Problems associated with alloplastic materials in rhinoplasty

Abstract

Purpose: Augmentation rhinoplasty using alloplastic materials is a relatively common procedure among Asians. Silicon, expanded polytetrafluoroethylene (Gore-tex®), and porous high density polyethylene (Medpor®) are most frequently used materials. This study was conducted to analyze revisional rhinoplasty cases with alloplastic materials, and to investigate the usage of alloplastic materials and their complications. We also reviewed complications caused by various materials used in plastic surgery while operating rhinoplasty.

Materials and methods: We report 581 cases of complications rhinoplasty with alloplastic implants and review of the literature available to offer plastic surgeons an overview on alloplastic implant-related complications.

Results: Among a total 581 revisional rhinoplasty cases reviewed, the alloplastic materials used were silicone implants in 376, Gore-tex® in 183, and Medpor® in 22 cases. Revision cases and complications differed according to each alloplastic implant.

Conclusion: Optimal alloplastic implants should be used in nasal structure by taking into account the properties of the materials for the goal of minimizing their complications and revision rates. A thorough understanding of the mechanism involved in alloplastic material interaction and wound healing is the top priority in successfully overcoming alloplastic-related complications.

Keywords: Rhinoplasty; implant; postoperative complications.

Fig. 1

Removed silicone implants, gross and histopathologic findings. (A) Fibrous capsule with implant, 30 years, gross finding. (B) Fibrous capsule with implant, 30 years, histopathologic finding. (C) Calcified capsule with implant, 20 years, gross finding. (D) Calcified capsule with implant, 20 years, histopathologic finding (H-E, ×200).

Fig. 2

Problem case associated with silicone implant. (A) Preoperative view, tissue contraction, implant shift. (B) Intraoperative view, contraction with implant shift. (C) Postoperative view.

Fig. 3

Gross and histopathologic findings of removed Gore-tex®, 3 yrs. (A) Gross finding of Gore-tex®, 3 yrs after rhinoplasty. (B) Histopathologic findings of tissue ingrowth into the Gore-tex® (H-E, ×200). (C) Gross finding of calcified capsule with Gore-tex®, 3 yrs after rhinoplasty. (D) Histopathologic findings of calcification of Gore-tex® (H-E, ×200).

Fig. 4

Problem case associated with Gore-tex®. (A) Preoperative frontal view. (B) Preoperative lateral view. (C) Postoperative frontal view. (D) Postoperative lateral view.

Fig. 5

Problem case associated with Medpor®. (A) Intraoperative view. Firmly attached to adjacent tissue. (B) Removed Medpor® with adhesive tissue. (C) Protrusion of Medpor® to septal mucosa. (D) Tissue- Medpor® adhesion.