Nasal Implant Removal After Asian Rhinoplasty?

I underwent Asian rhinoplasty 5 months ago. During the surgery, my surgeon inserted a silicone implant on the bridge of my nose and used ear cartilage to refine my tip. However, this week, I noticed that there was a bump on the tip of my nose. At first, I thought it was a bug bite or a pimple, but it felt very different. I went in to see my surgeon about this, and he said that my implant is too large and is pushing down on the tip. Thus, a bump has been created. He suggests I can either remove the implant altogether or replace it with a smaller implant. When I decided to get rhinoplasty, I was most concerned about my nostril size and the tip of my nose. I did not have a desire to work on the bridge. My doctor asked me last minute if I wanted to do it, and I said I trust his expertise. Now, I really don't want the implant anymore (it is also a bit crooked), but I'm scared that since it has been 5 months since my surgery, my skin will have stretched?? Will I look odd (with sagging skin on the bridge of my nose) if I take out the implant completely (without replacing it with a smaller one)? I was actually fine with my own bridge before. My main concern is how I will look afterwards, especially after stretching out the skin with an implant and taking it out at this point. Please advise!! Thank you very much!

Doctor Answers (10)

Yes

+3

Generally speaking a nasal implant can be removed. Silicone implants have the least amount of ingrowth from the surrounding tissues and are the easiest implants to remove. Gore-tex and med-por are much more difficult implant to remove due to the tissue in growth. Redness in the nose after an implant can be the sign of an infection. Once the skin of the nose has been violated with an implant, the damage is permanent. Prior to a rhinoplasty procedure, a well planned operative plan with both the patient and surgeon on the same page should be performed. Computer imaging, if done in a reasonable manner, can help facilitate communication and help determine whether or not augmentation to your nasal bridge is aesthetically desirable.


Chicago Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Asian Rhinoplasty Implant Removal

+1
Removing Nasal Implants are probably medically indicated especially in light of your history and that the "pimple" you may describe may indicate an infected implant area and or impending pressure necrosis of the skin.  The prior operative note would be very important for your surgeon to review prior to this procedure.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 41 reviews

You can remove the implant with little sequelae.

+1

Hello,

Yes, if you are having second thoughts about your silicone implant, it is reasonable to go ahead and remove it.  With a little assistance the "extra" skin will more than likely settle down and flatten out to the correct contour.  While it is probable that the implant is putting pressure on the tip, it is also possible that the cartilage grafts in the tip are malpositioned making them easier to feel.  Either way revising your nose is possible.  Additionally, if the skin doesn't completely settle down, injectible filler can be used to expand what little extra skin there may be creating a smooth appearance to the dorsum of the nose.  Make sure you thoroughly discuss your surgical plan before going back in.  Revision rhinoplasty is never easy.

Good luck,

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
5.0 out of 5 stars 19 reviews

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Migration of implant after Asian rhinoplasty

+1

If you newly discovered a "bump" at the tip of your nose 5 months after the surgery, most likely your implant may have migrated to the tip. It sounds like your doctor may have used a dorsal implant. If this is the case, I would recommend not delaying the revision as your condition will not improve with time. If you liked the way your bridge looked before the surgery, simply removing the implant may solve the problem. However, since it has been 5 months and the implant might have affected the architect of the tip, you may require a tip revision in addition to the implant removal. The skin should not be a problem.

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Nasal implant removal after original rhinoplasty

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The type of implant you had placed along the bridge will determine whether there will be an issue with its removal. If the implant extends to the tip of the nose (a variation of the L implant, or and extended I implant), then it may affect the tip of the nose. If the implant was simply placed on the tip only recently, it may be safe to remove it altogether. However, if significant alteration of the tip cartilage was performed, then the tip may need further work after removal of the implant.

Charles S. Lee, MD, FACS
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Implant removal after Asian rhinoplasty

+1

You can have your implant removed as soon as you are sure that swelling has subsided enough for an accurate diagnosis of your issues.  Usually this can be anywhere between 6-12 months after surgery.  Silicone implants in general form a significant capsule around the implant, and it may be advantageous to remove the implant closer to the 6 month mark to avoid mature scar contracture.  When having a revision, make sure that you visit a surgeon who has experience in revision rhinoplasty and especially Asian implant-related rhinoplasty.  Rhinoplasty is a tremendous passion of mine and I would be happy to provide you a comprehensive evaluation.  Good luck!

 

Thomas T. Le, MD
Baltimore Facial Plastic Surgeon
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Recommend waiting at least nine months to a year before making any changes

+1

I’d generally recommend waiting at least nine months to a year before making any changes following nasal surgery. Close communication and follow-up with your surgeon along the way is important.

In the case of Medpor implants, they are notoriously difficult to remove much later down the road because of extensive tissue in-growth which, incidentally, is helpful in fixing the implants in position.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
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Nasal implant removal

+1

The implant can be removed but the second operation better get things right. There is a "law" of diminishing returns with any operation. You might end up with a scarred up and irreparable nose if you submit to too many operations. I would interview several surgeons who do a lot of secondary rhinoplasties and choose the one you trust the most to get a good result with only one more operation.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
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Better to remove nasal implant soon

+1

Generally, removing a silicone nasal implant is better done sooner rather than later.

Implants which are kept in for a prolonged period may cause a prolonged tissue reaction which can create additional scarring. Attempting to "save" an implant with antibiotics doesn't tend to work either and usually delays the inevitable: removal of the implant.

Think about the reverse process with a causcasian rhinoplasty. People have large humps all their lives and when the hump is removed, it does not usually cause a sagging nose.

If you do not desire the implant, have it removed sooner rather than later.

I hope this helps!

Otto Joseph Placik, MD
Chicago Plastic Surgeon
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Nasal Implants with Silicone; Asian Rhinoplasty for a low nasal dorsum; Removal of Implants

+1

Asian noses have a specific pattern of low nasal dorsum, wide alar width, decreased columellar show, and thicker nasal skin. Despite these characteristics, variations commonly occur and should be individually analyzed. In patients with silicone implants to the nasal dorsum, the reason for implantation is to improve the height of the nasal bridge and projection. There are, however, other options using your own body's tissue.

We often see patients in our Santa Monica office who are not satisfied with a malpositioned and poorly fitted silicone implant in the nose. Another source of dissatisfaction is implant failure or infection.

Fortunately, the skin of the nose is resilient and will generally bounce back to its native state. In the worst case scenario, prolonged delay may cause the silicone implant to extrude through the skin and cause permanent scarring.

Discuss these options with your physician.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.