The ENTific Centre
Gore-Tex implants for Asian rhinoplasty
Gore-Tex, or expanded polytetrafluoroethylene (ePTFE), is a very popular alloplastic material used currently in Asian rhinoplasty. It is relatively inert with a low implant infection and reaction rate. Its semi-rigidity allows it to be easily sculptured and worked by the surgeon. The final implant mould also resists the shrink-wrapping forces sufficiently to allow the underlying implant features to be subtlely evident beneath the soft tissue nasal envelope.
The ePTFE implant can be used as individual sheets or preformed stacked sheets of varying thickness. For thinner ePTFE sheets, the surgeon can surgically stacked the sheets to their required height and transfixed the sheets prior to sculpturing and insertion. The authors (GS & FW) prefer the pre-formed stacked ePTFE blocks which are reduced and carved to shape for height, breadth and three-dimensional contour by the surgeon.
For augmentation of the radix, a measured boat-shaped radix Gore-Tex graft is cut out of the block with a scalpel. The deep surface of the implant is then gouged out by diamond burring under cool irrigation. The superficial lateral edges of the implant, that would form the brow-tip line, are contoured using the same diamond burr and cool irrigation. The deep lateral margin of the implant is similarly drilled and feathered thinly. This permits a seamless transition of the lateral implant surface to the lateral nasal bones upon which the implant sits; if this feathering is poorly done, a palpable step can be felt and/or seen several months later.
Finally the deep guttered surface of the Gore-Tex implant is scored to allow it to better conform to the bony concave curvature of the natural radix (see Figures 13 a-c). The finished implant is impregnated in an antibiotic-saline solution before insertion. It is placed in a subperiosteal pocket over the radix, and up toward the glabellar as the aesthetics require. Any subrhinion and supratip extension of the implant will sit supraperichondrially (see Figures 14 a-c). This camouflages any irregularities in this area with a relatively soft fill appearance.
The thinner ePTFE sheets can also be used for grafting in other areas of the nose. They can be cut to shape and used as cap grafts, shield grafts, supratip fills and alar base grafts. However our experience has shown that the use of these synthetic ePTFE grafts in mobile regions of the nose e.g. tip and alar, has a higher risk of associated graft complications of infection and extrusion.