From Dr. Kook's Plastic Surgery Clinic; and the Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine.
Plast Reconstr Surg. 2019 Oct;144(4):575e-585e. doi: 10.1097/PRS.0000000000006095.
Little is known about contributory factors of unremoved periimplant capsule causing nasal deformities after postrhinoplasty silicone implant extraction. This study investigated the impact of retained capsule causing contracture deformity and effect of subsequent capsulectomy in preventing and correcting the deformity.
A total of 103 patients underwent secondary surgery for silicone implant removal and grafted cartilage between May of 2015 and June of 2017. Among them, 67 patients without septal extension graft or open wound and with 8-week or more follow-up were analyzed retrospectively. All operations were approached with an intranasal incision. Three procedures were performed: (1) removal of implant plus tip graft only (n = 12), (2) removal of implant plus tip graft plus subtotal capsulectomy (n = 47), and (3) removal of implant plus tip graft plus subtotal capsulectomy in patients with contraction and thick capsule (n = 8). Preremoval/postremoval of nasal bridge length index and nasolabial angle were measured with the lateral view.
In group 1, nasal bridge length index decreased by 6.2 percent and nasolabial angle increased by 5.7 percent. In group 2, nasal bridge length index increased by 2.5 percent and nasolabial angle decreased by 2.2 percent. In group 3, nasal bridge length index increased by 8.6 percent and nasolabial angle decreased by 7.9 percent.
For patients undergoing surgical removal of a nasal silicone implant with or without cartilage, a concomitant capsulectomy is required to prevent potential contractures and to minimize tip deformity. Capsulectomy can release and lengthen the contracted nose without septal extension or derotation grafting. Dorsal skin irregularity did not occur regardless of whether capsulectomy was performed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
硅胶隆鼻后假体取出时遗留的包膜是导致鼻畸形的原因之一，但包膜挛缩的影响因素知之甚少。本研究旨在探讨包膜的存在对鼻尖挛缩的影响以及行包膜切除术预防和矫正畸形的效果。
2015 年 5 月至 2017 年 6 月，103 例硅胶假体取出及软骨移植的患者行二期手术，其中无鼻中隔延伸或开放切口，随访 8 周以上的 67 例患者被回顾性分析。所有手术均采用经鼻切口入路。行 3 种手术：（1）单纯取出假体加鼻尖移植物（12 例）；（2）取出假体加鼻尖移植物加部分包膜切除术（47 例）；（3）取出假体加鼻尖移植物加有挛缩和厚包膜患者的部分包膜切除术（8 例）。术后即刻及末次随访时拍摄侧位片，测量鼻背长度指数和鼻唇角。
第 1 组鼻背长度指数减少 6.2%，鼻唇角增加 5.7%；第 2 组鼻背长度指数增加 2.5%，鼻唇角减少 2.2%；第 3 组鼻背长度指数增加 8.6%，鼻唇角减少 7.9%。
对于行硅胶假体取出或联合软骨移植的患者，需要同时行包膜切除术，以预防潜在的挛缩，最小化鼻尖畸形。包膜切除术可以松解和延长挛缩的鼻子，而无需鼻中隔延伸或旋转移植。无论是否行包膜切除术，均未出现鼻背皮肤不平整。
临床问题/证据水平：治疗性，IV 级。
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