Nose Implants

What are nose implants? What are they indicated for?

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.

What are the different types of nose implants?

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).

What are autografts?

Autograft may be harvested from

Cartilage

• Nasal septal cartilageis 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 cartilageis the second choice for cartilage as it is available in larger quantities than septal cartilage.
• Costal or rib cartilage is harvested if a large amount of cartilage is required. This is done via a small incision just below the ribs. This procedure has more complications and is reserved for specific indications.

Soft tissue

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.

These are harvested from the same patient.

What are homografts?

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.

What are 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 to stabilise the implant while still allowing for graft removal if required. It is soft and flexible and is thus primarily used for volume enhancement.

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.

What are the advantages and disadvantages of the different types of nose implants?

Autografts are most often preferred over other implant materials as there is no risk of incompatibility, rejection or toxicity. Among the alloplast implants, silicone implants do not react with the host tissue. e-PTFE is not recommended as a structural graft. PHDPE implants are easy to sculpt and provide good structural support, but it is difficult to remove them if needed.