Korean Rhinoplasty - Concerning Nose Bridge Augmentation Material

Question

Hello I'm Korean male with bulbous nose tip and low nose bridge and it's wide at the same time. 50% of Korean doctors recommend silicone for nose bridge + own cartilage for nose tip and the other 50% gortex for nose bridge and own cartilage for nose tip. However most N. American surgeons tend to agree with patients cartilage for nose tip but not use silicone for nose bridge. If I use silicone will I have to remove it later anyway? Also I can't swim if I have silicone? Thank you~!

Rod J. Rohrich, MD · Answer

Optimally, it is better to use your own tissue such as your own septum, ear or even rib cartilage for dorsal augmentation rhinoplasty as this has the best long lasting results. However, silicone is commonly used globally as a dorsal solid silicone implant. If a soft silicone implant is placed just in the dorsum and not in the tip it can be long lasting.

Edward S. Kwak, MD · Answer

Your question is one of the most common concerns for patients inquiring about augmentation rhinoplasty. Both silicone and Gore-Tex can be safely used for augmenting the nasal bridge. Any changes to the tip I would recommend strictly using cartilage grafts. Synthetic materials placed at the tip of the nose tend to have more long-term complications.

Daniel Reichner, MD, FACS · Answer

This is a common concern in the Asian Rhinoplasty patient. Besides the height of the nasal dorsum, one of the major differences between Asian and Caucasian noses is skin thickness. I think that most North American rhinoplasty surgeons have seen cases of silicone implant infection or extrusion (an implant poking through the skin). I believe the risk of infection, extrusion and complications is higher in thinner skin patients.  So skin thickness is a very important factor that I look at when deciding whether a silicone implant is appropriate - regardless of race.

	Using cartilage grafts (solid, crushed or diced ) will reduce these infection risks.  However, they usually provide less augmentation (unless the surgeon uses rib cartilage) and there are risks associated with graft visibility, symmetry and smoothness that are not seen with silicone implants.  However, I have seen silicone implants become encapsulated and/or distorted in a way which makes them visible on the nasal dorsum.

Thomas Buonassisi, MD · Answer

Various types of implant materials have been used for nasal augmentation. You are right, silicone implants seem to be more commonly used in Asia than in North America. What’s probably more important than the type of implant material is the size of the implant. Too large an implant causing too much stretching of the skin simply will not last. I personally prefer to use Gortex for augmenting the bridge and a patient’s own cartilage for the tip. If you do end up having a silicone implant for the bridge I see no reason for not swimming as long as it has completely healed.

John Philip Connors III, MD · Answer

Great question! I have removed silicone and Gortex from the nose in Asians...many of which had their procedure performed abroad. I would recommend using your own tissue.

	Specifically , I would recommend a rhino-septoplasty with harvest of both superficial temporal fascia from just above your ear and rib cartilage. The rib and fascia will make a graft of diced cartilage with will augment your radix(bridge) and dorsum and the septal cartilage would be used at the tip. 

	Bottom line is, I think it is paramount that you use your own tissue...implants are quick and easy for a nose surgeon to put in, but they are the gift that keeps on giving (infection, malposition, extrusion, etc.)

	Aggressive recommendation, but lasting results require preparation and execution.

	Hope this helps!

	Good luck!

	Dr. C

	johnconnorsmd.com

Otto Joseph Placik, MD · Answer

Silicone is occasionally used but rib cartilage is generally preferred in the US. Generally speaking there is a lifetime risk of implant infection, rotation, erosion with silicone that is not seen with cartilage. However, it involves no donor site and is relatively easy to place or remove so it does have its advantages. Problems arise generally when it is not removed and prolonged attempts at saving it are made ultimately without success and prolonged infection and scarring.

Houtan Chaboki, MD · Answer

Hi Munchikens in BC,

	Nasal augmentation of the bridge is a common part of rhinoplasty in Asian patients. Augmentation material is typically "plastic" material such as goretex or silicone. While one's own cartilage is generally preferred to augment the bridge, there may be insufficient nasal cartilage to provide adequate augmentation. Ear cartilage is another option. As a result, many plastic surgeons will use either of these materials. Both materials have advantages and disadvantages. There is a possibility with either implant that it may become infected, requiring removal. Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you. Best of luck.

	Dr. Chaboki

Toby Mayer, MD · Answer

Many Asian patients have silicone in their nose without a problem! Having said that, in 35 years of rhinoplasty and rhinoplasty revision, I have seen several patients who have had an infection and required removal of the implant. You can swim with silicone in the nose. I prefer to augment the nasal bridge with your own septal or ear cartilage. I do not like gortex in the nose since it is difficult to remove if you have an infection.

Louis W. Apostolakis, MD · Answer

A low bridge is a very common concern among Asian patients seeking rhinoplasty. Unfortunately, it is a very challenging thing to change. As you might imagine, it is much easier to remove tissue from a nose than to add it. Far and away the simplest way to obtain that extra material is to buy it. Dorsal grafts are commonly made of silastic (a silicone product), or Gortex and are preshaped to produce very nice dorsal shape. These materials usually produce excellent results. . . in the short term. In the long term there is a real risk of things going very badly. I have seen horrible problems with these implants as they can erode out through the skin, get infected, become mobile, or all of the above. I always recommend using the patient's own cartilage because these long term risks are much smaller. Rib cartilage is the best location to obtain large quantities of cartilage for this use. Certainly using your own cartilage has its problems as well, but I think all things considered, you are better off going that route.

William Portuese, MD · Answer

The best tissues for augmentation rhinoplasty is always the patient’s own natural cartilage. With Asian rhinoplasty there typically is not enough cartilage in the nose to create the proper augmentation. Silastic silicone plastic nasal dorsal augmentation is frequently used. Any tip work is done with the patient’s own natural cartilage. It is not recommended to have any synthetic implant in the tip of the nose. The silastic implant can always be removed if it becomes displaced, infected, or the patient simply wants it removed. It is very easy to have removed and usually done under local anesthesia.

Korean Rhinoplasty - Concerning Nose Bridge Augmentation Material

Answers (12)

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