Implants in rhinoplasty, or nose reshaping surgery, can be made from silicone or silastic, Gore-Tex, Medpore, or biologically derived materials such as rib cartilage from a rib bank. While they can produce good results long term, the consensus among surgeons is to always consider the patient’s own tissue as the first choice.
Autologous materials or living tissues, which are derived from the patient’s septum (wall between the nostrils), behind the ear, or rib, have a lower rejection and infection rate compared to synthetic implants. But sometimes, one’s cartilage is too weak and soft to produce the desired and most stable results.
Patients of Asian and African descent typically have weak cartilage, and individuals needing a revision rhinoplasty after the initial surgery depleted their cartilage supply could achieve better results with implants.
Interestingly, Asians and Africans—two ethnic groups who often require synthetic implants in rhinoplasty—are typically good candidates because their thick nasal skin minimizes the risk of extrusion and visibility. Caucasians, meanwhile, generally have thin skin that could expose them to such risks.
In patients with thin skin and have depleted or weak cartilage, implants in rhinoplasty should be combined with soft tissue thickening graft such as Alloderm or temporalis fascia to avoid or at least minimize risk of extrusion and visibility.
Leading Orange County plastic surgeon Dr. Tarick Smiley says rhinoplastic patients today have many options in terms of synthetic implants and autologous materials; in fact, these are sometimes combined to achieve the most stable and most desirable results.
In the past, silicone or silastic implants were the only choice. While some surgeons still use them up to this day, others deliberately stay away from them due to the higher rate of infection, protrusion, shifting, and visibility.
However, newer implants in rhinoplasty are designed to promote tissue ingrowth. For instance, Medpore and Gore-Tex are porous materials that they literally become part of the nose; hence, the risk of shifting and rejection is significantly diminished.
While Medpore and Gore-Tex allow tissue ingrowth, silicone implant does not allow such process to occur. The body simply creates a scar capsule around the material where to a certain degree it can shift or move inside.
Studies have already proven the reasonable safety and predictability of Medpore and Gore-Tex, making them a viable alternative to autologous materials or living tissue. However, smokers, diabetic patients, drug abusers (particularly cocaine users), and individuals with reduced immunity function are poor candidates for any type of synthetic implants in rhinoplasty.