Pros and Cons of Gore-tex and Sillicone in Rhinoplasty?

A frequent goal during rhinoplasty for Asian patients is increasing the height of the dorsum (dorsal augmentation). This gives better definition of the bridge from the frontal view and a fuller, higher appearing bridge from the lateral view. Implants made from various materials including silicone and Gore-Tex are used frequently for dorsal augmentation as they are generally convenient and quick to use during surgery. However, implants in the nose are associated with complications including infection and extrusion (pushing out through the skin) both necessitating removal. Additionally, these implants can twist and warp over time which is a frequent reason why patients prevent for revision rhinoplasty. There are ways to perform dorsal augmentation with your own cartilage from inside your nose (septal), the cup of your ear (conchal) or a small piece of rib cartilage. These pieces of cartilage can be shaped and placed along the dorsum instead of an implant. Although this is technically more demanding and can take slightly longer during surgery to perform than an implant, the results appear to be better longterm as the risk of infection and extrusion are significantly less than with implants. Rhinoplasty surgeons that are experienced with using your own cartilage for dorsal augmentation can perform this procedure efficiently with consistent results. Additionally, there is a technique that combines both your own cartilage and fascia (temporal fascia is a piece of tissue just above the ear under the scalp skin) called diced cartilage-fascia that can be used for dorsal augmentation. Using this technique, it is possible to achieve significant dorsal augmentation but the risk of twisting, warping, or irregularities of the dorsum longterm appears to very low. Patients considering rhinoplasty for dorsal augmentation should give strong consideration to finding a surgeon that is experienced using autologous cartilage for dorsal augmentation.

In general, it is highly unadvisable to use non-autologous material like Gore-Tex or silicone implants in rhinoplasty as the long term effects for infection and exposure are not insignificant. However, in some ethnic populations such as in Asia it is very popular to use a silicone implant. When it is placed deep in the subcutaneous tissue away from the tip, it can last a long time. However, I do not do this procedure. I would prefer to do a nasal dorsal augmentation with the patient’s own ear or rib cartilage or use an injection of hyaluronic acid filler which is biodegradable over a couple of years.