What are nasal implants (NI)?
A nasal implant is either a synthetic biocompatible material or a biological material processed through FDA approved methods to be used as implants. Examples of synthetic implants are medpor , silicone, or Gor-tex. Examples of biologically derived implants are irradiated rib cartilage from a rib bank or Alloderm (collagen like soft material used to thicken nasal skin). Biological implants may absorb (shrink) to some extent with time but synthetic implants do not shrink or change with time. Synthetic implants are used and have been tested not just for cosmetic or reconstructive purposes in the nose but are used for reconstructive purposes in other parts of the face, body, and joints with a long record of follow up.
What are NI made of?
Nasal implants come in varying sizes and shapes for the tip and dorsum (bridge of the nose).
Nasal silicone implants – Sometimes called Silastic implants. These implants are made of medical grade solid silicone and are nonporous. I uses these in the majority of reconstructive cases.
Medpor (Porex)-implants – a biocompatible high density polyethylene (HDPE) implant made of a lightweight porous material. This implant has been used for many years in the nose and face and is immobilized by ingrowth of the body’s tissue into the porous areas of the implant. Occasional extrusion has been reported.
Gor-tex (ePTFE) – expanded polytetrafluoroethylene – a biocompatible implant that is less porous than Medpor but more porous than silicone. They allow some tissue integration, and are not as firm as silicone.
Autologous Graft options using your body’s own cartilage from the nasal septum, or ear (conchal) cartilage are also an option and are used depending in many of my rhinoplasty procedures.
Homologous Graft irradiated rib cartilage (from a rib bank) – another implant option- but as with human-derived products have a certain percentage of warping (twisting) and absorption with time, making these a less favorable option.
Why are NI’s used?
Nasal implants are used in nasal reconstruction for aesthetic deformities or nasal obstruction due to structural nasal collapse or volume loss caused by trauma (including previous surgery), autoimmune disease, neoplasm, or infection.
Are there any side effects of NI’s?
I’ve had excellent success using medpor implants in healthy individuals. However, this procedure in general, has a risk of infection, movement, extrusion and may occasionally need to be removed. Infection or extrusion risks vary between the various implants. I decrease these risks by using implants soaked in antibiotic solution and operating on healthy nonsmoking patients. Their advantage as opposed to natural autogenous grafts is a lack of absorption (shrinkage with time) and their strength to provide support and superior definition. The advantage of autogenous (one’s own tissue) grafts is a very low rate of rejection and infection.
Is it better to use NI or rib grafts?
Autogenous grafts (from one’s own body) can be used in the nose either from the septum or ear or from other sources. I can use autogenous cartilage in the nose. However, and especially in ethnic noses, sometimes, one’s own cartilage is too soft and weak to provide the needed support or definition to the bridge and tip of the nose. Sometimes I use autogenous cartilage grafts in combination with implants to give the needed support and definition. Also sometimes in severe saddle nose deformities in revision rhinoplasty or in traumatic noses, one’s own cartilage is not thick enough to give the needed height in a nose. In Asian and African-American rhinoplasty, the patient’s nose cartilage tends to be thin and weak with inadequate support their thicker skin. These patients are ideal for Silastic implants in the Voloshin or Flower’s style. The manufacturer of these FDA approved implants is Implantech in California. The implants are available in many different sizes and shapes. During a consultation, I’ll be able is able to decide the best choice for each individual.
How often does Dr. Gross use NI’s?
5-10% of cases, due to the complexity of referral base.