Medpor, Gore-tex and Banked Carlilage for Building the Bridge w/ an Asian Revision, Which is the Best? (photo(
- Asked by SS IN NY in Astoria, NY
- 2 years ago
I need a revision asap. Year 1996 had a L-shape silicone implant, It was straight and fine. Year 2006, in order to avoid extrusion (never happened by then), dirtectly add a ear cartilage on the tip without removing the silicone. Right after that, the tip looks funny, crooked and bumpy. As time passed by, the tip skin gets thinner and tighter(too much pressure). The cartilage edge and a white spot on the tip is very noticiable. Can't wait to take everything out and get a better permanant one.
L - Shaped Silicone Implants
In my practice I remove alot of L shaped silicone implants from my ethnic patients. The problem is that they create the deformity that you have and can also create other problems such as pollybeak deformity and tissue necrosis. Some the implants are not even placed in the right tissue plane which makes for easier extrusion. The best solution is to have this implant removed and put a custom carved silicone implant for dorsal ( bridge elevation). The use cartilage to create a more refined tip. You can definitely have a better result.
Web reference: http://www.africanamericanrhinoplasty.com
Seconday Nasal Reconstruction with Rib Cartilage
You have now come to the point where the concept of using any form of synthetic material for your rhinoplasty has now passed. Once your tip skin has thinned as yours now has, you should only be considering using your own cartilage as a replacement. Any other material, even including any form of homograft cartilage irradiated or otherwise, is not likely to be successful. Even the use of your own cartilage must be done carefully to not put any pressure on the thin and fragile tip skin.
Web reference: http://www.eppleyrhinoplasty.com
Asian nasal implant
As you know by now, L-shaped silicone nasal implants can be a real problem with thinning of the tip of the nose from the unyielding pressure of the non-living implant. This thinning is unfortunately compounded by the normal thinning of your own tissue over the past 15 years. The ear cartilage that was added underneath the tip for tissue padding may have also added to the pressure on the overlying skin. You are correct that you need to have the implant removed and replaced. My best advice would be to seriously consider using your own cartilage for tip support: septum, ear, or rib. Anything else is a shortcut that might or might not be appropriate under other conditions, but at this point you need the best replacement available. Iit sounds as though you might be near a threatened extrusion or exposure of the implant. That would be unfortunate indeed because the implant would need to be left out for several months and you would have permanent scarring on the tip of your nose. You are on the right track. Please see a plastic surgeon with the appropriate skills. This can be handled if it is treated before there is implant exposure. Good luck.
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Replace your silicone implant with your own tissue
You need to be examined by the surgeon to determine the best course of action. If the size of the implant is not too large, you may be able to use ear cartilage and septum to rebuild your nose. Otherwise, you may have to resort to harvesting rib cartilage. The may difficulty will be the damage to your skin from having an implant leave it's impression on the undersurface.
Implants in nose
This may be very difficult to treat if the skin is very thin because there is a risk that the skin over the graft may slough( not heal). If it can be removed other dorsal grafting may be better like using your own rib cartilage or irradiated cartilage.
Diced cartilage fascia (DCF) for dorsal augmentation
Using tissue from your own body is safer than any synthetic implant. It will become fully incorporated into your nose and provide a permanent result. Silicone and Goretex remain as foreign bodies within your nose, and will carry a risk of infection, migration and extrusion as long as they are in place.
I prefer to use diced cartilage wrapped in fascia to build the bridge and cartilage grafts to build the tip.
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.