Silicone-Related Contracted Nose Correction Case (Nasal Silicone Implant Removal & Secondary Surgery for Contracted Nose Correction)

After augmentation rhinoplasty with a silicone implant,

as many years pass,

the skin thins and eventually, at the tip,

✅ Skin perforation

✅ Implant extrusion

and similar problems occur in quite a few cases.

In such cases, because the implant has been exposed,

it is difficult to correct the contracted nose in a single surgery;

as the first stage, the implant and infected tissue are removed,

and then, at least 6-12 months later,

correcting the contracted nose as the second stage

can be the right course.

Let us look at a case and the process involved.

Past History: 30 years ago at another clinic, augmentation rhinoplasty

with an L-shaped silicone implant; a lump formed at the tip,

and after laser treatment at a dermatology clinic,

the skin was damaged, and skin perforation and silicone implant extrusion

developed.

PE: On presentation at our clinic,

✅ Skin perforation

✅ Silicone implant extrusion

✅ Infection and granuloma

were present, so removal surgery was planned as the first stage,

followed 1 year later by secondary contracted nose correction.

Chief Complaint: The nose often swelled because of the infection,

and the patient reported distress

over the skin perforation.

OP: First-stage surgery to remove the infected tissue and implant

was performed.

<8 Months After First-Stage Nasal Implant (Silicone) Removal>

This is the appearance 8 months

after removal of the silicone implant.

Because of contracture, the tip is upturned

and twisted,

and a depressed scar remains on the tip.

Since the first stage only removed the implant and infected tissue,

the columellar deviation is about the same as before removal.

Compared with before the silicone implant was removed,

the tip is more upturned and blunt afterward.

Past History: After the first-stage removal surgery,

8 months have passed.

PE: The site of the skin perforation on the tip is depressed,

and the tip is visibly twisted.

✅ Nostril asymmetry

✅ Bulbous tip

✅ Deformities such as an upturned tip were also present.

OP: As the second-stage revision surgery,

the scar tissue of the dorsum and tip was removed,

septal cartilage was resected, and septal and ear cartilage were used

for an extension graft, with a lateral crural strut graft (LCSG) of ear cartilage, 

and dorsal augmentation with MegaDerm.

A:  The tip cartilages and columella are deviated

and twisted.

B: Septal cartilage harvested by septal cartilage resection.

C: The tip cartilages have been separated 

and a septal extension graft placed.

A: Harvested ear cartilage;

B: After a columellar strut and lateral crural strut graft

were placed using ear cartilage.

Comparing before and after, the twisting and asymmetry of the tip

have been completely corrected,

and the augmentation with MegaDerm

can be seen to look natural.

The columella stands straight, and the tip and nostrils as well

are now symmetric.

The tip, which had deviated to the right, also sits

straight in the midline,

and the low bridge has been raised naturally.

The tip, which had been bunched into a round shape, now extends forward

with definition, and the length has also increased.

Nasal length, tip shape, bridge height,

and other aesthetic aspects

are also clearly much improved.

===========================

Through this case of correcting a silicone-related contracted nose,

both aspects, aesthetic & functional,

can be seen to have improved.

If something that even interferes with daily life,

a contracted nose,

has been a concern for you, we hope you will find

the surgical approach that is right for you.

This concludes the case presentation.