Why I Dislike Nasal Implants #1 (Nasal Implant Removal, Implant Extrusion, Revision Rhinoplasty, Dorsal Perforation)

Silicone implants remain, in Asia and

worldwide, the most widely used material for raising the dorsum.

The association is so direct that "rhinoplasty" brings "silicone" to mind.

In Asia in particular, when it comes to "rhinoplasty," both doctors and patients

are often seen to take the use of silicone for granted.

This is a very inappropriate and even dangerous notion in rhinoplasty.

For example, even in rhinoplasty whose goal is not to raise the bridge, such as dorsal hump correction or deviated nose surgery,

we see many patients in whom silicone was used.

When such patients come for a revision consultation and are examined, we often find that the silicone

did nothing for the shape or function of the nose and instead caused side effects.

In fact, having seen many side effects from silicone and artificial materials over years of revision rhinoplasty,

I have long wanted to organize and present them systematically.

 So today, under the title "Reasons I Dislike Using Nasal Silicone (in Rhinoplasty),"

I have prepared case studies on each side effect.

Side Effects Caused by Silicone Implants After Rhinoplasty

• 1. Silicone breaking through the skin of the nasal tip or the mucosa inside the nose due to physical pressure
• 2. Acute or chronic inflammation caused by silicone or artificial materials used with it
• 3. Contracture due to capsule formation and inflammation
• 4. Silicone repeatedly becoming crooked even after corrective surgery
• 5. Tip cartilages deformed by silicone that extends to the nasal tip
• 6. Calcium deposits on the silicone making the dorsum protrude unevenly
• 7. Dorsal skin thinning and turning red, with the silicone showing through
• 8. Recurrent hematoma in the dorsum (inside the silicone capsule)

The probability of side effects after rhinoplasty with a silicone implant differs somewhat

among the published papers, ranging fairly widely from 4-36%.

The difference arises from when the side effects were diagnosed.

The most common side effects are contracture (34.8%), implant deviation (30.1%),

inflammation (10.1%), skin thinning (19.9%), and extrusion through a perforation (5%).

This case study will continue as a series of 8 parts, and we hope you will follow it.

A. Perforation of the skin of the nasal tip

A 34-year-old woman had augmentation rhinoplasty with a silicone implant 12 years ago.

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After the skin of the nasal tip perforated, it was covered by a granuloma, so the patient was unaware of the perforation,

and the entire dorsum was swollen and bulging from infection, with discharge pooled inside.

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The implant and infected tissue were removed through a closed approach.

Immediately after removal, a depression remained in the perforated skin of the nasal tip, but it gradually faded,

and 1 year later the trace can be seen to have completely disappeared.

The patient reports having had rhinoplasty with silicone and ear cartilage 3 years ago.

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From 2 weeks earlier, the columella turned red, and something protruded at the left side of the nasal tip with discharge;

a perforation was already present, covered by a granuloma, and discharge was coming from it.

The columella is tilted, and the nostril entrance can be seen to be narrowed by scarring.

The implant and infected tissue were removed through an open approach, and the nostril was widened along with tip cartilage repositioning.

It is only day 10 after surgery, so swelling remains,

but the nose is much slimmer and longer than before surgery.

A 63-year-old woman who said she had augmentation rhinoplasty with silicone over 40 years ago.

Something began protruding from the nasal tip 1 year ago, and it turned out to be silicone extruding through perforated skin.

The entire dorsum was swollen from infection, with thick scar tissue as well.

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B. Perforation inside the nose

The patient understood that rhinoplasty had been done with silicone and ear cartilage 10 years ago;

from 3-4 years ago there was pain in the nose and the middle of the dorsum began to sink,

for the most recent 6 months the nose throbbed and ached,

and one month ago the patient noticed an implant protruding inside the nose.

Endoscopy confirmed that Gore-Tex had broken through the mucosa inside the right nostril.

The glabella was very swollen, the nose was upturned as if bent, and the contracture was severe.

In such cases, correcting the contracted nose with cartilage grafting in a single stage carries a high risk of recurrent infection,

so first, as a 1st-stage surgery, the implant and infected tissue were removed, and about 4 months later,

contracted nose correction was performed to lengthen the nose using ear cartilage.

The patient did not want anything more placed in the dorsum, so the surgery was limited to lengthening the nasal tip.

As the photo shows, the columellar scar and nostril asymmetry have improved markedly.

The nose has lengthened considerably.

The patient reports having had rhinoplasty with silicone and ear cartilage 4 years ago.

Mucosa protruded inside the right nostril from immediately after surgery, but the patient left it alone,

and 3 months ago noticed silicone protruding inside the nose.

The nose was deformed, and silicone could be seen protruding inside the nose.

Through an incision inside the nose, the silicone, ear cartilage, capsule, and infected tissue were all removed, and tip cartilage repositioning was performed.

After surgery the nose became slim and natural.

The patient had rhinoplasty with an "L"-shaped silicone implant and septal cartilage 5 years ago,

and reports having had corrective surgery 4 years ago because the silicone had bent.

The patient reports that an implant has been visibly protruding inside the right nostril since 3 months ago.

3 weeks after removal surgery.

Tissue contraction is still strong at this stage, so the nasal tip looks slightly upturned, but it gradually comes down over 3-6 months.

The infection has fully resolved, and the nose looks natural.

C. Perforation of the dorsum

Perforation of the dorsum is rare, but occasionally a perforation is found

covered by a granuloma like this.

In this situation the silicone implant must be removed without exception; after removal the wound heals well and the scar gradually fades.

After removal, adipose-derived stem cell treatment was performed to eliminate the scar.

The photo above shows the appearance after 3 sessions.

The patient reports that perforation and infection occurred after surgery with an L-shaped silicone implant 30 years ago.

Starting 1 month after silicone removal, 2 sessions of stem cell treatment were performed.