Porous High-density Polyethylene Implants Research Articles

CURRENT APPROACHES TO MANAGING MICROTIA

Microtia, a developmental anomaly of the external ear resulting in a deformed auricle, affects 1 to 5 individuals per 10,000. Literature suggests a male predominance, with nearly 2.5 times more male patients affected than females. Additionally, there is a notable right-sided predilection, leading to pronounced asymmetry, observed in approximately 83% of cases. Surgical reconstruction is the primary treatment for microtia, albeit a technically demanding procedure with challenges in achieving optimal aesthetic outcomes. Reconstruction typically involves autologous costal cartilage, known for its effectiveness but requiring advanced surgical skills. Complications, including pneumothorax, postoperative pain, chest wall deformity, and pathological scarring, are common with this approach. In recent years, surgeons have increasingly adopted modern techniques utilizing porous high-density polyethylene implants for reconstruction. This approach is gaining popularity due to the challenges associated with achieving satisfactory cosmetic results using autologous costal cartilage reconstruction. Based on the bibliosemantic and analytical methods employed to analyze the literature, we posit that this topic necessitates further investigation and a multidisciplinary approach. The involvement of otolaryngologists and maxillofacial surgeons is imperative for the comprehensive treatment of this pathology.

Standard and Customized Alloplastic Facial Implants Refining Orthognathic Surgery: Outcome Evaluation

Conventional orthognathic osteotomies provide appropriate functional outcomes but might be unable to correct midface deficiency, achieve a satisfactory outcome in asymmetrical cases, or allow sufficient chin advancement. We evaluated the outcome of both standard and customized facial high-density porous polyethylene implants used to refine the cosmetic outcome of orthognathic surgery. We implemented a retrospective study. The sample was composed of all patients who underwent facial alloplastic augmentation between June 2011 and October 2018 in our department. The complication rate was recorded after a mean follow-up period of 41months postoperatively, and patient satisfaction was assessed through a qualitative evaluation based on an 11-item questionnaire. The sample was composed of 24 implants placed in 14 patients: 13 mandibular angle implants, among which 4 were customized; 8 malar implants; and 3 chin implants. No physical complications such as hematoma, infection, migration, or hypoesthesia were observed. Two implants had to be removed because of early unsatisfactory esthetic outcomes. Of 14 patients, 11 answered our questionnaire. Eighty-two percent strongly agreed that the overall outcome was satisfactory. The results of this study confirm the low physical complication rate described in the literature, and the esthetic complication rate remains lower than the rates observed in previous reports. A high satisfaction rate was found among patients. The lowest mean satisfaction score was noted for appropriate implant symmetry (3.5), whereas the highest mean satisfaction score (3.8) was achieved when using customized implants. If standard high-density porous polyethylene implants appear to be relevant adjuncts to orthognathic surgery, customized implants seem to achieve higher satisfaction, although their prohibitive cost should be considered.

Septorhinoplasty for Destructed Septal L-Strut in Patients with Previously Applied Porous High-Density Polyethylene Implants (Medpor®).

Porous high-density polyethylene implants (Medpor®) have been extensively used for septal extension grafts in Asian rhinoplasty. However, studies on the long-term complications associated with Medpor® have not been reported. Therefore, the purpose of this study was to evaluate the long-term complications of septal extension grafts using Medpor® and present a reconstructive strategy for destructed septal L-struts. We conducted a 12-year retrospective medical chart review of 428 patients who visited our center for septorhinoplasty. Among 428 patients, 43 patients had Medpor® for septal extension grafts previously applied at other clinics. The quadrangular cartilage was devoid or destructed in the area where Medpor® was previously applied. Therefore, all patients underwent secondary septorhinoplasty using autogenous cartilage grafts. Patient outcome was assessed to evaluate satisfaction, hardness of nasal tip, functional nasal obstruction symptom evaluation (NOSE) scores, and pain scores. Anthropometric analyses were carried out with patients' photographs. Postoperative complications were also evaluated. After septal L-strut reconstruction, 87% of patients were satisfied with their aesthetic results. Hardness of nasal tip, NOSE scores, and pain scores also improved after reconstruction. Anthropometric analyses demonstrated that increased nasal length and decreased columellar-labial angle were achieved in patients with short nose deformities. No postoperative complications related to the reconstruction were recorded for any patient. The devastated destruction of nasal support lines was found after the use of Medpor® for septorhinoplasty. Therefore, the use of Medpor® should be reduced. Autogenous cartilage grafts are the last resort for reconstruction of destructed septal L-struts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

High-Density Polyethylene Material versus Autogenous Grafts in Craniofacial Augmentation Procedures.

Aim:The objective was to do a comparative study and to evaluate the outcome in overall acceptance for correction of residual facial deformity with autogenous graft versus porous polyethylene implants.Materials and Methods:A total of 16 patients in the age group of ≥15 years irrespective of sex, caste, religion, and socioeconomic status presenting with signs and symptoms of residual facial deformities and who were declared fit for surgery were included in the study. The study patients were further divided into two groups, of eight each. Deformity correction using autogenous grafts was performed in Group A and using high-density polyethylene (HDPE) alloplastic implants was performed in Group B. During the follow-up period, patients’ and doctor rating of overall acceptance between autogenous and alloplastic (HDPE) bone grafts was recorded on 100-mm visual analog scale (VAS) on the 2nd day and 7th day and at 3, 6, and 12 weeks.Results:The unpaired t-test is used for evaluation. VAS score at all the follow-up periods above stated was significantly higher in alloplastic group than in the autogenous group for both in patients and doctor evaluation.Conclusion:From the present study, it can be concluded that porous HDPE implants are an effective alternative to autogenous grafts in accordance of overall acceptance for correction of residual facial deformity when proper case selection, exclusion of negative prognostic factors, and meticulous surgical procedure are followed.

Maxillofacial reconstruction with Medpor porous polyethylene implant: a case series study.

ObjectivesThe role of alloplastic materials in maxillofacial reconstruction is still controversial. Determining the utility of porous, high-density, polyethylene implants as a highly stable and flexible, porous alloplast, with properties such as rapid vascularization and tissue ingrowth, is crucial in cases of maxillofacial deformities and aesthetic surgery.Materials and MethodsThirty high-density porous polyethylene implants were implanted in 16 patients that had been referred to a private office over a three-year period. These implants were used for correcting congenital deformities, posttraumatic defects and improving the aesthetic in nasal, paranasal, malar, chin, mandibular angle, body and orbital areas.ResultsThe outcomes of the cases in this study showed good aesthetic and functional results. The majority of patients had no signs of discomfort, rejection or exposure. Two implants suffered complications: a complicated malar implant was managed by antibiotic therapy, and an infected mandibular angle implant was removed despite antibiotic therapy.ConclusionBased on the results, the Medpor implant seems to be an excellent biomaterial for correcting various facial deformities. Advantages include its versatility and relatively ideal pore size that allows for excellent soft tissue ingrowth and coverage. It is strong, flexible and easy to shape.

Porous polyethylene implants in facial reconstruction: Outcome and complications

The aim of the present study was to assess the indications, results and complications of patients treated with porous polyethylene (Medpor(®)) implants in the Department of Oral and Maxillofacial Surgery of VU Medical Centre, Amsterdam over 17 years. A total of 69 high-density porous polyethylene implants (Medpor(®) Biomaterial; Porex Surgical, Newman, GA) were used in forty patients (22 males, 18 females). All patients were analysed for gender, age, diagnosis, indications for surgery, follow-up period and postoperative complications. A mean age of 34.1 years was observed. The main reason for implant surgery was post-traumatic functional impairment (27.5%). Most implants were placed at the mandibular angel and the orbital floor. Unsatisfactory appearance scored the highest in postoperative complications (10.1%) followed by infection rate (7.2%). Comparing the number of implants placed over the years and the incidence of complications, makes the overall complications rate of porous polyethylene very low. A consensus about antibiotic prophylaxis is needed. The objective measurements in patient satisfaction and proper implant design would be of great use.

Utility of high density porous polyethylene implants in maxillofacial surgery.

The aim of this paper was to determine the utility of high density porous polyethylene implants (HDPE) in a variety of facial skeletal deformities. Sixteen patients (age range 14-28 years) with facial deformities requiring skeletal defect reconstruction or augmentation, treated between January 2008 and December 2010. The follow-up of the patients ranged from 6 months to 2 years.The types of deformities and defects treated include: one patient each with hemifacial microsomia and nasal tip correction, two patients each with malar deformities and orbital floor reconstruction, three patients with paranasal deformities and mandibular hypoplasia and four patients with chin augmentation. A total of 24 implants were placed. The complications included infection and wound dehiscence in one patient. The implants were palpable extraorally in two patients. It is concluded that HDPE is an excellent alternative to autogenous grafts for facial skeletal augmentation. Its porous nature, excellent soft tissue growth and coverage are the advantages and disadvantages include its rigidity and sometimes it is palpable extraorally.

Nasal Measurements in Asians and High-Density Porous Polyethylene Implants in Rhinoplasty

To understand Asian noses, set goals for rhinoplasty, and find the best alternative columellar strut. Six values were used to evaluate the morphology of the nose: tip projection, alar-tip-columellar base angle, alar-columellar base-philtrum angle, nasolabial angle, nasofacial angle, and tip angle. One hundred average Chinese people (50 males and 50 females) were compared with 36 preoperative Chinese patients (13 males and 23 females). We presented an application of high-density porous polyethylene (Medpor) implant as a columellar strut for use in lengthening. We performed 3 surgical techniques: a single-plate strut, a double-plate strut, and a butterfly-shaped strut. Open rhinoplasty (transcolumella incision) was performed on 21 patients; closed rhinoplasty (marginal incision) was performed on 15 patients. Prominent changes in the 6 values were found in both male and female patients after rhinoplasty. An analysis of the Asian nose will help surgeons achieve better results. High-density porous polyethylene columellar strut grafts provide adequate support for refined tip definition and the shaping of the columellar-lobular angle.

Use of Silicone Sizers in Implantation of Porous Polyethylene Nasal Dorsal Implants in Asians

Introduction. A new technique of implantation of high-density porous polyethylene nasal dorsal implants in Asians is described in this paper. Silicone sizers, which have smooth surfaces, were used to facilitate implantation of porous polyethylene implants in Asian patients. Materials and Methods. Twenty-three patients of Asian descent underwent dorsal augmentation rhinoplasty with open technique using high-density porous polyethylene implants. In all cases, silicone sizers were used to facilitate implantations of high-density porous polyethylene nasal dorsal implants. Patient selection criteria exclude patients with history of cocaine use, history of nasal or sinus disorders, previous nasal surgery, deviated septum, poor cartilage support, and thin skin. Results. No bleeding, infection, rejection, displacement, or extrusion was noted. One implant was removed because of a patient's dissatisfaction with the resulting tip height. Conclusion. The use of silicone sizers to facilitate implantations of high-density porous polyethylene nasal dorsal implants was safe and efficacious.

The Reconstruction of Nasal Septal Perforation with High Density Porous Polyethylene Covered with Fascia Lata: An Experimental Study on Rabbit Model

ObjectivesEvaluation of a new material, high-density porous polyethylene (HDPP), which is covered with fascia lata, for experimental nasal septal perforation closure.MethodsTwenty New Zealand albino rabbits were included and divided into study and control groups. A lateral incision was made from the lateral aspect of the left nares to the incisura nasomaxillaris. After exposure of the cavum nasi, the nasal mucoperichondrium was elevated bilaterally. A full-thickness 0.5×0.5-cm perforation was created over the septum nasi with a No. 11 surgical blade. A fascia lata graft was used for the study group. The HDPP was covered with fascia lata and placed under the elevated mucosa. HDPP without a fascial covering was used in the control group. Four months after the procedure, magnetic resonance imaging was performed to evaluate resorption of the material. The animals were sacrificed, and the nasal septum was completely removed. Macroscopic and histopathological examinations were performed on the nasal septum.ResultsAll rabbits had survived after the 4-month period. Macroscopically, nine of 10 (90%) perforations were closed in the fascia lata-covered HDPP group. Histopathological examination of these nine rabbits revealed that the continuity of cartilage was disturbed in the perforation areas. Granulation tissue was inverted in areas in which the cartilage continuity was disturbed. The HDPP had remained intact at the edge of the perforation. In the HDPP group, six of 10 implants were still perforated (60%) and four (40%) were closed. The fascia lata-covered HDPP implant had a significantly higher perforation closure rate than that of the HDPP implant alone (P<0.05).ConclusionIn cases of septal perforation, it is better to cover the HDPP implant with fascia lata. This covered implant can be used for the repair of nasal septal perforations. HDPP implants are easy to work with and avoid the increased operative time and morbidity associated with harvesting autografts.

Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective

ABSTRACT Context: With the increasing emphasis on well-sculpted facial features, today there is a growing need for tools to augment the facial skeleton; either for cosmetic reasons or to re-contour deformities—congenital, post-traumatic and post-ablative. The limitations of autogenous materials has lead to evolution of numerous ‘alloplasts’, of which, high-density porous polyethylene (HDPE) seems to be a promising alternative. Aims: To evaluate the long term results of HDPE in facial skeletal augmentation in terms of achieving desired facial contour, patient satisfaction and complications. Settings: A tertiary care referral centre in a metropolitan set-up. Design: Case Series Materials and Methods: All patients undergoing HDPE implant insertion for facial skeletal augmentation between July 2001 and November 2009 were included in the study. A total of 70 HDPE implants were inserted in 44 patients. All procedures were performed by a single surgeon following standardized pre, intra and post-operative protocols. The results were evaluated with respect to improvement in facial contour desired and achieved, overall patient satisfaction and complications encountered. Results: The study included 44 patients with a male:female ratio of 1:1, a mean age of 25.09 years (14 to 58 years) and a mean follow-up of 45.34 months (0.5 to 100 months). HDPE implants were used to augment the nasal dorsum, maxilla, malar eminence, chin, mandibular body and angle, orbital rim and frontal region. The overall recontouring afforded by the HDPE implants was good, with most patients reporting satisfactory results. There were seven complications (10%), including three cases of deviation (4.29%), three cases of exposure (4.29%) and one case of sub-clinical infection (1.43%). None however necessitated implant removal. Nasal dorsal HDPE implants, especially those involving secondary surgery, suffered a much higher complication rate compared to other implants. Conclusions: HDPE is an alternative to autogenous grafts for facial skeletal augmentation with good long-term results and a low incidence of complications, provided there is adequate vascular soft tissue cover.

Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: An Indian perspective.

Context:With the increasing emphasis on well-sculpted facial features, today there is a growing need for tools to augment the facial skeleton; either for cosmetic reasons or to re-contour deformities-congenital, post-traumatic and post-ablative. The limitations of autogenous materials has lead to evolution of numerous 'alloplasts', of which, high-density porous polyethylene (HDPE) seems to be a promising alternative.Aims:To evaluate the long term results of HDPE in facial skeletal augmentation in terms of achieving desired facial contour, patient satisfaction and complications.Settings:A tertiary care referral centre in a metropolitan set-up.Design:Case SeriesMaterials and Methods:All patients undergoing HDPE implant insertion for facial skeletal augmentation between July 2001 and November 2009 were included in the study. A total of 70 HDPE implants were inserted in 44 patients. All procedures were performed by a single surgeon following standardized pre, intra and post-operative protocols. The results were evaluated with respect to improvement in facial contour desired and achieved, overall patient satisfaction and complications encountered.Results:The study included 44 patients with a male:female ratio of 1:1, a mean age of 25.09 years (14 to 58 years) and a mean follow-up of 45.34 months (0.5 to 100 months). HDPE implants were used to augment the nasal dorsum, maxilla, malar eminence, chin, mandibular body and angle, orbital rim and frontal region. The overall recontouring afforded by the HDPE implants was good, with most patients reporting satisfactory results. There were seven complications (10%), including three cases of deviation (4.29%), three cases of exposure (4.29%) and one case of sub-clinical infection (1.43%). None however necessitated implant removal. Nasal dorsal HDPE implants, especially those involving secondary surgery, suffered a much higher complication rate compared to other implants.Conclusions:HDPE is an alternative to autogenous grafts for facial skeletal augmentation with good long-term results and a low incidence of complications, provided there is adequate vascular soft tissue cover.

Fibrovascularization and Osteogenesis in High-Density Porous Polyethylene Implants

High-density porous polyethylene (HDPP) has been extensively used in craniofacial reconstructions with high-level success and minimal complications. It is known for its biocompatibility and satisfactory stability in the receptor bone area, presenting only a few reports of mobility and infection. In the current study, attention was given to the interface area between HDPP and bone surface to analyze fibrous and bone tissue formation and ingrowth into the pores of the material placed in the mandible of rabbits. Twelve male New Zealand rabbits underwent surgical procedure to receive bilateral HDPP implants in buccal face of dentate mandibular alveolar process, fixed with titanium screws. After 7, 14, 45, and 90 days, the animals were killed, and the specimens were retrieved for histologic and immunohistochemical analyses. No implant loss or infection was detected at the retrieval of the specimens. The microscopic analysis presented satisfactory integration of the material to the bone surface, with new bone formation from the receptor bed and inside the pores of the material, observed from the 15th day. After 90 days, remodeling bone and fibrous tissue was seen in the interface region. Among some of the pores, mature lamellar bone was present. Immunohistochemistry pointed out a moderate expression either to Core binding factor protein 1/RUNX2 or to vascular endothelial growth factor for early periods evaluated, that is, 7 and 15 days after surgery. These results confirm the osteoconductive behavior and high biocompatibility of the material, associated to its adequate immobilization, leading to its lifelong presence in human biologic system.

Medpor in maxillofacial deformities: report of three cases

This paper deals with the usefulness and versatility of the porous high-density polyethylene implants for correction of various facial deformities as an augmentation and an onlay graft material with its advantages. Prefabricated porous high-density polyethylene implants were used in three patients (post-trauma facial deformity, Goldenhar syndrome, nasal deformity in cleft patient) for secondary reconstruction of orbital floor, depressed nose and supra-orbital ridge, augmentation of hypoplastic mandible and depressed nasal dorsum under general anaesthesia. Good esthetic results were achieved in all the three patients treated with porous high-density polyethylene implants with no complications. Porous high-density polyethylene alloplastic implant is an excellent biomaterial for reconstruction of various facial deformities with many advantages over autogenous and other alloplastic materials.

Correction of Septal and Midface Hypoplasia in Maxillonasal Dysplasia (Binder’s Syndrome) Using High-Density Porous Polyethylene

Maxillonasal dysplasia (Binder's syndrome) is a congenital malformation characterized by an extremely flat and retruded nose. This report describes an 18-year-old woman with maxillonasal dysplasia (Binder's syndrome). The septal deficiencies and maxillary retrusion of the patient were corrected by using an L-shaped implant and a crescent-shaped high-density porous polyethylene implant through the oral vestibular sulcus via an external rhinoplasty approach. After the operation, the tip of the nose had moved 5.5 mm anteriorly in the sagittal plane and 11.9 mm coronally in the vertical plane. Also, the nasolabial angle had increased after the surgery. Follow-up evaluation at 24 months showed good correction of the nasal and midface projection. High-density porous polyethylene implants are a good alternative for patients with Binder's syndrome, especially those who will not accept costal cartilage grafts or orthognathic surgery and who have tendency for hypertrophic scarring.

Improved Non-Coupled Prosthetic Motility Utilizing Motility-Enhancing Fornix Sutures

Purpose: To evaluate the surgical technique and the motility of non-coupled ocular implant and prosthesis complex, utilizing fornix sutures, by examining the outcomes following evisceration surgery. Materials and Methods: Forty patients with atrophic, phthyiscal, or staphylomatous globes underwent evisceration using the scleral overlapping technique with a transequatorial release incision. All the patients were implanted with high-density porous polyethylene implants. Twenty patients underwent evisceration utilizing fornix sutures. The remaining 20 patients underwent a conventional described evisceration technique. Care was taken that no conjunctival shortening was present. Follow-up was for three months. The patients were all fitted by a non-coupled ocular prosthesis at one month and follow-up continued as usual. Results: All cases showed functional improvement with an average increase of motility measurements when utilizing the motility-enhancing fornix sutures in comparison to the described conventional evisceration technique. Motility was measured by evaluating horizontal and vertical excursions. Results were documented up to three months postoperatively. Apart from a late postoperative exposure developing in one case, no cases of additional infection, extrusion, or granuloma formation were encountered. Conclusion: The non-coupled prosthetic motility utilizing motility enhancing sutures was more predictable with superior motility effect over the conventional evisceration technique. However, a longer follow-up and perhaps a larger number of cases may be needed to provide additional support to the findings of this study.

Medpor® Lower Eyelid Spacer: Does it Biointegrate?

Purpose: To report the histopathologic findings of explanted Medpor® lower eyelid spacers (LES) in complicated cases. Materials and Methods: Four cases of lower eyelid retraction due to thyroid orbitopathy (n = 2), facial nerve palsy (n = 1), and post-enucleation socket syndrome (n = 1) were treated with Medpor® LES. Results: All implants were removed between 6 months to 2 years following their original insertion due to exposure, poor stability, or contour. Histopathology of the implants showed fibrosis and vascularization although clinically, at the time of removal, did not appear vascularized. In addition, immunohistochemistry was positive for Factor VIII related antigen and CD34, thus highlighting the presence of vessels in the pores and around the implant. Conclusion: To our knowledge, we are the first to report histopathologic findings of explanted high-density porous polyethylene implants from the lower eyelid in humans. Although this study shows that Medpor® LES does biointegrate, we advocate using it sparingly due to associated complications such as exposure, poor stability, and contour.

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

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

Experimental study on axial pedicled composite flap prefabrication with high density porous polyethylene implants: medporocutaneous flap

Composite flaps including soft tissues with bone or cartilage are widely used in reconstruction of three-dimensional defects, but have some disadvantages. Flap prefabrication with alloplastic implants is an alternative procedure. Axial pattern vascularised high density porous polyethylene (HDPP) implants are capable of sustaining skin grafts. The purpose of this study was to examine the vascularisation pattern of the skin island in a composite flap prefabrication model prepared with vascularised HDPP implants. Forty male Wistar rats divided into four groups were used. A 9.5 x 6 x 2 mm HDPP block was centered on the dissected saphenous pedicle and anchored under the abdominal skin in the experimental group I (n=10). In experimental group II (n=10) saphenous artery and vein were put between the skin and the implant. Thus, the structures were laid as skin, HDPP block, pedicle in experimental group I and skin, pedicle, HDPP block in experimental group II. HDPP block-implanted and pedicle-implanted only groups served as control groups I and II, respectively. Eight weeks after prefabrication, skin islands 1.5 x 5 cm in size incorporated with implants were elevated based on saphenous vessels in the experimental groups and skin islands only based on the pedicle in control group II. Skin islands of the same dimensions were raised as grafts in control group I. Nylon sheets were put under the flaps and grafts to prevent vascularisation from the recipient bed. Flap viability was assessed by measuring the surface area on the 7th day. Total necrosis developed in composite grafts of control group I. Flap survival was higher in experimental group II and control group II (45% and 46.8%) than in group I (29.28%). Histologic studies demonstrated fibrovascular ingrowth into the HDPP implants, except in control group I, with significant inflammatory response and necrosis. Vascularisation of skin and implants from the pedicle was seen also microangiographically. In conclusion, a composite flap prefabrication model including vascularised HDPP implant, skin and vascular carrier was developed. This new flap was termed a 'medporocutaneous flap'.

Porous Polyethylene Implants In Secondary Revision Of Rhinoplasty: A Safer Procedure?

Revision rhinoplasty is one of the most challenging operations in facial surgery. Not only is a surgical procedure being performed on a scarred facial structure, which limits overall success, but also the patient undergoing revision rhinoplasty often has unrealistic expectations of the final results. Revision rhinoplasty has stimulated a variety of reconstructive techniques by surgeons dedicated to restoration of both nasal form and nasal function. Supportive materials are widely used in this operation. These materials may be categorized as autogenous tissue, homograft materials, and alloplastic materials. In this study we present our experience with high density porous polyethylene (HDPP) in thirteen patients who had operated for aesthetical revision rhinoplasty with autogenous tissue before. HDPP implants were used in nasal dorsum in aesthetical revisions. We detected only one complication as implant malposition. We speculate that prior augmentation of the nasal dorsum forms a preexpanded nasal skin and increases the vascularity of the region. Rasping of the nasal dorsum increases the bare contact surface adding to tissue ingrowth to the implant and stabilization of it. Scar tissue due to prior surgery and subperiosteal placement of the implant increases the barrier effect of the nasal skin. Although autogenic materials should be preferred in nasal dorsal augmentation, in secondary cases in which donor area limitations are encountered, HDPP implants can easily and effectively be used for nasal dorsum augmentation.