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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-Eastern 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 in rhinoplasty surgery 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, there may not be 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 The patient’s own rib cage. Despite the fact that these autografts (bone or cartilage 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 freeze dried 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 tendency to warp and distort, and although some doctors have successfully minimized these problems with their superior techniques, there is still the issueS of increased harvesting expense and a scar on the chest wall.

As an alternative to harvesting autografts 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 have developed an innovation to help people with flat noses, saddle noses and overly dissected bridges.

Dr. Clark HAS currently published 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 over 10 years without transmission 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. This bone graft has revascularized and become live healthy bone. 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.