Doctor's Column

Rhinoplasty using artificial materials such as Medpor®, Mesh, and silicone on the nasal tip often requires revision surgery over time due to issues such as inflammation, contracture, perforation, and skin thinning. In particular, Medpor® adheres strongly to tissues, making it difficult to remove, and cases where the structure of the nasal tip collapses after removal are common. In this blog, from the perspective of Dr. Seong-hoon Kim of SH Plastic Surgery, we introduce the anatomical difficulty and strategies of Medpor® revision surgery, cartilage reconstruction methods for recovery, and a lifting-based rhinoplasty approach that naturally and safely restores the nose after removing artificial materials, focusing on actual cases.

Face Designer, Dr. Seong-hoon Kim of SH Plastic Surgery

Can a nose operated on with Medpor® be restored to its original state? – Revision surgery strategies for artificial materials

A female patient in her 50s visited the clinic.

She said the surgery was performed 15 years ago at a hospital in the provinces.

At the time, she inserted Medpor® into her nasal tip after hearing it described as a "solid and long-lasting material."

A few years ago, the skin gradually became thinner, making the nasal tip appear visible through it,

and recently, even mild inflammation recurred, causing discomfort in her daily life.

As a result of the examination, Medpor® was found to be strongly adhered to the soft tissue,

and inflammatory tissue within the capsule was also observed.

Removal was not simple, and above all, the key was how to restore the space after removal.

Anatomical problems of Medpor® insertion surgery

Medpor® is high-density porous polyethylene (HDPE), which has the advantage of integrating quickly with tissue,

but that very point becomes a major disadvantage in revision surgery. The following problems occur:

Tissue ingrowth: Surrounding soft tissue penetrates into the material, causing severe bleeding or tissue damage during removal.

Skin atrophy: In the long term, the skin of the nasal tip becomes thin and translucent, and in severe cases, leads to skin perforation.

Induction of inflammation: Chronic inflammation easily occurs due to foreign body reactions or bacterial infections, and contracture (shrinkage) also develops.

Structural weakening: After removal, the structure of the nasal tip collapses, and the nasal septum is also damaged, breaking down the normal support structure.

Medpor®

<Photo Source>

Shabahang Mohammadi. Use of porous high-density polyethylene grafts in open rhinoplasty: no infectious complication seen in spreader and dorsal grafts. Head Face Med. 2014 Dec 22;10:52

“Medpor® is good for facial bones, but not suitable for the nasal tip.”

When Medpor® first came out, it was truly considered a "dream material."

This was because it had the advantages of being rigid and integrating well with tissue.

However, problems were revealed as it was used on the nasal tip.

Over time, it thinned the surrounding tissue, and cases of inflammation, perforation, and even contracture became more frequent.

Even now, many people come for revision surgery because of Medpor®.

To be honest, it is a material that should no longer be used on the nasal tip.

It is still an excellent material for reinforcing bone, such as in orbital fractures.

However, every material has its "right place."

It is my judgment that it is not suitable for sensitive and thin areas like the nasal tip.

Mesh

Mesh, more precisely a material called PCL (polycaprolactone),

suddenly began to be used extensively in Korea around the late 2010s.

Because it is a biodegradable material that dissolves in the body,

there were expectations that it would "absorb naturally and reduce inflammation."

However, problems began to emerge one after another.

It takes a very long time for PCL to degrade.

Moreover, during the degradation process, it can end up melting surrounding tissues along with it.

In fact, there were quite a few cases where the nasal septum melted away together with it.

Ultimately, the nasal tip collapses, and the internal structure of the nose itself becomes ruined.

When revision surgery is required, even bigger problems arise.

Because the mesh either hardens rigidly or becomes brittle,

it is difficult to remove completely, and in many cases, even the nasal septum must be reconstructed.

That is why now, as of 2025,

mesh is hardly ever used in nasal tip surgery.

Even if it is used, I believe it is desirable to restrict its use to very small amounts as a supplementary material,

solely for the purpose of reinforcing other cartilage or tissue.

Silicone

Silicone is the easiest material for elevating the nasal tip.

In particular, L-shaped silicone is used extensively in places with low understanding of plastic surgery, like Southeast Asia,

because the surgery is fast and shaping it is easy.

But the problem is that it eventually shows through.

There are many cases where it protrudes, the skin thins, and the silicone is exposed through the columella or nasal tip,

and even bolstering it with ear cartilage has its limits.

Above all, L-shaped silicone carries the highest risk of causing contracture.

That is why, even if there appear to be no issues, I recommend replacing it whenever possible.

Ultimately, we have no choice but to return to "human-derived components" rather than artificial materials.

As I have discussed so far,

artificial materials such as Medpor®, mesh, and silicone

may appear attractive initially in terms of maintaining shape and surgical convenience.

However, recurring problems become evident as time passes.

Severe adhesion

Occurrence of capsular contracture

Inflammatory reaction

Thinning of skin layers

Transparency, deformation

Secondary damage that is difficult to remove

All of these ultimately leave the burden of revision surgery.

That is why I always ask:

“Will your face still be alright even after 10 or 20 years?”

The conclusion is clear.

A safe reconstruction strategy based on human-derived materials—specifically autologous tissue—

is ultimately the path that lasts the longest and carries the fewest side effects.

Autologous rib cartilage, donated rib cartilage, autologous septal cartilage, etc.

have no graft rejection, achieve natural tissue adhesion,

and can yield predictable results even in revision surgery.

I believe that the perfection of surgery does not lie in "height,"

but stems from a philosophy of anatomical restoration and naturalness.

SH Plastic Surgery is not merely a place that performs surgery;

it is a place that designs the time and changes your face will undergo together with you.

The perspective of Facial Designer Dr. Kim Seong-hoon, Director of SH Plastic Surgery

“Plastic surgery that takes full responsibility, even for the unseen details”

(20) Foolproof #Rhinoplasty #NoseSurgery ! Getting it right the first time is best! - YouTube

SH Plastic Surgery Clinic