title: The use of alloplastic materials in secondary rhinoplasties: 32 years of clinical experience.
abstract: BACKGROUND
  A retrospective evaluation of the authors' 32 years of experience in revision rhinoplasty is presented. The authors suggest that iatrogenic nasal deformities are studied under four groups on the basis of their location and the affected structures: lower third, middle third, upper third, and combined deformities. The authors also present the vertical columellar incision for insertion of alloplastic implants and cartilage grafts, a genuine approach avoiding contamination with the nasal flora.
  
  
  METHODS
  A total of 182 cases were studied, as follows: lower third (n = 81), middle third (n = 65), upper third (n = 17), and combined (n = 19) deformities. The mean age of the patients was 40 years.
  
  
  RESULTS
  Our follow-up was a minimum of 2 years, and some of the cases with Proplast implants have been followed for as long as 21 years. During this rather long follow-up, only two of the Proplast implants had to be removed (one because of an acute infection and the other because of a chronic infection causing extrusion after 5 years).
  
  
  CONCLUSIONS
  The authors have always preferred to use autogenous cartilage grafts for tip deformities and Proplast implants for middle and upper third saddle nose deformities whenever necessary. Their long-term results with Proplast for more than 20 years show that alloplastic materials may be as reliable as autogenous implants if the surgical principles are met and the cases are carefully selected.
authors.affiliation: Plastic and Reconstructive Surgery Department, Yeditepe University, Istanbul, Turkey. ncbaran@ada.net.tr
authors.forename: Cihat Nazmi
authors.initials: CN
authors.lastname: Baran
authors.forename: Yigit Ozer
authors.initials: YO
authors.lastname: Tiftikcioglu
authors.forename: Namik Kemal
authors.initials: NK
authors.lastname: Baran
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009295:Nasal Bone / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery; D011428:Proplast / Q000627:therapeutic use*; D019736:Prostheses and Implants; D012086:Reoperation; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000379:methods* / Q000639:trends; D014182:Transplantation, Autologous
chemical_list: D011428:Proplast