Gore-Tex Implant Removal from the Nose
Gore-Tex implants should be removed through a direct surgical approach—either an endonasal incision along the original implant pocket or an open rhinoplasty approach—with careful dissection to separate the implant from surrounding fibrous tissue, followed by copious irrigation and primary closure.
Indications for Removal
Gore-Tex nasal implants require removal in the following situations:
- Infection (most common indication, occurring in 1.2-5.4% of cases, with higher rates in revision rhinoplasty) 1, 2
- Extrusion or migration of the implant 1
- Excessive augmentation or unfavorable aesthetic outcome 3, 4
- Irregularity or visible implant silhouette 3
- Persistent soft tissue swelling or seroma formation 5
- Deviation or asymmetry 3
Surgical Technique for Removal
Approach Selection
- Endonasal approach is preferred when the original implant was placed through an endonasal incision, as this avoids external scarring and maintains nasal anatomy 6
- Open rhinoplasty approach may be necessary for complex cases requiring simultaneous revision or when extensive fibrous tissue needs to be addressed 1
Step-by-Step Removal Procedure
Incision placement: Reopen the original surgical pocket through either an endonasal incision (typically intercartilaginous or marginal) or external columellar approach 1, 2
Tissue dissection: Carefully elevate the soft tissue envelope to expose the Gore-Tex implant, noting that fibrous tissue integration will have occurred around the implant 5, 3
Implant mobilization: Gently separate the implant from surrounding fibrous capsule using sharp and blunt dissection—Gore-Tex typically has tissue ingrowth that requires careful release 1, 4
Complete removal: Extract the entire implant en bloc when possible to avoid leaving fragments 2, 5
Irrigation: Perform copious saline irrigation of the pocket to remove any debris and reduce infection risk 6
Closure: Achieve primary tension-free closure of the soft tissue envelope 6
Critical Technical Considerations
Tissue Integration Characteristics
- Gore-Tex (expanded polytetrafluoroethylene) allows tissue ingrowth through its microporous structure, creating fibrous tissue integration that makes removal more challenging than smooth silicone implants 1, 4
- Expect moderate fibrous adhesion requiring sharp dissection rather than simple implant "pop-out" 5, 3
Infection Management
- If infection is present, remove the implant immediately and do not attempt salvage with antibiotics alone 2, 5
- Infection rates are significantly higher in revision cases (5.4%) compared to primary rhinoplasty (1.2%) 2
- Nasal septal perforation is a contraindication to Gore-Tex implantation and increases infection risk if present 2
Postoperative Management
- Antibiotic coverage is recommended when infection was the indication for removal 2, 5
- Monitor for adequate soft tissue healing before considering any revision augmentation 3, 4
- Most patients do not require subsequent augmentation after Gore-Tex removal if the original indication was complication-related 4
Common Pitfalls to Avoid
- Do not attempt piecemeal removal: This increases the risk of retained fragments and incomplete resolution of complications 1, 2
- Avoid aggressive tissue trauma: The soft tissue envelope may be thinned from previous surgery, particularly in revision cases 5, 3
- Do not underestimate tissue ingrowth: Gore-Tex is not encapsulated like silicone but rather has tissue integration requiring more extensive dissection 1, 4
- Recognize high-risk scenarios: Revision rhinoplasty cases have 4-5 times higher complication rates requiring removal compared to primary cases 2
Timing Considerations
- Early removal (within weeks to months) may be easier due to less fibrous tissue formation 5
- Late removal (years after placement) requires more extensive dissection but is still feasible with proper technique 1, 4
- Average follow-up data shows complications requiring removal typically manifest within the first 40 months, though long-term follow-up extends to 10+ years 1, 2