Q: Dr. Eppley, I’ve been browsing your website for a couple of weeks and it has proved a tremendously useful resource on rhinoplasty. This is something I’ve been thinking of getting for a while, but I would like your opinion on the options available. From what I’ve read, silicone implants tend to come with a risk of extrusion, which is why many surgeons recommend rib grafts. However, I would prefer to avoid the scar and a more invasive procedure. After posting on various forums, I have been recommended to get a silicone implant for the bridge, but to use ear cartilage to reinforce the tip and to further build up the bridge and radix. Do you think that this will be a viable alternative to rib grafting? Lastly, as I’m from out of the state, would you be able to perform a rhinoplasty on me, and how long should I expect to have to stay before flying back home?
A: It is understandable that many patients want to avoid the use of a rib graft for their rhinoplasty. The use of an implant makes the operation far less complex and much easier for recovery. But, as you have pointed out, the use of an implant for nasal augmentation must be carefully done to avoid its well known complications. For implant nasal augmentation, I currently prefer the use of a PTFE-coated silicone implant as it allows some better tissue adhesion than pure silicone alone but avoids the severe scar adherence of a Medpor implant. The key to prevent long-term complications is to avoid too much pressure on the overlying skin, particularly that of the tip. For this reason, many surgeons will cover the tip with an ear cartilage graft which is a perfectly valid approach. When possible, I prefer to place the end of the implant under the nasal dome cartilages which have been lifted, narrowed and sewn together over a columellar strut cartilage graft. This achieves the same purpose but buries the implant under more natural tissue. This can only be done when the nasal implant is a dorsal style only and not a dorso-columellar style implant. Many times the dorso-columellar style can be avoided with columellar strut grafts. It is unclear to me yet as to what your nasal augmentation needs are.
With a rhinoplasty that uses a nasal implant, the recovery is only a matter of days until one can return home.
Dr. Barry Eppley