Innovations in surgery may eliminate unnecessary nose jobs for some patients.

A report in the January/February issue of Archives of Facial Plastic Surgery indicates that the method of attaching a durable polymer called polydioxanone to septum cartilage makes it easier for surgeons to perform a septoplasty.

The septoplasty is an operation that straightens out a deviated septum. But in years past, this has been a tricky procedure, since attempted surgeries tend to weaken the cartilage in the inner nose. Surgeons have had to resort to fixing only the septum cartilage that is visible. Even then, trying to strengthen these regions with splints often failed, resulting in cosmetic or functional problems in the nose on a long-term basis. The more primitive forms of septum surgery didn’t maintain their visual results, and some patients re-developed their breathing problems.

But in 1996, a procedure was developed that seems to have satisfied doctors and patients both. Surgeons are now able to create strength in the septum by removing its cartilage and grafting it to small, durable plates of polydioxanone. From there, doctors re-implant the “new,” grafted cartilage back into the septum. Out of the 396 patients who underwent this procedure in 1996, 93.2 percent of them attained a straight nasal septum that sustained itself for up to 10 years later. No complications were reported on a short or long-term basis, and most of the patients observed improved breathing and nasal flow. To date, the study authors wrote, this procedure has produced largely successful surgical results.

“The use of polydioxanone plates during septal surgery facilitates external septoplasty, corrects several combined nasal deformities, such as post-traumatic and iatrogenic [medically induced] irregularities, and avoids postoperative saddle nose deformity without risk to the patient,” researchers noted.



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Varieties of rhinoplasty vary

Many people who suffer facial paralysis due to injury or illness, such as a stroke, lose the ability to close their eyes. And losing this ability can result in severe corneal damage, since the moving eyelid cleans the surface of the eye and keeps it lubricated. Now, a team of plastic surgeons have devised a way to help them blink again, in many cases saving their vision.

Surgeons at the University of California-Davis Medical Center have developed a new technique involving synthetic muscle that may help patients restore their eyelid movement.  Doctors used a device called an eyelid sling mechanism that creates a blinking action  with help from artificial muscle constructed from electrode leads and silicon polymers.

The surgeons used titanium screws to attach a miniature fabric sling to the small bones of the eye on cadavers. This sling was attached to a small amount of battery-powered artificial muscle, which moved the sling and created a blinking movement over the eye surface. The material behaves like human muscle, swelling or contracting based on the amount of power behind it.

“This is the first-wave use of artificial muscle in any biological system,” said Dr. Travis Tollefson, a facial plastic surgeon in the UC Davis Department of Otolaryngology – Head and Neck Surgery, a lead researcher in the study of alternative methods for eyelid rehabilitation in permanent facial paralysis. Officially, the approach is known as electroactive polymer artificial muscle, or EPAM.

Although there are currently other treatments for eyelid paralysis, they are more time-consuming, with uneven results. One approach involves a muscle transfer from the leg to the face – which can take up to 10 hours of surgery and be a harsh undertaking for some patients. The other approach requires surgeons to fuse a small weight inside the eyelid, which uses gravity to close the eyelid. This technique works well, but creates a blinking rhythm that is slower than the patient’s other eye.

Overall, EPAM appears more promising. Based on the general success of the demonstration, scientists at UC Davis feel they may be able to control various parts of the body by way of powered synthetic muscles, if necessary.

The study results were recently published in the January-February issue of the Archives of Facial Plastic Surgery.

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Cosmetic patients opt for younger eyelids

A new study indicates that computer imaging can be a useful tool to help surgeons and rhinoplasty patients decide how the patient’s new nose should look. The report, published in the Archives of Facial Plastic Surgery, indicates that computer imaging software helps doctors offer their patients the “ideal” nose.

Researchers at the University of Wisconsin studied 20 women who were undergoing rhinoplasty. They examined each patient’s facial proportions before and after surgery. The researchers found that most of the desired parameters were close to the ideal.

But, this ideal isn’t based on celebrity examples – instead, it is based instead on “Proportions of the Aesthetic Face.” This is the 1984 standard established by the American Academy of Facial Plastic and Reconstructive Surgery.

The report, published in the Archives of Facial Plastic Surgery, indicates that computer imaging software helps doctors offer their patients the “ideal” nose.

The researchers later concluded that doctors are using computer imaging software to store information about common patient preferences. And, they can also use it to help future patients make choices that work just as well.

All of these stories, plus this week’s Celebrity News report, are in this week’s Plastic Surgery News. Click the player below to view the newscast now!

The following organizations were mentioned in this episode:

• LoveYourLook.com
• The W.K. Kellogg Foundation
• Interplast
• Archives of Facial Plastic Surgery
• University of Wisconsin
• Penn State Hershey Medical Center
• Zurich University Hospital
• FDA
• American Society of Plastic Surgery
• AquaVage