Which is Best for Bridge: Goretex Implant Vs. Rib Graft Vs. Ear Graft?

I am sorry to hear you had such a difficult time with your first rhinoplasty. It is important to go to a rhinoplasty surgeon who is well versed with revision rhinoplasty.
There are several different grafts available for reconstructing the nose. Stay away from Gortex implants in the nose since they have a propensity to get infected and we have seen many problems from those implants.

The best option is a septal cartilage graft provided there is septal cartilage still left inside your nose.
The next best graft source would be cartilage from the ear, which can build up the nasal bridge height. The cartilage may also be diced and placed in the temporalis fascia pocket to augment a large area.
Rib grafts also are acceptable, however, they tend to warp and bend in the postoperative healing phase.
A small silastic implant can be used if you do not wish to use any grafts.

I would use septal and ear cartilage before rib, and rib cartilage before Goretex.

Kenneth Hughes, MD

Los Angeles, CA

Your situation is difficult. Without seeing photos of you it is hard to guess how much work is involved in correcting your problem. Usually in cases like yours there is a significant loss of supporting cartilage, that is why the tip turns up. In that case you will need cartilage to repair and rebuild the bridge of your nose.
Gortex has no strength so it is not a good choice for a structural rebuild. Ear cartilage is fairly short and doesn't have the stiffness needed to push the tip back down. My number one choice in a case like yours is rib cartilage. I use it rebuild what is missing and try to restore a natural shape. Septal cartilage could be used in a similar fashion if you have any left.
The most important thing for you is find a skilled and experience rhinoplasty surgeon who can handle a case like yours without making it worse. I hope this helps.