3 years post revision rhinoplasty - Is gore tex removal medically necessary? (Photos)

Hello and thank you for your question. Although an exam in person is ideal, from your photographs alone I agree that you can benefit from a revision to your dorsum, in addition to tip refinement.

The question is how to do address the dorsum and your implant -- my experience in Gore-Tex (or ePTFE) implants is confined to their removal alone. I never place nose implants, only remove them. This is because it's difficult to predict how they can shift, displace or cause deformities over time, in addition to the risk of foreign body reactions/inflammatory episodes that can ensue. I augment the dorsum with DCF (diced cartilage wrapped in fascia). I only use mastoid fascia to prevent hairline scarring/hair loss from a temporal fascia harvest. If you have an open roof deformity (along the dorsum), I use extended spreader grafts from rib allograft, not autograft. I don't use your own rib because of the additional chest scar, risk of injury to the lungs, increased operative time, and the incredible safety profile of MTF allograft. In terms of your nasal tip, the modification of your nasal cartilage can be done with trimming, stitching or further grafting. Of note, if you have any breathing difficulty, a septoplasty or other maneuvers may benefit you as well, and insurance can cover this to reduce the price of your surgery overall☝️

I think you're doing the right thing by talking to a number of surgeons. My opinion is certainly not gospel by any means, but the techniques I described above have served me well in my career.

Hope this helps. For more information on rhinoplasty, please refer to my link below. Good luck and please let me know if I can help.

Happy Holidays :)

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon in Boston & Miami

Hello and thank you for your question. I would absolutely recommend removing the Gore-Tex. It is not a good idea to ever place that. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Unfortunately, this would not be covered by insurance. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon