A nose implant is used in nasal reconstruction for the purpose of correcting aesthetic deformities or nasal obstruction caused by structural collapse, trauma, infection, neoplasm, or other serious conditions. The nose is particularly vulnerable to injury due to its position on the face and relatively weak chondrocutaneous support structure - but surgery can be used to correct many of these injuries before they completely disfigure a person.
Patients have to undergo a number of examinations before surgery; and factors such as nasal anatomy, baseline perception, pathologic defects, etc., are all closely assessed, after which the right materials are brought in for the operation.
Due to its availability, compatibility and ease of use, cartilage is the most commonly used material in nasal surgery. It is firm yet flexible enough to carve the desired nasal contour; and in addition, cartilage provides good structural support without interfering with a patient’s cartilaginous skeleton. A number of donor websites are dedicated to providing some of the parts used in surgery (i.e., auricular conchal, cartilage nasal septum, rib, etc.) but cartilage from such sources varies in texture, rigidity and contour.
According to eMedicine, silicone implants are used in different states of viscosity to correct or expand tissue but the body struggles to penetrate the material, instead creating a fibrous tissue capsule around the implant. Without proper tissue infiltration, the nose implant may have a higher extrusion rate and/or remain slightly mobile.
When used as a columellar strut implant, silicone comes in medium-grade rubber and is very effective in correcting both columellar retrusion and nasolabial angle, and also to enhance tip performance projection by elevating the medial crura on the lower lateral cartilages.
Silicone columellar strut has its benefits:
- Low extrusion rate
- Flexibility when sculpting implant
- Minimal resorption (therefore no need for second procedure to obtain graft)
- No disruption to the tip cartilage during tip projection
- Easy removal - no damage to tissue
Porous implants present the risk of infection due to the presence of bacteria and other infection but they also make it possible for the body to treat itself thanks to the incorporation of host tissue into implant pores (which brings in immune response mediators to the site).
The surgeon has to account for chemical and biologic nature of all implant materials used in the operation, and the medical assistant has to ensure the proper sterilization of all equipment used. Here are a few common porous polymers:
Mersilene and similar nose implants are good at initiating prolific fibrous in-growth but they're also difficult to remove if infected
Proplast may shred when exposed to extreme mechanical forces but its ability to be ‘carved’ into any shape makes it popular
Gore-Tex (polytetrafluoroethylene) is commonly used in vascular surgery but it can also be included in the polymer category due to its ability to facilitate cellular in attachment and tissue infiltration.
These are tissues transplanted from a donor and used to reconstruct various features of the nose. The benefits include availability of large quantities of tissue with proper matrix invasion and connective tissue replacement. The most common risk with these materials is infection- which can be avoided by using irradiated cartilage in the nasal dorsum, which minimized mobility and re-absorption.
Medora Centre recommends a visit with a surgeon to determine if you’re a good candidate for the procedure - and also, your expectations should be realistic regardless of the implants used.