Nasal Implant FAQs – Why Our New Hampshire Surgeon Does Not Use Artificial Materials

Dr. Mark Constantian has long been an advocate of using only a patient's own natural bone and cartilage to build up or support the nose. Because many surgeons insist that these are unreliable or difficult to use and prefer to place artificial implants that are made of silicone or other material, we receive a lot of questions about nasal implant surgery at our New Hampshire office, near the Massachusetts border.

"I have had five operations on my nose that include having a silicone implant put in, but the nasal implant moves and it's cold in the winter. I've been told that I've had too many operations and nothing else can be done. Is that true?"

I am generally opposed to any artificial materials (like silicone, radiated bone or cartilage, artificial meshes or sheeting) in the nose because they frequently give unsatisfactory results, or become infected and have to be removed. The only permanent way to rebuild the nose is by using the patient's own cartilage and bone. This is more complicated, but it offers the patient the best chance of having a permanent reconstruction of living tissue from his/her own body. If cartilage and bone have already been removed from the nasal septum (the wall that divides one air passage from the other inside the nose) other options are ear cartilage, rib cartilage or bone from the outer table of the skull. The more operations a person has had, the more difficult the problem; but almost always something can be done to improve the airway and the appearance; the difficulty of the operation depends upon what building materials remain and how complicated the nasal deformity is.

"I have had two rhinoplasties and the bridge of my nose has begun to sink. One surgeon has recommended that AlloDerm be used to fill the depression on my bridge, and a second suggested Gore-Tex®. Would you follow this procedure, and if not, why would cartilage be better?"

Both AlloDerm and Gore-Tex® are "easy" at the time of your surgery, but ultimately will not be easy unless they are permanent solutions. I do not use this type of nasal implant at my New Hampshire practice, just north of Massachusetts, because no artificial material has the proven track record of your own cartilage or bone. Both of these materials have only been used for a relatively short time in nasal reconstruction. Your own cartilage or bone, although a bigger initial procedure, will be a far better reconstruction and should be permanent. Furthermore, the sunken bridge (saddle nose) often affects the position of the tip, the airway, and even upper lip position; it is best to correct all of these problems, which simply filling in the dent on the bridge will not do.

"If I sent you a few pictures, would you be able to tell me if I have a good chance to get my nose fixed? I have been to see one of the top doctors in my country, but he does use Gore-Tex® and I am still not sure about having that put in my nose."

I would be happy to review any pictures that you send along with a letter indicating what operations you have had, what you currently do not like about your nose, and what you would like to have fixed. Obviously, any plan I could devise through photographs would be a "best guess" without examining you (follow the "At-home Consultation" method). I do not use Gore-Tex® in the nose because I am looking for a permanent solution using materials with a proven track record; to fit those criteria, there is nothing that matches the patient's own cartilage and bone. Though Gore-Tex® may work in some situations, for patients like you, who have had multiple prior surgeries (and therefore have a scar and decreased circulation in your nose), artificial materials of any kind are not a good solution.

"I have had four nose operations and want to remove the silicone nasal implant in my nose. My nose is too big and long and the silicone moves. I am a black woman and have been told by many doctors that they cannot help me. I wear glasses to hide how I look. Can you help me?"

It is certainly not too late to have a procedure done, but the silicone nasal implant has been put in your nose for a reason, and if it is taken out, something else (probably rib) will need to be placed in order to support your nose and give it shape. Remember that the shape of the nose is not the shape of the skin: The shape of the nose is created by the forces of the underlying cartilage and bone. The amount of nasal skin you have cannot really be changed, but the shape can often be altered to make the nose look more balanced, more attractive, and frequently "smaller."

"I had my fourth rhinoplasty about six months ago. Too much was taken from the bridge of my nose and a piece of Gore-Tex® was implanted. The Gore-Tex® had to come out in two months because of infection. After four years, I chose another surgeon who took grafts from both my ears and rib and built up my nose. Unfortunately, the rib now extends from the tip of my nose all the way up to about the top of my forehead.

I have suffered an enormous amount of emotional distress and have lost my self-identity. My last surgeon said that after three months he can make an incision close to my eyebrow and carve down the graft at the top of my nose, but when I visited him again, he changed his story. I don't know what to do at this point."

Thank you for your e-mail and for recounting your long story. It is unfortunately a common one. The surgeons that you have seen have given you the correct advice, because the nose has to heal after each operation before anyone can make judgments about what needs to be done and before the tissues are soft enough to "cooperate" with what the surgeon wishes. The last thing that you need at this point is another unsuccessful result, and so it is very important that we control as many variables as possible before surgery.

Without seeing your nose, my suspicion is that someone will have to start over again with a new rib. If your nasal septum has been removed, rib provides the best source for a long, straight bridge, and even if both ears were available, rib would still give you a better outcome. Despite the difficulty of working with rib cartilage itself, that graft should give you the best result. As to the question of who should perform your surgery, it is a little like asking who should repair your car. As you have discovered, you can get as many opinions as there are surgeons. What you need to decide is that the surgeon's plan makes sense to you, and you trust that he or she has your best interest at heart.

I am happy to evaluate you if you wish. I do agree that you would need to wait until it has been at least a year since your last surgery, and even that may be too soon if your tissues are still tight or stiff; I would only know that by examining you. If you wish to arrange a consultation, I can certainly give you my thoughts about what honestly can be achieved, and what the problems are that we might face. It should, however, be possible to make improvements over what you have.

Contact Our New Hampshire Practice, near Massachusetts

If you would like to learn more about the pros and cons of nasal implant surgery, please contact our New Hampshire office, just north of Massachusetts. We will be happy to answer any questions you have.

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If you have been told that you need a nasal implant and are unsure, contact our New Hampshire practice, serving Massachusetts and beyond, to discuss your case with Dr. Mark Constantian.






Mark B. Constantian, M.D., F.A.C.S.
19 Tyler Street, Suite 302
Memorial Medical Building
Nashua, New Hampshire 03060, USA
Phone: 603.880.7700