Cosmetic Surgery Times, March 1st, 2007
New York Compared with Caucasians, rhinoplasty in African-American patients is complicated by characteristic anatomical features of the nose, including a depressed nasal frontal angle, and little cartilage and increased fatty tissue in the tip of the nose.
After performing a series of rhinoplasty procedures on African-American patients, Oleh Slupchynskyj, M.D., was struck by the similarity between implants he had carved to correct a low bridge and deep frontal angle in these patients. In early 2006, he patented the Silastic (S-) implant.
"There isn't any other implant on the market like this one," Dr. Slupchynskyj, director of the Aesthetic Facial Surgery Institute of New York, tells
Cosmetic Surgery Times
. "Certainly, the nasal frontal angle can be augmented by the insertion of a piece of Gore-tex or cartilage grafting. However, the S-implant is the only implant that addresses the nasal frontal angle in addition to addressing the height of the dorsum."
Dr. Slupchynskyj performs a rhinoplasty using an S-implant approximately 10 times a month and has treated more than 50 patients to date with this technique.
THE S-IMPLANT PROCEDURE Through an open approach, a midline pocket is created below the plane of the superficial muscular aponeurotic system of the nasal dorsum.
The nasal frontal angle is assessed visually and the cephalic end of the S-implant is beveled to approximate the appropriate angle. The implant is then placed into a dorsal pocket and patient-specific adjustments are made using a #15 blade and a SuperCut Scissor. If necessary, the dorsal height of the implant can be supplemented by stacking silicone pieces and securing them with 5-0 nylon. The implant is then replaced in the dorsal pocket and attached to the upper lateral cartilages with 5-0 nylon. If the pocket is too large, a 5-0 silk stitch may be made through the dorsal skin and implant, using a cotton bolster, which is left in place until the cast is removed at seven days.
In addition to African-American patients, the S-implant may be suitable for rhinoplasty in patients of other ethnicities if augmentation of the nasal frontal angle is an issue.
A QUESTION OF SATISFACTION Dr. Slupchynskyj conducted a retrospective review via questionnaire of 47 African-American patients who had been treated with rhinoplasty using the S-implant.
The questionnaire covered patient satisfaction, subjective evaluation of ethnic changes, and changes in self-esteem. Compared with an overall revision rate of approximately 1 percent to 2 percent for rhinoplasty on a national level, patients in this study indicated a 0.05-percent rate of revision. In addition, results showed a significant increase in self-esteem. According to Dr. Slupchynskyj, the analysis demonstrates that these African-American patients sought not to change their ethnicity, but to achieve facial harmony.
Results of this study were presented at the recent meeting of the American Academy of Cosmetic Surgery.
SURGEON SCARCITY Adjustment of the nasal frontal angle is only one element in the full palette of African-American rhinoplasty options.
Typically, explains Dr. Slupchynskyj, these patients are looking for augmentation of the dorsum, narrowing of the nostrils, and refinement of the nose tip. Dr. Slupchynskyj, who is double board certified by the American Board of Facial Plastic Surgery and the American Board of Otolaryngology, speculates that black patients in search of a rhinoplasty may encounter some difficulty finding a surgeon who feels comfortable taking on the task. Lack of training, the complexity of the surgery, and a substantial time commitment are all inhibitory factors.
"Rhinoplasty surgeries in African-Americans can only be done properly by way of an open approach," he asserts.
"The majority of cosmetic surgeons have not been trained in open rhinoplasty. Furthermore, the entire procedure of defatting the tip, making the right pocket for the implant, carving the implant, placing it, and making the tip graft may require as many as two or three hours to complete." According to Dr. Slupchynskyj, this undertaking is a far cry from the 20-minute commitment required to complete many simpler rhinoplasties, such as the removal of a dorsal hump from a Caucasian nose.
In addition, narrowing the nostrils of an African-American patient may be regarded as a risky procedure. Dr. Slupchynskyj explains that there are several ways to perform alar resections or alar-based reductions.
"I have been doing a horizontal and vertical reduction of the alar base, requiring a number of incisions on the ala and on the columella. Regardless of the lack of probability of developing a keloid on the nose, the anticipated risk for keloid associated with incision in a black patient can be seen as prohibitive. As a whole, the level of complexity associated with this type of surgery is enough to cause many surgeons to shy away."
AN UNMET NEED Since posting information on African-American rhinoplasty surgery on his Web site, Dr. Slupchynskyj is starting to field inquiries from African-American patients from all over the United States and around the world.
"There appears to be a void that has not been filled," he concludes.
For more information
Oleh Slupchynskyj, M.D.
www.facechange.com|~
,
info@facechange.org
