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.