I am thinking whether or not to have a nose surgery. My doctor said I do not have enough carilage on my ears and I also do not want a scar on my breast. Will silastic implants look more fake? Will silastic implants last a lifetime?
Does Silastic Implant for Rhinoplasty Look More Fake Than Cartilage?
Doctor Answers (13)
No longer use Silastic Implants. I now prefer Gore-Tex (or ePTFE)
I used to do a ton of very slim profile silastic implants but I found that they tend to become shrink wrapped over time where you could see the edges of the implant. I also had problems with extrusion.
Cartilage may be a viable option. However, I have found that the edges can become visible over time and there is not enough cartilage to build a bridge smoothly with it.
For ethnic noses (like the Asian nose), I prefer to use Gore-Tex sheets that are preformed that I also crimp and smooth the edges out. Today, Gore-Tex is no longer made by Gore for the cosmetic market. They still make them for the cardiac (heart) market. I get my supply from Surgiform or Implantech.
Here is a video on Asian noses that might help flesh out my view points.
Avoid implants in the nose.
Most experienced surgeons will tell you that silicone implants with rhinoplasty are associated with a lot of problems such as extrusion and malposition and infection. You are much better off with your own tissues
Silastic vs. cartilage
It sounds as though you need dorsal augmentation. I do not know if you have had previous surgery on your nose which may have an effect on the answer.
First of all assume nothing lasts a lifetime and will need to be changed in terms of implants or grafts. I do use both depending upon the deformity in the nose. If there is adequate soft tissue in the nose and no previous scarring from a rhinoplasty I start with a silastic or silicone graft. These do change over time and will probably need revision. If a patient has thin skin or scarring I prefer autologous tissue sometimes covered with an acellular dermis like alloderm to hide the edges and thicken the skin.
If you are unsure why not go on a second consultation and seek a second or even a third opinion, after all, you will be living with this for a long time. Good luck.
Steven Schuster MD FACS
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Silastic nasal implants in rhinoplasty
Silastic implants have been used rhinoplasty with good success. The are used most commonly during Asian rhinoplasty, where an augmentation of the bridge is desired. However, the problems with these implants are related to extrusion and, in some cases, an unnatural appearance. The unnatural look is a result of an obvious edge along the side that starts to show several years after the procedure. My personal preference is to use cartilage in most cases. For the bridge of the nose, I like to use diced cartilage grafts wrapped in fascia. In cases were a limited supply of cartilage is available, Gortex sheets are an excellent alternative.
I find it very difficult to believe you do not have enough cartilage on your ears (plural) and/or septum. If your deficit is that large, it is most likely you will need a substantial graft which is traditionally your rib (hip bone and skull have also been used).
The size of comparable silicone or PTFE (gortex) or polypropylene (medpor) implants to achieve a comparable augmentation would most likely make it more prone to complications, either visibility or rotation, encalpsulation, extrusion, body erosion, etc. Silicone is probably the most coomonly used material and therefore it s complications are frequently described. It is not likely to be permanent. The search for the perfect implant has gone on for over a 100 years. People have even used ivory. However, the perfect implant has not been found. Implants which are the "rage" today may not prove to be ideal in the future as complications arise.
Nasal implant for rhinoplasty
I have successfully used preformed nasal implants for years, but to answer your questions:
1. I would not plan on anything lasting a "lifetime".
2. Whether cartilage, bone or a pre made nasal implant are used, the skill and judgement of the surgeon is the primary factor. ie. the most important part of getting a good result, is the surgeon you choose.
Silastic implant for rhinoplasty comparable to cartilage
Silastic implants are very natural-feeling and feel just like a cartilage implant to the nose. They work best with Asian rhinoplasty. They do tend to last a lifetime and generally do not need to be removed or replaced.
Silastic Implants in the Nose
Done properly, neither silastic or cartilage grafts should look unnatural. I prefer cartilage grafts because they become incorporated in the surrounding tissue and last a lifetime. The problem with large silastic imlants is with time they may shift, extrude through the skin, or the edges may become visible. The breast scar after harvesting rib cartilage is usually very small and inconspicuous.
Silastic Implants Look & Feel Natural in The Nose
Silastic implants look and feel natural. The only issue is the longevity and the possiblity of implant extrusion over time. The risk of that is low for primary (first time) rhinoplasty.
Your reasons for not having rib or ear cartilage used are sound. If the silastic implant fails then you can think of using rib cartilage as a back up.
Implants for use in rhinoplasty
You ask very good questions. Silastic and silicone implants carry with them a risk for extrusion and exposure with rhinoplasties. They may look natural, but using your rib cartilage would also look natural without the high risk of exposure. The incision to remove the rib may not be as noticeable as you would expect. Therefore, take into accout all of the risks and benefits of each choice before making your final decision. Good luck!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.