Gore-Tex Implant Removal in Revision Rhinoplasty: Evidence from the Literature
Direct Answer to Your Question
Yes, there are multiple published journal articles specifically addressing Gore-Tex (expanded polytetrafluoroethylene/ePTFE) implant removal in revision rhinoplasty, with substantial data on complications, removal rates, and outcomes. The literature spans over two decades and provides clear guidance on when and how to remove these implants.
Published Evidence on Gore-Tex Removal
Major Studies Documenting Removal Procedures
Three landmark studies from the Archives of Facial Plastic Surgery and Archives of Otolaryngology provide comprehensive data on Gore-Tex implant removal:
A 10-year retrospective study of 309 patients reported that 10 grafts (3.2%) required removal due to infection, with significantly higher removal rates in revision cases (5.4%) compared to primary rhinoplasty (1.2%) 1
A 17-year follow-up study of 521 patients with 685 Gore-Tex implants documented that biological complications requiring implant removal occurred in 1.9% of patients, including infection, soft tissue swelling, migration, and extrusion 2
An earlier 6-year study of 137 patients found that 3 grafts (2.2%) became infected and required removal, with one additional graft removed due to excessive augmentation 3
Comprehensive Analysis of Complications
A large Korean study analyzing 581 revision rhinoplasty cases with alloplastic materials included 183 Gore-Tex cases, providing detailed analysis of complications and revision procedures specific to Gore-Tex implants 4. This study emphasizes that complications differ according to each alloplastic implant type and provides comparative data.
Another Korean series of 873 patients with Gore-Tex dorsal augmentation reported an overall complication rate of 3.8%, with 30 of 257 long-term follow-up patients (11.7%) requiring implant removal and revision for irregularity, infection, deviation, unfavorable height, apparent silhouette, and supratip deformity 5
Key Clinical Findings on Removal Indications
Absolute Indications for Removal
The literature identifies specific scenarios requiring Gore-Tex removal:
- Active infection - the most common reason, requiring complete implant removal 1, 2, 3
- Extrusion - when the implant begins protruding through the skin 2
- Migration - when the implant shifts from its original position 2, 5
- Excessive augmentation - when the aesthetic result is unacceptable 1, 3
Contraindications for Gore-Tex Use (Preventing Future Removal)
Nasal septal perforation present preoperatively is considered a contraindication for Gore-Tex implantation, as 3 patients with pre-existing perforations developed infections requiring removal in one series 1. This represents a critical clinical pearl for avoiding complications.
Risk Stratification for Removal
Primary vs. Revision Surgery
The infection and removal risk increases dramatically in revision cases:
This 4.5-fold increased risk in revision cases must be carefully weighed when considering Gore-Tex in secondary procedures 1
Implant Thickness Considerations
Most successful cases used implants 1-4 mm thick (>95% of cases), with thicker implants (8-10 mm) showing acceptable results in only 5% of cases 2. The literature documents grafts ranging from 1-10 mm thickness across studies 1, 2, 3.
Surgical Technique for Removal
While the provided evidence doesn't detail specific removal techniques for Gore-Tex in rhinoplasty, the general principles from implant removal literature apply:
- Complete removal of all implant material is essential when infection is present
- Thorough irrigation should be performed
- Primary closure should be achieved when possible
- Subsequent augmentation may not be required after removal 3
Notably, none of the patients who underwent implant removal in one series required subsequent augmentation, suggesting that removal alone can provide acceptable outcomes 3
Long-Term Outcomes After Removal
Patient satisfaction remains high even after implant removal, with all 137 patients in one series reporting satisfaction with their results despite some requiring removal 3. This suggests that Gore-Tex removal, when necessary, does not necessarily compromise the overall rhinoplasty outcome.
Clinical Algorithm for Decision-Making
When encountering a patient with Gore-Tex implant complications:
- Assess for infection (erythema, warmth, drainage, pain) - if present, removal is mandatory 1, 2, 3
- Evaluate for extrusion or migration - visible or palpable implant displacement requires removal 2, 5
- Document aesthetic concerns - irregularity, deviation, apparent silhouette, or supratip deformity may warrant removal 5
- Consider conservative management first for minor complications without infection 5
- Plan complete removal if any absolute indication is present, with no attempt at partial removal or salvage
Important Caveats
The complication and removal rates for Gore-Tex appear similar to silicone implants in Asian populations 5, suggesting that Gore-Tex does not offer definitive advantages over other alloplastic materials in terms of avoiding revision surgery.
Pre-existing nasal septal perforation is an absolute contraindication that significantly increases infection risk 1, and this must be identified preoperatively to prevent complications requiring removal.