Complications associated with alloplastic implants in rhinoplasty

Winkler AA, Soler ZM, Leong PL, Murphy A, Wang TD, Cook TA.

What this paper says

In 662 rhinoplasties at one academic practice, every postoperative infection (19, 2.8%) involved a synthetic implant; porous polyethylene became infected in 1 of every 5 cases it was used, ePTFE alone in 5.3%, and 12% of implants became exposed.

Overview

Synthetic implants avoid harvesting the patient's own cartilage, but they can become infected or work through the skin. The authors reviewed a decade of rhinoplasties by three faculty surgeons to measure infection and exposure rates for two common materials, porous high-density polyethylene (pHDPE, sold as Medpor) and expanded polytetrafluoroethylene (ePTFE, sold as Gore-Tex).

Sections of note

Retrospective review of 662 rhinoplasties, 1999 to 2008, three surgeons.
Postoperative infection in 19 of 662 (2.8%); alloplastic material had been used in every infected case.
Infection in 1 in 5 procedures using pHDPE implants.
Infection rate 5.3% when ePTFE was used alone.
Exposure in 12% of patients in whom an alloplast was used.
Not associated with infection: sex, surgeon, functional versus cosmetic purpose, current tobacco use, cocaine history (P > .05 for all).
Described as the largest evaluation of pHDPE in rhinoplasty to date; the authors strongly recommend caution with pHDPE.

What it means for a patient

In this series, nasal infections after rhinoplasty happened only when a synthetic implant was present.
Porous polyethylene carried a 20% infection rate, and about 1 in 8 implants of either type became exposed.
Single institution with unstated implant positions and follow-up; earlier studies reported lower pHDPE complication rates.

Why this paper matters

This study is a widely cited warning against porous polyethylene in the nose and part of the evidence base that pushed surgeons back toward the patient's own cartilage. Why its pHDPE rates were so much higher than earlier reports is not resolved in the abstract.

Terms

Alloplastic implant: a manufactured synthetic implant.
Porous high-density polyethylene (pHDPE): a rigid porous plastic implant, sold as Medpor.
Expanded polytetrafluoroethylene (ePTFE): a soft porous polymer implant, sold as Gore-Tex.
Exposure: an implant becoming visible through the skin or nasal lining.
Bivariate analysis: testing one factor at a time for association with an outcome.
Comorbidity: another medical condition present in the patient.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“To evaluate the incidence of infection and extrusion of porous high-density polyethylene (pHDPE) and expanded polytetrafluoroethylene (ePTFE) implants used in rhinoplasty at a high-volume, academic facial plastic surgery practice. Methods: A total of 662 rhinoplasty procedures performed by 3 faculty surgeons from 1999…”

Excerpt; the full abstract is on PubMed.