One hundred seventeen patients underwent a total of 122 nasal operations using IHCC. Three patients underwent a secondary procedure to supplement nasal augmentation beyond what was originally performed at the primary procedure. One patient required two secondary procedures to replace IHCC grafts that were completely resorbed following a severe localized infection that was associated with the primary procedure.
Revision rhinoplasty accounted for the largest group of surgical cases (82 of 122). Most of these patients required IHCC to correct structural and volume deficiencies resulting from overaggressive rhinoplasties performed elsewhere. Forty patients underwent primary augmentation rhinoplasty; 12 received IHCC for cosmetic alterations and 12 required IHCC to reconstruct severe posttraumatic deformities (Figs 3 and 4). Other reasons for using IHCC included poor tip support, congenital nasal deformities, and large anterior septal perforations that were associated with absent caudal septum support (Table 1). A total of 306 grafts were used, most of which were needed to augment the nasal dorsum as an onlay graft or to support the nasal tip as a columellar strut (Table 2).
Patient follow-up ranged from 1 month to 84 months (average, 15.0 months). There were four postoperative infections (Table 3), all of which were localized to the nasal tip and columella, and all of which involved the use of braided sutures for implant stabilization. Three infections occurred early in the postoperative period, within 1 month of surgery. One of these three infections accounted for the only case of short-term graft resorption. Definitive treatment was delayed in that patient, resulting in complete and rapid resorption of a tip graft and a columellar strut. A dorsal onlay graft that was placed at the same time as the tip graft and the columellar strut remained isolated from the localized infection and did not exhibit any signs of resorption. In both other early postoperative infections, prompt wound drainage and early systemic antibiotic therapy resulted in complete preservation of the regional cartilage grafts. One patient had development of a localized columellar abscess 27 months postoperatively that resulted in complete resorption of a previously placed columellar strut. The abscess was drained and a permanent braided polyester suture was removed from the center of the abscess cavity, after which the patient healed without incident. The last 62 patients in this series all had monofilament sutures used for graft stabilization; none of these have yet to show any signs of infection.
Noninfectious, long-term graft resorption was observed in two patients. Both patients were judged to have minimal resorption of their dorsal onlay grafts, one at 26 months postoperatively and the other at 75 months postoperatively. All of the remaining IHCC grafts appeared intact and seemed to maintain the nasal augmentation originally intended. Other long-term complications were limited to the 74 dorsal onlay grafts; these included three cases of persistent mobility and two cases of warping.
