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kwelll
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Nose

Postby kwelll » Fri, 03 Aug 2007 12:27 pm

Okay guys......... its getting abit much now........ found out from my Korean friends who had a reduction rhinoplasty at time time as I did also did not turn out welll............... it looked good at 2 weeks but now at 4 weeks, the middle portion has collapsed (curved) and the tip is as round as ever ............. according to the opinion of a few other surgeons, they are all of my opinion that the tip might only reduce in size (residual swelling) by say 10-15% max, with no difference to projection and tip definition!! (I already knew that long ago) ANOTHER, friend found her nose bridge becoming uneven with humps along the way, and the height decreasing within 6 months postoperative. Had it removed and replaced with silicone and tip autologous graft from rib for added support and projection.

We also found out that Gortex is structurally unstable material as it loses volume, thickness and length with time (remember some of you said yours noses looking better with time?? ..... cos its losing volume and becoming softer and rate of infection is still higher than silicone albeit it comes with his complications, too.

Its 4 week post op, here are my findings:

1. Soft ---> uneven contour by sight and touch; tend to lose volume post operative.

2. Hard to remove with time (past 6 mths is worst) unlike silicone

3. Tends to destroy surrounding tissues during removal

4. Hard to shape because it is soft,hence result is not as predictable as compared to silicone

5. Fibrovascular tissue ingrowth into pores is minimal

If you guys interested in a publised Korean report on Gortex, let me know.

mynose!
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Postby mynose! » Fri, 03 Aug 2007 3:57 pm

hey kwell...can u send the korean gortex report to me..i want to have a read through it.

With your firends, did they actually use gortex for the bridge it went uneven?...in general if you get ur tip done with cartliage does the is there no diff in projection in the end?....its not permanent?.

one more thing...see if gortex has higher rate of infection and its harder to remove why do ppl do it in the first place?...

keenose
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Re: Nose

Postby keenose » Fri, 03 Aug 2007 4:09 pm

kwelll wrote:Okay guys......... its getting abit much now........ found out from my Korean friends who had a reduction rhinoplasty at time time as I did also did not turn out welll............... it looked good at 2 weeks but now at 4 weeks, the middle portion has collapsed (curved) and the tip is as round as ever ............. according to the opinion of a few other surgeons, they are all of my opinion that the tip might only reduce in size (residual swelling) by say 10-15% max, with no difference to projection and tip definition!! (I already knew that long ago) ANOTHER, friend found her nose bridge becoming uneven with humps along the way, and the height decreasing within 6 months postoperative. Had it removed and replaced with silicone and tip autologous graft from rib for added support and projection.

We also found out that Gortex is structurally unstable material as it loses volume, thickness and length with time (remember some of you said yours noses looking better with time?? ..... cos its losing volume and becoming softer and rate of infection is still higher than silicone albeit it comes with his complications, too.

Its 4 week post op, here are my findings:

1. Soft ---> uneven contour by sight and touch; tend to lose volume post operative.

2. Hard to remove with time (past 6 mths is worst) unlike silicone

3. Tends to destroy surrounding tissues during removal

4. Hard to shape because it is soft,hence result is not as predictable as compared to silicone

5. Fibrovascular tissue ingrowth into pores is minimal

If you guys interested in a publised Korean report on Gortex, let me know.



Hey I would like that report too. Please send it to me.

But I was just wondering... since it may take months for the nose to fully deswell, at 2 weeks.. his nose looked good.. at 4 weeks it collapsed.. ..

But could that be part of the deswelling process?

I also read that the tip is the slowest to deswell... you said his tip projection is not good... what did the doctor use for the tip projection?
Could it be he didnt project it as much as your friend wanted it to be? Like a miscommunication or something?


Please share with us why the infection rate of goretex is higher than silicon. :)

and... sorry my english is not very good.. hehehe

What is " Fibrovascular tissue ingrowth into pores is minimal" ?


Thanks for sharing... :D
New nose please~

keenose
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Re: Dr Ng Vit C Drip

Postby keenose » Fri, 03 Aug 2007 4:14 pm

Jang wrote:Hi candall,

He charge quite cheap for Vit C drip le, it took about 10mins to finish the whole pack ( this is what he told me ) He also tell me that there is alots of different grade but what he use is good one, but i forgot what brand liao #-o

Do check it out men :wink: really sound so temping to me =P~


where where?? "HE" is who?
New nose please~

kwelll
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Postby kwelll » Fri, 03 Aug 2007 5:00 pm

[quote="mynose!"]hey kwell...can u send the korean gortex report to me..i want to have a read through it.

Please read the report below that I have posted. It is a report by more than 3 surgeons in Korea, it may not be conclusive but nothing is for medical science, only medical opinions. Some would still rebut and argue till the cows come home
....

With your firends, did they actually use gortex for the bridge it went uneven?...in general if you get ur tip done with cartliage does the is there no diff in projection in the end?....its not permanent?.
Yes, the gortex looked good with the swelling nice and firm, but when it deswells, you see the actual "augmentation work", nothing more or less. This is when you can see the real thing. His tip was augmented using rib cartilage - the strongest and most abundant available.

one more thing...see if gortex has higher rate of infection and its harder to remove why do ppl do it in the first place?...
Guess once people hear all the negative aspects of Silicone (used for over 50years btw!!!), people tend to go for the next 'best' material out of curiosity and recommendation??? Its only human nature to do now and worry later..........unfortuately......... do they think they would fall under the unfortunate 2-3% of complicated cases????
Last edited by kwelll on Fri, 03 Aug 2007 7:25 pm, edited 2 times in total.

kwelll
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Re: Nose

Postby kwelll » Fri, 03 Aug 2007 5:04 pm

But I was just wondering... since it may take months for the nose to fully deswell, at 2 weeks.. his nose looked good.. at 4 weeks it collapsed.. ..

But could that be part of the deswelling process? [color=darkblue][color=blue]When I say "collapse", I mean the part where it used to be "correct" changed to a different shape, in his case, the bridge WAS straight and now it CURVED!!! Now, do you think deswelling should make a nose bridge curve???[/color][/color]I also read that the tip is the slowest to deswell... you said his tip projection is not good... what did the doctor use for the tip projection?
Could it be he didnt project it as much as your friend wanted it to be? Like a miscommunication or something? [color=blue][color=blue]His tip is still 20% swollen, it is bulbous and round, but from his profile, one cannot see much projection EVEN WITH SWELLING, so my question is........can you imagine the tip without the swelling ?? Leave it to you to ponder..........[/color]

Please share with us why the infection rate of goretex is higher than silicon. :) [/color]

and... sorry my english is not very good.. hehehe

What is " Fibrovascular tissue ingrowth into pores is minimal" ?


Thanks for sharing... :D[/quote]
Last edited by kwelll on Fri, 03 Aug 2007 5:15 pm, edited 2 times in total.

keenose
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Re: Nose

Postby keenose » Fri, 03 Aug 2007 5:07 pm

kwelll wrote:But I was just wondering... since it may take months for the nose to fully deswell, at 2 weeks.. his nose looked good.. at 4 weeks it collapsed.. ..

But could that be part of the deswelling process? [color=darkblue][color=blue]When I say "collapse", I mean the part where it used to be "correct" changed to a different shape, in his case, the bridge WAS straight and now it CURVED!!! Now, do you think deswelling should make a nose bridge curve???[/color][/color]I also read that the tip is the slowest to deswell... you said his tip projection is not good... what did the doctor use for the tip projection?
Could it be he didnt project it as much as your friend wanted it to be? Like a miscommunication or something? His tip is still 20% swollen, it is bulbous and round, but from his profile, one cannot see much projection EVEN WITH SWELLING, so my question is........can you imagine the tip without the swelling ?? Leave it to you to ponder..........


Please share with us why the infection rate of goretex is higher than silicon. :)

and... sorry my english is not very good.. hehehe

What is " Fibrovascular tissue ingrowth into pores is minimal" ?


Thanks for sharing... :D
[/quote]

where is the report? I cant see it...
New nose please~

kwelll
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Multicentre Evaluation of Safety of Gortex as Implant

Postby kwelll » Fri, 03 Aug 2007 5:11 pm

A Multicenter evaluation of the safety of Gore-Tex as an implant in Asian rhinoplasty

Authors: Jin, Hong-Ryul; Lee, Joo-Yeon; Yeon, Je-Yeob; Rhee, Chae-Seo
Source: American Journal of Rhinology, Volume 20, Number 6, November-December 2006 , pp. 615-619(5)
Publisher: OceanSide Publications, Inc

Background: A retrospective multicenter study examined the safety of Gore-Tex as a nasal implant in rhinoplasty.

Methods: This study involved 853 patients (656 primary surgeries and 197 secondary surgeries) who had undergone rhinoplasty and used Gore-Tex either at the dorsum or at the nasal tip. Data were extracted from the medical records by surgeons and entered on a standard form. Data included the information about the demographics and history of the patient, method and results of surgery, complications, follow-up, and various factors believed to predispose to complications.
Results: The average follow-up period was 18 months. Overall complication rate associated with Gore-Tex was 2.5% (21 cases). Infection was the most common complication (18 cases; 2.1%) followed by two cases of seroma and one case of persistent nasal swelling. Among the 21 suffering complications, 19 patients (91%) needed graft removal. Nine cases of infection developed in primary surgeries (1.4%) and nine cases developed in secondary surgeries (4.6%), which represented a statistically higher complication rate in those undergoing secondary surgery (p = 0.0062). Infections developed within 1 month in five cases and nine cases developed infection >6 months postoperatively. Other complications including esthetic problems were identified in 16 cases (1.9%).
[color=red][color=red]Conclusion: Gore-Tex should be used judiciously in rhinoplasty because of a 2.1% infection rate, a risk that is higher still after secondary surgery; moreover, once infected, Gore-Tex implants usually require removal.
Document Type: Research article
DOI: 10.2500/ajr.2006.20.2948[/color]


Problems of Expanded Polytetrafluoroethylene (Gore-Tex(R)) in Augmentation Rhinoplasty.

Yang SJ, Lee JH, Tark MS.

Dr. Yang's Institute of Rhinoplasty, Korea.
Department of Plastic and Reconstructive Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea.

Augmentation rhinoplasty is one of the most popular aesthetic procedures in Asians. Numerous alloplastic implants have been used, however alloplastic implants may cause many problems in nasal and perinasal areas because of thin soft tissue cover. For these reasons, an ideal implant should be nonpalpable, readily exchangeable and biocompatible. Among these alloplastic implants, Gore-Tex(R) is a polymer of carbon bound to fluorine composed of solid nodes connected by very fine fibers. It has been reported that this material become permeated and surrounded by mature connective tissue, forming a strong supporting envelop for the material, yet the implant is easily removed because of limited tissue ingrowth. Since it's development, Gore-Tex(R) has found many applications in the field of facial plastic and reconstructive surgery. From November, 2001 to December, 2002, Gore-Tex(R) implants were removed from 17 patients due to several problems such as; decreased dorsal height, tip deformity, chronic inflammation. The implants were very hard to remove and coinciding injury of the surrounding tissue were inevitable. An analysis of the length and thickness changes in these removed implants was made. The results showed, decrease in length and thickness with a volume loss averaging, 46.3% in 45x4.0mm implants, 49.3% in 50x5.0mm implants. In view of the experiences of 17 cases of Gore-Tex(R) implants in rhinoplasty, we have concluded that Gore-Tex(R) implants were structurally unstable, fibrovascular tissue ingrowth into pores were minimal, the implants were very hard to remove and the implants caused a postoperative volume reduction. Therefore, Gore-Tex(R) use in augmentation rhinoplasty should be approached with caution.
[/color]

Michale Crown
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Postby Michale Crown » Fri, 03 Aug 2007 9:16 pm

What are the charges for plastic surgery in Thailand .???? :wink:

WAsadeha
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GOOD COSMETIC CLINICS RHINOPLASTY IN JOHOR BAHRU M'sia

Postby WAsadeha » Fri, 03 Aug 2007 10:07 pm

As above, seen a thread on KALO any more to add on?

Price is abt 2000+ SGD from what i read.? is this abt Singapore pricing?



how do u guys find msia compared to Bangkok|?

who
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Postby who » Sat, 04 Aug 2007 3:58 am

kwell,

i know you went to Jung...but did your friends go there too?

keenose
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Postby keenose » Sat, 04 Aug 2007 3:42 pm

who wrote:kwell,

i know you went to Jung...but did your friends go there too?


yeah Kwell... please let us know which doctor did your friend's nose.
New nose please~

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Postby candall » Sat, 04 Aug 2007 3:53 pm

hi kwell

thanks for sharing the report
your friends and yourself ok now?
dont worri too much k
afterall you r still recovering,
as one of us here put it, PS is a phase of emotional roller coaster

kwelll
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Hi

Postby kwelll » Sat, 04 Aug 2007 7:59 pm

Hi ladies,

Glad you managed to read the report, it is a fairly recent one so I thought it must be of relevance to most of you, especially those who are thinking of having a rhinoplasty.

My Korean's friend (Handsome) last nose job was performed by Dr Jung using rib cartilage as graft on his bridge, there was no tiplasty as he had his tip scultped by a few other surgeons (he started off with a huge nose). He had removed his silicone pillars with Dr Jung and opted for his own rib as support thereof.

Before I left him, his nose was in good shape, although still swollen at 2 weeks. At 4 weeks he told me most of the swelling is gone because he takes pictures of his nose daily for record /comparison except his tip which is understandably still swollen but still not as much as before. What puzzled me is that his radix (highest point of his height) has dropped and followed by a curve instead what it used to be. I must confess the curve is way off tangent and alittle much for my acceptance,never mind his. LoL... it looks weak and very slopy - i wish i could post his photos to illustrate my point unfortunately I cant. I have also drawn an imaginary line beside his bridge just to show the degree of curvature - its shocking.

I suspect the cartilage is not big enough to augment his rather large nose bridge and his tip is not sufficiently projected with DEFINITION. Warping can happen at any time post operative and this must be rectified immediatey. From my experiences, I am reasonably certain his tip might get smaller by 10-15% top side in 1-2 mths time BUT .. the degree of projection and definition might not be there [deswells & settles, everything else loses volume] unless his cartilage work was made very strong with extra emphasis on his tip support and collumela strut. From my own reading and research, rhinoplasties fail because of a lifelong scar contracture affect that tends to narrow and collapse the nose, especially secondary cases.

In fact, his result is more disappointing than mine but he will revisit Dr Jung again. As for my case, it is now confirmed that it is slightly deviated and somewhat wider than it should - tip same as before. I really cannot imagine how cartilage can grow to 5-10 mm unless rib cartilage is used.
Without undue disrespect to Dr. Jung because I do like him as a person, I am sorry but this is a big NO-NO.

It is my opinion that whilst cartilage grafts can augment noses quite well with much less complications, the final outcome remains fairly uncertain as cartilage grafts do change in size and thickness once settles albeit not always the case. It is therefore common that the bridge of such augmentation may not be as smooth or uniform in appearance as those of silicone (doesnt change shape or size or thickness at all). However, autologous implantation does give patients a rather natural look to the nose viewed in totality. The question is how well you wish you nose to look.

It is therefore said that rhinoplasty remains the most skill demanding facial surgery of all time and he who masters tiplasty masters rhinoplasty.
Please take note that the above was written in good faith and the opinion of mine only.
Last edited by kwelll on Sat, 04 Aug 2007 8:41 pm, edited 1 time in total.

mynose!
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Postby mynose! » Sat, 04 Aug 2007 8:38 pm

KWELL...thnkas heaps for your info on your friend...quick qns..i;m not sure i understand what you mean by radix and the off line tangent?....think u can send us a phtos but cover his eyes?...that way his identity is unknown?...

i didnt know that bridge augmentation could increase the height your radix..i thought it changes the height of ur bridge only?

\Now that you tell me about Dr.JUng im having second thoughts about going to him in dec...if you had the chance would u go back to him or would you rather choose another surgeon


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