Revision Rhinoplasty Using Porous High-Density Polyethylene Implants to Reestablish Ethnic Identity

Abstract

As is widely known, no ideal alloplastic material exists for augmentation or secondary rhinoplasty. This is an interesting article because it describes another attempt to achieve success managing the different problems with alloplastic materials when autologous cartilage is not available. I remark from my experience that the only justification for using these materials is that no septal or conchal cartilage was available. Besides, an important fact to mention is that the thick skin of some ethnic groups is ideal for success in augmentation rhinoplasty with alloplastic materials. In my experience, an adequate harvest of conchal cartilage leaves no deformity, and with the ‘‘tandem’’ method described by Dr. Ronald Gruber [1], it is very useful for restoration of dorsal height and regularity. The costal cartilage tends to warp, and osseus grafts resorb at a very high rate. Although there is no ideal alloplastic material, the surgeon must maximize perfection by managing the material he uses. I emphasize that when a surgeon places these kinds of implants, careful closure of incisions should be done. I believe, according to my experience with alloplastic materials, which includes more than 1,100 patients and more than 18 years of follow-up evaluation [2], that the advantages the authors mention in their article regarding the porosity of this material might represent a problem in the long term. If the material ever needs to be removed, it might be a difficult task. I agree with the importance of antibiotic prophylaxis to increase success in dealing with alloplastic materials. Finally, besides congratulating the authors for their enthusiasm, I encourage them to share with us, in the future, a long-term report with radiographic and clinical controls.