Dr. Sam Lam Plastic Surgery Forum

Hi Dr.Lam,

I have question regarding material used in Asian rhinoplasty. I have read in your FAQ section that you prefer to use Gore-tex to augment nasal bridge. I was wondering if you ever consider using freeze dried and frozen bone approved by American Bone Bank. I just had a consultation with one of surgeons in California and he said that artificial materials such as silicone, Gore-Tex are fraught with a certain instance of infection and distortion. In your opinion, is freeze dried and frozen bone better than Gore-Tex?

Thanks, Tom

i personally think that freeze dried bone has the following problems:
1. it is simply too thick and can look unnatural, especially for an asian nose. i like things much much thinner. like a 1 or 2 mm thin gore-tex sheet. that is my aesthetic.
2. it is too firm. our nose is not a solid stick. just rub your hand back and forth and you will see that you can move it normally which you can't with solid bone.
3. bone can reabsorb and warp over time. that is the truth. gore-tex should not do either one.
4. i think that the bone can become quite visible over time. gore-tex less so.

with gore-tex, there is a big drawback. in someone who has had 3 or 4 revision rhinoplasties, the blood supply to the area is compromised and the risk of infection increases with gore-tex. in those cases, i would not use gore-tex. but in a native case or after a single revision, gore-tex is in general much safer. the nice thing is that i typically can remove gore-tex under light anesthesia whereas a bone graft gets stuck to everything and to remove it requires a formal revision nose surgery and still very hard to do.

no implant is ever perfect. each doctor can give you the pros and cons. you just have to find a surgeon that you trust that can be honest and open about his or her experience.
best,
sml

Dr. Lam, thank you for the fast reply. I will schedule a consultation with you soon. And I have one more question, I know you prefer open rhinoplasty but I was wondering if you can achieve following things (1. Augment nasal bridge 2. straighten a deviated septum) with closed rhinoplasty.

The deviated septum can be done closed. Augmentation of the bridge with Gore-Tex should be done open. When I did silicone implants, I did them closed.
best,
sml