What are the safest materials in rhinoplasty?

Surgeons perform the rhinoplasty using autologous (harvested from the patient’s own body) or synthetic augmentation material. Many people wonder which material is the safest for their nose surgery. In this blog, we will introduce you most used nasal implants and evaluate their advantages, disadvantages and most importantly – safety.

Autologous materials

Septal cartilage

Used mostly for tip augmentation and in minor cases of bridge augmentation. It is harvested from nasal septum itself. That’s interesting that for nasal bridge augmentation, the material from the nose itself is used. The small portion of cartilage is harvested from the septum. Portion small enough to not affect the nose shape but big enough to shape the tip, fill the irregularities or slightly lift the dorsum (nasal bridge).

Advantages:

+ easily harvested natural material

+ lower risks of infection

+ eliminating risks of rejection by the body.

+ harvesting doesn’t require general anaesthesia

+ softer than rib cartilage

+ short recovery process

Disadvantages:

– low volume of material to use

– cannot be used for major augmentation

Safety:

Very low risk of infection and no risk of rejection.

Ear cartilage

Similarly, to septal cartilage, it is used for tip plasty and minor dorsal augmentations. The material is harvested from the area on the back of the ear – auricular cartilage. This material is a little softer than septal cartilage, so it’s used often for tip shaping.

Advantages:

+ easily harvested natural material

+ lower risks of infection

+ eliminating risks of rejection by the body.

+ harvesting doesn’t require general anaesthesia

+ softer than septal cartilage – perfect for natural effect of tip plasty.

+ short recovery process

Safety:

Very low risk of infection and no risk of rejection.

Rib cartilage

Rib cartilage is harvested from the patient’s own ribs. It is used mainly for dorsal augmentation rhinoplasty, reconstruction rhinoplasty, complicated primary and revision nose surgeries. Thanks to its long shape and abundant volume to use it is a perfect material for bridge augmentation. The big disadvantage of costal cartilage autograft is the risk of warping. However multilayered rib cartilage augmentation technique invented by Dr Suh Man Koon effectively prevent this condition. You can read about the technique here.

Advantages:

+ much volume of material to use

+ tick and solid

+ allows for the augmentation desired by the patient

Disadvantages:

– more difficult to graft

– risk of warping

– might be visible through the skin

– might be absorbed irregularity causing irregular dorsum

Safety:

Low risk of infection and no risk of rejection.

Synthetic materials

Silicone

Silicone is a polymer frequently used by plastic surgeons. It is the most common and the oldest material used for nasal dorsum implants. The silicone implants used in rhinoplasty come in two types: the sculpted block type and the liquid type that is poured directly on a cast to mould into the desired shape. Silicone implant doesn’t change its height, so it’s very stable and the final shape is predictable. Silicone is a foreign body, so there is a probability of side effect occurrences, such as infection, rejection or calcification. However, since it’s been studied for many years it has developed greatly to minimize such risk. Modern silicone implants are considered to be almost as safe as autologous material.

Advantages:

+ doesn’t change its shape and height – a stable material

+ desired effect easily achievable

+ no graft required

Disadvantages:

– Foreign body – might cause infection or rejection

Safety:

Modern silicone implants are very safe. The risk of infection or rejection is low.

Gore-Tex

Gore-Tex is a synthetic resin has a porous molecular structure that allows air and sweat to pass through while blocking off rain and other complex molecules. Therefore, it’s frequently used in sports apparel. Clinically, it is utilized as sutures, artificial blood vessels, and patches used during heart surgeries. It has useful applications in neurosurgery, ophthalmology, and urology. In 1983 it has been introduced as a safe material for facial tissue reconstruction. From 1993 it is used in rhinoplasty.

Advantages:

+ tissues can grow within the pores

+ less mobility

+ slightly higher resistance against infections

Disadvantages:

– The height and shape can change after inserting the implant

– Removal is complicated due to tissues ingrowth

– More visible through the skin

– Foreign body – might cause infection or rejection

Safety

Gore-Tex implant is very safe. The risk of infection or rejection is low. However, in case of side effects, implant removal is complicated.

PCL Mesh (Soft mesh implants)

PCL, or ‘Polycaprolactone’, is a hydrophobic, semi-crystalline polymer with a good flexibility. It is an absorbable mesh which is easy to manipulate and has a slow degradation rate to H20 and CO2, over approximately 3-4 years.

Because of these characteristics, PCL mesh is currently being used as a mechanically and structurally implantable rhinoplasty scaffold.

There is a lot to say about the safety of PCL mesh implant. According to Dr Suh Man Koon PCL mech implant application may cause serious side effects, such as septal cartilage erosion and saddle nose deformity. You can read more about the dangers here.

Advantages

+ natural effect thanks to the soft nasal tip

+ naturally movable tip

Disadvantages:

– Fibrosis cannot maintain the new position of the nose tip

– Absorption may cause a septal cartilage erosion

– High risk of side effects

– Prone to infections

Safety:

PCL Mesh is not a safe material for nasal implant.