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Achieving facial harmony: Novel S-implant addresses the complexities of African-American rhinoplasty

Article-Achieving facial harmony: Novel S-implant addresses the complexities of African-American rhinoplasty

Patient shown pre-operatively.
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.

Patient shown pre-operatively with "S" nasofrontal implant.
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.

S-implant rhinoplasty patient shown 3 months post-operatively.
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.

Dr. Slupchynskyj
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.

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