Soft versus hard implants in dorsal nasal augmentation: a comparative clinical study.

BACKGROUND: Dorsal nasal augmentation plays an important role in cosmetic and reconstructive rhinoplasties performed to achieve an aesthetically pleasing result while creating facial harmony. Although it is known that the ideal implant should be biocompatible, biointegrated, nonabsorbable, and without inflammatory response, the selection of an ideal implant still remains controversial as to whether it should be biologic or synthetic. This study introduces a new question: ''What is better for the nasal dorsum, a soft or a hard implant?''.

METHODS: In this study, 21 women and 7 men with a mean age of 23.5 years underwent augmentation rhinoplasty between December 2007 and July 2011. Conchal and septal cartilage grafts and Medpor were categorized as hard implants and applied for 15 patients. Soft implants, inserted in 13 patients, included diced auricular cartilage wrapped in Surgicel sheets, dermofat blocks, and rolls of Prolene mesh.

RESULTS: Patient satisfaction was assessed through simple postoperative questionnaires. The satisfaction rate in the soft implant group was 100 %, whereas the overall satisfaction rate was 82.2 %. Unsatisfactory results and complications were recorded in the hard implant group, which had a dissatisfaction rate of 33.3 %, contributing to a general dissatisfaction rate of 17.8 % in the whole series.

CONCLUSION: The authors recommend soft implants for both aesthetic and reconstructive surgeries because of their better ability to achieve a dorsum with a smoother contour and pad. Soft implants have fewer complications and higher satisfaction rates and can be applied for most indications using both closed and open methods.

LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article.