Understanding the Use of Polycaprolactone in East Asian Structural Rhinoplasty: Questions and Answers

• Main Author: Eduardo Yap
• Format: Article
• Language: English
• Published: Philippine Society of Otolaryngology-Head and Neck Surgery, Inc. 2021-05-01
• Series: Philippine Journal of Otolaryngology Head and Neck Surgery
• Subjects: Polycaprolactone; PCL mesh; structural rhinoplasty; extended spreader graft; septal extension graft; septoplasty
• Online Access: https://pjohns.pso-hns.org/index.php/pjohns/article/view/1673

Surgery as an art in rhinoplasty involves grafting techniques wherein materials (usually autologous) are taken from the septum and supplemented by conchal cartilage. However, not all noses have adequate cartilage material. The quest for materials as possible replacement for human tissue have led to invention of synthetic (e.g. silicone, e-PTFE, porous polyethelene) and non-synthetic products (e.g. processed homograft and xenograft). In this era of advanced medical science, tissue engineering has started the use polycaprolactone (PCL) as a template and scaffold for tissue growth. Because of this characteristic feature, PCL as a mesh has a significant role in structural rhinoplasty.   What is structural rhinoplasty? The surgical goal of rhinoplasty is to achieve functional improvement in breathing and aesthetic overall look, most notably the tip. The tip is determined by the final shape of the lower cartilage in its proper location - - but since the lower cartilage is a floating structure supported only by fibrous tissue and ligaments, there is a high incidence of tip drooping post op. So, the idea of structured rhinoplasty was conceptualized in 1997 by Dr. Byrd and popularized by Dr. Toriumi.1,2 A piece of central septum is harvested and fashioned as an extension of the caudal margin of the septum. This is called a septal extension graft (SEG) and the lower cartilage is sutured to the caudal margin of the SEG for better control of the tip. Since then, the technique has been the main workhorse support graft for the tip.3 (Figure 1)   Why is structural rhinoplasty needed in East Asian noses? East Asian noses, particularly Southeast Asian noses are usually short and small, with low dorsum and upturned bulbous nose. Tremendous strength in the design of the structural support with its foundation base at the caudal septum should be achieved in order to elongate the nose, counter rotate and project the tip. (Figure 2) This is made possible by using the central harvested cartilage as a SEG attached to the residual strong dorsal and caudal strut.4 (Figure 3)