Hi, I had rhinoplasty done a month ago and now that the swelling has gradually subsided, I see that the silicon implant is gradually slanting to the right. When I touch the implant with my thumb and fingers lightly, I can feel it jutting to the right. What should I do? Wait for till further swelling has subsided and maybe the implant will straighten out? The surgeon did open method, used an 'I' shape implant, reduced my nostrils and did work on my tip using septal cartilage. I need advice.
Slanted Nasal Implant After Rhinoplasty, What's Causing It? What Can I Do?
Doctor Answers (10)
Silicone nasal implants
I am not a fan of the silicone nasal implants. There may be swelling or fluid around the implant. I prefer cartilage grafts myself.
Slanted Nasal implant after Rhinoplasty
You either have asymmetrical swelling or a silicone implant that has moved. Although many surgeons use the silicone implants this is a possible complication after their use and the reason I prefer to augment a nose using the patient's own cartilage. Our best advice is to to talk to your surgeon who will examine you and determine the cause of your problem.
Silicone Nasal Implants
First and foremost ask your surgeon what he thinks has happened. One would assume that everything was lined up accurately at the completion of your surgery. However, regardless of the cause it will be necessary to revise a portion of your procedure to correct the problem you're seeing. Depending upon how easy it is to correct you could touch it up relatively early, especially if it is very obvious and causing significant concern. Otherwise the longer you wait for swelling to abate and for healing to progress the easier it will typically be to correct the problem you're having. Work with your surgeon to obtain a satisfactory resolution and obtain an outside opinion if you would feel better having another independent assessment. Best of Luck Dr Harrell
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Silastic nasal implants versus autologous cartilage grafts.
Sorry things may not have turned out as you hoped. Unfortunately, at this point in time, the implant will not return back to the midline. It the result is unacceptable to you, a revision surgery will most likely be necessary and it would be best to wait approximately 9-12 months before proceeding with that surgery.
Silastic or any other type of synthetic nasal implants carry significant rsks that need to be considered before surgery:
- Chronic inflammation or recurrent infection. The reason underlying this problem is the relative close proximity of the implant to both the outer skin surface and the internal mucosal surface of the nose.
- Implant shift or migration. Silastic (rubberized silicone) is particularly notorious for this because of its smooth smooth surface which leads to a capsule . Porous polyethylene implants (Medpore) has a porous surface and tissue ingrowth into these small holes help to stabilize the implant. Also, implant shifting can be minimized by securing the implant with either screws or suture techniques.
- Extrusion. Implants can spontaneously break through the external skin surface or the internal nasal lining.
- Bone resorption. Varying degrees of bone loss can occure under nasal implants, particularly if they are in place for long periods of time.
As a result of these complications, the rate of synthetic implant removal ranges from 15 to 20 %. This is a number based on my personal experience and extensive reviews of the literature. My first choice when performing nasal augmentation is to use the patient's own tissue, either ear or rib grafts. If they insist on a synthetic implant then i would recommend using porous polyethylene (Medpore).
Sincerely, M. J. Imola, MD, DDS, FRCSC.
Nasal implant has shifted
Smooth silicone nasal implants can shift, and your doctor will be able to tell after a month if the implant has remained in the correct position, or there is swelling to blame.
Best of luck,
Once a silicone implant shifts out of position you can only get it back in position by doing more surgery. A silicone implant can shift any time after surgery-days, months or years. The risk of shifting can be decreased by using an implant that has some holes in it for tissue ingrowth or switching to cartilage or an implant that gets incorporated like medpor. Once a silicone implant shifts out of position the risk of extrusion also increases. The main question is when to do the revision surgery and that cannot be decided based solely on the limited information in your post.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
The best advice will come from your own surgeon who is best qualified to know what was done and if this is shifting or swelling. If it is shifting then you have to have it replaced.
You will need to wait and have your body heal around the implant
Thank you for the question. You may be feeling swelling and or the implant moving. If the implant is moving the pocket may have been created a little too big. Your body will want to close down any extra space so the implant pocket should stabilize if the implant is kept secure. Your plastic surgeon may be able to guide you with regards too taping to help accomplish this.
All the best,
Dr. Remus Repta
Wait 6 months and see your surgeon
Unfortunately this can happen. It is recommended that you wait at least 6 months and then follow up with your surgeon. It is possible that it may need to be replaced and repositioned. Good luck!