Rhinoplasty
Nose correction

About Aquamid please see below.

The shape and size of the nose lends the individual person his or hers personal features which by no means that is has to be changed. Due to trauma the nose can be deformed and cause functional problems like obstructed airways.
As the nose plays a central role in our appearance, the evaluation has to consider the balance between the different segments of the face and their relation to the nose. Many persons seeking a rhinoplasty, for instance, have a weak chin or flat cheekbones and a normal nose. Anatomically the nose-profile is "lifted" up by the nasal bones and the cartilage. The skin is mostly thin and stiffly connected to these structures by fibrous tissues, which explains the long duration of the postoperative swelling after a rhinoplasty.

Technique: Incisions are usually made in the nostrils and the soft tissues are separated from the bones and cartilage which now can be reshaped. If breathing problems or deviations are present, this can be improved by a septoplasty. Sometimes an "open" procedure could be beneficial; leaving a tiny scar on the columella or sometimes the nostrils should be narrowed through incisions at their bases.
A cast or splint is placed over the nose for 6-7 days and in some cases an internal dressing is applied for 2-3 days.
The healing procedure can produce unexpected irregularities due to scar formations that may need a secondary correction. This happens in about 5%.

Anaesthetic: Conscious sedation and local anaesthetic.

Operating time: 1-2 hours.

What happens afterwards?

• When the anaesthetic subsides, a short intensive pain can be felt for about ½ an hour. After that there is no pain.
• As the nose is only tamponated in cases where deviations are corrected, blood will drip from the nose during the first two days.
• To prevent for bleeding you should not bend forwards during the first two weeks.
• Immediately after splint removal the new shape can be seen. Already after an hour the natural swelling which gradually will disappear during the first month hides this. The maturation of the scary tissues takes a year and fist then the final outcome can be judged.
• Crusts obliterating the nostrils can be dissolved by the 3rd day with moistened cottonpellets moistened with water. The crusts should not be torn away!
• Physical activities should be abandoned for one month.

Complications

Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections that in case it happens will be treated with antibiotics.

Swelling: A little swelling over the noseridge and the tip can pertain for several months, as the skin has to shrink and redrape itself over the new "stand". In few cases a secondary boneformation can occur that need a minor correction. Normally smaller irregularities can be felt but as long as they are invisible, no correction is needed. Smaller scarformations can also need revision. All these unfavourable biological outcomes can occur even in the best hands

Numbness: It is quite normal with numbness over the tip and nostrils after a rhinoplasty. It normally disappears spontaneously.

Deviations: Deviations caused by the septum can reoccur despite proper correction.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation.

 

AQUAMID

Recently a new filler for permanent tissue augmentation by injection was introduced in Europe, Aquamid® . The information about this material is put in front of our normal information on nose corrections, which of course still should be read by anyone seeking information about this type of operation. The clinic expects the treatment with Aquamid® to replace some bone orcartilage implantations.

As general tissue augmentation like breasts, lips, malars, chins and calf for a long time have been and still are demanded corrections, the industry has been seeking for a suitable substance for this indication. Through years injectables with time restricted durability like collagen and hyaluronic acid have been used. Due to resorbtion the injections had to be repeated. Allergic reactions have been reported.

Other injectable substances with more or less permanent durability have also been used. These are silicone and polymethylmethacrylate, which can aggregate and cause lumps or disappear depending on the molecular size. Again other materials as a permanent filler is the Gortex® tube. Autologous tissues with a variety of long term results have been used. Fat injections do mostly have a transient filling effect and are no alternatives for permanent augmentation. Fat-dermis or fascia implants do commonly have a permanent filling effect, although they can be absorbed. Acellular implants from corps does also exist for this purpose. Biologic auto transplants need vascular ingrowth to survive and if this does not occur, the material is partially or totally absorbed.

Bigger augmentations like breasts, muscle, buttocks etc. can only be achieved by implants today.

Aquamid® is a neutral hydrogel consisting of a stable chain of polyacrylamide in 90% of water. Polyacrylamide should not be confused with the poisonous acryl amide. The gel can be directly injected into the subcutis where it integrates with the tissues. If injected gel is to be removed, it can at least partially be aspirated or pressed out during the fist 8 months after injection. After this time there is an ingrowth of fibrous tissues into the gel which makes a surgical removal necessary to ablate it. Polyacrylamide gel has been used successfully for over 10 years in Ucraine, mostly for breast augmentation and facial corrections. The cosmetic results have been excellent with a very low frequency of side effects/complications of about 0,02%.

This information is related to facial corrections as the only officially cleared indication.

Method: With a very thin needle, the gel can be introduced into areas to be filled or enlarged.

Typical areas:
Malar region, chin, cheeks, lips and nose.

There will be a short swelling and erythema that will disappear within 12 hours.

There will be no pain.

The injected gel stays soft or hard depending of the injection technique and it does not migrate.

The treatment is done under local or bloc anesthetic. The anesthesia makes the face feel hard and big, but have no fear, it is invisible! The analgesia disappears within a couple of hours.

No after treatment is needed.

Side effects:

· No reports of any complications so far.
· Irregularities can occur. This can be corrected by massaging or secondary injections. It is important that the physician should be able to see and to manage these side effects.
· Infections can occur when the needle penetrates the skin. Antibiotics is then prescribed.
· Sometimes it is difficult to decide what volume is aesthetically needed. If one is in doubt, it is better to give a secondary treatment at a later time than to overinject.
· Injected Aquamid® can be firm for a month. It softens gradually with time.

Aquamid® will be cleared for other indications. At that time more information will be completed.
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