Revision Rhinoplasty, from Goretex to Silicone??

Question

I had goretex and ear cartilage for my primary rhinoplasty almost a year ago. I plan to do a revision. Is it okay to do a revision with silicone? I've emailed many doctors and some say silicone is perfectly fine and some say I have to use rib. I honestly really DO NOT want to use rib. So I would like to know if silicone is okay to use from goretex for revision rhinoplasty. I know that all implants and materials will have risks, so please let me know your thoughts or if you have any advise.

Sam Naficy, MD, FACS · Answer

There is no problem in switching Goretex to Silicone except for the fact that you will still have a synthetic implant in your nose which may extrude or become infected at any point in your life.

Eric M. Joseph, MD · Answer

I read your question:

	It's not clear why you're requesting revision rhinoplasty surgery. GoreTex and silicone implants both are used to raise the height of your bridge, and it's not clear why you want your GoreTex swapped for a silicone implant.

	After your GoreTex is removed, you may want to opt for a non-surgical rhinoplasty using injectable fillers to raise your bridge. In my practice, Silikon-1000, an off-label filler for permanent results, may be used after your GoreTex is removed.

	I hope this is helpful for you.

	Regards from NJ.

Michael L. Schwartz, MD · Answer

Synthetic implants are not usually needed in primary rhinoplasty. You must have needed a lot of augmentation to require this. Many doctors recommend using your own cartilage only as it is less likely to become infected or extruded. if you don't want to use your own rib you can have banked irradiated cartilage as long as the area to be grafted does not need structural support. Silicone has nice shapes but often has a tendency to move after implantation which can be upsetting. Medpor may be a better choice.

Andrew Winkler, MD · Answer

Great question!

	The use of non-human materials in the nose has been going on for centuries.  Though its widely accepted that your own tissues are best and carry the least risk, there are downsides to using rib cartilage, for example.  It leaves a relatively unsightly scar, is painful and the cartilage is rather stiff.

	Silicone

	There are a few different formulations of silicone, but my guess is that you're considering Silastic silicone, which is a nasal implant.  It is my opinion that Silastic is not a viable option in rhinoplasty.  Though popular in Asia, these implants have a tendency to work their way out through the skin (23% in one study).  This is because the nose is flexible but silastic is fairly stiff, which the delicate nasal skin doesn't like.  However, it does make a difference exactly where it will be used--it fairs worse in the columella.

	Gore Tex

	Gore Tex, on the other hand, is fairly safe.  Its use as a nasal implant has been well studied.  The risk of infection in revision rhinoplasty, such as yours, is about 2.5%, and that risk goes up if you have a perforated septum.  Gore Tex is used mainly to augment the bridge of the nose, and does not provide structural support. So whether or not you are a candidate for Gore Tex depends on the particulars of your nose.

	In the last 317 rhinoplasties that I've done, I've used Gore Tex in 40 cases.  Of these, I had 1 complication (Gore Tex infection) in a patient who had had multiple rhinoplasty surgeries.  The only experience I've had with Silastic is that I've taken it out in 2 patients in whom it was coming out of the skin.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	I have use silicone implants for the past 12 years with very good success. The key is to have a custom carved implant and not a preformed factory implant. Also make sure the surgeon is experienced with silicone implants to ensure proper placement to avoid infection and movement. The biggest challenge is placing the right size and shape of implant for your nose. If you don't have the right shape and size then there is a greater risk of movement or infection. Gortex can work well too but depends on what shape you are looking for.

	Best,

	Dr.S.

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