Nasal Implants – Nose Surgery by Houston Cosmetic Surgeon
After correction with Dr. Capriotti’s Implant.
Non-Caucasian rhinoplasty also called nose surgery differs from Caucasian in that it usually involves augmentation of the dorsum and tip, whereas the Caucasian operation frequently involves a subtraction from these structures. The goal of procedures in both groups of patients is the same: a straight, relatively narrow dorsum ending in a delicate, distinct tip slightly higher than the dorsum and slightly proximal to the most distal extent of the nose, usually a portion of the columella.
It is axiomatic in the West that augmentation be done using the patient’s own tissue; throughout the world, however, alloplastic nasal implants are by far the most common means of achieving augmentation. Silicone implants for cosmetic surgery have been used for years throughout the Orient in an attempt to give patients a desired narrow, elevated bridge and sculptured elevated tip. In Oriental patients, attempts to achieve nasal augmentation with autogenous tissue is often less than satisfactory because of thick lobular skin and weak lower lateral cartilages that are not useful for support reinforcing techniques applicable to the Western patient. The risks of alloplastic implants appear to be overstated, at least with regard to Oriental patients, as thousands of implants are inserted yearly with good results that have stood up over time. Dr. Capriotti has removed many of these implants from patients who wish to change the shape of their noses. Most of the implants had been in for years and showed no sign of extrusion. Invariably, a smooth silicone implant is surrounded by a dense fibrous tissue capsule similar to a breast capsule. Perhaps in this instance the capsule is beneficial and helps to explain the longevity of the implant.
The most common type of reconstructive surgery implant currently in use is the L-shaped implant. This implant gives satisfactory elevation of the dorsum of the nose, but its treatment of the tip of the nose often leaves much to be desired. By its nature, the use of this implant results in a nose job with a sharp angulation at the most distal aspect of the nose. The narrow configuration of the implant at the tip defining angle often results in a “tent pole” effect as the upward thrusting of the implant thins the skin over time. While the implant does not extrude, it often results in an unnatural and at times an unsightly nose. Second-generation Oriental females, while not wanting complete Westernization of their noses, increasingly request elevated tips and tips with a defining point. Satisfying these requests with the L-shaped implant is not possible since most noses done with this implant look very much alike.
For these reasons a new implant has been developed. This implant is made from silicone but differs from the L-shaped implants in important structural features: the tip is expanded, rounded, and sits atop a rectangular “keel” instead of a strut. Another differentiating feature associated with this implant is the technique of the insertion; it is placed using an open rhinoplasty approach.
The new implant shape has several advantages over the L-shaped implant. The expanded tips results in a more natural looking tip which can be set at any distance from the most distal point of the smaller nose resulting in a Western “double beak” or the most traditional Oriental look in accordance with the patient’s wishes. The African American nose can likewise be addressed with the same considerations in mind. Placing the implant through the open incision allows its removal and replacement with ease to facilitate individualization. The open incision allows easy access to the undersurface of thick nasal skin for conservative defatting and skin scoring techniques not possible with a rim incision. The open technique also allows for easier, more complete elevation of the nasal bone periosteum. Placing the implant under nasal bone periosteum prevents abnormal movement and results in implant fixation in 2-3 weeks. Implants placed in this manner are often indistinguishable from nasal bones in the area of the bridge.
In the frontal view the implant provides a natural flow from the medial aspect of the brows to the nasal tip while maintaining the nasofrontal angle in the lateral view. Correction of previous implant misadventures can be accomplished with minimal trauma using the open rhinoplasty incision restoring a “natural” looking appearance in according to the patient’s wishes.
This implant was developed and patented by Houston cosmetic surgeon Dr. Capriotti and is being used worldwide. The implant is proving to be useful not only in Asian and African Americans patients but in any nose that needs augmentation.