Best Implant for Asian Rhinoplasty?

I just saw this question and thought I'd chime in with an answer that is contrary to many of the answers here:

In my opinion, the best implant for the nose is to never to use an implant in the nose, but rather to use your own materials. Look elsewhere here on RealSelf as I have several answers as do others that discuss cartilage grafts and diced cartilage grafts for augmenting the nose.

Hope this helps,

Nick Slenkovich, MD FACS

Thanks! That’s a great question I get asked rather often. Using a silicone for augmentation of the nasal dorsum (bridge) does not narrow the nose physically but it does give the illusion of a narrower nose as the bridge is projected. To truly narrow the nasal bone, one would have to do osteotomies to move the bones closer. I hope that answers your first question. See your plastic surgeon and ask for sizers to try so you can see how the implants look. A wider implant can prevent this problem. There are also 3D Simulations by Crisalix which can be used during consultation to simulate the final result of the surgery. Yes you have rightly pointed out that one of the risks of using a silicone implant is that it may shift. However, use of good technique will limit the size of the pocket and there are also techniques to fixate the implant. Use of autologous tissue (your own) is a good option. Diced cartilage and deep temporal fascia can be used to make a neo-implant for dorsal augmentation. This avoids the use of the silicone implant and the complications that come with it. Speak to your surgeon today to find out more.
Best Regards,
Dr. Terence Goh
MBBS (S'pore), MRCS (Edinburgh), MMed (S'pore)Fellow, Academy of Medicine, Singapore (Plastic Surgery)President, Singapore Association of Plastic Surgeons (SAPS)International Member, American Society of Plastic Surgeons (ASPS)

Surgery
with silicone implants is quicker, since they are pre-fabricated and easier to
place than autologous grafts (tissue from your own body), and the recovery may
be a bit easier. The results may also look good for several years,
however they are not a permanent solution. As long as the implant is in
place there will be an associated risk of infection, migration, and extrusion
(coming through the skin) which is higher than that of autologous grafts.

The reason for the lack of permanence is that
synthetic implants never become fully incorporated into your body. Using
tissue from your own body will give you the safest, longest lasting results and
a beautiful nose.

The most commonly used implant for asian rhinoplasty would be a silicone implant.  While many of my colleagues have reservations about this, silicone implants are commonly used in Asia and when the surgery is performed properly, the risk of problems is minimal.  The problems that I see from other patients are when too large an implant is placed, or an L-shaped implant is used.  The preference among most experienced Asian rhinoplasty surgeons is for an I shaped implant, an implant that does not extend into the tip of the nose.  Another problem I often see is how the implant is placed.  The implant can be placed below the periosteal layer (my preference) or below the skin.  When the implant is placed under the skin, the implant shifts with pressure to the nose and the edges of the implant become visible.  Deeper placement of the implant works much better and it can be often be difficult to determine whether an implant is present or not when placed in this manner.An implant alone will make the bridge appear narrower.  You may need reshaping of the tip of the nose with cartilage if the bridge is done.  If you feel your nose widens when smiling, the base of the nose may need to be narrowed as well.Aloha,Shim Ching, MD

The answer is simple.  The best implant is your own cartilage.  This is how the great masters of the past current time and future perform rhinoplasty.  The only reason that silicone implantation is popular in asian noses is that it is easy and quick and generally the thick skin of an asian nose tolerates the implant well.  I NEVER place artificial implants in my practice because of the inferior aesthetic result, movement, lifetime risk of potentially devastating complications including infection and extrusion.  I suggest that you visit a plastic and reconstructive surgeon well versed in advanced rhinoplasty the way rhinoplasty should be done- by tailoring a cartilage scaffold to make your nasal tissues drape naturaly and beautifully with no foreign body! 

All the best!

Rian A. Maercks M.D.

Foreign materials such as silicone, gortex, etc. make the operation faster for the surgeon. However, in 30 years of rhinoplasty I have removed many of these implants secondary to infection. I have never had this problem using your own cartilage. See an experienced rhinoplasty surgeon who has done many Asian noses.

In order to raise the bridge of your nose, there are a number of implants that can be used. Silicone (silastic) is my least favorite since it can shift and if you get hit in the nose it can extrude (poke out) years after surgery.
Other options for nasal implants are using the cartilage from your own septum. Ear cartilage is also used for grafts but these are short pieces and curved so they don't work well in the bridge. I think rib cartilage is too extreme for a primary rhinoplasty in an Asian lady. My preference is to use gortex. Medpor is also another option.
I suggest you seek out a specialist in Rhinoplasty and discuss the options as well as ways to reduce the tip of your nose from getting wide on smiling.

Unfortunately, there are many differing opinions when it comes to nasal implants or dorsal augmentation or enhancement of the bridge.
Temporary augmentation can be achieved non-surgically with fillers. Although Radiesse is popular, it can remain present for many years and some other surgeons prefer the use of hyaluronic acid fillers (i.e., Restylane, Perlane). Some have even injected fat into the dorsum.
When it comes to surgical augmentation this can be achieved with grafts (from yourself and called autogenous or from cadavers) or with implants.
Grafts include:

Septum
Ear cartilage
Rib cartilage
Hip carilage or bone
Skull bone

Implants include:

Silicone
Porous polyethylene
Polypropylene
PTFE (Gortex)

Implant options for Asian rhinoplasty include silicone and Gore-Tex, which are the most commonly used materials: SiliconeThe most popular implant material in Asia, silicone is inexpensive, easy to use, and produces good aesthetic results. Silicone implants come in various shapes and can be placed on the dorsum of the nose. Gore-TexA porous implant that's becoming more popular in Asian rhinoplasty. Gore-Tex implants are stable, have a lower risk of extrusion than silicone, and are less likely to cause capsule formation. However, they decrease in volume after insertion and are more difficult to remove than silicone implants. Cadaver tissueA third option for Asian rhinoplasty is tissue from a cadaver, which can be irradiated to remove bacteria and viruses. The tissue can be cartilage or dermis (skin). In Asian rhinoplasty, dorsal augmentation is often necessary for patients with a low nasal dorsum. The amount of augmentation needed is usually more extensive for Asian patients than for Caucasians

In my opinion, the best implant for rhinoplasty in general is the patient's own cartilage.  The Asian nose has traditionally been receptive to implants such as silicone, but I do not recommend them over your own cartilage.For more information, please go to my website at:WirthPlasticSurgery.com