Goretex infection: should I have the goretex out and wait before revision surgery? or should it be replaced right away? (photo)

Hello dangernose,Thanks for your question.If there is any infection, then the Goretex needs to be removed and nothing else placed back until the infection is under control. Cartilage placed into a contaminated pocket could be absorbed rapidly.Your surgeon is correct that collagen scar tissue will replace the 1mm height of the Goretex sheet with time.If you need more dorsal augmentation, you can come back in a year and use a cartilage graft more safely at that time.I hope this helps.Good luck,Dr. Shah

From the photo it's not certain that there is any infection or impending extrusion of any Gore-Tex. Generally, however, if a Gore-Tex implant is infected or extruding it needs to be removed. My preference, though, when removing such an implant is to NOT replace it at the time, since infection and inflammation can adversely affect anything being replaced there. Also, depending on how much volume of Gore-Tex is present, scar may well fill in the volume loss--at least partially--and nothing further may be required. Generally best to remove a problematic implant and let things heal first.All the best,--DCPPearson Facial Plastic Surgery®

The problem with synthetic implants is the lifetime risk of infection. The overall risk is low, but it never goes away. I would agree that skin changes (redness, small vessels) on the bridge of the nose indicate inflammation that may be a smoldering infection. If this is the case, you should start antibiotics and the Goretex implant should come out.Before surgery, you should have a discussion with your surgeon. A decision needs to be made during surgery. If there is active infection or the skin is damaged, you may need to wait for it to heal before correcting any lost height. If things look great, you have the potential to replace the lost height immediately with rib. If there is no height loss, you may not need a replacement graft. This is a discussion between you and your surgeon. With a clear plan you can have a safer surgery and better outcome. 

You would need an in person examination to determine specifically how you should proceed. There are different schools of thought when it comes to removing infected implant material. If the Gore-Tex can be removed safely and it will not change the appearance of your nose much, then maybe it can be just removed and nothing else done. If you still need some height to the dorsum, I would recommend taking out the implant material (if it is actually causing infections) and then doing a second surgery once everything has healed to augment the dorsum again. Follow the advise of a surgeon who has seen you in person. Best of luck

Goretex infection can be fixed with implant removal, and reconstruction with autologous rib grafting effectively; you will also require prolonged antibiotic coverage based on your cultures. Please see example of implant infection case below.

Dear dangernose, I would follow your surgeons plan and remove the Gore-Tex and let the nose heal and see if it fills in. Best regards, Michael V. Elam, M.D.