In the last couple of weeks, we have seen several patients seeking revision augmentation rhinoplasty who have had silicone or medpor implants previously placed in the nose. These have become warped and displaced and are in need of revision.
Here at Profiles, we are fans of silicone rubber (silastic) implants for chin, cheek, and jaw augmentation. But, for the nose, we much prefer to use your own cartilage for augmentation, if available. Why is that?
There are several good reasons for this philosophy:
1. Chin, cheek, and jaw implants are ‘contour’ implants; that is, they are placed only to improve the overall contour of the cheek or jawline. Whereas, nasal implants must improve contour while also providing structure, definition, and support to the nasal bridge and tip. And, cartilage does a better job of that.
2. The skin, muscle, and fat covering the chin and cheek areas are quite thick whereas these same soft tissues overlying the nose are quite thin by comparison. One risk of a foreign implant is the possibility that it may place pressure on the nasal skin and further thin it over time, especially in the tip area, risking exposure of the implant. Also, in areas of thinner skin, implants can sometimes appear more visibly obvious. Again, cartilage is not a risk here.
3. Moreover, the chin and cheek skeleton is made up of a large continuous bony surface, areas that lend themselves well to coverage by a large solid implant. The nasal skeleton, on the other hand, is made up of an intricate group of cartilage structures that give the nose its unique surface appearance. For this reason, a single lump of silicone can look unnatural in the nose. Cartilage grafts can be tailored to more naturally reconstruct this elaborate topography.
4. Cartilage is desirable for other reasons, including a lower risk of infection and tissue rejection, since it is your own tissue. We also suture cartilage grafts in place so the risk of migration or displacement is minimized.
The end result? You have the best chance of getting a great rhinoplasty result that lasts for a lifetime. Read more about this and other rhinoplasty topics in our online Modern Rhinoplasty text.No comments