Houston Cosmetic Surgeon |
|||||||||||||||||||||||||||||
 |
||
|
|
Home > Articles > Correction of the Soft Tissue Polly Beak
Using Triamcinolone Injection The POLLYBEAK, or surpratip deformity, has arisen as a consequence of modern rhinoplasty and, as Hanosono et al1 have correctly identified, originates primarily from 2 sources: overresection of skeletal structures with tissue thinning or underresection of the distal eptal angle and upper lateral cartilages. Sheen2 attributes nearly 95% percent of all supratip deformities to the paradoxical overresection of the caudal nasal suppert strctures. The distinction between the 2 pathogenetic fectors ois of paramount importance, as the tratment options differ considerably. Often, palpation alone is not suficient to secure the diagnosis, and the rhinopasty surgeon must have an ultimate awareness of what was done at the primary operation. In our esperience, the majority of soft tissue spratip deformities are the result of dead-space replacement with scar tissue. Therefore, the use of triamcinilone acetonide injections for the reduction of scar tissue seems logical. Numerous authors that have documented the efficacy or intralesional injections of corticosteroids; however, the timing of treatment remains undecided. Many surgeons use systemic perioperative corticosteroids3,4 as an adjunct to decrease nasal edema. As early as 1971, Rees5 advocated corticosteroid injection to aid in the tratment of supratip swelling after rhinoplasty. We laud Hanasono and colleagues' attempts to provide scientific data regarding the use of triamcinolone for this very dificult clinical entity. While the benefit of triamcinolone injections seems clear, the frequency of tratments and the end points remain elusive. Hanasono and coworkers seem to set an arbitrary limit of 4 to 6 injections, regardless of the concentration used. Unfortunately, the studies of triamcinolone for scar tratment have been limited to the intralesional injections; therefore, it is difficult to extrapolate the data for subcutaneous injections. The pharmacokinetics for this form of treatment are yet to be clarified. Traditionally, we have treated established supratip deformities by open axpiration along with resection of scar excess and dorsal septal cartilage. It is prudent to wait at least 12 months for full edema resolution and scar maturation before consideration before consideration of revision. Our technique for minimizing the asymetry in this difficult setting involves exposure through an open approach and careful excision of the scar tissue under direct vision, with extreme care taken to preserve the subdermal plexus. The underside nasal skin flap is scored, and an absorbable suture is used to obliterate the dead space by securing the deep dermis to the anterior septal angle. Taping and a dorsal splint are used for 7 to 10 days, and silicone sheeting is used for an additional 6 weeks. This technique was provided satisfactory results in the tratment of the established supratip deformity, but it is dependent en the experience of the surgeon. We have reserved the use of subcutaneous triamcinolone injections for the infrequent patient with a refractory deformity; however, Hanasono and colleagues have shown that this modality can be a useful option if used cautiously as outlined intheir article. While the exact mechanism of action of subcutaneous injection of triamcinolone remains unclear, the authors' results confirm its efficacy in the tratment of soft tissue swelling after rhinoplasty. Clearly, in their hands, it is most effective when used early and can be a useful adjunct to the care of the patient who has undergone rhinoplasty. REFERENCES
|
||||||||||||||||||||||||||||
