KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMDNot Available
Dr Porter's article sets out to establish that autogenous grafts are preferable to synthetic materials in rhinoplasty, and does so in a well-documented fashion. My experience allows me to add some nuances and variation of opinion, and perhaps some additional insights, to this challenging issue.
There is little doubt that autogenous cartilage is the preferable implant material for nasal tip grafting, and it is usually available in the quantities required. The nasal dorsum that requires substantial augmentation continues to present the major problem in choice of material. Over the years, I have used many different grafting materials. I initially used polyamide (Supramid mesh; S. Jackson Inc, Alexandria, Va), which was relatively satisfactory but seemed to have a high incidence of resorption over several years. Polyethylene terephthalate (Mersilene mesh; Ethicon Inc, Somerville, NJ) subsequently seemed to have a substantially lower risk of resorption and might still be an acceptable dorsal alloplast, except that expanded polytetrafluoroethylene (PTFE) (Gore-Tex; W. L. Gore & Co, Flagstaff, Ariz) has essentially supplanted it because of its ease of application and apparently lower infection rate. It should continue to be stressed, however, as Porter does, that cartilage contributes the dual functions of volume filling and structural support where needed. Alloplasts should be used only for volume filling because extrusion rates are unacceptably high when they are used for structural support.
Adamson PA. Grafts in RhinoplastyAutogenous Grafts Are Superior to Alloplastic. Arch Otolaryngol Head Neck Surg. 2000;126(4):561-562. doi:10.1001/archotol.126.4.561