Which is Best for Bridge: Goretex Implant Vs. Rib Graft Vs. Ear Graft?

Question

I went to a doctor for rhinoplasty- he told me he was just going to refine it a little and take very little off.He said no one would even notice. I did not know he was going to scoop out my bridge and take my tip off my nose- now I have an upturned- scooped out- short nose-small nose- with nostrils showing,crooked-and does not look like it fits my face. Doctors that I have seen want to use different grafts and I am confused-I hear good and bad about these different graft materials -Please help,Thank you

Kenneth Hughes, MD · Answer

I would use septal and ear cartilage before rib, and rib cartilage before Goretex.

Kenneth Hughes, MD

Los Angeles, CA

Ivan Wayne, MD · Answer

Your situation is difficult. Without seeing photos of you it is hard to guess how much work is involved in correcting your problem. Usually in cases like yours there is a significant loss of supporting cartilage, that is why the tip turns up. In that case you will need cartilage to repair and rebuild the bridge of your nose. 
Gortex has no strength so it is not a good choice for a structural rebuild. Ear cartilage is fairly short and doesn't have the stiffness needed to push the tip back down. My number one choice in a case like yours is rib cartilage. I use it rebuild what is missing and try to restore a natural shape. Septal cartilage could be used in a similar fashion if you have any left. 
The most important thing for you is find a skilled and experience rhinoplasty surgeon who can handle a case like yours without making it worse. I hope this helps.

Toby Mayer, MD · Answer

I feel that any of the materials you mention can work well. I do not like using gortex or any foreign material in revision noses. In 35 years of revision rhinoplasty, I have used septal and ear cartilage. It is your own material and does not have the pain associated with rib grafts.

Michael A. Persky, MD · Answer

Hi Mermaid,
Sorry to hear about your rhinoplasty unsatisfactory results.  It is so very important that patients and rhinoplasty surgeons communicate in an exact manner before surgery.  Many times computer imaging is an excellent tool to clear up any miscommunication about the degree of profile reduction or augmentation.  At this point you should consult with a few rhinoplasty revision experts (as well as your original surgeon if you still have faith in his/her work).  The type of graft is not as important as the rhinoplasty surgeon who will be constructing the graft and placing it.  Your revision will likely be complicated so choose your rhinoplasty surgeon most carefully.  Good luck and be well.
Dr. P

Eric M. Joseph, MD · Answer

I'm sorry that you had an unfavorable Rhinoplasty experience. I have found that Injectable Fillers are wonderful for adding volume to a nasal bridge that is too low, and for lowering nostrils that are too high.
I am passionate about Revision Rhinoplasty surgery, but if you could get improvement without the inconvenience of additional surgery, that would be preferable. Feel free to email your photos and a description, and I'll be happy to share my thoughts with you.
I hope you find this helpful.

William Portuese, MD · Answer

I am sorry to hear you had such a difficult time with your first rhinoplasty.  It is important to go to a rhinoplasty surgeon who is well versed with revision rhinoplasty.
There are several different grafts available for reconstructing the nose.  Stay away from Gortex implants in the nose since they have a propensity to get infected and we have seen many problems from those implants.

The best option is a septal cartilage graft provided there is septal cartilage still left inside your nose.
The next best graft source would be cartilage from the ear, which can build up the nasal bridge height.  The cartilage may also be diced and placed in the temporalis fascia pocket to augment a large area.
Rib grafts also are acceptable, however, they tend to warp and bend in the postoperative healing phase.
A small silastic implant can be used if you do not wish to use any grafts.

Darryl J. Blinski, MD · Answer

After all the expert answers the one that should impress you is Dr Jack Gunter's from Dallas. He is the true rhinoplasty expert here in the USA. 
From MIAMI Dr. B

Nina S. Naidu, MD, FACS · Answer

Every surgeon has his or her own preference for graft material in the nose, so you'll probably read some different opinions on this. I personally like to use septum if it is available and will provide enough volume. In Asian patients, a Goretex or silastic implant is often necessary. I do not like to use synthetic grafts in Caucasian patients given their relatively thin skin. I reserve rib cartilage for patients who need a large amount on their dorsum, but who are not good candidates for a synthetic graft. Ear cartilage is not as strong as the other options, so I rarely use it. I hope this helps, good luck, /nsn.

Kamran Khoobehi, MD · Answer

It was not clear how long been since your surgery. Please attache pictures and more information. The redo surgery is more complex and you need to wait at least 12 months before and revision. The graft site depends on the amount of tissue needed.

Peter A. Aldea, MD · Answer

The natural instinct of anyone with a substandard result is to immediately have it "fixed". This may often result in a worsening of the result which may make return to normal much harder. At this time, I would not spend as much time pondering the choice of dorsal implants. I would instead spend a lot of time choosing several qualified nose surgeons who like to do revision nose surgery.
Fixing your nose is NOT as simple as sticking a graft under the skin and walking away. It may require reversing several factors. I suspect you may need SPREADER GRAFTS to both lengthen the foreshortened nose and de-rotate (push down) the tip. Augmenting the dorsum is another issue.
After taking the time to visit several such surgeons, you will be able to understand all of your options including which implants goretex implant vs. rib graft vs. ear graft may be best for you. Most Plastic surgeons would stir you towards your OWN tissues instead of synthetic ones.

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