Dr. Sam Lam Plastic Surgery Forum

Hi Doc,

Quick question. Could silicone and gortex last a lifetime without removing or replacing? If no, why? if yes, what are the success rate would you say.
Thank you

the answer is yes and no. any alloplast risks infection. if there is severe trauma to the nose or you have a systemic body infection then there is a small risk the implant could be infected. o/w without those extreme cases, the implants should last a lifetime. the reason i do not like silicone is sometimes even without trauma, i have seen the implants continue to encapsulate the outer skin and put pressure on the underlying cartilages so that the skin starts to shrink upwards creating a problem with the nose over time. here is a photo of a lady that has that exact problem that i recently repaired with cartilage grafts through an open technique:

http://www.lamfacialplastics.com/galler ... e.jpg.html

So you would recommend gortex as oppose to silicone? what are the advantage and disadvantage of gortex? In the long run would gortex be a better option with less chance of future complications? Could it be planted in any different type of asian nose?
Thanks again.

hi,
yes, definitely goretex. i stopped using silicone many years ago. don't like it. it causes too much shrinkage to the overlying skin and damage to the underlying tissues. goretex, the main risk, is infection which is pretty rare and also it is more difficult to remove than silicone but still doable. in summary, thin gore-tex sheets are very safe in the right hands. also, yes, it is safe in almost all asian noses.
best,
sml

Doc,
Thank you for the feedback.
Another Question. What do you generally use for the nose tip? Ear, rib cartilage or others? pro/cons?. What would be best?
Thanks.

septal and ear cartilage is what i use. i also use rib but only when there is no cartilage left. the septum is the best because it is the strongest but ear is sometimes necessary because asians have very little cartilage supply. if there is no septum to be had either due to poor supply or if it was already harvested, then i reinforce my ear cartilage with a dissolvable vicryl plate that reinforces it but then slowly dissolves over a few months keeping the support through fibrosis without having a foreign substance retained.
best,
sml