Silicon Bridge and Irradiated Coastal Cartilage for Tip Projection?

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

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22 Doctor Answers | Asked by pumpkin84 in Aisa

Doctor Answers (22)
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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

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

80 reviews

Seattle Facial Plastic Surgeon

www.seattleface.com

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

17 reviews

Boca Raton Facial Plastic Surgeon

www.drsteiger.com

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

5 reviews

Toronto Facial Plastic Surgeon

revesse.ca

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

11 reviews

San Diego Facial Plastic Surgeon

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

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

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

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

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