This is a case report describing a 54-year-old man who had had a rhinoplasty 10 years earlier and was unaware that he had had a porous polyethylene dorsal nasal implant inserted. He presented with a small pustule in the lower central forehead. This was surgically explored and a porous polyethylene implant was found and removed. This case is unusual because the implant had migrated and was starting to extrude through the forehead, rather than through the nose. A literature review showed extrusion and infection rates ranging from 2.8% to 7.4% with alloplastic implants. Nasal cyst formation and implant migration have been reported after silicone augmentation but the authors state that there is no report in the literature of such complications with Medpor. Complication rates of alloplastic nasal dorsal augmentation may be higher in a long-term evaluation than that initially reported. Nasal dorsum augmentation is one of the most frequently performed procedures during rhinoplasty, especially in Asians and reconstructive cases. Autogenous cartilage grafts or alloplastic implants can be used for this purpose. However, the potential for permanent damage to the skin and soft tissues, as well as complications such as infection and extrusion of an alloplastic implant make autogenous tissue augmentation preferable. This paper contributes to the literature on complications of alloplastic facial implant augmentation and gives a warning about potential long-term complications which must be taken into account before offering this option to patients. 

Long-term complication after rhinoplasty using porous polyethylene implant: cutaneous fistula of the forehead.
Alonso N, de Pochat VD, de Barros AR, Tavares LS.
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Aina Greig

St Thomas' Hospital, London, UK

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