Ethnic Revision Nose Job and Medpor Implant Removal From Columella
Medpor Implants (biocompatible, porous polyethylene material) have been used for many years for implant purposes and for filling gaps. This Porous Polyethylene Implants are used in cranial, reconstructive, oculoplastic and cosmetic operations. However, no artificial and industrial implants can be as reliable and healthy as the patient's own tissue.
The main advantages of Medpor implants are easy access to surgeons, augmenting stud without requiring additional incision in the patient. Medpor implants are interconnecting, omni-directional pore structure may allow for fibrovascular in-growth and integration of the patient’s tissue.
These implants are also frequently used in nasal dorsum restorations. However, I would like to summarize a few reasons why I have rarely used these implants until now:
- In my experience, I have not encountered any serious complications in nasal augmentation and revision rhinoplasty operations performed with the patient's own cartilage and tissues taken from his own body.
- If there is a need for an external tissue, I think that cadaver cartilage is not compatible with other industrial, human body or that it is more reliable and healthier than materials that are not normally found in the human body.
- There have been published tissue reactions related to medpor implants and other artificial implants (although medpor implant is thought to have a lower risk than others!) (If you want to take a look at the relevant scientific article links >> An Unusual Complication of a Medpor Implant in Nasal Reconstruction: A Case Report / Extent of Inflammation and Foreign Body Reaction to Porous Polyethylene In Vitro and In Vivo / Complications associated with alloplastic implants in rhinoplasty).
I would like to share a case with you. About 2 years ago, a patient who underwent nasal tip lifting and primary ethnic rhinoplasty using a medpor implant in a different clinic, contacted us because of recurrent inflammatory discharge, swelling, skin discoloration (darkening) and pitting on both sides of the columella, especially at the tip of the nose.
In the online evaluation of the patient, it was recommended to remove the Medpor Implant placed in the columella at the tip of the nose, augmentation of the nasal dorsum and the placement of a new columellar strut graft and cap graft at the tip of the nose, and placing a cartilage graft in the sunken skin areas on the upper part of the columella at the tip of the nose. In the clinical examination performed when the patient came to the office, it was evaluated that the nasal tip skin was quite thick and oily. The patient expressed a feeling of stinging on the tip of the nose, playfulness and stretching on the tip of the nose, especially when she smiled.
The photographs below show the patient's medpor implant removed before revision ethnic rhinoplasty and Medpor Implant removal and immediately after surgery.
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| Medpor Nasal Implant Removal From Columella and Revision Ethnic Rhinoplasty |
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| Medpor Nasal Implant Removal From Columella and Revision Ethnic Rhinoplasty |
Rib cartilage was used for nasal tip reconstruction of the patient. It was observed that the old incision scar tissue in the columella was very close to the upper lip (behind normal and in a visible area). An incision was made instead of the previous incision so that there was no new incision scar.
For nasal dorsum augmentation, after nasal tip dissection with the open technique, the subcutaneous tissue was resected by bilevel dissection and this removed subcutaneous tissue was placed on the nasal dorsum (blue arrows).
Small cartilage grafts were placed in the sunken areas at the tip of the nose and in the nasal canal (green arrows - self-dissolvable stitches are shown to fix these cartilages).
On the background of chronic inflammation and infection due to Medpor Implant, the area closest to the nasal tip of the columella, the foremost part of the nostril, more prominent on the left, dark-colored and sunken skin areas (red arrows).
In the first surgery performed in the other clinic, the incision scar was made at the back of the columella, in the junction area with the upper lip, and an infiltration was performed in the same place. You can see the stitches in this area (yellow arrow).
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| Medpor Nasal Implant Removal From Columella and Revision Ethnic Rhinoplasty |
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| Medpor Nasal Implant that removed from columella. |
The reasons why the operation was more difficult than normal in this patient:
- modified anatomy
- Tissue changes at the tip of the nose due to surgical trauma and chronic foreign body reaction
- thick and ethnic skin features
- needing more cartilage tissue than normal and tissue for augmentation.
This patient may require more than 2 years to fully recover from the nose. There was no problem with her follow-up, and from now on, we wish her to live with an infection-free, breathable, beautiful nose.
Before and after the operation video
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
Fax: +90 212 542 74 47
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