What is the Safest Material for Asian Nose Bridge Augmentation? (Rhinoplasty)

I like a combination fascia, along with your own cartilage, either diced or a whole intact piece.  

I have a collection of various artificial material from around the world I found during revision rhinoplasty.
That being said, silicone and Goretex nasal implants, when used properly, has a high safety profile.
However, I can not create the natural appearance I tried to achieve with such material.  Furthermore, the most challenging aspect of East Asian Rhinoplaty is the refinement of the tip.  This simplely cannot be done without cartliage grafts.I recommendation for anyone who is consider this surgery is to avoid implants.

Surgery
with silicone implants is quicker, since they are pre-fabricated and easier to
place than autologous grafts (tissue from your own body), and the recovery may
be a bit easier. The results may also look good for several years,
however they are not a permanent solution. As long as the implant is in
place there will be an associated risk of infection, migration, and extrusion
(coming through the skin) which is higher than that of autologous grafts.

The reason for the lack of permanence is that
synthetic implants never become fully incorporated into your body. Using
tissue from your own body will give you the safest, longest lasting results and
a beautiful nose. Your
own tissue has a much lower risk of infection or extrusion. Cartilage can
be harvested from within your nose (septum) or from your ear, through an
incision hidden in the crease behind your ear. Even in Asian patients
these areas heal impeccably.

For a flat nose bridge that needs significant augmentation, I feel you will need a more substantial graft.  Silicone I feel is a safe and effective implant that is most commonly used for this.  I frequently see goretex implant infections from other practices and do not use this material.  The choices for grafts harvested from your own body that would give you the degree of change you desire include rolled dermal fat graft, diced cartilage wrapped in fascia and rib cartilage graft.  These all could work, but would lengthen your surgery time and cost.  There is some variability in results as well.  For example, rib cartilage can warp with time, causing distortion of the nose.  Some degree of shrinkage of dermal fat grafts or wrapped diced cartilage is usually expected.  Generally, for most Asian rhinoplasty surgeons, these materials are used in cases which a silicone implant didn't work, which is the minority of cases.  Please consider the vast majority of patients who have had perfect results from an Asian rhinoplasty have had a silicone implant without any problems at all.

Thank you for the question. You are correct: Goretex and silicone (Silastic) implants are used for building up the nasal bridge. The alternative to these materials is to use your own tissue. In most cases, this is the preferred method as there is a lower incidence of infection or complications. Cartilage can be harvested from the septum, ear, and/or the rib. This is either carved into a single piece or diced into a "cartilage paste" and wrapped in fascia (connective tissue) that is also borrowed from your own tissue. The costs of the implants are generally quite reasonable and the procedure is faster. However, this is off set by the higher rate of complications. Best of luck moving forward!

Using tissue from your own body is safer than any synthetic implant.  It will become fully incorporated into your nose and provide a permanent result.  Silicone and Goretex remain as foreign bodies within your nose, and will carry a risk of infection, migration and extrusion as long as they are in place.  

Typically the cost of surgery with your own cartilage is more expensive because it is a longer, more involved surgery.  Instead of using a pre-made implant, the surgeon must harvest the tissue and fashion it specifically for the patient.  This adds OR time, anesthesia time, and surgeon time, thus creating some added costs vs. a synthetic implant.  

I prefer using a patient's own tissue for augmenting the nasal bridge (septal, ear or rib cartilage) as it is incorporated into the nose in the most natural manner.

There are risks with warping of cartilage grafts (mainly rib cartilage) but by using advanced cartilage carving techniques I have not found this to be an issue in my own practice.

Silicone, medpore or gortex are alternative implant materials that can be used. They are more commonly used in patients with thicker skin, especially Asian patients. They come in L-shaped and I-shaped. The L-shaped type is meant to augment the nasal tip, but in a way which I don't feel looks particularly natural.

I have seen many patients with silicone implants that were placed years or decades ago who presented to me with delayed reactions to the implants necessitating implant removal.

Hi Montebello1346,

As other rhinoplasty surgeons have stated, cartilage is generally the ideal material to build the bridge. Cartilage is typically obtained from the nasal septum or ear. Occasionally, rib cartilage may be required for rhinoplasty. Goretex and silicone have been used with good results for rhinoplasty too. Rhinoplasty surgery is permanent, but revisions may be required as needed. Foreign materials, such as Goretex and silicone, have a higher chance of infection as compared to your own natural tissue. Only after a comprehensive evaluation can a rhinoplasty surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

I have used septal or ear cartilage for 35 years and have never had any infection or rejection. Therefore, I feel it is the best.

There is really no question that your own cartilage (septal, auricular, or rib) is by far the safest and most preferable material for use in augmenting the nasal structure in Rhinoplasty.  Non-native materials are generally utilized only when there is a lack of autogenous cartilage available.  Any foreign material carries with it the life-long possibility of extrusion when used in Rhinoplasty.