Grafts in rhinoplasty: alloplastic vs. autogenous.

Abstract

Over the past 15 years, grafts have been used with increasing frequency during rhinoplasty procedures as the transition has been made from reductive rhinoplasty to augmentation or restructuring rhinoplasty. There are a number of grafting materials available, including autogenous materials (bone, cartilage), homograft materials (rib cartilage, dermis), and a wide variety of synthetic or alloplastic materials. With regard to the autogenous materials, cartilage has been the mainstay for augmentation in rhinoplasty. Bone is used infrequently because it often yields unsatisfactory results in the aesthetic appearance of the nose, and has problems with graft resorption. I will therefore not discuss bone herein. This article focuses on the differences between autogenous cartilage implants and synthetic materials, in particular expanded PTFE (Gore-tex; WL Gore & Associates Inc, Flagstaff, Ariz). Certainly, there is no argument that autogenous grafts, in particular cartilaginous grafts, are superior as a grafting material in rhinoplasty for a variety of reasons. Cartilaginous grafts are considered the criterion standard by many authors. The more debatable issue is in the case where substantial dorsal augmentation is required: is autologous material preferable to synthetic? Arguments to both support and refute the notion that autologous cartilage is superior will be presented here. Overall, the ideal implant should have biocompatible physical properties. It should retain constant shape and volume and be nonresorbable. Removal should be easy, and migration should not be a problem. As well, the implant should be easily modified and molded, readily available, and cost-effective. On a microscopic level, there should be no inflammatory response, and there should be resistance to infection. The tissue should not degrade, transmit disease, or act as a carcinogen. These characteristics apply to implants throughout the body. Another desirable characteristic with respect to the nose is that in the area of thin skin over the upper dorsum, the implant should be easily camouflaged. These issues as they pertain to both the autogenous and synthetic graft will be addressed and conclusions offered. While comparison of the aesthetic results is impossible and has not been evaluated in a series, patient satisfaction and revision rates will be emphasized. The wide variety of synthetic materials that have been used for the purpose of rhinoplasty is an indication of the need for a perfect alloplastic implant. Through the years, numerous synthetic materials have had relatively high complication rates. I will address only 2 synthetic implants that continue to be used frequently: silicone and expanded PTFE. Silicone is widely used in rhinoplasty for the Asian patient, and the issues relative to this procedure will be addressed. Expanded PTFE has been gaining in popularity over the past 10 years, and results after long-term follow-up will be assessed. PRO