Asian and super soft silicon Vs America and Cartilage. Which is best?

Question

Hi Doctors: I've researched from thousands of these forums and there seems to be a preference from Western doctors to use cartilage for the bridge because silicone has a high infection and complication rate. However, the east disagrees and there's evidence that shows that silicone is best for Asians. Upon further investigation, I realized that Westerners have been used HARD silicone for the bridge with terrible results. Are any doctors on this forum familiar with SOFT silicone for the bridge?

Edward J. Gross, MD · Answer

I have used the solid silicone nasal implants from Implantech for 20 years with a an infection and extrusion rate ~ 5%. The majority of the implants used in our practice are Voloshin and Flowers style. The implants are now more soft and pliable and cause no tissue reaction. See durometer. I have found the low complication rate to be acceptable and that proper technique, implant sizing, and patient section are the best predictors outcome. The Flowers dorsal implant is the safest to use and I have seen no extrusions. If placed in a precise mid line pocket  and secured during the week of healing, it's a beautiful result. The Voloshin implant however must be sized so that it applies NO pressure on the nasal tip skin and rests below the domes. The columellar component must be trimmed appropriately with this caveat in mind. The African American and Asian patients are ideally suited for these implants, due to their skin thickness, and are generally very happy following surgery.

Kenneth Hughes, MD · Answer

Placing the implant is a shorter and easier procedure, but the infection and extrusion rate is higher with a foreign body.Kenneth Hughes, MDLos Angeles, CA

Toby Mayer, MD · Answer

I have removed many infected silicone implants over 35 years of rhinoplasty and have never had an infection with cartilage. How lucky do u feel--your choice!

Benjamin Chu, MD, FACS · Answer

The use of silicone dorsal implants should be limited just to the dorsum and not extend towards the tip of the nose.  Tip should be created with cartilage either taken from the ear, septum or as a last resort the ribs.  If the dorsal silicone implant is properly fixed it should not move around or rotate.  Infection with dorsal implant are extremely low if done with this technique.  The use of soft silicone is usually associated with implants that augment the tip such as the Voloshin nasal implant.  L-shaped dorsal implants should be avoided.  Other methods of using rolled fascial cartilage grafts can work but the dorsum height may change in the future due to some cartilage absorption.

Kimberly Lee, MD · Answer

Regardless of type of silicone, the complications of infection, migration, extrusion, etc. have resulted in a high percentage of revision surgeries in which the implant is removed and replaced using one's own cartilage and soft tissue.  Please consult with a board certified specialist who can assist you with achieving the results you seek.  3-dimensional computer imaging can help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

David Reinstadler, MD · Answer

You are absolutely correct that you will get different answers from different schools of thought. The majority of silicone implants used here are relatively 'soft'. I am not sure if you are referring to a specific brand of implant, but silicone ranges form a liquid to a very hard solid. The underlying issue is that any foreign material (silicone, goretex, etc) does not develop a blood supply like cartilage or your own tissue. Without a blood supply, the risk of infection increases because your infection fighting blood cells can not get in to fight it. You will have to discuss your specific situation with a surgeon, in person, so they can give you their thoughts and recommendations. Best of luck

Frederic H. Corbin, MD (license restricted) · Answer

Ideally one one like to use natural tissue on the bridge of the nose as a foreign body soft or hard is still a foreign body where as your natural tissue is your tissue and less likely to infectDr Corbin

Richard W. Fleming, MD (retired) · Answer

Soft or hard the problem with foreign materials is that they are more prone to infection. They are more likely to move or extrude because they never become integrated into the surrounding tissue as cartilage does.

Asian and super soft silicon Vs America and Cartilage. Which is best?

Answers (8)

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