Rhinoplasty With Nasal Augmentation
Although many types of cosmetic or reconstructive rhinoplasty involve making the nose smaller or slimmer, or removing a bump, some people need to have material added to their nose. For some people, the bridge of the nose needs to be built up, or the septum, columella, or base of the nose repaired. The structure of the nose may have been broken down due to disease, trauma, birth defects, repeat surgeries, and even from prolonged drug use. Some of these deformities can be extremely disfiguring. In these cases, the nose is augmented with implants that can be made of either synthetic or natural materials.
Nasal implants are used to correct defects in the bridge of the nose, the base of the nose, and the columella. It is possible to use bone grafts from your hip, leg, or rib and cartilage grafts from your septum, ear, or ribs as nasal implants in rhinoplasty surgery. Synthetic implants are made from solid silicone, polyethylene, expanded polytetrafluoroethylene (ePTFE), a bone-like material called hydroxyapatite, and other materials.
The most common site for nasal implants is the bridge of the nose and the columella. However, implants are also used in other sites around and under the nose to repair birth defects and damage due to trauma.
Nasal Augmentation With Bone and Cartilage Grafts
A rhinoplasty surgeon can build up your nose using pieces of bone and cartilage. Bone can be taken from your ribs, hip, or leg and will be carved into the right shape. However, this means that you will have an incision, pain, and the possibility of complications such as infection at whatever site from which the surgeon harvested the bone.
A bone graft can also come from a cadaver, called an allograft. These grafts are sterilized and do not cause rejection problems. They are used in several types of orthopedic and spine surgeries and in periodontal surgery.
Cartilage to be used in nasal augmentation can be taken from the septum of your nose (if you have a good supply of it there), from your ear, or from a rib. Again, you will have a second surgical site on your body, but this type of nasal implant works relatively well. When cartilage is taken from the ear, the incision is on the back of the ear and the amount taken is a small sliver. Cartilage from both ears might be needed if your nose needs a lot of remodeling.
With both bone and cartilage grafts, there is the chance that your body will reabsorb the graft, at least to some extent, or that the graft may deteriorate.
Synthetic Nasal Implant Options
Solid silicone has been used as a material for facial plastic surgery for decades. The silicone facial implants are solid, yet flexible, and come in several sizes and shapes and can even be custom made from a solid block of silicone. The body creates a capsule of scar tissue around almost any kind of implant, but this actually allows for an easier removal in the future with nasal implants.
One drawback to silicone implants is that they can be felt in some patients who have thin skin on their nose. This can be especially true if the nasal implant was not sized correctly or is slightly out of place. There is a small possibility of infection even years after implantation.
A nasal augmentation implant can also be made of polyethylene, a type of plastic, and expanded polytetrafluoroethylene (ePTFE), which is sold under the brand name of Gore-Tex. Both polyethylene and ePTFE have been used in medicine for decades and implants in these materials are available in a variety of sizes and shapes. Both can be custom carved to suit a specific individual's need.
Polyethylene is available in a porous form, which allows the body to grow tissue into the implant. This helps keep the implant in place, but can make removing it very difficult.
Hydroxyapatite is made from coral and is very similar to the make up of bone. Implants made from this can be used in the bony portions of the nose only.