When considering nose reshaping, one of the most important decisions is "which material to use." This article explains the merits and demerits of major materials such as autologous rib cartilage, silicone, and Medpor. Please use this as a reference to realize your ideal nose shape.
1. Autologous Rib Cartilage: A material with extremely high biocompatibility because it is self-tissue
Autologous cartilage (ACC) is a method that uses cartilage harvested from the patient's own rib bone. The greatest merit is that because it is self-tissue, biocompatibility is extremely high, and ultimately blood flow recovers around the surrounding tissue and it becomes established as part of "your own nose." Once stable, unlike artificial materials such as silicone, it does not require future replacement, and long-term stability can be expected.
On the other hand, there are several points to note. First, a small incision in the chest is required to harvest the cartilage, and there is a risk that minor scarring may remain. Additionally, as a phenomenon unique to autologous rib cartilage, there is a rare possibility that the cartilage may slightly bend over time—a phenomenon called "warping (distortion)." Furthermore, because it becomes firmly adhered as self-tissue, if in the future you wish to change the design, compared to artificial materials, removal and revision become extremely difficult.
In nose reshaping using autologous rib cartilage, because it is often used in difficult revision surgery, the reported complication rate tends to be higher compared to initial surgery using other materials, but this is thought to be more influenced by the surgical background rather than being a problem with the material itself.Systematic reviews have also confirmed that the complication rate of autologous rib cartilage tends to be higher compared to other materials (Vila PM, 2020).
2. Silicone Implant (prosthesis): Ease of revision and design freedom
Silicone is the most widely used artificial material for nose reshaping in the Asia-Pacific region due to its low cost and ease of processing. A major advantage is that it easily creates clear nasal lines and can be easily adjusted in shape according to the patient's wishes.
Additionally, what is noteworthy about silicone is the "ease of revision." In meta-analyses, cases requiring silicone removal are reported at a certain rate. This is also an advantage in that "if a problem occurs or you want to change the design, it can be relatively easily removed and replaced, and because there is minimal adhesion, it is possible to respond while minimizing damage to surrounding tissue." Unlike self-tissue, it does not adhere to surrounding tissue, so for those considering future maintenance or design changes, it becomes a major source of reassurance.Similar removal rates have also been reported in meta-analyses comparing autologous rib cartilage with artificial materials(Liang X, 2018).
However, as a long-term risk, the possibility of implant exposure, infection, or deformation due to calcification cannot be ruled out. Therefore, in recent times, the technique of covering silicone with self-cartilage (such as auricular cartilage) to mitigate risks has also become standard practice.
3. Medpor: Risks and Current Status of High-Density Polyethylene
Medpor is a porous artificial material that has been said to have superior fixation strength because tissue easily penetrates it. As initial surgical results, good aesthetic and functional outcomes can sometimes be achieved.
However, the medical field takes its risks seriously. The greatest problem is that due to its porous structure, surrounding tissue deeply penetrates (adheres to) the material, making removal extremely difficult if complications occur. If infection or exposure occurs, surrounding tissue must be separated with significant injury, and revision surgery carries the risk of severe inflammation or tissue loss. In fact, it has been pointed out that revision after Medpor is far more difficult than revision using autologous rib cartilage in secondary surgery.
In Japan, it is an approved material by the Ministry of Health, Labour and Welfare, but due to its characteristics making revision extremely difficult, very careful judgment is required for its use.
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4. Comparison summary of each material
5. Conclusion: Optimal selection through dialogue with your physician
There is no "absolute right answer" when choosing a material for rhinoplasty. Autologous costal cartilage offers long-term stability but has difficulty with revision surgery. Silicone provides flexibility for future modifications. Medpor offers strong fixation but carries significant consequences if complications arise.
The optimal material depends on your nasal condition, surgical history, and what kind of nose you wish to maintain in the future. It is important to receive a thorough explanation including both benefits and drawbacks, and to consult during counseling until you are satisfied. We will select the most appropriate material based on your individual circumstances.
Our clinic proposes treatment plans tailored to each patient. For more details, please see ourTreatmentspage. Additionally, ourColumn listprovides you with the latest information on other beauty-related topics.
References
- Vila P, Jeanpierre L, Rizzi C, et al. Comparison of Autologous vs Homologous Costal Cartilage Grafts in Dorsal Augmentation Rhinoplasty. JAMA Otolaryngology–Head & Neck Surgery. 2020 (DOI)
- Liang X, Wang K, Malay S, et al. A Systematic Review and Meta-Analysis of Comparison Between Autologous Costal Cartilage and Alloplastic Materials in Rhinoplasty. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2018 (DOI)
Author of this article
Hiromitsu NakamuraPhysician
Zetith Beauty Clinic Ginza, Osaka, Fukuoka
With a track record of research presentations at domestic and international academic conferences, he is also involved in technical guidance and education across Zetith Beauty Clinic. He specializes in precision rhinoplasty based on anatomical principles, pursuing natural results tailored to each individual's skeletal structure and tissue composition.
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