john1: Ear cartilage is never, ever used for the bridge; it is only used for tip work. The structure is such that it can't warp - it's kinda like minced meat lol.
"most surgeons these days use an I-shaped implant on the bridge and cartilage on the tip. so the "pole" is cartilage not silicone. silicone is on the bridge where there is not nearly as much pressure" <- Honestly, if you've read medical literature (i had the privilege, courtesy of college's subscription!), most silicon work out there is still L-shaped silicon. And seriously, no. The real world, especially in places like thailand, still uses a lot of implant only, without any added cartilage. Though the better docs like dr lee do use the implant + cartilage approach, it is still not widely adopted.
"silicone is on the bridge where there is not nearly as much pressure so to speak."<- Yea, you're right. I missed out this part. In fact, it's precisely cos the implant is on the bridge that makes things even more dangerous. The bridge CAN be quite mobile. I have friends with silicon noses and it can move. The reason why the silicon implant can stay rather stationary without wobbling about is cos right before the insertion of the implant, the doc is supposed to scrape the inner lining (periosteum of the nose) to remove some tissue, so after the implant is put in, scar tissue will grow back around the area and help to keep the implant in place <- That's the really layman explanation of it; the actual article was a lot more technical and i can't remember the exact words used but the intended meaning is there.
Rib can warp, but the occurence is very low in the hands of a skilled surgeon. Warping happens when the cartilage is trimmed/augmented into an unnatural shape or cut against the natural 'grain' of the cartilage.
I think you missed my point about caucasians + foreign implants. What i was trying to put across is that the same foreign implant in an asian can hold up relatively well compared to caucasians -only- because of the nasal skin type. I really wish i could put up some of the rhino medical articles here but i can't; my college has some way of preventing the articles from being saved. Doctors have in time past tried to use silicon for rebuilding caucasian noses in time past and the results were terrible, with extrusion occuring very soon post-surgery. For the rare caucasian without a tall and strong nose, why would he/she have septal cartilage to work with when they don't even have good nose bridge/definition. Obviously they won't. Again, i'm only talking about caucasians without a caucasian nose.
I understand that you came from having a silicon rhino done so maybe that's why you feel more compelled to 'speak up' for that method. I'm not saying -everyone- who has silicon/gortex done is definitely gonna get complications, but the risks are real.
Yes, it's sad that not many doctors in the west are not well-versed with rib/autologous rhino; but in korea/taiwan, the trend is increasingly towards rib/autologous. Which i think, is a good thing.
cerepsn:
1. yes ear is used in the bridge in some places, malaysia for one. it also has been mentioned in medical literature as an option as has rib and skull and septal. its not correct to say ear is not used in the bridge.
2. korea and usa use i-shaped for bridge and cart for tip mainly, not 100% but mostly. if that doesnt count as most, or at least the part of the world that really matters, then i stand corrected. but dont lead people to believe that silicone is bad due to the extrusion problems associated with L-shaped implants. if you find a surgeon that uses L-shaped, find a different surgeon. L-shaped implants should be excluded entirely from the conversation.
now the extrusion rate for I-shaped is not zero, but its no where near as high as L-shaped. so i think it only fair that this differentiation be made clear.
3. you make the risk of rib warping "in the hands of a skilled surgeon" sound like its zero. its not. its probably somewhere around 3% in the hands of a skilled surgeon and much higher in the unskilled hands.
4. your citing asian skin type is really irrelevant because i am assuming no one in there right mind would get an L-shaped implant.
5. i dont have an axe to grind i just want to make sure people have the correct information. i found yours a little unfairly balanced making it sound like rib was the only logical choice with very little risk. if it were, everyone would be doing rib.
i went back and forth between rib and silicone and ultimately decided on silicone.
the bottom line for me was that if something went wrong with silicone, i can always get it removed. i would have the option to replace it with silicone or rib or goretex or nothing.
but if something went wrong with rib, i would basically be screwed because it is deforming and cannot be removed easily if at all. and if it is removed there would be some residual deformity and probably would not be able to correct it.
so if people are confident that rib will not have complications, then rib is the obvious choice.
but for me, i like the fact that the silicone can be popped out very easily whether it be 1, 5, 10 or 20 years from now. i was not willing to risk having something irreversible that had a chance, however small, of going awry.
its a personal decision.