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.