L Shaped Silicone Implant Removal - 3rd Revision Rhinoplasty

Tertiary Revision Nose Job

The patient, who had undergone two nose operations before and had a closed technique augmentation rhinoplasty with L-shaped silicone implant in a different clinic in the last operation, applied to our clinic due to asymmetry and foreign body sensation at the tip of the nose. On examination, it was found that the nostrils were asymmetrical and there was an implant on the nose that could be felt by palpation. Open technique tertiary revision rhinoplasty operation was planned for the patient using rib cartilage. In the video below, there are pre-operative and post-operative videos of how the implant is removed from the nose. There are L Shaped nasal implants that do not react in the body, produced from silicone, used for augmentation of nose dorsum (nasal bridge) augmentation and contouring - supporting the nose tip. By placing it in the nose in a simple and practical way, it can provide the completion of nasal operations without the need for cartilage grafting. So far, I have not used this type of industrial, non-human tissue, silicone implant, but I have had many patients who had surgical removal, as in the case I shared here.

Definition of  L-shaped silicone nasal implants

L-shaped silicone nasal implants were used in rhinoplasty procedures to reshape and augment the nose. These implants are made of medical-grade silicone, and their L-shaped design allows for better stability and integration within the nasal structure.

The primary purpose of L-shaped silicone nasal implants is to enhance the nasal bridge and tip. Surgeons use them to correct nasal deformities, improve the projection of the nose, and create a more balanced and aesthetically pleasing facial profile.

During the procedure, the surgeon makes small incisions inside the nose or on the outside, depending on the specific case and desired outcomes. They carefully insert the L-shaped silicone implant into the appropriate position, ensuring a natural and symmetrical result. Once in place, the implant provides support to the nasal framework and helps achieve the desired shape.

Complications of L-shaped silicone nasal implants

Like any surgical procedure, the use of L-shaped silicone nasal implants in rhinoplasty can come with certain risks and potential complications. It's essential to be aware of these potential issues before undergoing the surgery. Some of the complications associated with L-shaped silicone nasal implants may include:

Infection: There is a risk of infection at the surgical site. Infections can occur during or after the surgery and may require antibiotic treatment or, in severe cases, removal of the implant.

Implant displacement or migration: The implant may shift from its intended position, leading to an asymmetrical or unnatural appearance. Revision surgery may be necessary to correct this issue.

Extrusion: In some cases, the implant may partially or completely extrude through the skin, causing visible deformities and requiring immediate medical attention.

Scarring: As with any surgery, scarring can occur at the incision sites. While surgeons try to minimize scarring, individual healing and genetic factors can influence the extent of scarring.

Tissue and bone damage: The presence of a foreign body (the implant) within the nose can lead to tissue irritation and, in severe cases, erosion of nasal cartilage or bone.

Chronic pain: Some patients may experience persistent discomfort or pain around the nasal area after the surgery.

Allergic reactions: Although rare, some individuals may develop allergic reactions to the silicone material.

Revision surgery: L-shaped silicone nasal implants may not always yield the desired aesthetic outcome, leading to the need for additional surgeries to address the concerns.

Breathing difficulties: In some cases, the implant may affect the nasal airway, resulting in breathing problems or nasal congestion.

Long-term changes: Over time, the body may react to the implant, causing changes in the implant's shape or position.

Extrusion of L-shaped silicone nasal implants

Extrusion of L-shaped silicone nasal implants is a potential complication that can occur after rhinoplasty surgery. Extrusion refers to the partial or complete displacement of the implant through the skin or mucosa, causing it to become visible or palpable. This complication can result in an unnatural appearance and may require immediate medical attention.

There are several factors that can contribute to the risk of extrusion:

1. Poor surgical technique: Inadequate placement of the implant during surgery can increase the risk of extrusion. It's essential for the surgeon to have the necessary experience and skill to properly position the implant within the nasal structure.

2. Infection: Infections that occur at the surgical site can compromise the surrounding tissues, potentially leading to implant extrusion. Infection prevention measures, such as proper sterilization techniques and post-operative care, are crucial to minimizing this risk.

3. Tissue quality: The condition of the nasal tissues can influence the likelihood of extrusion. Weakened or compromised tissues may not adequately support the implant, making extrusion more likely.

4. Implant size and material: The size and material of the L-shaped silicone implant can also play a role in the risk of extrusion. Larger implants or those made of less biocompatible materials might exert more pressure on the surrounding tissues, increasing the chances of displacement.

5. Trauma: Any trauma to the nose, whether accidental or intentional, could potentially displace the implant and lead to extrusion.

6. Patient factors: Individual patient characteristics, such as healing abilities and underlying medical conditions, can influence the risk of complications, including extrusion.

Preventing extrusion requires meticulous surgical technique, proper patient selection, and careful post-operative management. In cases where extrusion does occur, revision surgery may be necessary to remove the displaced implant and address any resulting deformities.

Symptoms of extrusion of L-shaped silicone nasal implants

Extrusion of L-shaped silicone nasal implants can cause various symptoms, which may become apparent after rhinoplasty surgery. These symptoms can range from mild discomfort to more noticeable visual changes in the appearance of the nose. If you have undergone a rhinoplasty with an L-shaped silicone implant and experience any of the following symptoms, it is essential to contact your surgeon promptly for evaluation and appropriate management. Common symptoms of extrusion of L-shaped silicone nasal implants may include:

1. Visible implant: One of the most noticeable symptoms is the appearance of the implant through the skin or nasal mucosa. This can manifest as a visible bulge or distortion on the surface of the nose.

2. Palpable implant: You may be able to feel the implant under the skin or inside the nasal passage, indicating that it has shifted from its original position.

3. Discomfort or pain: Extrusion of the implant can cause discomfort or pain in the nose and surrounding areas. It may feel tender or sore to the touch.

4. Redness or swelling: The presence of an extruded implant can lead to local inflammation, causing redness and swelling in the affected area.

5. Wound or ulceration: In some cases, the implant may break through the skin or mucosa, resulting in an open wound or ulceration.

6. Infection: Extrusion of the implant can increase the risk of infection at the surgical site, which may present as persistent or worsening redness, warmth, and pus.

7. Nasal obstruction or breathing difficulties: The displaced implant can potentially interfere with the nasal airway, leading to breathing problems or nasal congestion.

8. Changes in the nasal shape: Extrusion of the implant may cause asymmetry or changes in the shape of the nose.

If you notice any of these symptoms or have concerns about your L-shaped silicone nasal implant after surgery, it's crucial to seek immediate medical attention. Your surgeon will be able to assess the situation and recommend appropriate treatment options, which may include removal of the extruded implant and revision surgery to address any resulting cosmetic or functional issues. Remember that early detection and intervention can lead to better outcomes and prevent further complications.

Cost of L-shaped silicone nasal implants

First of all, I would like to say that my patients have always applied for the removal of these implants and I prefer to remove only these implants. I prefer to use cadaveric cartilage belonging to another person in patients who do not have enough cartilage tissue in the stroke and do not accept cartilage grafts from their own body.

The cost of L-shaped silicone nasal implants can vary widely depending on several factors, including the location of the surgical facility, the expertise of the surgeon, and the specific needs of the patient. Other factors that may influence the cost include the complexity of the procedure, the surgical techniques used, and any additional procedures performed in conjunction with the rhinoplasty.

Generally, the cost of L-shaped silicone nasal implants, including the surgical fees, anesthesia fees, and facility fees, can range from a few thousand dollars to several thousand dollars. In some cases, the total cost may be higher if there are additional medical tests or consultations required before the surgery.

It's important to note that elective cosmetic procedures like rhinoplasty, which includes the use of nasal implants, are typically not covered by health insurance, as they are considered to be elective and performed for cosmetic purposes. However, some insurance plans may cover rhinoplasty if it is medically necessary to correct breathing difficulties or structural issues caused by trauma or congenital abnormalities.

Before undergoing any surgical procedure, including rhinoplasty with L-shaped silicone nasal implants, it's crucial for patients to have a thorough consultation with a board-certified plastic surgeon. During the consultation, the surgeon will assess the patient's specific goals and needs, explain the potential costs involved, and discuss the risks and benefits of the procedure.

Link group where you can read previously published articles about silicone implant removal from this website >> https://www.ent-istanbul.com/search?q=silicone+implant+removal

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Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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