I like cartilage

I think that your own nasal or ear cartilage is the best implant materiel. This is always a difficult problem and there is no one answer, but I do not like alloplastic materials.

The choices for nasal dorsal (bridge) implants are many. First you need to decide if you want a foreign, yet compatible material. The best of these are Medpor, Gortex, and Silastic. Each surgeon has their own personal favorites and can discuss the pros and cons of each.

Many of us also like to use the patent's own cartilage. Again, the choice is nasal septum, ear cartilage then rib cartilage. Septum is easiest but often not long enough, especially in revision cases. Ear is not my favorite since it is soft and curved. Rib is excellent but can warp. What we do now as well is diced cartilage wrapped in your own fascia. Again, discuss with a qualified revision rhinoplasty expert to get the best choices.

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Hi John,

As mentioned there are several  "non-warping" implants on the market, they include gortex and silicone implants (medipore is also available but I do not recommend its use) as well as some others.

Its also very important to make a precise pocket in the right plane for an implant to be stable. Its should also be sutured to the tissue underneath it so it doesn't move.

So the choice of implant is only part of the story; the implant must be placed in the right tissue plane in order to prevent it from moving.

I use a silastic custom carved implant I call the SLUPimplant. 

Best,

Dr.S.

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John

There are many options to augment a nasal bridge, each with its pros and cons. There is no perfect solution.

1.  Cartilage: septal cartilage is ideal when sufficient cartilage is available. This is not always the case in revision cases. Ear cartilage tends to warp as well as resorb.

2.  Rib cartilage works well but can warp and there is more donor site morbidity/downtime.

3.  Alloplast implants i.e. medpore, gortex, silastic work well but have a higher risk of infection and potential extrusion in the future. These are very popular because they are readily available and easy to use.

Your surgeon will assess your particular need and determine which implant is best suited for your nose.

Good luck!

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Hi, this is a tough problem and every surgeon has his or her own opinion on what is best.  Most of us prefer to use the patient's own cartilage if it is available.  Other implants include silicone and Gortex which are both man-made and permanent.  I personally only use these if I have no other choice and if the patient's skin is thick enough to reduce the risk of extrusion of the implant.  I would recommend seeing a rhinoplasty surgeon with experience with revision rhinoplasty.  Good luck, /nsn.

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