Does Silastic Implant for Rhinoplasty Look More Fake Than Cartilage?

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.

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.
Regards

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!

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.

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 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.

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

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.
best,
sml

Silastic nasal implants are used quite often for dorsal augmentation in rhinoplasty.  They can extrude over time and if this happens, they need to be removed.  There are other products that can be used including your own rib or septal cartilage of even irradiated cartilage from a cadaver.

My doctor said I do not have enough cartilage on my ears and I also do not want a scar on my breast. - I assume you need a nose augmentation. This is commonly done with an on lay graft on the top of the nose. Apparently, your surgeon felt that harvesting cartilage from the back of both ears would not be sufficient and felt that harvesting rib cartilage (through an under the breast incision) may be called for.
BE AWARE - Grafts from your OWN body (AUTOLOGOUS) have the longest track record for safety and duration.
Will silastic implants look more fake? Because they outlast your own tissues, they gradually and contoinously exert pressure on the overlying skin causing the fat under the skin to go away. Then - they thin the skin itself making the implant outline to become very obvious and eventually they poke through the skin and become exposed. The which point if they are not removed they become infected and can cause greater nose destruction.
Will silastic implants last a lifetime? Hardly ever. The above sequence happens in the vast majority of people. It happens much faster in Caucasians than in Asians and African skin which is thicker in whom it may take years but eventually the vast majority of silastic (silicone) nasal implant have to be removed.