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J Cosmet Med 2018; 2(1): 27-31

Published online June 30, 2018

https://doi.org/10.25056/JCM.2018.2.1.27

A systematic review of complications associated with nasal augmentation implants: expanded polytetrafluoroethylene (Gore-Tex) versus silicone

Han Le Thuc Hoang, MD1 , Michael Januszyk, MD2, J. Brian Boyd, MD2

1Institute of Cosmetic and Reconstructive Surgery, Fountain Valley, CA, USA, 2Department of Surgery, University of California, Los Angeles, CA, USA

Correspondence to :
Han Le Thuc Hoang, E-mail: hanhoang@gmail.com, ORCID: https://orcid.org/0000-0001-9011-1254

Received: February 5, 2018; Revised: June 12, 2018; Accepted: June 14, 2018

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Augmentation rhinoplasty has been one of the most common cosmetic procedures in Asian population. Silicone is the most widely used nasal augmentation material in Asia. However, in the past few decades, expanded polytetrafluoroethylene (ePTFE, Gore-tex®) has become more popular as an alternative.
Objective: In this study, complications associated with each implant aresystematically reviewed.
Methods: Heuristic searches of MEDLINE, PubMed, and the Cochrane Library were performed using the keywords “ePTFE”, “Goretex”, “silicone”, and “rhinoplasty” to identify manuscripts for inclusion. The reference lists of these articles were systematically reviewed to further identify relevant articles. Only studies with detailed complication reports (i.e., infection, malposition) were considered. Random effects meta-analysis was performed to calculate the significance of differences in complication rates between silicone and ePTFE.
Results: Eighteen studies encompassing a total of 7,759 patients were analyzed, 12 with ePTFE and 6 with silicone. Among studies in which sex was reported, 88.8% of the patients were female. 88.4% of cases in the silicone group were primary, as compared to 78% in the ePTFE group. Overall complications were 5.3% for the ePTFE group and 9.2% for silicone (p<0.05). Infection rate was similar between the two groups, 1.4% for ePTFE versus 1.9% for silicone group (p>0.05). Exposure rate was also similar, 0.7% for silicone and 1.2% for ePTFE (p>0.05). Malposition rates were significantly lower in ePTFE group compared to those receiving silicone implants (2.4% versus 6.8%, p<0.05).
Conclusion: Although the gold standard graft material for rhinoplasty remains autologous tissue, implant based rhinoplasty is far more common in Asian populations. Both silicone and ePTFE have acceptable risk profiles when used in selective patients for dorsal augmentation. However, given the additional risks of capsular contracture and implant malposition associated with silicone implants, ePTFE should be considered as a first-line option for implant-based nasal augmentation.

Keywords: ePTFE, Gore-tex, nasal augmentation, rhinoplasty, silicone

  1. Jang YJ, Yi JS. Perspectives in Asian rhinoplasty. Facial Plast Surg 2014;30:123-30.
    Pubmed CrossRef
  2. Li D, An Y, Yang X. An overview of Asian rhinoplasty. Ann Plast Surg 2016;Supp 1:S22-4.
    Pubmed CrossRef
  3. Jin HR, Won TB. Rhinoplasty in the Asian patient. Clin Plast Surg 2016;43:265-79.
    Pubmed CrossRef
  4. Sajjadian A, Naghshineh N, Rubinstein R. Current status of grafts and implants in rhinoplasty: Part II. Homologous grafts and allogenic implants. Plast Reconstr Surg 2010;125:99-109e.
    Pubmed CrossRef
  5. Malone M, Pearlman S. Dorsal augmentation in rhinoplasty:a survey and review. Facial Plast Surg 2015;31:289-94.
    Pubmed CrossRef
  6. Kim YK, Shin S, Kang NH, Kim JH. Contracted nose after silicone implantation: a new classification system and treatment algorithm. Arch Plast Surg 2017;44:59-64.
    Pubmed KoreaMed CrossRef
  7. Sunwoo W, Jung H, Kim DW, Jin HR. Immunohistochemical analysis of capsular contracture in silicone implant rhinoplasty. JAMA Facial Plast Surg 2017;19:436-7.
    Pubmed KoreaMed CrossRef
  8. Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 1998;102:1230-7.
    Pubmed CrossRef
  9. Zeng Y, Wu W, Yu H, Yang J, Chen G. Silicone implants in augmentation rhinoplasty. Aesthetic Plast Surg 2002;26:85-8.
    Pubmed CrossRef
  10. Lam SM, Kim YK. Augmentation rhinoplasty of the Asian nose with the “bird” silicone implant. Ann Plast Surg 2003;51:249-56.
    Pubmed CrossRef
  11. Ahn J, Honrado C, Horn C. Combined silicone and cartilage implants: augmentation rhinoplasty in Asian patients. Arch Facial Plast Surg 2004;6:120-3.
    Pubmed CrossRef
  12. Tham C, Lai YL, Weng CJ, Chen YR. Silicone augmentation rhinoplasty in an oriental population. Ann Plast Surg 2005;54:1-5; discussion 6-7.
    Pubmed CrossRef
  13. Chuangsuwanich A, Lohsiriwat V. Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: a 15-year experience. Indian J Plast Surg 2013;46:533-7.
    Pubmed KoreaMed CrossRef
  14. Godin MS, Waldman SR, Johnson CM Jr. Nasal augmentation using Gore-Tex. A 10-year experience. Arch Facial Plast Surg 1999;1:118-21; discussion 122.
    Pubmed CrossRef
  15. Lohuis PJ, Watts SJ, Vuyk HD. Augmentation of the nasal dorsum using Gore-Tex: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci 2001;26:214-7.
    Pubmed CrossRef
  16. Jin HR, Lee JY, Yeon JY, Rhee CS. A multicenter evaluation of the safety of Gore-Tex as an implant in Asian rhinoplasty. Am J Rhinol 2006;20:615-9.
    Pubmed CrossRef
  17. Inanli S, Sari M, Baylancicek S. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. Aesthetic Plast Surg 2007;31:345-8.
    Pubmed CrossRef
  18. Conrad K, Torgerson CS, Gillman GS. Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg 2008;10:224-31.
    Pubmed CrossRef
  19. Dong L, Hongyu X, Gao Z. Augmentation rhinoplasty with expanded polytetrafluoroethylene and prevention of complications. Arch Facial Plast Surg 2010;12:246-51.
    Pubmed CrossRef
  20. Hong JP, Yoon JY, Choi JW. Are polytetrafluoroethylene (Gore-Tex) implants an alternative material for nasal dorsal augmentation in Asians? J Craniofac Surg 2010;21:1750-4.
    Pubmed CrossRef
  21. Yap EC, Abubakar SS, Olveda MB. Expanded polytetrafluoroethylene as dorsal augmentation material in rhinoplasty on Southeast Asian noses: three-year experience. Arch Facial Plast Surg 2011;13:234-8.
    Pubmed CrossRef
  22. Serin GM, Polat S, Aksoy E, Baylançiçek S, Inanli S. Importance of placing Gore-Tex in the subperiosteal plane for augmentation rhinoplasty. J Craniofac Surg 2012;23:e359-61.
    Pubmed CrossRef
  23. Winkler AA, Soler ZM, Leong PL, Murphy A, Wang TD, Cook TA. Complications associated with alloplastic implants in rhinoplasty. Arch Facial Plast Surg 2012;14:437-41.
    Pubmed CrossRef
  24. Shadfar S, Farag A, Jarchow AM, Shockley WW. Safety and efficacy of expanded polytetrafluoroethylene implants in the surgical management of traumatic nasal deformity. JAMA Otolaryngol Head Neck Surg 2015;141:710-5.
    Pubmed CrossRef
  25. Joo YH, Jang YJ. Comparison of the surgical outcomes of dorsal augmentation using expanded polytetrafluoroethylene or autologous costal cartilage. JAMA Facial Plast Surg 2016;18:327-32.
    Pubmed CrossRef
  26. ISAPS. The International Study on Aesthetic/Cosmetic Procedures Performed in 2016 [Internet]. Hanover: International Society of Aesthetic Plastic Surgery, 2016 [cited 2017 Dec 28].
    Available from: https://www.isaps.org/wp-content/uploads/2017/10/GlobalStatistics2016-1.pdf.
  27. Neaman KC, Boettcher AK, Do VH, Mulder C, Baca M, Renucci JD, et al. Cosmetic rhinoplasty: revision rates revisited. Aesthet Surg J 2013;33:31-7.
    Pubmed CrossRef
  28. Chang GU, Jung DH. A new classification system of nasal contractures. J Cosmet Med 2017;1:106-11.
    CrossRef
  29. Jang TY, Choi JY, Jung DH, Park HJ, Lim SC. Histologic study of Gore-Tex removed after rhinoplasty. Laryngoscope 2009;119:620-7.
    Pubmed CrossRef
  30. Jung DH, Kim BR, Choi JY, Rho YS, Park HJ, Han WW. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty:221 revision cases. Plast Reconstr Surg 2007;120:1997-2003.
    Pubmed CrossRef

Article

Original Article

J Cosmet Med 2018; 2(1): 27-31

Published online June 30, 2018 https://doi.org/10.25056/JCM.2018.2.1.27

Copyright © Korean Society of Korean Cosmetic Surgery.

A systematic review of complications associated with nasal augmentation implants: expanded polytetrafluoroethylene (Gore-Tex) versus silicone

Han Le Thuc Hoang, MD1 , Michael Januszyk, MD2, J. Brian Boyd, MD2

1Institute of Cosmetic and Reconstructive Surgery, Fountain Valley, CA, USA, 2Department of Surgery, University of California, Los Angeles, CA, USA

Correspondence to:Han Le Thuc Hoang, E-mail: hanhoang@gmail.com, ORCID: https://orcid.org/0000-0001-9011-1254

Received: February 5, 2018; Revised: June 12, 2018; Accepted: June 14, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Augmentation rhinoplasty has been one of the most common cosmetic procedures in Asian population. Silicone is the most widely used nasal augmentation material in Asia. However, in the past few decades, expanded polytetrafluoroethylene (ePTFE, Gore-tex®) has become more popular as an alternative.
Objective: In this study, complications associated with each implant aresystematically reviewed.
Methods: Heuristic searches of MEDLINE, PubMed, and the Cochrane Library were performed using the keywords “ePTFE”, “Goretex”, “silicone”, and “rhinoplasty” to identify manuscripts for inclusion. The reference lists of these articles were systematically reviewed to further identify relevant articles. Only studies with detailed complication reports (i.e., infection, malposition) were considered. Random effects meta-analysis was performed to calculate the significance of differences in complication rates between silicone and ePTFE.
Results: Eighteen studies encompassing a total of 7,759 patients were analyzed, 12 with ePTFE and 6 with silicone. Among studies in which sex was reported, 88.8% of the patients were female. 88.4% of cases in the silicone group were primary, as compared to 78% in the ePTFE group. Overall complications were 5.3% for the ePTFE group and 9.2% for silicone (p<0.05). Infection rate was similar between the two groups, 1.4% for ePTFE versus 1.9% for silicone group (p>0.05). Exposure rate was also similar, 0.7% for silicone and 1.2% for ePTFE (p>0.05). Malposition rates were significantly lower in ePTFE group compared to those receiving silicone implants (2.4% versus 6.8%, p<0.05).
Conclusion: Although the gold standard graft material for rhinoplasty remains autologous tissue, implant based rhinoplasty is far more common in Asian populations. Both silicone and ePTFE have acceptable risk profiles when used in selective patients for dorsal augmentation. However, given the additional risks of capsular contracture and implant malposition associated with silicone implants, ePTFE should be considered as a first-line option for implant-based nasal augmentation.

Keywords: ePTFE, Gore-tex, nasal augmentation, rhinoplasty, silicone

References

  1. Jang YJ, Yi JS. Perspectives in Asian rhinoplasty. Facial Plast Surg 2014;30:123-30.
    Pubmed CrossRef
  2. Li D, An Y, Yang X. An overview of Asian rhinoplasty. Ann Plast Surg 2016;Supp 1:S22-4.
    Pubmed CrossRef
  3. Jin HR, Won TB. Rhinoplasty in the Asian patient. Clin Plast Surg 2016;43:265-79.
    Pubmed CrossRef
  4. Sajjadian A, Naghshineh N, Rubinstein R. Current status of grafts and implants in rhinoplasty: Part II. Homologous grafts and allogenic implants. Plast Reconstr Surg 2010;125:99-109e.
    Pubmed CrossRef
  5. Malone M, Pearlman S. Dorsal augmentation in rhinoplasty:a survey and review. Facial Plast Surg 2015;31:289-94.
    Pubmed CrossRef
  6. Kim YK, Shin S, Kang NH, Kim JH. Contracted nose after silicone implantation: a new classification system and treatment algorithm. Arch Plast Surg 2017;44:59-64.
    Pubmed KoreaMed CrossRef
  7. Sunwoo W, Jung H, Kim DW, Jin HR. Immunohistochemical analysis of capsular contracture in silicone implant rhinoplasty. JAMA Facial Plast Surg 2017;19:436-7.
    Pubmed KoreaMed CrossRef
  8. Deva AK, Merten S, Chang L. Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 1998;102:1230-7.
    Pubmed CrossRef
  9. Zeng Y, Wu W, Yu H, Yang J, Chen G. Silicone implants in augmentation rhinoplasty. Aesthetic Plast Surg 2002;26:85-8.
    Pubmed CrossRef
  10. Lam SM, Kim YK. Augmentation rhinoplasty of the Asian nose with the “bird” silicone implant. Ann Plast Surg 2003;51:249-56.
    Pubmed CrossRef
  11. Ahn J, Honrado C, Horn C. Combined silicone and cartilage implants: augmentation rhinoplasty in Asian patients. Arch Facial Plast Surg 2004;6:120-3.
    Pubmed CrossRef
  12. Tham C, Lai YL, Weng CJ, Chen YR. Silicone augmentation rhinoplasty in an oriental population. Ann Plast Surg 2005;54:1-5; discussion 6-7.
    Pubmed CrossRef
  13. Chuangsuwanich A, Lohsiriwat V. Augmentation rhinoplasty with custom-made S-shape silicone implant in Asians: a 15-year experience. Indian J Plast Surg 2013;46:533-7.
    Pubmed KoreaMed CrossRef
  14. Godin MS, Waldman SR, Johnson CM Jr. Nasal augmentation using Gore-Tex. A 10-year experience. Arch Facial Plast Surg 1999;1:118-21; discussion 122.
    Pubmed CrossRef
  15. Lohuis PJ, Watts SJ, Vuyk HD. Augmentation of the nasal dorsum using Gore-Tex: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci 2001;26:214-7.
    Pubmed CrossRef
  16. Jin HR, Lee JY, Yeon JY, Rhee CS. A multicenter evaluation of the safety of Gore-Tex as an implant in Asian rhinoplasty. Am J Rhinol 2006;20:615-9.
    Pubmed CrossRef
  17. Inanli S, Sari M, Baylancicek S. The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty. Aesthetic Plast Surg 2007;31:345-8.
    Pubmed CrossRef
  18. Conrad K, Torgerson CS, Gillman GS. Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg 2008;10:224-31.
    Pubmed CrossRef
  19. Dong L, Hongyu X, Gao Z. Augmentation rhinoplasty with expanded polytetrafluoroethylene and prevention of complications. Arch Facial Plast Surg 2010;12:246-51.
    Pubmed CrossRef
  20. Hong JP, Yoon JY, Choi JW. Are polytetrafluoroethylene (Gore-Tex) implants an alternative material for nasal dorsal augmentation in Asians? J Craniofac Surg 2010;21:1750-4.
    Pubmed CrossRef
  21. Yap EC, Abubakar SS, Olveda MB. Expanded polytetrafluoroethylene as dorsal augmentation material in rhinoplasty on Southeast Asian noses: three-year experience. Arch Facial Plast Surg 2011;13:234-8.
    Pubmed CrossRef
  22. Serin GM, Polat S, Aksoy E, Baylançiçek S, Inanli S. Importance of placing Gore-Tex in the subperiosteal plane for augmentation rhinoplasty. J Craniofac Surg 2012;23:e359-61.
    Pubmed CrossRef
  23. Winkler AA, Soler ZM, Leong PL, Murphy A, Wang TD, Cook TA. Complications associated with alloplastic implants in rhinoplasty. Arch Facial Plast Surg 2012;14:437-41.
    Pubmed CrossRef
  24. Shadfar S, Farag A, Jarchow AM, Shockley WW. Safety and efficacy of expanded polytetrafluoroethylene implants in the surgical management of traumatic nasal deformity. JAMA Otolaryngol Head Neck Surg 2015;141:710-5.
    Pubmed CrossRef
  25. Joo YH, Jang YJ. Comparison of the surgical outcomes of dorsal augmentation using expanded polytetrafluoroethylene or autologous costal cartilage. JAMA Facial Plast Surg 2016;18:327-32.
    Pubmed CrossRef
  26. ISAPS. The International Study on Aesthetic/Cosmetic Procedures Performed in 2016 [Internet]. Hanover: International Society of Aesthetic Plastic Surgery, 2016 [cited 2017 Dec 28]. Available from: https://www.isaps.org/wp-content/uploads/2017/10/GlobalStatistics2016-1.pdf.
  27. Neaman KC, Boettcher AK, Do VH, Mulder C, Baca M, Renucci JD, et al. Cosmetic rhinoplasty: revision rates revisited. Aesthet Surg J 2013;33:31-7.
    Pubmed CrossRef
  28. Chang GU, Jung DH. A new classification system of nasal contractures. J Cosmet Med 2017;1:106-11.
    CrossRef
  29. Jang TY, Choi JY, Jung DH, Park HJ, Lim SC. Histologic study of Gore-Tex removed after rhinoplasty. Laryngoscope 2009;119:620-7.
    Pubmed CrossRef
  30. Jung DH, Kim BR, Choi JY, Rho YS, Park HJ, Han WW. Gross and pathologic analysis of long-term silicone implants inserted into the human body for augmentation rhinoplasty:221 revision cases. Plast Reconstr Surg 2007;120:1997-2003.
    Pubmed CrossRef

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