Soko,
No one knows for sure how much of each Cymetra injection resorbs in the nose. Anthony has had six injections over a period of about two years and he FEELS that it's permanent, but that's no way to tell for sure (pardon me Anthony). The only way to know for sure is through a controlled study and someone objective to monitor it's size in the nose.

Studies following nasal augmentation operations using almost any material you can imagine have been performed for over one hundred years. If there is one common denominator for all those studies, up to Dr. Houser's most recent one about Alloderm, is that there is no substance that doesn't resorb to some degree. The questions are - how much and how long does it take?

Self harvested bone and cartilage have been shown on average to last up to two-three years, although here also - it does vary between individuals and for some it hasn't resorbed at all (about 30%, Kern and Moore, 2001)or has resorbed to some degree but not totally.
In a review article from 1955 (if I recall correctly) Maurice Cottle, who was the most famous American rhinologist and nasal researcher of the 20th century - says clearly that although allografts (live grafts from the patient himself) get resorbed over a few years, for most, something always remains and through multiple implantation procedures to the same site (2 or 3 in minimum) you can achieve a long lasting permanent effect. He mentions this specifically for cases which he refers to as "mild undetected cases of atrophic rhinitis caused by over aggressive surgeries, especially turbinetomies" (I'm quoting from memory. Note that he expresses himself that way because the term ENS was coined only in 1994, and until then it was referred to as "secondary atrophic rhinitis" or "nasal cripple").

Other materials that have been used successfully, which are not harvested from the patient - include - fibrine glue, plastipore, and hydroxyapatite cement. In all these cases authors reported a follow up of up to 2 years, but not longer. They all claim very high rates of success with hardly any resorption, but critics say that it does resorb in the next few years to come - although I have not yet seen a study to actually prove this. The only official statistic we can go by is that of Kern and Moore's in which they say that in around 70% of cases the majority of the graft resorbs after a few years.
Please note that all these studies were of materials implanted into sub - submucosa layers of the inner nose, in different locations, but never to the turbinates themselves. The first to ever attempt to augment a partially resected inferior turbinate are Freidman and Houser (see next paragraph), with Houser being the most successful to date.
Dr Houser is also the first to report permanent long term results (4.5 years and counting) with Alloderm implanted underneath the sub-mucosa in locations other than the turbinates - such as the septum, nasal floor and lateral wall
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Now, here are the two most important facts to consider in your case:

A) Alloderm: out of seven cases that Kern implanted, one was with Alloderm (to the septum) and in a two year follow up it was still there. Hasn't been reported since. Friedman then followed with a series of another 7 (if I recall correctly) which in some he augmented existing inferior turbinates and with those who lost too much of their ITs he augmented the septum and/or nasal floor. His follow up was short, up to a year, and his results varied and confused him - so he never published this data officially: In those who had Alloderm into their ITs the resorption seemed to relate to amount of turbinate left - the more turbinate left initially the less resorption and vice versa. He was not too encouraged with the results of his implants into other locations.

Dr Houser, on the other hand, has reported much more encouraging results in his latest ENS series article, with follow ups of up to 4.5 years. He claims that there is no resorption in any of his implanted sites - be it to the turbinates themselves (in cases of partial resection) or be it in cases where a look alike turbinate has to be fabricated - when implanting the septum or the lateral wall.
He does notice that there is an initial shrinkage in the volume of the implant (up to 10%) in the first 6 months (the incorporation period), which he says - is not due to resorption but to the implant settling in - getting tighter and firmer - and then he says that the volume remains stable for years (as I said - he has followed up to 4.5 years currently). It's important to note that he uses a different technique than Friedman to implant the ITs and that might explain his improved results.

B)Nobody to date has reported any data about the longevity of Cymetra in the ITs. Common sense has it that as it is micronized Alloderm - it has some permanent effect, but difficult to tell how much. Common sense also has it that what ever the results are - they will not be as permanent as Alloderm - simply because Cymetra lacks the basic cell matrix (the biological scaffold that hold tissues together) that Alloderm has. It's like the difference between concrete and very diluted cement.

Anthony is worried that implanting an IT into the submucosa obstructs the turbinate's erectile capabilities. He is not totally satisfied with the very fine strips of Alloderm that Dr Houser places into the turbinate's submucosal layer, although he did have it himself and acknowledges that he benefited greatly from it. He believes that small amounts of Cymetra injected into the IT's submucosa are safer, although he acknowledges that this kind of treatment will take many injections of Cymetra, over a very long period of time (way over a year for most).

I personally think that Alloderm is as safe as Cymetra is to the ITs blood supply network and erectile capabilities, but I must say that I can't see anything wrong with Cymetra either, besides this: It will take many injections and a very long time to achieve the result that can be achieved in a single short procedure with Alloderm, and there is absolutely no objective knowledge on it's longevity in the turbinates or the nose. If you wish - you are welcome to be the first that has had only Cymetra to her ITs.
In my opinion the prudent thing to do is to have Alloderm strips first and then if there is any need for further augmentations for fine tuning - to try Cymetra in addition - which is precisely what Anthony did.

I wholeheartedly agree with Anthony on the last thing he said to you:
if you are seriously thinking about getting augmentations, you really just need to sit down and have a talk with Dr. Houser.


Best of luck!