Nasal septal perforation - what material for my bridge?
Doctor Answers 3
Revision Rhinoplasty - Rib cartilage
Tissue from your own body (autologous grafts) will give you a safer, more permanent result than synthetic implants. While en bloc cartilage grafts, especially from the rib, can warp over time, there are ways to eliminate this problem. Especially for dorsal augmentation (building up the bridge) using cartilage that is finely diced and wrapped in fascia taken from your scalp can be made into a custom size and shape for your particular nose (DCF). By dicing the cartilage the problem of warping is eliminated, and since it is tissue from your own body, it quickly becomes incorporated into your nose within 2-3 weeks. Results are certainly surgeon dependent, so it's important to do your research in finding an Asian rhinoplasty specialist.
Your doctor is correct that if you have a chronic septal perforation then having any artifical material like silicon or Medpor close by is a recipe for infection and disaster sooner or later unless the perforation can be closed first - if not then rib cartilage is needed
Asian Rhinoplasty : Nasal Implants vs Autologous materials Rib, Fat, cartilage
Nasal implasnt are very common in Asian rhinoplasty because in general ASians have thicker nasal skin and tolerate implants better than others. This allows surgeons to "get away" with implants for some time but they always cause soft tissue erosion and tend to show through the skin and get displaced with time. Your immediate risks of infection will be similar with any technique if there is inadequate soft tissue coverage. You may be able to "get away" with a smaller implant but that would assure that you will haave more problems in your lifetime as you are only 25. If what you have is a septal perforation that is asymptomatic without raw edges it should not affect your surgery at all. However I believ your doctor is referring to eroded soft tissue with inadequate coverage. In cases like yours I have had success with removal of implant and fat grafting. If further augmentation is needed rib, cartilage or secondary fat grafting can be performed in a delayed manner. I hope this helps!
All the best,
Rian A. Maercks M.D.