The days of injecting paraffin and liquid silicone to build up nasal structure are long gone. Use of solid implants, both natural and synthetic, are now a standard feature of augmentation rhinoplasty.
In Asia, solid silicone implants remain the most popular material used to build up a flattened nasal dorsum. Synthetic materials like Gore-Tex-like fabric and Med-Por are felt to be even more biocompatible.
Problems such as infection, shifting, and exposure over time can occur if the implant is too large, too hard, poorly shaped, or not skillfully placed.
Some such complications appear to be technique-dependent, and many experienced rhinoplasty specialists still prefer the reliability and ease of use of solid silicone, especially now that the latest generation of implants are softer and better shaped.
Other surgeons (especially those in the United States) prefer using natural tissues taken from the patient's own body, particularly cartilage from the ear (auricular) or other parts of the nose (nasal septum) or fascia. Many feel that synthetic implants are clearly inferior; if they become infected or extrude, problems can be dramatic, dangerous, and difficult to repair.
Rib grafts (costal cartilage) have been suggested for difficult cases but are not popular for routine use due to healing issues at the donor site and the greater complexity and operating time. Shaping the graft can be difficult.
All of the materials noted here can yield excellent results. As with all plastic surgery, the quality of the final outcome is most dependent on the skill and aesthetic sensibility of the surgeon.