Hello. this question might help other people too. The picture is not mine i have seen it while doing a research. The image shows a hollowed/dented nose tip after an L silicone removal. Will the ear graft from the tip have the same result if it was removed? or it will just simply drop the tip like how it used to be without any dents such as that? I have thick skin. Thanks
L Silicone Tip Vs Ear Graft for Tip?
Doctor Answers 6
Ear Cartilage Graft Safer For Rhinoplasty Than Silicone
Thank you for your question. Your question reveals a common problem with silicon L-shaped grafts for rhinoplasty. Because of the thin nasal skin and reduced blood supply in the tip silicon grafts often fail and have to be removed resulting in the scarring that you mentioned.
Most rhinoplasty surgeons prefer to use your own cartilage from the ear, nasal septum, or bone grafts from the skull or rib when doing reconstructive rhinoplasty surgery.
Using your own body tissues usually results in a more successful and long-lasting result.
My suspicion is that if a cartilage graft has to be removed, which would be unusual, scarring would be less than that caused by removal of the silicone implant.
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Silicone nose implants
Silicone nose implants have a small role in Rhinoplasty. Typically anatomy of Asian noses allows for a more predictive long term result. Silicone implants, whether for the tip of for the dorsum, should not be used in revision Rhinoplasty, as the failure rate is quite high. An experience nasal surgeon will usually use nose, ear or rib cartilage graft to achieve the desired result in revision Rhinoplasty.
I strongly recommend against using implants in the nose (e.g. silicone, medpore, gortex, etc). It is better to use your own cartilage to obtain a more natural result. Please consult with a board certified specialist in Rhinoplasty surgery who can assist you with achieving the results you seek.
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Your tip deformity after removal of a graft will depend on the type of graft.
Thanks for your question. The amount of tip deformity after the removal of a graft will depend on several things. The size of the graft and the type of material the graft is constructed from are important variables. Also the type of skin coverage is important. Cartilage grafts tend to be soft and malleable. They may exhibit some tissue ingrowth that allows stabilization with the overlying skin. They also tend to exert less pressure to the overlying skin reducing the incidence of thinning of the nasal tip skin. They also have variable amounts of absorption. All this means that the physics of how they effect nasal tip skin are limited. Medpor implants which are made of porous ePTFE, even though they are manmade, allow for tissue ingrowth, reducing their effect on the overlying skin, but not as much as cartilage grafts. Silicone implants tend to be stiffer and have no tissue ingrowth. They exert more pressure on the surrounding skin and tend to cause more overlying thinning. Also, like Medpor implants, they don't shrink at all so they are quite dominant in terms of the physics of implants. This is the reason that silicone implants in the tip of the nose often erode over time.
I hope this helps.
Silicone vs Cartilage nasal implants
Silicone implants, over time can make the skin over them quite thin -- and they are prone to infections. Chances are that the picture you saw was the result of an implant having to be removed due to infection. This, of course, damages the skin and causes the skin flat to heal down in unpredictable ways. I have removed a number of infected silicone implants that were placed in Asian countries and when this happens, a new implant cannot be placed to stent the space open and tape cannot be applied to help shrink and shape the skin because the infection needs to drain as free from compression and obstruction as possible. So it tends to heal in a fairly haphazard way. Your own cartilage, however, is not prone to infections and integrates with your own tissues and does not thin them out, so these problems are not seen with their use. When given the choice, ALWAYS choose your own cartilage over a synthetic nasal implant.
L Silicone Tip Vs Ear Graft for Tip?
If the skin has not been thinned or compromised, the removal of a graft in thick skin should be uneventful. Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA