Where should I get rhinoplasty? A doctor who can explain both Implant (prosthesis) and costal cartilage?

Where to get rhinoplasty (nose bridge augmentation) depends on choosing a clinic that handles both silicon Implant (prosthesis) and your own costal cartilage, and can explain the complication rates of each with specific numbers. A meta-analysis of 53 studies showed that costal cartilage has a complication rate of 14%, higher than synthetic materials, because it is more commonly used in revision surgery; however, the authors recommend costal cartilage as the first choice for both primary and revision procedures[1]. On the other hand, one surgeon's 30-year record of placing silicone in 1,019 patients showed extrusion in less than 1% and infection in less than 0.4%[2].

What determines the material used in rhinoplasty (nose augmentation)?

The material is determined by the thickness of the nasal skin, the desired height, past surgical history, and whether the surgeon is experienced with that material. Meta-analyses of synthetic materials show that Gore-Tex, Medpor, and silicone are the three most commonly used materials, and the surgeon's familiarity with the material can significantly affect complication rates and outcomes.[3].

In rhinoplasty for Asian noses, most procedures involve adding material to the nose.[3]Therefore, it is important to choose a clinic not only skilled in 'reduction surgery,' but also one that offers multiple options for augmentation materials when selecting a facility for rhinoplasty.

How do complications differ between silicone and rib cartilage?

With silicone, the main risks are displacement, extrusion, and infection, while with rib cartilage, the main risks are warping, resorption, and scarring at the donor site on the chest.[2]In a series of 1,019 silicone cases, the most common complication was implant (prosthesis) displacement (37 cases, 4%), and the most common reason for revision was patient dissatisfaction (43 cases, 4%).[2]Exposure occurred in 9 cases and infection in 4 cases.[2].

A meta-analysis of 6 studies involving 888 patients undergoing nasal surgery with rib cartilage showed complications in 7% overall (range 5–9%), mostly minor issues such as infection, warping, and graft displacement, with 92% of patients satisfied.[4]However, there is considerable variation between studies, and the numbers cannot be directly applied to your own case.[4].

A meta-analysis of 53 studies notes that while Medpor has a low complication rate, revision surgery becomes extremely difficult if problems do occur.[1]Whether a physician can explain the "ease of correction if complications arise" for each material is a key point in evaluating doctors.

Can you trust good results from a single physician as presented?

The better the numbers, the more you should verify the conditions. The 30-year record for silicone represents results from one physician using the same surgical technique, and the authors themselves have written about the limitation that "the results may not apply directly to other physicians."[2]The good outcomes are explained as resulting from the accumulated surgical skills: creating an accurate pocket beneath the periosteum, selecting appropriate length, and avoiding tension at the nasal tip.[2].

Conversely, when selecting a facility, asking "which material, how many cases, and what surgical technique" is a shortcut to verifying what the numbers really mean.[3][2].

Do they honestly discuss the possibility of dissatisfaction and revision?

Both textbooks and meta-analyses acknowledge that nasal surgery is a procedure with low patient satisfaction rates.[5][6]。Textbooks note that even experienced physicians cannot avoid certain complications and patient dissatisfaction, and facilities that do not hide this premise are more trustworthy.[5]、The way photographs are confirmed and the number of consultations are also factors in choosing a facility.

A survey using FACE-Q with 183 patients showed that those who underwent revision surgery had lower satisfaction than after their initial procedure, and the most common reason for revision was dissatisfaction with the nasal tip[7]。This survey recommends having two consultations before surgery to confirm patient motivation and expectations.[7]。The number of consultations and the method of photo confirmation also serve as factors in facility selection.

There is a definition that distinguishes between revision surgery performed by a different physician (called secondary surgery) and revision surgery performed by the same physician (called corrective surgery).[8]When asking about 'costs and conditions for corrections,' it's helpful to clarify which type is being referred to so the conversation aligns.

For people with thin skin, what should you confirm?

Since thin skin makes the Implant (prosthesis) outline more prone to show through or be felt, ask about the compatibility between the material and skin. There is a report evaluating 52 nasal cases in thin-skinned Asians using a technique that preserves the perichondrium on the surface of cartilage grafts[9], demonstrating that the final result changes not only based on the material itself but also on 'what is placed beneath the skin.'

There are also review articles that organize the positioning of allografts and synthetic materials[10], and material choices are not limited to one option. Whether the surgeon can specifically discuss design considerations for thin skin is a useful benchmark.

Conditions of your nose that we want to confirm during examination

We want to confirm four things: skin thickness and your desired height[3], candidate materials and the likelihood of complications for each[1][4][2], that surgeon's case numbers and techniques for each material[3][2], and the conditions if revision becomes necessary[7][8]. A review summarizing post-operative complications from 36 studies states that providing accurate pre-operative information is the foundation of informed consent[11].

Whether rhinoplasty is suitable depends on skin thickness, the shape of the nasal bone and cartilage, and history of past surgery or injections. During examination, communicate your wishes separately for the bridge and tip of the nose, confirm the benefits and risks for each material, the process if revision is needed, and work together to determine which material is realistic for your nose.