When a typical nose job revision patient reports to a master plastic surgeon to repair one or more botched rhinoplasties, the surgeon never knows what he or she is going to find inside the patient’s nose.


Why? The noses’ insides look different after other surgeries. One study found the average rhinoplasty revision patient – among 150 revision patients — has had a whopping 3.6 previous nose surgeries.


Sometimes, the interior of the nose has been operated on so much, there is no cartilage left to rebuild a nose. Then, the nasal surgeon must take donations of cartilage from the patient’s ears or from between the ribs.


But, in some cases, the cosmetic surgeon and patient choose to go with a plastic implant.


Now, a recent study in the medical journal, Archives of Facial Surgery finds that some plastics used in nose job revisions can result in stubborn infections.


So far, choices for nasal implants have been Gore-Tex, surgically known as ePTFE or a plastic known as Medpor.


According to a new study, as many as one in five revision rhinoplasties using Medpor resulted in nasty infections. It wasn’t hard for the patients to see something was wrong – the Medpor implant started sticking out through the nasal incision!


The new study looked at 662 rhinoplasties performed between 1999 and 2008 and found 2.8 percent of the surgeries, or 19 patients, ended in infection. Tellingly, all 19 had one of the two types of plastic supports used in the nose. In all, plastics were used in 151 cases.


The researchers, led by Denver plastic surgeon Andrew Winkler, M.D., noted that an infected nose job or revision rhinoplasty is usually not cured by antibiotics. Rather, the situation often requires yet another surgery to remove the implant.


Leading the infected cases was the Medpor implant, with one in five nasal surgeries leading to infection. But people who received donations of cartilage from their own bodies reported no infections at all.


The Gore-Tex or ePTFE implants showed a lower rate of infection at 5.3 percent of surgeries. Unfortunately, Gore-Tex is soft, floppy and can’t be used in all aspects of nasal surgery. Its most common use in nose surgery is building up height on the bridge of the nose.


According to the American Academy of Facial Plastic and Reconstructive Surgery, rhinoplasty is the most frequently performed cosmetic plastic surgery for men and women under age 35. (Look at some rhinoplasty before and after pictures.)


Did you know that nose job revisions can be done with injections only? (Read more about non-surgical rhinoplasty revision.)