Comparison of Clinical Results of Crescent-Shaped Expanded Polytetrafluoroethylene (e-PTFE) and Granulated Rib Cartilage for Filling The Nasal Base to correct Midface Depressions.

[OBJECTIVE] The center of the face plays an important role in the fullness of our facial contours, however, sunken center of the face is more common in Asians than in Europeans and Americans. Expanded polytetrafluoroethylene (PTFE) and rib cartilage are commonly used to fill the nasal base to improve the hollowing of the center of the face. This study aimed to compare the efficacy and safety of crescent-shaped expanded polytetrafluoroethylene (e-PTFE) with granulated rib cartilage for nasal base filling to treat midface depressions.

[METHODS] Fifty-one patients with mild to moderate midface depression and normal occlusion admitted to our department from June 2017 to August 2020 were selected. Comprehensive rhinoplasty was performed, which included nasal base filling using crescentic e-PTFE or granulated rib cartilage. They are all women, with an average age of 27.4 years. The e-PTFE group (group A) had 27 cases, while the granulated rib cartilage group (group B) had 24. Changes in two face parameters, the wing ear line and facial convexity, were measured and recorded based on preoperative and postoperative photographs of the patients and using 3D imaging technology. Postoperative complications and satisfaction were assessed by questionnaires to compare the two surgical approaches' differences, advantages, and disadvantages.

[RESULTS] Postoperative midface depression improved significantly in 51 patients. Most of the patients who underwent both procedures showed significant improvement in the wing ear line and facial convexity. The 3D imaging has also helped us to more objectively assess the changes in midface concavity. Some patients experienced acute discomfort, such as foreign body sensation and stiffness in the surgical area, for the first three months after nasal base filler surgery. Still, these symptoms resolved on their own within six months. Most patients (92.6% in group A and 91.6% in group B) felt that they had natural facial expressions and were satisfied with the filler results.

[CONCLUSION] The use of crescentic e-PTFE and granular rib cartilage to fill the nasal base is easy to operate and has a quick postoperative recovery, allowing for good postoperative results. However, after some of the granular rib cartilage filling treatments, the height of the nasal base was lowered, which may be connected to its limited structural support, ease of displacement, and resorption. Crescentic e-PTFE is superior to granular rib cartilage in terms of both morphology and mechanical support. The crescentic e-PTFE filling method provides rapid postoperative recovery and good shape maintenance, but local stiffness is more pronounced than in the granular rib cartilage group. This may help the plastic surgeon's choice of surgical procedure.