What is the right implant for thick, heavy skin revision? 3rd Rhinoplasty with removal of old implant; worried about rib.

Question

I've suffered complications with a shifted medpor implant that will have to come out. I have very thick skin so I'm going to need another implant to support my nose structure, which is (still) mostly a bulbous one with little bone structure and heavy ethnic skin.I'm frightened not only because of the implant removal but because I'll need a NEW implant or graft. I'd like to hear from other patients that had tip implants removed and have similar skin type what they chose--goretex, Silastic, etc.One doctor I liked suggested rib. There are so many risks for rib, but I have a complicated rhinoplasty on my hands--more complicated than #2. I don't know what to do and I don't want to make this oily, bulbous, perpetually swollen, mildly infected tip worse.I'm worried about anything that will make my oily, thick skinned nose bulkier than it already is.. I want to get this revision and move on with my life in the next six months. Are my fears unfounded? I have yet to meet a doctor that can convince me he can find an implant (synthetic or otherwise) that will support my nose without looking "fake", shiny, or massively bulky, and unfortunately, a lot of my natural cartilage is gone.

Tae Ho Kim, MD · Answer

The kind of problems you describe are very difficult to make better. First, you need to get the Medpor implant removed and allow everything to heal properly. Once you have healed with no infection and inflammation, only then would I proceed with the reconstructive operation. You may or may not need a rib graft. It depends on much support your nasal tip needs. I would advise you to get evaluated by an experienced Rhinoplasty surgeon, like myself, who can give you good options for a difficult situation. Good luck!

Steven Wallach, MD · Answer

I have used rib cartilage form patients or from a cadaver a irradiated cartilage.  The irradiated cartilage works quite well, and avoids the pain or incision on the chest.  Best of luck.

Vincent P. Marin, MD, FACS · Answer

From your story, it sounds you have  complicated situation and you will likely need an expert in revision rhinoplasty as well as a rib graft. The reason your medpor implant is having issues is why it will happen again - whatever that reason is. See an expert in revision rhinoplasty in your area or travel if you have to. Also, your skin cannot be changed and you will always have some issues associated with that if you are presently unhappy. That is something your surgeon cannot change.Be sure to find a board certified expert in rhinoplasty surgery before you proceed. 
Best of luck,
Vincent Marin, MDSan Diego Plastic SurgeonMarinAesthetics.com

What is the right implant for thick, heavy skin revision? 3rd Rhinoplasty with removal of old implant; worried about rib.

Answers (3)