Augmented Asian Augmented Asian RhinoplastyRhinoplasty

The Art and The ScienceThe Art and The Science

Past, Present and Past, Present and FutureFuture

Thanee Thanee Sakhakorn MD.Sakhakorn MD.

Characteristics of Asian Characteristics of Asian nosenose

Wash out dorsum or saddle deformityWash out dorsum or saddle deformity Deficient tip projectionDeficient tip projection Wide lobule, thick lobular skin Wide lobule, thick lobular skin Abundant subcutaneous fatty tissueAbundant subcutaneous fatty tissue Alar flaringAlar flaring Retracted columella Retracted columella

Asian saddle noseAsian saddle nose

Asian Rhinoplasty requiresAsian Rhinoplasty requires Augmentation of dorsum areaAugmentation of dorsum area Augmentation of middle portion of Augmentation of middle portion of

upper and lower lateral cartilage areasupper and lower lateral cartilage areas Augmentation of columella-tip area for Augmentation of columella-tip area for

tip projection and increase nasal lengthtip projection and increase nasal length Refining the lobule/tip areaRefining the lobule/tip area Decrease the width of the nostrilsDecrease the width of the nostrils

Augmentation Asian Augmentation Asian RhinoplastyRhinoplasty

In the In the oldold day of Asian rhinoplasty day of Asian rhinoplasty Injected liquid paraffin Injected liquid paraffin

or liquid siliconeor liquid silicone

L-shaped alloplasticL-shaped alloplastic implant, mainlyimplant, mainly silicone elastomer.silicone elastomer.

Rib autograft or Rib autograft or homograft.homograft.

To the Present timeTo the Present time Novel design siliconeNovel design silicone implant with tip implant with tip

protection using ear, protection using ear, septal or lowerseptal or lower

lateral cartilage. lateral cartilage.

Autogenous costal Autogenous costal cartilage graft.cartilage graft.

Autogenous ear cartilage Autogenous ear cartilage graft in multiple graft in multiple layers(onlay graft).layers(onlay graft).

To the present timeTo the present time (continue)(continue)

Bioplastic.Bioplastic. The weird technology: The weird technology: hard silicone in hard silicone in

solvent.solvent.

Fabricated Fabricated perichondrocartilage perichondrocartilage complexcomplex from both from both

ears into auto-nasalears into auto-nasal bioprosthesis.bioprosthesis.

What is the What is the perichondrocartilage complexperichondrocartilage complex??

Cartilage with intact Cartilage with intact perichondrium.perichondrium.

In asian rhinoplasty, weIn asian rhinoplasty, we harvest this complex fromharvest this complex from both external ears.both external ears.

The complex will functionThe complex will function as a as a living tissueliving tissue when it is when it is implanted in human body.implanted in human body.

Harvest

DesignFabricate

Finish

From raw materials to finished bioprosthesisFrom raw materials to finished bioprosthesis

Bioprostheses correct the problems of Bioprostheses correct the problems of silicone prosthesis in Asian rhinoplastysilicone prosthesis in Asian rhinoplasty

InfectionInfection

ProtrusionProtrusion

PerforatioPerforationn

Bioprostheses correct the dorsum Bioprostheses correct the dorsum injecton of liquid siliconeinjecton of liquid silicone

Bioprostheses in miscellaneous Bioprostheses in miscellaneous conditionsconditions

Bioprostheses and Asian Bioprostheses and Asian RhinoplastyRhinoplasty

ขยายความจาก มติชน ขยายความจาก มติชน สดุสปัดาห์สดุสปัดาห์

โปรเฟสเซอร์ แวรเ์นอร์ มางก์ จาก รพ โปรเฟสเซอร์ แวรเ์นอร์ มางก์ จาก รพ . . โบเก็นเซ โบเก็นเซซึ่งมชีื่อเสยีงทางศัลยกรรมตกแต่งจมูกได้สวยที่สดุคนซึ่งมชีื่อเสยีงทางศัลยกรรมตกแต่งจมูกได้สวยที่สดุคน

หนึ่งได้กล่าววา่หนึ่งได้กล่าววา่

“ “ กระดกูอ่อนท่ีหู เป็นวสัดชุัน้ยอด สำาหรบั กระดกูอ่อนท่ีหู เป็นวสัดชุัน้ยอด สำาหรบั ”การตกแต่งจมูกใหม่ ไมใ่ชซ่ลิิโคน ”การตกแต่งจมูกใหม่ ไมใ่ชซ่ลิิโคน

The future is comingThe future is coming Regenerative medicine :Regenerative medicine : In the future, tissue damages will be replace In the future, tissue damages will be replace

withwith tissue substitutes.tissue substitutes.

Tissue engineering:Tissue engineering: Bioengineer and biomedical engineer make Bioengineer and biomedical engineer make

tissue substitutes as “body parts” and ready to tissue substitutes as “body parts” and ready to use. No more donor site morbidity and use. No more donor site morbidity and deformity at all. deformity at all.

In cartilage tissue engineer labIn cartilage tissue engineer lab

ConclusionConclusion

Silicone elastomer and new inert biomaterials still Silicone elastomer and new inert biomaterials still have place in asian rhinoplasty.have place in asian rhinoplasty.

Autogenous cartilage fabrication in the form of Autogenous cartilage fabrication in the form of nasal prosthesis will replace and use more and nasal prosthesis will replace and use more and more.more.

Cartilage tissue engineering in the form of nasalCartilage tissue engineering in the form of nasal prostheses will be used in the future.prostheses will be used in the future.