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Silicon Bridge and Irradiated Coastal Cartilage for Tip Projection?

asked 2 years ago by pumpkin84 in Aisa
Latest answer by Roy A. David, MD
Question viewed 1,049 times
Tags: nose

I am considering a revision rhinoplasty. However I am having big headache to choose an appropriate material for the revision surgery, since self cartilage could not promise a good result in long term due to its reaborption problem.

Could I use silicon implant to augment my bridge and irradiated costal rib for the nose tip support? Compared with autologous costal rib, would irradiated costal rib have a higher absorption rate? Can you please shed some light on this matter? Thanks

22 answers to Silicon Bridge and Irradiated Coastal Cartilage for Tip Projection?

+2

Choosing a Grafting Material for Revision Rhinoplasty

There are many choices of grafting materials when considering revision rhinoplasty. Allografts are obtained from your own body and can include septal cartilage grafts, ear cartilage grafts, and rib cartilage grafts. Sometimes donor rib cartilage from a cadaver (that has been irradiated) may be used as well. Foreign material (implants) are also available in silicone/sialastic, ePTFE (Goretex), and medpor.     Each material has its advantages and disadvantages. I base my... more
Jacob D. Steiger, MD

Boca Raton Facial Plastic Surgeon

www.drsteiger.com

+2

Natural cartilage is a good grafting material

The benefits of using the patient's own cartilage in nasal reconstruction are significant.  There is no risk of transmitted virus (known or unknown), less risk of infection/extrusion/overlying redness.  Rib cartilage can be shaped to obtain a very good reconstruction.
Robert Mounsey, MD

Toronto Facial Plastic Surgeon
+1

Implant materials for Revision Rhinoplasty

In the tip, it is generally best to use autologous material: septal or ear cartilage, as implants in this area tend extrude or look unnatural. In primary rhinoplasty in Asia silicone tip/bridge implants have been used with some success but this could be risky with thin skin in a revision rhinoplasty. Personally, I prefer gortex to silicone in the bridge/ I find it more natural looking and feeling and have had no problems with mobility or extrusion/ infection.
Roy A. David, MD

San Diego Facial Plastic Surgeon
+1

Implant Materials And Reabsorption

Each material has distinct benefits and disadvantages.  I have a strong preference towards autologous (your own body's tissues) then the use of a foreign implant.  Autologous tissues have better tissue integration and less chance for infection than a foreign body.  The downside of autologous implants is that the patient has to have a donor site (i.e. rib or ear cartilage) to recover from as well. Foreign bodies have a higher risk of infection and extrusion than... more
Anil R. Shah, MD

Chicago Facial Plastic Surgeon
+1

Which dorsal augmentation material to choose?

Silicone is not a popular product in the U.S. due to concerns regarding extrusion and infection. Certainly, if you require improvement to your nasal tip support sticking with cartilage would be ideal. Autologous (your own) cartilage is the ideal source for this and depending on how much augmentation is desired septal, ear or rib cartilage are options. In experienced hands autologous cartilage has been shown to be very durable with excellent longevity. An important point regarding... more
Thomas A Lamperti, MD

Seattle Facial Plastic Surgeon

www.drlamperti.com

+1

What Material to Choose for Revision Rhinoplasty?

I would recommend staying away from any alloplastic material such as silicone. In my years of doing revision rhinoplasty, I have had to remove quite a few silicone implants due to problems with contour and infection. Irradiated costal (rib) cartilage is not a poor choice for rebuilding your bridge and tip as long as your surgeon is experienced in its use. Autologous costal cartilage is perhaps a better choice since some reports indicate less resorption and warping when compared to... more
John M. Hilinski, MD

San Diego Facial Plastic Surgeon

www.drhilinski.com

+1

Irradiated rib grafts for rhinoplasty

I would caution against using an artificial material such as silicone along with irradiated rib.   Irradiated rib has been shown to be long lasting, with a low risk of resorption or warping.  A recent landmark study by Dr. Kridel et al showed excellent results over 20 years using irradiated rib grafts:  Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose  Russell W. H. Kridel, Faramarz Ashoori, Edmund S. Liu, Carol G. Hart... more
Matthew Bridges, MD

Richmond Facial Plastic Surgeon
+1

Rhinoplasty with Implant and Rib Graft

There's a lot of missing information here. How many surgeries have you had? What was done to the nose? What are your remaining concerns and how significant are they? What septal or ear cartilage do you have left? After a good consultation or two or three, you should have a good idea of what will work well for you. I have been favorably impressed with dorsal implants if they are placed properly. I have combined these with autogenous cartilage grafts many times with no problems.... more
Jon F. Harrell, DO

Miami Plastic Surgeon
+1

Ideal tip graft choices

Revision rhinoplasty surgery is a rather difficult procedure, performed best by a talented, skilled and experienced Rhinoplasty surgeon.  You need to be able to trust your surgeon as to the best material to use.  In general ideal choice in revision rhinoplasty is autologous cartilage ( septal, ear or rib).  These grafts, if well executed, tend to have the lowest rate of resorption and distortion.  Silicone implants in revision rhinoplasty typically do not lead to a... more
Boris M. Ackerman, MD

Newport Beach Plastic Surgeon

www.doctorackerman.com

+1

Irradiated rib cartilage is a poor choice for rhinoplast

Irradiated cartilage will resorb in time and will warp if there is any pressure on its structure before the resorption occurs.  Septal and ear cartilage are better choices.  For structural support, I like a very thin sheet of medpore that is easly tailored to the needs of the patient and comes out of package.
Vincent N. Zubowicz, MD

Atlanta Plastic Surgeon
+1

Silicone, Irradiated Rib, and Revision Rhinoplasty

There are many reasons why alloplasts like silicone have not been favored by North American surgeons.  If you are young, the material has to be stable over your lifetime.  Any foreign material can lead to complications many years after implantation, so the safes material is your own.  Irradiated rib is an alternative, but the literature is divided on its effectiveness in the long term.  I recommend only your own body's materials when possible; ear cartilage is often a... more
Minas Constantinides, MD

Manhattan Facial Plastic Surgeon
+1

Grafts are better than implants

As a general rule of course. North American surgeons have not embraced implants and they remain unpopular. This is because infection rates are significant and can occur even years later such that we wonder if the infection rates is under estimated. Furthermore extrusion rates are not rare and may lead to permanent scaring. That said they more easily create a pleasing aesthetic result and are easier to use. More surgeons are most comfortable in recommending autologous cartilage. more
Oakley Smith, MD

Toronto Facial Plastic Surgeon

www.droakleysmithrhinoplasty.com

+1

Revision rhinoplasty options for rib graft and silicone nasal implants

Revision rhinoplasty with grafting, whether autologous or alloplastic, has risks that relate to extrusion, infection, and absorption profiles of each graft.  I would recommend autologous graft placement but this is clearly a matter of surgical preference and expertise.  In my practice, autologous grafting provides the highest satisfaction with minimal risk. 
Raffy Karamanoukian, MD

Los Angeles Plastic Surgeon
+1

Choosing the materials for a revision rhinoplasty

As you are learning, a revision rhinoplasty can be a complicated surgery. Not only does your surgeon need to work to establish your aesthetic goals, but they are also wrestling with the scarring and deformities caused by your previous surgeries. Many times in patients such as yourself there is not sufficient good-quality tissue to create a great result. In these cases, surgeons may decide to use a variety of materials. For your best results, you should consider using materials that come from... more
B. Pat Pazmino, MD

Miami Plastic Surgeon
+1

Revision Rhinoplasty and Silicone

I would recommend you see an experienced rhinoplasty surgeon to discuss your options.  In my opinion, silicone implants have little use in modern rhinoplasty.  Silicone implants are prone to infection, displacement, and even erosion through the skin.  Irradiated costal cartilage is a better option, but would suggest you consider your own tissues.  Have you ever had cartilage grafts harvested?  If not, I would suggest you use your own ear or rib cartilage. ... more
Gregory Pippin, MD

New Orleans Facial Plastic Surgeon

www.pippinmd.com

+1

Your own cartilage is the best option

Autologous (your own) cartilage is by far the best long-term option for revision rhinoplasty.  Autologous cartilage is less likely to resorb but may still have partial resorption over time.  Implants can sometimes be an OK option for the bridge but it depends on the specific situation.
Sam Naficy, MD

Seattle Facial Plastic Surgeon

seattleface.com

+1

Rib with rhinoplasty

Rib cartilage is good for tip support. When taking rib, I use diced rib cartilage and the perichondrium from the rib. In regards to absorption, irradiated rib from a cadaver may absorb, but your own rib will not absorb. Hope this helps answer your question. Thank you and best of luck.
Paul S. Nassif, MD

Beverly Hills Facial Plastic Surgeon
+1

Silicone vs Cartilage for Nasal Augmentation

In the United States few surgeons favor the use of silicone for nasal augmentation because of the risk of extrusion. For the past 35 years I have used autologous cartilage. A few excellent surgeons have  reported good success and minimal resorption with irradiated cartilage. Chose an experienced surgeon and rely on his/her recommendations.
Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon
+1

Best graft material for rhinoplasty

The best graft material is autologus grafts. Therefore the best graft for you would be your autologus rib cartilage graft. In the long term the results are best and the complication rates are the least.
Samir Shureih, MD

Baltimore Plastic Surgeon
+1

Dorsal onlay products for the nose

Silicone implants for nasal augmentation is not a preferred product in the US.  Autologous cartilage is the best cosntruct.    Irradiated cartilage is a reasonable alternative.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Silicone and irradiated costal rib cartilage for nasal implants

Although silicone bridge implants are popular in Asia, they remain unpopular here in the USA. Irradiated rib cartilage has a long and controversial history with some surgeons reporting excellent long term resutls and others expressing their dissatisfaction with long term maintenance of volume
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+1

Silicone implant for the nose

In general I would not place silicone in the nose. it will never revascularize. Irradiated costal rib has the benefit of no extra incision and recent  studies show that in most cases the tissue revascualrizes. Autologous tissue can be used, as mention there will be an extra scar. As far as resorption, expect some resorption with both autologous and irradiated costal rib. autologous will probably resorb less but if both grafts revascualize there shouldn't be much difference in the end... more
Sharon Theresa McLaughlin MD

Long Island City Plastic Surgeon

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