Nasal Implant

Q: Dr. Eppley, I am getting a nasal implant for my rhinoplasty but I am very leary of necrosis and the aesthetic results and safety of a Shirakabe vs. Dorsal nasal implant. I would like to ask you whether the Shirakabe or Dorsal nasal is best for avoiding necrosis. Which one? or does it not matter? Would a dorsal nasal implant have good results since I have a bulbous tip? Aren’t Shirakabe’s better for Black/Afro American? Could you define my nasal tip more (having a dorsal nasal implant in comparison to a Shirakabe) without necrosis developing? Thanks.

A: I think in general one has to be very leery of having any type of synthetic material under the skin across the nasal tip. A nasal implant that puts any pressure on the nasal tip skin is destined for long-term problems. The issue is not immediate skin necrosis but long-term skin thinning, implant visibility and/or infection. Synthetic implants that cross the nasal tip area have a significant long-term risk of these issues. While implants work well for the nasal dorsum and have a much lower incidence of problems, the same can not be said for the nasal tip. The best ‘implant’ for the nasal tip is your own cartilage, particularly that of rib cartilage. If you were asking me what is the best to use both in terms of results and the lowest risk of potential complications, I would choose cartilage over an implant every time in rhinoplasty surgery.