eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Nasal Implants: Follow-up

Author: Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Contributor Information and Disclosures

Updated: Nov 12, 2008

Outcome and Prognosis

Upon review of a group of 187 cases of functional and aesthetic nasal reconstruction using multiple PHDPE implants, only 6 implants were removed. One implant was removed, reduced in size, and reimplanted because of excessive augmentation. A second implant was removed 3 months postoperatively after the patient developed nasal cellulitis that did not respond to intravenous antibiotics. In a third patient with cocaine-induced septal perforation and saddle-nose deformity, removal of a dorsal implant was necessary following a blistering sunburn and subsequent infection. Three alar-batten implants were removed because of infection. The skin/soft tissue envelopes in these patients who developed cellulitis had been traumatized by ischemic changes from postoperative edema in an unpacked nose, heavy tobacco use, and/or multiple prior surgeries.

Reported results of silicone nasal implants vary widely and are clearly related to local factors, such as prior surgery, intercurrent vascular disease, or technique. Although some have reported successful use of silicone nasal implants, others have reported extrusion rates of 30% or higher, most notably when the implants were used for structural support in compromised skin/soft tissue envelopes. In contrast, expanded polytetrafluoroethylene (Gore-Tex) implants appear to be well tolerated in the nose. Conrad and Gillman reported a 97.3% long-term success rate with these implants.1

Longer-term follow-up is necessary to determine the actual success rate of these implants through the lifetime of the patient. Minimizing trauma and attention to sterile technique are essential to the success of any implant.

Future and Controversies

The technique of nasal reconstruction has undergone a slow transformation from simple skin coverage of gross midfacial tissue defects, to aesthetic contouring, and finally, to the dual goals of functional and aesthetic reconstruction.

Enough progress has been made in the understanding of implant physiology to facilitate a rational decision regarding implant use when adequate autologous tissue is unavailable. Although autogenous tissue is still by far the preferred material for nasal augmentation, it is no longer acceptable to maintain that alloplasts should never be used in the nose. Patients requiring significant amounts of augmentation, as well as those in whom sufficient autologous tissue of acceptable quality is unavailable, should be considered candidates for alloplast augmentation in the nose.

Further refinements in the form, texture, microstructure, and chemical composition of these implants will improve the short-term and long-term cosmetic and functional results of nasal reconstruction using alloplasts.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Andrew J Parker, MD, to the development and writing of this article.



More on Nasal Implants

Overview: Nasal Implants
Treatment: Nasal Implants
Follow-up: Nasal Implants
Multimedia: Nasal Implants
References
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References

  1. Conrad K, Gillman G. A 6-year experience with the use of expanded polytetrafluoroethylene in rhinoplasty. Plast Reconstr Surg. May 1998;101(6):1675-83; discussion 1684. [Medline].

  2. Berghaus A, Stelter K. Alloplastic materials in rhinoplasty. Curr Opin Otolaryngol Head Neck Surg. Aug 2006;14(4):270-7. [Medline].

  3. Costantino PD, Friedman CD, Lane A. Synthetic biomaterials in facial plastic and reconstructive surgery. Facial Plast Surg. Jan 1993;9(1):1-15. [Medline].

  4. Davis PK, Jones SM. The complications of silastic implants. Experience with 137 consecutive cases. Br J Plast Surg. Oct 1971;24(4):405-11. [Medline].

  5. Romo T 3rd, Sclafani AP, Sabini P. Use of porous high-density polyethylene in revision rhinoplasty and in the platyrrhine nose. Aesthetic Plast Surg. May-Jun 1998;22(3):211-21. [Medline].

  6. Sclafani AP, Romo T. Alloplasts for nasal augmentation. In: Advances in Facial Implants. Vol 7. 1999.

  7. Staffel G, Shockley W. Nasal implants. Otolaryngol Clin North Am. Apr 1995;28(2):295-308. [Medline].

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Further Reading

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Keywords

nasal implants, nasal implant, silicone nasal implant, nasal reconstruction, nasal restoration, nasal contour, nasal augmentation, nasal surgery, nose implants, saddle-nose deformity, rhinoplasty, nose job, alloplast, nasal deformity, nasal dorsum, poor nasal tip projection

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Contributor Information and Disclosures

Author

Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Anthony P Sclafani, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Medicis None Speaking and teaching; Contura None Board membership; Contura Grant/research funds Independent contractor; Cascade Medical Grant/research funds Independent contractor; Cascade Medical None Board membership

Medical Editor

Gregory Branham, MD, Vice-Chair, Director, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine
Gregory Branham, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dean Toriumi, MD, Department of Otolaryngology, Associate Professor, University of Illinois Medical Center
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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