The Nose has not only commanded attention on its own accord for its size and shape, but has governed Facial Aesthetics like no other part of the body. Not only it defines facial proportions, but also influences the personality of the individual.
Aesthetic Augmentation of the Nose using autogenous and alloplastic material have come a long way. The variety of autogenous and alloplastic material used over the ages is not only exhaustive, but bewildering as well. This asserts the fact that perfection in this field is less than becoming.
The autogenous material include the gold standard – bone and cartilage grafts . The range of alloplastic material attempted extend from fingernails, injected paraffin, porcelain gold, ducks breastbone to the more recent biocompatible polymers like Silastic, Proplast II Medpore, Mersiline and Supramid.
We are presenting here a series of 65 cases that came to us between 1985 and 1999, for aesthetic correction of the Nose, primarily using Poly-Tetra-Fluoro-Ethylene (Proplast II) or expanded Poly-Tetra-Fluoro-Ethylene (ePTFE, GORE-TEX) essentially for an Augmentation of the Nasal Dorsum.
Every surgeon faces obligatory situations in his practice where an alloplastic implant has to be considered. We have experience with silastic and Proplast but here we present our work with expanded Poly-Tetra-Fluoro-Ethylene (ePTFE, GORETEX, W.L Gore and Associates Inc, Flagstaff, Arizona)
This is a polymer of fluorine and carbon extruded under high pressure, through a dye to create a microporous material that has a weaves of ePTFE fibrils interspersed with PTFE nodules. The internodal separation that approximates the pore size has an average internodal space of 22, which allows for limited tissue ingrowth and stabilization of the implant. ePTFE is available in a form and a reinforced form, which incorporates fluorinated ethylene propylene.
The material has multidirectional fibrils that internally reorient the nodes when uniaxial shearing forces are applied. This conforming property should not be interpreted as stretching as the surface area is still maintained. ePTFE was introduced clinically by Soyer et al in 1972, as a vascular prosthesis. Neel in 1989 introduced it in Plastic Surgery following his histologic experiments on an animal model. To date ePTFE has been used in mesh form for hernia repair and reconstruction, soft tissue deficiencies, cardiovascular patching, great vessel and peripheral vascular reconstruction etc.
The plastic surgeons hesitation in attempting new alloplastic material is well based on the promises and failures of previously well-publicized synthetic products, the use of ePTFE in various other biocompatible mode has established its reputation as a relatively inert, biocompatible and bioadaptable alloplastic implant.
But its use in ‘low threshold area’s ’ as in the nasal dorsi where the implant is superficial, under a shallow skin cover and relatively proximate to a contaminated field (Nares) has not been undergoing considerable evaluation. Our report attempts to expand and add to this still lean body of information.