Removing medpor implant

Medpor is porous polyethylene which has many pores that tissue grows in. Thin sheet of Medpor is commonly used as septal extension graft, columellar strut, and splinting graft of the septum. Sometimes it is used as dorsal implant, too.

Common problems of Medpor used for rhinoplasty are bad smell from the nasal cavity, hard and painful tip, extrusion of implant, and infection. Removal of implant is the only solution for these problems. As tissue grows into the pores, removal is sometimes difficult, but it can be safely removed in most cases. Important point is maintaining the septal support or tip support after removal. After removal, often the septum or tip cartilage is weak with loss of dorsal or tip height, needing support with autologous cartilages.

Below is a case of Medpor removal. She complained of overly projected tip with stiffness and pain. From the surgical photo, you can see the L-strut made with Medpor. After removal of Medopor, septum was reconstructed and tip and dorsum was also resotored. More natural tip and dorsal line was obtained after removal. Her tip pain disappeared and the tip became more soft.

microsopic view of Medpor

before and after Medpor removal

surgical view of Medpor at caudal septum

removed L-shaped Medpor

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Deviated & hump nose correction

This lady in below photos had nasal deviation, hump nose, and tip ptosis with breathing difficulty. Septum was corrected first, and this made the lower 2/3 of the nose straight. Hump was not resected but rasped with Piezotome and this did not breach the keystone area, which made spreader grafts unnecessary.Bilateral osteotomies with Piezotome made her bone straight. Together with septum correction and effective osteotomies, her nose became straight from the frontal view. Tip was modified with sutures and onlay graft only. No strut or septal extension graft was used and this made the tip soft even after considerable amount of rotation and projection increase. Radix was augmented with bruised cartilage. Overall, she could breath much better after surgery and her nose became more harmonious and feminine.

Creating more feminine nose

The lady in below photos visited my clinic for rhinoplasty. She wanted to have more feminine nose instead of her muscline nose. She had a long nose with slight bump on the dorsum, overprojected, slightly bulbous and droopy tip, and slighly wide dorsum. Surgery was focused on creating more feminine look: hump removal, narrowing the bony dorsum with osteotomies, tip volume reduction, decreasing tip projection, and slight cephalic rotation. Photos taken 2 weeks after surgery (because she returnd back to her country after surgery) shows changes on the dorsum and the tip. Dorsum became slender with creation of smooth brow-tip aesthetic line. Tip was refined with volume reduction, slight underprojection, and cephalic rotation. Although the changes are not radical, her nose looks more feminine.

Rib cartilage rhinoplasty

Using rib cartilage in rhinoplasty needs lots of attention both in patient's and surgeon's perspective. For patient, it means additional incision on the chest, possible harvest site complications including chest pain, scar, and penumothorax, more cost, longer surgery time, and possibility of warping. From the surgone's perspective, rib cartilage is usually the last resort of autogenous material for rhinoplasty. It affords a lot of possibilities for rhinoplasty such as dorsal augmentation, tip grafts, and lots of septal grafts, all of which are not possible with other autogenous sources. It also means a lot of experience is necessary for skillful use of rib cartilage. I have used rib cartilage for rhinoplasty for more than 15 years. As cases accumulate, I can harvest the rib with small incision (less than 1.5 cm) without any complications such as peumothorax or severe pain. I do not cut the muscle and only retract it and this helps to reduce pain. Scar can be minimi...

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