Why I Avoid Silicone Implants in the Nose for Rhinoplasty
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I had a consultation on Friday afternoon with a lady who wanted a rhinoplasty, Asian rhinoplasty. And she said she had seen or talked to four other consults and she asked whether I did silicone implants in the nose for Asian patients. And I said absolutely not and she said well, you know, there’s was about six hundred dollars less, you know in charge and a large reason is that the implant cost like thousand dollars. And I’ll tell you the history of my using silicone implants. So back when I first started practice almost 20 years ago. I learned in Asia how to do silicone implants. It literally took me about 10 minutes in the office. Totally awake didn’t L-strut implant into the nose and the problem with the L-strut implant is that it has so many issues infection, extrusion, contraction, calcification, and so many problems. So, I migrated from a single piece L-strut silicone implant over to what’s called a two-piece augmentation using a i-shaped silicone implant for the bridge and cartilage tip grafting which then took my ten minute procedure up to about two and a half hours or let’s say an hour and a half, two hours. The problem with that is the same problem silicone contracts. It shrinks. It doesn’t look right can it can actually drop down to the bottom of the nose extrude being pushed through the skin serious problems. Now, what’s interesting in contrast to this is that silicone implants as a chin implant is fantastic highly stable, removable, just fantastic, doesn’t compress.
And after silicone I try this for a few years really hated it. I migrated over to Gore-Tex or expanded polytetrafluoroethylene. That’s a mouth mouth filled full. Gore-Tex I used for about 10 years. Pretty happy with it overall. It didn’t compress or shrink like silicone did not slip down or extrude like silicone ever had that rarely got infected. I only saw one infection and that was from another doctor coming into me. It was actually a big disaster, but I have never seen an infection in my hands over 10 years. So Gore-Tex was an amazingly good product. The same issues in the Gore-tex is that there was still some shrink wrapping I didn’t like. There was a little bit of distortion where the implant actually start to become compressed slightly over time. And that was not so good because it’s Gore-Tex. I used to use this chin implants. They would actually lose about a millimeter of augmentation to us. It didn’t like that. So I migrated over now and the last few years to dice cartilage to seal. So I use a dice rib graft and cadaveric rib which they choose the best rib for that and then I use glue. Which is a temporary glue that goes away in a few months. I like that because very low absorption. No real warping with that, much softer, smoother look, doesn’t compress over time. And so there’s so many advantages a lot more work a lot more labor to get it done, but it’s just totally, totally so much better With the tip, also, this is something that’s probably overkill on this conversation because we’re really talking about silicone implants on why don’t I use them. But the tip you can listen to my podcast on this about coddled step septal extension grafts where I’m getting a much more reliable tip projection. In the past, I would just put a little L-strut graft in there and the tip would drop. With Asian noses there are so many advantages to a caudal septal extension graft. Actually. I should just do a separate podcast on that sort of an update and revisit of that concept. So maybe save it for a separate podcast. But the real benefit of avoiding silicone is all the complications that come with that implant.