We were asked today what we think about using Goretex in the nose. This is a great question and always a ‘hot button’ issue of debate at Facial Plastic Conferences. Some surgeons are very dogmatic about such topics but, often, one may find that they have an agenda to push. We have a nuanced view of foreign implant materials.
In almost every case, we believe that you are better off with an implant using your own tissue, if at all possible. Cartilage is an ideal implant, whether from the septum, ear, or rib. Bone, on the other hand, doesn’t fare so well in the nose since much of it resorbs over time. We must recognize that there is a trade-off with everything…your own tissue (other than septum) requires a separate surgical site with all that goes along with that.
That’s why foreign implants are enticing. They are in abundant supply, do not require any other operative sites, and often cut down on operative time. But, there are also risks of infection, migration, rejection and exposure. There are many types of implant materials available. Of these, Goretex is a good one, and has its uses. The type of Goretex used in the nose is a thin sheet that is soft and pliable. It leaves a nice, smooth contour when contour is what the doctor ordered. But, because it’s so soft, it doesn’t do much for support. We have used it from time to time for dorsal augmentation when a lot of augmentation is needed, especially in thick-skinned patients, with very satisfying results. Studies, including one by one of our mentors, show that it is well-tolerated with a low complication rate. Problems can increase when it is used in the setting of a septal perforation, so this should definitely be avoided. So, while we are admittedly biased towards cartilage grafting, we like to keep our minds open and our ‘bag of tricks’ full…you never know when you’re going to need to dig deeper.No comments
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