Nasal Implants

Nasal Implants

No Results

No Results


The nose is critically involved in appearance, both to oneself and to others, and it is significantly involved in the perception of beauty both publicly and privately. Because of its central location on the face, plane of projection, and relatively weak chondrocutaneous support structure, the nose is susceptible to injury, and deformities are readily apparent.

Whatever the circumstances that led to the nasal deformity, the complex tasks of assessing the patient’s nasal anatomy, pathologic defect, aesthetic qualities, baseline perception, planning the reconstruction, and preparing the patient for the possible positive and negative outcomes can be daunting. In planning for nasal reconstruction requiring an implant, careful decisions need to be made regarding the types of materials to substitute for support. Final soft-tissue coverage of the planned reconstruction is of paramount importance in the preparation.

In northern India, during the 6th century BC, Susruta focused on soft-tissue augmentation for amputation injuries and nasal reconstruction. [1] See the image below.

In the 16th and 17th centuries, Tagliocozzi used a tubed pedicle flap and Carpue, an Englishman, reinstituted the forehead flap. [2, 3] See the images below.

Various nonautogenous materials have been employed over the centuries to improve reconstruction of the nose by providing bridge support. Early attempts at finding the ideal or most suitable nasal implant for bridge construction included trials of materials such as paraffin, gold, silver, aluminum, ivory, cork, stones from the Black Sea, polyethylene, rubber, silicone, lead, and a toothbrush handle.

Currently, general categories of available materials include autografts, homografts, and allografts. This article covers the variety of materials commonly employed. The pros and cons of various materials are detailed and illustrated.

The choice of nasal implants to be placed in reconstructive surgery of the nose is a difficult but important component in the patient’s care. The degree of loss noted in tip support, bridge contour, or nasal valve collapse may mandate implant use in nasal reconstruction. Each of the various materials has benefits and pitfalls, which must be balanced against the surgeon’s familiarity with each material. Because of the nose’s central location, minor defects of reconstruction may be particularly noticeable to any casual observer but may play a much larger role psychologically in the patient’s perception of self. Based on the authors’ review of the literature and clinical experience, autogenous cartilage and/or bone are recommended as the primary choices for nasal implants.

Although the major underlying cause of nasal reconstruction is trauma, a number of pathologic entities traditionally have required surgical nasal reconstruction (eg, congenital malformations, malignant destruction, septal perforations, granulomatous disease, congenital syphilis, leishmaniasis, leprosy). Whatever the cause of the defect, nasal reconstruction with or without various implant materials allows restoration of function along with restoration of an aesthetically critical component of the face.

A prerequisite to nasal reconstruction is familiarity with nasal anatomy and proportions. The nose is generally divided by anatomic units into thirds. The upper third of the nose, or bony vault, is represented by the paired nasal bones that overlie the nasal spine of the frontal bone. The cartilaginous vault represents the lower two thirds of the nose, with the middle third being the region of the upper lateral cartilages, and the lower third involving the nasal tip, septum, and lower lateral (alar) cartilages. The general function of the nose is to warm and humidify incoming air. To achieve both form and function, the nasal vestibule should comprise approximately one half to two thirds of the nasal lobule as viewed from the basal projection. Attention should be dedicated to reconstructing the columella, tip, and ala to form an adequate nostril internally while incorporating aesthetics externally.

Ongoing infection or conditions requiring further therapy (eg, serial débridements) are examples of contraindications to reconstruction. Address patient stabilization and optimization, including nutritional status when possible, prior to surgical intervention. Therapies such as radiation or chemotherapy should be completed prior to reconstruction.

Susruta AN. Kaniraj Kunjabal Blushagratna, ed. English translation of the Susrita Samhita, based on original Sanskrit text. Calcutta: Kaniraj Kunjabal Blushagratna; 1916.

Gnudi MT, Webster JP. The life and lives of Gaspar Tagliacozzi. Los Angeles: Zeitlin & Ver Brugge; 1976.

Carpue JC. An account of two successful operations for restoring a host nose. The Classics of Medicine Library. Birmingham: 1981.

Lee SH, Koo MG, Kang ET. Septal Cartilage/Ethmoid Bone Composite Graft: A New and Improved Method for the Correction Underdeveloped Nasal Septum in Patients with Short Noses. Aesthetic Plast Surg. 2017 Apr. 41 (2):388-94. [Medline].

Maas CS, Monhian N, Shah SB. Implants in rhinoplasty. Facial Plast Surg. 1997 Oct. 13(4):279-90. [Medline].

Sheen JH. Secondary rhinoplasty. McCarthy JG, ed. Plastic Surgery: The Face, Part II. Philadelphia, Pa: WB Saunders Co; 1990. Vol 3: 1895-923.

Ortiz-Monasterio F, Olmedo A, Oscoy LO. The use of cartilage grafts in primary aesthetic rhinoplasty. Plast Reconstr Surg. 1981 May. 67(5):597-605. [Medline].

Erol OO. The Turkish delight: a pliable graft for rhinoplasty. Plast Reconstr Surg. 2000 May. 105(6):2229-41; discussion 2242-3. [Medline].

Guerrerosantos J. Temporoparietal free fascia grafts in rhinoplasty. Plast Reconstr Surg. 1984 Oct. 74(4):465-75. [Medline].

Daniel RK, Calvert JW. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg. 2004 Jun. 113(7):2156-71. [Medline].

Erol OO, Gundogan H. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg. 2005 Sep 15. 116(4):1169-71; author reply 1171-3. [Medline].

Daniel RK. Diced cartilage grafts in rhinoplasty surgery. Plast Reconstr Surg (Letters and Viewpoints). 2005 Sept. 116(4):1171-3.

Brenner KA, McConnell MP, Evans GR. Survival of diced cartilage grafts: an experimental study. Plast Reconstr Surg. 2006 Jan. 117(1):105-15. [Medline].

Britt JC, Park SS. Autogenous tissue-engineered cartilage: evaluation as an implant material. Arch Otolaryngol Head Neck Surg. 1998 Jun. 124(6):671-7. [Medline].

Romo T, Jablonski RD. Nasal reconstruction using split calvarial grafts. Otolaryngol Head Neck Surg. 1992 Nov. 107(5):622-30. [Medline].

Carter WW. Transplantation of bone for the correction of depressed deformities of the nose, with report of cases. Laryngoscope. 1911. 21:94-97.

Macomber DW. Cancellous iliac bone in depression of forehead, nose and chin. Plast Reconstr Surg. 1949. 4:157-162.

Zins JE, Whitaker LA. Membranous versus endochondral bone: implications for craniofacial reconstruction. Plast Reconstr Surg. 1983 Dec. 72(6):778-85. [Medline].

Powell NB, Riley RW. Facial contouring with outer-table calvarial bone. A 4-year experience. Arch Otolaryngol Head Neck Surg. 1989 Dec. 115(12):1454-8. [Medline].

Celik M, Haliloglu T, Baycin N. Bone chips and diced cartilage: an anatomically adopted graft for the nasal dorsum. Aesthetic Plast Surg. 2004 Jan-Feb. 28(1):8-12. [Medline].

Lee MR, Unger JG, Rohrich RJ. Management of the nasal dorsum in rhinoplasty: a systematic review of the literature regarding technique, outcomes, and complications. Plast Reconstr Surg. 2011 Nov. 128(5):538e-550e. [Medline].

Miller TA. Temporalis fascia grafts for facial and nasal contour augmentation. Plast Reconstr Surg. 1988 Apr. 81(4):524-33. [Medline].

Kridel RW, Konior RJ. Irradiated cartilage grafts in the nose. A preliminary report. Arch Otolaryngol Head Neck Surg. 1993 Jan. 119(1):24-30; discussion 30-1. [Medline].

Welling DB, Maves MD, Schuller DE, Bardach J. Irradiated homologous cartilage grafts. Long-term results. Arch Otolaryngol Head Neck Surg. 1988 Mar. 114(3):291-5. [Medline].

Demirkan F, Arslan E, Unal S. Irradiated homologous costal cartilage: versatile grafting material for rhinoplasty. Aesthetic Plast Surg. 2003 May-Jun. 27(3):213-20. [Medline].

Burke AJ, Wang TD, Cook TA. Irradiated homograft rib cartilage in facial reconstruction. Arch Facial Plast Surg. 2004 Sep-Oct. 6(5):334-41. [Medline].

Strauch B, Wallach SG. Reconstruction with irradiated homograft costal cartilage. Plast Reconstr Surg. 2003 Jun. 111(7):2405-11; discussion 2412-3. [Medline].

Suh MK, Lee KH, Harijan A, Kim HG, Jeong EC. Augmentation Rhinoplasty With Silicone Implant Covered With Acellular Dermal Matrix. J Craniofac Surg. 2017 Mar. 28 (2):445-8. [Medline].

Yang CE, Kim SJ, Kim JH, Lee JH, Roh TS, Lee WJ. Usefulness of Cross-Linked Human Acellular Dermal Matrix as an Implant for Dorsal Augmentation in Rhinoplasty. Aesthetic Plast Surg. 2018 Feb. 42 (1):288-94. [Medline].

Ayshford CA, Shykhon M, Uppal HS, Wake, M. Endoscopic repair of nasal septal perforation with acellular human dermal allograft and an inferior turbinate flap. Clin Otolaryngol Allied Sci. 2003 Feb. 28(1):29-33. [Medline].

Gryskiewicz JM, Rohrich RJ, Reagan BJ. The use of alloderm for the correction of nasal contour deformities. Plast Reconstr Surg. 2001 Feb. 107(2):561-70; discussion 571. [Medline].

Gryskiewicz JM. Waste not, want not: the use of AlloDerm in secondary rhinoplasty. Plast Reconstr Surg. 2005 Dec. 116(7):1999-2004. [Medline].

Jackson IT, Yavuzer R. AlloDerm for dorsal nasal irregularities. Plast Reconstr Surg. 2001 Feb. 107(2):553-8; discussion 559-60. [Medline].

Saray A. Porcine dermal collagen (Permacol) for facial contour augmentation: preliminary report. Aesthetic Plast Surg. 2003 Sep-Oct. 27(5):368-75. [Medline].

Colton JJ, Beekhuis GJ. Use of Mersilene mesh in nasal augmentation. Facial Plast Surg. 1992 Jul. 8(3):149-56. [Medline].

Sclafani AP, Thomas JR, Cox AJ, Cooper MH. Clinical and histologic response of subcutaneous expanded polytetrafluoroethylene (Gore-Tex) and porous high-density polyethylene (Medpor) implants to acute and early infection. Arch Otolaryngol Head Neck Surg. 1997 Mar. 123(3):328-36. [Medline].

Niechajev I. Porous polyethylene implants for nasal reconstruction: clinical and histologic studies. Aesthetic Plast Surg. 1999 Nov-Dec. 23(6):395-402. [Medline].

Li J, Huang Y, Zhang Y, Pu Z. Application of a Porous Polyethylene Spreader Graft for Nasal Lengthening in Asian Patients. Aesthet Surg J. 2018 Jan 18. [Medline].

Romo T, Choe KS, Sclafani AP. Cleft lip nasal reconstruction using porous high-density polyethylene. Arch Facial Plast Surg. 2003 Mar-Apr. 5(2):175-9. [Medline].

Romo T, Choe KS, Sclafani AP. Secondary cleft-lip rhinoplasty utilizing porous high-density polyethylene. Facial Plast Surg. 2003 Nov. 19(4):369-77. [Medline].

Romo T, Litner JA, Sclafani AP. Management of the severe bulbous nasal tip using porous polyethylene alloimplants. Facial Plast Surg. 2003 Nov. 19(4):341-8. [Medline].

Deshpande S, Munoli A. Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective. Indian J Plast Surg. 2010 Jan. 43(1):34-9. [Medline]. [Full Text].

Ham J, Miller PJ. Expanded polytetrafluoroethylene implants in rhinoplasty: literature review, operative techniques, and outcome. Facial Plast Surg. 2003 Nov. 19(4):331-9. [Medline].

Jin HR, Lee JY, Yeon JY, Rhee CS. A multicenter evaluation of the safety of Gore-Tex as an implant in Asian rhinoplasty. Am J Rhinol. 2006 Nov-Dec. 20(6):615-9. [Medline].

Maas CS, Gnepp DR, Bumpous J. Expanded polytetrafluoroethylene (Gore-Tex soft-tissue patch) in facial augmentation. Arch Otolaryngol Head Neck Surg. 1993 Sep. 119(9):1008-14. [Medline].

Inanli S, Sari M, Baylancicek S. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. Aesthetic Plast Surg. 2007 Jul-Aug. 31(4):345-8. [Medline].

Chang AA, Reuther MS, Briggs KK, Schumacher BL, Williams GM, Corr M, et al. In vivo implantation of tissue-engineered human nasal septal neocartilage constructs: a pilot study. Otolaryngol Head Neck Surg. 2012 Jan. 146(1):46-52. [Medline].

Godin MS, Waldman SR, Johnson CM. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. A 6-year experience. Arch Otolaryngol Head Neck Surg. 1995 Oct. 121(10):1131-6. [Medline].

Fanous N, Tournas A, Cote V, et al. Soft and Firm Alloplastic Implants in Rhinoplasty: Why, When and How to Use Them: A Review of 311 Cases. Aesthetic Plast Surg. 2017 Apr. 41 (2):397-412. [Medline].

Zeng YJ, Sun XP, Yang J, et al. Mechanical properties of nasal fascia and periosteum. Clin Biomech (Bristol, Avon). 2003 Oct. 18(8):760-4. [Medline].

Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg. 1998 Sep. 102(4):1230-7. [Medline].

Bikhazi NB, Chow AW, Maas CS. Nasal reconstruction using a combination of alloplastic materials and autogenous tissues: a surgical alternative. Laryngoscope. 1997 Aug. 107(8):1086-93. [Medline].

Okada E, Maruyama Y, Hayashi A. Nasal augmentation using calcium phosphate cement. J Craniofac Surg. 2004 Jan. 15(1):102-5. [Medline].

Beekhuis GJ. Saddle nose deformity: etiology, prevention, and treatment; augmentation rhinoplasty with polyamide. Laryngoscope. 1974 Jan. 84(1):2-42. [Medline].

Brent B. The versatile cartilage autograft: current trends in clinical transplantation. Clin Plast Surg. 1979 Apr. 6(2):163-80. [Medline].

Brown BL, Neel HB, Kern EB. Implants of Supramid, Proplast, Plasti-Pore, and Silastic. Arch Otolaryngol. 1979 Oct. 105(10):605-9. [Medline].

Bujia J. Determination of the viability of crushed cartilage grafts: clinical implications for wound healing in nasal surgery. Ann Plast Surg. 1994 Mar. 32(3):261-5. [Medline].

Daniel RK. Rhinoplasty and rib grafts: evolving a flexible operative technique. Plast Reconstr Surg. 1994 Oct. 94(5):597-609; discussion 610-1. [Medline].

Elahi MM, Jackson IT, Moreira-Gonzalez A, Yamini, D. Nasal augmentation with Surgicel-wrapped diced cartilage: a review of 67 consecutive cases. Plast Reconstr Surg. 2003 Mar. 111(3):1309-18; discussion 1319-21. [Medline].

Frodel JL, Marentette LJ, Quatela VC, Weinstein GS. Calvarial bone graft harvest. Techniques, considerations, and morbidity. Arch Otolaryngol Head Neck Surg. 1993 Jan. 119(1):17-23. [Medline].

Kline RM, Wolfe SA. Complications associated with the harvesting of cranial bone grafts. Plast Reconstr Surg. 1995 Jan. 95(1):5-13; discussion 14-20. [Medline].

Kridel RW, Kraus WM. Grafts and implants in revision rhinoplasty. Facial Plast Surg Clin North Am. 1995. 3:473-86.

Lawson W, Reino AJ, Seidman D. The silicone columellar strut. Plast Reconstr Surg. 1996 Apr. 97(5):938-43. [Medline].

Lindsey WH, Ogle RC, Morgan RF, et al. Nasal reconstruction using an osteoconductive collagen gel matrix. Arch Otolaryngol Head Neck Surg. 1996 Jan. 122(1):37-40. [Medline].

McDowell F, Valone JA, Brown JB. Bibliography and historical note on plastic surgery of the nose. Plast Reconstr Surg. 1952. 10:149-86.

Silver WE, Goldberg J. Nasal grafts and implants. Facial Plast Surg Clin North Am. 1994. 2:477-99.

Stucker FJ. Auto-Alloplast: a contemporary concept in facial implantation. Facial Plast Surg. 1986. 3:137-9.

Tardy ME, Denneny J, Fritsch MH. The versatile cartilage autograft in reconstruction of the nose and face. Laryngoscope. 1985 May. 95(5):523-33. [Medline].

Taylor IT, Yavuzer R. Alloderm for dorsal nasal irregularities. Plast Reconstr Surg. 2001. 107(2):553-8.

Tholpady SS, Schlosser R, Spotnitz W, et al. Repair of an osseous facial critical-size defect using augmented fibrin sealant. Laryngoscope. 1999 Oct. 109(10):1585-8. [Medline].

Garrett A Wirth, MD, MS, FACS Clinical Professor of Plastic Surgery, Medical Director of the Wound Healing Center, Long Beach Memorial Medical Center

Garrett A Wirth, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, California Society of Plastic Surgeons, International Society of Aesthetic Plastic Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Musculoskeletal Transplant Foundation; Acelity<br/>Serve(d) as a speaker or a member of a speakers bureau for: Musculoskeletal Transplant Foundation; Acelity.

James G Hoehn, MD Program Director, Professor, Department of Surgery, Division of Plastic Surgery, Albany Medical Center Hospital

James G Hoehn, MD is a member of the following medical societies: American Society of Plastic Surgeons, American Burn Association, American Cleft Palate-Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Edward Owen Terino, MD Director, Department of Plastic Surgery, Los Robles Medical Center

Edward Owen Terino, MD is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, International College of Surgeons

Disclosure: Nothing to disclose.

Deepak Narayan, MD, FRCS Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center

Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Plastic Surgery Research Council, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Indian Medical Association

Disclosure: Nothing to disclose.

Gregory Gary Caputy, MD, PhD, FICS Wound Healing Consultant, Advantage Surgical and Wound Care

Gregory Gary Caputy, MD, PhD, FICS is a member of the following medical societies: American Society for Laser Medicine and Surgery, International College of Surgeons, International College of Surgeons US Section, Wound Healing Society

Disclosure: Nothing to disclose.

Nasal Implants

Research & References of Nasal Implants|A&C Accounting And Tax Services