Day 2 :
Nasal and Facial Plastic Surgery Institute, Canada
Dr Kris Conrad is Associate Professor at the University of Toronto, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery. Director of Facial Cosmetic Surgery Clinic, Mount Sinai Hospital, Toronto. Past President of the Canadian Academy of Facial Plastic and Reconstructive Surgery and past Canadian Director of the Board of the American Academy of Facial Plastic and Reconstructive Surgery. An author of numerous peer-reviewed, scientific papers and book chapters pertaining to Facial Plastic Surgery. Director of Continuing Medical Education courses in Facial Plastic Surgery, University of Toronto. Dr Conrad has lectured worldwide as a visiting professor and a guest speaker and he is also a consultant in Facial Plastic and Reconstructive Surgery for Canada International Scientific Exchange Program
Statement of the problem: The choice of augmentation material has been a significant challenge associated with rhinoplasty. The thin skin-soft tissue envelope of the nose renders it a high-risk area particularly for implant materials but also in some way even for autografts with regard to the incidence of complications of biological and esthetic nature. The universally accepted technique relies on the use of autografts for the purpose of adding volume or giving structural support to improve the symmetry, tip projection, the dorsal length or strengthen the external nasal valve.
Orientation: Over many decades surgeons tempted by easy availability, the absence of donor site morbidity and shorter operating time have persevered in the search for an alloplast which would pass the test of acceptance by the recipient tissue. Many materials have been tried and rejected mainly by the unacceptably high incidence of extrusion if used in the nose. I used the first nasal implant of Gore-tex to the lateral nasal wall in a secondary rhinoplasty in the 1980’s without any complications.
Significance: The availability of Gore-tex membrane as a safe method of nasal augmentation has been now documented by more than a thousand implants followed up for up to 25 years or longer in my practice and recently published by other authors claiming its superiority even over autografts in nasal augmentation. As with any surgical method, the use of nasal grafts or implants demands a thorough knowledge of physical characteristics of the material, meticulous technique and requires a proper choice of patients for achieving most rewarding permanent results. The objective of this presentation is to outline clinical indications for the use of ePTFE (Gore-tex), its physical properties as well as the detailed surgical technique. Examples of results justifying the choice of this method over the available methods for properly selected patients will be shown.