I am trying to figure out which is between Gore-tex or Silicone is better for Rhinoplasty. I heard that Gore-tex can shrink 40% in size over time and silicone has a chance of popping out (seen pictures) and make the nose very pointy looking. I'm Asian and seeking a little height as well as smaller base. What do you advise?
Pros and Cons of Gore-tex and Sillicone in Rhinoplasty?
Doctor Answers 22
Improving the shape of your nose
Silicone and Gore-Tex can both pop-out after a rhinoplasty. Did you consider using your own cartilage or bone? These materials are from you own body and the chance that you'll have problems is less. The cartilage can be taken from the middle part of your nose or septum, your ears, and even part of your rib. All of these areas heal well, so talk to your plastic surgeon about these options. Good luck!
Both nasal implants have been used with success
Goretex implants for nasal augmentation / rhinoplasty are usually made out of sheets and are formed by the surgeon to fit the nasal characteristics of the patient. Goretex is made up of fibrillated polymer of polytetrafluoroethylene with pore sizes in the range of 22um which allow limited tissue in growth. It has been determined that pore sizes between 1 and 50 um (micrometers) will allow bacteria to get into the pores but not tissue ingrowth to fight off the bacteria. Hence pore sizes between 1-50 um are not supposed to be good.
But there are a lot of surgeons that have used gore tex in the nose without a lot of problems and it has a proven track record in the nose. It is a soft implant and allows the tissue to fixate the implant for a more stable feel. Theoretically, the chance of extrusion or rejection of these implants versus silicone should be higher and some studies show that is the case but the chances of this is still pretty low. I have a good colleague that is very well known and totally believes this is the best implant to use in the nose.
I, however, based on experience and knowledge of different products, believe that silicone is the best implant for the nose during rhinoplasty. It is the most compatible of all implants and has a lot of characteristics that come close to the ideal implant. It allows limited tissue ingrowth but is very stable. Some people believe that the implants allow to much movement, are not as stable, and can look unnatural.
There are ways to fix the implant to the deeper structures that make the implant feel as if it were bone in certain places such as in the nasal dorsum/ bridge. The silicone implant can also be placed within the tip in a judicious way to augment the tip, raise it and shape it with great success. The alternative to this is to harvest cartilage from the septum or ear with the drawbacks of these areas. Septal cartilage is sometimes sparse in the asian nose and ear cartilage is often times too flimsy and curvy for the nose. Rib cartilage is sometimes the best natural alternative for the bridge and all the other areas an Asian nose might need.
Augmentation of the Nose with Gore-tex and Sillicone in Rhinoplasty
The problem with all man made implants placed in the nose is that eventually the vast majority of such implants will have to come out because they poke through the skin (ie extrude), thin the overlying skin, become deformed by scar OR become warped and render the appearance artificial or worse.
Some implants are better tolerated under the nasal skin than other man made implants. Some implants are better tolerated under thicker nasal skins of some ethnic groups than under European skin. BUT - experience has shown repeatedly that sooner or later the vast majority of artificial onlay nasal implants will have to be surgicall removed.
Whenever possible, it remains preferable to use your own tissues. Starting first in the nose itself, then the cup of the ear, then rib carilarge.
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Gortex implant not advised.
Gore-Tex and Silicone
You do not mention an excellent third choice - your own tissue. Silicone and similar materials are very popular in Asian augmentation rhinoplasty, but there are problems such as movement or extrusion. This can be avoided by using your on cartilage.
No --better to use your own tissue.
No reason to use foreign material when you can use your own tissue. Both of these products can cause serious problems, so why take the chance.
Use your own tissues whenever possible
I would generally advise that you use your own ear, rib, or septal cartilage.
Any foreign material suchs as gortex or silicone has the possibility of extruding the implants through the skin.
Gore-Tex vs. silicone vs. autograft nasal implants
There is no question that the patient's own tissue is the safest, but even it can absorb. The main problem is the morbidity of the donor site.
Silicone has about a 10% incidence of extrusion, sometimes even without minor trauma.
I like Gore-Tex. I have had one extrusion and that came about because of trauma to a pre-exixting divot or scar in the patient's nose. When I have gone back in to place a larger implant, as I did once, I found the Gore-Tex implant solidly in place and infiltrated with the patient's own soft tissue. It becomes part of the patient. I have had no problems with it except the one case stated above. One must be careful not to over stretch the skin trying to place too large an implant.
The problem is that Gore has stopped making the nasal implants and even the Gore-Tex blocks from which to carve the nasal implants. My next one may be from an arterial implant as I just used the last available block in my operating theater, and they are not permitted to be resterilized even though I only use a minor part of the large block. Such is life.
Silicone and Goretex in Rhinoplasty
Synthetic implants used for rhinoplasty always add some risk to the procedure. Over time the chance of infection or wearing through the skin is high. A better long term bet is to use a patient's own cartilage to augment the bridge or shape the tip. The infection and extrusion rate is then close to zero.
I have removed many nasal implants of all types. There always seems to be a new and popular implant coming up, but a few years later the story is the same for all of them. Nothing works better, or is safer, than your own cartilage.
Pros and cons to everything
As you have eloquently expressed, there are pros and cons to every that is placed into the nose. Silicone can extrude (expose). Gortex can contract. Natural materials can dissolve. And yet, there are many satisfied rhinoplasty patients out there with all of these materials in place. The risks of using any of the materials are small and that is the reason why. I know a colleague that only uses silicone in Asian noses. So, you have to pick your poison, but at least know that the poison is not very potent. Good luck!