My belief is that Latera has a small but legitimate place in functional rhinoplasty and, quite frankly, the same with filler rhinoplasty. —Stephen S. Park, MD
Explore This Issue
June 2020
Latera: A Tool for Functional Rhinoplasty
“Performing rhinoplasties, I quickly learned that it’s a technically difficult procedure that usually requires quite a bit of tissue dissection. I started wondering about how to improve the structure of the nose with less disruption of the nasal tissue,” Dr. Saidi said, explaining the genesis of Latera, which was approved by the FDA in 2016.
While most functional rhinoplasties involve the use of cartilage or polymer grafts to reshape the interior structure of the nose, Latera is a tiny absorbable PLLA polymer implant that has a ball tip on one end and a forked tip on the other. The implant can be placed inside the lateral wall of the nose to support the upper and lower lateral cartilage. The implant gradually dissolves and is absorbed by the body over approximately 24 months. During that time, fibrous scar tissue forms in the area.
“It’s conjectured that the scar tissue may provide longer-lasting structural support after the Latera material has dissolved,” Dr. Saidi said. “We’ve followed patients up to three years after insertion, and most people continue to report benefits even past the point where we’d expect that actual implant to have dissolved.”
LATERA vs. Liquid Rhinoplasty
| LATERA | Liquid Rhinoplasty | |
|---|---|---|
| Description | Dissolvable nasal implant designed to treat nasal valve collapse | The injection of dermal fillers to reshape the nose |
| Availability | Released & received FDA clearance in 2016 | Available for >15 years |
| Use | For functional rhinoplasty | For cosmetic rhinoplasty |
| Results | Implant dissolves in about 24 months; effect lasts for years | Results last for about a year; procedure can be repeated |
| Risks | Risks include mild bruising, inflammation, and pain | Risks include blindness, skin necrosis, and infection |
A two-year follow-up study published in Facial Plastic Surgery reported the outcomes of 30 patients who underwent Latera implantation—14 in an operating room under general anesthesia and 16 under local anesthesia in a clinic setting. A total of 56 implants were placed across the 30 patients. Patients noted significant quality-of-life improvement, including reduced nasal congestion, less trouble breathing through the nose, and less difficulty sleeping, as measured by the Nasal Obstruction Symptom Evaluation (NOSE) survey. A 57.7% reduction in nasal obstruction symptoms was noted two years post-procedure (Facial Plast Surg. 2017;32:233-240).
“Latera is a nice procedure for a directed problem, meaning nasal valve collapse,” said Krista Olson, MD, associate professor of otolaryngology and director of the Baylor Facial Plastic and Reconstructive Surgery Center in Houston. “It won’t do anything for a septal deviation or turbinate hypertrophy, but as an isolated procedure, I do consider it a useful tool in my armamentarium.”
Some physicians use Latera alongside other procedures. “When used in combination with septoplasty and turbinate work, Latera can stabilize the lateral wall,” said Dean M. Toriumi, MD, an otolaryngologist in private practice in Chicago.
However, because multiple factors can contribute to nasal obstruction, surgical rhinoplasty may still be the best option for many patients, including those who have experienced nasal trauma or previously undergone septoplasty or rhinoplasty. Even patients who have nasal valve collapse may not be ideal candidates for treatment with Latera.
“It really depends on what area of the nasal valve is affected,” Dr. Olson said. “If I need to address upper lateral cartilage collapse, my preference is to do that with cartilage grafts.”
On the flip side, Latera can be a good option for appropriately selected patients who would prefer to avoid surgery. “If a patient is particularly elderly, or unsafe to go to the operating room, an office-based procedure such as this may be a viable option,” Dr. Park said.
Side effects of Latera appear to be minimal. Dr. Olson said that some patients report being able to feel the implant through the skin; some complain that it makes wearing glasses uncomfortable. “Usually, that’s a short-lived phenomenon,” she said, “but I’ve had to remove a few of them, usually from older patients with thin skin.”