Collins St, Melbourne | Brighton | Bentleigh East
Dr Mansoor Mirkzem - Cosmetic & Plastic Surgeon - BMedSci MBBS FRACS[Plas]

Procedures

Nose Implants

Nose implants are used in nasal reconstruction for correction of aesthetic deformities or nasal obstruction caused by trauma, autoimmune disease, cancer, or infection. A favoured implant is one which satisfies and suits the individual's requirements.

Various materials can be used for nasal reconstruction. These may be harvested either from the same patient (autograft), from a donor (homograft) or manufactured from synthetic or semi-synthetic materials (alloplast).

Autograft

Autograft may be harvested from the cartilage (septal, conchal, costal) or soft tissue (fascia, dermis) of the same patient. These are most often preferred over other implant materials as there is no risk of incompatibility, rejection or toxicity.

Nasal septal cartilage is the most preferred autograft material for nasal reconstruction, when available in sufficient quantity and quality. The advantage with nasal septal cartilage is that it can be harvested from the same surgical site. Conchal cartilage is the second choice for cartilage as it is available in larger quantities than septal cartilage. If a large amount of cartilage is required, the costal or rib cartilage is harvested via a small incision just below the ribs, however, this procedure has more complications and is reserved for specific indications. Soft tissues such as fascia, dermis, and fat are sometimes used for volume augmentation, to hide minor irregularities or also over other implant materials as an onlay graft.

Homograft

Homografts include irradiated rib cartilage and cadaveric dermal grafts. Rib cartilage is preferred by some surgeons for structural grafting whereas cadaveric dermal grafts are used as onlay graft or to hide minor irregularities.

Alloplasts

Alloplasts are now being increasingly used as nasal implants. They are made up of synthetic polymers and include the following:

Silicone implants

Silicone implants are made up of silicone rubber and have been in use for many years. However, their use is limited because they do not interact with the host tissue due to their non-porous nature. In Asians, who possibly have thicker skin, they have shown some good results.

Expanded-polytetrafluoroethylene (e-PTFE) implants

e-PTFE is a micro-porous polymer with the pore size of about 22 micrometres. This allows for some host tissue ingrowth, sufficient enough to stabilise the implant while still allowing for graft removal if required. e-PTFE is soft and flexible and thus is primarily used for volume enhancement but is not recommended as a structural graft.

Porous High Density Polyethylene (PHDPE) implants

PHDPE implants are made up of PHDPE polymer which is easy to sculpt into a desired shape. Moreover, PHDPE polymer contains pores with sizes ranging from 100-250 micrometres which allows for significant host tissue ingrowth. Thus they are used for both nasal soft tissue augmentation and for structural support. Moreover, they are also used for implants for other areas of the face, and are available in various shapes and sizes. The only disadvantage is difficulty in removal of implant, if needed.

Dr. Mansoor Mirkazemi - Cosmetic & Plastic Surgeon
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Australian Society of Plastic Surgeons Fellow Royal Australian College Of Surgeons
International Plastic Reconstructive Aesthetic Surgery