Augmentation of the nose can be done by a variety of rhinoplasty techniques and materials. When possible, one’s own cartilage is always the best from a biologic standpoint and is preferred if it can provide a satisfactory aesthetic outcome. The use of septum, ear and rib cartilages offer a wide variety of graft choices that can meet almost every type of nasal augmentation need.
But there are circumstances where the use of autologous cartilage in the nose is not an option. It is almost always due to patient preference or convenience as the supply of cartilage from the ribs is virtually endless given the small size of the nose.
Implants offer a preformed approach to nasal augmentation with emphasis on raising up the dorsum. A silicone nasal implant is the most commonly used facial implant in the world and comes in a variety of shapes and sizes. While implants in the nose has its own risks and disadvantages (as well as its surgeon critics), in the properly selected patient it can create very pleasing aesthetic results that have good long-term persistence and a low rate of complications.
A silicone implant has the advantage of a preformed shape that will never change and it is easy to surgically insert due its smooth surface. Its smooth surface also creates a low rate of bacterial adhesion due to lack of surface attachment points. The disadvantage to its smooth surface is that it does not allow for tissue ingrowth or tissue attachment. Thus the implant develops a smooth encapsulating layer of tissue into which the implant passively resides. Without being fixed into the recipient tissue bed, there is always the opportunity for implant shifting, tissue thinning and even infection.
One modification that has been useful to the silicone nasal implant is a coating of ePTFE. (expanded polytetrafluoroethylene) Originally known as Gore-tex, ePTFE creates a coating on the implant that has a microporous structure due to its microfibrillar structure. This creates a nasal implant, which has all the advantages of pure silicone, but also creates the opportunity for tissue attachment/adherence.
ePTFE nasal implants offers a near perfect dorsal implant for rhinoplasty surgery. Its smooth surface and saddle-like design provides a good fit for most nasal dorms. Its placement ensures that the nose will be straight and smooth and have good aesthetic lines. Soft tissue adherence will stabilize the implant long-term. While the soft tissue adherence is not as good as would occur with cartilage graft, it makes the silicone implant a little more like a graft than an implant.
ePTFE nasal implants are a good choice in dorsal augmentation rhinoplasty in which the straightness of the result needs to be most assured. As long as the implant is not too big or stresses the nasal skin excessively an uncomplicated long-term result should occur.
Dr. Barry Eppley