cosmetic outcomes.
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Affiliation(s)
- Sarah M Dermody
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Robin W Lindsay
- Department of Otolaryngology-Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Natalie Justicz
- Department of Otorhinolaryngology-Facial Plastic and Reconstructive Surgery, University of Maryland, Baltimore, Maryland
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Wan R, Weissman JP, Williams T, Ullrich PJ, Joshi C, Huffman K, Galiano RD. Prospective Clinical Trial Evaluating the Outcomes Associated with the Use of Fresh Frozen Allograft Cartilage in Rhinoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5315. [PMID: 37799442 PMCID: PMC10550040 DOI: 10.1097/gox.0000000000005315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/16/2023] [Indexed: 10/07/2023]
Abstract
Background There are different types of grafts for rhinoplasty, each with certain advantages and disadvantages. Fresh frozen cadaveric costal allograft (CCA) provides an alternative to rhinoplasties. The aim of this study was to compare the outcomes of fresh frozen CCA and traditional autologous costal cartilage in cosmetic and reconstructive rhinoplasty procedures. Methods This is a prospective, single-center, nonrandomized, open-label clinical trial. Objective assessment to evaluate warping, resorption, and displacement of the cartilage was achieved by measuring the differences of standardized values (deviation angle, nasofrontal angle, total facial convexity, nasofacial angle, and nasolabial angle) obtained at 6-months and 12-months postoperative follow-up on standard two-dimensional photographs (Δ = ∣measurement6 - measurement12∣). Subjective assessment was measured by the FACE-Q assessment. Results Fifty eligible patients between March 2017 and October 2020 were included. The average age was 43.9 ± 16.6 years and the mean follow-up period was 14.8 months. In the control group, the changes (Δ) in the deviation angle and nasolabial angle were greater than in the CCA group (P < 0.05). In the CCA group, the mean score of satisfaction with nose improved at 6 months and 1 year postoperatively (P < 0.05). The mean score of satisfaction with nostrils and overall facial appearance also increased in the CCA group at 6 months postoperatively (P < 0.05). Six patients from the CCA group and 10 patients from the control group experienced postoperative complications. Conclusions Fresh frozen CCA is a safe and reliable source of rhinoplasty grafts. It is aseptic, readily available, and free of donor site complications.
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Affiliation(s)
- Rou Wan
- From the Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minn
| | - Joshua P. Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tokoya Williams
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chitang Joshi
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kristin Huffman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert D. Galiano
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Gruber RP, Li AY, Gonzalez SR. Commentary on: Immediate Nasal Reconstruction in Management of Infected Nasal Alloplast and Allografts: A Case Series. Aesthetic Plast Surg 2023:10.1007/s00266-023-03557-y. [PMID: 37721625 DOI: 10.1007/s00266-023-03557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Ronald P Gruber
- Division of Plastic & Reconstructive Surgery, University of California (SF), San Francisco, USA.
- Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, CA, USA.
| | - Alexander Y Li
- Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Santiago R Gonzalez
- Division of Plastic & Reconstructive Surgery, University of California (SF), San Francisco, USA
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Shih S, Askinas C, Caughey S, Vernice N, Berri N, Dong X, Spector JA. Sourcing and development of tissue for transplantation in reconstructive surgery: A narrative review. J Plast Reconstr Aesthet Surg 2023; 83:266-275. [PMID: 37279636 DOI: 10.1016/j.bjps.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023]
Abstract
The wealth of allogeneic and xenogeneic tissue products available to plastic and reconstructive surgeons has allowed for the development of novel surgical solutions to challenging clinical problems, often obviating the need to inflict donor site morbidity. Allogeneic tissue used for reconstructive surgery enters the tissue industry through whole body donation or reproductive tissue donation and has been regulated by the FDA as human cells, tissues, and cellular and tissue-based products (HCT/Ps) since 1997. Tissue banks offering allogeneic tissue can also undergo voluntary regulation by the American Association of Tissue Banks (AATB). Tissue prepared for transplantation is sterilized and can be processed into soft tissue or bone allografts for use in surgical reconstruction, whereas non-transplant tissue is prepared for clinical training and drug, medical device, and translational research. Xenogeneic tissue, which is most often derived from porcine or bovine sources, is also commercially available and is subject to strict regulations for animal breeding and screening for infectious diseases. Although xenogeneic products have historically been decellularized for use as non-immunogenic tissue products, recent advances in gene editing have opened the door to xenograft organ transplants into human patients. Herein, we describe an overview of the modern sourcing, regulation, processing, and applications of tissue products relevant to the field of plastic and reconstructive surgery.
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Affiliation(s)
- Sabrina Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Carly Askinas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Sarah Caughey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Nicholas Vernice
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Nabih Berri
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Xue Dong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Jason A Spector
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America.
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Wan R, Weissman JP, Ullrich PJ, Joshi C, Williams T, Galiano RD. The Utilization of Fresh Frozen Cartilage in Asian Rhinoplasty: A New Approach. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4903. [PMID: 37124386 PMCID: PMC10132705 DOI: 10.1097/gox.0000000000004903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/02/2023] [Indexed: 05/02/2023]
Abstract
Asian rhinoplasty generally requires augmentation procedures rather than reduction. Alloplastic grafts are fraught with higher complication rates. Autologous cartilage grafts are safer. However, Asian patients typically do not have adequate septal cartilages, and other autologous cartilage grafts may cause surgical site morbidities, prolonged surgical time, and complications, including warping and infection. Asian rhinoplasties were performed using fresh frozen cartilage by the senior author. Patients' demographics and medical histories were recorded. Anthropometric measurements (nasofrontal angle, nasofacial angle, nasolabial angle, and Goode ratio) were taken on two-dimensional photographs. FACE-Q scales were used to assess patient-reported outcomes. Five Asian patients underwent rhinoplasty using the fresh frozen cartilage and were followed up for an average period of 14.2 ± 3.35 months. There was no resorption, warping, or infection. Anthropometric measurements showed no significant changes 2-4 months or 8-20 months after surgery. At the time of the 1-year follow-up, mean FACE-Q Satisfaction with Nose, and Satisfaction with Nostrils scores improved from 35.2 ± 10.06 to 60 ± 15.48 (P = 0.0002), and 42.6 ± 20.31 to 59.8 ± 38.21 (P = 0.12), respectively. Fresh frozen cadaveric cartilage is a novel option for Asian rhinoplasty. Our study demonstrated its safety and satisfying surgical outcomes.
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Affiliation(s)
- Rou Wan
- From the Division of Plastic and Reconstructive Surgery, Mayo Clinic Rochester, Rochester, Minn
| | - Joshua P. Weissman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Chitang Joshi
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Tokoya Williams
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
| | - Robert D. Galiano
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine , Chicago, Ill
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Use of auricular versus costal cartilaginous grafts for secondary rhinoplasty procedures: comparison of long-term outcomes. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-02028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Milkovich J, Ahmad J. A Canadian Experience With Off-the-Shelf, Aseptically Processed, Costal Cartilage Segment Allografts in Complex Rhinoplasty. Aesthet Surg J Open Forum 2022; 4:ojac085. [PMID: 36518492 PMCID: PMC9732856 DOI: 10.1093/asjof/ojac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Complex primary and secondary rhinoplasties usually necessitate grafting materials when native nasal cartilage is inadequate for reconstruction. Fresh frozen, aseptically processed, and nonterminally sterilized costal cartilage segment allografts (CCSAs) are a novel grafting material for such cases that avoid donor-site morbidity, improve operating efficiency, and mitigate the postoperative risks. Objectives To report the early experience using fresh frozen, aseptically processed, and nonterminally sterilized CCSAs used in complex primary and secondary rhinoplasties, in Canada. Methods We retrospectively reviewed 21 patients (17 female and 4 male patients) who underwent a primary or secondary rhinoplasty surgery using CCSAs from June 2019 to April 2022. Results The mean age was 39 years (range, 27-58 years), and the mean body mass index was 23.7 kg/m2 (range, 24-40 kg/m2). Of the 21 procedures, 11 were primary (52.4%) and 10 were secondary (47.6%) rhinoplasties. The mean operative time was 185 min (range, 85-330 min), with a mean follow-up time of 15.0 months (range, 2.0-37.8 months). At follow-up, 19 patients (90.5%) reported being "very satisfied" with their aesthetic results, and only 2 (9.5%) underwent revision surgery. No serious complications were reported, and only 1 case showed evidence of graft resorption. Conclusions Based on early experience, this CCSA avoids donor-site morbidity and reduces operative time while maintaining a low complication rate, providing a viable alternative to the use of autologous costal cartilage when indicated in complex primary or secondary rhinoplasties with inadequate native nasal cartilage. Level of Evidence 4
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Affiliation(s)
- John Milkovich
- Student, Faculty of Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Jamil Ahmad
- Corresponding Author: Dr Jamil Ahmad, 1421 Hurontario St, Mississauga, Ontario L5G 3H5, Canada. E-mail: ; Twitter and Instagram: @drjahmad
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