The Profiles Perspective: Our Belief that Synthetic (Alloplastic) Materials Should Not Be Used in Rhinoplasty
At Profiles, we have always held the standard and belief that when doing rhinoplasty and revision rhinoplasty, there is a hierarchy we can follow when grafting material is needed. Ideally, whenever possible, we use septal cartilage. It allows us to replace any missing cartilage or to build support using tissue that is essentially identical to the normal cartilage we find in your nose. In some cases, the septal cartilage is too thin and flimsy and unsuitable for use; even in primary cases. And in revision rhinoplasty, the quantity and quality of remaining septal cartilage may be inadequate for reconstruction.
However, even in cases when septal cartilage is not suitable or insufficient for our needs we have always felt that synthetic materials are the last and least desirable option. As long ago as three years ago we originally posted a couple of blogs about the use of synthetic implants and why we don’t use them:
Most recently, we blogged about our preferred option of irradiated rib cartilage and highlighted why we think it is a great option:
Of course, this all becomes more relevant in light of the newest study in the Archives of Facial Plastic Surgery by a number of well respected rhinoplasty surgeons who reported there retrospective analysis of almost 700 patients whom they operated on over a 9 year period. What they found was that of the 151 cases in which a synthetic material was used- in their cases they used either porous high density polyethylene (Medpor) or expanded polytetrafluoroethylene (Gore-Tex)- almost 13% of the patients developed an infection. Even more compelling was there finding that almost all of these patients who developed an infection went on to have extrusion of the implant- meaning the implant started breaking through skin or mucosa and was exposed. In these cases, the implants would then have to be removed and the nose revised.
This is an important study because oftentimes patients are led to believe that synthetic materials are a safe and effective alternative. While it is true that this study defines the experience of only 3 surgeons at one institution, it is our belief here at Profiles that because better alternatives are available it is almost never necessary to use synthetic materials in the nose.No comments
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