We agree that the pore size in porous polyethylene (ppe) ranges between 100 and 250 μm in diameter. These pores are engineered to possess tunnel like interconnecting networks which allows for excellent soft tissue in growth and coverage. Also, the rapidity of vascularized tissue in growth that pervades through ppe has been relied upon to make this material more resistant to infection than other implants.

As per the concerns of obliteration of the pores, we would like to stress that since the pore size is in the range of 100–250 μm with maximum above 150 μm, cutting the ppe into morsels of 1 mm would only reduce the number of pores and not obliterate it. The manufacturers do mention that the pores are resistant to collapse on carving or shaping of the implant. Hence, the number of useful pores will only reduce but still be sufficient enough so as to allow fibrovascular tissue in growth.

As far as concerns of host v/s foreign body reaction are concerned, we have not encountered any such event till date with morcellized medpor. The probable reason could be the rapidity of the vascularized tissue in growth that makes this material more resistant to infection than other implants. Also, it was found that probability of medpor getting infected is higher if it is inoculated during insertion and the risk of infection reduces substantially if inoculated after considerable fibrovascular ingrowth. However, in case of manifestation as multiple foci of infection it will surely be extremely difficult to do a revision rhinoplasty.

We have till date not encountered any instances of seroma/haematoma accumulation which could be due to the placement of steristrips post surgery for a minimum of 5–7 days; the pressure of which prevents any collection. Also, we have not encountered graft migration at 3 weeks. However, the possibility of particulate ppe migration cannot be ruled out and utmost care should be taken while preparing the pocket before the modified Turkish delight is placed.

The patients are under regular follow-up and hence evaluation of long term results with respect to contours, soft tissue drape, migration and infection is under way.