We prefer cartilage over synthetic nasal implants
We were asked recently what we think about using Goretex in the nose. This is a great question and an issue of debate at Facial Plastic Conferences.
Some surgeons are very dogmatic about such topics but, often, one may find that they have an agenda to push.
We have a nuanced view of foreign implant materials. In almost every case, we believe that you are better off with an implant using your own tissue, if at all possible. Cartilage is an ideal implant, whether from the septum, ear, or rib.
Bone, on the other hand, doesn’t fare so well in the nose since much of it gets absorbed and disappears over time. We must recognize that there is a trade-off with everything…your own tissue (other than septum) requires a separate surgical site with all that goes along with that. That’s why foreign implants are enticing.
They are in abundant supply, do not require any other operative sites, and often cut down on operative time. But, there are also risks of infection, migration, rejection and exposure. There are many types of implant materials available.
Of these, Goretex is a good one, and has its uses. The type of Goretex used in the nose is a thin sheet that is soft and pliable. It leaves a nice, smooth contour when contour is what the doctor ordered. But, because it’s so soft, it doesn’t do much for support. We have used it from time to time for dorsal augmentation when a lot of augmentation is needed, especially in thick-skinned patients, with very satisfying results.
Studies, including one by one of our mentors, show that it is well-tolerated with a low complication rate. Problems can increase when it is used in the setting of a septal perforation, so this should definitely be avoided.
So, while we are admittedly biased towards cartilage grafting, we like to keep our minds open and our ‘bag of tricks’ full…you never know when you’re going to need to dig deeper.
Avoid foreign materials/implants when possible in rhinoplasty
While the majority of patients who have had alloplastic (foreign) materials used in the nose as implants - silicone, Gortex, Medpore, etc. - do not experience any problems, for those few patients that have had problems, the complications can be disaterous.
I have seen many patients with Gortex implants that have become infected and several patients who have had their Gortex erode through the skin. Other patients have complained of "lumpiness" of the implant.
I prefer to use the patient's natural tissues and avoid any "foreign" materials.
GoreTex, or ePTFE, is a synthetic implant that may be considered for nasal dorsal augmentation during rhinoplasty.
Extended polytetrofluoroethelene (ePTFE) is the chemical name for GoreTex. To my knowledge, the Gore company no longer produces nasal implants, but we have used sheets for custom carving, from Implantech. The likelihood of an infection over a lifetime is less than 5%, and ePTFE gets significant tissue in-growth. ePTFE is more difficult to remove than rubberized silicone implants, but may be better suited than silicone for those with thinner and lighter skin types. Hope this helps. Dr Joseph
In general alloplastic nasal implants are not a good idea - especially in someone with thin skin where a minor trauma can introduce bacteria onto the graft. Once these grafts get infected, they usually have to be removed. The resulting inflammation and scar tissue can, at the very least, be a real setback or at the very worst, result in long term problems. This is a classic risk/benefit discussion that needs to be had between the surgeon and patient about the potential benefits of these material versus the risks associated with a infected nasal graft.
Gortex implants in rhinoplasty
As you have read, your own cartilage is the best source of material for augmenting a nose. Usually we get cartilage from the septum. Having said that, many people who need revision rhinoplasty do not have available septum to use and require something else. The other cartilage options are ear or rib and ear tends to not be very good.
Many people do not want their rib used ( to avoid the cost and the length of surgery and recovery time associated with using rib). In this case implants are a very reasonable option and I have used many of them with minimal downside. Gortex is a very reasonable option as are silicone implants. Your surgeon can give you his opinion regarding which he likes the best.
I prefer to use a patients own tissue but I definitely like Gortex as an implant. I have used Gortex implants in the nose for many years and have had few problems. The most important aspect of using Gortex is to discuss the potential results and complications using it.
An artificial implant like Goretex is a last resort. I have useed it succesfully to augment (add) height to a traumatized nose with very good success.
However, I always prefer to use the patients own tissue, septal or ear cartilage are the easiest materials to find and use. Ariticial implants in the nose can get infected. This is rare, but why chance it if you do not have to.
Gortex nasal implants bad idea.
Implants in the nose tend to have a lot of complications. If something needs to be added as part of a rhinoplasty, it is much safer to use your own cartilage, usually from your own nose.
Be cautious about nasal implants
Foreign body implants can be problematic. Although they are more popular in Asia where the complication rate seems to be less. Of all the available implants (Silastic, Medpor, titanium) I find Gortex to be the least likely to cause a major problem. And there are 1000's of people with implants who do very well and are happy. The benefits to an implant is that the surgery is much quicker, less traumatic and should result in a smooth bridge (dorsum). However if the implant gets infected it most likely will have to be removed. After an implant is placed, at the first sight of a tender or red nose should prompt an immediate call to your physician for antibiotics.
Occasionally, an early infection can be treated and the implant preserved but more likely it will have to come out. If the infection is not treated the implant may pop out through the skin! Making a big hole and scar in the nose that is difficult to repair. Gortex and all implants for that matter seem to do better in those with thicker skin and when the least amount of surgical dissection is performed. Implants also are better tolerated on the bridge of the nose and less likely to be reliable if placed in the tip or deeper in the nose. An implant or graft that comes from your own tissue whether your ear or rib is usually a better choice for the long term.
I hope this helps.
Best of luck.
Using material from your own body is preferable, but Gortex is a good back up option
Using an implant based on your own body's material (septal cartilage, rib cartilage, ear cartilage) is usually considered ideal because the risk of infection and extrusion is minimized. Many leading rhinoplasty surgeons are inflexible on this point.
However, other rhinoplasty authorities strongly advocate for the use of artificial implants in certain circumstances and have had good results over many years. Sometimes grafts from the patients body are not available or may not provide the ideal characteristics.
Goretex has been shown to be well tolerated in many patients. It's critical for the surgeon to use absolutely sterile technique when handling the goretex. If the goretex is placed some distance from any incisions (eg. on the dorsum) it is often tolerated well. However, even with these precautions, goretex can become infected or cause inflammation in the surrounding tissue.
In my practice, I use natural implants to the greatest degree possible, but artificial implants are used when there are no good substitutes.
Hope that's helpful.