Skip to main content

Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis

Abstract

Background

Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials.

Materials and methods

After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis.

Result

Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively.

Conclusion

The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57).

Trial registration

This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644).

Background

Over the time, the different approaches on rhinoplasty have shifted from reductive towards augmentative. The nasal dorsum height and shape, and its harmonious alignment with tip of nose, play a key role in creating perfect esthetic results [1, 2]. In cases with indistinct nasal bridges, dorsal deficiencies, and under-projected nasal dorsum, dorsal augmentation is the recommended procedure [3]. Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials [4].

First is widely used in west while the latter is the preferred item among Asian surgeons [5, 6].

There remains a controversy regarding the selection of the appropriate material with more advantages and lower complication rates. The autologous materials are preferred for dorsal augmentation due to low infection and extrusion rates and high biocompatibility. Although there remains concerns of complications such as major resorption and graft harvesting site morbidity with autologous grafting. Alloplastic materials such as silicone, ePTFE, and high-density polyethylene are an alternative. They are associated with varying incidences of infection and extrusion. Owing to their affordability, lack of any graft harvesting site and being tailorable to a particular deformity, in certain circumstances, alloplastic materials might be used [5]. In 2008, Peled et al. conducted a meta-analysis on rates of infection, extrusion, revision, and removal of different implants used in rhinoplasty surgery and mentioned that alloplastic implants have acceptable complication rates and might be used when facing limitations in using autogenous materials [7].

The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials.

Materials and methods

Protocol and registration

This meta-analysis was registered at the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/ PROSPERO, registration number CRD42020209644). Also, the PRISMA 2020 Guidelines were followed in this systematic review and meta-analysis [8].

PICO question

(P) Patient: patients with nasal dorsum deformities undergoing reconstructive or cosmetic rhinoplasty. (I) Intervention: reconstructive or cosmetic rhinoplasty of nasal dorsum augmentation without other nasal deformities. (C) Comparison: polymer-based alloplastic materials such as silicone, high-density polyethylene (Medpor), and polytetrafluoroethylene (Gore-Tex). (O) Outcome: complication rates including visible bulging of the graft, hematoma, graft displacement, irregularity, supra-tip depression, infection, deviation, overcorrection, insufficient augmentation, and major resorption.

Search strategy

An electronic survey was conducted using the following databases up to and including September 2020 written in English without any time restriction: PubMed/MEDLINE, Google Scholar and the Cochrane Central Register of Controlled Trials (Central). The searching was completed by a manual hand search of the references of all selected full-text articles. The following search terms were screened with its appearance limited to title of the article: (a) “rhinoplasty,” (b) “nasal augmentation,” (c) “revisional rhinoplasty,” (d) “dorsum augmentation,” (e) “nasal dorsum,” (f) “alloplast,” (h) “silicone,” (i) “high-density polyethylene,” (j) “Medpor,” (k) “polytetrafluoroethylene,” and (l) “Gore-Tex” (Table 1).

Table 1 Search strategy

Study selection

Inclusion criteria were as follows:

  1. 1.

    Randomized clinical trials (RCTs), controlled clinical trials (CCTs), prospective and retrospective cohort studies, and case series with more than 10 participants which provided detailed report on complications (visible bulging of the graft, hematoma at the recipient area, graft displacement, irregularity, supra-tip depression, infection, deviation, overcorrection, insufficient augmentation, major resorption). (Report of at least one complication and revision surgery was mandatory.)

  2. 2.

    No follow-up restrictions

  3. 3.

    Only papers in English are included

Exclusion criteria were as follows:

  1. 1.

    Any cadaver studies or nonhuman studies

  2. 2.

    Studies reporting ratios (risk ratio, odds ratio, hazard ratio) instead of the absolute outcomes were not of our interest.

  3. 3.

    Any article that did not provide any detailed data regarding complication rates

  4. 4.

    Reports of using graft in other parts than nasal dorsum

  5. 5.

    Reports of using liquid alloplastic materials

Data extraction

Based on a predefined paper checklist, the following data was retrieved from the finally included studies by two reviewers (M A.V and R.G) independently and supervised by third author (Sh.R). Any disagreements were resolved by discussion with a third author (Sh.R).

Data extraction included the following categories:

First author, year of publication, study location, study type, mean age, mean follow-up (range), sex, number of total cases, and cases with complication, incidence of complications after dorsum augmentation with polymer-based alloplastic materials such as silicone, high-density polyethylene (Medpor), and polytetrafluoroethylene (Gore-Tex), rates of complications, revision surgical procedures, and satisfaction rate (percent). The complications assessed were as follows:

visible bulging of the graft, hematoma at the recipient area, graft displacement, irregularity, supra-tip depression, infection, deviation, overcorrection, insufficient augmentation, major resorption.

Risk of bias assessment within the studies

The methodological quality and synthesis of included materials was assessed using a tool for bias assessment in case series by Murad et al. [9]. There were 8 questions in the following domains: selection, ascertainment, causality, and reporting.

Data analysis

Considering the challenges with meta-analysis in observational studies [10], we carefully checked whether included materials in hand were able to answer our clinical question (PICO). The proportion meta-analysis was performed using MedCalc version 18.9.1 (MedCalc Software Ltd., Ostend, Belgium). Both random and fixed model were used based on the heterogeneity. If the heterogeneity was significant, random model was preferred. We conducted the χ2 and I2 tests to convey the potential heterogeneity. Potential publication biases were evaluated using funnel plots.

Results

Study selection

Figure 1 shows the PRISMA flow diagram for the study selection process at different stages. 572 papers were obtained through the first search. After duplication removal, 491 papers remained that title and abstract were assessed for eligibility. Reports sought for retrieval of 77 papers. Of those, 50 papers were excluded with reason (3 reports not retrieved) and finally 27 papers remained which were included in the analysis [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37].

Fig. 1
figure 1

PRISMA Flowchart for study selection

Study characteristics

The characteristics of included materials are shown in Table 2. Regarding the study type, 27 observational studies were included, 21 retrospective, and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis. The mean age of patients was 33 (age range 10–72). Although 3 papers did not specify mean and/or age range [16,17,18,19]. Four hundred twenty-eight cases were male and 2573 were female although 10 studies did not specify gender [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32]. The mean follow-up time was 30 months with a range of 3 months to 15 years. Two papers did not report mean follow-up time specifically [16,17,18,19]. The included materials were conducted between years 1980 and 2019 in the following countries: South Korea [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33], the USA [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37], Spain [17], Taiwan [22,23,24,25,26,27,28,29,30,31], the UK [24], Turkey [26], Canada [27], Netherlands [28], China [34], Iran [29], Sweden [37], and Philippines [11].

Table 2 Characteristics of the included

Complications

The data on each complication are available in Table 3. The meta-analyses were available for the following complications: infection, deviation, irregularity, hematoma, extrusion, and over correction.

Table 3 Data regarding complications and revisions

Twenty-seven articles with a sample size of 3153 reported on the incidence of infection after dorsum augmentation with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%) (Fig. 2). The same articles (3153 cases) also reported on the deviation and irregularity and extrusion rates; the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%) (Fig. 3), 0.72% (95% CI 0.316 to 1.31%) (Fig. 4), and 0.78% (95% CI 0.43 to 1.24%) (Fig. 5) respectively. The weighted mean of hematoma and over-correction in a random-effects model were 0.70% (95% CI 0.24 to 1.40%) and 0.49% (95% CI 0.28 to 0.77%) respectively (Figs. 6 and 7).

Fig. 2
figure 2

The weighted mean percentage of Infection rates reported synthetic materials in both fixed and random-effects

Fig. 3
figure 3

Deviation rates reported for synthetic materials in both fixed and random-effects model

Fig. 4
figure 4

Irregularity rates reported for synthetic materials in both fixed and random-effects model

Fig. 5
figure 5

Extrusion rates reported for synthetic materials in both fixed and random-effects model

Fig. 6
figure 6

Hematoma rates reported for synthetic materials in both fixed and random-effects model

Fig. 7
figure 7

Over correction rates reported for synthetic materials in both fixed and random-effects model

Other complications

Some rare complications did not meet the criteria for meta-analysis and therefore reported narratively:

One case of opening of the tube the diced cartilage pieces, in a cleft lip patient, pleural tear, and air leak during rib harvesting, of strike skin necrosis (Table 3)

Revision rates

All included material with a total of 451 patients reported on revision surgery rates; the pooled rate was 6.40% (95% CI 3.81 to 9.57%) (Fig. 8). Four papers did not report a specific number of revision surgery and therefore not included in the meta-analysis. The revision rates for the three most commonly used materials (Medpore, Gore-Tex, and silicone) were 6.61% (95% CI 3.98 to 9.85%), 4.91% (95% CI 1.81 to 9.43%), and 7.64% (95% CI 4.93 to 10.88%) respectively (Figs. 9, 10, and 11).

Fig. 8
figure 8

Revision rates reported for synthetic materials in both fixed and random-effects model

Fig. 9
figure 9

Revision rates reported for Medpore in both fixed and random-effects model

Fig. 10
figure 10

Revision rates reported for Gore-Tex in both fixed and random-effects model

Fig. 11
figure 11

Revision rates reported for silicone in both fixed and random-effects model

Publication bias

We performed funnel plot for publication bias assessment for each of variables. In the current study, some levels of bias were reported for all complications.

Discussion

One of the greatest challenges in rhinoplastic surgeries is the management of nasal dorsum augmentation. Due to the ease of use, producing ideal aesthetic results and removing needed for graft harvesting sites, alloplastic materials play an important role in typical cosmetic dorsal augmentation [1]. The use of alloplastic materials to address dorsal deficiencies is common among patients avoiding autogenous tissue harvest. Also, patients with several prior nasal operations and significant deformities are the best candidates for alloplastic materials as they mostly have depleted potential autogenous harvesting site [7]. Although there are concerns over several complications associated with synthetic materials including infection, deviation, extrusion, etc. [1]. In this systematic review and meta-analysis, we determined the complications reported for different alloplastic materials. Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and over correction were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on random effects model, was 6.40% with 95% CI (3.84 to 9.57).

We reported a subsequent revision of 0–21% in our included studies. The pooled rate for the need for revision surgery was 6.40%. The revision rates for the three most commonly used materials Med-pore, ePTFE, and silicone were 6.61%, 7.06%, and 7.64%, respectively. The decision for implant removal is quite controversial; although, surgical removal of infected implants followed by an immediate or delayed reconstruction has higher chances of resolution [39].

The highest revision rates were related to silicone (7.64%). A similar study reported 6.5% revision rate for silicone implants [7]. Being the most commonly used alloplastic material in Asian countries, silicone is a smooth, cost benefit, and easy-carved implant which can be easily removed in case of failure. The lack of pores leads to fibrous capsule formation around the implant within the body.

Infections and displacement are the main causes of revision surgery in silicones and therefore in order to reduce such problems aggressive modification of the natural barriers and anatomical structure should be strictly avoided [40]. If shaped appropriately according to the nasal phenotype, the extrusion rate would reduce [41]. To manage and reduce complications, this method supports alloplastic materials better for patients with thicker skin than for patients with thinner skin.

The high-density polyethylene (Medpore), with pore size range from 160 to 368 μm, and more than half of these pores are larger than 150 μm in diameter and have excellent biocompatibility. In candidates of augmentation rhinoplasty with severe over resections or severe deformities, these implants have been a useful option. Our findings for revision surgery of high-density polyethylene have been higher than previously reported rates [7].

The revision rate for polytetrafluoroethylene/expanded polytetrafluoroethylene (Gore-Tex) was 4.91%. This hydrophobic polymer with pores of up to 30 μm allows for bacterial adherence and levels of issue integration that provides implant stability with ease of removal if needed. Our results are in line with previous studies mentioning low incidence of revision rates compared with other synthetic materials. A similar previous meta-analysis (in 2008) reported the removal of 3.1% for both ePTFE and high-density polyethylene [7].

Nevertheless, our results suggested a relatively high total rate for revision rate (6.40%) compared with autogenous grafts (3.03%) [42]. This might be attributed to the fact that infection in synthetic materials, unlike autogenous grafts, conservative treatments are inapplicable and mostly require revisional surgery [42, 43]

The use of autograft materials in nasal dorsum augmentation is a safer treatment with fewer complications compared to the alloplastic method. Complications of using autogenous grafts materials such as diced cartilage include graft resorption, insufficient augmentation, deviation (graft displacement), infection, irregularity, supra-tip depression, over-correction, hematoma at the recipient site, and the visible bulging of the graft. According to the findings of the article, infections caused by the use of alloplastic usually require revision surgery, while most infections that occur in the autograft method can be controlled by intravenous antibiotics [42].

In fact, it can be said that the complications of the autograft method are manageable and controllable complications.

Also, the use of alloplastic materials is a risky method in comparison with autograft materials taken from the patient himself, because the use of alloplastic materials acts as a foreign body in the body and its high-risk side effects can lead to nasal deformity and aesthetic complications. Undesirability in the systematic study [44] was reported in autograft materials, which are usually removed from the abdomen or thighs, has fewer reported complications after surgery, and in most cases, complications such as numbness gradually decrease after surgery and are completely eliminated by 3 months after surgery.

In addition to the side effects of using alloplastic materials, some side effects may be preventable, such as bending along the natural convexity, bone resorption, and foreign body reactions such as fibrous capsule formation and tissue ingrowth.

Due to the fact that the complications mentioned throughout the article are not only common but also lead to major problems both during surgery and after surgery. By examining the problems and complications of this method, treatment-related techniques will be developed in the future. With the passage of time and the development of new surgical methods and materials, it shows that current methods are always associated with complications, and at no time are failures and complications announced at the same time as successes.

Current articles widely support autografts instead of using alloplastic in rhinoplasty. Surgeons describe alloplastic implants as dangerous, unpredictable, and hard to use. Therefore, the reported complications are less than 5%. Complications that require revision surgery and cause the material to be removed are 3.7%, which is a significant amount compared to the use of autografts [45], which is 1% [96]. Therefore, the use of alloplastic materials seems to be mentioned with the desire of the patient and the surgeon and acceptance of the possibility of complications (Tables 4 and 5).

Table 4 Excluded studies with reason
Table 5 Risk of bias assessment

Limitations and strengths

Reports of complications often come from other investigators, citing their own experience with implants inserted by other surgeons. The major limitation with current systematic review and meta-analysis was the descriptive nature of much of the current literature and lacking comparator groups. Also, a proper tool for quality assessment in case series was lacking and we had to make adaptations in domains. Some levels of bias might be caused by excluding non-English materials.

The time frame for follow-ups in this study assumed rationale for complications appearance. Having a clear understanding of complications of each material and the ways to prevent and treat them is possible by accurate disclosure of shortcoming in the literature. In the future, the development of alloplasts that approximate the ideal implant with low complication rates is warranted. The technology of prefabrication of precise three-dimensional bioactive and biocompatible implants might reduce the incidence of complications and lower the chance of failure.

Conclusion

To recapitulate, this meta-analysis suggested an acceptable rate of complications and revision surgery with synthetic materials. Synthetic materials might be a proper option when the use of autogenous grafts is not applicable. Judicious case selection and prompt management of complications are crucial whit alloplastic materials. Some practical clinical recommendations may be helpful in future research and clinical procedures. These recommendations are just based on experts’ experience.

Availability of data and materials

Not applicable.

Abbreviations

ePTFE:

Polytetrafluoroethylene

PRISMA:

Preferred Reporting Items for Systematic Reviews

RCT:

Randomized clinical trial

CCT:

Controlled clinical trial

References

  1. Na HG, Jang YJ (2017) Dorsal augmentation using alloplastic implants. Facial Plast Surg 33(02):189–194

    PubMed  Article  Google Scholar 

  2. Tardy M (1997) Dynamics of rhinoplasty. In: Rhinoplasty: the art and the science, pp 188–276

    Google Scholar 

  3. Liang X, Wang K, Malay S, Chung KC, Ma J (2018) A systematic review and meta-analysis of comparison between autologous costal cartilage and alloplastic materials in rhinoplasty. J Plast Reconstr Aesthet Surg 71(8):1164–1173

    PubMed  Article  Google Scholar 

  4. Dresner HS, Hilger PA (2008) An overview of nasal dorsal augmentation. Semin Plast Surg 22(2):65–73 Thieme Medical Publishers

    PubMed  PubMed Central  Article  Google Scholar 

  5. Sajjadian A, Rubinstein R, Naghshineh N (2010) Current status of grafts and implants in rhinoplasty: part I. Autologous grafts. Plast Reconstr Surg 125(2):40e–49e

    PubMed  Article  Google Scholar 

  6. Jin HR, Won TB (2016) Rhinoplasty in the Asian patient. Clin Plast Surg 43(1):265–279

    PubMed  Article  Google Scholar 

  7. Peled ZM, Warren AG, Johnston P, Yaremchuk MJ (2008) The use of alloplastic materials in rhinoplasty surgery: a meta-analysis. Plast Reconstr Surg 121(3):85e–92e

    PubMed  Article  Google Scholar 

  8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol 18(3):e1003583

    Google Scholar 

  9. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23(2):60–63

    PubMed  PubMed Central  Article  Google Scholar 

  10. Metelli S, Chaimani A (2020) Challenges in meta-analyses with observational studies. Evid Based Ment Health 23(2):83–87

    PubMed  Article  Google Scholar 

  11. Yap EC, Abubakar SS, Olveda MB (2011) Expanded polytetrafluoroethylene as dorsal augmentation material in rhinoplasty on Southeast Asian noses: three-year experience. Arch Facial Plast Surg 13(4):234–238

    PubMed  Article  Google Scholar 

  12. Kim YS, Hyun DW, Seong SY, Park DY, Kim CH, Yoon JH (2015) Immediate re-insertion of non-autologous materials in revision augmentation rhinoplasty. Ann Plast Surg 74(5):524–527

    PubMed  Article  Google Scholar 

  13. Shadfar S, Farag A, Jarchow AM, Shockley WW (2015) Safety and efficacy of expanded polytetrafluoroethylene implants in the surgical management of traumatic nasal deformity. JAMA Otolaryngol Head Neck Surg 141(8):710–715

    PubMed  Article  Google Scholar 

  14. Joo YH, Jang YJ (2016) Comparison of the surgical outcomes of dorsal augmentation using expanded polytetrafluoroethylene or autologous costal cartilage. JAMA Facial Plast Surg 18(5):327–332

    PubMed  Article  Google Scholar 

  15. Winkler AA, Soler ZM, Leong PL, Murphy A, Wang TD, Cook TA (2012) Complications associated with alloplastic implants in rhinoplasty. Arch Facial Plast Surg 14(6):437–441

    PubMed  Article  Google Scholar 

  16. Beekhuis GJ (1980) Polyamide mesh used in facial plastic surgery. Arch Otolaryngol 106(10):642–644

    PubMed  Article  Google Scholar 

  17. Alvarez-Buylla Blanco M, Sarandeses García A, Chao Vieites J, Babarro Fernández R, Deus Abelenda C, Padín Seara A (2011) Functional and aesthetic results after augmentation rhinoplasty. Acta Otorrinolaringol Esp 62(5):347–354

    PubMed  Article  Google Scholar 

  18. Karnes J, Salisbury M, Schaeferle M, Beckham P, Ersek RA (2000) Porous high-density polyethylene implants (Medpor) for nasal dorsum augmentation. Aesthet Surg J 20(1):26–30

    Article  Google Scholar 

  19. Colton JJ, Beekhuis GJ (1992) Use of Mersilene mesh in nasal augmentation. Facial Plast Surg 8(3):149–156

    PubMed  Article  Google Scholar 

  20. Niechajev I (2012) Facial reconstruction using porous high-density polyethylene (medpor): long-term results. Aesthet Plast Surg 36(4):917–927

    Article  Google Scholar 

  21. Han K, Jeong JW, Kim JH, Son D, Kim S, Park SW et al (2012) Complete septal extension grafts using porous high-density polyethylene sheets for the westernization of the Asian nose. Plast Reconstr Surg 130(1):106e–115e

    PubMed  Article  Google Scholar 

  22. Chen CT, Hu TL, Lai JB, Chen YC, Chen YR (2010) Reconstruction of traumatic nasal deformity in Orientals. J Plast Reconstr Aesthet Surg 63(2):257–264

    PubMed  Article  Google Scholar 

  23. Hong JP, Yoon JY, Choi JW (2010) Are polytetrafluoroethylene (Gore-Tex) implants an alternative material for nasal dorsal augmentation in Asians? J Craniofac Surg 21(6):1750–1754

    PubMed  Article  Google Scholar 

  24. Schwaiger M, Echlin K, Atherton D, Haers P (2019) The use of Medpor implants for midface contouring in cleft patients. Int J Oral Maxillofac Surg 48(9):1177–1184

    PubMed  Article  Google Scholar 

  25. Jeong JY, Ha Y, Kim S, Yang HJ, Oh SH (2018) Availability and safety of osteotomy in esthetic rhinoplasty of east Asian patients. Ann Plast Surg 81(2):141–145

    PubMed  Article  Google Scholar 

  26. Turegun M, Acarturk TO, Ozturk S, Sengezer M (2008) Aesthetic and functional restoration using dorsal saddle shaped Medpor implant in secondary rhinoplasty. Ann Plast Surg 60(6):600–603

    PubMed  Article  Google Scholar 

  27. Conrad K, Torgerson CS, Gillman GS (2008) Applications of Gore-Tex implants in rhinoplasty reexamined after 17 years. Arch Facial Plast Surg 10(4):224–231

    PubMed  Article  Google Scholar 

  28. Lohuis P, Watts S, Vuyk H (2001) Augmentation of the nasal dorsum using Gore-Tex®: intermediate results of a retrospective analysis of experience in 66 patients. Clin Otolaryngol Allied Sci 26(3):214–217

    PubMed  Article  Google Scholar 

  29. Mohammadi S, Mohseni M, Eslami M, Arabzadeh H, Eslami M (2014) Use of porous high-density polyethylene grafts in open rhinoplasty: no infectious complication seen in spreader and dorsal grafts. Head Face Med 10(1):1–7

    Article  Google Scholar 

  30. Waldman SR (1991) Gore-Tex for augmentation of the nasal dorsum: a preliminary report. Ann Plast Surg 26(6):520–525

    PubMed  Article  Google Scholar 

  31. Zelken JA, Hong JP, Chang CS, Hsiao YC (2017) Silicone-polytetrafluoroethylene composite implants for Asian rhinoplasty. Ann Plast Surg 2(1):27–31

    Google Scholar 

  32. Godin MS, Waldman SR, Johnson CM (1995) The use of expanded polytetrafluoroethylene (Gore-Tex) in rhinoplasty: a 6-year experience. Arch Otolaryngol Head Neck Surg 121(10):1131–1136

    PubMed  Article  Google Scholar 

  33. Hwan Wang J, Lee BJ, Ju Jang Y (2007) Use of silicone sheets for dorsal augmentation in rhinoplasty for Asian noses. Acta Otolaryngol 127(sup558):115–120

    Article  Google Scholar 

  34. Zeng Y, Wu W, Yu H, Yang J, Chen G (2002) Silicone implants in augmentation rhinoplasty. Aesthet Plast Surg 26(2):85–88

    Article  Google Scholar 

  35. Pham R (2011) Use of silicone sizers in implantation of porous polyethylene nasal dorsal implants in asians. Plast Surg Int 2011(2011):606941

    PubMed  PubMed Central  Google Scholar 

  36. Pham RT, Hunter PD (2006) Use of porous polyethylene as nasal dorsal implants in Asians. J Cosmet Laser Ther 8(2):102–106

    PubMed  Article  Google Scholar 

  37. Niechajev I (1999) Porous polyethylene implants for nasal reconstruction: clinical and histologic studies. Aesthet Plast Surg 23(6):395–402

    Article  Google Scholar 

  38. Zelken JA, Hong JP, Chang CS, Hsiao YC (2017) Silicone-polytetrafluoroethylene composite implants for Asian rhinoplasty. Ann Plast Surg 78(2):131–137

    PubMed  Article  Google Scholar 

  39. Ferril GR, Wudel JM, Winkler AA (2013) Management of complications from alloplastic implants in rhinoplasty. Curr Opin Otolaryngol Head Neck Surg 21(4):372–378

    PubMed  Google Scholar 

  40. Jung YG, Kim KH, Dhong HJ (2012) Ultrasonographic monitoring of new expanded polytetrafluoroethylene implant thickness after augmentation rhinoplasty. Am J Rhinol Allergy 26(5):e137–e141

    PubMed  Article  Google Scholar 

  41. Deva AK, Merten S, Chang L (1998) Silicone in nasal augmentation rhinoplasty: a decade of clinical experience. Plast Reconstr Surg 102(4):1230–1237

    PubMed  Article  Google Scholar 

  42. Keyhan SO, Ramezanzade S, Bohluli B, Fallahi HR, Shakiba M, Yates J (2021) A systematic review and meta-analysis of complications associated with autogenous diced cartilage wrapped in fascia used in nasal dorsum augmentation. Aesthet Surg J 41(9):NP1152–NP1165

    PubMed  Article  Google Scholar 

  43. Wee JH, Park MH, Oh S, Jin HR (2015) Complications associated with autologous rib cartilage use in rhinoplasty: a meta-analysis. JAMA Facial Plast Surg 17(1):49–55

    PubMed  Article  Google Scholar 

  44. Keyhan SO, Ramezanzade S, Bohluli B, Fallahi HR, Mirzahoseini S, Nahai F (2021) Autologous fat injection for augmentation rhinoplasty: a systematic review. Aesthet Surg J Open Forum 3(2):ojab010

    PubMed  PubMed Central  Article  Google Scholar 

  45. Juraha LZ (1992) Experience with alternative material for nasal augmentation. Aesthet Plast Surg 16:133–140

    Article  Google Scholar 

  46. Andrade NN, Raikwar K (2009) Medpor in maxillofacial deformities: report of three cases. J Maxillofac Oral Surg 8(2):192–195

    PubMed  PubMed Central  Article  Google Scholar 

  47. Cohen E, Yatziv Y, Leibovitch I, Kesler A, Cnaan RB, Klein A et al (2016) A case report of ophthalmic artery emboli secondary to Calcium Hydroxylapatite filler injection for nose augmentation- long-term outcome. BMC Ophthalmol 48(16):98

    Article  Google Scholar 

  48. Sung HM, Suh IS, Lee HB, Tak KS, Moon KM, Jung MS (2012) Case reports of adipose-derived stem cell therapy for nasal skin necrosis after filler injection. Arch Plast Surg 39(1):51–54

    PubMed  PubMed Central  Article  Google Scholar 

  49. Chen W, Wu L, Jian XL, Zhang B, Li JY, Qin XL et al (2016) Retinal branch artery embolization following hyaluronic acid injection: a case report. Aesthet Surg J 36(7):Np219–Np224

    PubMed  Article  Google Scholar 

  50. Fan X, Dong M, Li T, Ma Q, Yin Y (2016) Two cases of adverse reactions of hyaluronic acid-based filler injections. Plast Reconstr Surg Glob Open 4(12):e1112

    PubMed  PubMed Central  Article  Google Scholar 

  51. De Carolis V (1993) A newly designed minigraft to achieve angularity and projection of the nasal tip: the asymmetrical bipyramidal graft. Ann Plast Surg 30(2):122–130

    PubMed  Article  Google Scholar 

  52. Moulonguet I, Arnaud E, Bui P, Plantier F (2013) Foreign body reaction to Radiesse: 2 cases. Am J Dermatopathol 35(3):e37–e40

    PubMed  Article  Google Scholar 

  53. De Souza MM, Jewell AD, Grief SN, Vail BA (2018) Plastic surgery for women. Prim Care 45(4):705–717

    PubMed  Article  Google Scholar 

  54. Xiong Z, Jiang Z, Liu K (2019) Midline volume filler injection for facial rejuvenation and contouring in Asians. Aesthet Plast Surg 43(6):1624–1634

    Article  Google Scholar 

  55. Santorelli A, Marlino S (2020) Non-surgical rhinoplasty with hyaluronic acid fillers: predictable results using software for the evaluation of nasal angles. Aesthet Plast Surg 44(3):919–926

    Article  Google Scholar 

  56. Bektas G, Cinpolat A, Rizvanovic Z (2020) Nasal filling in plastic surgery practice: primary nasal filling, nasal filling for post-rhinoplasty defects, rhinoplasty after hyaluronidase injection in dissatisfied nasal filling patients. Aesthet Plast Surg 11(23):11489

    Google Scholar 

  57. Stupak HD, Moulthrop TH, Wheatley P, Tauman AV, Johnson CM (2007) Calcium hydroxylapatite gel (Radiesse) injection for the correction of postrhinoplasty contour deficiencies and asymmetries. Arch Facial Plast Surg 9(2):130–136

    PubMed  Article  Google Scholar 

  58. Endo T, Nakayama Y, Ito Y (1991) Augmentation rhinoplasty: observations on 1200 cases. Plast Reconstr Surg 87(1):54–59

    PubMed  Article  Google Scholar 

  59. Jung DH, Moon HJ, Choi SH, Lam SM (2004) Secondary rhinoplasty of the Asian nose: correction of the contracted nose. Aesthet Plast Surg 28(1):1–7

    Article  Google Scholar 

  60. Slupchynskyj O, Rahimi M (2014) Revision rhinoplasty in ethnic patients: pollybeak deformity and persistent bulbous tip. Facial Plast Surg 30(4):477–484

    PubMed  Article  Google Scholar 

  61. Kim SK, Kim JC, Lee KC, Kim HS (2012) Correction of the supratip deformity of the nose. Aesthet Surg J 32(8):943–955

    PubMed  Article  Google Scholar 

  62. Reddy SG, Devarakonda V, Reddy RR (2013) Assessment of nostril symmetry after primary cleft rhinoplasty in patients with complete unilateral cleft lip and palate. J Craniomaxillofac Surg 41(2):147–152

    PubMed  Article  Google Scholar 

  63. Kim EK, Daniel RK (2012) Operative techniques in Asian rhinoplasty. Aesthet Surg J 32(8):1018–1030

    PubMed  Article  Google Scholar 

  64. Emsen IM (2008) E-M shaped septal encircling with Medpor reconstruction on crooked noses: personal technique and postoperative results. J Craniofac Surg 19(1):216–226

    PubMed  Article  Google Scholar 

  65. Pak MW, Chan ES, van Hasselt CA (1998) Late complications of nasal augmentation using silicone implants. J Laryngol Otol 112(11):1074–1077

    PubMed  Article  Google Scholar 

  66. Yang KC, Tseng WK, Kuo YS, Wu CC (2007) Periorbital necrotizing fasciitis and orbital apex syndrome as a delayed but emergent complication of silicone nasal augmentation. Ann Emerg Med 49(4):542–543

    PubMed  Article  Google Scholar 

  67. Viñal MA, Saladino CN, Ginesin LM (1998) Management of wide nasofrontal angle with GORE-TEX implants. Aesthet Plast Surg 22(2):116–119

    Article  Google Scholar 

  68. Beekhuis GJ (1964) Silicone rubber implants in nasal reconstructive surgery. Laryngoscope 86(1):88–91

    Google Scholar 

  69. Bravo BSF, Bravo LG, Mariano Da Rocha C, De Souza SB, Lopes FL, Totti J (2018) Evaluation and proportion in nasal filling with hyaluronic acid. J Clin Aesthet Dermatol 11(4):36–40

    PubMed  PubMed Central  Google Scholar 

  70. de Lacerda D (2018) Prevention and management of iatrogenic blindness associated with aesthetical filler injections. Dermatol Ther 31(6):e12722

    PubMed  Article  Google Scholar 

  71. Liew S, Scamp T, de Maio M, Halstead M, Johnston N, Silberberg M et al (2016) Efficacy and safety of a hyaluronic acid filler to correct aesthetically detracting or deficient features of the Asian nose: a prospective, open-label, long-term study. Aesthet Surg J 36(7):760–772

    PubMed  PubMed Central  Article  Google Scholar 

  72. Li J, Huang Y, Zhang Y, Pu Z (2018) Application of a porous polyethylene spreader graft for nasal lengthening in Asian patients. Aesthet Surg J 38(5):491–499

    PubMed  Article  Google Scholar 

  73. Moon HJ (2016) Use of fillers in rhinoplasty. Clin Plast Surg 43(1):307–317

    PubMed  Article  Google Scholar 

  74. Nguyen AH, Bartlett EL, Kania K, Bae SM (2015) Simple implant augmentation rhinoplasty. Semin Plast Surg 29(4):247–254

    PubMed  PubMed Central  Article  Google Scholar 

  75. Fanous N, Tournas A, Côté V, Ali Y, Berbari P, Fanous A et al (2017) Soft and firm alloplastic implants in rhinoplasty: why, when and how to use them: a review of 311 cases. Aesthet Plast Surg 41(2):397–412

    Article  Google Scholar 

  76. Wei J, Herrler T, Deng N, Xu H, Shi B, Dai C (2018) The use of expanded polytetrafluoroethylene in short nose elongation: fourteen years of clinical experience. Ann Plast Surg 81(1):7–11

    PubMed  Article  Google Scholar 

  77. Bai SS, Li D, Xu L, Duan HC, Yuan J, Wei M (2020) A novel method to enhance dynamic rhinoplasty outcomes: double “V” carving for alloplastic grafts. Ear Nose Throat J 99(4):262–267

    PubMed  Article  Google Scholar 

  78. Harb A, Brewster CT (2020) The nonsurgical rhinoplasty: a retrospective review of 5000 treatments. Plast Reconstr Surg 145(3):661–667

    PubMed  Article  Google Scholar 

  79. Deshpande S, Munoli A (2010) Long-term results of high-density porous polyethylene implants in facial skeletal augmentation: an Indian perspective. Indian J Plast Surg 43(1):34–39

    PubMed  PubMed Central  Article  Google Scholar 

  80. Scopelliti D, Amodeo G (2016) Nasal dorsum reconstruction with alloplastic material. J Craniofac Surg 27(7):e676–e678

    PubMed  Article  Google Scholar 

  81. Schuster B (2015) Injection rhinoplasty with hyaluronic acid and calcium hydroxyapatite: a retrospective survey investigating outcome and complication rates. Facial Plast Surg 31(3):301–307

    PubMed  Article  Google Scholar 

  82. Romo T 3rd, Sclafani AP, Sabini P (1998) Use of porous high-density polyethylene in revision rhinoplasty and in the platyrrhine nose. Aesthet Plast Surg 22(3):211–221

    Article  Google Scholar 

  83. Kurkjian TJ, Ahmad J, Rohrich RJ (2014) Soft-tissue fillers in rhinoplasty. Plast Reconstr Surg 133(2):121e–126e

    PubMed  Article  Google Scholar 

  84. Kim HS, Park SS, Kim MH, Kim MS, Kim SK, Lee KC (2014) Problems associated with alloplastic materials in rhinoplasty. Yonsei Med J 55(6):1617–1623

    PubMed  PubMed Central  Article  Google Scholar 

  85. Wang TD (2010) Nasal dorsal augmentation. Hno 58(9):907–911

    PubMed  Article  Google Scholar 

  86. Rauso R, Tartaro G, Chirico F, Zerbinati N, Albani G, Rugge L (2020) Rhinofilling with hyaluronic acid thought as a cartilage graft. J Craniomaxillofac Surg 48(3):223–228

    PubMed  Article  Google Scholar 

  87. Wei J, Luo J, Herrler T, Xu H, Deng N, Li Q et al (2017) A simple technique for the correction of maxillonasal dysplasia using customized expanded polytetrafluoroethylene (ePTFE) implants. J Plast Reconstr Aesthet Surg 70(9):1292–1297

    PubMed  Article  Google Scholar 

  88. Park CH, Kim IW, Hong SM, Lee JH (2009) Revision rhinoplasty of Asian noses: analysis and treatment. Arch Otolaryngol Head Neck Surg 135(2):146–155

    PubMed  Article  Google Scholar 

  89. Berbis P, Lebeuf C, Vaisse C, Zanaret M, Privat Y (1989) Pyodermatitis of the nasal pyramid disclosing a complication of rhinoplasty with silicone implant. Ann Dermatol Venereol 116(3):233–235

    PubMed  Google Scholar 

  90. Bertossi D, Malchiodi L, Albanese M, Nocini R, Nocini P (2020) Nonsurgical rhinoplasty with the novel hyaluronic acid filler VYC-25L: results using a nasal grid approach. Aesthet Surg J 41(6):1–9

    Google Scholar 

  91. Chen L, Li SR, Yu P, Wang ZX (2014) Comparison of Artecoll, Restylane and silicone for augmentation rhinoplasty in 378 Chinese patients. Clin Invest Med 37(4):E203–E210

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

O.K contributed to the design, drafting of the article, data analysis/interpretation, statistics, data collection, and critical revision of the article. Sh.R contributed to the design, data interpretation, drafting of the article, critical revision of the article, approval of article. critical revision of the article, and approval of the article. R.G.Y contributed to the data analysis/interpretation, statistics, and data collection. M.A.V contributed to the data analysis/interpretation, statistics, and data collection. H.R.F contributed to the critical revision of the article and approval of article. M.Sh contributed to the critical revision of the article and approval of the article. M.A contributed to the critical revision of the article and approval of the article. All authors are the major contributors in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shaqayeq Ramezanzade.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Keyhan, S.O., Ramezanzade, S., Yazdi, R.G. et al. Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis. Maxillofac Plast Reconstr Surg 44, 17 (2022). https://doi.org/10.1186/s40902-022-00344-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40902-022-00344-8

Keywords

  • Rhinoplasty
  • Augmentation rhinoplasty
  • Alloplastic
  • Complications
  • Revision rate of rhinoplasty