Articles
New Concepts
Although in the United States there are many people with large noses and high bridges, which may be a consequence of their European or Mid-Easter ancestry, there is also a large population of people, whether Asian, Hispanic or African-American who have low flat noses. Many substances have been used to augment the bridge of the nose, including artificial materials, such as, silicone, porex, hydroxyapatite and gortex. There are certain populations of people that tolerate silicone implants better than others. As a matter of fact, the most common cosmetic operation in Japan is the use of solid silicone implants to augment the nose. Be that as it may, the high extrusion rate and "wobbly" nature of silicone has made it fall out of favor as a choice for nasal bridge enlargement. The other artificial materials mentioned are also fraught with a certain instance of infection and distortion.
Many plastic surgeons, especially in the United Sates, prefer natural materials taken from the patient’s own body. My first choice is cartilage harvested from the patient’s septum and my second choice is cartilage harvested from the patient’s ear cup. Unfortunately often this is not enough cartilage available to do the job. When this is the case, many plastic surgeons favor taking the bone from the patient’s own skull or taking cartilage from he patient’s own rib cage. Despite the fact that these autografts (taken from one part of the body to use on another part of the body) tend to survive, there still is a less than perfect situation. Cranial bone grafts can still partially re-absorb and one must take into account the increased cost of harvesting the skull graft and the weakening of the integrity of the skull. The rib grafts have a tenancy to warp and distort, and although some doctors have successfully minimized these problems with their superior techniques, there is still the issue of increased harvesting expense and a scar on the chest wall.
As an alternative to harvesting autografts grafts from the patient’s skull or chest, irradiated rib cartilage has been used. These cadaver grafts are treated with x-rays in a manner to destroy viruses and contaminants to render the tissue inert and thus acceptable as an implant. Variable success has been recorded with irradiated rib cartilage with the biggest problems being warping distortion and reabsorption. Therefore, since all choices mentioned have potential problems, there is need for a safe, inexpensive, non-distorting alternative implant. Dr. Clark and associates are trying to develop an innovation to help people with flat noses, saddle noses and overly dissected bridges.
Dr. Clark is currently doing a pilot study using freeze dried and frozen bone to augment and straighten the nasal dorsum (bridge). Dr. Clark uses American Bone Bank approved treated bone which has an excellent history of use in orthopedic surgery for 10 years without transmition of any disease or rejection of implants. (For details of the extensive evaluation of bone donors and cleansing of the bone, please contact Dr. Clark.) The first patient receiving a dorsal implant with a frozen bone was in June, 2004. That patient’s bone graft remains in perfect position and has maintained it’s size and remains thus far to be a success. We are following over 10 patients with excellent results, and time will tell as to whether this will be an answer to the quandary of dorsal augmentation, and we remain very hopeful.
Frequently Asked Questions
Q: Why does Dr. Clark think that Scarless Rhinoplasty is best?
A: First of all, the incision approach to the nose is not as important as the overall beauty of the result. If a doctor can achieve a more comely nose by placing a scar on the columella, he or she should do so. Unfortunately, fewer doctors are being trained to do the scarless rhinoplasty and, therefore, an increasing number of surgeons will need to make that scar to get their best result. Whouldn't it be better, however, if a doctor can achieve an equally good result without that columellar scar? I believe that most surgeons, with patience and willingness, can learn to perform excellent rhinoplasty with incisions placed inside the nose... why have a scar if it can be avoided?
Q: Where do doctors place the scar when they perform an "Open Rhinoplasty"?
A: Across the middle of the columella.
Q: What is the columella?
A: The skin column between the two nostrils is called the columella.
Q: Does the columella scar always look unsightly?
A: No... I have seen beautiful scars that, with time, become almost imperceptible. The problem is that I have also seen scars that are hideous. Most of the time the scar may be only noticeable at conversational distances... but don't most people want to have scarless beauty at intimate distances?
Q: Does Scarless Rhinoplasty mean that there is never a scar?
A: Of course there must be a scar, but the scars are placed routinely inside the nose where they are not seen. In the case where the nostrils are too wide and flared, in order to reduce this width, I will have to place a scar in the groove where the nostril joins the cheek. Scarless Rhinoplasty refers to the omission of a scar on the columella.