Traditionally available materials utilized in nasal and chin augmentation such as silicon implants and autologous cartilage graft are beset by several limitations. Despite a long history of usage, silicon implants are prone to extrusion and possible bone re-sorption. Autologous cartilage grafts on the other hand can be harvested only in small limited volumes and is associated with donor site morbidity. We have introduced a novel material, cultured autologous chondrocytes (CAC) since 2004. Our results have been reported in the following papers: Aesth Plast Surg 2004, 28:212, Plast Reconstr Surg 2006,117: 2019, Plast Reconstr Surg 2009,124: 817 and Aesth Plast Surg 2009, 33:795. These papers reported on a one-stage CAC implantation procedure operated on 150 cases over a 10-year period. As a development from these initial studies, we now present the two-stage CAC implantation procedure of chondro-fat composite graft.
Methods/Technique:
One cm2 of cartilage was harvested from the auricular concha. The harvested cartilage was then treated with collagenase to obtain chondrocytes. These chondrocytes were cultured and expanded to sufficiently large numbers such that they become capable of producing chondroid-rich matrix and began forming immature cartilaginous tissues in-vitro. Subsequently, in the second stage of the implantation process, these immature cartilaginous tissues were then injection-implanted to the lower abdomen of the patient where the tissues will grow into larger neo-cartilage with neo-pericondorium in 6 months. Once of sufficient size, the neo-cartilage was then surgically harvested from the abdomen and used as material for chin and nasal augmentation. This two-stage procedure was performed on 20 patients.
Results/Complications:
The immature cartilaginous tissue with soft gel consistency transformed intra-abdominally to a larger sized, stable neo-cartilage with adherent fat tissue within 6 months. 20 patients underwent this procedure and reported stable neo-cartilage after a 6 month~5years postoperative follow-up. The neo-cartilage obtained in our 2-stage procedure maintained good shape and minimal re-sorption in all our 20 patients.
Conclusion:
The two-stage CAC implantation procedure is a novel, safe and proven option for implant material in nasal and chin augmentation. It has the potential of application to a wide variety of facial augmentation in aesthetic plastic surgery.